Mastering the BDS Ist Year

(Last 25 Years Solved Questions)

Mastering the BDS Ist Year
(Last 25 Years Solved Questions)
Thoroughly Revised and Updated According to the Latest Syllabus of DCI

8TH EDITION

Hemant Gupta MDS

(Oral and Maxillofacial Pathology, Microbiology and Forensic Odontology)
General Practitioner and Consultant
Shivom Multispeciality Dental Clinic
Indore, Madhya Pradesh, India

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Mastering the BDS Ist Year (Last 25 Years Solved Questions)
First Edition: 2006
Second Edition: 2007
Third Edition: 2009
Fourth Edition: 2011
Fifth Edition: 2013
Sixth Edition: 2015
Seventh Edition: 2017
Eighth Edition: 2019
ISBN: 978-93-5270-575-7
 Dedicated to
Almighty SAI BABA
My grandparents Shri HD Gupta and Smt Vijaylakshmi Gupta

In loving memory of my parents

Late Shri VK Gupta and Late Smt Anju Gupta
My wife Smita Gupta
for being so much understanding and
Last but not least
my lovely son Meetaan Gupta
for making life worthwhile
 PREFACE TO THE EIGHTH EDITION

It is a matter of great pride and pleasure to introduce the eighth edition of Mastering the BDS Ist Year (Last 25 Years
Solved Questions). The aim of this text enables the students of dentistry to learn fundamentals. All the sections
are rewritten and the answers of each and every section are revised as per the latest syllabus. This new edition is
updated and expanded, bringing forth new information gained since production of last edition. The text has been
made more clinically oriented so as to better correlate the text with clinical aspects. The text consists of a large
number of illustrations, which enhances the understanding of written description. In this edition, additional matter is
added, which will help students to know the basic pattern of competitive examinations such as AIIMS, NEET, PGI, etc.
I, as an author, wish to express my hope that material presented is clear and understandable. The book is never
meant to replace any of the textbook. All the respective textbooks of all subjects should be read thoroughly to gain
the deep knowledge of subject. This book provides an idea of questions and answers in BDS examinations and
multiple choice questions (MCQs) in pre-PG examinations. I hope that the content will be enough to stimulate the
insight and new trends of thoughts in all the subjects of year.
Any of the suggestions and criticism should be welcomed at macrocyte@gmail.com.

Hemant Gupta
 PREFACE TO THE FIRST EDITION

The subjects of first year still ring fear in the minds of students—baseless fear that rest on silent assumptions
and those that distort thinking. However, self-study, dedication, motivation and hard work are the virtues that go
a long way in the making of a genius—a success. Listen, think, read and analyze with an open mind and you
definitely cannot go wrong. I would like to clarify that this book is not meant to replace your standard textbooks, but
yet coupled with your effort and sincerity, it will definitely make you clinch and help you put your best foot forward
to reach great heights of success.

“When the actions become frequent than the words

Success become heavier than the dreams do more, say less.”
Hemant Gupta

This book is not meant as a replacement for the respective textbook of various subjects. It is truly an
exam-oriented book.

Hemant Gupta
 ACKNOWLEDGMENTS

Achievement of this book was possible by the help and support of Almighty “SAI BABA”, my grandparents, parents,
my wife, teachers and friends.
Special thanks to those who remain behind the curtain and help in arrangement of study material for the book.
Finally, my grateful thanks to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS
Mani (Group President) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, especially Dr Madhu
Choudhary (Publishing Head–Education), Ms Pooja Bhandari (Production Head), Ms Sunita Katla (Executive
Assistant to Group Chairman and Publishing Manager), Mr Rajesh Sharma (Production Coordinator), Ms Seema
Dogra (Cover Visualizer), Mr Narsingh (Proofreader), Mr Nitesh (Graphic Designer), and Mr Kuldeep (Typesetter),
for making my dream come true by publishing this book.
 CONTENTS

149
Section 1: Anatomy

3 157
3
5 161
10
161
23
162
29
165
34

166
52 166
58 168
169
72 169
72 170
79 174
83
95
105
107 182
114 184
117 186
186

119 190
119 192
121 193
125
127 195
197
129
198
129

Section 2: Embryology
131
137
140
144 206
146 4. Further Development of Embryonic Disc 208
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

348
210 366
216 376
394
221 403
224 423
225 430

Section 3: Osteology

229
440

Section 4: Histology Section 6: Biochemistry

239
241 445
243
244
245
246
248
248 491
498
499
505
253
255
257 516
258 519
259 530


534
535
269
Viva-voce Questions for Practical Examination 273

Section 5: Physiology 542

281
Section 7: Dental Anatomy
287
306 547
315 555
332 3. Chronology of Tooth Development 558
 Contents  xv

665
672
678
685
706
714
718

719
606
720
609
721
616
617

736
626
Section 9: Oral Physiology
Section 8: Dental Histology

741

639 743
650 744
659 745
 1
SECTION

Anatomy

Head, Neck and Brain 7. The Fourth Ventricle

1. Mandible 8. Cerebrum
2. Scalp 9. The Third Ventricle, Lateral Ventricle and Limbic
3. Face System
4. Side of the Neck 10. Blood Supply of Spinal Cord and Brain
5. Anterior Triangle of Neck Upper Limb and Thorax
6. The Parotid Region
1. Pectoral Region
7. Temporal and Infratemporal Region
2. Axilla
8. Submandibular Region
3. Scapular Region
9. Structures in the neck
4. Cutaneous Nerves, Superficial Veins and
10. The Prevertebral and Paravertebral Region
Lymphatic Drainage
11. Back of the Neck
5. Arm
12. The Cranial Cavity
6. Bone and Joints of Thorax
13. Contents of the Orbit
7. Wall of Thorax
14. The Mouth and Pharynx
8. Thoracic Cavity and Pleurae
15. The Nose and Paranasal Sinuses
9. Lungs
16. Larynx
10. Pericardium and Heart
17. The Tongue
11. Trached, Esophagus and Thoracic Duct
18. The Ear
19. Miscellaneous Lower Limb, Abdomen and Pelvis
Functional Anatomy of Musculoskeletal System 1. Front of Thigh
1. Skeleton 2. Popliteal Fossa
2. Joints 3. Joints of Lower Limb
3. Circulatory System 4. Male External Genital Organs
5. Abdominal Part of Esophagus and Stomach
Genetics 6. Kidney and Ureter
Neuroanatomy 7. Diaphragm
1. Introduction to Brain 8. Female Reproductive Organs
2. Meninges of the Brain and Cerebrospinal Fluid
Fill in the Blanks as per DCI and Examination
3. The Spinal Cord
Papers of Various Universities
4. Cranial Nerves
5. The Brainstem Image-Based Questions
6. The Cerebellum Additional Matter
 HEAD, NECK AND BRAIN

2. In adults:
1. MANDIBLE Mental foramen opens midway between
upper and lower borders because alveolar and
subalveolar parts of bone are equally developed.
(Sep 2001, 4 Marks) Mandibular canal runs parallel with mylohyoid
Ans. The nerves and vessels related to mandible are: line.
Enumeration of nerves and vessels of mandible The angle reduces to about 110 or 120° because
Mental nerve and vessels ramus is vertical.
Inferior alveolar nerve and vessels 3. In old age:
Mylohyoid nerve and vessels Teeth exfoliate and alveolar border is absorbed,
Lingual nerve leading to reduction of height of body of mandible.
Masseteric nerve and vessels Mental foramen and mandibular canal are close
• Auriculotemporal nerve and superficial temporal to alveolar border.
artery The angle again becomes obtuse, i.e. 140° because
Facial artery the ramus is oblique.

A B C

Figs 2A to C: Age changes in mandible.

A. Infant, B. Adult, C. Old age
Q.3. Write a short note on general features of mandible.
(Sep 2006, 5 Marks)
Ans. Mandible has the following general features:
1. Parts:
Fig. 1: Nerves and vessels related to mandible a. Body: Part of mandible extending from the
(For colour version see Plate 1) canine to the anterior border of masseter muscle.
b. Ramus: Broad, superior, vertical extension from
Q.2. Write a short note on age changes of mandible. the posterior part of the body.
(Feb 1999, 4 Marks) (Apr 2010, 10 Marks) c. Angle: Junction formed by the ramus and body
Or of the mandible.
d. Symphysis: Region corresponding to the midline
Write a short note on age related changes in mandible.
of the mandible.
(Sep 2017, 3 Marks)
e. Parasymphysis: Region adjacent to the symphysis.
Ans. Age Changes of Mandible Are 2. Processes:
1. In infants and children: a. Condylar process: Rounded projection from the
– Two halves of mandible fuse during the first year upper border of the ramus which articulates with
of life. the temporal bone to form the temporomandibular
At birth, the mental foramen opens below the joint.
sockets of two deciduous molar teeth near lower b. Coronoid process: Sharp triangular projection
border because bone is made up of only alveolar from the upper border of the ramus that provides
part with teeth sockets. attachment to muscles of mastication.
Mandibular canal runs near lower border. c. Alveolar process: Part of the mandible that bears
The angle is obtuse, i.e. 140° or more because the teeth.
head of mandible is in the line of body. Coronoid 3. Ridges:
process is large and project upward above the a. External oblique ridge: Linear bony elevation
level of condyle. crest on the lateral aspect of the mandible that
4 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
extends from the first molar region and continues
upward as the anterior border of the ramus.
b. Internal oblique ridge: Linear bony elevation
crest on the medial aspect of the mandible.
4. Notches:
a. Mandibular/sigmoid notch: The curvature or
depression between the condyle and the coronoid
processes.
b. Coronoid notch: Depression/concavity on the
anterior body of ramus.
5. Foramina:
a. Mental foramen: Present on the anterolateral
aspect of the body of the mandible between the
two premolars. Mental nerve and vessels pass
through the foramen.
b. Mandibular foramen: Present on the medial
surface of the ramus. The inferior alveolar nerve
and vessels are transmitted through the foramen.
6. Fossae:
a. Submandilbular fossa: Shallow depression
present on the medial surface of the mandible
to lodge the submandibular gland.
b. Sublingual fossa: Shallow depression present on
the medial surface of the mandible to lodge the
sublingual gland.
c. Digastric fossa: Depression on the lingual surface
of mandible near the symphysis menti from
where the anterior belly of digastric muscle
originates.
7. Tubercle:
a. Genial tubercles: Small bony elevations that
provide attachment to the geniohyoid and
genioglossus muscles.
b. Lingula: Lip-like projection on the medial surface
of the mandible just above the mandibular
foramen.
Q.4. Name the nerves related to mandible. Describe the
movements of mandible.
(Sep 2006, 4 Marks) (Mar 2013, 4 Marks)
Or
Write short note on movements of mandible.
Ans. The nerves related to mandible are:
1. Lingual nerve.
2. Inferior alveolar nerve.
3. Mylohyoid nerve.
4. Mental nerve.
5. Nerve to masseter.
6. Auriculotemporal nerve.
Movements of Mandible
Muscles of the mastication causes the movements of mandible.
1. Masseter muscle elevates the mandible to close the mouth.
2. Temporalis elevates the mandible and posterior fibers of
the muscle retract the protruded mandible.
3. Lateral pterygoid muscle depresses the mandible to open
the mouth.
4. Medial pterygoid elevates the mandible and protrude the
mandible.
5. The medial and lateral pterygoid muscles of two sides
contact alternately to protrude side to side movement of
mandible.
Q.5. Write a short note on ossification of mandible.
(Apr 2007, 4 Marks)
Ans. Mandible is the second bone to ossify after the clavicle.
• Greater part of the mandible ossifies in membrane.
• Part which ossifies in cartilage is incisive part which
lies below the incisor teeth. Condylar and coronoid
processes, upper half of ramus above the level of
mandibular foramen.
• Each half of the mandible ossifies only from one
center which appears at 6th week of intrauterine life
in mesenchymal sheath of Meckle s cartilage near
future mental foramen.
At birth mandible consists of two halves which is
connected at symphysis menti by fibrous tissue.
Bony union occurs during first year of life.
Q.6. Write short note on inferior alveolar nerve.
(Nov 2009, 5 Marks) (Jan 2012, 5 Marks)
(Sep 2017, 3 Marks) (Dec 2014, 5 Marks)
Inferior Alveolar Nerve
♦ It is the largest branch of mandibular nerve.
♦ It descends medial or deep to lower head of lateral
pterygoid muscle and lateraloposterior to lingual nerve
to the region between sphenomandibular ligament and
medial surface of ramus of mandible; where it enters
mandibular canal at the level of mandibular foramen.
♦ Throughout its path, it is accompanied by inferior alveolar
artery (a branch of internal maxillary artery) and inferior
alveolar vein. The artery lies just anterior to the nerve.
♦ In the mandibular canal, the three structures together are
referred to as lnferior alveolar neurovascular bundle .
♦ It supplies the following structures:
Inferior portion of the ramus of the mandible
Entire body of the mandible
Pulps of the mandibular incisors, canines, premolars,
and molars.
♦ The nerve, artery and vein travel anteriorly in mandibular
canal, as far forward as mental foramen which is located at
a point below and between roots of the premolars where
the nerve divides into its terminal branches
Mental nerve.
Incisive nerve.
1. Mental nerve: It emerges from the mandibular canal
through the mental foramen in the form of a major
bulk and divides into three branches that innervate:
i. Skin of chin,
ii. Skin and mucous membrane of lower lip, and
iii. Buccal mucosa from the incisor to the premolars.
It carries a few secretomotor fibers from chorda
tympani to labial minor salivary glands.
 Anatomy  5

2. Incisive nerve: It is the smaller terminal branch and ♦ Genioglossus muscle: It originates from superior genial
the continuation of inferior alveolar nerve within the tubercle.
substance of the body of the mandible, anterior to the Q.9. Write in short on pterygomandibular raphe.
mental foramen. (July 2016, 5 Marks)
It supplies the pulps of anterior teeth, central and lateral
Or
incisors, and canine, and sometimes the first bicuspid,
supporting alveolar bone, periodontal ligament, and the Answer in brief pterygomandibular raphe.
overlying soft tissues anterior to the mental foramen. (Oct 2016, 2 Marks)
It is commonly found that the mandibular central Ans. Pterygomandibular raphé (pterygomandibular ligament)
incisor has a dual nerve supply from the incisive nerve is a tendinous band of the buccopharyngeal fascia,
on its own side and from the terminal twigs of the attached by one extremity to the hamulus of the medial
incisive nerve of the opposite side. pterygoid plate, and by the other to the posterior end of
Q.7. Write the name of various movements that the the mylohyoid line of the mandible.
mandible undergoes. (Oct 2016, 2 Marks) Its medial surface is covered by the mucous membrane of
Ans. Various movements which mandible undergoes are: the mouth.
Protrusion Its lateral surface is separated from the ramus of mandible
Retraction by a quantity of adipose tissue.
Elevation Its posterior border gives attachment to superior constrictor.
Depression Its anterior border, to part of buccinator.
Lateral movements.
Q.8. Write short note on genial tubercle. (Oct 2016, 3 Marks)
Or
Write very short answer on genial tubercles.
(Aug 2018, 2 Marks)
Ans. Genial tubercle is also known as mental spine.
Posterior surface of symphysis menti is marked by four
small elevations known as inferior and superior genial
tubercles.
Superior genial tubercles give origin to genioglossus
muscle and inferior tubercles to geniohyoid muscle.

Fig. 4: Pterygomandibular raphe

2. SCALP
Q.1. Describe various layers, innervations, venous drainage
and arterial supply of scalp. (Sep 2002, 10 Marks)
Or
Enumerate the layers of scalp. (Aug 2018, 1 Mark)
Fig. 3: Genial tubercles Ans. Soft tissues covering the cranial vault form scalp.

Relations Layers of Scalp

♦ Mylohyoid line: It runs obliquely anterior and inferior, ♦ Skin
behind the 3rd molar tooth which is nearly 1 cm inferior ♦ Superficial fascia
to the alveolar border towards the symphysis menti below ♦ Deep fascia in the form of epicranial aponeurosis or galea
the genial tubercles. aponeurotica with occipitofrontalis muscle
♦ Geniohyoid muscle: It originates from inferior genial ♦ Loose areolar tissue
tubercle. ♦ Pericranium
6 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 5: Layers of scalp

Skin Pericranium
♦ It is thick and hairy. ♦ This layer is the fifth layer of scalp.
♦ Skin adheres to epicranial aponeurosis via the dense ♦ This layer is loosely attached to surface of bone.
superficial fascia. ♦ Pericranium is firmly attached to their sutures where the
sutural ligaments bind pericranium to endocranium.
Superficial Fascia
Innervation
♦ This layer is more fibrous and is dense in center as
compared to periphery at head. Scalp is supplied by ten nerves on each side. Out of these five
♦ Superficial fascia binds the skin to subjacent aponeurosis nerves (four sensory and one motor) enter the scalp in front of
and provide proper medium for passage of vessels and ear and other five behind the ear.
nerves to the skin.

Galea Aponeurotica with Occipitofrontalis Muscle

♦ This layer is freely movable on pericranium along with
overlying and adherent skin and fascia.
♦ Anteriorly the layer receives insertion of frontalis muscle,
posteriorly it receives insertion of occipitalis muscle and
the layer is attached to external occipital protuberance and
to highest nucal lines in between occipital bellies.
♦ On each side the layer is attached to superior temporal
line, but sends down a thin expansion which passes over
temporal fascia and attached to zygomatic arch.
♦ Occipitofrontalis muscle consists of two bellies, i.e.
occipital or occipitalis and frontal or frontalis. Both of the Fig. 6: Innervation of scalp
bellies are inserted in this layer.
♦ Occipital bellies are small and separate. Each belli arises A. Preauricular
from lateral two-third of superior nuchal line and is 1. Sensory nerves:
supplied by posterior auricular branch of facial nerve. Supratrochlear
♦ Frontal bellies are longer and wider, they are partly Supraorbital
united in the median plane. Each belly arises from the Zygomaticotemporal
skin of forehead and mingle with obricularis oculi and Auriculotemporal.
corrugators supercilli. It is supplied by temporal branch 2. Motor nerve: Temporal branch of facial nerve.
of facial nerve.
B. Posterior Auricular
Loose Areolar Tissue
1. Sensory nerve:
♦ Fourth layer is made up of loose areolar tissue. Posterior division of great auricular nerve
♦ This layer extends anteriorly into the eyelids, this is Lesser occipital nerve
because frontalis has no bony attachment. Greater occipital nerve
♦ This layer provides passage to emissary veins which Third occipital nerve.
connect extracranial veins to intracranial venous sinuses. 2. Motor nerve: Posterior auricular branch of facial nerve.
 Anatomy  7

Venous Drainage ♦ Emissary veins connect extracranial veins with intracranial

venous sinuses to equalize pressure. Two of the emissary
♦ Supratrochlear and supraorbital veins unite at medial
veins are present, i.e.
angle of the eye and form angular vein which continues
1. Parietal emissary vein: It passes via parietal foramen
as facial vein.
to enter superior sagittal sinus.
2. Mastoid emissary vein: It passes via mastoid foramen
to reach sigmoid sinus.
♦ Diploic veins: These veins start from cancellous bone inside
the two tables of skull. There are four veins on each side, i.e.
1. Frontal diploic vein: It emerges at supraorbital notch
and open in supraorbital vein.
2. Anterior temporal diploic vein: It ends in anterior deep
temporal vein or sphenoparietal sinus.
3. Posterior temporal diploic vein: It ends in transverse
sinus.
4. Occipital diploic vein: It opens either in occipital vein,
or into transverse sinus near median plane.

Arterial Supply
Two set of arteries five on each side, out of these five arteries,
three arteries lie in front of ear and two behind the ear.
Fig. 7: Venous drainage of scalp Arteries
(For colour version see Plate 1)
Preauricular
♦ Superficial temporal vein descend in front of tragus, a. Supratrochlear
enters parotid gland and joins maxillary vein to form b. Supraorbital
retromandibular vein. Retromandibular vein consists of c. Superficial temporal arteries
two divisions, i.e. Out of these arteries 1st and 2nd are the branches of
1. Anterior division of retromandibular vein unites with ophthalmic branch of internal carotid artery. The third
facial vein to form common facial vein which drains artery is branch of the external carotid artery.
into internal jugular vein.
Posterior Auricular
2. Posterior division of retromandibular vein unites with
posterior auricular vein and form external jugular Behind the ear there is posterior auricular artery. One more
vein which drains to subclavian vein. Occipital veins artery which is in the occipital region is known as occipital
terminate in suboccipital venous plexus. artery. These two arteries are branches of external carotid artery.

Fig. 8: Nerve supply and arterial supply of scalp

8 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

 Arresting of bleeding is done by applying pressure above

the ears by tight cotton bandage against bone.
♦ Due to density of fascia, subcutaneous hemorrhages are
not extensive, inflammation in this layer leads to little
swelling but more pain.
♦ Since pericranium is attached to the sutures, collection of
fluid deep to pericranium is called as cephalhematoma,
which take the shape of bone concerned.

(May 2014, 10 Marks)



(Sep 2015, 5 Marks)



(Sep 2017, 10 Marks)



(Jan 2018, 5 Marks)

Fig. 9: Layers of scalp

 Anatomy  9

Q.7. Write a short note on dangerous area of scalp. 

(Jan 2012, 4 Marks) (Aug 2012, 4 Marks)
Or
Give explanation about dangerous area of scalp.
(Feb 2013, 2 Marks) (Mar 2009, 5 Marks)
 (Jan 2012, 5 Marks)
Dangerous Area of Scalp
The subaponeurotic layer (fourth layer) forms a potential
space filled with loose areolar tissue beneath the aponeurotic
layer. The emissary veins which communicate the veins of the
scalp with the intracranial venous sinuses, pass through this
space. This space is closed on all sides except anteriorly where
it extends into the upper eyelid. It is known as the dangerous
area of scalp.

(Apr 2018, 3 Marks)



Fig. 10: Dangerous area of scalp

(July 2016, 10 Marks)

Clinical Significance Or

♦ Fluid collected in this space tends to gravitate in the eyelid. Draw a well labeled diagram to show the blood vessels
In this way black eye is produced if there is bleeding in this and nerves supplying the scalp. (Oct 2016, 5 Marks)
space due to scalp injury on direct blow to the skull. The Ans. For diagram of venous drainage of scalp refer to Ans 1
infection in this space readily enters the cranium through of same chapter.

Fig. 11: Arterial supply and nerve supply of scalp

10 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.12. Enumerate layers of scalp. (May 2017, 3 Marks) Contd...

Ans. Following are the layers of scalp: Name of Foramen of Veins outside Venous
Skin emissary vein skull skull sinuses
• Superficial fascia Emissary vein Hypoglossal Internal Sigmoid sinus
Deep fascia in the form of epicranial aponeurosis or canal jugular vein
Galea aponeurotica with occipitofrontalis muscle
Condylar Posterior Suboccipital Sigmoid sinus
Loose areolar tissue
emissary vein condylar venous plexus
Pericranium foramen
Q.13. Answer in brief on black eye. (May 2017, 3 Marks) 2 to 3 emissary Foramen Pharyngeal Cavernous
Ans. As blood is collected in layer of loose connective tissue, it veins lacerum venous plexus sinus
leads to generalized swelling of scalp. Blood can extend Emissary vein Foramen Pterygoid Cavernous
anteriorly into the roof of nose and into the eyelids, since ovale venous plexus sinus
frontalis muscle has no bony attachment this causes
Emissary vein Foramen Veins of roof Superior
black eye. Posterior limit of hemorrhage is not seen when
cecum of nose saggittal
injury to scalp occur, it can only be seen when bleeding venous sinus
is due to local injury.

3. FACE


Fig. 12: Right eye—black eye due to injury to the scalp; left eye— (Apr 2018, 3 Marks)
black eye due to local injury

♦ In right eye, black eye occur due to injury to scalp. Sensory Nerve Supply
♦ In left eye, black eye is due to local injury. ♦ Ophthalmic divisions of trigeminal nerve:
Q.14. Answer in brief on emissary vein. Supratrochlear
(May 2017, 3 Marks) Supraorbital
Ans. The veins connecting the veins outside the cranium with Lacrimal
the intracranial dural venous sinuses by passing through Infratrochlear
foramina in the cranium are called emissary veins. External nasal.
Emissary vein connect pterygoid venous plexus to the
cavernous sinus. 1. Supratrochlear
2. Supraorbital
Emissary Veins in the Region of the Scalp
3. Lacrimal nerve
On each side of the midline in the region of the scalp two sets 4. Infratrochlear
of emissary veins are encountered, viz. 5. External nasal
1. Parietal emissary vein, which passes through parietal 6. Infraorbital
foramen and communicates with the superior sagittal 7. Zygomaticofacial
sinus. 8. Zygomaticotemporal
2. Mastoid emissary vein, which passes through mastoid 9. Auriculotemporal
foramen and communicates with the sigmoid sinus.
10. Buccal
Emissary Veins of Skull 11. Mental
12. Greater auricular
Name of Foramen of Veins outside Venous 13. Transverse cutaneous nerve
emissary vein skull skull sinuses
Parietal Parietal Veins of scalp Superior Fig. 13: Sensory supply of face
emissary vein foramen saggittal
venous sinus ♦ Maxillary division of trigeminal nerve:
Infraorbital
Mastoid Mastoid Veins of scalp Sigmoid sinus
emissary vein foramen Zygomaticofacial
Zygomaticotemporal.
Contd...
 Anatomy  11

♦ Mandibular division of trigeminal nerve: Q.2. Describe sensory innervation of face.

Auricular temporal (Sep 2000, 4 Marks) (Dec 2009, 5 Marks)
Buccal nerve Or
Mental nerve.
♦ Cervical plexus: Describe in brief sensory nerve supply of face.
Anterior division of greater auricular nerve (Sep 2007, 4 Marks) (Mar 2008, 3 Marks)
Upper division of transverse cutaneous nerve of neck. Or

Sensory Nerve Supply Write a short note on sensory supply of face.

(Feb 2016, 3 Marks)
All these above mentioned nerves have following areas of
Or
distribution:

Name of the nerve Area of distribution
Ophthalmic division of trigeminal nerve
Supratrochlear nerve Upper eyelid and forehead
Supraorbital nerve Upper eyelid, frontal air sinus, scalp (Mar 2009, 5 Marks)
Lacrimal nerve Lateral part of upper eyelid
Infratrochlear Medial part of both eyelids
Blood Supply of the Face
External nasal Lower part of dorsum and tip of nose
Arterial Supply
Maxillary division of trigeminal nerve
Infraorbital nerve Lower eyelid, side of nose and It is supplied by:
upper lip ♦ Facial artery
Zygomaticofacial nerve Upper part of cheek
♦ The transverse facial artery
♦ Arteries that accompany cutaneous nerves.
Zygomaticotemporal nerve Anterior part of temporal region
These are the small branches of ophthalmic maxillary and
Mandibular division of trigeminal nerve superficial temporal arteries.
Auriculotemporal nerve Upper two-third of lateral side of
auricle, temporal region
Buccal nerve Skin of lower part of cheek
Mental nerve Skin over chin
Cervical plexus
Anterior division of great Skin over angle of jaw and parotid
auricular nerve gland
Upper division of transverse Lower margin of lower jaw
cutaneous nerve of neck

Motor Nerve Supply

Motor supply of face is obtained through facial nerve. It emerges
from substance of parotid gland and divide into following branches:
♦ Temporal branch
♦ Zygomatic branch
♦ Buccal branch
♦ Marginal mandibular branch
♦ Cervical branch. Fig. 14: Arteries supply of face
Motor Nerve Supply
Venous Drainage
These terminal branches supplies to following muscles:
Name of the nerve Muscles supplied
Venous blood from face is drained by two veins, i.e. facial vein
and retromandibular vein
Temporal Frontalis, auricular muscle, orbicularis oris
1. Facial vein: This is the largest vein of face. This is formed
Zygomatic Orbicularis oculi at medial angle of eye by union of supratrochlear and
Buccal Muscles of cheek and upper lip supraorbital veins. As it is formed, it runs straight
downward and backward behind facial artery to reach
Marginal mandibular Muscles of lower lip
anteroinferior angle of massater. Here it pierces deep
Cervical Platysma muscle
12 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
fascia, crosses superficial to submandibular gland and
join anterior division of retromandibular vein below angle
of mandible to form common facial vein which drains to
internal jugular vein. Tributaries of facial vein correspond
to branches of facial artery.
Deep connections of facial vein
A communication between the supraorbital and
superior ophthalmic vein.
Another connection with the pterygoid plexus
through the deep facial vein which passes backward
over the buccinator deep to ramus of mandible and
communicate with pterygoid venous plexus around
lateral pterygoid muscle which communicate with
cavernous sinus via emissary vein.
2. Retromandibular vein: It is formed by union of superficial
temporal and maxillary vein within parotid gland. On
leaving parotid gland, it is divided into two divisions, i.e.
anterior and posterior. Anterior division joins facial vein
to form common facial vein, while posterior division joins
posterior auricular vein to form external jugular vein.
Fig. 15: Venous drainage of face
Q.4. Write a short note on facial artery. (July 2016, 5 Marks)
(June 2010, 5 Marks) (Jan 2012, 5 Marks)
(Apr 2017, 4 Marks) (Jan 2018, 5 Marks)
Or
Write a short note on facial artery in the face.
(Aug 2016, 3 Marks)
Or
Write short answer on facial artery. (Aug 2018, 3 Marks)
Ans. Facial Artery
Introduction: Facial artery is the chief artery of face. It
is a branch of external carotid artery which is given off
in carotid triangle just above the tip of greater cornue of
hyoid bone. It runs upwards and crosses its passage in
cervical region in order to reach the face.
Course of Facial Artery
♦ Facial artery enters the face by winding around the base
of mandible and by piercing the deep cervical fascia at
anteroinferior angle of massater muscle.
♦ First the artery run forward and upward to a point 1.25 cm
lateral to angle of mouth. Now the artery ascends by the
side of nose till medial angle of an eye where it terminates
by supplying lacrimal sac and by anastomosing with dorsal
nasal branch of ophthalmic artery.
♦ Facial artery is tortuous and it lies between the superficial
and deep muscles of the face.
Fig. 16: Course of facial artery
Branches of Facial Artery
The large anterior branches are:
1. Inferior labial: To lower lip
2. Superior labial: To upper lip and anteroinferior part of
nasal septum
3. Lateral nasal: To ala and dorsum of nose
4. Branch to lacrimal sac.
Anastomosis
1. The large anterior branches anastomose with arteries of
same name on opposite side and with mental artery.
2. The posterior branches anastomosis with infraorbital artery
and transverse facial artery.
3. At medial angle of eye, terminal branches anastomose
with branches of ophthalmic artery. So this is a site of
anastomosis between external and internal carotid arteries.
Q.5. Write a short note on lymphatic drainage of face.
(Sep 1999, 4 Marks)
 Anatomy  13

Ans. Lymphatic Drainage of Face Write a short note on dangerous area of face.
This is divided into three groups. (Oct 2007, 5 Marks) (Dec 2010, 5 Marks)
1. Upper territory: It drains into preauricular parotid  (Dec 2009, 5 Marks) (Sep 2013, 5 Marks)
group of lymph nodes. It drains greater part of  (Sep 2017, 2 Marks)
forehead, lateral half of eyelids, conjunctiva, lateral
part of cheek and parotid area.
2. Middle territory: It drains into submandibular
lymph nodes. It drains the median part of forehead,
external nose, upper lip, medial halves of eyelids,
medial part of cheek and greater part of lower jaw.
3. Lower territory: It drains into submental group of
lymph nodes from area which includes central part
of lower lip and chin.

Fig. 19: Dangerous area of face

Ans. Dangerous Area of Face

Facial vein communicates with the cavernous sinus via
emissary veins, through these connection infection from
the face can spread in retrograde direction and causes
thrombosis of cavernous sinus. This is specially likely to
occur in presence of infection in upper lip and in lower
part of nose. Hence, the area is known as the Dangerous
area of the face.
Fig. 17: Lymphatic drainage of face
As facial veins and its deep connecting veins are devoid
of valves which provide an uninterrupted passage of
blood to cavernous sinus. So, squeezing the pustules or
pimples in the area of upper lip or side of nose or side
of cheeks can lead to infection which may be carried to
cavernous sinus leading to cavernous sinus thrombosis.

Q.7. Write a short note on extracranial course of facial nerve.

(Feb 1999, 4 Marks) (Mar 2008, 4 Marks)
(Oct 2014, 3 Marks)
Or
Write a short note on extracranial part of facial nerve.
(Sep 2004, 10 Marks)
Or
Write note on extracranial course of facial nerve.
(Apr 2008, 4 Marks) (Mar 2008, 4 Marks)
Or
Describe in detail the extracranial course of facial nerve.
Fig. 18: Lymphatic drainage of face
(Mar 2008, 8 Marks) (Apr 2010, 5 Marks)
Q.6. Write a note on dangerous area of face. Or
(Sep 2002, 5 Marks) (Sep 2001, 6 Marks) 
Or (Mar 2013, 4 Marks)
14 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Ans. Extracranial Course of Facial Nerve

In its extracranial course the facial nerve crosses the
lateral side of base of styloid process. It enters the
posteromedial surface of parotid gland, runs forward
through the gland crossing the retromandibular vein
and external carotid artery. Behind the neck of mandible
it divides into its five terminal branches which emerge
along anterior border of parotid gland.

Fig. 20: Course of facial nerve

Branches of Facial Nerve

1. Greater petrosal nerve: It arises from the geniculate ganglion
and leaves the middle ear through tegmen tympani. It joins
with the deep petrosal nerve to form nerve to pterygoid
canal. This nerve conveys preganglionic secretomotor fibers
to the lacrimal gland and nasal mucosa. They relay in the
pterygopalatine ganglion.
2. A twig from geniculate ganglion joins the lesser petrosal
nerve.
3. Nerve to stapedius: This arises in the facial canal behind
the middle ear and runs forward through a short canal to
reach and supply the stapedius muscle.
4. Chorda tympani nerve: It arises in the facial canal about
6 mm above the stylomastoid foramen and enters the middle
ear. It passes forward across the inner surface of the tympanic Buccinator muscle–muscle of cheek
membrane internal to the handle of malleus and then leaves Origin • Upper fibers: From maxilla opposite to
the middle ear by passing through the petrotympanic fissure molar teeth
to appear at the base of skull. Here it runs downwards and • Lower fibers: From mandible opposite to
forwards in the infratemporal fossa and joins the lingual molar teeth
nerve at an acute angle. The chorda tympani nerve carries: • Middle fibers: From pterygomandibular
raphe
a. Taste fibers from anterior 2/3rd of the tongue, except
from vallate papillae Insertion • Upper fibers: Straight to upper lip
b. Secretomotor fibers to the submandibular and • Lower fibers: Straight to lower lip
• Middle fibers: Middle fibers decussate
sublingual salivary glands.
5. Posterior auricular nerve: It arises just below the styloid Nerve supply Lower buccal branches of facial nerve
foramen. It further divides into two branches, i.e. Action • Puffing of the mouth and blowing
a. Auricular branch, which supplies the muscles of auricle. • Flattens cheek against gums and teeth
b. Occipital branch, which supplies the occipital belly • Prevents accumulation of food inside the
vestibule
of the occipito-frontalis.

 expression lines, etc.
(Feb 2005, 8 Marks)
Or
Describe the extracranial course and branches of facial
nerve. Add a note on its applied anatomy.
(March 2007, 8 Marks) (Sep 2007, 3 + 1 = 4 Marks)
Or
Anatomy  15
Lower Motor Neuron Facial Palsy
It is further of 2 types
1. Nuclear paralysis: It is due to involvement of the nucleus of
facial nerve. This can occur due to poliomyelitis or lesions
of the pons. The motor nucleus of facial nerve is close to
the abducent nerve which is also usually affected.
Effect: Paralysis of muscles of the entire face on ipsilateral
side.
2. Infranuclear paralysis: This occurs due to involvement of
the facial nerve. Clinical effects vary according to the site
of injury of the nerve.
Facial nerve can get injured at various sites.
Site A: At or just above the stylomastoid foramen: It
leads to Bell s palsy which presents as loss of motor
functions of all muscles of facial expression leading
to the deviation of mouth toward the normal side,
inability to close the mouth and eye and accumulation
of food in the vestibule of mouth, flattening of
Site B: Above the origin of chorda tympani: All the
signs and symptoms of lesion A (i.e. Bell s palsy) along
with decreased salivation and loss of taste sensation
in the anterior two-third of the tongue.
Site C: Above the origin of nerve to stapedius: All the
signs and symptoms of lesion B along with hyperacusis
(i.e. enhanced sensitivity to hearing).
Site D: At the geniculate ganglion: All the signs and
symptoms of lesion C along with loss of lacrimation.
Bell’s Palsy
Bell s palsy is a lower motor neuron type of facial nerve
involvement. It leads to paralysis of muscles of facial expression.
There may be associated symptoms according to the site of
lesion. Facial muscles of the same side are paralysed and this
leads to the following features:
1. Facial asymmetry — due to unopposed action of muscles
of the normal side. There is deviation of angle of mouth
to the opposite side.
2. Loss of wrinkles on forehead—due to paralysis of fronto-
occipitalis muscle.
3. Widening of palpebral fissure and inability to close the
eye—due to paralysis of orbicularis oculi.
4. Inability of angle of mouth to move upwards and laterally
during laughing — due to paralysis of zygomaticus major.
5. Loss of nasolabial furrow — due to paralysis of levator labi,
superioris alaeque nasi.
6. Accumulation of food into the vestibule of mouth — due
to paralysis of buccinator muscle.
7. Dribbling of saliva from the angle of mouth — due to
paralysis of orbicularis oris.
8. When one presses the cheek with inflated vestibule, the air
leaks out between the lips — due to paralysis of orbicularis
oris.
9. Loss of resistance while blowing out air in mouth — due
to paralysis of buccinator muscle.
16 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Crocodile Tear Syndrome C. Muscles of the eyelid

1. Orbicularis oculi
Lacrimation during eating occurs because of aberrant
2. Corrugator supercilli
regeneration after trauma. This is crocodile tear syndrome.
In case of damage to the facial nerve proximal to geniculate 3. Levator palpebrae superioris.
ganglia, regenerating fibers for submandibular salivary gland D. Muscles of the nose
grow in an endoneural sheath of preganglionic secretomotor 1. Procerus
fibers supplying the lacrimal gland. Due to this patient 2. Compressor naris
lacrimates during eating. 3. Dilator naris
4. Depressor septi.
Ramsay–Hunt Syndrome
Involvement of geniculate ganglia by herpes zoster leads to
this syndrome.
The syndrome consists of hyperacusis, loss of lacrimation,
loss of sensation of taste in anterior two-third of tongue, Bell s
palsy and lack of salivation, vesicles on an auricle.
Q.10. Write a short note on venous drainage of face.
(Sep 2005, 5 Marks)
Ans. Refer to Ans 3 of the same chapter.
Q.11. Describe various drainage of face. (Aug 2005, 15 Marks)
Ans. For arterial supply and venous drainage refer to Ans 3
of the same chapter and for lymphatic drainage refer
to Ans 5 of the same chapter. Fig. 23: Muscles of eyelid and nose

Q.12. Describe venous drainage of face. Add a note on

dangerous area of face. (Sep 2006, 10 Marks) E. Muscles around the mouth
Ans. For venous drainage refer to Ans 3 of the same chapter. 1. Orbicularis oris
For dangerous area of face refer to Ans 6 of the same 2. Levator labii superioris alaeque nasi
chapter. 3. Levator labii superioris
4. Levator anguli oris
Q.13. Classify and name the muscles of facial expression.
5. Zygomaticus major
Add a note on Bell s palsy. (Mar 2006, 10 Marks)
6. Zygomaticus minor
Ans. Classification and Names of Facial Muscles 7. Depressor anguli oris
A. Muscles of scalp 8. Depressor labii inferioris
1. Occipitofrontalis. 9. Mentalis
B. Muscles of the auricle 10. Risorius
1. Auricularis anterior 11. Buccinator.
2. Auricularis superior F. Muscles of the neck
3. Auricularis posterior. 1. Platysma.
For Bell s palsy refer to Ans 9 of the same chap-
ter.

Fig. 22: Muscles of scalp and auricle (Apr 2007, 4 Marks)

 Anatomy  17

Ans. Ans. Nuclei of Facial Nerve

Fibers of the nerve arise from four nuclei situated in the
lower pons.
1. Motor nucleus (branchiomotor).
2. Superior salivatory nucleus (parasympathetic).
3. Lacrimatory nucleus (parasympathetic).
4. Nucleus of the tractus solitarius (gustatory).
Motor nucleus lies deep in the reticular formation of the
lower pons. The part of the nucleus that supplies muscles
of the upper part of the face receives corticonuclear
fibers from the motor cortex of both right and left
sides.
In contrast the part of the nucleus supplies muscles of
Fig. 25: Muscle attachment of hyoid bone
the lower part of the face receive corticonuclear fibers
only from the opposite cerebral hemisphere.
Q.15. Write a short note on facial palsy.
(Apr 2008, 3 Marks) Course of Facial Nerve
Ans. Refer to Ans 9 of the same chapter. Intracranial Course
Q.16. Describe facial nerve under following headings: Facial nerve is attached to brainstem by two roots, i.e. motor
(Dec 2010, 3+3+2 Marks) and sensory. Sensory root is known as nervus intermedius.
a. Nuclei and course of nerve Two roots of facial nerve are attached to lateral part of lower
b. Branches border of pons medial to vestibulocochlear nerve. Two roots
c. Bell s palsy run laterally and forward along with vestibulocochlear nerve
to reach internal acoustic meatus.

Fig. 26: Facial nerve and its distribution

18 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

In internal acoustic meatus motor root lies in groove on ♦ Small accessory lacrimal glands are found in conjunctival
vestibulocochlear nerve with sensory root intervening. Here fornices.
facial nerve and vestibulocochlear nerve are accompanied by ♦ It is of J shaped and is indented by the tendon of levator
labyrinthine vessels. At fundus of meatus the two roots sensory palpabrae superioris.
and motor fuse to form a single trunk which lies in petrous ♦ It consists of two parts, i.e.
temporal bone. Within the canal the course of nerve is divided 1. An orbital part: It is large and deeper
by three parts by two of its bands. The first part is directed 2. A palpebral part: It is superficial and smaller lying
laterally above the vestibule and second part run backward in within the eyelid.
♦ Lacrimal gland consists of a dozen of ducts which pierce
relation to medial wall of middle ear above promontory and
conjunctiva of upper eyelid and open in conjunctival sac
third part is directed vertically downward behind promon-
near superior fornix.
tory. First bend at junction of first and second part is sharp
♦ Most of the ducts of orbital part pass through palpebral
and is known as genu. part.
Second bend lies between promontory and aditus to the ♦ It is supplied by lacrimal branch of ophthalmic artery.
mastoid antrum. Facial nerve leaves the skull by passing ♦ It secretes lacrimal fluid which flows in conjunctival sac
through stylomatoid foramen. where it lubricate the front of eye and deep surface of
eyelids.
Extracranial Course
Refer to Ans 7 of the same chapter.
For branches of facial nerve refer to Ans 7 of the same chapter.
For Bell s palsy refer to Ans 9 of the same chapter.
Q.17. Enumerate extracranial branches of facial nerve.
(Jan 2012, 2 Marks)
Ans. The extracranial branches of facial nerve are:
1. Temporal
2. Zygomatic
3. Buccal
4. Marginal mandibular
5. Cervical.
Q.18. Write briefly on bell’s palsy.
(Aug 2012, 5 Marks) (Apr 2007, 5 Marks)
Or
Write short note on bell s palsy. (Jan 2018, 5 Marks)
(Feb 2013, 5 Marks) (Feb 2016, 3 Marks)
Ans. Refer to Ans 9 of the same chapter. Fig. 27: Lacrimal apparatus Conjunctival
Q.19. Describe lacrimal apparatus and its nerve supply.
Sac
(Feb 2014, 4 Marks)
♦ Conjunctiva lining the deep surface of eyelids is known as
Or
palpebral conjunctiva and which lines the front of eyeball
Describe briefly lacrimal gland and its nerve supply. is bulbar eyeball.
(Nov 2008, 5 Marks) ♦ Potential space between palpebral and bulbar part is
Ans. Structures which are related to the secretion and drainage conjunctival sac.
of lacrimal gland forms the lacrimal apparatus. ♦ Lines at which the palpaberal conjunctiva of upper and
Lacrimal apparatus constitutes following parts, i.e. lower eyelids is reflected on eyeball are known as supe-
1. Lacrimal gland and its ducts rior and inferior conjunctival fornices.
2. Conjunctival sac ♦ Palpebral conjunctiva is opaque, thick and is vascular.
3. Lacrimal puncta and lacrimal canaliculi ♦ Bulbar conjunctiva covers the sclera and is thin, transparent
4. Lacrimal sac and is loosely attached to eyeball.
5. Nasolacrimal duct.
Lacrimal Puncta and Canaliculi
Lacrimal Gland
♦ Each single lacrimal canaliculus starts at the lacrimal
♦ Lacrimal gland is a serous gland which is situated chiefly punctum.
in lacrimal fossa on anterolateral part of roof of bony orbit ♦ It is 10 mm long.
and partly on the upper eyelid. ♦ A dilated ampulla is present at the bend.

Lacrimal Sac
♦ It is a membranous sac and is situated in lacrimal groove
behind the medial palpebral ligament.
♦ Upper end of lacrimal sac is blind and lower end is
continuous with nasolacrimal duct.
Nasolacrimal Duct
♦ Nasolacrimal duct is a membranous passage and is 18
mm long.
♦ It starts from lower end of lacrimal sac and run down-
ward, backward and laterally and opens in inferior meatus of
nose.
♦ Valve of Hasner, i.e. a fold of mucous membrane form an
imperfect valve at lower end of duct.
Nerve Supply of Lacrimal Apparatus
1. Sensory: Sensory supply is by lacrimal branch of
ophthalmic division of trigeminal nerve.
Fig. 28: Nerve supply of lacrimal apparatus
Q.20. Write a short note on chorda tympani nerve.
(May 2014, 5 Marks)
(Apr 2017, 4 Marks) (May 2017, 3 Marks)
Or
Write in brief on chorda tympani nerve.
(Sep 2015, 5 Marks)
Or
Answer in brief on chorda tympani nerve.
(Oct 2016, 2 Marks)
Ans. Chorda tympani is the sensory nerve. Chorda tympani
nerve is so called because it has intimate relationship
with middle ear.
Anatomy  19
2. Sympathetic:
a. Preganglionic fibers arise from T1 spinal segment of
spinal cord to superior cervical sympathetic ganglion.
b. Postganglionic fibers are the sympathetic plexus
around internal carotid artery to deep petrosal nerve,
pterygopalatine ganglion zygomatic nerve, zy-
gomaticotemporal nerve to lacrimal nerve to lacrimal
gland.
3. Parasympathetic nerve: It carries secretomotor fibers.
a. Preganglionic fibers arise from lacrimatory nucleus
and via facial nerve goes to greater petrosal nerve
and join deep petrosal nerve to form nerve to ptery-
goid canal and reaches to pterygopalatine ganglion
for relay.
b. Postganglionic fibers arise from cell of pterygopala-
tine ganglion and passes successively via maxillary
nerve, zygomatic nerve, zygomaticotemporal
branch of maxillary nerve to lacrimal nerve and
from lacrimal nerve to lacrimal gland.
Functional Components
The nerve consists of:
♦ General visceral efferent fibers: They are preganglionic
parasympathetic or secretomotor fibers to submandibu-
lar and sublingual salivary gland.
♦ Special visceral afferent fibers: They carry taste sensa-
tions from anterior 2/3rd of tongue.
Origin, Course and Relations
Chorda tympani nerve arises from facial nerve in the facial
canal at about 6 mm above the stylomastoid foramen within
the posterior wall of the tympanic (middle ear) cavity. It enters
the middle ear through the posterior canaliculus of chorda
tvmpani in the posterior wall, runs across the lateral
20 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
wall (tympanic membrane). Here it crosses medial aspect of
handle of malleus and lateral aspect of long process of incus.
At the anterior margin of tympanic membrane it enters anterior
canaliculus in the anterior wall of the middle ear and passes via
canaliculus and emerges at the base of skull through medial
end of petrotympanic fissure. It then goes medially, forwards
and downwards, grooves the medial side of the spine of the
sphenoid, running anteroinferiorly deep to lateral pterygoid to
join the posterior aspect of the lingual nerve about 2 cm below
the base of the skull.
Distribution
♦ Chorda tympani nerve supplies secretomotor fibers to
submandibular and sublingual gland via submandibular
ganglion.
♦ It carries taste sensations from anterior 2/3rd of tongue.
Fig. 29: Origin, course and relations of chorda tympani nerve
Q.21. Describe facial nerve under following heads:
(Oct 2014, 3+3+2 Marks)
a. Nucleus
b. Course and branches
c. Applied anatomy
Ans. For nucleus of facial nerve refer to Ans 16 of the same
chapter.
For course of facial nerve refer to Ans 16 of the same
chapter. For branches of facial nerve refer to Ans 7 of
the same chapter.
For applied anatomy of facial nerve refer to Ans 9 of the
same chapter.
Q.22. Write a short note on blood and nerve supply of face.
(Dec 2010, 5 Marks)
Ans. For blood supply of face refer to Ans 3 of the same chapter.
For nerve supply refer to Ans 1 of the same chapter.
Q.23. Describe facial nerve under following heads:
(Apr 2015, 3+3+2 Marks)
a. Intracranial course
b. Extracranial course and branches
c. Applied anatomy
Ans. Intracranial Course of Facial Nerve
Facial nerve is attached to the brainstem by two roots,
i.e. motor and sensory. Two roots of facial nerve are
attached to lateral part of lower border of pons which
is just medial to eighth cranial nerve. Two roots run
laterally and forward with eighth nerve to reach internal
acoustic meatus.
Fig. 30: Horizontal disposition of deep cervical fascia
In the meatus motor root lies in a groove on eighth nerve
with sensory root intervening. At fundus of meatus two
roots, i.e. sensory and motor fuse to form a single trunk
which lie in the petrous temporal bone. In the canal course of
nerve is divided into three parts by two bends. First part get
directed laterally above vestibule, second part go backwards
in relation to medial wall of middle ear above promontory.
Third part move vertically downwards behind promontory.
First bend is at the junction of first and second part is
sharp. This bend lies above the anterosuperior part of
promontory and is known as genu. Second bend is
gradual and lie between promontory and aditus to
mastoid antrum. Facial nerve leaves the skull by passing
stylomastoid foramen.
For extracranial course of nerve and branches refer to
Ans 7 of the same chapter.
For applied anatomy of facial nerve refer to Ans 9 of the
same chapter.
Q.24. Write a short note on retromandibular vein.
(Sep 2017, 2 Marks)
Ans. Superficial temporal vein descends in front of tragus
and
enters the parotid gland. Here it joins the maxillary vein
and form retromandibular vein.
Retromandibular vein on leaving parotid gland is
divided into two divisions, i.e. anterior and posterior.
1. Anterior division joins facial vein to form common
facial vein which drains to internal jugular vein.
2. Posterior division joins posterior auricular vein
to form external jugular vein which drains to
subclavian vein.
 Anatomy  21

Fig. 31: Retromandibular vein

 (Aug 2018, 10 Marks)

Ans. Following are the muscles of facial expression:
Name Origin Insertion Actions
Muscles of eyelid
Corrugator supercilii From medial end of superciliary arch Into the skin of mid eyebrow It produces vertical lines on forehead
Orbicularis oculi
• Orbital part, on • From medial part of medial • Into the concentric rings return • It protects eye from bright light,
and around the palpebral ligament, frontal process to the point of origin wind and rain by forcefully closure
orbital margin of maxilla and nasal part of frontal • Into lateral palpebral raphe of eyelids.
• Palpebral part, in bone • It pass laterally in front of tarsal • It closes eyelids gently as in
the lids • From lateral part of medial plates of eyelids to the lateral blinking and sleeping.
• Lacrimal part, palpebral ligament palpebral raphe • It dilates lacrimal sac for sucking of
lateral and deep • From lacrimal fascia and posterior lacrimal fluid into the sac, directs
to lacrimal sac lacrimal crest, forms sheath for lacrimal puncta into lacus lacrimalis.
lacrimal sac It also supports the lower lid
Muscles around nasal opening
Procerus From nasal bone and upper part of Into skin of forehead between It leads to transverse wrinkles
lateral nasal cartilage eyebrows and over the bridge of
the nose bridge of the nose
Compressor naris From maxilla just lateral to nose Into aponeurosis across the It leads to compression of nasal
dorsum of nose aperture
Dilator naris From maxilla over the lateral incisor Into the alar cartilage of nose It leads to dilation of nasal aperture
tooth
Depressor septi From axilla over the medial incisor Into the lower mobile part of nasal It pull the nose inferiorly
septum
Muscles around the lips
Orbicularis oris
• Intrinsic part, • Superior incisivus is derived from • Into the angle of mouth It closes lips as well as protrudes lips,
deep stratum, maxilla and inferior incisivus, is • Into the lips and angle of mouth numerous extrinsic muscles make
very thin sheet derived from mandible it most versatile for various types of
• Extrinsic part, two • Thickest middle stratum is derived grimaces
strata, formed from buccinator; thick superficial
by converging stratum is derived from elevators
muscles and depressors of lips and their
angles

Contd...
22 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd...

Name Origin Insertion Actions

Buccinator
It is the muscle of • Upper fibers are derived from • Upper fibers straight into the It flattens the cheek against gums and
the cheek maxilla opposite molar teeth upper lip teeth. It also prevents accumulation of
• Lower fibers are derived from • Lower fibers straight into the food into the vestibule
mandible, opposite molar teeth lower lip
• Middle fibers are derived from • Middle fibers decussate
pterygomandibular raphe
Levator labii From frontal process of maxilla Into the upper lip and alar cartilage It lifts upper lip and dilates the nostril
superioris alaeque of nose
nasi
Zygomaticus major From posterior aspect of lateral Into the skin at the angle of mouth It pulls the angle upwards and laterally
surface of zygomatic bone as in smiling
Levator labii From infraorbital margin of maxilla Into the skin of upper lateral half of It elevates the upper lip, forms
superioris upper lip nasolabial groove
Levator anguli oris From maxilla just below infraorbital Into the skin of angle of mouth It elevates angle of mouth and forms
foramen nasolabial groove
Zygomaticus minor From anterior aspect of lateral surface Into the upper lip medial to its It leads to elevation of the upper lip
of the zygomatic bone angle
Depressor anguli From oblique line of mandible below Into the skin at angle of mouth and It draws angle of mouth both
oris first molar, premolar and canine teeth fuses with orbicularis oris downwards and laterally
Depressor labii From anterior part of anterior line of Into the lower lip at midline, fuses It draws lower lip downwards
inferioris mandible with muscles from the opposite side
Mentalis From mandible inferior to incisor teeth Into the skin of chin It both elevates and protrudes lower
lip as it wrinkles skin on the chin
Risorius From fascia on to the massater muscle Into the skin at angle of mouth It retracts the angle of mouth
Muscles of the neck
Platysma • From upper part of pectoral and • Anterior fibers into the base of • It releases pressure of skin on
deltoid fasciae. mandible subjacent veins
• Its fibers run upward and mesially • Posterior fibers into the skin of • It depresses mandible
lower face and lip and can be • It pulls the angle of mouth
continuous with risorius downwards during frightening

Fig. 32: Muscles of facial expression

 Anatomy  23

superficial lamina is thick and dense and is attached

4. SIDE OF THE NECK to zygomatic arch. The deep lamina is thin and is
attached to styloid process, mandible and tym-
Q.1. Write short answer on investing layer of neck. panic plate. Between styloid process and angle
(Apr 2018, 3 Marks) of mandible deep lamina is thick and forms
Ans. The investing layer of deep cervical fascia lies deep to stylomandibular ligament which seperates parotid
gland from submandibular gland and is pierced by
platysma, and surround neck like a collar. It forms the the external carotid artery. At base of mandible it en-
roof of posterior triangle of neck. closes submandibular gland superficial lamina is att-
ached to the lower border of body of mandible and
Attachments
deep lamina to mylohyoid line.
A. Superiorly B. Inferiorly
1. External occipital protuberance 1. Spine of scapula
2. Superior nucal line 2. Clavicle
3. Mastoid process 3. Acromion process
4. Base of mandible 4. Manubrium
5. Between the angle of mandible and mastoid process, Fascia splits to enclose suprasternal and supraclavicular
the fascia splits to enclose parotid gland. The spaces.

Fig. 33: Horizontal disposition of deep cervical fascia

C. Posteriorly
1. Ligamentum nuchae
2. Spine of seventh cervical vertebrae
D. Anteriorly
1. Symphysis menti
2. Hyoid bone
Both above and below hyoid bone, it is continuous with
fascia of opposite side.

Other Features
1. The investing layer of deep cervical fascia splits to enclose
trapezius, sternomastoid, parotid, submandibular gland
and suprasternal and supraclavicular space.
2. It also forms pulleys to bind tendons of digastric and
omohyoid muscles.
Fig. 34: Vertical disposition of deep cervical fascia
24 Mastering the BDS Ist Year (Last 25 Years Solved Questions)


(Aug 2012, 10 Marks)
Or

(Sep 2013, 5 Marks)
Or
(Feb 2016, 2 Marks)

Or (Oct 2016, 3 Marks)
Write a short note on carotid sheath.
(Sep 2017, 3 Marks) (Oct 2016, 3 Marks) Or
Or 
Name the contents of carotid sheath.
(Aug 2018, 1 Mark) (Dec 2012, 4 Marks)
Ans. It is the condensation of the fibroareolar tissue around Ans. Boundaries of Posterior Triangle
main vessels of neck and vagus nerve. • Anterior: Formed by posterior border of sterno-
mastoid.
• Posterior: Formed by anterior border of trapezius.
• Inferior or base: Formed by middle 1/3 of clavicle.
• Apex: Lies on superior nucal line where the trapezius
and sternocleidomastoid meet.
• Roof: Roof is formed by the investing layer of deep
cervical fascia.
• Floor: Floor of posterior triangle is formed by
prevertebral layer of deep cervical fascia covering
the following muscles:
1. Splenius capitis
2. Levator scapulae
3. Scalenus medius
Fig. 35: Carotid sheath 4. Semispinalis capitis may also form part of floor.

Contents of Posterior Triangle

Contents Occipital triangle Subclavian triangle
A. Nerves 1. Spinal accessory 1. Three trunks of
nerve brachial plexus
2. Four cutaneous 2. Nerve to serratus
branches of cervical anterior
plexus 3. Nerve to subclavius
a. Lesser occipital 4. Suprascapular nerve
b. Greater auricular
c. Anterior
cutaneous nerve
of neck
d. Supraclavicular
nerve
3. Muscular branches
a. Two small
branches to
levator scapulae
b. Two small
branches to
trapezius
c. Nerve to
rhomboids
4. C5, C6 roots of
brachial plexus
(Apr 2010, 5 Marks)
Or Contd...
 Anatomy  25

Contd...

Contents Occipital triangle Subclavian triangle

B. Vessels 1. Transverse cervical 1. Third part of
artery and vein subclavian artery
2. Occipital artery and vein
2. Suprascapular
artery and vein
3. Commencement
of transverse
cervical artery
and termination of
corresponding vein
4. Lower part of
external jugular vein
C. Lymph Supraclavicular and Few members of
nodes occipital lymph nodes supraclavicular chain

Fig. 38: Muscles forming floor of posterior triangle

Q.4. Write a short note on sternocleidomastoid muscle.

(Sep 2004, 10 Marks) (Feb 1999, 4 Marks)
(Apr 2007, 5 Marks) (Aug 2011, 5 Marks)
(Aug 2016, 3 Marks)
Or
Write short note on sternomastoid muscle.
(May/June 2009, 5 Marks)
Ans. Introduction: It is a largest muscle of side of neck and
divides it into two triangles, i.e. anterior triangle and
posterior triangle.
Origin: It takes origin from two heads.
1. Sternal head: It takes origin from superolateral part
in front of manubrium sterni.
2. Clavicular head: It takes origin from medial 1/3
of superior aspect of clavicle. It passes vertically
upward deep to sternal head with which it unites
to form a fusion belly.
Insertion: Muscle is inserted:
Fig. 36: Boundaries of posterior triangle
1. By a thick tendon into the lateral surface of mastoid
process from its tip to superior border.
2. By thin aponeurosis into the lateral half of superior
nuchal line of occipital bone.
Nerve supply
Spinal accessory nerve provides motor supply.
Branches from ventral rami of C2 are proprioceptive.

Relations
The sternocleidomastoid muscle is enclosed in the investing
layer of deep cervical fascia, and is pierced by the accessory
nerve and by the four sternocleidomastoid arteries. It has the
following relations.

Superficial Relations
♦ Skin
♦ Superficial fascia
Superficial lamina of the deep cervical fascia
Fig. 37: Contents of posterior triangle ♦ Platysma.
26 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦ External jugular vein and superficial cervical lymph nodes ♦ When both muscles contract together:
lying along the vein. They draw the head forwards, as in eating and in lifting
♦ Great auricular the head from a pillow.
Transverse or anterior cutaneous. With the longus colli, they flex the neck against
Medial supraclavicular nerves resistance.
Lesser occipital nerve It also helps in forced inspiration.
♦ The parotid gland overlaps the muscle.
Applied Anatomy
Deep Relations
♦ Torticollis or wry neck: It is a clinical condition in which
♦ Bones and joints:
head is bent to one side and chin points to opposite side.
Mastoid process above
This occur because of spasm of sternocleidomastoid and
Sternoclavicular joint below.
trapezius muscles.
♦ Carotid sheath
♦ Muscles: ♦ Sternomastoid tumor: It is the swelling in middle third of
Sternohyoid sternomastoid muscle due to edema and ischemic necrosis
Sternothyroid caused by the birth trauma.
Omohyoid
Three scaleni
Levator scapulae
Splenius capitis
Longissimus capitis
Posterior belly of digastric.
♦ Arteries:
Common carotid
Internal carotid
External carotid
Sternocleidomastoid arteries, two from the occipital
artery, one from the superior thyroid, one from the
suprascapular
Occipital
Subclavian
Suprascapular
Transverse cervical
♦ Veins:
Internal jugular
Fig. 39: Sternocleidomastoid muscle
Anterior jugular
Facial Q.5. Write a short note on external jugular vein.
Lingual (Oct 2016, 3 Marks) (Apr 2008, 5 Marks)
♦ Nerves: (Oct 2007, 5 Marks) (Mar 2009, 5 Marks)
Vagus Ans. It is a large vein present in superficial fascia under cover
Parts of IX, XI, XII of platysma muscle.
Cervical plexus
Upper part of brachial plexus
Phrenic
Ansa cervicalis
♦ Lymph nodes, deep cervical.
Blood Supply
Arterial supply is from one branch, i.e. each from superior
thyroid artery and suprascapular artery and two branches
from the occipital artery supply the big muscle. Veins follow
the arteries.

Actions
♦ When one muscle contracts:
It turns the chin to the opposite side.
It can also tilt the head towards the shoulder of same
side. Fig. 40: The external jugular vein

Course
♦ External jugular vein is formed by the union of posterior
division of retromandibular vein and posterior auricular
vein behind mandible just below parotid gland.
♦ The origin lies within the lower part of parotid gland or
just below it. The level corresponds to angle of mandible.
From here vein run downwards and somewhat backwards
and ends by joining subcutaneous vein.
♦ The termination lies behind middle of the clavicle, near
lateral margin of scalene anterior muscle.
♦ The greater part of vein is superficial being covered by skin,
superficial fascia and platysma. It pierces the deep fascia
near its termination to reach subcutaneous vein.
♦ The vein crosses the sternocleidomastoid obliquely running
downwards and backwards at the level of anteroinferior
angle of posterior triangle. It pierces the deep fascia and
opens in subclavian vein.
Tributaries
1. Transverse cervical vein
2. Suprascapular vein
3. Anterior jugular vein
4. Posterior external jugular vein.
Oblique jugular vein connects external jugular vein with internal
jugular vein across middle one-third of anterior border of
sternocleidomastoid.
Applied Anatomy
♦ Right external jugular vein is examined to assess the
venous pressure; right atrial pressure is reflected in it
as there are no valves in it through its entire course. It is
straight.
♦ As external jugular vein pierces the fascia, margins of vein
adhere to fascia. So if vein get cut, it should not be closed
and air is sucked due to negative intrathoracic pressure.
This leads to air embolism for preventing this deep fascia
has to be cut.
Q.6. Discuss anatomy of posterior triangles of neck. Add a
note on its applied anatomy. (June 2010, 10 Marks)
Ans. Posterior triangle is subdivided by inferior belly of
omohyoid into:
1. A large upper part which is known as occipital triangle.
2. A smaller lower part which is known as supraclavicular
or subclavian triangle.
Occipital Triangle
From above to downward it consists of:
♦ Occipital artery at apex
♦ Spinal accessory nerve
♦ Four cutaneous branches of cervical plexus, i.e.
a. Lesser occipital
b. Greater auricular
c. Anterior cutaneous nerve of neck
d. Supraclavicular nerves.
♦ Transverse cervical artery and vein
Anatomy  27
♦ Muscular branches:
a. Two small branches to levator scapulae
b. Two small branches to trapezius
c. Nerve to rhomboids.
♦ C5 and C6 roots of brachial plexus.
Occipital artery: It crosses the apex of posterior triangle
superficial to splenius capitis
Spinal accessory nerve: It emerges little above the middle of
posterior border of sternocleidomastoid. It runs via tunnel in
the fascia and form roof of triangle and pass downward and
laterally and disappear under anterior border of trapezius.
Four cutaneous branches of cervical plexus: All the branches
pierce fascia covering floor of triangle and pass through the
triangle and pierce the deep fascia to become cutaneous.
1. Anterior cutaneous nerve: Arises from ventral rami of C2
and C3 and run across sternomastoid to supply skin and
neck to sternum.
2. Supraclavicular nerve: Formed by ventral rami of C3
and C4 nerves. The nerve emerges at posterior border of
sternocleidomatoid muscle.
3. Greater auricular nerve: It is the largest ascending branch
of cervical plexus. It arises from ventral rami of C2 and
C3 nerves. It ascends on sternomastoid muscle to reach
parotid gland where it subdivides into anterior and
posterior branches.
4. Lesser occipital: It arises from ventral ramus of C2 of spinal
cord. It is visible at posterior border of sternocleidomastoid
muscle.
♦ Transverse cervical artery: It is a branch of thyrocervical
trunk. It crosses scalenus anterior, phrenic nerve, upper
trunk of brachial plexus, nerve to subclavius, supra-
scapular nerve and scalenus medius.
♦ Muscular branches: These branches appear about middle
of sternocleidomastoid. Those to levator scapulae ends
into it and branches to trapezius runs below and parallel
to accessory nerve across the middle of the triangle.
Subclavian Triangle
It consists of:
♦ Three trunks of brachial plexus.
♦ Nerve to serratus anterior.
♦ Nerve to subclavius.
♦ Suprascapular nerve.
♦ Subclavian artery.
♦ Suprascapular artery.
♦ Subclavian vein.
Three trunks of brachial plexus: They emerge between scalenus
anterior and scalenus medius. It carries axillary sheath around
them. Sheath consists of brachial plexus and subclavian artery.
All the structures lie deep to the floor of triangle.
Nerve to serratus anterior: It arises by three roots. Roots from
C5 and C6 pierce the scalenus medius and join the root from
C7 over the first digitations of serratus anterior.
28 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 41: Floor of posterior triangle of neck

Q.9. Write in short on deep fascia of neck.

(Aug 2012, 5 Marks)
Ans. Deep fascia of neck is condensed to form following
layers, i.e.
Investing layer
Pretracheal layer
Prevertebral layer
Carotid sheath
Buccopharyngeal fascia
Pharyngobasilar fascia

Investing Layer
This layer lies deep to platysma and surrounds neck like a collar.
It forms roof of posterior triangle of neck.
For more details refer to Ans 1 of the same chapter.

Pretracheal Layer
Importance of this fascia is that it encloses and suspends the
thyroid gland and forms its false capsule.
(Oct 2016, 2 Marks)
Prevertebral Fascia
Ans. Muscles forming the floor of posterior triangle of neck
are: It lies in front of prevertebral muscles and forms the floor of
Splenius capitis posterior triangle of neck.
Levator scapulae
Carotid Sheath
Scalenus medius
Semispinalis capitis It is a condensation of fibroareolar tissue around the main
Muscular floor of posterior triangle is covered by the vessels of neck. It is formed on anterior aspect by the pretracheal
prevertebral layer of deep cervical fascia which forms fascia and on posterior aspect by prevertebral fascia. Contents
first carpet of floor of posterior triangle of neck. are common or internal carotid arteries, internal jugular vein
 Anatomy  29

 Pharyngeal vein which end in internal jugular vein.

Lingual vein which terminates in internal jugular vein.

(Aug 2018, 1 Mark)

Ans. It is a clinical condition in which head is bent to one side
and chin points to opposite side.

5. ANTERIOR TRIANGLE OF NECK

Q.1. Write a short note on boundaries and contents of
carotid triangle. (Sep 2004, 5 Marks)
Or
Write short answer on contents of carotid triangle.
(Aug 2018, 3 Marks)
Ans. Boundaries of Carotid Triangle Fig. 42: Boundaries and contents of carotid triangle
• Anterosuperiorly: Posterior belly of digastric muscle
and stylohyoid C. Nerves:
• Anteroinferiorly: Superior belly of omohyoid. Vagus running vertically downwards Superior
• Posteriorly: Anterior border of sternocleidomastoid laryngeal branch of vagus, dividing in
muscle. external and internal laryngeal nerves.
Roof: Spinal accessory nerve running backward over internal
jugular vein
1. Skin.
Hypoglossal nerve running forward over external and
2. Superfacial fascia containing:
internal carotid artieries
a. Platysma.
Sympathetic chain run vertically downward posterior
b. Cervical branch of facial nerve.
to carotid sheath. Carotid sheath with its contents.
c. Transverse cutaneous nerve of neck.
3. Investing layer of deep cervical fascia D. Lymph nodes: Deep cervical lymph nodes are situated
along internal jugular vein, and include jugulodiagastric
Floor: It is formed by part of: node below the posterior belly of digastric and jugu-
1. Middle constrictor of pharynx loomohyoid node above the inferior belly of omohyoid.
2. Inferior constrictor of pharynx
Q.2. Write a short note on ansa cervicalis (Ansa Hypoglos-
3. Thyrohyoid membrane.
si). (Sep 2004, 5 Marks) (Dec 2010, 3 Marks)
Contents of Carotid Triangle (Feb 2014, 3 Marks)
Or
A. Arteries:
Common carotid artery with carotid sinus and carotid Write short note on ansa cervicalis. (Sep 2018, 5 Marks)
body at its termination (Aug 2016, 3 Marks) (Nov 2008, 5 Marks)
Internal carotid artery Or
External carotid artery with its superior thyroid,
Write short answer on ansa cervicalis.
lingual, facial, ascending pharyngeal and occipital
branches. (Aug 2018, 3 Marks)
B. Veins: Ans. It is a thin nerve loop that lies embedded in the anterior
Internal jugular vein wall of carotid sheath on lower part of larynx. It supplies
Common facial vein draining into internal jugular vein. infrahyoid muscles.
30 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Formation: It is formed by superior and inferior root.

Superior root is continuation of descending branch
of hypoglossal nerve. Its fibers are derived from
first cervical nerve. This root descends over internal
carotid artery and common carotid artery.
Inferior root is derived from second and third
cervical spinal nerves. As this root descends, it winds
round the internal jugular vein and then continues
anterioinferiorly to join superior root in front of
common carotid artery.

Distribution
♦ Superior root: To the superior belly of omohyoid.
♦ Ansa Cervicalis: To sternohyoid, sternothyroid and Fig. 44: Branches of external carotid artery
inferior belly of omohyoid.
Q.4. Write a short note on lingual artery.
Diagram of Ansa Cervicalis (Aug/Sep 1998, 4 Marks)
Ans. The lingual artery arises from the external carotid artery
opposite the tip of the greater cornua of the hyoid bone.
This artery is tortuous in its course. Its course is divided
into three parts by the hyoglossus muscle:
1. First part lies in the carotid triangle. It forms a
characteristic upward loop which is crossed by the
hypoglossal nerve. The lingual loop permits free
movements of the hyoid bone.
2. Second part lies deep to the hyoglossus along the
upper border of hyoid bone. It is superficial to the
middle constrictor of the pharynx.
3. Third part is called the arteria profunda linguae,
or the deep lingual artery. It runs upwards along
the anterior border of the hyoglossus, and then
horizontally forwards on the undersurface of the
tongue as the fourth part.
In its vertical course, it lies between the genioglossus
Fig. 43: Ansa cervicalis medially and the inferior longitudinal muscle of the
tongue laterally. The horizontal part of the artery is
Q.3. Enumerate the branches of external carotid artery. accompanied by the lingual nerve.
(Mar 2000, 4 Marks) (Apr 2007, 3 Marks)
During surgical removal of tongue the first part of artery is
(Sep 2007, 3 Marks) (Feb 2013, 2 Marks) ligated before it gives any branch to tongue or to the tonsil.
Or
Name the branches of external carotid artery.
(Aug 2018, 1 Mark)
Ans. It gives off 8 branches which are:
A. Anteriorly
1. Superior thyroid artery.
2. Lingual artery.
3. Facial artery.
B. Posteriorly
1. Occipital artery.
2. Posterior auricular artery.
C. Medially
1. Ascending pharyngeal artery.
D. Terminally
1. Maxillary artery.
2. Superficial temporal artery. Fig. 45: Lingual artery

Q.5. Write short note on digastric triangle.
(Feb 2013, 5 Marks) (May/June 2009, 5 Marks)
(Aug 2016, 3 Marks)
Ans. Digastric triangle is so named because it is located
between the two bellies of digastric muscle and below
the base of mandible.
The boundaries of the digastric triangle are as follows:
• Anteroinferiorly: Anterior belly of digastric.
• Posteroinferiorly: Posterior belly of digastric and
stylohyoid.
• Superiorly (base): Base of the mandible and a line
joining the angle of the mandible to the mastoid
process.
Roof: The roof of the triangle is formed by:
1. Skin.
2. Superficial fascia containing:
a. Platysma
b. Cervical branch of the facial nerve
c. The ascending branch of the transverse
(anterior) cutaneous nerve of the neck.
3. Deep fascia, which splits to enclose the sub-
mandibular salivary gland.
Floor: The floor is formed by the mylohoid muscle
anteriorly, and by the hyoglossus posteriorly. A
small part of the middle constrictor muscle of the
pharynx appears in the floor.
Fig. 46: Boundaries of digastric triangle
Contents
A. Anterior part of the triangle
1. Structures superficial to mylohyoid are:
a. Superficial part of the submandibular salivary
gland.
b. The facial vein and submandibular lymph nodes are
superficial to it and the facial artery is deep to it.
c. Submental artery.
d. Mylohyoid nerve and vessels.
2. Structures superficial to the hyoglossus are:
a. Submandibular salivary gland
b. Intermediate tendon of the digastric and the
stylohyoid
c. Hypoglossal nerve.
Anatomy  31

(Sep 2013, 5 Marks)
Ans. External carotid artery is the terminal branch of
common carotid artery.
External carotid artery gives off 8 branches:
Anterior Branches
♦ Superior thyroid artery: It passes deep to three long
infrahyoid muscles to reach the upper pole of lateral lobe
of thyroid gland. Apart from its terminal branches to
thyroid gland, it gives one important branch, i.e. superior
laryngeal artery which pierces thyrohyoid membrane in
company with internal laryngeal nerve.
♦ Lingual artery: The lingual artery arises from the external
carotid artery opposite the tip of the greater cornua of the
hyoid bone. This artery is tortuous in its course. Its course
is divided into three parts by the hyoglossus muscle:
First part lies in the carotid triangle. It forms a
characteristic upward loop which is crossed by the
hypoglossal nerve. The lingual loop permits free
movements of the hyoid bone.
Second part lies deep to the hyoglossus along the
upper border of hyoid bone. It is superficial to the
middle constrictor of the pharynx.
Third part is called the arteria profunda linguae, or the
deep lingual artery. It runs upwards along the anterior
border of the hyoglossus, and then horizontally
forwards on the undersurface of the tongue as the
fourth part.
In its vertical course, it lies between the genioglossus
medially and the inferior longitudinal muscle of the
tongue laterally. The horizontal part of the artery is
accompanied by the lingual nerve.
♦ Facial artery: It arises from the external carotid just above
the tip of the greater cornua of the hyoid bone. It runs
32 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

upwards first in the neck as cervical part and then on the

face as facial part. The course of the artery in both places
is tortuous.
Cervical part of the facial artery runs upwards on the
superior constrictor of pharynx deep to the posterior
belly of the digastric with the stylohyoid and to the
ramus of the mandible. It grooves the posterior border
of the submandibular salivary gland. Next the artery
makes an S-bend (two loops) first winding down over
the submandibular gland, and then up over the base
of the mandible.
Facial part of the facial artery enters the face at
anteroinferior angle of masseter muscle, runs upwards
close to angle of mouth, side of nose till medial angle
of eye.
The cervical part of the facial artery gives off the
ascending palatine, tonsillar, submental, and glandular (Aug 2012, 5 Marks)
branches for the submandibular salivary gland and Or
lymph nodes. Write in brief on external carotid artery.
Ascending palatine artery arises near the origin
of the facial artery. It passes upwards between the (Sep 2015, 5 Marks)
styloglossus and stylopharyngeus crosses over the Ans. External carotid artery is one of the terminal branches
upper border of the superior constrictor and supplies of the common carotid artery. It lies anterior to the
the tonsil and the root of the tongue. internal carotid artery, and is the main artery of supply
Submental branch is a large artery which accompanies to structures in the front of neck and in the face.
the mylohyoid nerve, and supplies the submental
Course and Relations
triangle and the sublingual salivary gland.
♦ It begins inside the carotid triangle at the level of upper
Posterior Branches border of the thyroid cartilage opposite the disc between
♦ Occipital artery: It arises from the posterior aspect of the third and fourth cervical vertebrae. The artery runs
external carotid artery, opposite the origin of the facial upwards and slightly backwards and laterally, and
artery. Hypoglossal nerve cross this artery at its origin. In terminates behind the neck of mandible by dividing into
the carotid triangle the artery gives off two sternocleido- maxillary and superficial temporal arteries.
mastoid branches. Upper branch accompanies accessory ♦ External carotid artery consists of slightly curved course, so
nerve and lower branches arises near origin of occipital that it is anteromedial to internal carotid artery in its lower part
artery. and anterolateral to internal carotid artery in its upper part.
♦ Posterior auricular artery: It arises from posterior aspect of ♦ In carotid triangle, external carotid artery is comparatively
external carotid just above the posterior belly of diagastric. superficial, and lies under cover of anterior border of the
It run upward and backward deep to parotid gland and sternocleidomastoid. It is crossed superficially by the
superficial to styloid process. It crosses base of mastoid cervical branch of facial nerve, hypoglossal nerve, and
process and ascend behind auricle. It supplies back of facial, lingual and superior thyroid veins. Deep to external
auricle skin over mastoid process and over back of scalp. carotid artery lies:
The wall of the pharynx.
Medial Branches Superior laryngeal nerve which divides into external
and internal laryngeal nerves.
Ascending pharyngeal: It is a small branch which arises from
Ascending pharyngeal artery
medial side of external carotid artery. It runs vertically upwards ♦ Above the carotid triangle, external carotid artery lies
between the side wall of pharynx, tonsil, medial wall of middle deep in the substance of parotid gland. Within the gland,
ear and auditory tube. It send meningeal branches in cranial cavity it is related superficially to the retromandibular vein and
via foramen lacerum, jugular foramen and hypoglossal canal. the facial nerve. Deep to external carotid artery, there are:
Terminal Branches Internal carotid artery.
Structures passing between the external and internal
1. Maxillary artery: It is the larger branch and begins behind carotid arteries, i.e. styloglossus, stylopharyngeus,
the neck of mandible. It run forward deep to the neck glossopharyngeal nerve, pharyngeal branch of vagus,
of mandible below auriculotemporal nerve and enter and styloid process.
infratemporal fossa. Two structures deep to internal carotid artery, namely
2. Superficial temporal artery: Refer to Ans 7 of the same the superior laryngeal nerve and superior cervical
chapter. sympathetic ganglion.
 Anatomy  33

Fig. 47: External carotid artery with its branches

Branches of External Carotid Artery ♦ Roof:

Skin.
It gives off 8 branches which are:
Superfacial fascia containing:
Anteriorly – Platysma.
– Cervical branch of facial nerve.
♦ Superior thyroid artery.
– Transverse cutaneous nerve of neck.
♦ Lingual artery.
Investing layer of deep cervical fascia
♦ Facial artery.
♦ Floor: It is formed by parts of:
Posteriorly Middle constrictor of pharynx
Inferior constrictor of pharynx
♦ Occipital artery.
Thyrohyoid membrane.
♦ Posterior auricular artery.
Medially
♦ Ascending pharyngeal artery.
Terminally
♦ Maxillary artery.
♦
Q.9. Describe carotid triangle with labeled diagram.
(Apr 2018, 10 Marks)
Or
Name any four contents of carotid triangle.
(Aug 2016, 2 Marks)
Ans. Carotid triangle is so called because it consists of all three
carotid arteries, i.e. common carotid, internal carotid and
external carotid.

Boundaries of Carotid Triangle

♦ Anterosuperiorly: Posterior belly of digastrics muscle;
and stylohyoid
♦ Anteroinferiorly: Superior belly of omohyoid.
♦ Posteriorly: Anterior border of sternocleidomastoid
muscle. Fig. 48: Boundaries and contents of carotid triangle
34 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contents of Carotid Triangle Carotid Body

♦ Arteries It is a small, oval, red brown structure situated behind
Common carotid artery with carotid sinus and carotid bifurcation of common carotid artery. It receives rich nerve
body at its termination supply mainly from glossopharyngeal nerve but also from
Internal carotid artery vagus nerve and sympathetic nerve. Carotid body act as
External carotid artery with its superior thyroid, chemoreceptor and respond to changes occur in oxygen, carbon
lingual, facial, ascending pharyngeal and occipital dioxide and pH content of blood.
branches.
External Carotid Artery and Its Branches
♦ Veins
Internal jugular vein For details refer to Ans 8 and Ans 6 of the same chapter.
Common facial vein draining into internal jugular vein
Ansa Cervicalis and Ansa Hypoglossi
Pharyngeal vein which usually ends in the internal
jugular vein For details refer to Ans 2 of same chapter.
Lingual vein which usually terminates in the internal Q.10. Name the infrahyoid muscles. (Oct 2016, 2 Marks)
jugular vein.
Or
♦ Nerves
Enumerate infrahyoid muscles in neck.
Vagus nerve running vertically downwards
Superior laryngeal branch of vagus, dividing into (Apr 2018, 2 Marks)
external and internal laryngeal nerves Ans. Infrahyoid muscles are ribbon like and comprises of
Spinal accessory nerve running backward over internal following four paired muscles:
jugular vein 1. Sternothyroid
Hypoglossal nerve running forward over external and 2. Sternohyoid
internal carotid arteries 3. Thyrohyoid
Sympathetic chain running vertically downwards 4. Omohyoid
posterior to carotid sheath. Carotid sheath with its Q.11. Enumerate midline structures of neck.
contents. (Apr 2018, 2 Marks)
♦ Lymph nodes: Deep cervical lymph nodes which are Ans. Following are the midline structures of neck from above
situated along the internal jugular vein, and include the to downwards:
jugulodigastric node below the posterior belly of digastrics Symphysis menti
and jugulo omohyoid node above the inferior belly of Fibrous raphae
omohyoid. Hyoid bone
Medial thyrohyoid ligament
Relevant Features of Contents of Carotid Triangle
Upper border of thyroid cartilage
Common Carotid Artery Angle of thyroid cartilage
Median cricothyroid ligament
Right common carotid artery is the branch of brachiocephalic
Cricoid cartilage
artery. It begins inside the neck behind the right sternoclavicular First tracheal ring
joint. Isthmus of thyroid gland
Left common carotid artery is the branch of arch of aorta. Inferior thyroid veins
It begins inside the thorax in front of trachea opposite to point Thyroidea ima artery
little to left of center of manubirum. It ascends to back of left Jugular venous arch
sternoclavicular joint and enters neck. Suprasternal notch
Inside the neck both arteries have same course.
Each artery run upward inside the carotid sheath under
cover of anterior border of sternocleidomastoid. At the level of 6. THE PAROTID REGION
upper border of thyroid cartilage, artery ends by dividing into
external and internal carotid arteries. 

Carotid Sinus
Termination of common carotid artery or beginning of internal
carotid artery shows slight dilatation known as carotid sinus. In
carotid sinus, tunica media is thin, while the tunica adventitia
is thick and receives rich innervations from glossopharyngeal
and sympathetic nerves. Carotid sinus act as baroreceptor and
regulates blood pressure. (Apr 2008, 5 Marks)
 Anatomy  35

Or External Features
 The gland resembles a three-sided pyramid with apex directed
downwards. It presents the following features:
An apex which is directed downwards.

(Aug 2018, 10 Marks) Four Surfaces

b. Relations 1. Superior surface or base
c. Nerve supply 2. Superficial surface
d. Applied anatomy 3. Anteromedial surface
Ans. Parotid is the largest of all salivary glands. It weights 4. Posteromedial surface.
about 15 g.
Situation: It is situated below external auditory meatus, Three Borders
between ramus of mandible and sternomastoid. They seperate the surfaces:
Anteriorly, the gland overlaps masseter muscle. A part 1. Anterior
of this forward extension is often detached and is known 2. Posterior
as accessory parotid, it lies between zygomatic arch and 3. Medial.
parotid duct.
Relations
Parotid Capsule
A. The apex
♦ Investing layer of the deep cervical fascia forms a capsule
It overlaps posterior belly of digastric and adjoining part
for the gland.
of carotid triangle.
♦ Fascia splits to enclose the gland.
Cervical branch of facial nerve.
♦ Superficial lamina is thick and adherent to the gland is
attached above to the zygomatic arch. The deep lamina is Two divisions of retromandibular vein.
thin and is attached to the styloid process, mandible and B. The superior surface
tympanic plate. It forms upper end of gland which is small and concave.
♦ A portion of the deep lamina extending between the It is related to:
styloid process and mandible is thickened to form the Cartilaginous part of external auditory meatus.
stylomandibular ligament which separates the parotid Posterior surface of temporomandibular joint.
gland from the submandibular salivary gland. External Superficial temporal vessels.
carotid artery pierces the stylomandibular ligament. Auriculotemporal nerve.

Fig. 49: Relations of parotid gland

36 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

C. The superficial surface: It is the largest of all four surfaces Structures within Parotid Gland
and is covered with:
1. Arteries: External carotid artery enters gland through
Skin
posteromedial surface. Maxillary artery leaves gland
Superfacial facia containing anterior branches of through anteromedial surface. Superficial temporal artery
great auricular nerve, preauricular lymph node and give transverse facial artery and emerges at anterior part
posterior fibers of platysma and risorius. of superior surface.
Parotid fascia is thick and adherent to gland
Few deep parotid lymph nodes embedded in gland.
D. Anteromedial surface: It is grooved by posterior border
of ramus of mandible. It is related to:
Masseter
Lateral surface of temporomandibular joint
Medial pterygoid
Posterior border of ramus of mandible
Emerging branches of facial nerve.

Fig. 51: Arterial supply

2. Veins: Retromandibular vein is formed inside the gland

by the union of superficial temporal and maxillary veins.
In the lower part of gland, veins divide in anterior and
posterior division which emerge at close to apex of gland.

Fig. 50: Shape, surfaces and borders of right parotid gland

Fig. 52: Venous drainage
E. Posteromedial surface
It is moulded to mastoid and styloid process and structures 3. Nerve: Facial nerve exit from cranial cavity via stylomastoid
attached to them. So it is related to: foramen and enter the gland through upper part of its
Mastoid process with sternocleidomastoid muscle and posteromedial surface and divides into terminal branches
posterior belly of digastric inside the gland. Branches leave the gland via anteromedial
surface and appear on surface of anterior border. Facial
Styloid process with structures attached to it
nerve lies in relation to isthumus of gland which separates
External carotid artery enters the gland through this
large superficial part from small deep part of gland. Facial
surface and internal carotid artery lies deep to styloid
nerve divides into two branches, i.e. temporofacial and
process.
cervicofacial. Temporofacial divides into temporal and
F. Anterior border
zygomatic branches, while cervicofacial divides into
It separates superficial surface from anteromedial surface.
buccal, marginal mandibular and cervical branches.
It is related to:
4. Parotid lymph nodes
Parotid duct
Parotid duct: It is thick walled and is about 5 cm long.
Terminal branches of facial nerve
It emerges from middle of anterior border of the gland.
Transverse facial vessels. It runs forward and slightly downward on masseter.
In addition the accessory parotid gland lies on parotid duct Because of oblique course of duct through buccinator
close to this border. inflation of duct is prevented during blowing. The
G. Posterior border: It separates superficial surface from duct run forwards for a short distance between the
posteromedial surface. It overlaps sternomastoid muscle. buccinator and oral mucosa. Finally the duct turn
H. Medial border: It separates anteromedial surface from medially and opens in vestibule of mouth opposite
posteromedial surface it is related to lateral wall of phaynx. the crown of upper second molar tooth.

Fig. 53: Nerve supply to parotid gland
Blood supply:
– Parotid gland is supplied by the external carotid
artery and its branches which arise inside the
gland.
– Veins drain into external jugular vein and internal
jugular vein.
Lymphatic Drainage
Lymph drains first to the parotid lymph nodes and from there
to upper deep cervical nodes.
Nerve Supply
Motor Supply
a. Parasympathetic nerves are secretomotor. They reach
the gland through the auriculotemporal nerve. The
preganglionic fibers begin in the inferior salivary nucleus
pass through the 9th nerve, its tympanic branch, tympanic
plexus and lesser petrosal nerve, and relay in otic ganglion.
The postganglionic fibers pass through auriculotemporal
nerve and reach the gland.
b. Sympathetic nerves are vasomotor and they are derived
from plexus at middle meningeal artery.
Sensory Supply
Sensory nerves to gland come from the auriculotemporal nerve.
Parotid fascia is innervated by the sensory fibers of greater
auricular nerve.
Anatomy  37
Applied Anatomy
♦ Parotid swellings are very painful due to unyeilding nature
of parotid fascia.
♦ Mumps is an infectious disease of salivary glands caused by
the specific virus. Viral parotitis or mumps characteristically
does not suppurate. It leads to complications such as
orchitis and pancreatitis.
♦ Parotid abscess is caused by spread of infection through
oral cavity. An abscess may also form due to suppuration
of parotid lymph nodes draining an infected area. Parotid
abscess is best drained by horizontal incison called as
Hilton s method.
♦ During surgical removal of parotid gland, the facial
nerve is preserved by removing gland into two parts, i.e.
superficial and deep parts separately, plane of cleavage is
defined by tracing nerve from behind forwards.
♦ Mixed parotid tumor is slowly growing, lobulated, painless
tumor without involvement of facial nerve. Malignant
changes of such tumor are indicated by pain, rapid
growth, fixity with hardness, involvement of facial nerve,
enlargement of cervical lymph nodes.
Q.2. Describe the parotid gland. Write a note on its
secretomotor fibers.
38 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

the inferior salivary nucleus pass through the 9th nerve,

its tympanic branch, tympanic plexus and lesser petrosal
nerve, and relay in otic ganglion. The postganglionic fibers
pass through the auriculotemporal nerve and reach the
gland.
Q.3. Write a short note on parotid duct.
(Mar 2000, 5 Marks) (Oct 2007, 5 Marks)
(Dec 2012, 3 Marks)
Ans. Introduction: It is thick walled and is about 5 cm long.
It emerges from middle of anterior border of the gland.
It runs forward and slightly downward on masseter.

Relations
♦ Superiorly: Accessory parotid gland, upper buccal branch
of facial nerve and transverse facial vessels.
♦ Inferiorly: Lower buccal branch of facial nerve.
At the anterior border of masseter it turns medially and
pierces:
a. Buccal pad of fat. (June 2010, 15 Marks)
b. Buccopharyngeal fascia. Ans. For nerve supply refer to Ans 1 of same chapter.
c. Buccinator. For histology refer to Ans 17 and 18 of HISTOLOGY
Because of oblique course of duct through buccinator SECTION.
inflation of duct is prevented during blowing. The
duct run forwards for a short distance between the Structures within the Gland
buccinator and oral mucosa. Finally the duct turn Structures within the parotid gland from medial to lateral side
medially and opens in vestibule of mouth opposite
are:
the crown of upper second molar tooth.
1. Arteries: Refer to Ans 1 of same chapter
Q.4. Describe parotid under the following headings. (a) 2. Veins: Refer to Ans 1 of same chapter
Gross anatomy with nerve supply (b) Histology and 3. Facial Nerve: Refer to Ans 1 of same chapter.
Development (in brief). (Apr 2008, 8 Marks)
Q.8. Write very short answer on parotid duct opening.
Ans. For gross anatomy with nerve supply refer to Ans 1 of
the same chapter. For histology refer to Ans 17 and 18 (Aug 2018, 2 Marks)
of HISTOLOGY SECTION. Ans. Parotid duct pierces the buccinator muscle and then
opens into the oral cavity on the inner surface of cheek,
Development: The parotid gland is an elongated
usually opposite the maxillary second molar tooth.
furrow running dorsally from angle of mouth between
mandibular and maxillary prominences. Parotid papilla is a small elevation of tissue that marks
opening of the parotid duct on the inner surface of cheek.
 The groove which is converted into a tube looses
its connection with the epithelium of mouth, except at
its ventral end, and grows dorsally into substance of
cheek. The tube persist as parotid duct and its blind 7. TEMPORAL AND
end proliferates in the local mesenchyme to form gland. INFRATEMPORAL REGION
Subsequently size of oral fissure is reduced by partial
fusion between maxillary and mandibular prominences 
and duct opens thereafter on inside of cheek at some
distance from angle of mouth.
Q.5. Write in short on parotid gland. (Jan 2012, 5 Marks) (Apr 2010, 20 Marks)
Ans. Refer to Ans 1 of the same chapter. Or
Q.6. Describe parotid gland under following heading: 
(Feb 2013, 10 Marks) (May/June 2009, 15 Marks)
a. Introduction Or
b. Capsule
c. Relations Describe muscles of mastication.
d. Development (Sep 2017, 10 Marks)
e. Histology Or
 Anatomy  39

Name the muscles of mastication. Tabulate them under

following headings: a. origin, b. course, c. insertion, d.
blood supply, e. nerve supply, f. action. (Feb 2004, 10 Marks)
(Aug 2016, 10 Marks) (Jan 2018, 10 Marks)
Or
Enumerate muscles of mastication. Give origin, (Aug 2012, 10 Marks)
insertion, nerve supply. (Mar 2000, 6 Marks) Or
Or Write short note on temporalis muscle.
(Feb 2013, 5 Marks)

(Aug 2011, 10 Marks)

Or (Dec 2009, 5 Marks)
Enumerate muscles of mastication. Give origin,
insertion, nerve supply and action of massater muscle
(Feb 2016, 10 Marks)
(Feb 2016, 3 Marks)

Or
Write short note on lateral pterygoid muscle.
(June 2010, 5 Marks) (Oct 2014, 3 Marks)
 (Dec 2010, 5 Marks)
Or
(Mar 2007, 4 Marks) Write short answer on relations of lateral pterygoid.
 (Aug 2018, 3 Marks)
Ans. Enumeration of muscles of mastication
Massater
Temporalis
Lateral pterygoid
(Apr 2018, 3 Marks) Medial pterygoid

Muscles of mastication
Blood Nerve
Muscle Origin Course Insertion supply Relations supply Action
Masseter a. Superficial • Superficial a. Superficial It is • Superficially: Are Masseteric a. Elevates
It is layer: From fibers pass layer: Into supplied skin, platysma, nerve, mandible
quadrilateral anterior 2/3 of downward lower part by risorius, zygomaticus branch of to close the
in shape lower border of and of lateral masseteric major, and parotid anterior mouth to bite
and covers backward gland duct, facial division of
zygomatic arch surface of artery b. Superficial
lateral at 45° nerve and transverse mandilbular
and adjoining ramus of fibers cause
surface of • Middle facial vessels cross nerve
ramus of zygomatic fibers pass mandible the muscle protrusion
mandible. process of vertically b. Middle layer: • Medially: Temporalis
It has three maxilla downwards Into central and Mandibular
layers b. Middle layer: • Deep part of ramus ramus. Fat separates
From lower fibers pass of mandible it anteriorly from
border of vertically c. Deep layer: buccinator. The
posterior 1/3 of downwards Into rest of massetric nerve and
artery
zygomatic arch ramus of
• Posteriorly: Margin
c. Deep layer: From mandible is overlapped by the
deep surface of parotid gland, anterior
zygomatic arch margin projects over
buccinator and is
crossed below by
facial vein.
Contd...
40 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd...

Muscles of mastication
Blood Nerve
Muscle Origin Course Insertion supply Relations supply Action
Temporalis a. Temporal fossa Anterior fibers a. Margins and It is • Superficial: Skin, Two deep a. Elevates
It is fan b. Temporal fascia run vertically, deep surface supplied auricularis anterior temporal mandible
shaped middle fibers of coronoid by the and superior, branches b. Posterior
and fills obliquely process anterior temporal fascia, from fibers retract
temporal and posterior superficial temporal
b. Anterior and anterior protruded
fossa fibers vessels, auricular
border of posterior division of mandible
horizontally. temporal nerve,
All of them ramus of deep temporal branches mandibular c. Helps in
converge and mandible temporal of facial nerve, nerve side to side
pass through arteries zygomaticotemporal grinding
a gap deep which are nerve, apocranial movement
to zygomatic branches aponeuresis,
arch of the zygomatic arch and
internal masseter
• Medial: Temporal
maxillary
fossa, lateral
artery pterygoid, superficial
head of medial
pterygoid, a small
part of buccinator,
the maxillary artery
and its deep temporal
branches, deep
temporal nerves and
buccal nerve and
vessels
• Posterior: The
tendon, massetric
vessels and nerve
that traverse the
mandibular incisure.
Fat separates its
anterior border from
the zygomatic bone
Lateral a. Upper Fibers run a. Pterygoid It is Superficial A branch a. Depresses
pterygoid head: From backward and fovea on supplied • Masseter from mandible
It is short intratemporal laterally and the anterior by • Ramus of mandible anterior to open
and conical, surface and crest converge for surface pterygoid • Tendon of temporalis division of mouth with
it consists • Maxillary artery
of greater wing insertion of neck of branches mandibular suprahyoid
of upper Deep
of sphenoid bone mandible of nerve muscle
and lower • Mandibular nerve
b. Lower head: b. Anterior maxillary b. Lateral
heads • Middle meningeal
From lateral margin of artery artery and medial
surface of lateral articular disc • Sphenomandibular pterygoid
pterygoid plate. and capsule ligament protrude
Origin is medial of temporo- • Deep head of the mandible
to insertion mandibular medial pterygoid c. Left lateral
joint Structures Emerging pterygoid
c. Insertion is at the Upper Border and right
posterolateral • Deep temporal medial
nerves
and is at pterygoid
• Masseteric nerve
higher level turn the chin
Structures Emerging
than origin at the Lower Border to left side
• Lingual nerve as a part
• Inferior alveolar nerve of grinding
• The middle meningeal movement
artery passes
upwards deep to it
Contd...
 Anatomy  41

Contd...

Muscles of mastication
Blood Nerve
Muscle Origin Course Insertion supply Relations supply Action
Structures passing
through the Gap
between two heads
• Maxillary artery
enters the gap
• Buccal branch of the
mandibular nerve
comes out via gap
Pterygoid plexus of
veins surrounds the
lateral pterygoid
Medial a. Superficial head: Fibers run Roughned It is Superficial and deep Nerve to a. Elevates
pterygoid From tuberosity downwards, area of medial supplied heads of medial medial mandible
It is of maxilla and backwards surface of angle by pterygoid enclose the pterygoid, b. Helps in
quadrilateral adjoining bone and laterally and adjoining pterygoid lower head of lateral branch of protruding
and has b. Deep head: ramus of branches pterygoid muscle. the main mandible
a small From medial mandible below of trunk of c. Right medial
Superficial relations
superficial surface of lateral and behind maxillary mandibular pterygoid
pterygoid plate mandibular artery The upper part of the nerve with left
and a large
and adjoining foramen and muscle is separated lateral
deep head
process of mylohyoid from the lateral pterygoid
palatine bone groove pterygoid muscle by: turn the chin
• Lateral pterygoid to left side
plate
• Lingual nerve
• Inferior alveolar
nerve.
Lower down the muscle
is separated from the
ramus of mandible
by the lingual and
inferior alveolar nerves,
maxillary artery, and
sphenomandibular
ligament.
Deep relations
The relations are:
• Tensor veli palatine
• Superior constrictor
of pharynx
• Styloglossus
• Stylopharyngeus
attached to the styloid
process.

Fig. 54: Masseter muscle (superficial layer) Fig. 55: Masseter muscle (deeper layer)
42 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

(Jan 2012, 3 Marks)

Ans. Introduction: This is the larger terminal branch of
external carotid artery given off behind the neck of
mandible. It has wide territory of distribution and
supplies external and middle ears and auditory tube,
dura mater, upper and lower jaws, muscles of temporal
and infratemporal regions, nose and paranasal air
sinuses, palate, roof of pharynx. Maxillary artery is
Fig. 55: Temporalis muscle
divided into three parts, i.e. mandibular part, pterygoid
part and pterygopalatine part.

Branches of Maxillary Artery

1. First part, i.e. mandibular part
a. Deep auricular artery: Supplies to external auditory
meatus, tympanic membrane and temporomandibular
joint.
b. Anterior tympanic branch: Supplies to middle ear.
c. Middle meningeal artery
d. Accessory meningeal artery: Supplies to infratemporal
fossa.
e. Inferior alveolar artery: Supplies to mandible
2. Second part, i.e. pterygoid part
It consists of:
a. Masseteric: Supplies to massater muscle
b. Deep temporal: Supplies to both branches of
temporalis
Fig. 56: Lateral pterygoid muscle
c. Pterygoid: Supplies to lateral and medial pterygoid
d. Buccal: Supplies to skin of cheek.
3. Third part, i.e. pterygopalatine part
a. Posterior superior alveolar artery: It gives branches
which supply to molars, premolars and maxillary air
sinus.
b. Infraorbital artery: It supplies to orbit, incisors and
canine. It also gives branches to lacrimal sac, nose and
upper lip.
c. Greater palatine artery: The branches of artery supply
to the gums.
d. The pharyngeal branch: Its supplies to part of
nasopharynx auditory tube and sphenoidal air sinus.
e. The artery of pterygoid canal: It supplies to pharynx,
auditory tube and tympanic cavity.
f. The sphenopalatine artery: The branches of artery
supplies to the paranasal air sinuses and posterior
Fig. 57: Medial pterygoid muscle septal branches to the nasal septum.
 Anatomy  43

Fig. 59: Branches of maxillary artery (For colour version see Plate 1)

Q.3. Describe temporomandibular joint.

(Sep 2002, 10 Marks) (Apr 2003, 10 Marks)
 (Aug 2011, 10 Marks) (Dec 2014, 10 Marks)
 (Aug 2018, 10 Marks) (Apr 2008, 15 Marks)
Or
Describe the temperomandibular joint. Add a note on
applied part. (Aug 2012, 10 Marks) (Oct 2014, 8 Marks)


(Dec 2010, 15 Marks)

Or

(Apr 2015, 8 Marks)
Or

(May 2017, 10 Marks)
a. Type, b. Articular surfaces, c. Ligaments, d. Movements
and muscle producing movements, e. Nerve and blood
(Sep 2017, 2 Marks)
supply
Or Or
Write in short on temperomandibular joint. Write short note on movements of TM joint.
(July 2016, 5 Marks) (Aug 2018, 5 Marks)
Or Ans. Type B
Write a short note on TM joint. This is a synovial type of condylor variety joint.
(June 2010, 5 Marks) It consists of following parts of temporal bone forms upper
Or articular surface, i.e.
44 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ The articular tubercle
♦ Anterior part of mandibular fossa
♦ Posterior non-articular part is formed by tympanic plate.
Inferior articular surface is formed by the head of mandible.
Fibrocartilage covers the articular surfaces.
Intra-articular disc divides joint cavity into upper and lower
parts.
Ligaments of Temporomandibular Joint
Following are the ligaments of temporomandibular joint:
♦ Fibrous capsule: It is attached above the articular tubercle,
in front by circumference of mandibular fossa behind by
squamotympanic fissure and below to neck of mandible.
Above intra articular disc the capsule is loose and below
it is tight. Synovial membrane lines the fibrous capsule
and neck of mandible.
♦ Lateral temporomandibular ligament: It reinforces and
provides strength to lateral part capsular ligament. Fibers
of ligament are directed downwards and backwards.
Ligament is attached above to articular tubercle and below
to posterolateral aspect of ramus of mandible.
♦ Sphenomandibular ligament: This is an accessory
ligament which lies on deep plane away from fibrous
capsule. The ligament is attached superiorly to spine of
sphenoid and inferiorly to lingula of mandibular foramen.
This is the remnant of dorsal part of Meckle s cartilage.
This ligament is related laterally to lateral pterygoid
muscle, auriculotemporal nerve and maxillary artery
while it is related medially to chorda tympani nerve
and wall of pharynx. Near its lower end, it is pierced
by mylohyoid nerve and vessels.
♦ Stylomandibular ligament: This is another accessory
ligament of joint. This ligament represents the thick part
of deep cervical fascia which causes the separation of
parotid and submandibular salivary glands. This ligament
is attached above to lateral surface of styloid process and
below to angle as well as adjacent part of posterior border
of ramus of mandible.
Articular Disc
♦ It is an oval fibrous plate which divides joint upper and
lower compartments.
♦ Upper compartment leads to gliding movements and the
lower compartment leads to both, i.e. rotatory as well as
gliding movements.
♦ Disc consists of concave convex superior surface and
concave inferior surface.
♦ Periphery of articular disc gets attached to fibrous capsule.
♦ It also consists of an anterior extension, anterior thick
band, intermediate zone, posterior thick band and
bilaminar region which consists of venous plexus
♦ It prevents the friction between articulating surfaces.
♦ It act as a cushion and absorbs the shock. It also stabilizes
the condyle by filling the space between articular surfaces.
♦ Proprioceptive fibers present inside the disc regulate
movements of joint.
♦ Disc also distributes the weight across temporomandibular
joint by enhancing area of contact.
Relations of Temporomandibular Joint
♦ Lateral: Skin and fasciae, parotid gland and temporal
branches of facial nerve.
♦ Medial: Tympanic plate separates the joint from
internal carotid artery, spine of sphenoid with upper
end of sphenomandibular ligament attached to it,
auriculotemporal and chorda tympani nerves, middle
meningeal artery.
♦ Anterior: Lateral pterygoid, masseteric nerve and artery.
♦ Posterior: Parotid gland separates joint from external
auditory meatus, superficial temporal vessels and
auriculotemporal nerve.
♦ Superior: Middle cranial fossa and middle meningeal
vessels.
♦ Inferior: Maxillary artery and vein.
Blood Supply
It is supplied by the branches from superficial temporal and
maxillary arteries, veins usually follow arteries.
Nerve Supply
Temporomandibular joint is supplied by the auriculotemporal
nerve and masseteric nerve.
Lymphatic Drainage
Lymph from temporomandibular joint drains into:
♦ Superficial parotid nodes
♦ Deep parotid nodes
♦ Upper deep cervical nodes.
Movements of Temporomandibular Joint
When temporomandibular joint of both the sides are in position
of rest, there exist a small free space between maxillary and
mandibular teeth but lips are in contact. Various movements
of mandible occur in this position.
Lower jaw can be depressed, elevated, protruded, retracted
and move from side to side due to movements of temporo-
mandibular joint.
Mechanism
There are two basic movements which occur at temporoman-
dibular joint but with the help of muscles. Two basic movements
are gliding movement and rotational movement.
♦ Upper meniscotemporal compartment of temporomandi-
bular joint leads to gliding movements at the time of
protraction, retraction and chewing.
♦ Lower meniscotemporal compartment permit rotation
around two axis, i.e. transverse axis at the time of
depression and elevation and vertical axis at the time of
side to side (chewing) movements.
♦ Movements occurring at temporomandibular joints are:
Depression (lowering of jaw to open the mouth):
During depression, head of mandible along with
 Anatomy  45

articular disc glide forward in upper meniscotemporal pterygoids of each side. For e.g. chewing from left side is
compartment on both the sides by contraction of produced by right lateral pterygoid, right medial pterygoid
lateral pterygoid muscle. During same time head which pushes the chin over left side. Now left temporalis,
rotates forward underneath the articular disc due left massater chew food. Chewing over the right side
to contraction of suprahyoid muscles, i.e. digastrics involve left lateral pterygoid, left medial pterygoid, right
geniohyoid and mylohyoid. Gravity also provides temporalis and right massater.
help in opening the mouth.
Elevation (elevating of jaw to close the mouth): Applied Anatomy or Clinical Anatomy
At the time of elevation, movements take place in a ♦ Dislocation of mandible: During excessive opening of
reverse order to that take place in depression, i.e., first mouth or during a convulsion, the head of the mandible
head of mandible along with an articular disc glide of one or both sides may slip anteriorly into infratemporal
backward in the upper meniscotemporal compartment fossa due to which there is inability to close the mouth.
by temporalis, masseter, and medial pterygoid, and Reduction is done by depressing the jaw with thumb
then head rotates backward on the lower surface of placed on last molar teeth and at same time elevating the
the disc by posterior fibers of temporalis. chin.
Protrusion/protraction: In protrusion, mandibular ♦ Derangement of articular disc may result from any injury,
teeth move forward in front of maxillary teeth. In like overclosure or malocclusion which causes clicking and
this act, head of the mandible along with the articular pain during movements of jaw.
disc glide forwards in the upper meniscotemporal ♦ In operations on temporomandibular joint facial nerve
compartment on both sides by simultaneous action of as well as auriculotemporal nerve, branch of mandibular
medial and lateral pterygoids of both sides. division of trigeminal nerve should be preserved with care.
Retraction: In retraction, head of mandible along
with articular disc glide backwards in the upper
meniscotemporal compartment by the contraction of
posterior fibers of temporalis muscle and bring the
joint in the resting position. The retraction is assisted
by deep fibers of masseter, digastric, and geniohyoid
muscles. During end of this movement head of
the mandible comes to lie underneath the articular
tubercle.
Side-to-side (Chewing) movements: These move-
ments take place alternately in the right and
left temporomandibular joints. During chewing
movements, head of the mandible on one side glides
forwards along with the disc (as in protraction), but
the head of the mandible on the opposite side merely
rotates on the vertical axis. Due to which the chin
moves forwards and to one side, i.e. towards the side (Feb 2002, 10 Marks)
on which no gliding has taken place. In this movement,
the medial and lateral pterygoids of one side contract Or
alternatively with those of opposite sides.
Alternate movements of this kind on the two sides
result in side-to-side movements of the lower jaw. (Sep 2000, 18 Marks)
Muscles Producing Movements of Temporomandibular Joint Or
♦ Depression (opening of mouth): This is caused mainly by Describe mandibular nerve in detail.
lateral pterygoid. Digastric, geniohyoid and mylohyoid (Mar 2006, 15 Marks) (Nov 2008, 15 Marks)
muscles help when mouth is opened wide or against Or
resistance.
Describe mandibular nerve with its applied anatomy.
♦ Elevation: It is caused by medial pterygoid muscle of both
(Nov 2008, 5 Marks)
sides, masseter, and anterior, vertical and middle oblique
fibers of temporalis muscle. These are antigravity muscles.
♦ Protrusion: It is done by lateral and medial pterygoids
as well as superficial oblique fibers of massater muscle. (Apr 2008, 8 Marks)
♦ Retraction: It is carried out by posterior horizontal fibers
of temporalis and deep vertical fibers of massater.
♦ Lateral or side to side or chewing movements: It is
carried out by alternate contraction of medial and lateral (Apr 2007, 3 Marks)
46 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Or the lateral part of trigeminal ganglion and leaves cranial cavity

via foramen ovale. Motor root lies deep to trigeminal ganglion
(Sep 2007, 8 Marks) and to sensory root. It passes via foramen ovale and join sensory
root below the foramen forming main trunk. Main trunk lies
Or in infratemporal fossa over tensor veli palatine, deep to lateral
pterygoid muscle. After a short distance main trunk divides
(June 2010, 10 Marks) into small anterior trunk and large posterior trunk.
Or Branches of Mandibular Nerve
Write short note on mandibular nerve.
♦ From the main trunk
(July 2016, 5 Marks) (Aug 2012, 5 Marks)
Meningeal branch.
Or Nerve to medial pterygoid.
♦ From anterior trunk
(Jan 2012, 5 Marks) Sensory branch: Buccal nerve.
Motor branch: Masseteric, deep temporal and nerve
Or to lateral pterygoid.
Describe mandibular nerve under following heads: ♦ From posterior trunk
(Mar 2013, 2+2+2+2 Marks) Auriculotemporal nerve
a. Formation Lingual nerve
b. Course and relation Inferior alveolar nerve.
c. Branches
d. Applied anatomy From the Main Trunk

Or Meningeal Branch or Nervous Spinosus

It enters skull via foramen spinosum along with middle
meningeal artery and supplies dura mater of middle cranial
(Feb 2014, 2+2+2+2 Marks) fossa.
Or Nerve to Medial Pterygoid
Describe mandibular nerve with its applied anatomy. It arises close to otic ganglion and supply medial pterygoid from
(May 2014, 10 Marks) its deep surface. It gives motor root to otic ganglion which does
Or not relay and supply tensor palati muscle and tensor tympani
Write branches and distribution of mandibular nerve muscle.
with a note on applied anatomy. (Sep 2015, 10 Marks) From Anterior Trunk
Or
All the branches are motor except buccal which is sensory.
Write short answer on branches of mandibular nerve.
(Aug 2018, 3 Marks) Buccal Nerve
Ans. Mandibular nerve is the largest mixed branch of This nerve is the only sensory branch of anterior division of
trigeminal nerve. mandibular nerve. This nerve passes between two heads of
lateral pterygoid, run downward and forward and supply
Formation of Mandibular Nerve to skin of cheek and mucus membrane which is related to
Mandibular nerve arises from the trigeminal nerve. It is a mixed buccinator. Labial aspect of gingiva of molar and premolar teeth
nerve with two roots—a large sensory root and a smaller motor is supplied by buccal nerve.
root. Sensory root of the mandible division originates at the
Masseteric Nerve
inferior angle of trigeminal ganglion, whereas motor root arises
in motor cells located in pons and medulla oblongata. Two roots It emerges at upper border of lateral pterygoid muscle mainly
emerge from cranium separately through foramen ovale, the in front of temporomandibular joint. It passes laterally via
motor root lying medial to sensory. They unite just outside the mandibular notch in company with masseteric vessels and
skull and form main trunk of third division. The trunk remains enters deep surface of massater. Temporomandibular joint is
undivided for only 2 to 3 mm before it splits into small anterior also supplied by this nerve.
and larger posterior division.
Deep Temporal Nerve
Course or Distribution and Relations
They are two in number, i.e. anterior and posterior. These nerves
Mandibular nerve starts from middle cranial fossa by large pass between the skull and lateral pterygoid. It enters at deep
sensory root and small motor root. Sensory root emerges from surface of temporalis.
 Anatomy  47

Nerve to Lateral Pterygoid
It runs with the buccal nerve and enters deep surface of both
heads of lateral pterygoid muscle which it supplies.
From Posterior Trunk
Auriculotemporal Nerve
It arises by two roots which run backwards and encircle
the middle meningeal artery and unite to form a single
trunk. It continues backward between neck of mandible and
sphenomandibular ligament above the maxillary artery. Behind
the neck of mandible it turn upward and ascend on temple
behind superficial temporal vessels.
♦ Auricular part of nerve supplies skin of tragus, upper
parts of pinna, external acoustic meatus and tympanic
membrane.
♦ Temporal part supplies skin of temple
♦ In addition auriculotemporal nerve also suppliesparotid
gland and temporomandibular joint.
Lingual Nerve
♦ It is one of the two terminal branches of the posterior
division of the mandibular nerve.
♦ It is sensory to the anterior two-third of the tongue and to
the floor of the mouth.
♦ However, the fibers of the chorda tympani (branch of facial
nerve) which is secretomotor to the submandibular and
sublingual salivary glands and gustatory to the anterior
two-third of the tongue are also distributed through the
lingual nerve.
Course and Relations
It begins just l cm below the skull. It runs first between the
tensor palati and lateral pterygoid, and then between the lateral
and medial pterygoids. About 2 cm below the skull it is joined
by the chorda tympani nerve. Emerging at the lower border of
the lateral pterygoid, the nerve runs downwards and forwards
between the ramus of the mandible and the medial pterygoid.
Next it lies in direct contact with the mandible, medial to the
third molar tooth. It soon leaves the gum and runs over the
hyoglossus deep to the mylohyoid. Finally it lies on the surface
of the genioglossus deep to the myelohyoid. Here it winds round
the submandibular duct and divides into its terminal branches.
♦ During running inside the mandibular canal, the inferior
alveolar nerve gives off the branches that supply the lower
teeth and gums.
♦ Mental nerve emerges at the mental foramen and supplies
to skin of chin and the skin as well as mucous membrane
of the lower lip. Its incisive branch supplies to labial aspect
of gums of canine and incisor teeth.
Applied Anatomy
♦ A lesion at foramen ovale involves mandibular nerve and
causes paresthesia along the mandible, in mandibular teeth
and side of the face. There is also paralysis of muscles of
mastication and loss of jawjerk reflex as the nerve supplies
both afferent and efferent limbs for jaw jerk reflex.
♦ Motor part of mandibular nerve is tested clinically by
asking the patient to clench his teeth and then feeling for
contracting massater and temporalis muscle on two sides.
If massater of one side is paralyzed, jaw deviates to the
paralyzed side, on opening the mouth by action of normal
lateral pterygoid of opposite side. Activity of pterygoid
muscles is tested by asking the patient to move chin from
side to side.
♦ In patients with the cancer of tongue pain radiates to ear and
temporal fossa over the distribution of auriculotemporal
nerve as both lingual and auriculotemporal nerves are
branches of mandibular nerve. At times lingual nerve is
divided to relieve interactable pain. This can be done where
the nerve lies in contact with mandible below and behind
last molar tooth and is covered by mucous membrane.

Inferior Alveolar Nerve

It is the larger terminal branch of posterior division of
mandibular nerve. It run vertically downwards lateral to medial
pterygoid and to the sphenomandibular ligament. The nerve
enters the mandibular foramen and runs inside the mandibular
canal. It is accompanied by inferior alveolar artery.
Branches
♦ Mylohyoid branch consists of all the motor fibers of
posterior division. The nerve arises just before the inferior
alveolar nerve and enters the mandibular foramen. It also
pierces sphenomandibular ligament along with mylohyoid
artery, runs in the mylohyoid groove, and supplies
mylohyoid muscle and anterior belly of the digastric.
48 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
maxillary and mandibular nerves. During the division the
ophthalmic fibers which lie in superomedial part of root
are preserved to spare corneal reflex this avoids damage
to cornea.
♦ Lingual nerve lies in contact with medial to third molar
tooth. In extraction of malplaced wisdom tooth, care
should be taken not to injure the lingual nerve. Its injury
causes loss of sensation from anterior two third of
tongue.
♦ During extraction of mandibular teeth, inferior alveolar
nerve should be anesthetized. Drug is given inside the
nerve before it enters mandibular canal.
♦ Inferior alveolar nerve travels the mandibular canal and
can be damaged by the fracture of mandible. This injury
is assessed by testing sensation over the chin.
♦ At the time of extraction of third molar, buccal nerve may
get involved by local anesthesia leading to temporary
numbness of cheek.
Q.5. Write short note on otic ganglion. (Oct 2016, 3 Marks)
(Feb 2016, 3 Marks) (Dec 2010, 5 Marks)
(Mar 2000, 5 Marks) (Mar 2009, 5 Marks) ♦ Sensory root comes from the auriculotemporal nerve and
Or
Write short answer on otic ganglion. (Apr 2018, 3 Marks) ♦
Ans. It is a peripheral parasympathetic ganglion which relay
secretomotor fibers to parotid gland. Topographically it
is related to mandibular nerve but functionally it is the
part of glossopharyngeal nerve.
Size and Location
It is usually 2 to 3 mm in size and is located inside the infra–
temporal fossa below foramen ovale.
Fig. 62: Otic ganglion and its connections
Relations
♦ Lateral: Mandibular nerve
♦ Medial: Tensor palate muscle
♦ Posterior: Middle meningeal artery
♦ Anterior: Medial pterygoid muscle.
Roots or Connections
♦ The motor or parasympathetic root is formed by lesser
petrosal nerve. Preganglionic fibers arise from inferior
salivary nucleus. They pass through glossopharyngeal
nerve, its tympanic branch, tympanic plexus and lesser
petrosal nerve to reach otic ganglion. The postganglionic
fibers join auriculotemporal nerve to parotid gland.
♦ Sympathetic root is derived from the plexus on middle
meningeal artery. It contains postganglionic fibers
arising in superior cervical ganglion. Fibers pass via
otic ganglion without relay and reach parotid gland via
auriculotemporal nerve. They are vasomotor in function
and are responsible for thick salivary secretion.
is sensory to parotid gland.
Various other fibers which pass through ganglion are:
Nerve to medial pterygoid provides motor root to
ganglion which passes through it without relay and
supply medially placed tensor veli palatine and
laterally placed tensor tympani muscle.
Chorda tympani nerve connected to otic ganglion and
also to nerve of pterygoid canal. These connections
leads to an alternative pathway of taste from anterior
two-third of tongue.

(Sep 2005, 15 Marks)
Ans. Extracranial Course
Both the roots pass through the foramen ovale and join
to form the main trunk which lies in infratemporal fossa.
After a short course the main trunk divides into the small
anterior and a large posterior division.
For branches and distribution refer to Ans 4 of the same
chapter.
Q.7. Describe in brief the mandibular nerve. Add a note on
trigeminal ganglion. (Sep 2006, 15 Marks)
Ans. For mandibular nerve in brief refer to Ans 4 of the same
chapter.
Trigeminal Ganglion
♦ Trigeminal ganglion is the sensory ganglion of the fifth
cranial nerve.
♦ This ganglion is homologus with dorsal nerve root ganglia
of spinal nerves.
♦ It is made up of pseudounipolar nerve cells with a T
shaped arrangement of their processes.
♦ The ganglion is crescentric or semilunar in shape with its
convexity directed anterolaterally.
The three divisions of trigeminal nerve emerges from
this convexity.
The posterior concavity of the ganglion receives the
sensory root of the nerve.
Situation and Meningeal Relation
Trigeminal ganglion lies on the trigeminal impression over
anterior surface of petrous temporal bone near its apex. Here it
occupies a special space of dura matter known as trigeminal cave
or Meckel s cave. Two layers of dura are present below ganglion.
Cave is lined by pia arachnoid, so, the ganglion along with motor Bone or Hard Tissue Parts
root of the trigeminal nerve is surrounded by cerebrospinal fluid. The hard tissue parts of TMJ are:
Ganglion lies at depth of 5 cm from the preauricular point.
Fig. 63: Relation of trigeminal ganglion
Anatomy  49
Relations
♦ Medially: Internal carotid artery and posterior part of
cavernous sinus
♦ Laterally: Middle meningeal artery
♦ Superiorly: Parahippocampal gyrus
♦ Inferiorly: Motor root of the trigeminal nerve, greater
petrosal nerve, apex of petrous temporal bone and foramen
lacerum.
Associated Root and Branches
♦ Central process of ganglion cells forms the large sensory
root of trigeminal nerve which is attached to pons at its
junction with middle cerebellar peduncle.
♦ Peripheral processes of the ganglion cells form three
divisions of the trigeminal nerve, i.e. ophthalmic, maxillary
and mandibular.
♦ Small motor root of trigeminal nerve attach to pons
superomedial to sensory root. It passes under the ganglion
from medial to lateral side and joins the mandibular nerve
at the foramen ovale.
Blood Supply
♦ Internal carotid artery
♦ Middle meningeal artery
♦ Accessory meningeal artery
♦ Meningeal branch of ascending pharyngeal artery.
Applied Anatomy
Intractable facial pain due to trigeminal neuralgia or carcino-
matosis may be abolished by injecting alcohol into the ganglion.
Q.8. Write short note on parts of temporomandibular joint.
(Mar 2006, 5 Marks)
Ans. Temporomandibular (TMJ) joint has two types of parts:
1. Bone or hard tissue parts
2. Soft tissue parts.
♦ Condyles of mandible: They are ovoid, convex processes
which are broader laterally and narrower medially.
Condyles are connected with the body of mandible by
narrow stalk on both the sides.
♦ Glenoid fossa of temporal bone: Articular surface
of temporal bone is situated on the inferior surface of
squamous part of the temporal bone. It articulates with
mandibular condyle and is known as glenoid fossa.
♦ Articular eminence: It binds mandibular fossa anteriorly
and form anterior root of zygomatic process.
Soft Tissue Parts
♦ Articular capsule: It is a thin part of dense cartilaginous
tissue which encloses joint cavity.
♦ Articular disc: It is a rough, oval, firm, thick plate of dense
fibrous cartilage which is located between condyle and
articulating surface of temporal bone. It divides joint into
superior and inferior compartments.
♦ Articular ligaments: TMJ has one major and three minor
ligaments. Temporomandibular is major ligament, while
50 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
(Oct 2007, 15 Marks)
Ans. For mandibular division of trigeminal nerve in details
refer to Ans 4 of same chapter.
Applied Anatomy of Branches of Mandibular Division of
Trigeminal Nerve
♦ In patients with the cancer of tongue pain radiates to ear and
temporal fossa over the distribution of auriculotemporal
nerve as both lingual and auriculotemporal nerves are
branches of mandibular nerve. At times lingual nerve is
divided to relieve interactable pain. This can be done where
the nerve lies in contact with mandible below and behind
last molar tooth and is covered by the mucous membrane.
♦ Lingual nerve lies in contact with medial to third molar
tooth. In extraction of malplaced wisdom tooth, care should
be taken not to injure the lingual nerve. Its injury causes
loss of sensation from anterior two-third of the tongue.
♦ During extraction of mandibular teeth, inferior alveolar
nerve should be anesthetized. Drug is given inside the
nerve before it enters mandibular canal.
♦ Inferior alveolar nerve travels the mandibular canal and
can be damaged by fracture of mandible. This injury is
assessed by testing sensation over the chin.
♦ At the time of extraction of third molar, buccal nerve may
get involved by local anesthesia leading to temporary
numbness of cheek.
Q.10. Draw diagram of distribution of maxillary nerve.
(Apr 2007, 5 Marks) (Sep 2009, 5 Marks)
Ans. Maxillary division of the trigeminal nerve is entirely
sensory in function.
(1) Zygomatic nerve (2) Lacrimal nerve (3) Zygomaticotemporal
(4) Zygomaticofacial nerve (5) Anterior superior alveolar
(6) Posterior superior alveolar (7) Middle superior (8) Inferior
palpebral (9) External nasal (10) Superior labial (11) Greater
palatine (12) Middle palatine (13) Posterior palatine (14) Pharyngeal
(15) Nasopalatine.
Fig. 64: Distribution of maxillary nerve
The maxillary nerve originates at the middle of the
semilunar ganglion.
Q.11. Write short note on lingual nerve. (Aug 2016, 3 Marks)
(Feb 2013, 5 Marks) (Dec 2009, 5 Marks)
Or
Describe briefly lingual nerve. (Dec 2010, 5 Marks)
Ans. It is one of the two terminal branches of the posterior
division of the mandibular nerve.
It is sensory to the anterior two-third of the tongue
and to the floor of the mouth.
• However, the fibers of the chorda tympani (branch
of facial nerve) which is secretomotor to the
submandibular and sublingual salivary glands and
gustatory to the anterior two-third of the tongue are
also distributed through the lingual nerve.
Course
Lingual nerve starts 1 cm below the skull. At about 2 cm below the
skull, it is joined by chorda tympani nerve at an acute angle. Then
it lie in contact with mandible medial to third molar. Finally it lies
over the surface of hyoglossus and genioglossus to reach the tongue.
Relations
It begins just l cm below the skull. It runs first between the tensor
palati and lateral pterygoid, and then between the lateral and
medial pterygoids. About 2 cm below the skull it is joined by the
chorda tympani nerve. Emerging at the lower border of the lateral
pterygoid, the nerve runs downwards and forwards between
the ramus of the mandible and medial pterygoid. Next it lies in
direct contact with the mandible, medial to the third molar tooth.
It soon leaves the gum and runs over the hyoglossus deep to the
mylohyoid. Finally it lies on the surface of the genioglossus deep
to the myelohyoid. Here it winds round the submandibular duct
and divides into its terminal branches.
Q.12. Write short note on nerve supply of maxillary teeth.
(Apr 2007, 5 Marks)
Ans. Maxilla is mainly supplied by maxillary nerve and its
branches.
Anterior superior alveolar nerve supplies the pulp,
investing structure and labial mucoperiosteum of
central incisor, lateral incisor and canine.
Middle superior alveolar nerve supplies the pulp,
investing structure and buccal mucoperiosteum of
first and second premolars and mesiobuccal root of
first molar.
Posterior superior alveolar nerve supplies the pulp,
investing structure and buccal mucoperiosteum
of maxillary first, second and third molars except
mesiobuccal root of first molar.
Greater palatine nerve supplies palatal mucoperio-
steum of maxillary first, second and third molars
and first and second premolars.
Nasopalatine nerve supplies palatal mucoperiosteum
of central incisor, lateral incisor and canine, incisive
papilla and gingiva behind incisor teeth.

Fig. 65: Nerve supply of maxillary teeth
Q.13. Answer in brief on trigeminal neuralgia.
(Feb 2016, 2 Marks)
Ans. Trigeminal neuralgia is also known as Tic douloureux
or Fothergill s Disease.
• It is a clinical condition which is characterized
by sudden paroxysmal attack of lancinating pain
which lasts from few hours to several days which is
confined to the distribution of one or more divisions In pterygopalatine fossa • Ganglionic branches
of trigeminal nerve.
It commonly starts in maxillary territory.
It occurs more frequently on right side.
• During attacks there is flushing of face, i.e. redness
of the face.
Q.14. Write short note on sphenomandibular ligament.
(Aug 2016, 3 Marks)
Ans. This is an accessory ligament which lies on deep plane
away from fibrous capsule.
The ligament is attached superiorly to spine of
sphenoid and inferiorly to lingula of mandibular
foramen.
This is the remnant of dorsal part of Meckle s
cartilage.
This ligament is related laterally to:
– Lateral pterygoid muscle
– Auriculotemporal nerve
– Maxillary artery
It is related medially to:
– Chorda tympani nerve
– Wall of pharynx. Near its lower end, it is pierced
by mylohyoid nerve and vessels.
Sphenomandibular ligament is an important
landmark for administration of local anesthetic
during inferior alveolar nerve block.
Anatomy  51
Q.15. Name the branches of maxillary nerve.
(Aug 2016, 2 Marks)
Ans. Following are the branches of maxillary nerve:
Region Branches
In middle cranial fossa Meningeal branch
• Zygomatic branches, i.e.
zygomaticotemporal and
zygomaticofacial (sensory branches)
• Posterior superior alveolar
In infraorbital canal • Middle superior alveolar
• Anterior superior alveolar
On face Infraorbital branches, i.e. palpebral,
labial and nasal branches (sensory
branches)
Q.16. Write short note on maxillary nerve.
(Apr 2017, 4 Marks)
Ans. Maxillary nerve is the second division of trigeminal is
purely sensory.
Course and Relations
This nerve arises from convex anterior border of trigeminal
ganglion and run forward in lateral wall of cavernous sinus
below ophthalmic nerve. It leaves middle cranial fossa by
passing via foramen rotundum. Maxillary nerve crosses upper
part of pterygopalatine fossa beyond which it continues as
infraorbital nerve. In middle cranial fossa it gives off meningeal
branch. In pterygopalatine fossa the nerve is related to
pterygopalatine ganglion and gives off ganglionic, posterior
superior alveolar and zygomatic nerves.
52 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 66: Origin, Course and branches of maxillary nerve

Branches and Distribution

In Middle Cranial Fossa
8. SUBMANDIBULAR REGION
In middle cranial fossa it gives off meningeal branch which
Q.1. Write a short note on digastric muscle.
supplies dura mater of middle cranial fossa.
(Mar 2000, 4 Marks) (June 2010, 5 Marks)
In Pterygopalatine Fossa (Oct 2014, 4 Marks) (Jan 2012, 5 Marks)
♦ Ganglionic branches: Pterygopalatine ganglion is suspended  (Nov 2008, 5 Marks)
by ganglionic branches and they are two in number. Ans. The muscle is so called because it consists of two belly
♦ Zygomatic nerve: It enters the orbit via inferior orbital which are united by an intermediate tendon.
fissure and runs along lateral wall outside periosteum
to enter zygomatic bone. Before or after entering the Origin
bone it divides into two of the terminal branches, i.e. ♦ Anterior belly from digastric fossa of mandible.
zygomaticotemporal and zygomaticofacial nerves which
♦ Posterior belly from mastoid notch of temporal bone.
supply anterior part of temple and skin of face.
♦ Posterior superior alveolar nerve: It enters posterior surface Fibers
of body of maxilla and supply to three maxillary molar
teeth and adjoining part of gum. ♦ Anterior belly run downward and backward.
♦ Posterior belly run downward and forward.
In the Orbit
♦ Middle superior alveolar nerve: It arises in infraorbital
groove, run in lateral wall of maxillary sinus and supply
to maxillary premolar teeth.
♦ Anterior superior alveolar nerve: It arises in infraorbital
canal and run inside sinuous canal consisting of
complicated course in anterior wall of maxillary sinus. The
nerve supplies to maxillary incisor, canine teeth, maxillary
sinus and anteroinferior part of nasal cavity.
On the Face
♦ Palpebral branches turn upward and supply to skin of
lower eyelid
♦ Nasal branches supply to skin of side of nose and the
mobile part of nasal septum
♦ Superior labial branches supply to skin and mucus
membrane of upper lip. Fig. 67: Digastric muscle
 Anatomy  53

Insertion Stylohyoid
Both the heads meet at intermediate tendon which perforates Parotid gland with retromandibular vein
stylohyoid and is held by fibrous pulley to hyoid bone. Submandibular salivary gland and lymph nodes
Angle of mandible with medial pterygoid.
Nerve Supply
B. Deep relation:
a. Anterior belly by nerve to mylohyoid branch of trigeminal Transverse process of atlas with superior oblique and
nerve
rectus capitis lateralis
b. Posterior belly by facial nerve.
Internal carotid, external carotid, lingual, facial and
Action occipital arteries
♦ It depresses mandible when mouth is wide opened or against Internal jugular vein
the resistance; it is secondary to lateral pterygoid muscle. 10th, 11th and 12th cranial nerves
♦ It leads to elevation of hyoid bone. Hyoglossus muscle.

Relations of Posterior Belly C. Its upper border is related to:

a. Posterior auricular artery
A. Superficial relation:
b. Stylohyoid muscle.
Mastoid process with sternomastoid, splenius capitis
and longissimus capitis D. Lower border is related to occipital artery.

Insertion
(Sep 2000, 4 Marks) (Feb 2016, 3 Marks) ♦ Posterior fibers are inserted into the body of hyoid bone
Ans. This is a flat triangular muscle lying deep to the anterior ♦ Anterior and middle fibers are inserted into median raphae
belly of digastric. The right and left mylohyoid muscles between mandible and hyoid bone.
together form the floor of mouth, deep to anterior belly
of digastric. Nerve Supply

Origin It is supplied by mylohyoid nerve.

From mylohyoid line of mandible. Actions

♦ Elevates the floor of mouth during first stage of deglutition.
Fibers
♦ Helps in depression of mandible and elevation of hyoid
Fibers run medially and slightly downwards. bone.
54 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Relations Glossopharyngeal nerve

Superficial Stylohyoid ligament
Lingual artery
♦ Anterior belly of digastric The diagram of superficial relation is mentioned in Ans 5
♦ Superficial part of submandibular salivary gland of the same chapter.
♦ Mylohyoid nerve and vessels Structures passing deep to posterior border of hyoglossus
♦ Submental branch of facial artery. from above downwards.
Deep Glossopharyngeal nerve
Stylohyoid ligament
♦ Hyoglossus with its superficial relations, i.e. styloglossus,
Lingual artery
lingual nerve, submandibular ganglion, deep part of
submandibular salivary gland, submandibular duct,
hypoglossal nerve and venae comitantes hypoglossi.
♦ Genioglossus with its superficial relations sublingual
salivary gland, lingual nerve, submandibular duct, lingual
artery and hypoglossal nerve.
Q.3. Write a short note on superficial relations of hyoglossus
muscle. (Sep 2017, 3 Marks) (Sep 2004, 5 Marks)
Ans. Superficial relations of hyoglossus muscles are:
Styloglossus, lingual nerve, submandibular ganglion,
deep part of submandibular gland, submandibular duct,
hypoglossal nerve and veins accompanying it.
Styloglossus muscle interdigitates with hyoglossus.
Lingual nerve crosses the upper part of muscle from
behind forwards
Submandibular ganglion lies between lingual nerve
and deep part of submandibular gland.
Deep part of submandibular gland and submandi-
bular duct. Gland lies in middle of hyoglossus
muscle and duct lies between the gland and muscle.
Hypoglossal nerve crosses lower part of muscle from
behind forwards. Fig. 69: Hyoglossus muscle
For diagram of superficial relations of hyoglossus refer
to Ans 5 of the same chapter. Q.5. Draw a well labeled diagram showing superficial
relations of hyoglossus muscle. (Oct 2014, 4 Marks)
Q.4. Write a short note on hyoglossus muscle.
Ans.
(Sep 2001, 4 Marks) (Apr 2017, 4 Marks)
(Dec 2012, 3 Marks) (Aug 2012, 5 Marks)
(Dec 2014, 5 Marks) (Apr 2008, 5 Marks)
Ans. Hyoglossus is a thin quadrilateral muscle and is a muscle
of tongue.
Origin: It originates from whole length of greater cornua
and in front of lateral part of body of hyoid bone.
Fibers and insertion: The fibers run upwards and
forwards and are inserted into side of tongue between
styloglossus and inferior longitudinal muscle of tongue.
Action: It depresses the tongue, make dorsum convex
and helps in retracting protruded tongue.

Relation Fig. 70: Superficial relation of hyoglossus

A. Superficial: The relations are mentioned in Ans 3 of the Q.6. Describe submandibular gland. Write a note on its
same chapter. secretomotor fibers. (Sep 2002, 10 Marks)
B. Deep:
Or
Inferior longitudinal muscle of tongue
Genioglossus Write a short note on secretomotor pathway for
Middle constrictor of pharynx submandibular salivary gland. (Sep 2000, 4 Marks)
 Anatomy  55

Or ♦ The lateral surface: It is related to:

 Submandibular fossa on mandible
Insertion of medial pterygoid
(Apr 2003, 10 Marks)
Facial artery.
a. Deep relation
b. Innervations
Ans. The submandibular gland is a large salivary gland
situated in anterior part of digastric triangle. It is of J-shaped.
It is divided into larger part superficial to muscles, and
smaller part deep to muscles. It lies in mandible bone
under submandibular fossa.

Superficial Part
The part fills digastric triangle. It extends upward deep to
mandible upto mylohyoid line. It has inferior, lateral and medial
surfaces. The gland is partially enclosed between two layers of
deep cervical fascia.
Superficial layer of fascia cover the inferior surface of gland
and is attached to, base of mandible while the deeper layer Fig. 71 Relations of superficial surface as well as relations of
covers medial surface of gland and is attached to mylohyoid anterior part of medial surface
line of mandible.
♦♦ The medial surface: It is extensively divided to three parts:
1. Anterior part is related to mylohyoid muscle,
Relations of Superficial Part
submental branch of facial artery mylohyoid nerves
♦ The inferior surface: It is covered by: and vessels.
Skin 2. Middle part (intermediate part) is related to hyoglossus
Platysma muscle, styloglossus muscle, lingual nerve, submandibular
Cervical branch of facial nerve ganglion and hypoglossal nerve.
Deep fascia 3. Posterior part is related to styloglossus muscle,
Facial vein stylohyoid ligament, the glossopharyngeal nerve and
Submandibular lymph nodes. the wall of pharynx.

Fig. 72 Relations of medial surface of submandibular salivary gland

56 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Deep Part
It lies deep to mylohyoid, and superficial to hyoglossus and
styloglossus. Posteriorly, it is continuous with superficial part
round the posterior border of mylohyoid. Anteriorly it extend
to posterior end of sublingual gland.
Relations of Deep Part
They are present between mylohyoid and hyoglossus:
♦ Medially it is related to hyoglossus muscle
♦ Laterally it is related to the mylohyoid muscle
♦ Superiorly it is related to lingual nerve and submandibular
ganglion
♦ Inferiorly it is related to hypoglossal nerve.
Fig. 73: Relations of deep part of submandibular salivary gland
Blood supply: It is supplied by facial artery. Veins drain
into common facial vein and lingual vein.
Lymphatic drainage: Lymph passes to submandibular
lymph nodes.
Nerve supply or innervations: It is supplied by branch
from submandibular ganglion.
The branches convey:
a. Secretomotor fibers.
b. Sensory fibers from lingual nerve.
c. Sympathetic fibers from plexus on facial artery.
Secretomotor Pathway
♦ Secretomotor fibers pass from the lingual nerve to
the ganglion through the posterior root. These are
preganglionic fiber that arise in superior salivary nucleus
and pass through the facial nerve, chorda tympani and
lingual nerve to reach the ganglion. The fibers relay in
ganglion. Postganglionic fibers for the submandibular
gland reach the gland through five or six branches from
the ganglion. Postganglionic fibers for sublingual and
anterior lingual glands re-enter the lingual nerve through
the anterior root and travel to gland through distal part
of lingual nerve.
♦ Sympathetic fibers are derived from plexus around facial
artery. It contains postganglionic fibers arising in superior
cervical ganglion. They pass through submandibular
ganglion without relay and supply vasomotor fibers to
submandibular and sublingual glands.
♦ Sensory fibers reach the ganglion through the lingual
nerve.
Fig. 74: Secretomotor pathway to submandibular gland
Q.7. Write a short note on submandibular salivary gland.
(July 2016, 5 Marks) (Mar 2009, 5 Marks)
(Apr 2007, 5 Marks)
Ans. Refer to Ans 7 of the same chapter.
Q.8. Write relations and histology of submandibular gland.
(Sep 2005, 10 Marks) (Apr 2010, 7 Marks)
Ans. For relations of submandibular gland refer to Ans 6 of
the same chapter.
Q.9. Describe submandibular gland with its relation and
microscopic anatomy. (Mar 2006, 10 Marks)
Ans. For description and relation refer to Ans 6 of the same
chapter and for microscopic anatomy refer to Ans 16 of
HISTOLOGY SECTION.
Q.10. Describe submandibular salivary gland under
following heads: Position, parts, relations, secretomotor
nerve and histological structure. (Dec 2009, 15 Marks)
Ans. Position
Submandibular gland is situated in anterior part of
digastric triangle and extend upto stylomandibular
ligament. It is indented by the posterior border of
myelohyoid which divides the gland into larger part
which is superficial to the muscle and smaller part which
is deep to the muscle.
Parts
Submandibular gland is divided into larger part which is
superficial to the muscle and smaller part which is deep to the
muscle, i.e. superficial part and deep part.
Superficial Part
This part fills digastric triangle. It extends upward deep to
mandible upto mylohyoid line. It has inferior, lateral and medial
surfaces. The gland is partially enclosed between two layers of
deep cervical fascia. Superficial layer of fascia cover inferior
surface of gland and is attached to the base of mandible, while
the deeper layer covers medial surface of gland and is attached
to mylohyoid line of mandible.
 Anatomy  57

(Mar 2013, 4+2+2 Marks)

a. Relations of superficial part
b. Microscopic anatomy (Diagram only)
c. Course, structure and opening of submandibular
duct Fig. 75: Opening of submandibular duct at floor of mouth
Ans. For relations of superficial part refer to Ans 6 of same
chapter.
Q.12. Write short note on deep part of submandibular gland.
For microscopic anatomy (diagram only) refer to Ans 16
(Feb 2014, 3 Marks)
of HISTOLOGY SECTION.
Ans. For deep part of submandibular gland refer to Ans 6 of
Course, Structure and Opening of Submandibular Duct same chapter.
By its structure submandibular duct is thin walled and
is 5 cm long. Q.13. Write in tabular form, the origin, insertion, nerve
supply and actions of following muscles:
In its course the submandibular duct emerges from
(May 2017, 10 Marks)
anterior end of deep part of submandibular gland and
run forward on hyoglossus in between the lingual and a. Genioglossus
hypoglossal nerves. At anterior border of hyoglossus the b. Mylohyoid
submandibular duct is crossed by lingual nerve.
c. Buccinator
The opening of submandibular duct is on the floor of
mouth on summit of sublingual papilla at the side of d. Sternomastoid
frenulum of tongue. Ans. See following table.

Name of
muscle Origin Insertion Nerve supply Action
Genioglossus Upper genial tubercle of • Upper fibers in tip of It is supplied It pulls up the root of tongue,
mandible tongue by hypoglossal approximate palatoglossal arches and
• Middle fibers into nerve closes the oropharyngeal isthumus.
dorsum
• Lower fibers in thyoid
bone

Mylohyoid Mylohyoid line of mandible • Posterior fibers: Body Nerve to • Pulls hyoid bone upwards and
of hyoid bone mylohyoid backward
• Middle and anterior • With other hyoid muscles, it fixes
fibers; median raphae, hyoid bone
between mandible and
hyoid bone

Buccinator • Upper fibers: From maxilla • Upper fibers: Straight Lower buccal • Puffing of the mouth and blowing
opposite to molar teeth to upper lip branches of • Flattens cheek against gums and
• Lower fibers: From mandible • Lower fibers: Straight facial nerve teeth
opposite to molar teeth to lower lip • Prevents accumulation of food inside
• Middle fibers: From • Middle fibers: Middle the vestibule
pterygomandibular raphe fibers decussate

Contd...
58 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd...

Name of
muscle Origin
Sternomastoid It takes origin from two heads:
1. Sternal head: It takes origin
from upper and lateral part of
manubrium sterni.
2. Clavicular head: It takes
origin from medial 1/3 of
superior aspect of clavicle.
It passes vertically upward
deep to the sternal head
with which it unites to form a
fusion belly
Insertion Nerve supply Action
The muscle is inserted on: • Motor When one muscle contracts:
• By a thick tendon supply is by • It turn the chin to opposite side
into lateral surface of the spinal • It can also tilt the head towards the
mastoid process, from accessory shoulder of same side.
its tip to superior border nerve When both the muscles contract:
• By thin aponeurosis • Branches
• They draw head forward, as in
into lateral half of from ventral
eating and lifting the head from
superior nuchal line of rami of C2 are
pillow
occipital bone proprioceptive
• With longus colli they flex the neck
against resistance
• It also gives help in forced respiration.

Q.14. Name the nerves supplying digastrics muscles.

(Aug 2018, 1 Mark)
Ans. Anterior belly of the digastric muscle is innervated by
the mylohyoid branch of the trigeminal nerve.
The posterior belly of the digastric muscle is innervated
by the facial nerve.
 (March 2007, 8 Marks)

(2 Marks)
 (1½ Marks)
 (1½ Marks)

9. STRUCTURES IN THE NECK



 (Apr 2007, 5 Marks)

(Nov 2009, 10 Mraks) Or
Or Describe thyroid gland under following headings:
 (Dec 2010, 4 + 2 + 2 Marks)
(Sep 2013, 10 Marks) a. Relations
 b. Histology
c. Development
(Feb 2016, 10 Marks) Ans. Thyroid is an endocrine gland situated in the lower part
 of the front and sides of neck.

Size of Thyroid Gland

Each lobe of thyroid measures about 5 cm × 2.5 cm × 2.5 cm and
the isthmus is 1.2 cm × 1.2 cm

Shape of Thyroid Gland

(Feb 2013, 15 Marks) Thyroid is a butterfly shape gland.

Or Situation or Location and Extent

  Describe the thyroid gland under following heads: ♦ The gland lies against vertebrae C5, C6, C7 and T1
(Apr 2015, 4+2+2 Marks) embracing upper part of trachea.
a. Size, shape and relations ♦ Each lobe extends from middle of thyroid cartilage to
b. Arterial supply and venous drainage fourth or fifth tracheal ring.
c. Clinical anatomy ♦ Isthmus extends from second to fourth tracheal ring.

External Features
♦ The gland consists of right and left lobes that are joined to
each other by isthmus. Sometimes a third small pyramidal
lobe may project upwards from isthmus usually to left of
midline.
♦ Not frequently it is connected to body of hyoid bone by
fibrous or fibromuscular band known as levator glandulae
thyroideae.
♦ Each lateral lobe of the gland extend upward to oblique line
of thyroid cartilage and below upto 5th or 6th tracheal ring.
♦ Isthumus extend across midline in front of 2nd, 3rd and
4th tracheal rings.
Capsules of Thyroid
a. True capsule is the peripheral condensation of the
connective tissue of the gland. A dense capillary plexus is
present deep to the true capsule.
b. False capsule is derived from the pretracheal layer of
deep cervical fascia. It is thin along the posterior border
of lobes, but thick on inner surface of gland where it forms
a suspensory ligament (of Berry) which connects the lobe
to cricoid cartilage.
Relations
The Lobes
They are conical in shape and consists of:
An Apex
The apex is directed upwards and slightly laterally.
A Base
The base is on level with 9th or 5th tracheal ring.
Surfaces
1. The lateral or superficial surface: It is convex and covered
by sternothyroid, sternohyoid, the superior belly of
omohyoid and anterior border of sternomastoid.
2. The medial surface: It is related to:
a. Two tubes: Trachea and esophagus
b. Two muscles: Inferior constrictor and cricothyroid.
c. Two nerves: External laryngeal and recurrent laryngeal
3. The posterolateral surface: It is related to carotid sheath
and overlaps common carotid artery.
Border
1. The anterior border: It is thin and is related to anterior
branch of superior thyroid artery and seperate medial and
posterior surfaces.
2. The posterior border: It is thick and rounded and separate
medial and posterior surfaces. It is related to inferior
thyroid artery, anastomosis between posterior branch of
superior and ascending branch of inferior thyroid arteries,
the parathyroid glands and thoracic duct only on left side.
Anatomy  59
The Isthmus
It connects the lower parts of two lobes. It consists of the
following parts:
Surfaces
1. The anterior surface: It is covered by right and left
sternohyoid and sternothyroid, anterior jugular veins,
fascia and skin.
2. The posterior surface: It is related to 2nd to 4th tracheal
ring.
Borders
1. The upper border: This is related to anastomosis between
the right and left superior thyroid arteries.
2. The lower border: Inferior thyroid veins leave the gland
at this border.
Fig. 76: Thyroid gland with its relations
Blood Supply
Arterial Supply
♦ Superior thyroid artery is the first anterior branch of
external carotid artery. It runs downward and forward
in an intimate relation with external laryngeal nerve. At
pretracheal lobe it is divided into anterior and posterior
branches. After providing branches to adjacent structures,
it pierces pretracheal fascia to reach upper pole of lobe
where nerve deviates medially. At upper pole artery
divides into anterior and posterior branches.
♦ Anterior branch descends into anterior border of the
lobe and is continues with the upper border of isthmus
to anastomose with its fellow of opposite side while the
posterior branch descends on posterior border of lobe and
anastomose with ascending branch of inferior thyroid
artery.
♦ Inferior thyroid artery is the branch of thyrocervical trunk.
It runs upwards then medially and finally downwards
to lower pole of gland. Its terminal part is intimately
related to recurrent laryngeal nerve, while proximal part
is away from the nerve The artery divides into four or five
glandular branches which pierce fascia separately to reach
lower part of gland. One ascending branch anastomose
with posterior branch of superior thyroid artery and
supply parathyroid gland.
60 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦ Sometime thyroid is supplied by lowest thyroid artery

which arises from bracheocephalic trunk or directly from
arch of aorta.
♦ Accessory thyroid arteries arising from tracheal and
esophageal arteries also supplies thyroid gland.

Fig. 77: Arterial supply of thyroid

Venous Drainage
Thyroid is drained by:
1. Superior thyroid vein: It emerges at upper pole and
accompanies superior thyroid artery. It ends in internal
jugular vein.
2. Middle thyroid vein: It emerges at middle of lobe and
enters internal jugular vein.
3. Inferior thyroid vein: It emerge at lower border of isthmus.
They form plexus in front of trachea and drain into left
brachiocephalic vein.

Fig. 78: Venous drainage of thyroid

Lymphatic Drainage
♦ Lymph from the upper part of the gland reaches the
upper deep cervical lymph nodes either directly or via
prelaryngeal lymph nodes.
♦ Lymph from the lower part of the gland drains to lower
deep cervical lymph nodes directly and also through
pretracheal and paratracheal nodes.
 Anatomy  61

(Sep 2004, 5 Marks)

Or
Write a short note on Internal jugular vein.
(Aug 2016, 3 Marks) (Mar 2009, 5 Marks)
Ans. It is a direct continuation of sigmoid sinus. It begins at
the jugular foramen and ends behind the sternal end
of clavicle by joining the subclavian vein to form the
bracheocephalic vein.
The origin is marked by a dilation, the superior bulb
which lies in jugular fossa of temporal bone. The
termination of the vein is marked by inferior bulb which
lies beneath supraclavicular fossae.

Relations
A. Superficially: Sternomastoid, posterior belly of digastric,
superior belly of omohyoid, parotid gland, styloid process,
internal carotid artery and glossopharyngeal, vagus,
accessory and hypoglossal cranial nerves.
B. Posteriorly: Fig. 80: Tributaries of internal jugular vein
1. Transverse process of Atlas
2. Scalenus anterior ♦ The thoracic duct opens into the angle of union between
3. Cervical plexus left internal jugular vein and left subclavian vein.
4. First part of subclavian artery. ♦ In the middle of the neck the internal jugular vein
C. Medially: Internal carotid artery, common carotid artery, may communicate with the external jugular vein via
and vagus nerve. oblique jugular vein which run across anterior border of
sternocleidomastoid.
Tributaries
The tributaries of internal jugular vein are: Applied Anatomy
1. Inferior petrosal sinus ♦ Deep to lesser supraclavicular fossa, internal jugular
2. Common facial vein vein is very easily accessible for recording venous pulse
tracings. Vein can be cannulated by direct puncture
3. Lingual vein
in interval between sternal and clavicular head of
4. Pharyngeal vein
sternocleidomastoid muscle.
5. Superior thyroid vein ♦ During congestive cardiac failure or any other disease
6. Middle thyroid vein where the venous pressure is raised, internal jugular vein
7. Occipital vein. is markedly dilated and engorged.
62 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.3. Briefly describe cervical part of sympathetic chain. c.
(Mar 1998, 6 Marks)
Ans. Cervical part of sympathetic chain, one on either side d.
of cervical part of vertebral column lies in front of
transverse processes of cervical of cervical vertebrae e.
and neck of first rib behind carotid sheath and in front
of prevertebral fascia.
Each trunk is continuous upwards into the cranial cavity
Branches of Middle Cervical Ganglion
as the internal carotid nerve accompanying the internal
carotid artery. Inferiorly, it becomes continuous with the a.
thoracic part of the sympathetic chain at the neck of the
lst rib. b.
The cervical part of sympathetic trunk does not
receive the preganglionic fibers through white rami c.
communicates from the cervical segments of the spinal d.
cord, but it does give gray rami communicantes to all the
cervical spinal nerves. Each trunk receives preganglionic
fibers from lateral horn cells of T1 to T4 spinal segments.
Theoretically, there should be eight sympathetic ganglia
corresponding to 8 cervical nerves, but due to fusion
there are three ganglia; superior, middle and inferior.
The external carotid branches forms a plexus around
external carotid artery.
Pharyngeal branches take part in the formation of
pharyngeal plexus.
Left superior cervical cardiac branch goes to the superficial
cardiac plexus with right branch goes to deep cardiac
plexus.
Gray rami communication are given to ventral rami of 5th
and 6th cervical nerves.
Thyroid branches accompany inferior thyroid artery to
thyroid gland. They also supply parathyroid gland.
Tracheal and esopharyngeal branches.
Middle cervical cardiac branches is the largest of
sympathetic cardiac branches. It goes deep to cardiac
plexus.

Superior Cervical Ganglion

This is largest of the three ganglia. It is spindle shaped and
about 1 inch long. It lies just below the skull, opposite to the
second and third cervical vertebrae. It is formed by fusion of
upper four cervical ganglion.
Communications: With the 9th, 10th and 12th cranial nerves
and with external and recurrent laryngeal nerves.

Middle Cervical Ganglion

♦ The ganglion is very small. It may be divided into two or
three smaller parts.
♦ It lies in the lower part of neck, in front of C6 just above
the inferior thyroid artery behind carotid sheath.
♦ It is formed by fusion of 5th and 6th cervical ganglia. It is
connected with inferior cervical ganglion directly and also
through a loop that winds round the subclavian artery.
This loop is known as ansa subclavia.

Inferior Cervical Ganglion

It is formed by fusion of 7th and 8th cervical ganglia.
♦ This is often with the first thoracic ganglion and
then is known as cervicothoracic ganglion or stellate
ganglion.
♦ It is situated between the transverse process of C7 vertebrae
and the neck of first rib. It lies behind the vertbral artery
and in front of ramus of spinal nerve C8. A cervicothoracic (Jan 2018, 5 Marks) (Apr 2010, 5 Marks)
ganglion extend in front of neck of first rib. Or
Briefly describe Horner’s syndrome.
Branches of Superior Cervical Ganglion (Apr 2007, 5 Marks)
a. Gray rami communication pass to ventral rami of upper Ans. Injury to cervical sympathetic trunk produces Horner s
4 cervical nerves. syndrome. It is characterized by:
b. The internal carotid nerve arises from the upper end of a. Ptosis, i.e. drooping of upper eyelid
ganglion. b. Miosis, i.e. constriction of pupil
 Anatomy  63

c. Anhydrosis, i.e. loss of sweating on that side of face. belly of digastric, facial vein, and internal jugular vein.
d. Anophthalmos, i.e. retraction of eyeball It is known as jugulodigastric node. It drains the lymph
e. Loss of ciliospinal reflex, i.e. pinching the skin on primarily from the palatine tonsil.
nape of neck does not produce dilatation of pupil. ♦ Lower group of deep cervical lymph nodes: One of the
Horner s syndrome can also be caused by a lesion within lymph nodes of this group lies above the intermediate
the CNS anywhere at or above the first thoracic segment tendon of omohyoid posterior to the internal jugular vein.
of spinal cord involving sympathetic fibers. It is known as jugulo-omohyoid lymph node. Since this
lymph node drains lymph primarily from the tongue, it is
Q.5. Write in brief on cervical lymph node. termed lymph node of the tongue. This node lies deep to
(Apr 2010, 5 Marks) sternocleidomastoid, and therefore, can be palpated only
Ans. if enlarged considerably.
Peripheral Lymph Nodes Some nodes of this group extend into the supraclavicular
fossa and are related to brachial plexus and subclavian
Peripheral lymph nodes are arranged in inner and outer circles
vessels. These are termed supraclavicular lymph nodes
♦ Outer circle: This is formed by lymph node groups which
(Virchow s lymph nodes). The left supraclavicular lymph
form pericervical or cervical collar at junction of head and
nodes are clinically important because they are common
neck and extends from chin in front to occiput behind. They
site of metastasis from malignant disease (cancer) of the
include submental, submandibular, superficial parotid,
stomach.
massater and occipital nodes. Outlying extensions of
lymph node groups of pericervical collar:
Facial nodes: These are extensions of submandibular
nodes and include:
– A small buccal node lying on the lateral surface
of the buccinator along the facial vein.
– A small mandibular node which is frequently
present where facial vessels cross the lower border
of the mandible.
– A small infraorbital node lying just below the
orbit.
Superficial cervical nodes: They are situated superficial
to sternomastoid (upper part) along the external
jugular vein. These are the extensions of parotid nodes.
Anterior cervical nodes: They are situated along
the anterior jugular vein. One member of this group
frequently lies in the suprasternal space (suprasternal
node). They are extensions of submental lymph nodes.
♦ Inner circle: The inner circle is formed by following lymph
node groups which lie deep to the investing layer of deep Fig. 82: Lymph nodes
cervical fascia:
Infrahyoid nodes: These lie in front of thyrohyoid Q.6. Write short note on styloid process.
membrane.
(May 2017, 3 Marks)
Prelaryngeal nodes: These are situated in front of the
Ans. Styloid process with the structures attached to it is known
conus elasticus or cricothyroid membrane.
Pretracheal lymph nodes: These lie in front of trachea as styloid apparatus.
below the isthmus of thyroid gland. • Structures attached to the process are stylohyoid,
styloglossus and stylopharyngeous muscles and
Deep Cervical Lymph Nodes stylohyoid and submandibular ligaments. The five
These lymph nodes lie along and around internal jugular vein, attachments resemble the reins of a chariot
some of them inside the carotid sheath and some on the surface Styloid process is a long, slender and pointed long
of sheath under cover of sternocleidomastoid. process projecting downwards, forwards and slightly
These deep cervical lymph nodes are divided into upper and medially from temporal lobe. It descends between
lower groups. the external and internal carotid arteries to reach the
♦ Superior or upper group of deep cervical lymph nodes: side of pharynx. It is interposed between the parotid
They lie above omohyoid muscle. One lymph node of this gland laterally and internal jugular vein medially.
group is situated below the posterior belly of digastric From anterior surface of styloid process the
between angle of the mandible and anterior border of the styloglossus muscle arises and is inserted inside of
sternocleidomastoid in the triangle formed by posterior tongue.
64 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

(Dec 2009, 15 Marks)

Or
Write in short on glossopharyngeal nerve.
(Aug 2011, 5 Marks)
Or
Write briefly on glossopharyngeal nerve.
(Apr 2008, 5 Marks)
Ans. Surface Attachment on Brainstem
Special visceral efferent fibers arise in nucleus
ambiguous and supply stylopharyngeous muscle.
General visceral efferent fibers arise in inferior
salivatory nucleus and travel to otic ganglion.
Postganglionic fibers arise in ganglion to supply
parotid gland.
General visceral afferent fibers are peripheral
processes of cells in inferior ganglion of nerve.
They carry general sensation from pharynx, palate,
posterior one-third of the tongue, tonsil, carotid
body and carotid sinus to ganglion. The central
processes carry the sensations of these fibers to lower
part of nucleus of solitary tract.
Special visceral afferent fibers are peripheral
processes of cells in inferior ganglion. They carry
sensation of taste from posterior one-third of the
tongue including circumvallate papillae to inferior
ganglion.The central processes carry the sensations
of these fibers to nucleus of solitary tract.
• General somatic afferent fibers are the peripheral
processes of the cells in inferior ganglion of the nerve.
These carry general sensations from the middle ear,
proprioceptive fibers from stylopharyngeous. The
central processes carry the sensations of these fibers
to spinal tract of trigeminal nerve.

 (Feb 2013, 2 Marks)

Ans. Following are the lesions which lie in the midline of neck:
Ludwig s angina
Enlarged submental lymph node
Sublingual dermoid cyst
Thyroglossal cyst
Subhyoid bursitis
Goiter of thyroid, isthmus and pyramidal lobe
Enlarged lymph node and lipoma in substernal space
of burns Fig. 84: Superior attachment on brainstem and nuclei of
Retrosternal goiter glossopharyngeal nerve

Fig. 85: Course and distribution of glossopharyngeal nerve
Course and Relations
♦ In its intraneural course fibers of glossopharyngeal nerve
pass forward and laterally in between the olivary nucleus
and inferior cerebellar peduncle via reticular formation
of medulla.
♦ At base of brain nerve is attached by three to four filaments
at upper part of posterolateral sulcus of medulla just above
roots of vagus nerve.
♦ In its intracranial course filaments get united and constitute
a trunk which passes forward and lateral to jugular foramen
by crossing and grooving jugular tubercle of occipital bone.
♦ Glossopharyngeal nerve leaves the skull via middle part
of juglar foramen anterior to vagus and accessory nerves.
♦ In jugular foramen nerve lies in a deep groove and leads
to cochlear canaliculus and separated from both vagus and
accessory spinal nerve by inferior peterosal sinus.
Extracranial Course
♦ In its extracranial course the nerve descend in between
internal jugular vein and internal carotid artery deep to
styloid process and muscles attached to it. It turn forward
and wind at lateral aspect of stylopharyngeous and pass
between external and internal carotid arteries and reaches
to side of pharynx. Here it gives off pharyngeal branches
and enters sub-mandibular region by passing deep to
hyoglossus where it split into tonsilar and lingual branches.
Anatomy  65
♦ At base of skull glossopharyngeal nerve presents superior
as well as inferior ganglion. Superior ganglion does
not give off any of the branches while inferior ganglion
occupies notch on lower border of petrous temporal and
gives communicating and tympanic branches.
Branches and Distribution
♦ Tympanic nerve: It is the branch of inferior ganglion of
glossopharyngeal nerve. The nerve enters middle ear via
tympanic canaliculus which forms tympanic plexus and
distribute its fibers to middle ear, auditory tube, mastoid
antrum and air cells. One branch of plexus is called as
lesser petrosal nerve and it consists of preganglionic
secretomotor fibers for parotid gland and relay in otic
ganglion. Postganglionic fibers join auriculotemporal
nerve to reach the gland.
♦ Carotid branch: It descends over internal carotid artery
and supplies to carotid sinus and carotid body.
♦ Pharyngeal branches: They take part in the formation
of pharyngeal plexus with vagal and sympathetic fibers.
Glossopharyngeal fibers are distributed to mucous
membrane of pharynx.
♦ Muscular branch: It supplies to stylopharyngeus.
♦ Tonsillar branch: It supplies to tonsil and join lesser
palatine nerves to form a plexus from which fibers are
distributed to soft palate and palatoglossal arches.
♦ Lingual branches: They carry taste and general sensations
from posterior one third of tongue including circumvallate
papillae.
Nuclei
There are three nuclei in upper part of medulla which are:
1. Nucleus ambiguous: It is branchiomotor
2. Inferior salivatory nucleus: It is parasympathetic
3. Nucleus of tractus solitarius: It is gustatory.
Q.10. Write short note on lymphatic drainage of oral cavity.
(Aug 2011, 5 Marks)
Ans. Lymphatic drainage of the oral cavity is divided firstly
into regional nodes and then into deep cervical nodes.
Parotid nodes lie upon the parotid gland and drain
it
Buccal nodes lie on the cheek over the buccinator
muscle and siphon off the lymph that is collecting
in the submandibular nodes
Submandibular nodes lie on the lateral wall of the
submandibular gland and drain the cheek, the upper
lip, lower lip, maxillary sinus, upper and lower teeth,
anterior two-third of the tongue, floor of the mouth,
vestibule and gums
Submental nodes are found in the submental triangle
below the chin and drain the tip of the tongue, the
floor of the anterior part of the mouth, the incisors,
the central part of the lower lip and the skin of the
chin
• Superficial cervical nodes lie on the external jugular
vein and drain the skin over the angle of the jaw and
66 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
the skin covering the lower portion of the parotid
gland.
Deep cervical nodes are as follows:
Jugulodigastric node sits posteroinferiorly to the jaw
and drains the tonsils and the tongue.
Jugulo-omohyoid node is found close to the
omohyoid muscle and drains the tongue.
Q.11. Describe hypoglossal nerve under following heads:
(Feb 2014, 3+3+2 Marks)
a. Course
b. Branches
c. Applied anatomy
Ans. Course
Intraneural course: Fibers pass forwards lateral to the
medial longitudinal bundle, medial lemniscus and
pyramidal tract, and medial to the reticular formation
and olivary nucleus. Hypoglossal nerve is attached to the
anterolateral sulcus of medulla in between the pyramid
and the olive, by 10 to 15 rootlets. These rootlets run
laterally behind the vertebral artery, and they join to
Fig. 86: Course of hypoglossal nerve
Branches
Branches containing fibers of the hypoglossal nerve proper:
These branches supply extrinsic and intrinsic muscles of the
tongue. Only extrinsic muscle, the palatoglossus is supplied
by fibers of the cranial accessory nerve through the vagus and
pharyngeal plexus.
Branches of the hypoglossal nerve containing fibers of nerve C1:
These fibers join the nerve at the base of the skull.
form two bundles which pierce the duramater separately
near hypoglossal canal. The nerve leaves the skull via
hypoglossal canal.
Extracranial Course: Hypoglossal nerve first lies deep
to the internal jugular vein and inclines between the
internal jugular vein and internal carotid artery. It
crosses the vagus and reaches in front of it.
The nerve descends between the internal jugular vein
and internal carotid artery in front of vagus deep to
the parotid gland, styloid process, posterior belly of
the digastric. At the lower border of the posterior belly
of the digastric, it curves forwards, crosses the internal
and external carotid arteries and the loop of the lingual
artery. The nerve then passes deep to posterior belly of
the digastric to enter the submandibular region.
The nerve then continues forwards on the hyoglossus
and genioglossus, deep to the submandibular gland and
the mylohyoid muscle and enters the substance of the
tongue to supply all its intrinsic muscles and most of its
extrinsic muscles.
a. Meningeal branch contains sensory and sympathetic fibers.
b. Descending branch continues as upper root of the ansa
cervicalis or descendens hypoglossi.
c. Branches to thyrohyoid and geniohyoid muscles.
Applied Anatomy
♦ Hypoglossal nerve is tested clinically by asking the patient
to protrude his/her tongue. In normal people the tongue is
protruded straight forward but if the nerve is paralysed,
tongue deviates to paralyzed side.

 Ans. It is a well separated joint which is formed between atlas
(May 2017, 3 Marks)
Ans. Due to unilateral damage there is lower motor neuron
type of paralysis of muscles on the tongue over that
side. On asking the patient to protrude his/her tongue,
tip of the tongue deviates to paralysed side because of
unopposed action of the muscles of healthy side.
On clinical testing of hypoglossal nerve, if there is
unilateral damage to hypoglossal nerve, the tongue
deviates to the side of the lesion or paralysis.
Q.13. Name the blood vessels supplying thyroid gland.
(Aug 2016, 2 Marks)
Ans. Following are the blood vessels supplying thyroid gland:
Superior thyroid artery
Inferior thyroid artery
Lowest thyroid artery or thyroidea ima artery
Accessory thyroid artery.
Q. 14. Name the structures attached to styloid process. cruciform ligament of atlas.
(Aug 2018, 1 Mark)
Ans. Structures attached to the process are:
Stylohyoid
Styloglossus
Stylopharyngeous muscles
Stylohyoid and submandibular ligaments.
The five attachments resemble the reins of a chariot.
Q.15. Write very short answer on thyrocervical trunk.
(Aug 2018, 2 Marks)
Ans. It is the short, wide branch of the subclavian artery.
Origin, Course, and Termination
The thyrocervical trunk arises from the upper aspect of the
first part of the subclavian artery at the medial margin of the
scalenus anterior and lateral to the origin of vertebral artery. It
immediately terminates into three branches.
Branches
These are:
♦ Inferior thyroid artery.
♦ Superficial cervical artery.
♦ Suprascapular artery.
10. THE PREVERTEBRAL AND
PARAVERTEBRAL REGION
Q.1. Write a short note on atlantoaxial joint.
(Sep 2002, 3 Marks) (Mar 2009, 5 Marks)
Anatomy  67
and axis.
Types and Articular Surfaces
♦ There are two lateral atlantoaxial joints between inferior
facets of atlas and superior facets of axis. They are the
plane joints.
♦ One median atlantoaxial joint between the dens, i.e.
odontoid process and the anterior arch and between dens
and transverse ligament of the atlas. This is a pivot joint.
It consists of two separate synovial cavities, anterior and
posterior.
Ligaments
♦ Lateral atlantoaxial joint is supported by:
Capsular ligament all around.
Lateral part of the anterior longitudinal ligament.
Ligamentum flavum.
♦ Median atlantoaxial joint is strengthened by following, i.e.
Anterior smaller part of the joint between anterior arch
of atlas and dens is surrounded by a loose capsular
ligament.
Posterior larger part of the joint between dens and
transverse ligament is often continuous with one
of the atlanto-occipital joints. Here main support
is transverse ligament which forms a part of the
Transverse Ligament
It is attached over each side to medial surface of lateral mass
of atlas. In median plane, its fibers are prolonged upwards
to basiocciput and downwards to body of axis, thus forming
cruciform ligament of atlas vertebra. Transverse ligament
embraces the narrow neck of the dens, and prevents its dislocation.
Ligaments Connecting Axis with Occipital Bone
Ligaments which connect axis with occipital bone are the
membrana tectoria, cruciate ligament, apical ligament of the
dens and the alar ligaments.
♦ Membrana tectoria: It is an upward continuation of posterior
longitudinal ligament. It lies posterior to transverse ligament.
Membrana tectoria is attached inferiorly to posterior surface
of the body of axis and superiorly to the basiocciput.
♦ Cruciate ligament: Transverse ligament is attached
over each side to medial surface of lateral mass of atlas.
In median plane, its fibers are prolonged upwards to
basiocciput and downwards to body of axis, thus forming
cruciform ligament of atlas vertebra.
♦ Apical ligament of dens: It extends from apex of dens
close to anterior margin of foramen magnum behind
the attachment of cruciate ligament. Mainly it is the
continuation of the notochord.
♦ Alar ligament, one on each side, extends from upper part
of lateral surface of dens to medial surface of occipital
condyles. They are strong ligaments which limit both
the rotation as well as flexion of head. They get relaxed
during extension.
68 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
 Contents
(Apr 2010, 5 Marks)
Ans. Introduction
Vertebral artery is one of the two principal arteries which
supply the brain. In addition it also supplies to spinal
cord, meninges, and surrounding muscles and bones.
Origin and Course
It arises from the posterosuperior aspect of first part of
subclavian artery near its commencement. It runs a long course
and end in cranial cavity by supplying brain.
b.
Fig. 87: Course and parts of vertebral artery
c.
Parts of Vertebral Artery
Artery is divided into four parts as follows:
a. First part of vertebral artery: It extends from origin of
artery to the transverse process of 6th cervical vertebrae.
This part of artery run upward and backward in triangular
space between scalenus anterio and longus colli muscles
known as scalenovertebral triangle.
Scalenovertebral triangle
It is present at the root of neck.
Boundaries
Medial: Lower oblique part of longus colli
Lateral: Scalenus anterior
Apex: Transverse process of C6 vertebrae
Base: First part of subclavian artery d.
Posterior wall: Transverse process of C7, ventral
ramus of C8 nerve, neck of first rib and cupola pleurae
First part of vertebral artery
Cervical part of sympathetic chain.
Fig. 88: Vertebral artery with branches
Relations
Anteriorly: Carotid sheath with common carotid artery,
vertebral vein, inferior thyroid artery and thoracic duct on
left side.
Posterior: Transverse process of C7 vertebrae, stellate
ganglion and ventral rami of C7 and C8 nerves.
Second part of vertebral artery: It runs through foramina
transversaria of upper six cervical vertebrae. Its course
is vertically upto axis vertebrae. It then run upward and
laterally to reach foramen transversarium of atlas vertebrae.
Relations:
1. Ventral rami of nerves C2-6 lie posterior to vertebral
artery.
2. The artery is accompanied by venous plexus and by
large branch from stellate ganglion.
Third part of vertebral artery: This part lies in suboccipital
triangle emerging from foramina transversarium of atlas,
the artery winds medially round the posterior aspect of
lateral mass of atlas. It runs medially lying on the posterior
arch of this bone and enter vertebral canal by passing
deep to lower arch margin of posterior atlanto-occipital
membrane.
Relations
Anteriorly : Lateral mass of atlas
Posteriorly : Semispinalis capitis
Laterally : Rectus capitis lateralis
Medial : Ventral ramus of 1st cervical nerve
Inferior : Dorsal ramus of C1 nerve
Posterior arch of atlas.
Fourth part:
It extends from posterior atlanto-occipital membrane
to lower border of pons
 Anatomy  69

In vertebral canal, it pierces dura and arachnoid, Posterior inferior cerebellar artery
and ascends in front of root of hypoglossal nerve. Medullary arteries.
As it ascends, it inclines medially to reach the front Development of vertebral artery
of medulla. At lower border of pons, it unites with First part: From branch of dorsal division of 7th
its fellow of contralateral side to form basilar artery. cervical intersegmental artery
Branches of vertebral artery: First part gives off no Second part: From postcostal anastomosis
branches. Third part: From spinal branch of first cervical
Cervical branches intersegmental artery
Spinal branches from second part enter vertebral canal Fourth part: From preneural branch of first cervical
via intervertebral foramina and supply spinal cord, intersegmental artery.
meninges and vertebrae. Q.3. Write on origin, insertion, nerve supply and action of
Muscular branches arise from third part and supply prevertebral muscle in tabular form.
suboccipital muscles. (Apr 2007, 15 Marks)
Cranial branches Ans. Prevertebral muscles are:
These branches originate from fourth part: 1. Longus colli
Meningeal branches 2. Longus capitis
Posterior spinal 3. Rectus capitis anterior
Anterior spinal artery 4. Rectus capitis lateralis.

Muscle Origin Insertion Nerve supply Action

Longus colli
It extends from atlas to
T3 vertebral
Longus capitis
It overlap longus colli. It
is thick above and narrow
below
Rectus capitis anterior
It is very short as well as
flat muscle. It lies deep to
longus capitis
Rectus capitis lateralis
It is a short flat muscle
a. Upper oblique part originates from a. Upper oblique part in anterior Ventral rami a. Neck flexion
anterior tubercle of transverse tubercle of atlas of nerve b. Oblique part flex
process of C3, C4, C5 b. Lower oblique part in anterior C3-C8 the neck laterally
b. Lower oblique part from bodies of tubercle of transverse process c. Lower oblique part
upper T2-T3 vertebrae of C5 and C6 vertebrae rotates the neck to
c. Middle vertical part from bodies c. Middle vertical part in bodies opposite side
of upper three thoracic and lower of C2, C3 and C4 vertebrae
three cervical vertebrae
It originates from the anterior It is inserted in inferior surface of Ventral rami Head flexion
tubercle of transverse processes of basilar part of occipital bone of nerves
C3, C4, C5 and C6 vertebrae C1-C3
It originates from anterior surface It is inserted in basilar part of Ventral Head flexion
of lateral mass of atlas in front of occipital bone ramus of
occipital condyle nerve C1
It originates from upper surface of It is inserted in inferior surface of Ventral rami Head flexion laterally
transverse process of atlas jugular process of occipital bone of nerves
C1, C2

(Apr 2007, 4 Marks)
Ans. Superior aspect of each lateral mass shows an elongated
concave facet which articulates with corresponding
condyle of occipital bone to form atlanto-occipital
bone.
• Main movement is flexion with a little lateral flexion
and rotation. Flexion is caused by longus capitis and
rectus capitis anterior.
Extension is caused by recti capitis posterior major
and minor, obliques capitis superior, semispinalis
capitis, splenius capitis and upper part of trapezius.
Lateral bending is caused by rectus capitis,
semispinalis capitis, splenius capitis, sternoclei-
domastoid and trapezius.
Fig. 89: Prevertebral muscles
70 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.5. Write short note on cervical plexus.

(Apr 2007, 5 Marks)
  Ans. Cervical plexus is formed by the ventral rami of upper
first four cervical spinal nerves C1, C2, C3 and C4. Rami
emerge between anterior and posterior tubercles of
cervical transverse processes grooving costotransverse
bars. Four roots connect to each other and form three
loops.

Position and Relations of Cervical Plexus

Cervical plexus is related:
a. Posteriorly to muscles which originates from posterior
tubercles of transverse process i.e. levator scapulae and
scalenus medius.
b. Anteriorly to prevertebral fascia, internal jugular vein and
sternocleidomastoid.
Branches of Cervical Plexus
I. Cutaneous branches or superficial branches: These
branches provide sensory innervations to the skin. They
arise at the level of middle third of sternocleidomatoid
at posterior border to innervate skin of neck and scalp
between auricle and external occipital protuberance.
Branches and the regions innervated by them are:
a. Anterior cutaneous nerve of neck: Arises from ventral
rami of C2 and C3 and run across sternomastoid to
supply skin and neck to sternum.
b. Supraclavicular nerve: Formed by ventral rami of C3
and C4 nerves. The nerve emerges at posterior border
of sternocleidomatoid muscle.
c. Greater auricular nerve: It is the largest ascending
branch of cervical plexus. It arises from ventral rami
of C2 and C3 nerves. It ascends on sternomastoid
muscle to reach parotid gland where it subdivides
into anterior and posterior branches.
d. Lesser occipital: It arises from ventral ramus of C2
of spinal cord. It is visible at posterior border of (Apr 2007, 4 Marks)
sternocleidomastoid muscle.

Ans.
Scalenus Anterior Muscle
♦ Origin: Orignates from anterior tubercles of transverse
process of cervical vertebrae 3, 4, 5 and 6.
♦ Insertion: Scalene tubercle and adjoining ridge on superior
surface of the first rib.
♦ Nerve supply: Ventral rami of nerves C4, 5 and 6.
Fig. 91: Relation of scalenus anterior
Actions
1. Anterolateral flexion of cervical spine.
2. Rotates cervical spine to opposite side.
3. Elevates the first rib during inspiration.
4. Stabilizes neck along with other muscle.
Relations
a. Anteriorly: Phrenic nerve covered by prevertebral fascia,
lateral part of carotid sheath containing internal jugular
vein, descendens cervicalis, sternomastoid and clavicle.
b. Posteriorly: Brachial plexus, subclavian artery, cervical
pleura covered by suprapleural membrane, scalenus
medius.
c. The lateral border of muscle is related to trunks of brachial
plexus and subclavian artery which emerges at this border
and enter posterior triangle.
Medial Border of Muscle is Related to
In its lower part to an inverted V shaped interval which is
formed by the diverging borders of scalenus anterior and longus
colli. This interval consists of many important structures, i.e.
♦ Vertebral vessels running vertically from base to the apex
of this space
♦ Inferior thyroid artery arching medially at level of 6th
cervical transverse process
♦ Sympathetic trunk
♦ First part of subclavian artery traverses lower part of gap
♦ Over left side, thoracic duct arches laterally at level of 7th
cervical transverse process
♦ Carotid sheath covers all the structures given above
♦ Sternocleidomastoid covers carotid sheath
Anatomy  71
In its upper part, scalenus anterior get separated from longus
capitis by ascending cervical artery.
Q.7. Write very short answer on phrenic nerve.
(Apr 2018, 2 Marks)
Ans. Phrenic nerve is basically a mixed nerve which carries
motor fibers to diaphragm and sensory fibers from
diaphragm, pleura, pericardium as well as part of
peritoneum.
Origin
It arises from ventral rami of third, fourth and fifth cervical
vertebrae but chiefly from fourth cervical vertebrae.
Course and Relations
♦ It is formed at lateral border of scalenus anterior, opposite
to middle of sternocleidomastoid, at the level of upper
border of thyroid cartilage.
♦ It runs vertically downwards on anterior surface of
scalenus anterior muscle. Since the muscle is oblique, nerve
appears to cross it obliquely from its lateral towards its
medial border. In this part, nerve is related anteriorly to
the prevertebral fascia, the inferior belly of the omohyoid,
transverse cervical artery, suprascapular artery, internal
jugular vein, sternocleidomastoid and thoracic duct on
left side.
♦ As the nerve leave anterior surface of scalenus anterior,
phrenic nerve runs downwards on cervical pleura just
behind the commencement of brachiocephalic vein. Here
it crosses internal thoracic artery from lateral towards
the medial side, and enters the thorax behind first costal
cartilage. Over left side, nerve leaves (crosses) the medial
margin of scalenus anterior muscle at a higher level and
crosses in front of the first part of subclavian artery.
Distribution
♦ Phrenic nerve alone provide motor supply to diaphragm
♦ It gives sensory innervations to diaphragmatic pleura,
pericardium and subdiaphragmatic pleura.
Q.8. Write very short answer on intervertebral joints.
(Apr 2018, 2 Marks)
Ans. The joints of the neck include intervertebral joints between
the lower 6 cervical vertebrae and craniovertebral joints.
The joints between the lower 6 cervical vertebrae are
typical cervical joints. These are similar to those in the
other parts of the vertebral column. They permit flexion,
extension, and lateral bending but little rotation.
The joints between lst and 2nd cervical vertebrae and
those between lst cervical vertebrae and skull permit
rotation and nodding of head, respectively.
The joints of neck are clinically important due to high
incidence of spondylosis, disc prolapse, and fracture
dislocation in the cervical region.
All intervertebral joints are innervated by adjoining
spinal nerves particular by their posterior divisions.
72 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Roof:
11. BACK OF THE NECK 1. Medially: Dense fibrous tissue covered by semi-
spinalis capitis.
2. Laterally: Longissimus capitis and occasionally
(April 2003, 10 Marks) splenius capitis
Or Floor: It is formed by:
Write short note on contents and boundaries of 1. Posterior arch of atlas.
suboccipital triangle. (Aug 2018, 5 Marks) 2. Posterior atlanto-occipital membrane.
Ans. Boundaries of Suboccipital Triangle
Contents of Suboccipital Triangle
Superomedially: Rectus capitis posterior major muscle
supplemented by the rectus capitis posterior minor. 1. Third part of vertebral artery.
Superolaterally: Superior oblique capitis muscle. 2. Dorsal ramus of nerve C1-suboccipital nerve.
Inferiorly: Inferior oblique capitis muscle. 3. Suboccipital plexus of veins.

Fig. 92: Boundaries and contents of suboccipital triangle

Third Part of Vertebral Artery ♦ Internal vertebral venous plexus

♦ Condylar emissary vein
Out of the four parts of vertebral artery only third part appears
in the suboccipital triangle. This part appears at foramen ♦ Deep cervical vein
transversarium of atlas vertebra. After emerging from foramen, ♦ Plexus of vein around vertebral artery.
the artery winds backward and medially behind the lateral mass
of atlas; lodges in the groove on upper surface of its posterior
arch, and finally leaves the triangle by passing deep to the thick 12. THE CRANIAL CAVITY
lateral edge of posterior atlanto occipital membrane to enter
vertebral canal where it continues as fourth part of vertebral 
artery. (Sep 2001, 5 Marks)
Vertebral artery is separated from posterior arch of atlas by Or
first cervical nerve and its dorsal and ventral rami. Briefly describe on falx cerebri. (Oct 2007, 5 Marks)
Ans. This is a large sickle shaped fold of dura mater occupying
Dorsal Ramus of Nerve C1–Suboccipital Nerve
medial longitudinal fissure between two hemispheres.
Dorsal ramus emerges between the posterior arch of atlas and It has two ends:
the vertebral artery and soon breaks up into five muscular 1. Anterior end is narrow and is attached to cristae
branches to supply four suboccipital nerves and semispinalis galli.
capitis. The nerve to inferior oblique gives off a communicating 2. Posterior end is broad and is attached along median
branch to the greater occipital nerve. plane to upper surface of tentorium cerebelli.
Suboccipital Plexus of Veins Falx cerebri consists of two margins:
It lies in and around the suboccipital triangle and drains to: 1. Upper margin is convex and is attached to lips of sagittal
♦ Muscular veins sulcus.
♦ Occipital veins 2. Lower margin is concave and free.
 Anatomy  73

It has right and left surfaces each of which is related to medial

surface of corresponding cerebral hemisphere.
Three important venous sinuses are present in relation to
this fold.
1. Superior sagittal sinus lies along upper margin. (Sep 2013, 20 Marks)
2. Inferior sagittal sinus lies along lower margin. Or
3. Straight sinus along the line of attachment of falx to
Write a short note on cavernous sinus.
tentorium cerebelli.
(May 2014, 5 Marks) (Feb 2005, 5 Marks)
(Feb 2014, 3 Marks) (Dec 2010, 5 Marks)
(Apr 2007, 5 Marks)
Or
Write short note on relations of cavernous sinus.
(Aug 2018, 5 Marks)
Ans. Situation
Each cavernous sinus is a large venous space situated in
a middle cranial fossa on either side of body of sphenoid
bone.
Boundaries
• Floor and medial wall: Formed by endosteal dura
mater.
• Roof and lateral wall: Formed by meningeal dura
mater.
Fig. 93: Falx cerebri • Anteriorly: Sinus extends to medial end of superior
orbital fissure.
Q.2. Enumerate paired and unpaired dural venous sinuses. • Posteriorly: To apex of petrous temporal bone.
(Sep 2004, 5 Marks) Contents or Relations
Ans. There are 23 venous sinuses out of which 8 are paired
and 7 are unpaired. A. Structure outside the sinus:
a. Superiorly: Optic tract, optic chiasma, olfactory
Paired Venous Sinus tract, internal carotid artery and anterior perforated
substance.
1. Cavernous sinus
b. Inferiorly: Foramen lacerum, junction of body and
2. Superior petrosal sinus
greater wing of sphenoid.
3. Inferior petrosal sinus
c. Medially: Hypophysis cerebri and sphenoidal air sinus.
4. Transverse sinus
5. Sigmoid sinus d. Below laterally: Mandibular nerve.
6. Sphenoparietal sinus e. Laterally: Temporal lobe with uncus.
7. Petrosquamous sinus f. Anteriorly: Apex of the orbit and superior orbital
8. Middle meningeal sinus. fissure.
g. Posteriorly: Apex of petrosal temporal and crus cerebri
In above sinuses there is one sinus on each side.
of the midbrain.
Unpaired Venous Sinus B. Structures inside lateral wall of sinus: From above to
downwards
They are median in position: Oculomotor nerve: In anterior part of cavernous sinus,
1. Superior sagittal sinus nerve divide in superior and inferior divisions which
2. Inferior sagittal sinus leave sinus by passing via superior orbital fissure.
3. Straight sinus Trochlear nerve: In anterior part of cavernous sinus
4. Occipital sinus the nerve crosses superficial to oculomotor nerve and
5. Anterior intercavernous sinus enters orbit via superior orbital fissure.
6. Posterior intercavernous sinus Ophthalmic nerve: In anterior part of cavernous sinus,
7. Basilar plexus of veins. nerve divides into lacrimal, frontal and nasociliary
branches.
Q.3. Mention situation, boundaries, contents, communica- Maxillary nerve: It leaves sinus by passing via foramen
tion and tributaries of cavernous sinus. rotundum on its way to pterygopalatine fossa.
(Feb 2002, 10 Marks) Trigeminal ganglion: Ganglion and its dural cave
Or project inside the posterior part of lateral wall of sinus.
74 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 94: Coronal section of cavernous sinus
Fig. 95: Communications and tributaries of cavernous sinus
C. Structure passing through medial aspect of sinus:
a. Internal carotid artery: With venous plexus and
sympa-thetic plexus around it.
b. Abducent nerve: Infralateral to internal carotid artery.
Structurs in lateral wall and on medial aspect of sinus are
seperated from blood by endothelial lining.
Communication
♦ The cavernous sinus drains into transverse sinus through
superior petrosal sinus.
♦ Cavernous sinus drains into internal jugular vein through
inferior petrosal sinus and through plexus around internal
carotid artery.
♦ Cavernous sinus drains into pterygoid plexus of veins
through emissary veins.
♦ Cavernous sinus drains into facial vein through superior
ophthalmic vein.
♦ The right and left cavernous sinus communicate with
each other through anterior and posterior inter cavernous
sinuses and through basilar plexus of veins.
All the above communications are valueless and blood can flow
via them in either direction.
Tributaries of Cavernous Sinus:
A. From the orbit.
a. Superior ophthalmic vein
b. A branch of inferior ophthalmic vein or sometimes
vein itself
c. The central vein of retina may drain either in superior
opthlamic vein or in cavernous sinus.
B. From the brain
a. Superficial middle cerebral vein
b. Inferior cerebral veins from temporal lobe.
C. From the meninges
a. Sphenoparietal sinus
b. The frontal trunk of middle meningeal vein may drain
either in pterygoid plexus via foramen ovale or in
sphenoparietal or cavernous sinus.
Applied Anatomy
♦ Thrombosis of cavernous sinus may be caused by sepsis in
dangerous area of face, in nasal cavities and in paranasal
air sinuses. This gives rise to:
Nervous symptoms:
– Severe pain in eye and forehead in the area of
distribution of ophthalmic nerve.
– Involvement of 3rd, 4th and 6th cranial nerves
resulting in paralysis of muscles supplied.
Venous symptoms: Marked edema of eyelid, cornea
and root of nose with exophthalmos due to congestion
of veins.
♦ Communication between cavernous sinus and internal
carotid artery may be produced by head injury. When
this happens the eye wall protrudes and pulsates with
each heart beat. It is also known as pulsating exopthalmos.
Q.4. Write a short note on superior sagittal sinus.
(March 2000, 5 Marks)
Ans. Superior Sagittal Sinus
The sinus occupies upper convex attached margin of falx
cerebri.
Fig. 94: Superior saggital sinus
It begins anteriorly at cristae galli by union of tiny
meningeal vessels, there it communicates with veins
of frontal sinus and occasionally with veins of nose.
As the sinus run upwards and backwards, it becomes
progressively larger in size. It is triangular in cross-
section. It ends near internal occipital protuberance
 Anatomy  75

 Relations
♦ Superiorly: Diaphragma sellae, optic chiasma, tuber
cinerium and infundibular recess of IIIrd ventricle.
♦ Inferiorly: Irregular venous channels between two layers
of dura mater lining the floor of hypophyseal fossa,
sphenoidal air sinus and hypophyseal fossa.
♦ On each side: Cavernous sinus with its contents.

Subdivisions
The gland has two main parts which differ morphologically,
embryologically and anatomically. The two parts are:
♦ Adenohypophysis:
It consists of the following parts:
Anterior lobe or pars anterior, pars distalis or pars
glandularis: This is the largest part of gland.
Intermediate lobe or pars intermedia: This is in the
form of thin strip which is separated from anterior
lobe by intraglandular cleft.
Tuberal lobe or pars tuberalis: It is an upward
extension of anterior lobe that surrounds and forms
the part of infundibulum.
♦ Neurohypophysis:
Posterior lobe: It is smaller than anterior lobe and lies
in the posterior concavity of larger anterior lobe.
Infundibular stem: It contains neural connections of
posterior lobe with hypothalamus.
Median eminence of tuber cinereum which is
continuous with infundibular stem.

(Aug 2005, 10 Marks)

Or
Write short note on pituitary gland. (Oct 2014, 3 Marks)
Ans. Anatomy of Pituitary Gland
Situation: The gland lies in the hypophyseal fossa. The
fossa is roofed by diaphragma sellae. Stalk of hypophysis
cerebri pierces diaphragma sellae and is attached above
to floor of IIIrd ventricle.

Fig. 98: Arterial supply of pituitary gland

(For colour version see Plate 1)

Blood Supply
Arterial Supply
♦ The hypophysis cerebri is supplied by the following
Fig. 97: Parts of hypophysis cerebri in saggital section branches of internal carotid artery:
76 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Superior hypophyseal artery on each side.
Inferior hypophyseal artery.
♦ Each superior hypophyseal artery supplies to the ventral
part of hypothalamus, upper part of infundibulum, lower
part of infundibulum via separate descending branch
known as trabecular artery.
♦ Each inferior hypophyseal artery divides into medial and
lateral parts which join to form arterial ring, the branches
from ring supply to posterior lobe.
♦ Anterior lobe is supplied by portal vessels arising from the
capillary tufts which is formed by superficial hypophyseal
arteries. Long portal vessels drain median eminence and
upper infundibulum while the short portal veins drain
lower infundibulum.
Venous Drainage
Short veins emerge on surface gland and drain into neighbouring
venous sinuses. Hormones pass out of gland via venous blood
and carried to their target cells.
Applied Anatomy
Pituitary tumors give rise to two main categories of symptoms:
A. General Symptoms: These are caused due to pressure over
surrounding structures. The symptoms are:
Sella turcica is enlarged in size.
Pressure over optic chiasma causes bitemporal
hemianopia.
Pressure over hypothalamus causes hypothalamic
syndromes.
A large tumor may press upon the third ventricle
causing rise in intracranial pressure.
B. Specific symptoms: These symptoms depend on the type
of cell tumor
Acidophil adenoma causes acromegaly in adults and
gigantism in younger patients.
Basophil adenoma causes Cushing s syndrome.
Chromophobe adenoma causes effects of hypo-
pituitarism.
Posterior lobe damage causes diabetes insipidus.
Q.6. Describe pituitary gland under following heads:
(Dec 2010, 4 + 4 Marks)
a. Gross anatomy
b. Microscopic anatomy
Ans. For gross anatomy refer to Ans 5 of the same chapter.
For microscopic anatomy refer to Ans 19 of SECTION
HISTOLOGY.
Q.7. Enumerate dural venous sinuses. Describe cavernous
sinus and give its applied anatomy.
(Dec 2012, 2+4+2 Marks)
Ans. For enumeration refer to Ans 2 of the same chapter.
For description of cavernous sinus along with applied
anatomy refer to Ans 3 of the same chapter.
Q.8. Write short note on tentorium cerebelli.
(Aug 2012, 5 Marks) (Nov 2008, 5 Marks)
Ans. Tentorium cerebelli is a tent shaped fold of dura mater
which form roof of posterior cranial fossa.
It separates cerebellum from occipital lobes
of cerebrum and divides cranial cavity into
supratentorial and infratentorial compartments.
Infratentorial compartment is the posterior cranial
fossa consisting of hindbrain and lower part of
midbrain.
Tentorium cerebelli consists of free margin as well
as an attached margin. Anterior free margin is of U-
shaped and is free. Ends of ‘U’ are attached anteriorly
to anterior clinoid processes. Anterior margin
bounds to tentorial notch which is occupied by the
midbrain as well as the anterior part of superior
vermis.
Outer or attached margin is convex and post-
erolaterally and it is attached to lips of transverse
sulci on the occipital bone and on the posteroinferior
angle of parietal bone. Anterolaterally, it is attached
to superior border of the petrous temporal bone and
to posterior clinoid processes. Along the attached
margin, there are the transverse and superior
petrosal venous sinuses.
Trigeminal or Meckel s cave is a recess of dura mater
which is present in relation to attached margin of
tentorium. Trigeminal cave is formed by evagination
of the inferior layer of tentorium over the trigeminal
impression on petrous temporal bone. It consists of
trigeminal ganglion.
• Free and attached margins of the tentorium cerebelli
cross each other near the apex of the petrous
temporal bone. Anterior to point of crossing, there
is presence of triangular area which forms posterior
part of roof of cavernous sinus, this is pierced by
third and fourth cranial nerves.
Tentorium cerebelli consists of two surfaces i.e
superior surface and inferior surface.
Superior surface is convex and it slopes to either side
from median plane. Falx cerebri is attached to this
surface in the midline; the straight sinus lies along
the line of this attachment. Superior surface is related
to the occipital lobes of the cerebrum.
• Inferior surface is concave and fits to convex superior
surface of cerebellum. Falx cerebelli is attached to its
posterior part.
Venous sinuses enclosed in the tentorium cerebelli on
each side are:
a. Transverse sinus—Lies within the posterior part of
the attached margin.
b. Superior petrosal sinus—Present within the
anterolateral part of the attached margin.
c. Straight sinus—Present along the line of attachment
between falx cerebri and tentorium cerebelli.
 Anatomy  77

Fig. 97: Tentorium cerebelli

Q.9. Write short note on Meckel’s cave. (Nov 2009, 5 Marks) • The cephalic part of anterior lobe persists as the pars
Ans. Meckel s cave is also known as trigeminal cave or cavum tuberalis.
trigeminale. • Sometimes the stomodeal end of the pouch invades
It is an arachnoidal pouch containing cerebrospinal fluid. the roof of the nasopharynx and persists as the
It is formed by two layers of dura mater which are part pharyngeal hypophysis.
of an evagination of the tentorium cerebelli near the apex
of the petrous part of the temporal bone.
It envelops the trigeminal ganglion.
It is bounded by the dura overlying four structures:
1. Superolaterally: The cerebellar tentorium
2. Superomedially: The lateral wall of the cavernous
sinus
3. Medially: The clivus
4. Inferolaterally: The posterior petrous face.
Q.10. Write a short note on Rathke s Pouch.
(Dec 2010, 5 Marks)
Ans. • Anterior pituitary develops from a diverticulum that Fig. 100: Development of anterior and posterior lobe of pituitary
evaginates from the roof of the stomodeum in front of
the buccopharyngeal membrane. This diverticulum
is known as the Rathke s pouch.
• Rathke’s pouch extends up to the floor of the fore
brain vesicle.
• The Rathke s pouch separates from the stomatodeum
by the second month due to growth of the
surrounding mesenchyme.
• The cells covering the anterior wall of the pouch
gives rise to anterior lobe of pituitary.
• The posterior wall of the pouch forms the par
intermedia.
• Cavity of the pouch persists as the intraglandular
cleft. Fig. 101: Rathke’s pouch
78 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.11. Write about branches of internal carotid artery.
(Dec 2009, 5 Marks)
Ans. Internal carotid artery starts in the neck as terminal
branch of common carotid artery. It is divided into four
parts which gives off its branches.
Cervical Part
It lies in the carotid sheath. It does not give any branch.
Petrous Part
It is the part of temporal bone. It gives off caroticotympanic
branches which enter middle ear and artery of pterygoid canal
which enters pterygoid canal and anastomose with greater
palatine artery.
Cavernous Part
In the cavernous sinus it gives off cavernous branch to trigeminal
ganglion and superior and inferior hypophyseal branches to
hypophysis cerebri.
Cerebral Part
It lies at base of the brain after emerging from cavernous sinus.
It gives off ophthalmic, anterior cerebral, middle cerebral,
posterior communicating and anterior choroidal branches.

The ganglion is crescentric or semilunar in shape with

 (Feb 2016, 2 Marks) its convexity directed anterolaterally.
Ans. Following are the structures passing through the The three divisions of trigeminal nerve emerges from
cavernous sinus: this convexity.
Structures in the lateral wall of sinus from above to The posterior concavity of the ganglion receives the
downwards: sensory root of the nerve.
1. Oculomotor nerve Situation and Meningeal Relation
2. Trochlear nerve
Trigeminal ganglion lies on the trigeminal impression over
3. Ophthalmic nerve
anterior surface of the petrous temporal bone near its apex. Here
4. Maxillary nerve
it occupies a special space of dura matter known as trigeminal
5. Trigeminal ganglion. cave or Meckel s cave. Two layers of dura are present below
Structures passing through the medial aspect of sinus: ganglion. Cave is lined by pia arachnoid so that the ganglion
1. Internal carotid artery with venous and sympathetic along with motor root of trigeminal nerve is surrounded by
plexus around it cerebrospinal fluid. Ganglion lies at depth of 5 cm from the
2. Abducent nerve. preauricular point.
Q.13. Write short note on trigeminal ganglion. Relations
(Apr 2008, 3 Marks)
♦ Medially Internal carotid artery and posterior part of
Ans. Trigeminal ganglion is the sensory ganglion of the fifth
cavernous sinus
cranial nerve.
♦ Laterally Middle meningeal artery
This ganglion is homologus with dorsal nerve root ♦ Superiorly Parahippocampal gyrus
ganglia of spinal nerves. ♦ Inferiorly Motor root of trigeminal nerve, greater petrosal
It is made up of pseudounipolar nerve cells with a T - nerve, apex of petrous temporal bone and foramen
shaped arrangement of their processes. lacerum.
 Anatomy  79

Associated Root and Branches Transverse sinus

Sigmoid sinus
♦ Central process of ganglion cells forms the large sensory
Sphenoparietal sinus
root of the trigeminal nerve which is attached to pons at
Petrosquamous sinus
its junction with the middle cerebellar peduncle.
Middle meningeal sinus.
♦ Peripheral processes of the ganglion cells form three
In above sinuses there is one sinus on each side.
divisions of the trigeminal nerve, i.e. ophthalmic, maxillary
and mandibular. Unpaired Venous Sinus
♦ Small motor root of trigeminal nerve attach to the pons They are median in position:
superomedial of the sensory root. It passes under the
• Superior sagittal sinus
ganglion from its medial to lateral side and join mandibular
• Inferior sagittal sinus
nerve at the foramen ovale.
Straight sinus
 Occipital sinus
Anterior intercavernous sinus
Posterior intercavernous sinus
Basilar plexus of veins.

13. CONTENTS OF THE ORBIT

Q.1. Give in tabular form the origin, insertion, nerve

supply and action of extraocular muscles.
(Apr 2010, 5 Marks)
(Oct 2016, 2 Marks)
Ans. Various paired intracranial venous system are: (Sep 2001, 5 Marks)
Cavernous
Or
Superior petrosal
Inferior petrosal
Transverse (Mar 2013, 3 Marks)
Sigmoid Or
Sphenoparietal
Write short note on extraocular muscles of eyeball.
Petrosquamous
(Oct 2014, 3 Marks)
Middle meningeal
Or
Q.15. Write short answer on venous sinuses of dura mater.
Write short note on recti muscles of eyeball.
(Aug 2018, 3 Marks)
(Feb 2014, 3 Marks)
Ans. Venous sinuses of dura mater are the venous spaces, Or
walls of which are formed by the dura mater.
Write short answer on extraocular muscles.
They consist of an inner lining of epithelium.
(Apr 2018, 3 Marks)
There is no muscle present in their walls.
They also do not have any valves. Ans. Extraocular muscles are of two types:
Venous sinuses of dura mater receive venous blood I. Voluntary muscles
from the brain, meninges and bones of skull. 1. Four recti
• Cerebrospinal fluid is poured in some of them. a. Superior rectus
Cranial venous sinuses communicate with veins b. Inferior rectus
outside the skull via emissary veins. These c. Medial rectus
communications keep blood pressure in sinuses d. Lateral rectus.
constant. 2. Two oblique
There are 23 venous sinuses out of which 8 are paired a. Superior oblique
and 7 are unpaired. b. Inferior oblique.
3. Levator palpabrae superioris.
Paired Venous Sinus II. Involuntary muscles
Cavernous sinus 1. Superior tarsal muscle
Superior petrosal sinus 2. Inferior tarsal muscle
Inferior petrosal sinus 3. Orbitalis.
80 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Voluntary muscles
Muscle Origin Insertion Nerve supply Action
Voluntary muscle Four recti arise from Recti are inserted into sclera little All recti are a. Superior rectus: At vertical
1. Four recti a common annular posterior to limbus supplied by axis it elevates; At horizontal
a. Superior rectus tendon or tendinous oculomotor axis it adducts and at
b. Inferior rectus ring of zim. Ring is nerve except anteroposterior axis it rotates
c. Lateral rectus attached to middle lateral rectus medially (intorsion)
d. Medial rectus part of superior which is supplied b. Inferior rectus: At vertical
orbital fissure. Lateral by abducent axis it depresses; At
rectus consists of an nerve horizontal axis it adducts
additional tendinous and at anteroposterior axis it
head which arises rotates laterally (extorsion)
from orbital surface c. Lateral rectus: At horizontal
of greater wing of axis it abducts
sphenoid bone lateral d. Medial rectus: At horizontal
to tendinous ring axis it adducts
2. Two oblique muscle a. It is arises from a. It is inserted into sclera behind a. It is supplied a. Superior oblique: At
a. Superior oblique undersurface equator of eyeball between by trochlear vertical axis it depresses;
b. Inferior oblique of lesser wing superior and lateral rectus. nerve At horizontal axis it abducts
of sphenoid, b. It is inserted close. It is supplied b. It is supplied and at anteroposterior axis it
superomedial to by superior oblique a little below by oculomotor rotates medially (intorsion)
optic canal. and posterior to later nerve b. Inferior oblique: At vertical
b. It arises from the axis it elevates; At horizontal
orbital surface of axis it abducts and at
maxilla, lateral to anteroposterior axis it rotates
lacrimal groove laterally (extorsion)
3. Levator palpebrae It arises from the The flat tendon of levator splits It is supplied by It elevates the upper eyelid.
superioris orbital surface into superior and inferior lamella the oculomotor
of lesser wing of superior is inserted to anterior nerve
sphenoid, antero- surface of superior tarsus and skin
superior to optic canal of upper eyelid.
and origin to superior Inferior lamella is inserted to upper
rectus margin of superior tarsus and in
superior conjunctival fornix

Involuntary Muscles

Fig. 103: Insertion of oblique and recti muscles of eyeball

Fig. 104: Nerve supply of extraocular muscles

♦ Superior tarsal muscle: It is the deep portion of levator
palpabrae superioris. It is inserted on upper margin of
superior tarsus. Elevates upper eyelid.
♦ Inferior tarsal muscle: It extends from the facial sheath
of inferior rectus and inferior oblique to lower margin of
inferior tarsus. It depresses lower eyelid.
♦ Orbitalis: It bridges inferior orbital fissure and its action
is uncertain.

(Sep 2009, 10 Marks)
Or
 nucleus which forms part of oculomotor nuclear complex.
(Sep 2002, 10 Marks)
Ans. It is a 3rd cranial nerve. It is distributed to both
extraocular and intraocular muscles. It is in series with
4th, 6th and 12th cranial nerves along with ventral root
of spinal nerves.
Fig. 105: Oculomotor nerve and its distribution
Anatomy  81
Functional Components
♦ It is general somatic efferent for movements of eyeball.
♦ Parasympathetic or general visceral efferent for contraction
of pupil and accommodation.
♦ General somatic afferent carry proprioceptive fibers
from extraocular muscles to mesencephalic nucleus of
trigeminal.
Nucleus
Oculomotor nucleus is situated in ventromedial part of central
gray mater of midbrain at level of superior colliculus. Fibers for
constrictor papillae and for ciliaris arise from Edinger Westphal
Ventrolaterally, this is closely related to medial longitudinal
bundle.
Connections of nucleus are:
♦ To pyramidal tract of both sides which form supranuclear
pathway of nerve.
82 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦ To pretectal nuclei of both sides for light reflex Q.3. Write a short note on ciliary ganglion.
♦ To fourth, sixth and eighth nerve nuclei by medial (Sep 2001, 4 Marks)
longitudinal bundle for coordination of eye movements. Ans. This is a peripheral parasympathetic ganglion placed in
♦ To tectobulbar tract for visuoprotective reflexes. course of oculomotor nerve.
Course and Distribution Location
♦ In its intraneural course, fibers arise from the nucleus and It lies near apex of orbit between the optic nerve and tendon of
pass ventrally via tegmentum, red nucleus and substantia lateral rectus muscle.
nigra.
♦ At the base of brain, nerve get attached to oculomotor Roots
sulcus on medial side of crux cerebri. It has motor, sensory and sympathetic roots. Three roots enter
♦ Nerve passes between superior cerebellar and posterior its posterior end which is as follows:
cerebral arteries and run forward in interpeduncular
♦ The motor or parasympathetic root arises from nerve to
cistern to reach cavernous sinus.
inferior oblique. It consists of preganglionic fibers which
♦ Now, the nerve enters cavernous sinus by piercing the
begin in Edinger-Westphal nucleus. The fibers relay in
posterior part of its roof over lateral side of posterior
ciliary ganglion. Postganglionic fibers arising in ganglion
clenoid process. It descends into lateral wall of sinus where
pass through short ciliary nerves and supply sphincter
it lies above the trochlear nerve. In anterior part of sinus, papillae muscles and ciliaris muscle. These intraocular
nerve divides into superior and inferior division. muscles are used in accommodation.
♦ Both divisions of nerve enter orbit via middle part of ♦ The sensory root comes from nasociliary nerve. It consists
superior orbital fissure. Inside the fissure, nasociliary nerve of sensory fibers from eyeball. The fibers do not relay in
lies in between both the divisions but abducent nerve lies ganglion.
inferolateral to both divisions. ♦ The sympathetic root is branched from internal carotid
♦ Inside the orbit, small upper division descends over lateral plexus. It contains postganglionic fibers arising in superior
side of optic nerve supplies the superior rectus and levator cervical ganglion which pass along internal carotid,
palpebrae superioris. Larger lower division divides into ophthalmic and long ciliary arteries. They pass out of ciliary
three branches of medial rectus, inferior rectus and inferior ganglion without relay in short ciliary nerves to supply
oblique. Nerve to inferior oblique is the longest and gives blood vessels of eyeball. They also supply to dilator papillae.
off parasympathetic root to ciliary ganglion and then it
supplies inferior oblique muscle. Branches
♦ All branches enter the muscles on their ocular surfaces
The ganglion gives off 8 to 10 short ciliary nerves which divides
except that for inferior oblique which enters from its
in 15 to 20 branches and then pierce sclera around entrance of
posterior border.
optic nerve. They consist of fibers from all three roots of ganglion.
Applied Anatomy
♦ Complete and total paralysis of oculomotor results in:
Ptosis, dropping of upper eyelid.
Lateral squint.
Dilatation of pupil.
Loss of accommodation
Diplopia, double vision
Slight proptosis.
♦ A midbrain lesion causing contralateral hemiplegia and
ipsilateral paralysis of oculomotor nerve known as Weber s
syndrome.
♦ Supranuclear paralysis of 3rd nerve causes loss of
conjugate movement of eye.
♦ Ptosis or dropping of upper eyelid because of paralysis
of voluntary part of levator palpabrae superioris muscle.
♦ In an affected eye pupillary light reflex is absent.
♦ Because of paralysis of parasympathetic fibers to sphincter
papillae muscle there occurs dilatation of pupil.
♦ Compression of oculomotor nerve: Due to extradural
hematoma, compression of oculomotor nerve leads to
dilatation of pupil. Parasympathetic fibers which lie
superficially get affected first. Pupil dilates over affected Fig. 106: Ciliary ganglion and its roots
side and there is little response to light. (For colour version see Plate 2)

Q.4. Write short note on nasociliary nerve.
(Sep 2011, 5 Marks)
Ans. It is one of the terminal branches of ophthalmic division
of trigeminal nerve.
Nasociliary nerve begins in the lateral wall of anterior
part of cavernous sinus. It enters orbit via middle part
of superior orbital fissure between two divisions of
oculomotor nerve. It crosses above the optic nerve from
lateral to medial side along with ophthalmic artery and
runs along medial wall of orbit between superior oblique
and medial rectus. It ends at anterior ethmoidal foramen by
dividing into anterior ethmoidal and infratrochlear nerves.
Branches
♦ Sensory communicating branch to the ciliary ganglion
form sensory root of ganglion. Often, it is mixed with
sympathetic root.
♦ Long ciliary nerves: They are 2 or 3 in number. These run
on medial side of optic nerve, pierce sclera and supply
sensory nerve to cornea, iris and ciliary body. These nerves
also carry sympathetic nerve to dilator pupillae.
♦ Posterior ethmoidal nerve: This passes through posterior
ethmoidal foramen and supplies the ethmoidal and
sphenoidal air sinuses.
♦ Anterior ethmoidal nerve: This is the larger terminal
branch of nasociliary nerve. It leaves orbit by passing
through anterior ethmoidal foramen. It appears for very
short distance in anterior cranial fossa over the cribriform
plate of ethmoid. It then descends into the nasal cavity by
passing through a slit at the side of anterior part of crista
galli. Inside the nasal cavity the nerve lies deep to nasal
bone. It gives off two internal nasal branches medial and
lateral to mucosa of nose. Finally it emerges at lower border
of the nasal bone as external nasal nerve which supply to
skin of lower half of nose.
♦ Infratrochlear nerve: This is the smaller terminal branch of
nasociliary nerve which is given off at anterior ethmoidal
foramen. This nerve emerges from orbit below trochlea
for tendon of superior oblique and appears on face above
medial angle of eye. It supplies to conjunctiva, lacrimal
sac and caruncle, medial end of eyelid and upper half of
external nose.
14. THE MOUTH AND PHARYNX
Q.1. Write a short note on vestibule of mouth.
(Feb 2002, 3 Marks) (Sep 2000, 4 Marks)
Ans. Vestibule of mouth is a narrow space bounded externally
by lips and cheeks and internally by teeth and gums.
It communicates:
a. With exterior through oral fissure
b. With the mouth open it communicates freely
with oral cavity proper.
Parotid duct opens on the inner surface of cheek
opposite the crown of upper second molar teeth,
Anatomy  83
numerous labial and buccal glands situated
in submucosa of lips and cheeks open into
vestibule. Four and five molar glands situated on
buccopharyngeal fascia open inside the vestibule.
Except for the teeth, the entire vestibule is lined
by mucous membrane. Mucous membrane form
median folds which pass from lips to gums and is
called as frenula of lips.
Applied Anatomy
♦ Papilla of parotid duct inside the vestibule of mouth gives
access to parotid duct for injection of radiopaque dye to
locate calculi in ductal system or gland.
♦ Koplik s spot are seen as white pin point spots around the
opening of parotid duct in measles which are diagnostic
of the disease.
Q.2. Write short note on gums. (Apr 2010, 5 Marks)
Ans. It is also known as gingiva.
Gums are soft tissue which envelope the alveolar process
of upper and lower jaws and surround neck of teeth.
Each gum has two parts:
a. Free part surrounds the neck of the tooth like a collar.
b. Attached part is firmly fixed to the alveolar arch
of jaw. Fibrous tissue of gums is continuous with
periosteum lining the alveoli.
Nerve Supply
♦ Labial part of upper gums is supplied by posterior, middle
and anterior superior alveolar nerves.
♦ Lingual part of upper gums is supplied by anterior palatine
and nasopalatine nerves.
♦ Labial part of lower gums is supplied by buccal branch of
mandibular and incisive branch of mental nerve.
♦ Lingual part of lower gums is supplied by lingual nerve.
Lymphatic Drainage
Lymphatics of upper gum pass to submandibular nodes.
The anterior part of lower gum drains into submental nodes,
whereas posterior part drains into the submandibular nodes.
Q.3. Enumerate the muscles of palate. (Sep 2000, 4 Marks)
Or
Enumerate muscles of soft palate. (Feb 2002, 2 Marks)
(Sep 2017, 2 Marks)
Or
Describe briefly soft palate. (Mar 2009, 5 Marks)
Ans. Soft Palate
It is a movable, muscular fold which is suspended
from the posterior border of hard palate.
It separates nasopharynx from the oropharynx and
is often looked as traffic controller as crossroads
between the food and air passages.
Soft palate has two surfaces, anterior and posterior,
and two borders, i.e. superior and inferior.
84 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Anterior surface is concave and is marked by median
raphe.
Posterior surface is convex and is continuous
superiorly with the floor of nasal cavity.
• Superior border is attached to the posterior border
of hard palate blending on each side with pharynx
Inferior border is free and is bound to oropharyngeal
isthmus. From its middle there hangs a conical
projection known as uvula. From each side of base of
uvula two curved folds of mucous membrane extend
laterally and downwards. The anterior fold is called
as palatoglossal arch or anterior pillar of fauces. It
consists of palatoglossus muscle and reaches the
side of tongue at junction of its both oral as well
as pharyngeal parts. This fold creates the lateral
boundary of oropharyngeal isthmus or isthmus of
fauces. Posterior fold is known as palatophryngeal
arch or posterior pillar of fauces. It consists of
palatopharyngeous muscle. It leads to the formation
of posterior boundary of tonsillar fossa and merges
inferiorly with the lateral wall of pharynx.
Structure of Soft Palate
Soft palate is a fold of mucous membrane which consists of
following parts:
♦ Palatine aponeurosis: It is the flattened tendon of tensor veli ♦
palatine which form fibrous basis of palate. Near median
plane, aponeurosis splits to enclose musculus uvulae.
♦ Levator veli palatine and palatopharyngeus lie over
superior surface of palatine aponeurosis.
♦ Palatoglossus lie over inferior or anterior surface of
palatine aponeurosis.
♦ Numerous mucus glands as well as some of the taste buds
are present at soft palate.
Enumeration of Muscles of Soft Palate
1. Tensor palati: It tightens the soft palate chiefly anterior part.
It opens the auditory tube to equalize air pressure between
middle ear and nose.
2. Levator palati: It elevates soft palate and closes pharyngeal
isthmus.
3. Musculus uvulae: It pulls up the uvula.
4. Palatoglossus: It pulls up root of tongue, approximates pala-
toglossal arches and thus closes oropharyngeal isthmus.
5. Palatopharyngeus: It pulls up wall of pharynx and
shortens it during swallowing.
Nerve Supply
♦ Motor supply: All muscles of soft palate except tensor
palati are supplied by pharyngeal plexus. Tensor palati is
supplied by mandibular nerve.
♦ General sensory nerves:
They are derived from middle and posterior lesser
palatine nerves, which are branches of maxillary nerve
via pterygopalatine ganglion.
Glossopharyngeal nerve
♦ Special sensory or gustatory nerves carry taste sensations
from oral surface and are contained in lesser palatine nerves.
Fibers travel via greater petrosal nerve to geniculate ganglion
of facial nerve and from here to nucleus of tractus solitaries.
♦ Secretomotor nerves are present in lesser palatine nerves.
Blood Supply
Arterial Supply
a. Greater palatine branch of maxillary artery.
b. Ascending palatine branch of facial artery.
c. Palatine branch of ascending pharyngeal artery.
Veins
They pass to pterygoid and tonsillor plexus of veins.
Lymphatics
It drains to upper deep cervical and retropharyngeal lymph nodes.
Applied Anatomy
♦ Paralysis of muscles of soft palate due to lesion of vagus
nerve produces
Nasal regurgitation of liquids
Nasal twang in voice
Flattening of the palatal arch on the side of lesion
Deviation of uvula opposite to the side of lesion.
Cleft palate is a congenital defect caused by non-fusion of
right as well as left palatal processes. It can be of different
degrees. In most severe case, cleft in palate is continuous
with harelip while in least severe type, defect should be
confined to soft palate.
Q.4. Write a note on Waldeyer s ring with applied anatomy.
(Feb 2002, 10 Marks)
Or
Answer in brief on Waldeyer’s ring. (Feb 2016, 2 Marks)
Or
Write short note on Waldeyer s lymphatic ring.
(Sep 2017, 2 Marks)
Ans. In relation to oropharyngeal isthmus, there are several
aggregations of lymphoid tissue that constitute Waldeyer s
lymphatic ring. The most important aggregations are right
and left palatine tonsils usually referred to simply as the
tonsils. Posteriorly and above there is prolaryngeal tonsil;
laterally and above there are tubal tonsils over posterior
part of dorsum of tongue.
Lymph from lymphoid tissue of this ring drains
into precervical chain and deep cervical chain which
constitutes external ring of Waldeyer.
Functions of Waldeyer’s Ring
♦ It filters the tissue fluid coming from inner surface of oral
cavity.
♦ It prevents entry of organism from outside and acts as a guard.
♦ It acts as first line of defence and protect body against
ingested and inspired bacteria by producing antibodies
against invading organisms.

Fig. 107: Waldeyer’s lymphatic ring
Applied Anatomy
Surgical neck dissection: Cancers arising in head and neck
region from structures such as nasopharynx, paranasal air
sinuses, oral cavity, oropharynx, larynx, and thyroid gland have
predictable patterns of spread via chains of lymph nodes in neck.
When surgery is carried out to remove malignant lesion in this
region, it is vitally important to understand these patterns of spread.
Surgeons classify lymph nodes in neck into the following levels:
♦ Level I nodes are in the submental and submandibular
triangles.
♦ Level II nodes lie around the upper portion of internal
jugular vein and upper part of spinal accessory nerve. They
extend from the base of the skull to the bifurcation of the
common carotid artery or the hyoid bone.
♦ Level III nodes lie around the middle third of the internal
jugular vein and extend from inferior border of level II to
the intermediate tendon of omohyoid (cricoid cartilage).
♦ Level IV nodes lie around the lower third of the internal
jugular vein and extend from the lower border of level III to
the clavicle. It also includes supraclavicular lymph nodes.
♦ Level V nodes are in the posterior triangle of the neck
related to the spinal accessory nerve.
♦ Level VI nodes are nodes surrounding the midline visceral
structures and include the pretracheal and paratracheal
nodes.
♦ Level VII nodes are in the superior mediastinum.
Knowing which levels of nodes are likely to be involved during
metastatic spread of a particular cancer, an appropriate nodal
clearance is undertaken.
Classical radical neck dissection involves the removal of level
I to level V nodes and removal of sternocleidomastoid muscle,
internal jugular vein and spinal accessory nerve.
Modified radical neck dissection involves the removal of
level I to V nodes but spares either or all of sternocleidomastoid
muscle, internal jugular vein, and spinal accessory nerve.
The selective neck dissection involves some but not level I
to V nodes.
Q.5. Write a short note on blood supply and clinical
importance of palatine tonsil. (Sep 2000, 4 Marks)
Or
Anatomy  85
Describe position, nerve supply, blood supply and
applied importance of palatine tonsil.
(Sep 2000, 4 Marks)
Or
Write short note on palatine tonsil. (Feb 2013, 5 Marks)
(June 2010, 5 Marks) (Nov 2009, 5 Marks)
(Aug 2011, 5 Marks)
Or
Write short note on blood supply of palatine tonsil.
(Sep 2017, 3 Marks)
Or
Write a note on blood supply of palatine tonsil.
(Sep 2006, 3 Marks)
Or
Describe palatine tonsil under following headings:
(Aug 2018, 10 Marks)
a. External features
b. Tonsillar bed
c. Nerve supply and blood supply
d. Applied anatomy
Ans. Position
Palatine tonsil occupies the tonsillar fossa between
palatoglossal and palatopharyngeal arches. It can be
seen through the mouth.
Fig. 108: Palatine tonsils
External Features
Palatine tonsil consists of surfaces i.e. medial and lateral; two
borders, i.e. anterior and posterior and two poles, i.e. upper
and lower pole.
♦ Medial surface: It is covered by stratified squamous
epithelium and is continuous with that of mouth. Medial
surface consists of 12 to 15 crypts. Largest cleft is known
as intratonsillar cleft. The cleft is semilunar in shape and
is parallel to dorsum of tongue.
♦ Lateral surface: It is covered by sheet of fascia which
forms hemicapsule of tonsil. Capsule is an extension of
pharyngobasilar fascia. Capsule is only loosely attached to
muscular wall of pharynx and is formed here by superior
constrictor and styloglossus, but anteroinferiorly capsule
is firmly adherent to side of tongue just infront of insertion
on palatoglossus and palatopharyngeus muscle. This
attachment keeps the tonsil in place during swallowing.
86 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Tonsillar artery enters the tonsil by piercing superior
constrictor just behind firm attachment.
Palatine vein descends from the palate in loose areolar
tissue on lateral surface of capsule and crosses tonsil
before piercing wall of pharynx.
More laterally, there is facial artery with its tonsillar
and ascending palatine branches. Internal carotid
artery is 2.5 cm posterolateral to tonsil.
♦ Anterior border: It is related to palatoglossal arch along
with its muscle.
♦ Posterior border: It is related to palatopharyngeal arch
along with its muscle.
♦ Upper pole: It is related to soft palate.
♦ Lower pole: It is related to tongue.
♦ Plica triangularis is a triangular vestigial fold of mucus
membrane covering anteroinferior part of tonsil.
♦ Plica semilunaris is the semilunar fold which may cross
upper part of tonsillar sinus.
Tonsillar Bed
The bed of tonsil is formed from within outwards by:
♦ Pharyngobasilar fascia
♦ Superior constrictor and palatopharyngeous muscles
♦ Buccopharyngeal fascia
♦ In the lower part, the styloglossus
♦ The glossopharyngeal nerve.
Fig. 109: Arterial supply of palatine tonsils
Blood Supply
A. Arterial supply
1. Main source: Tonsillar branch of facial artery.
2. Additional source:
a. Ascending palatine branch of facial artery
b. Dorsal lingual branch of lingual artery
c. Ascending pharyngeal branch of external carotid
artery
d. Greater palatine branch of maxillary artery.
B. Venous drainage: One or more veins leave the lower part
of deep surface of tonsil, pierce superior constrictor and
join palatine pharyngeal or facial vein.
Lymphatic Drainage
Lymphatics pass to jugulodigastric node.
Nerve Supply
It is mainly supplied by the two nerves, i.e.
a. Glossopharyngeal nerve
b. Lesser palatine nerve
Applied Importance or Clinical Importance
1. Tonsillectomy is usually done by guillotine method.
Hemorrhage after tonsillectomy is checked by removal
of clot from raw tonsillar bed. This is to be compared for
method of checking postpartum hemorrhage from uterus.
These are only two organs in body where bleeding is
checked by removal of clots. In other parts of body clot
formation is encouraged.
2. Tonsillitis may cause referred pain in ear.
3. Suppuration in peritonsillar area is called quinsy. A
peritonsillar abscess is drained by making an incision at
most prominent point of abscess.
4. Tonsils are often the site of septic focus. Such focus can lead to
serious diseases like pulmonary tuberculosis, meningitis, etc.
5. Tonsils are larger in children and they retrogress after the
puberty.
Q.6. Enumerate the muscles of pharynx with their nerve
supply. (Sep 2002, 2 Marks)
Ans. Constrictors of Pharynx
There are three constrictors of pharynx namely:
a. Superior constrictor
b. Middle constrictor
c. Inferior constrictor
Fig. 110: Constrictor and longitudinal muscles of the pharynx

The above muscles are supplied by pharyngeal plexus.
Pharynx also consists of three muscles which run
longitudinally
a. Stylopharyngeus
b. Palatopharyngeus
c. Salpingopharyngeus.
Nerve Supply
♦ Motor fibers are derived from cranial accessory nerve
through branches of vagus, they supply all muscles of
pharynx except stylopharyngeus which is supplied by
glossopharyngeal nerve.
♦ Inferior constrictor receives an additional supply external
and recurrent laryngeal nerves.
Q.7. Write a short note on constrictor muscles of pharynx.
(Mar 2000, 4 Marks)
Or
Write briefly on constrictors of pharynx.
(Aug 2012, 5 Marks)
Ans. Muscular basis of wall of pharynx is formed by three
constrictors, i.e. superior, middle and inferior.
Origin
Origin of constrictors is situated anteriorly in relation to ♦
posterior openings of nose, mouth and larynx. From here the
fibers of muscles pass to lateral and posterior walls of pharynx,
fibers of two side meet in midline in fibrous raphe.
♦ Superior constrictor originates from:
Pterygoid hamulus
Pterygomandibular raphae
Fig. 111: Origin of constrictors of pharynx
Anatomy  87
Medial surface of mandible at posterior end of
mylohyoid line
Side of posterior part of tongue.
♦ Middle constrictor originates from:
Lower part of stylohyoid bone
Lesser cornue of hyoid bone
Upper border of greater cornue of hyoid bone.
♦ Inferior constrictor consists of two parts, i.e. the thyroph-
aryngeous part which originates from thyroid cartilage and
cricopharyngeal part which originates from cricoid cartilage.
Insertion of Constrictors
Arrangement of all three constrictors is like that the inferior
constrictor overlaps the middle constrictor which in turn
overlaps superior constrictor.
All the three constrictors of pharynx inserted inside the
median raphe on posterior wall of pharynx. Upper end of
raphe reaches to base of skull where it is attached to pharyngeal
tubercle on basilar part of occipital bone.
Nerve Supply
♦ Superior constrictor and middle constrictor are supplied
by pharyngeal branch of vagus nerve carrying fibers of
cranial root of accessory nerve.
Thyropharyngeus part of inferior constrictor is supplied
by pharyngeal plexus and external laryngeal nerve,
while cricopharyngeus part is supplied by the recurrent
laryngeal nerve.
Action of Constrictors of Pharynx
All the constrictors help in deglutition.
88 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

pterygomandibular raphae to cover the buccinator.

Between the buccopharyngeal fascia and pharyngeal coat
(Sep 2011, 15 Marks) there lies pharyngeal plexus of veins and nerves.
Ans. Anatomy of Pharynx
Pharynx is a wide muscular tube which is situated behind
the nose, mouth and larynx.

Boundaries
♦ Superiorly: It is bounded by base of skull including
posterior part of body of sphenoid and basilar part of
occipital bone in front of pharyngeal tubercle.
♦ Inferiorly: It is continuous with esophagus at the level of
sixth cervical vertebrae corresponding to the lower border
of cricoid cartilage.
♦ Posteriorly: Pharynx glides freely over prevertebral fascia
which separates it from cervical vertebral bodies.
♦ Anteriorly: Its communication is with nasal cavity, oral
cavity and larynx, so anterior wall is incomplete.
♦ Over each side:
Pharynx gets attached to medial pterygoid plate,
pterygomandibular raphae, mandible, tongue, hyoid
bone, thyroid and cricoid cartilages.
Pharynx communicates on each side with middle ear
cavity via auditory tube.
Pharynx is related on either side to styloid process
Fig. 112: Anatomy of pharynx (For colour version see Plate 2)
and muscles attached to it, common carotid, internal
carotid and external carotid arteries along with the
Blood Supply
cranial nerves related to them.
Arterial Supply
Parts of Pharynx
Arteries supplying pharynx are:
Pharynx is divided into three parts from above downwards 1. Ascending pharyngeal branch of external carotid artery
which are as follows: 2. Ascending palatine and tonsillar branches of facial artery
1. Nasopharynx, lie behind the nose 3. Dorsal lingual branches of lingual artery
2. Oropharynx, lie behind the oral cavity 4. Greater palatine, pharyngeal and pterygoid branches of
3. Laryngopharynx, lie behind the larynx maxillary artery.
Structure of Pharynx Venous Drainage
The wall of pharynx is composed of the following five layers Veins form a plexus on posterolateral aspect of pharynx and
from within outwards. collects blood from pharynx, soft palate and prevertebral region.
1. Mucosa It drains into internal jugular vein and facial vein.
2. Submucosa
3. Pharyngobasilar fascia: This is a fibrous sheet internal Lymphatic Drainage
to pharyngeal muscles. It is thickest in upper part where
It drains to retropharyngeal and deep cervical lymph nodes.
it fills the gap between upper border of the superior
constrictor and base of skull, and also posteriorly where it Mechanism of Deglutition or Swallowing
forms pharyngeal raphae. On its superior aspect, fascia get
attached to basiocciput, petrous temporal bone, auditory Swallowing of food occurs in three stages.
tube, posterior border of medial pterygoid plate and First Stage
pterygomandibular raphae. Over its inferior aspect, it lost
gradually deep to muscles and does not extend beyond ♦ First stage is voluntary in character.
superior constrictor muscle. ♦ Anterior part of tongue gets raised and is pressed against
4. Muscular coat: It consists of an outer circular layer made hard palate by intrinsic muscles of tongue mainly the
up of three constrictors and an inner longitudinal layer superior longitudinal and transverse muscles.
made up of stylopharyngeus, salpingopharyngeus and ♦ Movement occurs from anterior to posterior side which
palatopharyngeus muscles. pushes food bolus to oropharynx.
5. Buccopharyngeal fascia: It covers outer surface of ♦ Now the soft palate closes down on the back of tongue
constrictor of pharynx and extend forwards across and helps to form bolus.
 Anatomy  89

♦ Hyoid bone move upwards as well as forward by Cartilagenous Part

suprahyoid muscles. Posterior part of tongue gets
elevated upward and backward by styloglossi and
palatoglossal arches get approximated by palatoglossi.
This causes pushing of bolus via oropharyngeal isthmus
to oropharynx.
Second Stage
♦ The stage is involuntary in character. During this food get
pushed from oropharynx to lower part of laryngopharynx.
♦ Nasopharyngeal isthmus is closed by elevation of soft
palate which occur due to levator veli palatine and tensor
veli palatine and by approximation to it of posterior
pharyngeal wall. This stops food bolus from entering nose.
♦ Inlet of larynx gets closed by approximation of aryepiglottic
fold by aryepiglottic and oblique arytenoid. This stops food
bolus from entering to larynx.
♦ Larynx and pharynx are elevated behind hyoid bone with
the help of longitudinal muscles of pharynx and bolus is
pushed over posterior surface of epiglottis, closed inlet
of larynx and posterior surface of arytenoids cartilages
due to gravity and by contraction of superior and middle
constrictors and of palatopharyngeus.
Third Stage
♦ It is involuntary in character.
♦ During this stage food passes from lower part of pharynx to
esophagus which is brought about by inferior constrictors
of pharynx.
Q.9. Write a short note on auditory tube.
(Sep 2002, 3 Marks) (Apr 2007, 4 Marks)
Ans. • It is also known as pharyngotympanic tube or
Eustachian tube.
Auditory tube is trumpet shaped channel which
connect middle ear cavity with nasopharynx.
This is 4 cm long and is directed downward, forward
and medially.
• Auditory tube forms an angle of 45° with sagittal
plane and 30° with horizontal plane.
It forms anterior and middle two-third of the auditory tube.
This is 25 mm long and lie inside sulcus tubae. This part is made
up of a triangular plate of cartilage which is curled to form the
superior and medial walls of auditory tube. Lateral wall as well
as floor gets completed by fibrous membrane. Apex of the plate
gets attached to medial end of bony part. Base is free and forms
tubal elevation in nasopharynx.
Relations of Cartilaginous Part
♦ Anterolaterally: Tensor veli palatini, mandibular nerve
with its branches, otic ganglion, chorda tympani, middle
meningeal artery and medial pterygoid plate.
♦ Postermedially: Petrous temporal bone and levator veli
palatini.
♦ Levator veli palatine get attached to its inferior surface
and salpingopharyngeus to its lower part near pharyngeal
opening.
Blood Supply
♦ Arterial supply of tube is derived from ascending pharyngeal
and middle meningeal artery and artery of pterygoid canal.
♦ Veins drain to pharyngeal and pterygoid plexus of veins.
♦ Lymphatics pass to retropharyngeal nodes.
Nerve Supply
♦ At ostium by pharyngeal branch of the pterygopalatine
ganglion.
♦ Cartilaginous part by nervous spinosus.
♦ Bony part by tympanic plexus which is formed by the
glossopharyngeal nerve.
Function
Auditory tube provide communication of middle car cavity with
the exterior which ensure equal air pressure over both sides of
tympanic membrane.

Parts of Auditory Tube

The tube is divided into bony and cartilaginous parts:

Bony Part
Bony part forms the posterior one-third of the tube. It is 12 mm
long, and lies in petrous temporal bone near tympanic plate. Its
lateral end is wide and opens on the anterior wall of middle ear
cavity. The medial end is narrow and is jagged for attachment
of cartilaginous part. Lumen of tube is oblong which is widest
from side to side.

Relations of Bony Part

♦ Superior: Canal for tensor tympani
♦ Medial: Carotid canal
♦ Lateral: Chorda tympani, spine of sphenoid, auriculo-
temporal nerve and temporomandibular joint.
90 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

each side of mandible. Third molars and some mandibular

second molars have two roots while maxillary molars have three
roots. All mandibular molars have crown which are roughly
quadrilateral. Mandibular permanent molars are the strongest
mandibular teeth because of their bulk and anchorage.

Diagram of Internal Structure of Canine Tooth

Fig. 114: Internal structure of canine

Q.11. Describe various nerves which supply teeth.

(Aug 2005, 15 Marks) (Mar 2010, 10 Marks)
Ans. Teeth are supplied by the branches of trigeminal nerve.
Branches of trigeminal nerve are ophthalmic, maxillary
and mandibular.

Maxillary Branch
♦ It supplies maxillary teeth. During its course when it passes
through pterygopalatine fossa it gives 5 branches out of
which one is posterior superior alveolar branch.

Fig. 115: Nerve supply of teeth

 Anatomy  91

♦ An internal branch of posterior superior alveolar nerve
goes along with a branch of the maxillary artery through
the posterior alveolar canal which opens on the posterior
surface of the maxilla. 2.
♦ In the bone nerve passes down the posterior or posterolateral
wall of the maxillary sinus, giving of sensory fibers. It then
supplies the maxillary molars except the mesiobuccal root
of the first molar.
♦ Within the depth of the alveolar bone or tooth socket some
nerve fiber passes to supply the periodontal ligament where
as other, the pulpal fibers passes through the apical foramina 3.
of the roots of the molar teeth to supply the dental pulp.
♦ When maxillary nerve passes through inferior orbital
groove and canal it gives
1. Middle superior alveolar nerve: From inferior orbital 4.
canal it passes in a downward and anterior direction
and supplies the maxillary bicuspid and mesiobuccal
root of the first molar.
2. Anterior superior alveolar nerve: The anterior superior
alveolar nerve descends in fine canal in the maxilla to
5.
pass the roots of the maxillary central, lateral incisor
and canine teeth.
Mandibular Division
♦ It supplies mandibular teeth.
♦ Inferior alveolar nerve which is the largest of the branches
of the posterior division of the mandibular part of the
trigeminal nerve supply mandibular teeth
♦ In the inferior alveolar canal it gives off branches to the
mandibular teeth as apical fibers that enter the apical
foramina of the mandibular teeth to supply the dental
pulp of mandibular molars and bicuspid.

Pulp is covered by a layer of tall columnar cells called
as odontoblasts which are capable of replacing dentin
during any time in life.
Dentin
It is a calcified material containing spiral tubules
radiating from the pulp cavity.
Each tubule is occupied by protoplasmic process from
one of the odontoblasts.
The calcium and organic matter are in same proportion
as in bone.
Enamel
It is the hardest substance in the body.
It is made up of crystalline prisms laying roughly at
the right angles to the surface of tooth.
Cementum
It is the boney covering over the neck and root of the
tooth but like enamel and dentin it has neither blood
supply nor any nerve supply.
Over the neck, cementum overlaps cervical end of
enamel or less commonly it can just meet enamel.
Periodontal membrane (ligament)
It holds the root in its socket.
It is present between the cementum and the socket
of the root.
It acts as periosteum to both cementum and bony socket.

(Mar 2006, 10 Marks)

Ans. Parts of the tooth
Each tooth consists of the following three parts:
1. Crown: Anatomical crown is the part of tooth that
is covered by enamel whereas clinical crown is the
part which projects in oral cavity.
2. Root: This is embedded within the socket of jaw
beneath the gum. Fig. 116: Structure of tooth
3. Neck: It is the part of tooth present between the
crown and root and is surrounded by the gum. Time of Eruption

Structure of the Tooth Age of eruption of deciduous teeth

Tooth Maxillary Mandibular
Structurally, each tooth is composed of:
Central Incisor 7 months 6 months
1. Pulp:
It is found in the center of the tooth. Lateral Incisor 9 months 7 months
Pulp is a loose fibrous connective tissue containing Canine 18 months 16 months
vessels nerves and lymphatics, all of which enter the First Molar 14 months 12 months
pulp cavity through apical foramen. Second Molar 24 months 20 months
92 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Age of eruption of permanent teeth Or

Tooth Maxillary Mandibular Write short note on parts and structure of tooth.
Central Incisor 7–8 years 6–7 years (May 2017, 3 Marks)
Ans. Refer to Ans 12 of the same chapter.
Lateral Incisor 8–9 years 7–8 years
Canine 11–12 years 9–10 years
Q.14. Enumerate deciduous teeth and their age of eruption.
(Sep 2006, 3 Marks)
First Premolar 10–11 years 10–12 years
Ans. Refer to Ans 12 of the same chapter.
Second Premolar 10–12 years 11–12 years
Q.15. Write a short note on baby teeth. (Sep 2006, 3 Marks)
First Molar 6–7 years 6–7 years Ans. Baby teeth are also known as deciduous teeth or primary
Second Molar 12–13 years 11–13 years teeth or milk teeth.
Third Molar 17–21 years 17–21 years Deciduous teeth begin to form prenatally at about 14
weeks in intrauterine life and completed postnatally
at 3 years of age.
Development of Teeth
Deciduous teeth begin to erupt at about 6 months
Refer to Ans 1 of chapter ALIMENTRY SYSTEM I: MOUTH, and all get erupted by end of second year or soon
PHARYNX AND RELATED STRUCTURES of EMBRYOLOGY after.
SECTION. Teeth of lower jaw erupt slightly earlier than those
compared to upper jaw.
Clinical Anatomy Deciduous teeth remain intact till 6 years of age.
a. Decalcification of enamel and dentin with At about that time permanent teeth begin to erupt
consequent softening and gradual destruction of the in mouth.
tooth is known as dental caries. A carious tooth is tender For time of eruption of deciduous teeth refer to table
and mastication is painful. in Ans 12 of the same chapter.
b. Irregular dentition is common in rickets and upper For dental formula of deciduous teeth refer to Ans
permanent incisors are notched. In congenital syphilis also 24 of same chapter.
the same teeth are notched but the notching corresponds Q.16. Write a short note on Gomphosis. (Apr 2008, 3 Marks)
to a large segment of a small circle, i.e. hutchinson s teeth. Ans. It is also called as articulation dentoalveolaris.
c. As tooth is the hardest and chemically most stable tissue • Gomphosis is a type of fibrous joint.
in body it is preserved after death and may It is a peg and socket junction between tooth and its
be fossilized, due to this property teeth are very socket.
helpful in medicolegal practice for identification of Periodontal ligament connects dental element to
unrecognized dead bodies. alveolar nerve.
d. Infection of apex of root of tooth, i.e. periapical abscess occurs Gomphosis is an articulation between two bones.
when pulp is dead. This condition is seen on a radiograph.
e. Third molars or wisdom teeth erupt at the age of 18 to 20 Q.17. Write a short note on muscles of soft palate.
years, they may not erupt normally because of less space (Oct 2007, 5 Marks)
and get impacted causing severe pain. If persist for longer Or
duration can lead to dentigerous cyst.
f. Time of eruption of tooth helps in age assessment. Write briefly on muscles of soft palate.
g. Improper oral hygiene can lead to gingivitis and (Dec 2010, 5 Marks)
suppuration with pocket formation between gums and Ans. Muscles of Soft Palate
teeth. This leads to chronic pus discharge at margin of
gums. This condition is called as pyorrhea alveolaris. It
is the common cause of foul breadth and patient hardly
consult the dentist as the condition is painless.
h. Maxillary canines are known as eye teeth as they consist of
long roots which reach to medial angle of eye. Infection of
these roots can spread to facial vein and causes thrombosis
of cavernous sinus.
i. Maxillary teeth need separate injections of anesthetic
over both buccal as well as palatal surfaces of maxillary
process just distal to tooth. Thin layer of bone permit rapid
diffusion of drug upto the tooth.
Q.13. Write a short note on structure of tooth.
(Mar 2006, 3 Marks) (Apr
(Dec 2017,
2014, 45 Marks) Fig. 117: Muscles of soft palate
 Anatomy  93

Muscles of soft palate

S. No. Muscle Origin Insertion Action
1. Tensor Palati a. Lateral side of the auditory tube Muscle desends, converges to form a a. Tightens the soft palate,
b. Adjoining part of the base of delicate tendon which winds round the chiefly anterior part.
the skull hamulus, passes through the origin of the b. Opens the auditory tube to
buccinator, and flattens to form palatine equalize the air pressure
aponeurosis. between the middle ear and
Aponeurosis is attached to: the nasopharynx
a. Posterior border of hard palate.
b. Inferior surface of hard palate behind the
palatine crest.
2. Levator Palati a. Medial aspect of auditory tube. Muscle enter pharynx by passing upper a. Elevate soft palate to close
b. Adjoining part of inferior surface concave margin of superior constrictor pharyngeal isthumus
of petrous temporal bone muscle, it run downward and medially b. Helps in opening the
and spread out inside the soft palate. It auditory tube
is inserted on upper surface of palatine
aponeurosis
3. Musculus a. Posterior nasal spine Mucous membrane of uvula Pulls up uvula forwards to its
Uvulae b. Palatine aponeurosis own side

4. Palatoglossus Oral surface of palatine Descends in palatoglossal arch, to the side Pulls up root of tongue,
aponeurosis of the tongue at the junction of its oral and approximate palatoglossal
pharyngeal parts. arches, and thus closes
oropharyngeal isthumus
5. Palatopharyn a. Anterior fasciculus: From Descend in the palatopharyngeal arch Pulls up the wall of pharynx
geus posterior border of hard palate and spreads out to form the greater part of and shortens it during
b. Posterior fasciculus: From longitudinal muscle coat of pharynx. swallowing
palatine aponeurosis. It is inserted into:
a. Posterior border of lamina of the thyroid
cartilage
b. Wall of the pharynx and its median
raphae

Q.18. Write a note on palate. (Mar 2008, 3 Marks) Soft Palate

Ans. It is the partition between the nasal cavity and oral cavity.
Refer to Ans 3 of same chapter.
It is of two types: Hard palate and soft palate
Q.19. Describe soft palate under following headings.
Hard Palate (Nov 2009, 10 Marks)
Its anterior two-third are formed by the palatine process of 
maxilla and its posterior one-third by the horizontal plates of
the palatine bones.
The anteriolateral margins of the palate are continuous with
the alveolar arches and gums.
The posterior margin gives attachment to the soft palate.
The superior surface forms the floor of the nose and the
inferior surface forms the roof of the oral cavity.

Vessels and Nerves

♦ Arteries: Greater palatine branches of maxillary artery. (Dec 2009, 5 Marks)
♦ Veins: Go to the pterygoid plexus of veins.
♦ Nerves: Greater palatine and nasopalatine branches of the Or
pterygopalatine ganglion. Draw a well labeled diagram to show the structures
♦ Lymphatics: They drain mostly to the upper deep cervical seen in the oral cavity in a fully opened mouth.
nodes and partly to the retropharyngeal nodes. (Oct 2016, 5 Marks)
94 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Ans.
Fig. 116: Structures seen in oral cavity (with mouth wide open)
Q.21. Write briefly on structure of cheek. (Aug 2011, 5 Marks)
Ans. Cheeks are fleshy flaps which forms large part of each
side of the face.
Cheeks are continuous in front with the lips, and the
junction is indicated by the nasolabial sulcus or furrow
which extends from the side of the nose to the angle of
the mouth.
Each cheek is composed of:
1. Skin
2. Superficial fascia containing some facial muscles,
parotid duct, mucous molar glands, vessels and nerves
3. Buccinator covered by bucopharyngeal fascia and
pierced by the parotid duct
4. Submucosa with mucous buccal glands
5. Mucous membrane.
Buccal pad of fat is best developed in infants and lies on
the buccinator partly deep to the masseter and partly in
front of it.
  Lymphatics of the cheek drain chiefly into the sub-
mandibular and preauricular nodes and partly also to
the buccal and mandibular nodes.
Q.22. Write short note on bed of tonsil. (Oct 2014, 3 Marks)
Or
Enumerate the only structures forming bed of tonsil.
(Sep 2005, 4 Marks)
Ans. Bed of tonsil is formed from within outwards by:
• Pharyngobasilar fascia
• Superior constrictor and palatopharyngeus muscle
• Buccopharyngeal fascia
• In lower part, styloglossus
• Glossopharyngeal nerve.
Q.23. Write short note on dental formula.
(May 2008, 3 marks)
Ans. The number and type of teeth present in the oral cavity
in one half of the face (either left side or right side)
in primary dentition are expressed by the following
formula:
I 2 C 1 M 2 = 10
2 1 2
• In this formula each tooth is represented by its initial
letter. I for incisor, C for canine and M for molar.
– Each letter is followed by a horizontal line and
the number of each type of tooth is placed above
the line for maxilla and below the line for the
mandible.
– The formula includes one side only. The above
formula should be read thus:
Incisors: Two maxillary and two mandibular.
Canines: One maxillary and one mandibular.
Molars: Two maxillary and two mandibular.

Similarly for permanent dentition (either left side or
right side), the dental formula is as follows:
I 2 C 1 P 2 M 3 = 16
2 1 2 3
In this premolars have now been added to the
formula.
In the case of permanent teeth, the formula should
be read as:
Incisors: Two maxillary and two mandibular.
Canines: One maxillary and one mandibular.
Premolars: Two maxillary and two mandibular.
Molars: Three maxillary and three mandibular.
To understand dental anatomy, the nomenclature
should be read first. of the jaw in relation to the position of gland, because
Q.24. Answer in brief dental formula for deciduous child.
(May 2017, 3 Marks)
Ans. The number and type of teeth present in the oral cavity
in one half of the face (either left side or right side)
in primary dentition are expressed by the following
formula.
I 2 C 1 M 2 = 10
2 1 2
• In this formula each tooth is represented by its initial
letter. I for incisor, C for canine and M for molar.
• Each letter is followed by a horizontal line and the
number of each type of tooth is placed above the line
for maxilla and below the line for the mandible.
• The formula includes one side only. The above
formula should be read thus:
Incisors: Two maxillary and two mandibular.
Canines: One maxillary and one mandibular.
Molars: Two maxillary and two mandibular.
To understand dental anatomy, the nomenclature
should be read first. Describe the nerve supply and blood supply of nasal
Q.25. Write short note on effect if soft palate is paralyzed.
(May 2017, 3 Marks)
Ans. Following are the effects produced if soft palate gets Write short note on blood supply and nerve supply of
paralyzed:
• Nasal regurgitation of liquids
• Nasal twang in voice
• Flattening of palatal arch on side of lesion
• Deviation of uvula, opposite to side of lesion.
Q.26. Enumerate type of pharynx. (Apr 2018, 2 Marks)
Ans. Pharynx is divided into three parts from above
downwards which are as follows:
• Nasopharynx, lie behind the nose
• Oropharynx, lie behind the oral cavity
• Laryngopharynx, lie behind the larynx.
Q.27. Write very short answer on oral diaphragm.
(Aug 2018, 2 Marks)
Ans. Oral diaphragm is also known as floor of the mouth.
• The floor of the mouth is a small horseshoe-shaped
region situated beneath the anterior two-third of the
tongue and above the muscular diaphragm formed
by two mylohyoid muscles.
Anatomy  95
• The surface of the floor is formed by mucus
membrane, which connects the tongue to the
mandible.
• Laterally the mucus membrane passes from the side
of the tongue onto the mandible.
• Anteriorly the mucus membrane stretches from
one half of the mandible to the other. The anterior
part of the floor is called sublingual region, which
intervenes between the ventral surface of the anterior
two-third of the tongue and the floor of the mouth.
• Clinical anatomy: The swellings of the submandibular
gland can be palpated bimanually by putting an
index finger in the mouth and thumb below the angle
part of the gland lies in the oral cavity above the
floor of the mouth and part outside the oral cavity
below the floor of the mouth. The submandibular
lymph nodes lying on the surface of the gland
cannot be palpated bimanually as they lie below
the floor of the mouth (oral diaphragm). Thus an
enlarged submandibular gland can be differentiated
from a mass of the submandibular lymph nodes by
bimanual palpation.
15. THE NOSE AND
PARANASAL SINUSES
Q.1. Describe gross anatomy, blood supply, nerve supply
and applied anatomy of nasal septum.
(May/June 2009, 15 Marks)
Or
septum. (Sep 2002, 10 Marks)
Or
nasal septum. (Aug 2012, 5 Marks)
(Aug 2011, 5 Marks) (Aug 2008, 5 Marks)
Or
Describe formation, blood supply and nerve supply of
nasal septum. (Mar 2000, 18 Marks)
Ans. It is a median osteocartilaginous partition between two
halves of nasal cavity.
On each side it is covered by mucous membrane and
forms medial wall of both nasal cavities. It consists of
three parts:
Formation of Nasal Septum
I. Bony part: It is formed by:
1. Vomer bone
2. Perpendicular plate of ethmoid bone. Moreover
its margins recieve contribution from nasal spine
of frontal bone, rostrum of sphenoid and nasal
crests of nasal, palatine and maxillary bones.
96 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
II. Cartilaginous part: It is formed by:
1. Septal cartilage
2. Septal process of inferior nasal cartilage.
III. Cuticular part: It is formed by fibro-fatty tissue
covered by skin.
Lower margin of nasal septum is known as
columella.
Nasal septum is rarely median. Its central part is
deflected to one or other side. Deflection is produced
by overgrowth of one or more parts.
Overall, septum, consists of four borders, i.e.
superior, inferior, anterior, posterior and two
surfaces, i.e. right and left surfaces.
Fig. 119: Formation of nasal septum
Blood Supply
Arterial Supply
♦ Anteriosuperior part is supplied by anterior ethmoidal
artery and posterior ethmoidal artery.
♦ Anteroinferior part is supplied by superior labial branch
of facial artery
Fig. 120: Arterial supply of nasal septum
♦ Posterosuperior part is supplied by sphenopalatine artery
which is the main artery.
♦ Posteroinferior part is supplied by branches of greater
palatine artery.
♦ Anteroinferior part or vestibule of septum consists of
anastomoses between septal ramus of superior labial
branch of facial artery, branch of sphenopalatine artery,
greater palatine and of anterior ethmoidal artery. These
form large capillary network known as Kiesselbach’s
plexus.
Venous Drainage
Veins forms a plexus which drains anteriorly into facial vein
and posteriorly through sphenopalatine vein to pterygoid
venous plexus.
Nerve Supply
♦ General sensory nerve arising from trigeminal nerve are
distributed to whole of septum.
• Anterosuperior part of septum is supplied by internal
nasal branch of anterior ethmoid nerve.
• Anteroinferior part: It is supplied by anterior superior
alveolar nerve
• Posterosuperior part: It is supplied by medial posterior
superior nasal branches of pterygopalatine ganglion
• Posteroinferior part is supplied by nasopalatine branch
of pterygopalatine ganglion. This is the main nerve.
♦ Special sensory nerves or olfactory nerves which are
confined to upper part or olfactory area.
Fig. 121 Nerve supply of nasal septum
Applied Anatomy
♦ Little’s area over the nasal septum is common site of
bleeding from the nose, i.e. epistaxis.
♦ Deviation of nasal septum pathologically is responsible for
repeated attacks of common cold, allergic rhinitis, sinusitis
and needs surgical correction.
♦ Artery of epistaxis is sphenopalatine artery.
Q.2. Enumerate openings in lateral wall of nose.
(Sep 2000, 4 Marks) (Apr 2010, 5 Marks)
 Anatomy  97

Ans. •  Opening of nasolacrimal duct is seen at inferior meatus Q.5. Write a short note on maxillary air sinus.
• Opening of frontal air sinus is seen in the anterior (Sep 2004, 5 Marks) (Mar 2000, 4 Marks)
part of hiatus semilunaris (Mar 2007, 3 Marks) (Sep 2007, 4 Marks)
• Opening of maxillary air sinus is seen in the posterior (Mar 2008, 4 Marks) (Apr 2007, 5 Marks)
part of hiatus semilunaris (Feb 2013, 5 Marks)
• Opening of anterior ethmoidal air sinus is present Or
at middle part of hiatus semilunaris
• Opening of middle ethmoidal air sinus is present at Write briefly on maxillary sinus. (Jan 2012, 5 Marks)
upper margin of ethmoidal bulla. Or
• Opening of posterior ethmoidal sinus is seen in the Enumerate paranasal air sinuses. Describe any one of
superior meatus them. (Feb 2002, 10 Marks)
• Opening of sphenoidal air sinus is seen in the
Or
sphenoethmoidal recess.
Enumerate paranasal air sinuses. Describe maxillary
Q.3. Draw a labeled diagram to show features of lateral wall
sinus in detail. Development and applied anatomy.
of nose. (Dec 2003, 7 Marks)
(Mar 1998, 18 Marks)
Ans.
Or
Enumerate paranasal air sinuses. Describe in detail
maxillary air sinus. (Sep 2012, 3 + 5 Marks)
Or
Enumerate paranasal air sinuses. Discuss anatomy of
maxillary air sinus. (Sep 2012, 3 + 5 Marks)
(Apr 2017, 10 Marks)
Or
State names of different paranasal air sinuses. Describe
maxillary air sinus under following headings:
Fig. 122: Features of lateral wall of nose
a. Situation (Aug 2016, 10 Marks)
Q.4. Draw a labelled diagram of lateral wall of nose showing b. Boundaries
various openings. c. Communication
(Dec 2010, 4 Marks) (Feb 2014, 4 Marks) d. Nerve supply
Or e. Blood supply
Draw a labelled diagram to show the openings in Or
lateral wall of nose. (Feb 2004, 7 Marks) Name the paranasal air sinuses. (Aug 2018, 1 Mark)
Ans. Ans.

Enumeration of Paranasal Air Sinuses

There are four paranasal air sinuses on each side and are named
after the bones containing them:
1. Frontal air sinus present in frontal bone.
2. Maxillary air sinus present in maxilla.
3. Sphenoidal air sinus present in sphenoid bone.
4. Ethmoidal air sinus present in ethmoid bone:
• Anterior ethmoidal air sinus.
• Middle ethmoidal air sinus.
• Posterior ethmoidal air sinus.
Clinically Sinuses are Divided into Two Main Groups
♦ Anterior group: It consists of those sinuses which drains
into middle meatus, i.e. frontal, anterior and middle
ethmoidal and maxillary sinus.
♦ Posterior group: It includes those sinuses which do not
drain into middle meatus, i.e. posterior ethmoidal and
Fig. 123: Openings in lateral wall of nose sphenoidal air sinus.
98 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Maxillary Sinus
Maxillary air sinus is the first sinus to develop.
Situation
Maxillary sinus lies in the body of maxilla and is largest of all
paranasal air sinuses.
Shape
It is pyramidal in shape with its base directed medially towards
lateral wall of nose, and apex directed laterally in zygomatic
process of maxilla.
Boundaries with Relations
♦ Roof is formed by floor of orbit. Infraorbital nerve and
artery traverse roof in bony canal.
♦ Floor is formed by the alveolar process of maxilla and
lies at about 1cm below level of floor of nose. This level
corresponds to level of lower border of ala of nose. Floor
is marked by several conical elevations produced by the
roots of upper molar and premolar teeth. Canine tooth
may project into anterolateral wall.
♦ Base is formed by the lateral wall of nose. It posses opening
or ostium of sinus in its upper part.
♦ Apex extends into zygomatic process of maxilla.
♦ Anterior wall is formed by the anterior surface of body
of maxilla and is related to infraorbital plexus of nerves.
In this wall runs the anterior superior alveolar nerve in
curved bony canal.
♦ Posterior wall is formed by the infratemporal surface
of maxilla, separating sinus from infratemporal and
pterygopalatine fossa. It is pierced by posterior superior
alveolar nerves and vessels.
Communications
♦ Maxillary sinus communicates with other sinuses through
lateral nasal wall.
♦ Opening through which the maxillary sinus communicates
with the middle nasal meatus is termed as ostium
maxillare. It is about 3 to 6 mm in diameter and is found
in a recess called hiatus semilunaris.
♦ Maxillary sinus may have septa that partially divide it
into intercommunicating compartments with separate
ostia may be found.
Openings
It opens into middle meatus of nose in lower part of hiatus
semilunaris. A second opening is often present at the posterior
end of hiatus.
In an isolated maxilla the opening of maxillary air sinus is
large. However, in the intact skull the size of opening is reduced
to 3 to 4 mm as it is overlapped by the following:
♦ From above by uncinate process of ethmoid and
descending part of lacrimal bone.
♦ From below, by inferior nasal conchae.
♦ From behind, by perpendicular plate of palatine bone.
Blood Supply
Arterial Supply
Maxillary air sinus is supplied by:
♦ Facial artery
♦ Infraorbital artery
♦ Greater palatine artery
Venous Drainage
It drains into the facial vein and pterygoid plexus of veins.
Nerve Supply
Posterior superior alveolar nerve from maxillary nerve, anterior
and middle superior alveolar nerves from infraorbital nerve.
Lymphatic Drainage
Lymph drains to the submandibular nodes.
Fig. 124: Maxillary sinus
Applied Anatomy
♦ Maxillary air sinus is commonly involved in the sinusitis. It
may be infected from nose or from carious tooth. Drainage
of sinus is difficult because its ostium lies at the higher level
than its floor. Another factor is that cilia in lining mucosa are
destroyed by chronic infection. Hence, the sinus is drained
surgically by making an artificial opening near the floor.
♦ Carcinoma of maxillary air sinus arises from mucosal
lining. Symptoms depend on the direction of growth
which are as follows:
• Invasion of orbit causes proptosis or diplopia, i.e.
blindness.
• Invasion of floor may produce bulging or ulceration
of palate.
• Forward growth obliterates canine fossa and produces
swelling on face.
• Backward growth can involve palatine nerves and
produce severe pain referred to upper teeth.
• Growth in medial direction produces nasal obstruction,
epistaxis and epiphora.
• Growth in lateral direction produces swelling on the
face and palpable mass inside labiogingival groove.
Development of Maxillary Sinus
♦ Among all the sinuses, maxillary sinus is the first to
develop.

♦ Maxillary sinus starts developing at 16th week of the
intrauterine life.
♦ It appears as a shallow groove on the medial surface of
maxilla during the fourth month of intrauterine life. It
grows rapidly during 6 to 7 years of life.
♦ When the crown-rump length (CRL) of an embryo is
32 mm, the CRL expands vertically in primordium of
maxillary body.
♦ At first, the horizontal shift of the palatal shelves occurs.
These shelves then fuse with each other and also with
the nasal septum. As a result of this the oral cavity gets
separated from the nasal chambers.
♦ All these changes result in the expansion of the lateral nasal
wall, which starts folding.
♦ As a result of this folding, three nasal conchae and three
meatuses arise. Superior and inferior meatuses remain as
shallow depressions along the lateral nasal wall and the
middle meatus expands into the lateral nasal wall.
♦ Maxillary sinus expands and modifies in form and it
reaches its final height after the eruption of all permanent
teeth.
Fig. 125: Beginning of development of maxillary sinus
Fig. 126: Folding of lateral nasal wall
Anatomy  99
Q.6. Describe paranasal air sinuses.
(Feb 2005, 10 Marks) (Sep 2000, 9 Marks)
Or
Write short note on paranasal sinuses (PNS).
(June 2010, 5 Marks) (Aug 2011, 5 Marks)
(Aug 2012, 5 Marks)
Or
Describe the paranasal sinuses and their applied
anatomy. (Nov 2008, 15 Marks)
Ans. There are four paranasal air sinuses on each side and are
named after the bones containing them:
1. Frontal air sinus present in frontal bone.
2. Maxillary air sinus present in maxilla.
3. Sphenoidal air sinus present in sphenoid bone.
4. Ethmoidal air sinus present in ethmoid bone
– Anterior ethmoidal air sinus.
– Middle ethmoidal air sinus.
– Posterior ethmoidal air sinus.
Clinically, sinuses are divided into two main groups viz
1. Anterior group: It consists of those sinuses, which drains
into middle meatus, i.e. frontal, anterior and middle
ethmoidal and maxillary sinus.
2. Posterior group: It includes those sinuses which do not
drain into middle meatus, i.e. posterior ethmoidal and
sphenoidal air sinus.
Description of Paranasal Air Sinus
♦ Frontal sinus: It lies in frontal bone deep to superciliary
arches. It extends upward above medial end of eyebrow
and backward into medial part of roof of orbit. It opens
in of middle meatus of nose at anterior end of hiatus
semilunaris through infundibulum or through frontonasal
duct. The sinuses are better developed in males than
females. They are well developed at 7th and 8th year of
age but reaches its full size only at puberty.
• Arterial supply: It is supplied by the supraorbital
artery.
• Venous drainage: It drains into supraorbital and
superior ophthalmic vein.
• Nerve supply: It is supplied by the supraorbital nerve.
• Lymphatic drainage: Drains to submandibular nodes.
♦ Maxillary air sinus: It is described briefly in Ans 5 of the
same chapter.
♦ Sphenoidal air sinus: Right and left sphenoidal sinuses
lie within body of sphenoid bone. Each sinus opens into
sphenoethmoidal recess of corresponding half of nasal
cavity. They are separated by septum each sinus relates
superiorly to optic chiasma and hypophysis cerebri and
laterally to internal carotid artery and cavernous sinus.
Arterial supply: It is supplied by:
• Posterior ethmoidal artery
• Internal carotid artery.
Venous drainage: Into pterygoid venous plexus and
cavernous sinus.
100 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 127: Paranasal air sinuses (For colour version see Plate 2)
Fig. 128: Formation of conchae and meatuses
Nerve supply: It is supplied by:
• Posterior ethmoidal nerve
• Orbital branch of pterygopalatine ganglion.
Lymphatic drainage: It drains to the retropharyngeal nodes.
♦ Ethmoidal air sinus: They are numerous intercommuni-
cation spaces which lie in labyrinth of ethmoid bone. They
get completed from above by orbital plate of frontal bone,
from behind by sphenoidal conchae and orbital process of
palatine bone, anteriorly by lacrimal bone. Basically, they
are three in number, i.e.
1. Anterior ethmoidal sinus: It is made up of 1 to 11 air
cells. It opens in anterior part of hiatus semilunaris
of nose. It is supplied by anterior ethmoidal nerve
and vessels. Its lymphatics drain into submandibular
nodes.
2. Middle ethmoidal sinus: It is made up of 1 to 7 air
cells. It opens in middle meatus of nose. It is supplied
by anterior ethmoidal nerve and vessels and orbital
braches of pterygopalatine ganglion. Lymphatics
drains to submandibular nodes.
3. Posterior ethmoidal sinus: It also consist of 1 to 7 air
cells. It opens in superior meatus of nose. It is supplied
by posterior ethmoidal nerve and vessels and orbital
branch of pterygopalatine ganglion. Its lymphatics
drain to retropharyngeal nodes.
Applied Anatomy
♦ The maxillary air sinus is commonly involved in the
sinusitis. It may be infected from nose or from carious
tooth. Drainage of sinus is difficult because its ostium lies
at the higher level then its floor. Another factor is that cilia
in lining mucosa are destroyed by the chronic infection.
Hence, the sinus is drained surgically by making an
artificial opening near the floor.
Carcinoma of maxillary air sinus arises from mucosal
lining. Symptoms depend on the direction of growth which
are as follows:
• Invasion of orbit causes proptosis or diplopia, i.e.
blindness.
• Invasion of floor may produce bulging or ulceration
of palate.
• Forward growth obliterates canine fossa and produces
swelling on face.
• Backward growth can involve palatine nerves and
produce severe pain referred to upper teeth.
• Growth in medial direction produces nasal obstruction,
epistaxis and epiphora.
• Growth in lateral direction produces swelling on the
face and palpable mass inside labiogingival groove.
♦ Frontal sinusitis and ethmoiditis can cause edema of lids
which is secondary to infection of sinuses.
♦ Pain from ethmoidal air sinus is referred to the forehead
since both of them are supplied by ophthalmic division
of trigeminal nerve.
♦ Pain of maxillary sinusitis can be referred to maxillary teeth
as well as infraorbital skin as all of them are supplied by
the maxillary nerve.
Q.7. Write a short note on pterygopalatine ganglion.
(Mar 1998, 4 Marks)
Ans. This is the largest parasympathetic peripheral ganglion.
It serves as relay station for secretomotor fibers to
lacrimal gland, paranasal sinuses, palate and pharynx.
Topographically, it is related to maxillary nerve, but
functionally it is connected to facial nerve via its greater
petrosal branch.
Connections
♦ Parasympathetic or motor root:
• It is formed by the nerve of pterygoid canal.
• Preganglionic fibers arises from neurons present near
superior salivatory nucleus and lacrimatory nuclei and
pass via nervus intermedius, facial nerve, geniculate
ganglion, greater petrosal nerve and nerve to pterygoid
canal to reach the pterygopalatine ganglion and relay.
• Postganglionic fibers arise in pterygopalatine ganglion
and supply secretomotor nerves to lacrimal gland,

mucous glands of nose, paranasal air sinuses, palate
and nasopharynx.
♦ Sympathetic root
• It is derived from nerve of pterygoid canal.
• Postganglionic fibers arise superior cervical sym-
pathetic ganglion which pass via internal carotid
plexus, deep petrosal nerve and nerve to pterygoid
canal to reach ganglion. Fibers does not relay and
supply to vasomotor nerves to mucous membrane of
nose, paranasal sinus, palate and nasopharynx.
♦ Sensory roots are derived from maxillary nerve. Fibers of
sensory root does not relay in ganglion and they emerge
as various branches, i.e. orbital branch, palatine branches,
nasal branches, pharyngeal branch and lacrimal branch.
Branches of Pterygopalatine Ganglion
Branches of ganglion are actually branches of maxillary nerve.
The branches are:
♦ Orbital branches: They pass through inferior orbital
fissure, periosteum of orbit and orbitalis contribution to the olfactory.
♦ Palatine branches: They supply to hard palate, lateral wall of
nose, lesser palatine nerve supply to soft palate and tonsils.
♦ Nasal branches: The lateral posterior superior nasal nerve
supply to posterior part of superior and middle constrictor.
Medial posterior superior nerve supply to posterior part of
roof of nose and nasal septum the largest of these nerves is
known as nasopalatine nerve which descends to anterior
part of hard palate.
♦ Pharyngeal branches: It supplies to the part of nasopharynx
behind auditory tube.
♦ Lacrimal branch: Postganglionic fibers pass back in maxillary
nerve to leave it via zygomatic nerve and zygomaticotemporal
branch to supply secretomotor fibers to lacrimal gland.
Fig. 129: Connections and branches of pterygopalatine ganglion
Q.8. Name the paranasal air sinuses.
(Feb 2003, 3 Marks) (Apr 2010, 5 Marks)
Ans. There are four paranasal air sinuses on each side and are
named after the bones containing them:
1. Frontal air sinus present in frontal bone.
2. Maxillary air sinus present in maxilla.
3. Sphenoidal air sinus present in sphenoid bone.
Anatomy  101
4. Ethmoidal air sinus present in ethmoid bone:
– Anterior ethmoidal air sinus.
– Middle ethmoidal air sinus.
– Posterior ethmoidal air sinus.
Clinically sinuses are divided into two main groups viz:
1. Anterior group: It consists of those sinuses which drains
into middle meatus, i.e. frontal, anterior and middle
ethmoidal and maxillary sinus.
2. Posterior group: It includes those sinuses which do not
drain into middle meatus, i.e. posterior ethmoidal and
sphenoidal air sinus.
Q.9. Enumerate the paranasal air sinus, give its functions
and openings in nasal cavity. (Mar 2006, 5 Marks)
Ans. For enumeration refer to Ans 8 of the same chapter.
Function
♦ Paranasal air sinus helps in both the functions olfactory
as well as respiratory.
♦ It causes humidification and warming of inspired air and
♦ It is possible that if air is arrested in the sinus for a certain
time, it quickly reaches the body temperature thus
protects the internal structure, particularly the brain
against exposure of cold air.
♦ Other contribution is in the response of voice, lightening
of skull weight, enhancement of the faciocranial resistance
to mechanical shock, and the production of bactericidal
lysozyme to nasal cavity.
Openings in Nasal Cavity
♦ Opening of nasolacrimal duct is seen in the inferior meatus.
♦ Opening of frontal air sinus is seen in the anterior part of
hiatus semilunaris
♦ Opening of maxillary air sinus is seen in the posterior part
of hiatus semilunaris
♦ Opening of anterior ethmoidal air sinus is present at
middle part of hiatus semilunaris
♦ Opening of middle ethmoidal air sinus is present at upper
margin of ethmoidal bulla.
♦ Opening of posterior ethmoidal sinus is the seen in the
superior meatus.
♦ Opening of sphenoidal air sinus is seen in the
sphenoethmoidal recess.
Q.10. Write a short note on openings in the lateral wall of
nasal cavity. (Mar 2006, 5 Marks)
Ans.
♦ Opening of nasolacrimal duct is seen in the inferior meatus
at junction of anterior one- third and posterior two-third.
The opening is guarded by lacrimal fold or Hasner’s valve.
♦ Opening of frontal air sinus is seen in the anterior part of
hiatus semilunaris.
♦ Opening of maxillary air sinus is seen in the posterior
part of hiatus semilunaris. It is often represented by the
two openings.
♦ Opening of anterior ethmoidal air sinus is present at
middle part of hiatus semilunaris. It is mainly present
behind the opening of frontal air sinus.
102 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Opening of middle ethmoidal air sinus is present at upper
margin of ethmoidal bulla.
♦ Opening of posterior ethmoidal sinus is seen in the
superior meatus.
♦ Opening of sphenoidal air sinus is seen in the sphenoe-
thmoidal recess which is the triangular fossa just above
superior concha.
Q11. Enumerate the paranasal air sinuses. What are the
functions of these sinuses? Name the nerves supplying
them. Add a note on their applied anatomy.
(Sep 2006, 8 Marks)
Ans. For enumeration refer to Ans 8 of the same chapter. For
function refer to Ans 9 of the same chapter. For applied
anatomy refer to Ans 6 of same chapter.
Name of the paranasal
air sinus Nerve supplying
Frontal sinus Supraorbital nerve
Maxillary sinus Posterior superior alveolar nerve
from maxillary nerve, anterior and
middle superior alveolar nerves from
infraorbital nerve
Sphenoidal sinus Posterior ethmoidal nerve and orbital
branches of pterygopalatine ganglion
Ethmoidal sinus
• Anterior ethmoidal • Anterior ethmoidal nerve
sinus • Anterior ethmoidal nerve and
• Midlle ethmoidal sinus orbital branches of pterygopalatine
• Posterior ethmoidal ganglion
sinus • Posterior ethmoidal nerve and
orbital branches of pterygopalatine
ganglion
Q.12. Write a note on lateral wall of the nose.
(Mar 2007, 4 Marks)
Or
Write in short on lateral wall of the nose.
(Aug 2012, 5 Marks) (Dec 2010, 5 Marks)
Or
Write short note on lateral wall of nose.
(Aug 2018, 5 marks)
Ans. Lateral wall of the nose is irregular and consists of three
shelf like bony projections called conchae.
• Conchae increases the surface area of the nose for
effective conditioning of the inspired air.
Lateral Wall Leads to Separation of the Nose
♦ From orbit above with ethmoidal air sinus and intervening
maxillary sinus below
♦ In front by lacrimal groove and nasolacrimal canal.
Subdivision of Lateral Wall of Nose
Lateral wall of nose is subdivided into three parts i.e.
1. A small depressed area in the anterior part is known as
vestibule. Vestibule is lined by modified skin containing
short, stiff, curved hair called “Vibrissae”. is known as the sphenoethmoidal recess.
2. Middle part is called as the atrium of the middle meatus.
3. Posterior part consists of conchae and the spaces separating
conchae are known as meatus.
Conchae and Meatuses form the Main Features of the
Lateral Wall
Conchae (also called turbinates) are the curved bony actions
directed downwards and medially. Below and lateral to each
concha is a corresponding meatus. From above downwards
the conchae are superior, middle, and inferior nasal conchae.
Sometimes a 4th concha, the concha suprema is also present.
Skeleton of the Lateral Wall
It is partly bony, partly cartilagenous and partly made up of soft
tissues.
♦ Bony part: It is formed by
• Nasal
• Frontal process of maxilla
• Lacrimal
• Labryinth of ethamoid with superior and middle
conchae.
• Inferior nasal concha made of spongy bone only.
• Perpendicular plate of the palatine bone together with
orbital and sphenoidal processes.
• Medial pterygoid plate.
♦ Cartilaginous part is formed by:
• Superior nasal cartilage
• Inferior nasal cartilage
• 3 or 4 small cartilages of ala.
♦ Cuticular lower part is formed by fibrofatty tissue covered
by skin.
Conchae
♦ Superior and middle nasal conchae are the projections from
the medial surface of the ethmoidal labyrinth.
♦ Inferior concha is an independent bone.
♦ The superior concha is smallest and inferior concha is
largest in size.
Meatuses
Meatuses are the passages (recesses) beneath the overhanging
conchae. They are visualized once conchae are removed.
♦ Inferior meatus is the largest and lies underneath the
inferior nasal concha.
♦ Middle meatus lies underneath the middle concha. It
presents following features:
• Ethmoidal bulla (bulla ethmoidalis), a round elevation
produced by the underlying middle ethmoidal sinuses.
• Hiatus semilunaris, a deep semicircular sulcus below
the bulla ethmoidalis.
• Infundibulum, a short passage at the anterior end of
middle meatus.
♦ Superior meatus is the smallest and lies below the superior
concha.
A triangular depression, above and behind the superior concha
 Anatomy  103

Fig. 130: Formation of lateral wall of nose

Openings of Lateral Wall of the Nose

♦ Opening of nasolacrimal duct is seen in the inferior meatus.
♦ Opening of frontal air sinus is seen in the anterior part of
hiatus semilunaris.
♦ Opening of maxillary air sinus is seen in the posterior part
of hiatus semilunaris
♦ Opening of anterior ethmoidal air sinus is present at
middle part of hiatus semilunaris.
♦ Opening of middle ethmoidal air sinus is present at upper
margin of ethmoidal bulla.
♦ Opening of posterior ethmoidal sinus is seen in superior
meatus.
♦ Opening of sphenoidal air sinus is seen in the sphenoe-
thmoidal recess.

Arterial Supply
♦ Anterosuperior quadrant by anterior ethmoidal artery
♦ Anteroinferior quadrant by branches from facial and
greater palatine arteries.
♦ Posteroinferior quadrant by few branches of sphenopalatine
artery. Fig. 131: Arterial supply of lateral wall of nose
♦ Posterionferior quadrant by branches from greater palatine
artery. a. Anterosuperior quadrant by anterior ethmoidal nerve
branch of ophthalmic nerve.
Venous Drainage b. Anteroinferior quadrant by anterior superior alveolar
Venous form a plexus which drains: nerve branch of infraorbital, continuation of maxillary
♦ Anterioly into facial vein nerve.
♦ Posterioly into pharyngeal plexuses of vein c. Posterosuperior quadrant by lateral posterior superior
♦ Middle part by pterygoid plexus of vein. nasal branches from pterygopalatine ganglion.
d. Posteroinferior quadrant by anterior palatine branch
Nerve Supply of pterygopalatine ganglion.
I. General sensory nerves: They are derived from the II. Special sensory nerves: These are the olfactory nerves
branches of trigeminal nerve which supplies to the lateral which are distributed to upper part of lateral wall below
wall. cribriform plate of ethmoid bone upto superior concha.
104 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 132: Nerve supply of lateral wall of nose
Lymphatic Drainage
♦ From anterior half to submandibular nodes
♦ From posterior half to retropharyngeal and upper deep
cervical nodes.
Q.13. Write short note on pterygopalatine fossa.
(Dec 2009, 5 Marks)
Ans. It is also known as sphenopalatine fossa or ganglion of
hay fever.
Pterygopalatine fossa is a small pyramidal space which
is situated deep below the apex of the orbit.
Boundaries
It is bounded:
♦ Anteriorly by superomedial part of the posterior surface
of the maxilla.
♦ Posteriorly by root of the pterygoid process and adjoining
part of the anterior surface of greater wing of the sphenoid.
♦ Medially by upper part of the perpendicular plate of the
palatine bone. Orbital and sphenoidal processes of the
bone are also involved.
♦ Laterally the fossa opens into infratemporal fossa through
the pterygomaxillary fissure.
♦ Superiorly by the undersurface of body of sphenoid.
♦ Inferiorly it is closed by the pyramidal process of palatine
bone in the angle between the maxilla and pterygoid
process.
Communications
It is communicated:
♦ Anteriorly by the orbit through medial end of the inferior
orbital fissure.
♦ Posteriorly with the middle cranial fossa via foramen
rotundum; with foramen lacerum via pterygoid canal; and
with pharynx via palatovaginal canal.
♦ Medially with nose via sphenopalatine foramen.
♦ Laterally with infratemporal fossa via pterygomaxillary
fissure.
♦ Inferiorly with the oral cavity via greater and lesser
palatine canals.
Contents
♦ Third part of maxillary artery and its branches which have
same name as branches of pterygopalatine ganglia and
accompany them all.
♦ Maxillary nerve and its two branches, i.e. zygomatic and
posterior superior alveolar.
♦ Pterygopalatine ganglion and its numerous branches
which consists of fibers of maxillary nerve mixed with
autonomic nerves.
Fig. 133: Pterygopalatine fossa along with its communications
Q.14. Write short note on openings of paranasal sinuses.
(Sep 2017, 2 Marks)
Ans. Following are the openings of paranasal sinuses:
♦ Opening of frontal air sinus is seen in the anterior part of
hiatus semilunaris.
♦ Opening of maxillary air sinus is seen in the posterior
part of hiatus semilunaris. It is often represented by the
two openings.
♦ Opening of anterior ethmoidal air sinus is present at
middle part of hiatus semilunaris. It is mainly present
behind the opening of frontal air sinus.
♦ Opening of middle ethmoidal air sinus is present at upper
margin of ethmoidal bulla.
♦ Opening of posterior ethmoidal sinus is seen in the
superior meatus.
♦ Opening of sphenoidal air sinus is seen in the sphenoe-
thmoidal recess which is the triangular fossa just above
superior concha.
Q.15. Enumerate arterial supply of nasal septum.
(Apr 2018, 2 Marks)
Ans. Following is the arterial supply of nasal septum:
• Anteriosuperior part is supplied by anterior
ethmoidal artery and posterior ethmoidal artery.
• Anteroinferior part is supplied by superior labial
branch of facial artery.

• Posterosuperior part is supplied by sphenopalatine
artery which is the main artery.
• Posteroinferior part is supplied by the branches of
greater palatine artery.
16. LARYNX
Q.1. Enumerate the cartilages of larynx.
(Sep 2002, 2 Marks)
Or
Write briefly on cartilages of larynx Thyroid Cartilage
(Nov 2008, 5 Marks)
Ans. Larynx is a organ for phonation. Larynx lies at anterior
midline of neck extending from root of tongue to
trachea. In adult male it lies in front of C3, C4, C5 and
C6 but in children or in adult female it lies at the higher
level.
Laryngeal Cartilages
Fig. 134: Laryngeal cartilages
Larynx consists of six cartilages out of which three are unpaired
and three are paired.
Fig. 135: Interior aspect of laryngeal cartilages
Anatomy  105
Unpaired Cartilage
♦ Thyroid cartilage (sheid like)
♦ Cricoid cartilage (ring like)
♦ Epiglottic cartilage (leaf like).
Paired Cartilage
♦ Arytenoid cartilage (cup shaped)
♦ Corniculate cartilage (horn shaped)
♦ Cuniform cartilage (wedge shaped).
Unpaired Cartilage
♦ It is V-shape cartilage.
♦ Thyroid cartilage consists of right and left laminae.
♦ Each lamina is roughly quadrilateral, laminae are placed
obliquely relative to midline, their posterior borders are far
apart while anterior borders approach each other which is
90° in males and 120° in females.
♦ Lower part of anterior border of right and left laminae
fuse and form a median projection known as laryngeal
prominence.
♦ Upper parts of both the anterior borders do not meet and
are separated by the thyroid notch.
♦ Posterior borders are free and are extended upwards
and downwards and are named as superior and inferior
cornua (horns).
♦ Superior cornua is connected with the greater cornua of the
hyoid bone by lateral thyrohyoid ligament, while inferior
cornua articulate with the cricoid cartilage to form the
cricothyroid joint.
♦ Inferior border of the thyroid cartilage concavo-convex,
i.e. convex in front and concave behind.
♦ In the median plane it is connected to the cricoid cartilage
by the conus elasticus.
♦ Outer surface of each lamina is marked by an oblique
line which extends from the superior thyroid tubercle in
front of the root of superior cornua to the inferior thyroid
tubercle behind middle of the inferior border.
Cricoid Cartilage
♦ It is of ring shape.
♦ This cartilage encircles the larynx below the thyroid
cartilage and makes, foundation of larynx.
♦ This cartilage is thick and strong as compared to thyroid
cartilage.
♦ Its anterior part is narrow and is called as arch, while its
posterior part is broad known as lamina.
♦ Lamina projects upwards behind thyroid cartilage, it
articulate superiorly with arytenoids cartilages.
♦ Inferior cornua of thyroid cartilage articulates with side of
cricoid cartilage at the junction of arch and lamina.
Epiglottic Cartilage
♦ It is of leaf shape placed in anterior wall of upper part of
larynx.
106 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Its upper end is broad and free, it projects upward behind
hyoid bone as well as tongue.
♦ Lower end or thyroepiglottic ligament is pointed and is
attached to upper part of angle between the two laminae
of thyroid cartilage.
Paired Cartilage
Arytenoid Cartilage
♦ They are two small pyramid shape cartilage which lie over
upper border of lamina of cricoids cartilage.
♦ Apex of arytenoid cartilage is curved posteromedially and
articulates with corniculate cartilage.
♦ Base is concave and articulates with lateral part of upper
border of cricoids lamina. This prolong anteriorly to form
vocal process and laterally to form muscular process.
♦ Surfaces of cartilage are anterolateral, medial and posterior.
Corniculate Cartilage
♦ These are two small conical nodules which articulate
with apex of arytenoid cartilage which are directed
posteromedially.
♦ These conical lie in posterior part of aryepiglottic folds.
Cuniform Cartilage
These are two small rod shaped pieces of cartilage placed in
aryepiglottic fold which are just ventral to corniculate cartilages.
Q.2. Write short note on nerve supply of larynx
(Apr 2008, 5 Marks)
Ans. A.  Motor nerve: All intrinsic muscles of larynx are
supplied by recurrent laryngeal nerve except
cricothyroid which is supplied by the external
laryngeal nerve.
B. Sensory nerve: The internal laryngeal nerve supply
mucous membrane upto level of vocal folds.
Recurrent laryngeal nerve supply it below the level
of vocal folds.
Q.3. Write short note on vocal folds. (Sep 2011, 5 Marks)
Ans. Within the laryngeal cavity, the mucous membrane presents
with two folds that extend on each side posteroanteriorly
from the arytenoid cartilages to the thyroid cartilage.
These are true and false vocal cords.
Vocal folds are also known as true vocal cords:
• These folds are produced by the underlying vocal
ligaments and vocalis muscle and lie below the false
vocal cords.
• Space between the right and left vocal folds is called
as ‘rima glottidis’
• Vocal cords act as entry valves. They prevent entry
of all substances through rima glottis except air.
• Speech (phonation) is produced by vibrations of the
vocal cords. Greater the amplitude of vibration, the
louder is the sound. Pitch of sound is controlled by
the frequency of the vibrations.
• Since males have longer vocal cords than females, they
have louder but low pitched voices than females.
Q.4. Write short note on thyroid cartilage.
(Sep 2011, 5 Marks)
Ans. •  Thyroid cartilage is V-shaped in its cross section.
• Cartilage consists of right and left laminae. Shape of
each lamina is roughly quadrilateral.
• Laminae are placed obliquely relative to the midline
and their posterior borders are far apart, but the
anterior borders approach each other at an angle
that is about 90° in the male and about l20° in the
female.
• Lower part of anterior borders of right and left
laminae combine and form a median projection
known as laryngeal prominence.
• Upper parts of both the anterior borders do not meet
and are separated by the thyroid notch.
• Posterior borders are free and are extended upwards
and downwards and are named as superior and
inferior cornua (horns).
• Superior cornua is connected with the greater cornua
of the hyoid bone by lateral thyrohyoid ligament.
• Inferior cornua articulate with the cricoid cartilage
to form the cricothyroid joint.
• Inferior border of the thyroid cartilage concavo-
convex, i.e. convex in front and concave behind.
• In the median plane it is connected to the cricoid
cartilage by the conus elasticus.
• Outer surface of each lamina is marked by an
oblique line which extends from the superior thyroid
tubercle in front of root of superior cornua to the
inferior thyroid tubercle behind middle of inferior
border.
• Thyrohyoid, sternothyroid and thyropharyngeus are
part of inferior constrictor of pharynx is attached to
oblique line.
Fig. 136: Anterior and posterior view of thyroid and cricoid cartilage
Attachments
♦ Lower border as well as inferior cornua provides insertion
to triangular cricothyroid.
♦ At posterior border connecting the superior and
inferior cornua is insertion of palatopharyngeus,
salpingopharyngeus and stylopharyngeus.
♦ Over the inner aspect following are attached:
• Median thyroepiglottic ligament
• Thyroepiglottic muscle over each side
 Anatomy  107

• Vestibular fold over each side ♦ This area is rich in lymphatics. These lymphatics drain into
• Vocal fold over each side the upper deep cervical group of nodes. Malignancy in this
• Thyroarytenoid area has a tendency for distant metastasis.
• Vocalis muscle over each side. ♦ Foreign bodies such as fish bones commonly gets lodged
Q.5. Write short note on cricoid cartilage. (Sep 2011, 5 Marks) in piriform fossa. These bones scratch mucosa and person
feel foreign body sensation because of dull visceral pain.
Ans. •  Cricoid cartilage has a shape of signet ring.
♦ Piriform fossa is also known as smuggler’s fossa as it is
• It encircle larynx below thyroid cartilage.
used to smuggle precious diamonds and stones.
• The cartilage is thick and strong as compared to
♦ Pooling of saliva occurs in pyriform fossa if there is any
thyroid cartilage.
obstruction in the food passage (Jackson’s sign).
• It consists of narrow anterior part known as arch
and broad posterior part known as lamina.
• Projection of lamina is upwards behind the thyroid
cartilage and it articulate superiorly with arytenoid
cartilage.
• Inferior cornua of thyroid cartilage articulate with
side of cricoid cartilage at junction of arch and lamina.
For diagram of cricoid cartilage refer to Ans 4 of same
chapter.

Attachment of Cricoid Cartilage

♦ Anterior part provides origin to cricothyroid muscle.
♦ Anterolateral part provide origin to lateral cricoarytenoid
muscle
♦ Lamina of cricoid cartilage give origin to posterior
cricoarytenoid muscle
♦ Cricothyroid and quadrate membranes are also attached.
Q.6. Write in brief about piriform fossa. (Sep 2015, 5 Marks)
Or
Fig. 137: Piriform fossa
Write short note on piriform fossa and clinical
Q.7. Name the muscles of larynx. (Aug 2016, 2 Marks)
significance. (Sep 2015, 5 Marks)
Ans. Following are the muscles of larynx:
Ans. Piriform fossa is deep recess broad above and narrow
below in the anterior part of lateral wall of the • Extrinsic muscles
laryngopharynx on each side of the laryngeal inlet. – Palatopharyngeus
These recesses are produced due to bulging of larynx – Salpingopharyngeus
into laryngopharynx. It is present one on each side of – Stylopharyngeus
– Thyrohyoid
inlet of larynx.
– Sternothyroid
Boundaries • Intrinsic muscles
– Cricothyroid
♦ Medial: Aryepiglottic fold and quadrangular membrane – Posterior cricoarytenoid triangular
of larynx. – Lateral cricoarytenoid
♦ Lateral: Mucous membrane covering the medial surface of – Transverse arytenoids
the lamina of thyroid cartilage and thyrohyoid membrane. – Oblique arytenoids and aryepiglottic
♦ The internal laryngeal nerve and superior laryngeal vessels – Thyroarytenoid and thyroepiglottic
pierce the thyrohyoid membrane and traverse underneath – Vocalis.
the mucous membrane of the floor of the fossa to reach
the medial wall.
♦ Above: Piriform fossa is separated from epiglottic vallecula 17. THE TONGUE
by lateral glossoepiglottic fold.
♦ Inferior: It continues as esophagus.
Q.1. Enumerate the sensory innervations of tongue.
Clinical Importance (Feb 2002, 2 Marks)
Or
♦ Anatomically it is a hidden area. Any malignancy in
Describe position, parts, blood supply, and innervations
this area will initially cause fewer symptoms and has a
of tongue. (Feb 2002, 10 Marks)
tendency to present late symptoms.
Or
108 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Describe muscles of tongue. (Apr 2010, 5 Marks) – Oral part is also known as anterior two-third of
Or tongue.
Describe the tongue and give its nerve supply. – Oral part presents a median furrow, representing
(Sep 2013, 10 Marks) bilateral origin of tongue as well as large number
Or of papillae
Write short note on nerve supply and lymphatic – Pharyngeal part or posterior one third by a V
drainage of tongue. (Aug 2012, 5 Marks) shaped groove known as sulcus terminalis. Two
Or limbs of V meet at median pit called as foramen
Write short note on blood supply and nerve supply of caecum. Both the limbs run laterally and forwards
tongue. (May/June 2009, 5 Marks) (Nov 2008, 5 Marks) upto palatoglossal arches.
Or – The third part is small posteriomost part.
Write short note on sensory innervations of tongue. 2. An inferior surface: This is confined to oral part only.
(July 2016, 5 Marks) (Apr 2007, 5 Marks) Mucous membrane lining this surface is thin, smooth
Or and purpulish. It is reflected onto the floor of the
mouth. The under aspect of the tongue presents the
Write a short note on innervation of tongue.
following features:
(Sep 2006, 5 Marks)
– Frenulum linguae, a median-fold of mucus
Or
membrane connecting the tongue to the floor of
Write short note on nerve supply of tongue.
the mouth.
(Sep 2007, 3 Marks) (Apr 2015, 3 Marks)
– Deep lingual veins, may be seen through mucous
(Jan 2018, 5 Marks)
membrane on either side of frenulum linguae (the
Or
lingual nerve and lingual artery are medial to the
Write a short note on lymphatic drainage of tongue. vein but not visible).
(Oct 2007, 5 Marks) (Jan 2012, 5 Marks) – Plica fimbriata, a fringed fimbriated fold of
(May 2017, 3 Marks) (June 2010, 5 Marks) mucous membrane lateral to the lingual vein
Or directed forwards and medially towards the tip
Write briefly lymphatic drainage of tongue and its of the tongue.
applied aspect. (Dec 2010, 5 Marks)
Or
Describe tongue in detail and give its applied aspect.
(Nov 2009, 10 Marks)
Or
Describe the tongue in detail. (Jan 2012, 15 Marks)
Or
Write very short answer on lymphatic drainage of
tongue. (Apr 2018, 2 Marks)
Or
Write very short answer on extrinsic muscles of tongue.
(Aug 2018, 2 Marks) Fig. 138: Dorsum of tongue

Ans. Position of Tongue

Tongue is a muscular organ situated in floor of the mouth.

Parts of Tongue
Tongue consists of following parts:
♦ Root: It is attached to styloid process and soft palate above
and to mandible and hyoid bone below. In between the
mandible and hyoid bones it is related to geniohyoid and
mylohyoid muscles.
♦ Tip: Tip of the tongue forms anterior free end which rest,
lie behind maxillary incisor teeth.
♦ Body: It is divided into two parts:
1. Dorsum:
– This is convex in all the directions. It is divided
into oral and pharyngeal parts by V-shaped sulcus
terminalis. Fig. 139: Inferior surface of tongue
 Anatomy  109

Muscles of the Tongue Extrinsic Muscles

Middle fibrous septum divides the tongue into right and left Muscle Origin Insertion Action
halves. Each half contains four intrinsic and four extrinsic
Palatoglossus From oral Descends Pulls the root
muscles. surface of inside the of tongue,
palatine palatoglossal approximate
Intrinsic Muscles aponeurosis arch to side of palatoglossal
tongue at the arches
These muscles occupy upper part of the tongue and attached to
junction of oral and closes
submucous fibrous layer and median fibrous septum. and pharyngeal oropharyngeal
parts isthmus
Intrinsic Hyoglossus From whole At the side Depresses
muscle Location Actions length of of tongue tongue,
greater cornua in between make dorsum
Superior Beneath the mucus • Shortens the tongue
as well as styloglossus convex, retracts
longitudinal membrane • Makes dorsum concave
lateral part of and inferior protruded tongue
Inferior It lies close to inferior • Shortens the tongue hyoid bone longitudinal
longitudinal surface between • Makes dorsum convex muscle
genioglossus and Styloglossus From tip and Side of tongue Pull tongue
hyoglossus part of anterior upward and
surface of backward i.e.
Transverse It extends from median • Makes tongue narrow
styloid process it retract the
septum to margins and elongated
tongue
Vertical It is found at borders of • Makes tongue broad Genioglossus From upper • Upper fibers • Depresses
anterior part of tongue and flattened genial tubercle into the tip the tongue
of mandible of tongue • Retracts the
• Middle fibers tongue
into dorsum • Pull posterior
• Lower fibers part of tongue
into hyoid forward and
bone protrude
tongue
forward. This
is also known
as life saving
muscle

Fig. 140: Intrinsic muscles of tongue

Fig. 142: Extrinsic muscles of tongue

Blood Supply

Arterial Supply of Tongue

It is chiefly supplied by tortuous lingual artery which is
branch of external carotid artery. Root of tongue is supplied
by the tonsillar artery a branch of facial artery and ascending
Fig. 141: Coronal section of tongue pharyngeal branch of external carotid artery.
110 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 143: Nerve supply of tongue
Venous Drainage
♦ Deep lingual vein is largest and principal vein of tongue.
It is visible on inferior surface of tongue.
♦ Arrangement of veins of tongue is variable. Two venae
comitants accompany lingual artery and one venae
comitant the hypoglossal nerve.
Fig. 144: Arterial supply of tongue (For colour version see Plate 2)
Applied Aspect
♦ Carcinoma of the tongue is common. This is better treated
by radiotherapy than by surgery. But since facilities for
irradiation are not always available, the affected side of the
tongue is removed surgically. All the deep cervical lymph
nodes are also removed because recurrence of malignant
♦ These veins unite at posterior border of hyoglossus to form
lingual vein which ends in internal jugular vein.
Lymphatic Drainage
♦ Tip of tongue drains bilaterally to submental nodes.
♦ Right and left halves of remaining part of anterior 2/3 of
the tongue drains unilaterally to submandibular nodes.
Few central lymphatics drain bilaterally to deep cervical
lymph nodes.
♦ Posterior 1/3 and posteriomost part drains bilaterally to upper
deep cervical lymph nodes including juglodigastric nodes.
♦ Whole lymph finally drains to jugulo-omohyoid lymph nodes.
Nerve Supply
♦ Motor supply: All extrinsic and intrinsic muscles except
palatoglossus are supplied by the hypoglossal nerve.
Palatoglossus is supplied by the cranial root of accessory
nerve through pharyngeal plexus.
♦ Sensory innervations:
• Lingual nerve is general nerve of sensation and chorda
tympani is nerve for taste for anterior 2/3 of tongue
except vallate papillae.
• For posterior 1/3 and circumvallate papillae glossophar-
yngeal nerve is nerve for both general and taste sensation.
• Posterior most part is supplied by vagus nerve through
internal laryngeal branch.
disease occurs in lymph nodes. Carcinoma of the posterior
one-third of the tongue is more dangerous due to bilateral
lymphatic spread.
♦ Sorbitrate is taken sublingually for immediate relief from
angina pectoris. It is absorbed due to rich blood supply of
tongue and by passing of portal circulation.
 Anatomy  111

Fig. 145: Lymphatic drainage of tongue (For colour version see Plate 3)

♦ Genioglossus is known as safety muscle of tongue, this is
because as this muscle get paralyzed, tongue will fall back parts by sulcus terminalis and the inferior surface is
to oropharynx and block passage of air. During anesthesia,
tongue should be pulled forward to clear the air passage.
♦ Genioglossus is the only muscle which protrudes forward.
It is used for testing integrity of hypoglossal nerve. If
hypoglossal nerve over right side gets paralyzed, tongue on
protrusion deviate to right side. Normal left genioglossus will
pull base to left side and apex will get pushed to right side.
♦ Glossitis is usually a part of generalized ulceration of
the mouth cavity (stomatitis). In certain anemias tongue
becomes bald due to atrophy of the filiform papillae. Oral or Papillary Part
♦ Presence of a rich network of lymphatics and of loose
areolar tissue in the substance of the tongue is responsible
for enormous swelling of the tongue in acute glossitis. The
tongue fills up the mouth cavity and then protrudes out of it. arch, each margin consists of 4 to 5 vertical folds known as foliate
♦ Undersurface of the tongue is a good site for observation
of jaundice.
♦ In unconscious patients tongue may fall back and obstruct
air passages. This can be prevented either by lying the
patient on one side with head down or by keeping the
tongue pulled out mechanically.
♦ In patients with grand mal epilepsy tongue is commonly
bitten between the teeth during the attack.
Q.2. Describe the tongue under the following headings:
(Sep 2007)
a. Gross anatomy (3 Marks)
b. Histology (2 Marks)
c. Development and anomalies (3 Marks)
Ans. Gross Anatomy
Tongue consists of root, a tip, and a body which is
divided into a curved upper surface of dorsum and an
inferior surface.
Dorsum of tongue is divided into oral and pharyngeal
confined to the oral part.
Tip of the tongue forms the anterior free end.
Dorsum of the tongue is convex from all aspects. It is
divided into an
a. An oral part, i.e. anterior two-third
b A pharyngeal part, i.e. posterior one-third part
c. Posteriomost part.
It lies on the floor of the mouth. Its margins are free and in
contact with the gums and teeth. In front of the palatoglossal
papillae. Superior surface of the oral part consists of median
furrow and is covered with papillae which make it rough. The
inferior surface is covered with a smooth mucous membrane,
which shows a median fold known as frenulum linguae. On
either side of the frenulum there is a prominence produced by
the deep lingual veins. More laterally there is a fold known as
plica fimbriata which is directed forwards and medially towards
the tip of the tongue.
Pharyngeal (lymphoid) Part of the Tongue
It lies behind the palatoglossal arches and sulcus terminalis.
Posterior surface of this part of tongue forms the anterior wall
of oropharynx and is also known as base of tongue. Mucous
membrane has no papillae, but consists of many lymphoid
follicles which collectively constitute lingual tonsil. Mucous
glands are also present.
112 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Posteriomost Part Connective Tissue

Posteriomost part of the tongue is connected to the epiglottis It develops from local mesenchyme.
by three folds of mucous membrane which are known as
median glossoepiglottic fold and the right and left lateral Anomalies of Tongue
glossoepiglottic folds. On each side of the median fold there Following are the anomalies of tongue:
is a depression known as vallecula. The lateral folds separate ♦ Aglossia: Absence of tongue
vallecula from the piriform fossa. ♦ Ankyloglossia: Tongue is adherent to palate in
ankyloglossia superior and tongue is adherent to floor of
mouth in ankyloglossia inferior.
♦ Bifid tongue: In this, there is cleavage of tongue because
of lack of fusion of lateral halves of tongue.
♦ Microglossia: Tongue too small in size
♦ Macroglossia: Tongue is too large in size
♦ Hemiglossia: Suppression of one lingual swelling of tongue
♦ Median rhomboid glossitis: It occur due to incomplete
desent of tuburculum impar and entrapment of portion
which lies between lateral half of the tongue. In this, there
is absence of papilla in center of tongue.
Fig. 146: Dorsum of tongue Q.3. Write a short note on muscle movement and innervation
of tongue.
(Apr 2007, 5 Marks)
Or
Enumerate the muscles of tongue and their nerve
supply.
(March 2006, 5 Marks)
Or
Name the muscles of tongue. (Aug 2016, 2 Marks)
Or
Write the name of extrinsic muscles of tongue.
(Oct 2016, 2 Marks)
Enumerate muscles of tongue. (Do not describe)
(Feb 2013, 2 Marks)
Fig. 147: Inferior surface of tongue
Ans. Tongue: Tongue is a muscular organ situated in the floor
Histology of mouth.
• It is associated with the functions of taste, speech,
For histology of tongue refer to Ans 22 in SECTION HISTOLOGY. mastication, and deglutition.
• Tongue is divided into right and left halves by a
Development of Tongue
middle fibrous septum.
Epithelium • Each half contains four intrinsic and four extrinsic
♦ Anterior two-third: It develops from two lingual swellings muscles.
which arise from first branchial arch. So it is supplied by
Muscles of Tongue
lingual nerve of first arch and chorda tympani of second
arch. ♦ Intrinsic muscles:
♦ Posterior one-third: It develops from cranial part of • Superior longitudinal
hypobranchial eminence, i.e. from third arch. So it is • Inferior longitudinal
supplied by the glossopharyngeal nerve. • Transverse
♦ Posteriormost part develops from fourth arch. It is supplied • Vertical.
by the vagus nerve. ♦ Extrinsic muscles:
• Genioglossus
Muscles • Hyoglossus
They develop by occipital myotomes which are supplied by • Styloglossus
the hypoglossal nerve. • Palatoglossus.
 Anatomy  113

Muscle Movement of Tongue Q.6. Name different types of lingual papillae.

(May 2017, 3 Marks)
Intrinsic muscles Muscle movement
Ans. Following are the lingual papillae:
Superior longitudinal Make tongue short and dorsum concave
• Vallate or circumvallate papillae: They are large in
Inferior longitudinal Make tongue short and dorsum convex size and 1 to 2 mm in diameter. They lie immediately
Transverse Make tongue narrow and elongated in front of the sulcus terminalis. Each papilla is a
Vertical Tongue become broad and flattened cylindrical projection which is surrounded by the
circular sulcus. Walls of papilla consist of taste buds.
Extrinsic muscles Muscle movement
• Fungiform papillae: They are numerous near the
Genioglossus Protrude the tongue tip as well as margins of tongue, some of them are
Hyoglossus Depress the tongue scattered over dorsum. These papillae are smaller
Styloglossus Tongue retraction than vallate papillae but larger than filiform papillae.
Each papilla has narrow pedicle and large rounded
Palatoglossus Tongue elevation
head.
Innervations of Muscles of Tongue • Filiform papillae or conical papillae: They cover
presulcal area of dorsum of tongue and provide it
Refer to the heading nerve supply in Ans 1 of same chapter a velvety appearance. They are smallest and most
Q.4. Write sensory, gustatory and motor nerve supply of numerous of all lingual papillae of tongue. Each of
tongue. (Dec 2010, 4 Marks) them is pointed and is covered by keratin. Apex get
Ans. For sensory and motor supply refer to Ans 1 of same split into filamentous processes.
chapter. • Foliate papillae: They are very few in number. They
have in constant vertical grooves and ridges near
Gustatory Innervation margin in front of the sulcus terminalis. They are
Gustatory innervation carries taste sensations. rudimentary in humans.
Q.7. Write a short note on pathway of taste.
Area Gustatory innervation
(Sep 2017, 3 Marks)
Anterior 2/3 Chorda tympani branch of facial nerve (VII nerve)
Ans. Taste sensation from anterior two-third of the tongue
Posterior 1/3 Glossopharyngeal nerve (IX nerve) except from vallate papillae is carried by chorda tympani
Posteriomost part Vagus nerve (X nerve) of the tongue branch of facial nerve upto geniculate ganglion. The
central process reaches to tractus solitarius inside
Q.5. Answer in brief on tongue tie. (Feb 2016, 2 Marks) medulla.
Ans. Tongue tie is also known as ankyloglossia.
• Tongue tie is the condition which arises when the
inferior frenulum attaches to the bottom of tongue and
subsequently restricts free movements of the tongue.
• It can cause feeding problems in infants.
• It causes speech defects specially articulation of the
sounds l, r, t, d, n, th, sh and z.
• It leads to persistent gap between the mandibular
incisors.

Fig. 149: Pathway of taste

• Taste sensation from posterior one-third of the

tongue include circumvallate papillae is carried by
glossopharyngeal nerve upto inferior ganglion. The
Fig. 148: Tongue tie central process reaches to tractus solitarius.
114 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Taste from posteriormost part of the tongue and
epiglottis travels via vagus nerve upto the inferior
ganglion of vagus. The central process reaches to
tractus solitarius.
• After relay in tractus solitarius, solitario thalamic
tract is formed which becomes part of trigeminal
leminiscus and reaches to posteroventromedial
nucleus of thalamus of contralateral side. Another
relay from here takes them to the lowest part of post
central gyrus which is the specific area for taste.
18. THE EAR
Q.1. Write a short note on tympanic membrane.
(Mar 1997, 4 Marks)
Ans. • It is a thin, translucent partition which lies between
external acoustic meatus and middle ear.
• It is oval in shape and is placed obliquely at an angle
of 55° with floor of meatus.
• Membrane has outer and inner surface.
• Outer surface of membrane is lined by thin skin and
is concave.
• Inner surface provides attachment to handle of
malleus which extends upto its center. Inner surface
is convex.
A Venous Drainage
Fig. 150: A. External surface of tympanic membrane;
B. Inner surface of tympanic membrane
• Point of maximum convexity lies at tip of the handle
of the malleus and is known as umbo.
• Membrane is thick at the circumference and is fixed
to tympanic sulcus of temporal bone on tympanic
plate. Superiorly sulcus is deficient.
• At sulcus membrane is attached to tympanic notch.
• At ends of the notch two bands, i.e. anterior and
posterior malleolar folds get prolonged to lateral
process of malleus.
• Greater part of tympanic membrane is tightly
attached and is known as pars tensa.
• Part between two malleoler folds is loose and is
known as pars flaccid.
• Chorda tympani crosses pars flaccid and this part is
more liable to rupture as compared to pars tensa.
• Tympanic membrane is held tense by the inward
pull of tensor tympani muscle which get inserted
in upper end of handle of malleus.
Structure
Tympanic membrane consists of following three layers:
1. The outer auricular layer of skin.
2. The middle fibrous layer made up of superficial radiating
fibers and deep circular fibers.
3. The inner mucous layer is lined by a low ciliated columnar
epithelium.
Blood Supply
♦ Outer surface supplied by the deep auricular branch of
maxillary artery.
♦ Inner surface is supplied by anterior tympanic branch
of maxillary artery and by posterior tympanic branch of
stylomastoid branch of posterior auricular artery.
Veins from outer surface drains to external jugular vein. Those
from inner surface drains into transverse sinus and into venous
plexus around auditory tube.
Fig. 151: Inner surface of tympanic membrane
 Anatomy  115

Lymphatic Drainage • Two limbs or crura: Anterior one is shorter and less
curved while posterior one is longer which diverge
Lymphatics pass to preauricular and retropharyngeal lymph
from neck and are attached to the footplate.
nodes.
• Footplate, a footpiece or base: It is oval in shape and
Nerve Supply fits into the fenestra vestibuli.

♦ Outer surface: Anteroinferior part is supplied by auricu- Joints of Ossicles

lotemporal nerve and posterosuperior part by auricular
♦ Incudomalleolar joint is a saddle joint.
branch of vagus nerve along with communicating branch
♦ Incudostapedial joint is a ball and socket joint. Both of
from facial nerve.
them are synovial joints. They are surrounded by capsular
♦ Inner surface: It is supplied by tympanic branch of
ligaments. There are three accessory ligaments for malleus,
glossopharyngeal nerve via tympanic plexus.
and one each for incus and stapes which stabilize the
Q.2. Write a short note on auditory ossicles. ossicles. All ligaments are extremely elastic.
(Feb 2002, 3 Marks)
Ans. Auditory ossicles are also known as ear ossicles.
There are three auditory ossicles, i.e. malleus, incus and
stapes.

Malleus
♦ It is so called because it resembles as a hammer.
♦ Malleus is the largest and most laterally placed ossicle.
♦ It consists of following parts:
• Round head: It lies in epitympanic recess. Head
articulates posteriorly with body of incus. Head
provide attachment to superior and lateral ligaments.
• Neck: It lies against pars flaccida and is related
medially to chorda tympani nerve.
• Anterior process: It is connected to the petrotympanic
fissure by the anterior ligament. Fig. 152: Ossicles of ear
• Lateral process: It projects from upper end of handle
and gives attachment to malleolar folds.
Q.3. Write a short note on boundaries of middle ear.
• Handle: It extends downwards, backward and
medially, it is attached to upper half of tympanic (Apr 2010, 5 Marks)
membrane. Ans. Boundaries of middle ear are as follows:

Incus or Anvil Roof or Tegmental Wall

♦ It is known as anvil because it resembles as an anvil which
is used by Blacksmiths.
♦ Incus resembles a molar tooth and consists of following
parts:
• Body: It is large and has an articular surface which is
directed forwards. It articulates along with the head
of malleus.
• Long process: It projects downwards just behind and
parallel along with handle of malleus. Its tip bears
a lentiform nodule which is directed medially and
articulates with head of stapes.
Stapes
♦ Stapes is so called because its shaped is like a stirrup.
♦ This is the smallest, and the most medially placed ossicle.
♦ It consists of following parts:
• Small head: It consists of a concave facet which
articulates with lentiform nodule of the incus.
• Narrow neck: This provides insertion, posteriorly, to
the thin tendon of the stapedius.
♦ It separates middle ear from middle cranial fossa.
♦ This wall is formed by thin plate of bone known as tegmen
tympani. This plate is prolonged backwards as roof of canal
for tensor tympani.
Floor of Jugular Wall
♦ It is formed by thin plate of bone which separates middle
ear from superior bulb of internal jugular vein. This plate
is the part of temporal bone.
♦ Near medial wall, floor presents tympanic canaliculus
which transmit tympanic branch of glossopharyngeal
nerve to medial wall of middle ear.
Anterior or Carotid Wall
♦ It is narrow because of approximation of medial and lateral
walls and due to descendent of roof.
♦ Uppermost part of anterior wall consists of opening of
canal for tensor tympani.
♦ Middle part consists of opening of auditory tube.
116 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 153: Boundaries of middle ear

♦ Inferior part of wall is formed by thin plate of bone which forms
posterior wall of carotid canal. This thin plate of bone separates
middle ear from internal carotid artery. The plate is perforated
by superior and inferior sympathetic caroticotympanic nerves
and tympanic branch of internal carotid artery.
♦ Bony septum between canals for tensor tympani and
auditory tube continued posteriorly on medial wall as
curved lamina known as processes cochleariformis.
Posterior or Mastoid Wall
It presents these features from above to downward:
♦ Superiorly there is presence of an opening or aditus via
which epitympanic recess communicates with mastoid or
tympanic antrum.
♦ Fossa incudis is a depression which lodges short process
of incus.
♦ Conical projection known as pyramid lie near junction of
posterior and medial wall. It consists of an opening at its
apex for passage of tendon of stapedius muscle.
♦ Lateral to the pyramid and near the posterior edge of
tympanic membrane lies posterior canaliculus for chorda
tympani nerve via which nerve enters middle ear cavity.
♦ Promontory: This is a rounded bulging which is produced
by first turn of cochlea. This is grooved by tympanic plexus.
♦ Fenestra vestibuli: It is an oval opening posterosuperior
to promontory. It leads inside vestibule of an internal ear
and is closed by footplate of stapes.
♦ Prominence of facial canal: It run backward just above the
fenestra vestibule and reach lower margin of aditus. Canal
now descend behind posterior wall to end at stylomastoid
foramen.
♦ Fenestra cochleae: It is round opening at bottom of
depression posteroinferior to promontory. It open inside
scala tympani of cochlea and is closed by secondary
tympanic membrane.
♦ Sinus tympani: It is a depression behind promontory,
opposite to ampulla of posterior semicircular canal.
♦ Processus cochleariformis.
♦ Prominance of lateral semicircular canal above facial canal.
Q.4. Draw a labeled diagram of lateral wall of middle ear.
(Mar 1998, 4 Marks)
Ans.

Lateral or Membranous Wall

♦ It separates middle ear from external acoustic meatus
and is formed mainly by tympanic membrane along
with tympanic ring and sulcus and partly by squamous
temporal bone.
♦ Near the tympanic notch, there are two small apertures,
i.e. petrotympanic fissure which lie in front of upper end
of bony rim and anterior canaliculus for chorda tympani
nerve which lie either in fissure or in front of it. Chorda
tympani nerve leaves middle ear via this canaliculus to
emerge at base of skull.
Medial Wall
It separates middle ear from the internal ear. It shows following
features: Fig. 154: Lateral wall of middle ear

Q.5. Name the contents of middle ear cavity.
(Aug 2016, 2 Marks)
Ans. Following are the contents of middle ear cavity:
• Three small bones or ossicles, i.e. malleus, incus
and stapes. Upper half of malleus and greater part
of incus remain in epitympanic recess.
• Ligaments of ear ossicles
• Two muscles, i.e. tensor tympani and stapedius
• Vessels supplying and draining middle ear
• Nerves i.e. chorda tympani and tympanic plexus
• Air.
19. MISCELLANEOUS
Q.1. Give explanation of dryness of mouth.
(Feb 2013, 5 Marks)
Ans. It is also known as xerostomia.
It is the dryness of mouth, which is a clinical manifestation
of salivary gland dysfunction.
Etiology
1. Radiation induced: Ionizing radiation to head and neck
region for treatment of cancer results in pronounced
changes in salivary glands located within primary beam.
2. Pharmacologically induced xerostomia: Drugs causes
decreased salivary flow are anticonvulsants, antiemetics,
antihistamines, antihypertensives and antispasmodics.
3. Systemic alterations resulting in xerostomia: Certain
deficiency states like pernicious anemia, iron deficiency
anemia and deficiency of vitamin A and hormone can
cause xerostomia.
4. Fluid loss associated with hemorrhage, sweating, diarrhea,
vomiting and diabetes insipidus.
5. Developmental abnormalities of salivary gland.
6. Systemic disease.
Clinical Features
A. Effect of xerostomia on oral functions:
• Increased thirst, increased uptake of fluid while eating.
• Frequent use of chewing gums and consumption of
sour candy.
• Burning and tingling sensations in mouth.
• Painful salivary gland enlargement.
• Oral infections, intolerance to dental appliances.
B. Effect of xerostomia on normal functions:
• Blurred vision and ocular dryness, itching, burning
in the eyes.
• Dryness of pharynx and skin. Itching and burning
sensation of vagina.
C. Clinical signs of xerostomia:
• Dryness of lining of oral mucosa.
• Tongue blade may adhere to soft tissues.
• Increase incidence of dental caries.
• Candidiasis—pseudomembranous.
• Angular chelitis.
Anatomy  117
Management
I. Stimulation of salivary production:
a. Local stimulation: By chewing gums, mints, paraffin
and citric acid containing lozenges and rinses.
b. Systemic stimulation.
c. Bromhexine 1/m/4–8 mg TDS.
d. Amethole trithionate 1/m/25 mg TDS.
e. Pilocarpine 1/m/5 mg TDS.
II. Symptomatic treatment: Salivary substitutes are given.
III. Suggestion to patient having xerostomia.
a. Try very sweet or tart foods and beverages such as
lemonade.
b. Try sucking ice cubes.
c. Use soft and liquid foods.
d. Avoid dry foods, chocolate, pastry.
e. Avoid over salty foods.
f. Have a sip of water in every few minutes which helps
in swallowing.
Q.2. Give explanation of lockjaw. (Feb 2013, 5 Marks)
Ans. Lockjaw is also known as tetanus
It is a disease of nervous system characterized by
intensive activity of motor neuron and resulting in severe
muscles spasm.
Mechanism of Lockjaw
♦ Clostridium tetani enters through large or small or even
unrecognized wound. Deep, infected punctures are most
susceptible as organism thrives best anaerobically.
♦ Exotoxins such as tetanospasmin and tetanolysin are
produced by bacteria.
♦ Tetnospasmin released by the bacteria travels along
perineural sheath, lymphatics along the nerve and via
blood to cause its effects.
♦ Tetanospasmin cleave into light part, i.e. fragment A and
heavy part, i.e. fragment B.
♦ Fragment B binds to nerve receptors and fragment A blocks
the neurotransmitter.
♦ Fragment A blocks release of inhibitory neurotransmitters,
i.e. glycine and GABA. Loss of inhibition alters the firing
rate of alpha motor neuron leading to lockjaw due to
rigidity and spasm of muscles, sympathetic overactivity.
♦ Tetanospasmin rapidly bind to gangliosides at presynaptic
membrane of inhibitory motor nerve endings.
Q.3. Give explanation about radiating pain of teeth.
(Feb 2013, 5 Marks)
Ans. Radiating pain is also known as referred pain. The pain
sensation produced in some parts of body is felt in other
structures away from place of development. This is called
referred pain or radiating pain.
Mechanism of Radiating Pain
Dermatomal rule: Pain is referred to a structure, which is
developed from same dermatome from which pain producing
structure is developed. This is dermatomal rule.
A dermatome includes all the parts and structure of body.
118 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
For example, heart and inner aspect of left arm originate from
some dermatome so, pain in heart is referred to left arm.
Examples of referred pain:
1. Pain in ovary is referred to umbilicus
2. Pain in testis is referred to abdomen
3. Pain in diaphragm is referred to right shoulder
4. Renal pain is referred to loin
5. Tooth pain felt in ear.
Q.4. Write short note on classification of glands.
(Mar 2013, 3 Marks)
Ans. Following is the classification of glands:
I. According to mode of secretion
– Exocrine glands: Secretions are carried via ducts
to target cells
– Endocrine glands: Secretions are secreted
directly in circulatory system
– Paracrine glands: Their secretions diffuse locally
to cellular targets in an immediate surrounding.
II. According to mechanism of secretion
– Merocrine glands: Secretions are packed into
vesicles. Vesicle membrane fuses with plasma
membrane to release their contents to exterior,
e.g. simple sweat glands
– Apocrine glands: In these glands some of apical
cytoplasm is lost along with secretion, e.g.
mammary glands
– Holocrine glands: Cells are filled with secretory
products and entire cell disintegrate to release
its secretion, e.g. sebaceous glands.
III. Structural and functional classification
– Unicellular glands: They are made of single cells
which are interspersed between nonsecretory
epithelial lining, e.g. goblet cell
– Multicellular glands: It consists of many cells
in sheets or clusters with common secretory
function, e.g. mucous lining of stomach
– Simple tubular glands without ducts: Cells
are arranged in a tubular fashion and open on
epithelial surface without a duct.
– Simple tubular glands with duct: Secreting cells
are arranged in tubular shaped structures with
upper nonsecretory parts which act as ducts.
– Simple branched tubular glands: Consists of
single duct with branched tubular arrangement
of secretory cells.
– Simple coiled tubular glands: Secretory part is
coiled and they have single duct
– Simple acinar or alveolar glands: Secretory part
is flask shape with connecting duct.
– Compound glands: In these glands ducts are
branched. These glands may be branched
tubuloalveolar or branched tubular or branched
alveolar type according to shape of secretory
part.
IV. According to secretion
– Mucous secreting or mucus glands: They secrete
mucous, e.g. sublingual salivary gland.
– Serous glands: They secrete serum, e.g. parotid
gland.
 FUNCTIONAL ANATOMY OF MUSCULOSKETAL SYSTEM

1. SKELETON In Long Short Bones

♦ Nutrient artery enters inside middle of shaft and divides
Q.1. Write short note on blood supply of bone. to form plexus.
(Aug 2005, 4 Marks) ♦ Periosteal artery supplies to major part of bone and can
Ans. replace the nutrient artery.

Arterial Supply In Short Bones

In Long Bone They are supplied by the numerous periosteal vessels which
enter inside their nonarticular surfaces.
Blood supply of a long bone is derived from the following
sources:
In Vertebra
Nutrient Artery ♦ In vertebra, body is supplied by anterior and posterior
♦ This artery enters the shaft via nutrient foramen, runs vessels.
obliquely through cortex, and divides into ascending and ♦ Vertebral arch is supplied by the large vessels entering the
descending branches inside medullary cavity. bases of transverse processes.
♦ Each of the branches divides into number of small parallel ♦ Bone marrow is drained by two large basivertebral veins.
channels which get terminate inside adult metaphysis by ♦ Foramina lie over posterior aspect of body of vertebrae.
anastomosing with epiphysial, metaphysial and periosteal
arteries. Rib
♦ Nutrient artery supplies medullary cavity, inner two-third
It is supplied by the nutrient artery which enters just beyond
of cortex and metaphysis.
the tubercle and periosteal arteries.
♦ Nutrient foramen is directed away from growing end of
bone.
Venous Drainage
Periosteal Arteries There are numerous veins and they are larger in the cancellous,
♦ They are numerous beneath muscular and ligamentous red marrow containing bones (e.g. basivertebral veins). In the
attachments. compact bone, they accompany arteries in the Volkmann's
♦ These arteries ramify beneath the periosteum and enter canals.
inside Volkmann's canals to supply the outer 1/3 of cortex.
Epiphysial Arteries
♦ These arteries are derived from periarticular vascular
arcades also known as circulus vasculosus which is found
over nonarticular bony surface.
♦ Out of these multiple vascular foramina in this region, only
a few admit the arteries (epiphysial and metaphysial), and
rest are venous exits.
♦ Number as well as size of these foramina can give an idea
of relative vascularity of the two ends of a long bone.
Metaphysial Arteries
♦ They are derived from neighboring systemic vessels.
♦ These arteries pass directly into the metaphysis and
reinforce metaphysial branches from the primary nutrient
artery.
♦ Inside miniature long bones, infection begins in middle
of shaft rather than at the metaphysis because nutrient
artery breaks up into a plexus immediately on reaching
medullary cavity. In adults, the chances of infection are
decreased because nutrient artery is mostly replaced by
the periosteal vessels. Fig. 155: Blood supply of long bone
120 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.2. Describe in brief epiphysis. (Nov 2009, 5 Marks)
Ans. Epiphysis is the rounded end of a long bone, at its joint
with adjacent bone.
• At the joint, epiphysis is covered with articular
cartilage; below that covering is a zone similar to
the epiphyseal plate, known as subchondral.
• It is the part of bone which ossifies from secondary
center
• Epiphysis is filled with red bone marrow, which
produces erythrocytes (red blood cells).
Fig. 156: Epiphysis
Types
There are four types of epiphysis:
1. Pressure epiphysis: Region of the long bone that forms the
joint is called pressure epiphysis. For example the head of
femur which is a part of the hip joint complex is a pressure
epiphyses. These epiphyses assists in transmitting the
weight of the human body and are the regions of the bone
which is under pressure during movement, or locomotion
hence they are named pressure epiphyses.
2. Traction epiphyses: Regions of the long bone which
are nonarticular, i.e. not involved in the joint formation
is called as traction epiphysis. It is mainly formed due
to pull of muscles. Traction epiphyses ossify later than
the pressure epiphyses. Examples of these epiphyses are
tubercles of humerus (greater tubercle and lesser tubercle),
trochanters of the femur (both greater and lesser), etc.
3. Atavistic epiphyses: As Homo Sapiens evolved from
being four legged to two legged, their lower limbs became
stronger and hands became free from being actively
involved in locomotion. This fused certain bones together
due to the change in functionality over generations.
These type of fused bones are called as Atavistic. These
independent bones which get attached to host bone
secondarily to receive nutrition. Example of this is the
coracoid process of scapula which has been fused in
humans but separate in four legged animals.
4. Aberrant epiphysis: These epiphysis are deviations from
the normal and are not always present. For example, the
epiphyses at the head of the first metacarpal bone.
Q.3. Classify bones. (Feb 2013, 5 Marks)
Ans. Following is the classification of bones:
According to Shape
♦ Long bones: Each of the long bone consists of an elongated
shaft (diaphysis) and two expanded ends (epiphyses)
which are smooth and articular. Shaft typically consists of
three surfaces separated by 3 borders, a central medullary
cavity, and a nutrient foramen directed away from the
growing end. Examples:
• Typical long bones like humerus, radius, ulna, femur,
tibia and fibula
• Miniature long bones have only one epiphysis like
metacarpals, metatarsals, and phalanges
• Modified long bones have no medullary cavity like
clavicle.
♦ Short bones: Their shape is usually cuboid or scaphoid.
Examples are tarsal and carpal bones.
♦ Flat bones: They resemble as shallow plates and form
boundaries of certain body cavities. Examples are bones
in the vault of the skull, ribs, sternum and scapula.
♦ Irregular bones: Examples are vertebra, hip bone, and
bones in the base of skull.
♦ Pneumatic bones: Certain irregular bones which consists
of large air spaces which are lined by epithelium. Examples
are maxilla, sphenoid, ethmoid, etc.
♦ Sesamoid bones: These are bony nodules which are found
embedded inside the tendons or joint capsules. They have
no periosteum and ossify after birth. Examples are patella,
pisiform, fabella, etc.
♦ Accessory (supernumerary) bones: They are not always
present. These may occur as ununited epiphyses developed
from extra centers of ossification. Examples: sutural bones,
lateral tubercle of talus, tuberosity of 5th metatarsal, etc.
♦ Heterotopic bones: Bones sometimes develop in soft
tissues, e.g. horse riders develop bones in adductor muscles
(rider's bones).
Developmental Classification
♦ Membrane (dermal) bones: These bones ossify inside
the membrane (intramembranous or mesenchymal
ossification), and are derived from mesenchymal
condensations. Examples are bones of the vault of skull
as well as facial bones.
• Cartilaginous bones ossify inside cartilage (intra-
cartilaginous or endochondral ossification), and
are derived from preformed cartilaginous models.
Examples are bones of limbs, vertebral column and
thoracic cage.

• Membrano-cartilaginous bones ossify partly inside
membrane and partly inside the cartilage. Examples:
clavicle, mandible, occipital, temporal, sphenoid.
♦ Somatic bones: Most of the bones are somatic.
♦ Visceral bones: These bones develop from pharyngeal
arches. Examples are hyoid bones, part of mandible and
ear ossicles.
Regional Classification
♦ Axial skeleton: It consists of skull, vertebral column, and
thoracic cage.
♦ Appendicular skeleton: It consists of bones of limbs.
Structural Classification
♦ Macroscopically, the architecture of bone may be compact
or cancellous:
• Compact bone: It is dense in texture, but is extremely
porous. It is best developed in the cortex of the long
bones. This is an adaptation to bending and twisting
forces.
• Cancellous or spongy, or trabecular bone: It is open
in texture and is made up of a meshwork of trabeculae
between which are marrow containing spaces.
Trabecular meshworks are of three primary types, i.e.:
1. Meshwork of rods
2. Meshwork of rods and plates
3. Meshwork of plates.
Cancellous bone is an adaptation to the compressive
forces.
♦ Microscopically: Bone is of five types, namely lamellar,
woven, fibrous, dentine and cementum.
1. Lamellar bone: Most of the mature human bones,
either compact or cancellous consist of thin plates of
bony tissue known as lamellae. These are arranged
in piles inside a cancellous bone, but in concentric
cylinders, i.e. Haversian system or secondary osteon
inside a compact bone.
2. Woven bone: This is seen in fetal bone, fracture repair
and in cancer of bone
3. Fibrous bone: This is found in young fetal bones, but
is common in reptiles and amphibia.
4. Dentine
5. Cementum occurs inside the teeth.
Q.4. Write short note on osteogenesis. (June 2010, 5 Marks)
Ans. Bones are first laid down as mesodermal (connective ♦
tissue) condensations. Conversion of mesodermal models
into bone is called intramembranous or mesenchymal
ossification, and the bones are called membrane (dermal)
bones.
However, mesodermal stage may pass through
cartilaginous stage by chondrification during 2nd month
of intrauterine life. Conversion of cartilaginous model
into bone is called intracartilaginous or endochondral
ossification, and such bones are called cartilaginous
bones.
Ossification takes place by centers of ossification, each
one of which is a point where laying down of lamellae
Anatomy  121
(bone formation) starts by the osteoblasts situated on the
newly formed capillary loops. The centers of ossification
may be primary or secondary. The primary centers appear
before birth usually during 8th week of intrauterine
life; the secondary centers appear after birth, with a few
exceptions of lower end of femur and upper end of tibia.
Many secondary centers appear during puberty.
A primary center forms diaphysis, and the secondary
centers form epiphyses. Fusion of epiphyses with the
diaphysis starts at puberty and is complete by the age
of 25 years, after which no more bone growth can take
place. The law of ossification states that secondary centers
of ossification which appear first are last to unite. The
end of a long bone where epiphysial fusion is delayed
is called the growing end of the bone.
Growth of a Long Bone
♦ Bone grows in length by multiplication of cells in the
epiphysial plate of cartilage.
♦ Bone grows in thickness by multiplication of cells in the
deeper layer of periosteum.
♦ Bones grow by deposition of new bone on the surface and
at the ends. This process of bone deposition by osteoblasts
is called appositional growth or surface accretion.
However, in order to maintain the shape the unwanted
bone must be removed. This process of bone removal by
osteoblasts is called remodelling. This is how marrow
cavity increases in size.
2. JOINTS
Q.1. Write in brief on fibrous joints.
(Aug/Sep 1998, 4 Marks) (Dec 2010, 5 Marks)
Ans. In fibrous joints bones are joined by fibrous tissue.
Fibrous joints are either immovable or permit slight
degree of movement.
Fibrous joint are grouped into three types:
1. Sutures
2. Syndesmosis
3. Gomphosis
Sutures
They are present only inside the skull.
♦ Two of the bones get separated by the connective tissue.
♦ Sutural side of each of the bone is covered by layer of
osteogenic cells or cambial layer, covered by the capsular
layer which is continuous with periosteum.
♦ Area between the bones reduces with the age, so osteogenic
surfaces get opposed.
♦ Sutures become synostose and become obliterated as the
age advances.
♦ Sutures are peculiar to skull, and are immovable.
♦ According to the shape of bony margins, the sutures can be:
• Plane, e.g. internasal suture
• Serrate, e.g. interparietal suture
122 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Squamous, e.g. temporoparietal suture
• Denticulate, e.g. lambdoid suture
• Schindylesis type, e.g. between rostrum of sphenoid
and upper border of vomer.
♦ Neonatal skull consists of fontanelles and these are
temporary in nature. At six specific points over sutures
inside the newborn skull are present membrane filled gaps
known as "fontanelles". These membrane filled gaps allow
underlying brain to increase in size. All these fontanelles
become bone by 18 months.
Fig. 157: Sutural joint
Syndesmosis
This is the fibrous union in between the bones. This can
be represented as interosseous ligament as seen in inferior
tibiofibular joint or as a tense membrane in posterior part of
sacroiliac joint.
Fig. 158: Syndesmosis
Gomphosis
♦ Gomphosis is a type of fibrous joint.
♦ It is a peg and socket junction between tooth and its socket.
♦ Periodontal ligament connects dental element to alveolar
nerve.
♦ Gomphosis is an articulation between two bones.
Fig. 159: Gomphosis
(For colour version see Plate 3)
Q.2. Write a short note on characteristics of synovial joint.
(Sep 2004, 5 Marks)
Ans.
♦ Articular surfaces are covered by hyaline (articular)
cartilage which is a fibrocartilage in certain membrane
bones. Articular cartilage is avascular, nonnervous and
is elastic. It is lubricated with synovial fluid, cartilage
provides slippery surfaces for free movements such as 'ice
on ice'. Surface of articular cartilage shows fine undulations
which are filled with the synovial fluid.
♦ Between articular surfaces there is presence of a joint
cavity which is filled with synovial fluid. The cavity can
be partially or completely subdivided by an articular disc
or meniscus.
♦ Synovial joint is surrounded by an articular capsule which
is formed of a fibrous capsule which is lined by synovial
membrane. Due to its rich nerve supply, fibrous capsule is
sensitive to stretches imposed by movements. This sets up
most appropriate reflexes to protect the joint from any type
of sprain. This is known as 'watch-dog' action of capsule.
Fibrous capsule is often reinforced by:
• Capsular or true ligaments which represent thickenings
of fibrous capsule.
• The accessory ligaments which can be intra or
extracapsular.
♦ Synovial membrane completely lines the interior of the
joint except for the articular surfaces covered by hyaline
cartilage. The membrane produces a slimy viscous fluid
known as synovial or synovial fluid which provides
lubrication to joint and nourishes articular cartilage.
Viscosity of fluid is because of hyaluronic acid which is
secreted by cells of synovial membrane.
♦ Varying degrees of movements are permitted by the
synovial joints.
 Anatomy  123

Synovial Joints According to Structural Classification of

Joints
♦ Plane synovial joints: In these joints articular surfaces are
more or less flat. These joint permit gliding movements
in various directions. E.g. intercarpal joints, intertarsal
joints, joints between articular processes of vertebrae,
cricothyroid joint, cricoarytenoid joint etc.
♦ Hinge joints: In these type of synovial joints articular
surfaces are of pulley-shaped. There are strong collateral
ligaments. Movements are permitted in one plane only at
around a transverse axis. Examples are elbow joint, Ankle
joint and interphalangeal joints.
♦ Pivot (trochoid) joints: In these type of synovial joints
Fig. 160: Synovial joint articular surfaces consists of a central bony pivot (peg)
which is surrounded by an osteoligamentous ring.
Q.3. Write a short note on gomphosis and arteries supplying Movements are permitted only in one plane at around a
various teeth. (Feb 2005, 15 Marks) vertical axis. Examples are superior and inferior radio-
Ans. The answer of gomphosis is given in same chapter in ulnar joints and median atlanto-axial joint.
Ans 1 and the answer of arteries supplying various teeth ♦ Condylar (bicondylar) joints: In these synovial joints
is given in chapter THE MOUTH AND PHARYNX in articular surfaces consists of two distinct condyles (convex
Ans 11. male surfaces) which fit inside reciprocally concave female
surfaces (which are also known as condyles). These
Q.4. Write a short note on synovial joints. joints permit movements mainly in one plane at around
(Sep 2006, 3 Marks) a transverse axis, but partly in another plane (rotation)
Ans. Synovial joints are also known as diarthrosis. around a vertical axis. Examples are knee joint and right
♦ Synovial joints are the freely movable joints, but in some and left temporomandibular joint.
of them movement is restricted due to the shape of their ♦ Ellipsoid joints: In these type of synovial joints articular
articulating surfaces and by ligaments which hold the bones surfaces include an oval, convex, male surface which fit
together. Such ligaments are of elastic connective tissue. into an elliptical, concave female surface. Free movements
♦ A synovial joint consists of fluid-filled cavity between its should be permitted around both axes, flexion and
articular surfaces which get covered by articular cartilage. extension around the transverse axis and abduction as well
Fluid present is known as synovial fluid. Synovial fluid is as adduction around the anteroposterior axis. Combination
produced by synovial membrane which lines the cavity of movements produces circumduction. Typical rotation
except for the actual articular surfaces and covers any around a third (vertical) axis does not occur. Examples
ligaments or tendons which pass through the joint. are wrist joint, metacarpophalangeal joints and atlanto-
♦ Synovial fluid basically acts as a lubricant. occipital joints.
♦ The form of articulating surfaces controls the type of ♦ Saddle (sellar) joints: In these synovial joints articular
movement which occurs at any joint. surfaces are reciprocally concavo-convex. Movements
are similar to those which are permitted by an ellipsoid
Classification of Synovial Joints According to Functional
joint, with addition of some of rotation (conjunct rotation)
Classification of Joints
around a third axis which cannot occur independently.
Type of joint Movement Examples are first carpometacarpal joint, sternoclavicular
joint, calcaneocuboid joint, etc.
Plane or gliding type Gliding movement
♦ Ball-and-socket (spheroidal) joints: In these ball and
Uniaxial joints socket joints articular surfaces include a globular head
• Hinge joint • Flexion and extension (male surface) which fit inside a cup-shaped socket
• Pivot joint • Rotation (female surface). Movements in these joint occur around an
Biaxial joints indefinite number of axes which consists of one common
center. Flexion, extension, abduction, adduction, medial
• Condylar joint • Flexion, extension and limited rotation
rotation, lateral rotation, and circumduction, all the
• Ellipsoid joint • Flexion, extension, abduction,
adduction and circumduction
movements occur freely. Examples are shoulder joint,
hip joint, etc.
Multiaxial joints
Q.5. Enumerate the types of joints with example.
• Saddle joint • Flexion and extension, abduction,
(Apr 2007, 5 Marks)
• Ball-and-socket adduction and conjunct rotation
joint • Flexion and extension, abduction and
Ans. Joint is a junction between two or more bones and is
adduction, circumduction, medial and responsible for movement, growth or transmission of
lateral rotation forces.
124 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Structural Classification According to structural classification of joints synovial joints are:

♦ Fibrous joints
• Sutures, e.g. internasal suture and interparietal suture
• Syndesmosis, e.g. in posterior part of sacroiliac joint
• Gomphosis, e.g. joint between tooth and its socket.
♦ Cartilaginous joints
• Primary cartilaginous joints or synchondrosis, e.g.
spheno-occipital joint
• Secondary cartilaginous joints or symphysis, e.g.
manubriosternal joints.
♦ Synovial joints
• Ball-and-socket or spheroidal joints, e.g. shoulder joint
and hip joint
• Sellar or saddle joints, e.g. sternoclavicular joint
• Condylar or bicondylar joints, e.g. knee joint
• Ellipsoid joints, e.g. wrist joint
• Hinge joints, e.g. elbow joint and ankle joint
• Pivot or trochoid joints, e.g. median atlantoaxial joint
• Plane joints, e.g. intercarpal joint, intertarsal joint.
Functional Classification (According to the Degree of
Mobility)
♦ Synarthrosis (immovable), like fibrous joints.
♦ Amphiarthrosis (slightly movable), like cartilaginous joints.
♦ Diarthrosis (freely movable), like synovial joints.
Regional Classification
♦ Skull type: Immovable.
♦ Vertebral type: Slightly movable.
♦ Limb type: Freely movable.
According to Number of Articulating Bones
♦ Simple joint: When two bones articulate, e.g. inter-
phalangeal joints.
♦ Compound joint: More than two bones articulate within
one capsule, e.g. elbow joint, wrist joint.
♦ Complex joint: When joint cavity is divided by an
intra-articular disc, e.g. temporomandibular joint and
sternoclavicular joint.
Q.6. Enumerate the types of synovial joint and write in brief
about ball-and-socket joint. (Dec 2012, 4 Marks)
Ans.
Enumeration of Types of Synovial Joint
According to functional classification of joints synovial joints are:
♦ Plane or gliding type
♦ Uniaxial joints
• Hinge joint
• Pivot joint
♦ Biaxial joints
• Condylar joint
• Ellipsoid joint
♦ Multiaxial joints
• Saddle joint
• Ball-and-socket joint
♦ Plane synovial joints
♦ Hinge joints
♦ Pivot (trochoid) joints
♦ Condylar (bicondylar) joints
♦ Ellipsoid joints
♦ Saddle (sellar) joints
♦ Ball-and-socket (spheroidal) joints.
Ball-and-Socket Joint
♦ It is a multiaxial type of synovial joint.
♦ It is also known as spheroidal joint.
♦ In ball-and-socket joint the articular surfaces include a
globular head (male surface) which fit inside a cup-shaped
socket (female surface).
♦ Movements in these joint occur around an indefinite
number of axes which consists of one common center.
♦ Flexion, extension, abduction, adduction, medial rotation,
lateral rotation, and circumduction, all the movements
occur freely.
♦ Examples are shoulder joint, hip joint, talocalcaneonavicular
joint and incudostapedial joint.
Q.7. Write about classification of joints. (Dec 2009, 5 Marks)
Or
Write briefly on classification of joints.
(Aug 2012, 5 Marks)
Ans. Following is the classification of joints:
Structural Classification
♦ Fibrous joints: Joined by dense irregular connective tissue
which are rich in collagen fibers:
• Sutures, e.g. internasal suture and interparietal suture
• Syndesmosis, e.g. in posterior part of sacroiliac joint
• Gomphosis, e.g. joint between tooth and its socket.
♦ Cartilaginous joints: They are joined by cartilage:
• Primary cartilaginous joints or synchondrosis, e.g.
spheno–occipital joint
• Secondary cartilaginous joints or symphysis, e.g.
manubriosternal joints
♦ Synovial joints: Bones have a synovial cavity and are
united by the dense irregular connective tissue that forms
the articular capsule that is normally associated with
accessory ligaments.
• Ball-and-socket or spheroidal joints
• Sellar or saddle joints, e.g. sternoclavicular joint
• Condylar or bicondylar joints, e.g. knee joint
• Ellipsoid joints, e.g. wrist joint
• Hinge joints, e.g. elbow joint and ankle joint
• Pivot or trochoid joints, e.g. median atlantoaxial joint
• Plane joints, e.g. intercarpal joint, intertarsal joint
Functional Classification (According to the
Degree of Mobility)
♦ Synarthrosis: Permits little or no mobility. Most synarthrosis
joints are fibrous joints, e.g. skull sutures.

♦ Amphiarthrosis: Permits slight mobility. Most amphiar-
throsis joints are cartilaginous joints, e.g. intervertebral
discs.
♦ Diarthrosis: Freely movable. All diarthrosis joints are
synovial joints, e.g. shoulder, hip, elbow, knee, etc.
Regional Classification
♦ Skull type: Immovable.
♦ Vertebral type: Slightly movable.
♦ Limb type: Freely movable.
According to Number of Articulating Bones
♦ Simple joint: When two bones articulate, e.g. inter-
phalangeal joints
♦ Compound joint: More than two bones articulate within
one capsule, e.g. elbow joint, wrist joint.
♦ Complex joint: When joint cavity is divided by an
intra-articular disc, e.g. temporomandibular joint and
sternoclavicular joint.
3. CIRCULATORY SYSTEM
Q.1. Write short note on anastomosis. (Mar 2006, 3 Marks)
Ans. Precapillary or postcapillary communication between
neighboring vessels is known as anastomoses. Circulation
via anastomosis is known as collateral circulation.
Types
♦ Arterial anastomoses: This is the communication between
the arteries or branches of arteries. It can be actual or
potential.
• In an actual arterial anastomosis arteries meet end to
end, e.g. palmar arches, plantar arch, circle of Willis,
intestinal arcades, labial branches of facial arteries.
• In potential arterial anastomoses communication
takes place between terminal arterioles. Such
communications may dilate only gradually for
collateral circulation. So on sudden occlusion of main
artery, anastomoses may fail to compensate the loss,
e.g. it is seen in coronary arteries as well as cortical
branches of cerebral arteries.
♦ Venous anastomoses: This is the communication between
veins or the tributaries of veins, e.g. dorsal venous arches
of hand and foot.
♦ Arteriovenous anastomosis (shunt): This is a communi-
cation between an artery and a vein. It serves as function
of phasic activity of an organ.
• When an organ is active such shunts get closed and
blood circulates via the capillaries. But, when the organ
is at rest, blood bypasses capillary bed and is shunted
back via arteriovenous anastomosis.
• Shunt vessel can be straight or coiled and possesses
a thick muscular coat, and is under the influence of
sympathetic system.
• Shunts of simple structure are found inside skin of
nose, lips and external ear; in the mucous membrane
Anatomy  125
of nose and alimentary canal; the coccygeal body; the
erectile tissue of sexual organs; the tongue; the thyroid
gland and sympathetic ganglia.
• Specialized arteriovenous anastomoses are seen inside
the skin of digital pads as well as nail beds. They form
a number of small units known as glomera.
• Preferential thoroughfare channels are also a kind
of shunts. They course via capillary network. Many
true capillaries arise as their side branches. One
thoroughfare channel with its associated capillaries
forms a microcirculatory unit. The size of the unit is
variable from 1–2 to 20–30 true capillaries. The number
of active units varies from time to time.
Q.2. Write short note on collateral circulation.
(June 2010, 5 Marks)
Ans. Collateral circulation is the process in which a system
of small, normally closed arteries connect and start to
carry blood to part of the heart when a coronary artery
is blocked, or to part of the brain when a cerebral artery
is blocked. These arteries can serve as alternate routes
of blood supply.
Cerebral Collateral Circulation
Blood flow to the brain is maintained via a network of collateral
arteries that anastomose in the circle of Willis, which lies at the
base of the brain. In circle of Willis so-called communicating
arteries exist between the front (anterior) and back (posterior)
parts of the circle of Willis, as well as between the left and right
side of the circle of Willis.
Cardiac Collateral Circulation
Another example is where a person suffers an acute myocardial
infarction (heart attack). Collateral circulation in the heart tissue
will sometimes bypass the blockage in the main artery and
supply enough oxygenated blood to enable the cardiac tissue
to survive and recover.
Collateral Circulation in the Venous System
Hepatic cirrhosis arising from chronic congestion in the hepatic
portal vein may give rise to collateral circulation between
branches of the portal and caval veins of the liver, or between
the two caval veins. Consequences of newly established venous
collaterals arising from portal hypertension include esophageal
varices and hemorrhoids (porta-caval collateral circulation).
Q.3. Write short note on pulse points of head and neck.
(May 2014, 5 Marks)
Ans. Pulse points are those where the arterial pulse is felt.
Following are the pulse points in head and neck:
♦ Carotid pulse: Common or external carotid artery can be
palpated in anterior triangle of neck. It is the strongest
pulses in the body. Carotid pulse is obtained by palpating
either the common carotid artery posterolateral to larynx
or external carotid artery immediately lateral to pharynx
midway between superior margin of thyroid cartilage
below and greater bone of hyoid bone below.
126 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦ Facial pulse: Facial artery can be palpated as it crosses

inferior body of mandible immediately adjacent to anterior
margin of masseter muscle.
♦ Temporal pulse: Superficial temporal artery can be
palpated anterior to ear and immediately posterosuperior
to the position of temporomandibular joint. Anterior
branch of superficial temporal artery can be palpated
posterior to zygomatic process of frontal bone as it passes
lateral to temporal fascia and into anterolateral region of
scalp.
Q.4. Define end artery. (Aug 2018, 1 Mark)
Ans. Arteries which do not anastomose with their neighbors
are called end arteries.

Fig. 161: Pulse points of head and neck. Each pulse point
is named after the artery it is associated with
 GENETICS

Q.1. Write a short note on Turner syndrome.

(Feb 2004, 5 Marks) (Aug 2012, 4 Marks)
(Dec 2011, 6 Marks)
Ans. Turner Syndrome
Turner syndrome is also known as Bonnevie-Ullrich syndrome
or monosomy X or Ullrich-Turner syndrome.
♦ The syndrome is named after Dr Henry Turner, who was
one of the first to describe it, this is a genetic disease that
effects the development of the body in females.
♦ The disorder is caused by the complete or partial absence
of one of the two X chromosomes.

Symptoms
As in many diseases of all types, symptoms between the
individuals vary in severity and presence.
♦ Most common deformity is short stature, starting out at
birth and continuing for the rest of a individual’s life
♦ About 90% of women experience early ovarian failure,
so that there are only enough hormones and egg cells
produced by the ovaries so that only secondary sexual
development occurs (poor breast development/ irregular
nipple spacing, no menstruation)
♦ Webbed neck (fold of skin stretching from the end of
shoulder to the bottom of chin)
♦ Small, narrow fingernails and toenails that turn up
♦ Elbow deformity called cubitus valgus (arms that turn out
slightly at the elbows)
♦ Nevi (brown spots appearing sparatically on the skin)
♦ Narrow, high-arched palate (roof of the mouth) Fig. 162: Turner syndrome
♦ Retrognathia (receding lower jaw)
Mental Problems
♦ Low-set ears and low hairline
♦ Slight droop to eyes ♦ On an average, most turner syndrome females have an
♦ Strabismus (lazy eye) overall normal intelligence with a variance similar to that
♦ Broad chest of the general population.
♦ Scoliosis (curvature of the spine) ♦ Spatial-temporal processing (imagining objects in relation
♦ Flat feet to each other) difficulties.
♦ Short fourth metacarpals (the ends of these bones form ♦ Nonverbal memory complexities.
the knuckles) ♦ Attention difficulties.
♦ Edema (fluid overload causing noticeable swelling) of These may cause further problems such as trouble with math, a poor
hands and feet especially at birth sense of direction, little manual dexterity, and poor social skills.
♦ Cardiac abnormalities including hypertension (high Karyotype of Turner Syndrome
blood pressure), dissection of the aorta, and a coarctation
(narrowing) of the aorta and bicuspid aortic valve (a valve ♦ Turner syndrome is the monosomy of sex chromosome.
with two leaflets instead of the usual three) ♦ For Turner syndrome the karyotype is 45, XO which is the
♦ Kidney problems that may result in urinary tract infections monosomy of X chromosome.
or an increased risk for hypertension ♦ Here one chromosome is missing, so no Barr body is seen,
♦ Hypothyroidism (low level of thyroid hormone) caused by though the individual is female.
autoimmune thyroiditis (inflammation of thyroid gland) Q.2. Write notes on Down syndrome. (Mar 2006, 5 Marks)
♦ Otitis media (ear infection), mainly in early childhood or (Apr 2010, 5 Marks) (Dec 2010, 3 Marks)
infancy. (Sep 2013, 5 Marks) (Sep 2015, 5 Marks)
♦ Sensorineural (nerve) hearing loss. (Apr 2017, 4 Marks) (Jan 2018, 5 Marks)
128 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Ans. Down syndrome is also known as mongolism or trisomy ♦ By adulthood, XXY males look similar to males without
21. the condition, although they are often taller. They are
♦ Down syndrome is the most common congenital also more likely than other men to have certain health
anomaly which occurs because of nuclear aberration of problems, such as autoimmune disorders, breast cancer,
chromosomes. vein diseases, osteoporosis, and tooth decay.
♦ Dr down describe this syndrome in 1866.
♦ In down syndrome there is trisomy of chromosome 21. Karyotype of Klinefelter Syndrome
The number of chromosomes is 47, i.e. 47XX or 47XY. Sex ♦ Cases of Klinefelter have karyotype of 47, XXY with some
can be either male or female. It is seen to occur as 1 in 700 of the individuals showing mosaic pattern.
newborn. ♦ Here the individual is male with an extra X chromosome.
♦ It is seen in elderly primigravida or mother suffering from ♦ As there are two X chromosomes, one Barr body is present.
viral infection during pregnancy.
♦ In elderly primigravida the syndrome occur due to the
aging of the ovum. Since sperms form fresh everytime, so
aging factor is not applied for sperms.
♦ Males are more commonly affected than females.
Clinical Features of Down Syndrome
♦ Presence of mental retardation
♦ Palpebral fissure slant upwards at lateral end
♦ Protrusion of tongue out of the mouth
♦ Presence of flat nasal bridge
♦ On the eyes there is presence of epicanthic folds
♦ Short broad hands with simian crease
♦ Presence of small ears and small head circumference
Karyotype of Down’s Syndrome
♦ Trisomy of 21st chromosome most commonly leads to
Down syndrome.
♦ Karyotype in a trisomic Down is either 47 + XY or 47 + XX
♦ Source of extra 21st chromosome is mostly from nondys-
junction in maternal meiosis.
Q.3. Write a short note on Klinefelter syndrome.
(Dec 2012, 5 Marks) (Dec 2014, 5 Marks)
(Aug 2018, 5 Marks) (July 2016, 5 marks)
Ans. 47, XXY, or XXY syndrome is a condition in which human
males have an extra X chromosome.
Fig. 163: Klinefelter syndrome
♦ Females have an XX chromosomal makeup, and males an
XY, affected individuals have at least two X chromosomes Q.4. Write short note on karyotypes of Klinefelter and
and at least one Y chromosome. Because of the extra
Turner syndrome. (Sep 2017, 4 Marks)
chromosome, individuals with the condition are usually
Ans. Identification of chromosomes according to the length
referred to as “XXY Males”, or “47, XXY Males”.
of arms including position of centromere is known as
♦ In humans, Klinefelter syndrome is the most common
karyotyping.
sex chromosome disorder and the second most common
condition caused by the presence of extra chromosomes. Karyotype of Klinefelter’s syndrome
♦ Affected males are almost always effectively infertile.
♦ Cases of Klinefelter have karyotype of 47, XXY with some
Features of Disease of the individuals showing mosaic pattern.
♦ Language learning impairment may be present. ♦ Here the individual is male with an extra X chromosome.
♦ In adults, possible characteristics vary widely and include ♦ As there are two X chromosomes, one Barr body is present.
little to no signs of affectedness, a lanky, youthful build
Karyotype of Turner’s Syndrome
and facial appearance, or a rounded body type with
gynecomastia (increased breast tissue). ♦ Turner syndrome is the monosomy of sex chromosome.
♦ Individual has very small pair of testes but a normal penis ♦ For Turner syndrome the karyotype is 45, XO which is the
and scrotum. monosomy of X chromosome.
♦ Secondary sexual characters do not develop fully and pubic ♦ Here one chromosome is missing, so no Barr body is seen,
and facial hair is scanty. though the individual is female.
 NEUROANATOMY
1. INTRODUCTION TO BRAIN
Q.1. Write a short note on types of neurons.
(Sep 2006,5 Marks)
Or
Write short note on classification of neurons.
(May 2014, 5 Marks)
Ans. Neurons are of various types, according to the polarity,
axon length, size and shape of neuronal cell body, i.e.
soma
I. Types according to number of their processes
1. Multipolar neurons: In man most of the
neurons are multipolar, e.g. all motor and
internuncial nucleus.
2. Bipolar neurons: These are confined to first
neuron of retina, olfactory mucosa and ganglia
of eight cranial nerve.
3. Pseudounipolar neurons: These neurons are
unipolar to begin with but they become bipolar
functionally. These are found in dorsal nerve
root ganglia and the sensory ganglia of cranial
nerves.
4. Unipolar neurons: They are seen in mesence-
phalic nucleus of trigeminal nerve and they also
occur during the fetal life. These neurons are
common in lower vertebrates.
II. According to axon length
1. Golgi type I: They consist of long axons and
numerous short dendrites. They are seen in
Purkinje cells of cerebellum, pyramidal cells of
cerebellar cortex and anterior horn cells of spinal
cord.
2. Golgi type II: They consists of small axons,
establish synapsis with neighboring neurons.
They are seen in cerebral cortex and cerebellar
cortex.
3. Amacrine neurons without axon only with
dendrite. They are seen in retina of eyeball.
III. Functional classification
Neurons are classified into sensory neurons, motor
neurons and autonomic neurons, i.e. sympathetic
and parasympathetic neurons.
1. Sensory neurons: They are divided into three types
a. Primary or first order sensory neurons:
Present as spinal or sensory neurons in dorsal
root ganglion of spinal nerves.
b. Secondary or second order sensory neurons:
Present in gray matter of spinal cord and
brainstem.
c. Tertiary or third order sensory neurons: Seen
in thalamus.
2. Motor neurons: Carry impulse from central
nervous system to distal part of body. They are
of two types:
a. Upper motor neurons: Lie in motor area of
brain
b. Lower motor neurons: Lie in cranial nerve
nuclei and anterior horn of spinal cord.
3. Parasympathetic neurons:
a. Preganglionic neurons are located in cranial
nerves, i.e. III, VII, IX and X and in sacral 2–4
segments of spinal cord
b. Postganglionic neurons are located close to
wall or within wall of viscera.
c. Parasympathetic outflow is known as
craniosacral outflow.
4. Sympathetic neurons
a. Preganglionic neurons are located in lateral
horn of T1 to L2 segments of spinal cord.
b. Postganglionic neurons are located in ganglia
of sympathetic trunk away from viscera.
c. Sympathetic outflow is known as thora-
columbar outflow.
IV. Types according to shape of soma
a. Stellate shape
b. Fusiform shape
c. Basket shape
d. Pyramidal shape.
V. According to size
a. Microneurons: The length of soma is less than
7 µm
b. Macro neurons: The length of soma is more than
7 µm.
2. MENINGES OF THE BRAIN AND
CEREBROSPINAL FLUID
Q.1. Write short note on CSF. (Jan 2012, 4 Marks)
Or
Write short note on CSF circulation. (June 2010, 5 Marks)
Or
Write short answer on cerebrospinal fluid.
(Aug 2018, 3 Marks)
Ans. Cerebrospinal fluid (CSF) is the modified tissue fluid. CSF
is contained inside the ventricular system of brain and in
subarachnoid space around the brain and spinal cord.
CSF replaces lymph inside the central nervous system.
130 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Formation
♦ Bulk of CSF is formed mainly by choroid plexus of lateral
ventricles and in less amount by choroid plexus of third
and fourth ventricles.
♦ It is also formed by capillaries over surface of brain and
spinal cord.
♦ Total quantity of CSF formed is 150 mL. This is formed at
the rate of 200 mL per hour or 5000 mL/day.
♦ Normal pressure of CSF is 60 to 100 mm of water.
Circulation
CSF passes from each lateral ventricle to third ventricle via
interventricular foramen of Monro. From third ventricle CSF
passes to fourth ventricle via cerebral aqueduct. From fourth
ventricle CSF passes to subarachnoid spaces of cerebrum
and vertebral canal via median and lateral apertures of
fourth ventricle. Some of CSF passes to central canal of
spinal cord.
Absorption
♦ CSF is absorbed chiefly via arachnoid villi and granulations,
it is thus drained into cranial venous sinuses.
Fig. 164: Circulation of CSF as shown by white arrows
♦ CSF is also absorbed partly by perineural lymphatics at
around first, second and eighth cranial nerves.
♦ CSF is also absorbed by veins which are related to spinal
nerves.
Functions of CSF
♦ It decreases sudden pressure or forces on delicate nervous
tissue.
♦ CSF nourishes nervous tissue. Only CEF comes in contact
with neurons. It provides nourishment and return product
of metabolism to venous sinuses.
♦ Neurons cannot survive without glucose and oxygen
for 3–5 minutes. Both glucose and oxygen are constantly
supplied by CSF.
♦ Pineal gland secretions reach to pituitary gland via CSF.
♦ CSF cushion the brain within its solid vault. Both brain
and CSF have same specific gravity, so brain simply floats
in the fluid.
♦ Since there is no CSF brain barrier, so drugs can reach to
neurons via CSF.
♦ Blood CSF barrier is present, so there are no antibodies
in central nervous system which make infection of brain
very serious.
 Anatomy  131

Q.2. Describe briefly folds of dura mater. (Apr 2008, 5 Marks)

Ans.
Name of
the fold Shape Attachments to the fold Venous sinus enclosed
Falx cerebri This is of sickle shape and leads to • Superiorly convex margins are attached to sides of • Superior sagittal sinus
the separation of right from the left groove lodging superior sagittal sinus • Inferior saggital sinus
cerebral hemisphere • Inferiorly the concave margin is free • Straight sinus
• Anterior attachment is to cristae galli and posterior is to
upper surface of tentorium cerebelli
Tentorium This is of tent shape and separates • It consists of anterior free margin and its ends are • Transverse sinuses,
cerebelli cerebral hemispheres from hindbrain attached to anterior clenoid processes. Rest of it is free superior petrosal sinus
and lower part of midbrain. It lifts off and concave
the weight of occipital lobes from • Its posterior margin is attached to lips of groove which
cerebellum consists of transverse sinus, superior petrosal sinus
and to posterior clinoid processes.
Falx This is a small sickle shaped fold • Its base is attached to the posterior part of inferior • Occipital sinus
cerebelli which partly separate two cerebellar surface of tentorium cerebelli
hemispheres
Diaphragma It is a small horizontal fold • Its anterior attachment is to tuberculum sellae • Anterior and posterior
sellae • Its posterior attachment is to dorsum sellae; laterally intracavernous sinuses
continuous with dura mater of middle cranial fossa

Functions of Folds of Dura Mater Function

♦ They divide cranial cavity into compartments to separate It carry the sensation of pain and temperature from opposite
different parts of brain and restrict their movement in half of the body.
cranial cavity.
♦ These folds enclose intracranial dural venous sinuses.

3. THE SPINAL CORD

Q.1. Write short note on lateral spinothalamic tract.
(Dec 2010, 3 Marks)
Ans. Origin: Laminae I to IV of spinal grey matter.
Beginning: From substantia gelatinosa of posterior gray
column.
Termination: Area 3, 1, 2 of cerebral cortex.
Crossing over: Fibers cross in the corresponding spinal
segment anterior to the central canal of spinal cord.

Course
First neuron fiber starts in dorsal root ganglia. They relay by
synapsing with neurons which lie in the gray matter of lamina
II and III. Pain fibers relay in lamina II. Second neuron fibers
cross immediately to opposite sides close to central canal and
ascend as tract in lateral white column of spinal cord. 3rd order
neurons lie in the ventro-posterolateral nucleus of thalamus
and axons of these neurons ascend through the internal capsule
and then the thalamic radiations to area no. 3, 1, 2 of the Fig. 165: Lateral spinothalamic tract
cerebral cortex. (For colour version see Plate 3)
132 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.2. Describe spinal cord in detail. (Aug 2011, 10 Marks)

Ans. Spinal cord is the long cylindrical lower part of central
nervous system.
Spinal cord occupies upper two-third of the vertebral
canal and is enclosed in three meninges.
Spinal cord is 45 cm in adult male and 42 cm in adult
female. It extends from upper border of atlas vertebra
to lower border of first lumbar vertebra. Superiorly it
is continuous with medulla oblongata and inferiorly
it terminate as conus medullaris. Conus medullaris is
a lower tapering extremity. Apex of conus medullaris
continue as thin thread like filament known as filum
terminale.

Fig. 167: Parts of lower end of spinal cord

Meninges Covering Spinal Cord

Spinal cord is surrounded by three meninges, outer is dura
mater, middle is arachnoid mater and inner one is pia mater.
Spinal cord is enclosed only by meningeal layer of dura mater.

Fig. 166: Lateral view of spinal cord showing exit of emerging

spinal nerves via intervertebral foramen

Fig. 168: Meningeal coverings of spinal cord


Spinal pia mater undergoes modification as: Gray Matter
a. Ligamentum denticulatum with 21 pairs of teeth like
projection which keep spinal cord in position.
b. Linea splendens is the thickening seen at anteromedian
sulcus.
External Features of Spinal Cord
External features of spinal cord are:
1. Fissures and sulci.
2. Attachment of spinal nerves.
3. Enlargements.
4. Cauda equina.
Fissures and Sulci
Anteriorly the spinal cord has a deep anterior median fissure
which lodges the anterior spinal artery. Anterior median fissure
is deep and extend along entire length of cord.
Posterior median sulcus is a thin longitudinal groove from
which septum runs in depth of spinal cord.
Each half of spinal cord is subdivided into anterior, lateral
and posterior region by anterolateral and posterolateral sulci.
Anterolateral region give rise to motor root and posterolateral
region give rise to sensory root.
Spinal Nerves
31 pairs of spinal nerves emerges from the side of cord. Out of
these 8 are cervical, 12 are thoracic, 5 are lumbar, 5 are sacral
and 1 is coccygeal. Cervical nerves leave vertebral canal above
the corresponding vertebrae with the exception of 8th which
emerges between C7 and T1 vertebrae. Remainder of spinal
nerves emerges below corresponding vertebrae. Each spinal
nerve is attached to the cord by two roots, i.e. motor root or
anterior root and sensory root or posterior root.
Enlargements
Spinal cord presents fusiform swellings, i.e. cervical and lumbar
enlargements.
Cervical enlargement extends from C5 to T1 whereas lumbar
enlargement extends from L2 to S3 spinal segements.
Cauda Equina
Since spinal cord is shorter than vertebral column, length
and obliqueness of spinal nerve roots increases from above to
downwards. As a result the nerve roots of lumbar, sacral and
coccygeal nerves from caudal part of cord take vertical course
and form bunch of nerve fibers around filum terminale which is
known as cauda equina. It is so called because of its resemblance
to horse of tail.
Internal Structure of Spinal Cord
Cross-section of spinal cord shows that it consists of inner core
of grey matter and peripheral zone of white matter.
White matter lies outside and gray matter lies inside. In the
center of gray matter is the central canal which consists of CSF.
Anatomy  133
♦ Gray matter is in the shape of H with gray commissure
joining gray matter of right and left sides.
♦ Gray matter consists of one posterior horn and one anterior
horn on each side.
♦ In T1-L2 and S2-S4 segments an additional horn is present
which is known as lateral horn.
♦ Structure of gray matter consists of nerve cells, neuroglia
and blood vessels.
White Matter
♦ White matter of spinal cord surrounds the central shaped
mass of gray matter and it mainly consists of nerve fibers.
♦ The majority of nerve fibers are myelinated and provide
white appearance to white matter.
Tracts of Spinal Cord
There are three types of tracts present descending, ascending
and intersegmental:
1. Descending tracts or motor tracts: They conduct impulses
to spinal cord from the brain. Descending tracts are
divided into pyramidal tracts, i.e. lateral corticospinal
tract, anterior corticospinal tract and extrapyramidal
tracts, i.e. rubrospinal, tectospinal, lateral vestibulospinal,
olivospinal, medial and lateral reticulospinal.
2. Ascending tracts or sensory tracts: They conduct impulses
from periphery to brain through the spinal cord. The
ascending tracts are lateral spinothalamic, anterior
spinothalamic, fasciculus gracilis, fasciculus cuneatus,
dorsal spinocerebellar, ventral spinocerebellar.
For diagram of ascending and descending tracts refer to
Ans 5 of same chapter.
3. Intersegmental tracts: These are short ascending and
descending tracts which originate and end in spinal
cord. They are present in anterior, posterior and lateral
columns of white matter. These tracts interconnect the
neurons of different segmental levels. The intersegmental
tracts are dorsolateral fasciculus, septomarginal and
comma tract.
Arterial Supply of Spinal Cord
Spinal cord is supplied by:
♦ Anterior spinal artery
♦ Two posterior spinal arteries
♦ Segmental arteries.
Anterior spinal artery supplies the anterior two-third of cord
while the two posterior spinal arteries together supplies
posterior one-third of the cord.
Segmental arteries along with anterior and posterior spinal
arteries form arterial trunks which communicate around a
cord and form plexus known as arteriae coronae. This corona
provides peripheral branches which supply to superficial region
of spinal cord.
134 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 169: Arterial supply of spinal cord: A. Anterior view, B. Posterior view (For colour version see Plate 3)

Venous Drainage
Veins draining the cord form six longitudinal venous channels
around the cord, i.e.
♦ Two median longitudinal, one in the anterior median
fissure and other in the posteromedian sulcus.
♦ Two anterolateral, one on either side, posterior to the
anterior nerve roots.
♦ Two posterolateral, one on either side posterior to the
posterior nerve roots.

Function of Spinal Cord

♦ Execution of simple reflexes
♦ Transmission of impulses to and from the brain.
Q.3. Describe briefly spinal cord.
(Feb 2013, 5 Marks) (May/June 2009, 5 Marks)
Ans. Refer to Ans 2 of same chapter.
Q.4. Write short note on radicular artery.
(Sep 2011, 5 Marks)
Fig. 167: Venous drainage of spinal cord Ans. Radicular artery is derived from various parent like
spinal branches of the vertebral, ascending cervical, deep
cervical, intercostals, lumbar and sacral arteries.
 Anatomy  135

Fig. 171: Radicular arteries (For colour version see Plate 4)

There are 8 anterior and 12 posterior radicular 

arteries which reaches the spinal cord.
Radicular arteries are regular serial enforcements to
spinal arteries.
As fetus grow most of the radicular artery disappear,
those that remain, form anastomoses with the
anterior and posterior spinal arteries and are
commonly known as booster or feeder vessels. The
most largest of the feeder vessels is arteria radicularis
(magna of Adamkiewicz).
Many of these radicular artery branches are small
and are end by feeding the nerve roots. Few of them
(Dec 2014, 10 Marks)
which are large and contribute blood to the spinal
arteries. Ans. For description of spinal cord refer to Ans 2 of same
One of the anterior radicular branches are very chapter.
large and is called the arteria reticularis magna. Its TS at Midcervical Region
position is variable. This artery may be responsible (See Fig. 173)
for supplying blood to as much as the lower two- Q.7. Write short note on corticospinal tract.
third of the spinal cord.
(Apr 2007, 5 Marks)
The function radicular artery is to make contributions
Or
to reinforce the longitudinal trunks.
Write briefly on pyramidal tract. (Dec 2010, 5 Marks)
Q.5. Write short note on lumbar puncture.
Ans. Corticospinal tract is also known as pyramidal tract.
(May 2014, 5 Marks)
Ans. Lumbar puncture is done for withdrawing cerebrospinal Origin: Most of the fibers of corticospinal tracts originate
fluid for various diagnostic and therapeutic purposes. from pyramidal cells of motor area of cerebral cortex.
• At the time of lumbar puncture a horizontal line Some of the fibers originate from other parts of cortex.
is drawn which joins the highest points of iliac Course: Fibers of corticospinal tract pass through
crest and the line passes via spine of L4 vertebrae. corona radiata, internal capsule, crus cerebri of cerebral
Now the interpinous spaces above and below this peduncles, ventral part of pons and pyramid of medulla
landmark are used with safety. oblongata.
136 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 172: Lumbar puncture (For colour version see Plate 4)

Fig. 173: Transverse section at midcervical region (For colour version see Plate 5)

In the lower part of medulla majority of fibers cross to the
opposite side at pyramidal decussation of medulla and descend
in lateral white column of spinal cord as lateral corticospinal
tract. Lateral corticospinal tract consists of some fibers which
arise from ipsilateral cerebral cortex. Lateral corticospinal tract
is located in lateral white column in front of posterior horn and
medial to posterior spinocerebellar tract.
Uncrossed fibers descend in anterior white column of spinal
cord as anterior corticospinal tract. Anterior corticospinal tract
is located in anterior white column close to anterior median
fissure.
At the lower level fibers of anterior corticospinal tract cross
to opposite side in the anterior white commissure of spinal cord
at the level of their termination.
 Anatomy  137

(Apr 2015, 3 Marks)

Ans. Following are the differences in spinal and cranial dura
mater:
Cranial dura mater Spinal dura mater
It is double layered It is single layer
It consists of an inner meningeal It consists of meningeal layer only
layer and outer endosteal layer
It form folds, i.e. falx cerebri, falx It does not form folds
cerebelli, tentorium cerebelli and
Fig. 174: Course and termination of corticospinal tract
diaphragma sellae
Epidural space is absent Epidural space is present
Termination
Most of the fibers of both lateral and anterior corticospinal 
tract terminate by synapsing with interneurons which project
(July 2016, 10 Marks)

Fig. 175: Position of various ascending and descending tracts in transverse section of spinal cord

♦ Mesencephalic nucleus of trigeminal nerve for proprio-

4. CRANIAL NERVES ceptive impulses from extraocular muscles, muscles of
tongue and mastication.
 Q.2. Draw a well labeled diagram to show the structures
(Oct 2016, 2 Marks) present in the transverse section of the pons at the level
Ans. Following are the nuclei of trigeminal nerve: of its inferior border. Describe course and branches of
♦ Spinal nucleus of trigeminal nerve for pain and temperature the intracranial part of the facial nerve.
from face (Oct 2016, 10 Marks)
♦ Superior sensory nucleus of trigeminal nerve for touch Ans. Structures present in transverse section of the pons at
and pressure from face the level of its inferior border.
138 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 176: Transverse section through lower part of pons
M= Medial longitudinal bundle, T = Tectospinal tract
R= Rubrospinal tract
Course of Intracranial Part of Facial Nerve
Facial nerve is attached to brainstem by two roots, i.e. motor
and sensory. Sensory root is known as nervus intermedius.
Two roots of facial nerve are attached to lateral part of lower
border of pons medial to vestibulocochlear nerve. Two roots
run laterally and forward along with vestibulocochlear nerve
to reach internal acoustic meatus.
In internal acoustic meatus motor root lies in groove on
vestibulocochlear nerve with sensory root intervening. Here
facial nerve and vestibulocochlear nerve are accompanied by
labyrinthine vessels. At fundus of meatus the two roots sensory
and motor fuse to form a single trunk which lies in petrous
temporal bone. Within the canal the course of nerve is divided
by three parts by two of its bands.
First part is directed laterally above the vestibule and second
part run backward in relation to medial wall of middle ear above
promontory and third part is directed vertically downward
behind promontory. First bend at junction of first and second
part is sharp and is known as genu.
Second bend lies between promontory and aditus to the
mastoid antrum. Facial nerve leaves the skull by passing
through stylomastoid foramen.
Branches of Intracranial Part of Facial Nerve
Following are the branches intracranial part of facial nerve:
1. Within the facial canal
Greater petrosal nerve
Nerve to stapedius
Chorda tympani nerve
2. At exit from stylomastoid foramen
Posterior auricular
Digastric
Stylohyoid
♦ Greater petrosal nerve: It arises from the geniculate
ganglion and leaves the middle ear through tegmen
tympani. It joins with the deep petrosal nerve to form
nerve to pterygoid canal. This nerve conveys secretomotor
supply to the lacrimal gland, nasal as well as palatal glands.
They relay in the pterygopalatine ganglion. Postganglionic
fibers for lacrimal gland join zygomatic nerve and pass
through communicating branches to lacrimal nerve and
lacrimal gland.
♦ Nerve to stapedius: This arises in the facial canal behind
the middle ear and runs forward through a short canal to
reach and supply the stapedius muscle.
♦ Chorda tympani nerve: It arises in the facial canal about
6 mm above the stylomastoid foramen and enters the
middle ear. It passes forward across the inner surface of
the tympanic membrane internal to the handle of malleus
and then leaves the middle ear by passing through the
petrotympanic fissure to appear at the base of skull. Here
it runs downwards and forward in the infratemporal fossa
and joins the lingual nerve at an acute angle. The chorda
tympani nerve carries:
Preganglionic secretomotor fibers to submandibular
ganglion for supply of submandibular and sublingual
salivary glands.
Taste fibers from anterior two-third of the tongue
except circumvallate papillae.
♦ Posterior auricular nerve: It arises just below the
stylomastoid foramen. It ascends in between the mastoid
process and external acoustic meatus and supplies to
Auricularis posterior
Occipitalis
Intrinsic muscles on back of auricle
♦ Digastric branch: It arises near the origin of posterior
auricular nerve. The nerve is short and supplies the
posterior belly of digastric.

 Lateral Geniculate Body
(Aug 2005, 8 Marks)
Ans. Optic pathway is also known as visual pathway. Optic
pathway consists of the structures which are concerned
with the reception, transmission and perception of visual
impulses.
Various Structures in Visual Pathway
A : Retina
B : Optic nerve
C : Optic chiasma
D : Optic tract, with its lateral and medial roots
E : Lateral geniculate body
F : Optic radiation
G : Visual area inside the cortex.
Retina
Retina is a thin delicate inner layer of the eyeball. It is continuous
posteriorly with the optic nerve. Retina decreases in thickness
and is divided into three parts, i.e. optic, ciliary and iridial.
Optic part consists of nervous tissue and is sensitive to light.
Ciliary and iridial parts of retina are formed by nonnervous
insensitive layer which covers ciliary body and iris. Fovea
centralis is the thinnest part of retina which has cones only and
is the site of maximum acuity of vision. Rods and cones are the
light receptors of an eye. Rods have a pigment known as visual
purple and they respond towards the dim light, i.e. scotopic
vision while cones respond only to bright light, i.e. photopic
vision and these are also insensitive to color. Periphery of retina
consists of rods only while the fovea centralis has cones only.
Towards the periphery of retina, number of cones diminishes.
Optic Nerve
This is made by axons of ganglionic cells of retina. Strictly, ♦
optic nerve is not a peripheral nerve, this is because its fibers
have no neurilemmal sheath. It is a tract and the fibers have no
power of regeneration.
♦ Argyll–Robertson pupil: Here the accommodation reflex is
Optic Chiasma
In this, nasal fibers including those from nasal half of macula,
cross the midline and enter opposite optic tract. Temporal fibers
pass through chiasma to enter optic tract of same side.
Optic Tract
Each of the optic tract wind round to cerebral peduncle of
midbrain. Near to lateral geniculate body, it divides into
lateral and medial roots. Lateral root is thick and terminates
inside lateral geniculate body. Few of its fibers pass to superior
colliculus, pretectal nucleus and hypothalamus. Medial root is
believed to consist of supraoptic commissural fibers. Each of the
optic tract has temporal fibers of retina of same side and nasal
fibers of opposite side.
Anatomy  139
It receives the lateral root of optic tract. Medially it is connected
to superior colliculus and laterally it give rise to optic radiation.
Cells inside the body are arranged in six layers. Layer number
2, 3 and 5 recieve ipsilateral fibers while layer number 1, 4 and
6 receive contralateral fibers.
Optic Radiation
It begins from lateral geniculate body and passes via
retrolentiform part of internal capsule and ends in visual cortex.
Visual Area Inside the Cortex
Optic radiation in striate area, i.e. area 17 where shape, color,
motion, size, illumination and transparency are separately
appreciated. Objects get identified by the integration of all
of these perceptions with past experience which is stored in
parastriate and peristriate areas. Area of the visual cortex which
receives impulses from macula is relatively larger than the part
related to rest of retina.
Applied Anatomy
♦ Lesion inside the retina causes scotoma in this certain
points may become blind spots.
♦ Optic nerve damage causes complete blindness of that eye.
♦ Lesion in optic chiasma, if it is central will cause bitemporal
hemianopia but if it is peripheral on both sides, it will lead
to binasal hemianopia.
♦ Unilateral complete destruction of optic tract, lateral
geniculate body, optic radiation or visual cortex lead to
loss of opposite half of field of vision.
♦ Lesion over right side causes left homonymous hemianopia.
♦ Papilloedema: It occurs because of increased intracranial
pressure. It causes swelling of optic disc because of
blockage of tributaries of retinal veins.
Optic neuritis: This is the lesion of optic nerve which causes
decrease of visual acuity. Optic disc is pale and smaller.
Methyl alcohol is the usual toxic chemical which causes
blindness.
present but light reflex is absent. Pretectal area is mainly
affected.
Q.4. Enumerate parasympathetic ganglion in head and neck.
(Apr 2018, 2 Marks)
Or
Enumerate parasympathetic ganglia.
(Aug 2018, 2 Marks)
Ans. Following are the parasympathetic ganglion in head and
neck:
♦ Ciliary ganglion
♦ Otic ganglion
♦ Pterygopalatine ganglion
♦ Submandibular ganglion.
140 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

5. THE BRAINSTEM

Fig. 177: Attachment of cranial nerve to brainstem

 (Feb 2005, 8 Marks)

Fig. 176: TS of open part of medulla

 Anatomy  141

Fig. 179: TS of at level of superior colliculus

Q.4. Draw a labeled diagram of transverse section of medulla
oblongata at the level of pyramidal decussation.
(Sep 2007, 3 Marks) (Mar 2008, 3 Marks)
Or
Write short note on section of medulla oblongata at
the level of motor decussation. (Sep 2017, 3 Marks)
Ans.
The section at this level passes via the inferior half of medulla
and resemble closely to that of spinal cord.
Gray Matter
♦ Decussating pyramidal fibers separate anterior horn from
central gray matter. Separated anterior horn form spinal
nucleus of accessory nerve laterally and supraspinal
nucleus for motor fibers of first cervical nerve medially.
♦ Central gray matter is pushed backwards.
♦ Nucleus gracilis and nucleus cuneatus appear as narrow
strip like projections and are continuous with central gray
matter.
White Matter
♦ Pyramids, anteriorly
♦ Decussation of pyramidal tract form most important
feature of medulla at the level of motor decussation. Fiber
of each run backward as well as laterally to reach lateral
white column of spinal cord where they form lateral
corticospinal tract.
♦ Fasciculus gracilis and fasciculus cuneatus occupy broad
posterior white column.
♦ Other features of white matter are similar to that of spinal
cord.

Fig. 180: TS of medulla oblongata at the level of pyramidal decussation

(For colour version see Plate 5)

Q.5. Write a short note on red nucleus.
(Feb 2005, 5 Marks) (Mar 2009, 5 Marks)
• Red nucleus is a cigar shaped mass of gray matter.
It appears oval shaped in cross-section.
It is 0.5 cm in diameter and lies dorsomedial to
substantia nigra.
It appears red in fresh specimen because of high
vascular supply and iron containing pigment present
in cytoplasm of its cells.
142 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

It receives afferent from the superior cerebellar

peduncle, globus pallidus, subthalamic nucleus
and cerebral cortex. It gives efferent to spinal cord,
reticular formation, thalamus, olivary nucleus,
subthalamic nucleus, etc.
• Red nucleus has inhibitory effect on muscle tone.

Fig. 181: Transverse section of pons at the level of facial nerve nucleus

Q.7. Draw a well labeled colored diagram of TS of midbrain passing at the level of superior colliculus.
(Aug 2011, 10 Marks)
Or
 (Sep 2015, 10 Marks)
Ans.

Fig. 182: TS of midbrain passing at the level of superior colliculus


Q.8. Write briefly on midbrain. (Jan 2012, 5 Marks)
Ans. Midbrain is upper and shortest part of brainstem.
Midbrain is also known as mesencephalon and it
connects hindbrain with forebrain.
Cavity of midbrain is known as cerebral aqueduct and
it connects third ventricle with fourth ventricle.
Midbrain passes through tentorial notch.
Midbrain is related on each side to the optic tract,
parahippocampal gyri, posterior cerebral artery,
basal vein, trochlear nerve and geniculate bodies.
Anteriorly it is related to interpeduncular structures,
i.e. mammillary bodies, tuber cinereum, etc.
Posteriorly to splenium of corpus callosum, great
cerebral vein, pineal body and posterior ends of
right and left thalami.
Midbrain like other parts of brainstem consists of gray
and white matter.
Subdivisions of Midbrain
When examination of transverse section is done through
midbrain. Following are the subdivisions:
♦ Tectum is the small posterior part to cerebral aqueduct
and consists of four colliculi, i.e. right and left, superior
and inferior.
♦ Large anterior part is divided into two equal right and left
halves by a vertical plane known as cerebral peduncle.
Each cerebral peduncle is subdivided into three parts:
Anteriorly as crus cerebri, posteriorly as tegmentum and
in the middle as substantia nigra.
Fig. 183: Transverse section of midbrain showing
its main subdivisions
Internal Structure of Midbrain
Transverse Section of Midbrain at the Level of Inferior Colliculi
Gray Matter
♦ Central gray matter consists of:
Nucleus of trochlear nerve in ventromedial part.
Mesencephalic nucleus of trigeminal nerve inside the
lateral part.
♦ Inferior colliculus receive afferent from lateral lemniscus
and gives off efferent to medial geniculate body.
Substantia nigra is a lamina of gray matter which is
made up of deeply pigmented nerve cells.
Anatomy  143
White Matter
♦ Crus cerebri consists of:
Corticospinal tract at middle
Frontopontine fibers at medial one-sixth
Temporopontine, parietopontine and occipitopontine
fibers in lateral one-sixth.
♦ Tegmentum consists of ascending tracts which are:
The lemnisci, i.e. medial, trigeminal, lateral and spinal
which are arranged in the form of band.
Decussation of superior cerebellar peduncles is seen
in median plane.
Medial longitudinal bundle lie in close relation to
trochlear nucleus.
Tectospinal and rubrospinal tracts.
Transverse Section of Midbrain at the Level of Superior
Colliculi
Gray Matter
♦ Central gray matter consists of:
Nucleus of oculomotor nerve with Edinger-Westphal
nucleus in ventromedial part.
Mesencephalic nucleus of trigeminal nerve in lateral
part. Oculomotor nuclei of two sides are very close
to each other.
♦ Superior colliculus receive afferent from retina.
♦ Pretectal nucleus lie deep to superolateral part of superior
colliculus.
♦ Red nucleus is 0.5 cm in diameter and has inhibitory
influence on muscle tone.
♦ Substantia nigra.
White Matter
♦ Crus cerebri consists of same tracts as described in white
matter of midbrain at the level of inferior colliculi.
♦ Tegmentum consists of:
Same leminisci which is seen in the lower part except
for lateral leminiscus which is terminated at inferior
colliculus
Decussation of tectospinal tracts from dorsal tegmental
decussation
Decussation of rubrospinal tracts from ventral
tegmental decussation
Medial longitudinal bundle
Emerging fibers of oculomotor nerve.
♦ Tectum shows posterior commissure connecting two
superior colliculi.
Arterial Supply
It is supplied by:
♦ Basilar arteries through its posterior cerebral and superior
cerebellar arteries. Basilar arteries also supply by direct
branches to midbrain.
♦ Branches of posterior communicating and anterior
choroidal arteries.
144 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Venous Drainage
Veins drain into greater cerebral and basal veins.
Q.9. Write in brief about Wallenberg syndrome.
(Sep 2015, 5 Marks)
Ans. It is also known as lateral medullary syndrome or
posterior inferior cerebellary artery syndrome.
Wallenberg s syndrome is a neurological condition
caused by a stroke in the vertebral or posterior inferior
cerebellar artery of the brainstem.
Features
♦ Ipsilateral paralysis of muscles of soft palate, pharynx and
larynx due to injury of nucleus ambiguus.
♦ Difficulties with swallowing, hoarseness, dizziness, nausea
and vomiting.
♦ Rapid involuntary movements of the eyes (nystagmus),
and problems with balance and gait coordination.
♦ Some individuals will experience a lack of pain and
temperature sensation on only one side of the face, or a
pattern of symptoms on opposite sides of the body—such
as paralysis or numbness in the right side of the face, with
weak or numb limbs on the left side.
♦ Uncontrollable hiccups may also occur, and some
individuals will lose their sense of taste on one side of the Q.1. Describe briefly cerebellum.
tongue, while preserving taste sensations on the other side.
Q.10. Enumerate the parts of brainstem. (Feb 2016, 2 Marks)
Ans. Following are the parts of brainstem:
a. Medulla oblongata
b. Pons
c. Midbrain.
Q.11. Write short answer on sections of lower part of pons.
(Aug 2018, 3 Marks) ♦
Ans. Transverse section through the lower part of the pons
passes via facial colliculi.
The tegmentum at this level presents the following
features:
Gray Matter
The gray matter at this level comprises:
♦ The abducent nerve nucleus which lie beneath the facial
colliculus inside the floor of the 4th ventricle.
♦ The motor nucleus of the facial nerve which lie in reticular
formation of pons.
♦ The superior salivatory, inferior salivatory, and lacrimatory
nuclei lie medial to motor nucleus of the facial nerve.
♦ The nucleus of tractus solitarius lie lateral to superior
salivatory nucleus.
♦ The vestibular nuclei lie beneath the vestibular area in the
floor of the 4th ventricle.
♦ The dorsal and ventral cochlear nuclei situated dorsal and
ventral to the inferior cerebellar peduncle.
♦ The spinal nucleus of the trigeminal nerve and its tract
located on the anteromedial aspect of the inferior cerebellar
peduncle.
White Matter
The white matter at this level comprises:
♦ The trapezoid body that is a trapezium-shaped mass of
white fibers which lie in the anterior part of the tegmentum,
just posterior to the basilar part of pons. It is formed by
decussation of transversely running fibers which arises
from cochlear nuclei of both the sides.
♦ The medial lemniscus forms the transverse band over
either side of the midline, behind the trapezoid body. This
is joined by anterior spinothalamic tract.
♦ The lateral spinothalamic tract lie lateral to medial
leminiscus.
♦ The inferior cerebellar peduncle lie lateral to floor of fourth
ventricle.
♦
For diagram refer to Ans 6 of same chapter.
6. THE CEREBELLUM
(Jan 2012, 5 Marks)
Ans. Cerebellum is the largest part of the hindbrain. It is
situated in the posterior cranial fossa behind the pons
and medulla. Its weight is 150 g in male adult.
Relations
♦ Anteriorly it is related to fourth ventricle, pons and
medulla.
Posteroinferiorly it is related to squamous occipital bone.
♦ Superiorly it is related to tentorium cerebelli.
External Features
♦ Cerebellum has two cerebellar hemispheres which are
united to each other via median vermis.
♦ It consists of two surfaces, i.e. superior and inferior
surfaces. Superior surface of cerebellum is convex and
both the hemispheres are continuous with each other on
this surface. Inferior surface present a deep median notch
known as vallecula which separates both the cerebellar
hemispheres.
♦ Anterior surface of cerebellum is marked by the deep notch
which consists of pons and medulla. Posterior cerebellar
notch is deep and narrow and lodges falx cerebelli.
♦ Each hemisphere is divided into three lobes. Anterior lobe
lies on anterior part of superior surface. Anterior surface
is separated from middle lobe by fissura prima. Middle
lobe is largest of three lobes. Middle lobe is limited in
front by the fissura prima and by posterolateral fissure.
Flocculonodular lobe is the smallest lobe of cerebellum.
It lies on the inferior surface, in front of the posterolateral
fissure.
 Anatomy  145

Parts of Cerebellum Parts of vermis Subdivisions of cerebellar hemisphere

Cerebellum is subdivided into numerous small parts by fissures. Lingula —
Each fissure cut vermis and both hemispheres. Following are Central lobule Ala
the fissures:
Culmen Quadrangular lobule
♦ Horizontal fissure: It separate superior surface from the
Declive Simple lobule
inferior surface.
♦ Posterolateral fissure: It separates middle lobe from Folium Superior semilunar lobule
flocculonodular lobe over the inferior surface. Tuber Inferior semilunar lobule
♦ Fissura prima or primary fissure: It separates anterior lobe Pyramid Biventral lobule
from the middle lobe over the superior surface of cerebellum. Uvula Tonsil
Various parts of cerebellum where both superior and inferior
Nodule Flocculus
surfaces cerebellum are drawn in single plane.

Fig. 184: Subdivisions of cerebellum

Morphological and functional division of cerebellum: Flocculonodular Lobe

1. Archicerebellum: It is the oldest part of cerebellum is Its function is with vestibular system in controlling equilibrium.
formed by flocculonodular lobe and lingula.
It controls the axial musculature and the bilateral Connections of Cerebellum
movement used for locomotion posture and
Fibers entering or leaving cerebellum are grouped to form three
maintenance of the equilibrium.
peduncles which connect cerebellum to midbrain, pons and
2. Paleocerebellum: It is made up of the anterior lobe (minus medulla. Constituent fibers are:
lingual) and pyramid and uvula of inferior vermis.
It controls the tone, posture and movement. Peduncle Afferent tract Efferent tract
3. Neocerebellum: It is newest part of the cerebellum to Superior • Anterior spinocerebellar • Cerebellorubral
develop. It is made up of middle lobe minus pyramid and cerebellar • Tectocerebellar • Dentatothalamic
uvula of inferior vermis. peduncle • Dentato-olivary
• Fastigial reticular
It is concerned with the regulation of fine movement
of the body. Middle • Pontocerebellar —
cerebellar
Lateral Zone peduncle
It is connected with association areas of brain and is involved Inferior • Posterior spinocerebellar • Cerebellovestibular
in planning and programing muscular activities. cerebellar • Cuneocerebellar • Cerebello–olivary
peducle • Olivocerebellar • Cerebelloreticular
Intermediate Zone • Parolivocerebellar
This is concerned with control of muscle of hands, finger, feet • Reticulocerebellar
and toes. • Vestibulocerebellar
• Anterior external arcuate
Vermis fibers
This is concerned with control of muscles of trunk, neck, • Striae medullares
• Trigeminocerebellar
shoulder and hips.
146 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Grey Matter of Cerebellum

It has cerebellar cortex and cerebellar nuclei. Four pairs of
nuclei are present:
1. Nucleus dentatus is neocerebellar
2. Nucleus globosus
3. Nucleus emboliformis are paleocerebellar
4. Nucleus fastigii is archicerebellar.
Q.2. Write a short note on functions of cerebellum.
(May 2017, 3 Marks) (Feb 2003, 5 Marks)
Ans. Function of Cerebellum
1. It controls same side of the body. The effects are
ipsilateral. Cerebellum coordinates voluntary
Fig. 185: Cerebellar nuclei
movements and makes them smooth, balanced and
accurate.
2. Archicerebellum and paleocerebellum control tone,
7. THE FOURTH VENTRICLE
posture and equilibrium.
3. Cerebellum acts as comparator. It receives informa-

tion from cerebrum and spinal cord, it correct and
modify the movements through thalamocortical
projections, reticulospinal tract and rubrospinal
tract.
4. Neocerebellum leads to the fine tuning of (Apr 2015, 3 Marks)
motor performance for the precise movements. Ans.
Neocerebellum also helps in planning as well as
production of skilled movements with cerebrum.
Q.3. Write a short note on cerebellar nuclei.
(Apr 2007, 4 Marks) (Sep 2009, 5 Marks)
Ans. Cerebellar nuclei are four in number, i.e. nucleus
dentatus or lateral nucleus, nuclei emboliformis, globose
and fastigial nucleus.
The most lateral and largest of the cerebellar nuclei
is nucleus dentatus or lateral nucleus, medial to
which are small nuclei emboliformis, globose and
fastigial.
The emboliform, or anterior, interposed nucleus is
continuous laterally with dentate. Fig. 186: Floor of the fourth ventricle
Globose, or posterior interposed nucleus is located (For colour version see Plate 5)
caudal and medial to emboliform nucleus. It is
continuous with fastigial nucleus which is located Q.2. Write short note on floor of fourth ventricle.
next to midline, bordering on fastigium of fourth (Aug 2016, 3 Marks) (Aug 2011, 5 Marks)
ventricle. Or
Globose and emboliform nuclei are collectively Write briefly on floor of fourth ventricle.
known as interpositus nucleus. (Apr 2008, 5 Marks) (Aug 2012, 5 Marks)
Nucleus dentatus within white core of hemisphere
Or
is an irregularly folded sheet of neurons which
encloses mass of white fibers largely derived from Describe floor of fourth ventricle of brain.
dentate neurons. (Sep 2015, 10 Marks)
Nucleus emboliform is partially covers dentate hilum, Ans. Floor of fourth ventricle is also known as rhomboid fossa
the nucleus globosus is located on dorsomedial side. since it is rhomboidal in shape.
• A large proportion of afferent fibers of fastigial It is formed by posterior surface of pons and posterior
nucleus crosses within cerebellar white matter and surface of open part of medulla oblongata.
anterior medullary velum in cerebellar commis- Deep to the floor there is presence of layer of gray matter
sure. which consists of cranial nerve nuclei.

Structural Layers
Floor of fourth ventricle is lined by the following:
♦ Ependyma
♦ Thin layer of neuroglia beneath ependyma
♦ Layer of gray matter forming various nucleoli deep to
neuroglia.
Floor of the fourth ventricle is divided into three parts, i.e.
1. Upper triangular part: It is formed by the dorsal surface of
pons.
2. Lower triangular part: It is formed by the dorsal surface
of medulla.
3. Intermediate part: It lies at the junction of medulla and
pons. It is prolonged laterally on either side over inferior
cerebellar peduncle as floor of lateral recess. This part is
marked by transversely running fibers of stria medullaris.
These fibers represent fibers from arcuate nucleus to
opposite cerebellum.
Common Features of Fourth Ventricle
♦ Dorsal median sulcus divides floor into two symmetrical
halves.
♦ Medial eminence: Median eminence is one on each side
of median sulcus. It is wider above and narrow below. It
presents facial colliculus just opposite as well as medial to
the depression known as superior fovea. Deep to colliculus
is genu of the facial nerve formed by this nerve looping
around abducent nucleus. Hypoglossal triangle occupies
lower narrow part of eminence. Beneath this triangle lies
is the hypoglossal nucleus.
♦ A sulcus limits medial eminence over the lateral side,
inside the uppermost part (pontine part) of sulcus limitans
overlies an area which is bluish in color and is known
as locus coeruleius. The upper part of sulcus limitans is
marked by a depression, i.e. superior fovea which lies
just lateral to facial colliculus. In medullary part of floor,
the sulcus limitans is marked by a depression known
as inferior fovea. Descending from the fovea, there is
a sulcus which runs obliquely towards midline. The
sulcus divides medial eminence into two triangles, i.e.
hypoglossal triangle medially and vagal triangle laterally.
These overlie the hypoglossal nerve nucleus and of vagus
nerve, respectively. Between the vagal triangle above and
gracile tubercle below there is a small area known as area
postrema.
♦ Vestibular area: This lies lateral to the inferior fovea (sulcus
limitans) which overlies the vestibular nuclei. This area is
partly in the pons and partly in the medulla.
For diagram refer to Ans 1 of same chapter.
Q.3. Describe in detail fourth ventricle of brain.
(Mar 2013, 8 Marks)
Ans. Cavity of hindbrain is known as fourth ventricle.
Fourth ventricle is a tent-shaped space which is situated
between pons and upper part of medulla oblongata in
front and cerebellum behind. So usually it lies dorsal to
pons and in upper part of medulla oblongata as well as
ventral to cerebellum.
It consists of lateral boundaries, floor, roof and a cavity.
Anatomy  147
Lateral Boundaries or Lateral Walls
On each side, the fourth ventricle is bounded to:
♦ Inferolaterally by the inferior cerebellar peduncle, supple-
mented by gracile and cuneate tubercles
♦ Superolaterally by the superior cerebellar peduncles.
Floor of Fourth Ventricle of Brain
For details refer to Ans 2 of the same chapter.
Roof
Roof of the fourth ventricle is of diamond shape and is divided
into superior as well as inferior parts:
♦ Superior or cranial part of the roof is formed by the
convergence of two superior cerebellar peduncles and
a thin sheet of white matter, i.e. the superior medullary
velum. Superior cerebellar peduncles on emerging from
central white matter of cerebellum pass first cranially and
ventrally forming at first lateral boundaries of ventricles.
On approaching towards inferior colliculi, the penduncles
converge and intermingle over ventricles to form part of
the roof. Superior medullary velum fills angular interval
between two superior cerebellar peduncles. This is covered
over dorsal surface by lingual of superior vermis.
♦ Inferior or caudal part of the roof is formed by a thin sheet
of nonnervous tissue, the inferior medullary velum which
is formed conjointly by the ventricular ependyma and
the double fold of pia mater or tela choroidea that covers
it posteriorly. Caudally, continuity of sheet is broken
by a gap known as median aperture via which cavity of
ventricle communicates freely with subarachnoid space in
region of cerebellomedullary cistern. Inferior medullary
velum form small part of roof in region lateral to nodule
of cerebellum. Superior to the region of inferior medullary
velum over each side, layer of tela choroidea in contact
with ependyma of caudal part of roof reaches inferolateral
boundary of ventricular floor which get marked by
narrow white ridge known as taenia. Two of the taenia
are continuous below along with small curved margin.
Tela Choroidea of Fourth Ventricle
♦ This is a double layer of pia mater which occupies the
interval between the cerebellum as well as lower part of
the ventricle.
♦ Posterior layer of tela choroidea provides a covering of
pia mater to inferior vermis and after covering the nodule,
is reflected ventrally and caudally in immediate contact
with ependyma.
♦ Tela choroidea along with the vascular fringes which are
covered by secretory ependyma form choroid plexuses of
fourth ventricle. These projects inside the lower part of
roof of fourth ventricle.
♦ Each plexus either left or right, consists of a vertical
limb which lie next to the midline and a horizontal limb
which extend into lateral recesses. Vertical limb of the
two plexuses lie side by side so that whole structure is
T shaped.
148 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦ Vertical limbs of T shaped structure reach the median cerebellar peduncle (ventrally) and peduncle of flocculus
aperture and project into the subarachnoid space via it. dorsally reaching as far as the medial part of flocculus.
The lateral ends of horizontal limbs reach lateral apertures. ♦ One of the recess which is present in the median plane is
called as median dorsal recess. This extends dorsally in
Communication white core of cerebellum and lies cranial to nodule.
Cavity of the fourth ventricle communicates inferiorly with the ♦ Two lateral dorsal recesses, one over each side. Each lateral
central canal and superiorly with cerebral aqueduct. dorsal recess get extend dorsally lateral to nodule and
cranial to inferior medullary velum. These lie over either
Openings Present Inside the Roof side of median dorsal recess.
♦ Inside the caudal part of roof of fourth ventricle there are
three openings present, i.e. one median and two lateral.
♦ Median aperture of fourth ventricle alternatively known
as foramen of Magendie is a large opening which
is situated caudal to nodule. This opening provides
principal communication between the ventricular system
and subarachnoid space. The lateral apertures are also
called as foramina of Luschka and are situated at the
ends of lateral recesses and are partly occupied by parts
of choroid plexuses. Through these fourth ventricle also
communicates with subarachnoid space.

Angles
Following are the angles present, i.e.
♦ Superior angle: It is continuous with cerebral aqueduct.
♦ Inferior angle: It is continuous below with central canal
of spinal cord.
♦ Lateral angle: It lies one on each side towards the inferior
cerebellar peduncles.
Ans. Inside the caudal part of roof of fourth ventricle there are

(Aug 2018, 2 Marks)
three openings present, i.e. one median and two lateral.
Median aperture of fourth ventricle alternatively
known as foramen of Magendie is a large opening
which is situated caudal to nodule. This opening
provides principal communication between,
ventricular system and subarachnoid space.
The lateral apertures are also called as foramina
of Luschka and are situated at the ends of lateral
recesses and are partly occupied by parts of choroid
plexuses. Through these fourth ventricle also
communicates with subarachnoid space.

Fig. 187: Fourth ventricle along with its relations

Recess of Fourth Ventricle

They are basically the extensions of main cavity of ventricle.
Five recesses have been identified, i.e.
♦ Two lateral recesses present, i.e. one on each side. Each lateral
recess passes laterally inside the interval between inferior Fig. 189: Openings of fourth ventricle of brain
 Anatomy  149

b. Long association fibers connect more widely

8. CEREBRUM distributed gyri to one another.
2. Projection fibers: Connects the cerebral cortex to the
 other parts of the CNS, e.g. brainstem, spinal cord,
(Mar 1998, 4 Marks) corticopontine, cortiocospinal and internal capsule
3. Commissural fibers: These fibers connect corres-
ponding parts of the two hemisphere.
a. Corpus callosum: Connects two hemisphere
b. Anterior commissure: Connecting the archipallia
of the two sides
c. Posterior commissure: Connect the two superior
colliculi.
d. Commissure of the formina: Connecting the
hippocampel foramen.
e. Habenular commissure: Connecting the
habenular nuclei.
Q.4. Write a short note on corpus callosum.
(Jan 2018, 5 Marks) (Dec 2012, 3 Marks)
(Nov 2009, 5 Marks) (Dec 2010, 3 Marks)
Fig. 190: Sagittal section of cerebral hemisphere (May/June 2009, 5 Marks) (Aug 2012, 5 Marks)
(Nov 2008, 5 Marks) (Dec 2014, 5 Marks)

Q.2. Draw a well labeled diagram of superolateral surface Or

of cerebrum showing functional areas. Write short note on corpus callosum of brain.
(Feb 2002, 4 Marks) (Sep 2001, 5 Marks) (May 2014, 5 Marks)
Ans. Corpus callosum is largest commissure of the brain. It
connects two cerebral hemisphere.
All parts of cerebral hemisphere are connected by corpus
callosum except the lower and anterior part of temporal
lobe which is connected by the anterior commissure.

Parts of Corpus Callosum

♦ Genu: Genu is the anterior end. It lies 4 cm behind the
frontal lobe. Genu is related anteriorly to anterior cerebral
arteries and posteriorly to anterior horn of lateral ventricle.

Fig. 191: Superolateral surface of cerebrum showing functional areas

Q.3. Enumerate white fibers of brain. (Feb 2002, 2 Marks)

Or
Enumerate white fibers of cerebrum.
(Mar 2000, 4 Marks)
Ans. White fibers of cerebrum consist chiefly of myelinated
fibers and connect various parts of cortex to the another
and also to the other parts of CNS.
These fibers are classified into 3 groups.
1. Association (arcuate fibers): Connects different
cortical areas of the same hemisphere to one another
Fig. 192 Parts of corpus callosum
and are subdivided to:
a. Short association fibers connect adjacent gyri to ♦♦ Rostrum: It is directed downward and backward from
one another. the genu and ends by joining the lamina anterior in front
150 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
of the anterior commissure. Rostrum related superiorly
to anterior horn of the lateral ventricle and inferiorly to
indusium griseum and longitudinal striae.
♦ Trunk: It is the middle part between the genu and
splenium. Superior surface of trunk is convex from before
backward and it is concave from side to side. Trunk is
related to anterior cerebral arteries as well as to lower
border of falx cerebri. Overlapping of trunk is done by
cingulated gyrus and it is covered by the indusium griseum
and longitudinal striae. Inferior surface of the trunk is
concave from before backward and convex from side to
side. This surface provides an attachement to septum
pellucidum and fornix, it forms the roof of central part of
lateral ventricle.
♦ Splenium: It is the posterior end of corpus callosum and it
is the thickest part. It lies 6 cm in front of the occipital pole.
Inferior surface of splenium is related to tela choroidea
of third ventricle, pulvinar, pineal body and tectum of
midbrain. Superior surface of splenium is related to
inferior sagittal sinus and falx cerebri. Posteriorly splenium
is related to great cerebral vein, straight sinus and free
margin of tentorium cerebelli.
Fig. 193: Fibers of corpus callosum
Fibers of Corpus Callosum
♦ Rostrum: It connects orbital surfaces of two frontal lobes.
♦ Forceps minor: It is made up of fibers of genu and it
connects two frontal lobes.
♦ Forceps major: It is made up of fibers of splenium and it
connects two occipital lobes.
♦ Tapetum: It is formed by some fibers from the trunk and
splenium of corpus callosum. It forms roof and lateral
wall of posterior horn and lateral wall of inferior horn of
lateral ventricle.
Significance of Corpus Callosum
It helps in coordination of activities of two cerebral hemi-
spheres.

(Feb 2002, 4 Marks)
Or

(Aug 2011, 10 Marks)
Ans. Internal capsule is a large band of fibers, situated in the
inferomedial part of cerebral cortex.
• It appears V-shaped on cross-section with the
concavity directed laterally. The concavity is
occupied by the lentiform nucleus.
• Internal capsule contains fibers going to and coming
from the cerebral cortex.
• When traced upward, the fibers of capsule diverge
and continuous with corona radiata when traced
downward. The fibers converge and continuous
with the crus cerebri of the midbrain.
Fig. 194: Boundaries and parts of internal capsule
Parts of Internal Capsule
♦ Anterior limb: It lies between the lentiform nucleus and
caudate nucleus.
♦ Posterior limb: It lies between the lentiorm nucleus and
thalamus.
♦ Genu: It is the bend between the anterior and posterior
limb.
♦ Retrolentiform part: It lies behind the lentiform nucleus.
♦ Sublentiform part: It lies below the lentiform nucleus.
Relations
♦ Medially: Head of caudate nucleus and thalamus
♦ Laterally: Lentiform nucleus.
 Anatomy  151

Fibers of Internal Capsule ♦ Inferior thalamic radiation: They connect medial geniculate
body with primary auditory cortex.
There are three types of fibers present in internal capsule, i.e.
motor fibers, sensory fibers and constituent fibers. Constituent Fibers
Motor Fibers Following are the constituent fibers:
♦ Corticopontine fibers lie in the anterior limb, genu and Part of an
posterior limb. internal
♦ Frontopontine fibers begin from the frontal lobe to reach capsule Descending tract Ascending tract
pontine nuclei where they relay to reach opposite cerebellar Anterior limb Frontopontine Anterior thalamic
hemisphere. These are known as corticopontocerebellar fibers which is a radiation, i.e. fibers from
fibers. part of cortico– anterior and medial nuclei
pontocerebellar of thalamus
♦ Parietopontine and occipitopontine fibers lie inside the
pathway
retrolentiform part of internal capsule.
♦ Temporopontine fibers lie in the sublentiform part of Genu Corticonuclear fibers, Anterior part of superior
internal capsule. i.e. part of pyramidal thalamic radiation, i.e.
tract which is going to fibers from posterior
Pyramidal Fibers motor nuclei of cranial ventral nucleus of
nerves and forming thalamus
♦ Corticonuclear to nuclei of IIIrd, IVth, Vth, VIth, VIIth, their supranuclear
XIIth and nucleus ambiguus for IXth, Xth, XIth nerves of pathway
opposite side. Posterior limb • Corticospinal tract • Superior thalamic
♦ Corticospinal: These are the fibers for anterior horn cells of i.e. pyramidal tract radiation
muscles of head and neck which lie in the genu. for upper limb, • Fibers from globus
♦ Fibers for the upper limb, trunk and lower limb lie in the trunk and lower pallidus to subthalamic
posterior limb of internal capsule in the sequential order. limb nucleus
• Corticopontine
Extrapyramidal Fibers fibers
• Corticorubral fibers
They start from cerebral cortex as corticostriate and corticorubral
fibers and reach corpus striatum and red nucleus. Retrolentiform • Parietopontine and Posterior thalamic radiation
part occipitopontine is formed of:
Sensory Fibers fibers • Optic radiation mainly
• Fibers from or partly by the fibers
Thalamocortical fibers form thalamic radiations, i.e. 3rd order occipital cortex to connecting thalamus
neuron fibers: superior colliculus to parietal and occipital
♦ Anterior thalamic radiation: Fibers from the anterior and and pretectal lobes
region
dorsomedial nuclei of thalamus terminate inside the cortex
at frontal lobe. Sublentiform • Parietopontine and • Auditory radiation
♦ Superior thalamic radiation: Fibers of ventral group of part temporopontine • Fibers connecting
nuclei of thalamus reach sensory areas of frontal and the fibers thalamus to temporal
• Fibers between lobe
parietal lobes.
temporal lobe and
♦ Posterior thalamic radiation: All these fibers connect the thalamus
lateral geniculate body to area 17 and form optic radiation.

Fig. 195: Fiber component of internal capsule

152 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Blood Supply of Internal Capsule

Arteries supplying different parts of internal capsule are:
Part of internal capsule Artery supplying
Anterior limb Branch of anterior cerebral and its recurrent branch
Genu Branch of internal carotid artery and branch of posterior communicating artery
Posterior limb Branches of lateral and medial striate, anterior choroidal, posterior communicating arteries
Sublentiform part Branch of anterior choroidal and posterior cerebral arteries
Retrolentiform part Branches of posterior cerebral arteries

Fig. 196: Arterial supply of internal capsule

Applied Aspect Connections

♦ Lesion of internal capsule is vascular because of involvement ♦ Afferents: Optic tract
of medial and lateral striate branches of middle cerebral ♦ Efferents: It give rise to optic radiation which go to visual
artery. They lead to hemiplegia over opposite half of the area of cortex via retrolentiform part of an internal capsule.
body. This is an upper motor neuron type of paralysis.
Larger lateral striate artery is known as Charcot s artery Function
of cerebral hemorrhage. Lateral geniculate body is the last relay station on visual
♦ Thrombosis of recurrent branch of anterior cerebral artery pathway to occipital cortex.
leads to upper motor neuron type of paralysis of opposite
upper limb and of face.
♦ Lesion at genu of internal capsule lead to sensory and
motor loss at contralateral side of head. This may not be
complete as there is bilateral cortical innervation of most
of the cranial nerve nuclei.
Q.6. Write a short note on lateral geniculate body.
(Feb 2004, 5 Marks) (Sep 2005, 5 Marks)
Ans. It is a part of metathalamus and is a small oval elevation
which lies anterolateral to medial geniculate body below
thalamus. It is overlapped by medial part of temporal
lobe and gets connected to superior colliculus by
superior brachium.
Structure
Structure of lateral geniculate body is of six layers.
Layers 1, 4 and 6 receive contralateral optic fibers and layers
2, 3 and 5 receive ipsilateral optic fibers. Fig. 197: Layers of lateral geniculate body

(Feb 2005, 7 Marks)
Or
Enumerate various commissural fibers of brain.
Describe Corpus Callosum. (Aug 2011, 10 Marks)
Ans. The answer is given in chapter cerebrum in Ans 4 of
corpus callosum.
Enumeration of Commissures of Brain
1. Corpus callosum: Connecting cerebral cortex of two sides.
2. Anterior commissure: Connecting archipallia of two sides.
(Mar 2006, 15 Marks)
Or
Write briefly about functional areas of cerebrum.
(Feb 2013, 5 Marks)
Ans. Following are the three basic functional divisions of
cerebral cortex:
1. Motor areas: Primary motor area should be
identified on the basis of elicitation of motor
responses at low threshold of electric stimulation
which causes contraction of the skeletal muscles.
These areas provide origin to corticospinal and
corticonuclear fibers.
2. Sensory areas: In sensory areas, electrical activity
can be recorded if proper sensory stimulus is given
to a specific part of the body. Ventral posterior
nucleus of thalamus is the main source of afferent
fibers for first sensory area. Thalamic nucleus is
an actual site of termination of all the fibers of
medial lemniscus and most of spinothalamic and
trigeminothalamic tracts.
3. Association areas: In these areas, direct motor or
sensory responses should not be elicited. Such
Anatomy  153
3. Posterior commissure: Connecting superior colliculus
4. Commissure of fornix or hippocampel commissure
5. Habenular commissure: Connecting habenular nuclei
6. Hypothalamic commissure: Brachium for corpus callosum
refer to Ans 4 of the same chapter.
Q.8. Draw a labeled diagram of superolateral surface of
cerebral hemisphere showing sulci and gyri.
(Feb 2004, 20 Marks) (Sep 2005, 10 Marks)
(Aug 2005, 8 Marks)
areas both integrate and analyze responses from
different sources. Many such areas are known to
have motor or sensory functions. Motor as well
as sensory functions overlap in same region of
cortex. If the motor function is predominant, this
is known as motor sensory (Ms) while where the
sensory function is predominant, it is known as
sensorimotor (Sm).
Motor Areas
Primary Motor Area
♦ This is located inside the precentral gyrus and also
includes anterior wall of central sulcus and inside the
anterior part of paracentral lobule over medial surface of
cerebral hemispheres. This mainly corresponds to area 4
of Brodmann.
♦ Electrical stimulation of primary motor area leads to
contraction of muscles which are mainly at the opposite
side of body.
♦ Cortical control of musculature is mainly contralateral,
there is significant ipsilateral control of most of the muscles
of head and axial muscles of body. Contralateral half of
the body is represented as upside down, except the face.
154 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Pharyngeal region and tongue are represented in most
ventral and lower part of precentral gyrus which is
followed by face, hand, arm, trunk and thigh. Remainder
of leg, foot and perineum is over medial surface of
hemisphere inside paracentral lobule.
♦ Another significant feature of this area is the size of cortical
area for particular part of body is determined by functional
importance of part and its need for both sensitivity and
intricacy of movements in that region.
Premotor Area
♦ It coincides with Brodmann area 6 and is situated anterior
to motor area in superolateral and medial surfaces of
hemisphere.
♦ This area contributes to motor function by its direct
contribution to pyramidal and other descending motor
pathways. It also carries this by its influence on primary
motor cortex.
♦ Premotor area program skilled motor activity and directs
primary motor area in its execution.
♦ Both premotor as well as primary motor areas together
referred as somatomotor area (Ms I). Both areas provide
origin to corticospinal and corticonuclear fibers and also
receive fibers from the cerebellum after relaying in ventral
intermediate nucleus of thalamus.
Supplementry Motor Area (Ms II)
♦ This is predominantly motor in its function.
♦ This area is in the part of area 6 which lie over medial
surface of hemisphere anterior to paracentral lobule.
♦ Different parts of body are represented in this area.
Motor Speech Area of Broca’s
♦ It occupies both opercular and triangular portions of
inferior frontal gyrus which correspond to area 44 and 45
of Brodmann.
♦ This is present over left side in 98% of right handed persons.
In 70% of left handers it is present in left hemisphere. Only
in 30% of people it is present in right hemisphere.
Frontal Eye Field
♦ This lies inside the middle frontal gyrus just anterior to
precentral gyrus.
♦ This is the lower part of area 8 of Brodmann over lateral
surface of cerebral hemisphere, extending slightly beyond
this area.
♦ Electrical stimulation inside this area leads to deviation
of both eyes to opposite side. This is known as conjugate
movement of eyes.
♦ Movement of head as well as dilatation of pupil can also
take place.
♦ Frontal eye field is connected to the cortex of occipital lobe
which is concerned with the vision.
Prefrontal Cortex
♦ It is the large area which lie precentral area.
♦ It consists of superior, middle and inferior frontal gyri;
medial frontal gyrus; orbital gyri and anterior half of
cingulated gyrus. These include Brodmann s areas 9, 10,
11 and 12.
♦ Prefrontal cortex is connected to other areas of cerebral
cortex, corpus striatum, thalamus and hypothalamus.
♦ It is connected to cerebellum via pontine nuclei.
♦ This area controls emotions, concentration, attention,
initiative and judgement.
Sensory Areas
First Somesthetic Area
♦ It is the general sensory area and is also known as first
somatosensory area (Sm I).
♦ This area occupies postcentral gyrus on superolateral
surface of cerebral hemisphere and posterior part of
paracentral lobule on the medial surface. This correspond
to areas 3, 1 and 2 of Brodmann.
♦ Representation of body in this area is contralateral half of
body is represented upside down except the face.
♦ Area of cortex which receives sensation from a particular
part of body is not proportional to size of that part, but
rather to intricacy of sensations received from it. So thumb,
fingers, lip and tongue have disproportionately large
representation.
♦ Different sensations, i.e. cutaneous and proprioceptive
are represented in different parts inside the sensory area.
♦ Ventral posterior nucleus of thalamus is the main source
of afferent fibers for sensory area. This nucleus is the site
of termination of all fibers of medial lemniscus.
♦ Most fibers of spinothalamic and trigeminothalamic tract
carry fibers for cutaneous sensibility end at anterior part of
area and those for deep insensibility end at posterior part.
Second Somesthetic Area
♦ It is also called as second somatosensory area (Sm II).
♦ It is situated in superior lip of posterior ramus of lateral
sulcus with postcentral gyrus.
♦ Parts of body are represented bilaterally.
Somesthetic Association Cortex
♦ It lies in superior parietal lobule over superolateral surface
of hemisphere and in precuneus over medial surface.
♦ It coincides with areas 5 and 7 of Brodmann.
♦ This area receives afferent from first sensory area and has
reciprocal connection with dorsal tier of nuclei of lateral
mass of thalamus.
Receptive Speech Area of Wernicke
♦ It is also known as sensory language area.
♦ It has auditory association cortex and of adjacent parts of
inferior parietal lobule. i.e. area 22.
Areas of Special Sensations
Vision
♦ Visual area is located both above and below the calcarine
sulcus over medial surface of occipital lobe.

A B
Fig. 199: Functional areas of: A. Superolateral surface of cerebral hemisphere; B. Medial surface of cerebral hemisphere
♦ This area corresponds to area 17 of Brodmann.
♦ Chief source of afferent fibers to area 17 is lateral geniculate
nucleus of thalamus by way of geniculocalcarine tract.
♦ Area 17 constitutes first visual area. It is continuous
both above as well as below with area 18 and beyond
with this with area 19 of Brodmann which is known as
visual association or psychovisual areas. As fibers of
geniculocalcarine tract terminate in these regions also,
these areas are regarded as second and third visual areas.
♦ Role of second and third visual areas are relating of present
or past visual experience with recognition of what is seen
and appreciation of its significance.
♦ All of the three areas are linked together by association
fibers.
Hearing
♦ Auditory area lies in the temporal lobe.
♦ Most of the auditory area is concealed as it lie in that part
of superior temporal gyrus which form inferior wall of
posterior ramus of lateral sulcus.
♦ It corresponds to area 41 and 42 of Brodmann.
♦ Medial geniculate body of thalamus is principle source
of fibers which end in auditory cortex with these fibers
constituting auditory radiation.
♦ There is presence of spatial representation in auditory area
with respect to pitch of sounds. Low frequency impulses
impinge over anterolateral part of area and high frequency
impulses get heared on posteromedial part.
♦ Cortex receives afferent from both the ears.
♦ Auditory radiation does not only end in first auditory
area but extend to neighboring area as well. This is called
as auditory association area or secondary auditory area.
♦ Second auditory area lies behind first auditory area in
superior temporal gyrus. This corresponds to area 22 of
Brodmann over lateral surface of superior temporal gyrus.
This region of cortex is called as Wernicke s area and has
role in language functions.
Taste
♦ Taste area or gustatory area is located at the dorsal wall of
posterior ramus of lateral sulcus with extension in insula
and correspond to area 43 of Brodmann.
♦ It places taste area adjacent to first sensory area of cortex
for tongue and pharynx.
Anatomy  155
Clinical Anatomy
Motor Areas
♦ Lesion of primary motor area 4 leads to voluntary paresis
of affected part of body. Spastic voluntary paralysis of
contralateral side of body follows if the lesion spreads
beyond area 4 or that interrupts projection fibers in
medullary center or internal capsule. Irritative lesion
of motor region causes focal convulsive movements of
corresponding part of body known as Jacksonian epilepsy.
♦ Lesion in supplementary motor area 6 causes apraxia. In
apraxia there is difficulty in performing skilled movements
once learned in the absence of paralysis, ataxia or sensory
loss. If disability affects writing, it is known as agraphia.
♦ Frontal eye field: Lesion in this region leads to conjugate
deviation of eyes towards the side of lesion. Patient is unable
to move his eyes in an opposite direction voluntarily, but
this movement occurs involuntarily when he observes an
object moving across field of vision.
♦ Speech area: Lesion present on Broca s area over dominant
side of hemisphere leads to expressive aphasia. This
is characterized by hesitant and distorted speech with
relatively good comprehension.
♦ Lesion at Wernicke s area and Broca s area leads to receptive
aphasia. In this auditory as well as visual comprehension of
language i.e. naming of objects and repetition of sentence
spoken by examiner are all defective.
♦ Lesion at Wernicke s area and superior longitudinal
fasciculus or arcuate fasciculus leads to jargon aphasia. In
this speech is fluent but unintelligible jargon.
♦ Voluntary smile in stroke patient will accentuate asymmetry.
Sensory Areas
♦ First somesthetic or general sensory area, i.e. areas 3, 1
and 2 of Brodmann: Lesion at this site produces a crude
form of awareness for sensation of pain, heat and cold
over opposite side of lesion. Stimulus is poorly localized.
There is also loss of discriminative sensations of fine touch,
movements and position of part of body.
♦ Somesthetic association cortex, i.e. areas 5 and 7 of
Brodmann: Lesion here causes defect in understanding
significance of sensory information which is known as
agnosia. Lesion which destroys a large portion of this
association cortex leads to tactile agnosia and astereognosis.
156 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

In this condition, patient is unable to recognize objects
held in hand, while eyes are closed. Person is not able to
correlate surface, texture, shape, size and weight of object
or compare the sensation with previous experience.
Special Sensory Areas
of hearing in both ears and loss is greater in opposite
ear. Impairment is less because of bilateral projection
to the cortex.
Auditory association cortex or secondary area 22:
Lesion at this region causes loss of sound interpretation.

♦ Primary visual area 17: Lesion in this region causes loss Q.10. Draw diagram of superolateral surface of cerebrum.
of vision in visual field of opposite side, i.e. homonymous (Feb 2013, 5 Marks)
hemianopia Or
♦ Auditory area Draw and label the superolateral surface of cerebrum.
Primary auditory areas 41 and 42: Unilateral lesion (Mar 2007, 3 Marks)
involving auditory area leads to diminution in acuity

Fig. 200: Superolateral surface of cerebral hemisphere

 ramus of lateral sulcus. Upper end of sulcus extends

for short distance over medial surface.
Lateral sulcus: It starts at inferior surface. On
reaching to lateral surface, it divides into three rami,
i.e. posterior ramus, anterior horizontal ramus and
anterior ascending rami. Out of these three posterior
ramus is the largest and its posterior end turn
upward into the temporal lobe. Apart from this other
two rami extend to lower part of the frontal lobe.

Fig. 201: Superolateral surface of cerebral hemisphere showing sulci and gyri (For colour version see Plate 6)

Frontal lobe is further divided by following sulci i.e.
– Precentral gyrus run parallel to central sulcus
mostly little in front of it. Precentral gyrus lie
between two sulci.
– Area which lie in front of precentral sulcus
is divided into superior, middle and inferior
frontal gyri by superior and inferior frontal sulci.
– Anterior horizontal and anterior ascending rami
of lateral sulcus subdivides the inferior frontal
gyrus into three parts, i.e. pars orbitalis, pars
triangularis and pars opercularis.
Parietal lobe is further divided by following sulci, i.e.
– Postcentral sulcus runs parallel to central sulcus,
little behind it. Postcentral gyrus lies between
two sulci.
– Area behind postcentral gyrus is divided into
superior and inferior parietal lobules by intra-
parietal sulcus.
– Inferior parietal lobule is invaded by upturned
ends of posterior ramus of lateral sulcus and
of superior and inferior temporal sulci. These
all divide inferior parietal lobule into three
parts, i.e. anterior, middle and posterior parts.
Anterior part is known as supramarginal gyrus
and middle part is known as angular gyrus.
Both superior and inferior temporal sulci divide
temporal lobe into superior, middle and inferior
temporal gyri.
Occipital lobe is further subdivided by following
sulci:
– Lateral occipital sulcus divides this lobe into
superior and inferior occipital gyri.
– Lunate sulcus leads to separation of these gyri
from occipital pole.
Area around the parieto-occipital sulcus is arcus
parieto-occipitalis. This is separated from superior
occipital gyrus by transverse occipital sulcus.
Q.12. Enumerate parts of corpus callosum.
(Sep 2017, 2 Marks)
Or
Name the parts of corpus callosum.
(Aug 2018, 1 Mark)
Ans. Following are the parts of corpus callosum:
Genu
Rostrum
Trunk or body
Splenium.
9. THE THIRD VENTRICLE, LATERAL
VENTRICLE AND LIMBIC SYSTEM
Q.1. Briefly describe lateral ventricle of brain.
(Apr 2010, 5 Marks)
Ans. Lateral ventricle are two irregular cavity which lies in
each cerebral hemisphere.
Anatomy  157
♦ Each lateral ventricle communicates with the third
ventricle through interventricular foramen/foramen of
Monro.
Each lateral ventricle consist of:
♦ Central part.
♦ Three horns, i.e. anterior, posterior and inferior.
Central Part
This part extends from the intraventricular foramen in front to
splenium of corpus callosum behind.
Boundaries
Roof: Undersurface of corpus callosum.
Floor: Formed lateral to medial side by:
♦ Body of caudate nucleus.
♦ Stria terminalis
♦ Thalomostriate vein
♦ Lateral portion of upper surface of thalamus.
Medial Wall
♦ Septum pellucidum.
♦ Body of fornix.
Choroid Fissure
♦ It is the line along which the choroid plexus invaginates
into the lateral ventricle.
♦ This is a C-shaped slit inside the medial wall of cerebral
hemisphere.
♦ Choroid fissure begins at interventricular foramen and
passes around the thalamus and cerebral peduncle to
uncus. So, it is present only in relation to central part and
inferior horn of lateral ventricle.
♦ Convex margin of choroid fissure are bounded by fornix,
fimbria and hippocampus, while the concave margin is
bounded by thalamus, tail of caudate nucleus and stria
terminalis.
♦ At fissure, pia matter and ependyma contact with each
other and both are invaginated into the ventricle by
choroid plexus.
♦ In the central part of lateral ventricle, choroid plexus is
the narrow gap between the edge of fornix and upper
surface of thalamus. Invagination of gap is by choroid
plexus.
Horns
♦ Anterior horn: It lies in front of the intraventricular
foramen and extends into the frontal lobe. Anterior horn is
directed forward, laterally and downward, it is triangular
in cross-section.
♦ Posterior horn: It lies behind the splenium of corpus
callosum extends in occipital lobe. It is directed backward
and medially.
♦ Inferior horn: It is the largest horn of lateral ventricle
which start at the junction of central part with the posterior
horn of lateral ventricle and extends into the temporal
lobe.
158 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

The area belonging to the occipital lobe is supplied

(Aug 2012, 10 Marks) by the posterior cerebral artery.
Ans. The ventricles of brain are: The main artery supplying medial surface is anterior
Two lateral ventricles cerebral artery.
One third ventricle
One fourth ventricle. Arteries Supplying Cerebellum
♦ The cerebellum is supplied by the branches of basilar and
Applied Aspect of Ventricles of Brain
vertebral artery.
♦ Third ventricle is a narrow space which is easily obstructed ♦ The superior surface is supplied by the superior cerebellar
by local brain tumors or by developmental defects. The branch of the basilar artery.
obstruction leads to raised intracranial pressure in adults ♦ Anterior part of inferior surface is supplied by the
and hydrocephalus in infants. anteroinferior cerebellar branch of the basilar artery.
♦ Tumors in the lower part of the third ventricle give rise to ♦ Posterior part of inferior surface is supplied by the
hypothalamic symptoms like diabetes insipidus, obesity, etc. posteroinferior cerebral branch of vertebral artery.
♦ The site of obstruction can be found out by ventriculography.
In an anteroposterior view of the ventriculogram, the third 
ventricle is seen normally as a narrow, vertical midline
shadow.
♦ Dilatation of the third ventricle would indicate obstruction
at a lower level, e.g. the cerebral aqueduct. If the obstruction
is in the third ventricle, both the lateral ventricles are dilated
symmetrically. Obstruction at an interventricular foramen
causes unilateral dilatation of the lateral ventricle of that side.
♦ Vital centers are situated in the vicinity of the vagal
triangle. An injury to this area is, therefore, fatal.
♦ lnfratentorial brain tumors block the median and lateral
foramina situated in the roof of the ventricle. This results
in a marked and early rise of intracranial pressure.
♦ Vital centers lie near fourth ventricle. Pressure on these
vital centers may cause deep comma and sudden death. (Sep 2013, 5 Marks)
Or
Write short answer on circulus arteriosus.
(Aug 2018, 3 Marks)
Ans. Circle of Willis is an arterial circle which is situated at
the base of brain inside interpeduncular fossa.
It is formed by the anterior and middle cerebral branches
of internal carotid artery and posterior cerebral branches
of basilar artery.

Formation of Circle of Willis

Two anterior cerebral arteries get connected by anterior
communicating artery; middle and posterior cerebral arteries
of same side are united by posterior communicating artery.
Fig. 202: Ventricles of brain
Branches
10. BLOOD SUPPLY OF SPINAL ♦ Circle of Willis has cortical and central branches.
CORD AND BRAIN ♦ Cortical or the external branches run on the surface of
cerebrum, they anastomose freely and if they get blocked,
they produce small infarcts.
Q.1. Name the arteries supplying cerebrum and cerebellum.
♦ Central branches perforate white matter and supply to
(Sep 1996, 5 Marks)
thalamus, corpus striatum and internal capsule. They do
Ans. Arteries Supplying the Cerebrum
not get anastomose and if they get blocked, they produce
The anterior, middle and posterior cerebral artery
large infarcts.
supplying the cerebrum.
♦ Central branches are arranged in six groups are described
Greater part of superolateral surface is supplied by
here.
the middle cerebral artery.

Anteromedial Group
Largest branch is known as medial striate or recurrent artery
of Heubner. It supplies corpus striatum and the internal
capsule which consists of motor fibers for face, tongue and
shoulder. They are arranged in two groups one over each
side.
Anterolateral Group
They are arranged in two groups. Largest branch is known as
lenticulostriate or Charcot s artery of cerebral hemorrhage. It
supplies to internal capsule which consists of motor fibers for
one side of body.
Posterolateral or Thalamogeniculate
They supply both, thalamus and geniculate bodies.
Posteromedial
They supply both, thalamus and hypothalamus.
Significance
It attempts to equalize the flow of blood to various parts of brain ♦
and provides collateral circulation in event of obstruction to one
(Mar 2006, 4 Marks)
Ans.
Branches of External Carotid Artery
It gives off 8 branches which are:
Anteriorly
♦ Superior thyroid artery
♦ Lingual artery
♦ Facial artery.
Anatomy  159
of its components. Hardly there is any mixing of bloodstreams
over right and left side of circle of Willis.
Clinical Anatomy
♦ Thrombosis of the lateral striate branches of middle
cerebral artery leads to motor and sensory loss towards
contralateral side of the body except lower limb.
♦ Hemiplegia is a common condition. This is an upper motor
neuron type of paralysis of one-half of body which also
includes the face. It occurs because of internal capsule lesion
caused due to thrombosis of one of the lenticulostriate
branches of middle cerebral artery. Mainly, one of the
lenticulostriate branches is most frequently ruptured which
is called as Charcot s artery of cerebral hemorrhage. It leads
to hemiplegia with deep coma and is fatal.
♦ Thrombosis of Heubner s recurrent branch of anterior
cerebral artery leads to contralateral upper monoplegia.
♦ Occurrence of occlusion proximal to anterior communi-
cating artery is well tolerated due to cross flow. Distal
occlusion leads to weakness and cortical sensory loss in
opposite lower limb with associated incontinence.
Thrombosis of paracentral artery leads to opposite lower
limb monoplegia.
Posteriorly
♦ Occipital artery
♦ Posterior auricular artery.
Medially
♦ Ascending pharyngeal artery.
Terminally
♦ Maxillary artery.
♦ Superficial temporal artery.
For description of Circle of Willis refer to Ans 2 of same chapter.
160 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.4. Draw a labeled diagram to show the blood supply on

the superolateral surface of cerebrum.
(July 2016, 10 Marks)
Ans.

Fig. 205: Venous drainage on superolateral surface of cerebrum

Fig. 204: Arterial supply on superolateral surface of cerebrum

 UPPER LIMB AND THORAX
1. PECTORAL REGION
 costal nodes. Among axillary lymph nodes lymphatics
(Feb 2013, 5 Marks)
Ans.
Lymphatic Drainage of Breast
Lymph Nodes
♦ Lymph from breast drains mainly in anterior axillary
lymph nodes. Posterior, lateral, central and apical groups
also receive lymph from breast.
♦ Lymph from breast also drains to Internal mammary
lymph nodes
♦ Some lymph from breast also reaches to supraclavicular
nodes, cephalic nodes, posterior intercostal node,
subdiaphragmatic and subperitoneal lymph plexus.
Lymphatic Drainage
♦ Superficial lymphatics drains the skin over breast
except areola and nipple. Lymphatics pass radially to
surrounding lymph nodes, i.e. axillary, internal mammary,
supraclavicular and cephalic.
Fig. 206: Lymphatic drainage of breast
(For colour version see Plate 7)
♦ Deep lymphatics drain parenchyma, nipple and areola.
♦ 75% of lymph from the breast drains into axillary nodes;
20% to parasternal lymph nodes and 5% to posterior inter-
ends in anterior group and partly in posterior and apical
groups. Lymph from anterior and posterior groups pass
from central and lateral groups and via them to apical
group. Lastly it reaches supraclavicular lymph nodes.
♦ Internal mammary nodes drain lymph from inner half and
outer half of breast.
♦ Subareolar plexus of Sappy and most of lymph from breast
drains to anterior and pectoral group of lymph nodes.
♦ Lymphatics from deep surface of breast pass via pectoralis
major muscle and clavipectoral fascia to reach apical lymph
nodes and to internal mammary nodes.
♦ Lymphatics from lower and inner quadrants may communi-
cate with subdiaphragmatic and subperitoneal lymph plexus.
Q.2. Write briefly on clavipectoral fascia.
(Nov 2008, 5 Marks)
Ans. Clavipectoral fascia is a fibrous sheet which is situated
deep to clavicular portion of pectoralis major muscle.
♦ Clavipectoral fascia extends from clavicle above to axillary
fascia below.
♦ Upper part of clavipectoral fascia splits and enclose the
subclavius muscle.
♦ Posterior lamina gets fused to the investing layer of deep
cervical fascia and to the axillary sheath.
♦ Inferiorly clavipectoral fascia splits and enclose pectoralis
minor muscle.
♦ Medially fascia is attached to the external intercostal
muscle of upper intercostals space and laterally fascia is
attached to the coracoid process.
Fig. 207: Clavipectoral fascia
162 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦ Below the external intercostal muscle the clavipectoral Origin of plexus may shift by one segment either
fascia continues as suspensory ligament which is attached upward or downward, resulting in prefixed or
to the dome of axillary fascia and helps to keep it pulled up. postfixed plexus.
♦ Clavipectoral fascia is pierced by: • In prefixed plexus, contribution by C4 is large and that
Lateral pectoral nerve form T2 is often absent.
Cephalic vein • In postfixed plexus, contribution by T1 is large, T2 is
Thoracoacromial vessels. always present, C4 is absent and C5 is reduced in size.
Lymphatics passing from breast and pectoral region Roots join to form trunk.
to apical group of axillary lymph nodes. 2. Trunks
Roots C5 and C6 join to form the upper trunk.
Roots C7 forms the middle trunk.
2. AXILLA Roots C8 and T 1 joins to form the lower trunk.
3. Divisions of the trunks: Each trunk divides into ventral
and dorsal divisions. These divisions join to form
cords.
4. Cords:
Lateral cord is formed by the union of the ventral
division of the upper and middle trunks.
The medial cord is formed by the ventral division of
(Sep 2006, 3 Marks)
the lower trunk.
Or Posterior cord is formed by the union of dorsal division
 of all the three trunks.
(Dec 2009, 5 Marks)
Branches of Brachial Plexus
Or
A. Branches of the root
Enumerate branches of posterior cord of brachial
1. Nerve to serratus anterior (C5, C6, C7)
plexus. (Do not describe) (Feb 2013, 2 Marks) 2. Nerve to rhomboids (C5)

Ans. Formation of Brachial Plexus 3. Branches to longus colli and scaleni muscles and
The plexus consist of roots, trunks, divisions and cords. branch to phrenic nerve.
1. Roots B. Branches of the trunk: These arises only from the upper
They are constituted by anterior primary rami of spinal trunk. It gives two branches:
nerves C5, C6, C7, C8 and T1, with contributions from 1. Suprascapular nerve (C5, C6)
anterior primary rami of C4 and T2. 2. Nerve to subclavius (C5, C6)

Fig. 208: Brachial plexus

 Upper Limb and Thorax  163

C. Branches of the cords The deformity is also known as policeman s tip hand or
1. Branches of the lateral cord Porter s tip hand .
a. Lateral pectoral (C5 C7)
b. Musculocutaneous (C5 C7) Disability
c. Lateral root of median (C5 C7). The following movements are lost:
2. Branches of Medial Cord
1. Abduction and lateral rotation of the arm at shoulder joint.
a. Medial pectoral (C8, T1)
2. Flexion and supination of forearm.
b. Medial cutaneous nerve of arm (C8, T1)
3. Biceps and supinator jerks are lost.
c. Medial cutaneous nerve of forearm (C8, T1)
4. Sensations are lost over a small area over the lower part
d. Ulnar (C7, C8, T1). C7 fibers reach by communicat-
of the deltoid.
ing branch from lateral root of median nerve.
e. Medial root of median (C8, T1) Q.3. Write briefly on Erb’s point and Erb’s paralysis.
3. Branches of posterior cord (Aug 2011, 5 Marks)
a. Upper subscapular (C5, C6) Ans. Erb’s Point
b. Nerve to latissimus dorsi (C6, C7, C8)
Erb s point is the one region of upper trunk of brachial
c. Lower subscapular (C5, C6)
plexus.
d. Axillary (C5, C6)
e. Radial (C5 C8, T1). Erb s point is the meeting junction of six nerves, i.e.
A. Ventral ramus of cervical five segment of spinal cord.
Q.2. Write short note on Erb’s paralysis.
B. Ventral ramus of cervical six segment of spinal cord
(Aug 2005, 4 Marks) (Apr 2008, 5 Marks)
(June 2010, 5 Marks) (Aug 2011, 5 Marks) The above two rami join and form upper trunk i.e.
Ans. Injury to the upper trunk of brachial plexus causes Erb s C. Suprascapular nerve from upper trunk
paralysis. D. Nerve to subclavius from upper trunk
E Anterior division of upper trunk
In Erb s paralysis arm cannot be abducted. Elbow is
F. Posterior division of upper trunk.
extended and forearm is pronated. This is Erb s paralysis.
The above divisions give fibers to deltoid, brachialis,
Causes of Injury biceps brachii and supinator.
1. Birth injury
Erb’s Paralysis
2. Fall on shoulder
3. During anesthesia. Refer to Ans 2 of same chapter.

Nerve Roots Involved

Mainly C5 and partially C6.
Muscle Paralysed
Mainly biceps brachii, deltoid, brachialis and bronchoradialis
and partially supraspinatus, infraspinatus and supinator.

Fig. 210: Erb’s point

Q.4. Write briefly on axilla. (Jan 2012, 5 Marks)

Ans. Axilla is a pyramidal space which lies in between the
upper part of arm and the chest wall.
It resembles a four sided pyramid and consists of an apex, a
base and four walls, i.e. anterior, posterior, medial, lateral.
Boundaries
Fig. 209: Erb’s paralysis
Apex
Deformity and Position of Limb
Apex is directed upwards and medially towards the root of neck.
Arm: It hangs by side, it is adducted and medially rotated. Apex is truncated and correspond to a triangular interval which is
Forearm: Extended and pronated. bounded anteriorly by posterior surface of clavicle, posteriorly by
164 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
superior border of scapula and medial aspect of coracoid process,
medially it is bounded by outer border of first rib. This oblique
passage is known as cervicoaxillary canal and axillary vessels,
axillary veins and brachial plexus pass via this canal to enter axilla.
Base
It is directed downwards. It is formed by skin, superficial,
axillary fasciae. This is convex upwards in congruence with
concavity of axilla.
Anterior Wall
It is formed by pectoralis major in front, clavipectoral fascia
and pectoralis major.
Fig. 211: Wall and contents of axilla (For colour version see Plate 7)
Contents of Axilla
1. Axillary artery and its branches
2. Axillary vein and its tributaries
3. Infraclavicular part of brachial plexus
4. Five groups of axillary lymph nodes and associated
lymphatics
5. Long thoracic and intercostobrachial nerves
6. Axillary fat and areolar tissue in which other contents get
embedded.
Layout
♦ Axillary artery as well as brachial plexus of nerves run from
the apex to base along the lateral wall of axilla, nearer to
anterior wall as compared to posterior wall.
♦ Thoracic branches of axillary artery lie in contact with the
pectoral muscles, lateral thoracic vessels running along
the lower border of pectoralis minor.
♦ The subscapular vessels run along the lower border of
subscapularis.
Subscapular nerve and the thoracodorsal nerve cross
the anterior surface of subscapularis.
Circumflex scapular vessels wind around the lateral
border of scapula.
Posterior Wall
It is formed by subscapularis above, teres major and latissimus
dorsi below.
Medial Wall
It is convex laterally and is formed by upper four ribs with
intercoastal muscles and upper part of serratus anterior
muscle.
Lateral Wall
It is narrow and is formed by Upper part of shaft of humerus
in bicipital groove and Coracobrachialis and short head of
biceps brachii.
Axillary nerve and posterior circumflex humeral vessels
pass backwards close to surgical neck of humerus.
♦ Medial wall of axilla is avascular, except for few small
branches from superior thoracic artery.
Long thoracic nerve (nerve to the serratus anterior)
descends on surface of muscle.
Intercostobrachial nerve pierces the anterosuperior
part of medial wall and crosses the spaces to reach
medial side of arm.
♦ Axillary lymph nodes are 20 to 30 in number and are
arranged in five sets, i.e.
Anterior group lies along the lower border of pectoralis
minor, on the lateral thoracic vessels.
Posterior group lies along the lower margin of
posterior wall along with subscapular vessels.
Lateral group lies posteromedial to axillary vein.
Central group lies inside the fat of axilla.
Apical group lies behind and above pectoralis minor,
medial to the axillary vein.
Q.5. Write briefly on posterior cord of brachial plexus.
(Dec 2010, 5 Marks)
Ans. Posterior cord of brachial plexus is formed by union of
dorsal divisions of all the three trunks.
 Upper Limb and Thorax  165

 ♦ Suprascapularis on the lesser tubercle of humerus

♦ Pectoralis major, teres major and latissimus dorsi on
intertubercular sulcus of humerus.
There is origin of:
♦ Coracobrachialis and short head of biceps brachii from
the coracoid process
♦ Long head of biceps brachii from supraglenoid tubercle
♦ Long head of triceps brachii from infraglenoid tubercle
♦ Lateral head of triceps brachii from upper part of posterior
(Feb 2016, 2 Marks) surface of humerus
Ans. Following are the branches of lateral cord of brachial
Vessels
plexus:
a. Lateral pectoral (C5 C7) ♦ Anterior circumflex humeral
b. Musculocutaneous (C5 C7) ♦ Posterior circumflex humeral
c. Lateral root of median (C5 C7). Nerve
For diagram please refer to Ans 1 of same chapter. Axillary nerve.
Joints and ligaments
3. SCAPULAR REGION ♦ Musculotendineous cuff of shoulder
♦ Coracoacromial ligament.

Bursae
(Feb 2003, 5 Marks)
Or All burase around shoulder joint, including subacromial or
Write short note on deltoid muscle. (Apr 2008, 3 Marks) subdeltoid bursa.
(Jan 2012, 4 Marks) (May 2014, 5 Marks)
Applied Anatomy of the Deltoid Muscle
Ans. Deltoid muscle is the muscle of scapular region.
♦ Intramuscular injections are often given into the deltoid.
Origin They should be given in the lower half of the muscle to
1. Anterior border of the adjoining surface of lateral one third avoid injury to the axillary nerve.
of clavicle. ♦ Clinical test and paralysis of deltoid: The deltoid muscles
2. Lateral border of the acromion where four septae of origin are tested by asking the patient to abduct the arm against
are attached. resistance and feeling for the contracting muscle.
3. Lower lip of the crest of spine of scapula.
Insertion
Deltoid muscle is inserted into the deltoid tuberosity of humerus
where three septae of insertion get attached.
Nerve Supply
By axillary nerve (C5, C6).

Action
1. Acromial fibers are powerful abductors of the arm at
shoulder joint from starting to 90°.
2. Anterior fibers are flexors and medial rotators of the arm.
3. Posterior fibers are extensors and lateral rotators of the arm.
Structures Under Cover of Deltoid
Bones
♦ Upper end of humerus
♦ Coracoid process

Muscles
There are insertions of:
♦ Pectoralis minor on the coracoid process
♦ Supraspinatus, infraspinatus and teres minor on greater
tubercle of humerus Fig. 212: Origin and Insertion of deltoid
166 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.2. Write in short on quadrangular space.
(Aug 2012, 5 Marks)
Ans. Quadrangular space is one of the three intermuscular
spaces of the scapular region.
It is the space in between scapular muscles.
Boundaries
♦ Superiorly:
1. Subscapularis in front
2. Capsule of shoulder joint
3. Inferior border of teres minor behind.
♦ Inferiorly: Superior border of teres major.
♦ Medially: Lateral border of long head of triceps brachii.
♦ Laterally: Surgical neck of humerus.
Contents
♦ Axillary nerve.
♦ Posterior circumflex humeral vessels.
When median cubital vein is absent, the basilic vein
is preferred over cephalic because former is more
efficient. Basilic vein run along straight path whereas
cephalic vein bend acutely to drain into axillary vein.
In 3% of individuals the ulnar artery may arise high
in arm and passes superficial to flexor muscles or
forearm and is known as superficial ulnar artery.
This variation should be keep in mind while giving
intravenous injections, because if superficial ulnar
artery is mistaken for a vein it can be damaged and
produce bleeding. If an irritating drug is injected
into the artery the result can be fatal.
5. ARM
Q.1. Write briefly on cubital fossa.
(May/June 2009, 5 Marks) (Aug 2011, 5 Marks)
Ans. Cubital fossa is a triangular hollow fossa that is situated
on the front of the elbow.

4. CUTANEOUS NERVES, SUPERFICIAL

VEINS AND LYMPHATIC DRAINAGE
Q.1. Write short note on intravenous injections.
(Jan 2018, 5 marks)
Ans. Intravenous injections are most commonly given in
superficial vein in front of elbow and in the dorsum of
hand.
Intravenous injection can be given in cephalic vein,
basilic vein and median cubital vein.
Median cubital vein is often the vein of choice
for intravenous injections. This vein is preferred
because:
– It has easy access, as it is superficial and
prominent.
– It is well supported by underlying bicipital
aponeurosis
– It is anchored by a perforating vein to deep veins
so that it does not slip during the procedure.

Fig. 214: Boundaries of cubital fossa

(For colour version see Plate 7)
Boundaries
♦ Laterally: Medial border of brachioradialis.
♦ Medially: Lateral border of pronator teres.
♦ Base: It is directed upwards, and is represented by an imaginary
line joining the front of two epicondyles of the humerus.
♦ Apex: It is directed downwards, and is formed by the
meeting point of the lateral and medial boundaries.
♦ Roof: It is formed by
a. Skin.
b. Superficial fascia containing the median cubital vein
Fig. 213: Intravenous injection in median cubital vein joining the cephalic and basilic veins.
 Upper Limb and Thorax  167

c. Deep fascia. Applied Anatomy

d. Bicipital aponeurosis.
♦ Floor: It is formed by:
a. Brachialis
b. Supinator surrounding the upper part of radius.
Contents
The fossa is very narrow. From medial to the lateral side, the
contents are:
♦ Median nerve: It provides branches to flexor carpi radialis,
Palmaris longus, flexor digitorum superficialis and leaves
the fossa by passing between two heads of pronator teres.
♦ Termination of brachial artery and beginning of radial as
well as ulnar arteries which lie inside the fossa. Radial artery
is smaller and is more superficial as compared to ulnar
artery. It gives off radial recurrent branch. Ulnar artery goes
deep at both heads of pronator teres and run downward as
well as medially, being separating from the median nerve by
deep head of pronator teres. Ulnar artery gives off anterior
ulnar recurrent, posterior ulnar recurrent and common
interosseous branches. Common interosseous branch get
divide into anterior and posterior interosseous arteries, they
later on gives off interosseous recurrent branch.
♦ Tendon of biceps brachii along with bicipital aponeurosis.
♦ Radial nerve appears inside the gap between brachialis and
brachioradialis and extensor carpi radialis longus laterally.
When running inside the intermuscular gap, radial nerve
supply to three flanking muscles, and just below the level
of lateral epicondyle it gives off posterior interossous nerve
and deep branch of radial nerve which leave fossa by
piercing supinator muscle. Superficial branch runs infront
of forearm for some distance.
♦ Median cubital vein is often the vein of choice for
intravenous injection.
♦ Blood pressure is universally recorded by auscultating
brachial artery in front of elbow.
♦ Anatomy of cubital fossa is important while dealing with
fractures around elbow.
Q.2. Write short note on biceps brachii muscle.
(Aug 2011, 5 Marks)
Ans. It is the muscle of anterior compartment of arm.
Origin
It has two heads of origin, i.e.
1. Short head arises with coracobrachialis from tip of coracoid
process.
2. Long head arises from supraglenoid tubercle of the scapula
and from the glenoidal labrum.
Insertion
The muscle is inserted in:
♦ Posterior rough part of the radial tuberosity. The tendon is
separated from the anterior part of the tuberosity by bursa.
♦ The tendon gives off an extension called as bicipital
aponeurosis which extends to ulna and it separates median
cubital vein from brachial artery.
Nerve Supply
The muscle is supplied by musculocutaneous nerve (C5, C6).

Fig. 215: Contents of cubital fossa Fig. 216: Biceps brachii muscle
(For colour version see Plate 7) (For colour version see Plate 8)
168 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Action
♦ Biceps brachii muscle is strong supinator when the forearm
is flexed. All the screwing movements are carried out by it.
♦ It flexes the elbow.
♦ Short head of the muscle is flexor of the arm.
♦ Long head of the muscle prevents upwards displacement
of the head of humerus.
Clinical Testing
Biceps brachii is tested by asking the patient to flex elbow against
resistance when the forearm is supinated. In this act, the muscle
forms a prominent bulge on the front of arm.
6. BONE AND JOINTS OF THORAX
Q.1. Briefly describe cervical rib.
(Oct 2007, 5 Marks) (Apr 2010, 5 Marks)
Ans. It is a small extra rib (cervical rib) which is attached to
vertebra C7.
It occurs in 0.5% of persons.
The condition can be unilateral or bilateral.
It is common in females and occur more towards
right side.
Cervical rib may have a blind tip or it articulate with
first rib by fibrous band or cartilage or bone.
It may develop in root of the neck in association with
the seventh cervical vertebra.
Its presence may result in compression on the
lower trunk of brachial plexus which leads to the
paresthesia along ulnar border of forearm as well
as wasting of intrinsic muscles of hand supplied by
segment T1.
Cervical rib may also cause pressure on subclavian
artery.
Fig. 217: Cervical rib Inspiration
Cervical rib is associated with thoracic inlet syndrome. The Quiet Inspiration
subclavian artery and lower trunk of the brachial plexus arch
over the first rib, hence they may be stretched and pushed up by ♦ Anterioposterior diameter of thorax gets increased by
the presence of a congenitally hypertrophied scalenus anterior
muscle or a cervical rib. This leads to thoracic inlet syndrome or
scalenus anterior syndrome or cervical rib syndrome. It presents
the following clinical features:
♦ Numbness, tingling, and pain along the medial side of
forearm and hand, and wasting of small muscles of the
hand due to the involvement of lower trunk of brachial
plexus (T1).
♦ There may be ischemic symptoms in the upper limb such
as pallor and coldness of the upper limb, and weak radial
pulse due to compression of the subclavian artery.
Q.2. Describe respiratory movements. (Apr 2015, 4 Marks)
Ans. Lungs get expand at the time of inspiration and retract
during the expiration. These movements are governed
by following two factors i.e.
Alterations in the capacity of thorax are carried
out by the movements of thoracic wall. Increase
in volume of thoracic cavity produces negative
intrathoracic pressure which sucks air inside the
lungs. Movements of thoracic wall occur chiefly at
costovertebral and manubriosternal joints.
Elastic recoil of pulmonary alveoli as well as of
thoracic wall expels air from lungs at the time of
expiration.
Principle of Respiratory Movements
♦ Each rib can be regarded as a lever and its fulcrum lies just
lateral to tubercle. Because of disproportion in length of
two arms of lever, slight movements at vertebral end of
rib are greatly magnified at the anterior end.
♦ Anterior end of rib is lower as compared to the posterior
end. So at the time of elevation of rib, the anterior end also
moves forwards. This occurs mainly in vertebrosternal ribs.
So in this manner anteroposterior diameter of thorax is
increased. Along with up and down movements of second
to sixth ribs, body of sternum also moves up and down
which is known as pump-handle movements. This leads
to formation of sternal angle.
♦ The middle of shaft of rib lies at a lower level as compared
to the plane passing through the two ends. So at the time
of elevation of rib, shaft also moves outwards. This leads
to increase in transverse diameter of thorax. These type of
movements occur inside vertebro - chondral ribs, and are
known as bucket-handle movements.
♦ Thorax resembles as a cone which taper upwards. As a
result each rib is longer than the next higher rib. During
elevation the larger lower rib comes to occupy the position
of smaller upper rib. This also increases transverse
diameter of thorax.
♦ Vertical diameter is increased by piston movements of
thoracoabdominal diaphragm.
Respiratory Movements during Different Types of Breathing
elevation of 2nd to 6th ribs. Here the first rib remains fixed.

♦ Transverse diameter is increased by elevation for 7th to
10th ribs.
♦ Vertical diameter is increased by descent of diaphragm.
Deep Inspiration
♦ Movements at the time of deep respiration are increased.
♦ First rib is elevated directly by scalene and indirectly by
sternocleidomastoid.
♦ Concavity of thoracic spine is decreased by erector spinae.
Forced Inspiration
♦ Here the movements which are described are exaggerated.
♦ Scapula is elevated and gets fixed by trapezius, levator
scapulae and rhomboids so that serratus anterior and
pectoralis minor muscles can act on ribs.
♦ Action of erector spinae is increased.
Expiration
♦ Quiet expiration: Air gets expelled by elastic recoil of
chest wall and pulmonary alveoli and partly by tone of
abdominal muscles.
♦ Deep and forced expiration: It is carried out by strong
contraction of abdominal muscles and latissimus dorsi.
7. WALL OF THORAX
(Oct 2014, 3+3+2 Marks)
a. Boundaries b. Contents
c. Applied Anatomy
Ans. Space intervening between typical ribs and traversed by
vessels and nerves which are confined to the thoracic
wall are known as typical intercostal space. Third, fourth,
fifth and sixth intercostals spaces are known as typical
intercostal spaces.
Typical intercostal spaces are typical in nature because
their contents are limited within the thorax.
Fig. 218: Typical Intercostal space and its contents
Upper Limb and Thorax  169
Boundaries of Typical Intercostal Space
♦ Superiorly: Sharp lower margin of upper rib and its cartilage.
♦ Inferiorly: Blunt upper margin of lower rib and its cartilage.
♦ Anteriorly: Lateral border of sternum between costal
notches.
♦ Posteriorly: Body of corresponding thoracic vertebra.
Contents of Typical Intercoastal Space
1. Intercostal muscles.
2. Intercostal arteries: Two anterior and one posterior
intercostals artery in each space.
3. Intercostal veins: Anterior and posterior intercostals veins.
4. Intercostal nerves: One nerve in each space.
5. Intercostal muscles: External intercostal muscle, Internal
intercostal muscle and Inner intercostal muscle.
Applied Anatomy of Typical Intercostal Space
♦ Local irritation of the intercostal nerves by such conditions
as Pott’s disease of the thoracic vertebrae (tuberculosis)
may give rise to pain that is referred to the front of the chest
or abdomen in the region of the peripheral termination of
the nerves.
♦ Local anesthesia of an intercostal space is easily produced
by infiltration around the intercostal nerve trunk and
its collateral branch a procedure known as intercostal
nerve block.
♦ Insertion of an emergency chest drain. For example for a
traumatic haemopneumothorax, is performed through the
5th intercostal space in the midaxillary line.
8. THORACIC CAVITY AND PLEURAE
Q.1. Write short note on pleura. (June 2010, 5 Marks)
Ans. Pleura is a serous membrane which is lined by
mesothelium.
Pleural sacs are two in number and lies one on either
side of mediastinum.
Each of the pleural sac is invaginated from its medial
side by the lung, so each pleural sac consists of outer
layer, i.e. parietal pleura and inner layer, i.e. visceral or
pulmonary pleura. Both the layers are continuous with
each other at hilum of lung and enclose a space between
them which is known as pleural cavity.
Visceral Pleura
♦ It is developed from the splanchopleuric mesoderm.
♦ It lines the surface of lungs including fissures.
♦ It is supplied by sympathetic nerves from T2-T5 ganglia
and parasympathetic innervations from vagus nerve.
♦ Visceral pleura is insensitive to pain.
♦ Blood supply of visceral pleura is through bronchial vessels
and veins drain into bronchial veins.
♦ Lymphatic drainage of visceral pleura is via tracheobron-
chial lymph nodes.
170 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Parietal Pleura
♦ It is thicker than the visceral pleura and consists of four
parts, i.e. costal, diaphragmatic, mediastinal and cervical.
Fig. 219: Layers of parietal pleura
Fig. 220: Mediastinal surface of left lung
(For colour version see Plate 8)
Q.2. Write a short note on bronchial artery.
(Sep 2007, 3 Marks)
Ans. Bronchial artery supplies nutrition to bronchial tree and
to pulmonary tissue.
These are small arteries that vary in number, size and
origin. They are as follows:
On right side there is one bronchial artery which
arises either from 3rd posterior inter costal artery
or from upper left bronchial artery.
♦ Parietal pleura are developed from somatopleuric meso-
derm.
♦ It lines the thoracic wall, mediastinum and diaphragm.
♦ It is supplied by thoracic and phrenic nerves.
♦ It is sensitive to pain which can be referred.
♦ Blood supply of parietal pleura is through intercostals and
pericardiacophrenic vessels. Veins drain into azygous and
internal thoracic veins.
♦ Lymphatic drainage of visceral pleura is via intercostal
lymph nodes.
9. LUNGS

(Mar 2006, 2.5 Marks)
On left side there are two bronchial arteries both of
which arises from descending thoracic aorta, The upper
opposite vertebra T5 and lower just below left bronchus.
Deoxygenated blood is brought to lungs by
pulmonary arteries and oxygenated blood is
returned to heart by pulmonary veins.
There are precapillary anastomoses between
bronchial and pulmonary arteries. These connections
get enlarge when any of them is obstructed in disease.
 Upper Limb and Thorax  171

Bronchopulmonary Segments
Bronchopulmonary segments of right lung
Lobes Segment
Upper 1. Apical
2. Posterior
3. Anterior
Middle 4. Lateral
5. Medial
Lower 6. Superior
7. Medial basal
8. Anterior basal
9. Lateral basal
10. Posterior basal
Bronchopulmonary segments of left lung
Upper
Upper Division 1. Apical
2. Posterior
3. Anterior
Lower Division 4. Superior lingular
Fig. 221: Bronchial Artery 5. Inferior lingular
Lower 6. Superior
Q.3. Write a short note on bronchopulmonary segment. 7. Medial basal
(Sep 2007, 3 Marks) (Mar 2008, 3 Marks) 8. Anterior basal
(Aug 2011, 5 Marks) 9. Lateral basal
10. Posterior basal
Ans. 1. They are well defined sectors of lung, each one of
which is aerated by tertiary or segmental branches. ♦ Relation to pulmonary artery: The bronchi of pulmonary
2. Each segment is pyramidal in shape with its apex artery accompany bronchi. Artery lies dorsolateral to
directed toward root of lung. bronchus. So each segment has its own separate artery.
3. There are 10 segments on right side and 10 on left side. ♦ Relation to pulmonary vein: Pulmonary veins do not
4. Each segment consists of segmental bronchus, segme- accompany bronchi or pulmonary arteries. They run in
ntal artery, autonomic nerves and lymphatic vessels. intersegmental planes. So each segment has more than
5. Segmental venule is surrounded by connective one vein and each vein drains more than one segment.
tissue between adjacent pulmonary units of
Clinical Anatomy
bronchopulmonary segments.
1. Usually infection of segment remains restricted to it, although
some infections may spread from one segment to another.
2. Segments are no barriers to spread of broncheogenic
carcinoma.
3. Knowledge of detailed anatomy of bronchial tree helps in
following.
a. Surgical removal of segment.
b. Drainage of infection.
In understating why abscesses are more common in some
segments.
Q.4. Write short note on bronchopulmonary segments of
right lung. (June 2010, 5 Marks) (Dec 2010, 3 Marks)
Ans. They are well defined sectors of lung, each one of which is
aerated by tertiary or segmental branches. Each segment
is pyramidal in shape with its apex directed toward root
of lung.
There are 10 segments on right side of lung.
There are three lobes in right lung, i.e. upper lobe,
middle lobe and lower lobe.
Fig. 222: Bronchopulmonary segments of lungs. Numbers in the Upper lobe usually consist of three segments, i.e.
table represent the naming of the numerical apical, posterior and anterior.
172 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Middle lobe consist of two segments, i.e. lateral and

medial.
• Lower lobe consist of five segments, i.e. superior,
medial basal, anterior basal, lateral basal and
posterior basal.

A B

Figs 224A and B: Left bronchopulmonary segment.

A. Costal Aspect, B. Medial Surface
(For colour version see Plate 9)
A B

Figs 223A and B: Right bronchopulmonary segment. Bronchopulmonary segments of left lung
A. Costal aspect, B. Medial surface Lobes Segments
(For colour version see Plate 9)
Upper Lobe
Bronchopulmonary segments of right lung
Upper Division 1. Apical
Lobes Segments
2. Posterior
Upper 1. Apical 3. Anterior
2. Posterior
3. Anterior Lower Division 4. Superior lingular
Middle 4. Lateral 5. Inferior lingular
5. Medial Lower Lobe 6. Superior
Lower 6. Superior 7. Medial basal
7. Medial basal 8. Anterior basal
8. Anterior basal 9. Lateral basal
9. Lateral basal 10. Posterior basal
10. Posterior basal
Q.6. Describe right lung under following heads:
(Feb 2014, 3+3+2 Marks)
(Aug 2012, 3 Marks) a. Relations of mediastinal surface
Ans. They are well defined sectors of lung, each one of which b. Bronchopulmonary segments
is aerated by tertiary or segmental branches. Each c. Histology of lung.
segment is pyramidal in shape with its apex directed Ans. Relations of Mediastinal Surface of Right Lung
toward root of lung. The relations of mediastinal surface of right lung are:
There are 10 segments on left side of lung. 1. Right atrium and auricle
There are two lobes in left lung, i.e. upper lobe and 2. Small part of right ventricle
lower lobe. 3. Superior vena cava
Upper lobe usually subdivided into two divisions, 4. Lower part of right brachiocephalic vein
i.e. upper division and lower division. 5. Azygos vein
Upper division consists of three segments, i.e. apical, 6. Esophagus
posterior and anterior. 7. Inferior vena cava
Lower division consists of two segments, i.e. 8. Trachea
superior lingular and inferior lingular 9. Right vagus nerve
All over after combining all the segments of both 10. Right phrenic nerve.
divisions of upper lobe there are five segments. For right bronchopulmonary segment refer to Ans 4 of
• Lower lobe consist of five segments, i.e. superior, same chapter.
medial basal, anterior basal, lateral basal and For histology of lung refer to Ans 23 of S E C T I O N
posterior basal. HISTOLOGY.
 Upper Limb and Thorax  173

Fig. 225: Mediastinal surface of right lung

(For colour version see Plate 9)

Q.7. Write briefly on roots of lungs. (Dec 2010, 5 Marks)

Fig. 226: Roots of right lung
Ans. Root of the lung is the short and broad pedicle which
connect medial surface of lung to mediastinum. Relation of Root of Lungs
Root of lungs lies opposite to the bodies of fifth, sixth ♦ Anterior
and seventh thoracic vertebrae. Common over both sides
– Phrenic nerve
Contents
– Pericardiacophrenic vessels
Root of the lung is formed by following structures: – Anterior pulmonary plexus.
A. Principle bronchus over left side and eparetrial and On right side
hyparetrial bronchi over right side. – Superior vena cava
B One pulmonary artery – One part of right atrium.
C Superior and inferior pulmonary veins ♦ Posterior
D. One bronchial artery on right side and two bronchial Common over both the sides
arteries on left side – Vagus nerve
E. Bronchial veins – Posterior pulmonary plexus.
F. Anterior and posterior pulmonary plexuses of nerves On left side
G. Lymphatics of lung – Descending thoracic aorta.
H. Bronchopulmonary lymph nodes
I. Areolar tissue.

Arrangement of Structures in Root of the Lung

From anterior to posterior side roots are similar i.e.
♦ Superior pulmonary vein
♦ Pulmonary artery
♦ Bronchus.
From above to downwards roots are different on both the
sides:
♦ On right side:
Eparterial bronchus
Pulmonary artery
Hyparterial bronchus
Inferior pulmonary vein.
♦ On left side:
Pulmonary artery
Bronchus
Inferior pulmonary vein. Fig. 227: Roots of left lung
174 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦ Superiorly Area of distribution

On right side: Terminal part of azygos vein It supplies to right atrium, ventricles, i.e. greater
On left side: Arch of aorta. part of right ventricle except area adjoining anterior
♦ Inferiorly. interventricular groove and smaller part of left ventricle
♦ Pulmonary ligament. adjoining posterior intraventricular groove, posterior part
of interventricular system, whole of conducting system of
heart except a part of left branch of AV bundle.
10. PERICARDIUM AND HEART 2. Left coronary artery: It arises from left posterior aortic
sinus of ascending aorta. It is larger than right coronary
Q.1. Write a short note on blood supply of heart. artery.
(Feb 2003, 5 Marks) (June 2010, 5 Marks) Branches of left coronary artery are:
Ans. Large branches: Anterior interventricular, Branches to
diaphragmatic surface of left ventricle including large
Arterial Supply
diagonal branch.
Heart is supplied by two coronary arteries arising from Small branches: Left arterial, pulmonary and terminal.
ascending aorta. Both arteries run in coronary sulcus. The two
Area of distribution
arteries are:
It supplies to left atrium, ventricle, i.e. greater part of left
ventricle except the area adjoining posterior interventricular
groove and small part of right ventricle adjoining anterior
interventricular groove, anterior part of interventricular
septum, a part of left branch of AV bundle.

A
B of right coronary artery. It may either drain to small
Fig. 228: Arterial supply of heart, A. Sternocostal surface;
B. Diaphragmatic surface
1. Right coronary artery: It is smaller than left coronary artery.
It arises from anterior aortic sinus of ascending aorta.
Branches of right coronary artery are:
Large branches: Marginal and Posterior interventricular
Small branches: Nodal, right atrial, Infundibular, terminal,
right ventricular and conus.
Venous Supply
Heart is mainly supplied by the 3 veins:
1. Coronary sinus: It is longest vein of the heart and receive
following tributaries, i.e. great cardiac vein, middle cardiac
vein, small cardiac vein, posterior vein of left ventricle,
oblique vein of left atrium of Marshall s, right marginal vein.
Great cardiac vein: It accompanies, first the anterior
interventricular artery and then left coronary artery
to enter left end of the coronary sinus.
Middle cardiac vein: It accompany the posterior inter-
ventricular artery and join middle part of coronary
sinus.
Small cardiac vein: It accompany right coronary artery
at right posterior coronary sulcus and joins right end
of coronary sinus. Right marginal vein can drain inside
the small cardiac vein.
Posterior vein of left ventricle: It runs over diaphrag-
matic surface of left ventricle and ends into the
coronary sinus.
Oblique vein of left atrium of Marshall: It is the small
vein which runs over posterior surface of left atrium.
It terminates at the left end of coronary sinus.
Right marginal vein: It accompany marginal branch
cardiac vein or can open directly inside the right
atrium.
2. Anterior cardiac vein: They are 3 to 4 small veins which
run parallel to each other on anterior wall of right ventricle
and open directly in right atrium via anterior wall.
3. Venae cordis minimi: They are smallest cardiac veins and
are numerous valveless veins present in four chambers
of heart which open in cardiac cavity. They are more
numerous on right side of heart.
 Upper Limb and Thorax  175

B
Fig. 229: Venous supply of heart, A. Sternocostal surface;
B. Diaphragmatic surface

Q.2. Write a short note on coronary arteries.

(Mar 2007, 3 Marks) (Mar 2013, 3 Marks)
Or
Write briefly on coronary arteries. (Jan 2012, 5 Marks)
Ans. The heart is supplied by two coronary arteries, arising from
ascending aorta, both arteries run in coronary sulcus.
Right Coronary Artery
It is smaller than left coronary artery. It arises from anterior
aortic sinus.
Course
♦ It first passes forward and to the right to emerge on surface
(Jan 2012, 10 Marks)
of heart between root of pulmonary trunk and right auricle.
♦ Then it run downward in right anterior coronary sulcus to Ans. For blood supply of heart refer to Ans 1 of same chapter.
junction of right and inferior borders of heart. Applied Aspect of Heart
♦ It winds round the inferior border to reach diphragmatic
surface of heart. Here it run backward and to left in the 1. In an adult, normal heart rate is 72 80 beats per minute. This
right posterior coronary sulcus to reach posterior inter is normal rhythm of S.A. node. Increased heart rate is known
ventricular groove. as tachycardia and decrease in heart rate is bradycardia. An
♦ It terminates by anastmoting with left coronary artery. alteration in regularity is known as arrythmia.
176 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
(Dec 2012, 4+2+2 Marks)
a. Gross anatomy
b. Blood Supply
c Histology of cardiac muscle
Ans. Gross Anatomy of Right Ventricle
Right ventricle is a triangular chamber which receives
blood from the right atrium and pumps it to the lungs
through the pulmonary trunk and pulmonary arteries.
It usually forms the inferior border of the heart and a
large part of the sternocostal surface of heart.
Fig. 230: Gross anatomy and blood supply of right ventricle
External Features
1. Externally, the right ventricle has two surfaces anterior
or sternocostal and inferior diaphragmatic.
2. Interior has two parts.
The inflowing part is rough due to the presence of
muscular ridges called Trabeculae carneae.
The outflowing part or infundibulum is smooth and
forms the upper conical part of the right ventricle
which gives rise to the pulmonary trunk.
The two parts are separated by a muscular ridge called
as supraventricular crest or infundibul ventricular crest
situated between the tricuspid and pulmonary orifices.
Internal Features
1. The interior part has two orifices:
i. The right atrioventricular or tricuspid orifice, guarded
by the tricuspid valve.
ii. The pulmonary orifice is guarded by the pulmonary valve.
2. The interior of the inflowing part shows trabeculae carneae
or muscular ridges of three types:
i. Ridges
ii. Bridges
iii. Pillars or papillary muscles with one end attached to
the ventricular wall, and the other end connected to
the cusps of the tricuspid valve by chordae tendinae.
There are three papillary muscles in the right ventricle,
anterior, posterior and septal.
Each papillary muscle is attached by chordae to the
contiguous sides of two cusps.
3. The septomarginal trabecula or moderator band is a
muscular ridge which extend from the ventricular septum
to the base of the anterior papillary muscle. It contains the
right branch of the AV bundle.
4. The cavity of the right ventricle is crescentic because of the
forward bulge of the interventricular septum.
5. The wall of the right ventricle is thinner than that of the
left ventricle, i.e. in a ratio of 1:3.

Interventricular Septum
♦ This is placed obliquely. One surface of the septum faces
forwards and to the right while other faces, face backward
and to the left.
♦ Upper part of septum is thin and membranous and
separates not only the two ventricles but also right atrium
and left ventricle.
♦ Lower part of septum is thick and muscular and separates
the two ventricles.
♦ Position of septum is indicated by anterior and posterior
interventricular grooves.
Blood Supply of Right Ventricle
♦ Right coronary artery supplies the greater part of
right ventricle, except the area adjoining the anterior
interventricular groove.
♦ Left coronary artery supplies to the small part of right
ventricle adjoining the anterior interventricular groove.
Histology of Cardiac Muscle
♦ Cardiac muscle has long and thick muscular fibers. Such
fibers show branching and so an individual fiber can
appear as Y shaped.
♦ Each of the muscle fiber is formed by many cells which
join from end to end at junctional specializations known
as intercalated discs.
♦ Each of the myocyte measures from 50 to 100 µm in length
and 15µm in thickness. Myocyte consists of single oval
nucleus which is centrally placed and is surrounded by
sarcoplasm, various organelles and myofibrils. Due to
high energy and oxygen requirements of cardiac muscle
fibers they have huge amount of mitochondria, glycogen,
triglycerides and abundant myoglobin. Sometimes
myocyte may have two nuclei also.
♦ Muscle fibers lie almost parallel to each other. Individual
muscle fibers branch and anastomose with myocytes of
neighboring fibers.
Fig. 231: Cardiac muscle
♦♦ Cardiac muscle fibers also show cross striations. But these
cross striations are less prominent as compared to cross Internal Features of Right Atrium
striations of skeletal muscle fibers.
Upper Limb and Thorax  177
♦ Myofibrils of cardiac muscle fibers consist of actin and
myosin filaments. Cardiac muscles also A and I bands
and also the Z discs which are also seen in skeletal muscle
fibers.
♦ Intercalated disc is the irregular transverse thickening of
sarcolemma. Such discs are broken into number of steps
and do not run straight across the fibers providing it stair–
case like appearance. This type of appearance of produced
because adjacent sarcolemmas are interdigitating and
present longitudinal and transverse portions.
♦ Transverse portions are thick and provide site of
attachment of myofilament to sarcolemma whereas
longitudinal portions are thin and consists of gap junction.
Q.5. Write briefly on right atrium. (May/June 2009, 5 Marks)
Ans. Position
Right atrium is the right upper chamber of heart.
Right atrium receives venous blood from whole body
and pumps it to right ventricle via right atrioventricular
opening.
Right atrium form the right border of heart as well as
parts of upper border, i.e. sternocoastal surface and base
of the heart.
External Features
♦ Right atrium is elongated vertically and receives superior
vena cava at upper end and inferior vena cava at lower end.
♦ Upper end of right atrium is prolonged to left and form
right auricle. Auricle covers root of ascending aorta and
partly overlaps infundibulum of right ventricle. Its margins
are notched and interior is sponge like.
♦ At right border of right atrium a shallow vertical groove is
present which passes from superior vena cava to inferior
vena cava and is known as sulcus terminalis. Sulcus
terminalis is produced by internal muscular ridge known
as crista terminalis. Upper part of sulcus terminalis has
SA node.
♦ Right atrioventricular groove separates right atrium from
right ventricle. It lodge the right coronary artery and small
cardiac vein.
Tributaries of Right Atrium
Following are the tributaries of right atrium:
♦ Superior vena cava
♦ Inferior vena cava
♦ Coronary sinus
♦ Anterior cardiac veins
♦ Venae cordis minimi
♦ Attimes the right marginal vein.
Right Atrioventricular or Tricuspid Orifice
Blood moves out of right atrium via tricuspid orifice and
go to right ventricle. This orifice is guarded by tricuspid
valve.
Refer to Ans 6 of same chapter.
178 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.6. Write about internal structure of right atrium of heart.
(Dec 2009, 5 Marks)
Or
Write in short on internal structure of right atrium.
(July 2016, 5 Marks)
Ans. Internal structure of right atrium of heart is divided into
three parts, i.e.
1. Smooth posterior part or sinus venarum.
2 Rough anterior part or Pectinate part including
auricle.
3 Interatrial septum.
Fig. 232: Internal structure of right atrium
(For colour version see Plate 9)
Smooth Posterior Part or Sinus Venarum
♦ This part is derived from right horn of sinus venosus.
♦ At this surface the superior vena cava and inferior vena
cava open at upper and lower end. Opening is guarded
by rudimentary valve or eustachian valve.
♦ Between the opening of inferior vena cava and right
atrioventricular orifice there is opening of coronary sinus.
This opening is guarded by thebesian valve.
♦ Venae cordis minimi are present over this part, these are the
small veins which are present on walls of all the chambers.
These veins open in right atrium via small foramina.
♦ A very small projection, i.e. intervenous tubercle of Lower
is seen on posterior wall of atrium below the opening of
superior vena cava.
Rough Anterior Part
♦ This part is derived from primitive atrial chamber.
♦ This part consists of musculi pectinati which is a series of
transverse muscular ridges.
♦ Musculi pectinati originates from crista terminalis and run
forward and downward towards atrioventricular orifice
and provide appearance of teeth of a comb.
Intra-atrial Septum
♦ This part is derived from septum primum and septum
secundum.
♦ This septum has a shallow saucer shaped depression in its
lower part which is known as fossa ovalis.
♦ A prominent margin of fossa ovalis is known as annulus
ovalis or limbus fossa ovalis.
♦ Annulus ovalis represents lower free edge of septum
secundum.
♦ Annulus ovalis is distinct above as well as at side of fossa
ovalis and is deficient inferiorly. Its anterior edge continues
with left end of valve of inferior vena cava.
♦ Foramen ovale is a small slit like valvular opening which
lies between upper part of fossa and limbus. Its remnants
are rarely present.
Q.7. Write about external features of heart.
(Aug 2011, 5 Marks) (Aug 2012, 5 Marks)
Ans. Human heart consists of four chambers i.e. right and
left atria as well as right and left ventricles. Atria lie
above and behind the ventricles. On surface of heart,
atria are separated from ventricles by an inter-atrial
groove. Ventricles are separated from each other by
interventricular groove which get subdivided into
anterior and posterior parts. Surfaces are demarcated
by upper, inferior, right and the left borders.
Grooves or Sulci
♦ Atria get separated from the ventricles by circular
atrioventricular or coronary sulcus.
♦ It is divided into the two parts i.e. anterior part and the
posterior part.
♦ Anterior part has both right and left halves.
♦ Right half is oblique between right auricle and the right
ventricle and this lodges right coronary artery.
♦ Left part is usually small in between the left auricle and left
ventricle which lodges circumflex branch of left coronary
artery.
♦ Anteriorly the coronary sulcus is overlapped by ascending
aorta and pulmonary trunk.
♦ Inter-atrial groove is faintly visible posteriorly, while
anteriorly it is hidden by aorta and pulmonary trunk.
♦ Anterior interventricular groove lies near to left margin
of heart. It runs downward and to the left. Lower end of
the groove separates apex from the rest of inferior border
of heart.
♦ Posterior interventricular groove is situated over
diaphragmatic or the inferior surface of heart. It lies near
to the right margin of inferior surface.
♦ Two of the interventricular grooves meet at inferior border
near to the apex.
♦ At crux of heart posterior interventricular sulcus meet the
coronary sulcus.
Apex of Heart
♦ It is formed completely by left ventricle. Apex is directed
downward, forward and to left and is overlapped by
anterior border of left lung.
 Upper Limb and Thorax  179

Fig. 233: External features of heart: 1. Line of incision for right atrium;
2. Line of incision for right ventricle; 3. Line of incision for left ventricle

♦ This is situated inside the left fifth intercostal space 9 cm
lateral to mid sternal line just medial to mid clavicular line.
♦ In the living person pulsations can be seen and felt at this
region.
♦ Usually in children less than 2 years of age, apex is situated
in left fourth intercostal space at midclavicular line.
Base of Heart
It is also known as posterior surface. Base of heart is formed by
left atrium and small part of right atrium. Related to base, the
openings of four pulmonary veins which open in left atrium
and the superior and inferior vena cava which opens in right
atrium are seen. Base of the heart is related to thoracic five to
thoracic eight vertebrae in lying posture, and descends by one
vertebrae in erect posture. Base is separated from vertebral
column by pericardium, right pulmonary veins, esophagus and
aorta.
Borders of Heart
left auricle. Left atrium is not visible on this surface since
it is covered by aorta and the pulmonary trunk. Most
of this surface is covered by the lungs, but a part of it
which lies behind the cardiac notch of left lung remain
uncovered. While on percussion the uncovered area is
dull which is clinically referred to as area of superficial
cardiac dullness.
♦ Inferior or diaphragmatic surface rest on central tendon
of diaphragm. This is formed in its left two third by left
ventricle and in its right one third by right ventricle. This
is traversed by posterior interventricular groove and this
is directed downward as well as slightly backward.
♦ Left surface is formed chiefly by left ventricle and at
its upper end by left auricle. Over its upper part, left
surface is crossed by coronary sulcus. This is related to
left phrenic nerve, left pericardiacophrenic vessels and
by pericardium.

♦ Surfaces of heart are demarcated by four borders, i.e.

upper, lower, right and left.
♦ Upper border is slightly oblique and is formed by two atria
mainly left atrium.
♦ Right border is vertical and is formed by right atrium. It
extends from superior vena cava to inferior vena cava.
♦ Inferior border is nearly horizontal and is formed by right
ventricle. Small part of inferior border near apex is formed
by left ventricle. It extends from inferior vena cava to apex.
♦ Left border is oblique and is curved. It is formed mainly
by left ventricle and partly by left auricle. This seperates
anterior and left surfaces of heart. It extends from apex
to left auricle.
Surfaces of Heart
♦ Heart consists of anterior, inferior and left surfaces.
♦ Anterior or sternocostal surface is formed mainly by right
atrium and right ventricle and partly by left ventricle and Fig. 234: Gross features: Sternocostal surface of heart
180 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 235: Posterior aspect of heart

11. TRACHEA, ESOPHAGUS AND Fig. 236: Course of thoracic duct

THORACIC DUCT In Posterior Mediastinum

Q.1. Write in short on thoracic duct. (July 2016, 5 Marks)
Or
Write short note on thoracic duct. (Oct 2016, 3 Marks)
Ans. Thoracic duct is the largest lymphatic vessel inside the
body.
Thoracic duct extends from upper part of abdomen to
lower part of neck, crossing posterior and superior parts
of mediastinum.
It is usually 45 cm and 18 inches long.
Duct has beaded appearance due to presence of many
valves inside its lumen.
♦ Anteriorly: Diaphragm, esophagus, Right pleural recess.
♦ Posteriorly: Vertebral column, Right posterior intercostal
arteries and Terminal parts of the hemiazygos veins
♦ Toward right: Azygos vein.
♦ Towards left: Descending thoracic aorta.
In Superior Mediastinum
♦ Anteriorly: Arch of aorta and Origin of left subclavian artery.
♦ Posteriorly: Vertebral column.
♦ Towards right: Esophagus
♦ Towards left: Pleura.

Course of Thoracic Duct

♦ It begins as continuation of upper end of cistern chili near
lower border of twelfth thoracic vertebra and enters thorax
via aortic opening of diaphragm.
♦ It then ascends via posterior mediastinum from level of
12th thoracic vertebra to 5th thoracic vertebra where it
crosses from right side to left side. It now courses via
superior mediastinum along the left edge of esophagus
and reaches the neck.
♦ Inside the neck, it arches laterally at level of transverse
process of seventh cervical vertebra. Finally it descends
in front of first part of left subclavian artery and ends by
opening into the angle of junction between left subclavian
and left internal jugular veins.

Relations
At Aortic Opening of Diaphragm
♦ Anteriorly: Diaphragm.
♦ Posteriorly: Vertebral column.
♦ Towards right: Azygos vein.
♦ Towards left: Aorta. Fig. 237: Tributaries of thoracic duct

Inside the Neck
♦ Thoracic duct forms an arch which rises about 3 to 4 cm
above the clavicle. The arch has the following relations:
♦ Anteriorly: Left common carotid artery, left vagus and Left
internal jugular vein.
♦ Posteriorly: Vertebral artery and vein, sympathetic trunk,
thyrocervical trunk and its branches, left phrenic nerve,
medial border of scalenus anterior, prevertebral fascia
covering all the structures mentioned above, first part of
the left subclavian artery.
Tributaries
♦ Thoracic duct receives lymph from both the halves of body
below diaphragm and left half above the diaphragm.
♦ Inside the thorax, thoracic duct receives lymphatic
vessels from posterior mediastinal nodes and from small
intercostal nodes.
Upper Limb and Thorax  181
♦ At the root of neck, efferent vessels of nodes inside the
neck form left jugular trunk, and those from nodes inside
axilla form left subclavian trunk. These trunks end inside
the thoracic duct.
♦ The left bronchomediastinal trunk drains lymph from left
half of thorax and ends inside the thoracic duct.
Q.2. Write very short answer on muscles in oesophagus.
(Apr 2018, 2 Marks)
Ans. The esophagus consists of an internal circular and
external longitudinal layer of muscle. Furthermore,
the external longitudinal layer is composed of different
muscle types in each third of the esophagus:
Superior third: Voluntary striated muscle
Middle third: Voluntary striated and smooth muscle
Inferior third: Smooth muscle.
 LOWER LIMB, ABDOMEN AND PELVIS
1. FRONT OF THIGH
Q.1. Write short note on femoral triangle. (Apr 2008, 5 Marks)
(Mar 2006, 3 Marks) (Mar 2009, 5 Marks)
(Aug 2011, 5 Marks) (Jan 2012, 5 Marks)
Ans. It is a triangular depression below the inguinal ligament
with the apex directed below, and is present in the upper
1/3rd in front of thigh.
Fig. 238: Boundaries of femoral triangle
Fig. 239: Contents of femoral triangle (For colour version see Plate 10)
Boundaries
♦ Base: It is formed by the inguinal ligament
♦ Apex: This is directed downwards and is formed by the
point where medial and lateral boundaries get crossed
♦ Medially: Medial border of adductor longus
♦ Laterally: Medial border of sartorius
♦ Floor: It is formed medially by adductor longus and
pectineus and laterally by iliacus and tendon of psoas major.
♦ Roof: It is formed by the following structures i.e.
Skin
Superficial fascia: It consists of superficial inguinal
lymph nodes, femoral branch of genitofemoral nerve,
branches of ilioinguinal nerve, superficial branches of
femoral artery with accompanying vein and the upper
part of great saphenous vein.
Deep fascia: With saphenous opening and cribriform
fascia.
Contents
Following are the contents of femoral triangle:
♦ Femoral artery and its branches: Femoral artery traverses
the triangle from its base at midinguinal point to apex.
Inside the triangle, it gives off six branches i.e. three
superficial branches and three deep branches.

♦ Femoral vein and its tributaries: Femoral vein accompany
femoral artery. Femoral vein lies medial to artery at base
of its triangle and is posteromedial to artery at its apex.
Femoral vein receives great saphenous vein, circumflex
veins and the veins which correspond to branches of
femoral artery.
♦ Femoral sheath: It encloses the upper 4 cm of the femoral
vessels.
♦ Nerves
Femoral nerve lies lateral to femoral artery outside
the femoral sheath inside the groove between iliacus
and psoas major muscle
Nerve to pectineus arises from femoral nerve just
above the inguinal ligament. It usually passes behind
femoral sheath to reach anterior surface of pectineus.
Femoral branch of genitofemoral nerve: It occupy
large compartment of femoral sheath along with
femoral artery. It usually supplies to the skin over
femoral triangle.
Lateral cutaneous nerve of thigh: It crosses lateral angle
of triangle. It runs over the lateral side of thigh and
ends up by dividing into both anterior and posterior
branches. These nerves supply anterolateral aspect
of front of thigh and lateral aspect of gluteal region.
♦ Deep inguinal lymph nodes: They lie deep to deep fascia.
They lie medial to upper part of femoral vein and receive
lymph from superficial inguinal lymph node, from glans
penis or clitoris and deep lymphatic of lower limb.
Q.2. Write short note on femoral sheath.
(Nov 2008, 5 Marks)
Ans. Femoral sheath is a funnel shaped sleeve of fascia which
encloses upper 3 to 4 cm of femoral vessels.
• Femoral sheath is formed by the downward
extension of two layers of the fascia of abdomen.
• Anterior wall of sheath is formed by fascia
transversalis.
• Posterior wall of sheath is formed by fascia iliaca.
• Inferiorly the sheath get merges with connective
tissue around femoral vessels.
• Lateral wall is vertical and medial wall is oblique
and is directed downward and laterally.
Fig. 240: Femoral sheath and its contents
Lower Limb, Abdomen and Pelvis 183
Divisions
Femoral sheath is divided into three compartments by septa:
1. Lateral or arterial compartment consists of femoral artery
and femoral branch of genitofemoral nerve.
2. Intermediate or venous compartment consists of femoral
vein.
3. Medial or lymphatic compartment is small and is also
known as femoral canal. It consists of fatty connective
tissue, cloquet lymph nodes which drains in males in glans
penis and in females to clitoris and cloquet lymph vessels.
Communication
♦ Superiorly it opens in abdomen.
♦ Inferiorly it merges with tunica adventitia of femoral
vessels.
♦ Structures piercing femoral sheath
♦ Laterally the sheath is pierced by femoral branch of
genitofemoral nerve.
♦ In front it is pierced by superficial epigastric artery,
superficial circumflex artery, superficial external pudendal
artery.
♦ Medially it is pierced by great saphenous vein.
Function
Femoral sheath allows free gliding in and out behind inguinal
ligament during movement of hip joint.
Q.3. Write briefly about femoral artery.
(Dec 2010, 5 Marks)
Ans. Femoral artery is the chief artery of lower limb.
Origin
Femoral artery is the continuation of the external iliac artery and
starts behind inguinal ligament at midlingual point.
Extent
Femoral artery extends from midlingual point to adductor canal.
Course
Femoral artery passes downward and medially first in femoral
triangle and then adductor canal. At lower end of adductor
canal, i.e. at junction of middle and lower third of thigh it passes
via an opening in adductor magnus to become continuous with
popliteal artery.
Relations
♦ Anteriorly: Skin, superficial fascia, deep fascia and anterior
wall of femoral sheath.
♦ Posteriorly: Psoas major, pectineus, adductor longus.
♦ Medially: Femoral vein.
♦ Laterally: Femoral nerve.
Branches of Femoral Artery in Femoral Triangle
Femoral artery gives three superficial and three deep branches
in femoral triangle.
184 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Fig. 241:  Femoral artery and its branches
Superficial Branches
♦♦ Superficial external pudendal: Supply skin of external
genital organs.
♦♦ Superficial epigastric artery: Supply skin and fascia of
lower art of anterior abdominal wall.
♦♦ Superficial circumflex iliac artery: Supply skin along
iliac crest.
Deep Branches
Profunda femoris: It gives off following branches:
♦♦ Lateral circumflex femoral gives off following branches:
• Ascending branch takes part in spinous anastomosis.
• Transverse branch takes part in cruciate anastomosis.
• Descending branch takes part in anastomosis around
knee joint.
♦♦ Medial circumflex femoral gives off following branches:
• Ascending branch takes part in trochanteric anasto-
mosis.
• Transverse branch takes part in cruciate Anastomosis.
♦♦ Perforating branches are four in number and they perforate
adductor magnus.
♦♦ Deep external pudendal supplies scrotum or labium majus
♦♦ Muscular branches supplies muscles of thigh.
Termination
It continues as popliteal artery through an opening present in
adductor magnus.
Applied Anatomy
♦♦ Femoral artery can be compressed at midinguinal point
against head of femur or against superior ramus of pubis
to control bleeding from distal part of limb inside the
thigh or leg.
♦♦ Pulsations of femoral artery can be felt at midinguinal
point, against head of femur and tendon of psoas major.
Bilateral absence or feebleness of femoral pulse can occur
from coarctation or narrowing of aorta or thrombosis.
♦♦ Stab wounds at apex of femoral triangle can cut all large
vessels of lower limb because femoral artery and vein, and
profunda femoris artery as well as vein are arranged in one
line. Injury to femoral vessels leads to fatal hemorrhage.
♦♦ As femoral artery is superficial in femoral triangle, it is
easily exposed for purpose of ligation. Catheter is passed
upwards till heart for certain minor surgeries.
♦♦ Femoral vein is used in intravenous infusion for infants
and in patients having peripheral circulatory failure.
2. POPLITEAL FOSSA
Q.1. Write a short note on popliteal fossa.
(Mar 2007, 3 Marks) (Aug 2012, 5 Marks)
Or
Write in briefly on popliteal fossa. (Feb 2013, 5 Marks)
Ans. Popliteal fossa is a diamond shaped depression lying
behind the knee joint, the lower part of femur, and the
upper part of the tibia.
Boundaries of Popliteal Fossa
1. Superolaterally: The biceps femoris.
2. Superomedially: Semitendinosus and semimembranosus
supplemented by the gracilis, sartorius and adductor magnus.
3. Inferolaterally: Lateral head of gastrocnemius and
supplemented by plantaris.
4. Inferomedially: Medial head of the gastrocnemius.
5. The roof of fossa is formed by deep fascia (popliteal fascia).
Superficial fascia over the roof consists of:
• Small saphenous vein and cutaneous nerves
• Three cutaneous nerves:
1. Branches and terminal part of posterior cutaneous
nerve of thigh

2. Posterior division of medial cutaneous nerve of
thigh
3. Peroneal or sural communicating nerve.
6. Floor: It is formed from above downwards by Popliteal
surface of femur, capsule of the knee joint and oblique
popliteal ligament, and popliteal fascia covering the
popliteal muscle.
Fig. 242:  Boundaries of popliteal fossa
Contents of Popliteal Fossa
Fig. 243:  Contents of popliteal fossa
1. Popliteal artery and its branches.
2. Popliteal vein and its tributaries.
3. Tibial nerve and its branches.
4. Common peritoneal nerve and its branches.
5. Posterior cutaneous nerve of the thigh.
6. Genicular branch of the obturator nerve.
7. Popliteal lymph nodes.
8. Fat.
Lower Limb, Abdomen and Pelvis 185
  Popliteal vessels and the tibial nerve cross the fossa
vertically and are arrange one over another. Out of these tibial
nerve is most superficial, popliteal vein lies deep or anterior to
tibial nerve and popliteal artery is deepest. Popliteal artery is
crossed posteriorly by the vein and nerve.
Q.2. Write short note on common peroneal nerve.
 (May/Jun 2009, 5 Marks)
Ans. Root value: Dorsal divisions of ventral rami of L4, L5,
Sl, S2.
Course of Nerve
Common peroneal nerve is the smaller terminal branch of the
sciatic nerve. The nerve lies in the superficial plane in which
the tibial nerve lies. The nerve extends from superior angle of
fossa to the lateral angle, along the medial border of biceps
femoris. It then continue downwards and forwards and winds
around the posterolateral aspect of neck of fibula, nerve than
pierces the peroneus longus, and divides into superficial and
deep peroneal nerves.
Fig. 244:  Common peroneal nerve
(For colour version see Plate 10)
Branches
♦♦ Cutaneous branches are of two types, i.e.
• Lateral cutaneous nerve of calf descend to supply skin
of upper two third of lateral side of leg.
• Sural communicating nerve arises inside the upper
part of fossa. It runs over posterolateral aspect of calf
and joins the sural nerve.
♦♦ Articular branches, i.e.
• Superior lateral genicular nerve accompany artery
of same name and lie above lateral femoral condyle.
• Inferior lateral genicular nerve run with artery of
same name to lateral aspect of knee joint above head
of fibula.
• Recurrent genicular nerve arises where common
peritoneal nerve divides into superficial and deep
186 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

peroneal nerves. This ascends anterior to knee joint partially covered by tunica vaginalis. Epididymis lies at
and supply to tibialis anterior muscle in addition to lateral part of posterior border. Medial surface of epididymis
knee joint. is seperated from testis by an extension of cavity of tunica
♦♦ Muscular branches donot arise from common peroneal vaginalis. This extension is known as sinus of epididymis.
nerve. But it can give a branch to short head of biceps femoris. 3. There are two surfaces, i.e. medial and lateral.
They both are smooth and convex.
3. JOINTS OF LOWER LIMB
Q.1. Write a short note on movements of ankle joint.
(Feb 2003, 5 Marks)
Ans. Active movements of ankle joint are as follows:
1. Dorsiflexion: In this movement the forefoot is raised
and angle between front of leg and dorsum of foot
is diminished. Wide anterior trochlear surface of
talus fits in the lower end of narrow posterior part
of lower end of tibia. During this movement there
are no chances of dislocation.
Principle muscles involved in dorsiflexion is tibialis
anterior and the accessory muscles are extensor
digitorum longus, extensor hallucis longus and
Peroneus tertius.
2. Plantar flexion: In this fore foot is depressed and
the angle between front of leg and dorsum of foot is
Fig. 245:  Lateral aspect of testis
increased. Narrow posterior part of trochlear surface
of talus loosely fit in wide anterior part of lower end
Coverings
of tibia.
Principle muscles involved in plantar flexion are Testis is covered by layers of scrotum and in addition it is also
gastrocnemius and soleus and the accessory muscles covered by three coats. From outward to inward the layers are
are plantaris, tibialis posterior, flexor hallucis longus tunica vaginalis, tunica albuginea and tunica vasculosa.
and flexor digitorum longus. ♦♦ Tunica vaginalis: It represents lower portion of processus
vaginalis. This is invaginated by testis from behind and so it
consists of parietal and visceral layer with cavity in between.
4. MALE EXTERNAL GENITAL ORGANS It covers whole of the testis except its posterior border.
♦♦ Tunica albuginea: It is a dense white fibrous coating which
Q.1. Write a short note on testis. (Feb 2003, 5 Marks) covers the testis all around. This is covered by the visceral
layer of tunica vaginalis except posteriorly where testicular
Ans. •  Testis is the male gonad.
vessels and the nerves enter the gland. Posterior border of
• Testis is suspended in scrotum via spermatic cord.
this layer is thickened to form incomplete vertical septum
• Testis lie obliquely, so that its upper pole is tilted
known as mediastinum testis. Numerous septa extend
forwards and medially.
from mediastinum to inner surface of tunica albuginea.
• Left testis is slightly lower shaped size than right
♦♦ Tunica vasculosa: Innermost vascular coat of testis lining
testis.
its lobules.
• Testis is oval in shape and is compressed from side
to side. Structure
• Testis is 3.75 cm long, 2.5 cm broad from before
backwards and 1.8 cm thick from side to side. Glandular part of testis has 200 to 300 lobules. A single lobule
has 2 to 3 seminiferous tubules. Each tubule is coiled. Tubules
External Features are lined by the cells which represent stages in formation of
Testis consists of: spermatozoa. Seminiferous tubules join at apices of lobules to
1. Two poles or ends, i.e. upper and lower. form 20 to 30 straight tubules, which enter mediastinum. In
Upper and lower poles are smooth and convex. Upper pole mediastinum they anastomose and form a network known as
gives attachment to spermatic cord. A small oval body is rete testis. Rete testis produce 12 to 30 efferent ductules which
attached to the testis known as appendix of testis. emerge at upper pole and enter epididymis. Here each tubule
2. There are two borders, i.e. anterior and posterior. become highly coiled and form a lobe of head of epididymis
Anterior border is smooth and convex and is covered by tubules end in single duct which is coiled and form body and
tunica vaginalis while posterior border is straight and is tail of epididymis, it is continuous with ductus deferens.

Fig. 246:  Structure of testis
Blood Supply
Arterial Supply
Testicular artery is the branch of abdominal aorta which is given
off at the level of vertebra L2. The artery descends over posterior
abdominal wall to reach deep inguinal ring where it enter spermatic
cord. At posterior border of testis, it is divided into branches. Some
of the small branches enter posterior border while larger branches,
i.e. medial and the lateral branches pierce tunica albuginea and run
over surface of testis to ramify inside tunica vasculosa.
Venous Drainage
Veins emerging from the testis form pampiniform plexus.
Anterior part of plexus is arranged around the testicular artery,
middle part around the ductus deferens and its artery, posterior
part remain isolated. Plexus get condensed into four veins at
superficial inguinal ring and into two veins at deep inguinal
ring. Such veins accompany testicular artery. Finally one vein
is formed which drains inside inferior vena cava over right side
and into left renal vein over left side.
Lymphatic Drainage
Lymphatic ascend along the testicular vessels and drain into
preaortic and paraaortic groups of lymph node at level of second
lumbar vertebra.
Nerve Supply
Testis is supplied by sympathetic nerves, which arises from
segment T10 of spinal cord. They pass via renal and aortic
plexuses. Nerves are both afferent for testicular sensation and
efferent to blood vessels.
5. ABDOMINAL PART OF ESOPHAGUS
AND STOMACH
Q.1. Briefly describe stomach. (Oct 2007, 5 Marks)
Ans. Stomach is a muscular bag forming the widest and most
distensible part of the digestive tube. It is connected above
to lower end of esophagus and below to duodenum.
Lower Limb, Abdomen and Pelvis 187
Location
Stomach lies obliquely in the upper and left part of the abdomen,
occupying the epigastric, umbilicus and left hypochondriac
region. Most of it lies under cover of left costal margin and ribs.
Shape
Empty stomach is ‘J’-shaped (vertical) when partially distended
it becomes piriform in shape. In obese person it is more
horizontal.
Size and Capacity
♦♦ Stomach is 25 cm long.
♦♦ Mean capacity is 30 ml at birth, 1 liters at puberty and
1½ -2 liters or more in an adult.
External Features
Orifices
♦♦ Cardiac orifice: It is joined by the lower end of the
esophagus. It lies behind left 7th coastal cartilage, i.e. 2.5
cm from its junction with sternum at level of vertebrae T11.
♦♦ Pyloric orifice: Opens into duodenum. In an empty
stomach or in supine position it lies 1.2 cm to right of
median plane at level of lower border of vertebrae L1 or
transpyrolic plane.
Curvatures
♦♦ Lesser curvature: It is concave and forms right border of
stomach. It provides attachment to the lesser omentum.
Most dependent part of curvature is marked by angular
notch or incisura angularis
♦♦ Greater curvature: It is convex and forms the left border of
stomach. It provides attachment to the greater omentum,
gastrosplenic ligament and gastrophrenic ligament. At the
upper end greater curvature present cardiac notch which
separate it from oesophagus. Greater curvature is 5 times
longer as compared to lesser curvature.
Surfaces
♦♦ Anterior or anterosuperior surface—faces forwards and
upwards.
♦♦ Posterior or posteroinferior surface—faces backwards and
downwards.
Subdivisions
Stomach is usually divided into two parts i.e. cardiac part and
the pyrolic part.
Large cardiac part is further divided into fundus and body
while small pyrolic part is subdivided into pyrolic antrum and
pyrolic canal.
Cardiac Part
♦♦ Fundus: It is the upper convex dome shaped part situated
above horizontal line drawn at level of cardiac orifice. This
part is commonly distended with gas which is seen in
radiographic examination under the left dome of diaphragm.
188 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Fig. 247:  External features and subdivisions of stomach
(For colour version see Plate 11)
♦♦ Body: It lies between the fundus and pyrolic antrum.
It is distended enormously along greater curvature.
Gastric glands which are distributed in fundus and body
of stomach consists of three types of secretory cells, i.e.
mucous cells, chief cells and parietal or oxyntic cells.
Pyloric Part
♦♦ Pyloric antrum: It is separated from pyrolic canal by an
inconstant sulcus, sulcus intermedius present on greater
curvature. This is 7.5 cm long. Pyrolic glands are richest
in having mucous cells.
♦♦ Pyloric canal: It is 2.5 cm long and is narrow and tubular.
At its right end it terminates at pylorus.
Blood Supply
Arterial Supply
Stomach is supplied along lesser curvature by:
1. Left gastric artery, which is the branch of coeliac trunk
2. Right gastric artery, which is the branch of proper hepatic
artery
Fig. 248:  Arterial supply of stomach
3. At greater curvature, it is supplied by right gastroepiploic
artery which is the branch of gastroduodenal
4. Left gastroepiploic artery, which is the branch of splenic artery
5. Fundus is supplied by 5 to 7 short gastric arteries which
are also the branches of splenic artery.
Venous Drainage
♦♦ Veins of the stomach drains into the portal, superior
mesenteric and splenic veins.
♦♦ Right and left gastric drains in portal vein.
♦♦ Right gastroepiploic ends in superior mesenteric vein
while left gastroepiploic and short gastric veins terminates
in splenic veins.
Lymphatic Drainage
♦♦ Upper part of left one third, i.e. area a drains into
pancreaticosplenic nodes lying along splenic artery.
Lymph vessels from these node travel along splenic artery
to reach coeliac nodes.
♦♦ Right two third, i.e. Area b drains in left gastric nodes
which lie along left gastric artery. These nodes drain
abdominal part of oesophagus. Lymph from these nodes
drains into coeliac nodes.
♦♦ Lower part of left one third, i.e. area c drains into the
right gastroepiploic nodes which lie along the right
gastroepiploic artery. Lymph vessels arising in these nodes
drain to subpyrolic nodes which lie in the angle between
first and second part of duodenum. From here lymph drain
to hepatic nodes which lie along hepatic artery and finally
to coeliac nodes.
♦♦ Lymph from pyrolic part, i.e. area d drains into different
directions into pyrolic, hepatic and left gastric nodes and
passes from all these nodes to coeliac nodes.
♦♦ Lymph from all areas of stomach reaches coeliac nodes.
From here it passes via intestinal lymph trunk to cisterna
chyli.

Fig. 249:  Lymphatic drainage of stomach
Q.2. Describe briefly structures forming stomach bed.
 (June 2010, 5 Marks)
Or
Enumerate structures forming stomach bed.
 (Apr 2015, 3 Marks)
Ans. Posterior surface of stomach is related to the structures
which form the bed of stomach.
All the structures are separated from the stomach by
cavity of lesser sac.
Structures forming the stomach bed are:
1. Diaphragm
2. Left kidney
3. Left suprarenal gland
4. Pancreas
5. Transverse mesocolon
6. Splenic flexure of the colon
7. Splenic artery.
Sometime spleen also come under the stomach bed and
is separated from stomach through cavity of greater sac.
Q.3. Describe stomach. Add a note on its clinical aspect.
 (May 2014, 10 Marks)
Ans. For location, shape, size, external features, subdivisions,
blood supply and lymphatic drainage refer to Ans 1 of
same chapter.
Relations of Stomach
Peritoneal Relations
♦♦ Stomach is lined by peritoneum over both of its surfaces.
♦♦ At lesser curvature, peritoneal layers lines anterior and
posterior surfaces, they meet and continue with lesser
omentum.
Lower Limb, Abdomen and Pelvis 189
♦♦ At greater part of greater curvature two layers meet and
form greater omentum.
♦♦ At fundus both layers meet and form gastrosplenic ligament.
♦♦ Near to cardiac end, peritoneum over the posterior surface
is reflected on diaphragm as gastrophrenic ligament.
♦♦ Cranial to this ligament a small part of posterior surface
of stomach is in contact with diaphragm. This is bare area
of stomach.
Fig. 250:  Structures forming stomach bed
(For colour version see Plate 11)
Visceral Relations
♦♦ Anterior surface of stomach is related to liver, diaphragm,
transverse colon and anterior abdominal wall.
♦♦ Diaphragm separates stomach from left pleura, pericardium
and sixth to ninth nerves.
♦♦ Costal cartilages get separated from stomach via
transversus abdominis. Gastric nerve and vessels ramify
deep to peritoneum
♦♦ Space between the left coastal margin and lower edge of
left lung over stomach is known as Traube’s space.
Posterior surface of stomach is related to the structures which
form the bed of stomach. All the structures are separated from
the stomach by cavity of lesser sac.
Structures forming the stomach bed are:
♦♦ Diaphragm
♦♦ Left kidney
♦♦ Left suprarenal gland
♦♦ Pancreas
♦♦ Transverse mesocolon
♦♦ Splenic flexure of the colon
♦♦ Splenic artery.
Sometime spleen also come under the stomach bed and is
separated from stomach through cavity of greater sac.
Nerve Supply
Both sympathetic and parasympathetic nerves innervate the
stomach.
Sympathetic Innervation
The sympathetic nerves travel along the arteries which supply
the stomach. Sympathetic nerves are vasomotor, motor to
190 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
pyrolic sphincter but inhibitory to rest of gastric musculature,
chief pathway for pain sensation from stomach.
Parasympathetic Innervation
♦♦ Anterior and posterior gastric nerves provide para-
sympathetic innervations.
♦♦ Anterior gastric nerve divides into multiple gastric
branches for anterior surface of fundus and body of
stomach. It also divides into two pyrolic branches, i.e. for
pyloric antrum and for pyrolus.
♦♦ Posterior gastric nerve divides into small gastric branches
or posterior surface of fundus, body and pyloric antrum. It
also divides into larger coeliac branches for coeliac plexus.
Parasympathetic nerves are motor and secretomotor to
stomach. Their stimulation leads to increased motility
of stomach and secretion of gastric juice rich in HCl and
pepsin. They are inhibitory to pyrolic sphincter.
A umbilical regions.
B
Figs. 251A and B:  Nerve supply of stomach:
A. Anterior gastric nerve; B. Posterior gastric nerve
Clinical Aspect
♦♦ Gastric pain is felt in epigastrum because stomach is
supplied by T6 to T9 segments of spinal cord. Pain
is produced either due to spasm of muscle or due to
overdistention. Ulcer pain is attributed to local spasm
due to irritation.
♦♦ Peptic ulcer can occur at site of pepsin and hydrochloric
acid, first part of duodenum, lower end of esophagus
and meckel’s diverticulum. It occurs commonly in blood
group O.
♦♦ Hyposthenic stomach is more prone to peptic ulcer
while hypersthenic stomach is more prone to duodenal
ulcer.
♦♦ Gastric carcinoma is common and occurs along greater
curvature. During this lymphatic drainage of stomach
gain importance. Metastasis occurs through thoracic duct
to left supraclavicular lymph node. These lymph nodes
are known as signal nodes.
♦♦ Pyrolic obstruction can be congenital or acquired. It leads
to visible peristalsis in epigastrum and vomiting after
meals.
6. KIDNEY AND URETER
Q.1. Write in brief on kidneys. (Feb 2013, 5 Marks)
Ans. Kidneys are the pair of excretory organs which are
situated on posterior abdominal wall one on each side
of vertebral column behind peritoneum.
Location
Kidneys are present in epigastric, hypochondriac, lumbar and
Vertically kidneys extend from upper border of 12th thoracic
vertebra to centre of body of 3rd lumbar vertebra.
Right kidney is slightly lower in position as compared to left
kidney and left kidney is little bit near to median plane than
right one.
Shape, Size and Weight
Kidney is bean shaped. Kidney is 11 cm long, 6 cm broad and
3 cm thick. Left kidney is little longer and narrower as compared
to right kidney.
A kidney weighs 150 gm in males and 135 gm in females.
Kidney is reddish brown in color.
External Features
Kidney has upper and lower poles, medial and lateral borders,
anterior and posterior surfaces.
Poles of Kidney
♦♦ Upper pole is broader and is in close contact with supra-
renal gland.
♦♦ Lower pole is pointed.
 Lower Limb, Abdomen and Pelvis 191

Surfaces ♦♦ Second part of duodenum

♦♦ Hepatic flexure of colon
Anterior surface is irregular and posterior surface is flat, but
♦♦ Small intestine.
it is difficult to recognize both anterior and posterior aspect of
kidney by looking their surfaces. Out of all anterior relations hepatic and intestinal surfaces
are covered by peritoneum. Lateral border of right kidney
Borders is related to right lobe of liver and to hepatic flexure of
♦♦ Lateral border is convex. colon.
♦♦ Medial border is concave.
Other Relations of Left Kidney
♦♦ Hilum or hilus is the middle part which shows depression.
Anterior Relations
Hilum
♦♦ Left suprarenal gland
From anterior to posterior side following structures are seen ♦♦ Spleen
in the hilum: ♦♦ Stomach
♦♦ Renal vein. ♦♦ Pancreas
♦♦ Renal artery. ♦♦ Splenic vessels
♦♦ Renal pelvis, this is the upper expanded end of ureter. ♦♦ Splenic flexure and descending colon
Relations of Kidneys ♦♦ Jejunum.
Out of these gastric, splenic and jejunal surfaces are covered by
Common Relation to Both Kidneys
peritoneum. Lateral border of left kidney is related to spleen
♦♦ Upper pole of both kidneys are related to suprarenal gland. and to descending colon.
Lower poles lie at about 2.5 cm above iliac creast.
♦♦ Medial border of each kidney is related to suprarenal gland
above the hilus and ureter below the hilus.
♦♦ Posterior surfaces of both kidneys are related to:
• Diaphragm
• Medial and lateral arcuate ligaments
• Psoas major
• Quadratus lumborum
• Transversus abdominis
• Subcostal vessels
• Subcostal, iliohypogastric and ilioinguinal nerve.
Additionally right kidney is related to 12th rib and left
kidney to 11th and 12th ribs.
♦♦ Structures related to hilum, i.e. renal vein, renal artery
and renal pelvis. Fig. 253:  Posterior relation of right kidney

Capsule or Covering of Kidney

Following are the coverings of kidney:
♦♦ Level II fibrous capsule: It is a thin membrane which
closely invests kidney and lines the renal sinus. In normal
conditions it is removed easily from the kidney but in some
diseased conditions it become adherent.
♦♦ Level II perirenal fat or perinephric fat: It is the layer of
adipose tissue which lies outside the fibrous capsule. It is
thick at the borders of kidney and fills extra space inside
renal sinus.
♦♦ Renal fascia: Renal fascia has anterior and posterior layer.
Anterior layer is called as fascia of Gerota and posterior
Fig. 252:  Anterior relation of kidneys layer is known as fascia of Zuckerkandall. These two fascia
Other Relations to Right Kidney fused laterally to form lateral conal fascia.
♦♦ Pararenal body or paranephric body: It consists of variable
Anterior Relations amount of fat lying outside the renal fascia. It is abundant
♦♦ Right suprarenal gland posteriorly and towards lower pole of kidney. It fills
♦♦ Liver paravertebral gutter and form cushion for kidney.
192 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Blood Supply Applied Anatomy

♦♦ During surgical exposures of kidney, when at times the l2th
rib is resected for easy delivery of kidney, there is danger
of opening of pleural cavity must be kept in mind. The
lower border of pleura lies in front of 12th rib and behind
diaphragm. Order of structures from anterior to posterior
side being diaphragm, pleura and rib. When the 12th rib is
absent or is too short to be felt, the 11th rib may be mistaken
for 12th, and the chances of opening the pleural cavity are
greatly increased.
♦♦ Angle between the lower border of 12th rib and outer
border of erector spinae is known as the renal angle. This
overlies to the lower part of kidney. Tenderness in the
kidney is elicited by applying pressure over this angle,
by the help of thumb.
♦♦ Blood from ruptured kidney or pus in perinephric abscess
first distends to renal fascia and then forces its way inside
the renal fascia downwards to pelvis. It cannot cross
the opposite side due to the fascial septum and midline
attachment of renal fascia.
♦♦ Kidney should be palpated bimanually, with one hand
placed in front and the other hand behind the flank. When
enlarged, the lower pole of kidney becomes palpable on
deep inspiration.
Lymphatic Drainage ♦♦ A floating kidney can move up and down inside the renal
fascia, but not from side to side. In this condition posterior
Lymphatics of kidney drain into lateral aortic nodes located at
layer of renal fascia can be sutured with diaphragm and
level of origin of renal arteries.
kidney can be fixed at its position.
Nerve Supply ♦♦ Common diseases of kidney are nephritis, pyelonephritis,
tuberculosis of kidney, renal stones and tumours. Common
♦♦ Kidney is supplied by the renal plexus, an off shoot of manifestations of a kidney disease are renal oedema and
coeliac plexus hypertension.
♦♦ Renal plexus consists of sympathetic fibers which are ♦♦ A common congenital condition of kidney is known as
vasomotor. polycystic kidney which causes hypertension.
♦♦ Afferent nerves of kidney belong to segment T10 and T12.
♦♦ During chronic renal failure dialysis needs to be done. It
can be done as peritoneal dialysis or haemodialysis.
♦♦ Kidneys are likely to be injured because of penetrating
injuries to lower thoracic cage. They can also be injured
by kicks in renal angle i.e. the angle between the vertebral
column and 12th rib.
♦♦ Kidneys are likely to have stones as urine become
concentrated here.
♦♦ Kidneys stone lies on the body of vertebra while the
gallstones lie anterior to body of vertebra.

7. DIAPHRAGM

Q.1. Write short note on openings in diaphragm.

 (Dec 2010, 3 Marks)
Ans. There are three large and multiple small openings in
diaphragm which allows passage of structures from
Fig. 254:  Arrangement of arteries of kidney abdomen to thorax or vice-versa.
 Lower Limb, Abdomen and Pelvis 193

Large or Major Openings of Diaphragm

(See following table)

Opening Shape Location Structure passing through Effects

Vena caval Quardilateral At level of T8 vertebra junction of right 1. Inferior vena cava On contraction
opening and median leaflet of central tendon 2. Right phrenic nerve undergo dilatation
3. Lymphatics of liver
Esophageal Elliptical At level of T10 vertebra, splitting of right 1. Esophagus On contraction
opening crus 2. Anterior and posterior vagal trunks undergo constriction
3. Left gastric vessels
Aortic opening Rounded At level of T12 vertebra, behind median 1. Abdominal aorta On contraction
arcuate ligament 2. Thoracic duct undergo no change
3 . Azygous vein

Small Openings of Diaphragm
♦♦ Each of the crus of diaphragm is pierced by greater and
lesser splanchnic nerves. Left crus is pierced in addition
to hemiazygos vein.
♦♦ Sympathetic chain passes from thorax to abdomen behind
medial arcuate ligament or medial lumbocostal arch.
♦♦ Subcostal nerve and vessels pass behind the lateral arcuate
ligament or lateral lumbocostal arch.
♦♦ Superior epigastric vessels and some of the lymphatics pass
between origins of diaphragm from xiphoid process and
7th costal cartilage. This gap is known as Larry’s space or
foramen of Morgagni.
♦♦ Musculophrenic vessels pierce diaphragm at level of 9th
costal cartilage.
vagina pass up into uterus and from there to uterine
tubes. Fertilization occurs in lateral part of tube.
Situation
Uterine tubes are situated in free upper margin of broad
ligament of uterus.
Dimension
♦♦ Each uterine tube is about 10 cm long.
♦♦ At its lateral end, uterine tube opens inside peritoneal cavity
via its abdominal ostium. The ostium is 3 mm in diameter.
Subdivisions
♦♦ Lateral end of uterine tube is funnel shape and is called as
infundibulum. It consists of number of finger like processes
known as fimbriae and that’s why it is called as fimbriated
end, one of the fimbriae is longer than others and is attached
to tubal pole of ovary and is known as ovarian fimbria.
♦♦ The part of uterine tube medial to infundibulum is called
ampulla. It is thin walled dilated and tortuous and forms
lateral 2/3rd of tube. Ampulla is site for fertilization.
♦♦ Isthmus succeeds the ampulla. It is narrow, rounded and
cord like and form medial one-third of tube.
♦♦ Uterine or intramural or interstitial part of tube lies in the
wall of uterus. It open in superior angle of uterine cavity
by narrow uterine ostium. The ostium is 1 mm in diameter.

Fig. 255:  Openings of diaphragm

8. FEMALE REPRODUCTIVE ORGANS

Q.1. Write a short note on uterine tube.

 (Mar 2007, 3 Marks) (Sep 2009, 5 Marks)
Ans. Uterine tube is also known as fallopian tube or salpinx.
Uterine tubes are tortuous ducts which convey oocyte
Fig. 256:  Subdivisions, relations and blood supply of uterine tube
from ovary to uterus. Spermatozoa introduce inside
194 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Course and Relations
♦♦ Isthmus as well as adjoining part of ampulla is directed
posterolaterally in horizontal plane. Near to the lateral
pelvic wall, ampulla arches over the ovary and is related
to its anterior as well as posterior borders, its upper pole
and the medial surface. Infundibulum projects beyond free
margin of broad ligament.
♦♦ Uterine tube lies in upper free margin of broad ligament
of uterus. Part of broad ligament between the attachment
of mesovarium and uterine tube is known as mesosalpinx.
This consists of termination of uterine and the ovarian
vessels and epoophoron.
Blood Supply
Arterial Supply
♦♦ Uterine artery supplies medial 2/3rd of uterine tube.
♦♦ Ovarion artery supplies lateral 1/3rd of uterine tube.
Venous Drainage
Veins run parallel to arteries and drain into pampiniform plexus
of ovary and into uterine veins.
Lymphatic Drainage
♦♦ Tubal lymphatics join lymphatics from ovary and drain
into lateral aortic and preaortic nodes.
♦♦ Lymphatics from isthmus accompany round ligament of
uterus and drains into superficial inguinal nodes.
Nerve Supply
♦♦ Uterine tubes are supplied by sympathetic and parasymp-
thetic nerves running along uterine and ovarian arteries.
♦♦ Sympathetic nerves from T10 to L2 are derived from
hypogastric plexus. They contain both visceral afferent
and visceral efferent fibers. Later ones are vasomotor and
stimulate tubal peristalsis. Peristalsis comes mainly under
hormonal control.
♦♦ Parasympathetic nerves are derived from vagus for lateral
half of tube and from the pelvic splanchnic nerves from
S2,S3,S4 segments of spinal cord for medial half. They
cause inhibition of peristalsis and cause vasodilatation.
Applied Anatomy
1. Salpingitis: Inflammation of uterine tubes.
2. Sterility: Inability to have child. Most common cause is
tubal blockage which is congenital, or caused by infection.
3. Tubal pregnancy: Sometimes fertilized ova instead of
reaching uterus adheres to the walls of uterine tube and
start developing here. This is called as tubal pregnancy.
Enlarging embryo can lead to rupture of tube.
4. Tubectomy: For purposes of family planning a women
can be sterilized by removing a segment of uterine tubes
on both side.
5. Transport of ovum: It chiefly occur due to muscular
contractions. Ciliary movements create an effective system
of lymph towards uterus which helps in nourishment of
ovum in lumen of tube over mucosal ridges.
 Lower Limb, Abdomen and Pelvis 195

FILL IN THE BLANKS

As per DCI and Examination Papers 1 Mark Each
of Various Universities

1. Name the arteries present in typical intercostal space. 9. Write name of cranial nerve which pass into internal
Ans. One posterior intercostal artery with its collateral branch auditory meatus.
and two anterior intercostals arteries Ans. Vestibulocochlear nerve and facial nerve.
2. Write the names of borders of lung. 10. Write name of unpaired intracranial venous sinuses.
Ans. Anterior, posterior and inferior Ans. Following are the unpaired intracranial venous sinuses:
3. Write name of various parts of stomach. ♦ Superior saggital sinus
Ans. Parts of stomach are: ♦ Inferior saggital sinus
♦ Straight sinus
♦ Cardiac part
• Fundus ♦ Occipital sinus
• Body ♦ Anterior intercavernous sinus
♦ Pyrolic part ♦ Posterior intercavernous sinus
• Pyrolic antrum ♦ Basilar plexus of veins.
• Pyrolic canal 11. Name the nerve supply of orbicularis oculi.
4. Write the name of all arteries which supply the thyroid Ans. Upper half of the orbicularis oculi muscle receives its
gland. innervation from the temporal branch of facial nerve,
Ans. Following are the name of arteries supplying thyroid while the lower half receives its innervation from the
gland: zygomatic branch of facial nerve.
♦ Superior thyroid artery 12. Name the largest sesamoid bone of the body.
♦ Inferior thyroid artery Ans. Patella
♦ Lowest thyroid artery or thyroidea ima artery
13. ........... is the nerve supply of anterior belly of digastrics.
♦ Accessory thyroid artery
Ans. Trigeminal nerve
5. Write the names of various components of hard palate.
Ans. Components of hard palate are: 14. Name two infrahyoid muscles.
♦ Palatine processes of maxillae in anterior two-third Ans. Following are two infrahyoid muscles:
♦ Horizontal plates of palatine bone in posterior one- 1. Sternothyroid
third 2. Sternohyoid
♦ Anterior and posterior parts unite by cruciform 15. Name the parts of corpus callosum.
suture to form hard palate Ans. Parts of corpus callosum are:
6. Write the names of all extrinsic muscles of tongue. ♦ Genu
Ans. Following are extrinsic muscle of tongue: ♦ Rostrum
♦ Genioglossus ♦ Trunk
♦ Hyoglossus ♦ Splenium
♦ Styloglossus 16. Name the branches of first part of maxillary artery.
♦ Palatoglossus Ans. Following are the branches of first part of maxillary
7. Write action of lateral pterygoid muscle. artery:
Ans. It depresses mandible to open mouth with suprahyoid ♦ Deep auricular
muscles. ♦ Anterior tympanic
♦ Middle meningeal
8. Write name of cranial nerve nuclei which are present
in midbrain. ♦ Accessory meningeal
♦ Inferior alveolar.
Ans. Following are the cranial nerve nuclei present in
midbrain: 17. Give two examples of secondary cartilaginous joint
♦ Nucleus of trochlear nerve (symphysis).
♦ Mesencephalic nucleus of trigeminal nerve Ans. Two examples of secondary cartilaginous joints
♦ Nucleus of occulomotor nerve with Edinger– (symphysis) are:
Westphal nucleus 1. Fibrocartilaginous joint
♦ Pretectal nucleus 2. Hyaline joint
196 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

18. Erb’s point lies on……………..trunk of brachial plexus. 24. Define sinusoid.
Ans. Upper Ans. A small irregularly shaped blood vessel found in certain
19. ………. muscle is supplied by glossopharyngeal nerve. organs, especially the liver.
Ans. Stylopharyngeus 25. Name the parts of internal capsule.
20. Skin is lined by………………epithelium. Ans. Following are the parts of internal capsule:
Ans. Keratinized stratified squamous. • Anterior limb
• Genu
21. Name the lobes of left lung.
• Posterior limb
Ans. Following are the lobes of left lung:
• Sublentiform part
• Upper
• Retrolentiform part
– Upper division
– Lower division 26. Why thyroid swelling moves with deglutition?
• Lower Ans. Thyroid swelling moves with deglutition because the
22. Name the branches of maxillary artery. thyroid gland is enclosed within the pretracheal fascia
Ans. Following are the branches of maxillary artery: which is attached to larynx which moves up and down,
while swallowing and along with that thyroid and its
1. Branches of first part of maxillary artery:
swellings also moves up and down.
– Deep auricular
– Anterior tympanic 27. Name the tributaries of internal jugular vein.
– Middle meningeal Ans. Following are the tributaries of internal jugular vein:
– Accessory meningeal • Inferior petrosal sinus
– Inferior alveolar • Common facial vein
2. Branches of second part of maxillary artery: • Lingual vein
– Masseteric • Pharyngeal veins
– Deep temporal • Superior thyroid vein
– Pterygoid • Middle thyroid vein
– Buccal
3. Third part of maxillary artery: 28. Which nerve supply sternocleidomastoid muscle?
– Posterior superior alveolar Ans. It is supplied by accessory nerve (cranial nerve XI) and
– Infraorbital direct branches of the cervical plexus (C1–C2).
– Greater palatine
29. Name the cervical nerves taking part in the formation
– Pharyngeal
of ansa cervicalis.
– Artery of pterygoid canal
– Sphenopalatine. Ans. Following are the cervical nerves taking part in formation
of ansa cervicalis:
23. Name the four structures passing through superior
• Superior root by first cervical nerve
orbital fissure.
• Inferior root or descending cervical nerve from
Ans. Following are the four structures passing through second and third cervical spinal nerves.
superior orbital fissure:
1. Lacrimal nerve 30. Name the arteries supplying the heart.
2. Frontal nerve Ans. Arteries supplying the heart are:
3. Trochlear nerve • Left coronary artery
4. Superior ophthalmic vein • Right coronary artery
 Lower Limb, Abdomen and Pelvis 197

IMAGE-BASED QUESTIONS

1. Which muscle in given color picture is responsible for

mandibular protrusion?
a. Lateral pterygoid
b. Masseter
c. Medial pterygoid
d. Temporalis

Ans. a. Zone of proliferation

3. Which of the following structures does not pass
through the area marked in the figure?
a. Sensory branch of mandibular nerve
b. Lesser petrosal nerve
c. Motor root of trigeminal nerve
d. Maxillary nerve
Ans. a. Lateral pterygoid
2. In following H & E stained secondary cartilage of
condyle, identify the marked layer:
a. Zone of proliferation
b. Zone of hypertrophy
c. Zone of chondroid formation
d. Zone of maturation

Ans. d. Maxillary nerve

198 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Additional Matter

Various Landmarks of Skull Contd...

Name of the Name of the

landmark Meaning foramina Transmission
Asterion This is the meeting point of parietomastoid, Foramen • Vertebral artery
occipitomastoid and lambdoid sutures transversarium • Vertebral veins
Bregma This is the meeting point between sagittal and • Branch from inferior cervical ganglion
lambdoid sutures Jugular • Anterior part: Inferior petrosal sinus, meningeal
Lambda This is the meeting point between coronal and foramen branch of ascending pharyngeal artery,
sagittal sutures sigmoid sinus
• Middle part: 9th, 10th and 11th nerve
Obelion This is the point on sagittal suture between the • Posterior part: Internal jugular vein and
two parietal foramen meningeal branch of occipital artery
Pterion This is an area inside the temporal fossa where Supraorbital It transmits supraorbital nerve and vessels
frontal, parietal, temporal and greater wing of foramen
sphenoid join and form a H shaped suture
Infraorbital Infraorbital nerve and vessels
Vertex This is the highest point on the sagittal suture foramen
Mental Mental nerve and vessels
Various Foramina and their Transmissions foramen
Incisive • Terminal parts of greater palatine vessels
Name of the foramen • Terminal part of nasopalatine nerve
foramina Transmission
Mastoid Emissary vein which connect sigmoid sinus with
Foramen • From anterior part
foramen posterior auricular vein
magnum -- Apical ligament of dens
Meningeal branch of occipital artery
-- Membrana tectoria
• Via subarachnoid space Palatovaginal • Pharyngeal branch of pterygopalatine ganglion
-- Spinal accessory nerve canal • Pharyngeal branch of maxillary artery
-- Vertebral arteries
Greater • Greater palatine vessels
-- Anterior and posterior spinal arteries
palatine • Anterior palatine nerve
• Via posterior part
foramen
-- Lower part of medulla
-- Tonsils of cerebellum Lesser • Middle palatine nerve
-- Meninges palatine • Posterior palatine nerve
foramen
Foramen • Middle meningeal artery
spinosum • Meningeal branch of mandibular nerve Vomerovaginal Branches of pharyngeal nerves and vessels
• Middle meningeal vein canal
Foramen • Mandibular nerve Anterior • Hypoglossal nerve
ovale • Accessory meningeal artery condylar canal • Meningeal branch of hypoglossal nerve
• Lesser petrosal nerve • Meningeal branch of ascending pharyngeal
• Emissary vein connecting cavernous sinus artery
with pterygoid plexus of veins • Emissary vein connecting sigmoid sinus with
Foramen Meningeal branch of pharyngeal artery jugular vein
lacerum Posterior Emissary vein connecting sigmoid sinus with sub
Carotid canal Internal carotid artery along with venous and condylar canal occipital venous plexus
sympathetic plexus around artery Optic canal • Optic nerve
Inferior orbital • Maxillary nerve • Ophthalmic artery
fissure • Zygomatic nerve
Foramen It is an inter ventricular foramen via which lateral
• Orbital branches of pterygopalatine ganglion
monro ventricles open in third ventricle
• Infraorbital vessels
• Inferior ophthalmic vein Foramen of Medial opening in roof of fourth ventricle of brain
magendie
Superior • In lateral part: Lacrimal, frontal and trochlear
orbital fissure nerves, lacrimal and middle meingeal artery Foramen of Opening of lateral recess of fourth ventricle
• In middle part: Occulomotor, nasociliary and Luschka
abducens nerves Internal 7th and 8th cranial nerves and labyrinthine
• In medial part: Inferior ophthalmic veinand sym- acoustic vessels
pathetic plexus around internal carotid artery meatus
Contd...
 Lower Limb, Abdomen and Pelvis 199

Various Craniosynostosis Contd...

Type of Occur due to Arterial

craniosynostosis Meaning premature closure of Name of and venous Lymphatic
the gland supply drainage Nerve supply
Brachycephally Expansion of skull Bilateral coronal
horizontally suture Postganglionic fibers
emerges from the
Oxycephaly All the sutures
ganglion and enter the
Plagiocephaly Asymmetrical, Unilateral coronal submandibular gland.
oriented to one side suture
Sublingual Both Lymph Nerve supply is same
Platycephaly Tower skull with Unilateral sublingual drains to as mentioned above in
peak at occiput occipitoparietal and sub­ sub mental submandibular gland.
Scaphocephaly Long and narrow skull Sagittal suture mental lymph node
arteries

Various Pneumatic Bones (Internal Cavities are Filled

Channels of Cavernous Sinus
with Air)
♦♦ Mastoid process of temporal bone Incoming channels Draining channels
♦♦ Maxillary sinus Superior ophthalmic vein Superior petrosal sinus
♦♦ Sphenoid sinus Inferior ophthalmic vein Inferior petrosal sinus
♦♦ Ethmoid sinus
Central vein of retina Superior petrosal sinus
Situation of Foramina in Base of Skull from Anterior to Superficial middle cerebral vein Emissary veins
Posterior
Inferior cerebral vein Superior ophthalmic vein
♦♦ Foramen ovale Sphenoparietal sinus Intercavernous vein
♦♦ Foramen spinosum
Middle meningeal vein
♦♦ Jugular foramen
♦♦ Stylomastoid foramen
Various Nerves
Various Major Salivary Glands
Sensory • Olfactory I
Arterial • Optic II
Name of and venous Lymphatic • Vestibulocochlear VIII
the gland supply drainage Nerve supply
Motor • Oculomotor III
Parotid • External Lymph • Parasympathetic: • Trochlear IV
carotid drains first Preganglionic fibers • Abducens VI
artery to parotid start from inferior • Hypoglossal XII
• External nodes salivatory nucleus, pass
Mixed • Trigeminal V
jugular and from via glossopharyngeal
• Facial VII
vein there to nerve and lesser
• Glossopharyngeal IX
upper deep petrosal nerve and
• Vagus X
cervical relay in otic ganglion.
• Accessory XII
lymph Postganglionic fibers
nodes reaches parotid gland via
auriculotemporal nerve. Nerves Carrying General Visceral Efferent Fibers
• Sensory: This
nerve supply is via ♦♦ Oculomotor
auriculotemporal ♦♦ Facial
nerve. Parotid fascia ♦♦ Glossopharyngeal
is supplied by sensory ♦♦ Vagus
fibers of greater
auricular nerve House–Brackmann Score
Sub­ • Facial Lymph • Parasympathetic: ♦♦ This score grades the degree of nerve damage in facial
mandibular artery drains Preganglionic fibers nerve palsy
• Venous to sub­ start from superior ♦♦ Its measurement is determined by measuring upward
drainage mandibular salivatory nucleus, pass
movement of mid portion of top of an eyebrow and
to lymph via chorda tympani
common nodes. of facial nerve and outward movement of angle of mouth
facial or the lingual nerve to ♦♦ Each reference point scores 1 point for each 0.25 cm
the lingual reach submandibular movement, upto maximum of 1 cm. Score is then added
vein ganglion. to give a number out of 8.
Contd... ♦♦ This score predict the recovery in patient’s with Bell’s palsy.
200 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Movements of Jaw and Muscles Associated with them Various Parts of Body and their Drainage to Lymph Nodes

Name of movement of Drainage to

jaw Muscles responsible Parts of the body lymph node
Depression of mandible • Digastric • Tip of tongue Sub-mental lymph
or Mouth opening • Mylohyoid • Adjoining gum nodes
• Geniohyoid • Chin
• Lateral pterygoid • Central part of lower lip
• Upper lip Sub-mandibular
Elevation of jaw or closing • Massater
of mouth • Temporalis • Nose and paranasal sinus lymph nodes
• Medial pterygoid • Centre of forehead
• Anterior 2/3rd of tongue
Protrusion Lateral pterygoid and medial pterygoid • Floor of mouth
• Outer part of lower lip with underlying gum
Retraction • Geniohyoid
and teeth
• Masseter
• Digastric • Part of scalp above and behind the auricle Postauricular
• Posterior fibers of temporalis • Upper half of medial surface and the lymph nodes
margin of auricle
Lateral movements Medial and lateral pterygoid • Posterior wall of external acoustic meatus
• Parotid gland Parotid lymph
Various Facial Expressions and Muscles Responsible for • Temporomandibular joint nodes
• Temple
them
• External acoustic meatus
Name of the facial expression Muscles responsible • Parts of eyelid and orbit
Part of cheek and lower eyelid Buccal and mandi­
Smiling and laughing Zygomaticus major
bular lymph nodes
Sadness • Levator labii superioris • Larynx Prelaryngeal and
• Levator anguli oris • Trachea pretracheal lymph
Grief Depressor anguli oris • Isthmus of thyroid nodes

Anger • Dilator naris • Esophagus Paratracheal

• Depressor septi • Trachea
• Larynx
Frowning • Corrugator supercilii
• Posterior part of hard palate Retropharyngeal
• Procerus
• Nose lymph nodes
Horror, terror, fight Platysma • Soft palate
• Auditory tube
Surprise Frontalis
• Pharynx
Doubt Mentalis
Grinning Risorius Various Levels of Neck Lymph Nodes
Contempt Zygomaticus minor Name of
the level Description
Level I It includes submental and submandibular lymph nodes
Various Cephaly
Level II • It consists of upper jugular lymph nodes and is
Name of cephaly Meaning divided into sublevels IIA and IIB
• Level IIA lymph nodes lie anterior to spinal
Acrocephaly Both coronal and sagittal sutures are premature accessory nerve
resulting in pointed skull • Level IIB lymph nodes lie posterior to spinal
Anencephaly This is characterized by missing of greater part accessory nerve
of vault of skull Level III It consists of lymph nodes of middle jugular group
Brachycephaly Premature fusion of coronal sutures forces the Level IV It consists of lymph nodes of lower jugular group
skull to grow wide relative to its length which
Level V • It consists of lymph nodes of posterior triangle.
leads to short and broad skull
• This group consists of lymph node along spinal
Dolichocephaly In this skull is long and thin accessory chain, transverse cervical nodes and
supraclavicular nodes
Microcephaly There is small skull due to failure of brain to grow
Level VI • It includes anterior compartment lymph nodes.
Plagiocephaly There is asymmetric union of sutures which • It includes pretracheal, prelaryngeal and
leads to twisted skull paratracheal lymph nodes
Scaphocephaly It is the premature union of sagittal suture which Level VII This constitutes the lymph node group in superior
leads to boat shaped skull mediastinum, but are no longer used.
 2
SECTION

Embryology

1. Some Preliminary Considerations 7. Face, Nose and Palate

2. Spermatogenesis and Oogenesis 8. Alimentary System I: Mouth, Pharynx and
3. Formation of Germ Layers Related Structures
4. Further Development of Embryonic Disc 9. The Nervous System
5. Formation of Tissues of the Body 10. Fate of Germ Layers
6. The Pharyngeal Arches

1. SOME PRELIMINARY CONSIDERATIONS
Q.1. Discuss in brief sex chromosomes.
 (Nov 2009, 5 Marks)
Ans. In diploid genome of human beings, there are 46
chromosomes, 44 of them are autosomes and two are
sex chromosomes. The individual inherits one of these
chromosomes from each parent.
• Human sex chromosomes are called X chromosome
and Y chromosome.
• Individuals having two X chromosomes (44 + XX)
are female.
• Individuals having one X chromosome and one Y
chromosome (44 + XY) are male.
• There are two portions of human sex chromosome,
i.e. homologous and heterologous portions.
• Homologous portion is that in which there are genes
having alleles in both Y and X sex chromosomes.
• Homologous portions are situated more in the
central part of the sex chromosomes, near the
centromere.
• Heterologous portion is that whose genes do
not have correspondent alleles in the other sex
chromosome.
• These genes are located more in the peripheral
regions of the arms of the Y and X chromosomes.
Fig. 1:  Chromosomes
♦♦ The individual of male sex is XY, so he forms gametes
containing either the X chromosome or the Y chromosome
in a 1:1 proportion.
♦♦ The individual of female sex is XX and thus she forms only
gametes containing an X chromosome.
♦♦ It is not only possible that an X chromosome of a woman
is from her father, it is certain. Every woman has an X
chromosome from her father and the other X chromosome
from her mother.
♦♦ In men, however the X chromosome comes always from
his mother and the Y chromosome is always from his
father.
♦♦ Besides sex genes the sex chromosomes have also
autosomal genes, genes that codify several proteins related
to nonsexual traits.
♦♦ Diseases caused by abnormal number of sex chromosomes
are called sex aneuploidies.
♦♦ Main sex aneuploidies are 44 + XXX, or trisomy X (women
whose cells have an additional X chromosome); 44 + XXY,
or Klinefelter’s syndrome (men whose cells have an extra X
chromosome); 44 + XYY, or double Y syndrome (men whose
cells have an additional Y chromosome); 44 + X, Turner’s
syndrome (women whose cells lack an X chromosome).
2. SPERMATOGENESIS AND OOGENESIS
Q.1. Write a short note on spermatogenesis.
 (April 2003, 5 Marks) (May/June 2009, 5 Marks)
 (Apr 2010, 5 Marks)
Ans. Spermatogenesis is the process of maturation of male
gametes in the wall of seminiferous tubules.
• It consists of series of changes leading to the
conversion of spermatogonia into spermatozoa.
• In the male, formation of gametes (spermatozoa)
takes place at the time of reproductive period, which
begins at the age of puberty (12 to l6 years) and
continues even into old age.
• Its duration is of 64–74 days.
• Various cell stages in spermatogenesis are spermato-
cytosis, meiosis and spermiogenesis. These stages
can be described as follows:
Spermatocytosis
♦♦ This is the process of conversion of spermatogonia to
primary spermatocytes. It takes 16 days. It is by repeated
mitotic divisions.
♦♦ Formation of stem cells: The primitive germ cells give rise
to spermatogonial stem cells.
♦♦ Cell growth: From these stem cells, a group of cells
are formed at regular intervals and are called type A
spermatogonia. Production of type A spermatogonia
marks the beginning of spermatogenesis.
♦♦ Mitotic divisions: Type A spermatogonia (44 + X + Y)
undergo a limited number of mitotic divisions and form
a clone of cells. The last division of cells becomes Type B
spermatogonia. The Type A spermatogonia are dark and
Type B are pale in color. Type A spermatogonia are reserve
cells. The spermatogonia (Type B) (44 + X + Y) enlarge, or
undergo mitosis, to form primary spermatocytes.
Meiotic Divisions
♦♦ In this, there is conversion of primary spermatocytes to
secondary spermatocytes and then spermatids. It takes
24 days.
♦♦ Primary spermatocytes (44 + X + Y) now divide so that
each of them forms two secondary spermatocytes.
204 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
This is the first meiotic division, i.e. it reduces the number
of chromosomes to half.
♦♦ Each secondary spermatocyte has 22 + X or 22 + Y
chromosomes. It divides to form two spermatids. This
is the second meiotic division and this time, there is no
reduction in chromosome number. It is called equation
meiosis. There occurs balancing of species specific
chromosome number and DNA content by reduction and
equation divisions.
Fig. 2:  Stages in spermatogenesis
Spermiogenesis
♦♦ It is the process of metamorphosis of spermatids to
spermatozoa and takes 24 days.
♦♦ Process by which a spermatid (22 + X/22 + Y) gradually
changes its shape to become a spermatozoon is called
spermiogenesis. It is the final stage in the maturation of
spermatids into mature, motile spermatozoa.
♦♦ The spermatid is a more or less circular cell containing a
nucleus, Golgi apparatus, centriole and mitochondria. All
these components take part in forming the spermatozoon.
♦♦ Major events in spermiogenesis:
• Nuclear morphogenesis and condensation
• Formation of tail
• Formation of acrosome
• Rearrangement of organelles (Mitochondria, centrioles)
• Shedding of excess cytoplasm.
♦♦ Various processes in spermiogenesis:
• Nucleus: Condensation of nucleus and its movement
to one pole forms the head.
• Golgi apparatus: Golgi apparatus is transformed into
the acrosomic cap. Acrosomal cap covers two-thirds
of nucleus.
• Centrosome: Centriole divides into two parts that are
at first close together. The proximal centriole becomes
spherical and comes to lie in the neck. The axial
filament appears to grow out of it. Distal centriole
forms the distal end of middle piece, i.e. annulus.
Centrioles are concerned for movement.
• Mitochondria: Form a spiral sheath around middle
piece. The part of the axial filament between the
neck and the annulus becomes surrounded by
mitochondria, and together with them forms the
middle piece. The remaining part of the axial filament
elongates to form the principal piece and tail.
• Cytoplasm: Most of it is shed as residual bodies of
Renaud and are engulfed by Sertoli cells.
• Cell membrane: Persists as a covering for the
spermatozoon. Presents specialization for fertilization
that includes sperm-egg recognition, sperm-egg
binding and sperm-egg fusion.
Q.2. Write short note on oogenesis. (May 2014, 5 Marks)
Ans. The process of maturation and differentiation of primitive
germ cells to oogonia, primary oocytes, secondary
oocytes and to mature ova in the female genital tract.
• It is located in ovarian cortex.
• Peculiarities of oogenesis:
– Starts before birth (10th week)
– Stops in the middle (birth to puberty)
– Restarts at puberty (11–13 years)
– Continues up to menopause (45–55 years)
• Various processes in oogenesis are:
– Mitosis
– Meiosis
– Growth of follicles
– Differentiation of follicles.
• Cortex contains many large round cells called
“oogonia”. All the oogonia to be utilized throughout
the life of a woman are produced at a very early
stage (possibly before birth) and do not multiply
thereafter.
• On arrival in the gonad, the primordial germ cells
differentiate into oogonia. The oogonia pass through
the stages of primary and secondary oocyte and ovum.
• Oogenesis at different phases of life can be described
here:
Before Birth
♦♦ Before 3rd month: The primitive germ cells undergo mitosis
to form oogonia. This occurs in the absence of testicular
differentiation factor.
♦♦ Before 7th month: The oogonia continue to divide mitotically.
The oogonia are surrounded by a layer of flat epithelial
cells. Some of the oogonia enlarge to form primary oocytes.
♦♦ 7th month to birth: Formation of primordial follicles
(primary oocyte with its surrounding flat epithelial cells)
and multiplication of primary oocytes to produce millions
 Embryology  205

of germ cells occurs. Primary oocyte enters prophase I of ♦♦ If fertilization does not occur, the secondary oocyte fails
meiosis I at that phase the meiosis is arrested by oocyte to complete the second meiotic division and degenerates
maturation inhibitor (OMI) factor. about 24 hours after ovulation.
♦♦ The oogonia are diploid (2n) in chromosome content.
Q.3. Briefly describe graafian follicle.
Many of these oogonia and primary oocytes degenerate
before birth.  (Oct 2007, 5 Marks)
Ans. Around 7th day of sexual cycle one of the tertiary follicles
increases in size in response to follicle-stimulating
hormone (FSH) and luteinizing hormone (LH) and forms
the largest mature follicle that is known as “Graafian
follicle”. Remaining follicles degenerate and become
atretic.
• A fully mature Graafian follicle is about 3–5 mm
in size. It reaches the periphery of the cortex and
starts projecting on to the surface of the ovary. The
follicular antrum is filled with fluid pushing the
primary oocyte with a layer of covering cells to one
side of the follicle.
• The layer of cells immediately surrounding the
oocyte and zona pellucida are called corona radiata
cells. The projection of granulosa cells covering the
Fig. 3:  Stages in oogenesis
primary oocyte projecting into the follicular antrum
is called cumulus oophorus. The area of attachment
Birth to Puberty of primary oocyte and corona radiata to the wall of
follicle is called discus proligerus.
♦♦ There will be both maturation and degeneration of
• As the follicle expands, the stromal cells surrounding
primordial follicle resulting in reduction in the number
the membrana granulosa become condensed to form
of primary oocytes.
a covering called the theca interna. Theca interna
♦♦ At the time of birth, all primary oocytes are in the prophase
increases in thickness and becomes more vascular.
of first meiotic division. At birth, approximately two lakh
The cells of the theca interna later secrete a hormone
primary oocytes in primordial follicles are present in each
called estrogen; and they are then called the cells of
ovary.
the thecal gland. Outside the theca interna, some
♦♦ Instead of entering metaphase, the primary oocytes enter
fibrous tissue becomes condensed to form another
prolonged resting or diplotene stage.
covering for the follicle called the theca externa. The
After Puberty ovarian follicle is now fully formed.
• The follicle gradually increases in size and finally
♦♦ After puberty, cyclic preparation for fertilization is known bursts and expels the ovum. This process of
as ovarian cycle. shedding of the ovum is called ovulation.
♦♦ From the time of birth to puberty, there is degeneration of • Just before ovulation the primary oocyte of mature
number of primary oocytes. Rest of the primary oocytes Graafian follicle completes first meiotic division and
remain in prophase and do not complete their first meiotic forms secondary oocyte and first polar body.
division until they begin to mature and are ready to ovulate.
♦♦ The first meiotic division of a primary oocyte produces two
unequal daughter cells. Each daughter cell has the haploid
number of chromosomes (23). The large cell, which receives
most of the cytoplasm, is called the secondary oocyte, and
the smaller cell is known as “the first polar body”. The
secondary oocyte immediately enters the second meiotic
cell division.
♦♦ Ovulation takes place while the oocyte is in metaphase.
The secondary oocyte remains arrested in metaphase till
fertilization occurs.
♦♦ The second meiotic division is completed only if
fertilization occurs. This division results in two unequal
daughter cells. The larger cell is called ovum. The smaller
daughter cell is called the second polar body. The first polar
body may also divide during the second meiotic division
making a total of three polar bodies. Fig. 4:  Mature Graafian follicle (For colour version see Plate 11)
206 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
3. FORMATION OF GERM LAYERS
Q.1. Write short note on fertilization.
 (Jan 2012, 5 Marks) (Dec 2014, 5 Marks)
Ans. Process of fusion of two highly specialized/highly
differentiated/mature, haploid germ cells, an ovum and
a spermatozoon resulting in the formation of a most
unspecialized/undifferentiated/diploid, mononucleated
single cell, the zygote.
• Fertilization is a signal for completion of second
meiotic division. Out of a few hundred capacitated
sperms, that surround the ovum, only one pierces
the zona pellucida and enters the ovum. As soon
as one spermatozoon enters the ovum, the second
meiotic division is completed, and the second polar
body is extruded.
• Site of fertilization: Fertilization of the ovum occurs
in the ampulla or lateral one-third of uterine tube.
• Stages: The various events in fertilization can be
described in three stages.
1. Approximation of gametes
2. Contact and fusion of gametes
3. Effects/results of fertilization.
Approximation of Gametes
It is by transport of male and female gametes in the female
genital tract.
♦♦ Spermatozoon transport: Following events play an important
role in successful fertilization.
• Semen: It is also known as seminal fluid, is an
organic fluid that contains spermatozoa. It includes
secretions of seminal vesicle (60%), prostate (25%)
and bulbourethral glands (5%) and the spermatozoa
(10%). The secretions from seminal vesicle are rich in
fructose that provides energy for the spermatozoa. The
normal amount of semen produced at each ejaculation
is about 2–3 mL. The number of spermatozoa released
in each ejaculation is 100 million/mL. The pH of semen
is maintained (7.2–7.6) by a base spermine present in
it. The semen contains fibrinolysin that liquefies semen
in 30 minutes after ejaculation.
• Maturity and motility of sperms: During their passage
through male genital tract the spermatozoa mature.
Movements of tail are important for their motility.
Motility is important for penetration of three barriers
surrounding the ovum.
• Transport of sperms: Prostaglandins present in semen
stimulate peristaltic contractions of female genital
tract at the time of sexual intercourse. During their
transport, there will be reduction in the number of
spermatozoa due to the constrictions in female genital
tract. Movements of their tails through uterus and
tubes assisted by muscular contraction are responsible
for the movement of spermatozoa. Time taken for
transport to uterus is 5 to 45 minutes.
• Fate of spermatozoa in female genital tract: Around
200–500 million sperms are deposited in the female
genital tract and about 300–500 spermatozoa only
reach the site of fertilization. The life span of
spermatozoa after ejaculation is 24 to 48 hours.
They have greater motility; hence, they rapidly lose
the fertilizing power. Acidic vaginal pH decreases
and alkalinity increases motility of spermatozoa.
The spermatozoa are attracted to the ovum by a
mechanism known as chemotaxis, i.e. release of certain
chemicals by the follicular cells.
• Capacitation: It is the final step in maturation of
spermatozoon before actual fertilization and it takes
place in female genital tract. It is a species-specific
interaction between sperm and oocyte. The time
required for capacitation is 7 hours. It starts in the
uterus and continues into the tubes. The mechanism
of capacitation is not known.
♦♦ Ovum transport: The structure of ovum at ovulation,
transport of ovum from ovary to ampulla of uterine tube
and the viability of sperm are important for the success
of fertilization.
• Structure of ovum at ovulation: At ovulation, the
ovum contains secondary oocyte with 23 unpaired
chromosomes enclosed in vitelline membrane,
surrounded by zona pellucida with proteins and
corona radiata with matrix rich in hyaluronic acid.
• Transport of ovum from ovary to ampulla of uterine tube:
Fimbriae of uterine tube moves over the ovary at
ovulation and the ciliary beats of fimbriae sweeps
the ovulatory mass into the infundibulum. The ciliary
heats of uterine epithelium and muscular contractions
of uterine tube are responsible for transcoelomic
migration of ovum from the surface of ovary into the
ampulla of uterine tube. The ovum reaches ampulla,
the site of fertilization in 25 minutes.
• Viability of ovum: The ovum that is released at ovulation
is viable for 24–48 hours. In the absence of fertilization,
it degenerates.
Contact and Fusion of Gametes
There are three barriers which the sperm has to penetrate before
fusing with the ovum. They are:
1. Corona radiata
2. Zona pellucida
3. Vitelline membrane.
Four processes are involved in the penetration of these barriers.
They are:
Acrosome Reaction
♦♦ Process of multiple contacts that capacitated sperm
head establishes between plasma membrane and outer
membrane of acrosomal cap, and discharging chemical
substances that facilitate penetration of barriers around
oocyte in succession.
♦♦ Coverings of sperm head: The head of sperm has three
coverings. From inside out, they are nuclear envelope,
 bilaminar acrosomal membrane containing enzymes for Nuclear Fusion
penetration of oocyte and plasma membrane.
Both head and tail of spermatozoon (excluding plasma
♦♦ Release of acrosomal enzymes: The acrosome reaction
membrane) enters the cytoplasm of oocyte. Approximation of
must be completed to facilitate fusion of sperm with
pronuclei takes place near the middle of cytoplasm of ovum.
the secondary oocyte. It occurs when sperms come into
♦♦ Immediately after the entry of sperm head into the cytoplasm
contact with the corona radiata of the oocyte. Perforations
of the oocyte, the latter completes its second meiotic division,
develop in the acrosome. Point fusions of the sperm plasma
releases ovum with 1N DNA and second polar body. Second
membrane and the outer acrosomal membrane occur.
polar body extruded into perivitelline space.
The acrosome reaction is associated with the release of
♦♦ Reconstitution of oocyte chromosomes forms female
acrosome enzymes that facilitate penetration of the zona
pronucleus.
pellucida by the sperm. The three acrosome enzymes
♦♦ The sperm head makes a rotation of l80° within the oocyte
that are released are hyaluronidase, the protease enzyme
cytoplasm with its nucleus swollen, transforms into a male
acrosin and acid phosphatase. The glycoprotein of the zona
pronucleus.
pellucida is responsible for induction of the acrosomal
♦♦ Formation of zygote: Each chromosome in the male and
reaction.
female pronuclei is made up of only one chromatid.
Replication of DNA takes place to form a second chromatid
Disintegration of Barriers
in each chromosome (lN—2N DNA) and two centrioles
The sperm has to pass through the following three barriers in appear. Disappearance of nuclear membranes and splitting
order. Disintegration of each barrier is by enzyme reaction: of each chromosome into two (as in mitosis) occurs.
♦♦ Corona radiata: Penetration of this first barrier depends The ovum is now called zygote. Meanwhile a spindle
on the release of hyaluronidase from the acrosome of forms between two centrioles and chromosomes from
sperm, tubal mucosal enzymes and movements of tail of each pronucleus (Haploid chromosomes with 2N DNA)
spermatozoon also aids in penetration of corona radiata. organizes on the spindle equator. One chromosome of
The hyaluronidase digests the cells of corona radiata. each pair moves to each end of the spindle. This leads
♦♦ Zona pellucida: The glycoproteins on the outer surface of to formation of two cells, each having 46 chromosomes.
sperm head binds with glycoproteins on the zona pellucida
of ovum. This is by binding to Zp3 and Zp2 receptors. Effects/Results of Fertilization
Acrosin causes digestion of ZP around sperm head. The From what has been said above, it will be clear that the results
reaction of zona is to prevent polyspermy. Alterations in of fertilization are:
the plasma membrane of oocyte and zona pellucida ensure ♦♦ Completion of second meiotic division of female gamete
that no other spermatozoon can enter the oocyte. The zona (secondary oocyte)
pellucida is altered due to release of lysosomal enzymes ♦♦ Restoration of diploid number (46) of chromosomes
by plasma membrane of the oocyte. This process is called
zona reaction.
♦♦ Vitelline membrane: When a spermatozoon comes in contact
with the oocyte, plasma membranes of two cells fuse. This
probably occurs at receptor sites that are specific for a
species. The disintegrin peptide released from sperm head
initiates fusion. The vitelline membrane contains integrin
peptides. This process takes 30 minutes.

Calcium Wave in Oocyte

The contact of sperm with vitelline membrane of oocyte triggers
calcium war (depolarization) in oocyte cytoplasm. This trigger
important event at fertilization.
♦♦ Secondary oocyte resumes second meiotic division.
♦♦ Contact of cortical granules with plasma membrane in the
periphery of ooplasm and release of lysosomal enzymes
from cortical granules produce vitelline block and prevents
polyspermy.
♦♦ Alterations taking place in the plasma membrane of the
oocyte, and in the zona pellucida, ensure that no other
spermatozoon can enter the oocyte.
♦♦ Metabolic activation of egg. Entry of the sperm leads
to metabolic changes within the ovum that facilitate its
development into an embryo. Fig. 5:  Chromosomes during fertilization
208 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

♦♦ Determination of chromosomal sex of the future individual

to be born 4. FURTHER DEVELOPMENT OF
♦♦ Initiation of cleavage (mitotic) division of zygote EMBRYONIC DISC
♦♦ Determination of polarity and bilateral symmetry of
embryo Q.1. Write short note on notochord. (Nov 2009, 4 Marks)
♦♦ Genetic diversity.  (Dec 2012, 3 Marks) (June 2010, 5 Marks)
 Embryo contains only maternal mitochondria—sperm Ans. Notochord
mitochondria are discarded. Notochord is a midline structure, that develops in the
The important points to note at this stage are that: region lying between the cranial end of the primitive
♦♦ The two daughter cells are still surrounded by the zona streak and the caudal end of primitive plate. During
pellucida. its development, the notochord passes through several
♦♦ Each daughter cell is much smaller than the ovum stages that are as follows:
♦♦ With subsequent divisions, the cells become smaller and 1. Cranial end of the primitive streak becomes
smaller until they acquire the size of most cells of the body. thickened.
Q.2. Write short note on stem cells. (May 2014, 5 Marks) This thickened part of the streak is called the
Ans. Stem cells are undifferentiated biological cells that can primitive knot, primitive node or Henson’s node.
differentiate into specialized cells and can divide through
mitosis to produce more stem cells.
• They are found in multicellular organisms.
• In mammals, there are two broad types of stem cells:
embryonic stem cells, which are isolated from the
inner cell mass of blastocysts, and adult stem cells,
which are found in various tissues.
• In adult organisms, stem cells and progenitor cells
act as a repair system for the body, replenishing
adult tissues.
• In a developing embryo, stem cells can differentiate A
into all the specialized cells of ectoderm, endoderm
and mesoderm and also maintain the normal
turnover of regenerative organs, such as blood, skin,
or intestinal tissues.
• Embryonic stem cells are stem cells derived from
the inner cell mass of a blastocyst. Human embryos
reach the blastocyst stage 4–5 days post fertilization,
at which time they consist of 50–150 cells.
• Embryonic stem cells are pluripotent and give rise
to all derivatives of the three primary germ layers:
ectoderm, endoderm and mesoderm.
• If these embryonic stem cells are exposed to certain
B
growth factors the stem cells can form various adult
cells, e.g. neuron, muscle cell, blood cell and cartilage
cell.
• Pluripotent adult stem cells are rare and generally
small in number, but they can be found in umbilical
cord blood and other tissues. Bone marrow is a rich
source of adult stem cells which have been used in
treating several conditions including spinal cord
injury, etc.
• It has observed that when the stem cells are
introduced into the tissues of living person, the
local environment help these stem cells differentiate
into cells which are similar to those of tissue in
C
which they are placed. This helps in treatment of
diseases like Parkinson’s disease, Alzheimer disease, Figs 6A to C:  Formation of: (A) Primitive knot, (B) Blastopore,
diabetes, osteoporosis, etc. (C) Notochordal process

2. A depression appears in the center of the primitive
knot.
This depression is called the blastopore.
3. Cells in the primitive knot multiply and pass
cranially in the middle line, between the ectoderm
and endoderm, reaching up to the caudal margin of
the prochordal plate. These cells form a solid cord
called the notochordal process or head process.
The cells of this process undergo several stages of
rearrangement ending in the formation of a solid
rod called the notochord.
Formation of the Notochord
1. After the formation of the blastopore, its cavity extends
into the notochordal process, and converts it into a tube
called the notochordal canal.
2. Cells forming the floor of the notochordal canal become
intercalated in (i.e. become mixed up with) the cells of the
endoderm. Cells forming the floor of the notochordal canal
now separate the canal from the cavity of the yolk sac.
3. Floor of the notochordal canal begins to break down. At
first, there are small openings formed in it. But gradually
the whole canal comes to communicate with the yolk sac.
Notochordal canal also communicates with the amniotic
cavity through the blastopore. Thus, at this stage, the
amniotic cavity and the yolk sac are in communication with
each other.
4. Gradually walls of the canal become flattened so that
instead of a rounded canal, we have a flat plate of cells
called the notochordal plate.
Fig. 7:  Stages of formation of notochord
Embryology  209
5. However, this process of flattening is soon reversed and
the notochordal plate again becomes curved, to assume the
shape of a tube. Proliferation of cells of this tube converts
it into a solid rod of cells. This rod is the definitive (i.e.
finally formed) notochord. It gets completely separated
from the endoderm.
6. As the embryo enlarges the notochord elongates
considerably and lies in the midline, in the position to
be later occupied by the vertebral column. However, the
notochord does not give rise to vertebral column. Most of
it disappears, but parts of it persist in the region of each
intervertebral disc as the nucleus pulposus and its cranial
continuation the apical ligament of dens of axis vertebra.
7. Notochord is present in all animals which belong to
phylum chordate.
8. Primitive streak is the primary organizer as it induces
formation of notochord and intraembryonic mesoderm.
9. Formation of notochord determines craniocaudal axis as
well as right and left sides of embryo.
5. FORMATION OF TISSUES OF THE BODY
Q.1. Write a short note on somites. (Sep 2009, 5 Marks)
(Mar 2013, 3 Marks) (Feb 2014, 3 Marks)
Ans. Paraxial mesoderm becomes segmented to form 40 to 45
pairs of somites that lie on either side of the developing
neural tube and notochord.
• The somites appear between the 20th and 30th day of
development. Hence, the 4th week of development
is known as somite period of development.
• A cross section through a somite shows that it is
triangular structure and has a cavity. The somite is
divisible into three parts:
1. The ventromedial part is called the sclerotome.
The cells of sclerotome migrate medially. They
surround neural tube and give rise to the
vertebral column and ribs.
2. The lateral part is called the dermatome. The
cells of part also migrate, and come to line the
deep surface of the ectoderm covering the entire
body. These cells give rise to the dermis of the
skin and to subcutaneous tissue.
3. The intermediate part is the myotome. It gives
rise to striated muscle.
Recently, it has been held that the dermatome only forms
dermis on the back of the head and trunk, and that dermis
elsewhere is derived from lateral plate mesoderm.
• In the cervical, thoracic, lumbar and sacral regions,
one spinal nerve innervates each myotome. The
number of somites formed in these regions,
therefore, corresponds to the number of spinal
nerves. In the coccygeal region, the somites exceed
the number of spinal nerves but many of them
subsequently degenerate.
210 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

• The first cervical somite is caudal to tip of notochord

(which becomes the apical ligament of dens of axis 6. THE PHARYNGEAL ARCHES
vertebra). The first cervical is not the most cranial
somite to be formed. Cranial to it, there are: Q.1. Write a short note on derivatives of 1st pharyngeal arch.
– Occipital somites (4–5) which give rise to (Mar 2000, 4 Marks) (Mar 1998, 4 Marks)
muscles of the tongue and are supplied by the (Oct 2007, 5 Marks) (Jan 2012, 5 Marks)
hypoglossal nerve. (Dec 2014, 5 Marks) (Feb 2014, 3 Marks)
– Preoccipital (or preotic) somites (somitomeres), Or
supplied by the third, 4th and 6th cranial nerves.
Enumerate derivatives of 1st branchial arch.
 (Apr 2003, 5 Marks)
Or
Write short note on 1st branchial arch.
 (Feb 2013, 5 Marks)
Or
Enumerate derivatives of 1st pharyngeal arch.
A  (Apr 2014, 3 Marks)
Ans. First pharyngeal arch is also called the “Mandibular arch”.
In the mesoderm of arch following structure are formed:
1. Cartilage.
2. Striated muscle.
3. Arterial arch.
First arch is known as mandibular arch.
B
Derivatives of Skeletal Elements
Cartilage of first arch is called “Meckel’s cartilage”. Incus,
malleus and spine of sphenoid are derived from its dorsal end.
The ventral part of the cartilage is surrounded by mesenchyme
that forms the mandible by membranous ossification. Meckle’s
cartilage is trapped in developing mandible and is absorbed. The
part of cartilage extending from the region of the middle ear to
C the mandible disappears, but its sheath (Perichondrium) forms
the anterior ligament of the malleus and the sphenomandibular
ligament.
Mesenchyme of ventral part of first arch forms the mandible
Figs 8A to C:  (A) Somites lying on either side of the neural tube. Note and that of dorsal part forms bone of the face including maxilla,
subdivisions of somites. (B) The cells of the sclerotome have migrated zygomatic bone, palatine bone and part of temporal bone by
medially and now surround the neural tube. The myotome is innervated membranous ossification.
by nerves growing out of the neural tube. (C) The cells of the dermatome Following are the skeletal derivatives of first arch:
have migrated to form the dermis of the skin
♦♦ Malleus
Distribution of Somites and their Skeletal and Muscular ♦♦ Incus
Derivatives ♦♦ Mandible
♦♦ Maxilla
Number Skeletal ♦♦ Zygomatic
Samites of pairs elements Musculature ♦♦ Palatine
Preoccipital 3 Extraocular muscles ♦♦ Temporal
of eyeball ♦♦ Anterior ligament of malleus
Occipital 4–5 Base of skull Tongue musculature ♦♦ Sphenomandibular ligament.
except palatoglossus
Cervical 8 Vertebra Striated muscles of
Nerve Derivative of First Arch
Thoracic 12 Vertebra and ribs trunk, diaphragm First arch has double nerve supply. Mandibular nerve is the
limbs post-trematic nerve of first arch, while chorda tympani are
Lumbar 5 Vertebra
pretrematic nerve. Double innervations is reflected in the nerve
Sacral 5
supply of anterior two-thirds of tongue which are derived from
Coccygeal 8–10
ventral part of first arch.
 Embryology  211

Maxillary (Sensory) and Mandibular (Motor and sensory) ♦♦ Platysma

branches of trigeminal nerve. ♦♦ Levator labii superioris, levator labii inferioris
♦♦ Levator anguli oris
Muscular Derivatives of First Arch ♦♦ Auricular muscles.
Following are the muscles of arch: All are migratory except stapedius, stylohyoid.
♦♦ Maseater
Artery Derivative of Second Arch
♦♦ Temporalis
♦♦ Medial pterygoid Artery of the arch is:
♦♦ Lateral pterygoid ♦♦ Hyoid artery
♦♦ Mylohyoid ♦♦ Stapedial artery.
♦♦ Anterior belly of digastrics
Q.3. Write a short note on derivatives of third branchial
♦♦ Tensor tympani
arch. (Aug 2005, 5 Marks)
♦♦ Tensor palate.
Ans. There are two types of derivatives of third branchial arch:
All the above muscles are migratory except tensor tympani.
1. Skeletal and ligamentous derivatives: Its dorsal
Artery Derivatives of First Arch part disappears and ventral part gives rise to
a. Greater cornua of hyoid bone
Maxillary artery is the artery of arch.
b. Lower half of body of hyoid bone.
Q.2. Enumerate the derivatives of 2nd pharyngeal arch. 2. Muscular derivatives: Stylopharyngeus.
(Sept 2000, 4 Marks) 3. Nerve derivatives: The muscles of third pharyngeal
Or arch are supplied by glossopharyngeal nerve.
4. Artery derivatives: Common carotid artery and
Write a short note on derivatives of 2nd pharyngeal
Internal carotid artery.
arch. (Feb 2005, 5 Marks)
(Aug 2011, 5 Marks) (Sep 2013, 5 Marks) Q.4. Write short note on derivatives of pharyngeal pouches.
Ans. Second pharyngeal arch also known as “Hyoid arch”. (Feb 2016, 3 Marks)
Ans. Endoderm of pharyngeal arch extends outwards in the
Derivatives of Skeletal Element form of a pouch and is known as endodermal pouch or
Cartilage of second arch is Reichert’s cartilage and forms the pharyngeal pouch. There are five pharyngeal pouch
following: 1. First pouch:
♦♦ Dorsal end of cartilage forms stapes and styloid process a. Its ventral part takes part in formation of tongue.
♦♦ Ventral part forms smaller cornu of hyoid bone and b. Its dorsal part receives a contribution from
superior part of body of hyoid bone. dorsal part of the 2nd pouch and together form
♦♦ Part between dorsal and ventral parts disappears but a diverticulum which is called “tubotympanic
perichondrium forms stylohyoid ligament. recess”. Proximal part of this recess give rise to
auditory tube, distal part of recess give rise to
Following are the skeletal derivatives:
middle ear cavity and tympanic antrum.
♦♦ Stapes
♦♦ Styloid process 2. Second pouch:
♦♦ Stylohyoid ligament a. Ventral part of this pouch contributes in the
♦♦ Lesser cornu of hyoid formation of tonsil.
♦♦ Upper half of body of hyoid. b. Dorsal part takes part in the formation of
tubotympanic recess.
Nerve Derivative of Second Arch 3. Third pouch: Communication of this pouch with
Nerve of second arch is facial nerve. pharynx gradually narrows and ultimately cut
off. This give rise to following structures which lie
Muscle Derivative of Second Arch outside the pharynx, i.e.
a. Parathyroid III or inferior parathyroid gland
Following are the muscles of second arch:
from the dorsal wing
♦♦ Stapedius
b. Thymus from the ventral wing.
♦♦ Stylohyoid
♦♦ Posterior belly of digastrics 4. Fourth pouch: Communications of this pouch with
♦♦ Epicranius pharynx disappears. Derivatives of this pouch are:
♦♦ Orbicularis oculi a. Dorsal wing form parathyroid IV or superior
♦♦ Orbicularis oris parathyroid gland
♦♦ Zygomaticus b. Ventral wing may contribute to thyroid gland.
♦♦ Buccinator 5. Fifth or ultimobranchial pouch: It give rise to
♦♦ Nasal muscles ultimobranchial body.
212 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Caudal–Pharyngeal Complex • Immediately behind the tuberculum, the epithelium

of floor of pharynx show thickening in middle line.
Fourth pouch joins with fifth pouch and form caudal pharyngeal
This region is depressed below the surface to form
complex. Neural crest cells migrates in this complex.
a diverticulum known as thyroglossal duct.
♦♦ Superior parathyroid glands arise from this complex.
• The site of origin of diverticulum is now seen as a
♦♦ Thymic element: It incorporates into developing thymus.
depression called the “foramen caecum”.
♦♦ Lateral thyroid: It fuses with median thyroid element from
hypoglossal duct • Diverticulum grow down in the midline into neck and
♦♦ Ultimobranchial body: It incorporates into substance of its tip soon bifurcates, proliferation of the cells of this
thyroid rudiment and gives origin to parafollicular or C bifid end gives rise to the 2 lobes of thyroid gland.
cells of thyroid gland. • Developing thyroid comes into contact with the
caudal pharyngeal complex and fuses with it.
Q.5. Write a short note on pharyngeal cleft. • Cells arising from this complex give origin to the
 (Sept 2000, 4 Marks)
parafollicular cells of thyroid.
Ans. Pharyngeal clefts are ectodermal-lined recesses that
appear on the outside of the pharnyx between the arches.
A
Pharyngeal clefts are seen in the 5-week embryo and
they disappear during development.
The second, third, and fourth clefts are overlapped by
B
the development of arch II and form a space lined by
squamous epithelium, the so-called cervical sinus. This,
too, disappears during extension of the cervical flexure.
1. Pharyngeal cleft 1: It is the only cleft which persists
and develops into the epithelium of external
auditory meatus and part of tympanic membrane. C
Defects in the development of pharyngeal cleft 1 can
result in preauricular cysts and/or fistulas.
2. Pharyngeal clefts 2, 3, and 4 are overgrown by
expansion of the 2nd pharyngeal arch and usually
obliterated. Remnants of pharyngeal clefts 2–4 can D
appear in the form of cervical cysts or fistulas found
along the anterior border of the sternocleidomastoid
muscle.
The cervical sinus sometimes persists in vestigial form Figs 9A to D:  Development of thyroid gland
and forms a branchial cyst. If it communicates only
with the outside, it forms a pharyngeal fistula, which is Q.8. Write a short note on development of thyroid gland
harmless. If it opens to both the interior and exterior, it and draw a labeled diagram of histology of thyroid
forms a pharyngocutaneous fistula, which allows saliva gland. (Feb 2004, 15 Marks)
to run out during mastication. Ans. The development of thyroid is given in Ans 7 of same
Q.6. Write a note on derivatives of 1st pharyngeal arch, chapter and diagram of histology of thyroid is given in
pouch and cleft. (Mar 2006, 5 Marks) Ans 20 of HISTOLOGY SECTION.
Ans. For derivatives of first pharyngeal arch refer to Ans 1 of Q.9. Give an account of development of thyroid and
the same chapter, for derivatives of pharyngeal pouch parathyroid gland and write its applied anatomy.
refer to Ans 4 of the same chapter. (Feb 2005, 7 Marks)
Derivatives of first pharyngeal cleft: External auditory Or
meatus and part of tympanic membrane. Write short note on development of thyroid and
Q.7. Write a short note on development of thyroid gland. parathyroid gland. (Apr 2008, 5 Marks)
(Sept 2000, 4 Marks) Ans. For development of thyroid refer to Ans 7 of same chapter.
(Aug 2012, 4 Marks) (Sep 2015, 5 Marks)
Ans. The thyroid develops mainly from thyroglossal duct. Development of Parathyroid Gland
• Parafollicular cells are derived from caudal Parathyroid glands are derived as follows:
pharyngeal complex. ♦♦ Inferior parathyroid glands develop from endoderm of the
• The medial end of the two mandibular (first) third pharyngeal pouch (parathyroid III).
arches is separated by a midline swelling called the ♦♦ Superior parathyroid glands develop from endoderm of
“tuberculum impar”. the fourth pharyngeal pouch (parathyroid IV).

• As the third pouch also gives origin to thymus, this
organ is closely related to parathyroid III. When the
thymus descends toward the thorax, parathyroid III is
carried caudally along with it for some of the distance.
• Parathyroid IV is prevented from descending caudally,
due to close relationship of the fourth pouch to the
developing thyroid gland. As a result, parathyroid III
becomes caudal to parathyroid IV.
• Now, the parathyroid glands derived from the fourth
pouch become the superior parathyroid glands and
those derived from the third pouch become the inferior
parathyroid glands.
• Seeing their developmental history, superior
parathyroid glands are relatively constant in position,
but the inferior parathyroid glands may descend into
the lower part of the neck or even into the anterior
mediastinum. Alternatively, they may remain at their
site of origin and are then seen near the bifurcation of
the common carotid artery.
Applied Anatomy
Applied anatomy of thyroid gland:
♦♦ Any enlargement of thyroid gland is known as goiter.
♦♦ Removal of thyroid with true capsule is necessary in
hyperthyroidism or thyrotoxicosis.
Fig. 10:  Development of parathyroid gland
♦♦ Hypothyroidism causes cretinism in infants and myxo-
edema in adults.
♦♦ During subtotal thyroidectomy posterior part of both, the
lobes are left behind. This prevents the risk of removal of
parathyroid gland and postoperative myxoedema.
♦♦ During thyroidectomy, superior thyroid artery is ligated
near to gland for saving external laryngeal nerve. Inferior
thyroid gland is ligated away from gland to save recurrent
laryngeal nerve.
♦♦ Benign tumors of gland may displace or compress
neighbouring structures like carotid sheath, trachea, etc.
♦♦ Malignant tumors invade and erode neighbouring
structures. Nerve involvement and pressure symptoms are
common in carcinoma of glands which leads to dysphagia,
dyspnea and dysphonia.
Applied anatomy of parathyroid gland:
♦♦ Tumors of parathyroid gland lead to excessive secretion of
parathormone. This causes increased removal of calcium
from bone making it weak and liable to fracture.
♦♦ Hypoparathyroidism can occur spontaneously by accidental
removal of parathyroid gland during thyroidectomy.
Embryology  213
This leads to hypocalcemia which causes increased
neuromuscular irritability, muscular spasm and convulsion.
Q.10. Write about Meckel’s cartilage. (Sep 2013, 5 Marks)
Ans. Cartilage of first arch is called “Meckel’s cartilage”.
• Incus, malleus and spine of sphenoid are derived
from dorsal end of Meckle’s cartilage.
• Ventral part of Meckle’s cartilage is surrounded
by mesenchyme that forms the mandible by
membranous ossification.
• Meckle’s cartilage is trapped in developing mandible
and is absorbed.
• The part of cartilage extending from the region of
the middle ear to the mandible disappears, but its
sheath (perichondrium) forms the anterior ligament
of the malleus and the sphenomandibular ligament.
Fig. 11:  Meckel’s cartilage
Q.11. Briefly describe pharyngeal arches.(Apr 2007, 5 Marks)
Or
Write short answer on pharyngeal arches.
 (Aug 2018, 3 Marks)
Ans. Neck is formed by elongation of area between
stomatodeum and the pericardium. This is achieved,
partly, by a “descent” of the developing heart. However,
this elongation is mainly due to the appearance of a
series of mesodermal thickenings in the wall of cranial-
most part of the foregut, i.e. future pharynx. These
mesodermal thickenings are called as pharyngeal
arches or branchial arches.
• Cranial most part of foregut, i.e. pharyngeal part
is of funnel shape to begin with. It is compressed
dorsoventrally and presents a ventral wall or floor,
dorsal wall or roof and two lateral walls. During this
stage, endodermal wall of foregut is separated from
the surface ectoderm by a layer of mesoderm.
• Soon, mesoderm comes to be arranged in form of
six cylindrical bars which run dorsoventrally in the
side wall of foregut in craniocaudal sequence. Each
of these “bars” grows ventrally inside the floor of
developing pharynx and fuses with corresponding
214 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
“bar” of the opposite side to form a pharyngeal
or branchial arch. Each bar when seen from front
is seem to be of horse-shoe shaped. Arches are
numbered craniocaudally as I to VI. In the interval
between any two adjoining arches, the endoderm
extends outward in the form of a pouch to meet
the ectoderm which dips into this interval as an
ectodermal cleft.
• Pharyngeal arches are six—curved mesodermal
thickenings with each arch having an ectodermal
covering and an endodermal lining containing a
mesodermal core. These provide support to the
ventral and lateral walls of primitive pharynx. By
the time that the anterior neuropore closes, the first
and second pharyngeal arches are present.
• Mesoderm of arches is derived from paraxial
mesoderm and lateral plate mesoderm. This is
invaded by neural crest cells that contribute for
skeletal elements and connective tissue of head and
neck region.
• First arch is also known as mandibular arch; and the
second, the hyoid arch. The third, fourth and sixth
arches do not have special names. The fifth arch
disappears soon after its formation, so that only five
arches remain.
Fig. 12:  Pharyngeal arch
• Following are the structures which form inside the
mesoderm of each arch:
– A skeletal element: This is cartilaginous to begin
with. It may remain cartilaginous, may develop
into bone, ligament or may disappear.
– Striated muscle: This muscle is supplied by the
nerve of the particular arch. In later development,
this musculature may or may not retain its
attachment to the skeletal elements derived
from arch. It may subdivide to form a number
of distinct muscles, which may migrate away
from the pharyngeal region. When they do
so, however, they carry their nerve with them
and their embryological origin can thus be
determined from their nerve supply.
– An arterial arch: Ventral to the foregut, an artery
called the ventral aorta develops. Dorsal to the
foregut, another artery called the dorsal aorta,
is formed. A series of arterial arches connect
ventral and dorsal aortae. One such arterial arch
lies in each pharyngeal arch. In a subsequent
development, the arrangement of these arteries
is greatly modified.
– Nerve of the arch: Each pharyngeal arch is
supplied by a nerve derived from hindbrain.
In addition to supplying the skeletal muscle
of the arch, it supplies sensory branches to the
overlying ectoderm, and endoderm. In some
lower animals, each arch is supplied by two
nerves. The nerve of the arch itself runs along the
cranial border of the arch. This is called the post-
trematic nerve of the arch. Each arch also receives
a branch from the nerve of the succeeding
arch. This runs along the caudal border of the
arch, and is called the pretrematic nerve of
the arch. In the human embryo, however, a
double innervation is to be seen only in the first
pharyngeal arch.
Fig. 13:  Structures are seen in pharyngeal arch
Q.12. Answer in brief structures derived from endoderm of
third pharyngeal pouch. (Oct 2016, 2 Marks)
Ans. Structures derived from endoderm of third pharyngeal
pouch are:
• Parathyroid III or Inferior parathyroid gland from
the dorsal wing
• Thymus from the ventral wing.
Q.13. Name the derivatives of second pharyngeal pouch.
 (Aug 2016, 2 Marks)
Ans. Derivatives of second pharyngeal pouch are:
• Palatine tonsil
• Tonsillar fossa.

Q.14. Write very short answer on structures developed from
second pharyngeal pouch. (Apr 2018, 2 Marks)
Ans. Following are the structures developed from second
pharyngeal pouch:
• Epithelium of ventral part of this pouch contributes
to the formation of tonsil.
• Dorsal part takes part in formation of tubotympanic
recess.
Q.15. Describe the development of thyroid gland with its
congenital anomalies. (Aug 2018, 10 Marks)
Ans. For development of thyroid gland refer to Ans 7 of same
chapter.
Congenital Anomalies of Thyroid Gland
Anomalies of Shape
♦♦ Pyramidal lobe is present so often that it is regarded as the
normal structure. The lobe may arise from the isthmus or
from one of the lobes. Lobe may have no connection with
rest of the thyroid and can be divided into two or more
parts. It may vary from a short stump to a process reaching
the hyoid bone.
♦♦ Isthmus may be absent.
♦♦ One of the lobes of the gland may be very small or absent.
Anomalies of Position
♦♦ Lingual thyroid: Thyroid may lie under the mucosa of
dorsum of tongue and may form a swelling that can lead
to difficulty in swallowing.
♦♦ Intralingual thyroid: Thyroid may be embedded in muscular
substance of tongue.
♦♦ Suprahyoid thyroid: The gland may lie in the midline of
neck, above the hyoid bone.
♦♦ Infrahyoid thyroid: The gland may lie below the hyoid bone,
but above its normal position.
♦♦ Intrathoracic thyroid: The entire gland, or part of it, may
lie in the thorax.
  This is to be noted that when thyroid tissue is present in the
anomalous positions which are mentioned above, an additional
thyroid may or may not be present at the normal site.
Fig. 14:  Tuberculum impar
Embryology  215
Ectopic Thyroid Tissue
♦♦ Small masses of thyroid tissue can be present at abnormal
sites.
♦♦ Thyroid tissue has been observed in the larynx, trachea,
esophagus, pons, pleura, pericardium and ovaries.
♦♦ Masses of ectopic thyroid tissue have been described
in relation to the deep cervical lymph nodes (lateral
aberrant thyroids) but these are now believed to represent
metastases in the lymph nodes from a carcinoma of the
thyroid gland.
Remnants of the Thyroglossal/Duct
These remnants may persist and lead to the formation of:
♦♦ Thyroglossal cysts that can occur anywhere along the
course of duct. They can acquire secondary openings on
the surface of neck to form fistulae.
♦♦ Thyroglossal fistula opening at the foramen cecum.
♦♦ Carcinoma of the thyroglossal duct.
Q.16. Write very short answer on tuberculum impar.
 (Aug 2018, 2 Marks)
Ans. Medial most parts of mandibular arches proliferate to
form two lingual swellings. These lingual swellings are
partially separated from each other by another swelling
which appears in the midline. This median swelling is
known as tuberculum impar or median tongue bud.
♦ Tuberculum impar appears during third week of
embryogenesis.
♦ Immediately behind tuberculum impar, epithelium
undergoes proliferation to form a downgrowth, i.e.
thyroglossal duct, from which the thyroid gland
develops.
♦ More recent researches, however, show that this part
of the tongue is mainly, if not entirely, developed
from a pair of lateral swellings which rise from the
inner surface of the pharyngeal arch and meet in the
middle line. The site of their meeting remains post-
embryonically as the median sulcus of the tongue.
♦ The tuberculum impar disappear in an adult tongue.
216 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
7. FACE, NOSE AND PALATE
Q.1. Describe the development of face. (Feb 2003, 15 Marks)
Or
Write short note on development of face.
(Jan 2012, 5 Marks) (Oct 2014, 3 Marks)
Or
Give an account of development of face.
(July 2016, 10 Marks)
Ans. Development of Face
Face is derived from the following structures that lie
around the stomatodeum, i.e.
– Frontonasal process from above
– First pharyngeal (or mandibular) arch of each side.
At this stage, each mandibular arch forms the lateral wall
of the stomatodaeum.
This arch gives off a bud from its dorsal end. This bud
is called the maxillary process. It grows ventro-medially
Fig. 15:  Development of face
cranial to the main part of the arch which is now called
the mandibular process.
The ectoderm overlying the frontonasal process soon
shows bilateral localized thickenings, that are situated a
little above the stomatodaeum. These are called the nasal
placodes. The formation of these placodes is induced by
the underlying forebrain. The placodes soon sink below
the surface to form nasal pits.
Pits are continuous with the stomatodaeum below. Edges
of each pit are raised above the surface, the medial raised
edge is called the medial nasal process and the lateral edge
is called the lateral nasal process. Lateral and cranial to nasal
placodes pair of thickenings appear known as lens placodes.
Lower Lip
Mandibular processes of the two sides grow towards each other
and fuse in the midline. They now form the lower margin of the
stomatodaeum. If it is remembered that the mouth develops from
the stomatodaeum, it will be readily understood that the fused
mandibular processes give rise to the lower lip and to the lower jaw.

Upper Lip
♦♦ Each maxillary process now grows medially and fuses,
first with the lateral nasal process and then with the medial
nasal process. The median and lateral nasal processes also
fuse with each other. In this way, the nasal pits are cut off
from stomatodaeum.
♦♦ The maxillary processes undergo considerable growth.
At the same time, the frontonasal process becomes much
narrower from side to side, with the result that the two
external nares come close together.
Stomatodaeum is now bounded above by the upper lip which
is derived as follows:
a. Mesodermal basis of the lateral part of the lip is formed
from the maxillary process. The overlying skin is derived
from ectoderm covering this process.
b. Mesodermal basis of the median part of the lip (called
philtrum) is formed from the frontonasal process.
Ectoderm of the maxillary process however, overgrows this
mesoderm to meet that of the opposite maxillary process in the
midline. As a result, the skin of the entire upper lip is innervated
by maxillary nerves.
Muscles of the face are derived from mesoderm of second
branchial arch and are therefore supplied by the facial nerve.
Cheeks
After the formation of the upper and lower lips, the
stomatodaeum (which can now be called the mouth) is very
broad. In its lateral part, it is bounded above by the maxillary
process and below by the mandibular process. These processes
undergo progressive fusion with each other to form the cheeks.
Maxillary process fuses with lateral nasal process. This
fusion not only occur in region of lip but also extends from
stomatodeum to the medial angle of developing eye. For
sometimes this line of fusion is marked by a groove known as
naso-optic furrow or nasolacrimal sulcus. Strip of ectoderm
become burried along this furrow and give rise to nasolacrimal
duct.
Eye
♦♦ Region of the eye is first seen as an ectodermal thickening,
the lens placode, which appears on the ventrolateral side
of the developing forebrain, lateral and cranial to the nasal
placode.
♦♦ The lens placode sinks below the surface and is eventually
cut off from the surface ectoderm. The developing eyeball
produces a bulging in this situation.
♦♦ Bulging of the eyes are at first directed laterally and lie in
the angles between the maxillary processes and the lateral
nasal processes.
♦♦ With the narrowing of the frontonasal process, they come
to face forward.
♦♦ Eyelids are derived from folds of ectoderm formed above
and below the eyes, and by mesoderm enclosed within
the folds.
Embryology  217
Nose
♦♦ Nose receives contributions from the frontonasal process,
and from the medial and lateral nasal processes of the
right and left sides.
♦♦ External nares are formed when the nasal pits are cut off
from the stomatodaeum by the fusion of the maxillary
process with the medial nasal process.
♦♦ External nares gradually approach each other. This is a
result of fact that frontonasal process become progressively
narrower and deep part ultimately form nasal septum.
♦♦ Mesoderm becomes heaped up in the median plane to
form the prominence of the nose.
♦♦ Simultaneously, groove appears between the regions of
the nose and the bulging forebrain.
♦♦ As the nose becomes prominent, the external nares come
to open downwards instead of forward.
♦♦ The external form of nose is thus established with fusion
of five processes, i.e.
• Frontonasal process forms the bridge of nose
• Fused medial nasal processes form dorsum and tip
of nose
• Lateral nasal processes form alae of nose.
External Ear
♦♦ External ear is formed around the dorsal part of the first
ectodermal cleft.
♦♦ A series of mesodermal thickenings (often called tubercles
or hillocks) appear on the mandibular and hyoid arches
where they adjoin this cleft. The pinna (or auricle) is
formed by fusion of these thickenings.
Nasal Cavities
♦♦ Nasal cavities are formed by extension of the nasal pits.
♦♦ These pits are at first in open communication with
the stomatodaeum. Soon the medial and lateral nasal
processes fuse and form a partition between the pit and
the stomatodaeum. This is called the primitive palate and
is derived from the frontonasal process.
♦♦ Nasal pits now deepen to form the nasal sacs which expand
both dorsally and caudally.
♦♦ Dorsal part of this sac is, at first, separated from the
stomatodaeum by a thin membrane called the bucconasal
membrane (or nasal fin). This soon breaks down.
♦♦ Nasal sac now has a ventral orifice that opens on the
face (anterior or external nares) and a dorsal orifice that
opens into the stomatodaeum (primitive posterior nasal
aperture).
♦♦ Two nasal sacs are at first widely separated from
one another by the frontonasal process However, the
frontonasal process becomes progressively narrower. This
narrowing of the frontonasal process, and the enlargement
of the nasal cavities themselves, bring them closer
together.
♦♦ This intervening tissue becomes much thinned to form
the nasal septum.
218 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
♦♦ Ventral part of the nasal septum is attached below to
the primitive palate. More posteriorly the septum is
at first attached to the bucconasal membrane, but on
disappearance of this membrane, it has a free lower
edge. Nasal cavities are separated from the mouth by the
development of the palate.
♦♦ Lateral wall of the nose is derived, on each side, from
the lateral nasal process. The nasal conchae appear as
elevations on the lateral wall of each nasal cavity.
♦♦ The original olfactory placodes form the olfactory
epithelium that lies in the roof, and adjoining parts of thin
walls, of the nasal cavity.
Q.2. Describe the development of face. Add a note on its
developmental defects. (Dec 2014, 10 Marks)
 (Apr 2017, 10 Marks) (Jan 2018, 10 Marks)
Or
Write short note on development of face and anomalies.
(Nov 2009, 5 Marks)
Or
Describe development of face. Add a note on its clinical
importance. (May 2014, 10 Marks)
Ans. For development of face refer to Ans 1 of same chapter.
Developmental Defects of Face
Formation of various parts of the face involves fusion of various
diverse components. This fusion is occasionally incomplete and
gives rise to various anomalies, i.e.
♦♦ Harelip: The upper lip of the hare normally has a cleft.
Hence, the term harelip is used for defects of the lips.
   Types of Harelip
• Unilateral harelip: Failure of fusion of maxillary process
with medial nasal process on one side.
• Bilateral harelip: Failure of fusion of both maxillary
processes with the medial nasal process.
• Midline cleft of upperlip: Defective development of the
lowermost part of the frontonasal process may give
rise to a midline defect of the upper lip.
♦♦ Cleft of lower lips: When the two mandibular processes do
not fuse with each other the lower lip shows a defect in the
midline. The defect usually extends into the jaw.
♦♦ Oblique facial cleft: Non-fusion of the maxillary and lateral
nasal process gives rise to a cleft running from the medial
angle of the eye to the mouth. The nasolacrimal duct is
not formed.
♦♦ Inadequate fusion of the mandibular and maxillary
processes with each other can cause abnormally wide
mouth, i.e. macrostomia. Lack of fusion may be unilateral;
this leads to formation of lateral facial cleft. Too much
fusion may result in a small mouth, i.e. microstomia.
♦♦ The nose may be bifid. This can be associated with median
cleft lip. Both of them occur because of bifurcation of
frontonasal process. Occasionally one half of it may be
absent. Very rarely the nose ‘forms a cylindrical projection
also known as proboscis jutting out from just below the
forehead. This anomaly may sometimes affect only one
half of the nose and is usually associated with fusion of
two eyes also known as cyclops.
♦♦ Entire first arch may remain underdeveloped either on
one or on both sides, affecting the lower eyelid, maxilla,
mandible and external ear. Prominence of cheek is absent
and the ear may be displaced ventrally and caudally.
There may be presence of cleft palate and faulty dentition.
This condition is known as mandibulofacial dysostosis,
Treacher Collins syndrome or first arch syndrome. This
is a genetic condition inherited as autosomal dominant.
♦♦ One half of face may be under developed or over­developed.
♦♦ The mandible may be small compared to the rest of the face
resulting in a receding chin, i.e. retrognathia. In extreme
cases, it may fail to develop, i.e. agnathia.
♦♦ Congenital tumors may be present in relation to the face.
These may represent attempts at duplication of some parts.
♦♦ The eyes may be widely separated also known as
hypertelorism. The nasal bridge is broad. This condition
results from the presence of excessive tissue in the
frontonasal process.
♦♦ The lips hay show congenital pits or fistulae. The lip may
be double.
Q.3. Describe the development of palate.
(Sept 2001, 12 Marks)
Or
Write short note on development of palate.
(June 2010, 5 Marks) (Feb 2016, 3 Marks)
 (May 2017, 5 Marks)
Or
Write short answer on development of palate.
(Apr 2018, 3 Marks)
Ans. Palate is formed by three components, i.e.
• Primary/primitive palate: Develops from frontonasal
process.
• Secondary palate/palatal processes: From each of
the maxillary processes, a palate like shelf grows
medially which is known as palatal process of
maxilla. They are two in number.
Primary Palate
By fusion of two medial nasal processes of frontonasal process at
a deeper level there forms a wedge-shaped mass of mesenchyme
opposite to the upper jaw which carries four incisor teeth. Part
of palate derived from frontonasal process forms premaxilla
or primary palate which carries the incisor teeth. This ossifies
and represents only small part lying anterior to incisive fossa.
Secondary Palate
Tongue develops inside the floor of oral cavity. Palatine
processes of maxilla are the hook like projections which are
present on either side of tongue. Later, these processes assume
horizontal position above the tongue and fuse with each other
which form secondary palate. During later stages, mesoderm
inside the palate undergoes intramembranous ossification and
form hard palate. Moreover, ossification does not extend into the
 Embryology  219

most posterior portion, which remains as soft palate. Secondary Give an explanation about cleft palate.
palate forms most of the hard palate and completely soft palate.  (Feb 2013, 2 Marks)
Soft palate is invaded by muscles migrating from first arch
Or
(Tensor palati) and fourth arch (Levator palati, palatoglossus,
palatopharyngeus and musculus uvulae). Write very short answer on cleft palate.
 (Aug 2018, 2 Marks)
Ans. Palate is formed from the Y-shaped fusion of premaxilla
and two palatine processes.
Imperfect fusion of these processes or developmental
anomalies results in cleft palate.
Cleft palate may result from:
• Failure of shelves and septum to contact each other
because of lack of growth or because of disturbance
in mechanism of shelf elevation.
Fig. 16:  Development of palate
• Failure of shelves and septum to fuse after contact
has been made because the epithelium covering the
shelves does not breakdown or is not resorbed.
• Rupture after fusion of shelves has occurred.
• Defective merging and consolidation of mesenchyme
of shelves.

Type
Defective fusion of various components of palate gives rise to
Fig. 17: Palate after ossification clefts in palate.
Definitive/Permanent Palate Complete Cleft Palate
Definitive/permanent palate is formed by fusion of three parts ♦♦ Bilateral complete cleft: Failure of fusion of both palatine
which is as follows:
processes of maxilla with premaxilla. A Y-shaped cleft
1. Fusion of palatal processes of maxilla along with primitive is present between primary and secondary palate and
palate: Each palatal process gets fused with posterior
between two halves of secondary palate. It presents
margin of primitive palate in Y-shaped manner. Each
bilateral cleft of upper lip also.
limb of Y extends between lateral incisor as well as canine
♦♦ Unilateral complete cleft: Non-fusion of one side palatine
teeth. Junction of these two components in the midline is
represented by the incisive fossa. process of maxilla with premaxilia. It presents unilateral
2. Fusion of both palatal processes of maxilla: Both palatal cleft of upper lip.
processes fuse with each other in midline. Fusion of these Incomplete Cleft Palate
two begins anteriorly and then proceeds backward.
3. Fusion of palatal processes with nasal septum: Medial edges ♦♦ Cleft of hard and soft palate: Cleft limited to hard palate.
of palatal processes get fuse with free lower edge of nasal ♦♦ Cleft of soft palate: Cleft limited to hard palate.
septum, thus separating both the nasal cavities from each ♦♦ Bifid uvula: Cleft limited to uvula.
other, and from the mouth.
 Anterior three-fourths of permanent palate is ossified in
membrane and forms hard palate. Posterior one-fourth is the
unossified part that forms the soft palate.
Q.4. Short note on development defects of palate.
 (Sep 2004, 5 Marks) (Feb 2013, 5 Marks)
Or
Write a short note on cleft palate.
 (Aug 2016, 3 Marks) (Aug 2012, 4 Marks)
Or
Write in detail about cleft palate.
 (Apr 2008, 4 Marks) (Sep 2007, 3 Marks)
Or Fig. 18:  Cleft palate (For colour version see Plate 11)
220 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Effects of Cleft Palate maxillary process, however overgrows this mesoderm

1. Interference with swallowing. to meet the opposite maxillary process in midline.
2. Unable to make the constant sound like B, P, D, K and T. Due to which skin of entire upper lip is innervated
3. Teeth—upper incisors may be small, maxilla tends to be by maxillary nerve.
smaller. Teeth are crowded. Q.6. Write a short note on development of mandible.
4. Nose—oral organisms contaminate the upper respiratory (Apr 2010, 5 Marks)
mucous membrane. Ans. Development of Mandible
5. Hearing—even with repair, acute and chronic hearing • On the lateral aspect of Meckle’s cartilage, during sixth
problem can occur. week of embryonic development, a condensation of
mesenchyme occurs in the angle formed by the
division of the inferior alveolar nerve and its incisor
and mental branches.
• At 7th week, intramembranous ossification begins
in this condensation, forming the first bone of the
mandible.
Fig. 19:  Cleft palate • From this center of ossification, bone formation spreads
rapidly anteriorly to the midline and posteriorly
Q.5. Write a short note on development of lips.
(Mar 2009, 5 Marks) toward the point where the mandibular nerve divides
into its lingual and inferior alveolar branches.
Or • Spread of new bone formation occurs anteriorly
Write in short about development of upper and lower along the lateral aspect of meckle’s cartilage, forming
lip. (Dec 2009, 8 Marks) a trough that consists of lateral and medial plates
Or that unite beneath the incisor nerve.
• This trough of bone extends to the midline, where
Write short note on development of upper lip.
it comes into approximation with a similar trough
(Apr 2007, 5 Marks)
formed in the adjoining mandibular process. The
Ans. Lips are derived from mandibular arch/first pharyngeal
two separate centers of ossification remain separated
arch.
at the mandibular symphysis until shortly after birth.
The arch gives a bud from its dorsal end known as
• The trough soon is converted into a canal as bone forms
“maxillary process”. It grows ventromedially which is
over the nerve joining the lateral and medial plates.
called “mandibular process.
• Similarly, a backward extension of ossification along
Lower Lip the lateral aspect of Meckel’s cartilage forms a gutter,
and converted into a canal that contains the inferior
Mandibular process of the two sides grow towards each other
alveolar nerve.
and fuse in the midline. They now form lower margin of
• This backward extension of ossification proceeds in
stomatodeum and fused mandibular process gives rise to the
the condensed mesenchyme to the point where the
lower lip and the lower jaw.
mandibular nerve divides into the inferior alveolar
Upper Lip and lingual nerves.
a. Each maxillary process grows medially below developing
eyes and fuse. It fuses first with lateral nasal process and
then with medial nasal process. The medial and lateral
nasal processes fuse with each other. Now the nasal pits
cut off from stomatodaeum.
b. Maxillary processes undergoes considerable growth. At
same time frontonasal process become much narrower
from side to side and the result is two external nares come
close together.
c. Stomatodaeum is now bounded above by upper lip which
is derived from:
i. Mesodermal basis of the lateral part of the lip is formed
from maxillary process. Its overlying skin is derived
from ectoderm covering the process.
ii. Mesodermal basis of median part of the lip (philtrum)
is formed from the frontonasal process. Ectoderm of Fig. 20:  Development of mandible

• From this bony canal, extending from the division
of the mandibular nerve to the midline, medial and
lateral alveolar plates of bone develop in relation
to the forming tooth germs so that the tooth germs
occupy a secondary trough of bone.
• This trough is partitioned, and thus the teeth come
to occupy individual compartments, which finally
are enclosed totally by growth of bone over the tooth
germ. In this way, body of mandible is formed.
• Ramus of mandible develops by rapid spread of
ossification posteriorly into the mesenchyme of first
arch, turning away from Meckle’s cartilage.
• Thus by 10 weeks the rudimentary mandible is
formed almost entirely by membranous ossification.
• Further growth of mandible until birth is influenced
strongly by the appearance of three secondary
cartilages, i.e. condylar cartilage, coronoid cartilage
and symphyseal cartilage as well as the development
of neural, alveolar and muscular attachments.
Q.7. Describe the development of palate. Add a note on its
developmental defect. (Sep 2013, 10 Marks)
 (Apr 2017, 10 Marks) (Jan 2018, 10 Marks)
Ans. For development of palate refer to Ans 2 of same chapter.
For developmental defect of palate refer to Ans 3 of same
chapter.
Q.8. Describe development of face and its correlation with
nerve supply. (Mar 2006, 15 Marks)
Ans. For development of face refer to Ans 1 of same chapter.
Development of Face and its Correlation with Nerve Supply
Process Part of face formed Nerve supply
Frontonasal Forehead, external nose, Ophthalmic division of
process nasal cavity, nasal septum, trigeminal nerve except
philtrum of upper lip philtrum which is innervated
by maxillary nerve
Maxillary Lateral part of upper lip, Maxillary division of trigeminal
process Upper part of cheek nerve
Mandibular Chin, lower lip and lower Mandibular division of
process part of cheek trigeminal nerve
Q.9. Write short note on cleft lip.
 (May/June 2009, 5 Marks) (Nov 2008, 5 Marks)
Ans. Cleft lip is present in both upper and lower lip.
Following are the clefts in upper and lower lip:
Cleft Upper Lip
Harelip: The upper lip of the hare normally has a cleft. Hence,
the term harelip is used for defects of the lips.
Types of Hairlip
♦♦ Unilateral harelip: Failure of fusion of maxillary process
with medial nasal process on one side.
♦♦ Bilateral harelip: Failure of fusion of both maxillary
processes with the medial nasal process.
Embryology  221
♦♦ Midline cleft of upper lip: Defective development of the
lowermost part of the frontonasal process may give rise
to a midline defect of the upper lip.
Cleft of Lower Lip
When the two mandibular processes do not fuse with each other
the lower lip shows a defect in the midline. The defect usually
extends into the jaw.
Q.10. Answer in brief harelip. (Aug 2016, 2 Marks)
Or
Answer in brief cleft upper lip (harelip).
 (May 2017, 3 Marks)
Or
What is harelip? (Aug 2018, 1 Mark)
Ans. The upper lip of the hare normally has a cleft. Hence,
the term harelip is used for defects of the lips.
Types of Harelip
♦♦ Unilateral harelip: Failure of fusion of maxillary process
with medial nasal process on one side.
♦♦ Bilateral harelip: Failure of fusion of both maxillary
processes with the medial nasal process.
♦♦ Midline cleft of upper lip: Defective development of the
lowermost part of the frontonasal process may give rise
to a midline defect of the upper lip.
8. ALIMENTARY SYSTEM I: MOUTH,
PHARYNX AND RELATED STRUCTURES
Q.1. Write a short note on development of tooth.
(Sep 2007, 4 Marks)
Or
Write in details, about development of tooth.
(Apr 2008, 4 Marks) (Mar 2008, 8 Marks)
(Dec 2010, 5 Marks) (Aug 2011, 10 Marks)
Ans. Teeth are developed from “stomatodaeum”.
Teeth are formed in relation to alveolar process.
Epithelium overlying the convex border of this process
gets thickened and projects into underlying mesoderm.
This epithelial thickening is known as dental lamina.
Dental lamina is apparent even before the alveolar
process itself is defined.
• As the alveolar process is semicircular in outline, the
dental lamina is similarly curved.
• Dental lamina shows a series of local thickenings,
each of which form one milk tooth. These thickenings
are known as enamel organs. There are total 10 such
enamel organs (five on each side) in each alveolar
process.
• Stages in formation of an enamel organ and
development of a tooth are as follows:
– Stage of dental lamina: Ectoderm over convex
upper border of alveolar process thickens and
222 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

projects into underlying mesoderm as dental tooth. Such buds form enamel organs. They give rise
lamina which is U-shaped and corresponds to to permanent incisors, canines and premolars.
alveolar process. • Permanent molars are formed from buds which
– Bud stage: During this stage, ten thickening of arise from dental lamina posterior to region of last
dental lamina appears five on each side. These deciduous tooth.
are called tooth buds/enamel organs. • Dental lamina gets established during 6th week of
– Cap stage: As enamel organ grows downward intrauterine life. At the time of birth germs of all
into the mesenchyme its lower end assumes temporary teeth, and of the permanent incisors,
a cup-shaped appearance. Cup comes to be canines and first molars, show considerable
occupied by a mass of mesenchyme known as development. Germs of permanent premolars and
dental papilla. The enamel organ and dental of second molars are rudimentary. Germ of third
papilla together constitute tooth germ. During molar is formed after birth. Developing tooth germs
this stage, the developing tooth appears like a undergo calcification. All the temporary teeth and
cap and is therefore, described as the cap stage the permanent lower first molar begin to calcify
of tooth development. Cells of enamel organ before birth; the other permanent teeth begin to
which line the papilla become columnar. These calcify at varying ages after birth.
are known as ameloblasts. • Eruption of a tooth is preceded by a major develop­
– Bell stage: Mesodermal cells of papilla which are ment of its root.
adjacent to ameloblasts arrange themselves as
a continuous epithelium like layer. Cells of this
layer are known as odontoblasts. Ameloblasts
and odontoblasts are separated by a basement
membrane. Remaining cells of the papilla form
pulp of tooth. Developing tooth now appears
like a bell.
– Apposition stage: Ameloblasts lay enamel
over superficial (outer) surface of basement
membrane. Odontoblasts lay down dentine
over its deeper surface. As layer after layer of
enamel and dentine are laid down, the layer
of ameloblasts and layer of odontoblasts move
away from each other.
• As enamel is fully formed, the ameloblasts disappear
and leave a thin membrane known as dental cuticle,
over the enamel. Odontoblasts continue to separate
the dentine from the pulp throughout the life of
tooth.
• Alveolar parts of maxillae and mandible are formed
by ossification in the corresponding alveolar process.
As ossification progresses, the roots of teeth are
surrounded by bone.
• Root of tooth is established by continued growth
into underlying mesenchyme. Odontoblasts here lay
down dentine. As layers of dentine get deposited,
pulp space becomes progressively narrower and
gradually gets converted into a canal through which
nerves and blood vessels pass inside the tooth.
Fig. 21:  Parts of developing tooth
• In the region of the root, there ameloblasts are absent.
Dentine is covered by mesenchymal cells which Q.2. Write a short note on development of tongue.
differentiate into cementoblasts. Cementoblasts lay  (Sept 2002, 5 Marks) (Sept 2004, 5 Marks)
down a layer of dense bone known as cementum.  (Mar 2008, 4 Marks) (Mar 2013, 3 Marks)
Further to outside, mesenchymal cells form  (Feb 2016, 3 Marks) (Sept 2017, 3 Marks)
periodontal ligament which connects root to socket
 (Oct 2016, 3 Marks)
in the jaw bone.
Permanent teeth are formed as follows: Or
• Dental lamina gives off a series of buds, one of which Describe innervations and development of tongue.
lies over medial side of each developing deciduous  (Mar 2000, 9 Marks)
 Embryology  223

Or ♦♦ Fibroareolar stroma is derived from the pharyngeal arch

Write short note on embryological basis of innervation mesoderm.
of tongue.  (Dec 2010, 5 Marks) ♦♦ Epithelium of tongue is at first made up of a single layer
of cells. Later, it becomes stratified and papillae become
Or evident. Taste buds are formed in relation to the terminal
Write short note on development of tongue in relation branches of the innervating nerve fibers. The circumvallate
to its nerve supply.  (Feb 2013, 5 Marks) papillae of tongue develop from the cranial part of
Or hypobranchial eminence and migrate to the anterior aspect
of sulcus terminalis.
Write development of tongue and correlate its
development with nerve supply.(Sep 2015, 10 Marks)
Ans. Epithelium

Development of Tongue
♦♦ Development of tongue occurs in relation to pharyngeal
arches (1st to 4th) inside the floor of developing mouth. It
develops during 4th to 8th weeks. Each pharyngeal arch
arises as a mesodermal thickening in lateral wall of foregut
and that it grows ventrally to become continuous with the
corresponding arch of opposite side.
♦♦ Medial most parts of mandibular arches proliferate to
form two lingual swellings. These lingual swellings are
partially separated from each other by another swelling
which appears in the midline. This median swelling is
known as tuberculum impar.
♦♦ Immediately behind tuberculum impar, epithelium
undergo proliferation to form a downgrowth, i.e.
thyroglossal duct, from which the thyroid gland develops.
Site of this downgrowth is subsequently marked by a
depression known as foramen caecum.
♦♦ Another, midline swelling is seen in relation to the medial ends
of second, third and fourth arches. This swelling is known
as hypobranchial eminence or copula of His. The eminence
soon shows a subdivision into a cranial part which is related
to second and third arches (called the copala) and a caudal
part related to the fourth arch. Caudal part forms epiglottis.
♦♦ Anterior two-thirds of tongue is formed by fusion of the
tuberculum impar and the two lingual swellings.
♦♦ Anterior two-thirds of tongue is thus derived from
mandibular arch.
♦♦ Posterior one-third of tongue is formed from the cranial Fig. 22:  Development of tongue
part of the hypobranchial eminence (copula). In this
situation, the second arch mesoderm gets buried below the Correlation of Development of Tongue with its Nerve Supply
surface. The third arch mesoderm grows over it to fuse with Motor Innervations
the mesoderm of the first arch. The posterior one-third of
Muscles of the tongue are supplied by the hypoglossal nerve
the tongue is thus formed by third arch mesoderm.
♦♦ The posteriormost part of tongue is derived from the because they develop from occipital myotomes.
fourth arch. Sensory Innervation
♦♦ The line of junction of anterior two-thirds and posterior
one-third of tongue is indicated by an inverted V-shaped In keeping with its embryological origin, the anterior two-
sulcus terminalis. thirds of the tongue is supplied by the lingual branch of the
♦♦ Components of tongue include mucous membrane, mandibular nerve, which is the post-trematic nerve of the first
muscles and fibroareolar stroma. Mucosa of tongue is arch, and by the chorda tympani which is the pretrematic nerve
derived from endoderm of foregut. of first arch. The posterior one-third of the tongue is supplied
♦♦ Musculature of the tongue is derived from the occipital by the glossopharyngeal nerve, which is the nerve of the third
myotomes. This explains its nerve supply by the arch. The most posterior part of the tongue is supplied by the
hypoglossal nerve, which is the nerve of these myotomes. superior laryngeal nerve, which is the nerve of the fourth arch.
224 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Tabular Presentation of Correlation of Development of Developmental Anomalies of Tongue

Tongue with its Nerve Supply ♦♦ Tongue can be too large which is known as macroglossia
Source of or too small which is known as microglossia. Very rarely
Structures development Nerve supply the tongue may be absent which is known as aglossia.
♦♦ Tongue may be bifid because of nonfusion of two lingual
Muscles Occipital Hypoglossal nerve
myotomes swellings.
♦♦ The apical part of tongue may be anchored to the floor of
Mucous First arch • Lingual nerve (post- mouth by an overdeveloped frenulum. This condition is
membrane trematic nerve of 1st arch)
• Chorda tympani nerve (pre­
known as ankyloglossia or tongue tie. It interferes with
• Anterior
trematic nerve of 1st arch) speech. Occasionally, the tongue may be adherent, to the
two-thirds of
tongue palate which is known as ankyloglossia superior.
♦♦ A red, rhomboid-shaped smooth zone may be present on
• Posterior one- Third arch Glossopharyngeal nerve
the tongue in front of foramen cecum. This is considered
third of tongue (nerve of 3rd arch)
to be the result of persistence of tuberculum impar.
• Posteriormost Fourth arch Internal laryngeal nerve ♦♦ Thyroid tissue may be present in the tongue either under
part of tongue (nerve of 4th arch) the mucosa or within the muscles.
♦♦ Remnants of the thyroglossal duct may form cysts at the
Q.3. Write a short note on development of tonsil. base of tongue.
 (Aug/Sept 1998, 6 Marks) ♦♦ Surface of the tongue may show fissures which are known
Ans. Palatine tonsils develop in relation to the lateral parts of as fissural tongue.
the second pharyngeal pouch.
• Endodermal lining of the pouch undergoes
considerable proliferation.
9. THE NERVOUS SYSTEM
• Lymphocytes collect in relation to the endodermal Q.1. Enumerate the derivatives of neural crest.
cell.  (Sept 2004, 5 Marks)
• Infratonsillar cleft or tonsillar fossa is believed to
represent a persisting part of the second pharyngeal Or
pouch. Answer in brief derivatives of neural crest.
• Similar epithelium proliferates and collection of  (Feb 2016, 5 Marks)
lymphoid tissue gives rise to the tubal tonsils, the Ans. At the time when neural plate is being formed and some
lingual tonsils and the pharyngeal tonsils. cells at the junction between the neural plate and the rest
of ectoderm become specialized to form neural crest.
Q.4. Write short note on development of parotid gland. Various derivatives of neural crest cells are:
(Sep 2013, 5 Marks)
Ans. Parotid gland is the first salivary gland to appear, i.e. at Dorsal Mass
around early 6th week. ♦♦ Neuroblasts:
• It arises from oral ectoderm near angle of stomato- • Pseudounipolar neurons of the posterior (dorsal)
deum. nerve root ganglia of spinal nerves
• It grows outward between maxillary process and • Neurons of the sensory ganglia of the fifth, seventh,
mandibular arch in form of ectodermal cords of cells. eighth, ninth and tenth cranial nerves
• Proximal part canalizes and forms duct that opens ♦♦ Spongioblasts:
into the mouth while distal part extends into the • Capsular/satellite cells of all sensory ganglia
cheek mesenchyme and reaches up to the developing • Schwann cells that form the neurilemma and myelin
ear where it branches and expands to form secreting sheaths of all peripheral nerves
units/alveoli of gland. ♦♦ Pluripotent cells:
• Fusion of maxillary process and mandibular arch • Mesenchyme of dental papilla, odontoblasts and
results in shifting of opening of parotid duct into dentine
the vestibule opposite upper second molar. • Melanoblasts: Pigment cells of the skin
• Cartilage cells of branchial arches
• Capsule and connective tissue is formed from the
• Leptomeninges (pia mater and arachnoid mater).
surrounding mesoderm.
Q.5. Describe the development of tongue with its nerve Ventral Mass
supply and its developmental anomalies. ♦♦ Sympathoblasts (small cells):
 (Aug 2018, 10 Marks) • Neurons of the sympathetic ganglia
Ans. For development of tongue with its nerve supply refer • Neurons of peripheral parasympathetic ganglia of
to Ans 2 of same chapter. cranial nerves (3rd, 7th, 9th, 10th).
 Embryology  225

♦♦ Chromaffin cells (large cells):

• Suprarenal medulla 10. FATE OF GERM LAYERS
• Para-aortic body
• Argentaffin cells Q.1. Enumerate the derivatives of ectoderm.
• Enterochromaffin cells/APUD cells. (Mar 2006, 5 Marks) (Sep 2009, Marks)
Other structures believed to arise from the neural crest are as Ans. Following are the derivatives of ectoderm:
follows: • Skin and appendages: Epidermis, hairs and nails,
♦♦ Bones of the face and part of the vault of skull (frontal, sebaceous and sweat glands, arrectores pilorum
parietal, squamous temporal, part of the sphenoid, maxilla, muscle and mammary glands.
zygomatic, nasal, vomer, palatine and mandible) • Eye: Lens of eye, corneal epithelium, conjunctiva,
♦♦ Dermis, smooth muscle and fat of face and ventral aspect lacrimal gland, nasolacrimal gland and muscle of
of neck iris.
♦♦ Muscles of the ciliary body • Ear: Utricle, semicircular ducts, epithelial lining of
♦♦ Sclera and choroids of eye external auditory meatus, outer lining of tympanic
♦♦ Substantia propria and posterior epithelium of cornea membrane
♦♦ Connective tissues of thyroid, parathyroid, thymus and • Nose: Epithelial lining of nasal cavity, paranasal air
salivary glands sinus, olfactory placode including olfactory nerve
♦♦ Derivatives of the first, second and third pharyngeal • Oral cavity and gastrointestinal tract: Epithelial lining
cartilages of anterior two-thirds of tongue, hard palate, side
♦♦ C cells of the thyroid gland of mouth, ameloblasts, parotid gland and ducts,
♦♦ Cardiac semilunar valves, and conotruncal septum (spiral epithelial lining of lower anal canal.
septum plus bulbar septum) • Urogenital system: Epithelial lining of distal penile
♦♦ Smooth muscle of blood vessels of the face and of forebrain. urethra, parts of female external genitalia.
 3
SECTION

Osteology

1. Osteology
 c. Medial part:
1. OSTEOLOGY – Inferior ophthalmic vein
– Sympathetic nerves from plexus around internal
Q.1. Enumerate the structures passing through foramen carotid artery.
ovale. (Mar 2000, 4 Marks)
Q.4. Enumerate the structures passing through jugular
(Sept 2017, 2 Marks) (Sept 1999, 4 Marks)
foramen. (Feb 1999, 4 Marks)
Or
Ans. Following are the structures passing through jugular
Answer in brief structures passing through foramen foramen:
ovale. (May 2017, 3 Marks) a. Through anterior part:
Ans. Structures passing through foramen ovale are: – Inferior petrosal sinus
• Mandibular nerve. – Meningeal branch of ascending pharyngeal
• Lesser petrosal nerve.
artery.
• Accessory meningeal artery.
b. Through middle part:
• An emissary vein connecting cavernous sinus with
– 9, 10 and 11 cranial nerves, i.e. glossopharyngeal,
the pterygoid plexus of veins.
• Occasionally, the anterior trunk of the middle vagus and spinal accessory nerve.
meningeal vein. c. Through posterior part:
– Internal jugular vein
Q.2. Enumerate the structures passing through foramen
– Meningeal branch of occipital artery.
spinosum. (Sept 2000, 4 Marks)
Ans. Structures passing through foramen spinosum are: Q.5. Write about structures passing through passing
• Middle meningeal artery. foramen magnum. (Sept 2011, 5 Marks)
• Meningeal branch of mandibular nerve or nervous Ans. It is divided into a small anterior and a large posterior com-
spinosus. partment by means of the alar ligaments of axis vertebra.
• Posterior trunk of middle meningeal vein. a. Structures passing through anterior compartment:
Q.3. Enumerate the structure passing through superior 1. Apical ligament of dens
orbital fissure. (Mar 2009, 10 Marks) 2. Vertical band of cruciate ligament
Ans. Three parts of superior orbital fissure transmits the 3. Membrana tectoria.
following structures: b. Structures passing through posterior compartment:
a. Lateral part: 1. Medulla oblongata
– Lacrimal nerve 2. Meninges, i.e. dura, arachnoid and pia mater.
– Frontal nerve c. Through subarachnoid space:
– Trochlear nerve 1. Spinal accessory nerve
– Superior ophthalmic vein 2. Vertebral arteries
– Meningeal branch of lacrimal artery 3. Sympathetic plexus around vertebral arteries
– Anastomotic branch of middle meningeal artery 4. Posterior spinal arteries
which anastomoses with recurrent branch of 5. Anterior spinal artery.
lacrimal artery.

Fig. 1: Structures passing through superior orbital fissure

(For colour version see Plate 11)
b. Middle part: Fig. 2: Structures passing through foramen magnum
– Upper and lower division of oculomotor nerve
– Nasociliary nerve in between two divisions of Q.6. Write short note on atlas and axis. (Sep 2011, 10 Marks)
oculomotor Ans. Atlas
– The abducent nerve. Atlas is the first cervical vertebra.
230 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Identification Points
♦ Atlas is ring shaped and does not consists of body and spine.
♦ Atlas consists of anterior arch which is short, posterior arch
which is long, right and left lateral masses and transverse
processes.
♦ Anterior arch of vertebra is marked by median anterior
tubercle and posterior surface has an oval facet which
articulates with dens.
♦ Posterior arch form two-fifth of the ring and is longer than
anterior arch.
♦ Posterior surface is marked by median posterior tubercle.
♦ Upper surface of the arch is marked behind lateral mass
by a groove.
♦ Lateral mass displays following features:
a. Upper surface consists of superior articular facet.
Facet is elongated, concave and is directed upward
and medially.
b. Lower surface is marked by inferior articular facet.
Facet is almost circular and is somewhat flat. Facet is
directed downwards, medially and backwards.
c. Medial surface of lateral mass is marked by small
rough tubercle.
d. Transverse process is projected laterally from lateral
mass. Transverse process is long. Transverse process
is pierced by foramen transversarium.
Fig. 3: Atlas
Attachments and Relations
♦ Anterior tubercle gives attachment to anterior longitudinal
ligament and gives insertion on both sides to upper oblique
part of longus colli.
♦ Upper border of anterior arch provide attachment to
anterior atlanto–occipital membrane.
♦ Lower border of anterior arch provide attachment to lateral
fibers of anterior longitudinal ligament.
♦ Posterior tubercle gives attachment to ligamentum nuchae
in median plane and provides origin to rectus capitis
posterior minor on both sides.
♦ Groove over the upper surface of posterior arch get
occupied by vertebral artery as well as by first cervical
nerve. Behind the groove upper border of posterior
arch provides attachment to posterior atlanto–occipital
membrane.
♦ Lower border of posterior arch provide attachment to
highest pair of ligament flava.
♦ Tubercle over medial side of lateral mass provides origin
to rectus capitis anterior.
♦ Transverse process provide origin to rectus capitis lateralis
from upper surface anteriorly and superior oblique from
upper surface posteriorly, inferior oblique from lower
surface of tip, levator scapulae from lateral margin as well
as lower border, splenius cervicis and scalenus medius
from posterior tubercle of transverse process.
Axis
Axis is the second cervical vertebra.
Identification of axis is done by the odontoid process or dens.
Fig. 4: Axis
Description of Body and Dens
♦ Superior surface of the body get fused with dens and it is
encroached on each side by the superior articular facets.
Articulation of odontoid process occurs anteriorly with
ovoid facet on posterior surface of anterior arch of atlas
and posteriorly with the transverse ligament of atlas.
♦ Inferior surface consists of prominent anterior margin
which is projected downwards.
♦ Anterior surface has a median ridge on each side of which
hollow out impressions are present.
Vertebral Arch
♦ Pedicles get concealed superiorly by superior articular
processes. Inferior surface has a deep and wide inferior
vertebral notch which is placed in front of inferior articular
process.
♦ Laminae are thick and strong.

♦ Articular facets: Both the superior articular facets occupy
upper surfaces of body and massive pellicle. Laterally, the
articular facet has foramen transversarium. This foramina
is a large, flat, circular facet which is directed upward and
laterally. The foramen transversarium articulates with the
inferior facet of atlas vertebra to form atlantoaxial joint.
Each of the inferior articular facets articulates with the
third cervical vertebra.
♦ Transverse process is small and represents true posterior
tubercles.
♦ Spine of the axis is large, thick and strong. Spine is deeply
grooved inferiorly. Tip of spine is bifid and terminate in
the two rough tubercles.
Attachments
♦ Odontoid process gives attachment at its apex to apical
ligament on each side and below the apex to alar
ligaments.
♦ Longus colli is inserted in anterior surface of the body.
Anterior longitudinal ligament is attached to anterior
surface.
♦ Posterior surface of body gives attachment to posterior
longitudinal ligament, membrane tectoria and vertical
limb of cruciate ligament.
♦ Laminae provide attachment to ligament flava.
♦ Transverse process provides origin by its tip to levator
scapulae, scalenus medius anteriorly and splenius cervicis
posteriorly. Intertransverse muscles get attached to the
upper and lower surfaces of transverse process.
♦ Spine of the vertebra provide attachment to ligamentum
nuchae, semispinalis cervicis, rectus capitis posterior
major, inferior oblique, spinalis cervicis, interspinalis and
multifidus.
Q.7. Write a short note on pterion. (Mar 2013, 4 Marks)
Or
Answer in brief on pterion. (May 2017, 3 Marks)
Ans. The pterion is the point corresponding with the posterior
end of the sphenoparietal suture.
  It is situated about 3 cm. behind, and a little above
the level of the zygomatic process of the frontal bone.
It marks the junction between four bones
1. The parietal bone
2. The squamous part of temporal bone
3. The greater wing of sphenoid bone
4. The frontal bone.
Clinical Significance
♦ The pterion is known as the weakest part of the skull.
♦ Clinically, the pterion is relevant because the anterior
division of the middle meningeal artery runs beneath it,
on the inner side of the skull, which is quite thin at this
point. The combination of both a vital artery in this area
and the relatively thin bone structure has lent itself to the
name “God’s little joke” by some physicians.
Osteology  231
♦ A blow to the pterion, (e.g. in boxing) may rupture the
artery causing an epidural hematoma. The pterion may
also be fractured indirectly. Blows to the top or back of the
head may not cause fracture at the site of impact, but may
place sufficient force on the skull that its weakest part, the
pterion, will fracture.
Fig. 5: Pterion
Q.8. Write short note on osteogenesis. (June 2010, 5 Marks)
Ans. Osteogenesis is also known as ossification
• Osteogenesis is the process of laying down new bone
material by cells called osteoblasts.
• There are two processes resulting in the formation
of normal, healthy bone tissue.
1. Intramembranous ossification.
2. Endochondral ossification.
Intramembranous Ossification
♦ Bone is formed by differentiation of mesenchymal cells
into osteoblasts.
♦ It occurs in flat bones of skull and clavicle.
♦ It begins at the end of second month of gestation.
Procedure of Intramembranous Ossification
♦ In membrane where the future bone formation has to
be taken place, few mesenchymal cells differentiate into
osteoblast cells. Osteoblasts secrete the organic intercellular
matrix of the bone.
♦ Area where the osteoblasts first appear in membrane is
called as center of ossification.
♦ Osteoblasts are now surrounded by bony matrix.
♦ Osteoblasts surrounded by bony matrix are converted to
osteocytes.
♦ Osteocyte is a resting cell which lies in lacuna and
processes lie in canaliculi.
♦ Osteoblasts on surface of bony matrix secrete phosphatase
which helps in calcification of intercellular matrix.
♦ Osteoblasts proliferate and differentiate in radiating manner
from center of ossification. Osteoblasts form bony trabeculae
on the surface of which bone is formed layer by layer.
232 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Bony trabeculae fuse with each other to form spongy bone.
♦ Blood vessels grow in spaces between trabeculae and the
connective tissue surrounding these blood vessels now
differentiate into red bone marrow.
♦ Mesenchymal cells on outer surface of developing bone
from periosteum membrane.
♦ Spongy bone formed by intramembranous ossification is
now replaced by the compact bone.
♦ Bone formed is known as membranous bone.
Endochondral Ossification
♦ This ossification involves replacement of the cartilaginous
model by bone.
♦ It occurs at extremities of all long bones, vertebrae, ribs,
articular extremity of mandible and base of skull.
♦ At the site where bone is to be formed there is presence of
condensation of mesenchymal cells.
♦ Mesenchymal cells are now transformed to chondroblast
cells which secrete the cartilage matrix.
♦ Thus, a hyaline cartilage covered by perichondrium is
formed.
♦ This cartilaginous model is replaced by formation of
bone and bone formed is known as cartilage bone. Most
of the bones of our body are formed by endochondral
ossification.
Procedure of Endochondral Ossification
Formation of Cartilagenous Model
♦ At a site where limb will later emerge, embryo shows
outgrowth of mesoderm covered by ectoderm.
♦ Mesenchymal cells at this area condense and differentiate
into chondroblasts and form cartilaginous matrix resulting
in the development of hyaline cartilage model.
Fig. 6: Formation of cartilagenous model
(For colour version see Plate 11)
♦ Model is surrounded by perichondrium which is made
up of inner chondrogenic layer and outer fibrous layer.
♦ Growth of cartilage model is by interstitial and appositional
growth.
♦ As the differentiation of cartilage cells move towards
metaphysis, cells organize into longitudinal columns
which are subdivided into following zones.
A. Zone of reserved cartilage
It exhibits no cellular proliferation or secretion of active
matrix production.
B. Zone of proliferation
• This zone lies adjacent to zone of reserve cartilage in
the direction of diaphysis.
• In this zone, cartilage cells undergo division and are
organized into distinct columns. These cells now can
actively produce matrix.
Fig. 7: Zones of differentiation of cartilage cells
(For colour version see Plate 12)
C. Zone of hypertrophy
• This is the broadest zone.
• It consists of enlarged cartilage cells and in early stages
they secrete type II collagen.
• As the cells become larger in size proteoglycans are
secreted.
• As chondrocytes reach their maximum size, they
secrete Type X collagen as well as noncollagenous
proteins.
 Osteology  233

D. Zone of calcified cartilage

• These enlarged cells degenerates and matrix becomes
calcified.
• Mineralization is by formation of matrix vesicles.
E. Zone of resorption
• This zone lies nearest to diaphysis.
• Calcified cartilage is in direct contact with connective
tissue of the marrow cavity.
• Small blood vessels and accompanying connective
tissue invade the region occupied by the dying
chondrocytes and they form a series of spear heads,
leaving calcifying cartilage as longitudinal spicules.

Formation of Bone Collar

♦ Capillaries grow into perichondrium to surround the
midsection of the model.
♦ Cells in the inner layer of perichondrium differentiate into
osteoblasts to form a thin collar of bone matrix by intra-
membranous ossification. At this stage, perichondrium is
called as periosteum.
♦ Vascularisation of middle of the cartilage occurs, and
chondroclasts resorb most of the mineralized cartilaginous
matrix.
Fig. 9: Formation of periosteal bud
(For colour version see Plate 12)
Formation of Medullary Cavity
♦ As the primary ossification center enlarges spreading
proximally and distally, osteoclasts brake down newly formed
spongy bone and open a medullary cavity in center of shaft.
♦ Two ends of developing bone still composed entirely of
cartilage. Midsection of developing bone become diaphysis
and cartilaginous end become epiphysis.
♦ Primary center of ossification is diaphyseal center of
ossification.

Fig. 8: Formation of bone collar

(For colour version see Plate 12)

Formation of Periosteal Bud

♦ Periosteal capillaries along with osteogenic cells invade
calcified cartilage in middle of the model and supply its
interior.
♦ Osteogenic cells and vessel comprise a structure called as
periosteal bud.
♦ Periosteal capillaries grow into the cartilage model and
initiate development of primary ossification centre.
♦ Osteogenic cells in periosteal bud give rise to osteoblasts
that deposit bone matrix on residual calcified cartilage.
This results in formation of cancellous bone with remnants
of calcified cartilage known as mixed spicule.
Fig. 10: Formation of medullary cavity
(For colour version see Plate 12)
Formation of Secondary Ossification Center
♦ Shortly before or after the birth secondary ossification
center appear in one or both the epiphysis.
♦ Chondrocytes in middle of epiphysis hypertrophied
and mature and matrix partitions between their lacunae
calcify.
234 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Spongy bone is retained and no medullary cavity is formed
in epiphysis.
♦ Ossification spreads from secondary center in all direction.
♦ After completion of secondary ossification hyaline cartilage
remains at two places on the epiphyseal surface as articular
cartilage and at junction of diaphysis and epiphysis where
it forms epiphyseal plate.
Union of primary and secondary ossification centers is called
as epiphyseal line.
Fig. 11: Formation of secondary ossification center
(For colour version see Plate 12)
Q.9. Answer in brief about odontoid process of axis vertebrae.
(Feb 2016, 2 Marks)
Ans. Odontoid process is also known as dens
• It is a strong tooth like process which projects
upward from the body.
• Odontoid process represents the centre or body of
atlas which is fused with the center of axis.
• Axis vertebra is identified by this odontoid process.
• Superior surface of body of axis is fused with the
odontoid process.
• Odontoid process articulates with oval facet on
posterior surface of anterior arch of atlas and
posteriorly with transverse ligament of atlas.
• Odontoid process gives attachment at its apex to
apical ligament on each side and below the apex to
alar ligaments.
For diagram refer to Ans 6 of same chapter.
Q.10. Write in brief about anterior fontanelle.
(Sep 2015, 5 Marks)
Ans. Fontanelles are basically the sites for the growth of skull. They
permit growth of brain and also helps in age determination.
• In fetal skull bregma is the site of membranous gap
and is known as anterior fontanel.
• Anterior fontanel closes at 18 months of age and
allows growth of brain.
• If anterior fontanel is bulged, there is rise in the
intracranial pressure.
• If anterior fontanel is depressed, it causes decrease
in intracranial pressure.
Fig. 12: Anterior fontanelle
Q.11. Answer in brief structures passing into internal
auditory meatus. (Oct 2016, 2 Marks)
Ans. Following are the structures passing into internal
auditory meatus:
1. Seventh cranial (facial) nerve.
2. Eighth cranial (vestibulocochlear) nerve.
3. Nervus intermedius.
4. Internal auditory (labyrinthine) vessels.
Q.12. Write short note on pterygomaxillary fissure.
(Oct 2016, 3 Marks)
Ans. It is the triangular gap between body of maxilla and
lateral pterygoid plate of sphenoid.
Pterygomaxillary fissure is located at lateral part of
pterygopalatine fossa.
Infratemporal fossa communicates with the pterygo-
palatine fossa through pterygomaxillary fissure.
Structures Passing
♦ Posterior superior alveolar nerve passes through
pterygomaxillary fissure to enter the infratemporal fossa.
♦ Pterygopalatine part or third part of maxillary artery
passes from infratemporal fossa into pterygopalatine fossa
via pterygomaxillary fissure.
♦ A variable network of veins such as sphenopalatine into
the pterygoid plexus of veins.
Q.13. Write short note on anatomical position.
(Apr 2017, 4 Marks)
Ans. In anatomical position the body is erect, eyes are directed
forward and look straight, upper limbs hang by side of
body with palms of hand turned forward and the fingers
are pointed straight down, the lower limbs, including
feet, are parallel to one another with feet flat on the floor
and toes pointing forwards.
 Osteology  235

• In medical profession, the body parts and their

relationships are always described presuming that
the body is in anatomical position, although it may
lie or be placed in any position.
• In anatomical position, the position of forearms and
hands is not a natural one, it does allow for accurate
description.
• This is the position assumed in all anatomical
descriptions to ensure accuracy and consistency.
• In medicine, all descriptions of the human body are
made in anatomical position.

Anatomical Position of Skull

Skull can be placed in proper orientation by considering any
one of the two planes, i.e.
♦ Reid’s baseline is a horizontal line which is obtained by
joining infraorbital margin to center of external acoustic
Fig. 14: Asterion
meatus, i.e. auricular point.
♦ Frankfurt’s horizontal plane of orientation is obtained by
Q.15. Write very short answer on foramen rotundum.
joining infraorbital margin to upper margin of external
acoustic meatus. (Aug 2018, 2 Marks)
Ans. The foramen rotundum is a circular hole in the sphenoid
bone that connects the middle cranial fossa and the
pterygopalatine fossa.
♦ The foramen rotundum is located in the middle cranial
fossa, inferomedial to the superior orbital fissure at
the base of greater wing of the sphenoid bone.
♦ Its medial border is formed by lateral wall of
sphenoid sinus.
♦ It runs downwards and laterally in an oblique
path and joins the middle cranial fossa with the
pterygopalatine fossa.

Structures Passing through Foramen Rotundum

It transmits the maxillary branch of trigeminal nerve, artery of
foramen rotundum, and emissary veins.

Fig. 13: Anatomical position of body

Q.14. Write short note on asterion. (Sep 2017, 4 Marks)

Ans. Asterion is the point where the parietomastoid,
occipitomastoid and lambdoid sutures meet.
Asterion is a depression located 2.5 cm behind the upper
part of root of ear.
At asterion, occipital, parietal and temporal bones meet.
Mastoid angle of parietal bone lie at asterion.
In infants, the asterion is the site of posterolateral or
mastoid fontanel which closes by 12 months. Fig. 15: Foramen rotundum
 4
SECTION

Histology

1. Epithelial Tissue 11. The Digestive System III: Liver, Gallbladder

2. Cartilage and Pancreas

3. Bone Tissue 12. The Endocrine System

4. Muscular Tissue 13. The Urinary System

14. Male Reproductive System
5. Circulatory System
15. The Nervous System
6. Lymphatic Tissue
Multiple Choice Questions as per DCI and
7. Skin
Examination Papers of Various Universities
8. Respiratory System
Fill in the Blanks as per DCI and Examination
9. The Digestive System I: Oral Cavity Papers of Various Universities
10. The Digestive System II: Alimentary Canal Viva-voce Questions for Practical Examination
 2. Stratified Epithelium (Multiple layer of cells)
1. EPITHELIAL TISSUE a. Stratified Squamous
b. Stratified Cuboidal
Q.1. Write a short note on types of epithelium with one c. Stratified Columnar
example each. (Sep 2002, 2 Marks) 3. Pseudostratified (Epithelium appears as it is stratified)
4. Transitional (Shape of epithelium is not fixed)
Or
Enumerate the types of epithelium with the example. Simple Epithelium
 (Apr 2007, 3 Marks) Squamous
Ans. Epithelium
♦♦ It consists of single layer of flat cells. Nucleus is oval or
Epithelium is a basic tissue of the body and consists of flat and is situated in the center of cell.
cells arranged as continuous sheets in either single or ♦♦ Examples of squamous simple epithelium are lung alveoli,
continuous layers. parietal layer of Bowman’s capsule, certain tubules
of kidney and at certain places on the inner aspect of
Types of Epithelium
tympanic membrane.
1. Simple Epithelium (Single layer of cells)
a. Squamous Cuboidal
b. Cuboidal ♦♦ The cells appear cuboidal in shape. Nuclei are round and
c. Columnar centrally placed. All nuclei are arranged at same level.

Fig. 1:  Various types of epithelium

(For colour version see Plate 13)
240   Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Examples of squamous cuboidal epithelium: Epithelium
lining the follicles of thyroid gland, ducts of exocrine
glands and pigmented epithelium of retina.
Columnar
♦♦ Cells of the epithelium are much taller compared to their
width.
♦♦ Nuclei are elongated and located in the lower half of the
cells. All nuclei are placed at the same level in neighboring
cells.
♦♦ On their free surface, modifications like microvilli or cilia
may be seen. It may also contain goblet cells.
♦♦ Examples of squamous columnar epithelium: Epithelial
lining of gallbladder, ducts of glands, gastrointestinal
tract (from stomach to anus), uterine tube, uterine cavity,
cervical canal and central canal of spinal cord.
Stratified Epithelium
Stratified Squamous (Nonkeratinized)
♦♦ Cells are arranged in many layers. Basal layer is attached
to basement membrane and is usually columnar, cuboidal
or rounded in shape.
♦♦ Intermediate cells are irregularly polyhedral in shape
and become increasingly flattened as they move towards
superficial layer.
♦♦ Superficial layer consists of thin squamous cells. Basal cells
replace surface cells as they are shed off.
♦♦ Examples of non-keratinized stratified squamous
epithelium: Epithelial lining of oral cavity, tongue, part
of epiglottis, esophagus and vagina.
Stratified Squamous (Keratinized)
♦♦ In this epithelium superficial cells become dead,
dehydrated and non-nucleated like scales.
♦♦ These dead cells become hard (cornified) as they are filled
with keratin.
♦♦ Examples of keratinized stratified squamous simple
epithelium is skin.
Stratified Cuboidal
♦♦ Epithelium consists of two or more layers of cells.
♦♦ Cells of superficial layer are cuboidal in shape.
♦♦ Examples of stratified cuboidal epithelium is ducts of
sweat glands.
Stratified Columnar
♦♦ It contains two or more layers of cells.
♦♦ Cells of superficial layer are columnar.
♦♦ Examples of stratified columnar epithelium: Epithelial
lining of large ducts of some glands, fornix of conjunctiva
and cavernous urethra.
Pseudostratified Epithelium
♦♦ It is not a true stratified epithelium but appears to be
stratified.
♦♦ All cells are attached to the basement membrane but are of
different heights. Hence, not all reach the apical surface.
Because of this, nuclei of cells are at different levels.
♦♦ The epithelium may be ciliated or non-ciliated and may
contain goblet cells.
♦♦ The non-ciliated pseudostratified epithelium is found in
the large excretory ducts, auditory tube and male urethra.
♦♦ Examples of pseudostratified epithelium is upper
respiratory tract.
Transitional Epithelium
♦♦ Appearance of epithelium varies during stretched and
relaxed conditions. When this epithelium is stretched then
it looks like stratified squamous epithelium. But when
the epithelium is in relaxed condition it appears stratified
cuboidal. Due to this apparent change in the shape this
epithelium is called as transitional epithelium.
♦♦ This epithelium is seen in epithelial lining of the urinary
tract.
Q.2. Write short note on stratified squamous epithelium.
 (Nov 2009, 5 Marks)
Ans. Stratified squamous (nonkeratinized)
• Cells are arranged in many layers. Basal layer is
attached to basement membrane and is usually
columnar, cuboidal or rounded in shape.
• Intermediate cells are irregularly polyhedral in shape
and become increasingly flattened as they move
towards superficial layer.
• Superficial layer consists of thin squamous cells.
Basal cells replace surface cells as they are shed off.
• Examples of non-keratinized stratified squamous
epithelium are epithelial lining of oral cavity, tongue,
part of epiglottis, esophagus and vagina.
Stratified squamous (keratinized)
• In this epithelium, superficial cells become dead,
dehydrated and non-nucleated like scales.
• These dead cells become hard (cornified) as they are
filled with keratin.
• Examples of keratinized stratified squamous simple
epithelium is skin.
Q.3. Enumerate classification of epithelium. (Do not
describe). (Feb 2013, 2 Marks)
Ans. Types of Epithelium
1. Simple epithelium (single layer of cells)
a. Squamous
b. Cuboidal
c. Columnar
2. Stratified epithelium (multiple layer of cells)
a. Stratified squamous
b. Stratified cuboidal
c. Stratified columnar
3. Pseudostratified (epithelium appears as it is
stratified)
4. Transitional (shape of epithelium is not fixed)
 Histology  241

♦ ,
2. CARTILAGE fi ,
♦ Elastic cartilage contains a meshwork of branching
 fi v w
(Feb 2002, 2 Marks) E fi H E
Or v z
fi ( )
Write a short note on types of cartilages with example. (Feb
2005, 5 Marks)
Ans. Cartilage
C fi z v
v ,
, fi
Three types of cartilage are found in the body
H
i. Coastal cartilage
ii. Articular cartilage
2. Elastic cartilage
3. Fibrocartilage
Hyaline Cartilage
♦ ,
x x fi and ground Hyaline cartilage
substance.
♦ x ,
present in small spaces called as lacunae.
♦ H
♦ fi
fi
♦ G ( ) - k
w ( x )
The main constituent of ground substance is sulfated
( ) x
to the presence of chondroitin and keratin sulfate
that are acidic in nature. This dark blue staining around
lacuna is x A w
the lacuna the concentration of sulfated
proteoglycans x
w that intense blue staining that is seen Elastic cartilage
in capsule. This x
x
♦ Only one type of cell (chondrocyte) is seen in the cartilage.

, x
w
♦ v v w
fi
v
♦ H , , w v
w fi v
♦ P w , fi
( fi v )
and an inner cellular layer (made up predominantly of
w v w
is growing).

Elastic Cartilage
♦ Cartilage is highly elastic in nature. It looks yellow in fresh Fibrocartilage
state and hence sometimes called as yellow elastic cartilage. Fig. 2: Various types of cartilage
242   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ Chondrocytes are present in lacunae. These cells are bigger up predominantly of cells which may convert to
than cells present in hyaline cartilage and are present singly chondrocyte when cartilage is growing).
or in groups of two. Cells are closely placed as intercellular
ground substance is much less than in hyaline cartilage.
Fibrocartilage
♦♦ It is also known as white fibrocartilage as it contains
bundles of thick collagen fibers.
♦♦ Histological structure of fibrocartilage resembles dense
regular connective tissue.
♦♦ In fibrocartilage all the collagen fibers are of type I and
type II varieties.
♦♦ Minimal amount of basophilic ground substance is seen
around chondrocyte.
♦♦ Very few chondrcytes are seen which are oriented between
large collagenous fiber bundles. Fig. 3: Hyaline cartilage
♦♦ Chondrocytes are either present in a row or scattered singly (For colour version see Plate 13)
between bundles of fibers.
♦♦ Perichondrium is absent in fibrocartilage. Q.3. Write short note on histology of elastic cartilage.
 (Feb 2013, 5 Marks)
Q.2. Write a short note on hyaline cartilage.
 (Dec 2012, 3 Marks) (Apr 2008, 5 Marks) Or
Ans. Hyaline Cartilage Write short note on histology of elastic cartilage.
• It consists of homogeneous, transparent and  (Apr 2015, 3 Marks)
amorphous intercellular matrix. The matrix consists Ans. Elastic cartilage is highly elastic in nature. It looks yellow
of collagen fibers and ground substance. in fresh state and hence sometimes called as yellow
• Throughout the matrix cartilage cells, i.e. chondro- elastic cartilage.
cytes are present in small spaces called as lacunae.
• Hyaline cartilage is surrounded by perichondrium.
• Ground substance of hyaline cartilage contains fine
type II collagen fibers that are about 15 to 40 nm in
diameter.
• Ground substance is featureless (homogeneous)
gel-like substance that stains blue with basic dye
(hematoxylin). The main constituent of ground
substance is sulfated proteoglycans (aggrecan).
The basophilia of matrix is due to the presence of
chondroitin and keratin sulfate that are acidic in
nature. This dark blue staining around lacuna is
called as capsule or territorial matrix. As far away
from the lacuna, the concentration of sulfated
proteoglycans becomes less and less and thus the
matrix does not show that intense blue staining Fig. 4: Elastic Cartilage  (For colour version see Plate 13)
that is seen in capsule. This matrix is called as inter-
territorial matrix. • The elastic cartilage also consists of ground
• Only one type of cell (chondrocyte) is seen in the substance, fibers, cells and perichondrium.
cartilage. These cells occupy lacunae in the matrix. • Elastic cartilage contains a meshwork of branching
• In a young cartilage, chondrocytes show mitotic cell and anastomosing elastic fibers that gives it a yellow
division and give rise to daughter cells. These newly appearance.
formed chondrocytes produce fibers and ground • Elastic fibers are not seen in H&E stain but are
substance around themselves. visualized by special staining methods for elastic
• Hyaline cartilage, on its free surface, is always fibers (orcein stain and verhoeff’s stain).
covered with a fibrovascular membrane called as • Chondrocytes are present in lacunae. These cells are
perichondrium. bigger than cells present in hyaline cartilage and are
• Perichondrium consists of two layers, i.e. an outer present singly or in groups of two. Cells are closely
fibrous layer (made up of dense irregular fibrous placed as intercellular ground substance is much
connective tissue) and an inner cellular layer (made less than in hyaline cartilage.

 II.
(Aug 2016, 2 Marks)
Ans. For diagram of hyaline cartilage refer to Ans. 2 of same
chapter. III. Based on shape.
Parts of Hyaline Cartilage
♦ Perichondrium which consists of fibrous layer and cellular
layer.
♦ Matrix which consists of ground substance and collagen
fibers.
♦ Cells, i.e. chondrocytes which reside in lacunae. Compact Bone
3. BONE TISSUE
 layer.
(Sep 2002, 4 Marks)
Or
Write short note on histology of bone.
(Aug 2011, 5 Marks) (Dec 2014, 5 Marks)
Or
Write short note on compact bone.
(Nov 2008, 5 Marks)
Or
Write short note on histological structure of compact
bone. (Apr 2007, 5 Marks)
Ans. Bone is a specialized type of connective tissue. Similar
to all other connective tissues it also consists of ground
substance, fibres and cells.
However, the bone is classified as specialized connective
tissue because of presence of minerals (calcium salts) in
its intercellular matrix.
Bone consist of four types of cells, i.e. osteogenic cells,
osteoblasts, osteocytes and osteoclasts.
Osteogenic cells are present in the cellular layer of
periosteum, endosteum and in haversian canals. These
are stem cells which after cell division give origin to
osteoblasts. These cells are derived from embryonic
mesenchymal cells.
Osteoblasts are bone-forming cells. They synthesize and
secrete matrix (collagen fibers and ground substance).
They are also responsible for calcification of matrix.
Osteocytes are the main cells of bone tissue. They are
formed from osteoblasts become entrapped in matrix
secretion at the time of formation of new bone. These
cells play role in maintenance of surrounding matrix
as well as they also respond to various pressure and
tensions applied on the bone.
Osteoclasts are the cells involved in the bone resorption.
Classification of Bone
I. Based on the microscopic structure:
1. Mature bone
a. Compact bone or cortical bone or lamellar bone
b. Cancellous or spongy bone.
2. Immature bone or Woven bone.
Histology  243
Based on the development:
1. Endochondral bone
2. Intramembranous bone.
1. Long bone
2. Short bone
3. Flat bone
4. Irregular bone
5. Sesamoid bone.
♦ Outer aspect of compact bone is surrounded by condensed
fibrocollagen layer, i.e. periosteum which has two layers
A- Outer layer: Dense irregular connective tissue fibrous
B- Inner layer: Lies next to bone surface consisting of bone
cells, their precursors and rich vascular supply.
♦ Inner surface of compact bone is covered by thin cellular
layer called as endosteum.
Fig. 5: Compact bone (For colour version see Plate 14)
♦ At periosteal and endosteal surfaces, lamellae are arranged
in parallel layers surrounding bony surface known as
circumferential lamellae.
♦ Haversian canal and concentric lamellae together form
osteon or haversian system.
♦ A cement line of mineralized matrix which is strongly
basophilic delineates haversian system.
♦ This line marks limit of bone erosion prior to formation of
osteon also known as reversal line.
♦ Resting line denotes the period of rest during bone
formation.
♦ Adult bone, between osteons, contains interstitial lamellae,
which are remnants of osteons left behind during
remodelling.
Cancellous Bone
♦ It has honeycomb appearance with large marrow cavities
and sheets of trabeculae bone in form of bar and plates.
♦
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)
(lacunae) containing osteocytes. Radiating from these
lacunae are canaliculi which are occupied by the processes
of osteocytes. Osteocytes situated in lacunae derive their
nutrition through canalicular system from blood vessels
present in bone marrow.
Fig. 6: Cancellous bone
(For colour version see Plate 14)
Woven or Immature Bone or Nonlamellar Bone
♦ It is first formed bone with irregularly oriented collagen
fibers of varying diameter.
♦ It is not seen after the birth.
♦ It is seen in alveolar bone and during healing of fractures.
♦ Marrow cavities and spaces in spongy bone contain bone
marrow.
4. MUSCULAR TISSUE
Fig. 7: Cardiac muscle (For colour version see Plate 14)
Q.2. Write a short note on cardiac muscles.
(Aug 1995, 5 Marks)
Ans. • Cardiac muscle has long and thick muscular fibers.
Such fibers show branching and so an individual
fiber can appear as Y-shaped.
Each of the muscle fiber is formed by many
cells which join from end to end at junctional
specializations known as intercalated discs.
• Each of the myocyte measures from 50 to 100 µm
in length and 15 µm in thickness. Myocyte consists
of single oval nucleus which is centrally placed and
is surrounded by sarcoplasm, various organelles
and myofibrils. Due to high energy and oxygen
requirements of cardiac muscle fibers they have huge
amount of mitochondria, glycogen, triglycerides and
abundant myoglobin. Sometimes myocyte may have
two nuclei also.
• Muscle fibers lie almost parallel to each other.
Individual muscle fibers branch and anastomose
with myocytes of neighboring fibers.
• Cardiac muscle fibers also show cross striations. But
these cross striations are less prominent as compared
to cross striations of skeletal muscle fibers.
• Myofibrils of cardiac muscle fibers consist of actin
and myosin filaments. Cardiac muscles also A and
I bands and also the Z discs which are also seen in
skeletal muscle fibers.
• Intercalated disc is the irregular transverse
thickening of sarcolemma. Such discs are broken
into number of steps and do not run straight across
the fibers providing it staircase-like appearance. This
type of appearance is produced because adjacent
sarcolemmas are interdigitating and present
longitudinal and transverse portions.
• Transverse portions are thick and provide site of
attachment of myofilament to sarcolemma whereas
longitudinal portions are thin and consists of gap
junction.
(Oct 2007, 5 Marks)
Or
Write a short note on skeletal muscle fiber.
(May/June 2009, 5 Marks)
Or
Write a short note on histology of skeletal muscle fiber.
(June 2010, 5 Marks)
Ans. Basic unit of skeletal muscle is long, cylindrical fiber.
• These fibers are arranged parallel to each other. The
fibers are long and cylindrical.
 Histology  245

A single muscle fiber consists of hundreds of nuclei.

The nuclei are present in sarcoplasm just beneath
plasma membrane which is called as sarcolemma.
• Nuclei are mainly euchromatic, flat, oval in shape
and are oriented along the long axis of muscle fiber.
Beneath the sarcolemma nuclei get displaced as
the core is occupied by the thousands of contractile
thread like structures known as myofibrils. Myofibril
extends throughout the length of muscle fiber.
• Under light microscopic examination muscle fiber
show characteristic transverse striations which are
seen as alternate dark and light bands. Dark bands
are known as A bands, while the light bands are
known as I bands.
• Each of the myofibril show characteristic dark and Fig. 10: Longitudinal section of muscle
light bands, i.e. cross-striations which are seen in (For colour version see Plate 14)
muscle fiber.
• Light area on a myofibril is known as I band and dark
area as A band. Thin transverse dark line is seen in 5. CIRCULATORY SYSTEM
middle of light area known as Z line. Mid region of
dark A band has a light H band. In the middle of H 
band there is presence of transverse dark line, i.e. M (Apr 2010, 5 Marks)
line. Area between two adjacent Z lines is known as

sarcomere. Sarcomere is the contractile unit of striated
muscle.
• Inside the myofibrils two types of even structures are
present which are known as myofilaments. They are
thick and thin filaments. Thick ones are known as
myosin and thin ones are known as actin filaments.
• Arrangement of thick and thin filaments has specific
relationship. Each thick filament is surrounded
equidistant by six thin filaments arranged in
hexagonal manner.
• Each thick filament has 200 to 300 myosin II
molecules. These molecules are closely packed in
a specific manner in thick filament. Each myosin II
molecule has two identical heavy chains and two
pair of light chains.
• Thin filament consists of two chains of F acting
filaments which are wrapped with each other in
association with tropomyosin and troponin.

Fig. 9: Transverse section of muscle

(For colour version see Plate 14)
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)
6. LYMPHATIC TISSUE
Q.1. Write a short note on microscopic anatomy of lymph
node. (Sep 2000, 4 Marks)
Or
Write a short note on microscopic structure of lymph
node. (Feb 1999, 4 Marks)
Or
Write a short note on histology of lymph node.
(Sep 2007, 3 Marks) (June 2010, 5 Marks)
(Oct 2014, 3 Marks)
Or
Write a short note on microanatomy of lymph node.
(May 2014, 5 Marks)
Ans. A section through lymph node shows an outer darkly
stained zone cortex and an inner medulla. Cortex is
darkly stained because it consists of densely packed
lymphocytes and medulla is lightly stained because it
has fewer lymphocytes.
Fig. 12: Lymph node (For colour version see Plate 15)
Supporting Elements of Lymph Node
♦ Lymph node is surrounded by a connective tissue capsule.
It is generally made up of dense connective tissue.
♦ Trabecula extends from capsule into the substance of
lymph node.
♦ Besides capsule and trabeculae, supporting elements in
lymph node are formed by reticular cells and the reticular
fibers, they both constitute a meshwork throughout cortex
and medulla.
♦ Dendritic cells which are present inside the parenchyma
of lymph node originate from bone marrow and present
antigen to specific T cells.
Passage of Lymph Through Lymph Node
♦ Afferent lymphatic vessels pour their lymph in subcapsular
sinus which is placed under the capsule in between capsule
and cortical lymphocytes.
♦ From here lymph flows inside the cortex in trabecular
sinuses and reach to medullary sinus.
♦ Sinuses in the medulla appear as interanastomosing
channels between cords of lymphocytes.
♦ Medullary sinuses drain into an efferent lymphatic vessel
at hilum via which lymph passes out of lymph node.
♦ Endothelium lines the sinuses, but their wall allows the
passage of lymphocytes in and out of sinuses.
Parenchyma of Lymph Node
♦ Parenchyma of lymph node is basically formed by cortex
and medulla.
♦ Cortex is the darkly stained part of lymph node which lies
deep to the capsule.
♦ Cortex is divided into outer and deep cortex.
♦ Lymphocytes are the predominant cells of parenchyma.
♦ Lymphocytes inside the outer cortex are organized in form
of nodules which can be in form of primary nodules or
secondary nodules.
♦ Primary nodules are formed by small lymphocytes which
have heterochromatic nucleus with little cytoplasm and
are deeply stained. Secondary nodules are those which
posses germinal center.
♦ Lymphocytes inside the deep cortex are diffusely arranged.
♦ In the outer cortex B lymphocytes are predominantly
present, while in deep cortex T lymphocytes are predo-
minantly present.
♦ Medulla is known as the inner part of lymph node and has
lymphocytic tissue arranged in cords known as medullary
cord.
♦ Beside the lymphocytes both cortex and medulla consists
of following cells:
Reticular cells: Such cells along with reticular fibers
form framework of lymph node.

(Feb 2002, 4 Marks)
Or
Write in short on histology of spleen.
(Aug 2011, 5 Marks)
Supporting Elements of Spleen
♦ Spleen is covered by capsule made up of dense connective
tissue.
♦ The capsule contains elastic fibers.
♦ From the capsule, trabeculae extend in the substance of
the organ where they repeatedly divide to form a network.
 Histology  247

♦ Small spaces within the trabecular network are occupied

by the delicate meshwork formed by reticular cells and
reticular fibers.
♦ Macrophages are also present in this delicate meshwork.
The spaces of this meshwork are filled by lymphocytes,
macrophages and blood cells. In red pulp these cells are
arranged in the form of cords which itself forms a network.
These cords are called as splenic cords. Spaces between
cords are occupied by blood sinusoids.
♦ The hilus of the organ gives passage to the splenic artery,
vein, nerves and efferent lymphatic vessels.

Fig. 14: Thymus (For colour version see Plate 15)

♦

♦ The delicate supporting stroma of the organ within a

Fig. 13: Spleen
(For colour version see Plate 15)
Pulps of Spleen
♦
i.e. white pulp and red pulp.
♦ In hematoxylin stained section, white pulp appear
♦ Medulla also contains thymic or Hassall’s corpuscles.
basophilic because of presence of small lymphocytes with
heterochromatic nuclei. Red pulp appears red because it
consists of many blood sinuses which are filled with RBCs.
♦ White pulp is the lymphatic tissue sheath which surrounds
the central artery. White pulp consists of lymphocytes and
♦ Macrophages are found in large number both in cortex
macrophages in reticular connective tissue meshwork.
White pulp can also consist of lymphatic nodules with
germinal center. Such nodules are known as splenic
nodules or malphigian corpuscles. Mostly the lymphocytes
in white pulp are T lymphocytes, while nodule consists
predominantly the B lymphocytes.
♦ Red pulp has network of interanastomosing splenic cord
which are made by reticular cells and reticular fibers
containing B and T lymphocytes, macrophages, plasma
cells, RBCs and granulocytes. Such splenic cords are
known as cords of Billroth.
Q.3. Write a short note on histology of thymus.
(Apr 2015, 3 Marks)
Ans. Thymus
Supporting Elements of Thymus
♦ Both the lobes of thymus are completely covered by a thin
layer of connective tissue capsule from which trabeculae
extend into the substance of the organ.
lobule is formed by epithelioreticular cells. These cells
are stellate in shape and their cytoplasmic processes are
joined with the processes of neighboring cells with the
help of desmosomes. Thus, epithelioreticular cells form a
cytoplasmic reticulum within the thymus.
Structure of Thymus Lobule
♦ Each lobule of thymus is surrounded by connective tissue
stroma and contains an outer cortex and inner medulla.
Cortex is darkly stained because of densely packed small
lymphocytes with heterochromatic nuclei. The outer
cortex receives stem cells from bone marrow which divide
repeatedly to form small lymphocytes.
These are masses of concentrically arranged type VI
epithelioreticular cells around a central degenerated
homogeneous mass. The Hassall’s corpuscles stain pink with
acid dyes and their number increases with increasing age.
and medulla.
Q.4. Write a short note on microscopic anatomy of tonsil.
(Sep 1999, 4 Marks) (Sep 2001, 6 Marks)
Or
Write a short note on histology of palatine tonsil.
(Apr 2003, 5 Marks) (Feb 2013, 5 Marks)
(Dec 2010, 5 Marks) (Jan 2012, 5 Marks)
Or
Write in brief about microanatomy of palatine tonsil.
(Sep 2015, 5 Marks)
Or
Write a short note on histology of tonsil.
(Apr 2017, 4 Marks)
Or
Write short answer on microscopic structure of tonsil.
(Aug 2018, 3 Marks)
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Ans. •  The outer covering of the palatine tonsil consists of 4. Stratum lucidum: This layer is seen only in thick skin.
connective tissue capsule and the pharyngeal part
is covered by stratified squamous nonkeratinized
epithelium which is invaginated to form crypts.
• Palatine tonsil consist of only efferent lymph vessels.
• Palatine tonsil has no cortex and medulla and the
lymphocytes remain united as small follicles along
the side of crypts.
In some of the follicles the germinal centers should
be seen.
Cells in this layer are flattened, translucent, eosinophilic
and without any organelles including nucleus.
5. Stratum corneum: It is the most superficial layer of
epidermis. It is composed of structureless dehydrated
dead cells. The interior of the cell is filled with keratin. The
thickness of stratum corneum is much more in thick skin
compared to thin skin.
Dermis
Dermis is predominantly made up of collagen bundles. It also
contains elastic fibers, connective tissue cells, nerves, lymphatics
and blood vessels. Dermis is usually divided into two layers:
1. Papillary layer: It is a narrow band of loose connective
tissue in contact with basement membrane of stratum
basale. This layer shows finger-like processes projecting
into undersurface of epidermis. These projections are called
as dermal papillae. The papillae contain type I collagen
and elastic fibers, nerves, blood vessels and various types
of connective tissue cells.

Fig. 15: Tonsil

(For colour version see Plate 15)

Palatine Tonsil
♦ Palatine tonsil consists of protective layer of stratified
squamous nonkeratinized epithelium.
♦ It shows invaginations by deep grooves known as crypts.
♦ A dense connective tissue underlies the tonsil and forms
its capsule consisting of some blood vessels.
♦ Below the epithelium, numerous lymphatic nodules are
distributed which merge frequently with each other and
exhibit lighter staining germinal center. Fig. 16: Skin (For colour version see Plate 15)
♦ Tonsillar crypts usually consist of dead antigen, broken
debris, disarmed bacteria, etc. 2. Reticular layer: The reticular layer of skin is an example of
dense irregular connective tissue. It contains coarse bundles
of type I collagen, thick elastic fibers, nerves, blood vessels
7. SKIN and few connective tissue cells, i.e. fibroblasts, mast cells,
lymphocytes, macrophages and fat cells.
Q.1. With the help of labeled diagram briefly describe
histology of skin. (Mar 1996, 5 Marks)
Ans. Skin
Skin consists of two layers, i.e. epidermis and dermis. 8. RESPIRATORY SYSTEM
Epidermis
It consists of stratified squamous (keratinized) epithelium.
Following five layers can be distinguished in thick skin from
deep to superficial surface.
1. Stratum basale: It consists of a single layer of cuboidal
cells which are situated on the dermis. A thin basement (Dec 2010, 5 Marks)
membrane is situated between stratum basale and dermis. Ans. Trachea
2. Stratum spinosum: It consists of several layers of polygonal Trachea divides into two principal (or primary) bronchi.
cells which are held together by desmosomes. The trachea and primary bronchi consist of four layers:
3. Stratum granulosum: This layer is made up of 3–5 layers a. Mucous membrane (epithelium and lamina propria):
of flattened polygonal cells. These cells are filled with The epithelium is pseudostratified ciliated columnar
keratohyalin granules. with goblet cells. The epithelium rests on thick basal

lamina. Three different types of common cells of
epithelium are ciliated cells (30%), goblet cells (28%) 9. THE DIGESTIVE SYSTEM I: ORAL CAVITY
and basal cells (29%). Lamina propria of trachea and
principal bronchi is made up of loose connective
tissue which is rich in elastic fibers. It may also
contain lymphatic tissue in both diffuse and nodular
forms.
b. Submucosa:Intrachea,itisdifficulttodistinguishthe
boundary between lamina propria and submucosa.
At the junction of two there is a dense layer
of elastic fibers which is seen with special stain.
The submucosa contains mixed seromucous
glands whose ducts open onto the surface of
epithelium.
c. Cartilage and smooth muscle layer: This layer
consists of hyaline cartilaginous ring separated by
interspaces bridged by fibroelastic connective tissue.
The rings of cartilage are incomplete posteriorly. The Enamel
gap is filled by smooth muscle (trachealis) and by
fibroelastic tissue.
d. Adventitia: External to cartilaginous ring there is
a layer of connective tissue that is rich in elastic
fibers.
Fig. 17: Trachea (For colour version see Plate 15)
Q.2. Draw a diagram to show histological features of lung.
(Mar 2006, 2.5 Marks) (Mar 2009, 2.5 Marks)
Ans. Lung
Fig. 18: Lung
(For colour version see Plate 15)
Histology  249
Q.1. Write a short note on histology of tooth.
(Nov 2009, 5 Marks) (Jan 2012, 5 Marks)
(Aug 2018, 5 Marks)
Ans. Dentin
• Dentin is characterized by dentinal tubules radiating
outward from the pulp cavity to the outer wall of
tooth. These tubules in living state are occupied by
the processes of odontoblasts. These cells line the
pulp cavity and are tall columnar in shape.
• Dentin is laid down in layers that lie parallel to
pulp cavity. The layer of newly formed dentine
near the apical end of odontoblasts which is yet to
be mineralized is called as predentine.
♦
♦ Enamel is an extracellular product of enamel organ cells. It
is produced by a layer of columnar cells called ameloblasts
that covers the crown as an epithelial membrane.
Cementum
♦ Cementum covers the dentine of the root. It extends from
the enamel at the neck (from dentinoenamel junction) to
the apical pore. It is bone-like tissue. It is mineralized. It
contains cementocytes which reside in lacunae.
♦ Cementocyte also contains many processes within
canaliculi which radiate from lacunae. Collagen bundles
of periodontal membrane are anchored to the cementum.
Periodontal Ligament
♦ Periodontal ligament connects cementum to the bone
of alveolar socket. It consists of cells and extracellular
substance. PDL comprises of bundles of collagen fibers.
♦ These group of fibers have specific orientation and are
called as principle fibers. They are as follows:
1. Alveolar crest group of fibers: Extending from the crest
of alveolar bone to the cervical part of the cementum.
2. Horizontal group: Running horizontally between
cementum and alveolar bone and arranged perpendi-
cular to the long axis of the tooth.
3. Oblique group: Are arranged obliquely from
cementum to alveolar bone and insertion in cementum
is more apical than insertion in bone. These constitute
the major group of fibers.
4. Apical group: Are located in the apical region of the
tooth radiating from the apex of the root to the base
of alveolar socket.
5. Interradicular fibers: Interradicular fibers are inserted
in cementum from crest of interradicular septum in
the multirooted teeth.
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Gingival Group of Fibers • Lingual salivary glands of posterior l/3rd of tongue are
mostly mucous in nature and are located in muscular
These are the secondary fibers of periodontal ligament seen in
layer. These glands open into the recesses of mucosa.
the lamina propria of the gingival and supplement the principal
Lingual papillae: Body of tongue (anterior 2/3rd), on
fibers in maintaining the functional integrity of the teeth. These
its dorsal surface, is covered with the specialization
include:
of epithelium called the lingual papillae. Lingual
1. Dentogingival: Extending from the cervical portion of the
papillae are projections of lamina propria covered
cementum to the lamina propria of gingiva.
with stratified squamous epithelium which may
2. Dentoperiosteal: Extending from cementum to the
be keratinized. Many papillae contain taste buds.
periosteum of the alveolar crest and of the vestibular and
The papillae are of four types: Filiform, fungiform,
oral surface of the alveolar bone.
circumvallate and foliate. The foliate papillae are not
3. Alveologingival: Extending from the crest of the alveolar
well developed in humans.
bone to the lamina propria of gingiva. Filiform papillae: These are most numerous of the
4. Circular fibers: These fibers are arranged in the gingival lingual papillae covering most of the anterior 2/3rd
connective tissue, encircling the tooth like a collar. of the tongue. These are conical projections about
5. Trans-septal fibers: Are also accessory fibers extending 2-3 mm in length. Their tips are keratinized. These
interproximally between adjacent teeth. papillae are distributed in parallel rows. Filiform
Dental Pulp papillae contain no taste buds; they increase the
friction between tongue and food.
In the pulp four distinct zones are seen microscopically:
1. Odontoblastic zone: This is the most peripheral zone of
pulp seen adjacent to the predentine layer. Odontoblast
cells are columnar in the crown and flattened in the root.
They have process at their apical portion extending into
the dentinal tubules.
2. Cell free zone: Beneath the odontoblast layer is cell free
zone of Weil which is devoid of cells, but has fibers and
nerves.
3. Cell rich zone: This zone is seen beneath the cell free zone
and is rich in cells. Cells present are mainly fibroblasts and
progenitor cells.
4. Pulp core: Central portion of pulp is called pulp core
that contains cells, large blood vessels and nerves, etc.
distributed in the ground substance.
Q.2. Write a short note on microscopic structure of tongue. Fig. 19: Filiform papillae (For colour version see Plate 16)
(Feb 1999, 4 Marks) (Dec 2010, 5 Marks)
(May 2017, 3 Marks) (Aug 2012, 4 Marks) Fungiform papillae: They are found distributed
among the filiform papillae. Their shape is like
Or mushroom and they project above the filiform
Write a short note on histology of tongue. papillae. They have highly vascularized connective
(Dec 2012, 3 Marks) (Dec 2014, 5 Marks) tissue core; hence, visible as red dots. The taste buds
(Apr 2017, 4 Marks) are present in the epithelium on its dorsal surface.
Ans. Tongue
• Tongue is an accessory digestive organ composed
of skeletal muscle covered with mucous membrane.
Lining mucosa consists of stratified squamous
epithelium and a lamina propria.
• An inverted V-shaped groove, the sulcus terminalis,
divides the dorsal aspect of tongue into anterior 2/3rd
(body of tongue) and posterior l/3rd (root of tongue).
The dorsal aspect of root of tongue (posterior l/3rd)
contains many oval or rounded elevations which
are due to the lingual tonsils. These elevations may
contain lymph nodules and may show presence
of germinal center in it. Elsewhere, where lymph
nodules are not present, the mucosa shows the
general properties of lining mucosa. Fig. 20: Fungiform papillae (For colour version see Plate 16)

Circumvallate papillae: Circumvallate papillae are
situated just in front of the sulcus terminalis. They
are about 8 to 16 and each one measures about 1–2
mm in diameter. Each papilla is surrounded by a
circular sulcus (trench). The stratitied squamous
epithelium covering the free surface is smooth while
the epithelium covering the walls of sulcus (trench)
contains many taste buds. At the bottom of trench
there are openings of the ducts of serous glands of
Von Ebner which are situated in submucosa.
Fig. 21: Circumvallate papilla
(For colour version see Plate 16)
Q.3 Write in brief histology of anterior two-third of
tongue. (Feb 2013, 5 Marks)
Ans. Anterior two-third portion of tongue is also known as
papillary portion of tongue.
• On anterior part there are numerous fine pointed,
cone shaped papillae which give it velvet-like
appearance.
• The body of tongue (anterior 2/3), on its dorsal
surface, is covered with the specialization of
epithelium called the lingual papillae. The lingual
papillae are projections of lamina propria covered
with stratified squamous epithelium which may
be keratinized. Many papillae contain taste buds.
The papillae are of four types: Filiform, fungiform,
circumvallate and foliate. The foliate papillae are not
well developed in humans.
Filiform papillae: These are most numerous of
the lingual papillae, covering most of the anterior
2/3 of the tongue. These are conical projections
about 2-3 mm in length. Their tips are keratinized.
These papillae are distributed in parallel rows.
Filiform papillae contain no taste buds; they
increase the friction between tongue and food.
Fungiform papillae: They are found distributed
among the filiform papillae. Their shape is
like mushroom and they project above the
filiform papillae. They have highly vascularized
connective tissue core; hence, visible as red dots.
The taste buds are present in the epithelium on
its dorsal surface.
Histology  251
Circumvallate papillae: Circumvallate papillae
are situated just in front of the sulcus terminalis.
They are about 8 to 16 and each one measures
about 1 2 mm in diameter. Each papilla is
surrounded by a circular sulcus (trench). The
stratitied squamous epithelium covering the free
surface is smooth, while the epithelium covering
the walls of sulcus (trench) contains many taste
buds. At the bottom of trench there are openings
of the ducts of serous glands of Von Ebner which
are situated in submucosa.
For histological diagram refer to Ans 22 of same
chapter.
Q.4. Write a short note on microscopic anatomy of parotid
gland. (Sep 2000, 4 Marks) (Feb 2016, 3 Marks)
 (July 2016, 5 Marks)
Or
Write a short note on microscopic structure of parotid
gland. (Sep 2013, 5 Marks)
Or
Write a short note on histology of serous salivary
gland. (Aug 2016, 3 Marks)
Ans. Parotid Gland
Parotid gland is the largest salivary gland. It has a well-
defined capsule. Septa divide the gland into lobes and
lobules.
a. Secretory acini: Acini are purely serous in nature.
Serous acini are smaller in size and rounded in
shape. Lumen of serus acini is very small or is
obliterated. The gland has abundant myoepithelial
(basket) cells that help to expel the secretory product
from lumen of acinus.
b. Serous cells: Serous cells are mostly pyramidal in
shape and are small in size. When these cells are
stained with H & E stain, these cells take up the dark
stain. Nuclei of the cell are rounded and are placed
near the center but are more toward the basal part of
cell. Apical portion of the cell is filled with secretory
granules or zymogen granules. Base of serous cell is
basophilic and apical portion is acidophilic.
c. Ducts: Interlobular ducts are present in the
connective tissue septa. These ducts may be lined
by simple columnar or pseudostratified columnar
epithelium. The intralobular ducts are seen between
acini. The intercalated ducts are lined by simple
squamous to low cuboidal epithelium. They are long
and branching in parotid gland. The striated ducts
are lined by simple low columnar epithelium and
show basal striations. Striations are responsible for
bright eosinophilic (acidophilic) staining reaction
of these ducts. Adipose tissue may be seen among
acini and smaller ducts.
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.5. Write a microscopic anatomy of submandibular

salivary gland. (Sep 2001, 6 Marks)
Or
Write a short note on histological structure of salivary
gland. (Oct 2007, 5 Marks) (Mar 2008, 3 Marks)
Or
Write short note on histology of mixed salivary gland.
(Feb 2014, 3 Marks)
Ans. Submandibular Salivary Gland

Fig. 22: Submandibular gland

(For colour version see Plate 16)

Submandibular gland is a mixed gland. It has a well-

defined capsule and septa which divide the gland into (Aug 2016, 2 Marks)
lobules. Ans.

Fig. 23: Taste bud (H&E Stain) (For colour version see Plate 16)

Q.7. Write a short note on microscopic structure of sub-
mandibular salivary duct. (Oct 2016, 3 Marks) ♦
Ans. Submandibular salivary duct is also known as Wharton’s
duct.
♦ Wharton’s duct begins as tiny branches in superficial lobe and
runs posteriorly emerging from anterior aspect of deep lobe.
♦ Wharton’s duct is an excretory duct.
Submandibular salivary gland duct is lined by stratified
columnar epithelium.
♦

cells. In large ducts occasionally goblet cells and ciliated
cells can be seen.
♦ Ductal epithelium slowly undergoes a transition to
stratified, cuboidal and finally into stratified squamous
epithelium when it merges with the epithelium of oral
cavity.
♦ It also consists of small number of other types of cells, i.e.
tuft or brush cells with long stiff microvilli.
♦ Sometimes cells with pale cytoplasm and dense nuclear
chromatin are seen at the base of duct epithelium. These
are lymphocytes and macrophages.
10. THE DIGESTIVE SYSTEM II:
ALIMENTARY CANAL
 and is divided into many lobes, i.e. right, left, caudate
(Mar 2006, 5 Marks)
Ans. Duodenum
Fig. 24: Duodenum
lt consists of four layers, i.e. mucosa, submucosa, muscle
layer and serosa/adventitia.
Mucosa: In duodenum, mucosa and submucosa are
thrown into circular folds called as plicae circularis.
The plicae are covered with villi. Villi are finger-like
mucosal projections. Core of each villus is formed by
loose connective tissue of lamina propria containing
fenestrated capillaries, smooth muscle fibers and
lymphatics (blind end lacteals). Surface of villi is
covered by epithelium consisting predominantly of
columnar cells with striated border (microvilli). In
between the columnar cells few goblet cells are also
present.
♦ Between the laminae blood passageways are present
Submucosa
Submucosa is almost completely occupied by highly branched,
tubuloacinar duodenal glands (Brunner s gland). Ducts of
these glands pass through muscularis mucosae and open into ♦
the lumen of duodenum. The acini of duodenal glands secrete
mucus, hence take light stain. These acini are lined with cuboidal
or low columnar cells.
Histology  253
Muscular Layer
It is made up of outer longitudinal and inner circular layers of
smooth muscle.
Serosa/Adventitia
As most of duodenum is retroperitoneal, some parts of its
surface may show serosa; otherwise, it is covered by adventitia.
11. THE DIGESTIVE SYSTEM III:
LIVER, GALLBLADDER AND PANCREAS
Q.1. Write a short note on histology of liver.
(Jan 2018, 5 Marks)
Ans. Liver is surrounded by a thin connective tissue capsule
and quadrate lobes.
Hepatic artery, bile duct and portal vein enter the liver
at porta.
Connective tissue which enters the liver at porta with
other structures branches inside the liver to form partial
boundary of liver lobules and support branching vessels
and ducts. Lobules are not well-defined in humans as
their interlobular connective tissue or interlobular septa
are poorly developed.
Branches of portal vein, hepatic artery and bile duct
course together in intralobular septa as triad known as
portal triad.
Microscopic Organization of Liver
♦ Substance of liver is formed by liver lobules and in cross
section liver lobule appears as hexagon.
♦ In human liver, the connective tissue between adjacent
lobules is scanty.
♦ At corners of hexagon small triangular areas of connective
tissue are present which consists of portal triads. So at
around periphery of each lobule several portal triads are
present.
♦ As boundary of hexagonal lobule touches each other,
every portal triad forms a partial boundary for more than
one lobule.
♦ Center of each hepatic lobule consists of a central vein.
♦ Hepatic cells, i.e. hepatocytes radiate from central vein
and are arranged in plates, i.e. laminae which are one cell
thick. Such plates anastomose to form three-dimensional
network.
known as sinusoids. Lateral branches of small hepatic
artery and portal venules which arise from portal triad,
join to form hepatic sinusoids.
Bile canaliculus is a small channel which occur at
interphase between adjacent pair of liver cells in plate.
Wall of canaliculus is formed by plasma membrane of
contralateral hepatocytes.
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ A hepatocyte is exposed on its two to three sides to
sinusoids via which blood flows towards the central vein.
Same hepatocyte also forms bile canaliculi over its left out
three or four remaining sides.
A empty.
B Over its inferior surface gallbladder get covered by serosa and
Figs 25A and B: Liver (For colour version see Plate 17)
Fig. 26: Gallbladder (H&E stain) (For colour version see Plate 17)
Q.2. Write a short note on histology of bladder.
(Jan 2018, 5 Marks)
Ans. There are two important bladders present in human
body, i.e. gallbladder and urinary bladder.
Gallbladder
Gallbladder is known as the temporary store house of bile and
concentrates it by water re-absorption.
Gallbladder consists of following layers, i.e.
♦ Mucosa
♦ Fibromuscular layer
Mucosa
♦ It has simple tall columnar epithelium and lamina propria
of loose connective tissue.
♦ Serosa/adventitia
♦ Mucosal glands and muscularis mucosae are absent.
♦ Mucosa remains in small folds when gallbladder is
♦ Epithelial cells present in gallbladder consist of basally
placed oval nucleus and faintly stained eosinophilic
cytoplasm. These cells consist of many small microvilli
over their apical surface.
♦ Lamina propria is present but submucosa is absent.
Fibromuscular Layer
♦ It consists of randomly arranged smooth muscle fibers.
♦ Between the muscle fibers, there lies the dense connective
tissue which is rich in elastic fibers.
♦ A layer of dense connective tissue lies outside the muscular
layer which has blood vessels, nerves and lymphatics. This
layer is known as adventitia.
Serosa
rest of it is covered by adventitia.
 Histology  255

Urinary Bladder • Exocrine part forms the major portion and consists
of secretory serous acini and zymogenic cells which
The urinary bladder consists of following layers, i.e.
are arranged in small lobules bounded by thin
♦ Mucosa
intralobular and interlobular connective tissue septa
♦ Muscle layer
which have interlobular ducts and blood vessels.
♦ Serosa/adventitia
Endocrine part is represented by isolated pancreatic
islets or Islets of Langerhans which are present
between serous acini. Islet of Langerhans are small
isolated mass of cells and are distributed throughout
pancreas. These are most numerous in tail.
Each of the acinus has pyramidal shaped protein
secreting cell which surrounds the small lumen.
Ducts of acinus are visible as centroacinar cells
and secretions leave through intralobular ducts to
interlobular ducts.

Fig. 27: Urinary bladder (H&E stain) (For colour version see Plate 20)

Mucosa
♦ It is made up of transitional epithelium as well as lamina
propria.
♦ Empty bladder shows many of the mucosal folds and its
epithelium increases in thickness till eight cell layers.
♦ Superficial layer is stained eosinophilic because of presence
of plaques. These plaques are the modified areas of plasma
Fig. 28: Pancreas (For colour version see Plate 17)
membrane.
♦ When the bladder got filled the mucosal folding disappears Islets get separated from acini by thin layer of
and epithelium become thin from 3 to 4 cells. reticular fibers and are compact cluster of epithelial
♦ Lamina propria is formed by moderately dense connective cells permeated by capillaries and have alpha, beta,
tissue. delta and F cells.
Muscular Layer • Beta cells are most important cells, they form 80%
of the cell population. Beta cells are granular and
♦ Thick muscle coat is formed by smooth muscle fibers which
basophilic.
run in all the directions.
• Alpha cells form 20% of the cell population and are
♦ In between bundles of muscle fibers there present is loose
granular and acidophilic. They have subtypes A1
connective tissue.
♦ Three muscular coats are described, i.e. transverse, and A2.
longitudinal and oblique. These muscular coats are difficult
to distinguish. 12. THE ENDOCRINE SYSTEM
♦ At trigone the mucosa is thin and is directly applied to
muscle layer.
Q.1. Write a short note on light microscopic structure of
Serosa/Adventitia pituitary gland. (Sep 2004, 5 Marks)
Ans. Hypophysis or pituitary gland consists of two parts
Serosa cover the superior surface of bladder and rest all the
which are distinct in structure and function, i.e.
surfaces are covered by tunica adventitia.
adenohypophysis and neurohypophysis.
Q.3. Describe briefly histology of pancreas.
(Apr 2008, 5 Marks) Adenohypophysis
Ans. Pancreas consists of both endocrine part and exocrine ♦ Adenohypophysis consists of three subdivisions, i.e. pars
part. distalis, pars intermedia and pars tuberalis.
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦ Axonal processes are associated with pituicytes which

resemble to neuroglial cells.
♦ Inside the axoplasm, hormone remains in the form of
secretory vesicles and reaches axon terminal in posterior
pituitary gland. Collection of these secretory granules
at terminal portion of axonal processing is known as
Herring’s bodies.
Q.2. Draw a well-labeled diagram of microscopic anatomy
of thyroid gland.
(Mar 2000, 6 Marks)
Or
Fig. 29: Pituitary gland adenohypophysis (pars distalis)
(For colour version see Plate 18)
♦ Pars distalis is the major subdivision and cells of pars
distalis are arranged as irregular cords or clusters between
thin walled fenestrated sinusoids.
♦ Pars distalis consists of two types of cells, i.e. chromophils
and chromophobes. Chromophils consists of secretory
granules and are stained darkly, while chromophobes has
few or no granules and are stained poorly.
♦ Chromophils are of two types, i.e. H&E stained sections it
is seen that one type of cells has secretory granules which
stain blue and these cells are known as basophils or beta
cells, while other cells consists of secretory granules which
stain pink and are known as acidophils or alpha cells.
Fig. 31: Thyroid gland
♦ Chromophobes consists of few secretory granules and are
(For colour version see Plate 18)
considered as degranulated chromophils.
♦ Pars intermedia consist of numerous basophils. Q. 3. Write a short note on microscopic structure of thyroid
♦ Pars tuberalis has cords or clusters of chromophilic and gland. (Sep 2017, 3 Marks) (Jan 2012, 4 Marks)
chromophobic cells.

Neurohypophysis
♦ It consists of median eminence, infundibular stalk and
pars nervosa.
♦ Pars nervosa consists of unmyelinated axons and axon
terminals of more than 100,000 neurosecretory neurons
whose cell bodies are located in paraventricular and
supraoptic nuclei of hypothalamus.

Fig. 30: Pars nervosa (For colour version see Plate 18)
 Histology  257

vesicular and rounded nucleus. The cytoplasm takes
light eosinophilic stain in H&E preparation.
A few cells called parafollicular cells may be
embedded within a follicle or lie between follicles.
They are not exposed to the lumen of follicle.
Parafollicular cells are either found singly or in small
groups. Nucleus is round or ovoid and cytoplasm
contains secretory granules. They are pale or light
staining cells. They secrete hormone calcitonin. These
cells are difficult to visualize under light microscope.
Q.4. Write a short note on histology of adrenal gland.
(Jan 2012, 5 Marks)
Ans. Gland consist of two structurally and functionally
distinct parts, i.e. a centrally located medulla and an
outer cortex.
3. Zona reticularis: It is a thin zone situated adjacent to
medulla. It consists of small, rounded, deeply staining
cells which are arranged in three-dimensional network of
branching and anastomosing cords.
Structure of Adrenal Medulla
Cells of medulla are large, epithelioid and arranged in groups
or short cords. These cells are closely related to sinusoidal
capillaries which drain into medullary veins. The cytoplasm is
relatively clear or light basophilic in H&E preparation.
Medulla may show the presence of sympathetic ganglion cells
present between the medullary cells. Cells of adrenal medulla
are innervated by preganglionic sympathetic myelinated fibers.
13. THE URINARY SYSTEM

Fig. 32: Adrenal cortex

(For colour version see Plate 18)

Structure of Adrenal Cortex

It has 3 zones or layers which are not sharply demarcarted
from each other, i.e. zona glomerulosa, zona fasciculate and
zona reticularis.
1. Zona glomerulosa: It is a thin outer zone situated beneath
the capsule. The cells of zona glomerulosa are arranged in
arches which when sectioned resemble rounded clusters or
ball of cells (hence the term glomerulosa). These clusters
of cells are separated by thin connective tissue septa
extending inward from the capsule. Cells of this zone are
columnar in shape and have dark staining spherical nuclei
and acidophilic cytoplasm containing few lipid droplets.
2. Zona fasciculata: It is a thick (widest) zone situated in the
middle of cortex. Zona fasciculata consists of large, pale
staining polyhedral cells arranged into parallel columns or
cords oriented in radial direction with respect to medulla.
Each of these parallel columns or fascicles (hence the
term fasciculata) is usually one- or two-cell thick. There is
presence of fenestrated sinusoidal capillaries between the
columns.
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)
other nephrons are called as cortical nephrons. A
nephron, its collecting tubule and collecting duct
together form a unit called as uriniferous tubule.
Q.2. Write a short note on histology of kidney.
(Mar 2009, 2.5 Marks) (Mar 2006, 3 Marks)
(June 2010, 5 Marks) (Nov 2008, 5 Marks)
Renal Corpuscle
♦ This is also known as malpighian corpuscle.
♦ Renal corpuscle consists of Bowman s capsule and
glomerulus.
♦ Bowman s capsule consists of outer parietal layer and
inner visceral layer.
♦ Parietal layer is lined by simple squamous epithelium and
visceral layer is lined by podocytes.
♦ Space between parietal and visceral layer is known as
urinary space or Bowman s space.
♦ At urinary pole space between both visceral and parietal
layer is continuous with lumen of proximal convoluted
tubule.
♦ Squamous epithelium of parietal layer at urinary pole
is continuous with cuboidal epithelium of proximal
convoluted tubule.
♦ Visceral epithelium of Bowman’s capsule is very closely
applied to endothelial lining of capillaries.
♦ Cells of visceral layer become modified and are known
as podocytes. These podocytes has many radiating
processes which consist of secondary processes known
as foot processes or pedicles. Foot process of neighboring
podocytes interdigitate with each other.
♦ Foot processes get separated from each other by narrow
intercellular spaces which are known as filtration slits and
gap of filtration slit is occupied by filtration slit membrane.
Proximal Convoluted Tubule
♦ It begins from urinary pole of renal corpuscle and extends
to thick portion of descending limb of Henle.
♦ This is seen only in the cortex.
♦ Complete tube is lined by simple cuboidal or low columnar
epithelial cells. Tubules consist of small uneven lumen.
♦ Brush border is formed by tall microvilli on apical surface
of cells.
♦ Nuclei is round and is centrally placed. Cytoplasm gets
deeply stained by the eosin.
Loop of Henle
♦ Proximal convoluted tubule continues down to medullary
ray and medulla as loop of Henle.
♦ Both descending as well as ascending thin limbs of loop
are of 15 µm in diameter and lined by squamous epithelial
cells which bear few microvilli.
♦ Cytoplasm is pale staining and nuclei get bulge inside
small lumen.
♦ Histological structure of thick descending limb of loop
of Henle is similar to proximal convoluted tubule, while
histological structure of thick ascending limb of loop of
Henle is similar to distal convoluted tubule.
Distal Convoluted Tubule
♦ It is half the length of proximal convoluted tubule.
♦ Tubules are lined by cuboidal epithelium.
♦ Cytoplasm of cell is light eosinophilic.
♦ Brush border is absent and height of cuboidal cells is less.
Collecting Tubules
♦ They start inside the cortex and proceed to medullary
ray where they join large collecting tubules known as
collecting ducts.
♦ Inside the medulla these collecting ducts run to apex of
pyramid and join each other to form duct of Bellini.
♦ Collecting tubules and ducts are lined by cuboidal to low
columnar epithelium.
♦ Cells are lightly stained with eosin and their outline is clear.
♦ Lumen of tubules and ducts are large.
Fig. 33: Kidney
(For colour version see Plate 18)
14. MALE REPRODUCTIVE SYSTEM
Q.1. Write short note on histology of testis.
(Aug 2018, 5 Marks)
Ans. Testes lie outside the body cavity in the scrotum and are
ovoid in shape.
♦ Testis consists of thick white fibrous connective
tissue capsule known as tunica albuginea.
♦ Tunica vasculosa is highly vascularized connective
tissue, which underlies tunica albuginea.
♦ Over posterior border of testis, dense connective
tissue of tunica albuginea projects inside its
interior and forms mediastinum of testis. Via the
mediastinum blood vessels, nerves and ducts of
testis enter and leave the organ.
♦ Connective tissue septa extend in between
mediastinum and tunica albuginea and divide
the testis into about 250 compartments known as
lobules.
 Histology  259

Fig. 34: Testis (For colour version see Plate 19)

♦ Each lobule consists of one to three tightly coiled

tubules known as seminiferous tubules. These
tubules are the sites where sperms production
occurs.
♦ In between seminiferous tubules there is presence of
loose connective tissue (interstitial tissue) and blood
vessels.
♦ Interstitial tissue consists of endocrine cells, Leydig
cells or interstitial cells, which produce testosterone.
♦ At the apex of lobule, near to mediastinum,
seminiferous tubules open into tubuli recti, which
connect an open end of each seminiferous tubule to
rete testis.
♦ Rete testis is epithelial lined labyrinthine spaces Fig. 35: Autonomic ganglion
within the mediastinum testis. As spermatozoa (For colour version see Plate 18)
passes through rete testis, it travels through l0 to 20 • Cells are multipolar, therefore appear irregular in
short tubules known as efferent ducts. These efferent shape. They contain eccentrically placed nuclei with
ducts fuse with epididymis. prominent nucleoli. The cytoplasm contains small
Nissl bodies.
Satellite cells are less in number as compared to
15. THE NERVOUS SYSTEM dorsal root ganglion cells.
• In between nerve cells there is supportive connective
Q.1. Write a short note on light microscopic structure of tissue, blood vessels and bundles of nerve fibers
autonomic ganglion. (Sep 2004, 5 Marks) (both myelinated preganglionic and unmyelinated
Ans. Autonomic Ganglion postganglionic).
Q.2. Write a short note on microscopic structure of
cerebellum. (Feb 2016, 3 Marks)
Ans. In cerebellum, cerebellar cortex is uniform throughout.
• Cerebellar cortex is highly folded and the folds are
known as cerebellar folia.
• Cerebellar folia are separated by transverse fissures
known as sulci.
• Folium consists of an inner core of white matter and
an outer cortex of gray matter which is covered by
thin connective tissue called as pia mater.
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

• Cerebellar cortex consists of three layers: cytoplasm. Dendrites of these cells are present in
1. Molecular layer: It is superficial layer, thick and molecular layer but axons form synaptic contact
is made up of nerve fibers and cells, i.e. stellate with glomeruli in granular layer.
cells above and basket cells below. • Deep to granular layer cerebellar cortex lie in contact
2. Purkinje cell layer: It is made up of purkinje cells with white mater.
or Golgi type I cells. The cells are arranged in
a single row between molecular and granular
layer. Purkinje cells is a large pyriform or flask
shaped neuron which send numerous dendrites
in molecular layer. These dendrites synapse
with axon of granular cells.
3. Granular layer: It is densely packed with very
small granule cells which stain deeply with
hematoxylin. Granular cells are small neurons
with round nuclei and are surrounded by
thin rim of cytoplasm. Granular cells receive
impulses from various parts of central nervous
system through Mossy fibers.
• At junction of molecular and granular layer golgi
Type II cells are found. Vesicular nuclei of Golgi
type II cells are larger than granular cells. Golgi Fig. 36: Cerebellum
type II cells consist of chromophil substance in their (For colour version see Plate 19)
 Histology  261

MULTIPLE CHOICE QUESTIONS

As per DCI and Examination Papers 1 Mark Each
of Various Universities

1. Which cranial nerve nucleus lies below facial 8. Cavity and hindbrain is:
colliculus: a. Lateral ventricle
a. Sensory nucleus of trigeminal nerve b. Third ventricle
b. Abducent nucleus c. Cerebral aqueduet
c. Motor nucleus of facial nerve d. Fourth ventricle
d. Vestibular nuclei 9. Arch of azygos vein is related to the following surface
2. Motor nerve supplying diaphragm is: of lung:
a. Vagus a. Mediastinal surface of right lung
b. Intercostal b. Mediastinal surface of left lung
c. Phrenic c. Coastal surface of right lung
d. Hypoglossal d. Diaphragmatic surface of left lung

3. Which of the following extraocular muscles are in intor- 10. Lumbar puncture is done at disc between:
sion of eyeball: a. T12 L1
b. L1 L2
a. Superior rectus and Superior oblique
c. L2 L3
b. Inferior rectus and Inferior oblique
d. L3 L4
c. Superior rectus and Inferior oblique
d. Inferior rectus and Superior oblique 11. Transverse facial artery is a branch of:
a. Facial artery
4. Following are the nuclei related to glossopharyngeal b. Maxillary artery
nerve except: c. Superficial temporal artery
a. Nucleus ambiguous d. External carotid artery
b. Superior salivatory nucleus 12. One of the following muscles is multipennate muscle:
c. Nucleus of tractus solitarius a. Teres major
d. Inferior salivatory nucleus b. Pectoralis major
5. Lining epithelium of esophagus is: c. Deltoid
a. Simple squamous d. Serratus anterior
b. Stratified squamous nonkeratinized 13. Structure crossing the sternomastoid is:
c. Stratified squamous keratinized a. Accessory nerve
d. Pseudostratified b. Lesser nerve
c. External vein
6. Example of simple coiled tubular type of gland is: d. Transverse cervical artery
a. Salivary gland
b. Brunner s gland 14. The following muscles are derived from 3rd arch:
a. Mylohyoid nerve
c. Gastric glands
b. Stylohyoid
d. Sweat gland
c. Posterior belly of diagastric
7. How many anterior intercostal arteries are present in d. Stylopharyngeous
each typical intercostal space: 15. Ureter is lined by epithelium :
a. One a. Cuboidal
b. Two b. Stratified squamous
c. Three c. Columnar ciliated
d. Four d. Transitional

Answers: 1. b 2. c 3. a 4. b
5. b 6. d 7. b 8. d
9. a 10. d 11. c 12. c
13. c 14. d 15. d
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

16. The following structures pass through internal

auditory meatus except:
a. Facial nerve
b. Abducent nerve
c. Auditory nerve
d. Labryrinthine artery
17. Composition of sex chromosome in Klinefelter
syndrome:
a. XO
b. XY
c. XXY
d. XXX
18. In middle meatus of nose which one of the following
does not open:
a. Maxillary air sinus
b. Frontal sinus
c. Posterior ethmoidal sinus
d. Nasolacrimal duct
19. Blastocyst implant in human beings is:
a. Central
b. Interstitial
c. Eccentric
d. None of these
20. Anterior belly of diagastric muscle is supplied by:
a. Facial nerve
b. Ansa cervicalis
c. Mandibular nerve
d. Maxillary nerve
21. Internal jugular vein is the continuation of:
a. Cavernous sinus
b. Sigmoid sinus
c. Superior sagittal sinus
d. Transverse sinus
22. Vertebral artery is a branch of:
a. Subclavian artery
b. Common carotid artery
c. Brachiocephalic artery
d. Arch of aorta
23. Lining epithelium of tonsils is:
a. Simple squamous
b. Stratified squamous
c. Pseudostratified
d. Transitional
24. Cartilage lining trachea is:
a. Elastic
b. White fibrocartilage
c. Hyaline
d. Cellular

Answers: 16. c 17. c 18. d 19. b

20. c 21. b 22. a 23. b
24. c 25. d 26. d 27. c
28. c 29. c 30. a 31. d
32. b 33. b
 Histology  263

34. Which of the following muscle is supplied by trochlear 42. Medial deviation of eyeball is caused by paralysis of:
nerve: a. Medial rectus muscle
a. Superior rectus b. Lateral rectus muscle
b. Superior oblique c. Superior rectus muscle
c. Inferior rectus d. Inferior rectus muscle
d. Inferior oblique
43. Following structures are contents of the lateral wall of
35. Which part of the internal carotid artery has no cavernous sinus except:
branches: a. Oculomotor nerve
a. Cerebral part b. Trochlear nerve
b. Cervical part
c. Maxillary nerve
c. Petrous part
d. Mandibular nerve
d. Cavernous part
44. Following part of vermis of cerebellum belongs to
36. Following structures are within parotid gland except:
paleocerebellum:
a. External carotid artery
b. Facial nerve a. Culmen
c. Facial artery b. Declive
d. Retromandibular vein c. Folium vermis
d. Tuber vermis
37. Which of the following muscle has got double nerve
supply: 45. Occipital blood sinus lies between the two layers of:
a. Lateral pterygoid a. Falx cerebri
b. Masseter b. Falx cerebelli
c. Medial pterygoid c. Tentorium cerebelli
d. Digastric d. Diaphragma sellae
38. Following structures pass through internal auditory 46. Normally lumbar puncture is done between:
meatus except: a. T12 and L1
a. 6th Cranial nerve b. L1 and L2
b. 8th Cranial nerve c. L4 and L5
c. 7th Cranial nerve d. S1 and S2
d. Labyrinthine artery
47. Supreme intercostal vein draining the first intercostal
39. Nasopharynx has got which of the following type of space drains into:
epithelium: a. Bracheocephalic vein
a. Nonciliated columnar
b. Internal thoracic vein
b. Cuboidal
c. Subclavian vein
c. Ciliated columnar
d. Azygous vein
d. Stratified squamous
48. Following are the branches of left coronary artery
40. Which of the following muscle is depressor of
mandible: except:
a. Temporalis a. Circumflex artery
b. Lateral pterygoid b. Conus artery
c. Masseter c. Marginal artery
d. Medial pterygoid d. Anterior interventricular artery
41. Following are the branches of posterior division of 49. “Alpha cells” of islet of Langerhans are responsible for
mandibular nerve except: secretion of:
a. Buccal a. Glucagon
b. Lingual b. Pancreatic polypeptide
c. Auriculotemporal c. Somatostatin
d. Inferior alveolar d. Insulin

Answers: 34. b 35. b 36. c 37. d

38. b 39. d 40. b 41. a
42. b 43. d 44. a 45. b
49. a
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

50. Following type of epithelium is also called as 59. Number of chromosomes in human beings:
endothelium: a. 44
a. Stratified squamous b. 48
b. Simple squamous c. 23
c. Simple cuboidal d. 46
d. Simple columnar
60. Through foramen ovale passes:
51. Hypoglossal nerve runs over the muscle: a. Mandibular nerve
a. Myelohyoid b. Lesser petrosal nerve
b. Styloglossus c. Accessory meningeal artery
c. Hyoglossus
d. All of the above
d. Palatoglossus
61. Following is the example of commissural fibers of
52. Following bone is the unpaired bone of skull:
brain:
a. Maxilla
b. Temporal a. Internal capsule
c. Occipital b. Fronto-occipital fasiculus
d. Parietal c. Corpus callosum
d. Corona radiata
53. All of the following are example of fibrous joint except:
a. Sutural 62. Motor nerve supply of superior oblique muscle of
b. Syndesmosis eyeball is:
c. Gomphosis a. Optic
d. Symphysis b. Oculomotor
54. Facial artery is: c. Trochlear
a. Terminates at lateral angle of eye d. Abducent
b. Very tortuous 63. Following are the structures opening in the right atrium
c. Branch of internal carotid artery of the heart except:
d. Within the parotid gland a. Superior vena cava.
55. Which of the following muscles of palate is supplied b. Inferior vena cava
by mandibular nerve: c. Coronary sinus
a. Palatoglossus d. Pulmonary veins
b. Tensor veli palatini
64. Floor of fourth ventricle shows following structures
c. Levator veli palatini
except:
d. Palatopharyngeous
a. Vagal triangle
56. First branch of external carotid artery is: b. Facial colliculus
a. Facial c. Vestibular area
b. Superior thyroid d. Pyramid
c. Lingual
d. Ascending pharyngeal 65. Esophageal opening in the diaphragm lies at the
following vertebral level:
57. Thyroid follicles are lined by:
a. T6
a. Simple squamous epithelium
b. Simple cuboidal epithelium b. T8
c. Simple columnar epithelium c. T10
d. None of the above d. T12
58. Odontoblast gives rise to: 66. Lining epithelium of palatine tonsils is:
a. Pulp a. Simple squamous
b. Enamel b. Stratified squamous nonkeratinized
c. Dentin c. Transitional
d. None of the above d. Pseudostratified

Answers: 50. b 51. c 52. c 53. d

54. b 55. b 56. b 57. b
58. c 59. d 60. d 61. c
62. c 63. d 64. d 65. c
66. b
 Histology  265

67. Sensory dorsal root ganglion contains following types 76. Crista galli is the part of:
of neurons: a. Sphenoid bone
a. Pseudounipolar b. Temporal bone
b. Unipolar c. Ethmoid bone
c. Bipolar d. Frontal bone
d. Multipolar
77. Digastric triangle contains except:
68. Pulsations of common carotid artery are felt at: a. Facial artery and vein
a. Anterior inferior angle of massetar b. Submandibular gland deep part
b. In front of tragus of ear c. Submandibular lymph node
c. Superior border of thyroid cartilage d. Submandibular gland superficial part
d. Suprasternal space
78. Mental foramen is located near:
69. How many bronchial arteries supply left lung:
a. Canine of mandible
a. One
b. Ist premolar of mandible
b. Two
c. Three c. IInd premolar of mandible
d. Four d. Canine of maxilla

70. Pars distalis of pituitary gland is formed by the 79. Following muscle is supplied by glossopharyngeal
following parts except: nerve:
a. Infundibulum a. Styloglossus
b. Pars anterior b. Stylohyoid
c. Pars intermedium c. Stylopharyngeous
d. Pars tuberalis d. Sternocleidomastoid
71. Bones developing in certain tendons are: 80. Composition of sex hormones in Turner’s syndrome:
a. Sesamoid bones a. XY
b. Short bones b. XO
c. Irregular bones c. XX
d. Pneumatic bones d. XXY
72. Hair like processes on top of cell moving in one 81. Goblet cell is the example of following type of gland:
direction only are: a. Serous
a. Cilia b. Simple tubular
b. Sterocilia c. Compound tubule alveolar
c. Microvilli d. Unicellular
d. Part of spermatozoa
82. Nucleus of hypoglossal nerve is situated in:
73. Following glands are ectodermal except:
a. Midbrain
a. Pitutary gland
b. Pons
b. Mammary gland
c. Liver c. Medulla oblongata
d. Sweat gland d. Pontocerebellar junction

74. Wharton’s duct is duct of: 83. Type of cartilage present in trachea is:
a. Parotid gland a. Hyaline
b. Sub-mandibular gland b. Elastic
c. Sub-lingual gland c. White fibrocartilage
d. Lacrimal gland d. Cellular
75. All the muscles of soft palate are supplied by accessory 84. Which of the following artery is palpated medial to
nerve (cranial part) except: the tendon of biceps brachii at elbow:
a. Tensor palati a. Axillary
b. Levator palati b. Brachial
c. Palatoglossus c. Radial
d. Palatopharyngeous d. Ulnar

Answers: 67. a 68. c 69. b 70. a

71. a 72. a 73. c 74. b
75. a 76. c 77. b 78. c
79. c 80. b 81. d 82. c
83. a 84. b
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

85. Motor nerve supplying diaphragm is: 93. Number of chromosome in human beings:
a. Intercostal a. 44
b. Vagus b. 23
c. Phrenic c. 48
d. Vago-accessory complex d. 46
86. Anterior interventricular artery is a branch of following 94. Skin over angle of mandible is supplied by:
artery: a. Mandibular nerve
a. Right coronary b. Facial nerve
b. Left coronary c. Greater auricular nerve
c. Arch of aorta d. None of them
d. Descending thoracic aorta
95. Free mobility is on:
87. Base of the heart is formed by following chambers of
a. Fibrous joint
heart:
b. Primary cartilaginous joint
a. Right ventricle and left atrium
b. Left ventricle and right atrium c. Synovial joint
c. Right and left atrium d. Secondary cartilaginous joint
d. Right and left ventricle 96. External carotid artery gives following branches except:
88. Mediastinal surface of left lung is related to the a. Superior thyroid artery
following structure except: b. Facial artery
a. Superior vena cava c. Inferior thyroid artery
b. Arch of aorta d. Occipital artery
c. Pulmonary trunk 97. Secretion of lacrimal gland is:
d. Left subclavian artery a. Serous
89. Sigmoid sinus is a continuation of following sinus: b. Mucus
a. Superior sagittal c. Oily
b. Inferior saggital d. Seromucous
c. Cavernous
98. Auditory tube opens in:
d. Transverse
a. Oropharynx
90. Lumbar puncture is done at a disc between: b. Inferior meatus of nose
a. L1 L2 c. Nasopharynx
b. L2 L3 d. None of them
c. L3 L4
d. L4 – L5 99. The following structures cross the sternomastoid
muscle except:
91. Tracheal cartilages are:
a. External jugular vein
a. Elastic cartilage
b. Greater auricular nerve
b. Fibrocartilage
c. Hyaline cartilage c. Transverse cervical nerve
d. None of them d. Lesser occipital nerve
92. Which of the following muscle is derivative from first 100. Which of the following muscle has got double (dual)
branchial arch: nerve supply:
a. Platysma a. Masseter
b. Cricothyroid b. Buccinator
c. Tensor tympani c. Digastric
d. Levator veli palatine d. Temporal

Answers: 85. c 86. b 87. c 88. a

89. d 90. c 91. c 92. c
93. d 94. c 95. c 96. c
97. a 98. c 99. d 100. c
 Histology  267

101. Pyramids are seen in the following part of the brain: 109. Parietal cells are found in microscopic study of
a. Medulla oblongata following organ:
b. Pons a. Esophagus
c. Midbrain b. Stomach
d. Cerebellum c. Duodenum
102. Lateral rectus muscle of eyeball is supplied by d. Ileum
following nerve: 110. The mediastinal surface of the left lung has all of the
a. Optic following impression except:
b. Oculomotor a. Azygos vein
c. Trochlear b. Arch of aorta
d. Abducent c. Left ventricle
103. Superior and inferior colliculi are seen in: d. Esophagus
a. Spinal cord 111. Patella of knee joint is an example of this type of bone:
b. Medulla oblongata a. Sesamoid
c. Pons b. Short
d. Midbrain c. Irregular
104. Esophageal opening in the diaphragm lies at the d. Pneumatic
following vertebral level: 112. All of the following structures pierce the parotid gland
a. T6 except:
b. T8 a. Facial nerve
c. T10 b. Superficial temporal artery
d. T12 c. Retromandibular vein
105. Epithelium of skin over the palm is: d. Mandibular vein
a. Simple squamous 113. The following is an example of circumpennate muscle:
b. Stratified squamous nonkeratinized a. Bisceps brachii
c. Stratified squamous keratinized b. Pectoralis major
d. Transitional c. Sartorius
106. Following is the most important relay station in pain d. Tibialis anterior
pathway: 114. The hip joint is synovial joint of this type:
a. Medulla oblongata a. Ellipsoid
b. Pons b. Saddle
c. Thalamus c. Hinge
d. Hypothalamus d. Ball and socket
107. Vermilion border is a feature of: 115. The maxillary nerve passes through this foramen at
a. Lip the base of skull:
b. Tongue a. Ovale
c. Esophagus b. Jugular
d. Stomach c. Rotundum
108. Hassal’s corpuscles are histological feature of following d. Lacerum
lymphoid organ: 116. The following organ is extraperitoneal:
a. Lymph node a. Liver
b. Spleen b. Kidney
c. Palatine tonsil c. Stomach
d. Thymus d. Spleen

Answers: 101. a 102. d 103. d 104. c

105. c 106. c 107. a 108. d
109. b 110. a 111. a 112. d
113. d 114. d 115. c 116. b
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

117. All of the following structures pass throughout the 119. The Kupffer cells are phagocytes found in:
sinus of morgagni in pharynx except: a. Lung
a. Auditory tube b. Liver
b. Ascending palatine artery c. Brain
c. Levator palate muscle d. Skin
d. Stylopharyngeous muscle 120. The myelin sheath of axons in CNS is formed by these
118. The only abductor muscle of vocal folds is: cells:
a. Posterior cricoarytenoids a. Astrocytes
b. Oblique arytenoids b. Stellate
c. Thyroarytenoids c. Oligodendrocytes
d. Cricothyroid d. Schwann

Answers: 117. d 118. a 119. b 120. c

 Histology  269

FILL IN THE BLANKS

As per DCI and Examination Papers 1 Mark Each
of Various Universities

1. Ulnar nerve is the branch of 18. Two terminal branches of basilar

…………….. cord of brachial plexus. artery are ……… …………………..
Ans. M Ans. Posterior cerebral artery and Superior cerebral artery
2. 19.
Paralysis of facial nerve leads to What is trigeminal neuralgia
…………………. palsy Ans. ………………………. Ans.
Bell s Trigeminal neuralgia is a neuropathic disorder

3. z
…………. and ………………. forms base of ,
v
heart. Ans.
Right atria and Left atria 20.
Derivatives of somites are
4. ………………………..
Enlargement of pharyngeal tonsil is
Ans. D S , Ax
called as………………….
A k , R
Ans. Adenoid v ,
5. 21.
Middle meningeal artery enters skull Referred pain of appendicitis is felt at
through ……………….. foramen. …………… …………..
Ans. Spinosum Ans. Around the umblicus
6. 22.
Removal of appendix is known as Br onchopulm onar y s egm ent is t he
…………………. Ans. ………… ……………….
Appendectomy Ans. W fi
7. Superior oblique muscle of eye is tertiary or segmental branch
innervated by …… ……………. 23.
Ans. Trochlear Skin of floor of axilla along with adjacent
area of skin of arm is innervated by
8. Mumps is a infectious disease of ……
………. gland ……………..
Ans. Parotid Ans. 2 N v

9. 24.
Myocardium of heart is supplied by Adenoids is an enlargement of
……………………. artery. …………………….. Ans.
Ans. Coronary Tonsil like glands located at the back of nose

10. 25. Sometime patient complaints of loss of taste

Wrist drop is caused by injury to sensation after tonsillectomy due to
involvement of ……………………
…………….. nerve. Ans.
Ans. G v
Radial
26. Base of heart is formed by
11.
……………………….
Action of lateral pterygoid muscle is
Ans. L x k
…………………… Ans. atrium.
Depress mandible to open mouth.
27. Lateral rectus muscle of eye is innervated
12. by ……… ………………….
Nerve supply of stylopharyngeous Ans. O v
………………… Ans.
28. Maxillary nerve leaves skull through
G v
…………… …………..
13. Ans. Foramen rotundum
Danger area of face is ……………………..
29. If right hypoglossal nerve is damaged,
Ans. Upper lip and lower part of nose tongue will deviate to …………………….
14. Nerve supply of upper lip is by Ans. Left
……………..
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

32. Superior oblique muscle of eye is v

supplied by ………………………… v
Ans. v v v
33. v
Removal of tonsil is known as 40. Tributaries of internal jugular vein.
………………………. Ans. Ans. M v
Tonsillectomy S v
34. L v
Referred pain of gallbladder is felt at C v
…………… ....................................................................................... P v
Ans. Epigastric region Inferior petrosal sinus
35. 41. Lobes of cerebral hemisphere.
……………. and ………………. forms base of Ans. Frontal Parietal
heart. Ans. Temporal Occipital
Right atria and left atria 42. Dangerous area of face.
36. Ans. It consists of area from the corners of the mouth
Actions of sternomastoid muscle. to the bridge of the nose,
Ans. Rotate the head to the opposite side or obliquely rotate x
the head. 43. Importance of sternal angle.
Ans. Sternal angle is an important bony landmark at the T4
fl x k v v
 
M  L j v
W fl x k So it is a reference point in counting ribs.
2. Oblique muscles
x head.
S q   q 44. Parts of large intestine.
3  L v
W Ans. Cecum Ascending colon
• v • D
38. ( )
Epithelium lining palatine tonsil.
Sigmoid colon Rectum
Ans. ( ) fl x side.
S fi q
Anal canal
37. Name extraocular
39. Nerves innervatingmuscle. Ans.
taste buds on tongue. 45. Derivative of 1st pharyngeal arch.
 R
Ans. v Ans.
S
v

Skeletal Cartilage Bone Ligament Artery Nerve

Muscles of mastication, Meckle’s cartilage Zygomatic bone, maxilla, Anterior malleolar Maxillary artery Maxillary and
mylohyoid, tensor veli palati, mandible, part of temporal ligament, and contribution mandibular
tensor typmpani and anterior bone, spine of sphenoid, sphenomandibular to external carotid divisions of
belly of digastrics incus and malleus ligament artery trigeminal nerve

46. Name any one nerve surrounding the oral cavity. 50. What is carotid sheath.
Ans. F v Ans. It is the condensation fi
47. Name any one branch of mandibular nerve. v k v v
Ans. v v 51. Which lung has groove for aorta.
48. What is morula. Ans. Left Lung
Ans. A morula is an embryo at an early stage of embryonic
52. Name the suprahyoid muscles.
v , 6
w z Ans. D , , ,

49. Which is the largest sesamoid bone of the body. 53. What is the nerve supply of lateral rectus muscle.
Ans. Patella Ans. v
 Histology  271

54. Name the terminal branches of external carotid artery. 66. Wry neck is deformity occurring due to spasm
Ans. The terminal branches are: of…………………………..
1. Maxillary artery  Ans. Sternocleidomastoid muscle
2. Superficial temporal artery
67. Diaphragm separates ………………. cavity from
55. Give any one example of synovial joint. …………………… cavity.
Ans. Knee Joint Ans. Abdominal from thoracic
56. Name any one facial muscle surrounding the oral 68. ERB’s point lies on …………………. trunk of brachial
cavity. plexus
Ans. Orbicularis oris Ans. Upper
57. Bronchopulmonary segment is the …………………. 69. Meckle’s cartilage belongs to ………………………….
Ans. Tertiary bronchi pharyngeal arch
58. Submandibular gland is innervated by following Ans. First
parasympathetic nerve …………… 70. Smallest bone of the body is called as ………………….
Ans. Chorda tympani, a branch of the facial nerve Ans. Stapes
59. Buccinator is innervated by following nerve 71. ………………….. is largest of all paranasal sinuses.
………………………….. Ans. Maxillary sinus
Ans. Motor innervation is from the buccal branch of the facial
72. Coronary sinus is the largest ……………………… of
nerve. Sensory innervation is supplied by the buccal
the heart.
branch of the mandibular part of the trigeminal nerve.
Ans. Vein
60. Skin over parotid region is innervated by ……………..
73. Nutrient artery supplies ………………………. cavity of
Ans. Greater auricular nerve
the bone.
61. Blood supply of scalp is ………………………… Ans. Medullary
Ans. Two set of arteries five on each side, out of these five
arteries, three arteries lie in front of ear and two behind 74. Facial artery is the branch of ……………………. artery
the ear. Ans. External carotid

Arteries 75. 9th, 10th and 11th cranial nerves pass through
…………………. foramen of base of skull.
I. Preauricular
Ans. Jugular
a. Supratrochlear b. Supraorbital
c. Superficial temporal arteries 76. Winging of scapula is caused by paralysis of
II. Posterior Auricular …………………… muscle.
Posterior auricular artery Ans. Serratus anterior
Occipital artery. 77. W r y n e c k ( t o r t i c o l l i s ) i s d u e t o s p a s m o f
…………………………..
Venous Drainage
Ans. Sternocleidomastoid muscle
Three groups of veins supply to the scalp:
78. Apex beat is visible in living at ………………………..
1. Veins proper, i.e. occipital vein
2. Emissary veins, i.e. parietal emissary veins and mastoid Ans. Elderly age
emissary veins 79. If left hypoglossal nerve is damaged, the tongue will
3. Diploic veins, i.e. frontal diploic veins and occipital diploic deviate to …………………….
veins. Ans. Left side
62. Sternocostal surface of heart is formed by ……………….. 80. The glossopharyngeal nerve leaves the skull through
Ans. Left, right, superior and inferior borders of the heart. the …………………….
63. The superior oblique muscle of eye is innervated by Ans. Jugular foramen
………………………..
81. Sometime patient complaint of loss of taste
Ans. Trochlear nerve sensation after tonsillectomy due to involvement of
64. Mandibular nerve leaves the skull through ………….. ……………………….
Ans. Foramen ovale Ans. Lingual branch of glossopharyngeal nerve
65. If levator palpebrae superior is paralysed. The upper 82. Hoarseness of voice is due to the involvement of
lid will ………………………… ………………………….
Ans. Droop Ans. Recurrent laryngeal nerve
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

83. Azygos vein opens in 88. Superior oblique muscle of eyeball moves eyeball
…………………………. Ans. x ………………………
Ans. M
82. Ulcers are common at ………………. of
stomach. Ans. v 89. Foramen rotundum opens into ………………………
85. Shoulder tip pain occur due to Ans. Sphenoid bone
irritation of ………………………… 90. Genioglossus is ………………… the tongue.
Ans. peritoneum Ans. x
86. 91. Bleeding after tonsillectomy is often ...……………..
……………….. teeth are used to tear the Ans. k v
flash Ans. 92. Black eye is related with …………… layer of scalp.
Canine Ans. loose areolar tissue
87. …
………… artery is related to submandibular
gland.
Ans. Facial
 Histology  273

VIVA-VOCE QUESTIONS FOR

PRACTICAL EXAMINATION

1. Who is the father of modern anatomy? 17. Which is the median point at the root of the nose where
Ans. Andreas Vesalius the internasal suture meets the frontonasal suture?
Ans. Nasion
2. How many bones does skull have?
Ans. 22 18. During which age of life the mastoid process appears?
Ans. Second year
3. How many bones does calvarium have?
Ans. 8 19. Which is an H-shaped suture where the frontal,
parietal, sphenoid and temporal bones meet?
4. How many bones does facial skeleton have? Ans. Pterion
Ans. 14
20. What forms the anterior 2/3rd of hard palate?
5. During childhood the sutures of the skull are open but Ans. Palatine process of maxilla
these sutures are closed by which age?
Ans. 30 to 50 years 21. What forms the posterior 1/3rd of hard palate?
Ans. Horizontal plate of palatine bone
6. Which is a horizontal line which is obtained by joining
the infraorbital margin to the center of the external 22. Where does palatovaginal canal opens?
acoustic meatus? Ans. Pterygopalatine fossa.
Ans. Reid s baseline 23. What does foramen of Vesalius is also known as?
7. Which are the unpaired bones of the facial skeleton? Ans. Emissary sphenoidal foramen
Ans. Mandible and vomer 24. Which structure divides the squamotympanic fissure
into petrotympanic and petrosquamous?
8. Which suture lie between the frontal bone and two
Ans. Tegmen tympani
parietal bones?
Ans. Coronal suture 25. Which is the largest foramen of the skull?
Ans. Foramen magnum
9. Which suture lie in the median between two parietal
bone? 26. Which foramen is placed at the posterior end of the
Ans. Sagittal suture pterygooccipital suture?
Ans. Jugular foramen
10. Which suture lies posteriorly between occipital and
two parietal bones? 27. Which structure separates the anterior cranial fossa
Ans. Lambdoid suture from the nasal cavity?
Ans. Cribriform plate of ethmoid bone
11. Which suture is present occasionally and lies in the
median plane and separates the two halves of the 28. Which structure separates the anterior cranial fossa
frontal bone? from the sphenoidal sinuses?
Ans. Metopic suture Ans. Jugum sphenoidal
29. Name the uveal tract of eyeball.
12. Which is the highest point over the sagittal suture?
Ans. Vascular coat
Ans. Vertex
30. Which structure provides attachment to the lateral
13. What is the meeting point of coronal and sagittal suture? check ligament of the eyeball?
Ans. Bregma Ans. Whitnall’s tuburcle
14. What does bregma in fetal skull is known as? 31. Which structure separates orbits from the middle
Ans. Anterior fontanelle cranial fossa?
15. Which is the point on sagittal suture between two Ans. Greater wing of the sphenoid
parietal foramen? 32. Which nerve is transmitted by tympanomastoid fissure?
Ans. Obelion Ans. Auricular branch of vagus nerve
16. Which is a median elevation connecting two 33. Name the bone of skull by which maxilla has no
superciliary arches? articulation.
Ans. Glabella Ans. Temporal bone
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

34. Which are the small irregular bones found in the region 53. Which is the most transparent membrane which covers
of the fossa nerves? the anterior surface of the eyeball?
Ans. Wormian bones Ans. Sclera
35. In which structure of the body wormian bones are seen? 54. Two nostrils which are separated by median partition
Ans. Skull is called as?
36. Which is largest as well as strongest bone of the face? Ans. Columella
Ans. Mandible 55. Which area is known as the dangerous area of the scalp?
37. Which fossa provides origin to the mentalis muscle Ans. Loose areolar tissue
and the mental slips of orbicularis oris? 56. Which is the artery responsible for pulsations in
Ans. Incisive fossa suprasternal space?
38. Which are the nerves and vessels which pass through Ans. Inferior thyroid
mandibular notch? 57. Hard palate receives major blood supply from which
Ans. Massetric nerves and vessels artery?
39. Which is the first bone to ossify in the body? Ans. Greater palatine artery
Ans. Clavicle 58. Ducts of Bellini are associated with which structure?
40. When do the center for ossification of the mandible Ans. Kidneys
appears? 59. Which is the first site for the appearance of renal edema?
Ans. During 6th week of intrauterine life. Ans. Eyelid
41. At what age does bony union of the symphysis takes 60. What is the function of the buccal pad of fat in infants?
place?
Ans. Suckling
Ans. During first year of life.
61. Which arch provides development to facial muscle?
42. When does the mental foramen opens below the
Ans. Second
sockets of the two primary molar teeth?
Ans. During birth 62. Facial artery is given off at which level of hyoid bone?
Ans. Greater cornue
43. At what age does the angle of mandible is obtuse?
Ans. During childhood and old age. 63. Which is the arterial trunk supplying infratemporal
fossa?
44. At what age does the angle of mandible is ll0° to l20°?
Ans. Maxillary artery
Ans. Adult
64. Name the artery through which facial artery
45. At which level of cervical vertebrae the hyoid bone rests?
anastomoses with.
Ans. Third cervical vertebrae
Ans. Dorsal nasal branch of ophthalmic artery
46. Which structures supply blood to cornea?
65. Which is the largest vein of the face?
Ans. Cornea is avascular
Ans. Facial vein
47. What is the identification characteristic of cervical
vertebrae? 66. Name the space between two eyelids.
Ans. Foramina transversaria. Ans. Palpebral fissure

48. Where does carotid artery palpated at neck? 67. Which type of glands are Zeis’ glands?
Ans. Thyroid cartilage Ans. Large sebaceous glands

49. Arterial supply of trachea is facilitated by which artery? 68. Which type of glands are Moll’s glands?
Ans. Inferior thyroid Ans. Modified sweat glands
50. Which cervical vertebra has a large transverse process 69. What is the shape of lacrimal gland?
and acts effectively for rotatory movement? Ans. J shaped
Ans. Atlas vertebrae 70. What is the inflammation of lacrimal sac is called as?
51. Which cervical vertebra is identified by the presence Ans. Dacryocystitis
of dens or odontoid process? 71. Side of the neck which is quadrilateral is divided
Ans. Axis vertebrae obliquely by which of the muscle into anterior and
52. Which cervical vertebra is known as vertebra prominens? posterior triangles.
Ans. Seventh cervical vertebrae Ans. Sternocleidomastoid
 Histology  275

72. Skin of the neck is supplied by which nerves?
Ans. C2, C3 and C4
73. Name the muscle supplied by ansa cervicalis.
Ans. Sternohyoid muscle
90. Which ganglia are made up of pseudounipolar nerve
cells with T shaped arrangement and homologus with
dorsal nerve root ganglia of spinal nerves?
Ans. Trigeminal

74. Which space contains the sternal heads of right and 91. Which artery is the commonest source of extradural
left sternomastoid muscles jugular venous arch, lymph hemorrhage?
nodes and interclavicular ligament? Ans. Middle meningeal artery
Ans. Suprasternal space. 92. Name the structures to which vena cava does not drain
75. Which vein is examined to assess the venous pressure? blood.
Ans. External jugular vein Ans. Heart and lungs
76. Tonsils are mainly supplied by. 93. Name the fossa by which middle meningeal artery
Ans. Facial artery enters the middle cranial fossa.
Ans. Foramen spinosum
77. Sternomastoid and trapezius muscles are supplied by
which nerves? 94. Which branch of the middle meningeal artery is closely
Ans. Spinal part of accessory nerve associated with the motor area of the brain?
78. Reflection of which of the muscle exposes the Ans. Frontal branch
suboccipital muscle? 95. Which part of internal carotid artery gives no branches?
Ans. Semispinalis capitis Ans. Cervical branch
79. Suboccipital triangle contains which part of the 96. Vidian nerve is formed by which nerves?
vertebral artery. Ans. Greater petrosal and deep petrosal nerves
Ans. Third part
97. Vertebral artery reaches the brain by passing through
80. Which is the thickest cutaneous nerve of the body. which foramina?
Ans. Greater occipital C2. Ans. Foramen magnum
81. Which is the first and largest branch of the first part of 98. Which structure forms the periosteum of the bony
the subclavian artery. orbit?
Ans. Vertebral branch Ans. Orbital fascia
82. Which artery arises from the external carotid artery 99. Which structure forms a thin, loose, membranous
opposite to the origin of facial artery.
sheath around the eyeball extending from the optic
Ans. Occipital artery nerve to the limbus?
83. Lumbar puncture is usually done along by which Ans. Tenon s capsule
vertebrae.
100. Lower part of the Tenon’s capsule is thickened to form
Ans. C3 and C4
which structure?
84. How many pairs of spinal nerves does spinal cord gives Ans. Suspensory ligament of Lockwood
rise to.
101. Four recti muscles arise from which structure and is
Ans. 31
inserted into.
85. How much amount of CSF is formed in a day? Ans. Tendinous ring and sclera
Ans. 5 Liter/day
102. Superior oblique muscle is supplied by which nerve?
86. Which layer of dura mater forms four folds and divides Ans. Trochlear nerve
the cranial cavity into compartments.
Ans. Meningeal layer 103. Weakness or paralysis of ocular muscle leads to.
Ans. Strabismus
87. Which is a sickle shaped fold of dura mater which
occupies the median longitudinal fissures. 104. What does involuntary rhythmic oscillatory movements
Ans. Falx cerebri are known as.
Ans. Nystagmus
88. Which is a tent-shaped fold of dura mater which forms
the roof of the posterior cranial fossa. 105. Which is the first branch of ophthalmic artery?
Ans. Tentorium cerebelli Ans. Central artery of retina
89. Which is a large venous space situated in the middle cranial 106. Lymphatic drainage of the orbit is through which
fossa on either side of the body of the sphenoid bone. lymph node?
Ans. Cavernous Ans. Preauricular nodes
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)

107. Which nerve has an intraorbital intracanalicular and 125. Which is the largest terminal branch of external carotid
intracranial course is? artery?
Ans. Optic nerve Ans. Maxillary artery
108. Which is the peripheral parasympathetic ganglion 126. Maxillary artery is divided into three parts by which
placed in the course of oculomotor nerve? muscle. Name it.
Ans. Ciliary ganglion Ans. Lateral pterygoid muscle
109. Name the midbrain lesion causing contralateral 127. Name the synovial joint of condylar variety.
hemiplegia and ipsilateral paralysis of the third cranial Ans. Temporomandibular joint
nerve. 128. Articular surface of the TM joint are covered by which
Ans. Weber’s syndrome cartilage?
110. Which is the only cranial nerve to emerge from the Ans. Fibrocartilage
dorsal aspect of the brainstem? 129. Which ligament reinforces or strengthens the lateral
Ans. Trochlear nerve part of the capsular ligament?
111. Which nerve has the longest intracranial course? Ans. Temporomandibular ligament
Ans. Occulomotor 130. Which is an accessory ligament of TMJ which is pierced
112. Infraorbital nerve is accompanied by which part of the by mylohyoid nerves and vessels.
maxillary artery? Ans. Sphenomandibular ligament
Ans. Third part 131. Skin over the parotid gland receives its sensory supply
113. Right common carotid artery is a branch of which artery. from which nerve.
Ans. Brachiocephalic artery Ans. Greater auricular nerve
132. Which is the only sensory branch of the anterior
114. Where does left common carotid artery arises from?
division of mandibular nerve?
Ans. Arch of aorta
Ans. Buccal branch
115. Which is the largest salivary gland of all the salivary
133. Otic ganglion is an peripheral sympathetic ganglion
glands?
which is topographically related to which nerve and
Ans. Parotid gland functionally related to which nerve?
116. How much is the weight of parotid gland? Ans. Topograhically to glossopharyngeal nerve; functionally
Ans. 15 gms. related to mandibular nerve.
117. Which is the structure which separates the parotid 134. Anterior belly and posterior belly of digastric muscle
gland from submandibular gland? is supplied by which nerve?
Ans. Stylomandibular ligament Ans. Anterior belly by nerve to myelohyoid; posterior belly
by facial nerve.
118. What is the name of sensory root of facial nerve?
Ans. Nervous intermedius 135. A salivary gland which is J-shaped and divided by
the mylohyoid into large superficial and smaller deep
119. Facial nerve leaves the skull by passing through which portion is.
of the foramina? Ans. Submandibular gland
Ans. Stylomastoid foramen
136. Which is the structure which runs forward on and
120. Posterior auricular, digastric and stylohyoid branches between lingual and hyoglossus nerves?
of facial nerve are given off from which of the foramen. Ans. Submandibular duct
Ans. Stylomastoid foramen
137. Which is the smallest of all the salivary gland and
121. Nerve to stapedius is a branch of which nerve. which weighs 3 to 4 gm and is of almond shaped?
Ans. Facial nerve which is given off in the facial canal Ans. Sublingual salivary gland
122. What is the function of temporalis muscle? 138. Which structure separates parotid gland from sub-
Ans. Elevation and retraction of protruded mandible mandibular gland?
123. Lateral pterygoid muscle along with which muscle Ans. Stylomandibular ligament
depresses the mandible to open the mouth. 139. Thyroid gland lies against which cervical vertebrae?
Ans. Suprahyoid muscle Ans. C5, C6, C7 and T1
124. Which are the structures passing between the two heads 140. Superior thyroid artery runs in intimate relation with
of the lateral pterygoid? which nerve?
Ans. Maxillary artery and buccal branch of mandibular nerve. Ans. External laryngeal nerve

141. Inferior thyroid artery is a branch of which nerve?
Ans. Thyrocervical trunk
142. Main nerve supply of the thyroid gland is via which
of the structure?
Ans. Middle cervical sympathetic ganglion
143. Name the artery which facilitates the arterial supply
of trachea.
Ans. Inferior thyroid artery
144. Thymus which is an important lymphoid organ
increase in size during puberty and undergoes atrophy
after puberty and later replaced by which tissue?
Ans. Fatty tissue
145. Direct communication of the sigmoid sinus is with.
Ans. Internal jugular nerve
146. How much is the right brachiocephalic vein is shorter
(2.5 cm) than the left brachiocephalic vein?
Ans. 60 m
147. Which veins unite to form the superior vena cava?
Ans. Brachiocephalic vein
148. Which nerve is motor to stylopharyngeus secretomotor
to the parotid, gustatory to the posterior 1/3rd of
tongue, and sensory to the pharynx is.
Ans. Glossopharyngeal nerve
149. Which is the branch of vagus which pieces the
thyrohyoid membrane and supplies the mucous
membrane of the larynx above the level of vocal folds?
Ans. Internal laryngeal branch.
150. Which is the nerve who accompanies the superior
thyroid artery and supplies the cricothyroid?
Ans. External laryngeal nerve
151. Which is the nerve who supplies all the intrinsic
muscle of the larynx except cricothyroid and sensory
innervation of the larynx below the vocal fold?
Ans. Recurrent laryngeal nerve
152. Irritation of which of the branch of vagus can cause
death due to sudden cardiac inhibition.
Ans. Auricular branch.
153. Stimulation of which branch of vagus may increase
appetite.
Ans. Auricular branch
154. Which nerve supplies all the intrinsic and extrinsic
muscles of the tongue except palatoglossus which is
supplied by cranial accessory nerve?
Ans. Hypoglossal nerve
155. Name the floating ribs.
Ans. 11 and 12
156. Which nerve provides sole motor supply to the
diaphragm?
Ans. Phrenic nerve
Histology  277
157. What is the length of trachea?
Ans. 10 to 15 cms.
158. Esophagus and trachea begin at the lower border of cricoid
cartilage opposite to the lower border of which vertebrae.
Ans. C6.
159. What is the length of esophagus?
Ans. 25 cm
160. Which is the main lymph node draining the tonsil?
Ans. Jugulodigastric lymph node
161. Which is the main lymph node of the tongue?
Ans. Jugulo-omohyoid
162. Which is the largest lymph trunk of the body?
Ans. Thoracic duct
163. Which is the key muscle in the lower part of the neck?
Ans. Scalenus anterior
164. Which apparatus resembles as the riens of a chariot?
Ans. Styloid
165. Name the structure which lies interposed between the
parotid gland laterally and the internal jugular vein
medially.
Ans. Styloid process
166. Which artery unites with the same artery on the
opposite half of the body to form a basilar artery?
Ans. Vertebral artery
167. Which is the largest branch of vertebral artery?
Ans. Posterior inferior cerebellar artery
168. How much is the length of pharynx?
Ans. 12 cm
169. As foreign bodies are removed from the piriform fossa
which may damage internal laryngeal nerve which
leads to.
Ans. Anesthesia of supraglottic part of larynx.
170. What is the name of the gap between superior
constrictor and the base of blank?
Ans. Sinus of Morgagni
171. Name the structures passing through the sinus of
Morgagni.
Ans. Auditory tube, levator palati muscle and ascending
palatine artery.
172. What are the structures passing between the superior
constrictor and middle constrictors?
Ans. Stylopharyngeal and glossopharyngeal
173. Name the structures passing between middle and
inferior constrictor.
Ans. Internal laryngeal and superior laryngeal vessels and nerve
174. Name the muscle of pharynx which is not supplied by
vago-accessory complex.
Ans. Stylopharyngeus
   Mastering the BDS Ist Year (Last 25 Years Solved Questions)
175. Which is the weak region present in the posterior wall
of the pharynx. ?
Ans. Killian s dehiscence
176. Name the structure which is trumpet shaped and
which connects the middle ear cavity with the
nasopharynx.
Ans. Auditory tube
177. Name an anastomosing site of superior labial branch
of facial artery, sphenopalatine artery and some large
capillary network.
Ans. Little’s area or Kiesselbach’s area.
178. Name the structures opening into the middle meatus
of the nose.
Ans. Frontal, maxillary and ethmoidal sinus
179. Name the structures opening into the superior meatus
of the nose.
Ans. Middle ethmoidal and posterior ethmoidal
180. Which is the largest parasympathetic peripheral
ganglion?
Ans. Pterygopalatine or sphenopalatine ganglion
181. Name the ganglion which is related topographically
to the maxillary nerve and functionally related to the
facial nerve.
Ans. Pterygopalatine ganglion
182. What is the length of the larynx?
Ans. 36 mm to 44 mm
183. In which organ the sound sensitive hair cells of inner
ear are located.
Ans. Organ of Corti
184. Name the laryngeal cartilage whose shape is like a ring.
Ans. Cricoid cartilage
185. Name the laryngeal cartilage whose shape is like a
leaf.
Ans. Epiglottis
186. Name the cartilages of larynx which ossify.
Ans. Thyroid, cricoids and arytenoid
187. Name the space between the vestibular folds.
Ans. Rima vestibule
188. Name the space between the vocal folds.
Ans. Rima glottides
189. When both recurrent laryngeal nerves are interrupted
the vocal cords lie in which position.
Ans. Cadaveric
190. From which structure primary germ layer of endoderm
is derived?
Ans. Yolk sac
191. What is the location for McBurney’s point?
Ans. Cecum
192. Hemopoiesis occur in adults in which areas?
Ans. Bone marrow and lymphoid tissues
193. Name the most narrowest part of gastrointestinal tract.
Ans. Pharyngoesophageal junction
194. Development of the tongue occur from which of the
structures.
Ans. Tuberculum impar, hypobranchial eminence and lingual
swellings
195. Name the branchial arches which forms tongue.
Ans. First, third and fourth branchial arches.
196. Name the safety muscle of tongue.
Ans. Genioglossus
197. During the fetal circulation a shunt occur between
pulmonary trunk and aorta. Name the shunt.
Ans. Ductus arteriosus
198. Where does maxillary artery arises from?
Ans. Neck of condyle.
199. Name the structure via which the lesser peritoneal sac
communicates with greater peritoneal sac.
Ans. Epiploic foramen
200. At the time of removal of submandibular gland which
nerve get injured?
Ans. Hypoglossal nerve
 5
SECTION
Physiology
1. General Physiology
2. Blood
3. Muscle Physiology
4. Digestive System
5. Renal Physiology and Skin
6. Endocrine System
7. Reproductive System
8. Cardiovascular System
296
9. Respiratory System
10. Nervous System
11. Special Senses
12. Metabolism and Nutrition
Multiple Choice Questions as per DCI and
Examination Papers of Various Universities
Viva-Voce Questions for Practical Examination
Additional Matter

1. GENERAL PHYSIOLOGY
Q.3. Write a short note on Na-K pump.
Ans. Na-K pump is a primary active transport of ions.
(Apr 2003, 4 Marks) (Apr 2010, 5 Marks)
Ans. Ribosomes are complex structures, containing many
different proteins and at least three ribosomal RNAs.
They are the site of protein synthesis. The ribosomes that
become attached to endoplasmic reticulum synthesize
proteins such as hormones that are secreted by cell;
proteins that are segregated in lysosomes, and proteins
that are inserted in cell membrane. The polypeptide
chain that form these proteins are extruded endoplasmic
reticulum. Free ribosomes synthesize cytoplasmic
proteins apparatus, which is involved in processing
proteins formed in ribosomes. Ribosomes in eukaryotes
measure approximately 22 by 32 nm. Each is made up
of a large and small subunit called on basis of their rates
of sedimentation in ultracentrifuge, the 60s and 40s
subunits.
Fig. 1: Ribosomes
(Mar 2000, 4 Marks) (Apr 2009, 4 Marks)
Sodium and potassium ions are transported across
cell membrane by means of common mechanism
called Na-K pump.
This transports sodium from inside the cell to outside
and potassium from outside to inside the cell.
This Na-K pump is present in all cells of the body.
Sodium potassium pump is responsible for distribu-
tion of sodium and potassium ions across the cell
membrane and development of negative electrical
potential inside the cell.
• Three sodium ions from cell get attached to the sites
of binding sodium ions on inner surface of carrier
protein.
• Two potassium ions outside the cell bind the sites
for potassium ions located on outer surface of carrier
protein.
The binding of Na and K ions to carrier proteins acti-
vates the enzymes ATPase which causes breakdown
of ATP into ADP.
• Now, energy liberated causes positional change in
molecule of carrier protein.
• Because of this, outer surface of molecule (with K+
ions) now faces inner side of protein molecule (with
sodium ions) faces ECF.
• Now the dissociation and release of ion take place
and the potentials get changed.
282 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 2: Na-K pump

Q.4. Write a short note on active transport. It is also located in cell membrane and in many cell
(Oct 2007, 5 Marks) organelle membranes.
Or c. K+ H+ Pump: It is present in cells of gastric mucosa and
Write briefly about active transport. renal tubules where it causes secretion of H+.
(Aug 2016, 2 Marks)
Secondary Active Transport Process
Or
In some tissues, active transport of Na+ is coupled to transport
Write very short answer on active transport and its
of other substances that is transport of many ions and nutrients
examples. (Aug 2018, 2 Marks)
against electrochemical energy gradient is accomplished by Na+
Ans. Substances are transported against their chemical and
dependent secondary active transport.
electrical gradient. This form of transport require energy
and is called as active transport. Examples are:
It includes: ♦ Glucose and amino acids are reabsorbed from proximal
1. Primary active transport process. renal tubules and absorbed from intestinal lumen only if
2. Secondary active transport process. sodium binds to the protein and is transported down its
3. Carrier type process. electrochemical gradient at same time.
4. Vesicular transport process. ♦ Calcium is exchanged from cytoplasm of cardiac and other
muscle cells for extracellular sodium known as Na+ Ca+
These active processes require energy so that’s why they
exchanger.
are called as pumps.
♦ Iodine pump.
Primary Active Transport Processes
Carrier Type Process
They directly use the energy obtained from hydrolysis of ATP.
Carriers are transport proteins that binds ions and other
It consist of:
molecules and they change their configuration, moving
a. Na+ K+ Pump. bounded molecules form one side of cell membrane to other.
b. Ca+ Pump. They are of three types, i.e. uniporters, symporters, antiporters.
c. K+ H+ Pump.
1. Uniporters: They transport a single particle in one
a. Na+ K+ Pump: Refer to Ans 3 of the same chapter. direction, e.g. facilitated diffusion of glucose.
b. Ca+ Pump: 2. Symporters: They transport two particles together in same
It is present in sarcoplasmic reticulum of muscle cells, direction, e.g. secondary active transport of glucose.
which maintains intracellular ionic 102+ concentration 3. Antiporters: They transport molecules in opposite
below 0.1 mmol/L. direction, i.e. exchange one substance from another.

Example: Na+ K+ Pump which moves 3 Na+ out of the cell in
exchange for 2K+ that moves into the cell.
Vesicular Transport Process
Many substances all transported across the cell membrane by
an endocytosis and exocytosis.
Q.5. Write briefly about cell membrane.
(Dec 2009, 5 Marks)
Ans. It is also known as plasma membrane or unit membrane.
The thickness of cell membrane is 7 to 10 nm.
• Cell membrane consists of proteins (55%), lipids
(40%) and carbohydrates (5%).
Structure of Cell membrane/Fluid Mosaic Model
♦ Structure of cell membrane consists of a double layer of
lipid molecules on which the proteins are embedded.
♦ Proteins embedded are of two types, i.e. lipoproteins
which function as enzymes and ion channels and
glycoproteins which function as receptors for hormones
and neurotransmitters.
♦ Some of the proteins are located on inner surface of
membrane are known as intrinsic proteins and some
are located on outer surface of proteins are known as
extrinsic proteins. Some of the proteins extend through
the membrane are known as transmembrane proteins.
♦ Intrinsic proteins act as enzymes, extrinsic protein contrib-
ute to cytoskeleton structure.
♦ Transmembranous proteins act as:
1. Channels: By which diffusion of ions and water
soluble substances occur.
2. Carriers: By which active or passive transport of
material occur through lipid layer.
3. Pumps: By which active transport of ions occur
through lipid layer.
4. Receptors: They initiate intracellular reactions.
♦ Clear area formed by bimolecular thickness of lipid mol-
ecules has following arrangement:
1. Head end: It consists of phosphate portion which is
positively charged and is soluble in water.
2. Tail end: It is insoluble in water. It has two fatty acid
chains. Hydrophobic ends facing each other meet at
water-pool in interior of membrane.
Function of Cell membrane
♦ Protective function: Cell membrane protects the cytoplasm
as well as organells in cytoplasm.
♦ Selective permeability: Cell membrane act as a semiper-
meable membrane which allows only some substances
to pass through it and act as barrier for other substances.
♦ Absorptive function: Nutrients are absorbed in cell
through cell membrane.
♦ Excretory function: Metabolites and other waste products
from the cell are excreted through cell membrane.
♦ Maintenance of shape and size of cell: Cell membrane
is responsible for maintainence of shape and size of cell.
Physiology 283

(Dec 2010, 5 Marks)
Ans. Structure of Mitochondria
The length of mitochondria is 5 12 μm and the
diameter is 0.5 1 μm.
The mitochondria is filamentous or globular in
shape and it occurs in variable numbers from a few
hundred to few thousands in different cells.
It is made up of outer membrane and inner membrane.
• Outer membrane consists of enzymes which lead to
biological oxidation.
• Inner membrane gets folded to form cristae which
project into the interior of the mitochondria.
Interior or the matrix of mitochondria consists
of enzymes concerned with citric acid cycle and
respiratory chain oxidation.
Inner membrane is made up of repeating units each
of which contains head piece, stalk and base piece.
Stalk consists of ATP and various other enzymes.
• Base piece consist of enzymes which leads to electron
chain transfer.
Functions of Mitochondria
♦ Mitochondria are the power generating organelles of the
cells and are numerous.
♦ It consists of DNA and at times synthesize proteins.
Q.7. Write short note on mitochondria. (June 2010, 5 Marks)
Ans. Refer to Ans 6 of same chapter.
Q.8. Write short note on facilitated diffusion.
(Apr 2007, 5 Marks)
Ans. Facilitated diffusion is a carrier mediated process which
enables molecule that are too large to flow via membrane
channels by simple diffusion.
For example, transport of glucose by glucose transporter
across intestinal epithelium.
• This process is faster than simple diffusion.
• In this process, the carrier protein undergo repetitive
configurational changes during which binding site
for substance is alternatively exposed for intracel-
lular fluid and extracellular fluid.
• Its rate of diffusion enhances with enhancement in
the concentration gradient to reach a plateau when
all binding sites on carrier proteins get filled. This
is known as saturation.
• Carrier proteins are of many types in membranes
each having specific binding site for particular sub-
stance.
Q.9 Describe the components of cell and their functions.
(Apr 2008, 15 Marks)
Ans. Components of Cell
Following are the components of the cell seen under light
microscope:
1. Cell membrane.
2. Cytoplasm.
3. Nucleus.
284 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 3: Components of a cell
Cell Membrane
♦ It is also known as plasma membrane.
♦ It is the protective sheath which envelops the cell body.
♦ It separates contents of cell from external environment and
control exchange of materials between extracellular fluid
and intracellular fluid.
♦ Cell membrane have a trilayer structure consists of total
thickness of 7 to 10 nm and is called as unit membrane.
♦ Biochemically, the cell membrane is composed of complex
mixture of lipids, proteins and carbohydrates.
Functions of Cell Membrane
♦ It forms the outermost boundary of cell organelles.
♦ It takes in the food and excrete waste products.
♦ Property of selective permeability of cell membrane helps
in maintaining the difference of composition between
extracellular and intracellular fluid.
♦ Cell membrane act as dielectric material of charged con-
denser and so the cell membrane has very high insulating
value.
♦ Cell membrane provides framework for arrangement of
ordered sequence of protein molecules in functionally
meaningful pattern.
♦ It joins adjacent cells together by junctional complexes to
form tissues.
Cytoplasm
♦ It is aqueous substance which consists of variety of cell
organelles and other structures.
♦ Structures dispersed in cytoplasm are divided into three
groups, i.e. organelles, inclusion bodies and cytoskeleton.
Organelles
Following are the organelles dispersed in cytoplasm:
Endoplasmic Reticulum
♦ It is a system of flattened membrane bound vesicles and
tubules known as cisternae.
♦ It is continuous with outer membrane of nuclear envelope,
golgi apparatus and with cell membrane.
♦ Morphologically endoplasmic reticulum is of two types,
i.e. smooth and rough.
♦ Agranular or smooth endoplasmic reticulum: Granules
are absent in this type. It is the site of lipid and steroid
synthesis. In skeletal and cardiac muscles smooth
endoplasmic reticulum is modified to form sarcoplasmic
reticulum which gets involved in release and sequestration
of calcium ions during muscular contraction.
♦ Granular or rough endoplasmic reticulum: It consists of
granules known as ribosomes. These granules are attached
to cytoplasmic side of membrane. Three to five ribosomes

clump together and form polyribosomes or polysomes.
Rough endoplasmic reticulum is well developed in cell
which is active in protein synthesis. For example, Russell
body of plasma cell, nissl granule of nerve cell.
Golgi Complex
♦ It is the collection of membranous tubules and vesicles
which lie close to the nucleus.
♦ It is prominent in actively secreting gland cells.
Functions of Golgi Complex
♦ It leads to the synthesis of carbohydrates and complex
proteins.
♦ It causes packaging of proteins synthesized in rough en-
doplasmic reticulum into vesicles.
♦ It is the site of formation of lysosomal enzymes.
♦ It causes glycosylation of proteins to form glycoproteins.
♦ It leads to transportation of material to other parts of cell.
Mitochondrion
♦ Mitochondria are filamentous or globular in shape.
♦ It occurs in variable numbers in different shapes.
♦ Mitochondrion consists of membrane and matrix.
♦ Membrane of mitochondrion consists of two layers, i.e.
outer smooth layer and inner folded layer into incomplete
septa known as cristae.
♦ Matrix of mitochondrion has enzymes which are required
in the Kreb’s cycle by which the products of carbohydrate,
fats and protein metabolism are oxidized to produce en-
ergy which is stored in form of ATP.
Functions of Mitochondrion
♦ They act as power generating units of cell.
♦ They consist of DNA and can synthesize proteins.
Lysosomes
♦ Lysosomes are irregular structures surrounded by unit
membrane and are found in cytoplasm.
♦ Lysosomes are filled with numerous small granules which
consist of various enzymes too known as lysozymes.
♦ Lysosomes are formed by the golgi apparatus.
♦ Primary lysosomes are formed from various hydrolytic
enzymes which are synthesized by rER and packed in
golgi apparatus.
♦ Secondary lysosomes are formed by fusion of primary lyso-
somes with parts of damaged or worn out cell components.
Functions of Lysosomes
♦ They act as digestive system for the cell because enzymes
present in it can digest all macromolecules.
♦ They engulf worn out components of cells in which they
are located.
♦ They engulf exogenous substances too and degrade them.
♦ When cell death occur, lysosomal enzymes causes autolysis
of remnants.
Physiology 285
Peroxisomes
♦ They are also known as microbodies.
♦ They are spherical in shape and are enclosed by single
layer of unit membrane.
♦ They consist of enzyme oxidases.
♦ They consume oxygen in small amount which is not used
in chemical reaction associated with ATP formation.
♦ They destroy certain products formed from oxygen spe-
cially hydrogen peroxide which is toxic to cell so that’s
why they are named as peroxisomes.
Functions of Peroxisomes
They consists of two types of enzymes
1. Oxidases are active in oxidation of lipid.
2. Catalases act on hydrogen peroxide to liberate oxygen.
Centrioles or Centrosomes
♦ They are cylindrical in shape and are known as centrioles.
♦ They are visible only during the cell division.
♦ Centrioles are located at each pole near nucleus and are so
arranged that they lie in right angle to each other.
♦ They are concerned with the movement of chromosomes
during cell division.
Cytoplasmic Inclusions
They are temporary components of certain cells. They may or
may not be enclosed in the membrane. Various examples of
cytoplasmic inclusions are:
♦ Lipid droplets: Seen in cells of adipose tissue, liver and
adrenal cortex.
♦ Glycogen: Seen in cells of liver and skeletal muscles
♦ Proteins: As secretory granules seen in secretory glandular
cells.
♦ Melanin pigment: Seen in cells of epidermis, retina and
basal ganglia.
♦ Lipofuscin: It is a yellow brown pigment derived from
secondary lysosomes and is seen in cardiac muscles and
brain cells of aged people.
Cytoskeleton
Cytoskeleton is a complex network of fibers which maintains
structure of the cell and allows it to change shape and causes
movement. It consists of microtubules, microfilaments and
intermediate fibers.
♦ Microtubules: Microtubules are long hollow structures.
They make structures or tracts on which chromosomes,
mitochondria and secretion granules move from one part
of the cell to another.
♦ Intermediate filaments: They are filamentous structures
which are 10 nm in diameter. Some of these filaments connect
nuclear membrane to cell membrane. Their main function is
to mechanically integrate cell organelles in the cytoplasm.
♦ Microfilaments: They are long solid fibers. They consist
of contractile protein actin and they are responsible for
motion of the cell. Extension of microfilaments along with
286 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
plasma membrane on the surface of cells form microvilli
which increases absorptive surface of cells.
♦ Functions of microtubules and microfilaments:
They lead to movement of chromosomes.
They causes movement of cell
These processes move secretion granules in cell.
They lead to the movement of proteins in the cell
membrane.
Nucleus
Nucleus is a spherical structure which consists of nuclear
membrane, nucleoplasm and nucleolus.
Nuclear Membrane
♦ It is a double layered porous structure which consists of 40
to 70 nm wide space known as perinuclear cistern which is
continuous with lumen of endoplasmic reticulum.
♦ Exchange of materials between nucleoplasm and cyto-
plasm occurs through nuclear membrane.
Nucleoplasm
♦ Nucleoplasm or nuclear matrix is a gel like ground sub-
stance having large quantity of genetic material in form
of DNA.
♦ When cell does not undergo division nucleoplasm appears
as dark staining thread like material known as nuclear
chromatin.
♦ At the time of division chromatin material become rod
shaped and is known as chromosomes.
 negative feedback which consists of series of changes which
(Nov 2008, 5 Marks)
Ans. It is a system of flattened membrane bound vesicles and
tubules known as cisternae.
• It is continuous with outer membrane of nuclear
envelope, golgi apparatus and with cell membrane.
• Morphologically endoplasmic reticulum is of two
types, i.e. smooth and rough.
Agranular or smooth endoplasmic reticulum: Granules
are absent in this type. It is the site of lipid and steroid
synthesis. In skeletal and cardiac muscles, smooth en-
doplasmic reticulum is modified to form sarcoplasmic
reticulum which gets involved in release and seques-
tration of calcium ions during muscular contraction.
Granular or rough endoplasmic reticulum: It consists of
granules known as ribosomes. These granules are
attached to cytoplasmic side of membrane. Three to
five ribososmes clump together and form polyribo-
somes or polysomes. Rough endoplasmic reticulum
is well developed in cell which is active in protein
synthesis. For example, Russell body of plasma cell,
nissl granule of nerve cell.
Q.11. Write about feedback mechanism. (Sep 2015, 7 Marks)
Ans. Since homeostasis is a complex phenomenon the mode
of operation of all the systems which are involved in
homeostasis is through ‘feedback mechanism’. Feedback
mechanism is of two types, i.e.
1. Negative feedback mechanism.
2. Positive feedback mechanism.
Negative Feedback Mechanism
Most of the homeostatic mechanisms of body act by negative
feedback mechanism, i.e. if the activity of particular system
become increased or decreased a control system initiates
bring back activity towards the normal.
Here the initial stimulus produces a response which
depresses the stimulus, i.e. stimulus and response are opposite
to each other.
Example of Negative Feedback Mechanism
When blood pressure suddenly raises or decreases, it leads
to initiation of the series of reactions which bring the blood
pressure to normal levels.
Positive Feedback Mechanism
Positive feedback mechanism sets off a chain of events which
exaggerates the disturbance further, i.e. it does not lead to
stability and displaces a system from its steady state.
Here the initial stimulus produces a response which
exaggerates original stimulus.
Example of Positive Feedback Mechanism
Fall in the blood pressure causes decrease in blood supply to
heat which also decreases myocardial contraction and there is
further fall in blood pressure.
At times positive feedback mechanism is useful too, i.e.
whenever there is injury to blood vessels, it leads to initiation
of clotting process and clotting proceeds which causes release
of chemicals which enhances the clotting process and seal the
break in vessel wall.

(Mar 2017, 2 Marks)
Ans. Osmosis: It is the process of movement of solvent from
the solution with the lower concentration of solutes to
the solution with higher concentration of solute, when
both the solutions are separated by a semipermeable
membrane.
Importance of Osmosis in Our Body
Osmosis mainly the total plasma osmolality is important in
assessing dehydration, overhydration and other fluid and
electrolyte abnormalities. Various examples are:
♦ Hyperosmolarity can lead to hyperosmolar coma
by causing water to flow out of the cells, i.e. cellular
dehydration.
♦ Flow of water inside or outside the capillaries depends on
whether the colloidal osmotic pressure or oncotic pressure
is greater or lesser than hydrostatic pressure of blood.
When water falls into or out of the capillaries, it carries
dissolve particles with it. This force is known as solvent
drag and its effect are very less in our body.
2. BLOOD
 polymorphism are haptoglobin, transferrin, cerulo-
(Mar 2001, 15 Marks)

(Apr 2008, 4 Marks)
Ans. Functions of Plasma Proteins
1. Role in coagulation of blood: Presence of fibrino-
gen, prothrombin and other coagulation proteins
in plasma play an important role in coagulation of
blood.
2. Role in defense mechanism of body: Gamma globu-
lins are the antibodies which play an important role in
immune mechanism of body by acting as antibodies.
3. Role in transport mechanism: Plasma proteins are
necessary for the transport of various substances
in the blood. Plasma proteins combine with many
substances and play essential role in transport as:
Carbon dioxide is transported via the plasma
proteins in form of carbamino compound.
• Thyroxine is transported via α globulin known
as thyroxine binding protein.
• Bilirubin is associated with albumin and with
fractions of α globulin.
4. Exert osmotic pressure: Plasma proteins exert coll-
oidal osmotic pressure. Osmotic pressure exerted by
plasma proteins is 25 mm of Hg. As concentration
of albumin is more than other plasma proteins
it exerts maximum pressure. Colloidal osmotic
pressure plays an important role in exchange of
water between blood and tissue fluid.
Physiology 287
5. Role in maintaining acid base balance of body:
Plasma proteins act as buffers and contribute to 15%
of buffering capacity of blood. As they are ampho-
teric, they combine with acid and bases. Albumin
plays an important role.
6. Role in blood viscosity: Fibrinogen and globulins
contribute in the blood viscosity due to their asym-
metrical shape. Blood viscosity maintains the blood
pressure by providing resistance to flow of blood in
blood vessels.
7. Role in erythrocyte sedimentation rate: Globulin
and fibrinogen accelerate the tendency of rouleaux
formation by red blood cells. Rouleaux formation is
responsible for ESR.
8. Role in suspension stability of red blood cells: Sus-
pension stability is the property of RBCs by virtue of
which they are uniformly suspended in the blood.
Globulins and fibrinogen accelerate this property.
9. Role as reserve proteins: Plasma proteins act as
reserve proteins and they are utilized by the body
tissues as last source of energy. They are used in the
conditions such as fasting, inadequate protein intake
and excessive catabolism of body proteins.
10. Role in genetic information: Many plasma proteins
exhibit polymorphism. Plasma proteins which show
plasmin and immunoglobulins.
Mechanism of Edema Formation
Edema
♦ Excessive accumulation of fluid in tissues is called edema.
♦ Tissue fluid is formed by the process of filtration.
♦ Normally, the blood pressure in arterial end of the capil-
lary is about 30 mm Hg along the course of the capillary,
the pressure falls gradually; and it is about 15 mm Hg at
the various ends.
♦ Plasma proteins in the blood exert a pressure that is about
25 mm Hg. It is an opposing force for the filtration of water
and materials from the capillary blood in the tissue spaces.
♦ However, the hydrostatic pressure in the arterial end of the
capillary is greater than the osmotic pressure. So, filtration
occurs continuously.
♦ Volume of tissue fluid is controlled by a pressure called
reabsorption at the venous end of capillary. The osmotic
pressure in venous end of capillary is greater than the
hydrostatic pressure. This pressure gradient causes reab-
sorption of water, and waste materials from tissue fluid
come back into the capillary blood.
♦ The formation of tissue fluid is by means of filtration and the
volume of this is regarded as reabsoprtion. The increased
volume of this fluid leads to the condition known as edema.
Q.2. Write a short note on fate of RBC.
(Sep 2004, 5 Marks) (Apr 2010, 5 Marks)
Ans. Senile RBCs are destroyed in reticuloendothelial system.
When the cell membrane becomes older, the cells get
more and more fragile.
288 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

  The diameter of capillaries is equal to size of normal 

RBC. Younger RBCs pass through the capillaries and
older cells get fragile.
  So, these cells are destroyed while trying to squeeze
through the capillaries, e.g. splenic capillaries of
the spleen is known as the graveyard of RBCs. The
destroyed RBCs are fragmented. From fragmented (May 2014, 5 Marks)
parts, hemoglobin is released. Iron and globulin parts of
hemoglobin are separated with production of bilirubin
and the iron part from ferritin.
Note: Daily 10% RBCs which are senile get destroyed in (Apr 2018, 2 Marks)
normal young healthy adults. Ans. Erythropoiesis is the process by which the origin,
Q.3. Write briefly on erythropoiesis. (Mar. 2007, 4 Marks) development and maturation of erythrocytes occur.
(Mar. 2009, 5 Marks) (Sep 2013, 5 Marks)
Or Stages of Development of Erythrocytes
Describe in detail the physiology of erythropoiesis and The following are the stages between stem cell and matured
factors that regulate it. (Dec 2010, 8 Marks) RBC:

Stage of Cell Cell Size Nucleus Cytoplasm Mitosis

Staining Hemoglobin
Hemocytoblast 19-23 µm It occupies whole cell with open Nucleus is deeply basophilic Absent Present
chromatin, having 4 to 5 nucleoli and and a rim is present all around
is deep basophilic the nucleus
Proerythroblast 15-20 µm Nucleus occupies ¾ of cell volume, Nucleus is deeply basophilic Absent Active mitosis
have 2 to 3 nucleoli. It has open and staining is more in amount
chromatin
Early normoblast 14-16 µm Size of cell decreases, nucleoli is Nucleus is less basophilic and Absent Active mitosis
absent and condensation of chromatin staining increases
is present.
Intermediate 10-14 µm Size of nucleus further decreases and Marked cytoplasm is present. Start appearing Active mitosis
normoblast chromatin condenses Polychromatophilic staining
is seen
Late normoblast
i. Early 8-10 µm Very small nucleus with chromatin dot. Staining increases markedly Increase in amount Mitosis Stops
It has cart wheel appearance
ii. Late 7-8 µm Degeneration of nucleus is present. Staining further increases and Further increases Absent
It is pyknotic and is uniformly and is less basophilic
deeply stained
Reticulocyte 7-8 µm Nucleus is absent, remnants of RNA Acidiophilic Further increases Absent
are present
Erythrocyte 7.2-7.4 µm Absent Acidiophilic Further increases Absent

Factors Regulating Erythropoiesis Action:

General Factors
♦ Erythropoietin: The erythropoietin is a general factor for
erythropoiesis which is secreted from kidney.
♦ Source of secretion: The erythropoietin is produced by
juxtaglomerular apparatus of kidney.
♦ Stimulant for secretion: Generally, hypoxia is responsible
for the production of erythropoietin.
It causes formation and release of new RBCs into
circulation 4 to 5 days after being secreted.
It causes production of erythroblast cells from stem
cells in bone marrow.
It causes further maturation of proerythroblasts into
matured RBCs through normoblastic stage.
It causes release of matured erythrocytes from
blood.

Fig. 4: Erythropoiesis
♦ Thyroxine: It accelerates the process of erythropoiesis in
hyperthyroidism and polycythemia.
♦ Interleukin-3: It stimulates growth of stem cells for RBC.
It is proteinaceous in nature.
♦ Vitamins: Vitamins A, B, C, D and E are necessary for
erythropoiesis. Deficiency of these vitamins lead to
anemia.
 life, liver is the main organ which forms RBC; some
(Dec 2010, 6 Marks)
Physiology 289
Ans. Site of Erythropoiesis
In Embryo
During embryonic life, erythropoiesis occurs in three stages:
a. Mesoblastic stage: During the first two months
of embryonic life, the primitive red blood cells are
developed from mesenchyme of yolk sac.
b. Hepatic stage: From third month of intrauterine
erythrocytes are produced by spleen and other
lymphoid tissues.
c. Myeloid stage: During the last three months of intrau-
terine life, the red cells are produced from red bone
marrow in addition to production of RBC from cells.
In Postnatal Life and in Adults
a. Up to age of 5 or 6 years: RBCs are produced in red
bone marrow of all bones.
b. From 6th to 20th year: RBCs are produced by long
and membranous bones.
c. After age of 20: The RBCs are produced by mem-
branous bones.
Stages of Development
Answer Refer to Ans 3 of the same chapter.
Factors Influencing Erythropoiesis
Answer Refer to Ans 3 of the same chapter.
Q.5. Write briefly on erythropoietin. (Mar 2008, 4 Marks)
Ans. Erythropoietin is a hormone and it regulates erythro-
poiesis.
Site of Formation
♦ It is produced by juxtaglomerular apparatus of kidney.
♦ It is also produced by liver and cells of tissue macrophages
system, specially when hypoxia is marked.
Stimulus for Secretion
RBC supply oxygen to the tissues but whenever there is hypoxia
or decrease in number of RBCs renal erythropoietic factor is
released from juxtaglomerular cells of kidney. This factor acts
290 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
(Apr 2007, 5 Marks)
Ans. After a lifespan of 120 days, RBC is destroyed in the
reticuloendothelial system in spleen. Hemoglobin is
phagocytized by reticuloendothelial cell and splits into
globin, iron and porphyrin.
1. Iron: It is stored in body as ferritin and hemosiderin.
2. Globin: It is utilized for re-synthesis of hemoglobin.
3. Porphyrin: of RBC. It occurs in the following conditions:
a. It is converted to a green pigment called bili-
verdin. In human beings most of biliverdin is
converted to yellow pigment bilirubin.
b. These pigments enter the blood and are carried
by plasma protein α-globulin.
c. When the bile pigments enter the liver, they are
released from plasma protein then conjugate
with glucoronic acid. The conjugated pigments
are carried to gallbladder by bile.
d. From gallbladder, the pigments reach intestine
and are converted to mesobilirubin.
e. From intestine, some amount of bile pigment is
secreted as the stercobilinogen along with feces.
f. Some amount of bile pigment is secreted through
urine as urobilinogen.
Q.7. Write a note on anemia. (Aug 2012, 5 Marks)
Or
What is anemia. Classify the types of anemias on mor-
phological and etiological basis. (Aug 2016, 10 Marks)
Ans. Anemia is a clinical condition characterized by reduction
in the number of RBCs less than 4 million/mL or their
content of hemoglobin less than 12 g/dL or both.
Classification of Anemia
It is classified by the two methods:
A. Morphological classification.
B. Etiological classification.
Morphological Classification or Wintrobe’s Classificaion
On basis of size and hemoglobin content of RBC, it is classified
into four types:
1. Normocytic normochromic anemia: In it, the size of RBC
and hemoglobin content of RBC is normal. Only RBC count
is reduced.
2. Macrocytic normochromic anemia: The RBCs are larger in
size and due to this RBC count is reduced. The hemoglobin
content is reduced.
3. Macrocytic hypochromic anemia: The RBCs are immature
and are larger in size and hemoglobin content in cell is less.
4. Microcytic hypochromic anemia: The RBCs are smaller
in size. The hemoglobin content in RBCs is less.
Etiological Classification or Whitby’s Classification
On basis of cause, it is divided into four types:
1. Hemorrhagic.
2. Hemolytic.
3. Nutrition deficiency.
4. Aplastic.
5. Anemia due to chronic diseases.
1. Hemorrhagic anemia: It occurs in conditions like accident,
ulcer, excessive uterine bleeding, purpura and hemophilia.
It occurs in both chronic and acute hemorrhagic conditions.
2. Hemolytic anemia: It occurs due to excessive destruction
i. By chemical poisoning, e.g. lead, coal, etc.
ii. Infections like malaria and septicemia.
iii. Presence of chemical hemolysins.
iv. Presence of isogglutinins.
v. Congenital or acquired default in shape of RBCs, e.g.
sickle cell anemia and thalassemia.
3. Nutrition deficiency anemia: The deficiency of iron, pro-
tein and vitamins such as vitamin C, folic acid and vitamin
B12 causes nutrition deficiency anemia, e.g. iron deficiency
anemia, protein deficiency anemia and pernicious anemia.
 Physiology 291

4. Aplastic anemia: It is due to disorder of red bone marrow 

(generally reduced). The bone marrow is reduced and
replaced by fatty tissues.
5. Anemia due to chronic diseases: It is seen in tuberculosis,
chronic infection, malignancies, chronic lung disease, etc.
Symptoms of Anemia
1. The color of skin becomes pale. The skin gets thin and (Jan 2012, 10 Marks)
dry loosing elasticity. There is loss and early grayness Ans. Types of WBCs (see following table)

Name of Diameter of
WBC Cell Nucleus Cytoplasm Diagram
Neutrophils 10–14 µm • Nucleus of neutrophil is horse Cytoplasm of neutrophil is pale blue in
shoe shaped and it become colour and consists of fine granules.
lobed as cell grows Granules acquire both acidic and basic
• Nucleus of mature neutrophil stain and are violet pink in color
is purple in colour and
is multilobed that’s why
neutrophils are known as (For colour version see Plate 19)
polymorphonuclear leucocytes
• Lobes of nucleus are conn-ected
by chromatin filaments
Eosinophils 10–14 µm • Nucleus of an eosinophil is • Cytoplasm is acidophilic and
purple in colour and is bilobed. appear as bright pink in colour
• Both the lobes are connected by • Cytoplasm of eosinophil has
chromatin strand and appear as coarse, deep red staining granules
spectacle shaped. which do not cover nucleus
• Some eosinophils have three • Granules in eosinophils consist
lobes of basic protein and stain more (For colour version see Plate 19)
intensely for peroxidase
• Granules of eosinophils have
histamine, lysosomal enzymes and
ECF – A i.e. eosinophil chemotactic
factor of anaphylaxis
Basophils 8–10 µm Nucleus of basophil is irregular • Cytoplasm of basophils is slightly
and it can be either bilobed or basophilic and is full of granules
trilobed. Boundary of nucleus • Granules of basophils are coarse
cannot be clearly appreciated due and stain deep purple
to overcrowding of coarse granules • Granules are numerous, they
completely fill the cell and overload
the nucleus (For colour version see Plate 19)
• Granules of basophils consists of
heparin, histamine and serotonin
Lymphocytes Large Nucleus of lymphocytes is large, • Cytoplasm is very less and its
lymphocyte: round and single which almost amount is less than the amount of
12–16 µm completely fills the cell. Nucleus nucleus. It appears as crescent of
Small appears deep blue giving an ink spot clear light blue colour around the
lymphocyte: appearance. Nuclear chromatin is nucleus. Cytoplasm lack visible
7–10 µm coarsely clumped and shapeless. granules.
(For colour version see Plate 19)
Monocytes 14–18 µm Nucleus of the cell is large, single Cytoplasm of monocyte is abundant,
and is eccentric in its position. pale blue and is clear. It can consists
Nucleus can be notched or indented of fine purple, dust like granules known
i.e. horseshoe or kidney shaped. as azure granules which can be few or
numerous
(For colour version see Plate 19)
292 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Functions of WBCs

Name of WBC Function

Neutrophils • Phagocytosis: Neutrophils engulf the foreign particles or bacteria and digest them and may kill them by phagocytosis
• Reaction of inflammation: They also release chemical mediators such as leukotrienes, prostaglandins etc. and bring
reaction of inflammation such as vasodilatation and edema
• Febrile response: Neutrophils consists of fever producing substance such as endogenous pyrogen which mediate febrile
response to bacterial pyrogen
Eosinophils • Mild phagocytosis: Since eosinophils are very less motile that’s why they produce mild phagocytic activity
• Role in parasitic infestations: They play an important role in defense mechanism mainly in parasitic infestations. Eosinophils
consist of granules which have lethal substances which are larvicidal
• Role in allergic reaction: They get increase in number in allergic reactions such as bronchial asthma and hay fever. They
detoxify inflammation inducing substances. They also inhibit mast cell degranulation
• Role in immunity: Since eosinophils are in abundance in respiratory tract, gastrointestinal tract and urinary tract where
they provide mucosal immunity
Basophils • Mild phagocytosis: They produce mild phagocytic action
• Role in allergic reaction: These cells release histamine, bradykinin and serotonin. These substances lead to local vascular
and tissue reactions which can lead to allergic manifestations
• Release of heparin: They release heparin in blood and prevent clotting of blood. It also activates enzyme lipoprotein lipase
which removes fat particles from blood after fatty meal
• Role in preventing spread of allergic inflammatory process: Basophils release eosinophil chemotactic factor which causes
eosinophils to migrate at inflamed allergic tissue. Here eosinophil undergoes phagocytosis and destroy antigen – antibody
complexes and prevent spread of local inflammatory process
Lymphocytes They constitute the immune system, i.e. humoral immunity. They are classified into T and B lymphocytes.
For more details refer to Ans 10 of same chapter
Monocytes • Role in defense mechanism: Along with neutrophils, monocytes undergo phagocytosis and play important role in defense
mechanism
• Role in tumor immunity: Monocytes can also kill tumor cells as they are sensitized by lymphocytes
• Synthesis of biological substances: Monocytes causes synthesis of complement and other biologically important substances

iii. Myelocyte proper: This is rounded in size,

nucleus size decreases, the cytoplasm gets de-
creased. It is less basophilic and granules appear
with special staining reactions.
iv. Metamyelocyte: The nucleus size decreases and
becomes lobed. The cytoplasm gets decreased
and granules show amoeboid movements.
c. Structure: Refer to Ans 8.
d. Function: Refer to Ans 8.
Fig. 5: WBCs e. Life Span: The average half-life of neutrophil in
circulation is 6 hours.
Q.9. Describe neutrophils under the following headings. Q.10. Write a short note on lymphocytes. (Mar 1998, 5 Marks)
(Apr 2010, 15 Marks)
Or
a. Site of development
b. Stages of development Write a short note on T and B lymphocytes.
c. Structure (Sep 2000, 5 Marks)
d. Function Or
e. Life span Write short note on function of lymphocytes.
Ans. a. Site of Development: The main site of development (Dec 2010, 5 Marks)
is bone marrow and process is extravascular. Ans. There are two types of lymphocytes:
b. Stages of Development: 1. T Lymphocytes.
i. Myeloblast: The cytoplasm is basophilic and has 2. B-Lymphocytes.
purple blue color. The size is less than hemocy-
T Lymphocytes
toblasts.
ii. Premyelocyte: In it, the size decreases and nu- Because of processing in thymus gland, they are called
cleoli disappear. The chromatin condenses and T lymphocytes. During the processing, the T lymphocytes are
the amount of cytoplasm increases. transformed into 4 types:
 Physiology 293

a. Helper T Cells. Role of Memory B Cells

b. Cytotoxic T Cells.
Some of B-lymphocytes activated by the antigens are trans-
c. Suppressor T Cells.
formed into memory B cells.
d. Memory T Cells.
The memory cells are in inactive condition till the body is
Helper T Cells exposed to the same organism for the second time. During the
They are so called because, they are stimulated by antigens and second exposure, the memory cells are stimulated by antigens
hence stimulate other T cells and B cells. and produce antibodies in more quantity at very fast rate.

Cytotoxic T Cells Role of Helper T Cells

They are so called because, they attack on antigens and destroy
them.
Suppressor T Cells
They are so called because, they suppress the action of cytotoxic
T cells.
Memory T Cells
They are so called because, they are activated by antigens and
remain in lymphoid tissue instead of entering circulation.
B-Lymphocytes
They are so called because, these were first discovered in bursa
of Fabricus in birds. In mammals, the processing takes place in
liver and bone marrow. They are transformed into two:
♦ Plasma Cells: They cause secretion of antibodies in re-
sponse to presence of antigens.

(Mar 1997, 5 Marks)
Or
(July 2016, 5 Marks)
Ans. Humoral immunity is by the antibodies, which are
circulating in blood. The antibodies are gamma globulins
produced by B-lymphocytes.
These antibodies fight against the invading organisms.
Humoral immunity is the major defense mechanism
against the bacterial infection.
Role of Antigen Presenting Cells
♦ When foreign bodies or organisms invade, macrophages
and other antigen presenting cells destroy them mostly
by phagocytosis.
♦ The antigen products activate the B-lymphocytes and also
the helper T cells.
Role of Plasma Cells
♦ B-lymphocytes are protuberated and transformed into two
types namely, plasma cells and memory cells.
♦ The plasma cells produce antibodies.
Helper T cells are simultaneously activated antigens. The
activated helper T cells secrete substances Interleukin-2 and
B cell growth factors, which promote:
1. Activation of more number of B-lymphocytes
2. Proliferation of plasma cells
3. Production of antibodies.
Q.12. Write a short note on immunoglobulins.
(Apr 2003, 5 Marks) (Mar 2009, 5 Marks)
Ans. They are produced by B-lymphocytes in response to the
presence of antigens. The immunoglobulins form 20%
of the total plasma proteins. The immunoglobulins are
found all over the body.
The immunoglobulins are of five types viz:
  IgA, IgD, IgE, IgG, and IgM.
The immunoglobulins are formed by two pairs of chain,
i.e. one pair of heavy or long chains and one pair of
light or short chains. Each heavy chain has 400 amino
acids and each light chain has 200 amino acids. Each
immunoglobulin has two halves, which are identical and
are together held by disulphide bond. Each half consist
of one heavy and one light chains. The disulphide bond
allow movement of immunoglobulins.
The functions of immunoglobulins are:
1. IgA participants in localized defense mechanism in
external secretion.
2. IgD participants in recognization of antigen by
B lymphocytes.
3. IgE involve in allergic reactions.
4. IgG is responsible for complement fixation.
5. IgM is responsible for complement fixation.
Q.13. Write in brief on platelets. (Mar 1997, 5 Marks)
Ans. Platelets or thrombocytes are small, non-nucleated,
colorless and moderately reactive bodies. Their diameter
is 2.5 µ. The normal platelet count is 2.5 lakhs/cu mm of
blood.
Properties of Platelets
1. When platelets come in contact with wet or rough surface,
they are activated and get stick to the surface.
2. Activated platelets aggregate together and get sticky due
to ADP and Thromboxane A2.
3. They undergo agglutination due to action of some agglu-
tinins.
294 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Stages of Development
Pluripotent stem cells (Hemocytoblast): These cells are
converted into colony forming units known as CFU –M
or colony forming unit-megakaryocyte.
Megakaryoblast: This is the most earliest precursor of
platelets in bone marrow.
• Diameter of megakaryoblast is 20 to 30μm.
• Cytoplasm of cell is non-granular and hematoxyphilic.
• Nucleus is oval or kidney-shaped and consists of
nucleoli.
Promegakaryocyte: Megakaryoblast get converted to
promegakaryocyte.
• Megakaryoblast does endoreduplication of nuclear
chromatin and leads to the formation of a large cell
which consists of 32 times the normal diploid content
of nuclear DNA.
Fig. 6: Platelets
• When nuclear replication caeses cytoplasm get
Function of Platelets granular.
• Granules of cytoplasm are basophilic.
1. They play an important role in blood clotting for formation
of intrinsic prothrombin activator. Megakaryocyte: Maturation of promrgakaryocyte occurs
2. They undergo clot retraction, the blood cells including and there is formation of megakaryocyte.
platelets are entrapped in between fibrin threads. • This cell is of 30 to 90μm in diameter.
3. They play role in prevention of blood loss. • Nucleus of cell is single and is multilobed (4 to 16
Q.14. Describe platelets under the following headings: lobes) with coarsely clumped chromatin.
i. Normal range and morphology • Abundant cytoplasm is present and has red-purple
ii. Stages of development granules.
iii. Functions • Margins of cell are irregular and show multiple
iv. Clinical conditions resulting from lack of platelets. pseudopodia.
(Apr 2010, 5 Marks) • Platelets formed from these pseudopodes of mega-
Ans. Normal Range and Morphology. karyocyte which become detached in bloodstream.
Refer to Ans 13 of the same chapter. • One megakaryocyte form atleast 4000 platelets.

Fig. 7: Platelets (For colour version see Plate 20)

Functions 
Refer Ans 13 of the same chapter. (Mar 2000, 15 Marks)
Clinical Condition Resulting from Lack of Platelets Or
The clinical condition resulting from lack of platelets is
Write short answer on hemostasis.
known as thrombocytopenia. It occurs in the following
conditions such as acute infections, acute leukaemia, (Apr 2018, 3 Marks)
aplastic and pernicious anemia, chickenpox, smallpox, Ans. Spontaneous arrest or prevention of bleeding by
splenomegaly, scarlet fever, typhoid and tuberculosis. physiological process is known as hemostasis.
 Physiology 295

 
(Dec 2009, 15 Marks)


(Sep 2015, 7 Marks)

 (May 2017, 5 Marks)

Or
Write short note on clotting mechanism.
(Sep 2017, 5 Marks)

 (Apr 2018, 2 Marks)

 (Apr 2017, 5 Marks)

Ans. Mechanism of Coagulation of Blood
Following are the factors which are involved in the
mechanism of coagulation of blood:
• Factor I Fibrinogen
• Factor II Prothrombin
• Factor III Thromboplastin (Tissue factor)
• Factor IV Calcium ions
• Factor V Labile factor
• Factor VI — Presence not approved
• Factor VII Stable factor
• Factor VIII Anti-hemophilic factor
• Factor IX Christmas factor
• Factor X
• Factor XI — Plasma thromboplastin antecedent
• Factor XII Hegman factor
• Factor XIII — Fibrin-stabilizing factor.

Clotting Occurs in Three Stages

1. Formation of Prothrombin Activator.
2. Conversion of Prothrombin into thrombin.
3. Conversion of Fibrinogen to Fibrin.
Formation of Prothrombin Activator
The prothrombin activator is formed into two ways:
1. Extrinsic Pathway:
(Apr 2003, 5 Marks) Factor III initiates this pathway after injury to
Or damage tissues. After injury, these tissues release
296 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

thromboplastin which contain protein, phospholipid When factor XII comes in contact with collagen, it is
and glycoprotein which act as proteolytic enzymes. converted to active factor XII.
The glycoprotein and phospholipid component of The active factor XII converts inactive factor XI to
thromboplastin convert factor X into activated factor active factor XI in presence of kininogen.
X, in presence of factor VIII. The activated factor XI activates factor IX in presence
Activated factor X reacts with factor V and phospholipid of calcium ions.
content of tissue thromboplastin to form prothrombin Activated factor IX activates factor X in presence of
activator in presence of calcium. factor VIII and calcium.
Factor V is activated by thrombin formed from When platelet comes in contact with collagen of
prothrombin. This factor V now accelerates formation damaged blood vessel, it releases phospholipids.
of prothrombin activator. Now, active factor X reacts with platelet phospholipid
and factor V to form prothrombin activation in
presence of calcium ions.
Factor V is activated by positive feedback method.
Conversion of Prothrombin into Thrombin
Prothrombin activator converts prothrombin into thrombin
in presence of calcium by positive feedback mechanism. This
accelerates formation of extrinsic and intrinsic prothrombin
activator.

Conversion of Fibrinogen to Fibrin

During this, the soluble fibrinogen is converted to fibrin by
thrombin. The fibrinogen is converted to activated fibrinogen
due to loss of two pairs of polypeptides. The first form fibrin
contains loosely arranged strands which are modified later
into tight aggregate by factor XIII in presence of calcium ions.
Three coagulants: Thrombin, sodium or calcium alginate,
snake venom.
Three anticoagulants: Heparin, EDTA, Citrates.
♦ The blood does not clot in vessels normally, because in
vessels it remains in circulation; and due to this, certain
enzymes which are involved in clotting remain in its
inactive form. Hence, it does not clot normally in vessels.
♦ Hemophilia: It is a sex-linked inherited disease affecting
males; females are the carriers. The feature of disease is
prolonged clotting time. Even mild trauma may lead to
excessive bleeding and then death.
The hemophilia is caused due to deficiency of factor VIII and
IX. The hemophilia due to deficiency of factor VIII is known
as classical hemophilia and due to factor IX, it is known as
Christmas disease.
Q.17. Classify blood groups. Add a note on mismatched
blood transfusion.
(Sept 2000, 5 Marks) (Mar 2008, 4 Marks)
Ans. • “Landsteiner” discovered the blood group in 1900
and is called as “Father of blood group”.
a = activated + = thrombin induces formation of more thrombin (positive
feedback) • According to the Landsteiner’s law, people are clas-
sified into three types of blood group depending on
2. Intrinsic Pathway: presence and absence of antigen.
It occurs in the following sequence: • There are two types of antigens, i.e. A agglutinogen
During injury, the blood vessel is ruptured, endothelium and B agglutinogen.
is damaged and collagen beneath endothelium is • Thus people belong to A, B and O blood groups.
exposed. • If antigen A is present in RBC, the blood group is A.
 Physiology 297

• If antigen B is present in RBC, the blood group is B. Determination of the ABO Group
• If no antigen is present in RBC, the blood group is O. ♦ It is also known as blood grouping or blood typing or
• Another blood group is discovered by De Castallo. blood matching.
• If both antigen is present in RBC. Blood group is AB. ♦ The blood typing is done on the basis of agglutination i.e. col-
• Other blood groups are: lection of separate particles like RBCs into clumps or masses.
- Levis blood group. ♦ Agglutination occurs if an antigen is mixed with its cor-
- MNS blood group. responding antibody which is called isoagglutinin.
♦ Agglutination occurs when A antigen is mixed with anti
Landsteiner’s Law
A or when B antigen is mixed with anti B.
♦ If an agglutinogen is present in RBC of a person, the cor-
responding agglutinin may be absent. Determination of Blood Group of a Person
♦ If an agglutinogen is absent in RBC, the corresponding For determination of blood group of a person, suspension of
agglutinin must be present. his RBC and testing antisera is required. Suspension of RBC is
prepared by mixing blood drops with isotonic saline (0.9%).
Mismatched Blood Transfusion
Test sera are:
Antigen Antibody Blood Group ♦ Antiserum A; containing anti A.
A antigen Beta antibody A ♦ Antiserum B, containing anti B.
B antigen Alpha antibody B Procedure
A and B antigen – AB ♦ One drop of antiserum A is placed on one end of a glass
– Alpha and Beta antibody O slide (or a tile) and one drop of antiserum B on the other end.
♦ One drop of RBC suspension is mixed with each antiserum.
 The slide is slightly rocked for 2 minutes. The presence or
absence of agglutination is observed by naked eyes and if
necessary it is confirmed by using microscope.
♦ Presence of agglutination is confirmed by the presence of
thick masses (clumping) of RBCs
♦ Presence of agglutination is confirmed by clear mixture
with dispersed RBCs.

(Oct 2007, 5 Marks)
Ans. ABO Blood Group System
Based on the presence or absence of antigen A and
antigen B, blood is divided into four groups, i.e.
1. A group.
2. B group.
3. AB group.
4. O group.
• Blood consisting of antigen A is known as A group
and it has β antibody in serum.
• Blood consisting of antigen B is known as B group
and it has α antibody in serum.
• If both antigens are present the blood group is called
as AB group and it has no antibodies.
• If both antigens are absent the blood group is called
as O group and it has both α and β antibodies.
Results
♦ If agglutination occurs with antiserum A: The antiserum
A contains anti A or α antibody. The agglutination occurs
if the RBC contains A antigen. So, the blood group is A.
♦ If agglutination occurs with antiserum B: The antiserum
B contains anti B or B antibody. The agglutination occurs
if the RBC contains B antigen. So, the blood group is B.
♦ If agglutination occurs with both anti-sera A and B: The
RBC contains both A and B antigens to cause agglutination
and, the blood group is AB.
♦ If agglutination does not occur either with anti-serum A or
anti-serum B: The agglutination does not occur if the RBC
does not contain antigen. The blood group is O.
Q.19. Write a short note on Rh factor.
(Oct 2016, 5 Marks) (May/June 2009, 5 Marks)
Or
Write briefly about Rh blood group.
(Aug 2016, 2 Marks)
Ans. Rh factor is an antigen present in the RBC. The antigen was
found in Rhesus monkey, so it was named as Rh factor.
There are many Rh antigens but D is more antigenic.
• The persons having D antigen are called Rh positive
and those without D antigen are Rh negative.
• Among Asian population, 85% of people are Rh
positive and 15% are Rh negative.
298 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

• Unlike ABO system, there is no corresponding an- ♦ If father is Rh positive and mother is Rh negative and
tibody present for Anti-D. fetus is Rh positive, then fetal RBCs may enter mother s
• Rh positive person can receive Rh negative blood blood and stimulate antibody production. This is normally
without the risk of developing complications. possible during first delivery and complications do
• Sometimes, when Rh negative mother carries Rh not arise during first delivery. But now antibodies are
positive fetus, the first child escapes from complica- developed. During second pregnancy antibodies cross
tions of Rh incompatibility because Rh agglutinogen through the placenta and, enter fetus and produce
cannot pass from fetal blood into mother s blood hemolysis. This leads to erythroblastosis fetalis.
through placental barrier. 
However, at the time of delivery, the Rh antigen from
fetal blood leaks into mother’s blood within a month after
delivery, the mother develops Rh antibody in her blood.
Now, at the time of second fetus, if it is again Rh positive,
the antibody from mother s blood crosses placental
barrier and enters fetal blood. So, the Rh agglutinins,
which enter fetus cause agglutination of fetal RBC and
hemolysis. The severe hemolysis causes jaundice in fetus.
To compensate hemolysis, there is rapid production of
RBCs. Now, more numbers of large and immature cells
in proerythroblastic stage are released in circulation.
Because of this disease is called erythroblastosis fetalis.
Rh blood group is also known as Rhesus blood group
♦ Rh blood group was discovered by Landsteiner and Weiner
in 1940.
♦ RBCs of Rhesus monkeys when injected to rabbits, the
rabbits respond to presence of an antigen in these cells by
forming an antibody which agglutinates Rhesus RBCs.
♦ If immunized rabbit s serum is tested against human RBCs,
agglutination occur in 85% of people which are known as
Rh positive and their serum has no Rh antibody whereas
in 15% of people no agglutination occur, these are known
as Rh negative and their serum also does not consists of
Rh antibody.
♦ Rh blood group system has not been detected in tissues
other than RBCs.
♦ Rh antigen is known as D and its antibody is known as
anti D.
♦ Three genotype combinations are present i.e. DD, Dd
and dd
♦ DD and Dd are Rh positive while dd is Rh negative.
Antibodies to D antigen develop only when Rh negative
individual is given Rh positive blood or Rh positive fetal
RBC enter accidentally Rh negative mother. So these (Aug/Sep 1998, 5 Marks)
antibodies are not natural but are acquired. Ans. Blood is a connective tissue. Blood containing the formed
♦ In Rh system, Rh antibodies are of IgG type and antigen- elements called as blood cells and liquid protein plasma.
antibody reaction occur best at body temperature. So Rh 1.  Blood cells also known as formed elements:
antibodies are known as warm antibodies. Antibodies a. Red blood cell: Erythrocytes are mononucleo-
being IgG types can cross the placenta. tides; the red color of these is due to hemoglobin.
b. White blood cell: They are colorless, nucleated
Significance of Rh Blood Grouping
formed elements. They play an important role
♦ At the time of first transfusion of Rh positive blood to an Rh in defense mechanism.
negative person, complications do not arise but antibodies c. Thrombocytes: They are small colorless non-
are produced. During next transfusion antibodies which nucleated and play an important role in blood
are developed react with Rh positive cells and produces clotting.
reaction. So Rh positive blood should not be transfused to - Blood cells form 45% of blood and 55% of
Rh negative individuals. blood is formed by plasma.
 Physiology 299

 Thrombocytopenia can occur due to three mechanisms:

1. Diminished production of platelets in bone marrow.
2. Excessive consumption and destruction of platelets
after their release in circulation.
3. Excessive sequestration of spleen.

Causes
♦ Impaired platelet production
Generalized marrow failure
– Aplastic anemia
– Leukemia
– Megaloblastic anemia
– Marrow infiltration.
Selective suppression of platelet production
It is due to drugs like quinine, thiazides, etc.
♦ Increased consumption or destruction of platelets
Disseminated intravascular coagulation
Thrombolytic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura
Viral infections.
♦ Splenic sequestration: It is due to hypersplenism.
Q.25. Define and classify immunity. Describe cellular
immunity in detail. 
(Oct 2007, 15 Marks) (Apr 2010, 5 Marks)
Ans. Resistance to the body against the pathogenic agents is
know as “Immunity”.

Classification of Immunity

Natural (Innate) Acquired

(Non-specific) (Specific)
(Mar 2005, 5 Marks)
Ans. Role of Vitamin B12 in erythropoiesis
This is essential for maturation of RBC. The deficiency Humoral Cell mediated Humoral Cell mediated
Response Response Response Response
of cyanocobalamin causes pernicious anemia so it is also
- Complement - Neutrophils - B lymphocytes - T lymphocytes
called as antipernicious factor. Vitamin B12 is essential
system - Monocytes - Antibodies
for synthesis of DNA. Its deficiency leads to failure - Interferon etc - Macrophages
in maturation of nucleus, maturation of the cell and
reduction in the cell division. Also the cell are large and
fragile and weak cell membrane. Cellular Immunity

Role of Folic Acid in Erythropoiesis
This is also essential for maturation. This is necessary for
synthesis of DNA. In absence of folic acid, the synthesis
of DNA is reduced causing failure of maturation of
RBCs. The anemia due to folic acid deficiency is called
as megaloblastic anemia in which cells are large and
appear in megaloblastic stage.
Q.24. Write a short note on thrombocytopenia.
(Mar 2006, 5 Marks)
Ans. This is a quantitative disorder of platelets. This disorder is
characterized by diminished platelet count, i.e. less than
1,50,000/mm3 and is known as thrombocytopenia.
The cellular immunity is by the activation of T-lymphocytes,
which destroy the organisms, entering the body.
♦ This is also called “cell mediated immunity” or “T-cell
immunity”.
♦ This is the major defense mechanism against infections by
virus, fungi and few bacteria like tubercle bacillus.
♦ Cellular immunity is also responsible for delayed allergic
reactions and the rejection of tissues transplanted from
other s body.
♦ The exposure or presentation of antigen to the lymphocytes
is an important process during development of immunity.
It is done by some special type of cells called antigen
presenting cells.
300 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Antigen Presenting Cells
1. Macrophages - Phagocyte.
2. Dendrite cells - Nonphagocyte.
Role of Antigen Presenting Cells
When foreign organisms invade the body, the macrophages
or other antigen presenting cells kill them mostly by means of
phagocytosis.
♦ Later the antigen from the organisms is digested into
polypeptides.
♦ These polypeptide products are presented to T-lympho-
cytes along with human leukocyte antigens.
♦ The antigen products activate the helper T cells and B-
lymphocytes.
♦ The macrophages also secrete interlukin-1. This causes
activation and proliferation of lymphocytes.
♦ The activated helper T-lymphocytes are proliferated and
released into circulation from lymphoid tissues.
Role of Helper T-lymphocytes
♦ These lymphocytes are also called helper T-cells because
these cells help in promoting the various activities of im-
mune system.
♦ These cells stimulate the other T-cell and the B-cell by
secreting interleukin 2 and B cell growth factor.
Other T-cells
Interleukin 2 secreted by helper T-cells activates the cytotoxic
T-cells and suppressor T-cells.
On B-lymphocytes
B cell growth factor secreted by the helper T-cells and produces:
1. Activation of B-lymphocytes.
2. Proliferation of plasma cells.
3. Production of more amount of antibodies by B-lymphocytes.
Role of Cytotoxic T-lymphocytes
The cytotoxic T-cells activated by the interleukin 2, directly
attack the microorganisms or other invading organisms and
destroy them.
Role of Suppressor T-lymphocytes
The suppressor T-cells are also called regularly T-cells. These
T-cells suppress the activities of the killer T-cells.
Role of Memory T-lymphocytes
♦ T-lymphocytes are an antigen remain in lymphoid tissue in-
stead of entering circulation, these are called memory T-cells.
♦ Later when the body is exposed to the same organism
second time, the memory cells activate the other T-cells. So
the invading organism is destroyed very quickly.
Specificity of T-lymphocytes
♦ Each T-lymphocytes is activated only by one type of an-
tigen, it is capable of developing immunity against that
antigen only.
♦ This property is called the specificity of T-lymphocytes.
Q.26. Describe different types of blood groups. Add a note
on blood transfusion. (Dec 2010, 20 Marks)
Ans. Following are the types of blood groups:
1. ABO Blood Group
2. Rhesus (Rh) Blood Group
3. M and N Blood group
4. Lewis Blood Group
5. Auber group
6. Diego group
7. Bombay group
8. Duffy Group
9. Lutheran group
10. P group
11. Kell group
12. I group
13. Kidd group
14. Sulter XG group.
For ABO blood group refer to Ans 18 of same chapter.
For Rhesus (Rh) blood group refer to Ans 19 of same
chapter.
M and N Blood Group
M and N factors depend on two minor genes. Each person
carries two of the gene of M and N group,. i.e. M + M (= M)
N + N (= N)
M + N (= MN)
This blood group is antigenic to rabbit.
Bombay Blood Group
♦ The first person that was discovered to have the Bombay
phenotype seemed to have an interesting blood type that
reacted to other blood types in a way never seen before.
♦ The serum contained antibodies that reacted with all red
blood cells normal ABO phenotypes.
♦ The red blood cells appeared to lack all of the ABO blood
group antigens plus an additional antigen that was previ-
ously unknown.
♦ Individuals with the rare Bombay phenotype (hh) do not
express H antigen (also called substance H), the antigen
which is present in blood group O. As a result, they can-
not make A antigen (also called substance A) or B antigen
(substance B) on their red blood cells, whatever alleles they
may have of the A and B blood-group genes, because A
antigen and B antigen are made from H antigen.
♦ For this reason people who have Bombay phenotype can
donate RBCs to any member of the ABO blood group sys-
tem (unless some other blood factor gene, such as Rhesus,
is incompatible), but they cannot receive blood from any
member of the ABO blood group system (which always
contains one or more of A and B and H antigens), but only
from other people who have Bombay phenotype.
♦ Receiving blood which contains an antigen which has
never been in the patient’s own blood causes an immune
reaction due to the immune system of a hypothetical
receiver producing immunoglobulins not only against
antigen A and B, but also against H antigen.

Blood Transfusion
Blood transfusion is the process of transferring blood or blood
components from one person to another.
Indications of Blood Transfusion
Blood transfusion is indicated in following situations:
♦ Blood loss: Accident and surgeries.
♦ Blood disorders such as hemophilia, clotting defects,
purpura.
♦ Blood diseases such as anemia, leukemia, blood dyscrasias.
♦ In poisoning such as carbon monoxide poisoning.
♦ In acute infections which causes fever.
♦ In various shocks.
Precautions to be Taken before Transfusing the Blood
♦ Donor should be healthy and not having any disease.
♦ Compatible blood should be transfused and Rh compat-
ibility should be confirmed.
♦ Blood matching and cross matching should be done.
Precautions to be Taken while Transfusing the Blood
♦ Apparatus for transfusion should be sterile.
♦ Temperature of transfusing blood should be same as body
temperature.
♦ Blood transfusion should be slow.
Q.27. Write short note on blood groups: ABO and Rh system.
(Aug 2011, 6 Marks)
Ans. For ABO blood group refer to Ans 18 of same chapter.
For Rhesus (Rh) blood group refer to Ans 19 of same
chapter.
Q.28. Write on blood groups and its importance. of the body for growth and production of energy.
(Feb 2013, 7 Marks)
Or
Write in brief blood group. (Jan 2012, 3 Marks)
Or
Write short note on blood group. (June 2010, 5 Marks)
Ans. For blood groups refer to Ans 26 of same chapter.
Importance of Blood Groups
♦ Blood group is very essential socially, medically and ju-
dicially. The importance of knowing blood group is that
it is important during blood transfusions and in tissue
transplants.
♦ One should know his or her own blood group and become
a member of the blood donor s club so that he or she can
be approached for blood donation during emergency
conditions.
♦ Knowledge of blood groups helps to prevent the compli-
cations due to Rh incompatibility and save the child from
the disorders like erythroblastosis fetalis.
♦ It is helpful in medicolegal cases to sort out parental
disputes and as a supporting evidence in identifying the
criminals.
Physiology 301

(June 2010, 10 Marks)
Ans.
Composition of Blood
♦ Total volume of blood is 5 6 lts.
♦ Specific gravity is 1050–1060.
♦ Viscosity is 4–5 times that of water.
♦ pH is 7.4 ± 0.05.
♦ The cellular elements of blood represents 45% of blood
volume. The cellular elements are Red blood cells, white
blood cells and platelets.
♦ Plasma is straw coloured fluid part of blood and presents
55% of total blood volume. It consist of 91% of water and
9% of solids. Solid consists of 1% inorganic and 8% organic
molecules.
♦ The inorganic molecules present in plasma are Na+, Ca2+,
Cl-, HCO3- which are extracellular while intracellular
inorganic molecules are K+, Mg2+, Cu2+, PO43-, Protein.
Other inorganic molecules are Fe2+, Fe3+.
♦ Of the 8% total organic molecules, 7% are plasma proteins
and 1% are non-proteinaceous nitrogenous substances,
sugar, fat, enzyme and hormones.
Functions
1. Nutritive: Substances like glucose, amino acids, lipids and
vitamins derived from digested food are absorbed from
gastrointestinal tract and carried by blood to different parts
2. Respiratory: Transport of respiratory gases is done by the
blood. It carries oxygen from alveoli of lungs to different
tissues and carbon dioxide from tissues to alveoli.
3. Excretory: Waste products formed in the tissues during
various metabolic activities are removed by blood and
carried to the excretory organs like kidney, skin, liver,
etc. for excretion.
4. Hormones and enzymes: Hormones which are secreted by
endocrine glands are released directly into the blood. The
blood transports these hormones to their target organs/
tissues. Blood also transports enzymes.
5. Water balance regulation: Water content of the blood is
freely interchangeable with interstitial fluid. This helps in
the regulation of water content of the body.
6. Acid-base balance regulation: The plasma proteins and
hemoglobin act as buffers and help in regulation of acid-
base balance.
7. Body temperature regulation: Because of the high specific
heat of blood, it is responsible for maintaining the ther-
moregulatory mechanism in the body.
8. Storage: Water and some important substances like
proteins, glucose, sodium and potassium are constantly
required by the tissues. All these substances are present
302 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
in the blood are taken by the tissues during the conditions
like starvation, fluid loss, electrolyte loss, etc.
9. Defensive: The WBCs in the blood provide the defense
mechanism and protect the body from the invading organ-
isms. Neutrophils and monocytes engulf the bacteria by
phagocytosis. Lymphocytes provide cellular and humoral
immunity Eosinophils protect the body by detoxification,
disintegration and removal of foreign proteins.
Q.30. Write in brief functions of platelets. (Nov 2012, 3 Marks)
Ans. Function of Platelets
1. In blood clotting: Platelets are responsible for the
formation of intrinsic prothrombin activator. This
substance is responsible for the onset of blood clotting
2. In clot retraction: In the blood clot, the blood cells
including platelets are entrapped in between the
fibrin threads. The cytoplasm of platelets contains
the contractile proteins namely actin, myosin and
thrombosthenin which are responsible for clot
retraction
3. In prevention of blood: Platelets accelerate hemo-
stasis by three ways:
i. Platelets secrete 5 HT, which causes the constric-
tion of blood vessels.
ii. Due to the adhesive property, the platelets seal
the damage in blood vessels like capillaries.
iii. By formation of temporary plug also platelets
seal the damage in blood vessels.
4. In repair of ruptured blood vessel: The platelet
derived growth factor (PDG F) formed in cytoplasm
of platelets helps in the repair of the endothelium
and other structures of the ruptured blood vessels.
5. Role in defense mechanism: By the agglutination,
platelets encircle the foreign bodies and destroy
them by phagocytosis.
Q.31. Describe briefly the mechanism of coagulation of Afibrinogenemia
blood. What is Rh factor. (Jan 2012, 11 Marks)
Ans. For mechanism of coagulation of blood refer to Ans 16
of same chapter and for Rh factor refer to Ans 19 of same
chapter.
Q.32. Describe in brief bleeding disorders.
(Dec 2010, 5 Marks)
Ans. These are also known as hemorrhagic disorders.
Major causes of bleeding disorders are classified as:
A. Defective blood clotting due to.
1. Deficiency of clotting factors, i.e. Factor I, II, V,
VIII, IX, X.
2. Deficiency of vitamin K.
3. Anticoagulant overdosage.
B. Defective capillary contractility, i.e. Purpura.
C. Combined defect.
Defective Blood Clotting
In this disorder a firm clot is not formed following an injury
during period of capillary contraction. When the capillaries
finally open up once more, oozing will recur.
l. Deficiency of clotting factors.
2. Vitamin K deficiency.
3. Anticoagulant overdose.
Hemophilia A
♦ It is caused by an abnormality or deficiency of factor VIII.
♦ It is an inherited sex-linked anomaly due to an abnormal
gene on X-chromosome.
♦ It is transmitted by females to males who manifest signs
of the disease.
♦ The gene responsible for hemophilia is present in the
X-chromosomes.
♦ In the presence of another normal X-chromosome the
gene acts as a recessive i.e. the individual has no sign of
hemophilia but can transmit the disease.
♦ The condition is characterized by a marked increase in
the coagulation time (CT), normal CT is 3-8 minutes. The
bleeding time (BT) is normal; normal BT is 2-5 minutes.
♦ Normal blood collected after venopuncture clots in 5-10
minutes, while hemophilic blood may take 1-12 hours and
may form only the soft clot.
Treatment
♦ Fresh blood transfusion, because factor VIII is lost rapidly
on storage, or
♦ Injecting factor VIII and IX, prepared from fresh frozen
plasma i.e. cryoprecipitates ; or
♦ Injecting thrombin or thromboplastin.
Von-Willebrand’s Disease
♦ It is caused due to deficiency of Von-Willebrand’s factor.
♦ This factor plays important role in platelet adhesion and
regulates circulating effects of factor VIII.
It is inherited blood disorder in which the blood does not clot
normally due to a lack of or a malfunction involving fibrinogen,
a protein necessary for coagulation.
Parahemophilia
♦ Parahemophilia is caused due to deficiency of Factor V.
♦ Factor V is a protein of the coagulation system, rarely
referred to as proaccelerin or labile factor.
♦ In contrast to most other coagulation factors, it is not
enzymatically active but functions as a cofactor.
♦ Deficiency leads to predisposition for hemorrhage, while
some mutations predispose for thrombosis.
Deficiency of Vitamin K
Vitamin K is required for the synthesis of prothrombin (factor
II) and factors VII, IX and X in the liver. Vitamin K in liver acts
on certain receptor sites to form all the factors. Anticoagulants
act by substrate competition by occupying vitamin K receptor
sites.
 Physiology 303

Causes
♦ Obstructive jaundice.
♦ Chronic diarrheas.
♦ Liver diseases, i.e. Cirrhosis, hepatitis, malignancy.
Treatment
Injection of Vitamin K should be a good cure.

Defective Capillary Contractility

The clinical condition in which capillary contractility results in
bleeding is known as purpura.
♦ The condition is characterized by spontaneous hemorrhages
beneath the skin, mucous membrane and internal organs.
♦ Purpura is of two types i.e. primary and secondary.
♦ Clotting time is normal in purpura while bleeding time
increases.
♦ Capillary endothelial resistance decreases causing increased
capillary fragility.
Q.33. Describe physiology of blood clotting. Give a brief
description of bleeding disorders.
(May/June 2009, 15 Marks)
Ans. For physiology of blood clotting refer to Ans 16 of same
chapter.
For bleeding disorders refer to Ans 32 of same chapter. (Jan 2012, 15 Marks)
Ans. For erythropoiesis and its stages refer to Ans 3 of same
Q.34. Write short note on role of lymphocytes in immunity. chapter.
(June 2010, 5 Marks) (Aug 2012, 5 Marks)
Ans. Anemia

Role of Helper T Cells Anemia is the clinical condition characterized by reduction

Helper T cells when enter the circulation activate T cells and B
cells. Helper T cells are of two types:
1. Helper-1 T cells.
2. Helper-2 T cells.
Helper-1 T Cells
♦ They secrete interlukin-2 which activate other T cells.
♦ They secrete gamma interferon which stimulates phago-
cytic activity of cytotoxic cells, macrophages and natural
killer cells.
Helper-2 T Cells
They are concerned with humoral immunity and secrete
interlukin-4 and interleukin-5 which are concerned with:
♦ Activation of B cells.
♦ Proliferation of plasma cells.
♦ Production of antibodies by plasma cell.
Role of Cytotoxic T Cells
They are activated by helper T cells which circulate through
blood, lymph and lymphatic tissues and destroy the invading
organisms by attacking them directly.
The receptors situated on the outer membrane of cytotoxic
T cells bind the antigens or organisms tightly with cytotoxic
T cells. Then, the cytotoxic T cells enlarge and release cytotoxic
in number of RBCs less than 4 million/µl or their content of
hemoglobin is less than 12 gm/dl or both.
Hemorrhagic Anemia
♦ It is caused due to the loss of blood. It is of two types, i.e.
acute and chronic.
♦ Acute is due to the sudden loss of large amount of blood.
RBCs become normocytic and normochromic.
♦ Chronic is due to loss of blood during the long period of
time i.e. by external or internal bleeding. In this RBCs are
microcytic and hypochromic.
Hemolytic Anemia
Hemolysis means destruction of RBCs. Anemia due to excessive
destruction of RBCs is called hemolytic anemia. Hemolysis
occurs because of liver failure, renal disorder, hypersplenism,
burns, etc.
Hereditary Disorders
♦ Sickle cell anemia: It is an inherited blood disorder char-
acterized by sickle shaped RBCs. It occurs when a person
inherits two abnormal genes (one from each parent). It is
also called sickle cell disease. In this hemoglobin becomes
abnormal with normal α chains and abnormal β chains.
Because of this, RBCs attain sickle shape and become more
fragile leading to hemolysis.
304 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦ Thalassemia: It is an inherited disorder characterized by
abnormal hemoglobin. In normal hemoglobin, the number
of α and β chains is equal. In thalassemia the number of
these chains is not equal. This causes the precipitation of
the polypeptide chains leading to defective formation of
RBCs or hemolysis of the matured RBCs. It is also known
as Cooley s anemia or Mediterranean anemia. Thalassemia
is of two types α and β thalassemia.
Nutrition Deficiency Anemia
♦ Iron deficiency anemia: It is the most common type of
anemia. It develops due to inadequate availability of iron
for hemoglobin synthesis. The RBCs are microcytic and
hypochromic.
♦ Protein deficiency anemia: Protein deficiency decreases
the hemoglobin synthesis and the RBCs become macrocytic
and hypochromic in nature.
♦ Vitamin B12 deficiency or pernicious anemia: Vitamin
B12 is a maturation factor for RBC and deficiency of this
causes pernicious anemia which is also called Addison’s
anemia. It occurs because of less intake of vitamin B12 or
poor absorption of vitamin B12. Vitamin B12 is absorbed
from the stomach with the help of intrinsic factor of Castle
which is secreted in the gastric mucosa. Decrease in the
production of intrinsic factor causes poor absorption of
vitamin B12. RBCs are macrocytic and normochromic.
Aplastic Anemia
It occurs due to the bone marrow disorder. In this red bone
marrow is reduced and replaced by fatty tissues. RBCs are
normocytic and normochromic. It occur due to repeated
exposure to X-ray, tuberculosis, hepatitis, etc.
Q.36. Write in brief about edema. (Aug 2012, 5 Marks)
Ans. Decrease in plasma protein level leads to decrease in
colloidal osmotic pressure which leads to increase in
filtration at arterial end and decrease in absorption of
fluid at venous end which causes abnormal collection
of fluid in interstitial spaces known as edema.
For mechanism of formation of edema refer to Ans 1 of
same chapter.
Fig. 8: Phagocytosis
Q.37. Write short note on phagocytosis. (Aug 2012, 5 Marks)
Ans. Phagocytosis means cell eating.
Phagocytosis is defined as the process through which
the extracellular substances, i.e. bacteria, dead tissue,
foreign particles, etc. get engulfed by cells.
Events in Phagocytosis
♦ Margination: At the place of infection neutrophils get
marginated i.e. they attached towards the capillary en-
dothelium and strat rolling along its surface. This is known
as margination or pavementing.
♦ Emigration and diapedesis: Marginated neutrophils emi-
grated in large number from blood at infection area. These
are motile and move via diapedesis in tissues by passing
through junction between endothelial cells of blood vessels.
♦ Chemotaxis: This is the process through which neutrophils
are attracted towards bacteria at the site of inflammation.
This process of chemotaxis is mediated by chemotactic agents
known as chemokines which get released from infected area.
♦ Opsonization: It is the process of coating of bacteria by
opsonins through which bacteria become tasty to phago-
cytes. The principal opsonins are IgG opsonin and opsonin
fragment of complement protein.
♦ Engulfment stage: Neutrophils project pseudopodia in all
directions around opsonized particle which is bound to sur-
face of neutrophil. Pseudopodia meet each other on opposite
side and fuse. This leads to formation of enclosed chamber
with engulfed material. It breaks away from membrane to
form phagocytic vesicle. Cellular lysosomes get fuse with
phagocytic vesicle and form phagolysosome or phagosome.
♦ Secretion stage: As bacteria get engulfed, lysosomes
pour their enzymes in vesicle and in interstitial space.
This process is known as degranulation. Large number of
proteolytic enzymes are secreted for digesting bacteria.
Lysosomes of macrophages also have lipases which digest
thick lipid membranes possessed by various bacterias.
♦ Killing or degradation stage: Neutrophils and mac-
rophages consists of bactericidal agents which can kill
most of the bacterias.

Q.38. Write in brief on erythroblastosis fetalis. Q.39. Describe in brief on plasma proteins.
(Mar 2013, 3 Marks)
Ans. It is also known as erythroblastemia.
When anemia occur in child within few days after its
birth the excessive destruction of RBCs is compensated
by normoblastic response of marrow associated with
high reticulocyte count and presence of many nucleated
RBCs in circulation. This is known as erythroblastosis
fetalis.
There are two main causes of erythroblastosis fetalis:
Rh incompatibility and ABO incompatibility. Both are
associated with blood type.
Mechanism of Occurrence of Erythroblastosis Fetalis
When a mother is Rh negative and fetus is Rh positive (the Rh
factor being inherited from the father), usually the first child
escapes the complications of Rh incompatibility. This is because
the Rh antigen cannot pass from fetal blood into the mother s
blood through the placental barrier.
However, at the time of parturition (delivery of the child)
the Rh antigen from fetal blood may leak into mother s blood
because of placental detachment. During postpartum period, i.e.
within a month after delivery, the mother develops Rh antibody
in her blood. When the mother conceives for the second time
and if the fetus happens to be Rh positive again, the Rh antibody
from mother s blood crosses placental barrier and enters the
fetal blood.
Thus, the Rh antigen cannot cross the placental barrier
whereas Rh antibody can cross it. The Rh agglutinins which
enter the fetus cause agglutination of fetal RBCs resulting in
hemolysis. The severe hemolysis in the fetus causes jaundice. To
compensate the hemolysis of more and more number of RBCs,
there is rapid production of RBCs, not only from bone marrow
but also from spleen and liver.
Now, many large and immature cells in proerythroblastic
stage are released into circulation. Because of the disease is
called erythroblastosis fetalis.
Complications of Erythroblastosis Fetalis
Ultimately due to excessive hemolysis severe complications
develop, such as severe anemia, hydrops fetalis and
kernicterus.
♦ Severe anemia: Excessive hemolysis results in anemia. The
infant dies when anemia becomes severe.
♦ Hydrops fetalis: It is a serious condition in fetus character-
ized by edema. Severe hemolysis results in development
of edema, enlargement of liver, spleen and cardiac failure.
When this condition becomes more severe it may lead to
intrauterine death of fetus.
♦ Kernicterus: Kernicterus is the form of brain damage in
infants caused by severe jaundice. If the baby survive ane-
mia in erythroblastosis fetalis then kernicterus develops
because of high bilirubin content.
Physiology 305
(Sep 2013, 5 Marks)
Ans. Plasma proteins are serum albumin, serum globulin and
fibrinogen. Out of these serum globulin is of three types
i.e. α-globulin, β-globulin and γ-globulin.
• In embryonic stage plasma proteins are synthesized
by Mesenchymal cells; in adults from reticuloen-
dothelial cells of liver, from spleen, bone marrow,
disintegrating blood cells and general tissue cells.
• Normal total plasma protein concentration is 6.4 to
8.3 gm/dl of blood.
• Albumin controls the colloidal osmotic pressure and
helps in transport of anion, cation etc.
• Globulin regulates and control iron absorption form
GIT; protect iron intoxication and helps in iron
transport.
• Fibrinogen helps in blood clotting.
For functions of plasma protein in detail refer to Ans 1
of same chapter.
Q.40. Write short note on hemophilia. (Oct 2014, 3 Marks)
Ans. Hemophilia is an inherited sex linked anomaly due
to abnormal gene on X chromosome. It is invariably
transmitted by females to males who manifest signs of
the disease.
Hemophilia is a bleeding disorder which is caused due
to the defect in blood clotting which leads to prolonged
clotting time.
Because of prolonged clotting time even if minor injury
occur, it leads to excessive bleeding which leads to death.
Cause/Etiology
It occurs due to deficiency of factor VIII, IX and Factor XI.
Types
♦ Hemophilia A or Classic Hemophilia: It occurs due to the
deficiency of factor VIII.
♦ Hemophilia B or Christmas Disease: It is due to the defi-
ciency of factor IX.
♦ Hemophilia C: It is due to the deficiency of factor XI. It
is very rare.
Diagnosis
♦ There is marked increase in clotting time.
♦ Bleeding time is normal.
Q.41. Write in brief functions of lymph. (Apr 2008, 5 Marks)
Ans. Following are the functions of lymph:
It leads to transportation of proteins i.e. Approxi-
mately 95% of the proteins lost per day from vas-
cular system to interstitial fluid which are returned
to blood through lymphatics via pinocytosis and
endothelial gaps.
It leads to the transportation of absorbed long chain
fatty acids as well as cholesterol from intestine
through lymphatics in blood.
• Lymph transport RBCs, WBCs and bacteria to
regional lymph node.
306 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Lymph causes transportation of antibiotics.
It helps in the formation of maximum concentrated
urine by maintaining the osmotic gradient between
medullary interstitium and vasa recta.
• Lymph supply nutrition and oxygen to those parts
where blood is unable to reach.
• It enhances efficiency of immune system.
Q.42 Describe structure, functions and fate of hemoglobin. hemoglobin. Due to this venous blood is suitable for
(Nov 2008, 15 Marks)
Ans. Structure of Hemoglobin
Fig. 9: Chemical representation of structure of hemoglobin
• Hemoglobin is a conjugated protein which consists
of protein known as globin which is combined with
iron containing pigment known as haem.
Globin is made up of four polypeptide chains.
Hemoglobin A has four polypeptide chains, i.e.
two α chains and two β chains. So the normal adult
hemoglobin A is written as HbA (α2β2).
• Heme is an iron porphyrin complex known as iron
protoporphyrin IX, i.e. it consists of porphyrin
nucleus and the iron. Porphyrin nucleus has four
pyrrole rings which are joined by four methane
bridges. Eight side chains are attached to pyrrole ring.
Iron in heme is in ferrous form. Iron is attached to
nitrogen atom of each pyrrole ring. On iron a bond
is available for loose union where oxygen, CO and
other derivatives can get attached.
One molecule of hemoglobin consists of four units of
haem, each attached to one of the four polypeptide
chains constituting globin. As there are four units
of haem in one molecule of hemoglobin, so there
are four iron atoms in one molecule of hemoglobin
which can carry four molecules of oxygen.
Functions of Hemoglobin
♦ It carries oxygen from lungs to tissues: In lungs one
molecule of oxygen is attached loosely and reversibly at
sixth covalent bond of each iron atom of hemoglobin to
form oxyhemoglobin. Oxygenation of first heme molecule
increases affinity for second heme molecule and so on. In this
manner affinity of hemoglobin for fourth oxygen molecule is
many times as compared to first one. Due to this hemoglobin
reacts with oxygen rapidly. Deoxygenation of hemoglobin
is also very rapid.
♦ Transport of carbon dioxide from tissues to lungs: Carbon
dioxide from tissues is transported by combining with
amino acids of globin part. Deoxygenated hemoglobin
form carbamino hemoglobin more readily than oxygenated
transport of carbon dioxide from tissues to lungs
♦ It controls pH of blood: Hemoglobin consists of most
important acid-buffer system of blood. Hemoglobin has six
times buffering capacity as compared to the plasma proteins.
For fate of hemoglobin in detail refer to Ans 6 of same
chapter.
Fig. 10: Arrangement of four units of heme in
single molecule of hemoglobin
3. MUSCLE PHYSIOLOGY
Q.1. Write a short note on sarcomere.
(Sept 2004, 6 Marks) (June 2010, 5 Marks)
Or
Write briefly on sarcomere. (Mar 2005, 5 Marks)
Ans. • Sarcomere is the functional unit of skeletal muscle.
Each sarcomere extends between the two “Z” lines
of myofibril.
• Each myofibril consists of alternative “A” band or
dark band and “I” band or light band.
• In the middle of A band, there is a light area called as
H zone; and in the middle of H zone lies the middle
part of myosin filament which is called “M” line.
• I band is divided into two equal halves by means of
“Z” line. The part of myofibril between two Z lines
is known as sarcomere.
• Sarcomere consists of two types of myofilaments:
1. Actin filament.
2. Myosin filament.
Actin filaments are thin which extend from either side
of Z line and run across I band.

Myosin filaments are thick which are situated in A band,
these are some lateral processes or cross bridges arising
from myosin filament which are enlarged structures and
are called myosin head which are at tip of these bridges.
• These myosin head attach themselves to actin fila-
ment and pulls the actin or myosin filament during
muscle contraction by means of mechanism called
sliding or ratchet mechanism.
• During muscle contraction, actin filaments glide
towards the M line so the H zone and I band are
shortened or disappear during contraction of muscle.
• During relaxation, the Z line and actin filaments
come to original position.
• Actin and myosin filaments are formed by contractile
proteins; out of which, myosin is formed by myosin,
protein and actin is formed by actin, troponin and
tropomyosin protein.
Fig. 11: Sarcomere
Q.2. Describe generation of action potential in nerve.
(Mar 1998, 5 Marks)
Or
Write a short note on nerve action potential.
(Oct 2007, 5 Marks)
Or
Write a short note on action potential.
(Apr 2010, 5 Marks)
Ans. When the nerve is stimulated, a series of changes occur
in membrane potential which is called action potential.
The action potential occurs in two phases: Or
a. Depolarization
b. Repolarization.
Depolarization
When the impulse reaches the nerve, the polarized conditions
(–70 mV) is altered, i.e. resting membrane potential.
Physiology 307
Repolarization
Within a short time, the nerve obtains the resting electrical
potential once again. Interior of nerve becomes negative and
exterior positive. So the polarized state of nerve is re-established.
This process is called repolarization.
1. Resting membrane potential is recorded at straight baseline
at 70 mV.
2. When a stimulus is applied, there is a slight irregular de-
flection of baseline for a very short period. This is called
stimulus antifact.
3. Latent period: The stimulus antifact is followed by a short
period without any change, i.e. latent period.
4. Firing level: The depolarization starts after latent period.
Initially, it is very slow up to –55 mV, then the rate of
depolarization increases suddenly; the point at which the
rate of depolarization increases is called firing level.
5. From firing level, the curve reaches isoelectric potential
rapidly and then overshoots zero line up to +35 mV.
6. Spike potential: When depolarization is completed (+
35 mV), the repolarization starts with rapid increase in
depolarization and rapid decrease in repolarization are
together called spike potential.
7. The rapid fall in spike potential is followed by slow re-
polarization process. This is called after depolarization.
8. After reaching the resting level (–70 mV), it becomes little
more negative than resting level.
In above way the action potential is generated, propagated
and produced along the nerve.
Fig. 12: Action potential
Q.3. Describe the mechanism of excitation-contraction
coupling in a muscle. (Aug/Sep 1998, 5 Marks)
(Mar 2001, 7 Marks) (Apr 2003, 4 Marks)
Write briefly excitation-contraction coupling in skeletal
muscle. (Apr 2008, 4 Marks) (Mar 2007, 4 Marks)
Ans. • When the muscle is stimulated, it is excited and
action potential is developed. Then, the muscle starts
contracting. The contraction of muscle starts due
to pulling of actin filaments by cross bridges from
308 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
myosin filaments. The process involved in between
the excitation and contraction of muscle is called
excitation-contraction coupling.
• When the impulse through a motor neuron reaches
the neuromuscular junction, acetylcholine is
released.
• The acetylcholine causes opening of ligand gated
sodium channels. So, sodium ions enter neuromus-
cular junction. This leads to development of endplate
potential. The endplate potential causes the genera-
tion of action potential from muscle fiber.
• The action potential spreads over sarcolemma and
also into the muscle fiber through the “T” tubules.
• When the action potential reaches the cisternae of
“L” tubules, these cisternae are released into the
sarcoplasm.
• The calcium ions from the sarcoplasm move towards
the actin filaments to produce the contraction.
• Thus, the calcium ions are linking or coupling ma-
terials between the excitation and the contraction of
muscle.
• Hence the calcium ions are said to form the basis of
excitation-contraction coupling.
Energy for Muscular Contraction
The energy for movement of myosin head (Power stroke) is
obtained by the breakdown of adenosine triphosphate (ATP).
Q.4. Write briefly on sliding filament theory of muscle cross bridge cycling causes movement of actin filament of either
contraction (skeletal). (Mar. 2005, 5 Marks)
Ans. This theory explains that sliding of filaments is brought
about by repeated cycle of formation of cross bridges
between head of myosin and actin molecules.
Steps of Cross Bridge Cycling
Initiation of Cross Bridge Cycling
♦ At the time of resting stage, troponin I is lightly bound
to actin and tropomycin molecules are located inside
the grooves between strands of actin filaments in such a
manner that they block myosin binding sites on actin. So
during resting stage, no actin myosin cross bridges are
formed, Thus, the troponin tropomyosin complex so-
called relaxing proteins inhibit the interaction between
actin and myosin.
♦ When activation takes place, the Ca2+ ions released in
cytosol from the terminal cisterns of the sarcoplasmic
reticulum and get attached to troponin-C subunit of the
protein troponin. It results in a change which causes
tropomyosin molecule to move laterally, uncovering the
binding sites on the actin molecules for head of the myosin
molecules. Seven myosin binding sites on the actin filament
are uncovered for each molecule of troponin that binds
a Ca2+ ion. Thus the cross-bridge cycle is initiated by the
lateral movement of the tropomyosin.
Formation of Actin – Myosin Complex
♦ Head of myosin molecule binds with adenosine triphos-
phate. The ATPase activity of myosin head immediately
causes breaking of ATP to adenosine diphosphate (ADP)
and Pi cleavage products which remain bound to the
myosin head. The head of myosin becomes energized.
Activated myosin head extends perpendicularly towards
the actin filament and gets attached to actin filament.
♦ Formation of the actin—myosin—ADP Pi complex leads
to the following events:
Release of the Pi and ADP from the complex.
A conformational change in the myosin head causing
it to flex towards the arm of the cross-bridge. The
flexion of the myosin head from the high-energy
90° conformation to low-energy 45° conformation
generates mechanical force (the power stroke).
Detachment of Head of a Cross Bridge from Active Site
of an Actin Filament
Release of ADP and Pi allows a fresh ATP molecule to bind the
myosin head. Myosin—ATP complex has a low affinity for actin
and, therefore, it results in the dissociation of myosin head from
the actin filament.
Reactivation of Myosin Head
Freshly bound ATP molecule splits again and myosin head is
reactivated for the next cycle to begin.
So with each cross-bridge cycle there is movement of actin
filament towards center of myosin to small degree. Repeated
side towards center of myosin filament of sarcomere leading to
muscle contraction.
Q.5. Write a short note on Myasthenia gravis.
(Mar 2006, 5 Marks) (May/June 2009, 5 Marks)
(Mar 2013, 3 Marks)
Ans. Myasthenia gravis a serious and sometimes a fatal
disease in which skeletal muscles are weak and tired
easily. (See Fig. 13)
• It is caused by the formation of circulating antibodies
due to nicotinic acetylcholine receptors.
• These antibodies destroy some of the receptors and
bind others to neighboring receptors, triggering their
removal by endocytosis.
• The reason for development of autoimmunity to ace-
tylcholine receptors in this disease is still unknown.
• Another condition which resembles to myasthenia
gravis is Lambert-Eaton syndrome.
Q.6. Write a short note on tetany. (Feb 2003, 5 Marks)
Ans. It is a condition characterized by hyperexcitability of
nerves and skeletal muscles resulting in muscular spasm
particularly in feet and hand. The increased neural
excitability results in convulsion. There are two types
of tetany.
1. Hypocalcemic tetany: If plasma calcium level falls
below 6 mg% from its normal value of 9.4 mg%, the
hypocalcemic tetany occurs.

Fig. 13: Sliding filament theory of muscle contraction
The signs and symptoms of hypocalcemic tetany are:
i. Carpopedal spasm.
ii. Laryngeal stridor, i.e. contraction of laryngeal
muscles.
iii. Dilatation of heart.
iv. Decreased permeability of cell membrane.
2. Latent tetany: Hypocalcemia causes hyperexcit-
ability even before onset of tetany. It is called latent
tetany.
It is characterized by general weakness and cramps
in feet and hand.
Q.7. Describe structure and function of skeletal muscles. or broad bands of fibrous connective tissue that cover
Add a note on molecular mechanism of muscle contrac-
tion and neuromuscular transmission.
(Dec 2010, 15 Marks)
Or
Describe structure of skeletal muscle and mechanism and adipose tissue, and may also be referred to as the
of muscle contraction. (Aug 2011, 20 Marks)
Ans. Structure of Skeletal Muscle
Skeletal muscles consist of 100,000s of muscle cells that
are also known as “muscle fibers”.
Physiology 309
These cells act together to perform the functions of the
specific muscle of which they are a part.
Periosteum: Periosteum is the outer layer of bone. It is
to this layer that ligaments and tendons are attached.
Tendon: Tendons attach muscle to bone.
They are tough pale colored (whitish) cords formed
from many parallel bundles of collagen fibers. Tendons
are flexible (they bend around other tissues, changing
position as they move), yet inelastic.
Fascia: The word “fascia” means bandage—a fitting
analogy as the tissue called fascia takes the form of sheets
muscles or organs, forming an outer-wrapping.
There are two types of fascia: (1) Superficial fascia and
(2) Deep fascia.
Superficial fascia consists of areolar connective tissue
“subcutaneous layer” of the skin. Deep fascia is more
relevant to the study of muscle structures because it is
deep fascia that holds the muscles together. It consists
of dense fibrous connective tissue.
310 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Skeletal Muscle (=“Voluntary” Muscle)
The type of muscle that causes movement of the skeletal system
(especially limbs), and of skin in the cases of the muscles of facial
expression in the head and neck area has many names. These
include “skeletal muscle” (because it moves bones), “voluntary
muscle” (because it is usually under conscious control), and
“striated muscle” (because they have a striped appearance).
Perimysium
Perimysium is a fibrous sheath that surrounds and protects
bundles of muscle fibers.
Epimysium
Epimysium is fibrous elastic tissue that surrounds muscle.
Fascicle
The term fascicle (sometimes expressed as a “fasciculus”),
refers to a “bundle”, such as a bundle of muscle fibers, e.g. as
illustrated above, or alternatively a bundle of nerve fibers.
Endomysium
Endomysium is the name of the fine connective tissue sheath
that surrounds/covers each single/individual muscle fiber.
Muscle Fiber (=“Muscle Cell”)
Muscle fibers also known as “muscle cells” are special cells that
are able to contract, thereby causing movement of other tissues/
parts of the body.
There are three types of muscle: striated/skeletal muscle
(causing the movement of bones/limbs), smooth muscle
(surrounding organs and blood vessels), and cardiac muscle
(forming the walls of the heart).
Fig. 14: Skeletal muscle fiber
Myofibril (See Fig. 14)
Myofibrils are small contractile filaments located within the
cytoplasm of striated muscle cells. These filaments cause the
distinctive appearance of skeletal=voluntary=striated muscle
because they consist of bands of alternating high and low
refractive index.
This gives the muscles their striped appearance.
Functions of Skeletal Muscle
1. Skeletal muscles are the mechanism for powering human
movement. While individual muscles are typically
regarded as distinct organic structures, the skeletal
muscles are the largest organ grouping in the body (the
skin is the largest contiguous organ). Virtually all joints
are moved by pairs of muscles working in contrasting
but complimentary ways, one set providing the extension
of the joint (extensors), the opposing, or antagonist, set
countering with flexion, or bending capability.
2. The skeletal muscles perform important roles relative
to the body’s energy system while the body is fasting or
otherwise not ingesting foods to be converted into useful
energy sources. The skeletal muscles release amino acids
during periods of fasting, particularly alanine and glu-
tamine. These acids work in the bloodstream to maintain
the body s blood glucose levels, stimulating the conversion
of glycogen stored in the liver into glucose.
3. Skeletal muscle moves the skeleton and is responsible for
all our voluntary movements, as well as for the automatic
movements required, for example, to stand, to hold up our
head, and to breathe.
4. Skeletal muscles maintain heat regulation.

Molecular Mechanism of Muscle Contraction
Molecular mechanism of muscle contraction is explained on the
basis of Sliding filament mechanism.
Sliding filament theory explains that sliding of filaments is
brought about by repeated cycle of formation of cross bridges
between head of myosin and actin molecules.
Steps of Cross Bridge Cycling
Initiation of Cross Bridge Cycling
♦ At the time of resting stage, troponin I is lightly bound
to actin and tropomycin molecules are located inside the
grooves between strands of actin filaments in such a manner
that they block myosin binding sites on actin. So during
resting stage, no actin myosin cross bridges are formed,
Thus, the troponin tropomyosin complex so-called relaxing
proteins inhibit the interaction between actin and myosin.
♦ When activation takes place, the Ca2+ ions released in cytosol
from the terminal cisterns of the sarcoplasmic reticulum and
get attached to troponin-C subunit of the protein troponin.
It results in a change which causes tropomyosin molecule
to move laterally, uncovering the binding sites on the actin
molecules for head of the myosin molecules. Seven myosin
binding sites on the actin filament are uncovered for each mol-
ecule of troponin that binds a Ca2+ ion. Thus the cross-bridge
cycle is initiated by the lateral movement of the tropomyosin.
Formation of Actin-Myosin Complex
♦ Head of myosin molecule binds with adenosine triphos-
phate. The ATPase activity of myosin head immediately
Fig. 15: The neuromuscular junction
Physiology 311
causes breaking of ATP to adenosine diphosphate (ADP)
and Pi cleavage products which remain bound to the
myosin head. The head of myosin becomes energized.
Activated myosin head extends perpendicularly towards
the actin filament and gets attached to actin filament.
♦ Formation of the actin—myosin—ADP Pi complex leads
to the following events:
Release of the Pi and ADP from the complex.
A conformational change in the myosin head causing
it to flex towards the arm of the cross-bridge. The
flexion of the myosin head from the high-energy
90° conformation to low-energy 45° conformation
generates mechanical force (the power stroke).
Detachment of Head of a Cross Bridge from Active Site
of an Actin Filament
Release of ADP and Pi allows a fresh ATP molecule to bind the
myosin head. Myosin—ATP complex has a low affinity for actin
and, therefore, it results in the dissociation of myosin head from
the actin filament.
Reactivation of Myosin Head
Freshly bound ATP molecule splits again and myosin head is
reactivated for the next cycle to begin.
So with each cross-bridge cycle there is movement of actin
filament towards center of myosin to small degree. Repeated
cross bridge cycling causes movement of actin filament of either
side towards center of myosin filament of sarcomere leading to
muscle contraction.
312 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

It is the specialized system of internal conduction.

This system surrounds the myofibrils which are
embedded in sarcoplasm.
The system is formed by two types of structures, i.e. ‘T’
tubules and ‘L’ tubules.

‘T’ Tubules
♦ They are also known as transverse tubules.
♦ Transverse tubules are narrow and are formed by invagina-
tion of sarcolemma.
♦ Transverse tubules penetrate from one side of muscle fiber
to another side.
♦ T tubules open to exterior of muscle cell and so the ECF
runs through their lumen.
♦ T tubules cause rapid transmission of impulse in the form
of action potential from sarcolemma to myofibrils.

‘L’ Tubules
♦ These are also known as longitudinal tubules.
♦ Longitudinal tubules are the closed tubules which run
to the long axis of muscle fiber forming the sarcoplasmic
reticulum.
♦ They form a close tubular system around each myofibril
and do not open exterior to muscle cell.
♦ Till complete length of lyofibrils at each regular interval
L tubules dilate to form a pair of lateral sacs known as
terminal cisternae.
♦ Each pair of terminal cisternae lies in close contact with
T tubule.
♦ ‘T’ tubule along with cisternae on both sides is known as
triad of skeletal muscle.
♦ ‘L’ tubules store large quantity of calcium ions.
♦ When action potential reaches at cisternae of ‘L’ tubule
calcium ions are released in sarcoplasm. Calcium ions
trigger excitation contraction coupling.
Q.11. Describe the ionic basis of action potential.
(Aug 2012, 15 Marks)
Ans. Following is the ionic basis of action potential.

Resting Membrane Potential

During rest, inside of the membrane is negative and outside
is positive. Ion imbalance is produced by sodium-potassium
pump and selective permeability of cell membrane. Since
permeability of K+ ion is greater than Na+ ion, therefore, K+
(Oct 2007, 5 Marks) channels maintains the resting membrane potential.
Or Depolarization

At the time of stimulation, slight decrease in the resting
membrane potential because of passive redistribution of ions,
causes increase in K+ and Cl- ion influx which restores the
resting membrane potential. When depolarization exceeds
 (Aug 2012, 5 Marks) voltage of 7 mV, Na+ channels get activated through M
Ans. It is the system of membranous structures which is in gates, i.e. voltage-gated Na+ channels opens at increased rate
the form of vesicles and tubules in sarcoplasm of muscle and when firing level is reached there is influx of Na+ along
fiber. with its concentration and electrical gradient is so high that it

overcomes the repolarizing forces and run away depolarization
starts. The membrane potential fails to reach +60 mV during the
action potential because increase in Na+ permeability is for a
short duration.
Fig. 16: Ionic basis of action potential
Physiology 313

(Aug 2012, 5 Marks)
Or
Write very short answer on muscle spindle.
(Aug 2018, 2 Marks)
Ans. Muscle spindles are sensory receptors within the belly
of a muscle that primarily detect changes in the length
of this muscle.
They convey length information to the central nervous
system via sensory neurons.
This information can be processed by the brain to
determine the position of body parts.
The responses of muscle spindles to changes in length
also play an important role in regulating the contraction
of muscles, by activating motoneurons via the stretch
reflex to resist muscle stretch.
Muscle spindles are found within the belly of muscles,
embedded in extrafusal muscle fibers.
Muscle spindles are composed of 3-12 intrafusal muscle
fibers, of which there are four types:
• Dynamic nuclear bag fibers (bag1 fibers)
• Static nuclear bag fibers (bag2 fibers)
• Nuclear chain fibers.
Axons of sensory neurons.
Axons of gamma motoneurons also terminate in muscle
spindles; they make synapses at either or both of the
ends of the intrafusal muscle fibers and regulate the
sensitivity of the sensory afferents, which are located in
the non-contractile central (equatorial) region.
Muscle spindles are encapsulated by connective tissue,
and are aligned parallel to extrafusal muscle fibers,
unlike Golgi tendon organs, which are oriented in series.
The muscle spindle has both sensory and motor
components.
314 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

• Primary and secondary sensory nerve fibers spiral Actin Molecule

around and terminate on the central portions of
These are the major constituents of thin actin filaments.
♦
the intrafusal muscle fibers, providing the sensory
There are about 300 to 400 actin molecules in each thin
♦
component of the structure via stretch-sensitive ion-
filament.
channels of the axons.

In mammals including humans, the motor
component is provided by up to a dozen gamma
motoneurons and to a lesser extent by one or two
beta motoneurons. Gamma and beta motoneurons
are called fusimotor neurons, because they activate
the intrafusal muscle fibers. Gamma motoneurons
innervate only intrafusal muscle fibers, whereas
beta motoneurons innervate both extrafusal and
intrafusal muscle fibers and so are referred to as
skeletofusimotor neurons.
• Fusimotor drive causes a contraction and stiffening
of the end portions of the intrafusal muscle fibers.
Q.13. Write in brief on contractile proteins of muscles.
(Nov 2008, 5 Marks)
Ans. These are also known as contractile elements of muscles.
Myosin filaments are formed by protein molecules
known as myosin molecules. Actin filaments are formed
by three types of proteins known as actin, tropomyosin
and troponin. All these four proteins constitute
contractile proteins of muscles.

Myosin Molecule
♦ Molecular weight of myosin molecule is 4,80,000.
♦ It consists of six polypeptide chains, two heavy chains and
four light chains.
♦ Two heavy chains twist around each other to form double
helix which constitute tail and body of myosin molecule.
♦ Light chains combine to the terminal part of heavy chains (May 2017, 2 Marks)
and form globular head of myosin molecule. Ans. There are three types of muscles present in our body:
♦ Myosin molecule present in the skeletal muscle consists 1. Skeletal muscle
of two heads and is known as myosin II. 2. Cardiac muscle
♦ At the time of muscle contraction head forms cross bridging. 3. Smooth muscle

Comparison of Muscles Present in Our Body

Features Skeletal muscle Cardiac muscle Smooth muscle
Location Most of them are attached to skeleton In heart In hollow viscera
Structure • Shows well developed cross Consists of well developed cross- • Lacks cross-striations
striations striations and is functionally syncytial. • They are of two types, i.e.
• Non-syncytial: Lack anatomic and single unit which is functionally
functional connections between syncytial and multi unit which is
individual muscle fibers. functionally non-syncytial
Control Under voluntary control Involuntary Involuntary
Size and Shape It is 1 to 40 mm long and 50 to 100 µm It is 100 µm long and 15 µm long. It is It has variable size and is
in diameter. It is cylindrical short and cylindrical. elongated
Sarcoplasm It is well developed It is more developed than skeletal It is poorly developed
reticulum muscle
Sarcotubular system Present; T- system at A - I junction; It is present with poorly developed It is present but not so
terminal cistern prominent terminal cistern. T system is characteristic
prominent and is present at Z lines
Contd...
 Physiology 315

Contd...

Features Skeletal muscle Cardiac muscle Smooth muscle

Nerve supply By somatic nerve and by special nerve It is via two branches of autonomic It is via two branches of autonomic
endings nervous system with ganglia and free nervous system with ganglia and
nerve terminals. free nerve terminals.
Control and It does not normally contract in It contracts rhythmically and Rhythmicity is of two types, i.e.
rhythmicity absence of nervous stimulation; under spontaneously in absence of external regular and irregularly discharging
voluntary control. So it is known as innervations because of presence of pacemaker. It is involuntary
voluntary muscle pacemaker tissue. It is involuntary
Blood supply and It is 840 ml/min with moderate oxygen It is 250 ml/min with high oxygen It is 350 ml/min with less oxygen
oxygen consumption consumption. consumption. consumption.
Resting membrane -90 mV -80 mV -55 mV
potential
Absolute refractory 1 to 3 msec 180 to 200 msec Not defined
period

Q.15. Define neuromuscular junction. (Sep 2017, 2 Marks) Or

Ans. Neuromuscular junction is a junction between the motor Write short note on saliva. (Dec 2009, 5 Marks)
nerve and skeletal muscle fiber.
Or
A typical neuromuscular junction is seen in skeletal
muscle fiber. Write on composition and function on saliva.

Q.16. Write very short answer on resting membrane potential. (Jan 2018, 5 Marks)
(Aug 2018, 2 Marks) Or
Ans. Resting membrane potential is defined as the electrical
potential difference across the cell membrane under
resting condition.
• It is also known as membrane potential, transmem-
brane potential, transmembrane potential difference
or transmembrane potential gradient.
• When two electrodes are connected to cathode-ray
oscilloscope via a suitable amplifier and is placed (Aug 2016, 5 Marks)
over surface of muscle fiber, there should be no
Ans.
potential difference, i.e. zero potential difference. But
if one electrode is inserted into the interior of muscle Functions of Saliva
fiber, potential difference is seen across sarcolemma. 1. Cleaning of mouth: Since saliva is watery it produces a
So there is negativity inside and positivity outside flushing action on the teeth which helps in removing the
the muscle fiber. Usually this potential difference
food debris as well as non-adherent forms of bacteria which
is constant and is known as resting membrane
collects over the teeth.
potential.
2. Lubrication and Deglutition: Saliva provides lubrication
Condition of muscle during resting membrane
to oral tissues by mucus and various other glycoproteins
potential is known as polarized state.
which help provide lubrication at time of speech. It also
In human skeletal muscle, resting membrane
helps in formation of bolus which can easily slide into the
potential is -90 mV.
oesophagus.
3. Antimicrobial function: Saliva consists of various com-
4. DIGESTIVE SYSTEM ponents which produce antimicrobial activity. The com-
ponents are lysozyme, lactoferrin, histatins and salivary
Q.1. Write on the composition and functions of saliva. peroxidases. Saliva also consists of immunoglobulin such
(Sept 2001, 5 Marks) (Apr 2008, 4 Marks) as IgA which provides antimicrobial action by agglutinat-
ing certain microorganisms and preventing their adher-
Or ence to the oral mucosa.
Write a short note on function of saliva. 4. Buffering function: Saliva consists of bicarbonate ions
(Sept 2006, 5 Marks) (Aug 2005, 5 Marks) which neutralize the acids which are produced by bacteria,
(Jan 2012, 5 Marks) (Feb 2014, 5 Marks) these acids can cause dissolution of teeth and cause dental
316 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
caries. So due to its buffering action saliva dissolve the acid
and prevent caries.
5. Digestive function: Saliva consists of digestive enzymes
such as amylase and lipase. These enzymes causes start
digestion of food from oral cavity. E.g. Enzyme amylase
and lipase break starch into maltase and lipids into diglyc-
erides and free fatty acids.
6. Mineralization: Tooth surface is always coated with sa-
liva. Since saliva consists of calcium and phosphate ions,
they increase the surface hardness of teeth which provide
resistance of teeth to demineralisation.
7. Taste: Saliva dissolves the food substances so that they can
be perceived by the receptors located in the taste buds.
8. Tissue repair: Saliva consists of epidermal growth factor
and vascular endothelial growth factor which leads to
repair and regeneration of oral tissues.
9. Excretion: Many substances from blood reaches saliva and
saliva is considered as the route of excretion.
Composition of Saliva
Saliva contains 99% of water, 1% organic and inorganic
substances.
Inorganic Contents of Saliva
♦ Calcium and Phosphate: They protect mineralized enamel
surface form dissolution. Calcium ion concentration in
saliva is 1.5 mmol/L. Phosphate ion concentration is 5.6
mmol/L.
♦ Fluoride: Fluoride promotes remineralisation of teeth
which are decaying by dental caries. Fluoride concentra-
tion is about 1.5 mM/L.
♦ Hydrogen carbonate: It acts as buffering agent in saliva.
Concentration of hydrogen carbonate is 2.9 mM/L. It neu-
tralizes the acids released by bacteria.
♦ Thiocyanate: Thiocyanate is oxidised by salivary peroxides
and it get converted to hypothiocyanate. Hypothiocyanate
acts as an antibacterial agent. Its concentration in saliva is
about 2.5 mM/L.
Other Inorganic Components
♦ Sodium ions are in very less quantity in saliva. Its con-
centrations increase along with the increase in flow rate.
♦ Potassium ions are the major inorganic ions in saliva, as
they are secreted throughout the ductal system.
♦ Other inorganic components such as lead, cadmium and
copper.
Organic Contents of Saliva
The organic contents of saliva are as follows:
♦ Amylase: It constitutes the major component of salivary
proteins, i.e. about 50% amylase digests the starch. Mostly
salivary amylase is secreted from parotid gland.
♦ Proline-rich proteins: They constitute about 40 to 45%
of salivary proteins. They reside in the salivary pellicle.
Pellicle act as diffusion barrier, and slows the attacks by
bacterial acids and loss of dissolved calcium and phosphate
ions.
♦ Mucins: Mucus consists of large, heavily glycosylated
proteins. It forms 5-10% of salivary proteins. Mucus
acts as diffusion barrier against contact with noxious
substances. It also act as a lubricant too, minimising
shear stresses.
♦ Lingual lipase: It is secreted by von Ebner’s glands as
well as parotid gland. It helps in the digestion of milk fat
in newborns.
♦ Statherins: Statherin has very high affinity for calcium
and phosphate minerals. They stop precipitation of su-
persaturated calcium phosphate in ductal saliva as well
as in oral fluid.
♦ Lysozyme: These enzymes play important role in anti-
bacterial action.
♦ Lactoferrin: It has antibacterial properties. The oxi-
dized iron part of the lactoferrin oxidizes bacteria by
formation of peroxides which causes break down of
cell membrane.
♦ Histatins: They have anti-fungal properties. They also
disrupt the cell cycle and causes generation of reactive
oxygen species.
Other Organic Components
♦ Various blood group antigens are secreted in the saliva.
♦ Sugars like glucose are secreted in the saliva.
♦ Steroid hormones like cortisol, oestrogen and testosterone
are secreted in minimal quantities.
♦ Ammonia and urea are also present in very less quantities.
Q.2. Write briefly on functions of stomach.
(Apr 2010, 5 Marks)
Ans. Following are the functions of stomach
1. Storage: The food is stored in the stomach for a long
period before entering the intestine. The maximum
capacity of stomach is 1.5 L.
2. Mechanical: The peristaltic movements of the stom-
ach mix the bolus with gastric juice and convert it
into chyme.
3. Digestive: The gastric juice is secreted by gland of
stomach and contains the enzymes which act on
protein.
4. Protective: The HCl present in gastric juice destroys
many bacteria entering the body along food.
5. Hemopoietic: The intrinsic factor of castle present
in gastric juice is necessary for absorption of vita-
min B12 which is called extrinsic factor. Vitamin
B12 is an important maturation factor during
erythropoiesis.
6. Excretory: Many substances like toxins, alkaloids
and metals are excreted through gastric juice.
Q.3. Describe composition, function of various important
components and control of secretion of gastric juice.
(Sep 2000, 15 Marks)
Or

Write briefly on functions and composition of gastric Gastric Lipase: It is the weak lipolytic enzyme, it
juice. (Mar 2006, 4 Marks) (June 2012, 5 Marks)
Or
Describe composition and function of various impor-
tant components and secretion of gastric juice.
(Sept 2005, 10 Marks)
Or
Describe composition and function of gastric juice. The mucus lubricates gastric mucosa and protects it
Give mechanism and regulation of gastric secretion.
(Aug 2012, 5 Marks)
Or
Write short note on regulation of gastric juice.
(Feb 2014, 3 Marks)
Or
Write short note on functions of gastric juice.
(Oct 2014, 3 Marks)
Or
Write about composition and functions of gastric juice.
(Sep 2018, 5 Marks) (Sep 2015, 7 Marks)
Or
Write on composition, mechanism of secretion of
gastric juice and its functions. (Apr 2017, 5 Marks)
Ans. Composition of Gastric Juice
It contains 99.5% of water and 0.5% of solids. The solids
are organic and inorganic substances.
The organic substances in gastric juice are:
1. Gastric enzymes: The enzymes present in gastric
juice are:
a. Pepsin: It is main proteolytic enzyme in gastric
juice.
b. Rennin: It is a milk curdling enzyme and is not
present in man.
c. Gastric lipase: It is a weak lipolytic enzyme.
d. Other gastric enzymes: The other enzymes of
gastric juice are gelatinase and urease.
2. Gastric mucus: It is secreted by neck cells of gastric
glands. It is a flexible gel covering gastric mucus
membrane.
3. Intrinsic factor: This is necessary for absorption of
extrinsic factor.
The inorganic substances in gastric juice are: HCl,
sodium, calcium, potassium, chloride, bicarbonate,
phosphate and sulphate.
Functions of Gastric Juice
♦ Digestive function: The gastric juice acts on proteins;
and enzymes acting on proteins are pepsin, rennin and
gastric lipase.
Pepsin: It is the main proteolytic enzyme in gastric
juice. It converts protein into proteases, peptones and
polypeptides.
Rennin: It is a milk curdling enzyme present in
animals and not in man.
Physiology 317
converts lipids into fatty acids and glycerol.
♦ Hemopoietic function: The intrinsic factor present in gastric
juice plays an important role in erythropoiesis. It is neces-
sary for absorption of extrinsic factor from GIT into blood.
♦ Protective function: The mucus present in gastric juice is
responsible for protection of wall of stomach. The func-
tions of mucus are:
from the mechanical injury.
It prevents digestive action of pepsin on gastric mucosa.
♦ Action of HCl: The HCl present in gastric juice has the
following functions:
Activates pepsinogen to pepsin.
Has bacteriolytic action.
Provides acidic medium for function of enzymes.
Mechanisms of Secretion of Gastric Juice
♦ Secretion of pepsinogen
Pepsinogen is synthesized from amino acids.
The pepsinogen molecules are packed into zymogen
granules by Golgi apparatus.
When zymogen granule is secreted into stomach from
chief cells, the granule is dissolved and pepsinogen is
released into gastric juice.
Pepsinogen is activated into pepsin by HCl.
♦ Secretion of HCl
HCl secretion is an active process taking place in
canaliculi of parietal cells.
The energy is derived from oxidation of glucose. In
parietal cell all the CO2 combines with H2O to form
carbonic acid.
Carbon dioxide is derived from the metabolic activities
in the cell. The carbonic acid is formed in presence
of carbonic anhydrase. It is present in the high
concentration in parietal cells. Carbonic acid is most
unstable compound.
Immediately it splits into hydrogen and bicarbonate
ion. The hydrogen ion is actively pump into canaliculi
of parietal cell.
Simultaneously the chloride ion is also pumped
into canaliculi actively. The chloride is derived
from sodium chloride of blood. Now, hydrogen ion
combines with chloride ion to form hydrochloric acid.
To compensate loss of chloride ion, the bicarbonate
ion from parietal cell enters the blood and combines
with sodium to form sodium bicarbonate.
Regulation of Gastric Secretion
The regulation of gastric secretion occurs in three phases:
1. Cephalic phase: This is purely under nervous control;
while taking food, the secretion of gastric juice starts before
food enters the stomach. The impulses are sent from head
and this phase is called cephalic phase.
This causes gastric secretion where food is placed in
mouth. Afferent impulses arising from taste buds and other
318 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

receptors in mouth reach the appetite center in amygdala

and hypothalamus. From here, efferent impulses pass
through dorsal nucleus of vagus. The gastric secretion  (Mar 2000, 5 Marks)
occurs by release of acetylcholine.
2. Gastric phase: The phase is under nervous and hormonal
control. When food enters the stomach secretion of gastric
juice increases. Pepsinogen and HCl are present in large
quantities. 
3. Intestinal phase: When the chyme leaves the stomach  (Feb 2016, 3 Marks)
and enters the intestine, the secretion of gastric juice is Ans. Composition of Pancreatic Juice
increased and later on it is inhibited. Pancreatic juice consists of 99.5% of water and 0.5%
Q.4. Write on proteolytic enzymes of GIT. solid substances. The solids are organic and inorganic
(Apr 2003, 5 Marks) (Sep 2004, 5 Marks) substances.

Enzymes of Pancreatic Juice nal mucous membrane. Once formed trypsin also activates
trypsinogen by means of “autocatalytic reaction”.
Pancreatic juice plays an important role in digestion of proteins
and lipids. It also digests carbohydrate. Trypsin and chymotrypsin is an endopeptidase because it
♦ Digestion of proteins: Digestion of proteins is carried by breaks interior bond of protein molecule by “hydrolysis”.
the following proteolytic enzymes present in the pancre- Trypsin
Protein Peptones + Polypeptide
atic juice. Chymotrypsin
1. Trypsin and Chymotrypsin: They are secreted as inac-
2. Carboxy peptidase: Procarboxy peptidase is precursor
tive tripsinogen and chymotrypsinogen respectively.
of carboxypeptidase activated by trypsin.
Enterokinase 3. Nucleases: The nucleases in pancreatic juice are ribo-
Trypsinogen Trypsin (active)
nuclease and deoxyribonuclease which are responsible
Trypsin for digestion of nucleic acids. These enzymes convert
Chymotrypsinogen Chymotrypsin
(active) nucleic acid into mononucleotides.
Nucleases
Enterokinase is secreted by brush bordered cell or duode- Nucleic acid Mononucleotide

4. Elastase:
Trypsin
Proelastase Elastase (Active)
Precursor
Elastase digests elastic fibers.
5. Collagenase: Activated by trypsin and causes diges-
tion of collagen.
♦ Digestion of lipids
Pancreatic lipase: It is a powerful lipolytic enzyme.
It hydrolysis neutral fat like triglyceride. It converts
triglycerides into monoglycerides and fatty acids.
Phospholipase A: It is activated by trypsin. It acts on
phospholipids and converts within and cephalin to
lysolecithin and lysocephalin.
Phospholipase B: It is activated by trypsin. It acts on
lysophospholipids, i.e. lysolecithin and lysocephalin
and convert them to phosphoryl choline.
♦ Digestion of carbohydrate: Pancreatic amylase is a single
amylolytic enzyme present in pancreatic juice. It converts
into maltose.
Functions of Pancreatic Juice
1. Digestive function: It has an important role in digestion of
proteins and lipids and also digests carbohydrates.
2. Neutralizing action: When acid chyme enters the intestine
from stomach, the pancreatic juice with more quantity of
bicarbonate ion is released into intestine. Due to presence
of large amounts of bicarbonate ions, the pancreatic juice
is highly alkaline and neutralizes acidity of chyme in
intestine.
Regulation of Pancreatic Juice
1. Cephalic phase: When food is taken in the mouth, there
is secretion of pancreatic juice. Slight thought of food also
causes secretion of pancreatic juice by conditioned reflex.
The afferent nerve impulses from cerebral cortex reach
dorsal nucleus of vagus. From dorsal nucleus, afferent
impulses reach pancreas by passing through efferent fibers
of vagus nerve. The vagal nerve fibers cause secretion of
pancreatic juice by releasing acetylcholine, which stimu-
lates acinar cells to release enzymes.
2. Gastric phase: When food enters stomach, gastrin in GIT
hormone is secreted from stomach. The gastrin is trans-
ported by blood; and while reaching pancreas, it causes
release of pancreatic juice.
3. Intestinal phase: When the chyme from stomach enters
the intestine, more amount of pancreatic juice is secreted.
This is due to two hormones, i.e. secretin and cholecysto-
kinin or CCK.
Acidic chyme increases the release of secretin from S cells
present in mucosa of upper part of small intestine. Secretin
stimulates pancreatic juice rich in aqueous component.
Presence of products of protein digestion such as amino acids
and peptides, and the products of fat digestion such as fatty
acids and monoglycerides in chyme evoke pancreatic secretion
Physiology 319
rich in enzymes, this is mediated by cholecystokinin secreted
from I cells in intestinal mucosa. Cholecystokinin potentiates
effect of secretin on ducts and secretin potentiates effect of
cholecystokinin on acinar cells.
Q.5. Write a short note on bile composition and function.
(Mar 2008, 4 Marks) (Dec 2010, 6 Marks)
Or
Write a short note on functions of bile.
(Mar 1997, 5 Marks) (Mar 2009, 5 Marks)
Ans. Composition of bile: Bile contains 97.6% of water and 2.4%
of solids. The solids are organic and inorganic substances.
Organic substances: Bile salts, bile pigments, cholesterol,
lecithin and fatty acids.
Inorganic substances: Sodium, calcium, potassium,
chloride and bicarbonate.
Functions of Bile
1. Digestive function: As lipids are insoluble in water,
various lipolytic enzymes cannot digest lipids. Lipids
are insoluble in water because of surface tension. Due
to detergent action, bile salts reduce surface tension of
lipids and lipids become water soluble. This is known as
emulsification of lipids.
2. Absorptive function: When bile salts combine with lipids,
miscelles are formed. The lipids of miscelles become water
soluble and are easily absorbed. This action of bile salts is
called hydrotropic effect.
3. Maintenance of pH in GIT: As bile is highly alkaline,
it neutralizes the acid chyme and hence optimum pH is
maintained for action of digestive enzymes.
4. Prevention of gallstone formation: Bile salts keep
lecithin and cholesterol in solution. In absence of bile
salts, cholesterol precipitates along with lecithin to form
gallstones.
5. Antiseptic action: Bile is a natural detergent. So inhibits
growth of certain bacteria in intestine.
6. Laxative action: Intestinal motility is stimulated by the bile
salts. This action of bile salts help in defecation.
7. Choleretic action: Bile stimulates liver to secrete more bile
which leads to fat digestion.
Q.6. Describe in brief functions of liver.
(Sep 2013, 5 Marks) (May/June 2009, 5 Marks)
Or
Write short note on functions of liver.
(Aug 2011, 5 Marks)
Ans. Following are the functions of liver
1. Storage function: Many substances are stored in
liver, i.e. glycogen, amino acids, iron, folic acid, etc.
2. Secretion of bile: Liver secretes bile, which contains
bile salts, bile pigments, cholesterol, fatty acids and
lecithin. The functions of bile are mainly due to bile
salts.
320 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

3. Defensive and detoxification function: The buffer ♦ Formation of Micelle: Bile salts combine with products of
cells of liver play a major role in defense mechanism; hydrolysis of triglycerides and form micelle which gets
liver is also involved in detoxification of foreign transported to brush border of epithelial cells for absorption.
bodies. ♦ Absorption of fat soluble vitamins: Bile salts form com-
4. Metabolic function: Liver is an organ where maxi- plexes which are more soluble in water.
mum metabolic actions are carried out. Metabolism ♦ Laxative action: Intestinal motility is stimulated by the bile
of carbohydrates, proteins, lipids and nutrients occur salts. This action bile salts help in defecation.
in liver. ♦ Choleretic action: Bile stimulates liver to secrete more bile
which leads to fat digestion.
5. Hemopoietic function: In this, fetus blood cells are
♦ Bile salts keep cholesterol in soluble form in gall bladder
produced in liver.
bile. This prevents formation of gallstones.
6. Heat Production: Due to metabolic actions, heat is
produced in liver.
7. Excretory functions: Certain exogeneous dyes like
bromsulphthalein and rose Bengal dye are excreted
through liver cells.
8. Synthesis function: Liver is the site for synthesis of:
- Plasma proteins mainly albumin and to some
extent α and β globulins.
- Liver causes conversion of preprothrombin to
active prothrombin in presence of vitamin K.
It also secretes other clotting factors such as
fibrinogen, factor V, VII, IX and X.
- It secretes various enzymes such as alkaline phos-
phatase, serum glutamic oxaloacetic transami-
nase, serum glutamic pyruvic transaminase.
- Liver removes ammonia from body to synthesize
urea.
9. Miscellaneous functions: Fig. 17: Formation of bile salts from bile acids
- Liver act as reservoir of blood and stores 650 ml Q.8. Write a short note on enterohepatic circulation.
of blood. It also regulates blood volume. (Sept 2000, 4 Marks)
- Liver leads to inactivation of some hormones Ans. Flow of blood from intestine to liver through portal vein
such as insulin, glucagon, vasopressin. is known as enterohepatic circulation.
- Destruction of RBCs also occurs in the liver.
Q.7. Write a short note on bile salts. (Mar 1998, 5 Marks)
Ans. Bile salts are the sodium and potassium salts of bile acids
which are conjugated with taurine or glycine.
Bile acids are of two types, i.e. primary and secondary.
1. Primary bile acids are cholic acid and chenodeoxy-
cholic acid which are synthesized by hepatocytes
from cholesterol.
2. Secondary bile salts are deoxycholic acid and litho-
cholic acid which are formed from primary bile salts
in colon by action of intestinal bacteria.
In liver bile acids are conjugated with glycine or taurine
and form conjugated bile acids.
Conjugated bile acids, i.e. glycocholic acid and taurocholic
acid form bile salts in combination with sodium or Fig. 18: Enterohepatic circulation
potassium.
The total bile salts which enter the duodenum, out of
Functions of Bile Salts them 90 to 95% of bile salts are reabsorbed from terminal
ileum in portal vein and return to the liver to excrete
The bile salts are required for digestion and absorption of fat again, this is enterohepatic circulation.
in intestine.
Enterohepatic circulation bile salts are necessary due to
♦ Emulsification of fats: Bile salts break large fat drops into the limited amount of bile salts present for digestion and
smaller drops. absorption of fats.
 Physiology 321

Q.9. Write in brief on deglutition. (Mar 1996, 5 Marks) Q.10. Write in brief on gastric emptying.
Or (Aug/Sep 1998, 10 Marks)
Ans. Slow transfer of food from stomach to intestine is called
Write brief on IInd stage of deglutition.
gastric emptying.
(Mar 1994, 5 Marks)
Ans. Deglutition or swallowing is a process that transfers chewed Causes
food from mouth to stomach. It occurs in three stages:
1. Oral stage ♦ The peristaltic waves arising in pyrolic part of stomach.
2. Pharyngeal stage ♦ Simultaneous relaxation of pyrolic sphincter.
3. Oesophageal stage.
Factors Affecting Gastric Emptying
Oral Stage ♦ Volume of gastric content: If the content of stomach is
When the chewed food is ready for swallowing, it is voluntary, more, a large amount is emptied into intestine.
rolled back into pharynx by backward and upward pressure of ♦ Consistency of gastric content: Emptying of stomach is
tongue against palate. proportional to consistency of contents. Water is emptied
into intestine as soon as it is swallowed, then liquid and
Pharyngeal Stage solid after being converted to fluid.
In pharyngeal stage, bolus is pushed from pharynx into
esophagus.
♦ It is an involuntary stage.
♦ Following are the events occurring during movement of
bolus from pharynx into the esophagus:
Oral cavity closes from the pharynx due to approxi-
mation of posterior pillars of fauces.
Nasopharynx is closed due to upward movement of soft
palate this prevents regurgitation of food in nasal cavity.
Palatopharyngeal folds get pulled medially and
make slit like opening for food which allow properly
masticated food to pass through.
Vocal cords approximate stopping the breathing
temporarily.
Larynx is elevated and pushed anteriorly by neck
muscles which lead to enlarging of opening of
esophagus, epiglottis swing backward to close laryngeal
opening. This guides the food towards esophagus and
prevents its entry in trachea.
Upper esophageal sphincter normally remain contracted
open up and allow bolus of food to be pushed in upper
part of esophagus due to peristaltic contraction wave of
pharynx which also continues in esophagus.
As bolus of food pass in esophagus, contraction of
cricopharyngeous occur, vocal cords open up which
allow normal breath to resume and upper esophageal
Fig. 19: Phases of deglutition
sphincter come in tonic contraction.
♦ This stage gets completed in 1-2 seconds.
♦ Chemical composition: The gastric content with more
Esophageal Stage carbohydrate leaves the stomach more rapidly then content
♦ It is an involuntary stage. with the protein. Protein leaves the stomach more rapidly
♦ The function of esophagus is to transport the food from than fat.
pharynx to stomach. ♦ pH of gastric content: The strong acid content leaves
♦ When bolus reaches the esophagus, the peristaltic waves the stomach slowly. The emptying of such content is
are initiated which pushes the bolus into stomach. accelerated by neutralizing acid.
♦ Two types of peristaltic contraction start in esophagus: ♦ Osmolar concentration of gastric content: The gastric
1. Primary peristaltic contraction content which is isotonic to blood, leaves stomach
2. Secondary peristaltic contraction. rapidly.
322 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Regulation of Gastric Emptying
The emptying of stomach stops mainly due to inhibition of
gastric motility. The inhibition motility of stomach is caused by:
1. Nervous factor.
2. Hormonal factor.
Nervous factor: The nervous factor which regulates the
emptying of stomach, is enterogastric reflex.
Hormonal factor: The major hormone which controls gastric
emptying is enterogasterone.
Fig. 20: Gastric emptying

Q.12. Write a short note on local GIT hormone.
(Sep 2004, 4 Marks)
Ans. Movements of Small Intestine
The movements of small intestine are essential for mixing
of chyme with digestive juices, propulsion of food and
absorption. The movements of small intestine are:
1. Mixing movements: The mixing movements of small
intestine are responsible for proper mixing of chyme
with digestive juices like, pancreatic juice, bile and in-
testinal juice. The mixing movements are of two types:
A. Segmentation movements: They are common
type of movements of small intestine which
occur in rhythmic fashion. So, these movements
are called rhythmic segmentation movements.
The contractions occur at regularly spaced
intervals along the section of intestine. The
segments of intestine in between contracted
segments are relaxed. The length of relaxed
segments is same as that of contracted segments.
After some time, the contracted segments are
relaxed and relaxed segments are contracted.
Therefore, the segmentation contraction chop
the chyme many times. This helps in mixing the
chyme with digestive juice.
B. Pendular movements: Small constrictive waves
sweep forward and backward or upward and
downward and the intestinal loops move like a
pendulum of clock and this is called pendular
movements.
2. Propulsive movements: The movements of small
intestine involved in pushing chyme toward aboral
end of intestine are called propulsive movements.
They are of two types:
A. Peristaltic movements: Peristalsis is defined
as wave of contraction followed by wave of
relaxation which travels aborally. The stimula-
tion of smooth muscle of intestine initiates
the peristalsis. The peristaltic contraction
starts at any part of small intestine and travels
towards and end at velocity of 1 to 2 cm/sec.
The contractions are weak and disappear after
traveling few cm distance. Because of this,
average movement of chyme through small
intestine is slow and average velocity is less than
1 cm/sec. Thus, chyme requires several hours to
travel from duodenum to end of small intestine.
B. Peristaltic rush: Sometimes, small intestine
shows powerful peristaltic contraction. This
is caused by excessive irritation of intestinal
mucous membrane. This type of powerful
contraction begins in duodenum and passes
through whole length of small intestine and
finally reaches ileocoecal valve within a few
minutes. This is peristaltic rush.
(Mar 2005, 4 Marks)
Or
Write briefly on gastrointestinal hormones.
(Sep 2007, 4 Marks)
Ans. Three Hormones Produced by GIT
1. Gastrin
Source of secretion: It is mainly secreted by cells
of pyrolic glands and also by G cells of stomach,
duodenum and jejunum.
Stimulant for secretion: It is secreted from stomach
during gastric phase of gastric secretion and from
small intestine during intestinal phase of gastric secre-
tion. Factors which cause secretion of gastrin are:
a. Presence of food in stomach
b. Stimulation of fibers of local nerve plexus in
stomach and intestine.
Action of Gastrin:
i. Secretion of gastric juice with more pepsin and
HCl.

ii. Acceleration of movements of stomach.
iii. Growth of mucus of stomach.
2. Secretin
Source of secretin: This was the first ever hormone
discovered and is secreted by S cells of duodenum,
jejunum and ileum.
Stimulant for secretin: It is first produced in its
inactive form known as prosecretin and gets con-
verted into its active form, i.e. secretin by acidity
of chyme. The stimulant for release and activation
of prosecretin is acidic chyme entering duodenum
from stomach.
Action of secretin:
i. Alkaline pancreatic juice protects intestinal
mucus from acid chyme by neutralizing it.
ii. It inhibits secretion of gastric juice
iii. It inhibits motility of stomach
3. CCK or Cholecystokinin or Pancreozymin
Source of secretion: It is secreted by I cell in mucosa
of duodenum and jejunum.
Stimulant for secretion: The stimulant for release of
this hormone is acidic chyme containing digestive
products of fats and proteins.
Action of CCK:
i. It leads to secretion of pancreatic juice which is
rich in enzymes.
ii. It causes contraction of gallbladder to release
bile.
iii. It potentiates effect of secretin to secrete more
alkaline pancreatic juice.
iv. It enhances the secretion of enterokinase from
duodenum.
v. CCK inhibits gastric motility.
vi It enhances motility of large and small intestine.
vii. It increases pancreatic growth.
viii. It is seen in neurons of brain where it is involved
in regulation of food intake.
Q.13. Summarize digestion of proteins. (Mar 1998, 5 Marks)
Ans. • The foodstuff containing high protein content are
meat, milk, egg, fish and pulses.
• Different types of protein which are found in diet are
albumin, globulin, nucleoprotein casein, collagen,
gelatin, mucin and elastin.
• Proteins are observed in the form of amino acid, so
proteins are digested to amino acids prior to their
absorption.
• Protein digestion starts in stomach and ends in
intestine.
• Enzymes responsible for digestion of proteins are
proteolytic enzymes.
Digestion of Protein in Stomach
♦ Pepsin is the most important proteolytic enzyme of gastric
juice.
♦ Optimum pH for activity of pepsin is 2 to 3 which is
provided by HCl present in gastric juice.
Physiology 323
♦ Pepsin acts on protein and converts it into peptone,
proteases and polypeptides.

(Dec 2004, 5 Marks)
Ans. Digestion and absorption of carbohydrates.
In Mouth
In saliva, the salivary amylase or ptylin is an enzyme which
helps in digestion of carbohydrates. In mouth, the food stays
for shorter time, so the action of ptylin continues for one hour
after reaching stomach, cooked starch and end products are
disaccharides, i.e. dextrins and maltose.
In Stomach
In stomach, gastric juice releases enzyme known as gastric
amylase, it is weak enzyme and its action is negligible.
In Small Intestine
Here pancreatic juice contains pancreatic amylase which acts on
polysaccharides and disaccharides and end product is disaccha-
rides, i.e. dextrins, maltose, maltriose and monosaccharides.
In small intestine succus entricus is present which releases
sucrose, maltose, lactase, dextrinase and trehalase, the enzymes
act on sucrose, maltose lactose, dextrin and trehalase and the
end product is glucose, fructose and galactose.
Q.15. Write a short note on hemolytic jaundice.
(Sept 2006, 5 Marks)
Ans. In hemolytic jaundice the excretory function of liver is
normal but there is excessive destruction of RBCs and
thus the bilirubin level in blood is increased and the liver
cells cannot excrete that much bilirubin rapidly.
• In this jaundice there is increased level of free bili-
rubin in the blood.
• The urobilinogen and stercobilinogen is present in
the excess.
• In hemolytic jaundice the anemia is present.
• In this type of jaundice the hemoglobin level get
decreased.
• In it the value of SGOT is slightly elevated.
Q.16. Describe in brief digestion and absorption of proteins.
(Oct 2007, 5 Marks)
Or
Describe digestion of protein in various parts of
gastrointestinal tract. (Nov 2008, 15 Marks)
324 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Ans. Digestion of protein does not occur in mouth, as there 

are no proteolytic enzymes in saliva.
  Enzymes responsible for digestion of proteins are
called proteolytic enzymes.

Digestion of Proteins in Stomach

♦ Pepsin leads to digestion of about 10 to 15% of proteins
entering gastrointestinal tract.
♦ Pepsinogen which is an active form is converted into
pepsin by action of HCl.
♦ Pepsin split proteins into proteoses, peptones and
polypeptides.
♦ Optimum pH for action of pepsin is 2.0.
♦ Protein digestion in the stomach is important as protein
digestion stimulate secretion of proteolytic enzymes of
pancreas.

Fig. 21: Summary of digestion of proteins

Digestion of Proteins in Small Intestine

♦ Proteins in small intestine are digested by pancreatic
proteases, brush border peptidases and intracellular pepti-
dases.
♦ Pancreatic proteases lead to the digestion of proteins (Dec 2010, 5 Marks)
and they break into dipeptides, tripeptides and small Ans. Digestion of fats.
polypeptides which later on get digested by brush border
Digestion of Fats in Mouth
peptidases.
♦ Some dipeptides as well as tripeptides get absorbed in Salivary lipase is active in the stomach and digest 30% of dietary
epithelial cells of mucosa of small intestine and get further triglycerides.
digested by intracellular enzymes into amino acids.
♦ Brush border peptidases consist of aminopeptidases, Digestion of Fats in Stomach
dipeptidases, tripeptidases, nuclease and related enzymes. ♦ Gastric lipase is a weak fat splitting enzyme and act at an
They convert protein to small polypeptides and amino acids. optimal pH of 4-4.5.

♦ Fat digestion in stomach occurs in exceptional circum-
stances, i.e. when pancreatic lipase may regurgitate into
the stomach from the duodenum and in achlorhydria.
Digestion of Fats in Small Intestine
♦ Pancreatic lipase and bile salts enter the second part of
duodenum and start the fat digestion.
♦ Pancreatic juice is alkaline and converts and adjusts the
highly acidic chyme to chyme at pH slightly above 7.0,
which is optimal pH for lipase activity.
♦ Bile salts play an important role in activating lipase and
produces a detergent action by its hydrotropic action
and lowers the surface tension, this leads to emulsification
of fats and provides a greater surface area for the lipase
enzyme to digest.
♦ Lipase acts at the interface between the fat particles and
water and successively hydrolyzes the double and triple
bonds of the triglycerides into diglycerides and monoglyc-
erides and releases the fatty acids.
♦ Dietary cholesterol remains in the form of cholesterol
esters and the pancreatic bile salt activate lipase and
cholesterol esterase of succus entericus which hydrolyzes
these esters in the intestinal lumen and finally convert it
to the cholesterol.
Absorption of Fats
♦ Monoglycerides, pancreatic electrolytes, fatty acids and
bile salts interact to form polymolecular aggregates called
as micelles.
♦ Fat content of micelles consist of monoglycerides and fatty
acids. In the intestinal wall, they act in following ways:
Fatty acids and monoglycerides with greater than 14
carbon atoms become re-esterified to triglycerides in the
mucosal cell, thus they are then coated with a layer of
α-lipoprotein, cholesterol and phospholipids forming
chylomicrons or esterified fatty acids of approx l– nm
diameter. Chylomicrons thus enter the lymphatics and
via thoracic duct enter into the bloodstream.
Short chain fatty acids with less than 12 14 carbon
atoms pass from mucosal cell in the villous of blood
capillaries and get transported as free fatty acid also
known as non-esterified fatty acids or unesterified
fatty acids. They get attached to albumin in blood
stream.
♦ Fat absorption is greatest in the upper part of the small
intestine but appreciable amounts are also absorbed from
the ileum.
 operates through reflex action.
(Aug 2012, 5 Marks)
Physiology 325
Ans. For composition and function refer to Ans 5 of same
chapter.
Regulation of Secretion
The secretion of bile from the liver and release of bile from the
gallbladder are influenced by some chemical factors which are
categorized into three groups:
1. Choleretics.
2. Cholagogue.
3. Hydrocholeretic agents.
Choleretics: These are the substances, which increase the
secretion of bile from liver, are known as choleretics. The
effective choleretic compounds are acetylcholine, secretin,
cholecystokinin, acid chyme in intestine and bile salts.
Cholagogues: Cholagogue is a compound, which increases the
release of bile from gallbladder into the intestine by contracting
the gallbladder. The common cholagogue are bile salts,
calcium, fatty acids, amino acids, inorganic acids. All the above
substances stimulate the secretion of cholecystokinin, which, in
turn causes action of gallbladder and flow of bile into intestine.
Hydrocholeretic agents: Hydrocholeretic agent is a substance,
which causes secretion of bile from liver with large amount
of water and less amount of solids. Hydrochloric acid is a
hydrocholeretic agent.
Q.21. Write about phases of gastric secretion.
(Jan 2012, 8 Marks)
Ans. Phases of Gastric Secretion
Gastric juice is secreted in three different phases:
1. Cephalic phase.
2. Gastric phase.
3. Intestinal phase.
4. In human beings, a fourth phase called interdigestive
phase exists.
All the above phases are regulated by neural mechanism
or hormonal mechanism or both.
Cephalic Phase
♦ Secretion of gastric juice by the stimuli arising from head
region (cephalus) is called cephalic phase.
♦ This phase is regulated by nervous mechanism.
♦ During this phase, the gastric secretion occurs even with-
out the presence of food in the stomach.
♦ The quantity of the juice is less but it is rich in enzymes
and hydrochloric acid.
♦ The nervous mechanism that regulates cephalic phase
Two types of reflexes occur:
1. Unconditioned reflex
2. Conditioned reflex.
Unconditioned Reflex
It is the inborn reflex. When food is placed in the mouth, it induces
salivary secretion. Simultaneously, gastric secretion also occurs.
326 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Stages of the reflex action:
♦ Presence of food in the mouth stimulates the taste buds
and other receptors in the mouth.
♦ Sensory impulses from mouth pass via afferent nerve fibers
of glossopharyngeal and facial nerves to appetite center
present in amygdala and hypothalamus.
♦ From here, efferent impulses pass through dorsal nucleus
of vagus and vagal efferent nerve fibers to the wall of the
stomach.
♦ Acetylcholine is secreted at the vagal efferent nerve end-
ings stimulates gastric glands to increase the secretion.
This is experimentally proved by Pavlov s pouch and
sham feeding.
Conditioned Reflex
Conditioned reflex is the reflex response acquired by previous
experience. Presence of food in the mouth is not necessary to
elicit this reflex. The sight, smell, hearing or thoughts of food
which induce salivary secretion also induce gastric secretion.
Stages of the reflex action:
♦ Impulses from the special sensory organs (eye, ear and nose)
pass through afferent fibers of neural circuits to the cerebral
cortex. Thinking of food stimulates cerebral cortex directly.
♦ From cerebral cortex the impulses pass through dorsal nu-
cleus of vagus and vagal efferents and reach stomach wall.
♦ The vagal nerve endings secrete acetylcholine. It stimulates
the gastric glands and increases its secretion.
Conditioned reflex of gastric secretion is proved by
Pavlov s pouch and bell dog experiment.
Gastric Phase
♦ The secretion of gastric juice when the food enters the
stomach is called gastric phase.
♦ This phase is regulated by both nervous and hormonal
mechanisms.
♦ The gastric juice secreted during this phase is rich in pep-
sinogen and hydrochloric acid.
♦ The mechanisms involved in this phase are:
Nervous mechanism through local myenteric reflex
and vagovagal reflex
Hormonal mechanism through gastrin.
Nervous Mechanism
♦ Local myenteric reflex: It reflex is elicited by stimulation
of myenteric nerve plexus in stomach wall. After entering
stomach, the food particles stimulate the local nerve plexus
present in the wall of the stomach. These nerve fibers re-
lease acetylcholine, which stimulates the gastric glands and
secrete a large quantity of gastric juice. Simultaneously,
acetylcholine stimulates G cells to secrete gastrin.
♦ Vasovagal reflex: Vasovagal reflex is the reflex in which
both afferent and efferent vagal fibers are involved. Pres-
ence of food in stomach stimulates the sensory (afferent)
nerve endings of vagus which generate sensory impulses.
The sensory impulses are transmitted to the brainstem via
sensory fibers of vagus. Brainstem in turn sends efferent
impulses through the motor (efferent) fibers of vagus back
to stomach and cause secretion of gastric juice. Since, both
afferent and efferent impulses pass through vagus, this
reflex is called vagovagal reflex.
Hormone Mechanism
♦ Gastrin is a gastrointestinal hormone secreted by the G cells
which are present in pyloric glands of stomach.
♦ Small amount of gastrin is also secreted in mucosa of
upper small intestine.
♦ Gastrin is a polypeptide containing G14, G17 or G34
amino acids.
♦ Gastrin is released when food enters stomach.
♦ The mechanism involved in the release of gastrin may be
the local nervous reflex or vagovagal reflex.
♦ The nerve endings release the neurotransmitter called
gastrin releasing peptide which stimulates the G cells to
secrete gastrin.
Intestinal Phase
♦ Intestinal phase is the secretion of gastric juice when chyme
enters the intestine. When chyme enters the intestine
initially the gastric secretion increases and later it stops.
Intestinal phase of gastric secretion is under both nervous
and hormonal control.
♦ During initial stage of intestinal phase the chyme entering
intestine stimulates the duodenal mucosa to release gastrin
which is transported to stomach through blood. There,
it increases gastric secretion. On later stage of intestinal
phase after the initial increase, there is decrease or com-
plete stoppage of secretion of gastric juice. Two factors are
responsible for the inhibition:
1. Enterogastric reflex.
2. Gastointestinal hormones.
Enterogastric Reflex
It is a reflex that inhibits the secretion and movements of
stomach due to the distention or irritation of intestinal mucosa. It
is mediated by myenteric nerve (Auerbach’s) plexus and vagus.
Gastrointestinal Hormones
The presence of chyme in the intestine stimulates the secretion
of many gastrointestinal hormones from intestinal mucosa
and other structures. All these hormones inhibit the gastric
secretion. Some of these hormones inhibit the gastric motility
also. Gastrointestinal hormones which inhibit gastric secretion:
♦ Secretin: Secreted by the presence of acid chyme in the
intestine.
♦ Cholecystokinin: Secreted by the presence of chyme con-
taining fats and amino acids in intestine.
♦ Gastric inhibitory peptide: Secreted by the presence of
chyme containing glucose and fats in the intestine.
♦ Vasoactive intestinal polypeptide: Secreted by the presence
of acidic chime in intestine.
♦ Peptide YY: Secreted by the presence of fatty chyme in
intestine.
 Physiology 327

In addition to these hormones, pancreas also secretes a
hormone called somatostatin during intestinal phase.
It also inhibits gastric secretion. The intestinal phase
of gastric secretion is demonstrated by Farrell and
Ivy pouch.
Interdigestive Phase
♦ Secretion of small amount of gastric juice in between
meals (or during period of fasting) is called interdiges-
tive phase.
♦ Gastric secretion during this phase is mainly due to the
hormones like gastrin.
♦ This phase of gastric secretion is demonstrated by Farrell
and Ivy pouch.
Q.22. Describe composition and functions of pancreatic juice.
(June 2010, 15 Marks)
Ans. Composition of Pancreatic Juice
♦ Trypsin activates other enzymes of pancreatic juice, e.g.
Chymotrypsinogen into chymotrypsin, procarboxy-
peptidases into carboxypeptidases, proelastase into
elastase, etc.
♦ Trypsin also activates collagenase, phospholipase A and
phospholipase B.
Chymotrypsin
♦ Digestion of proteins: Chymotrypsin is also an endopepti-
dase and it breaks the proteins into polypeptides.
♦ Digestion of milk: Chymotrypsin digests casein faster
than trypsin. The combination of both enzymes causes
more rapid digestion of milk.
Carboxypeptidases
Carboxypeptidases split the polypeptides and other proteins
into amino acids.

Pancreatic Juice Nucleases

The nucleases of pancreatic juice are ribonuclease and
deoxyribonuclease, which leads to the digestion of nucleic
Water - 99.5% Solid - 0.5% acids. These enzymes convert RNA and DNA into mono-
nucleotides.

Organic substances Inorganic substance Elastase

1. Sodium Elastase digests the elastic fibers.
2. Calcium
Enzymes Other organic substances 3. Potassium Collagenase
Albumin and globulin 4. Magnesium Collagenase digests collagen.
5. Bicarbonate
Proteolytic Lipolytic Amylolytic 6. Chloride Digestion of Lipids
enzymes enzymes enzyme 7. Phosphate Lipolytic enzymes present in pancreatic juice are pancreatic
Pancreatic 8. Sulfate
1. Trypsin 1. Pancreatic lipase lipase, cholesterol ester hydrolase phospholipase A,
2. Chymotrypsin 2. Cholesterol ester amylase
phospholipase B and coenzyme called colipase.
3. Carboxypepti- hydrolase
dases 3. Phospholipase A Pancreatic Lipase
4. Nuclease 4. Phospholipase B
Pancreatic lipase is a powerful lipolytic enzyme. This enzyme
5. Elastase 5. Colipase
digest triglycerides into monoglycerides and fatty acids. The
6. Collagenase 6. Bile salt-activated lipase
activity of pancreatic lipase is accelerated in the presence of
bile. Optimum pH required for activity of this enzyme is 7 to
Functions of Pancreatic Juice
9. About 80% of fat is digested by pancreatic lipase.
Digestion of Proteins
Cholesterol Ester Hydrolase
Trypsin and chymotrypsin are the major proteolytic enzymes of
pancreatic juice. Various other enzymes are carboxypeptidases, Cholesterol ester hydrolase converts cholesterol ester into free
nuclease, elastase and collagenase. cholesterol and fatty acid by hydrolysis.

Trypsin
♦ Digestion of proteins: Trypsin is the most powerful pro-
teolytic enzyme. It is an endopeptidase and breaks the
interior bonds of the protein molecules. It converts proteins
into proteoses and polypeptides.
♦ Curdling of milk: It converts caseinogens in the milk
into casein.
♦ Trypsin accelerates blood clotting.
Phospholipase A
Phospholipase A digest phospholipids namely lecithin and
cephalin and converts them into lysolecithin and lysocephalin.
Phospholipase B
Phospholipase B is also activated by trypsin. This enzyme
converts lysolecithin and lysocephalin into phosphoryl choline
and free fatty acids.
328 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Colipase
It is a small coenzyme which facilitates the hydrolysis of fats
by pancreatic lipase.
Bile Salt Activated Lipase
This enzymes digest lipids like phospholipids, cholesterol,
esters and triglycerides.
Digestion of Carbohydrates
Pancreatic amylase converts starch in dextrin and maltose.
Neutralizing Action
When acid chyme enters intestine from the stomach, pancreatic
juice is released into the intestine which consists of large amount
of bicarbonate which makes it alkaline. This juice neutralizes
acidity of chyme in intestine. This action protect intestine from
destructive action of acid in chyme.
Q.23. Write short note on bile and its functions. • Secretory function: Large intestine secretes mucin
(June 2010, 5 Marks)
Ans. Bile is a golden yellow or greenish fluid.
It enters the digestive tract by ampulla of Vater.
Properties of Bile
♦ Its volume is 800 to 1200 ml/day
♦ It is alkaline in nature
♦ Its pH is 8 to 8.6
♦ Its specific gravity is 1.010 to 1.011.
Composition of Bile
Bile contains 97.6% of water and 2.4% of solids. The solids are
organic and inorganic substances.
♦ Organic substances: Bile salts, bile pigments, cholesterol,
lecithin and fatty acids.
♦ Inorganic substances: Sodium, calcium, potassium, chlo-
ride and bicarbonate.
Functions of Bile
For function of bile refer to Ans 5 of same chapter.
Q.24. Write short note on pancreas and its functions. So the final reaction is expressed as:
(June 2010, 5 Marks)
Ans. Pancreas is an organ with dual function, i.e. exocrine
and endocrine function.
• The exocrine function is concerned with secretion of
digestive juice, i.e. pancreatic juice and the endocrine
function is to produce the hormones.
• Exocrine part of pancreas is formed of acini or
alveoli. Each acinus has single layer of acinar cells
with lumen in center. Acinar cells consist of zymogen
granules which possess digestive enzymes.
• Pancreatic juice is released from apices of cells into
lumen of pancreatic ducts.
• Pancreatic juice passes through intercalated and
excretory ducts and is collected by the two ducts,
i.e. duct of Wirsung and duct of Santorini.
Pancreas secretes pancreatic juice which undergoes
digestive functions and neutralizing functions. For
details refer to Ans 22 of same chapter.
Q.25. Write short note on functions of large intestine.
(June 2010, 5 Marks)
Ans. Following are the functions of large intestine
• Absorptive function: Large intestine leads to the
absorption of various substances such as water, elec-
trolytes, organic substances like glucose, alcohol and
drugs like anesthetic agents, sedatives and steroids.
• Formation of feces: After the absorption of nutri-
ents, water and other substances, the unwanted
substances in the large intestine form feces. This is
excreted out.
• Excretory function: Large intestine excretes heavy
metals like mercury, lead, bismuth and arsenic
through feces.
and inorganic substances like chlorides and bicar-
bonates.
• Synthetic function: The bacterial flora of large intes-
tine forms the folic acid, vitamin B12 and vitamin K.
By this large intestine contributes in erythropoietic
activity as well as blood clotting mechanism.
Q.26. Write short note on functions of bile salts.
(Mar 2013, 3 Marks)
Ans. For function of bile salts refer to Ans 7 of same chapter.
Q.27. Write short note on mechanism of HCl secretion in
gastric juice (diagrammatically). (Apr 2007, 5 Marks)
Ans. Hydrochloric acid is made up of hydrogen and chloride
ions so its secretion is explained in two steps:
Secretion of H+ ion
Hydrogen ions are generated inside the parietal cell from
metabolic carbon dioxide and water which is present inside
the cell. Enzyme carbonic anhydrase present in the parietal cell
is very essential for the secretion. It enhances the formation of
bicarbonic acid, i.e. H2CO3 which split to release H+ and HCO3 .
CO2 + H2O H2CO3 H+ + HCO3
Hydrogen ions generated by the above reaction secreted
into the lumen of canaliculi in exchange for potassium ion by
primary active transport mediated by H+ - K+ - ATPase pump.
Bicarbonate ions produced in the parietal cell transported
in the antiport in serosal membrane into the blood in exchange
of chloride ion by an active transport.
Secretion of Cl– ion
Due to high intracellular negativity chloride ion present in
parietal cell is forced in lumen of gland through chloride ion
channels which are located on apical membrane of cell.

Fig. 22: Diagrammatic presentation of mechanism of HCl secretion
in gastric juice
Q.28. Write short note on functions of gallbladder. Ans. Following are the enzymes of gastrointestinal tract along
(Apr 2007, 5 Marks)
Enzyme Description
Pepsin Pepsin is secreted by chief cells of main gastric glands.
Pepsin is secreted as inactive pepsinogen. Pepsinogen
is converted to pepsin by hydrochloric acid secreted by
parietal cells. It is activated at pH 2
Gastric lipase It is a weak lipolytic enzyme. It activates in acidic
medium when pH is between 4 and 5
Gastric amylase Gastric amylase activates in acidic medium
Gelatinase Gelatinase activates in acidic medium
Urease Urease activates in acidic medium
Pancreatic α amylase • It is stable at pH range of 4 to 11
• Its molecular weight is 45000
Pancreatic lipase Its pH range of activity is from 7 to 9.
Pancreatic esterase — It converts cholesterol esters to cholestrol
Pancreatic It is secreted in an inactive form and get converted to
prophospholipase A2 phospholipase A2 by trypsin
Pancreatic proteolytic enzymes
Trypsin • Trypsin is a single polypeptide with molecular weight
of 25,000
• Trypsin is secreted as inactive trypsinogen which is
converted into active trypsin by enterokinase
Chymotrypsin • Chymotrypsin is a polypeptide with molecular weight
of 25,700 and 246 amino acids
• Chymotrypsin is secreted as inactive chymotrypsinogen
and activated into chymotrypsin by trypsin
Physiology 329
(Apr 2008, 20 Marks)
 (Feb 2013, 7 Marks)
with their functions:
Functions
• It acts on proteins and split them into proteoses,
peptones and polypeptides
• Pepsin also causes curdling and digestion of milk
Gastric lipase acts on tributyrin and hydrolyse it into fatty
acids and glycerol
It acts on starch and split it into dextrin and maltose
It acts on gelatin and collagen of meat and the end
product is peptide
It hydrolyse urea and resultant end product is ammonia
It splits α – 1 – 4 glycosidic bond of starch and digests
starch to maltose
It hydrolyses neutral fats to glycerol esters and fatty acids.
Phospholipase A2 splits a fatty acid of lecithin forming
lysolecithin which damages cell membrane
• Trypsin breaks interior bonds of protein molecules and
split proteins into proteoses and polypeptides
• Trypsin accelerate clotting of blood
• Trypsin activates other enzymes of pancreatic juice
such as chymotrypsinogen, procarboxypeptidases etc
• Trypsin also activates collagenase, phospholipase A
and phospholipase B
• It has autocatalytic action i.e. once formed it itself
converts trypsinogen into trypsin
• Chymotrypsin breaks proteins into polypeptides
• It digests casein faster than trypsin. Combination of both
enzymes digests milk faster
Contd...
330 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd...

Enzyme Description Functions

Carboxypeptidases There are two carboxypeptidases, i.e. carboxypeptidase Carboxypeptidases splits polypeptides and other proteins
A and carboxypeptidase B. They are secreted in an into amino acids
inactive form, i.e. procarboxypeptidase A & B. Inactive
form get converted to active form by trypsin
Nucleases Nucleases of pancreatic juice, i.e. ribonuclease and Ribonuclease and deoxyribonuclease convert DNA and
deoxyribonuclease are responsible for the digestion of RNA into mononucleotides
nucleic acids
Elastase It is secreted as inactive proelastase and is activated into Elastase digests the elastic fibers
active elastase by trypsin
Collagenase It is secreted as inactive procollagenase and is activated Collagenase digests collagen
into active collagenase by trypsin
Enteropeptidases — Enteropeptidases convert peptides into amino acids
Lactase, sucrase They act at pH 5 to 7 They convert disaccharides into two molecules of
and maltase monosaccharides
Dextrinase — It converts dextrin, maltose and maltriose into glucose
Trehalase — It causes hydrolysis of trehalose glucohydrolase or trehalase
and converts it into glucose
Intestinal lipase — It act on triglycerides and convert them into fatty acids
Cholestrol esterase — It convert cholesterol esters to free cholesterol
Lecithinase — It convert phospholipids to simpler phospholipids
Alkaline phosphatase — It converts organic phosphate to free phosphate

Q.30. Write in brief on CCK (Cholicystokinin-Pancreozymin). Q.31. Write briefly about secretin.
(Nov 2008, 5 Marks) Ans. Secretin was the first hormone to be discovered by Bayliss
Ans. CCK is a polypeptide which consists of 33 amino acids.
Source of secretion: It is secreted by endocrinal I cell
located in mucosa of duodenum and jejunum.
Actions
♦ It leads to secretion of pancreatic juice which is rich in
enzymes.
♦ It causes contraction of gallbladder to release bile.
♦ It potentiates effect of secretin to secrete more alkaline
pancreatic juice.
♦ It enhances the secretion of enterokinase from duodenum.
♦ CCK inhibits gastric motility.
♦ It enhances motility of large and small intestine.
♦ It increases pancreatic growth.
♦ It is seen in neurons of brain where it is involved in regula-
tion of food intake.
Regulation of CCK Secretion
It occurs via positive feedback mechanism:
(Oct 2016, 2 Marks)
and Starling in 1922.
Structure: Secretin is a polypeptide hormone consist-
ing of 27 amino acids.
Source: Secretin is produced by argentaffin or S cells
in crypts of mucosa of upper part of small intestine
i.e. duodenum and jejunum.
Secretion: Secretin is secreted as prosecretin, which
is an inactive form, this inactive form is converted
to active form i.e. secretin by gastric HCl and salts
of fatty acids.
Mechanism of action: Secretin acts on adenylate
cyclase on cell membrane and increases cytosolic
formation of cAMP.
Regulation of secretion: Secretin secretion is
increased by acidic chyme and products of protein
digestion which enter upper part of intestine.
Secretin stimulates water and alkaline pancreatic
secretion. When watery and alkaline pancreatic
juice enters intestine, acidic content of upper small
intestine is neutralized. Increase in pH of duodenal
and upper jejunal content decreases secretin
secretion by feedback mechanism.

Functions
♦ Secretin increases secretion of pancreatic juice rich in
bicarbonate.
♦ It also increases alkaline bile secretion.

 cations and anions. The sodium and potassium ion con-
(May 2017, 5 Marks)
Name of Salivary Glands
♦ Parotid glands
♦ Submandibular or submaxillary gland
♦ Sublingual gland
Enumeration of Functions of Saliva
♦ Cleaning of mouth
♦ Lubrication and deglutition
♦ Antimicrobial function
♦ Buffering function
♦ Digestive function
♦ Mineralization
♦ Taste
♦ Tissue repair
♦ Excretion.
Q.33. Write short answer on pancreatic secretions.
(Apr 2018, 3 Marks)
Ans. Pancreas is a dual organ having two functions, i.e.
endocrine function and exocrine function. Endocrine
function is concerned with production of hormones
while exocrine function is concerned with secretion of
digestive juice known as pancreatic juice.
Composition of Pancreatic Secretion
For composition refer to Ans 22 of same chapter.
Functions of Pancreatic Secretion
♦ Pancreatic secretion consists of enzymes which help in
digestion of fat, protein and carbohydrate. Pancreatic
enzymes are primary requirement for digestion and
absorption. Protein deficiency leads to severe malabsorption
syndrome.
♦ Pancreatic secretion consists of bicarbonate and water
which neutralizes acid chyme entering intestine from
stomach. It also neutralizes effects of bile acids. So, it
prevents formation of duodenal ulcer.
Mechanism of Pancreatic Secretion
It is divided into two components, i.e. secretion of aqueous
component and secretion of enzyme component.
Secretion of Aqueous Component
Aqueous component of pancreatic secretion is produced by
columnar epithelial cells which lines the pancreatic ducts.
♦ Pancreatic juice is nearly isotonic with plasma at any rate
of formation and flow. Ionic composition includes mainly
Physiology 331
centration of pancreatic juice is similar to that of plasma
but bicarbonate and chloride concentration vary according
to rate of secretion. When secretion of bicarbonate and
chloride is low, their concentration is 70% of plasma but
when their secretion is high their concentration is more
than 100% of plasma.
♦ Aqueous component secreted by the ductal cell is hyper-
tonic to plasma as it consists of more of bicarbonate. But
when secretion passes through the ducts water move into
duct lumen to make pancreatic juice isotonic, during which
bicarbonate is partially with chloride ion by HCO3 Cl
exchanger present on luminal membrane.
♦ Bicarbonate in epithelial cell is derived from carbonic acid,
which is formed by carbon dioxide and water.
♦ In ductal epithelial cells, on basolateral surface, Na+ - K+
pump actively pumps potassium ion into the cell.
♦ Cytosolic hydrogen ion is exchanged by Na+ H+ exchanger.
♦ In the resting state, secretion of aqueous component occur
mainly from intercalated and intralobular ducts but in
stimulated state secretion occur from additional extra-
lobular ducts, which has high bicarbonate concentration.
Secretion of Enzyme Component
Pancreatic enzymes are synthesized in acinar cells and are stored
in zymogen granules. Granules are located towards the apical
region of cells. In response to appropriate stimulation, granules
are released by exocytosis into the lumen of acinus.
Regulation of Pancreatic Secretion
♦ Cephalic phase: When food is taken in the mouth, there
is secretion of pancreatic juice. Slight thought of food also
causes secretion of pancreatic juice by conditioned reflex.
The afferent nerve impulses from cerebral cortex reach
dorsal nucleus of vagus. From dorsal nucleus, afferent
impulses reach pancreas by passing through efferent fibers
of vagus nerve. The vagal nerve fibers cause secretion of
pancreatic juice by releasing acetylcholine, which stimu-
lates acinar cells to release enzymes.
♦ Gastric phase: When food enters stomach, gastrin in GIT
hormone is secreted from stomach. The gastrin is trans-
ported by blood; and while reaching pancreas, it causes
release of pancreatic juice.
♦ Intestinal phase: When the chyme from stomach enters the
intestine, more amount of pancreatic juice is secreted. This
is due to two hormones, i.e. secretin and cholecystokinin or
CCK. Acidic chyme increases the release of secretin from
S cells present in mucosa of upper part of small intestine.
Secretin stimulates pancreatic juice rich in aqueous com-
ponent. Presence of products of protein digestion such as
amino acids and peptides, and the products of fat digestion
such as fatty acids and monoglycerides in chyme evoke
pancreatic secretion rich in enzymes, this is mediated by
cholecystokinin secreted from I cells in intestinal mucosa.
Cholecystokinin potentiates effect of secretin on ducts and
secretin potentiates effect of cholecystokinin on acinar cells.
332 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.34. Write very short answer on gastrin. 

(Aug 2018, 2 Marks)
Ans. Gastrin is one of the gastrointestinal hormones.
• Gastrin is secreted by G cells in the stomach which
are located mainly in antral region.
• Gastrin is a polypeptide hormone which has marked
heterogeneity.
• There are different types of gastrin described but
three types are physiologically important, i.e. G34,
G17 and G14.
G17 is the principal gastrin secreted from the stom-
ach and is major stimulator of gastric acid secretion.

Metabolism
Gastrin is secreted from G cells, enter the general circulation.
In blood half-life of gastrin is less. It is inactivated inside the
intestine and degraded in kidney.
Mechanism of Action
Primary function of gastrin is to stimulate the acid secretion
from parietal cells of stomach. Gastrin act on gastrin or CCK
receptors on parietal cells and increases intracellular calcium
concentration via second messenger, IP3. Increased cytosolic
calcium activates protein kinase which stimulates H+ K+ ATPase
to promote acid secretion.
Functions
♦ Primary function of gastrin is the stimulation of gastric
acid and pepsin secretion. ln fact, gastrin is the most potent
natural stimulator of HCl secretion from parietal cells of
stomach. Therefore, hypergastrinemia causes peptic ulcer.
♦ Gastrin stimulates growth of gastric mucosa and mucosa
of intestine. This is called trophic action of gastrin.
♦ It stimulates gastric motility.
♦ It causes contraction of muscles at the gastroesophageal
junction (lower esophageal sphincter ). Therefore, it
prevents reflux esophagitis.
♦ It stimulates exocrine pancreatic secretion.
♦ It also stimulates insulin secretion.
♦ It stimulates mass movement of large intestine.
♦ It causes colonic contraction that initiates gastrocolic reflex
after a meal. Therefore, usually defecation is activated
after a meal.
♦ It stimulates histamine secretion from ECL (enterochro-
maffin like cells) in Gl mucosa.
5. RENAL PHYSIOLOGY AND SKIN
 As blood passes via glomerular capillaries, plasma is filtered in
(Mar 1998, 5 Marks)
Ans. By the excretion of hydrogen ion and retention of
bicarbonate ion, kidney plays an important role in
maintaining acid-base balance in body fluid.
Normally, urine is acidic in nature at pH of 6. The
urine becomes acidic because of tubular secretion of
(Feb 2014, 8 Marks)
Or
Write short note on glomerular filtration.
(Aug 2016, 5 Marks)
Ans. Glomerular filtration is the process by which the blood
that passes through gromerular capillaries is filtered via
filtration membrane. This is the first process of urine
formation.
Filtration membrane consists of three layers, i.e.
1. Glomerular capillary membrane: It is formed by the
single layer of endothelial cells which are attached to
basement membrane. Capillary membrane consists
of many pores known as fenestra or filtration pores.
These pores has diameter of about 0.1 μ.
2. Basement membrane: Basement membrane of
glomerular capillaries fuses with the basement
membrane of visceral layer of Bowman’s capsule.
This basement membrane separates the endothelium
of glomerular capillary and the epithelium of
visceral layer of Bowman’s capsule.
3. Visceral layer of Bowman’s capsule: It consists of
single layer of flat epithelial cells which rest on the
basement membrane. Each cell get connected with
the basement membrane by cytoplasmic extensions
known as pedicle or feet. These pedicles are arranged in
the interdigitating manner leaving small cleft like space
in between. This cleft like space is known as slit pore.
Filtration takes place through these slit pores. Epithelial
cells with their pedicles are known as podocytes.
Procedure of Glomerular Filtration
Bowman’s capsule. All substances of plasma are filtered except
plasma proteins. This filtrate is known as glomerular filtrate. It
is also known as ultrafiltration as minute particles get filtered.
But plasma proteins due to their large size cannot be filtered
from slit pores. So this filtrate consists of all substances of plasma
except plasma proteins.

Factors Controlling Formation of Glomerular Filtrate
Renal Blood Flow
It is the most important factor that is necessary for glomerular
filtration. GFR is directly proportional to renal blood flow. The
renal blood flow itself is controlled by autoregulation.
Tubuloglomerular Feedback
Tubuloglomerular feedback is the mechanism that regulates
GFR through renal tubule and macula densa. Macula densa
of juxtaglomerular apparatus in the terminal portion of thick
ascending limb is sensitive to the sodium chloride in the tubular
fluid. When glomerular filtrate passes through the terminal
portion of thick ascending segment, macula densa acts like a
sensor. It detects the concentration of sodium chloride in the
tubular fluid and accordingly alters the glomerular blood flow
and GFR.
Glomerular Capillary Pressure
The GFR is directly proportional to glomerular capillary
pressure. The capillary pressure, in turn depends upon the renal
blood flow and arterial blood pressure.
Colloidal Osmotic Pressure
The GFR is inversely proportional to colloidal osmotic pressure
which is exerted by plasma proteins in the glomerular capillary
blood. When colloidal osmotic pressure increases as in case of
dehydration or increased plasma protein level, GFR decreases.
During hypoproteinemia, colloidal osmotic pressure is low and
GFR increases.
Hydrostatic Pressure in Bowman’s Capsule
GPR is inversely proportional to this. The hydrostatic pressure
in Bowman’s capsule increases in conditions like obstruction of
urethra and edema of kidney beneath renal capsule.
Constriction of Affrent Arteriole
The constriction of afferent arteriole reduces the blood flow to
the glomerular capillaries which in turn reduces GFR.
Constriction of Efferent Arteriole
If efferent arteriole is constricted, initially the GFR increases
because of stagnation of blood in the capillaries. Later when all
the substances are filtered from this blood, further filtration does
not occur because, the efferent arteriolar constriction prevents
outflow of blood from glomerulus and no fresh blood enters
the glomerulus for filtration.
Systemic Arterial Blood Pressure
Renal blood flow or GFR are not affected till the mean arterial
blood pressure is between 60 and 180 mm Hg. lt is due to the
autoregulation mechanism. Variation in pressure above 180 mm
Hg or below 60 mm Hg affects the renal blood flow and GFR
according because the autoregulatory mechanism fails beyond
this range.
Physiology 333

(Nov 2008, 5 Marks)
Or
Write briefly on mechanism of formation of urine.
(July 2016, 5 Marks)
Ans. Formation of urine takes place in three steps:
1. Glomerular filtration: Plasma is filtered in glomeruli
and substances reach the renal tubules along with
the water as filtrate.
2. Tubular reabsoption: 99% of filtrate gets absorbed
in various segments of renal tubules.
3. Tubular secretion: Some substances are secreted
from blood into the renal tubule and with these
changes filtrate get converted to urine.
Glomerular Filtration
Glomerular filtration is the process by which the blood that
passes through glomerular capillaries is filtered via filtration
membrane. This is the first process of urine formation.
Filtration membrane consists of three layers, i.e.
1. Glomerular capillary membrane: It is formed by the single
layer of endothelial cells which are attached to basement
membrane. Capillary membrane consists of many pores
known as fenestra or filtration pores. These pores has
diameter of about 0.1μ.
2. Basement membrane: Basement membrane of glomerular
capillaries fuses with the basement membrane of visceral
layer of Bowman’s capsule. This basement membrane
separates the endothelium of glomerular capillary and the
epithelium of visceral layer of Bowman’s capsule.
3. Visceral layer of Bowman’s capsule: It consists of single
layer of flat epithelial cells which rest on the basement
membrane. Each cell get connected with the basement
membrane by cytoplasmic extensions known as pedicle
or feet. These pedicles are arranged in the interdigitating
334 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
manner leaving small cleft like space in between. This
cleft like space is known as slit pore. Filtration takes place
through these slit pores. Epithelial cells with their pedicles
are known as podocytes.
Procedure of Glomerular Filtration
As blood passes via glomerular capillaries, plasma is filtered in ♦
Bowman’s capsule. All substances of plasma are filtered except
plasma proteins. This filtrate is known as glomerular filtrate. It
is also known as ultrafiltration as minute particles get filtered.
But plasma proteins due to their large size cannot be filtered
from slit pores. So this filtrate consists of all substances of plasma
except plasma proteins.
Tubular Reabsorption
When the glomerular filtrate passes through the tubular portion
of nephron, both quantitative and qualitative changes occur.
Large quantity of water, electrolytes and other substances are
reabsorbed by tubular epithelial cells. The substances which
are reabsorbed pass into interstitial fluid of renal medulla, and
from here substances move into blood in peritubular capillaries.
As substances are taken back into blood, the entire process is
called tubular reabsorption.
The tubular cells of kidney selectively, reabsorb the
substances present in glomerular filtrate, according to need of
body. So, it is also called as selective reabsorption.
Mechanism of Reabsorption
It occur by active and passive reabsorption:
♦ Active reabsorption: It is the movement of molecules
against electrochemical gradient and it needs liberation of
energy which is derived from ATP. Substances resorbed
actively in renal tubule are sodium, calcium, potassium,
phosphate, sulphate, bicarbonate, glucose, amino acid,
ascorbic acid, uric acid and ketone bodies.
♦ Passive reabsorption: It is the movement of molecules
along electrochemical gradient. This process does not
need any energy. Substances resorbed are chloride, urea
and water.
Reabsorption of substances occurs in all segments of tubular
portion of nephron:
♦ Substances resorbed from PCT: It resorbs 67% of the
filtered water, Na+, Cl , K+ and other solutes. All glucose
and amino acids are filtered by glomerulus. Total of the
88% filtrate is resorbed in PCT. Brush border of epithelial
cell in PCT increases surface area and facilitate resorption.
♦ Substances resorbed in loop of Henle: 20% of filtered Na+
and Cl , 15% of filtered water and cations, i.e. K+, Ca2+, Mg2+
get resorbed in loop of Henle.
♦ Substances resorbed in DCT and CT: 7% of filtered NaCl
and 8 to 17% of water is resorbed in these segments.
Tubular Secretion
♦ It is the process by which the substances are transported
from blood into renal tubules.
♦ Potassium is secreted actively by sodium potassium pump
in proximal and distal convoluted tubules and in collect-
ing ducts.
♦ Ammonia is secreted in proximal convoluted tubule.
♦ Hydrogen ions are secreted in PCT and DCT. Maximum
hydrogen ion secretion occurs in PCT.
So urine formation occurs in nephron by process of glomer-
ular filtration, selective reabsorption and tubular secretion.
Fig. 23: Urine formation
Q.4. Write in brief on countercurrent multiplier exchange
system of concentrated urine. (Mar 2009, 5 Marks)
Or
Write short note on countercurrent mechanism.
(Oct 2014, 3 Marks)
Ans. The countercurrent system is a system of “U” shaped
tubules in which the flow of fluid is in opposite direction
in different limbs of “U” shape tubules. In kidney, the
structures which forms the countercurrent system are
loop of Henle and vasa recta. The loop of Henle forms
countercurrent multiplier, and vasa recta forms the
countercurrent exchangers.
• Countercurrent multiplier: The operation of each
loop of Henle as countercurrent multiplier depends
on active transport of sodium and chloride out of the
thick ascending limb, the high permeability of this thin
descending limb to water and inflow of tubular fluid
form proximal tubule, with outflow in distal tubule.
In juxtamedullary nephrons with longer loops and
thin ascending limbs, the osmotic gradient is spread
over a greater distance, and osmolality at tip of loop
is greater. This is because thin ascending limb is rela-
tively impermeable to water but permeable to sodium
and chloride. Therefore sodium and chloride move
down their concentration gradient into interstitium
and there is additional passive countercurrent multi-
plication. The greater the length of loop of Henle, the
greater is osmolality which reaches to the tip.
 Physiology 335

• Countercurrent exchanger: It is formed by vasa 

recta. Vasa recta is responsible for maintenance of
hyperosmolarity of medullary interstitial fluid and
medullary gradient developed by countercurrent
multiplier. Vasa recta is highly permeable to water
and sodium, when the blood enters vasa recta, it
is isotonic to systemic plasma. When this capillary
descend downwards into deeper part of medulla,
water diffuses out passively from blood. Sodium and
urea passively diffuses in the blood. Since, vasa recta
has hair pin like structure, so when blood passes
through ascending limb of vasa recta, sodium and
urea diffuse out of blood and enter interstitial fluid of
medulla, and water diffuses in blood. The vasa recta
retains sodium and urea in medullary intersitium
and removes water from it. So hyperosmolalrity of
medullary interstitium is maintained.
Q.5. Write briefly on formation of concentrated urine.
(Apr 2003, 5 Marks) (Mar 2001, 5 Marks)
Or
Write on mechanism of concentration of urine.
(May 2014, 5 Marks)
Ans. As glomerular filtrate passes through renal tubule, the
osmolarity is altered and concentration of urine occurs
in the following fashion:
1. Bowman’s capsule: The glomerular filtrate at
Bowman’s capsule has same osmolarity of plasma as
it contains all substances of plasma except proteins.
Osmolarity of filtrate at Bowman’s capsule is 300
milliosmoles/L.
2. Proximal convoluted tubule: There is active re-
absorption of sodium and chloride followed by
obligatory reabsorption of water. So osmolarity of
fluid remains same, i.e. 300 milliosmoles/L.
3. Thick descending segment: Here, water is reab-
sorbed from tubule into outer medullary interstitium
by means of osmosis. The osmolarity is 450 to 600
milliosmoles/L.
4. Thin descending segment of Henle’s loop: In
this, more water is reabsorbed and osmolarity of
tubular fluid becomes equal to that of surround-
ing medullary interstitium. The osmolarity is 1200 (Dec 2004, 5 Marks)
milliosmoles/L. Or
5. Thin ascending segment of Henle’s loop: In this

segment due to concentration gradient, sodium
chloride diffuses out of tubular fluid and osmolarity
decreases to 400 milliosmoles/L.
6. Thick ascending segment: It is impermeable to
water. But there is active reabsorption of sodium
and chloride. The fluid inside becomes hypotonic to
plasma. The osmolarity is 150 to 200 milliosmoles/L.
7. Distal convoluted tubule and collecting duct: The
two segments are totally impermeable to water, but (Aug 2018, 5 Marks)
permeable to solutes. So sodium and chloride are Ans. Normal GFR refers to the volume of glomerular filtrate
reabsorbed. The tubular fluid becomes more hypo- formed each minute by all the nephrons in both the
tonic at DCT and osmolarity is 100 milliosmoles/L. kidneys.
336 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

  Its normal value is 125 ml/min i.e. 170 to 180 L/day.
Its value is 10% less in females as compared to males.
  At the rate of 125 ml/min kidneys filter 4 times total
body water, 15 times the extra cellular fluid volume and
60 times the plasma volume.
Procedure of Glomerular Filtration
As blood passes via glomerular capillaries, plasma is filtered in
Bowman’s capsule. All substances of plasma are filtered except
plasma proteins. This filtrate is known as glomerular filtrate. It
is also known as ultrafiltration as minute particles get filtered.
But plasma proteins due to their large size cannot be filtered
from slit pores. So this filtrate consists of all substances of plasma
except plasma proteins.
Factors Affecting Glomerular Filtration Rate
Renal Blood Flow
It is the most important factor that is necessary for glomerular
filtration. GFR is directly proportional to renal blood flow. The
renal blood flow itself is controlled by autoregulation.
Tubuloglomerular Feedback
Tubuloglomerular feedback is the mechanism that regulates
GFR through renal tubule and macula densa. Macula densa
of juxtaglomerular apparatus in the terminal portion of thick
ascending limb is sensitive to the sodium chloride in the tubular
fluid.
When glomerular filtrate passes through the terminal portion
of thick ascending segment, macula densa acts like a sensor. It
detects the concentration of sodium chloride in the tubular fluid
and accordingly alters the glomerular blood flow and GPR.
Constriction of Efferent Arteriole
If efferent arteriole is constricted, initially the GFR increases
because of stagnation of blood in the capillaries. Later when all
the substances are filtered from this blood, further filtration does
not occur because, the efferent arteriolar constriction prevents
outflow of blood from glomerulus and no fresh blood enters
the glomerulus for filtration.
Systemic Arterial Blood Pressure
Renal blood flow or GFR are not affected till the mean arterial
blood pressure is between 60 and 180 mm Hg. lt is due to the
autoregulation mechanism. Variation in pressure above 180
mm Hg or below 60 mm Hg affects the renal blood flow and
GFR accordingly because the autoregulatory mechanism fails
beyond this range.
Surface Area of Capillary Membrane
GFR is directly proportional to the surface area of the capillary
membrane. If the glomerular capillary membrane is affected as
in the cases of some renal diseases, the surface area for filtration
decreases. So there is suction in GFR.
Permeability of Capillary Membrane
GFR is directly proportional to the permeability glomerular
capillary membrane. In many abnormal conditions like hypoxia,
lack of blood supply, presence of toxic agents, etc. the permeability
of the capillary membrane increases. In such conditions, even
plasma proteins are filtered and excreted in urine.
Q.8. Draw a labeled diagram of structure of nephron.
(Sep 2004, 5 Marks)
Ans.

Glomerular Capillary Pressure

The GFR is directly proportional to glomerular capillary
pressure. The capillary pressure, in turn depends upon the renal
blood flow and arterial blood pressure.

Colloidal Osmotic Pressure

The GFR is inversely proportional to colloidal osmotic pressure
which is exerted by plasma proteins in the glomerular capillary
blood. When colloidal osmotic pressure increases as in case of
dehydration or increased plasma protein level, GFR decreases.
During hypoproteinemia, colloidal osmotic pressure is low and
GFR increases.

Hydrostatic Pressure in Bowman’s Capsule

GPR is inversely proportional to this. The hydrostatic pressure Fig. 24: Nephron
in Bowman’s capsule increases in conditions like obstruction of
urethra and edema of kidney beneath renal capsule. Q.9. Describe the functions of skin.
(Sep 2000, 5 Marks) (Aug 2012, 5 Marks)
Constriction of Affrent Arteriole
Or
The constriction of afferent arteriole reduces the blood flow to Write short note on functions of epithelial tissues.
the glomerular capillaries which in turn reduces GFR. (Feb 2013, 7 Marks)
 Physiology 337

Ans. Following are the functions of skin ♦ They are innervated by sympathetic nerve fibers. They
1. Protective function: Skin forms the covering of all release rennin in response to sympathetic discharge.
organs of body and protects these organs from: ♦ These cells acts as baroreceptors and produce their action
a. Bacteria and toxic substances in response to changes occurring in the transmural pres-
b. Mechanical blow sure gradient between afferent arterioles and interstitium.
c. UV rays. ♦ They act as vascular volume receptors and monitor renal
2. Role of skin as sense organ: It is the largest sense perfusion pressure, they are stimulated by hypovolemia
organ in body. It consists of cutaneous receptors or decrease renal perfusion pressure.
which are stimulated by sensation of touch, pain,
temperature and pressure and convey these sensa-
tions to brain.
3. Storage function: It stores fat, water, chloride and
sugar. It also stores blood during dilatation of blood
vessels.
4. Regulation of body temperature: Skin plays an
important role in regulation of body temperature.
Excessive heat is lost from body through skin by
radiation. Sweat glands of skin take active part in
heat loss by secreting sweat.
5. Secretory function: Skin secretes sweat through
sweat glands and sebum through sebaceous glands.
By secreting sweat, skin regulates body temperature
and water balance. Sebum keeps skin smooth and
moist.
6. Synthesis of vitamin D: It is secreted in skin by
action of UV rays on cholesterol. Fig. 25: Juxtaglomerular apparatus
7. Excretory function: Skin regulates water balance
and electrolyte balance by excreting water and salts Macula Densa Cells
through sweat.
♦ These are specialized renal tubular epithelial cells of short
8. Absorptive function: Skin absorbs fats, soluble
segment of thick ascending limb of loop of Henle.
substances and some ointments.
♦ These cells are in direct contact with mesangial cells and
Q.10. Describe countercurrent system. Add note to GFR. in close contact with JG cells.
(Mar 2006, 15 Marks) ♦ These cells have prominent nuclei and they act as chemo-
Ans. For countercurrent mechanism refer to Ans 4 of the same receptors. They are stimulated by decreased sodium ion
chapter and for GFR refer to Ans 7 of the same chapter. load causing increase in rennin release.
Q.11. Write a short note on juxtaglomerular apparatus. ♦ Macula densa cells are not innervated.
(Feb 2003, 5 Marks) (Aug 2005, 5 Marks)
Mesangial Cells or Lacis Cells
(Dec 2010, 5 Marks)
Ans. Juxtaglomerular apparatus is the collection of specialized ♦ These are the supporting cells of juxtaglomerular appara-
cells which is located near to glomerulus. tus and are seen between capillary loops.
  It forms the major component of rennin-angiotensin- ♦ They are in contact with the JG cells and macula densa cells.
aldosterone system. ♦ These cells are contractile and play an important role in
regulation of glomerular filtration.
Juxtaglomerular apparatus consists of three types of cells:

a. Juxtaglomerular cells.
b. Macula densa cells.
c. Mesangial cells.
(Sep 2006, 4 Marks)
Juxtaglomerular Cells or JG Cells Ans. The functions of distal convoluted tubule are:
♦ JG cells are the specialized myoepithelial cells which are 1. They are involved in sodium reabsorption.
located in media of afferent arteriole in region of juxtaglo- 2. They are involved in vasopressin stimulated water
merular apparatus. reabsorption.
♦ Juxtaglomerular cells synthesize, store and releases the 3. They are concerned with acid secretion and bicar-
enzyme known as rennin which is stored inside the secre- bonate transport.
tory cells of juxtaglomerular cells. 4. They causes hypertonicity of urine.
338 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.13. Enlist the functions of kidney. Describe the role of Ans. Functions of ADH
kidney in regulation of blood pressure.
(Sep 2006, 15 Marks)
Ans. Functions of Kidney
1. They regulate and maintain volume and composition
of body fluids by regulating secretion of ADH from
posterior pituitary.
2. The kidneys retain certain useful substances by
maintaining threshold called as renal threshold.
3. The kidneys are main excretory organs. They nor-
mally excrete waste products, i.e. urea, uric acid,
creatinine.
4. They play a role in homeostasis of sodium, potas-
sium, magnesium, calcium, phosphorus, hydrogen
and bicarbonate ions.
5. Kidney performs certain metabolic and hormonal
functions like they secrete an enzyme known as
renin which causes regulation of blood pressure. It
also produces a hormone called as erythropoietin
which stimulates erythropoiesis in bone marrow.
6. They regulate the osmotic pressure (osmolality) of
the body fluids by excreting osmotically dilute or
concentrated urine.
7. They play an essential role in acid base balance by
excreting H+ when there is excess acid or HCO3-
when there is excess base.
8. They regulate the volume of the ECF by controlling
Na+ and water excretion.
9. They remove many drugs (e.g. penicillin) and
foreign or toxic compounds.
10. They are the major sites of production of
certain hormones, including erythropoietin and
1,25-dihydroxy vitamin D3.
11. They degrade several polypeptide hormones,
including insulin, glucagon, and parathyroid
hormone.
12. They synthesize ammonia, which plays a role in
acid-base balance.
13. They synthesize substances that affect renal blood
flow and Na+ excretion, including arachidonic acid
derivatives (prostaglandins, thromboxane A2) and
kallikrein (a proteolytic enzyme that results in the
production of kinins).
For the role of kidney in regulation of blood pressure refer
to Ans 13 of chapter CARDIOVASCULAR SYSTEM.
Q.14. What are the functions of ADH? What is diabetes
insipidus? (Aug 2005, 7 Marks)
Or
Write very short answer on functions of ADH.
(Apr 2018, 2 Marks)
Or
Answer in brief functions of ADH.
(Sep 2017, 2 Marks)
1. The major function of ADH is retention of water in
ECF by acting on kidney.
2. It increases water reabsorption from DCT and col-
lecting duct in absence of ADH.
3. It causes constriction of blood vessels.
4. It increases blood pressure.
5. It reduces the osmolarity of ECF.
Diabetes Insipidus
The disorder of ADH causes diabetes insipidus. This disease
is characterized by excessive excretion of water through urine.
Causes
This is a syndrome developed due to the deficiency of ADH
of posterior pituitary. The deficiency occurs due to following
reasons:
♦ Injury or degeneration of supraoptic and paraventricular
nuclei of hypothalamus.
♦ Leison in hypothalamohypophyseal tract.
♦ Atrophy of posterior pituitary.
♦ It can also occur due to the inability of renal tubules to give
response to ADH. This condition is called as nephrogenic
diabetic insipidus.
Types of Diabetes Insipidus
♦ Central or neurogenic: It is due to complete or partial
failure of ADH secretion.
♦ Nephrogenic: It is due to complete or partial failure of
collecting tubules to respond to ADH. It occurs due to
V2 receptor unresponsiveness or due to mutation of
aquaporin 2.
Signs and Symptoms
♦ Polyurea: Excretion of large quantity of dilute urine with
increased frequency of voiding is known as polyuria. Daily
output of urine is between 4 and 12 litres.
♦ Polydipsia: Intake of excess water is known as polydipsia.
Loss of water due to polyurea stimulates the thrist center
in hypothalamus which results in intake of large quantity
of water.
♦ Dehydration: Thirst center in hypothalamus is affected.
Water intake decrease in these patients and loss of water
through urine is not compensated. This leads to dehydra-
tion. Signs and symptoms of dehydration are dry tongue,
xerostomia, hypotension and loss of consciousness.
Q.15. Discuss in brief renal tubular functions.
(Oct 2007, 10 Marks)
Ans. Refer to Ans 3 of the same chapter.
Q. 16. Describe in short about acidification of urine.
(Mar 2007, 4 Marks)
Ans. Urine is acidic in nature with a pH of 6.
• The urine becomes acidic because of tubular
secretion of hydrogen ions.

• Hydrogen ions are secreted in exchange of sodium
ions in the proximal and distal convoluted tubules
and by the formation of ammonia.
Excretion of Hydrogen in Exchange to Sodium Ions
♦ In proximal convoluted tubule:
Proximal convoluted tubule contains large quantity
of sodium bicorbonate, which associates into sodium
and bicarbonate
Simultaneously CO2 enters the cells from tubular fluid.
In tubular cells, CO2 combines with H2O to form
carbonic acid which dissociates into hydrogen and
bicarbonate ions.
When sodium ion is resorbed from the tubular fluid
into tubular cell, hydrogen ion is secreted from the cell
into the tubular fluid in exchange for sodium ion.
♦ In distal convoluted tubule:
In tubular cell, CO2 and H2O combine to form H2CO3
which dissociate into H+ and HCO3
This H + is secreted into tubular lumen from the
exchange of sodium ion.
Sodium ion absorbed into tubular cell under the
influence of aldosterone.
The hydrogen ion combines with sodium hydrogen
phosphate to form sodium dihydrogen phosphate
which causes the acidity of urine.
Excretion of Hydrogen Ions by the Formation of Ammonia
♦ Kidney increases the excretion of hydrogen ions, by the
formation of ammonia.
♦ In tubular cells, ammonia is formed when glutamine is
converted into glutamic acid.
♦ Ammonia is also formed by the deamination of some of
the amino acids like glycine and alanine.
♦ The ammonium formed in tubular cells is released into tubu-
lar luman and here it combines with a hydrogen ion to form
ammonium, which combines with sodium acetoacetate to
form ammonium acetoacetate which excreted through urine.
♦ Thus, hydrogen ions enter the urine in the form of
ammonium compounds and causes acidity of urine.
Q.17. Write briefly about micturition.
(Apr 2008, 4 Marks) (Mar 2009, 5 Marks)
Ans. Micturition is a process by which urine is voided from
the urinary bladder.
• It is a reflex process.
The functional anatomy and nerve supply of urinary
bladder are essential for the process of micturition.
• Urinary bladder consists of the body, neck and
internal urethral sphincter.
The smooth muscle forming the body of bladder is
called detrusor muscle.
• At the posterior surface of the bladder wall, there is
a triangular area called trigone. At the upper angles
of this trigone, two ureters enter the bladder.
• The lower part of bladder is narrow and forms the neck.
The distal end of this has a internal sphincter made
by detrusor muscle.
Physiology 339
• It opens towards urethra, at the other end of urethra
there is eternal urethral sphincter.
Nerve Supply to Urinary Bladder and Sphincters
♦ Urinary bladder and internal sphincter are supplied by
both sympathetic and parasympathetic nerves.
♦ The external sphincter is supplied by somatic nerve.
♦ Sympathetic nerve: Causes relaxation of detrusor muscle
and contraction of internal sphincter so causes filling of
urinary bladder.
♦ Parasympathetic nerve (pelvic nerve): Causes contraction
of detrusor muscle and relaxation of the internal sphincter
leading to emptying of urinary bladder.
♦ Somatic nerve (pudendal nerve): It maintains the tonic
contraction of the skeletal muscle fibers forming external
sphincter.
Micturition Reflex
Filling of urinary bladder
Stimulation of stretch receptors in urinary bladder
Afferent impulses via pelvic nerve
Sacral segments of spinal cord
Urinary bladder
Relaxation of
destrusor muscle internal sphincter
Flow of urine in urethra and stimulation of stretch receptors
Efferent impulses via pelvic nerve
Inhibition of pudendal nerve
Relaxation of external sphincter
Voiding of urine
Q.18. Write short note on body temperature and functions
of skin. (Aug 2011, 6 Marks)
Ans. Body Temperature
Body temperature can be measured by placing the
clinical thermometer in different parts of the body
such as mouth, axilla, rectum, over the skin.
The normal body temperature in human is 37°C
(98.6°F) when measured by placing the clinical
thermometer in the mouth.
Variations of Body Temperature
1. Age: In infants, the body temperature varies in accordance
to environmental temperature for the first few days after
birth. In children the temperature is slightly (0.5°C) more
340 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
than in adults because of more physical activities. In old
age, since the heat production is less, the body temperature
decreases slightly.
2. Sex: ln females, the body temperature is less because of
low basal metabolic rate when compared to that of males.
During menstrual phase it decreases slightly.
3. Diurnal variation: In early morning, the temperature is
1°C less. In the afternoon, it reaches the maximum.
4. After meals: The body temperature rises slightly (0.5°C)
after meals.
5. Exercise: During exercise, the temperature raises due to
production of heat in muscles.
6. Sleep: During sleep, the body temperature decreases by
0.5°C.
7. Emotion: During emotional conditions, the body tempera-
ture increases.
For functions of skin refer to Ans 10 of same chapter.
Q.19. Write about factors affecting glomerular filtration rate.
(Feb 2013, 7 Marks)
Ans. Following are the factors affecting glomerular filtration
rate:
Renal Blood Flow
It is the most important factor that is necessary for glomerular
filtration. GFR is directly proportional to renal blood flow. The
renal blood flow itself is controlled by autoregulation.
Tubuloglomerular Feedback
Tubuloglomerular feedback is the mechanism that regulates
GFR through renal tubule and macula densa. Macula densa
of juxtaglomerular apparatus in the terminal portion of thick
ascending limb is sensitive to the sodium chloride in the tubular
fluid. When glomerular filtrate passes through the terminal portion
of thick ascending segment, macula densa acts like a sensor. It
detects the concentration of sodium chloride in the tubular fluid
and accordingly alters the glomerular blood flow and GPR.
Glomerular Capillary Pressure
The GFR is directly proportional to glomerular capillary
pressure. The capillary pressure, in turn depends upon the renal
blood flow and arterial blood pressure.
Colloidal Osmotic Pressure
The GFR is inversely proportional to colloidal osmotic pressure
which is exerted by plasma proteins in the glomerular capillary
blood. When colloidal osmotic pressure increases as in case of
dehydration or increased plasma protein level, GFR decreases.
During hypoproteinemia, colloidal osmotic pressure is low and
GFR increases.
Hydrostatic Pressure in Bowman’s Capsule
GPR is inversely proportional to this. The hydrostatic pressure
in Bowman’s capsule increases in conditions like obstruction of
urethra and edema of kidney beneath renal capsule.
Constriction of Afferent Arteriole
The constriction of afferent arteriole reduces the blood flow to
the glomerular capillaries which in turn reduces GFR.
Constriction of Efferent Arteriole
If efferent arteriole is constricted, initially the GFR increases
because of stagnation of blood in the capillaries. Later when all
the substances are filtered from this blood, further filtration does
not occur because, the efferent arteriolar constriction prevents
outflow of blood from glomerulus and no fresh blood enters
the glomerulus for filtration.
Systemic Arterial Blood Pressure
Renal blood flow or GFR are not affected till the mean arterial
blood pressure is between 60 and 180 mm Hg. lt is due to the
autoregulation mechanism.Variation in pressure above 180 mm
Hg or below 60 mm Hg affects the renal blood flow and GFR
according because the autoregulatory mechanism fails beyond
this range.
Surface Area of Capillary Membrane
GFR is directly proportional to the surface area of the capillary
membrane. If the glomerular capillary membrane is affected as
in the cases of some renal diseases, the surface area for filtration
decreases. So there is suction in GFR.
Permeability of Capillary Membrane
GFR is directly proportional to the permeability glomerular
capillary membrane. In many abnormal conditions like hypoxia,
lack of blood supply, presence of toxic agents, etc. the permeability
of the capillary membrane increases. In such conditions, even
plasma proteins are filtered and excreted in urine.
Q.20. Write in detail structure and functions of kidney.
(Dec 2010, 6 Marks) (Aug 2011, 8 Marks)
Ans. Structure of kidney.
Gross Structure
♦ The two kidneys, each weighing 150 gm in adults are
located retroperitoneally in the upper dorsal region of the
abdominal cavity, on either side of the vertebral column.
The kidneys are bean-shaped organs, approx 10 cm long,
5 cm wide and 2.5 cm thick. The right kidney is usually
slightly lower than the left because of the considerable
space occupied by the liver. Vertical section of the kidneys
shows:
Outer cortex: Reddish in color
Inner Medulla: Pale in color. It contains 10 15
Pyramids which terminate medially in the renal
papillae. Papillae projects into calyces ; such 10 15
minor calyces join to form two major calyces which
come out through the pelvis of kidney to the widened
end of the ureter.
♦ The ureters exit from the hilum of the kidney and pass
to the bladder. The blood vessels, lymphatics and nerves
enter into or exit from the kidney via the hilum.

Fig. 26: Vertical section of human kidney
Microscopic Structure
♦ The basic functional unit of the kidney is the nephron.
♦ There are approximately 1 to 1.3 million nephrons in each
kidney which drain into the renal pelvis. Total length of a
nephron ranges from 45 to 65 mm.
♦ The different parts of the nephron are Bowmann’s capsule;
Glomerulus, the proximal convoluted tubule (PCT), loop of
Henle, distal convoluted tubule (DCT), collecting tubules.
Bowman’s capsule: It is the initial dilated part of the
nephron. Its epithelial cell lining is about 5 μm thick.
Glomerulus: It is about 200 μm in diameter and
formed by the invagination of a tuft of capillaries
into the Bowman’s capsule. The capillaries are
supplied by afferent arteriole. Bowman’s capsule and
the glomerulus together constitute the Malpighian
Corpuscle.
The Bowman’s capsule has two layers:
1. Visceral: Visceral cell layer is very closely applied to the
loops of the capillaries so as to surround each loop on all
sides. It is continuous at the site of entrance of the afferent
and efferent arterioles with the parietal layer.
2. Parietal: Parietal cell layer is applied to the Bowman
capsule proper and forms the outer lining of the
glomerulus. It is continuous with the proximal convoluted
tubule. A space is present between the visceral and parietal
layers of the Bowman’s capsule, called Bowman’s space.
The structures intervening blood within the capillary loop
and Bowman’s space is called glomerular membrane or
glomerular capillary wall.
Structure of Glomerular Membrane
♦ It is an extremely thin membrane and is made up of five
layers.
Layer 1: Foot process of podocytes: Visceral epithelial cell
layer covering the capillaries is not continuous. It gives
out series of processes called pedicles, interdigitating
Physiology 341
upon capillary surface to form filtration slits along the
capillary wall.
Layer 2: Outer Cement Layer: Over this lie the foot
processes of podocytes.
Layer 3: Lamina Densa: Dense structural portion of the
basement membrane.
Layer 4: Inner Cement Layer: It provides a bed for the
capillary endothelium.
Layer 5: Endothelial cell Layer: The endothelium of the
glomerular capillaries is fenestrated with pores of
100 nm in diameter due to this plasma filtration with
retention of plasma proteins and blood cells.
♦ The glomerular capillaries form a freely branching anasto-
motic network. Each glomerulus contains six lobules and
each of these consists of 3-6 capillary loops, i.e. 20-40 loops
in all. Many anastomoses occur between the capillaries
within any one lobule.
♦ The major function of glomerular membrane is to produce
an ultrafiltrate, i.e. the glomerular filtrate will contain all
the constituents of plasma except proteins.
Proximal Convoluted Tubule (PCT)
1. PCT lumen is continuous with that of Bowman’s capsule.
2. It is 15 mm long and 55m in diameter, consisting of single
layer of cells with curved outline and brush border formed
by numerous microvilli which markedly increase the sur-
face area for absorption.
3. Tubular cells are united at the apex by tight junctions while
the bases of the cells have extensions into extracellular
space, called the lateral intercellular spaces.
4. PCT is divided into two parts:
i. Pars convoluta-convoluted portion of PCT
ii. Pars recta-straight portion of PCT.
Loop of Henle
1. It consists of a descending limb which arises in continuity
with the terminal part of the PCT.
2. Descending limb continues into the thin segment where
the epithelium is of attenuated flat cells. Length of the thin
segment of the loop is 2 to 14 mm.
Distal Convoluted Tubule (DCT)
Thick ascending limb is continued as DCT (length 5 mm).
1. DCT is characterized by low cuboidal epithelium with few
scattered microvilli.
2. This tubule comes very close to its own glomerulus and
establishes a close proximity to the afferent and efferent
arterioles of the glomerulus. At this site the cells of DCT
get modified to become columnar and are closely crowded
together, that is why this part of DCT is called the macula
densa.
3. The macula densa and the adjacent juxtaglomerular part
of the afferent arteriolar wall are functionally associated
forming juxtaglomerular apparatus (JGA).
342 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Collecting Tubules (CT)
1. DCT join to form collecting tubules and is lined by clear
cuboidal epithelium.
2. CT passes through the renal cortex and medulla to empty
into the pelvis of the kidney at the apices of the medullary
pyramids.
3. CT epithelium consists of two types of cells:
i. P-Cells: These cells increases the permeability of CT to
water in the presence of ADH by increasing the pore
size. P-cells leads to Na+ reabsorption.
ii. I-Cells: These cells secrete acid (H+), helps transport
of HCO3 and are responsible for acidic urine.
– The whole kidney is enveloped by a thin but tough
fibrous membrane, called renal capsule. It limits
the swelling.
For functions of kidney refer to Ans 13 of same chapter.
Q.21. Write short note on kidney functions.
(Dec 2009, 5 Marks)
Ans. For kidney functions refer to Ans 13 of same chapter.
Q.22. Give the structure of kidney and functions of kidney
in detail. Also write down about the role of kidneys
in regulation of pH of blood. (June 2010, 10 Marks)
Ans. For structure of kidney refer to Ans 20 of same chapter.
For functions of kidney refer to Ans 13 of same chapter.
Role of Kidneys in Regulation of pH of Blood
Role of kidneys in maintainence of blood pH is highly
significant. Renal mechanism try to provide a permanent
solution for acid-base disturbances.
The enzyme carbonic anhydrase leads to the renal regulation
of pH which occur by following mechanism:
1. Excretion of H+ ions
2. Reabsorption of bicarbonate
3. Excretion of titratable acid
4. Excretion of ammonium ions.
Excretion of H+ ions
♦ Kidney eliminated the H+ ion from the body.
♦ H+ excretion occur in proximal convoluted tubule and is
coupled with regeneration of bicarbonate.
♦ Carbonic anhydrase catalyses production of carbonic
acid from carbon dioxide and water in renal tubular
cell.
♦ Bicarbonate then dissociate to hydrogen ion and bicar-
bonate ion.
♦ Hydrogen ions are secreted in tubular lumen in exchange
for sodium ion.
♦ Sodium ion in association with bicarbonate ion is reab-
sorbed in blood
♦ By this way hydrogen ions are eliminated from body and
bicarbonate ions generated in body.
♦ Hydrogen ion combines with non-carbonate base and is
excreted in urine.
Reabsorption of Bicarbonate
It conserves the blood bicarbonate with excretion of hydrogen
ions. Normal urine is free from bicarbonate ions.
Excretion of Titratable Acid
♦ Titratable acidity refers to the number of millimeters of
N/10 NaOH which is required to titrate 1 liter of urine
to pH 7.4.
♦ Titratable acidity reflects the hydrogen ions excreted in
urine which causes fall in pH from 7.4.
♦ Excreted hydrogen ions are buffered in urine by phosphate
buffer.
Excretion of Ammonium Ions
♦ It is another mechanism for buffering of hydrogen ions
which are secreted in tubular fluid.
♦ Hydrogen ions combine with ammonia to form ammo-
nium ion.
♦ Renal tubular cells deamidate glutamine to glutamate and
ammonia and this reaction occur in presence of enzyme
glutaminase.
♦ Ammonia liberated in this reaction diffuses in tubular
lumen where it combines hydrogen to form ammonia.
♦ Ammonium ions cannot diffuse back in tubular cells and
are excreted in urine.
Q.23. Write in brief TmG and renal threshold.
(June 2010, 5 Marks)
Ans. TmG
When reabsorptive limit of tubule, i.e. Tr exceeded
the amount of glucose which passes in urine in-
creases with plasma glucose concentration the limit
is referred to as Tubular maximum for glucose, i.e.
TmG
• TmG is the rate at which glucose is reabsorbed from
the renal tubule
• TmG in males is 375 mg/min and in females it is 300
mg/min.
Renal Threashold
♦ It is the plasma concentration at which the particular sub-
stance first appear in urine.
♦ Every substance has threashold level in plasma or blood.
Below this level the substance is completely reabsorbed
and does not appear in urine. When the concentration of
that particular substance reaches the threashold, excess
amount is not resorbed and appears in urine. This is renal
threashold of the substance.
♦ Renal threashold for glucose is 180 mg/dl, it means that
glucose is completely reabsorbed from tubular fluid if its
concentration in blood is less than 180 mg/dl. So glucose
does not appear in urine. When blood level of glucose
reaches 180 mg/dl, it is not absorbed completely and
appears in urine.

Q.24. Write down names of different tissues present in the ♦
body. Describe epithelial tissue. (June 2010, 15 Marks)
Or
Write in brief on epithelial tissue.
(Nov 2008, 5 Marks)
Ans. Human body is composed of four basic types of tissues:
1. Epithelium: Lines and covers surfaces
2. Connective tissue: Protect, support, and bind together
3. Muscular tissue: Produces movement
4. Nervous tissue: Receive stimuli and conduct impulses
Fig. 27: Types of epithelium
Epithelial Tissue
Epithelium forms the coverings of surfaces of the body. As
such, it serves many purposes, including protection, adsorption,
excretion, secretion, filtration, and sensory reception.
When considering the characteristics that make a tissue
epithelium.
♦ Polarity: Epithelium is arranged so there is one free surface,
i.e. apical surface and one attached surface, i.e. basal surface.
♦ Cellular nature: Cells in epithelium fit closely together side
by side and sometimes atop each other to form sheets of
cells. These sheets are held together by specialized junctions.
Epithelium Microscopic appearance
Simple Single layer of flattened cells with disc shape
squamous central nuclei and sparse cytoplasm
epithelium
Simple cuboidal Single layer of cube like cells with large spherical
epithelium central nuclei.
Physiology 343
Supported by connective tissue: Attachment to a layer of
connective tissue at the basal surface forms a layer called
the basement membrane, an adhesive layer formed by secre-
tions from the epithelial cells and the connective tissue cells.
♦ Avascular: Epithelium typically lacks its own blood supply.
♦ Regeneration: Epithelium cells can regenerate if properly
nourished.
Classification of epithelium is based on the shape of the cells
and the arrangement of the cells within the tissue.
Typically, the arrangement of the cells is stated first, then the
shape, and is followed by “epithelium” to complete the naming,
(e.g. simple squamous epithelium).
Arrangements
♦ Simple: Cells are found in a single layer attached to the
basement membrane.
♦ Stratified: Cells are found in 2 or more layers stacked atop
each other.
♦ Pseudostratified: A single layer of cells that appears to be
multiple layers due to variance in height and location of
the nuclei in the cells.
♦ Transitional: Cells are rounded and can slide across one
another to allow stretching.
Shapes
♦ Squamous: Flat, thin, scale like cells.
♦ Cuboidal: Cells that have a basic cube shape. Typically
the cell’s height and width are about equal.
♦ Columnar: Tall, rectangular or column shaped cells. Typi-
cally taller than they are wide.
Special Features of Epithelium
♦ Cilia: Hair like appendages attached to the apical sur-
face of cells that act as sensory structures or to produce
movement.
♦ Goblet cells: Specialized cells that produce mucus to
lubricate and protect the surface of an organ.
♦ Villi: Finger like projections that arise from the epithelial
layer in some organs. They help to increase surface area
allowing for faster and more efficient adsorption.
♦ Microvilli: Smaller projections that arise from the cell s
surface that also increase surface area. Due to the bushy
appearance that they sometimes produce, they are some-
times referred to as the brush border of an organ.
Function Location
Allow passage of materials by Kidney glomeruli, air sacs of lung,
diffusion and filtration in sites lining of heart, blood vessels and
where protection is not important lymphatic vessels
Secretion and absorption Kidney tubules, duct and secretory
portions of small glands
Contd...
344 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd...

Epithelium Microscopic appearance Function Location

Simple columnar Single layer of tall cells with round to oval nuclei Absorption; secretion of mucus, Digestive tract, gallbladder, excretory
epithelium and some cells bear cilia; layer may contain mucus enzymes and other substances duct of some glands, uterine tubes
secreting unicellular glands, i.e. goblet cells ciliated type propels mucus by and some region of uterus
ciliary action
Pseudostratified Single layer of cells of different height, some of Secretion of mucus, propulsion Non-ciliated type in male sperm
columnar them not reaching the free surface, nuclei seen of mucus by ciliary action. carrying duct and duct of large
epithelium at different levels, may contain goblet cells and glands; Ciliated type lines the trachea
contain cilia and most of upper respiratory tract.
Stratified Thick membrane composed of several cell Protects underlying tissues in Non-keratinized is mostly seen in
squamous layers; basal cells are cuboidal or columnar and areas subjected to abrasion linings of esophagus and mouth.
epithelium metabolically active; surface cells are flattened Keratinized is seen in epidermis of
(squamous) in keratinized type, surface cells are full skin.
of keratin and dead; basal cells are active in mitosis
and produce the cells of more special layers.
Transitional Resembles both stratified squamous and stratified It stretches readily and permits Kidney tubules, ovary surface,
epithelium cuboidal; basal cells cuboidal or columnar; surface distention of urinary organ by secretory portion of small glands
cells dome shaped or squamous like depending contained urine.
on degree of organ stretch

Q.25. Describe in brief diabetes insipidus. Q.27. Describe structure and functions of a nephron.
(Aug 2011, 5 Marks) (Sep 2013, 10 Marks)
Or Or
Write short note on diabetes insipidus.
Write on structure and function of nephron.
(Apr 2008, 5 Marks)
(Apr 2017, 5 Marks)
Ans. Refer to Ans 14 of same chapter.
Ans. Nephron is defined as the structural and functional unit
Q.26. Write short note on micturition reflex. of kidney.
(Jan 2012, 5 Marks) (Feb 2014, 3 Marks)
Nephron is formed by two parts, i.e.
Ans. Micturition reflex is the reflex by which micturition occurs.
1. Renal corpuscle or malphigian corpuscle.
Mechanism of Micturition Reflex 2. Renal tubule.
Filling of urinary bladder Renal Corpuscle

Stimulation of stretch receptors in urinary bladder It is sphaeroidal and slightly flattened structure with diameter
of 200 μ.
Afferent impulses via pelvic nerve Renal corpuscle is formed by two portions, i.e.
1. Glomerulus.
Sacral segments of spinal cord 2. Bowman’s Capsule.

Glomerulus
Urinary bladder

Relaxation of
Glomerulus is 200 μm in diameter, it is formed by invagination
destrusor muscle internal sphincter of tuft of capillaries in Bowman’s capsule. These capillaries
are supplied by afferent arteriole and blood leaves through
Flow of urine in urethra and stimulation of stretch receptors
efferent arteriole. Diameter of efferent arteriole is lesser than
the afferent arteriole. The capillaries are made up of single layer
Efferent impulses via pelvic nerve of endothelial cells which are attached to basement membrane.
Endothelium consists of pores which are known as fenestra or
filtration process.
Inhibition of pudendal nerve
Bowman’s Capsule
Relaxation of external sphincter
It is the dilated part of nephron. Its epithelial cell lining 5 μm
thick. Bowman’s capsule encloses the glomerulus. Diametere
Voiding of urine
of capsule is 200 µ. It is formed by two layers, i.e.

1. Inner visceral layer: This layer is close to the loops of capil-
laries and surrounds each loop over all the sides.
2. Outer parietal layer: It forms outer lining of glomerulus
and is continuous with proximal convoluted tubule.
In between both the layers a space is present which is known
as Bowman’s space.
Structures intervening blood in capillary loop in Bowman’s
space is known as glomerular membrane.
Glomerular membrane is a thin membrane and consists of
following layers:
♦ Ist Layer: Foot processes of podocyte: Capillaries are
covered by visceral cell layer which is not continuous all
over. It produces a series of processes known as pedicles
which interdigitate on capillary surfaces and form filtration
slit over capillary wall.
♦ IInd Layer: Outer cement layer: Foot processes of podo-
cytes overlie this layer.
♦ IIIrd Layer: Lamina Densa: Dense portion of basement
membrane is known as lamina densa.
♦ IVth Layer: Inner cement layer: This layer provides bed
for capillary endothelium.
♦ Vth Layer: Endothelial cell layer: This layer is fenestrated
100 nm pores which allows plasma filtration.
♦ The glomerular capillaries form a freely branching anasto-
motic network. Each glomerulus contains six lobules and
each of these consists of 3 6 capillary loops, i.e. 20 40 loops
in all. Many anastomoses occur between the capillaries
within any one lobule.
♦ The major function of glomerular membrane is to produce
an ultrafiltrate, i.e. the glomerular filtrate will contain all
the constituents of plasma except proteins.
Tubular Portion
It is the continuation of Bowman’s capsule and consists of
three parts:
a. Proximal convoluted tubule.
b. Loop of Henle.
c. Distal convoluted tubule.
Proximal Convoluted Tubule
♦ It is continuous with Bowman’s capsule.
♦ It is 14 mm long and 55 μm in diameter.
♦ It consists of single layer of cuboidal cells with brush
border formed by multiple microvilli.
♦ Cells of proximal convoluted tubule get united at apex by
tight junctions and base of the cell is extended in extracel-
lular surface.
♦ Proximal convoluted tubule is divided into two parts, i.e.
pars convolute and pars recta.
Loop of Henle
It consists of three parts, i.e.
1. Descending limb.
2. Hairpin bend.
3. Ascending limb.
Physiology 345
Descending Limb
♦ Descending limb of loop of Henle is made by thick descending
segment and thin descending segment.
♦ Thick descending segment is the direct continuation of
proximal convoluted tubule.
♦ It descends in medulla.
♦ Thick descending segment of Henle s loop is in continua-
tion with thin descending segment.
Hairpin Bend
♦ Thin descending segment is continued as hairpin bend
of loop.
♦ It is continued as the ascending segment of loop of Henle.
Ascending Limb
♦ It consists of two parts, i.e. thin ascending segment and
thick ascending segment.
♦ Total length of thin descending segment, hairpin bend and
thin ascending segment of Henle s loop is 10 to 15 mm.
♦ Thin ascending segment continues as thick ascending seg-
ment. It is 9 mm long and 30 μm in diameter.
♦ Thick ascending segment ascend to cortex and continue
as distal convoluted tubule.
♦ Length of loop of H enle varies in both the nephrons,
in cortical nephrons length is short and hairpin bend
penetrate upto outer medulla while in juxtamedullary
nephrons length is long and hairpin bend extends deep
in inner medulla.
Distal Convoluted Tubule
♦ Distal convoluted tubule is the continuation of thick
ascending segment and occupies cortex of kidney.
♦ It continues as collecting duct.
♦ The tubule consists of low cuboidal epithelium.
♦ This tubule is close to glomerulus and establishes close
proximity to afferent and efferent arterioles of glomerulus.
Here the cells become columnar and get crowded, this part
is known as macula densa.
♦ Macula densa and adjacent juxtaglomerular part of afferent
arterial wall form juxtaglomerular apparatus.
Collecting Tubule
♦ Distal convoluted tubule continues as initial or arched
collecting duct which lies in cortex.
♦ Lower part of the collecting duct lies in medulla.
♦ Seven to ten initial collecting ducts unite to form straight
collecting duct which passes through medulla.
♦ Collecting duct is formed by cuboidal or columnar epi-
thelial cells.
♦ Epithelial cells are of two types, i.e. Principal cells or
P cells and Intercalated or I cells.
♦ Pcells increases permeability of collecting tubule to water
in presence of ADH hormone by enhancing pore size.
♦ I cells releases acid which helps in transport of bicarbonate
ions and leads to acidic urine.
346 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Normal GFR
♦ Normal GFR refers to the volume of glomerular filtrate
formed each minute by all the nephrons in both the kidneys.
♦ Its normal value is 125 mL/min i.e. 170 to 180 L/day. Its
value is 10% less in females as compared to males.


(Sep 2015, 7 Marks)
Ans. Following are the differences between cortical and
juxtamedullary nephron.
Juxtamedullary
Features Cortical nephron nephron
Location of In upper region of At near junction of
glomerulus cortex cortex and medulla
Total percentage of 85 to 86% 14 to 15%
nephron
Size of glomeruli Size is small Size is larger
Fig. 28: Structure of nephron
Size of loop of Henle Size is small. It Size is larger. It
Functions of Nephron extends to outer layer extend deep in
of medulla. medulla
Functions of nephron are conducted by its various parts which Descending limb Thin segment Thin segment
are as follows. of loop of Henle
consists of
Part Function
Ascending limb Thick segment Thin segment
Renal Filtration of water and dissolved substances from of loop of Henle
corpuscle plasma consists of
Glomerulus Receive glomerular filtrate Efferent arterioles Diameter is large and Diameter is small
break up in peritubu- and continue as vasa
Proximal • Reabsorption of glucose, amino acids, creatinine, lar capillaries recta
convoluted lactic acid, citric acid, uric acid and ascorbic acid
tubule • Reabsorption of proteins by pinocytosis Rate of filtration It is slow It is fast
• Reabsorption of water by osmosis Function Excretion of waste Concentration of
• Reabsorption of chloride ions and other negatively products in dissolved urine by countercur-
charged ions by electrochemical attraction form in urine rent system
• Active secretion of substances such as penicillin,
histamine, creatinine and hydrogen ions Q.30. Write short note on renal function test.
Descending Reabsorption of water by osmosis (Feb 2016, 3 Marks)
limb Ans. Renal function tests are done for assessing the functional
capacity of kidneys and to detect renal impairment as
Ascending Reabsorption of sodium, potassium and chloride ions
limb by active transport early as possible.
Renal function tests are divided into the following
Distal • Reabsorption of sodium ions by active transport. groups:
convoluted • Reabsorption of water by osmosis
1. Urine examination.
tubule • Active secretion of hydrogen ions
• Secretion of potassium ions both actively and by 2. Blood examination.
electrochemical attraction 3. Renal clearance tests.
4. Miscellaneous tests
Collecting Reabsorption of water by osmosis
duct Urine Examination
Urine examination is limited for assessing the kidney
Q.28. Discuss in brief mechanism of glomerular filtration. functioning. Patients who are suspected for renal disorder
How much is normal GFR. (Apr 2007, 10 Marks) in them urine examination is done for volume, specific
Ans. For mechanism of glomerular filtration refer to Ans 2 of gravity, osmolality, pH, abnormal constituents, microscopic
same chapter. examination.
 Physiology 347

Color of Urine During kidney dysfunction the level of substances in blood

♦ Normal color of urine is pale lemon yellow get elevated.
♦ Brownish yellow in hepatic and post-hepatic jaundice ♦ Blood urea: Its normal value is 20 to 40 mg/dl. Its level
♦ Cloudy appearance due to precipitation of calcium phos- increases after 50% glomerular damage has occurred.
phate and urates ♦ Serum creatinine: Its normal value is 0.6 to 1.5 mg/dl. Its
♦ Frothy appearance in proteinuria level increases with failure of glomerular filtration.
♦ Red dark brown in porphyria. ♦ Serum electrolytes:
Serum potassium is 5 mEq/L normally but its value
Composition increases in oliguria or anuria.
♦ Inorganic constituents: Na+ is 6 g/day Serum sodium is 152 mEq/L
K+ is 2 g/day Serum calcium is 9 to 11 mg/dL
Ca2+ is 0.2 g/day Serum phosphate is 3 to 4.5 mg/dL
P is 1.7 g/day. Serum sulphate is 0.5 to 1.5 mEq/L
♦♦ Organic constituents: Urea is 20 to 30 g/day Serum magnesium is 1.5 to 2.5 mEq/L
Uric acid is 0.6 g/day ♦ Serum proteins:
Creatinine is 1.2 g/day. Total: 6.4 to 8.3 gm/dL
Albumin: 3 to 5 gm/dL
Volume of Urine Globulin: 2 to 3 gm/dL
♦ Normally: 1 to 2.5 L/day A/G ratio: 1.7:1
♦ Oliguria: 400 mL/day In nephrotic syndrome serum albumin decreases
♦ Polyuria: > 2.5 L/day serum globulin increases which leads to reversal of
♦ Anuria: <100 mL/day. A/G ratio.
♦ Serum cholesterol: Its normal value is 150 to 240 mg/dL.
Specific Gravity It gets increase in nephrotic syndrome.
♦ 1001 to 1040 by urinometer
Renal Clearance Tests
♦ 1001 with maximum diluted urine
♦ 1040 with maximum concentration power of kidneys It is divided into:
♦ Increase in specific gravity is seen in low water intake, 1. Test for glomerular functions
diabetes mellitus, albuminuria, acute nephritis. 2. Test for tubular functions
♦ Decrease in specific gravity is seen in kidney damage and
absence of ADH. Test for Glomerular Functions

pH of Urine ♦ Inulin clearance

Normal value of pH in urine is 4.5 to 8.0.
Intake of high protein and non-vegetarian diet shift urinary
pH to acidic side while vegetarian diet shifts it to alkaline side.
Microscopic Examination
♦ Creatinine clearance: They measure the glomerular
filtration rate and are indicators of plasma clearance
mechanism.
♦ Others, i.e. measurement of renal plasma flow and renal
blood flow; measurement of filtration fraction.

When urine is centrifuged at the rate of 3000 rpm for 15 min
urinary segments are obtained which consists of:
♦ 1 to 2 WBC or pus cells/HPF: These cells are slightly larger
than normal WBCs.
♦ Nonsquamous epithelial cells or hyaline casts are occasion-
ally seen. These are clear, colorless cast of tubule. They are
seen as small cylinders with round ends, pale, transparent
and homologus bodies.
♦ Granular casts are the hyaline casts embedded with RBCs
or WBCs or they are degenerated glomerular cells or
tubular epithelial cells which are numerous.
♦ Presence of granular cast, RBC, bacteria, glucose, albumin
and ketone bodies in urine is abnormal.
Blood Examination
♦ Examination of blood is carried out to measure the sub-
stances in blood which are normally excreted by kidney.
Test for Tubular Functions
Reabsorptive and secretory functions of renal tubules can be
tested by following tests:
♦ Urine concentration test: Ability of tubules to concentrate
urine is assessed by measuring specific gravity of urine
either after 12 hour of water deprivation or 12 hour after
injection of vasopressin. In either case if specific gravity is
more than 1.020 tubular function is normal.
♦ Urine dilution test: In this test patient is asked to drink
1L of water and urine sample get collected in every 1 hour
for next 4 hours. Normally 750 mL of urine is excreted
during this period.
♦ Urine acidification test: In this patient is given ammonium
chloride orally in the dose of 0.1 gm/Kg and pH of urine
is tested in sample collected after 6 hour. Normally pH of
urine is below 5.3.
348 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Miscellaneous Tests
♦ Intravenous pyelography: Agents such as diodrast are
rapidly excreted by the kidney and are opaque to X rays.
15 gm of agent in 20 ml of 10% glucose is given IV and X
ray is taken. A pyelogram is obtained in 2 to 10 min. In
renal insufficiency this is delayed for hours.
♦ Arteriography: After administration of radio-opaque dye
in any artery X-ray is taken. This provides data about renal
vasculature and obstruction in it.
♦ Ultrasonography: Shape as well as size of kidney and pres-
ence of any cyst/tumor/stone can be diagnosed.
♦ Renal biopsy: A special needle is inserted in back, biopsy
specimen of kidney is taken for histological and cytological
examination. This is also known as fine needle aspiration
cytology. It is widely used to detect kidney dysfunctions.
Q.31. Write briefly about renin. (Oct 2016, 2 Marks)
Ans. Renin is an acid protease or proteolytic enzyme secreted,
stored and released from juxtaglomerular cells of kidney.
This is a glycoprotein having the molecular weight of
37,326.
Like other peptide hormones, it is synthesized as
preprorenin (406 amino acids), prorenin (383 amino
acids), that finally becomes renin (340 amino acids).
When rennin is released into blood, it acts on a specific
plasma protein known as angiotensionogen. By activity
of renin, angiotensinogen is converted into angiotensin
I.
Regulation of Renin Secretion
Renin activates the renin-angiotensin system, which is essential
for regulation of ECF volume, blood volume and blood pressure.
Control of extracellular fluid volume is closely related to control
of plasma electrolyte concentration, especially Na+, Cl and K+.
Therefore, change in plasma concentration of these solutes
affects renin secretion. Blood volume and pressure are also
affected by sympathetic activity, circulating catecholamine
and ADH. Therefore, alteration in these factors alters rennin
secretion.
Factors that Increase Renin Secretion
♦ Decreased blood volume and/or pressure
♦ Decreased plasma Na+ concentration, increased K+ con-
centration
♦ Increased sympathetic activity (stimulation of juxtaglo-
merular cells via renal nerve)
♦ Increased circulating catecholamines
♦ Prostaglandins.
Factors that Decrease Renin Secretion
♦ Increased plasma Na concentration (increased sodium
+ Abnormalities of growth hormone consist of hypersecretion
reabsorption via macula densa)
♦ Increased blood pressure (increased afferent arteriolar
pressure)
♦ ADH
♦ Angiotensin II.
6. ENDOCRINE SYSTEM
Q.1. Write a short note on growth hormone.
(Aug 2005, 5 Marks)
Or
Write in brief on growth hormone. (Sep 2007, 4 Marks)
(Jan 2012, 3 Marks) (Dec 2009, 5 Marks)
Ans. Growth hormone is also known as somatotropin.
• Structure: Growth hormone is a protein which consists
of single chain polypeptide with 191 amino acids.
• Synthesis: It is synthesized by the acidophilic cells
or somatotrophs of anterior pituitary.
• Plasma level: Its plasma level varies from 2 to 4 ng/mL.
• Circulation: Circulating growth hormone bounds
to growth hormone binding protein.
• Half life: Its half life in humans is 0 to 20 min.
• Metabolism: It is rapidly metabolized mostly in part
of the liver.
Regulation of Growth Hormone Secretion
Regulation of growth hormone occurs by two ways, i.e.
♦ Hypothalamic control
♦ Negative feedback control of growth hormone secretion.
Hypothalamic Control
♦ Hypothalamus controls the secretion of growth hormone
by releasing two hormones, i.e. growth hormone releasing
hormone and growth hormone release inhibiting hormone.
♦ Growth hormone releasing hormone stimulates secretion
of growth hormone from anterior pituitary.
♦ Growth hormone release inhibiting hormone inhibits re-
lease of growth hormone from anterior pituitary.
♦ Negative feedback control of growth hormone secretion
♦ It consists of role of somatomedins, growth hormone and
growth hormone releasing hormone.
♦ Negative feedback control by somatomedins: Somato-
medins are produced when growth hormone causes its
action on target tissues. Somatomedin inhibits secretion
of growth hormone directly or by stimulating secretion
of somatostatin from hypothalamus.
♦ Negative feedback control by growth hormone: Growth
hormone inhibits its own secretion by stimulating secretion
of somatostatin from hypothalamus.
♦ Negative feedback control by growth hormone releasing
hormone: Growth hormone releasing hormone inhibits its
own secretion from hypothalamus.
Abnormalities of Growth Hormone
and hyposecretion of growth hormone:
♦ Hypersecretion of growth hormone: Hypersecretion of
growth hormone leads to gigantism in children while
hypersecretion of growth hormone in adults lead to ac-
romegaly.

♦ Hyposecretion of growth hormone: Hyposecretion of
growth hormone in children leads to dwarfism while hypose-
cretion of growth hormone in adults leads to mild anemia.
Q.2. Write a short note on acromegaly.
(Nov 2008, 5 Marks) (Dec 2004, 5 Marks)
Or
Write briefly on acromegaly. (Oct 2016, 2 Marks)
Ans. Acromegaly is a clinical condition which occurs due to
excessive secretion of growth hormone in adults and leads
to excessive growth in those areas where cartilage persists.
Acromegaly occurs after the epiphyseal closure of long
bones.
It occurs due to acidophilic cell tumor of anterior
pituitary which causes excessive secretion of growth
hormone in adults.
Clinical Features
♦ Acromegalic face: This is characterized by thick lips,
macroglossia, broad and thick nose, prominent eyebrows,
thick skin and coarse facial features.
♦ Mandibular prognathism: Elongation and widening of
mandible which leads to underbite and increased inter-
dental spaces.
Fig. 29: Clinical features of acromegaly
Physiology 349
♦ Kyphosis: Periosteal growth of vertebrae leads to bowing
of spine.
♦ Prominent brows: There is enlargement of frontal,
mastoid, ethmoid and maxillary sinuses causing prominent
brows.
♦ Hypertrophy of body tissues: There is hypertrophy of body
tissues such as heart cardiomegaly, liver hepatomegaly,
kidney renomegaly, spleen splenomegaly, tongue and
muscles.
♦ Acral part abnormalities: It consists of large spade like
hands, thick wide fingers, large feet with increase in size
of shoes. Build of patient is stout and stocky.
♦ Increased sympathetic activity: This leads to increase in
sweating and hypertension.
♦ Scalp of patient is thickened and is thrown into fold and
wrinkles like bulldog scalp.
♦ Presence of general overgrowth of body hair.
♦ Thyroid gland, parathyroid gland and adrenal glands
show hyperactivity.
♦ Presence of hyperglycemia and glucosuria which results
in diabetes mellitus.
♦ Presence of visual disturbances such as bitemporal hemia-
nopia.
350 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.3. Write a short note on dwarfism.
(Mar 2001, 5 Marks) (Mar 2006, 3 Marks)
Ans. The dwarfism is a disorder in children and is characterized
by stunted growth.
Causes of Dwarfism
♦ Deficiency of growth hormone releasing hormone from
hypothalamus.
♦ Atrophy or degeneration of acidophilic cell in anterior
pituitary.
♦ Tumor of the chromophobes: It is a non-functioning tumor
which composes and destroys normal cells secreting growth
hormone.
Clinical Features of Dwarfism
♦ Presence of short stature, i.e. patient shows stunted skel-
etal growth.
♦ Patient appear plumpy, i.e. fatty.
♦ Pitutary dwarf has immature face and delicate extremities.
♦ Absence of sexual maturity when it is associated with
gonadotropin deficiency (panhypopituitarism).
♦ Mental activity is normal.
Q.4. Write a short note on antidiuretic hormone. Dilution syndrome.
(Sept 2004, 5 Marks)
Ans. Antidiuretic hormone prevents diuresis and mainly
conserves the body water.
Antidiuretic hormone also known as vasopressin as it
leads to vasoconstriction.
• Structure: ADH is a polypeptide with molecular
weight of 1000, it is rapidly metabolized in liver and
kidneys.
• Synthesis: It is synthesized in the cell bodies of
magnocellular neurons of both paraventricular and
supraoptic nuclei of hypothalamus.
• Storage: ADH is stored in pars nervosa.
• Secretion: It is released when a nerve impulse is
transmitted from cell body in hypothalamus down
the axon where it depolarizes neurosecretory vesicles.
• Biological half-life: Its biological half life is 16 to 20
min.
Action of ADH
Action of ADH occurs via three types of receptors:
1. V1—A receptors: They produce vasoconstrictor effect of
ADH
2. V1—B receptors: They play role in action of ADH on
anterior pituitary
3. V1—C receptors: They play role in action of ADH on
kidney
Action on kidney: ADH regulates water balance on body by
acting on kidney where it decreases excretion of free water.
Action on anterior pituitary: ADH reaches to anterior pituitary
through portal veins and get combine with V1 – B receptors and
enhances ACTH secretion.
Vasoconstrictor effect: In high doses it leads to vasoconstriction
and causes rise in blood pressure. It also plays an important
role in blood pressure homeostasis by causing constriction
of splanchnic vascular bed. ADH bind to V1 A receptors on
arterial smooth muscles and leads to vasoconstriction.
Regulation of ADH
ADH secretion is regulated through:
♦ Plasma osmolality: Change in plasma osmolality causes
ADH regulation. Deprivation of water stimulates ADH
secretion while the water load decreases ADH secretion.
♦ Changes in blood volume: Changes in circulating blood
volume, central blood volume, cardiac output and blood
pressure affect secretion of ADH.
♦ Other factors affecting ADH secretion:
Emotional stress, stress of pain and surgical procedure
leads to increase in ADH secretion which decreases
urine formation.
Adrenaline decreases ADH secretion.
Abnormalities of ADH Secretion
♦ Syndrome of inappropriate hypersecretion of ADH or
♦ Diabetes insipidus.
Q.5. Summarize formation and secretion of thyroid hormones.
(Mar 1998, 5 Marks)
Ans. Formation or Synthesis of Thyroid Hormones
Iodine and tyrosine are essential for formation of thyroid
hormone. Iodine and tyrosine are consumed through
diet and are absorbed from GIT. Various stages which
and involved in the formation of thyroid hormones are:
• Iodine trapping: Thyroid gland undergoes uptake
of iodide which occur against chemical and electrical
gradient, it is an energy gaining process.
• Synthesis and secretion of thyroglobulin: Thy-
roglobulin is synthesized on rough endoplasmic
reticulum of thyroid epithelial cells and release in
lumen of follicle. Each molecule of thyroxine has 140
tyrosine residues.
• Oxidation of iodide: Iodine in thyroid gland rap-
idly moves to apical surface of the epithelial cells,
from here they get move into the lumen of follicles
by a transporter known as pendrin. Iodide is now
oxidized to iodine by peroxidase enzyme.
• Organification of thyroglobulin: It is the iodina-
tion of tyrosine residues present in thyroglobulin
molecule. This reaction occurs at apical membrane
of cell and need thyroid peroxidase. Tyrosine get first
iodinated at position 3 to form monoiodotyrosine
and then at position 5 to form diiodotyrosine.
• Coupling reaction: Two molecules of diiodotyrosine
get coupled to form thyroxine (T4). One molecule of
monoiodotyrosine when coupled to one molecule of
diiodotyrosine, triiodothyronine (T3) is produced.
Enzyme peroxidase is necessary for coupling.

• Storage: As thyroglobulin is iodinated it is stored in
lumen of follicle as colloid for several months.
Secretion of Thyroid Hormones
Follicular cells of thyroid gland send pseudopodia like
extension, which close around thyroglobulin hormones
complex. This forms pinocytic vesicles. Then, lysosomes of
cells which contain digestive enzymes like proteinase which
fuses with vesicles. The enzymes digest the thyroglobulin and
release the hormones. Now, the hormones diffuse through base
of follicular cells and enter capillaries.
Q.6. Describe synthesis, action and regulation of thyroxin. in liver
Write a short note on endemic goiter.
(Sep 2004, 10 + 5 Marks)
Ans. The thyroxine is also known T4.
Synthesis of the Thyroxin
Refer to Ans 5 of the same chapter.
Actions of Thyroxin (T4)
Following are the actions of thyroxin on various tissues of the
body:
♦ On protein metabolism
Thyroxin at its physiological dose enhances protein
synthesis which leads to positive nitrogen balance.
Thyroxin at its pharmacological dose causes protein
catabolism because of increase in basal metabolic rate
which leads to negative nitrogen balance, enhances
potassium excretion in urine.
Thyroxine at its pharmacological dose also produces
catabolic effect on muscles which leads ot muscle
weakness and fatigability.
Thyroxine leads to mobilization of bone proteins
which decreases bone mass and increases calcium
ion loss in urine.
♦ On cardiovascular system
T4 along with catecholamines increases the heart
rate, increases force of myocardial contraction and
decreases the circulation time.
T4 increase the body temperature and leads to
vasodilatation so increases the blood flow produces
warm and moist skin and also decreases peripheral
resistance which lowers the diastolic blood pressure.
♦ On bone marrow metabolism
Deficiency of T4 causes anemia due to decreased bone
marrow metabolism which decreases erythropoiesis.
There is also decrease in absorption of vitamin B12
from GIT which leads to megaloblastic anemia.
Excess of T4 stimulates erythropoiesis.
♦ On vitamins: T4 leads to hepatic conversion of β-carotene
to vitamin A and convert vitamin A to retinene. So in T4
deficiency blood carotene level rises which provides yel-
low colour to skin.
♦ On lactation: T4 is very important for maintainence of ga-
lactopoiesis. When thyroxine decreases lactation decreases
and vice versa.
Physiology 351
♦ On gonads: T4 is essential for normal menstrual cycle and
fertility. Alteration thyroxine impairs fertility in women.
♦ On carbohydrate metabolism
T4 increases the peripheral utilization of glucose and
leads to hypoglycemia.
T4 can also leads to hyperglycemia as it enhances
absorption of glucose from intestine; increases
glycogenolysis; causes breakdown of insulin;
decreases secretion of insulin.
♦ On lipid metabolism
On cholesterol: T4 increases synthesis of cholesterol
On lipids: T4 stimulates synthesis of lipids. It also
leads to mobilization and degradation of lipids by
increasing activity of lipase.
♦ On growth and development
T4 produce normal body growth and skeletal
maturation as it increases protein synthesis and can
lead to increased release and action of growth hormone.
• T4 also causes tissue differentiation and maturation.
♦ On nervous system
On central nervous system: Deficiency of T4 after
birth leads to mental retardation. In adults deficiency
of thyroxine leads to myxoedema madness. Excess
of T4 in adults leads to increase in responsiveness to
catecholamines which stimulate reticular activating
system.
On peripheral nervous system: T4 stimulates muscle
spindle and causes contraction of muscles. Deficiency
of T4 decreases impulse conduction in muscle fibers
and also there is decrease in muscle contraction and
relaxation.
♦ On gastrointestinal system: T4 modifies motility of
intestine. Deficiency of thyroxine decreases intestinal
motility and also decreases food intake which causes
constipation. Excess of thyroxine leads to diarrhea.
♦ On water and mineral metabolism
Administration of thyroxine leads to:
In myxedematous patients there is diuresis with
excretion of NaCl.
In nomal persosns there is mild diuresis with loss of
potassium ions.
In hyperthyroidism there is mild diuresis with
potassium and calcium ion excretion in urine.
Regulation of Thyroxin
Secretion of thyroxin is regulated through following mecha-
nisms, i.e.
♦ Negative feedback mechanism through hypothalamus
anterior pituitary thyroid gland axis.
♦ Autoregulation by thyroid gland.
Regulation via Negative Feedback Mechanism
This mechanism operates via hypothalamo anterior pituitary
– thyroid gland axis which controls secretion of various thyroid
hormones as:
352 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Thyroid Stimulating Hormone
It produces following effects:
♦ Enhances secretion of thyroid hormones and speeds up
all steps in biosynthesis.
♦ Enhances both number and size of follicular cells.
♦ It enhances vascularity of thyroid gland.
Regulation of Thyroid Stimulating Hormone Production
♦ Feedback control by plasma T4 and T3: Secretion of TSH
depends on negative feedback control which is exerted
by plasma levels of free T4 and T3. Decrease in T4 and T3
levels stimulates secretion of TSH from anterior pituitary
while increase in T4 and T3 levels inhibits TSH secretion.
♦ Hypothalamic control of TSH: Hypothalamus produces
its effects by secreting thyrotropin releasing hormone.
This hormone act on thyrotrophs in anterior pituitary and
controls release of TSH.
Autoregulation by Thyroid Gland
Secretion of the thyroid gland is regulated by food iodine
contents. If there is presence of deficiency of iodine content in
diet iodine trapping mechanism get efficient while when there is
excess of iodine content in food then iodine trapping become less
efficient and organification of excess amount of iodine does not
occur. In this manner iodine availability for thyroxine synthesis
remain constant and this process is known as autoregulation
of thyroid gland.
Endemic Goiter
♦ It is also known as iodine deficiency goiter.
♦ It occurs when the dietary intake of iodine falls below 50µg.
♦ Due to lack of iodine there is no formation of hormones.
Through feedback mechanism hypothalamus and anterior
pituitary are stimulated. This increases secretion of TRH
and TSH. The TSH causes thyroid cells to secrete tremen-
dous amount of thyroglobulin in follicle. As there are no
hormones to be cleaved, the thyroglobulin remains as it is
and gets accumulated in follicles of gland. This increases
size of gland.
♦ In certain areas of world, i.e. Swiss Alps, Andes, Great
Lake region of US; and in Kashmir Valley, the soil does not
contain iodine. So food stuffs are devoid of iodine. Thus in
these parts of the world, endemic goiter is common before
introduction of iodized salts.
 ♦
(Apr 2003, 15 Marks)
Or
Write short note on functions of thyroid hormone.
(Apr 2008, 5 Marks)
Or
(Aug 2018, 5 Marks)
Ans. Mechanism of Action of thyroid hormones: Refer to
Ans 6.
Functions of Thyroid Hormones
♦ On basal metabolic rate: Thyroid hormones cause stimu-
lation of metabolic activities and enhances basal rate of
oxygen consumption along with heat production in most
of the tissues of body. But this has no effect on brain, retina,
gonads, lungs and spleen.
♦ On carbohydrate metabolism: Both T3 and T4 leads to an
increase in the enzymatic activity which leads to:
Increased glucose absorption from gastrointestinal
tract.
They also enhances glucose metabolism.
♦ On fat metabolism: Thyroid hormones lead to:
They mobilize fat from adipose tissue.
They increases fatty acid levels and enhance oxidation
of free fatty acids by cells.
These hormones also lower the cholesterol, phospho-
lipids and triglycerides in the plasma.
♦ On protein metabolism:
Physiologically thyroid hormones lead to anabolism
i.e. they increases RNA and protein synthesis which
leads to positive nitrogen balance.
Thyroid hormones in excess leads to catabolism which
causes negative nitrogen balance. This can cause
muscle weakness and creatinuria.
♦ On vitamin metabolism: Thyroid hormones increase
the enzymes in quantity. Vitamins are the parts of some
enzymes and coenzymes. Thyroid hormones lead to an
increased need for vitamins which causes vitamin defi-
ciency in hyperthyroidism.
♦ On body temperature: Thyroid hormones increase the
heat production in body by enhancing various cellular
metabolic processes and by increasing basal metabolic rate.
♦ On growth:
T4 produce normal body growth and skeletal
maturation as it increases protein synthesis and can
lead to increased release and action of growth hormone.
T4 also causes tissue differentiation and maturation.
T3 is necessary for proper axonal and dendritic
development along with normal myelination in
nervous system.
Effect on water and electrolyte balance: Thyroid hormones
regulates water and electrolyte balance.
♦ On respiratory system: Thyroid hormones increase the rate
as well as force of respiration indirectly. Increase in metabolic
rate increases the demand for oxygen and formation of excess
carbon dioxide. These both factors stimulate the respiratory
centers to increase the rate and force of respiration.
♦ On cardiovascular system: Thyroid hormones produce
following effects on the cardiovascular system:
They cause vasodilatation and enhance blood flow
to tissues.
They increase the heart rate.

Blood volume in circulation is increased due to the
vasodilatation effect.
If there is moderate increase in the level of thyroid
hormones force of cardiac contraction is increased.
Cardiac output gets increased because of increased
blood volume, increased heart rate and increased
force of contraction.
♦ On nervous system:
On central nervous system: Thyroxine enhances
various stimulus. Thyroid hormones maintain normal
emotional tone.
On peripheral nervous system: Thyroid hormone
enhances speed and amplitude of peripheral nerve
reflexes.
♦ Effect on gastrointestinal tract: Thyroid hormones
increases appetite and enhances food intake; enhances
gastrointestinal motility and enhances rate of secretion of
digestive juices.
♦ On skeletal muscles: Thyroid hormones in excess
causes weakening of muscles due to increase in protein
catabolism.
♦ On reproductive system:
In males decrease in thyroid hormones leads to loss of
libido and excess of thyroid hormones causes impotence.
In females decrease in the thyroid hormones lead to
menorrhagia and polymenorrhagia.
♦ On other endocrine glands
Production of growth hormone is increased and of
prolactin get decreased.
Ratio of estrogen and androgen in males get increased.
This leads to gynecomastia in males during hypert-
hyroidism.
Parathyroid hormone and vitamin D get decreased
as compensatory effect of thyroid hormone on bone
resorption.
Assessment of Thyroid Functions
Thyroid functions are assessed by thyroid function tests:
♦ Based on metabolic effects of T4
Basal metabolic rate: It indicates the consumption
of oxygen by patient under physical and mental
rest. Its normal value is ± 20%. Its value increases in
hyperthyroidism and decreases in hypothyroidism.
Blood sugar: Its normal value is 70 to 90 mg/dL. Its
value increases in hyperthyroidism and decreases in
hypothyroidism.
Serum cholesterol: Its normal value is 150 to 240
mg/dL. Its value increases in hypothyroidism and
decreases in hyperthyroidism.
Serum creatinine: Its normal value is 0.6 mg/dl. Its
value increases in hyperthyroidism and decreases in
hypothyroidism.
♦ Based on handling of iodine
Protein bound iodine: Its normal value is 3.5 to 7.5
µgm/dL. This test shows index of circulating level of
Physiology 353
T4 and T3. Amount of T3 is so low as compared to T4
and T3 does not contribute in protein bound iodine.
Butanol extractable iodine: Its normal value is 3 to 5
µgm/dL. Its value increases in hyperthyroidism and
decreases in hypothyroidism.
Radioactive iodine uptake: Its normal value is 20
to 40%. Its value increases in hyperthyroidism and
decreases in hypothyroidism.
T3 suppression test: It is very useful in suspected
cases of thyrotoxicosis. Thyroxine is given orally for
two days. In euthyroids radioactive iodine decreases
because of T3 suppression while in thyrotoxicosis
value of T3 does not decrease.
Serum thyroid hormone and TSH levels: Its normal
value is 2.3µU/mL. In primary hypothyroidism
its value increases by 10 folds while in secondary
hypothyroidism its value decreases. In hyperthyroidism
its value decreases or remains undetectable.
Q.8. Write a short note on hypothyroidism.
(Mar 2000, 5 Marks)
Or
Give an account of hypofunction of thyroid gland in
children and adult. How does it differ and why?
(Feb 2003, 15 Marks) (Apr 2010, 15 Marks)
Ans.
Hypothyroidism
♦ Hypothyroidism occurs due to autoimmune disease which
causes destruction of gland.
♦ In most of the patients, it starts as glandular inflammation
called thyroidism. This results in fibrosis of gland.
♦ Hypothyroidism leads to cretinism in children and myx-
edema in adults.
Myxedema
This is due to hypothyroidism in adults and is also known as
Gull s disease.
Causes
Complete lack of thyroid hormones.
Symptoms
♦ Swelling of face, scaliness of skin
♦ Mental struggishness
♦ Increased body weight
♦ Constipation
♦ Nonpitting type of edema
♦ Depressed hair growth.
Cretinism
Hypothyroidism in children.
Causes
Congenital absence of thyroid gland, genetic disorder or lack
of iodine in diet.
354 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Symptoms
♦ Skeleton: Stunted growth.
♦ Skin: Rough, thick, dry and wrinkled.
♦ Sex: Sex gland, sex organ and secondary sex characters
retarded.
♦ Blood: Low blood sugar, iodine, high serum cholesterol.
♦ Mental Growth: Stunted mental growth.
♦ Abdomen: Pot bellied, umblicus often protruding.
Q.9. What is normal blood calcium level? Give an account tubules.
of hormonal regulation of it. (Mar 2000, 15 Marks)
Or
Write a short note on hormonal control of blood cal-
cium level. (Sep 2006, 5 Marks) (Mar 2005, 5 Marks)
Or
What is normal blood calcium level? Describe the
hormonal regulation of calcium level.
(Dec 2004, 5 + 10 = 15 Marks)
Or
Write a short note on regulation of serum calcium level.
(Mar 2006, 3 Marks)
Ans. The normal blood calcium level in young healthy adult
is 1,100 gm. The normal blood calcium level is 9.4 mg%.
Hormonal Regulation of Blood Calcium Level
The regulation of blood calcium level took place through three
hormones.
♦ Parathormone: It is secreted by parathyroid gland and
its main function is to increase blood calcium level by
mobilizing calcium from bone. Parathormone maintains
blood calcium level by following actions, on bones, kidney
and GIT.
By increasing reabsorption of calcium from bones.
By decreasing excretion of calcium through kidneys.
By increasing absorption of calcium from GIT.
♦ 1, 25-dihydroxy cholecalciferol: It is a steroid hormone
synthesized from vitamin D by means of hydroxylation
reactions in liver and kidneys. The main action is to
increase blood calcium level by increasing calcium
absorption from small intestine. The main actions of 1,
25-dihydroxy cholecalciferol are:
It increases the absorption of calcium from intestine.
It does this by increasing formation of calcium-
binding proteins in intestinal epithelial cells.
These proteins act as carrier proteins for facilitated
diffusion by which calcium ions are transported.
The proteins remain in cells for several weeks after
1, 25-dihydroxy cholecalciferol has been removed
from body, thus causing prolonged effect on calcium
absorption.
It increases the synthesis of calcium-induced ATP in
intestinal epithelium.
It increases synthesis of alkaline phosphates in
intestinal epithelium.
♦ Calcitonin: It is secreted by parafollicular cells of thyroid. It
is a calcium lowering hormone. It decreases blood calcium
level by decreasing reabsorption. It reduces blood calcium
level by acting on bone, kidney and intestine.
On bones: It facilitates deposition of calcium on bones.
It suppresses the activity of osteoclasts which are
responsible of calcium from bones.
On kidney: It increases excretion of calcium through
urine by inhibiting reabsorption of calcium from renal
On intestine: It prevents the absorption of calcium
from intestine into blood.
Q.10. Write a short note on parathyroid hormone.
(Aug/Sept 1998, 5 Marks)
Ans. Parathyroid hormone is also known as parathormone.
• Structure: Parathormone is a single chain polypep-
tide having 84 amino acids with molecular weight
of 9500.
• Synthesis: It is synthesized from prepro PTH
which is a precursor molecule.
• Secretion: Parathormone is secreted from chief
cells through exocytosis. This occur in response to
decrease in plasma ionized calcium concentration
which is sensed by calcium receptors in parathyroid
cells.
Actions of Parathromone
Following are the actions of parathormone:
♦ Action on bone: Parathormone stimulates calcium and
phosphate resorption from bones. It causes demineraliza-
tion of bone.
♦ Action on kidney: Following are the actions on kidney:
Increase in calcium reabsorption: Parathormone
enhances reabsorption of calcium from ascending limb
of loop of Henle as well as distal tubules of kidney.
This prevents hypocalcaemia.
Inhibition of phosphate reabsorption in proximal
tubule: It leads to phosphaturia and hypophosphatemia.
It inhibits reabsorption of sodium and bicarbonate in
proximal tubule and stimulates Na+ H+ exchanger
which leads to acidification, this prevents occurrence
of metabolic acidosis.
It stimulates reabsorption of magnesium by the renal
tubules.
It stimulates synthesis of 1, 25 dihydroxycholecalciferol.
♦ Action on intestine: Parathormone increases calcium
and phosphate absorption from intestine, this happens
indirectly by increasing synthesis of 1, 25 dihydroxychole-
calciferol in kidney.
Regulation of Secretion of Parathyroid Hormone
♦ Directly through calcium serum level or calcium feed-
back loop: Decrease in serum calcium causes stimulation
of parathyroid gland which leads to increase in secretion
of parathormone, this causes mobilization of calcium from

bones and normal serum calcium levels are maintained.
This effect can occur vice-versa too.
♦ Role of serum magnesium concentration:
Mild decrease in the serum magnesium concentration
enhances parathyroid secretion.
Severe decrease in the serum magnesium concentration
totally abolishes parathyroid secretion.
♦ Role of plasma phosphate concentration: Rise in plasma
concentration of phosphate leads to fall in ionized calcium
concentration which stimulates parathyroid secretion.
♦ Role of 1, 25 dihydroxycholecalciferol: It decreases the
secretion of parathyroid hormone.
Regulation of Parathormone
Calcium ion concentration in blood is the main factor for
regulation of secretion of parathormone.
♦ Increase in calcium concentration in blood decreases para-
thormone secretion.
♦ Increase in vitamin D in diet decreases parathormone
secretion.
♦ Concentrations of parathormone are also increased in case
of rickets, pregnancy and in lactation.
Q.11. Write a short note on osteomalacia.
(Sep 2000, 5 Marks) (Sep 2009, 5 Marks)
Ans. The rickets in adults is called osteomalacia or adults
rickets. It occurs due to deficiency of vitamin D. It
also occurs due to prolonged damage of kidney. The
characteristic features of osteomalacia are vague pain,
tenderness in bones and muscle. Myopathy can occur
leading to waddling gate. In waddling gate feet are wide
apart and walk resembles that of a duck.
Causes for Osteomalacia
1. Deficiency of Vitamin D due to: ii. It increases formation of glucose from proteins
i. Low dietary intake.
ii. Inadequate synthesis in skin.
iii. Reduced absorption from intestine.
2. Due to Renal Diseases:
i. Chronic renal failure.
ii. Dialysis-induced bone diseases.
iii. Renal tubular acidosis.
Q.12. Give an account of hormonal regulation of blood sugar. actions of cortisol:
What is diabetes mellitus? (Mar 2001, 15 Marks)
Or
Write in brief on regulation of blood sugar level.
(Aug/Sept 1998, 5 Marks)
(Sept 2001, 5 Marks) (Apr 2003, 5 Marks)
Or
Write a short note on regulation of blood glucose level. iii. It accelerates the process of gluconeogenesis.
(Sep 2006, 3 Marks) (Mar 2006, 5 Marks)
(Aug 2011, 6 Marks)
Or
Write a short note on blood sugar. to reduced secretion of insulin by beta cells of islet of
(Mar 2007, 3 Marks) (Mar 2008, 4 Marks)
Physiology 355
Or
Describe blood sugar regulation in detail.
(Nov 2012, 8 Marks)
Ans. In normal persons, after overnight fasting in early
morning, blood glucose level ranges between 80 and 90
mg/dl. And postprandial, the blood glucose level rises
to 120-140 mg/dl. The regulation of blood sugar level is
as follows:
1. Role of insulin: Insulin is antidiabetic hormone as
it reduces blood sugar level by the following ways:
i. Transport and uptake of glucose: When a food
with excess amount of carbohydrate is taken,
the blood sugar level is increased and insulin is
secreted. The insulin causes transport of glucose
from blood into cells by increasing the perme-
ability of cell membrane to glucose. It enhances
uptake of glucose by all tissues particularly by
liver, muscle and adipose tissue.
ii. Peripheral utilization of glucose: The glucose en-
tering the cells is oxidized by most of the cells. The
rate of utilization depends on intake of glucose
and glucose utilization is enhanced by insulin.
iii. Storage of glucose: It promotes conversion of
glucose to glycogen in liver and muscles, and
stores glycogen in liver and muscle.
iv. Inhibition of glycogenolysis.
v. Inhibition of gluconeogenesis.
2. Role of glycogen: It increases blood sugar level by
the following ways:
i. It increases breakdown of glycogen into glucose
and glucose formed is released from liver cells
in blood.
in liver.
3. Growth hormone: It increases blood sugar level by:
i. Decrease in peripheral utilization of glucose for
production of energy.
ii. Increase in deposition of glycogen in cells.
iii. Decrease in uptake of glucose by cells.
4. Cortisol: It increases the blood sugar level by acting
on liver cells and peripheral tissues. Following are
i. It increases gluconeogenesis
ii. It decreases glucose uptake by peripheral cells
and utilization of glucose.
5. Thyroxine: It increases blood sugar level by the
following ways:
i. It increases absorption of glucose from GIT.
ii. It increases breakdown of glycogen to glucose.
Diabetes Mellitus
This is a condition with elevated blood sugar level.
In most of the cases, diabetes mellitus develops due
Langerhans. There are two types of diabetes mellitus:
356 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
 
(Aug 2005, 8 Marks)
Ans. Hormones of Anterior Pituitary
1. Growth hormone (GH, somatotropin)
2. Thyroid stimulating hormone (TSH, thyrotropin)
3. Luteinizing hormone (LH, interstitial cell stimulating
hormone)
4. Follicular stimulating hormone
5. Prolactin (luteotropic hormone)
6. Adrenocorticotropic hormone (ACTH, corticotropin)
7. β-Lipotropin.
Hormones of Posterior Pituitary
1. Antidiuretic hormone (vasopressin)
2. Oxytocin.
Q.15. Write a short note on BMR. (Aug 2005, 5 Marks)
Ans. The metabolic rate determined at rest in a room at a
comfortable temperature in the thermoneutral zone
12 14 hours after the last meal is called as BMR or basal
metabolic rate.
(Nov 2009, 8 Marks)
 (Jan 2018, 5 Marks)
Ans. Hormones of Anterior Pituitary
1. Growth hormone
2. Thyroid stimulating hormone
3. Luteinizing hormone
4. Follicular stimulating hormone
5. Prolactin
6. Adrenocorticotropic hormone
7. β-Lipotropin.
For actions of growth hormone refer to Ans 30 of same
chapter.
For acromegaly refer to Ans 2 of same chapter.
Q.17. Describe the action of thyroxine on major systems of
the body. Describe cretinism briefly.
(Dec 2010, 8 Marks)
Ans. Action of thyroxine on major systems.
Basal Metabolic Rate
Thyroxine increases the metabolic activities of all tissues of the
body except brain, retina, spleen, testes and lungs. lt increases
the basal metabolic rate (BMR) by increasing the oxygen
consumption of the tissues. The action that increases the BMR
is called calorigenic action.
Biliary System
Thyroxine increases deposition of fats in the liver leading to
fatty liver. Thyroxine decreases plasma cholesterol level by
increasing its excretion from liver cells into bile. Cholesterol
enters the intestine through bile and then it is excreted through
the feces.
 Physiology 357

Vitamin Metabolism 
Thyroxine increases the formation of many enzymes. Since, the
vitamins form the essential parts of the enzymes, it is believed
that the vitamins may be utilized during the formation of
the enzymes. Hence, vitamin deficiency is possible during
hypersecretion of thyroxine.

On Blood
Thyroxine increases the production of RBCs. It is one of the
important general factors necessary for erythropoiesis. Thus,
thyroxine increases erythropoietic activity and blood volume.

Cardiovascular System
♦ Thyroxine increases overall activity of cardiovascular
system.
♦ It acts directly on heart and increases rate and force of
contraction.
♦ Thyroxine causes vasodilatation by increasing the meta-
bolic activity.
♦ During metabolic activity, production of metabolites is
increased.
♦ The metabolites cause vasodilatation and increase the
blood flow.
♦ Thyroxine increases systolic blood pressure by increasing
rate and force of contraction of the heart, blood volume
and cardiac output.
♦ At the same time it decreases diastolic pressure by it (Dec 2010, 5 Marks)
vasodilator effect.
Ans. Action of Insulin on Carbohydrate Metabolism
♦ So only the pulse pressure increases and the mean pres-
Insulin is the only hormone in the body that reduces
sure is not altered.
blood sugar level. Insulin reduces the blood sugar level
Respiratory System by its following actions on carbohydrate metabolism.
Thyroxine increases the rate and force of respiration indirectly. Increases Transport and Uptake of Glucose by the Cells
The increased metabolic rate increases the demand for oxygen
and formation of excess carbon dioxide. These two factors ♦ Insulin facilitates the transport of glucose from the blood
stimulate respiratory centers to increase the rate and force of into the cells by increasing the permeability of cell mem-
respiration. brane to glucose.
♦ Insulin stimulates the rapid uptake of glucose by all the
Gastrointestinal Tract tissues particularly liver, muscle and adipose tissues.
♦ Insulin also increases the number of glucose transporters
Generally, thyroxine increases the appetite and food intake. It
called GLUT 4 in the cell membrane.
also increases the secretions and movements of gastrointestinal
tract. Promotes Peripheral Utilization of Glucose
Central Nervous System Insulin helps in the peripheral utilization of glucose. In the
♦ Thyroxine is very essential for the development and main- presence of insulin, glucose which enters the cell is oxidized
tenance of normal functioning of central nervous system. immediately. Rate of utilization depends upon intake of glucose.
♦ Thyroxine is very important to promote growth and devel-
Promotes Storage of Glucose, i.e. Glycogenesis
opment of the brain during fetal life and during the first
few years of postnatal life. Thyroid deficiency in infants Insulin promotes the rapid conversion of glucose into glycogen,
results in mental retardation. which is stored in muscle and liver. Thus, glucose is stored in
♦ Thyroxine is a stimulating factor for the brain so normal these two organs in the form of glycogen. Insulin activates the
functioning of the brain needs presence of thyroxine. enzymes, which are necessary for glycogenesis. In liver, when
♦ Thyroxine also increases the blood flow to brain. Thus, glycogen content increases beyond its storing capacity, insulin
during the hypersecretion of thyroid there is excess causes conversion of glucose into fatty acids.
358 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Inhibits Glycogenolysis
Insulin prevents the breakdown of glycogen into glucose in
muscle and liver.
Inhibits Gluconeogenesis
Insulin prevents gluconeogenesis, i.e. formation of glucose
from proteins.
Thus, insulin decreases the blood sugar level by:
♦ Facilitating transport and uptake of glucose by the cells.
♦ Increasing peripheral utilization of glucose.
♦ Increasing the storage of glucose converting it into
glycogen in liver and muscle
♦ Inhibiting glycogenolysis
♦ Inhibiting gluconeogenesis.
Q.20. Write short note on hormones of anterior pituitary ventricular and supraoptic nuclei of hypothalamus.
gland and their actions.
(Aug 2011, 6 Marks) (Aug 2012, 5 Marks)
Ans. Hormones of Anterior Pituitary Gland
1. Growth hormone
2. Thyroid stimulating hormone
3. Luteinizing hormone
4. Follicular stimulating hormone
5. Prolactin
6. Adrenocorticotropic hormone
7. β-Lipotropin.
Actions
♦ Growth Hormone: Refer to Ans 30 of same chapter.
♦ Thyroid stimulating hormone:
It increases number of thyroid cells.
It increases size and secretory activity of cells.
It increases iodine pump and iodide trapping.
It increases thyroglobulin secretion in follicles.
♦ Luteinizing hormone:
In males: It stimulates the interstitial cells of leydig in
testes. Luteinizing hormone is essential for secretion
of testosterone from leydig cells.
In females: It leads to maturation of vesicular follicle
which become graffian follicle along with FSH.
– It induces synthesis of androgens from theca cells
of growing follicle.
– It leads to ovulation.
– It is necessary for formation of corpus luteum.
♦ Follicular stimulating hormone
In males: In males FSH acts along with testosterone
and accelerates the process of spermatogenesis.
In females: It is responsible for development of
graffian follicle from primordial follicle.
Stimulates theca cells of graffian follicle and causes
secretion of estrogen.
Promote aromatase activity in granulose cells resulting
in conversion of androgens into estrogen.
♦ Prolactin: It is necessary for final preparation of mammary
glands for production and secretion of milk.
♦ Adrenocorticotropic hormone: It is necessary for the
structural integrity and secretory activity of adrenal cortex.
♦ β-lipotropin:
It helps in enkephalins synthesis
It mobilizes fat from adipose tissue and promote
lipolysis.
Q.21. Write in brief milk ejection reflex.
(Nov 2012, 3 Marks)
Ans. Numerous touch receptors are present on the mammary
glands mainly around the nipple. When the infant suck
mothers nipple, touch receptors get stimulated and
impulses are discharged.
Impulses from nipple during sucking are carried by
the somatic afferent nerve fibers and reach the para-
Hypothalamus sends impulses to the posterior
pituitary through hypothalamo-hypophyseal tract
and cause release of oxytocin into the blood.
When the hormone reaches the mammary gland, it
causes contraction of myoepithelial cells resulting
in ejection of milk from mammary glands.
• As this reflex is initiated by the nervous factors and
completed by the hormonal action, it is called a
neuroendocrine reflex.
During this reflex, large amount of oxytocin is
released by positive feedback mechanism.
Q.22. Write about hormones of adrenal gland.
(Feb 2013, 7 Marks)
Ans. Adrenal gland is made up of two parts, i.e. adrenal cortex
and adrenal medulla.
Hormones secreted from adrenal cortex are miner-
alocorticoids, glucocorticoids and sex hormones.
Hormones secreted from adrenal medulla are
adrenaline, noradrenaline and dopamine.
Mineralocorticoids
Functions
Life saving hormone: Aldosterone is very essential for life and
it is usually called life saving hormone because, the total loss
of this hormone causes death within 3 days to 2 weeks. It is
mainly because of loss of mineralocorticoids which are essential
to maintain the osmolarity and volume of ECF.
♦ On sodium ions: Aldosterone increases reabsorption of
sodium from distal convoluted tubule and the collecting
duct in kidney.
♦ On blood pressure: Increase in ECF volume and the blood
volume finally leads to increase in blood pressure.
♦ On potassium ions: Aldosterone increases the potassium
excretion through the renal tubules.
♦ On hydrogen ion concentration: While increasing the
sodium reabsorption from the renal tubules, aldosterone
causes tubular secretion of hydrogen ions which is essential
to maintain acid-base balance in the body.

♦ On intestine: Aldosterone increases sodium absorption
from the intestine, especially from the colon and prevents
loss of sodium through feces.
Glucocorticoids
Glucocorticoids are the corticosteroids which act mainly on
glucose metabolism. Glucocorticoids are secreted mainly
by zona fasciculata of adrenal cortex. A small quantity of
glucocorticoids is also secreted by zona reticularis.
Glucocorticoids are:
1. Cortisol
2. Corticosterone
3. Cortisone.
Functions
Life saving hormone: Like aldosterone, cortisol is also essential
for life but in a different way. Aldosterone is a life saving
hormone, whereas cortisol is a life protecting hormone because,
it helps to withstand the stress and trauma in life.
♦ On carbohydrate metabolism: Glucocorticoids increase
the blood glucose level by two ways:
1. By promoting gluconeogenesis in liver from amino
acids.
2. By inhibiting glucose uptake and utilization by
peripheral cells.
♦ On protein metabolism: Glucocorticoids promote catabo-
lism of proteins leading to decrease in cellular proteins
and increase in plasma amino acids and protein content
in liver by the following methods:
Glucocorticoids decrease the protein in the body cells
except liver cells by accelerating protein catabolism
and release of amino acids from the tissues.
Glucocorticoids increase the transport of amino acids
into hepatic cells. In hepatic cells, the amino acids are
used for synthesis of proteins, plasma proteins and
for gluconeogenesis.
♦ On fat metabolism: Glucocorticoids cause mobilization
and redistribution of fats. The actions on fats are:
Mobilization of fatty acids from adipose tissue
Increasing the concentration of fatty acids in blood
Increasing the utilization of fat for energy.
♦ On water metabolism: Glucocorticoids accelerate the
excretion of water and play an important role in the main-
tenance at water balance.
♦ On mineral metabolism: Glucocorticoids enhance the
retention of sodium and to a lesser extent increase the
excretion of potassium. Glucocorticoids decrease blood
calcium by inhibiting absorption of calcium from intestine
and increasing the excretion of calcium through urine.
Sex Hormones
Adrenal sex hormones are secreted mainly by zona reticularis.
Zona fasciculata secretes small quantities of sex hormones. Most
of the hormones are male sex hormones (androgens). But small
quantities of estrogen and progesterone are also secreted by
Physiology 359
adrenal cortex. The androgens secreted by adrenal cortex are:
♦ Dehydroepiandrosterone
♦ Androstenedione
♦ Testosterone.
Dehydroepiandrosterone is the most active adrenal
androgen.
The androgens, in general, are responsible for
masculine features of the body. But in normal
conditions, the adrenal androgens have insignificant
physiological effects, because of the low amount of
secretion both in males and females.
Adrenaline and Noradrenaline
Actions
On Metabolism
Adrenaline acts through both alpha and beta receptors equally.
Noradrenaline acts mainly through alpha receptors and
occasionally through beta receptors. Adrenaline influences the
metabolic functions more than noradrenaline.
1. General metabolism: Adrenaline increases oxygen con-
sumption and carbon dioxide removal. It increases basal
metabolic rate. So, it is said to be a calorigenic hormone.
2. Carbohydrate metabolism: Adrenaline increases the blood
glucose level. It is by increasing the glycogenolysis in liver and
muscle. So, a large quantity of glucose enters the circulation.
3. Fat metabolism: Adrenaline causes mobilization of free
fatty acids from adipose tissues. Catecholamines need the
presence of glucocorticoids for this action.
On Blood
Adrenaline decreases blood coagulation time. It increases RBC
count in blood by contracting smooth muscles of splenic capsule
and releasing RBCs from spleen into circulation.
On Heart
Adrenaline has stronger effects on heart than noradrenaline. It
increases overall activity of the heart, i.e.
i. Heart rate
ii. Force of contraction
iii. Excitability of heart muscle
iv. Conductivity in heart muscle.
On Blood Vessel
Noradrenaline has strong effects on blood vessels. It causes
constriction of blood vessels throughout the body via alpha
receptors. So it is called general vasoconstrictor . The
vasoconstrictor effect of noradrenaline increases total peripheral
resistance.
On Blood Pressure
Adrenaline increases systolic blood pressure by increasing
the force of contraction of the heart and cardiac output. But,
it decreases diastolic blood pressure by reducing the total
peripheral resistance. Noradrenaline increases diastolic
360 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

 Acromegaly
It is the disorder characterized by the enlargement, thickening
and broadening of bones, particularly in the extremities of the
body.

Cause
Acromegaly is due to hypersecretion of growth hormone in
adults after the fusion of epiphysis with shaft of the bone.
Hypersecretion of growth hormone is due to adenomatous
tumor of anterior pituitary involving the acidophil cells.

Signs and Symptoms

♦ The striking facial features are protrusion of supraorbital
ridges, broadening of nose, thickening of lips, thickening
and wrinkles formation on forehead, and protrusion of
lower jaw (prognathism). The face with these features is
called acromegalic or guerrilla face.
♦ Enlargement of hands and feet with bowing of spine.
♦ The scalp is thickened and thrown into folds or wrinkles
like bulldog scalp. There is general overgrowth of body
hair.
♦ The visceral organs such as lungs, heart, liver and spleen
are enlarged.
(Aug 2012, 5 Marks)
Acromegalic Gigantism
Ans. Hyperactivity of anterior pituitary leads to:
1. Gigantism It is a rare disorder with symptoms of both gigantism and
2. Acromegaly acromegaly. Hypersecretion of growth hormone in children,
3. Acromegalic gigantism before the fusion of epiphysis with shaft of bone causes
4. Cushing s disease. gigantism. And, if hypersecretion of the growth hormone is
Hypoactivity of anterior pituitary leads to: continued even after the fusion of epiphysis, the symptoms of
acromegaly also appear.
1. Dwarfism
2. Acromicria Cushing’s Disease
3. Simmonds disease.
It is also a rare disease characterized by obesity.
Gigantism
Hypoactivity of Anterior Pituitary
Gigantism is the pituitary disorder characterized by excess
growth of the body. The sects look like the giants with average Dwarfism
height of about 7-8 feet. It is a pituitary disorder in children characterized by the stunted
Cause growth.

Gigantism is due to hypersecretion of growth hormone Causes

childhood or in the pre-adult life before the fusion of
epiphysis of bone with the shaft. It occurs due to pituitary
tumors.
Signs and Symptoms
♦ General over growth of the person leads to the develop-
ment of a huge stature with a height of more than 7 or 8
feet. The limbs are disproportionately long.
♦ Giants are hyperglycemic and they develop glycosuria
and pituitary diabetes.
♦ Pituitary tumor also causes visual disturbances.
♦ Pituitary tumor leads to headache.
Reduction in the growth hormone secretion in infancy or early
childhood causes dwarfism.
Sign and symptoms
♦ The primary symptom of hypopituitarism in children is the
stunted skeletal growth. The maximum height of anterior
pituitary dwarf at the adult age is only about 3 feet.
♦ But the proportions of different parts of the body are
almost normal. Only, the head becomes slightly larger in
relation to the body.
♦ Pituitary dwarfs do not show any deformity and their
mental activity is normal with no mental retardation.

Acromicria
It is a rare disease in adults characterized by the atrophy of the
extremities of the body.
Causes
Deficiency of growth hormone in adults causes acromicria.
Signs and Symptoms
♦ Atrophy and thinning of extremities of the body (hands
and feet) are the major symptoms in acromicria.
♦ Acromicria is mostly associated with hypothyroidism and
hyposecretion of adrenocortical hormones
♦ The person becomes lethargic and obese.
♦ There is loss of sexual functions.
Simmonds’ Disease
It is a rare pituitary disease. It is also called pituitary cachexia.
Symptoms
♦ A major feature of Simmonds disease is the rapidly
developing senile decay. Thus, a 30 years old person looks
like a 60 years old person.
♦ There is loss of hair over the body and loss of teeth.
♦ The skin on face becomes dry and wrinkled. So, there is
shrunken appearance of facial features. It is the most com-
mon feature of this disease.
Q.24. Write about diseases related to thyroid hormones.
(Feb 2013, 5 Marks)
Ans. Diseases related to thyroid hormones.
Hyperthyroidism
Grave’s Disease
Grave s disease is an autoimmune disease. Normally,
thyroid stimulating hormone (TSH) combines with surface
receptors of thyroid cells and causes the synthesis of thyroid
hormones.
In Graves’ disease the B lymphocytes (plasma cells)
produce autoimmune antibodies called thyroid stimulating
autoantibodies. These antibodies act like TSH by binding with
membrane receptors of TSH and activating cAMP system of the
thyroid follicular cells. This results in hypersecretion of thyroid
hormones.
Thyroid Adenoma
Sometimes, a localized tumor develops in the thyroid tissue. It
is known as thyroid adenoma and it secretes large quantities
of thyroid hormones.
Signs and Symptoms
♦ Intolerance to heat because production more heat during
increased basal metabolic rate caused by hyperthyroidism
♦ Increased sweating due to vasodilatation
♦ Decreased body weight due to fat mobilization
♦ Diarrhea due to increased motility of gastrointestinal tract
Physiology 361
♦ Muscular weakness due to excess protein catabolism
♦ Neuronal disturbances such as nervousness, extreme
fatigue, inability to sleep. Mild tremor in hands and
psychoneurotic symptoms such as hyperexcitability,
extreme anxiety or worry
♦ Toxic goiter
♦ Oligomenorrhea or amenorrhea
♦ Exophthalmos
♦ Polycythemia
♦ Tachycardia and atrial fibrillation
♦ Systolic hypertension
♦ Cardiac failure.
Hypothyroidism
Decreased secretion of thyroid hormones is called hypo-
thyroidism. Hypothyroidism leads to myxedema in adults and
cretinism in children.
Myxedema
It is the hypothyroidism in adults characterized by generalized
edematous appearance.
Causes for Myxedema
Myxedema occurs due to diseases of thyroid gland, genetic
disorder or iodine deficiency. In addition, it is also caused
by deficiency of thyroid stimulating hormone or thyrotropic
releasing hormone.
Signs and Symptoms of Myxedema
Typical feature of this disorder is an edematous appearance
throughout the body. It is associated with the following
symptoms:
♦ Swelling of the face
♦ Bagginess under the eyes
♦ Nonpitting type of edema, i.e. when pressed, it does not
make pits and the edema is hard.
♦ Atherosclerosis: It is the hardening of the walls of arteries
because of accumulation of fat. In myxedema it occurs be-
cause of increased plasma level of cholesterol which leads
to deposition of cholesterol on the walls of the arteries.
♦ Other general features of hypothyroidism in adults are
anemia, fatigue and muscular sluggishness, extreme
somnolence, menorrhagia and polymenorrhea, increase in
body weight, constipation, mental sluggishness, depressed
hair growth, scaliness of the skin, frog like husky voice,
cold intolerance.
Cretinism
Cretinism is the hypothyroidism in children characterized by
stunted growth.
Causes for Cretinism
Cretinism occurs due to congenital absence of thyroid gland,
genetic disorder or lack of iodine in the diet.
362 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Features of Cretinism Q.26. Write short note on hormones of adrenal cortex.

♦ A newborn baby with thyroid deficiency may appear nor- (Dec 2009, 5 Marks)
mal at the time of birth because thyroxine might have been Ans. Hormones secreted from adrenal cortex are mineralo-
supplied from mother. But a few weeks after birth, the baby corticoids, glucocorticoids and sex hormones.
starts developing the signs like sluggish movements and For details refer to Ans 22 of same chapter.
croaking sound while crying. Unless treated immediately, Q.27. Write in brief on hormones secreted by pituitary and
the baby will be mentally retarded permanently. the target glands on which they act.
♦ Skeletal growth is more affected than the soft tissues. So, (June 2010, 5 Marks)
there is stunted growth with bloated body. The tongue Ans. Hormones Secreted by Pituitary
becomes so big, that it hangs down with dripping of saliva.
I. Hormones secreted by anterior pituitary
The big tongue obstructs swallowing and breathing. The
1. Growth hormone
tongue produces characteristic guttural breathing that may
2. Thyroid stimulating hormone
sometimes choke the baby.
3. Luteinizing hormone
Goiter 4. Follicular stimulating hormone
5. Prolactin
♦ Goiter means enlargement of the thyroid gland.
6. Adrenocorticotrophic hormone
♦ It occurs both in hypothyroidism and hyperthyroidism.
7. β-Lipotropin.
♦ Toxic goiter is the enlargement of thyroid gland with in-
creased secretion of thyroid hormones caused by thyroid II. Hormones secreted by posterior pituitary
tumor. 1. ADH or vasopressin
♦ Nontoxic goiter is the enlargement of thyroid gland 2. Oxytocin.
without increase in hormone secretion. It is also called
Hormone Target(s) Function
hypothyroid goiter.
Adrenocor- Adrenals Stimulates the adrenal gland to produce
Q.25. Write short note on thyrotoxicosis. ticotropic a hormone called cortisol
(May/June 2009, 5 Marks) hormone
Ans. Thyrotoxicosis results from the increased circulating Thyroid Thyroid Stimulates the thyroid gland to secrete its
levels of free T4 and T3. stimulating own hormone, which is called thyroxine.
The commonest cause for thyrotoxicosis is Grave s hormone TSH is also known as thyrotropin
disease. Luteinizing Ovaries Controls reproductive functioning and
hormone (women) sexual characteristics. Stimulates
Grave s disease is an autoimmune disease.
and follicular Testes the ovaries to produce estrogen and
Grave’s Disease stimulating (men) progesterone and the testes to produce
hormone testosterone and sperm. LH and FSH
Normally thyroid stimulating hormone combine with are known collectively as gonadotropins.
surface receptors of thyroid cells and causes synthesis of LH is also referred to as interstitial cell
thyroid hormones, but in Grave s disease B lymphocytes stimulating hormone (ICSH) in males
produce autoimmune bodies known as thyroid stimulating Prolactin Breasts Stimulates the breasts to produce milk.
autoantibodies. These antibodies attack like thyroid stimulating This hormone is secreted in large amounts
during pregnancy and breast feeding, but is
hormone by binding with membrane receptors of thyroid
present at all times in both men and women
stimulating hormone and activating cAMP system of thyroid
Growth All cells in Stimulates growth and repair. Research
follicular cells. This leads to hypersecretion of thyroid hormones.
hormone the body is currently being carried out to identify
Sign and Symptoms of Thyrotoxicosis the functions of GH in adult life
ADH Kidneys Controls the blood fluid and mineral
♦ Heat intoleration is present. levels in the body by affecting water
♦ Increased sweating is present. retention by the kidneys. This hormone
♦ Body weight is decreased. is also known vasopressin or argenine
♦ Diarrhea is present. vasopressin (AVP)
♦ Muscular weakness is present. Oxytocin Uterus, Affects uterine contractions in pregnancy
♦ Neuronal disturbances such as nervousness, fatigue, breasts and birth and subsequent release of
inability to sleep, mild tremor in hands, etc. breast milk
♦ Presence of oligomenorrhea or amenorrhea.
♦ Exopthalmos. Q.28. Write short note on thyroid gland.
♦ Polycythemia. (June 2010, 2.5 Marks)
♦ Presence of tachycardia and atrial fibrillation. Ans. Adult thyroid gland is the largest endocrine gland.
♦ Systolic hypertension. • Its weight is approximately 15 to 25 gm.
♦ Cardiac arrest. Thyroid gland is highly vascular.
 Physiology 363

Thyroid gland is situated infront of larynx and is Q.30. Enumerate the endocrine glands in order of location
bilobed. from head downwards. Describe the actions of growth
Thyroid gland is connected by a bridge of tissue hormone in details. (Aug 2012, 15 Marks)
known as isthmus. Ans. Enumeration of Endocrine Glands in Order of Location
Thyroid gland is larger in females as compared to from Head Downwards
males.
Name Location
Histology of Thyroid Gland 1. Pineal gland Head
♦ Thyroid gland is composed of large number of closed fol- 2. Pituitary-anterior posterior Head
licles which are 50 to 500 µm in diameter. 3. Thyroid and parathyroid Throat
♦ Approximately 40 follicles group together to form a lobule.
4. Thymus Upper chest
♦ The follicular epithelium consists of single layer of cuboi-
dal cells. 5. Pancreas Solar plexus region
♦ Lumen is filled with clear pink material known as colloid. 6. Adrenals-cortex medulla Behind the kidneys
Colloid is thyroglobulin containing iodine. 7. Gonads Lower abdomen
♦ Thyroid cells are the highly vascular cells and their micro-
villi project in colloid. Actions of Growth Hormone
♦ Follicular cells secrete T4 and T3. On Metabolism
♦ In between follicles parafollicular cells are present.
Growth hormone causes synthesis of proteins, mobilization of
Functions of Thyroid Gland lipids and conservation of carbohydrates.
♦ Thyroid gland maintains level of oxidative metabolism. ♦ Effect on protein metabolism
♦ Gland helps to regulate fat and carbohydrate metabolism. It increases amino acid transport via cell membrane.
♦ Thyroid gland is necessary for tissue differentiation, nor- It increases translation of RNA due to which
mal growth and maturation. ribososmes are activated and more of the proteins
are synthesized.
Q.29. Enumerate the hormones secreted by the posterior
It increases transcription of DNA to RNA which
pituitary and actions of any one hormone.
accelerates synthesis of proteins in cells.
(Jan 2012, 10 Marks)
It decreases catabolism of proteins.
Ans. Hormones secreted by posterior pituitary are anti-
It promotes anabolism of proteins by the release of
diuretic hormone and oxytocin.
insulin which has anabolic effect on proteins.
Action of Oxytocin ♦ Effect on fat metabolism: Growth hormone mobilizes fat
from adipose tissue. Due to this concentration of fatty acids
♦ Oxytocin causes contraction of smooth muscle cell which
increases in body fluid and these fatty acids are used for
lines the duct of mammary glands and causes milk ejec-
production of energy by cells.
tion from breast. The process by which the milk is ejected
♦ Effect on carbohydrate metabolism
from alveoli of mammary glands is known as milk ejec-
Growth hormone decreases the peripheral utilization
tion reflex.
of glucose for the energy.
♦ Oxytocin stimulates contraction of smooth muscle of
It increases deposition of glucose in form of glycogen
the uterus. Myometrium is sensitive to the exogeneous
in cells.
oxytocin at the time of pregnancy and as the pregnancy
advances the sensitivity increases. Oxytocin causes Decrease uptake of glucose by cells. As deposition of
contraction of uterus and helps in expulsion of fetus. glycogen increases the cells become saturated with
It also stimulates release of prostaglandins in placenta. glycogen.
Prostaglandins intensify uterine contraction induced by Diabetogenic effect: Increase in secretion of growth
oxytocin. hormone causes increase in blood glucose level. It
♦ Oxytocin facilitates the transport of transport of sperm leads to stimulation of β cells of langerhans in pancreas
through female genital tract upto the fallopian tube by and increases insulin secretion. Growth hormone also
producing uterine contraction during sexual intercourse. stimulates β cells of islets in pancreas directly and
♦ Oxytocin at high doses causes relaxation of blood vessels causes secretion of insulin. Due to this stimulation the
causes fall in blood pressure. β cells are burn out at one stage. This causes deficiency
♦ In males oxytocin receptors are found in testis, epididy- of insulin and diabetes occur.
mus and prostrate gland, so at the time of ejaculation
On Bone
oxytocin facilitates transport of sperms towards urethra
by causing increased contraction of smooth muscle of ♦ During embryonic stage growth hormone is responsible
vas deferens. for the differentiation and development of bone cells.
364 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 30: Endocrine gland from head to downward
♦ In later stages growth hormone increases the growth of
skeleton. In bones growth hormone increases:
Protein synthesis by chondrocytes and osteogenic cells.
Multiplication by chrondrocytes and osteogenic cells.
Formation of new bones by converting chondrocytes
into osteogenic cells.
It increases calcium absorption from the intestine.
Growth hormone acts on bone, growth as well as protein
metabolism by somatomedin which is secreted by liver. The
hormone stimulate liver to secrete somatomedin-C which is
insulin like growth factor (IGF-I).
On Electrolytes
Growth hormone conserves electrolytes such as calcium,
sodium, potassium, fluoride, etc. and later on they are send to
the site of active mineralization.
On Gonads
Growth hormone stimulates the growth of male and female
genitalia.
On Milk Production
Growth hormone helps in the maintenance of milk secretion.
On Erythropoiesis
Growth hormone enhances erythrocyte production from the
kidney.
On Lymphocytes
Growth hormone enhances growth of lymphoid tissue as well
as proliferation of lymphocytes.
Q.31. Describe physiological actions of growth hormone.
Add a note on acromegaly. (Mar 2013, 8 Marks)
Ans. For physiological actions of growth hormone refer to
Ans 30 of same chapter.
For acromegaly refer to Ans 2 of same chapter.
Q.32. Describe thyroid hormones. (Sep 2013, 5 Marks)
Ans. Thyroid hormones are:
1. Thyroxine (T4).
2. Tri-iodothyronine (T3).
3. Calcitonin.
- T3 and T4 are amino acids which consist of
iodine.
- Both T3 and T4 are secreted by follicular cells.
- Both T3 and T4 are synthesized in colloid
by iodination and condensation of tyrosine
molecules and bound by peptide linkage in
thyroglobulin. Both the hormones remain bound
to thyroglobulin until secreted.
- When they are secreted colloid is ingested by
thyroid cells and peptide bonds are hydrolysed
discharging free T3 and T4 in capillaries.
- Calcitonin is secreted by parafollicular cells
which lie in between follicular cells.
Q.33. Describe in brief on sex hormones. (Sep 2013, 5 Marks)
Ans. The hormones commonly considered to be “sex hormones”
in the body are testosterone, estrogen and progesterone.
Testosterone is often referred to as a “male” hormone,
and estrogen and progesterone are often referred to as
“female” hormones.
Testosterone, estrogen, and progesterone are produced
mainly in the “gonads” (the testes and the ovaries). Two
other important hormones “luteinizing hormone” (LH)
and “follicle-stimulating hormone” (FSH) stimulate the
gonads into secreting sex hormones.
The androgen testosterone and its derivative dihy-
drotestosterone is responsible for producing masculine
secondary sex characteristics such as facial hair growth,
deepening of the voice, increased body hair growth, and
increased muscle development.
Estrogen and progesterone play a vital role in the
menstrual cycle in females.
Estrogen is also mainly responsible for producing
feminine secondary sex characteristics such as breast
development and increased body fat deposits around
the hip and thigh areas.
Q.34. Write on regulation of hormone secretion.
(May 2014, 5 Marks)
Ans. Regulation of hormone secretion takes place by two
mechanisms, i.e. direct control and nervous control.
Direct Control
In this, the hormone secretion is regulated by concentration of
the blood of those substances which directly control hormone
by themselves.

Nervous Control
Secretion of hormones through endocrine glands is controlled
by central nervous system.
Mainly the neurotransmitters are concerned with rapid
transmission of stimulation or inhibition.
Nervous control of the endocrine glands occurs through
following mechanisms:
♦ Direct innervations through autonomic nervous system
♦ Neurosecretory neurons controls the posterior lobe: In this
there is depolarization of neurosecretory cells in posterior
pituitary through the acetylcholine which is released at the
synapses at cell bodies of these neurons which lead to the
release of ADH and oxytocin.
♦ Neurosecretory neurons control the anterior pituitary:
The regulation is done by peptidergic neurons which
synthesize as well as secrete various specific releasing
factors. These factors enter hypothalamic-hypophyseal
portal system and inhibit or stimulate secretion of anterior
pituitary hormones in blood. Secretion of anterior pitui-
tary hormones is regulated by negative feedback control
too. Negative feedback control is subdivided into three
phases, i.e.
i. Long loop feedback: Substances originating from the
tissue metabolism and hormones of peripheral gland
exert long loop feedback control on hypothalamus and
anterior lobe of pituitary gland. This feedback controls
thyroid, gonadal and adrenocortical secretions.
ii. Short loop feedback: Negative feedback is exerted
by anterior pituitary trophic hormones on release of
hypothalamic releasing or inhibiting hormones which
are called as hypophysiotropic hormones.
iii. Ultrashort loop feedback: Inhibition of synthesis
and release of hypophysiotropic hormones through
a control system is called as ultrashort loop
feedback.
Q.35. Write short note on the functions of growth hormone. Ans. Following are the actions of parathormone
(Oct 2007, 5 Marks)
Ans. For functions of growth hormone in detail refer to Ans
30 of same chapter.
Q.36. Name hormones regulating calcium metabolism.
Discuss regulation of secretion and action of one of them.
(Apr 2007, 15 Marks)
Ans. Hormones regulating calcium hormone are:
1. Parathyroid hormone.
2. Vitamin D.
3. Calcitonin.
Regulation of Secretion of Parathyroid Hormone
♦ Directly through calcium serum level or calcium feedback
loop: Decrease in serum calcium causes stimulation of
parathyroid gland which leads to increase in secretion of
parathormone, this causes mobilization of calcium from
bones and normal serum calcium levels are maintained.
This effect can occur vice-versa too.
Physiology 365
♦ Role of serum magnesium concentration:
Mild decrease in the serum magnesium concentration
enhances parathyroid secretion.
Severe decrease in the serum magnesium concentration
totally abolishes parathyroid secretion.
♦ Role of plasma phosphate concentration: Rise in plasma
concentration of phosphate leads to fall in ionized calcium
concentration which stimulates parathyroid secretion.
♦ Role of 1,25-dihydroxycholecalciferol: It decreases the
secretion of parathyroid hormone.
Actions of Parathormone
Following are the actions of parathormone:
♦ Action on bone: Parathormone stimulates calcium and
phosphate resorption from bones. It causes demineraliza-
tion of bone.
♦ Action on kidney: Following are the actions on kidney:
Increase in calcium reabsorption: Parathormone
enhances reabsorption of calcium from ascending limb
of loop of Henle as well as distal tubules of kidney.
This prevents hypocalcemia.
Inhibition of phosphate reabsorption in proximal
tubule: It leads to phosphaturia and hypophosphatemia.
It inhibits reabsorption of sodium and bicarbonate in
proximal tubule and stimulates Na+ - H+ exchanger
which leads to acidification, this prevents occurrence
of metabolic acidosis.
It stimulates reabsorption of magnesium by the renal
tubules.
It stimulates synthesis of 1,25-dihydroxycholecalciferol.
♦ Action on intestine: Parathormone increases calcium
and phosphate absorption from intestine, this happens
indirectly by increasing synthesis of 1,25-dihydroxychole-
calciferol in kidney.
Q.37. Write short note on actions of parathormone.
(Apr 2008, 5 Marks)
• Action on bone: Parathormone stimulates calcium
and phosphate resorption from bones. It causes
demineralization of bone.
• Action on kidney: Following are the actions on kidney:
- Increase in calcium reabsorption: Parathormone
enhances reabsorption of calcium from ascend-
ing limb of loop of Henle as well as distal tubules
of kidney. This prevents hypocalcemia.
- Inhibition of phosphate reabsorption in proximal
tubule: It leads to phosphaturia and hypophos-
phatemia.
- It inhibits reabsorption of sodium and bicar-
bonate in proximal tubule and stimulates Na+
- H+ exchanger which leads to acidification, this
prevents occurrence of metabolic acidosis.
- It stimulates reabsorption of magnesium by the
renal tubules.
- It stimulates synthesis of 1,25 dihydroxychole-
calciferol.
366 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

• Action on intestine: Parathormone increases cal- 5. It causes increase in conversion of 25 hydroxy chole-
cium and phosphate absorption from intestine, this calciferol to 1,25-dihydroxycholecalciferol in kidney.
happens indirectly by increasing synthesis of 1,25 6. It leads to the activation of adenyl cyclase in the
dihydroxycholecalciferol in kidney. target tissues.
Q.38. Name the hormones secreted by adrenal gland. Write Q.41. Write on functions of thyroid hormones and its disorders.
down the functions of mineralocorticoids. (Apr 2017, 5 Marks)
(Nov 2008, 5 Marks) Ans. For functions of thyroid hormones refer to Ans 7 of same
Ans. Hormones secreted by adrenal gland are: chapter.
I. Hormones secreted from adrenal cortex. Disorders of thyroid hormones
A. Mineralocorticoids i.e. aldosterone and 11-
For disorders of thyroid hormones refer to Ans 24 of
deoxycorticosterone.
same chapter.
B. Glucocorticoids, i.e. cortisol and corticosterone.
C. Sex steroids, i.e. androgen, oestrogen and
progesterone.
II. Hormones secreted from adrenal medulla.
7. REPRODUCTIVE SYSTEM
A. Adrenaline or epinephrine.
B. Noradrenaline or Norepinephrine. Q.1. Write a short note on spermatogenesis.
C. Dopamine. (Mar 1998, 5 Marks) (Sept 2001, 5 Marks)
(Apr 2015, 3 Marks) (Mar 2008, 4 Marks)
Functions of Mineralocorticoids Ans. Spermatogenesis is a process by which spermatozoa are
For functions refer to Ans 22 of same chapter. developed from the primitive germ cells. This occurs in
four stages:
Q.39. Describe the effects of growth hormone in the body.
1. Stage of proliferation: The spermatogonia near
Write in brief on clinical conditions resulting from
basement membrane of semniferous tubules are
hypersecretion of hormone. (Apr 2015, 8 Marks)
larger. Each one contains diploid number of chro-
Ans. For effects of growth hormone in the body refer to the
mosomes. One member of each pair is from maternal
heading actions of growth hormone in Ans 30 of same
origin and other from paternal origin.
chapter.
During proliferative stage, the spermatogonia
Clinical Conditions Resulting from Hypersecretion of divide by mitosis without any change of chromo-
Hormone some number. In man, there are seven generation
of spermatogonia. The last generation enters stage
Hypersecretion of hormone Clinical condition of growth as primary spermatocyte.
Growth hormone a. Gigantism 2. Stage of growth: The primary spermatocyte grows
b. Acromegaly
into larger cell.
Antidiuretic hormone Syndrome of inappropriate
hypersecretion of ADH
Thyroid hormone a. Grave’s disease
b. Toxic nodular goiter
Parathormone Hyperparathyroidism
Glucocorticoid Cushing’s syndrome
Aldosterone Hyperaldosteronism
Adrenal androgens Adrenogenital syndrome
Catecholamines Pheochromocytoma
(epinephrine and norepinephrine)

Q.40. Write briefly about functions of parathormone.

(Feb 2016, 2 Marks)
Ans. Following are the functions of parathormone:
1. It increases calcium levels and decreases phosphate
levels in body.
2. It leads to hyperphosphaturia, hypocalciuria fol-
lowed by hypercalciuria.
3. It increases urinary hydroxyproline excretion.
4. It increases the resorption of bone which enhances
the number of osteoclasts and osteocytes in bone. Fig. 31: Spermatogenesis

3. Stage of maturation: After reaching full size, the
spermatocyte quickly undergoes miotic division
which occurs in two stages.
In the first stage, two secondary spermatocytes
are formed. In the second stage, each secondary
spermatocyte divides into two spermatids. The im-
portant result of two stages of maturation division
is, each spermatid receives haploid chromosomes.
4. State of transformation: The spermatids do not di-
vide further but are transformed into spermatozoa
by spermatogenesis.
Q.2. Write in brief on functions of testes.
(Apr 2010, 5 Marks)
Ans. The functions of testes are as follows:
1. Gametogenic function: The production of gamete
cells is called gametogenic functions. Refer to Ans 1
of same chapter for detail.
2. Endocrine function: The testes secrete the male
sex hormones called androgens. The androgens
are testosterone, dihydrotestosterone and
androstenedione. For detail refer to Ans 15 of same
chapter.
Q.3. Write in brief on menstrual cycle.
(Dec 2009, 5 Marks) (June 2010, 5 Marks)
Ans. The cyclic events that take place in rhythmic fashion
during reproductive period of women’s life is called
menstrual cycle.
The menstrual cycle starts at age of 13 to 15 years
which marks onset of puberty.
Fig. 32: Menstrual cycle
Physiology 367
The commencement of menstrual cycle is called
menarche and permanent cessation of menstrual
cycle in old age is called menopause.
There are various changes during the menstrual
cycle in uterus, which are in following phases.
Menstural Phase
♦ Ovum which is shed during ovulation does not fertilize
and bleeding from female genital canal begins which last
for 3 to 5 days.
♦ During menstrual phase secretion of progesterone and
estrogen fall rapidly due to degeneration of corpus luteum.
♦ Bleeding and shedding of superficial two-third of endome-
trium which occur in its different parts because of spasm
of spiral arteries for several hours leading to endometrial
necrosis.
♦ As the vessels relax the shedding of necrotic endometrium,
leakage of blood and release of mucus make debris lost
during menstruation.
♦ Menstural blood clot in uterus and is liquefied by fibrinoly-
sin in vagina.
♦ Total blood loss is 10 to 80 ml.
♦ Menstural blood contains prostaglandins.
Proliferative or estrogenal Phase
♦ This phase presents restoration of epithelium from the
menstruation.
♦ Estrogen is secreted from the developing ovarian follicles
under influence of follicular stimulating hormone which
leads to this phase.
♦ As the bleeding ends endometrium becomes thin, i.e. less
than 2 mm thick and has ciliated columnar epithelium
which is dipped in a loose stroma for forming simple
tubular glands.
♦ From 5th to 14th day endometrium get thick and start
proliferating and becomes 4 mm thick. Uterine glands
increase in length but do not secrete.
♦ Cervical secretion increases in volume and become alka-
line as well as watery. The secretion causes survival and
transport of sperms.
Ovulatory Phase
♦ It occurs at 14th day.
♦ Ovulatory phase occurs due to rise in luteinizing hormone
secretion secondary to rise in estrogen concentration.
♦ At 14th day ovulation occur and during this cervical mucus
increases in volume and become watery and so there is very
small vaginal discharge of cervical fluid which is watery.
♦ Cervical mucosa is thinnest during ovulation and so is
easily penetrated by spermatozoa.
Secretory or Luteal Phase
♦ It occurs from 14th to 28th day.
♦ This phase represent preparation of uterus for implanta-
tion of the fertilized ovum.
368 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
 
(Sept 2001, 15 Marks)
Ans. Gonadotropins are follicular stimulating hormone
and luteinizing hormone.
In females menstrual cycle depends on secretion
of hypothalamic gonadotropin releasing hormone,
i.e. follicular stimulating hormone and luteinizing
hormone.
Increase in concentration of follicular stimulating
hormone leads to the development of ovarian folli-
cles and also causes increase in secretion of estrogen.
So increase in follicular stimulating hormone increases
serum concentration of estrogen to reach a peak at 12
to 13 days which is known as estrogen surge.
• Estrogen surge increases response of pituitary to
gonadotropin releasing hormones which causes
heavy amount of secretion of luteinizing hormone
which is known as LH surge.
• Ovulation occurs at about 9 hours of the LH surge.
So the luteinizing hormone is known as ovulating
hormone.
Process of ovulation depends on luteinizing hor-
mone and follicular stimulating hormone. So with
LH surge, FSH surge occur simultaneously. Estrogen
secretion decreases at time of ovulation.
• As ovulation finishes, serum luteinizing hormone
and follicular stimulating hormone concentration
falls, but as corpus luteum is formed, concentration
of serum progesterone and estrogen increases along
with inhibin-B at second half of cycle.
• Elevated levels of progesterone, estrogen and inhi-
bin-B levels inhibit follicular stimulating hormone
and luteinizing hormone secretion through negative
feedback on hypothalamus.
• Progesterone acts on endometrium which is primed
by estrogen which leads to the secretory phase of
endometrial development which is progestational.
If pregnancy occurs corpus luteum does not disap-
pear but persist and continue to secrete progesterone
(Apr 2003, 5 Marks)
Ans. For endometrial cycle refer to Ans 3 of same chapter
and for its hormonal regulation refer to Ans 5 of same
chapter.
Q.7. Write a short note on puberty. (Sep 2000, 5 Marks)
(Sep 2005, 5 Marks) (Dec 2004, 5 Marks)
Ans. A period in which the gonads of both sexes are
quiescent until they are activated by gonadotropins
from the pituitary to bring about the final maturation
of reproductive system. This period of final maturation
is known as adolescence or puberty. Puberty generally
occurs between the ages of 8 and 13 in girls and 9 and
14 in boys.
Changes in the male during puberty due to the test-
osterone:
1. Muscular growth.
2. Bone growth testosterone: It causes broadening of
shoulders and it also has a specific effect on pelvis
causing.
- Narrowing of pelvis outlet.
- Lengthening of pelvis.
3. Change in skin: Increases thickness of skin.
Secretory activity of sebaceous glands, excessive
secretion of sebum leads to development of acne on
the face.
4. Hair distribution: Hair growth on the pubis, on face,
on chest and other parts of body like back.
5. Change in voice: Hypertrophy of laryngeal muscles,
the enlargement of larynx produces a cracking voice.
6. Basal metabolic rate increases about 5 to 10%.
Changes in female during puberty due to the secretion
of estrogen:
1. Effect on breast: Development of stromal tissues of
the breasts, deposition of fat in the ductile system.
2. Hair distribution develops in the pubic region and
axilla.
3. Skin: Softness and smoothness to the skin.

Fig. 33: Phase of menstural cycle
4. Body shape: The shoulders become narrow, hip
broadens, the thighs converge, the fat deposition
increases in the breast and buttocks.
5. Voice: The larynx remains in prepleural stage pro-
ducing high pitch voice.
Q.8. Describe briefly gonadotropins.
(Aug/Sep 1998, 10 Marks)
Ans. • Gonadotropin hormone is secreted from anterior
pituitary gland.
• The basophil cells secrete gonadotropin which con-
trols the growth and activity of gonads.
• There are two gonadotropins:
1. Follicle-stimulating hormone (FSH)
2. Luteinizing hormone (LH)/Interstitial cell they are necessary.
stimulating hormone (ICSH).
Chemistry: The two gonadotropin hormones are
glycoprotein in nature.
Functions of Gonadotropins
♦ Functions of FSH:
In males: It accelerates the process of spermatogenesis.
In females:
– It is responsible for development of graafian fol-
licle from primordial follicle.
– It stimulates these cells of graafian follicle and
causes secretion of estrogen.
♦ Functions of LH:
In males: In males, it is also known as interstitial cell
stimulated hormone (ICSH) because it stimulates
Leydig cells in testes.
This hormone is essential for secretion of testosterone
from Leydig cells.
Physiology 369
In females:
– It is responsible for ovulation.
– It is necessary for formation of corpus luteum.
– It activates secretory functions of corpus luteum.
Control of gonadotropic secretion.
Gonadotropin secretion is under control of hypothalamus
and sex hormones.
1. Hypothalamus: Hypothalamus nuclei are known
to secrete specific releasing factors for release of
specific gonadotropic hormones.
  Luteinizing hormone releasing factor for LH
and follicle-stimulating hormones releasing factor
for FSH are secreted from hypothalamus when
2. Sex hormone: Injection of estrogen and androgen
for long time causes degeneration of anterior pi-
tuitary, and secretion of gonadotropin is inhibited.
This shows that concentration of sex hormone in
blood regulates secretion of gonadotropins. A
high concentration inhibits, whereas low concen-
tration stimulates secretion.
Q.9. What is mechanism of ovulation?
(Sep 2009, 10 Marks)
Ans. Prior to ovulation, a large amount of luteinizing hormone
is secreted. This causes changes in graafian follicle leading
to ovulation, LH also causes synthesis of progesterone.
  After maturation, the follicles move towards periphery
of ovary. Because of activities of LH and progesterone,
new blood vessels are formed in ovary. These blood
vessels protrude into the wall of follicle, so that blood flow
to follicle is increased. Now, prostaglandin is released
370 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
from granulosa cells. This causes leakage of plasma into
follicle leading to follicular swelling.
  Just before ovulation near the wall of ovary, the follicle
swells and protrudes against capsule of ovary. This
protrusion is called stigma. Now progesterone activates
proteolytic enzymes. These enzymes cause making of the
follicular capsule and degeneration of stigma. After about
30 minutes, fluid begins to ooze from the follicle through
stigma. This reduces size of follicle causing rupture of
stigma. Now ovum is released from follicle.
Q.10. Write a short note on test for ovulation.
(June 2010, 5 Marks)
Or
Write briefly about indicators of ovulation.
(Oct 2016, 2 Marks)
Test for Ovulation
♦ Rise in of basal body temperature: The basal body
temperature increases during ovulation by about 0.5°C.
Accurate charting of this temperature can exactly detect
the day of ovulation.
It is recorded orally, early in the morning before getting
up of the bed, and before taking any drink or washing
the mouth. The increase in body temperature is due to the
influence of progesterone that starts increasing with the
beginning of secretory phase. Progesterone is thermogenic.
♦ Fleeting lower abdominal pain (mittelschmerz): With
ovulation, bleeding occurs into the antrum of follicle.
Small amount of blood also escapes into the abdominal
cavity, which causes peritoneal irritation and produces
fleeting (short-lived) lower abdominal pain. This is called
as mittelschmerz.
♦ Vaginal discharge (spotting): There may be transitory
increase in vaginal discharge during ovulation.
When rise in basal body temperature is associated with
mittelschmerz and spotting, they are collectively called
as ovulation cascade. If all the three features are present,
occurrence of ovulation is almost confirmed.
♦ Spinnbarkeit: In the proliferative phase, estrogen makes
the cervical mucous thin and alkaline.
With the beginning of secretory phase, progesterone
secreted from corpus luteum makes the cervical mucous
thick and tenacious. Thus, uterine mucous is thinnest at the
time of ovulation and its elasticity is maximal. Therefore, a
drop of cervical mucous collected at the time of ovulation
can be stretched to as long as 10 cm or more like a thread.
This elastic nature of the mucous is called spinnbarkeit.
Decreased elasticity indicates ovulation has already taken
place.
♦ Fern test: Under effect of estrogen cervical mucous before
ovulation forms an arborizing fern like pattern, when
mucus is spreaded on the slide. It is confirmed by micro-
scopic examination of mucus smear. As ovulation period
is over fern like pattern is not observed.

(Mar 1996, 10 Marks)
Ans. Physiological changes during pregnancy are as follows:
1. Blood: The blood volume increases by about 20%
or about 1 liter. This is due to increase in plasma
volume that may cause hemodilution.
2. Cardiovascular system:
- Generally cardiac output is increased by 30% in
first trimester. This is because of increase in force
of contraction of heart and blood volume.
- The arterial blood pressure remains unchanged
during the first trimester. During second
trimester, there is decrease in blood pressure.
This is due to diversion of food on uterine sinus.
3. Respiratory system: The tidal volume, pulmonary
ventilation and oxygen utilization are all increased.
4. Excretory system: Renal blood flow and GFR in-
crease result in increased urine formation. This is
because of increased in fluid intake and increased
excretory products from fetus.
5. Digestive system: During initial stages in preg-
nancy, the morning sickness occurs leads to nausea,
vomiting and giddiness. This is due to hormonal
imbalance. The motility of GIT is decreased and
constipation is common.
6. Endocrine system:
i. Anterior pituitary: During pregnancy, there is
increase in size of pituitary by 50% as there is
increased secretion of corticotropin, thyrotropin
and prolactin. However, the secretion of FSH and
LH decreases very much due to feedback control
by estrogen and progesterone.
ii. Adrenal cortex: There is increase in secretion
of cortisol which helps in the mobilization of
amino acids from mother s tissue to fetus. Aldos-
terone secretion is also increased. This reaches
maximum at the end of pregnancy. Along with
oestrogen and progesterone, androstenedione is
responsible for retention of water and sodium.

iii. Thyroid: The size and secretory activity of
thyroid gland increase during pregnancy. The
increased secretion of thyroxine helps in prepa-
ration of mammary glands for lactation. It is also
responsible for increase in metabolic activities.
Q.13. Write in brief on pregnancy test.
(Mar 2001, 5 Marks) (June 2010, 5 Marks)
Ans. The basis of pregnancy test is to determine the presence
of hormone human chorionic gonadotropin in urine of
women suspected for pregnancy. Both biological and
immunological tests are available to test presence of
hCG in women.
• Biological tests: These tests are performed by
using experimental animals. The biological tests for
pregnancy can be performed after 2 to 3 weeks of
conception so that concentration of hCG in urine is
sufficient to show the result, e.g. Kupperman test,
Friedman test, etc.
• Immunological test: The presence of hCG can be
determined by using immunological techniques. The
immunological tests are based on double antigen-
antibody reactions. The most commonly performed
immunological test is Gravindex test.
Gravindex Test
Principle
It is to determine agglutination of RBCs of sheep coated with
hCG. Latex particles could also be used instead of RBCs of sheep.
Requisites
♦ Antiserum from rabbit: Urine from a pregnant women is
collected and hCG is isolated from urine. The hCG is in-
jected to the rabbit and rabbit develops antibodies against
hCG. These antibodies are called Anti-hCG. The rabbits se-
rum containing hCG antibody is known as hCG antiserum.
♦ RBC from sheep: The RBCs are obtained from sheep s
blood. These cells are coated with pure hCG obtained
from urine of pregnant woman. Now-a-days, instead of
sheep s RBC, the rubberised synthetic particles called latex
particles are used.
♦ Urine: Urine of woman who needs to confirm pregnancy.
Procedure
♦ One drop of hCG antiserum is taken on a glass slide. One
drop of urine from woman who wants to confirm preg-
nancy is added to this and both are mixed well. If urine
contains hCG, all antibodies of antiserum are used for
agglutination of hCG molecules.
♦ Now, one drop of latex particles is added to this and mixed.
Observation and Result
If urine contains hCG, it gets agglutinated by antibodies
of antiserum and all antibodies are fully used up. No free
antibodies is available and absence of agglutination of latex
particles confirms pregnancy.
Physiology 371
Advantages of Immunological Test for Pregnancy
♦ The test is more accurate.
♦ The result is obtained within a few minutes.
♦ The test is carried out easily. The procedure is not cumber-
some.
♦ Recently available immunological tests are more sensi-
tive and involve single step method. These tests can be
performed during the first few days of conception.
Q.14. Write a short note on oral contraceptives.
(Aug 2005, 5 Marks)
Or
Write short note on contraceptives.
(May/June 2009, 5 Marks)
Ans. The oral contraceptives are used to prevent maturation
of follicles and ovulation. Prevention of follicular growth
and ovulation can be done by suppressing the secretion
of gonadotropin from the pituitary. This is done by
using some synthetic substances. The method of fertility
control is called pill method. These pills alter menstrual
cycle and prevent maturation of follicles and ovulation.
So the menstrual cycle becomes anovulatory cycle. The
pills containing synthetic estrogen and progesterone are
called oral contraceptives. The pills are of three types:
1. Classical or combined pills: They consist of moder-
ate dose of synthetic estrogen and mild dose of syn-
thetic progesterone. The pills are taken daily from
5th to 25th day of menstrual cycle. The withdrawal
of pills after 25th day causes menstrual bleedings.
  During continuous intake of pills, there is rela-
tively large amount of estrogen and progesterone in
blood. This suppresses release of gonadotropins FSH
and LH from pituitary by means of feedback mecha-
nism. The lack of FSH and LH prevents maturation
of follicle and ovulation. In addition, progesterone
increases the thickness of mucosa which is not fa-
vorable for transport of sperm.
2. Sequential pills: They contain high dose of oestro-
gen along with moderate dose of progesterone.
3. Mini pills: They contain only low dose of progester-
one. They are taken throughout menstrual cycle. This
prevents pregnancy without affecting ovulation.
Q.15. Write a short note on the functions of testosterone.
(Mar 2005, 5 Marks)
Or
Write very short answer on functions of testosterone.
(Apr 2018, 2 Marks)
Or
Enumerate functions of testosterone.
(Sep 2018, 5 Marks)
Ans. The functions of testosterone are:
• Testosterone with follicular stimulating hormone
maintains spermatogenesis.
• Testosterone promotes and maintains the motility
and fertilizing power of sperms.
372 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

 Other Factors
♦ Temperature: In scrotum the temperature is about 2°C
less than that of body, this low temperature is essential
for spermatogenesis.
♦ Infectious disease: Such as mumps causes degeneration
of seminiferous tubules and absence of sperma-
togenesis.
Q.17. Write in brief of maternal changes during pregnancy.
(Dec 2010, 6 Marks)
Ans. Following are the maternal changes during pregnancy:

Changes in Genital Organs

♦ Uterus: For accommodating the growing fetus there is
increase in the size of uterus. The enlargement occurs due
to hypertrophy and also due to hyperplasia of myometrial
smooth muscle fibers.
(Apr 2008, 8 Marks) ♦ Ovaries: Ovulation stops and follicular changes do not
occur since FSH and LH are inhibited.
Ans. Spermatogenesis is regulated by sertoli cells, some
♦ Cervix: Hypertrophy of endocervix occur, cervical glands
hormones and other factors.
increase in number and their secretions create a plug which
1. Role of sertoli cells:
causes closure of cervical canal and tough cervix become soft.
- Sertoli cells provide nutrition to the developing
♦ Mammary glands: There is breast enlargement in early
sperms.
pregnancy. Ductal and alveolar tissue shows hyperpla-
- These cells secrete estrogen, which is essential
sia, areola gets pigmented and sebaceous glands become
for spermatogenesis.
prominent in areola. Nipples increases in size and become
- Sertoli cells secrete hormone binding proteins,
pigmented.
and make testosterone and estrogen hormones
available for the maturation of sperms. Weight Gain
2. Role of hormones: Following are the hormones,
Women gain total of 10 to 12 Kg of weight in normal pregnancy.
necessary for spermatogenesis:
This is contributed as:
- Testosterone
- Follicle stimulating hormone ♦ Weight of fetus is 3 kg.
- Leutinizing hormone ♦ Weight of placenta and amniotic fluid is 1.5 kg
- Estrogen ♦ Weight of uterus and breast enlargement is 1 kg
- Growth factor. ♦ Blood volume and intestinal fluid rises upto 1.5 kg
♦ Deposition of fat is 3.5 to 4 kg.
Testosterone
Hematological Changes
♦ It stimulates spermatic gene s.
♦ Blood volume: Blood volume increases upto 30%. Increase
♦ It is also necessary for the formation of secondary
in plasma volume is more than that of red cell volume. This
spermatocyte from primary spermatocyte.
leads to hemodilution and there is physiological anemia
Follicle Stimulating Hormone of pregnancy.
♦ Hematological indices: There is decrease in RBC count,
Combined effect with testosterones.
hemoglobin concentration and packed cell volume. There
Luteinizing Hormone is increase in ESR and reticulocyte count.
♦ Plasma proteins: Concentration of plasma proteins
This hormone is essential for the secretion of testosterone from decreases from 7.5 to 6 gm% due to hemodilution. There
leyding cells. is increase in fibrogen level but serum albumin level
markedly decreases.
Estrogen
♦ Leucocytes: There is rise in total leucocyte count upto
Necessary for spermatogenesis. 20000/mm3.
♦ Platelets: There is slight decrease in the platelet count.
Growth Hormone ♦ Coagulation factors: Pregnancy is a hypercoagulable
♦ Essential for background metabolism of testis. state in which there is an increase in fibrinogen, factors
♦ Necessary for proliferation of spermatogenesis. VII, VIII, IX and X.

Changes in Cardiovascular System
♦ Position of heart: Uterus pushes the diaphragm upwards
which changes the position of heart.
♦ Heart rate: Heart rate increases by 10 to 12 beats/min.
♦ Cardiac output: There is an increase in cardiac output from
5L/min to 7L/min during 20 weeks of gestation.
♦ Blood pressure: Systolic blood pressure remains normal
while diastolic blood pressure decreases and by 16 to 20
weeks of pregnancy its value is lowest, after this it starts
increasing and becomes normal.
♦ Blood flow: There is an increase in blood flow to skin,
uterus and kidneys to meet the demands.
♦ Venous pressure: Gravid uterus applies pressure on pel-
vic vein, abdominal vein and femoral vein in this way it
increases the venous pressure.
Changes in Respiratory System
♦ Hyperventilation: As there are high levels of plasma
progesterone at the time of pregnancy this increases the
sensitivity of respiratory neurons to carbon dioxide which
leads to hyperventilation.
♦ Gas exchange: Exchange of gases across alveoli is en-
hanced due to marked increase in pulmonary blood flow.
♦ Consumption of oxygen: It get increased by 15% to meet
demands of growing fetus and for extra work of heart,
uterus and other tissue.
Changes in Urinary System
♦ Renal blood flow: Renal blood flow gets increased.
♦ Glomerular filtration rate: It increases by 50% as there is
increase in renal blood flow.
♦ Renal tubular absorptive capacity for sodium and chloride
ions increases by 50% as high levels of steroid hormones
are secreted by placenta and adrenal cortex.
♦ Proteinuria: There is presence of proteinuria.
♦ Water balance: In last months of pregnancy there is pres-
ence of water retention.
♦ Acid-base balance: Hyperventilation at the time of preg-
nancy leads to respiratory alkalosis. Kidneys compensate
this by excreting bicarbonate ions in urine.
Changes in Gastrointestinal System
♦ GIT secretions: Hypochlorhydria is present as gastric
secretions are reduced.
♦ GIT motility: Motility decreases under the influence of
hormones which causes delayed gastric emptying.
♦ Gall bladder functions: Size of gallbladder increases and
empties it contents at slow rate.
♦ Liver functions: They get altered during pregnancy.
There is an increase in fibrinogen synthesis and decrease
in albumin synthesis so plasma albumin to globulin ratio
is decreased.
Metabolic Changes
♦ Basal metabolic rate: BMR increases to 15% in pregnancy
during later half of pregnancy.
Physiology 373
♦ Protein metabolism: When balanced diet is given there is
nitrogen retention and positive nitrogen balance. Proteins
get deposited in uterus, breast, fetus and placenta.
♦ Carbohydrate metabolism: There is an increase in blood
glucose level. Glycosuria is present due to increase in GFR
and decrease in renal threashold for glucose. Ketosis can
occur due to anorexia and excessive vomiting.
♦ Fat metabolism: 3 to 4 Kg of fat gets deposited during
pregnancy. There is an increase in plasma concentration
of cholesterol, phospholipids and triglycerides.
♦ Mineral metabolism: In pregnancy mother retains 50 gm
of extra calcium and 30 to 40 gm of phosphorus. These
minerals are deposited in fetus and retained in mother
stores. Requirement of iron also increases.
Changes in Endocrine System
All endocrine glands of pregnant lady react substantially during
pregnancy. Due to increased metabolic load and due to the
hormones produced by placenta and fetus.
Changes in the Skin
♦ Hyperpigmentation: It occurs on face, areola, nipple,
midline of abdomen. It is due to the increased secretion
of ACTH and MSH at the time of pregnancy.
♦ Stria gravidarum: Presence of linear scars on lower abdo-
men due to stretching of skin.
Changes in Psychology
Nervous system show mild changes in form of craving for
particular type of food items, alteration in behavior and mood.
Q.18. Write short note on corpus luteum.
(June 2010, 5 Marks)
Ans. It is also known as yellow body.
It is a glandular yellow body which is developed from
ruptured graffian follicle after the release of ovum.
Formation and Fate of Corpus Luteum
♦ Following ovulation as ruptured graffian follicle is filled
with the blood it is known as corpus hemorrhagicum.
♦ The luteinizing hormone neutralizes leutinization inhibit-
ing factor in initiates leutinization.
♦ Granulosa and theca cells show fat droplet in cytoplasm and
the structure appears yellow in color. Both the cells now
are known as granulose leutin cells and theca leutin cells.
♦ Corpus luteum produce large amount of estrogen and
progesterone under the influence of luteinizing hormone.
♦ If fertilization occur corpus luteum produce these
hormones as placenta take over the function.
♦ If fertilization has not occurred corpus luteum produce
hormones at high level till 24th day and from 25th day
secretion of hormones decreases and reaches to its basal
level at 28th day.
♦ Corpus luteum degenerates and is known as corpus
albicans.
374 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
 Ans. Female Reproductive Cycle
(Apr 2008, 5 Marks)
Ans. Pituitary
• FSH/LH falls to low levels
• ACTH and melanocyte-stimulating hormone
increase
• Prolactin level increases
• Levels of progesterone and estrogens rise continually
throughout pregnancy, suppressing the hypothalmic
axis and subsequently the menstrual cycle. Estrogen
is mainly produced by the placenta and is associated
with fetal well-being
• Women also experience increased human chorionic
gonadotropin (β-hCG); which is produced by the
placenta. This maintains progresterone production
by the corpus luteum. The increased progesterone
production, first by corpus luteum and later by the
placenta, functions to relax bronchiolar smooth
muscle.
Thyroid and Parathyroid
♦ Thyroxine-binding globulin concentrations rise due to
increased estrogen levels.
♦ T4 and T3 increase over the first half of pregnancy but there
is a normal to slightly decreased amount of free hormone
due to increased TBG-binding.
♦ TSH production is stimulated. A large rise in TSH is likely
to indicate iodine deficiency or subclinical hypothyroidism.
♦ Serum calcium levels decrease in pregnancy, which
stimulates an increase in parathyroid hormone.
♦ Cholecalciferol (vitamin D3) is converted to its active
metabolite, 1,25-dihydroxycholecalcifero, by placental
1α-hydroxylase.
 of blood from female genital canal.
(Jan 2012, 10 Marks)
Female reproductive cycle occur periodically during the
reproductive age. The changes taking place in the organs
are as follows:
1. Change in the ovaries, i.e. the ovarian cycle
2. Changes in uterus, i.e. the menstural cycle
3. Changes in vagina
4. Changes in gonadotrophin secretion, i.e. hormonal
control of female sexual cycle.
Changes in Ovaries or the Ovarian Cycle
Premenarchal Ovary
♦ Starting from birth till menarche the ovarian weight
increases because of increased volume of developing
follicles as well as increase in stroma.
♦ After the age of 8 years the estrogen secretion by ovary is
sufficient for promoting increase in uterine weight.
Postmenarchal Ovary
♦ During menarche the hypothalamic maturation leads to
onset of cyclic ovulation.
♦ At each cycle of the month 10 to 15 follicles enlarge
and become secondary follicle in presence of follicular
stimulating hormone from anterior pituitary. Fluid gets
filled inside these follicles and a single follicle out of
fifteen enlarged follicles undergoes ovulation. Ovum is
surrounded by zona pellucid and granulose cells and now
it is known as cumulus oophorus. This cumulus oophorus
shed in abdominal cavity and is picked by fimbriae of
fallopian tube.
♦ During ovulation, antral fluid escape and the follicle wall
get collapse and collapse leading to hemorrhage in theca
interna and this causes formation of corpus hemorrhagicum.
♦ As ovulation get finished capillaries from theca interna
invade granulose layer and the clotted blood get replaced
by yellowish lipid rich luteal cells which forms corpus
luteum.
♦ Corpus luteum enlarges for a week or more during which
luteal cells secrete estrogen and progesterone, at this time
if fertilization occur corpus luteum grow for months and
degenerate at 6th month. If fertilization does not occur
corpus luteum regress and become corpus albicans.
Changes in Uterus or the Menstural Cycle
Menstural cycle is defined as the recurrent monthly discharge
Menstural cycle in humans is counted from the day at which
the menstrual bleeding starts. It occurs in 4 stages:
I. Menstural Phase
♦ Ovum which is shed during ovulation does not fertilize
and bleeding from female genital canal begins which last
for 3 to 5 days.
♦ During menstrual phase secretion of progesterone and
estrogen fall rapidly due to degeneration of corpus luteum.
 Physiology 375

♦ Bleeding and shedding of superficial two-third of endome- Changes in Vagina

trium which occur in its different parts because of spasm At the time of proliferative phase vaginal epithelium is
♦
of spiral arteries for several hours leading to endometrial cornified.
necrosis. 
♦ As the vessels relax the shedding of necrotic endometrium,
leakage of blood and release of mucus make debris lost
during menstruation.
♦ Menstural blood clot in uterus and is liquefied by fibrinoly-
sin in vagina.
♦ Total blood loss is 10 to 80 ml.
♦ Menstural blood contains prostaglandins.
II. Proliferative or estrogenal Phase
♦ This phase presents restoration of epithelium from the
menstruation.
♦ Estrogen is secreted from the developing ovarian follicles
under influence of follicular stimulating hormone which
leads to this phase.
♦ As the bleeding ends endometrium becomes thin, i.e. less than
2 mm thick and has ciliated columnar epithelium which is
dipped in a loose stroma for forming simple tubular glands.
♦ From 5th to 14th day endometrium get thick and start
proliferating and becomes 4 mm thick. Uterine glands
increase in length but do not secrete.
♦ Cervical secretion increases in volume and become alka-
line as well as watery. The secretion causes survival and
transport of sperms.
III. Ovulatory Phase
♦ It occurs at 14th day.
♦ Ovulatory phase occurs due to rise in luteinizing hormone
secretion secondary to rise in estrogen concentration.
♦ At 14th day ovulation occur and during this cervical mucus
increases in volume and become watery and so there is very
small vaginal discharge of cervical fluid which is watery.
♦ Cervical mucosa is thinnest during ovulation and so is
easily penetrated by spermatozoa.
IV. Secretory or Luteal Phase
♦ It occurs from 14th to 28th day.
♦ This phase represent preparation of uterus for implanta-
tion of the fertilized ovum.
♦ It is influenced by progesterone and is secreted by leuteal
cells of corpus luteum.
♦ About one and a half day after ovulation when corpus
luteum is formed in the ovary the endometrium undergoes
development to become 6 mm thick at end of 28th day
during onset of menstruation.
♦ Endometral glands increase in length and diameter and
become tortuous and get filled with mucous. Stromal
cells proliferate and enlarge. Spiral arteries get coiled and
dilated and the veins get filled with blood. (Feb 2016, 2 Marks)
♦ Cervical secretion become thick, cellular and tenacious, Ans. It is also known as estrogenal phase.
it form a viscous plug which act as a barrier against • This phase presents restoration of epithelium from
spermatozoa as well as infectious micro-organisms. the menstruation.
376 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

• Estrogen is secreted from the developing ovarian 

follicles under influence of follicular stimulating
hormone which leads to this phase.
As the bleeding ends endometrium becomes thin,
i.e. less than 2 mm thick and has ciliated columnar
epithelium which is dipped in a loose stroma for
forming simple tubular glands.
• From 5th to 14th day endometrium get thick and
start proliferating and becomes 4 mm thick. Uterine
glands increase in length but do not secrete.
• Cervical secretion increases in volume and become
alkaline as well as watery. The secretion causes
survival and transport of sperms.

8. CARDIOVASCULAR SYSTEM

Q.1. Write a short note on properties of cardiac muscles.

(Sep 2004, 5 Marks) (Aug 2012, 5 Marks)
Ans. The properties of cardiac muscles are as follows:
1. Excitability: The ability of a tissue to give response
to stimulus is called excitability.
Electric potential in cardiac muscles:
a. Resting membrane potential: In cardiac muscle
fibers, the resting membrane potential is about
85 to 95 mV.
b. Action potential: In electrical activity that take
place in cardiac muscle is known as action poten-
tial. Action potential in a single cardiac muscle
fiber occurs in 4 phases namely:
1. Rapid depolarization
2. Initial rapid repolarization
3. A plateau
4. Slow repolarization.
The duration of action potential in cardiac muscle
is 250 to 360 msec. (Oct 2014, 8 Marks)
2. Rhythmicity: The ability of a tissue to produce its Or
own impulses regularly is called rhythmicity or Write short note on cardiac cycle. (Jan 2018, 5 Marks)
self-excitation or autorhythmicity. Or
- The property of rhythmicity is possessed by all Define cardiac cycle. Describe in brief phases and
tissues of heart. events occurring during cardiac cycle.
- The heart has a specialized structure which gener-
(Apr 2018, 10 Marks)
ates impulses. This structure is called pacemaker.
Ans. The sequence of changes in the pressure and flow in
In mammalian heart pacemaker is SA node.
heart chambers and blood vessels in between the two
3. Conductivity: In human heart the impulses pro- subsequent cardiac contractions is known as cardiac cycle.
duced by SA node are transmitted to cardiac muscles
  Every heart beat consists of two major periods called
by means of specialized conductive system.
systole and diastole. During systole, there is contraction
- The impulse originated at SA node spreads the of cardiac muscle and blood is pumped out; and during
atria and reaches AV node through internodal diastole, there is relaxation of cardiac muscle and filling
fibers. of blood.
- AV node transmits the impulse through bundle
of his and it branches to ventricle. From the apex Phases and Events in Cardiac Cycle
of heart through the Purkinje fibers, the impulses Each cardiac cycle consists of atrial and ventricular cycles along
are conducted to base. with their phases:

♦ Atrial cycle
Atrial systole or atrial contraction phase (0.1s)
Atrial diastole (0.7s).
♦ Ventricular cycle
Ventricular systole (0.3s)
– Isovolumic contraction phase (0.05s)
– Phase of ventricular ejection which is subdivided
into rapid ejection phase (0.1s) and slow ejection
phase (0.15s).
Ventricular diastole (0.5s)
– Protodiastole (0.04s)
– Isovolumic relaxation phase (0.06s)
– Rapid passive filling phase (0.11s)
– Reduced filling phase or diastasis (0.19s)
– Last rapid filling phase (0.1s).
Atrial Cycle
Before commencement of the atrial systole ventricles get relaxed
and atrioventricular valves get opened and blood flow from
great veins into the atria and from atria to ventricles. Now atria
and ventricles form continuous cavity.
Atrial Systole
♦ Atrial systole lasts for 0.1s.
♦ This phase coincides with last rapid filling phase of ven-
tricular diastole.
♦ Atrial contraction increases intra-arterial pressure by 4 to
6 mm Hg in right atrium and 7 to 8 mm Hg in left atrium
which leads to a pressure wave recorded as a wave from
jugular vein.
♦ There is also an increase in the ventricular pressure because
of pumping of blood in ventricles.
♦ When atrial contraction starts 105 ml of blood flow into
the ventricles. Atrial contraction causes additional 25 ml
of filling of the ventricles. So at the end of atrial systole
the ventricular volume is 130 ml. This is known as end
diastolic volume.
♦ At the time of atrial systole pressure in aorta is 80 mm of Hg.
Atrial Diastole
♦ As atrial systole completes there is commencement of
atrial diastole.
♦ Its duration is of 0.7 sec.
♦ During atrial diastole, atrial musculature gets relaxed
and there is gradual filling of atria because of continuous
venous return.
♦ Pressure in the atria gradually increases and drops down
to zero along with opening of AV valves.
♦ Now pressure again increases and follows ventricular
pressure during rest of the atrial diastole.
Ventricular Cycle
As atrial contraction phase get over ventricles get excited by
impulse which travels along conducting system and starts their
contraction.
Physiology 377
Ventricular Systole
♦ Duration of ventricular systole is 0.3 sec.
♦ Ventricular systole consists of following phases, i.e. phase
of isovolumic contraction and phase of ventricular ejection.
Phase of Isovolumic Contraction
♦ As ventricular contraction starts, pressure in the ventricles
exceeds atrial pressure rapidly which causes closure of AV
valves and this leads to the production of first heart sound.
♦ As AV valves closed and semilunar valves do not open, due
to this ventricles contract as closed chamber and pressure
in ventricles increases rapidly.
♦ As the ventricles contract, volume of blood in ventricles
does not change and this phase is known as isovolumic
contraction phase.
♦ As this phase due to increase in ventricular pressure bulg-
ing of AV valves occur in atria which produces small but
sharp rise in intra-arterial pressure known as c–wave.
♦ Phase of isovolumic contraction lasts for 0.05 seconds till
pressure in left and right ventricles exceeds pressure of
aorta and pulmonary artery and aortic and pulmonary
valves open.
Phases of Ventricular Ejection
♦ This phase starts with opening of semilunar valves.
♦ Duration of this phase is 0.25 sec.
♦ This phase is subdivided into two phases i.e. rapid ejection
phase and slow ejection phase.
Rapid Ejection Phase
♦ As semilunar valves get open up blood is ejected out
rapidly for 0.1 sec.
♦ Approximately two-third of stroke volume is ejected
through each of the ventricle in rapid ejection phase.
♦ Contraction of ventricles occurs at the greater rate as com-
pared to rate at which the blood is ejected so that great rise
in pressure occurs. Here pressure rises to 120 mm of Hg in
left ventricle and 25 mm of Hg in right ventricle.
Slow Ejection Phase
♦ Slow ejection phase is of 0.15 sec.
♦ In this phase ventricular contraction decreases and the
ejection declines.
♦ Approximately one-third of stroke volume is ejected dur-
ing this phase.
♦ In this phase intra-ventricular pressure also starts declining
and falls to the value which is slightly lower as compared
to the pressure of aorta but for very short time due to
momentum blood flow forward.
Percentage of end diastolic volume which is ejected with
each stroke during systole is known as ejection fraction and 50
ml of blood in each ventricle at the end of ventricular systole is
known as end systolic volume.
378 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 34: Pressure changes in heart
Ventricular Diastole
Protodiastole
♦ As ventricular systole end up, the ventricles start relaxing
and intraventricular pressure decreases rapidly.
♦ Duration of protodiastole is 0.04 sec.
♦ In this phase increased pressure in distended arteries
pushes the blood back towards ventricles which causes
semilunar valves to close.
♦ As semilunar valves get closed the movement of blood
into the ventricles stops and produces second heart sound.
Isovolumic or Isometric Relaxation Phase
♦ As semilunar valves get close this phase begins.
♦ Its duration is of 0.06 sec.
♦ As there is closure of semilunar valves and opening of AV
valves does not occur ventricles get relaxed. This leads to
fall in pressure in ventricles.
♦ As in this phase ventricular volume remains constant this
is known as isovolumic relaxation phase.
♦ As diastole rests aortic pressure smoothly declines. As
aortic pressure declines to 80 mm of Hg next ventricular
systole enhances aortic pressure again.
♦ As AV valves get opened this phase begins.
Rapid Passive Filling Phase
♦ Duration of this phase is 0.11 sec.
♦ At the time of ventricular systole atria remains in diastole
and venous return continues due to which atrial pressure
is high.
♦ As AV valves get opened high atrial pressure leads to rapid
initial flow of blood in ventricles.
♦ Rapid passive filling phase produces third heart sound.
♦ As AV valves get opened atria and ventricles become
common chamber and pressure in both cavity declines as
ventricular relaxation continues.
Reduced Filling and Diastasis
♦ Duration of this phase is 0.19 sec.
♦ Dring this phase pressure in atria and ventricles decreases
slowly and remains just above zero which decreases blood
flow from atria to ventricle leading to a slow filling known
as diastasis.
Last Rapid Filling Phase
♦ Duration of this phase is 0.1 sec.
♦ This phase of ventricular diastole coincides with atrial
systole.
♦ Atrial systole brings the last rapid filling phase and pushes
additional 25% of blood in ventricles. With this phase
ventricular cycle gets completed.
Q.3. Write a short note on ventricular diastole.
(Mar 1998, 5 Marks)
Ans. Total duration of ventricular diastole is 0.5 sec.
Ventricular diastole consists of following phases:
i. Protodiastole (0.04 s).
ii. Isovolumic relaxation phase (0.06 s).
iii. Rapid passive filling phase (0.11 s).
iv. Reduced filling phase or diastasis (0.19 s).
v. Last rapid filling phase (0.1 s).
Protodiastole
♦ As ventricular systole end up, the ventricles start relaxing
and intraventricular pressure decreases rapidly.
♦ Duration of protodiastole is 0.04 sec.
♦ In this phase increased pressure in distended arteries
pushes the blood back towards ventricles which causes
semilunar valves to close.
♦ As semilunar valves get closed the movement of blood
into the ventricles stops and produces second heart sound.
Isovolumic or Isometric Relaxation Phase
♦ As semilunar valves get close this phase begins.
♦ Its duration is of 0.06 sec.
♦ As there is closure of semilunar valves and opening of AV
valves does not occur ventricles get relaxed. This leads to
fall in pressure in ventricles.
♦ As in this phase ventricular volume remains constant this
is known as isovolumic relaxation phase.
♦ As diastole rests aortic pressure smoothly declines. As
aortic pressure declines to 80 mm of Hg next ventricular
systole enhances aortic pressure again.
♦ As AV valves get opened this phase begins.
Rapid Passive Filling Phase
♦ Duration of this phase is 0.11 sec.
♦ At the time of ventricular systole atria remains in diastole
and venous return continues due to which atrial pressure
is high.
♦ As AV valves get opened high atrial pressure leads to rapid
initial flow of blood in ventricles.

 
(Mar 2001, 7.5 Marks)
Or
Describe in brief pressure changes in left ventricle
during cardiac cycle.
(Dec 2004, 7.5 Marks) (Sep 2009, 5 Marks)
Ans. The pressure developed inside the ventricles of heart is
called intraventricular pressure. Maintenance of blood flow
into systematic and pulmonary circulation depends on the
pressure at which the blood is pumped out of left ventricle.
• The minimum pressure in left ventricle is 5 mm Hg
and maximum pressure is 120 mm Hg.
• During atrial systole, the pressure rises to about
7 to 8 mm Hg in left ventricle.
• During ejection period, the pressure in left ventri-
cle rises to peak and then falls down. The pressure
change during ejection period is 120 mm Hg.
• During protodiastole, the pressure is around
100 mm Hg.
• The pressure during isometric relaxation phase is
around 40 mm Hg.
• During rapid filling phase, the pressure is 20 to
30 mm Hg due to relaxation of ventricles.
• During slow filling phase due to relaxation of ven-
tricles, the pressure decrease to 0 to 10 mm Hg.
Wave Configuration Cause
P wave P wave is the positive deflection Produced due to
atrial depolarization
QRS It has three consecutive waves Caused by
complex Q wave is small negative wave ventricular
which can be present normally. This depolarization
wave is continued as tall positive
R wave followed by small negative
S wave
Physiology 379
(Aug 2005, 5 Marks) (Sep 2005, 5 Marks)
 (Feb 2003, 5 Marks) (Sep 2000, 5 Marks)
 (Sep 2001, 5 Marks) (Mar 2007, 3 Marks)
 (Sep 2018, 5 Marks) (Dec 2010, 3 Marks)
Ans. The mechanical activities of heart during each cardiac
cycle cause the production of some sounds which are
called heart sounds.
The factors involved in production of heart sounds are:
1. Movement of blood through chamber of heart.
2. Movement of cardiac muscle.
3. Movement of valves of heart.
• The first heart sound or “LUBB” is a long, soft and
low pitched. It occurs during the isometric contrac-
tion and a part of ejection phase. It is caused due
to closure of AV valves. The duration of first heart
sound is 0.1 to 0.17 second and its frequency is 25
to 45 cycles/second.
• The second heart sound or “DUBB” is a short, sharp
and high pitched. It occurs during protodiastole
and part of isometric relaxation. It is caused due to
closure of semilunar valves. The duration of second
heart sound is 0.1 to 0.14 second and its frequency
is 50 cycles/sec.
• The third heart sound is low pitched. It occurs during
rapid filling phase. It is caused due to rushing of blood
into ventricles. The duration of third heart sound is 0.07
to 0.1 second and its frequency is 1 to 6 cycles/sec.
• The fourth heart sound is an inaudible sound. It
occurs during atrial systole. It is caused due to con-
traction of atrial vasculature. The duration is 0.02 to
0.04 second and its frequency is 1 to 4 cycles/sec.
Q.6. Write a short note on normal ECG. (Sep 2004, 5 Marks)
Or
Write in brief on ECG. (Apr 2008, 5 Marks)
Ans. The ECG or Electrocardiogram is graphical registration
of electrical activities of heart.
Waves of ECG
(See Following Table)
Duration Amplitude Clinical Significance
Not more than 0.1 to 0.12 mV Magnitude of P wave act is a guide
0.1 sec to functional activity of atria
Less than 0.08 Q wave – 0.1 to • Deep Q wave along with
sec 0.2 mV other changes is the sign of
R wave – 1.0 mV myocardial infarction
S wave – 0.4 mV • Tall R wave is seen in ventricular
hypertrophy
• Low voltage QRS complex is
seen in hypothyroidism and
pericardial effusion
• QRS complex is prolonged in
bundle branch block
Contd...
380 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd...

Wave Configuration Cause Duration Amplitude Clinical Significance

T wave It is the last positive dome shaped T wave represents 0.27 sec 0.3 mV • Inverted T wave is the important
deflection. It is in the same ventricular sign of myocardial infarction.
direction as QRS complex because depolarization • Tall and peaked T wave occur in
ventricular repolarization follows hyperkalemia
path opposite to depolarization
W wave Small round positive wave Occur due to slow 0.08 sec 0.2 mV It is prominent in hypokalemia
repolarization of
papillary muscle

♦ Ischemia and ventricular conduction defects prolonged

Fig. 35: Normal ECG
Intervals and Segments of ECG
P-R Interval
♦ It is measured from onset of P wave to onset of QRS
complex.
♦ The interval actually is P-Q interval but Q wave is
frequently absent so it is known as P-R interval.
♦ This interval measures AV conduction time including AV
nodal delay.
♦ Its duration ranges from 0.12 to 0.21 sec depending on
heart rate.
♦ Prolonged P-R interval is indicative of AV conduction
block.
J Point
It refers to the point on ECG which coincides with end of
depolarization and start of repolarization of ventricles. At J
point all parts of ventricles get depolarized so no current flows
around the heart.
Q-T Interval
♦ Time from beginning of QRS complex to the end of T wave.
♦ It indicates total systolic time of ventricles, i.e. both
ventricular depolarization and ventricular repolarization.
♦ Duration of this interval is 0.4 sec.
Q-T interval. In hypocalcemia it is also prolonged.
T-P Interval
♦ This is measured from end of T wave to beginning of P wave.
♦ It measures diastolic period of heart.
♦ Variability in T-P interval indicated AV dissociation.
P-P Interval
♦ It is the interval between two successive P waves.
♦ This indicates rhythmic depolarization of atria.
ST Segment
♦ Isoelectric period between end of QRS complex and begin-
ning of T wave is known as ST segment.
♦ Its duration is 0.32 sec.
♦ It corresponds with ventricular repolarization.
♦ It is elevated in patients with the myocardial infarction.
Q.7. Write a note on cardiac output, methods of determina-
tion and factors determining it. (Mar 1997, 8 Marks)
Ans. Cardiac output is the amount of blood pumped out by
each ventricle into circulation each minute.
Cardiac output is most important factor in cardiovascular
system, because the rate of blood flow through different
part of body depends on cardiac output.
• Cardiac output in average adult is about 5 L/min.
Cardiac output = Stroke volume × Heart Rate
• Methods of Determination: Cardiac output is meas-
ured by following methods.
Factors Regulating Cardiac Output
Cardiac output in experimental animals is measured with the
help of electromagnetic flowmeter. In humans only indirect
methods are possible which includes:
1. Fick’s principle
2. Indicator or dye dilution method
3. Thermodilution method
4. Physical methods:
a. Doppler technique echocardiography
b. Ballistocardiography.
Based on Fick’s Principle
As per the Fick’s principle the amount of substance taken up
by an organ per unit time is equal to the arterial level of the
 Physiology 381

substance minus the venous level (A – V difference) times the
blood flow i.e. amount of substance taken per min = (A – V)
difference of the substance × blood flow per min.
Amount of substance taken/min
Blood flow/min =
(A – V) difference of the substance
Fick’s principle is used to determine cardiac output, So
Amount of oxygen consumed by the
   whole body per unit time
LV Output =
(A – V) oxygen difference across the lungs
As arterial blood has same oxygen content in all parts of the
body, the arterial oxygen content can be measured in sample
obtained from any convenient artery. Sample of venous blood
in pulmonary artery is obtained by cardiac catheter which is
inserted via a foramen vein and its tip is guided in right atrium
by fluoroscope and through right ventricle in pulmonary artery.
Oxygen consumption is determined by the close circuit spirometry.
Calculation of cardiac output is as follows:
Resting oxygen consumption in body (mL/min)
LV output =
[AO2] [VO2]
is measured by determining the resultant change in blood
temperature in pulmonary artery.
Physical Methods
Following are the physical methods used to measure cardiac
output:
Echocardiography
It is the ultrasonic evaluation of cardiac functions. It involves
B-scan ultrasound frequency of 2.25 MHz using a transducer
which act as receiver for the reflected waves. The recording of
the echoes displayed against time on an oscilloscope provides
the complete record of:
♦ Movement of both ventricular wall and septum along with
valves during cardiac cycle.
♦ When this procedure gets combined with the Doppler
techniques, echocardiography is used to measure velocity
and volume of flow through valves.
♦ So it is useful in evaluating end diastolic volume, end
systolic volume, cardiac output and valvular defects.


250 mL/min
=
19 mL/dL arterial blood – 14 mL/dL venous
     blood in pulmonary artery
250 mL/min
=
5 mL/dL

250 × 100
=
5
= 5000 mL/min or 5 L/min.

Indicator or Dye Dilution Technique (Mar 2000, 5 Marks)

In this technique, a known amount of dye is injected into the
arm vein. Dye will first pass through the heart and then the
pulmonary circulation and finally evenly distributed in the
blood stream. Its mean concentration during the first passage
through an artery is determined from the successive samples
of blood taken from artery.
Blood flow in liters/min (F) is given by the formula:
Q to heart will increase. Therefore, more is end diastolic
F =
Ct
F = Blood flow in litres/min
Q = Quantity of the injected dye
C = Mean concentration of dye
t = Time duration in second of the first passage of dye
through artery.
Thermodilution Method
Principle: It is an indicator dilution technique in which in place
of dye cold saline is used as an indicator. Cardiac output
Ans. The force of contraction of myocardium depends upon
its preload, i.e. the degree to which myocardium is
stretched before it contracts; and after load is resistance
against which the ventricles pump the blood.
  In heart, extent of preload is directly proportional to
end diastolic volume, i.e. amount of blood remaining
in ventricles at the end of diastole. Any factor which
increases venous return, i.e. volume of blood returning
volume, more will be stretching of myocardium, i.e.
initial length of cardiac muscle fiber and more is force
of contraction of myocardium.
  So, this is the heterometric regulation of cardiac output.
Q.9. Write in brief on regulation of heart rate.
(Sept 2000, 5 Marks) (Jan 2012, 6 Marks)
Ans. The activities of heart are continuously regulated by
nervous regulation. This is essential for heart to cope up
with needs of body. The stimulation of nerves to heart
produces several effects on heart rate. These effects are:
382 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Chronotropic action: It is the effect on the heart rate.
Two types of chronotropic actions are:
I. Tachycardia, i.e. increase in heart rate.
II. Bradycardia, i.e. decrease in heart rate.
The cardiac centers are mainly responsible for regulation
of heart rate. There are two centers:
1. Cardioinhibitory center: It is situated in reticular
formation of medulla oblongata. The cardioinhibi-
tory center reduces the heart rate. It sends inhibitory
impulses through vagus nerve fibers and causes dila-
tation of blood vessels. Stimulation of this center with
weak electric stimulus causes reduction in heart rate.
2. Cardioaccelerator center: It is situated in reticular
formation of medulla in floor of IVth ventricle. The
center accelerates the heart rate by inhibiting cardi-
oinhibitory centers. It causes constriction of blood
vessels. Stimulation of center causes tachycardia.
- The baroreceptors decrease the heart rate.
Whenever blood pressure is increased, they are
stimulated and send stimulatory impulses to
cardioinhibitory centers and causes bradycardia.
- The chemoreceptors on the other hand increase
the heart rate. Whenever there is hypoxia, hyper-
capnia on increased hydrogen ion concentra-
tion in blood these receptors send inhibitory
impulses to cardioinhibitory center. Vagal tone
is reduced and heart rate is increased.
Q.10. Write briefly on baroreceptors. Ans. •
(Aug 2012, 5 Marks) (Sep 2006, 4 Marks)
Ans. •  The receptors which give response to change in blood
pressure are called baroreceptors or pressoreceptors.
• The baroreceptors are situated in the carotid sinus.
These receptors are also situated in wall of arch of aorta.
Baroreceptors in carotid sinus are supplied by Her-
ing s nerve. The baroreceptors in arch of aorta are
supplied by aortic nerve.
• When the blood pressure is increased, the barorecep-
tors are stimulated and send stimulatory impulses to
cardioinhibitory center. The vagal tone is increased
and heart rate is reduced. When pressure is less, the
baroreceptors do not sent impulses and heart rate is
not decreased.
Q.11. Describe short-term regulation of blood pressure.
(Sep 2001, 7.5 Marks) (Feb 2003, 7.5 Marks)
(Feb 2016, 10 Marks)
Or
Describe nervous regulation of blood pressure.
(Mar 2005, 8 Marks)
Or
Describe in brief nervous control of blood pressure.
(Mar 2007, 4 Marks)
 (July 2016, 5 Marks)
The nervous regulation is called short-term
regulation of blood pressure. It is very rapid among
all mechanism involved in regulation of blood
pressure.
• The nervous mechanism regulates the blood pres-
sure by causing constriction and dilatation of vessels.
• The nervous mechanism constitutes the vasomotor
system. Vasomotor system consists of:
1. Vasomotor center
2. Vasoconstrictor fibers
3. Vasodilator fibers.

Vasomotor Center
Bilaterally situated in reticular formation of medulla oblongata
and lower part of pons. Vasomotor center has three areas:
1. Vasoconstrictor area.
2. Vasodilator area.
3. Sensory area.
Vasoconstrictor Area
It is also called pressure area and is situated in the anterior part
of vasomotor center in medulla oblongata.
♦ This area sends impulses to vessels through sympathetic
vasoconstrictor fiber.
♦ Stimulation of this area causes vasoconstrictor area and
Fig. 36: Baroreceptors increases blood pressure.
♦ The area also concerned with heart rate.

Vasodilator Area
It is also called depressor area and is situated in the upper part
in medulla and suppresses the vasoconstrictor area and causes
vasodilation. It is also concerned with cardioinhibition.
Sensory Area
♦ It is situated in the posterior part of vasomotor center
which is situated in medulla and pons.
♦ This receives sensory impulses from glossopharyngeal and
vagal nerve and from baroreceptor.
Vasoconstrictor Fibers
♦ The nerve fibers which cause constriction of blood vessels
are called vasoconstrictor fibers.
♦ The vasoconstrictor fibers belong to sympathetic division
of autonomic nervous system.
♦ The fibers cause vasoconstriction by release of neurotrans-
mitter substance noradrenaline.
Vasodilator Fibers
The nerve fibers which cause dilatation of blood vessels are
called vasodilator fibers. They are of three types:
1. Parasympathetic vasodilation fibers
2. Sympathetic vasodilation fibers
3. Antidromatic vasodilation fibers.
The vasomotor center regulates blood pressure by receiving
in from baroreceptors.
Q.12. Write in brief on vasovagal attack. (Mar 2009, 6 Marks)
Ans. The severe emotional disturbances may cause fainting,
this is known as vasovagal attack.
• This is due to activation of sympathetic vasodilator
fibers, which causes dilatation of peripheral blood
vessels and fall in blood pressure.
• Simultaneously, cardioinhibitory center is stimu-
lated. This increases vagal tone and reduced heart
rate.
• The reduced blood pressure and heart rate leads to
ultimate result in reduction of blood flow to brain
which causes fainting.
• The vasovagal attack is a neurogenic shock due to
decreased vascular capacity.
Q.13. Write about the role of renin angiotensin aldosterone spreads around line of stroke. It spreads for about
system in long-term regulation of blood pressure.
(Mar 1998, 5 Marks)
Or
Describe in brief renin angiotensin mechanism for
regulation of blood pressure. (Mar 2006, 10 Marks)
Or
Write on long-term regulation of blood pressure.
(Apr 2017, 5 Marks)
Ans. Blood pressure is the lateral pressure exerted by blood
on the vessel walls while flowing through it. The blood
pressure is expressed in different terms.
Physiology 383
systole
diastole
3. Pulse pressure : Difference between systolic
and diastolic pressure.
4. Mean pressure : Average pressure exerting
on vessels.
• When blood pressure is decreased the extraglomeru-
lar apparatus secretes the hormone renin. When
renin is released into blood, it acts on specific plasma
protein called angiotensinogen and convert it into
decapetide called angiotensin I. This is converted to
angiotensin II by activity of converting enzyme in
lungs.
• Angiotensin II acts in two ways to increase the blood
pressure:
1. It causes vasoconstriction in the body so that
peripheral resistance is increased and blood
pressure rises.
2. Angiotensin II also stimulates adrenal cortex
to stimulate aldosterone. This increases reab-
sorption of sodium from renal tubules. Sodium
reabsorption is followed by water reabsorption
and thereby ECF volume is increased and blood
pressure becomes normal.
Q.14. Write a short note on triple response.
(Mar 2000, 5 Marks)
Ans. It is the response by blood vessels of skin to a mechanical
stimulus. This is called triple response. It constitutes
three reactions which occur one after another. The three
reactions of this response are:
1. Red reaction: If a pointed instrument is drawn firmly
over the surface of skin, a red line appears instead of
white line. This is called red reaction. The reaction
occurs over the line of stroke. Red reaction is because
of dilatation of capillaries produced by mechanical
stimulus. The reaction is purely a local response. It
occurs mostly due to release of histamine substances.
2. Flare: If a stroke is applied with little more force or
if stroke is repeated on same line, the red reaction
10 cm from line of stroke. This is called flare
or spreading flush. Flare is due to dilatation of
arterioles. This is due to axon reflex.
3. Wheal: If the intensity of stimulus is severe, the
surface of skins on line of stroke is interrupted. A
small elevation or swelling is seen on surrounding
area up to height of 2 mm. This is called wheal or
local edema. Wheal appears due to leakage of fluid
from capillaries.
Q.15. Write in brief on hemorrhagic shock.
(Apr 2007, 10 Marks)
(Aug/Sep 1998, 6 Marks) (Sep 2007, 4 Marks)
384 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Ans. Hemorrhage means excessive loss of blood due to 

rupture of blood vessels due to which shock is produced
which is known as hemorrhagic shock.

Types and Causes of Hemorrhage

1. Accidental hemorrhage: It occurs in road of industrial
hemorrhage.
2. Capillary hemorrhage: Due to rupture of blood vessels,
this is very common in brain and heart during cardiovas-
cular system.
3. Internal hemorrhage: Caused by rupture of blood vessels
in viscera.
4. Postpartum hemorrhage: This occurs immediately after
labor.
5. Hemorrhage due to premature detachment of placenta.

Compensatory Mechanism in Hemorrhagic Shock

After hemorrhage, series of compensatory reactions are
developed in the body to cope up with blood loss; some of
compensatory reactions take place. There are two types of
compensatory reactions:
1. Immediate compensatory effects
Reduced blood volume after hemorrhage decreases
venous return, ventricular filling and cardiac output.
In severe hemorrhage there is fall in blood pressure.
The mechanism for maintaining blood pressure is
that carotid and aortic baroreceptors stop discharging
impulses which leads to vasoconstriction and take
blood pressure to normal level.
Heart rate is increased to maintain cardiac output.
Respiration increases both in rate and depth.
The skin is cold and there is less evaporation of sweat
leading to cold sweat.
Diminution in urine flow occurs due to impaired renal
circulation.
2. Delayed compensatory effect: If hemorrhage is not severe,
some delayed compensatory reactions occur. These reac-
tions help to restore blood volume, blood pressure and
blood flow to different regions of body; the reactions are:
1. Restoration of plasma volume: Because of increase
in plasma, hemodilution occurs. So concentration of
plasma proteins and hemoglobin is low.
2. Restoration of plasma proteins: Mobilization of
reserve proteins store in liver start within few hours
after hemorrhage. The plasma proteins help to retain
the fluid transported from tissues to blood.
3. Restoration of RBC count and hemoglobin: Hypoxia
after hemorrhage stimulates secretion of erythropoietin
from kidney. This in turn stimulates erythropoiesis
and hemoglobin level also comes to normal level with
maintained RBC count.
Q.16. Write briefly about circulatory shock.
(Dec 2009, 5 Marks)
Ans. The depression of body functions produced by any
disorder is generally called shock. When it is developed by
cardiovascular disorder, it is known as circulatory shock.
(Apr 2003, 15 Marks)
Ans. Cardiovascular adjustment during the exercise:
During exercise, there is an increase in metabolic needs
of body tissues, particularly muscles. Thus, the various
adjustments which take place in the body are aimed
at:
1. Supply of various metabolic requisites like nutrients
and oxygen to muscles and other tissues involved
in exercise.
2. Prevention of increase in body temperature: Exercise
is generally classified into two types depending
on types of muscular contraction. Cardiovascular
adjustments are slightly different in two types of
exercises:
a. Dynamic exercise: This involves isotonic
muscular contraction. In this type of exercise
heart rate, force of contraction, cardiac output
and systolic blood pressure increase. However,
diastolic pressure is altered or reduced. This is
because the peripheral resistance is unaltered or
decreased.
b. Static exercise: This involves isometric muscu-
lar contraction. In this apart from increase in
heart rate, force of contraction, cardiac output
and systolic blood pressure, the diastolic blood
pressure also increases. This is due to increase
in peripheral resistance.
Effect of exercise on cardiovascular system:
1. On blood: The mild hypoxia developed
during exercise stimulates juxtaglomerular
apparatus to secret erythropoietin. This
causes release of RBC.

2. On heart rate: Heart rate increases during
exercise. The heart rate increase during
exercise is due to vagal withdrawal.
3. On cardiac output: During exercise, the
cardiac output is increased because of
increase in heart rate and stroke volume.
Increased heart rate is because of vagal
withdrawal and increase stroke volume is
because of increase in force of contraction.
4. On blood pressure: During moderate
isotonic exercise, the systolic pressure is
elevated. This is due to increased heart rate
and stroke volume. Diastolic pressure is not
altered since peripheral resistance is not
changed during moderate isotonic.
Respiratory adjustment during exercise: On the
basis of severity, the exercise is classified into three
types:
1. Severe exercise: It includes strenous muscle ac-
tivity but severity can be maintained for severe
duration. Complete exhausion occurs at end of
severe exercise.
2. Moderate exercise: It does not involve strenous
muscular activity. So this type of exercise is
performed for longer period. Exhaustion does
not occur at the end of moderate exercise.
3. Mild exercise: This is very simple form of
exercise. Little or no changes occur in respiratory
system during this exercise. So exhaustion does
not occur during mild exercise.
Effects of Exercise on Respiratory System
1. Effect on pulmonary ventilation: It is the
amount of air that enters and lungs being in one
minute. During exercise, hyperventilation occurs
causing increase in rate and force of respiration.
The factors which undergo adjustments during
increase in pulmonary ventilation are higher
centers, chemoreceptors, proprioceptors, body
temperature and acidosis.
2. Effects on diffusing capacity for oxygen: During
exercise, blood flow through pulmonary capillaries
is increased. Because of this, diffusing capacity of
alveoli for oxygen is increased.
3. Effect on consumption of oxygen: The oxygen
consumed by the tissues particularly by skeletal
muscles is greatly enhanced during exercise.
Because of vasodilatation in muscles during
exercise, more amount of blood flows through
muscles, so more amount of oxygen diffuses
into muscles from blood and amount of oxygen
utilized by muscles is directly proportional to
amount of oxygen available.
4. Effects on respiratory quotient: It is the ratio be-
tween the volume of CO2 evolved and volume of
oxygen consumed. It increases during exercises.
Its value during exercise is 1.5 to 2 and at resting
condition is 0.8.
Physiology 385
Q.18. Write in brief on Fick’s principle.
(Mar 2006, 3 Marks)
Ans.
As per the Fick’s principle the amount of substance taken up
by an organ per unit time is equal to the arterial level of the
substance minus the venous level (A–V difference) times the
blood flow i.e. amount of substance taken per min = (A–V)
difference of the substance × blood flow per min.
Amount of substance taken/min
Blood flow/min =
(A—V) difference of the substance
Fick’s principle is used to determine cardiac output, So
LV Output = Amount of Oxygen consumed by the whole
body per unit time
(A—V) oxygen difference across the lungs
As arterial blood has same oxygen content in all parts of the
body, the arterial oxygen content can be measured in sample
obtained from any convenient artery. Sample of venous blood
in pulmonary artery is obtained by cardiac catheter which is
inserted via a foramen vein and its tip is guided in right atrium
by fluoroscope and through right ventricle in pulmonary
artery. Oxygen consumption is determined by the close circuit
spirometry.
Calculation of cardiac output is as follows:
LV output = Resting oxygen consumption in body (mL/min)
[AO2] [VO2]
= 250 mL/min
19 mL/dL arterial blood – 14 mL/dL venous
blood in pulmonary artery
= 250 mL/min
5 mL/dL
= 250 ×100
5
= 5000 mL/min or 5L/min.
Disadvantages
♦ As this technique is invasive so risk of hemorrhage and
infection is present.
♦ As patient get conscious about the whole technique so
cardiac output of the patient can be somewhat higher as
compared to the normal.
♦ During this method ventricular fibrillation may occur
which is a fatal complication. This occurs if the indwell-
ing catheter irritates the ventricular walls specially when
cardiac output is being measured during heavy exercise.
Q.19. Write a short note on brain bridge reflex.
(Dec 2004, 5 Marks)
Ans. It is also called as cardioaccelerator reflex.
• Increase in venous return causes stretching of the
wall of right atrium and big veins. Stretch receptors
are stimulated in the wall.
386 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• They send afferent impulses via vagus inhibiting
cardioinhibitory area, i.e. dorsal nucleus of vagus
and heart rate increases.
This reflex helps to increase heart rate during ex-
ercise when venous return is more and also after
transfusion of blood and fluids.
Q.20. Describe in brief control of cardiac output.
(Sep 2007, 4 Marks) (Mar 2008, 4 Marks)
Ans. Cardiac output is the amount of blood pumped from
each ventricle.
Cardiac output is the most important factor in
cardiovascular system, because the rate of blood flow
through different parts of the body depends upon the
cardiac output.
Various factors control or maintain the cardiac output:
1. Venous return.
2. Force of contraction.
3. Frequency of heart beat.
4. Peripheral resistance.
Venous Return
Venous return is the amount of blood, which is returned
to the heart from different parts of the body. When it is
increased, the ventricular filling is increased and cardiac
output is increased.
Venous Return Depends On
♦ Respiratory pump:
During inspiration, the intrapleural pressure becomes
more negative.
Same time descent of diaphragm increases the intra-
abdominal pressure.
Because of negative pressure in thorax, the diameter
of inferior vena cava is increased with reduction in
pressure inside.
Due to increased intra-abdominal pressure, the flow
of blood into right atrium is increased.
This action is called respiratory pump.
♦ Muscle pump:
During muscular activity, the veins are compressed
or squeezed.
Due to the presence of valves in veins during compression
the blood is moved towards the heart. This is called the
muscle pump.
When muscular activity increases the venous return
is more.
Force of Contraction
♦ The cardiac output is directly proportional to the force of
contraction.
♦ Force of contraction depends upon diastolic period and
ventricular filling.
♦ According to frank Starling’s law, the force of contraction
is directly proportional to the initial length of muscle fibers
within physiological limits.

(Apr 2008, 4 Marks)
Ans. Chemoreceptor are receptors giving response to change
in chemical constituents of blood.
Situation: Peripheral chemoreceptor are situated in the
carotid body and aortic body.
• Peripheral chemoreceptors are discovered by Hey-
man” in 1930.
• There is a carotid body near the common carotid
artery bifunction on each side and there are usually
two or more aortic bodies near the arch of aorta.
• Each carotid and aortic body contains two types of
cells, type I and II cells.
• These cells are surrounded by fenestrated sinusoidal
capillaries.
• Type II cells are glial cells that support the type I cells.
Nerve Supply
The chemoreceptor in the carotid body are supplied by Hering s
nerve which is the branch of glossopharyngeal nerve.
The chemoreceptors in aortic body are supplied by the aortic
branch of vagus nerve.
Functions
♦ When ever there is hypoxia, hypercapnea and increased
hydrogenions concentration in the blood, the chemorecep-
tors send inhibitory impulses to cardioinhibitory center.
♦ Vagal tone is reduced and heart rate is increased.
♦ The chemoreceptors take major role in maintaining respira-
tion than the cardiovascular system.
Q.22. Describe in brief vasomotor center.
(Mar 2008, 3 Marks)
Ans. Vasomotor center: Bilaterally situated in reticular
formation of medulla oblongata and lower part of pons.
Vasomotor center has three areas:
a. Vasoconstrictor area
b. Vasodilator area
c. Sensory area.
Vasoconstrictor Area
It is also called pressure area and is situated in the anterior part
of vasomotor center in medulla oblongata.
♦ This area sends impulses to vessels through sympathetic
vasoconstrictor fiber.

♦ Stimulation of this area causes vasoconstrictor area and
increases blood pressure.
♦ The area also concerned with heart rate.
Vasodilator Area
It is also called depressor area and is situated in the upper part
in medulla and suppresses the vasoconstrictor area and causes
vasodilation. It is also concerned with cardioinhibition.
Sensory Area
It is situated in the posterior part of vasomotor center which is
situated in medulla and pons. This receives sensory impulses
from glossopharyngeal and vagal nerve and from baroreceptor.
Q.23. Describe in brief arterial blood pressure.
(Aug 2012, 5 Marks)
Or
Write on arterial blood pressure and its variations.
(Feb 2013, 7 Marks)
Or
Write short note on arterial blood pressure.
(Aug 2011, 5 Marks)
Ans. Arterial blood pressure is defined as the lateral pressure
exerted by the column of blood on the wall of arteries.
Arterial blood pressure is expressed in four different terms:
1. Systolic blood pressure
2. Diastolic blood pressure
3. Pulse pressure
4. Mean arterial blood pressure.
Systolic Blood Pressure
Systolic blood pressure is defined as the maximum pressure exerted
in the arteries during systole of the heart. The normal systolic
pressure is 120 mm Hg. It ranges between 110 and 140 mm Hg.
Diastolic Blood Pressure
Diastolic blood pressure is defined as the minimum pressure
in the arteries during diastole of the heart. The normal diastolic
pressure is 80 mm Hg. It varies between 60 and 80 mm Hg.
Pulse Pressure
Pulse pressure is the difference between the systolic pressure
and diastolic pressure.
Normally, it is 40 mm Hg (120 to 80).
Mean Arterial Blood Pressure
It is the average pressure existing in the arteries. It is not
the arithmetic mean of systolic and diastolic pressures. It
is the diastolic pressure plus one-third of pulse pressure.
To determine the mean pressure, the diastolic pressure is
considered than the systolic pressure because the diastolic
period of cardiac cycle is longer (0.53 second) than the systolic
period (0.27 second). Normal mean arterial pressure is 93 mm
Hg.
Physiology 387
Physiological Variations
Age
Arterial blood pressure increases as age advances, e.g. the
systolic pressure in newborn is 40 mm Hg while in 50 years it
is 140 mm Hg.
Sex
In females, up to the period of menopause, the arterial pressure
is about 5 mm Hg less than in males of same age. After
menopause, the pressure in females becomes equal to that in
males of same age.
Body Built
The pressure is more in obese persons than in lean persons.
Diurnal Variation
In early morning, the pressure is slightly low. It gradually increases
and reaches the maximum at noon. It becomes low in evening.
After Meals
The arterial blood pressure is increased for few hours after meals
due to increase in cardiac output.
During Sleep
Usually, the pressure is reduced up to 15 to 20 mm Hg
during deep sleep. However, it increases slightly during sleep
associated with dreams.
Emotional Conditions
During excitement or anxiety, the blood pressure is increased
due to release of adrenaline.
Pathological Variations
The hypertension and hypotension are the pathological
variations of arterial blood pressure.
Q.24. Write a brief account of cardiac output.
(Jan 2012, 8 Marks)
Ans. Refer to Ans 7 and Ans 20 of same chapter.
Q.25. Write in brief on baroreceptor reflex.
(Jan 2012, 3 Marks) (Dec 2014, 5 Marks)
Or
Write briefly about sinoaortic reflex.
(Aug 2016, 2 Marks)
Ans. Baroreceptor reflex is one of the cardiovascular reflex and
it regulates blood pressure within seconds. Baroreceptor
reflex is therefore a lifesaving reflex. This is also called
baroreflex or sinoaortic reflex.
Receptors and Stimulus
♦ The receptors for baroreceptor reflex are baroreceptors. They
detect change in pressure in the blood vessels and chambers
of the heart. Usually, baroreceptors are classified into two
categories—high pressure and low pressure receptors.
388 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦ High-pressure baroreceptors are located in the ventricle When Blood Pressure Increases
and arterial side of circulation, and the low-pressure
baroreceptors are mainly present in the atria and
pulmonary circulation (cardiopulmonary baroreceptors).
♦ Receptors for baroreceptor reflex are high-pressure baro-
receptors that are present in the wall of the carotid sinus
and aortic arch.
♦ These receptors are branched, knobby and intertwined
terminals of myelinated nerve fibers.
♦ Baroreceptors detect change in pressure in blood vessels
in the wall of which they are located.
♦ The increase in blood pressure causes distension of carotid
sinus and aortic arch and stimulates receptors as they
respond to stretch of the organ. Conversely, decreased
pressure decreases the receptor stimulation.

Afferent Pathways
Ninth cranial (glossopharyngeal) nerve is the afferent from
carotid sinus and tenth cranial (vagus) nerve is the afferent
from aortic arch.
♦ The fibers from carotid sinus in the glossopharyngeal nerve
form a distinct branch called carotid sinus nerve. This is
also called as buffer nerve as it buffers blood pressure when
blood pressure changes.
♦ The fibers in the vagus nerve that carry sensation from
aortic arch form the aortic nerve.
♦ Distension of carotid sinus and aortic arch causes stretch-
ing of the baroreceptors and increases the firing (nerve
traffic) in IX and X cranial nerves respectively.

Centers When Blood Pressure Decreases

♦ Centers for baroreceptor reflex are medullary cardiovas-
cular centers.
♦ These include vasomotor center and cardioinhibitory
centers
♦ Though bulbospinal pathway, vasomotor center projects to
intermediolateral grey column of spinal cord from where
sympathetic fibers originate.
♦ Vagus nerve originates from NTS.
♦ Normally NTS inhibits vasomotor center through interneu-
rons. So excitation of cardioinhibitory center stimulates
vagus nerve and inhibits sympathetic fibers.

Efferent Pathways and Effector Organs

Efferent fibers for baroreceptors are sympathetic fibers and
vagus nerve.
♦ Sympathetic fibers originate from intermediolateral gray
column of the spinal cord, which is controlled by vasomo-
tor center.
♦ Vagus nerve originates from NTS. Vagus nerve innervates
heart and sympathetic fibers innervate heart and blood
vessels.

Responses
Responses depend on the nature of change (increase or decrease)
in blood pressure. Responses also depend on degree and rate
of change in blood pressure.

Pressure Range for Responses
Baroreceptors regulate blood pressure in the pressure range of
50 to 200 mm Hg. However, a linear relationship is observed
for the change in blood pressure and the baroreceptor discharge
between pressure range of 70 to 140.1 mm Hg. No response is
detected when pressure is less than 50 mm Hg and no further
increase in response occurs when pressure is more than 200
mm Hg.
Types of Responses
Baroreceptors respond to change in pulse pressure and change
in mean arterial pressure.
♦ Response to change in pulse pressure is called phasic or
dynamic response and response to change in sustained
pressure is called tonic or static response.
♦ Decrease in pulse pressure without change in mean arterial
pressure decreases carotid sinus discharge, and decrease
in mean arterial pressure without change in pulse pressure
also decreases sinus nerve discharge.
♦ However changes in pulse pressure and mean arterial
pressure usually occur simultaneously.
Physiological Significance of Baroreceptor Reflex
♦ When blood pressure falls, baroreceptor reflex operates
within few seconds to correct the pressure, which is essen-
tial and life saving in acute hypotension and hemorrhage.
This is also life saving in day-to-day activities
♦ Baroreceptor reflex regulates blood pressure when pres-
sure change is within the range of 50 to 200 mm Hg. So,
baroreceptors and their reflex pathway constitute a feed-
back mechanism to stabilize blood pressure over a wide
range of fluctuation in pressure.
♦ Baroreceptor reflex explains the physiological basis for
Marey's law, which states that heart rate is inversely pro-
portional to blood pressure.
♦ Baroreceptor resetting occurs in chronic hypertension.
Q.26. Write in brief on atherosclerosis.
(May/June 2009, 5 Marks)
Ans. Atherosclerosis is the condition which is characterized
by infiltration of cholesterol under the tunica intima of
arterial wall.
• This causes the changes in smooth muscle cells,
platelets, macrophages and inflammatory mediators
which produce proliferative lesions which ulcerate
and calcify.
• The above changes predisposes to myocardial infarc-
tion, cerebral thrombosis, etc.
Q.27. Describe cardiac cycle in detail, explaining pressure – Ventricular pressure decreases as ventricular
and volume changes during various phases.
(Nov 2009, 8 Marks)
Ans. Sequence of changes in pressure and flow in heart
chambers and blood vessels in between the two
subsequent cardiac contractions is known as cardiac
cycle.
Physiology 389
Events in Cardiac Cycle Explaining Pressure and Volume
Changes
Arterial Systole
♦ Its duration is of 0.1 second.
♦ During this phase arterial pressure rises along with the
ventricular pressure. Right arterial pressure rises up to 4 to
6 mm Hg while left arterial pressure rises to 7 to 8 mm Hg.
♦ This increases approximate 30% of blood volume in ven-
tricles.
Ventricular Systole
It consists of two major phases, i.e. isovolumetric ventricular
contraction and ventricular systole proper.
Isovolumetric Ventricular Contraction
♦ Its duration is of 0.05 seconds.
♦ As atrial contraction is off, pressure in both atria and
ventricles decreases. The ventricles get invaded by excita-
tion process. Ventricular contraction start and pressure in
ventricles increases which exceed atrial pressure rapidly
causing closure of AV valves.
♦ Pressure in ventricles rises at the time of isometric phase.
♦ Onset of ventricular systole leads to bulging of AV valve in
atrium which causes sharp rise in atrial pressure.
Ventricular Systole Proper
♦ Its duration is of 0.25 sec.
♦ When pressure in left ventricle exceed pressure of aorta,
i.e. 80 mm of Hg and pressure in right ventricle exceed
pressure in pulmonary artery, i.e. 10 to 12 mm of Hg the
semilunar valves open.
♦ As semilunar valves open, ejection phase occur. In this
phase articular and ventricular pressure are close to each
other. This is subdivided in three phases
1. Initial phase or rapid ejection phase
– Its duration is of 0.1 second.
– Pressure inside the ventricles rises to 120 mm
of Hg in left ventricle and 25 mm of Hg in right
ventricle which causes increase in output of ven-
tricular volume.
– Around two-third of stroke volume is ejected in
this phase.
– As there is opening of semilunar valves the AV
valves regain their position and blood pressure falls.
2. The Summit or Peak of ventricular curve occurs
when aortic or pulmonary artery pressure exceeds
ventricular pressure.
3. Final phase or slow ejection phase
– Its duration is 0.15 sec.
contraction subsides with slow ejection of blood
from ventricles to arteries.
Volume of blood which is ejected by each ventricle per
stroke at rest is 70 to 80 ml and is known as stroke volume.
End diastolic ventricular blood volume is 120 to
140 ml and leaves 50 ml of blood in each ventricle at end
390 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

of systole which is known as end systolic ventricular • AV node is a muscular bridge which connects atrium
blood volume. and ventricular musculature.
• From AV node the conduction of impulse is slow
Ventricular Diastole which is known as AV nodal delay. Conduction
It consists of four phases: velocity is 0.05 m/sec.
• From AV node impulse travel via bundle of His and
Protodiastole stimulates ventricular myocardium. The conduction
♦ It is of 0.04 sec duration. velocity is 1 m/sec.
♦ At end of ventricular systole the ventricular pressure • Middle part of interventricular septum over left side
decreases rapidly. is the first region in ventricle to be stimulated.
♦ During protodiastole arterial pressure is sustained and • From here impulse passes via septum to the right
immediately it increases. This causes closure of semilunar side and then it spread to apex over other side.
valves and produces second heart sound. • In ventricle, the impulse is conducted by purkinje
fibers at velocity of 4 m/sec. Conduction of impulse
Isovolumetric Ventricular Relaxation Phase is at rate 1 m/sec.
Its duration is of 0.08 sec.
♦ Q.29. Write in brief on regulation and measurement of BP.
In this pressure inside the ventricles drop rapidly and
♦ (Dec 2010, 6 Marks)
ventricular muscles relax, but there is no change in the Ans. For regulation of blood pressure refer to Ans 11 and 13
volume of ventricles. of same chapter.

Measurement of Blood Pressure
Arterial pressure is most commonly measured via a sphyg-
momanometer.
For each heartbeat, BP varies between systolic and diastolic
pressures. Systolic pressure is peak pressure in the arteries, which
occurs near the end of the cardiac cycle when the ventricles
are contracting. Diastolic pressure is minimum pressure in the
arteries, which occurs near the beginning of the cardiac cycle
when the ventricles are filled with blood. An example of normal
measured values for a resting, healthy adult human is 120 mm
Hg systolic and 80 mm Hg diastolic (written as 120/80 mm Hg).
Measuring pressure invasively, by penetrating the arterial
wall to take the measurement, is much less common and usually
restricted to a hospital setting.

Non-invasive
The non-invasive auscultatory and oscillometric measurements
are simpler and quicker than invasive measurements, require less
expertize, have virtually no complications, are less unpleasant and
less painful for the patient. However, non-invasive methods may
yield somewhat lower accuracy and small systematic differences
in numerical results. Non-invasive measurement methods are
more commonly used for routine examinations and monitoring.

Auscultatory
Auscultatory method aneroid sphygmomanometer with
stethoscope.
(June 2010, 5 Marks)
Ans. Following is the conduction of cardiac impulse in heart:
• Cardiac impulse originates in SA node and travel to
the myocardium of atrium in radial direction.
• Conduction velocity of impulse in SA node is 0.05
m/sec. Impulse spread to left atrium through the
common musculature which encircles it.
• Conduction velocity of impulse in atrium is 1 m/sec.
• Impulse is now conducted to AV node by atrial
muscle or internodal tract. Fig. 37: Sphygmomanometer with stethoscope

Mercury Manometer
Fig. 38: Sphygmomanometer
The auscultatory method uses a stethoscope and a sphyg-
momanometer.
This comprises an inflatable cuff placed around the upper
arm at roughly the same vertical height as the heart, attached
to a mercury or aneroid manometer. The mercury manometer,
considered the gold standard, measures the height of a
column of mercury, giving an absolute result without need for
calibration and, consequently, not subject to the errors and drift
of calibration which affect other methods. The use of mercury
manometers is often required in clinical trials and for the clinical
measurement of hypertension in high-risk patients, such as
pregnant women.
A cuff of appropriate size is fitted smoothly and snugly,
then inflated manually by repeatedly squeezing a rubber bulb
until the artery is completely occluded. Listening with the
stethoscope to the brachial artery at the elbow, the examiner
slowly releases the pressure in the cuff. When blood just starts
to flow in the artery, the turbulent flow creates a “whooshing”
or pounding (first Korotkoff sound). The pressure at which
this sound is first heard is the systolic BP. The cuff pressure is
further released until no sound can be heard (fifth Korotkoff
sound), at the diastolic arterial pressure.
The auscultatory method is the predominant method of
clinical measurement.
Oscillometric
It involves the observation of oscillations in the sphygmoma-
nometer cuff pressure which are caused by the oscillations of
blood flow, i.e. the pulse. The electronic version of this method
is sometimes used in long-term measurements and general
practice. It uses a sphygmomanometer cuff, like the auscultatory
Physiology 391
method, but with an electronic pressure sensor (transducer) to
observe cuff pressure oscillations, electronics to automatically
interpret them, and automatic inflation and deflation of the
cuff. The pressure sensor should be calibrated periodically to
maintain accuracy.
Oscillometric measurement requires less skill than the
auscultatory technique and may be suitable for use by untrained
staff and for automated patient home monitoring.
The cuff is inflated to a pressure initially in excess of the
systolic arterial pressure and then reduced to below diastolic
pressure over a period of about 30 seconds. When blood flow
is nil (cuff pressure exceeding systolic pressure) or unimpeded
(cuff pressure below diastolic pressure), cuff pressure will be
essentially constant. It is essential that the cuff size is correct:
undersized cuffs may yield too high a pressure; oversized
cuffs yield too low a pressure. When blood flow is present,
but restricted, the cuff pressure, which is monitored by the
pressure sensor, will vary periodically in synchrony with the
cyclic expansion and contraction of the brachial artery, i.e. it
will oscillate. The values of systolic and diastolic pressure are
computed, not actually measured from the raw data, using an
algorithm; the computed results are displayed.
Invasive
Arterial blood pressure (BP) is most accurately measured
invasively through an arterial line. Invasive arterial pressure
measurement with intravascular cannulae involves direct
measurement of arterial pressure by placing a cannula
needle in an artery (usually radial, femoral, dorsalis pedis
or brachial).
The cannula must be connected to a sterile, fluid-filled
system, which is connected to an electronic pressure transducer.
The advantage of this system is that pressure is constantly
monitored beat-by-beat, and a waveform (a graph of pressure
against time) can be displayed. This invasive technique is
regularly employed in human and veterinary intensive care
medicine, anesthesiology, and for research purposes.
Cannulation for invasive vascular pressure monitoring is
infrequently associated with complications such as thrombosis,
infection, and bleeding. Patients with invasive arterial
monitoring require very close supervision, as there is a danger of
severe bleeding if the line becomes disconnected. It is generally
reserved for patients where rapid variations in arterial pressure
are anticipated.
Invasive vascular pressure monitors are pressure monitoring
systems designed to acquire pressure information for display
and processing. There are a variety of invasive vascular
pressure monitors for trauma, critical care, and operating room
applications. These include single pressure, dual pressure, and
multiparameter (i.e. pressure/temperature). The monitors can
be used for measurement and follow-up of arterial, central
venous, pulmonary arterial, left atrial, right atrial, femoral
arterial, umbilical venous, umbilical arterial and intracranial
pressures.
392 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

 
(Jan 2012, 15 Marks)
Ans. Blood pressure is defined as the pressure of column of
blood in the arterial system.
Its normal value is 120/80 mm Hg.

Factors Affecting Blood Pressure

Age
Both systolic and diastolic blood pressure increases with age.
Systolic blood pressure increases more than diastolic blood
pressure because of decreased distention of arteries. Diastolic
blood pressure decreases after 50 to 60 years of age.

Sex
In females before the menopause systolic blood pressure is
4 to 5 mm Hg less as compared to males of same age. After the
menopause systolic blood pressure 4 to 5 mm Hg more than
males of same age.

Body Built
In obese individuals brachial arterial pressure is high.

Climate
♦ In colds both systolic and diastolic blood pressures are high.
♦ In summer both systolic and diastolic blood pressures are
low as compared to winter season.
Diurnal Variation
In systolic blood pressure diurnal variation of 5 to 10 mm
Hg is common in systolic blood pressure. Peak values are
seen at the time of afternoon and low values are seen at early
morning.
Exercise
At the time of exercise blood pressure is high while at the time
when exercise is stopped blood pressure come to its normal
level within 5 min.
Emotions
Worry excitement and fear increases systolic blood pressure.
Hereditary
Family tendencies of high or low blood pressure is common.
Meals
Changes in systemic blood pressure is seen due to:
♦ Pressure over heart because of distended abdomen increases
heart rate.
♦ Increase in epinephrine release from adrenal medulla.
The above both factors increases systolic blood pressure by
5 to 6 mm of Hg upto 1 hour after meals.
 (May 2014, 5 Marks)
Ans. Refer to Ans 27 of same chapter.
Q.33. Write about factors affecting heart rate.
(Sep 2005, 5 Marks)
Ans. Following are factors affecting heart rate:
• Age: As age advances vagal tone increases and heart
rate decreases but in old age heart rate is slightly
higher because of fall in the vagal tone.
• Sex: Heart rate is slightly higher in females as com-
pared to males.
• Body temperature: Due to rise in temperature there
is increase in the heart rate while with fall in body
temperature there is decrease in the heart rate.
• Drugs: Epinephrine increases heart rate because of
direct action on the heart. Nor-epinephrine increases
heart rate due to direct action on heart but its pressor
action leads to fall in heart rate.
• Respiration: With inspiration there is an increase in
the heart rate while during expiration the heart rate
decreases this is known as sinus arrhythmia.
• Emotional stimuli: Emotions such as excitement,
fear, anger, etc. increases heart rate while shock,
grief, apprehension leads to decrease in heart
rate.
• Exercise: Along with the severity of exercise there
is increase in the heart rate.
 Physiology 393

Name of ECG
wave Cause of production of wave
P wave It is produced due to depolarization of atrial musculature
QRS complex It is caused by ventricular depolarization
T wave It is caused due to ventricular repolarization
U wave It occurs due to slow repolarization of papillary muscle


(Feb 2013, 6 Marks)
Ans. Origin of Heart Beat
• Part of heart from which rhythmic impulses for heart
beat generated is known as pacemaker.
• SA node acts as pacemaker as the rate of impulse
generation is highest by SA node.
• Whenever there is blockage of transmission of im-
pulse from SA node to AV node pacemaker activity
shifts from SA node to other sites such as AV node.
This is known as ectopic pacemaker.

Conduction of Heart Beat

For details refer to Ans 28 of same chapter.
 (Sep 2017, 10 Marks)
Q.37. Describe briefly the regulation of blood pressure by Ans. The amount of blood pumped out by each ventricle into
renal mechanism. What is essential hypertension. the circulation per minute is known as cardiac output.
(Oct 2016, 10 Marks)
Factors Affecting Cardiac Output
Ans. For regulation of blood pressure by renal mechanism
refer to Ans 13 of same chapter. Main factors affecting cardiac output are:
♦ Venous return
Essential Hypertension ♦ Myocardial contractility
It is also known as primary hypertension. When arterial blood ♦ Peripheral resistance
pressure is persistently more than 150/90 mm of Hg it is known ♦ Heart rate
as essential hypertension. For details of above mentioned points refer to Ans 20 of same
chapter.
Types Q.40. Define cardiac output. (Apr 2018, 2 Marks)
Essential hypertension is of two types, i.e. benign type and Ans. The amount of blood pumped out by each ventricle into
malignant type. the circulation per minute is known as cardiac output.
394 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
9. RESPIRATORY SYSTEM
Q.1. How does control of respiration demonstrates principle
of homeostasis? (Dec 2004, 8 Marks)
Ans. The control of respiration demonstrates principle of
homeostasis in the following ways:
• The pH of ECF has to be maintained at critical value
of 7.4. The tissues cannot survive if it is altered; the
respiratory system helps in regulation of pH.
• The temperature of body has to be maintained at
37.5°C. Increase or decrease in temperature alters the
metabolic activities of cells. This is done by respira-
tory system.
• Adequate amount of oxygen should be made available
to cells for metabolism of nutrients. Simultaneously,
the carbon dioxide and other products of metabolism
must be removed. Respiratory system takes major
role in supply of oxygen and removal of carbon
dioxide.
• The respiratory system involves homeostatic mecha-
nism, which operates through feedback mechanism.
The feedback mechanism is of two types:
1. Negative feedback mechanism: If the activity of
respiratory system is increased, the regulatory
mechanism will immediately reduce the activity.
This type of mechanism is called negative
feedback mechanism.
2. Positive feedback mechanism: The positive
feedback mechanism is less compared to negative
feedback mechanism. It generally increases the
activities of respiratory system when it suppresses.
Q.2. Write a short note on surfactant. (Sep 1996, 4 Marks)
Or
Write short note on lung surfactant.
 (Aug 2016, 5 Marks)
Ans. Any surface acting material or agent that is responsible
for lowering the surface tension of a fluid is called
surfactant. The surfactant present in alveoli of lungs is
known as pulmonary surfactant. It is a phospholipid
substance. It reduces the surface tension of fluid lining
alveoli and prevents collapsing tendency of lungs.
• The surfactant is secreted by the type II alveolar
epithelial cells of lungs which are called pneumocytes.
• Surfactant consists of phospholipids, other lipids
and proteins.
Functions of Surfactant
1. The surfactant reduces surface tension in alveoli of lungs
and prevents collapsing tendency of lungs. Surfactant acts
by the following mechanisms:
The phospholipids of surfactant have two portions; out
of which, one is hydrophilic which dissolves in water
and lines alveoli. The other is lipid portion which is
hydrophobic and is directed towards the air present in
alveoli. The apoproteins and calcium ions of surfactant
help phospholipids to spread over the fluid surface of
alveoli rapidly.
2. The surfactant is responsible for stabilization of alveoli
which have tendency to deflate.
3. It plays an important role in inflation of lungs during
birth. The collapse of lungs occurs due to absence of
surfactant. This condition is called hyaline membrane
disease. In adults, the deficiency of surfactant leads to
adult respiration distress syndrome (ARDS).
Q.3. Write a short note on vital capacity.
(Mar 1998, 5 Marks) (Nov 2009, 3 Marks)
Or
Describe in brief vital capacity. (Apr 2008, 3 Marks)
(May/June 2009, 5 Marks)
Or
Answer in brief vital capacity. (Sep 2017, 2 Marks)
Ans. Vital capacity is the maximum amount of air that can be
expelled out forcefully after a deep inspiration.
Vital capacity includes tidal volume, inspiratory reserve
volume and expiratory reserve volume.
Normal Value
Tidal volume + Inspiratory + Expiratory reserve volume
500 + 3300 + 1000 = 4800 mL
Significance of Vital Capacity
♦♦ Estimation of vital capacity allows assessment of maximum
inspiratory and expiratory efforts and so gives useful in-
formation about strength of respiratory muscles.
♦♦ Vital capacity provides useful information about various
aspects of pulmonary functions through forced expiratory
volume.
Factors Affecting Vital Capacity
♦♦ Size of thoracic cavity: Vital capacity is more in males due
to large chest size and more muscle power than females.
♦♦ Age: In old age vital capacity decreases due to decrease
in elasticity of lungs.
♦♦ Strength of respiratory muscles: In swimmers and divers
vital capacity is more due to increased strength of respira-
tory muscles.
♦♦ Gravity: During standing vital capacity is more as com-
pared to sitting and lying down position.
♦♦ In pregnancy: Vital capacity decreases due to pushing of
diaphragm and reduced capacity of thoracic cavity.
♦♦ In ascites (accumulation of fluid in peritoneal cavity): There
is decrease in vital capacity.
♦♦ In pulmonary diseases such as pulmonary fibrosis,
emphysema, respiratory obstruction, pulmonary edema,
pneumothorax vital capacity decreases.
Measurement of Vital Capacity
Vital capacity is measured in two stages:
♦♦ Stage I: Subject is asked to breathe in maximally after
normal expiration then he takes few normal breadths.

♦♦ Stage II: Subject is asked to breadth out maximally after
normal expiration.
Sum of stage I and stage II volumes give two stage vital capacity.
Q.4. Describe various lung volumes and capacities.
(Jan 2012, 10 Marks)
Ans. Lung volumes and capacities are divided into two parts:
A. Static lung volume and capacities
B. Dynamic lung volume and capacities.
Static Lung Volume and Capacities
Lung Volumes
♦♦ Tidal volume: The volume of air breathed in and out in a
single normal quite respiration. Tidal volume signifies the
normal depth of respiration. Its value is 500 ml in normal
adult male.
♦♦ Inspiratory reserve volume: The additional amount of
air that can be inspired forcefully often tidal volume is
called inspiratory reserve volume. Its value is 3,300 ml in
normal adult male.
♦♦ Expiratory reserve volume: The additional amount of air
that can be expelled out forcefully beyond tidal volume
is called expiratory reserve volume. Its value is 1000 ml
in normal adult male.
♦♦ Residual volume: Some amount of air always remain in
lungs, this remaining amount of air after forceful respi-
ration is called residual volume. Its value is 1,200 ml in
normal adult male.
Lung Capacities
♦♦ Inspiratory capacity: It is the maximum amount of air
which is inspired starting from end of expiration.
Inspiratory capacity = Tidal reserve volume + Inspiratory
reserve volume
= 500 + 3300
= 3800 ml.
♦♦ Expiratory capacity: It is the maximum amount of air
which is expired starting from end of inspiration.
Expiratory capacity = Tidal reserve volume + Expiratory
reserve volume
= 500 + 1000
= 1500 ml.
♦♦ Vital capacity: The maximum amount of air which is ex-
pelled out after forceful inspiration. It includes:
= Tidal volume + Inspiratory reserve volume + Expira-
tory reserve volume
= 500 + 3300 + 1000
= 4800 ml.
♦♦ Functional residual capacity: The maximum amount of
air in lung after normal expiration. It includes
FRC = Expiratory reserve volume + Residual volume
= 1000 + 1200
= 2200 ml.
♦♦ Total lung capacity: The amount of air present in lung
after maximum inspiration.
Physiology 395
TLC = Tidal + Inspiratory + Expiratory + Residual
volume reserve reserve volume
volume volume
= 500 + 3300 + 1000 + 1200
= 6000 ml.
Dynamic Lung Volume and Capacities
1. Timed vital capacity or forced vital capacity: Forced
vital capacity is the maximum volume of air which is
breathed out as forcefully and rapidly as possible following
maximum inspiration. So timed vital capacity is similar to
vital capacity except that there is special stress on “rapid,
forcible and complete exhalation.
Components of timed vital capacity:
• FEV1: It is the forced expiratory volume in 1 sec. It
is the volume of forced vital capacity in first second
of exhalation. Its normal value is 80% of forced vital
capacity.
• FEV2: It is the forced expiratory volume in 2 sec. It is
the volume of forced vital capacity in first two seconds
of exhalation. Its normal value is 95% of forced vital
capacity.
• FEV3: It is the forced expiratory volume in 3 sec. It
is the volume of forced vital capacity in first three
seconds of exhalation. Its normal value is 98 to 100%
of forced vital capacity.
• Timed vital capacity distinguishes between restrictive
and obstructive lung disorders.
2. Expiratory flow during 25 to 75% of expiration: It is the
mean expiratory flow rate during middle 50% of forced
vital capacity. Its normal value is 300 L/min. This is the
sensitive indicator of small airway disease where most of
chronic obstructive pulmonary diseases start.
3. Forced expiratory flow during 200 to 1200 mL of expira-
tion: It is the mean expiratory flow rate between 200 to
1200 mL segment of forced vital capacity. Its normal value
is 350 L/min.
4. Minute ventilation or pulmonary ventilation: It is the
volume of air expired or inspired by lungs in one min. Its
normal value is 6 L/min.
5. Peak expiratory flow rate: It is the expiratory flow rate
during peak of forced vital capacity. It normal value ranges
from 400 to 450 L/min. It is the simple test of ventilator
function which is used in the clinical practice.
6. Maximum breathing capacity or maximum voluntary
ventilation or maximum ventilation volume: It is the larg-
est volume of air which is moved in and out of the lungs
in one minute by maximum voluntary effort. Its normal
value ranges from 90 to 170 L/min.
7. Pulmonary reserve or breathing reserve: It is the maxi-
mum amount of air above the pulmonary ventilation which
can be breathed in and out of lungs in one min.
It is computed as maximum ventilation volume—pulmo-
nary ventilation. Its value is expressed in percentage. Its
value ranges from ≥ 60–70%. If value is less than 60% it is
suggestive of presence of dyspnea.
396 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.5. Explain how CO2 is picked up by tissue capillary and
then discharge into alveoli. (Sep 2009, 5 Marks)
Ans. 1. Diffusion of carbon dioxide from tissues capillary
into blood: Due to continuous metabolic activity,
carbon dioxide is produced constantly in the cells
of tissue. So partial pressure of carbon dioxide in the
cells is high, i.e. 46 mm Hg, and the partial pressure
of carbon dioxide in arterial blood is 40 mm Hg. The
pressure gradient of 6 mm Hg is responsible for
diffusion of carbon dioxide from tissues to blood.
2. From blood into alveoli: The partial pressure of
carbon dioxide in alveoli is 40 mm Hg, whereas in
blood it is 45 mm Hg. The pressure gradient of 5 mm
Hg is responsible for diffusion of carbon dioxide
from blood into alveoli.
So, the above methods suggest that how CO2 is picked
up by tissue capillary and then discharge into alveoli.
Q.6. Describe how CO2 is transported from tissues to lungs.
Write a note on periodic breathing.
(Sep 2004, 10 + 5 Marks)
Ans. The transport of CO2 from tissues to lungs is described
in Ans 5 of the same chapter.
Periodic breathing: The abnormal or uneven respiratory
rhythm is called periodic breathing. There are two types
of periodic breathing:
1. Cheyne-stokes breathing: This is the most common
type of periodic breathing. It is marked by two al-
ternate periods, which are:
i. Rapid deep respiration, i.e. hyperemic period
ii. Complete cessation of respiration, i.e. apenic
period
This type of breathing occurs during deep sleep;
in newborn babies; in high attitude, during in-
creased intracranial pressure. During advance
cardiac diseases leading to cardiac failure and
during advance renal diseases leading to uremia.
2. Bitot’s breathing: This is another form of periodic
breathing. This is characterized by period of apnea
and hyperpnea. It occurs in condition involving
nervous disorders, due to lesions or injuries to brain.
Q.7. Write about oxygen transport in body.
(Mar 1998, 5 Marks)
Or
Describe in brief transport of oxygen in blood.
(Oct 2007, 5 Marks) (Mar 2008, 4 Marks)
(Dec 2009, 5 Marks)
Or
Write on transport of oxygen and carbon dioxide by
blood. (Feb 2013, 7 Marks) (June 2010, 2.5 Marks)
Or
Write short note on transport of respiratory gases in
blood. (Feb 2013, 7 Marks)
Or
Write short answer on oxygen transport in blood.
 (Aug 2018, 5 Marks)
Ans. Oxygen Transport or Carriage in Blood
The oxygen is transported by blood from alveoli to tissue.
The oxygen is transported in blood in two forms:
1. As simple physical solution/by plasma
2. In combination with hemoglobin.
1. Transport of oxygen as simple solution: Oxygen
dissolves in water of plasma and transported in its
physical form:
- The transport of oxygen in this form is less than
3%.
- This type of transport is important in condi-
tion like muscular exercise to meet the excess
demand of oxygen by tissues.
2. Transport of oxygen in combination of hemoglobin.
Oxygen combines with hemoglobin in blood and
is transported as oxyhemoglobin. The transport
of oxygen in this form is very important because
as much as 97% of oxygen is transported by this
method.
Oxygen combined with hemoglobin only such as a
physical combination. No oxidation takes place. It
is only oxygenation. The advantage of this type of
combination is that oxygen can be readily released
from hemoglobin when it is needed.
Oxygen combines with the iron of heme part of
hemoglobin which is present in ferrous form. Each
iron combines with oxygen and remains in ferrous
form. So the combination of hemoglobin with oxy-
gen is a physical process. No oxidation takes place. 1
gm of hemoglobin carries 1.34 gm of oxygen, this is
known as oxygen-carrying capacity of hemoglobin.
Carbon Dioxide Carriage in Blood
Carbon dioxide is transported by blood from tissues into alveoli;
carbon dioxide is transported in blood in the following ways:
♦♦ Dissolved form: CO2 diffuses into blood and dissolves in
fluid of plasma forming a simple solution. This is about
7% of CO2 in blood.
♦♦ As carbonic acid: Part of dissolved carbon dioxide in
plasma, combines with water to form carbonic acid.
♦♦ Transport of carbon dioxide as bicarbonate: About 63%
of CO2 is transported as bicarbonate. From, plasma CO2
enters the RBCs. Inside RBCs, it combines with water
to form carbonic acid. This is carried out in presence of
carbonic anhydrase. The carbonic acid is unstable and
breaks into bicarbonate and hydrogen ions. The increased
concentration of bicarbonate inside RBC causes diffusion
of bicarbonate ions through cell membrane into plasma.
Q.8. Write a short note on oxygen dissociation curve and
factors affecting it. (Sep 2000, 5 Marks)
Or
Write short note on oxygen hemoglobin dissociation
curve. (Oct 2014, 3 Marks)
Or
Write about O2 hemoglobin dissociation curve.
 (Sep 2015, 7 Marks)

Ans. It is a curve which demonstrates the relation between
partial pressure of oxygen and percentage saturation
hemoglobin with oxygen.
In the blood, the hemoglobin is saturated with oxygen
only up to 95%.
The saturation of hemoglobin on which oxygen depend
upon the partial pressure of oxygen when PO2 is more.
Hemoglobin is associated with oxygen when PO2 is less
dissociated from hemoglobin.
Under normal conditions, the oxygen hemoglobin
dissociation curve is slightly “S” shaped or sigmoid
shaped. The upper part of curve indicates acceptance of
oxygen by hemoglobin and lower part of curve indicates
the dissociation of oxygen form hemoglobin depend on
partial pressure of oxygen.
When PO2 is 25 mm Hg, the hemoglobin gets saturated
about 50%. The partial pressure at which hemoglobin is
saturated is 50%.
Factors affecting oxygen hemoglobin dissociation curve
The oxygen dissociation curve shifted to either left or
right by various factors.
Shifting to right indicates dissociation of oxygen by
hemoglobin and shifting to left indicates association of
oxygen.
Shift to Right: Following conditions arise:
1. PO2 is less
2. PCO2 is more
3. Increase in hydrogen ion concentration and decrease
in pH.
4. Increase in body temperature.
Shift to Left:
1. PO2 is more
2. pH is more.
Fig. 39:  Oxygen dissociation curve
Q.9. Write a short note on chloride shift.
(Mar 2001, 5 Marks)
Physiology 397
Or
Write briefly on chloride shift in RBC.
(June 2010, 5 Marks)
Ans. It is also known as Hamburger phenomenon.
It is the exchange of chloride ion for a bicarbonate ion
across erythrocyte membrane.
Chloride shift occur when carbon dioxide enters blood
from tissues.
In plasma, plenty of sodium chloride is present. It
dissociates into sodium and chloride ions when the
negatively charged bicarbonate ions move out of RBC
into plasma to maintain electrolyte equilibrium, the
negatively charged chloride ions move to RBC. This
is called chloride shift or Hamburger’s phenomenon.
The hydrogen ions are buffered by hemoglobin inside
cell. The bicarbonate ions combine with sodium ions in
plasma and form sodium bicarbonate.
Q.10. Write on chemical regulation of respiration.
(Mar 2000, 5 Marks) (Mar 2007, 4 Marks)
(Mar 2013, 8 Marks)
Or
Write briefly on nervous regulation of respiration.
(Sep 2001, 7.5 Marks)
Or
Describe nervous regulation of respiration.
(Feb 2003, 5 Marks) (Apr 2008, 4 Marks)
(Apr 2010, 5 Marks)
Or
Describe regulation of respiration.
(Aug 2012, 5 Marks) (Aug 2011, 5 Marks)
Or
Describe mechanics of breathing. (Jan 2012, 6 Marks)
Or
Explain neural regulation of respiration.
(Nov. 2012, 8 Marks)
Or
Write on neural regulation of respiration.
(May 2014, 5 Marks)
Or
Write short note on regulation of respiration.
(Sep 2017, 5 Marks)
Or
Write short answer on regulation of respiration.
(Aug 2018, 3 Marks)
Ans. Respiration is a reflex process. Respiration is controlled
by two mechanism.
1. Chemical mechanism
2. Nervous/neural mechanism.
Chemical Mechanism
The chemical mechanism of regulation of respiration is operated
through “Chemoreceptor”.
398 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Chemoreceptor
The chemoreceptors are the receptors which give response to
any change in constitutent of blood.
♦♦ These receptors are sensory nerve ending.
♦♦ These receptors are highly sensitive to any chemical change
in blood like in hypoxia, hypercapnia and increase in
concentration of hydrogen ion.
♦♦ The chemoreceptors are classified into two groups.
a. Central chemoreceptors: The chemoreceptors
present in the central of brain are called central
chemoreceptors.
Situation: Central chemoreceptors present in deeper
part of medulla. This area is known as chemosensitive
area and these neurons are known as chemoreceptors.
These neurons are directly in contact with blood or
CSF.
Function/mechanism of action: The chemoreceptors
are stimulated by increase in concentration of
hydrogen ion. When the concentration of hydrogen
ion increases in blood, it cannot stimulate central
chemoreceptors because hydrogen ion cannot cross
the blood-brain barrier.
On the other hand when CO2 increases in the blood, it
crosses the blood-brain barrier and reaches the brain
in CSF and reacts with water and forms carbonic
acid. This acid is unstable and is dissociated to form
hydrogen ion and bicarbonate ion. Now this hydrogen
ion stimulates the central chemoreceptors.
These chemoreceptors send impulses to inspiratory
center and increase the rate of depth of breathing.
b. Peripheral chemoreceptors
Situation: These chemoreceptors are situated in aortic
and carotid region.
Action of Mechanism: These chemoreceptors are
stimulated by reduced partial pressure of oxygen.
When PO2 decreases, it stimulates and sends the
impulses to respiratory center through sinus and
aortic nerve.
When inspiratory center is stimulated, it increases the
rate and force of breathing.
Nervous Regulation
Nervous control involves the respiratory center, afferent nerve
and efferent nerve.
Respiratory center: It is situated in reticular formation of
brainstem. Depending on position in brainstem, respiratory
centers are classified into:
♦♦ Medullary group
♦♦ Inspiratory center
♦♦ Expiratory center
♦♦ Pontine center
♦♦ Pneumotaxic center
♦♦ Apneustic center.
♦♦ Inspiratory center: It is situated in upper part of medulla
and is also known as “dorsal group of respiratory neurons.”
Function: Inspiratory center is related with inspiration.
The nucleus of tractus solitary receives impulses from
peripheral baroreceptor, chemoreceptor and pulmonary
receptor.
♦♦ Expiratory center: It is situated anterior in medulla and
lateral to inspiratory center.
Function: Normally, this center is creative during normal
breathing. Expiratory center becomes active during force-
ful breathing or when inspiratory center is inhibited; dur-
ing quite breathing, expiration is a passive process.
♦♦ Pneumotaxic center: It is situated in dorsolateral part of
pons.
 Function:
• It controls medullary center particularly the inspiratory
center through apneustic center.
• It always controls the inspiration and inhibits activity
of inspiratory center.
• It increases rate of inspiration by decreasing the
duration of inspiration. Expiratory time also decreases.
4. Apneustic center: It is situated in lower part in reticular
formation in pons.
Function: Apneustic center always increases the activity of
inspiratory center and it increases depth of inspiration.
Efferent Pathway
♦♦ The nerves from respiratory center leave brainstem and
remain in anterior part of spinal cord.
♦♦ It terminates in motor neuron in anterior horn of cervi-
cal and thoracic segment of spinal cord, and two sets of
nerve arises:
1. Phrenic nerve—which supplies diaphragm
2. Intercostal nerve—which supplies intercostal muscles
Afferent pathway: The impulses from peripheral and central
chemoreceptor from baroreceptor are carried to respiratory
center by fibers of glossopharyngeal and vagus nerve.
Q.11. Write a short note on hypoxia. (Aug/Sep 1998, 5 Marks)
(Sep 2000, 5 Marks) (Sep 2001, 5 Marks)
 (Sep 2005, 5 Marks) (Feb 2003, 5 Marks)
 (Sep 2007, 3 Marks) (Dec 2010, 3 Marks)
 (Feb 2014, 5 Marks) (Nov 2008, 5 Marks)
 (Apr 2015, 3 Marks) (Feb 2016, 3 Marks)
Or
Discuss in brief hypoxia (anoxia).
(Mar 2006, 10 Marks) (Mar 2008, 3 Marks)
Or
Write on hypoxia.
 (Sep 2018, 5 Marks) (Apr 2017, 5 Marks)
Ans. Hypoxia is defined as the reduced availability of oxygen
to the cells of the body.
Types of Hypoxia
A. Hypoxic hypoxia
B. Anemic hypoxia
C. Stagnant hypoxia
D. Histotoxic hypoxia
 Physiology 399

Following is the description of various hypoxias:

Features Hypoxic hypoxia Anemic hypoxia Stagnant hypoxia Histotoxic hypoxia
Pathophysiology It occur because of decrease It occurs because of low It occurs because It occurs because of
in oxygen tension oxygen carrying capacity of decreased blood decreased ability of
of blood flow to tissue tissue to utilize oxygen
Causes • Due to low oxygen tension • Decrease in RBC count Due to shock and Due to cyanide poisoning
• Hypoventilation • Decrease in circulatory failure
• Decrease in the diffusion of hemoglobin content of
oxygen across respiratory blood
membrane • Altered hemoglobin
• Physiological shunt
• Anatomical shunt
Arterial pO2 It is decreased It is normal It is normal It is normal
Arterial O2 contents It is decreased It is markedly decreased It is normal It is normal
Arterial hemoglobin contents It is normal It is reduced It is normal It is normal
% O2 saturation It is decreased It is decreased It is normal It is normal
Oxygen carrying capacity of It is normal It is decreased It is normal It is normal
arterial blood
Arterial—venous pO2 It is decreased It is normal It is more than It is less than normal
difference normal
Cyanosis It is present It is absent It is present It is absent
Peripheral chemoreceptor It is present It is absent It is present It is present
stimulation
Tachypnoea It is present It is absent It is absent It is absent

Q.12. Write a short note on cyanosis.
(Apr 2003, 5 Marks) (Aug 2012, 5 Marks)
Ans. Cyanosis is clinical condition in which the skin and
mucous membrane assume a bluish color. It is due to
large amounts of reduced hemoglobin in blood. The
quantity of hemoglobin should be at least 5 to 7 g% in
the blood to cause cyanosis.
Distribution of cyanosis: When it occurs, cyanosis is
distributed over whole body. But it is more marked in
certain region where the skin is thin. These areas are lips,
cheek, nose, ear, lips and finger tips above the base of nail.
♦ Central cyanosis: It is seen in the earlobes and the mucus
membranes of lips and tongue.
Q.13. Write a short note on acclimatization at high altitude.
(Aug/Sep 1998, 5 Marks) (Mar 2001, 5 Marks)
Or
Describe in brief acclimatization to high altitude.
(Aug 2005, 7.5 Marks)
Ans. While staying at high altitude for several days to several
month, a person gets slowly adapted or adjusted to low
oxygen tension so that hypoxia causes lesser and lesser
effect on the body.

Factors Causing Cyanosis Changes During Acclimatization

1. Inadequate oxygenation of blood in the lungs, i.e. Following changes occur in body during acclimatization.
a. Disease of lungs 1. Blood: During acclimatization, the hematocrit value rises
b. Collapse of lungs from 49 to 59%, the hemoglobin concentration in blood
increases from 15 to 20% g. So oxygen-carrying capacity
c. Carbon monoxide poisoning
of blood also increases thus the more oxygen is carried to
d. Heart failure.
the tissue.
2. Admixture of arterial and venous blood: This takes place
 During hypoxia, erythropoietin is released from
in certain congenital heart diseases. juxtaglomerular apparatus and it stimulates bone marrow
3. Greater reduction of oxyhemoglobin: formation and causes formation of RBC, so that RBC count
a. Venous obstruction: This will restore the local circulation increases in the blood.
and allow more time for greater reduction of hemoglobin. 2. Cardiovascular system: There is increase in heart rate,
b. Local chilling. cardiac output, and vascularity is increased in the body.
There is increase in blood flow in vital organs of body.
Types of Cyanosis
3. Respiratory center: Due to increase in pulmonary ventila-
♦♦ Peripheral cyanosis: It is seen in nail beds and is sugges- tion and increased blood flow, the diffusion capacity of
tive of stagnant hypoxia. gases increase in alveolar level.
400 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.14. Write a short note on Hering-Breuer reflex.
(Dec 2004, 5 Marks)
Ans. Hering-Breuer Reflex
• The impulses from the lungs bring about a respira-
tory reflex called Hering-Breuer reflex.
• Wall of the bronchi and bronchiole contain stretch
receptors, which give response to stretch of lung
tissues.
• So, during inspiration when there is stretching of
lung tissues due to expansion, the stretch recep-
tors or Hering-Breuer are stimulated and produce
impulses.
• The impulses are carried by vagal afferent fibers to
respiratory centers. The impulses actually inhibited
inspiratory center and so inspiration stops expiration
starts.
This reflex is a protective reflex, it restricts the inspiration
and limits over stretching of lung tissues. This is called
Hering-Breuer inflation reflex. The reverse of this reflex
is called Hering-Breuer deflation reflex.
Q.15. Write a short note on spirometry. (Sep 2006, 5 Marks)
Ans. The method by which lung volumes and capacities are
measured is called as spirometry.
  The simple instrument is used for this purpose is
called as spirometer.
Spirometer
It is made up of metal, it contain two chambers outer and
inner. Outer chamber is filled with water. The drum is counter
balanced by a weight which is attached to the inner drum. A long
metal tube passes through the inner chamber from the bottom
towards the up. A rubber tube is connected to the outer end of
the metal tube and a mouthpiece is attached to the other end
through which subject respires.
When the subject breathes with the spirometer, during
inspiration the drum moves up and the counter weight
comes down and reverse of this occur during inspiration.
The upward and downward movement of the counter weight
can be recorded in the form of a graph paper by attaching a
pen with ink to the counter weight. The upward curve of the
graph shows inspiration and the downward deflection denotes
expiration. The spirometer can be used only for a single breath.
Repeated cycle cannot be recorded due to accumulation of CO2
in spirometer.
Q.16. Write in brief factors affecting diffusion of gases.
(Dec 2010, 5 Marks)
Ans. Factors affecting diffusion of gases are as follows:
1. Pressure gradient
2. Solubility of gases
3. Alveolocapillary membrane
4. Molecular weight of gas
1. Pressure gradient: Higher pressure gradient leads
to the better diffusion.
2. Solubility of gas: Diffusion get increased with in-
crease in the solubility of gas in water.
- Diffusion is directly proportional to solubility.
- Carbon dioxide get diffuses with high rate as its
solubility is more than oxygen.
3. Molecular weight of gas: Diffusion is inversely
proportional to molecular weight of gas.
4. Alveolocapillary membrane: The thickness of
alveolocapillary membrane is 0.2-0.5 µm.
- Gas diffusion is inversely proportional to thick-
ness.
- Increase in thickness of alveolocapillary mem-
brane is seen in pulmonary edema and fibrosis
of lung.
- Diffusion is directly proportional to permeability
of membrane.
- Fibrosis leads to decrease in permeability.
- Diffusion is directly proportional to surface area
of alveolocapillary membrane.
- Surface area decreases in lung collapsation.
Q.17. Write in detail about physiology of respiration.
(Aug 2011, 11 Marks)
Or
Write in brief mechanics of respiration.
 (Apr 2008, 5 Marks)
Ans. Following is the physiology of respiration: Main
function of respiratory system is to remove oxygen
from atmosphere and to deliver it to tissues and to
remove carbon dioxide from tissues and discharge it in
atmosphere.
• Lungs expand and the atmospheric air which con-
sists of oxygen enters inside the lungs.
• Oxygen is extracted and is transferred to blood
present in pulmonary capillaries.
• Oxygenated blood is circulated to the tissues all
throughout the body.
• At the level of tissue blood deliver oxygen to the
tissues which utilizes oxygen and produce carbon
dioxide. Carbon dioxide is delivered back into the
blood.
• Deoxygenated blood brings carbon dioxide to lungs
whereas carbon dioxide is diffused out of lungs.
• Lungs deflate and discharge impure air which is
carbon dioxide to atmosphere.
• Physiology of respiration is divided in three divisions:
1. External respiration, i.e. breathing: Absorption
of oxygen and removal of carbon dioxide from
body.
2. Transport of gases in blood.
3. Internal respiration, i.e. utilization of oxygen
and production of carbon dioxide by cells and
gaseous exchange between cells and their fluid
mechanism.
External Respiration
Inspiration
♦♦ At the time of inspiration the thoracic cavity expands in three
dimensions, i.e. vertical, transverse and anteroposterior.

♦♦ Diaphragm contracts and leads to increase in vertical
dimension, this causes increase in thoracic cavity.
♦♦ Contraction of intercoastal muscle leads to increase in
anterioposterior and transverse dimensions of thorax.
♦♦ Upper six ribs leads to the increase in anteroposterior and
transverse dimensions of the thorax.
♦♦ Seven, eighth and tenth rib causes increase in transverse
dimension.
Expiration
♦♦ It is a passive process.
♦♦ Contraction of anterior abdominal muscles causes increase in
intra-abdominal pressure and pull lower ribs down and me-
dially, pushing diaphragm upwards and causing expiration.
Transport of Gases in Blood
Transport of Oxygen
Oxygen is carried in blood in two forms, i.e.
1. In dissolved form
2. In combination with hemoglobin
In dissolved form the amount of oxygen is 0.3 ml per 100 ml of
blood per 100 mm Hg partial pressure of oxygen. The quantity
of dissolved oxygen increases in linearity with arterial partial
pressure of oxygen. Tension exerted by a gas in blood is the
property of dissolved gas.
Single hemoglobin molecule consists of iron in ferrous form.
Six valency bond of each ferrous iron combines with 1 mole
of oxygen. So four moles of oxygen combine with one mole
of oxygen. Oxygen carrying power of hemoglobin is given by
oxygen hemoglobin dissociation curve.
Transport of Carbon Dioxide
Tissue produces carbon dioxide which enters the blood because of:
♦♦ Difference in partial pressure of carbon dioxide between
arterial blood and tissues. Arterial partial pressure of
carbon dioxide is 40 mm Hg and tissue partial pressure
of carbon dioxide is 46 mm Hg.
♦♦ Carbon dioxide has high diffusion coefficient, i.e. 20 times
more than oxygen; therefore even this small pressure gradi-
ent of 6 mm Hg is sufficient for transport of carbon dioxide.
♦♦ Decrease in oxygen content shift carbon dioxide dissociation
curve to left leading to further loading of carbon dioxide
from tissues to blood.
Internal Respiration
Carriage of Oxygen in Tissues
At rest due to partial pressure gradient tissues remove 5 mL of
oxygen for each 100 mL of blood passing through it. 250 mL of
oxygen per minute is transported from blood to body tissues
and this is called as oxygen consumption of whole body at rest.
Carriage of Oxygen in Lungs
In lungs venous blood partial pressure of oxygen is 40 mm Hg
and alveolar air partial pressure of oxygen is 100 mm Hg. So
because of the pressure gradient oxygen rapidly diffuses from
Physiology 401
alveoli through thin pulmonary and capillary endothelium
in plasma so the arterial blood leaves the lungs almost fully
saturated with oxygen.
Carriage of Carbon Dioxide in Blood
♦♦ Carbon dioxide content of arterial blood is 48 mL /dL
and that of venous blood is 52 mL/dL. So each 100 mL of
arterial blood which passes through tissue pick 4 mL of
carbon dioxide.
♦♦ Carbon dioxide get accommodated in plasma, when
plasma is fully saturated carbon dioxide get accumulated
in RBCs. So total 4 mL/dL of carbon dioxide is transported
in blood, 2.4 mL/dL is transported in plasma and remain-
ing 1.6 mL/dL within RBC.
♦♦ Carbon dioxide is carried in plasma and RBCs in three
forms, i.e. dissolved form, as carbamino compound and
as bicarbonate.
Carriage of Carbon Dioxide in Lungs
Partial pressure of carbon dioxide in venous blood is 46mm of
Hg with carbon dioxide content 52 ml/dl whereas alveolar air
partial pressure of carbon dioxide is 40 mm Hg with carbon
dioxide content 48 ml/dl. For each 100 ml of venous blood while
passing through lungs releases 4 ml of carbon dioxide.
Part of carbon dioxide from dissolved solution and
carbamino compound break to liberate carbon dioxide.
Hemoglobin becomes oxygenated forming oxyhemoglobin
which increases the acidity of cell to mobilize chloride shift
in the reverse order. Chloride comes out of cell reacts with
bicarbonate in plasma forming sodium chloride and liberating
bicarbonate. Bicarbonate from plasma enters cell and combine
with free potassium ion forming potassium bicarbonate. Within
RBC the oxyhemoglobin being stronger acid than carbonic acid
releases hydrogen from hemoglobin. Released hydrogen joins
with bicarbonate released from potassium bicarbonate forming
bicarbonic acid and free potassium ion with oxyhemoglobin
forms potassium oxyhemoglobin. Bicarbonic acid is broken
up by carbonic anhydrase in RBC in water and carbon dioxide.
Carbon dioxide diffuses in plasma and there is nothing to fix it
so carbon dioxide is liberated through lungs along the pressure
gradient.
Q.18. Describe pulmonary ventilation. (Sep 2013, 5 Marks)
Ans. It is also known as minute ventilation.
• Pulmonary ventilation is the volume of air expired
or inspired by the lungs in one minute.
• Normal pulmonary ventilation is 6 L/min.
• In moderate exercise it increases to about 60 L/min.
• In severe exercise it increases to about 100 L/min.
Q.19. Write short note on Bohr’s effect. (Feb 2014, 3 Marks)
Ans. This phenomenon was given by Bohr in 1904.
• In the tissues the metabolic activities shift oxygen-
hemoglobin dissociation curve to right decrease the
affinity of hemoglobin for oxygen, so carbon dioxide
enters the blood from tissues and causes unloading
of oxygen. This is called as Bohr’s effect.
402 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• During this phenomenon the partial pressure of
oxygen is low while partial pressure of carbon
dioxide is high due to which carbon dioxide enters the
blood.
Q.20. Draw a well labeled diagram of CO2 dissociation curve.
 (Apr 2007, 5 Marks)
Ans. Following is the labeled diagram of carbon dioxide
dissociation curve:
Fig. 40:  Synapse
Q.21. Write briefly on hypoxic hypoxia.
 (July 2016, 5 Marks)
Ans. Hypoxic hypoxia is characterized by low arterial partial
pressure of oxygen (pO2) and when oxygen carrying
capacity of blood and rate of blood flow to tissues are
normal or elevated.
Characteristic Features
Various characteristic features of hypoxic hypoxia are:
♦♦ Low arterial partial pressure of oxygen.
♦♦ Low arterial oxygen content
♦♦ Low arterial percentage oxygen saturation of hemo­globin
♦♦ Low arteriovenous partial oxygen difference.
Causes
♦♦ Due to low partial pressure of oxygen in inspired air, e.g.
• At high altitudes
• Breathing inside the close chambers
♦♦ Due to decreased pulmonary ventilation in:
• Airway obstruction
• Weakness or paralysis of respiratory muscles
• Depression of respiratory centers due to drugs mainly
morphine
♦♦ Due to defect in exchange of gas: This occur via alveolar
capillary membrane
♦♦ Venous arterial shunts: In these venous blood enter inside
the arterial blood without going into lungs, this lead
to decrease in arterial partial pressure of oxygen, e.g.
congenital cyanotic heart disease.
Pathophysiology
Q.22. What is oxyhemoglobin dissociation curve. Give the
causes which shift the curve right and left.
 (May 2017, 5 Marks)
Ans. Oxyhemoglobin dissociation curve explains the
relationship between partial pressure of oxygen in blood
with oxygen saturation of hemoglobin. This curve is
an S-shaped curve over the range of partial pressure of
oxygen in from 0 to 100 mm Hg.
Causes Which Shift the Curve to Right
♦♦ Decrease in partial pressure of oxygen
♦♦ Increase in partial pressure of carbon dioxide
♦♦ Increase in hydrogen ion concentration and decrease in pH
♦♦ Increase in the body temperature: High temperature
decreases affinity of hemoglobin for oxygen. This helps in
release of oxygen in metabolically active tissues in which
temperature is more.
♦♦ Due to excess of 2, 3 diphosphoglycerate in RBC.
Diphosphoglycerate is a by product in Embden–Meyerhof
pathway of carbohydrate metabolism. It combines with
beta-chains of hemoglobin. In conditions such as muscular
exercise and in high altitude, diphosphoglycerate increases
in RBC. So the curve shifts to right to a great extent.
Causes Which Shift the Curve to Left
It is shifted to left in the following conditions:
♦♦ In fetal blood as fetal hemoglobin has more affinity for
oxygen than adult hemoglobin.
♦♦ Due to decrease in hydrogen ion concentration and
increase in pH.
Q.23. Transport of oxygen in body. (Jan 2018, 5 Marks)
Ans. Transport of Oxygen in Tissues
♦♦ At rest: Due to partial pressure gradient at rest tissue
removes 5 mL of oxygen for each 100 ml of blood passing
 Physiology 403

through them. As cardiac output is 5 liter/minute, so ♦ Accumulation of carbon dioxide leads to hyperventilation
approximately 250 mL of oxygen per minute is transported which lowers partial pressure of carbon dioxide.
from blood to body tissues known as oxygen consumption ♦ Decreased partial pressure of carbon dioxide eliminates
of whole body at rest. carbon dioxide drive on ventilation and produces apnea,
♦ During activity: At the time of activity changes taking place which consequently increases partial pressure of carbon
in the body are: dioxide again.
Increase in carbon dioxide production ♦ Increase sensitivity of respiratory mechanism to partial
Rise in the body temperature pressure of carbon dioxide produces hyperventilation and
Increase in hydrogen ion concentration the cycle continues.
Increase capillary density
Local arteriolar dilatation: Increased capillary density
along with local arteriolar dilatation increase blood 10. NERVOUS SYSTEM
flow to tissues.
Depending on the degree of activity, oxygen tension 
inside the tissues may fall to zero. This causes very
steep oxygen pressure gradient between blood and
tissues, thereby leading to rapid diffusion of oxygen.
So, coefficient of oxygen utilization varies from 65
to 80%
Increase in RBC count due to splenic contraction:
Increase in capillary density and increase in RBC count
due to splenic contraction leads to increase in delivery
of oxygen to tissues by 5 times. This along with three
times more oxygen extraction by tissues eventually
increases oxygen transport to tissues by 15 times.

Transport of Oxygen in Lungs

Partial pressure of oxygen in venous blood if 40 mm Hg and
Partial pressure of oxygen in alveolar air is 100 mg Hg.
So due to pressure gradient oxygen rapidly diffuses from
alveoli via thin pulmonary and capillary endothelium into
plasma, so arterial blood finally leaves the lungs almost fully
saturated with oxygen, at partial pressure of oxygen 100 mm
Hg with oxygen content of 19 mL/dL; 0.3 mL/dL in dissolved
form and 18.7 mL/dL bound to hemoglobin.
Q.24. Write short note on Cheyne-Stokes breathing.
(Oct 2016, 5 Marks)
Ans. Cheyne-stokes breathing is also known as Cheyne-Stokes
respiration.
Repeated sequence of gradual onset of apnea which is
followed by gradual restoration of respiration is known
as Cheyne-Stokes breathing.
Causes
♦ Physiological
Voluntary hyperventilation
High altitude
During sleep in some normal individuals
♦ Pathological
Heart failure
Brain damage
Uremia.
Mechanism
♦ Patients have increased sensitivity to carbon dioxide be-
cause of disruption of neural pathways.
(Sep 2000, 5 Marks)
Ans. The degeneration change in the distal cut end of nerve
fiber is called Wallerian degeneration. During Wallerian
degeneration the following occur:
1. Axis cylinder swells and brakes up into small pieces.
After few days, debris is seen in space occupied by
axis cylinder.
2. The myelin sheath is slowly disintegrated into fat
droplets.
3. The cells of Schwann multiply rapidly. The mac-
rophages remove the debris of axis cylinder and
fat droplets of disintegrated myelin sheath. So
neurilemmal sheath becomes empty. This is filled
by cytoplasm of Schwann cell.
At the Time of Regeneration
1. First the cells of Schwann from proximal and distal cut
ends of nerve grow in all direction of nerve in the form
of pseudopodia like fluids. The filling up of gap leads to
development of continuity of neurilemmal tube.
2. The axis cylinder is fully established inside neurilemmal
tube.
404 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

3. The myelin sheath is formed by cells of Schwann slowly. The
cell looses the excess fluid and nucleus occupy central position.
Q.3. Write a short note on saltatory conduction.
 (Mar 2000, 5 Marks)
Ans. The conduction of impulse through a myelinated
nerve fiber is 50 times faster than non-myelinated
nerve fiber. This is because myelin sheath forms on
effective insulation, and flow of current through this
sheath is negligible, but action potential jump from one
node to another node of Ranvier. So velocity of conduction
is faster. This type of jumping of action potential from one
node to another is called saltatory conduction.
Mechanism of Saltatory Conduction
The myelin sheath is not permeable to ions. So the entry
of sodium from ECF into nerve fibers occurs only in node
of Ranvier, where myelin sheath is absent. This causes
depolarization in node.
Thus, the depolarization occurs at successive nodes. So,
action potential jump from one node to another. Hence, it is
called saltatory conduction.
Q.4. Write in tabular form different receptors and their
functions. (Sep 2013, 5 Marks)
Ans. The different receptors and their functions are as
follows:

Receptors
1. Extroceptors
a. Cutaneous receptors
i. Touch receptors
ii. Pressure receptors
iii. Temperature receptors
iv. Nociceptors
b. Chemoreceptors
c. Telereceptors
i. Phonoreceptors
ii. Photoreceptors
2. Introceptors
a. Visceroreceptors
i. Stretch receptors
ii. Baroreceptors
iii. Chemoreceptors
b. Proprioceptors
i. Muscle spindle
ii. Golgi tendon organ
iii. Pacinian corpuscle
iv. Free nerve ending
Functions
1. Give response to stimuli arising from outside the body
a. They give response to mechanical stimulus
i. Give response towards touch
ii. Give response towards pressure
iii. Give response towards temperature
iv. Give response towards pain
b. Give response towards chemical stimuli
c. Give response to stimuli arising away from body
i. Give response to auditory sensation
ii. Give response to visual sensation
2. They give response to stimuli arising within the body
a. They give response to stimuli arising from viscera
i. Give response towards stretch
ii. Give response towards blood pressure changes
iii. Give response towards chemical stimuli from inside the body
b. They give response to change in position of different parts of body
i. It is the receptor organ for stretch reflex
ii. It gives response to change in force of tension developed in skeletal muscle during contraction
iii. It gives response to pressure changes
iv. It gives response to pain sensation

Q.5. Write briefly on synaptic transmission. is influx of calcium ions from ECF into axon termi-
(Mar 1998, 7.5 Marks) (Mar 2008, 3 Marks) nals. Now there is opening of vesicle and release of
Or neurotransmitter acetylcholine. The neurotransmitter
passes through presynaptic membrane and synaptic
Write short note on synapse. (Dec 2010, 5 Marks) cleft and reaches postsynaptic membrane.
Ans. • The junction between two neurons is called synapse.
• Synapse is formed by presynaptic and postsynaptic
neuron, the spaces between the two neurons is called
synaptic cleft.
• Synaptic transmission
The main function of the synapse is to transmit the
impulse, i.e. action potential from one neuron to another.
When the action potential reaches presynaptic axon
terminal, the following events occur in synaptic
transmission:
1. Presynaptic neuron: As the action potential reaches
the axon terminal, the voltage gated calcium channels
get opened in presynaptic neuron/membrane. There Fig. 41:  Synapse

2. Postsynaptic neuron: Now, here the binding of
acetylcholine with receptor protein of postsynaptic
membrane and formation of acetylcholine receptor
complex takes placed. The ligand gated sodium
channels in postsynaptic membrane get opened and
there is influx of sodium from ECF. Now develop-
ment of excitatory postsynaptic potential takes place.
The influx of sodium from ECF and development
of action potential take place. The action potential
through the axon of postsynaptic neuron spreads.
In this way synaptic transmission takes place.
Q.6. Write a short note on properties of synapse.
(Sep 2004, 5 Marks) (Jan 2012, 6 Marks)
Ans.
Properties of Synapse
♦♦ One way conduction: According to Ball Magendie law, the
impulses are transmitted only in one direction in synapse,
i.e. from presynaptic neuron to postsynaptic neuron.
♦♦ The synaptic delay: During transmission of impulses via
the synapse, there is a little delay in transmission. This is
called synaptic delay. This may be due to time taken for:
• Release of neurotransmitter
• Movement of neurotransmitter from axon terminal to
postsynaptic membrane.
• Action of neurotransmitter to open the ionic channels
in postsynaptic membrane.
♦♦ Fatigue: The fatigue at synapse is due to depletion of
neurotransmitter substance, i.e. acetylcholine. After pro-
ducing the action, the neurotransmitter is destroyed by
acetylcholinesterase.
♦♦ Summation: When many members of presynaptic excita-
tory terminals are stimulated simultaneously or when sin-
gle presynaptic terminal is stimulated repeatedly there is
summation, i.e. there is progressive increase in excitatory
postsynaptic potential. It is of two types:
1. Spatial summation: This occurs when many pre­
synaptic terminals are stimulated simultaneously.
2. Temporal summation: It occurs when one presynaptic
terminal is stimulated repeatedly.
♦♦ Electrical property: The electrical properties of synapse are
excitatory and inhibitory postsynaptic potential.
Q.7. Write a short note on reflex arc. (Mar 1997, 5 Marks)
Ans. The anatomical nervous pathway for a reflex action is
called reflex arc. In a simple reflex arc, there are five
components:
1. Receptor: It is the end organ which receives the
stimulus; when the receptor is stimulated, impulses
are generated in afferent nerve.
2. Afferent Nerve: Afferent or sensory nerve transmits
sensory impulses from receptor to center.
3. Center: The center receives the sensory impulses via
afferent nerve fibers and sends it to motor impulses.
It may be in the brain or spinal cord.
4. Efferent Nerve: It transmits motor impulses from
center to effector organ.
Physiology 405
5. Effector organ: The effector organs like muscle or
gland show response to stimulus.
Fig. 42:  Reflex arc
Q.8. Write briefly on conditioned reflex. (Sep 2004, 5 Marks)
Ans. • Conditioned reflex is a reflex response acquired or
learnt by experience. It is the basis of learning. The
conditioned reflex is acquired after the birth.
• The conditioned reflex are of two types:
1. Classical conditioned reflex: These reflexes are
those reflexes which can be established by a con-
ditioned stimulus followed by an unconditioned
stimulus. They are divided into two groups:
a. Positive or excitatory conditioned reflex:
They are of three types:
i. Primary conditioned reflex: The develop­
ment of conditioned reflex with one
unconditioned reflex stimulus and one
conditioned stimulus is called primary
conditioned reflex.
ii. S econdary conditioned reflex: The
development of a conditioned reflex with
one unconditioned stimulus and two
conditioned stimulus is called secondary
conditioned reflex.
iii. Tertiary conditioned reflex: The develop­
ment of a conditioned reflex with one
unconditioned stimulus and three
conditioned stimulus is called tertiary
conditioned reflex.
b. Negative or inhibition conditioned reflex:
This is of two types:
i. External or indirect inhibitions: The
established conditioned reflex is inhibited
by some form of stimulus, which is quite
different from conditioned stimulus. It is
not related to conditioned stimulus.
ii. I nternal or direct inhibition: It is
abolished by four ways, i.e. extinction
of conditioned reflex, conditioned
inhibition, delayed conditioned reflex
and differential inhibition.
2. Instrumental conditioned reflex: These are those
reflexes in which behavior of a person is instrumen-
tal. This type of a reflex is developed by conditioned
stimulus followed by reward or punishment.
406 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.9. Draw the TS of spinal cord showing ascending and
descending tract. (Apr 2007, 4 Marks)
Ans. kinesthetic sensation.
Fig. 43:  TS of spinal cord
Q.10. Write in brief on function of ascending tract.
(Mar 1998, 7.5 Marks)
Or
Write a short note on ascending tracts and their func-
tions. (Mar 2000, 5 Marks)
Or
Describe in brief the ascending tracts of spinal cord.
(Sep 2007, 4 Marks) (Mar 2008, 3 Marks)
Ans. Ascending Tracts
Ascending tracts in anterior white funiculus:
♦♦ Anterior spinothalamic tract: It is formed by fibers of
second-order neuron of pathway for crude touch.
Function: It carries impulses for crude touch sensation.
Lesion: The bilateral lesion of tract leads to loss of crude
touch sensation and loss of sensation like itching and
tickling.
Ascending tracts in lateral white funiculus:
♦♦ Lateral spinothalamic tract: It is formed by the second-
order neurons of pathway for sensation of pain and
temperature.
Function: The fibers of tract carry impulses of pain and
thermal sensations.
Lesion: The unilateral lesion causes loss of pain and tem-
perature below level of lesion of opposite side. The bilateral
lesion of this tract leads to loss of pain and temperature
sensation on both sides.
♦♦ Ventral spinocerebellar tract or Gower’s tract: This is
constituted by fibers of second-order neurons of pathway
for subconscious kinesthetic sensation along with
dorsospinal cerebellar tract.
Lesion: It leads to loss of subconscious kinesthetic sensa-
tion mostly in opposite side.
♦♦ Dorsal spinocerebellar tract: This is constituted by
second-order neuron fibers of pathway for subconscious
Function: The tract carries impulses of such conscious
kinesthetic sensation which are known as nonsensory
impulses.
Lesion: This leads to unilateral loss of subconscious
kinesthetic sensation.
♦♦ Spinotectal tract: It is a considered as component of
spinothalamic tract. This is constituted by second-order
neurons.
Function: The tract is concerned with spinovisual reflex.
Lesion: It leads to loss of spinovisual reflex.
♦♦ Fasiculus dorsolateralis: It is constituted by fibers of first-
order neurons.
Function: The fibers of tract carry impulses of pain and
thermal sensation.
Lesion: Due to lesion, there is loss of impulses of pain and
thermal sensation.
♦♦ Spino reticular tract: The fibers of tract arise from inter-
mediolateral cell column.
Function: The fibers of tract are concerned with conscious-
ness and awareness.
Lesion: There is loss in sensation consciousness and aware-
ness.
♦♦ Spino-olivary tract: From this tract, the neurons project
into cerebellum, origin of fibers is not specific.
Function: The tract is concerned with proprioception.
Lesion: There is loss in sensation of proprioception.
♦♦ Spinovestibular tract: The fibers arise from all seg-
ments of spinal cord and terminate in lateral vestibular
apparatus.
Function: The tract is concerned with sensation of proprio-
ception.
Lesion: There is loss in sensation of proprioception.
♦♦ Fasciculus cuneatus and fasciculus gracilis: These both
are constituted by fibers of first-order neurons of sensory
pathway.
Function: They convey impulses to the following sensa-
tions, i.e. tactile sensation, tactile discrimination, tactile
localization, vibratory sensation and conscious kinesthetic
sensation.
Lesion: There is loss in sensations of tactile discrimina-
tion, tactile localization, vibratory sensation and conscious
kinesthetic sensation.
Q.11. Write a short note on spinothalamic tracts.
(Aug 2012, 5 Marks)
Ans. There are two spinothalamic tracts:
1. Anterior spinothalamic tract
2. Lateral spinothalamic tract.
Both are described in Ans 10 of the same chapter.

Q.12. Trace the path for pain, temperature and crude touch
with help of diagram. (Oct 2000, 5 Marks)
Ans.
Fig. 44:  Path for pain temperature and crude touch
Q.13. Write in brief on motor tracts and their lesions.
(Sep 1996, 6 Marks)
Ans. Motor Tracts and their Lesions
The motor tract of spinal cord are of two types:
A. Pyramidal tract: They are concerned with voluntary
motor activities of body. They are of two types:
1. Anterior corticospinal tract
2. Lateral corticospinal tract
They originate from Betz cells and other cells
of motor area. They originates uncrossed of
anterior corticospinal tract and crossed of lateral
corticospinal tract.
Lesion:
1. Voluntary movements of body are very much
affected during lesion in this tract.
2. The muscle tone is increased leading to
spasticity of muscles.
3. All superficial reflexes are lost and Babinski’s
sign is positive.
B. Extrapyramidal tract: They are as follows:
1. Medial longitudinal fasciculus: It originates
from cell of Cajal the fibers are uncrossed which
extend up to upper cervical segments.
Lesion: The movements of body are affected
during lesion.
2. Anterior vestibulospinal tract: It originates from
lateral; vestibular nucleus. The fibers are mostly
uncrossed.
Physiology 407
Lesions: During lesion, the increased and loss
in posture.
3. Lateral vestibulospinal tract: It originates
from lateral vestibular nucleus. The fibers are
uncrossed and extend to all segments.
Lesion: The lesion in this tract affects the position
of head and body during acceleration.
4. Reticulospinal tract: It originates from reticular
formation of pons and medulla. The fibers are
mostly uncrossed.
Lesion: The lesion to this tract causes disturbance
in voluntary and reflex movements. The muscle
tone is increased. And the control over respira-
tion and blood vessels is lost.
5. Tectospinal tract: The fibers originate from
superior colliculus. The fibers extend up to lower
cervical segments.
Lesion: The lesion of this tract causes distur-
bances in movement of head in response to
visual and auditory impulses.
6. Rubrospinal tract: The fibers originate from red
nucleus. These fibers extend upto thoracic seg-
ments.
Lesion: The control over flexor muscle tone is lost.
7. Olivospinal tract: The fibers originate from in-
ferior olivary nucleus. Their extension or coarse
is not clear.
Lesion: There is loss of control over movements
arising due to proprioception.
Q.14. Write in brief on functions of descending tract.
(Apr 2003, 7 Marks)
Ans. Functions of descending tracts
A. Pyramidal tracts
1. Anterior corticospinal tract
2. Lateral corticospinal tract
Function: The pyramidal tracts are concerned
with voluntary movements of body.
B. Extrapyramidal tracts
1. Median longitudinal fasciculus
Function: The tract is responsible for coordina-
tion of reflex ocular movements and integration
of movements of eyes and neck.
2. Anterior vestibulospinal tract
Function: It maintains muscle tone and posture.
3. Lateral vestibulospinal tract
Function: It is concerned with position of head
and body during acceleration.
4. Reticulospinal tract
Functions: It controls voluntary and reflex
movements, muscle tone, respiration and blood
vessels.
408 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

5. Tectospinal tract Contd...

Function: It causes movements of head in
S.
response to visual and auditory impulses. no. Lower motor neuron lesion Upper motor neuron lesion
6. Rubrospinal tract 4. Disuse atrophy of the muscle Muscle atrophy is not very
Functions: It causes facilitatory influence on occur, i.e. there is shrinkage severe because muscles
flexor muscle tone. of muscle fiber which get though not used in voluntary
7. Olivospinal tract finally replaced by fibrous movements are continuously
tissue in action to maintain posture
Function: Here movements are arising due to by reflexes
proprioception.
5. Babinski sign is absent Babinski sign is abnormal, i.e.
Q.15. Write briefly about effects of lesion of lower motor by stroking the outer edge of
neuron. (Feb 2016, 2 Marks) sole of foot with firm tactile
stimulus produces upward
Ans. Lower Motor Neuron Lesion
movement of great toe and
Lower motor neurons are anterior gray horn cell in spinal fanning out of small toes. This
cord and motor neurons of cranial nerve nuclei situated occurs due to contraction of
in brainstem which innervate muscle directly. extensor hallucis longus
The lesion in neurons of anterior gray horns in spinal 6. Clonus is not present Clonus is present
cord and motor neurons of cranial nerve nuclei situated 7. Electrical activity is absent Electrical activity is normal
in brainstem is called lower motor neuron lesion. 8. Fascicular twitch in EMG is Fascicular twitch in EMG is
present absent
Effects of Lower Motor Neuron Lesion

Lower Motor Neuron Q.17. Describe in brief physiology of pain.

Effects Lesion (Aug 2005, 7.5 Marks) (Feb 2013, 7 Marks)
Clinical Muscle tone Hypotonia (Aug 2012, 5 Marks)
observation Paralysis Flaccid type of paralysis Or
Wastage of muscle Wastage of muscle occurs Write short note on pathway of pain sensation.
Superficial reflexes Lost (Mar 2005, 5 Marks) (Apr 2010, 5 Marks)
Plantar reflex Absent Or
Deep reflexes Lost Describe pain pathway. (July 2016, 5 Marks)
Clonus Absent
Ans. Pain is sensation. It has got two components namely:
1. Fast pain
Clinical Electrical activity Absent
confirmation
2. Slow pain
Muscles affected Individual muscles are Whenever a pain stimulus is applied, first a bright sharp
affected
and localized pain sensation is produced. This is called
Fascicular twitch in EMG Present fast pain. The fast pain is followed by a dull, diffused
Q.16. Write a short note on upper and lower motor neuron and unpleasant pain. This is known as slow pain. The
paralysis. (Mar 2001, 5 Marks) receptors of both the components of pain are free nerve
Ans. endings. The fast pain sensation is carried by Aδ fibers
and slow pain sensation by C type of fibers.
S.
no. Lower motor neuron lesion Upper motor neuron lesion Pathway of Pain Sensation
1. It occurs due to the lesion It occurs due to the lesion ♦♦ Receptors: The receptors of both components of pain are
of lower motor neurons, of upper motor neurons, i.e. free nerve endings which are distributed throughout the
i.e. there is involvement neurons in brain and spinal cord body
of both spinal and cranial which influences the activity of
• First-order neurons: They are the cells in posterior
motor neurons which directly lower motor neurons. The major
innervate the muscles cause is lesion of pyramidal nerve root ganglia. They receive impulses of pain
tracts sensation from pain receptors through dendrites.
These impulses are transmitted to spinal cord
2. In this lesion either single or In this lesion group of muscles
individual muscle is affected are affected through axons of these neurons. The fibers of fast
pain sensation are carried by Aδ type afferent fibers
3. In this flaccid paralysis is In this spastic paralysis is
present, i.e. muscle become present i.e. affected muscles
and slow pain sensation is carried by C type afferent
hypotonic and completely become hypertonic fibers.
paralysed • Second-order neurons: Neurons of marginal nucleus
Contd... and cells of substantia gelatinosa of Ronaldo form

second-order neurons. Fibers from these neurons
ascend in form of lateral spinothalamic tract. Fibers of
fast pain arise from neurons of marginal nucleus. The
fibers arising from substantia gelatinosa for slow pain
cross midline and run along with fibers of fast pain
as paleospinothalamic fibers in lateral spinothalamic
tract. One-fifth of these fibers terminate in ventral
posterolateral nucleus of thalamus.
• Third-order neurons: The third-order neurons of pain
pathway are the neurons of thalamic nucleus, reticular
formation, tectum and grey mater around aqueduct
of Sylvius. Axons from these neurons reach sensory
area of cerebral cortex. Sometimes fibers from reticular
formation reach hypothalamus.
The center for pain sensation is postcentral gyrus
of partial cortex. Fibers reaching hypothalamus are
concerned with arousal mechanism due to pain
stimulus.
Q.18. Write a short note on endogenous analysis mechanisms
in CNS. (Aug/Sep 1998, 5 Marks)
Or
Write briefly on endogenous pain inhibiting mecha-
nisms. (Sep 2001, 8 Marks)
Ans. The CNS has got its own control system which inhibits
impulses of pain sensation. This is also called as
analgesia system. The control system is present in brain
and spinal cord.
• Pain control system in brain: This blocks the
impulses before entering into the brain. The system
is present in grey matter surrounding aqueduct
of sylvius and raphae magnus nucleus in pons. The
neurotransmitters involve in inhibition of pain by
control system in brain are serotonin and opiate
receptor substances.
• Pain control system in spinal cord: This is in
posterior grey horn, when pain sensation is
produced in a part of body along with pain fibers,
some of afferents, i.e. touch fibers reaching posterior
column of spinal cord are activated. The dorsal
column fibers send collaterals to cells of substantia
gelatinosa in posterior grey horn. So, some of the
impulses ascending via dorsal column fibers through
collaterals reach substantia gelatinosa. Here, the
impulses inhibit release of substance P by pain
fibers ending on substantia gelatinosa so that pain
sensation is suppressed.
Q.19. Write a short note on referred pain and applied
significance. (Mar 1998, 5 Marks)
Or
Write briefly about referred pain.
(Aug 2016, 2 Marks)
Ans. The pain sensation produced in some parts of body is
felt in other structures away from place of development.
This is called referred pain.
Physiology 409
Mechanism of referred Pain
Dermatomal rule: Pain is referred to a structure, which is
developed from same dermatome from which pain producing
structure is developed. This is dermatomal rule.
A dermatome includes all the parts and structure of body.
For example, the heart and inner aspect of left arm originate
from some dermatome so, pain in heart is referred to left arm.
Examples of Referred Pain
♦♦ Pain in ovary is referred to umbilicus
♦♦ Pain in testis is referred to abdomen
♦♦ Pain in diaphragm is referred to right shoulder
♦♦ Renal pain is referred to loin.
Q.20. Write in brief on functions of hypothalamus.
 (Sep 2017, 2 Marks) (Aug/Sep 1998, 5 Marks)
(Sep 2000, 5 Marks) (Sep 2001, 7 Marks)
(Mar 2005, 7.5 Marks) (Sep 2005, 5 Marks)
(Feb 2003, 7.5 Marks) (Sep 2007, 4 Marks)
Or
Describe function of hypothalamus in detail.
(Dec 2009, 15 Marks)
Or
Write on functions of hypothalamus.
(Sep 2018, 5 Marks) (Apr 2017, 5 Marks)
Ans. Functions of Hypothalamus are as follows
1. Control of anterior pituitary: Hypothalamus
controls anterior pituitary gland by secreting,
releasing and inhibiting hormones which control
release of anterior pituitary.
Following hormones are secreted by hypothalamus
and transported to anterior pituitary by hypothalo-
mohypophyseal tract.
1. Somatotropic releasing hormone
2. Somatotropic inhibiting hormone
3. Thyrotropic releasing hormone
4. Corticotropic releasing hormone
5. Gonadotropic releasing hormone
6. Prolactin inhibitory hormone.
2. Secretion of posterior pituitary hormones: Hy-
pothalamus is source of secretion for posterior
pituitary hormones. ADH and oxytocin are secreted
by supraoptic and paraventricular nuclei. These two
hormones are transported by means of axonic and
axoplasmic flow through fibers of hypothalamohy-
pophyseal tract to posterior pituitary.
3. Regulation of heart rate: It regulates heart rate
through cardiac centers in medulla oblongata.
Stimulation of posterior and lateral nuclei of
hypothalamus increases heart rate and stimulation
of preoptic area decreases heart rate.
4. Regulation of body temperature: The hypothalamus
consists of both heat loss and heat gain centers.
Through these centers, it helps in regulating
410 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
temperature. The heat loss center is in anterior
hypothalamus and heat gain center is in posterior
hypothalamus.
Apart from temperature receptors, some are heat
sensitive cell in preoptic area. The thermoreceptors
of hypothalamus are stimulated and causes heat loss
in two ways:
a. Peptic thermoreceptors stimulate sweat gland
and increases sweat secretion.
b. Preoptic thermoreceptors inhibit posterior
hypothalamus which control SNS. This leads to
cutaneous vasodilation and increase in blood
flow to skin, due to increase in blood flow, more
heat is lost.
Now, when body temperature is reduced, heat loss
is prevented and production of heat is increased.
a. When body temperature is decreased, the
preoptic thermoreceptors are not activated so
posterior hypothalamus is not inhibited and
blood flow to skin is reduced and heat loss is
prevented.
b. Whenever the body temperature is decreased,
activity of posterior hypothalamus is increased
and muscular activity is enhanced leading to
shivering due to which more heat is produced.
5. Regulation of water balance: Hypothalamus regulate
water balance of body by two ways:
a. By causing sensation of thirst leading to intake
of water by activating thirst center.
b. By regulation of excretion of water through urine
by ADH.
6. Control of adrenal cortex: Hypothalamus control
adrenal cortex through anterior pituitary. Anterior
pituitary regulate adrenal cortex by secreting
adrenocorticotropic hormone. ACTH secretion
is regulated by corticotropic releasing hormone
which is secreted by paraventricular nucleus of
hypothalamus.
7. Control of adrenal medulla: Dorsomedial and
posterior hypothalamic nuclei are excited by
emotional stimuli. These hypothalamic nuclei send
impulses to adrenal medulla through sympathetic
fibers and cause release of catacholamines which are
essential to cope up with emotional stress.
8. Regulation of autonomic nervous system: Hypo­
thalamus control autonomic nervous system.
Sympathetic division of autonomic nervous
system is regulated by posterior and lateral nuclei
of hypothalamus. Parasympathetic division of
autonomic nervous system is controlled by anterior
group of nuclei.
9. Regulation of blood pressure: Hypothalamus
regulates blood pressure by acting on vasomotor
center. Stimulation of posterior and lateral
hypothalamic nuclei increases arterial blood
pressure and stimulation of preoptic area decreases
blood pressure.
10. Regulation of sleep and wakefulness: Mammil-
lary body in posterior hypothalamus is considered
as wakefulness center. Stimulation of mammillary
body causes wakefulness and its lesion leads to
sleep.
11. Role in response to smell: Posterior hypothalamus
along with hippocampus and brainstem nuclei is
responsible for autonomic responses of body to
olfactory stimuli. These responses include feeding
activities and emotional responses like fear, excite-
ment and pleasure.
12. Role in circadian rhythm: Circadian rhythm is
regular recurrence of physiological processes or
activities which occur in cycle of 24 hours. It is known
as diurnal rhythm. Cyclic changes taking place in
various physiological process are set by means of
hypothetical internal clock known as biological
clock. Suprachiasmatic nucleus of hypothalamus
set biological clock by its connection with retina via
retinohypothalamic fibers. By efferent fibers it send
circadian signals to different parts and maintain
circadian rhythm of sleep, thirst, hunger, etc.
Q.21. Write a short on mechanism of heat loss.
(Feb 2002, 5 Marks)
Ans. Refer to Ans 20 of same chapter in function number 4,
i.e. regulation of body temperature by hypothalamus.
Q.22. Write a short note on regulation of body temperature.
(Apr 2003, 5 Marks) (Jan 2012, 5 Marks)
 (Feb 2013, 6 Marks)
Or
Write short note on role of hypothalamus in tempera-
ture regulation. (Oct 2007, 5 Marks)
(Apr 2008, 3 Marks) (Sep 2006, 3 Marks)
Or
Write a short note on regulation of body temperature
in man. (Mar 2006, 5 Marks)
Ans. Refer to Ans 20 of the same chapter in function no. 4, i.e.
regulation of body temperature by hypothalamus.
Q.23. Write short note on function of cerebellum.
(Sep 2006, 5 Marks) (Nov 2009, 3 Marks)
Ans. Functions of cerebellum are as follows:
1. Vestibulocerebellum or archicerebellum plays an
important role in maintenance of tone, posture and
equilibrium because of its connection with vestibu-
lar apparatus, vestibular nuclei and spinal motor
neurons.
2. Spinocerebellum or paleocerebellum is receiving
area for tactile, proprioceptive, auditory and visual
impulses.
3. Spinocerebellum regulates posture reflexes by modi-
fying muscle tones.
4. Corticocerebellum or neocerebellum is concerned
with integration and regulation of well coorindated
muscular activities.

5. Corticocerebellum receives nerve fibers from pro-
prioceptors in muscles. Thus, it receives feedback
system from muscles during muscular activity.
Q.24. Write a short note on functions of basal ganglia.
(Mar 2000, 5 Marks)
Or
Write on functions of basal ganglia.
(Jan 2018, 5 Marks)
Ans. Functions of basal ganglia are as follows:
1. Control of voluntary motor activity: The movements
during voluntary motor activity are initiated by
cerebral cortex. However, these movements are
controlled by basal ganglia. Basal ganglia control
motor activities because of presence of circuits
between basal ganglia and brain involving in motor
activity.
2. Control of reflex muscle activity: The visual and
labyrinthin reflexes are important in maintenance
of posture. The co-ordination and integration of
impulses for these activities depend on basal ganglia.
3. Control of muscle tone: The gamma motor neurons,
muscle spindle and muscle tone are all controlled
by basal ganglia.
4. Control of autonomic associated movements:
Swinging of arms during walking, appropriate
facial expressions while doing any work and other
movements associated with motor activities are
called autonomic associated movements. These are
controlled by basal ganglia.
5. Role in arousal mechanism: Globus pallidus and red
nucleus are involved in arousal mechanism because
of their connection with reticular formation. Exten-
sive lesion in globus pallidus causes drowsiness
leading to sleep.
Q.25. Write significance of stretch reflex.
(Apr/Sep 1998, 5 Marks)
Or
Write in brief on stretch reflex. (Apr 2003, 4 Marks)
Or
Write short note on stretch reflex.(Nov 2008, 5 Marks)
Ans. When a muscle is stretched, it responds by contracting.
It is called as stretch reflex. It is a myotactic reflex.
Mode of action of stretch reflex: Stretching the muscle
fibers stimulates muscle spindle which are specialized
sensory end organs lying parallel to muscle fibers.
Muscle spindle send impulses to spinal cord through
sensory fibers. Sensory nerve fibers from muscles reach
to spinal cord, via posterior nerve roots. Within spinal
cord these impulses are transferred over single synapse
to motor cells of anterior grey horn. The motor cells in
turn send impulses through motor nerve fibers to muscle.
The impulses from anterior motor cell causes contraction
of muscles. This type of reflexes are more pronounced
in extensor muscles.
Physiology 411
Physiological significance of stretch reflex:
1. This is a basic reflex which involves in maintenance
of posture.
2. The reflex maintains the body in upright position.
Q.26. Write briefly on functional areas of cerebral cortex.
(Sep 2004, 5 Marks)
Ans. The functional areas of cerebral cortex are as follows:
1. The motor area: It is located in precentral gyrus on
superolateral surface of hemisphere and in anterior
part of paracentral lobule. The electrical stimulation
of the area 4 causes discrete isolated movements in
opposites sides of body.
2. The premotor area: It lies anterior to motor area. It
occupies the posterior part of superior, middle and
inferior frontal gyri. It is concerned with postural
movements and send motor signals to axial muscles.
It has areas 6, 8, 44 and 45.
The area 6 is concerned with isolated movements in
body in opposite side.
The area 8 causes conjugate movements of eyeball
to opposite side, opening and closure of eyelids,
papillary dilatation and lacrimation.
3. The motor speech area or broca’s area: It is motor
area for speech. This has areas 44 and 45. The area
is responsible for movements of tongue, lips and
larynx, which are involved in speech.
4. The sensory area: It is located in postcentral gyrus.
It also extends in posterior part of paracentral lobule.
It has areas 3, 1, 2, 5 and 7.
The area 1 is concerned with sensory perception.
The areas 2 and 3 are involved in integration of these
sensations.
The areas 5 and 7 are concerned with synthesis of vari-
ous sensations prescribed by primary sensory area.
5. The visual area: It is located in occipital lobe, mainly
on medial surface both above calcarine sulcus. It
consists of three areas:
a. Primary visual area—Area 17
b. Visual association area—Area 18
c. Occipital eye field—Area 19
Functions
a. Area 17 is concerned with perception of visual
impulses.
b. Area 18 is concerned with interpretation of visual
impulses.
c. Area 19 is concerned with movement of eyes.
6. The acoustic area: It is located in temporal lobe. It
lies partly on surface of temporal lobe. It has 3 parts:
a. Primary auditory area: It includes areas 41, 42
and Wernicke’s area. The areas 41 and 42 are
concerned with perception of auditory impulses.
However, the interpretation of sound occur
through Wernicke’s area.
b. Auditopsychic area: This occupies superior
temporal gyrus. This is called as Area 22.
This is concerned with interpretation of auditory
impulses.
412 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

c. Area of equilibrium: It is in posterior part of Q.30. Describe, in brief, pyramidal tracts.

superior temporal gyrus. It causes maintenance (Mar 2006, 4 Marks) (Sep 2009, 5 Marks)
of equilibrium in the body. (May/June 2009, 5 Marks)
Q.27. Write a short note on Broca’s Area. (Sep 2004, 5 Marks) Or
Ans. The Broca’s area is motor area for speech. This is a Describe the origin, course and termination of pyrami-
special region of premotor cortex situated in inferior dal tract with help of labelled diagram.
frontal gyrus. It has areas 44 and 45. Area 44 is situated
(Nov 2012, 8 Marks)
in pars triangularis and area 45 is situated in pars
Ans. The pyramidal tracts of spinal cord are descending tracts
opercularis of this gyrus. Broca’s area is also called
concerned with voluntary motor activities of body.
speech center.
These tracts are otherwise known as corticospinal tracts,
Function: This area is responsible for movements of
i.e. anterior corticospinal tract and lateral corticospinal
tongue, lips and larynx, which are involved in speech.
tract. While running from cerebral cortex towards spinal
This area is situated in left hemisphere in right-handed
cord, the fibers of two tracts give the appearance of
persons.
pyramid on the upper part of the anterior surface of the
Q.28. Write a short note on lateral spinothalamic tract. medulla. Hence, the two tracts are called as pyramidal
(Sep 2006, 3 Marks) tracts.
Ans. It is formed by the second-order neurons of pathway for
sensation of pain and temperature.
Situation: The tract is situated on the lateral funiculus
near the grey matter.
Origin: The fiber of lateral spinothalamic tract takes
origin from substantia gelatinosa of Rolando situated
in the posterior grey column.
Course: All the fibers passes through medulla pons
and midbrain towards thalamus along with the fiber of
anterior spinothalamic tract.
Termination: Fiber terminates in the ventral posterolateral
nucleus of thalamus.
Function: The fibers of tract carry impulses of pain and
thermal sensations.
Lesion: The unilateral lesion causes loss of pain and
temperature below level of lesion of opposite side. The
bilateral lesion of this tract leads to loss of pain and
temperature sensation on both sides.
Q.29. Write a short note on neuromuscular junction.
(Sep 2006, 5 Marks) (Dec 2009, 5 Marks)
Or
Write briefly about neuromuscular junction.
 (Feb 2016, 2 Marks)
Ans. The neuromuscular junction is the specialized area where
the motor nerve terminates on a skeletal muscle nerve
fiber and in the site of stereotyped transmission process.
As the axon supplying a skeletal muscle fiber approaches
Fig. 45:  Pyramidal tracts
its termination, it looses its myelin sheath and divides
into a number of terminal buttons or end-feet. The end Origin
feet contain many, small, clear vesicles that contain
acetylcholine, the transmitter at these junctions. The Fibers of pyramidal tracts arise from the following nerve cells
endings fit into depressions in the motor-end plate, the in cerebral cortex.
thickened portion of the muscle membrane of the junction. ♦♦ Giant cells or Betz cells or pyramidal cells in precentral
Underneath the nerve ending, the muscle membrane gyrus of motor cortex.
of end plate is thrown into junctional folds. The space ♦♦ Other areas of motor cortex, i.e. premotor area and
between the nerve and the thickened muscle membrane supplementary area.
is compared the synaptic cleft at synapses. The whole ♦♦ Other parts of frontal lobe.
structure is known as neuromuscular or myoneural ♦♦ Parietal lobe of cerebral cortex particularly from soma-
junction. tosensory areas.

Course
The fibers of anterior corticospinal tract are the uncrossed fibers
and the fibers of lateral corticospinal tract are crossed fibers.
Termination
All the fibers of pyramidal tracts, either crossed or uncrossed
terminate in motor neurons situated in anterior gray horn either
directly or through internuncial neurons.
Function
It is concerned with the voluntary movements and form the
upper motor neurons.
Q.31. Describe, in brief, disorders of basal ganglia.
(Mar 2006, 3 Marks)
Ans. The disorders of basal ganglia are:
1. Parkinson’s disease: It occurs due to the damage
of basal ganglia. It is mostly due to destruction of
substantia nigra and the nigro strial pathway which
has dopaminergic fibers.
2. Wilson’s disease: This develops due to damage of
lenticular nucleus particular putamen. Along with
all symptoms of Parkinsonism there is degeneration
of basal ganglia.
3. Chorea: This is an abnormal involuntary movement.
Chorea means rapid jerky movements. It involves
the limbs. It is due to lesion in caudate nucleus and
putamen.
4. Athetosis: This is another type of abnormal involun-
tary movement, which refers to slow rhythmic and
twisting movements. The cause for this is the lesion
in caudate nucleus and putamen.
5. Hemiballismus: It is characterized by the violent
involuntary abnormal movements on one side of the
body involving mostly the arm. This occurs due to
degeneration of subthalamic nucleus of luys.
Q.32. Write a short note on reflex. (Mar 2006, 5 Marks)
Ans. Response to the peripheral nervous stimulation that occurs
without our consciousness is known as reflex activity.
• It is a type of protective mechanism and it protects
the body from irreparable damage.
• Reflex arc is the anatomical nervous pathway for
a reflex action. In a simple reflex arc, there are five
components.
1. Receptor
2. Afferent nerve
3. Center
4. Efferent nerve
5. Effector organ.
Classification of Reflexes
A. Depending upon whether inborn or acquired
1. Unconditional reflexes or inborn reflexes: They are pre-
sent at the time of birth, do not require previous learning.
2. Conditioned reflexes or acquired reflexes: They are
acquired after birth.
Physiology 413
B. Depending upon the situation of the center
1. Cerebellar reflexes
2. Cortical reflexes
3. Midbrain reflexes
4. Medullary reflexes
5. Spinal reflexes.
C. Depending on the purpose or functional significance
1. Protective reflexes or flexor reflexes: These reflexes
protect the body from harmful stimuli, which are called
nociceptive stimuli.
2. Antigravity reflexes or extensor reflexes: These reflexes
protect the body against the gravitational force.
D. Depending on the number of synapse
1. Monosynaptic reflexes
2. Polysynaptic reflexes.
E. Depending on the clinical basis
1. Superficial reflexes: They are elicited from mucus mem-
brane and skin
2. Deep reflexes
3. Visceral reflexes
4. Pathological reflexes.
Q.33. Describe in brief, knee jerk. (Mar 2006, 3 Marks)
Ans. Knee jerk is also known as patellar tendon reflex.
• It is a type of deep reflex.
• Tapping the patellar tendon elicits the knee jerk,
a stretch reflex of quadriceps femoralis muscle,
because the tap on the tendon stretches the muscle.
• On percussion of patellar ligament there is extension
of leg.
• Center of this reflex is spinal cord. Spinal segments
involved in this reflex are L2, L3, L4.
Q.34. Describe in brief extrapyramidal tracts.
(Mar 2007, 4 Marks)
Ans. Refer to Ans 14 of the same chapter.
Q.35. Discuss the function of cerebellum.
(Oct 2007, 15 Marks) (Mar 2009, 15 Marks)
(Jan 2012, 6 Marks)
Ans. Cerebellum: Cerebellum lies dorsal to the brain stem in
posterior (occipital) fossa.
• Cerebellum plays an important role in planning,
programming and integration of skilled voluntary
movements.
• It also concerns with maintenance of muscle tone,
posture and equilibrium.
• Cerebellum receives impulses from proprioceptors
of muscle, vestibular apparatus, cerebral cortex,
brainstem and basal ganglia.
• It sends signals to the motor cortex, reticular forma-
tion and spinal cord.
Functions of the Cerebellum
1. Control of body posture and equilibrium:
- The floculonodular lobe (vestibulocerebellum) is con-
cerned with control of body posture and equilibrium.
414 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
- Afferents from the vestibular apparatus pass directly or
after relay in the vestibular nuclei to the floculonodular
lobe.
- The efferent impulses therefore return back to the ves-
tibular nuclei.
- From these nuclei the vestibulospinal tract connects
with the spinal motor neurons.
2. Control of muscle tone and stretch reflexes: The medial
part of anterior lobe of cerebellum inhibits the muscle tone
(stretch reflex), where as the lateral parts of anterior lobe
facilitates the muscle tone.
- Normally, the influence of the cerebellum of the muscle
tone and stretch reflexes is inhibition.
- Pathway: The anterior lobe inhibits the muscle tone
(mainly in the extensor muscle) of the same side of the
body.
- The effects are mediated via the fastigial nucleus to the
ipsilateral vestibular nuclei and to the bulbar reticular
formation.
- These nuclei in turn relay the effects to the spiral motor
neurons.
3. Control of movements: The cerebellum does not initiate
movements, rather it cordinates movements that are initi-
ated in the motor systems.
- Co-ordination of movements is the result of appropri-
ate regulation of time, rate range force and direction of
muscular activity.
a. Control of involuntary movements: The afferent
pathways to the cerebellum transmit propriocep-
tive, kinesthetic and sensory information from all
parts of the body.
- The cerebellar integrates these impulses and
provides feedback impulses starting from the deep
cerebellar nuclei back to the motor cortex, basal
ganglia and reticular formation that correct the
error in the involuntary movements.
b. Control of voluntary movements: The cerebellum
control and guides all the voluntary movements, i.e.
movements accompanied by a conscious awareness
of an individual. The movements produced are
accurate in time, rate, range, force and direction.
- The cerebellum receives a representation of
corticospinal activity which is transmitted to the
muscle and the representations of the result in terms
of the muscle movement from the proprioceptors
of the muscle.
4. Other functions:
a. Functions of pyramis: It is concerned with movement
of eyeball because its stimulation causes upward eye
movements to the ipsilateral side.
b. Uvula: It has vestibular function, its removal produces
disturbance of equilibrium.
Q.36. Write a short note on Babinski’s sign.
(Mar 2007, 3 Marks) (Aug 2012, 5 Marks)
Ans. Babinski’s sign is the response obtained by stroking (to
pass gently in one direction) outer edge of sole of the
foot with firm tactile stimulus (form heel towards the
lower toe and then medially across metatarsus) in normal
healthy individuals it produces downward movement
(planter flexion) of great toes and small toes. This is due
to contraction of flexor hallucis longus.
• Babinski plantar response appears with the toe
development of pyramidal tracts. Therefore, its pres-
ence indicates development of these tracts. Normally
it is flexor response.
• Babinski’s sign if one become positive, will remain
positive for rest of life there after. In some normal
individuals it is always positive.
• Individuals with positive babinski’s sign neither can
rules faster nor can travel long distances.
Causes of Positive Babinski’s Sign
♦♦ Infants (below 1 year of age) as the pyramidal treats are
not developed till child starts walking.
♦♦ During deep sleep
♦♦ Inhibition of pyramidal tracts
♦♦ Cheyne-stroke respiratory due to hypoxia.
♦♦ Babinski’s sign is not elicited in lower motor neuron
lesion.
♦♦ Babinski’s sign is positive in upper motor neuron lesion,
stroking outer age of sole of foot with firm tactile stimulus
produces first on upward movement of great toe and
fanning out of small toes. This is due to contraction
of extensor hallucis longus physiologically a flexor
response.
Q.37. Write, in brief, on conditioned reflexes.
(Oct 2007, 5 Marks)
Or
Write short note on conditional reflex.
(June 2010, 5 Marks)
Ans. Conditional reflex is a reflex response acquired or learnt
by experience.
It is a basis of learning.
Types of Conditioned Reflex
♦♦ Classical Conditioned reflex.
♦♦ Instrumental Conditional reflex.
Classical conditioned reflex
These are those reflexes, which are established by conditioned
stimulus followed by unconditioned stimulus.
Types of Classical Conditioned Reflexes
A. Positive conditional reflexes
B. Negative conditional reflexes
A. Positive conditioned reflexes
i. Primary conditioned reflexes: The development of
conditioned reflex with one unconditioned stimulus
and one conditioned stimulus is called as primary
conditioned reflex.
 Physiology 415

ii. Secondary conditioned reflex: The development of Composition

Conditioned reflex with one unconditioned stimulus ♦♦ Water: 99.13%
and two conditioned stimuli is called secondary con-
♦♦ Solids: 0.87%
ditioned reflex.
♦♦ The organic substances present are amino acid, urea,
iii. Tertiary conditioned reflex: In this, third conditioned
sugar, cholesterol, proteins, uric acid, creatinine, lactic
stimulus is added and reflex is established.
acid. Inorganic substances which is present are sodium,
B. Negative conditioned reflex. The established conditioned
reflexes can be inhibited by some factors. The inhibition is calcium, potassium, magnesium, chloride, phosphate,
of two types. bicarbonate and sulphates.
i. External inhibition: The established conditioned reflex ♦♦ Lymphoctes are also added in CSF 6/mm3 when it flows
is inhibited by some form of stimulus, which is quite through spinal cord.
different from conditioned stimulus.
Formation
ii. Internal inhibition: There are four different ways:
a. Extinction of conditioned reflex CSF is formed by choroid plexus which is situated in ventricles.
b. Conditioned inhibition.
c. Delayed conditioned reflex Circulation
d. Differential inhibitor.
Instrumental Conditioned Reflex CSF forms in lateral ventricle

These are those reflexes in which behavior of person is

instrumental. This type of reflexes is developed by conditioned
stimulus followed by reward or punishment. From lateral ventricle it passes through foramen of
Q.38. Describe, in brief, functions of thalamus. Monro in third ventricle
(Apr 2008, 3 Marks) (Sep 2009, 5 Marks)
Ans. Thalamus is primary concerned with somatic functions
and it plays little role in the visceral functions. From third ventricle it passes to fourth ventricle through
aqueduct of Sylvius
Various Functions
1. Relay center: The impulses of almost all sensitizers reach
thalamus nuclei, particularly in ventral posterolateral From fourth ventricle CSF moves to cistern magna and cistern
nucleus. After being processed in thalamus, impulses are lateralis through foramen of Magendie and Luschka
carried to cerebral cortex through thalomocortical fibers.
This forms relay center.
2. Center for integration of impulses: Thalamus forms the
CSF circulates through subarachanoid space over spinal cord
major center for integration and modification of peripheral
and cerebral hemisphere
sensory impulses before impulses are projected to specific
areas of cerebral cortex. This function is called as process-
ing of sensory information. Functions
3. Center for sexual sensations: Thalamus is center for
♦♦ It acts as a medium by which nutritive substances and
perception of sexual sensation.
4. Role in arousal and alertness: Reactions: Because of con- waste materials are exchanged between blood and brain
nections with nuclei of reticular formation, thalamus plays tissues.
important role in arousal and alertness reactions. ♦♦ It helps in regulation of cranial content volume because
5. Center for reflex activity: As sensory fibers relay here, increase in the cranial content volume leads to brain
thalamus forms relay center for many reflex activities. damage.
6. Center for integration of motor functions: Through the ♦♦ CSF acts like a cushion because of presence of large amount
connections with cerebellum and basal ganglia, thalamus of fluid and hence protects the brain from shock.
serves as center for integration of motor functions.
Q.40. Describe the connection and function of cerebellum.
Q.39. Write short note on CSF (cerebrospinal fluid). (Dec 2010, 20 Marks)
(Dec 2010, 3 Marks) Ans. Connection of Cerebellum
Ans. CSF is the colorless, clear and transparent fluid which
get circulated through ventricles present in brain, Afferent Connections
subarachnoid space and central canal of spinal cord.
Dorsal Spinocerebellar Tract
• Specific gravity of CSF is 1.005
• Volume of CSF is 150 ml ♦♦ Carries mainly unconscious kinesthetic and cutaneous
• CSF forms 0.3 mL/min and its reaction is alkaline. afferents from the trunk and leg.
416 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ It undergoes the ipsilateral inferior cerebellar peduncle Efferent Connections

and is distributed to the anterior lobe, pyramis, uvula and
the median part of the paramedian lobe.
Ventral Spinocerebellar Tract
♦♦ Carries a large proportion of exteroceptive and propriocep-
tive fibers from all parts of the body.
♦♦ It undergoes the cerebellum via the ipsilateral superior
cerebellar peduncle and is distributed mainly to the vermis
and the anterior lobe.
Olivocerebellar Tract
♦♦ It undergoes via the superior cerebellar peduncle to supply
all parts of the cerebellar cortex and the deep cerebellar
nuclei via climbing fibers.
♦♦ It carries proprioceptive inputs from the whole body via
relay in inferior olive.
♦♦ The inferior salivary nucleus itself is stimulated and
receives fibers from all levels of the spinal cord, from brain
stem nuclei and from the opposite cerebral cortex.
♦♦ Purkinje cell axons pass deep cerebellar nuclei in an orderly
manner.
♦♦ Purkinje cell axons has influence on these nuclei which is
purely inhibitory via release of GABA.
♦♦ Within the white matter there are four pairs of nuclei which
are the dentate, emboliform, fastigial and globose.
♦♦ As the emboliform and globose nuclei have similar connec-
tions, these are together known as the nucleus Interpositus.
The pathways to and from the individual cerebellar nuclei.
For functions of cerebellum refer to Ans 23 of same chapter.
Q.41. Write short note on classification of nerves.
(Aug 2011, 6 Marks)
Ans.
Classification of Nerves
Erlanger and Gasser’s Classification
Nerve fibers are divided into A B and C groups. Groups are
further divided into α, β, γ and δ.

Vestibulocerebellar Tract Fiber Type Function

♦♦ Originate in the vestibular nuclei. Aα Somatic motor golgi tendon organs, proprioception
♦♦ The fibers enter via the ipsilateral inferior cerebellar Aβ and touch
peduncle and supply the flocculonodular lobe and uvula. Aγ Touch, pressure and motor functions
Aδ Motor to muscle spindle
Cuneocerebellar Tract B Pain, temperature, crude touch
♦♦ Carries proprioceptive impulses from the arm and neck C Preganglionic autonomic nerve fibers
muscles and in the external arcuate nucleus. i. Dorsal root Pain, touch, temperature and conduct impulses
♦♦ It undergoes via the ipsilateral inferior cerebellar peduncle generated by cutaneous receptors
to the anterior lobe, the pyramis and uvula. ii. Sympathetic Postganglionic sympathetic nerve fibers
Tectocerebellar Tract
Numerical Classification
♦♦ Originates from the superior and inferior colliculi which
relays fibers respectively from the eye and ear. S. No. Origin Fiber Type
♦♦ It undergoes via the superior cerebellar peduncle to the Ia. Muscle spindle, annulospiral ending Aa
lobulus simplex, the declive and tuber.
Ib. Golgi tendon organ Aa
Cortico-Ponto-Cerebellar Tract II. Muscle spindle secondary ending, Ab
♦♦ It originates in the motor cortex, i.e. areas 4 and 6 and kinesthesia, touch, pressure
other parts of cerebral cortex and ends in the nuclei pontis. III. Pain and temperature receptors; crude Ad
♦♦ From the nuclei pontis the pontocerebellar fibers cross to touch and pressure receptors
enter the opposite side in the middle cerebellar peduncle IV. Pain, touch, pressure, temperature Dorsal root C fibers
and are distributed to all parts of the cerebellar cortex.

Rubrocerebellar Tract Physioclinical Classification

♦♦ Originates from the red nucleus.
♦♦ It undergoes via the superior cerebellar peduncle and
distributed mainly to the dentate nucleus.
♦♦ It transmits impulses which have originated from the
motor cortex and relays in the red nucleus.
Reticulocerebellar Tract
♦♦ Originates in the reticular nucleus.
♦♦ It is distributed via the ipsilateral inferior cerebellar
peduncle to the whole of the cerebellar cortex.
The classification is based on sensitivity to hypoxia, pressure
and anesthetic agents.
1. Hypoxia: It is associated with alteration in autonomic
functions as preganglionic autonomic B fibers are sus-
ceptible to it.
2. Pressure: Pressure on a nerve leads to loss of conduction
in motor, touch and pressure fibers in group A.
3. Local anesthetics: They can block transmission of pain
sensation in group C fibers before they affect touch fibers
in group A.

Most Least
Susceptibility susceptible Intermediate susceptible
Sensitivity to hypoxia B A C
Sensitivity to pressure A B C decrease the release of substance P in the dorsal horn. Thus
Sensitivity to local C B A inhibiting the transmission in pain pathway in the spinal cord.
anesthetics
Q.42. Describe in brief about pain inhibiting mechanism.
(Jan 2012, 6 Marks)
Ans. Pain inhibiting mechanism is also known as analgesia.
Analgesia can be achieved by two mechanisms:
a. Stimulation produced analgesia
b. By release of endogenous opioid peptide.
Stimulation Produced Analgesia
Electrical stimulation of specific areas of the CNS can produce
a profound reduction of pain by inhibiting pain pathways, a
phenomenon called stimulation produced analgesia. Thus,
within CNS are pathways which inhibit the activity of the
central neurons by peripheral noxious stimulation. Two main
pathways involved are—segmental and supraspinal inhibition.
Segmental Inhibition
Stimulation of nerves in the same segment in which pain is felt
can relieve such pain. It can be achieved by:
1. Activation of group A afferent nerve fibers
2. Stimulation of the dorsal column of spinal cord which in
turn aggrevates segmental collaterals.
Gate Control Theory
♦♦ Gate control theory explains the pain suppression. Accord-
ing to this theory, the pain stimuli transmitted by afferent
pain fibers are blocked by gate mechanism located at the
posterior gray horn of spinal cord. lf the gate is opened,
pain is felt. lf the gate is closed, pain is suppressed. Brain
also plays some important role in the gate control system
of the spinal cord.
♦♦ Thus, the gating ot pain at spinal level is similar to pr-
esynaptic inhibition. It forms the basis for relief of pain
through rubbing, massage techniques, application of ice
packs, acupuncture and electrical analgesia.
Supraspinal Inhibition
A descending inhibitory pathway from the brain stem to the
Rexed laminae I, IV and V can also produce analgesia. One such
important pathway is mesencephalic pain inhibitory system.
This system arises from mid brain and descends to the dorsal
horn cells, in the spinal cord. It contains opiate receptors.
By Release of Endogenous Opioid Peptides
Substance P is a mediator of pain. The terminals of substance P
containing afferents possess opiate receptors on the membrane
surface. Morphine and opioid peptides produce analgesia
by binding to these receptors. The two major type of opioid
peptides are enkephalins and endorphins. These peptides
Physiology 417
function as ‘synaptic transmitters’ and bind to opiate receptors
therby produce analgesia. Enkephalins containing neurons
probably act presynaptically at the site of the receptors on
substance P secreting primary afferent neurons and in turn
Q.43. Write in brief on sleep. (May/June 2009, 5 Marks)
Ans. Sleep is the physiological process by which body
functions are periodically rested. At the time of sleep
consciousness as well as power of will are partially or
completely suspended and bodily activity get reduced.
Types of Sleep
There are two types of sleep, i.e.
1. Nonrapid eye movement sleep or slow wave sleep
2. Rapid eye movement sleep or paradoxical sleep.
Factors Affecting Sleep
Sleep occurs due to the reduction in sensory inputs. So the
procedures which decrease sensaory stimulation favor the onset
of natural sleep. Factors are:
1. Dark room
2. Relaxed body musculature
3. Warm surroundings
4. Silence.
Physiological Changes during Sleep
Following are the physiological changes during sleep, i.e.
1. Cardiovascular system: There is decrease in heart rate,
cardiac output, vasomotor tone and blood pressure.
2. Respiratory system: There is decrease in tidal volume,
respiratory rate, pulmonary ventilation. At times respira-
tion is unchanged or becomes faster.
3. BMR: It decreases
4. Urine: Volume of urine decreases while specific gravity
and phosphate content increases. So urine is more con-
centrated.
5. Muscles: They are relaxed and muscle tone is reduced.
6. Blood volume: It increases and causes dilution of plasma.
7. Nervous system: Deep reflexes get reduced, superficial
reflexes are unchanged, light reflex is retained.
Q.44. Describe briefly hypothalamus and its functions.
(Jan 2012, 15 Marks)
Ans. Hypothalamus lies below the thalamus.
It is separated from thalamus by hypothalamic sulcus.
Hypothalamus forms anteroinferior wall and floor of
third ventricle.
It receives more blood supply than does any structure
in vein.
Boundaries of Hypothalamus
♦♦ Anteriorly it is bounded by optic chiasma
♦♦ Posteriorly it is bounded by mammillary bodies as well as
a pair of white masses.
♦♦ Laterally it is bounded by internal capsule.
418 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Nuclei of Hypothalamus Phylogenetic Division

Hypothalamus consists of many nuclear masses which are Based on lobes of cerebellum there are three types of cerebellum:
grouped in following areas, i.e. 1. Archicerebellum: It is the first part to develop evolution
1. Preoptic area: Preoptic nucleus and is represented by flocculonodular lobe.
2. Anterior area: It consists of 2. Paleocerebellum: It is next to develop and is represented
a. Supraoptic nucleus by anterior lobe and posterior lobe, i.e. pyramis, uvula,
b. Suprachiasmatic nucleus parafloccule.
c. Paraventricular nucleus 3. Neocerebellum: It is the newest part to evolve. It is rep-
resented by remaining parts of posterior lobe, i.e. declive,
d. Anterior nucleus.
tuber, lateral ansiform and paramedian lobules.
3. Middle area
a. Dorsomedial nucleus Functional Divisions
b. Ventromedial nucleus
Functional divisions of cerebellum are:
c. Arcuate nucleus.
1. Flocculonodular lobe: It is functionally related to vestibular
4. Posterior area. apparatus and is known as vestibulocerebellum. It controls
a. Posterior nucleus the body posture, equilibirium and maintain visual fixation.
b. Mammillary body 2. Complete anterior lobe and the parts of posterior lobe, i.e.
5. Lateral area: Lateral nucleus. lobules simplex, pyramis, uvula and parafloccule receive
information from spinal cord and are known as spinocer-
Connections of Hypothalamus ebellum. It controls the trunk, limb muscles and postural
♦♦ Afferent connections: Main afferent connection of hypo- reflexes.
thalamus is with limbic system and midbrain tegmentum. 3. Remaining part of posterior lobe receive information from
♦♦ Efferent connections: Main efferents from hypothalamus cerebral cortex and pons and is known as neocerebellum.
are projected to limbic system, midbrain, thalamus, It is concerned with skilled voluntary movements.
posterior pituitary and spinal cord.
Functions of Cerebellum
Functions of Hypothalamus For details refer to Ans 35 of same chapter.
Refer to Ans 20 of same chapter. Q.46. Write in brief on short term memory.
Q.45. Describe briefly cerebellum and its functions. (Aug 2012, 5 Marks)
 (Jan 2012, 15 Marks) Ans. It is also known as recent memory.
Ans. Cerebellum lies dorsal to brainstem in posterior fossa. Short term memory is the recalling of the events which
On each side it is connected to brainstem by three happened very recently, i.e. within the hours and days.
peduncles viz: It is lost in individuals with certain neurological
1. By inferior cerebellar peduncle to medulla disorders.
2. By middle cerebellar peduncle to pons Example of short term memory is telephone number
3. By superior cerebellar peduncle to midbrain. which is known today if not remembered till next day,
if it is not recalled repeatedly, it may be forgotten on the
Divisions third day.
Anatomical Division Q.47. Write short note on Wallarian degeneration.
It is divided into: (Aug 2012, 5 Marks)
1. Two large laterally placed cerebral hemispheres. Ans. The degenerative changes in distal part of cut nerve fiber
2. A small median portion, i.e. vermis were first described by Augustus Waller in 1862.
Cerebellum is further divided into two parts by posterolateral It is also known as orthograde degeneration.
fissure into: It is the pathological change that occurs in the distal cut
1. Flocculonodular lobe: It consist of floccules and nodule nerve fiber (axon).
2. Corpus cerebellum: This is divided by primary fissure into Wallerian degeneration starts within 24 hours of injury.
anterior lobe and posterior lobe. The change occurs throughout the length of distal part
a. Anterior lobe consists of lingual, lobules, centralis and of nerve fiber simultaneously.
culmen. • Axis cylinder swells and breaks up into small pieces.
b. Posterior lobe is subdivided into: After few days, the broken pieces appear as debris
i. Lateral part consisting of ansiform and paramedian in the space occupied by axis cylinder.
lobules. • The myelin sheath is slowly disintegrated into fat
ii. Median and paramedian part have lobules simplex, droplets. The changes in myelin sheath occur from
declive, tuber, pyramis, uvula and parafloccule. 8th to 35th day.

• The neurilemmal sheath is unaffected, but the
Schwann cells multiply rapidly. The macrophages
invade from outside. The macrophages remove the
debris of axis cylinder and the fat droplets of disin-
tegrated myelin sheath. So, the neurilemmal tube
becomes empty. Later it is filled by the cytoplasm of
Schwann cell. All these changes take place for about
2 months from the day of injury.
Q.48. Define synapse. Describe the structure and mechanism
of synaptic transmission. (Feb 2014, 8 Marks)
Or
Define synapse. Draw a labelled diagram of synapse. Passage of Ach through synaptic cleft
 (May 2017, 2 Marks)
Ans. Synapse is the junction where the axon of one cell
terminates on the dendrites or some other portion of
another cell. Neuron which send messages is known as
presynaptic cell and the neuron which receives messages
is known as postsynaptic neuron.
Fig. 46:  Structure of synapse
Structure
Following is the structure of synaptic transmission:
A. Synaptic knob: It is the terminal bulbous ending of presyn-
aptic axon which is devoid of neurofilaments and contain
i. Synaptic vesicles: Presynaptic cytoplasm consists of
vesicles which are 50 nm in diameter. They accumu-
late near the membrane. They have small packet of
chemical transmitter which causes excitation. They are
transferred to axon along with microtubules.
ii. Mitochondria containing large amount of ATP.
iii. Microtubules
iv. Presynaptic membrane is the nerve membrane which
is close to the membrane of postsynaptic cell.
B. Subsynaptic and postsynaptic membrane: It is the surface
of cell membrane which causes synapsis and is known as
subsynaptic membrane. Remainder of motor neuron cell is
called as postsynaptic membrane.
C. Synaptic cleft: It is a gap of 20 to 30 nm which separates
pre and postsynaptic membranes.
Physiology 419
Mechanism of Synaptic Transmission
Arrival action potential in axon terminal
Presynaptic neuron
Opening of calcium channels in presynaptic membrane
Influx of calcium ions from ECF into the axon terminal
Opening of vesicles and release of Ach
Formation of Ach–receptor complex
Opening of sodium channels and influx of sodium ions from ECF
Postsynaptic neuron
Development of EPSP
Opening of sodium channels in initial segment of axon
Influx of sodium ions from ECF and development of action potential
Spread of action potential through axon of postsynaptic neuron
Q.49. Write on structure and properties of synapse.
(May 2014, 5 Marks)
Ans. For structure refer to Ans 48 of same chapter. For
properties refer to Ans 6 of same chapter.
Q.50. Describe the function and effects of lesions of cerebel-
lum. (Oct 2014, 8 Marks)
Ans. For functions of cerebellum refer to Ans 35 of same chapter.
Effects of Lesions of Cerebellum
Disturbance of Posture
1. Atonia or hypotonia: Muscle tone is lost or decreases
over the affected side because of loss of facilitatory effect
of neocerebellum.
2. Attitude: Face gets rotated over the opposite side.
Homolateral shoulder is lowered. Leg become abducted
and rotated outwards.
3. Spontaneous deviation: If eyes are closed and arms are
held straight in front of body, homolateral arms bend.
4. Nystagmus: When a person concentrates his/her eyes on
an object tremor occur in eyeballs.
5. Deep reflexes: The deep reflexes become weak and pendular.
Disturbance in Voluntary Movement
1. Asthenia: There is feebleness of movements. Voluntary
movements become slow.
2. Ataxia: There is incoordination of movement. So there is
• Decomposition of the movement
• Asynergia: There is lack of coordination between
protagonists, antagonists and synergists.
420 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
• Dysmetria: The movement is poorly carried out in
direction, range as well as force, so the movements
shoot their intended mark.
3. Intention tremor: The patients cannot perform the move-
ments freely. Movements of patients are jerky and accom-
panied by oscillating, to and fro tremors which become
more marked.
Q.51. Write about withdrawal reflex. (Dec 2014, 5 Marks)
Ans. Withdrawal reflex is a polysynaptic reflex which occurs
in response to a noxious stimulus. As noxious stimulus
is applied to a limb, it causes:
a. It contracts flexor muscles and inhibits extensor
muscles. So the limb which is stimulated is flexed
and is withdrawn from stimulus. It is known as
flexor reflex.
b. A powerful stimulus is added to flexor reflex which
leads to extension of opposite limb. This is known
as cross extensor reflex response.
Withdrawal reflex is a protective reflex as the flexor
responses are produced by nondamaging stimulation
of skin or stretching of muscle while the powerful flexor
responses with withdrawal are produced by nociceptive
stimuli. So as the stimulated limb gets withdrawn to be
away from source of stimulus. Extension of other limb
supports body.
Q.52. Write about function and properties of nerve fibers.
 (Dec 2014, 5 Marks)
Ans. Function of Nerve Fibers
♦♦ Sensory or afferent nerve fibers carry sensory impulses
from different parts of body to CNS.
♦♦ Motor or efferent nerve fibers carry motor impulses from
CNS to different parts of body.
Properties of Nerve Fiber
♦♦ Excitability: It is defined as the physiochemical change
which occurs in a tissue when stimulus is applied. Stimulus
is the external agent which causes excitability in tissues.
When nerve fiber is stimulated action potential develops.
♦♦ Conductivity: It is the ability of nerve fibers to transmit
impulse from the area of stimulation to other areas. Ac-
tion potential is transmitted through nerve fiber as nerve
impulse.
♦♦ Refactory period: It is the period at which the nerve does
not give any response to a stimulus.
♦♦ Summation: When one subliminal stimulus is applied
it does not produce any response in nerve fiber because
subliminal stimulus is weak. But if two or more subliminal
stimuli are applied in a short interval of 0.5 m/sec the re-
sponse is produced. It is because the subliminal stimuli are
summed up together to become strong enough to produce
response. This is known as summation.
♦♦ Adaptation: As nerve fiber is stimulated continuously the
excitability of nerve fiber is more in beginning and later
on it decreases and finally nerve fiber does not show any
response. It is known as adaptation or accommodation.
♦♦ Infatigability: A nerve fiber cannot be fatigued even if it
is stimulated continuously for a long time. This is because
nerve fiber can conduct only one action potential at a time.
♦♦ All or None Law: This law states that when a nerve fiber
is stimulated by stimulus it give maximum response or
does not give any response at all.
Q.53. Write short note on wallerian and retrograde degenera-
tion in nerves. (Apr 2007, 5 Marks)
Ans. For Wallerian degeneration of nerves refer to Ans 49 of
same chapter.
Retrograde Degeneration in Nerves
♦♦ Retrograde degeneration are the pathological changes
which occur in nerve cell body and axon proximal to the
cut end.
♦♦ Retrograde degeneration begins within 48 hours of nerve
section and reach to maximum by 15 to 20 days.
♦♦ Following are the retrograde changes:
a. Chromatolysis: Nissl granules disintegrate and loose
their staining reaction after 15 to 20 days and cell be-
come colorless. This process starts in the zone around
nucleus and spreads to periphery of cell.
b. Golgi apparatus, mitochondria and neurofibrils get
fragmented and disappear gradually.
c. Cell draws more fluid and lost its polygonal shape and
gets rounded.
d. Nucleus increases in size become oval in shape and
get displaced towards the periphery. Nucleus can be
completely thrown out of the cell in cases with cell
atrophy and finally the cell death occurs.
Q.54. Write short note on endocrinal functions of hypothala-
mus. (Apr 2007, 5 Marks)
Ans. Following are the endocrinal functions of hypothalamus:
A. Control of anterior pituitary: Hypothalamus leads to
following functions through the releasing hormones:
• It controls the metabolism by controlling thyroid
gland.
• As its influence is over the adrenal cortex it
controls the metabolism of different foodstuffs
and maintains electrolyte balance.
• It causes inhibition of gonads till physical growth
get complete. As physical growth gets complete
this inhibition is removed and gonads start func-
tioning and gametes are produced.
• It controls the formation of milk by breast by
controlling prolactin secretion.
B. Regulation of posterior pituitary functions: Neural
control of posterior pituitary with secretion of
ADH in regulation of water balance by controlling
regulation of water secretion by kidneys.
C. Regulation of uterine contractility and regulation
of milk ejection from breast: Secretion of oxytocin
enhances the contractility of uterus at the end of
pregnancy and helps during parturition. It contracts
myoepithelial cells which surrounds alveoli of breast
and leads to milk ejection.

Q.55. Write short note on neuroglia. (Nov 2008, 5 Marks)
Ans. Neuroglia is also known as glial cells.
• Neuroglia is the supporting cells present in the brain
and spinal cord.
• Neuroglia are numerous and are 10 times more than
neurons.
• Glial cells can multiply by mitosis.
• Glial cells are divided on the basis of their
distribution into two types, i.e. central neuroglial
cells and peripheral neuroglial cells
Central Neuroglial Cells
In CNS they are of three types, i.e. astrocytes, microglia and
oligodendrocytes.
Astrocytes
They are star shaped neuroglial cells present in all parts of brain.
They are of two type, i.e. fibrous astrocytes and protoplasmic
astrocytes.
Functions of Astrocytes
They help in support, transport mechanisms, inflammatory and
reparative reactions.
♦♦ They help in the formation of blood brain barrier.
♦♦ They help in maintaining optimal concentration of ions
and neurotransmitters in brain neurons.
Microglia
They are the small glial cells which are mesodermal in origin.
They have flattened cell body and short processes. These are
more numerous in grey matter as compared to white matter.
They act as phagocytes and become active after damage to
nervous tissue by trauma or disease.
Oligodendrocytes
They are neuroglial cells which produce myelin sheath around
nerve fibers in CNS. They provide myelination around nerve
fibers in CNS where Schwann cells are absent.
Peripheral Neuroglial Cells
They are of two types, i.e. Schwann cells and satellite cells.
a. Schwann cells: They are major glial cells in peripheral nerv-
ous system. These cells provide myelination around nerve
fibers in peripheral nervous system. These cells remove
cellular debris during regeneration by their phagocytic
activity.
b. Satellite cells: They are the glial cells present on the exterior
surface of peripheral nervous system neurons. They provide
physical support to PNS neurons.
Q.56. Describe the functions of the cerebellum. Briefly
describe the clinical features of cerebellar lesions.
 (Apr 2015, 8 Marks)
Ans. For functions of cerebellum refer to Ans 23 of the same
chapter.
Physiology 421
Clinical Features of Cerebellar Lesions
Cerebellar
Lesion Clinical features
Disturbances • Atonia or hypotonia: Loss of tone in muscles
in tone and or muscle tone is markedly decreased over the
posture affected side
• Attitude: Trunk get bend with concavity towards
opposite side; face get rotated towards opposite
side; homolateral shoulder become lower as
compared to normal shoulder; leg become
abducted and rotated outwards
• Nystagmus: Tremor occurs in eyeballs when
patient fix his eye on an object
• Deviation movement: When eyes get closed
and both arms held straight in front of the body,
bending is seen in homolateral arms
• Effect on deep reflexes: Deep reflexes become
weak and pendular
Disturbances • Asthenia: There is feebleness of movements.
in voluntary Muscles get tired and voluntary movements
movements become slow
• Ataxia: There is marked incoordination of
movement. So there is
a. Decomposition of movement
b. Asynergia, i.e. there is lack of coordination
between protagonists, antagonists and
synergists
c. Dysmetria, i.e. movement poorly occurs
in direction, range and force so there is
hypermetria or hypometria
• Intention tremor: In this patient is unable to
perform movements smoothly. Movements become
jerky and there are oscillating, to and fro tremors
which increase as hand approaches the object
• Gait: Patient has difficulty in maintaining the
balance as gait appears drunken. Patient walks
in a zig zag line and deviates to affected side
because of hypotonia
• Speech: It is slow and lalling like a baby
Q.57. Write briefly about synaptic inhibition.
 (Oct 2016, 2 Marks)
Ans. Synaptic inhibition is of five types, i.e.
1. Postsynaptic or direct inhibition
2. Presynaptic or indirect inhibition
3. Negative feedback
4. Feedforward inhibition
5. Reciprocal inhibition
Postsynaptic or Direct Inhibition
It is the type of synaptic inhibition that occur due to release
of an inhibitory neurotransmitter from presynaptic terminal
instead of an excitatory neurotransmitter substance. It is also
called as direct inhibition.
Presynaptic Inhibition or Indirect Inhibition
It occurs due to failure of presynaptic axon terminal to release
sufficient quantity of excitatory neurotransmitter substance. It
is also known as indirect inhibition. Presynaptic inhibition is
mediated by axoaxonic synapses.
422 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Negative Feedback Inhibition or Renshaw Cell
It is the type of synaptic inhibition which is caused by Renshaw
cells in spinal cord. These cells are small motor neurons which
are present in anterior grey horn of spinal cord.
Feedforward Inhibition
Feedforward synaptic inhibition occurs in cerebellum and it
controls the neuronal activity in cerebellum. During the process of
neuronal activity in cerebellum, stellate cells and basket cells, which
are activated by granule cells, inhibit the Purkinje cells by releasing
GABA. This type of inhibition is called feedforward inhibition.
Reciprocal Inhibition
Inhibition of antagonistic muscles when a group of muscles
are activated is called reciprocal inhibition. It is because of
reciprocal innervation.
Q.58. Enumerate the components of reflex arc.
 (May 2017, 2 Marks)
Ans. Following are the components of reflex arc:
• The receptor
• Afferent limb
• Center
• Efferent limb
• Effector organ.
Fig. 47:  Reflex arc
Q.59. Describe the Parkinson’s disease. (May 2017, 2 Marks)
Ans. Parkinson’s disease is the disease of basal ganglia.
Parkinson’s disease is characterized by rigidity,
tremors (hyperkinetic) and weakness of movements
(Hypokinetic).
Parkinson’s disease occurs in late middle age because of
degeneration of dopaminergic nigrostriatal tract. So the
concentration of dopamine is reduced.
Causes
It is commonly seen in:
♦♦ Primary or idiopathic, i.e. condition occurring without
apparent cause
♦♦ In cerebral arteriosclerosis
♦♦ Complication of encephalitis
♦♦ Complication of tranquilizer drugs such as phenothiazine
which block D2 dopamine receptors.
Features
♦♦ Tremor: Tremor occurs due to regular alternating contrac-
tions of antagonists muscles at a frequency of 8 per second.
Typically tremor is observed only at rest. Once patient
initiates the movement, tremor disappears.
♦♦ Slowness of movements: Over the time movements starts
to slow down and it takes a long time even to perform a
simple task. Gradually patient becomes unable to initiate
voluntary activity or voluntary movements are reduced.
It is due to hypertonicity of muscles.
♦♦ Poverty of movements: It is the loss of all automatic
associated movements, body becomes statue like.
Face becomes mask like due to absence of appropriate
expressions like blinking and smiling.
♦♦ Rigidity: Stiffness of muscles occurs in limbs which
results in rigidity of limbs. Muscular stiffness occurs
due to increased muscle tone which is due to removal of
inhibitory influence of gamma motor neurons. Both flexor
and extensor muscles are affected equally. Limbs become
rigid like pillars.
♦♦ Gait: Patient looses normal gait and walks quickly in
short steps by bending forward, as if he is going to catch
up center of gravity.
Q.60. Write very short answer on upper motor neuron.
 (Aug 2018, 2 Marks)
Ans. Upper motor neurons are the neurons which are derived
from various motor areas of brain like motor cortex,
brainstem motor nuclei, etc.
• They terminate directly or indirectly on lower motor
neurons inside the spinal cord.
• Axons of these neurons form descending pathways.
• Some of the important examples of these pathways
are corticospinal, rubrospinal, vestibulospinal and
reticulospinal tracts.
Fig. 48: Upper motor neurons

11. SPECIAL SENSES
Q.1. Define visual pathway and effects of its lesion at different
levels. (Aug 2005, 7.5 Marks)
Or
Write a short note on visual pathway.
(Mar 2007, 3 Marks) (Oct 2007, 5 Marks)
(Mar 2008, 4 Marks)
Or
Write in brief visual pathway. (Jan 2012, 3 Marks)
Ans. The retinal impulses are carried to visual center in cerebral
cortex by the nervous pathway called visual pathway.
Course of Visual Pathway
1. Optic nerve: It is formed by the axons of ganglionic cells.
Optic nerve leaves the eye through optic disc.
2. Optic chiasma: The medial fibers of each optic nerve cross
the midline and join the uncrossed lateral fibers of opposite
side to form the optic tract.
3. Optic tract: After forming optic chiasma, all fibers run
backward and outward towards the lateral geniculate
body.
4. Lateral geniculate body: The lateral geniculate body forms
the subcortical center for visual sensation.
5. Optic radiation: Fibers from lateral geniculate body pass
through internal capsule and form optic radiation and
ends in visual cortex.
6. Visual cortex: The primary cortical center for vision is
called visual cortex.
Fig. 49:  Visual pathway
Physiology 423
Effects of Lesion at Different Levels
1. Optic nerve: The lesion in one optic nerve will cause total
blindness in corresponding visual field.
2. Optic chiasma
• Pressure on uncrossed lateral fibers causes blindness
in the temporal part of retina of same side.
• If lateral fibers of both sides are affected, the vision is
lost in basal half of both visual field causing binasal
hemianopia.
• If crossed fibers are affected, causes bitemporal
hemianopia.
3. The lesion of optic tract or lateral geniculate body or optic
radiation causes homonymous hemianopia.
4. The lesion of upper lower part of visual cortex leads to
inferior or superior homonymous hemianopia.
Q.2. Define the pupillary reflexes. (Mar 2001, 8 Marks)
Ans. Pupillary reflexes are the reflexes in which, the size of
pupil is altered. Pupillary reflexes are:
1. Light reflex
2. Ciliospinal reflex
3. Accommodation reflex
1. Light reflex: When light is flashed into the eyes, it
causes constriction of pupil, this is known as light
reflex.
i. Direct light reflex: When light is thrown into one
eye, the constriction of pupil occurs in that side.
ii. Indirect light reflex: If light is flashed into
one eye, the constriction of pupil occurs in the
opposite eye.
2. Ciliospinal reflex: The stimulation of skin over
the neck causes dilatation of pupil. This is called
the ciliospinal reflex. It is due to the constriction of
dilator pupillae muscle.
The impulses pass via sympathetic nerve fibers and
reach the dilator pupillae.
3. Accomodation reflex: See Ans 3.
Q.3. Define the accommodation reflex. (Sep 2001, 5 Marks)
Or
Write a short note on accommodation (changes in
eyeball for near vision). (Sep 2006, 3 Marks)
Or
Write short note on accommodation.
(Dec 2010, 3 Marks)
Ans. Accommodation is a reflex action when a person looks at
a near object. After seeing a far object, three adjustments
are made in the eyeballs.
1. Convergence of the eyeballs: Convergence of eye
occurs because of contraction of medial recti.
2. Constriction of the pupil: The constriction of pupil
is due to the contraction of sphincter pupillae of iris.
3. Increase in the anterior curvature of lens: Anterior
curvature of lens increase due to contraction of cili-
ary muscle.
424 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Eye • Color blindness is an inherited sex-linked recessive

character. It also occurs due to injury or disease of
retina.
Optic nerve
• Classification of color blindness:
1. Monochromatism.
Optic chaisma 2. Dichromatism.
3. Trichromatism.
1. Monochromatism: The retina of monochromats
Optic tract
is totally insensitive to color, the subject cannot
appreciate any color.
Lateral geniculate body
Types:
A. Rod monochromatism: The cones are function-
Optic radiation less and vision depends purely on rods.
B. Cone monochromatism: The vision apparently
Visual cortex depends upon the cones.
2. Dichromatism: In this condition, the subject can
appreciate only two colors.
Frontal eye field (area-8)
Types:
A. Protanopia: Red color cannot be appreciated.
The protanope uses blue and green to match the
Edinger-Westphal nucleus Somatic motor nucleus of
colors.
of oculomotor nerve oculomotor nerve
B. Deuteranopia: Defect in the second reception,
i.e. green receptor, the deuteranope uses blue
Ciliary gangilon and red colors.
C. Tritanopia: Defect in third receptor blue receptor
Short ciliary nerve Contraction of and the trianope uses red and green colors.
medial rectus 3. Trichromatism: The persons with this defect are able
to perceive all the three colors, but the intensity of
one of the primary colors cannot be appreciated very
Contraction of Contraction of Convergence of much.
ciliary muscle constrictor of pupilae eyeball
Types:
1. Protanomaly: Perception for red is less.
Increase in anterior Constriction 2. Deuteranomaly: Perception for green is less.
curvature of lens of pupil 3. Tritanomaly: Perception for blue is less.
Q.6. Write a short note on errors of refraction.
Fig. 50:  Pathway of accommodation reflex (Mar 1998, 6 Marks) (Mar 2004, 5 Marks)
(Jan 2012, 5 Marks)
Q.4. Write a short note on presbyopia. (Sep 1997, 4 Marks) Or
Ans. It is gradual reduction in the amplitude of
Write short note on refractive errors.
accommodation and programs as the age advances.
(Dec 2009, 5 Marks)
Presbyopia starts developing after middle age. In
Or
presbyopia the distant vision is unaffected, only the
near vision is affected. Write in brief about refractive errors and their
correction. (Aug 2012, 5 Marks)
Causes of Presbyopia Or
1. Reduced elasticity of lens due to physical changes in lens Write about errors of refraction. (Sep 2015, 7 Marks)
and its capsule. So the anterior curvature is not increased Or
during near vision. Write briefly on errors of refraction.
2. Reduced convergence of eyeballs due to the concomitant
weakness of ocular muscles in old age.  (July 2016, 5 Marks)
Ans. A.  Ametropia: Eye with normal refractive power is
Q.5. Write a short note on color blindness. called emmetropic eye and the condition is called
(Mar 1997, 5 Marks) emmetropia. Any deviation in the refraction from
Ans. The failure to appreciate one or more color is called color normal condition is called ametropia. There are 2
blindness. forms of ametropia:

1. Myopia: In emmetropia, the far point is infinite.
In myopia, the near vision is normal but the far
point is not infinite.
Cause: The anteroposterior diameter of the eye-
ball is abnormally long. The image is brought to
a focus a little in front of retina.
Correction of myopia: By using concave lens.
2. Hypermetropia or long sightedness: In this
defect, the distant vision is normal, but, the near
vision is affected.
Cause: Due to reduced anteroposterior diameter
of the eyeball, the light rays are brought to a
focus behind retina.
Correction: By using convex lens.
B. Anisometropia: In this, there is a difference between
the refractive power of both eyes.
Correction: By using different appropriate lens for
each eye.
C. Astigmatism: It is a common optical defect the light
rays are not brought to a sharp point upon retina,
e.g. stars appear as radiating short line.
Correction: By using cylindrical glass lens.
D. Presbyopia: It is the gradual reduction in the ampli-
tude of accommodation and progresses as the age
advances.
Cause: The lens loses the elastic property.
Correction: By using convex glasses.
Q.7. Write a short note on taste pathway.
(Mar 2001, 5 Marks) (Dec 2014, 5 Marks)
Ans. 1. Receptors: Receptors for taste sensation are in taste
bud; each taste bud is inverted by about 50 sensory
nerve.
2. First-order neuron: First-order neurons in taste
pathway are in the nuclei of three different cranial
nerves:
a. Chorda tympani fibers of facial nerve run from
anterior two-thirds of tongue.
b. Glossopharyngeal nerve fibers run from poste-
rior one-third of the tongue.
c. Vagal fibers run from taste buds in other regions.
Axons of the first-order neurons run together in
medulla oblongata and terminate in the nucleus
of tractus solitarius.
3. Second-order neuron: Second-order neurons are in
the nucleus of tractus solitarius. Axons of second-
order neurons cross the midline and terminate in
thalamus.
4. Third-order neuron: The third-order neuron is in
the posteroventral nucleus of thalamus. The axons
from these neurons project into parietal lobe of the
cerebral cortex.
5. Taste center: The center for taste sensation is in the
opercular insular cortex, i.e. in lower part of post-
central gyrus.
Physiology 425
Fig. 51:  Taste pathway
Q.8. Write a short note on the taste sensation.
 (Apr 2003, 5 Marks)
Or
Write a short note on sensation of taste.
(Aug 2005, 5 Marks)
Ans. The sense organs for taste or gustatory sensation are the
taste bud.
The four primary or fundamental taste sensations are:
1. Sweet
2. Salt
3. Sour
4. Bitter.
The taste buds have the property of specificity, i.e. each
taste bud gives response to a particular taste.
- The receptors of salt and sweet tastes are more at
the top of the tongue.
- Receptors of bitter taste are more in the posterior part
and those of sour taste are more at the sides of tongue.
Taste Sensation and Chemical Constitution
1. Sweet taste: Produced mainly by organic substances like
monosaccharides polysaccharides, glycerol, alcohol, alde-
hydes, ketones and chloroform.
2. Salt taste: Salt taste is produced by chlorides of sodium,
potassium and ammonium.
3. Sour taste: Produced by hydrogen ions in acids and acid salts.
4. Bitter taste: Produced by organic substances like quinine,
morphine, glucosides, picric acid and bile salts.
Abnormalities of Taste Sensation
1. Ageusia: Loss of taste sensation.
2. Hypogeusia: Decrease in taste sensation.
3. Taste blindness: It is a rare genetic disorder in which the
ability to recognize substance by taste is lost.
4. Dysgeusia: The disturbance in the taste sensation.
Q.9. Write briefly on physiology of sense of smell.
(2004, 5 Marks)
Or
Describe in brief physiology of sense of smell.
(Dec 2004, 7.5 Marks) (Mar 2009, 5 Marks)
426 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Or
Write short note on physiology of olfaction.
(May/June 2009, 5 Marks)
Olfaction is the Sense of Smell
♦♦ For commencement of olfaction the molecules of smell
produce a substance which is odoriferous substance which
comes in contact with receptor cells of olfactory epithelium.
For this substance should pass from nasal cavity and then
it dissolve in thin layer of mucus which covers olfactory
epithelium.
♦♦ Deep breathing leads to the substance at olfactory mucous
membrane by causing turbulence in flow in nasal cavity.
♦♦ Substance then penetrate mucous layer and cover olfactory
epithelium in which cilia of receptor cells are present in
constant motion.
♦♦ Substance combines with the receptors on surface of cilia.
♦♦ When odor producing substances get attached with
olfactory mucous membrane a generator potential develop
for 4 to 6 seconds. Action potential then set in receptors
and are conducted along axons to olfactory bulb.
♦♦ Receptors in olfactory mucous membrane are couple to
G proteins. Some act through adenyl cyclase and cAMP
and others through phospholipase C. All of them leads to
sodium and potassium influx.
♦♦ Humans can distinguish from 4000 to 10000 different odors
which is possible due to presence of different odorant
receptors as well as frequency of action potential in afferent
nerve reaching the brain.
Q.10. Write briefly on mechanism of hearing and auditory
pathway. (Mar 2000, 5 Marks)
Or
Write short note on mechanism of hearing.
(Mar 2005, 5 Marks) (Aug 2011, 5 Marks)
Ans. (Mar 2006, 5 Marks)
Mechanism of Hearing
Fig. 52:  Mechanism of hearing
♦♦ The external ear directs the sound waves towards the
tympanic membrane.
♦♦ Sound waves produce vibration in tympanic membrane.
♦♦ Vibrations set up in tympanic membrane are transmitted
through the malleus and incus, and cause the movement
of stapes.
♦♦ This leads to the origin of vibrations in the fluids of cochlea.
♦♦ The vibration now stimulates the hair cells in the organ
of corti.
♦♦ This in turn causes the generation of action potential in
the auditory nerve fibers.
♦♦ When the auditory impulses reach the cerebral cortex, the
perception of hearing occurs.
Auditory Pathways
1. Receptors: The hair cells in the organ of corti situated over
the basilar membrane and obsession spiral lamina are the
receptors of the auditory sensation.
2. First-order neurons: The first-order neurons of the audi-
tory pathway are the bipolar cells.
The dendrites of these cells are distributed around the hair
cells. The axons of these cells leave the internal auditory
meatus forming the cochlear nerve.
3. Second-order neurons: The second-order neurons of
auditory pathway are the cells of dorsal and ventral
cochlear nuclei present in medulla oblongata.
4. Third-order neurons: The third-order neurons are in the
superior olivary nuclei and nucleus of lateral lemniscus.
The fibers of the third-order neurons end in medial genicu-
late body of thalamus.
Form medial geniculate body, fiber pass to the temporal
cortex as auditory radiation.
5. Cortical auditory centers: The cortical auditory centers
are in the temporal lobe of cerebral cortex.
The auditory areas are area 41 and area 42 and Wernicke’s
area.
Q.11. Draw visual pathway. What is light reflex?
Ans. For diagram of visual pathway refer to Ans 1 of same
chapter and for light reflex refer to Ans 2 of same chapter.
Q.12. Write a short note on middle ear (functions).
(Sep 2006, 5 Marks)
Ans. The functions of middle ear are:
1. The tympanic membrane in the middle ear moves
in and out of the ear and acts as the resonator that
reproduces the vibration of the sound.
2. The auditory ossicles present in the ear causes trans-
mission of vibrations in the fluid of internal ear.
3. The Eustachian tube present in the middle ear causes
equalizing of pressure on either side of tympanic
membrane.
4. Middle ear causes conduction of sound wave.
Q.13. Describe in brief hearing tests. (Mar 2006, 3 Marks)
Ans. Following are the tests for the hearing:
1. Rinne’s Test
2. Weber’s test
3. Audiometry

1. Rinne’s test: Base of the vibrating tuning fork is
placed on the mastoid process, until the subject
no longer feels the vibration and hears the sound.
When the subject does not hear the sound any more,
the tuning fork is held in air in front of ear of same
side. Normal person hears vibration in ear even
after bone conduction is ceased because in normal
conditions air conduction is better than the bone
conduction.
2. Weber’s test: Base of vibrating tuning fork is placed
on the vertex of skull or the middle of the forehead.
Normal person hears the sound equally on both the
sides. In unilateral condition deafness, the sound is
heared louder in the diseased ear. In unaffected ear,
there is masking effect of environmental noise. So
the sound through bone conduction is not heared
as clearly as on the effected side. In affected side
sound is louder due to absence of masking effect of
environmental noise.
3. Audiometry: The nature as well as extent of
auditory defect could be determined by the
technique called as audiometry. An instrument
called as audiometer is used. The instrument is an
electronic function generator or oscillator connected
to an ear phone. This instrument is capable of
generating sound waves of different frequencies
form lowest to highest. Before calibrating the
instrument, the minimum volume or intensity or
loudness for each frequency of sound heared by
normal person is determined. This intensity is set
in the instrument as zero. Now, while testing the
patient the loudness can be increased above zero
level. The intensity of sound is expressed in decibel
(dB).
Q.14. Write briefly on color vision. (Sep 2005, 5 Marks)
Ans. The human eye can recognize about 150 different colors
in the visual spectrum.
• The discrimination and appreciation of colors
depends upon the ability of receptors in retina.
• Many theories are available to explain the mechanism
of perception of color vision like Thomas-Young’s
trichromatic theory according to which there are
three types of cones in retina each of the three types
of cones gives response to one of the primary colors.
Red, green and blue.
• The different color sensation is produced by the
stimulation of various combinations of three types
of receptors.
• Retinal areas sensitive to colors.
1. The peripheral part of retina is devoid of cones
and is insensitive to colors and gives sensation
of white, black and grey only.
2. The central portion of retinal fovea centralic has
more cones so it is more sensitive to colors.
• Applied physiology: Color blindness refer to Ans 5
of same chapter.
Physiology 427
Q.15. Describe in brief taste sensation. (Apr 2008, 4 Marks)
Ans. Situations of Taste Buds
Taste buds are located in the walls of papillae. Papillae
are of four types, i.e.
a. Fungiform papillae: They are rounded in shape
and are most numerous near the tip of tongue. They
consist of 5 taste buds per papilla and these taste
buds are located at top of papilla.
b. Filiform papillae: These are small conical papillae
which are arranged in diverging rows to right and
left of midline and are confined to back edge of the
tongue. Taste buds are missing in these papillae.
c. Circumvallate papillae: They are prominent papillae
arranged in the form of V at back of the tongue. These
papillae are 10 to 12 in number and consist of 100 taste
buds which are located along the sides of papillae.
d. Foliate papillae: They are occasionally found on the
posterolateral surfaces of tongue.
Fig. 53:  Taste bud
Structure of Taste Bud
♦♦ Taste buds are oval cluster of cells inside the epithelial
layer with small pore opening on the surface which allows
substances to reach interior of the taste bud.
♦♦ It measures 60 to 80 µm in length and 40 µm in diameter.
♦♦ Cells inside the taste buds are of two type, i.e. gustatory
receptor cells and supporting or sustentacular cells.
♦♦ All cells in taste bud are sensory but in different stages of
development. Only gustatory receptor cells make synaptic
connection to sensory nerve fibers.
♦♦ Taste cells are formed from the epithelial cells. They sur-
round the taste bud and migrate towards the center as they
mature and final degenerate in 10 days. Each gustatory
receptor cell ends in microvilli at the top near the pore.
Primary Taste Sensations
The four primary or fundamental taste sensations are:
1. Sweet
2. Salt
428 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
3. Sour
4. Bitter.
- The receptors and salt and sweet tastes are more at the
tip of the tongue.
- Receptors of bitter are more in the posterior part and
those of sour taste are more at the sides of tongue.
Taste Pathway
1. Receptors: Receptors for taste sensation are in taste buds.
2. First-order neuron: They are in the nuclei of three different
cranial nerves.
a. Chorda tympani fibers of facial nerve run from taste
bud on anterior two-third of tongue.
b. Glossopharyngeal nerve fibers run from posterior one­
third of tongue.
c. Vagal fiber runs from taste buds in other region.
- First-order neurons run together in medulla oblongata
and terminate in the nucleus of tractus solitarius.
3. Second-order neuron
- Second-order neurons are in the nucleus of tractus
solitarius.
- Axons of the second order neurons cross the midline,
run through medial lemniscus and terminate in poster-
oventral nucleus of thalamus.
4. Third-order neuron
- The third-order neurons are in the posteroventral
nucleus of thalamus.
- The axons from these neuron project into parietal lobe
of the cerebral cortex.
5. Taste center: The lower part of postcentral gyrus.
Q.16. Describe in brief visual receptors.
(Apr 2008, 3 Marks) (Sep 2009, 5 Marks)
Ans. Rods and cones which are present in the retina of the
eye, form the visual receptors. The impulses from rods
and cones reach the cerebral cortex through optic nerve.
Structure of Rod Cell
Rod cells are cylindrical structure. Each rod is composed of four
structures, namely
1. Outer segment
2. Inner segment
3. Cell body
4. Synaptic terminal
1. Outer segment
- This is long and slender.
- This segment is in close contact with the pigment epi-
thelial cells.
- It is formed by modified cilia.
- It contains the pigment rhodopsin.
2. Inner segment
- The inner segment is connected to the outer segment
by means of modified cilia.
- The rhodopsin is synthesized in the inner segment.
3. Cell body: Rod fiber which arises from the inner segment of
rod cell enlarge to form cell body or rod granule that consist
of nucleus.
4. Synaptic terminal: A thick fiber arising from the cell body
passes to outer plexiform layer and ends in a small and
enlarged synaptic terminal and body.
Structure of Cone Cell
♦♦ Cone cell is flask shaped
♦♦ The cone in the fovea are long, narrow and almost similar
to rods.
♦♦ In the periphery of retina, the cones are short and broad.
It is also formed by four parts:
1. Outer segment
2. Inner segment
3. Cell body
4. Synaptic terminal.
1. Outer segment: It is smaller and conical.
2. Inner segment: The inner segment is connected to the outer
segment by a modified cilium.
- This segment synthesize photosensitive pigment of
cone.
3. Cell body: In the inner nuclear layer the cone fibers form
the cell body or cone granules that posses the nucleus.
4. Synaptic terminals: The fibers from the cell body of the cone
leaves the inner nuclear layer and enters the outer flexiform
layer, here it ends in the form of an enlarge synaptic termi-
nal.
- Rods are extremely sensitive to light so responsible for
the dim light vision or the night vision. The vision by
the rod is black, white or in combination of black and
white.
- Cone have sensitivity only to bright light, so called
receptors of bright light vision or day light or pho-
topic vision.
- The cones are responsible for acuity of vision and
the colour vision.
Q.17. Draw pathway of taste sensation and well labeled
diagram of taste buds. (Apr 2007, 5 Marks)
Ans. For diagram of pathway of taste sensation refer to Ans 7
of same chapter and for labeled diagram of taste buds
refer to Ans 15 of same chapter.
Q.18. Write short note on myopia. (Nov 2008, 5 Marks)
Or
Write briefly about myopia. (Feb 2016, 2 Marks)
Ans. Myopia is an error of refraction.
• Myopia is also known as short sightedness.
• In myopia the parallel rays of light from distant
object are focused in front of retina. This occurs
because either the length of eyeball is too long,
i.e. axial myopic eye or refractive power of lens
increases, i.e. refractive myopic eye.
Characteristic Features
♦♦ Person who is affected by myopia cannot see the distant
object.
♦♦ Far point of vision is at definite distance from the eye.

♦♦ Near point of vision becomes nearer as axial length of
eyeball increases.
♦♦ As far and near point are closely approximated the range
of accommodation decreases.
Correction of Myopia
It is corrected by the concave glasses which lead to divergence
of incident rays. The power of lens required gives a measure
of degree of myopia.
Q.19. Write briefly about hypermetropia.
 (Aug 2016, 2 Marks)
Ans. Hypermetropia is also known as far sightedness.
• Hypermetropia is a refractive error in which parallel
rays of light from a distant object are brought into
a focus behind the retina when the accommodation
is at rest.
• It occurs due to decreased anteroposterior diameter
of the eye.
• Hypertrophy of ciliary muscles occurs because indi-
vidual will be using the accommodation all the time
for seeing the far object. Sustained accommodation is
tiring and can lead to severe headache and blurring
of vision.
• Prolonged convergence of visual axes is associated
with accommodation, finally leads to squint.
• It can be corrected by using spectacles with biconvex
lens that converges the incident rays before they
strike the cornea. Near point is farther than the nor-
mal, so the patient need biconvex lens at an earlier
age.
Q.20. Trace optic pathway and add a note on effect of lesion
at different sites of tract. (Jan 2018, 5 Marks)
Ans. The effects of lesions on field of vision at different level
of visual pathway are as follows:
Fig. 54:  Optic pathway
Physiology 429
♦♦ Optic nerve: Lesion of one optic nerve causes total
blindness or anopia in the corresponding visual field.
Lesion occurs due to increased intracranial pressure.
♦♦ Optic chiasma: The defect depends upon the fibers
involved.
• Pressure of uncrossed lateral fibers by aneurysmal
dilatation of carotid artery leads to blindness in
temporal part of retina of same side, i.e. retina cannot
receive light stimulus from objects in nasal half of same
visual field. So there is development of hemianopia
which is known as left or right nasal hemianopia.
• If lateral fibers of both sides are affected, vision is lost
in nasal half of both visual fields leading to binasal
hemianopia.
• Compression of nasal fibers i.e. crossed fibers by
pituitary tumor causes bitemporal hemianopia.
♦♦ Optic tract: If the lesion is on the right side it causes
left homonymous hemianopia and if the lesion is on
the left optic tract it leads to right lateral homonymous
hemianopia. The damage of fibers connecting the optic
tract with pretectal nucleus leads to loss of light reflex
with normal accommodation reflex known as Argyll
Robertson pupil.
♦♦ Optic radiation:
• Damage to medial fibers leads to homonymous lower
quadrant anopia.
• Damage to lateral fibers leads to homonymous upper
quadrant anopia.
♦♦ Visual cortex: Damage to this leads to homonymous
hemianopia with macula sparing i.e. macula is not affected
as it has a larger area of representation and is also supposed
to have bilateral representation.
 Injury to any part of the optic pathway leads to visual
defect, site and severity of the injury decides the nature of
defect.
• Loss of vision in one visual field is referred as anopia.
• Loss of vision in one-half of the visual field is called
hemianopia. It is two types, i.e. homonymous
hemianopia and heteronymous hemianopia.
• Loss of vision in one quarter of visual field is known
as quadrantanopia.
Q.21. Write on functions of rods and cones.
 (Sep 2018, 5 Marks)
Ans. Functions of Rods
Rods are very sensitive to light and have low threashold. So
these are responsible for the dim light vision or night vision or
scotopic vision. Vision by rod is black, white or in combination
of black and white, namely gray. Therefore, color objects appear
faded or grayish in twilight.
Functions of Cones
They have high threshold for light stimulus, so cones are
sensitive only to the bright light. So the cone cells are called as
receptors of bright light vision or day light vision or photopic
vision. Cones are also responsible for the acuity of vision and
color vision.
430 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
12. METABOLISM AND NUTRITION
Q.1. Write short note on basic principles of dietetics.
 (Apr 2008, 5 Marks)
Ans. In formulating diet for any individual following
principles should be adopted:
• It should be a fiber rich balanced diet and must
provide the required recommended daily calories.
• Of total calorie requirements at least 50% should be
provided by carbohydrates, 25 to 30% by proteins
and 20 to 25% from fats.
• Cost of diet should be reasonably low.
• Diet should be such that it can be prepared easily.
• As far as possible locally and seasonally available
foods should be used this will reduce cost of the diet.
• Menu should be frequently changed to avoid
monotony.
 Physiology 431

MULTIPLE CHOICE QUESTIONS

As per DCI and Examination Papers 1 Mark Each
of Various Universities

1. In developing erythrocyte hemoglobin first appears at 9. The root value of knee jerk is:
the stage of: a. C5,6
a. Proerythroblast b. C6, 7
b. Early normoblast c. L2,3,4
c Intermediate normoblast d. L5 S1
d. Late normoblast
10. Neurons present in posterior horn of spinal cord are:
2. The disorder in which bleeding time is prolonged but a. Gamma motor neurons
coagulation time is normal is:
b. Alpha motor neurons
a. Purpura
c. Renshaw cells
b. Hemophilia
d. None of these
c. Christmas disease
d. All of these 11. The process of erythropoises takes:
a. 7 days
3. Muscle fatigue occurs due to:
b. 7 hours
a. Accumulation of lactic acid
c. 7 months
b. Exhaustion of stores of glycogen
d. 7 weeks
c. Exhaustion of stores of ATP
d. All of these 12. In isotonic contraction:
4. All are examples of positive feedback mechanism except: a. Length of muscle increases
a. LH surge b. Tone of muscle changes
b. Coagulation of blood c. Tone remains same
c. Regulation of thyroxine secretion d. Length remains same
d. Uterine contraction during labor 13. Action potential in a motor nerve has the following
5. Surfactant is synthesised by: phases except:
a. Type I pneumatocytes a. Depolarization
b. Type II pneumatocytes b. Repolarization
c. Alveolar macrophages c. Hyperpolarization
d. Epithelial cells d. Plateau
6. Synthesis of thyroxine requires: 14. The pacemaker of human heart is:
a. Iron a. SA node
b. Iodine b. AV node
c. Cooper c. Sinus venosus
d. Manganese d. Bundle of His
7. All are contents of gastric juice except: 15. Conducting system of heart has following parts except:
a. Pepsinogen a. SA node
b. Trypsinogen b. AV node
c. HCl c. Mossy fibers
d. Intrinsic factor d. Purkinje fibers
8. Normal GFR in mL/min is: 16. Normal cardiac output is:
a. 125 a. 5–6 mL/min
b. 170 b. 70–80 mL/min
c. 650 c. 5–6 L/min
d. 1200 d. 20–30 L/min

Answers: 1. c 2. a 3. d 4. c
5. c 6. b 7. d 8. a
9. c 10. d 11. a 12. d
13. d 14. a 15. c 16. c
432 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

17. The substance used for the estimation of GFR is: 26. Increased vagal tone causes:
a. Insulin a. Hypertension
b. Inulin b. Tachycardia
c. Renin c. Bradycardia
d. Rennin d. Increase in cardiac output
18. The hormone acting on kidney is: 27. Hering-Breur reflex in humans:
a. Aldosterone a. Decrease rate of respiration
b. Thyroxine b. Is not activated until tidal volume increases above
c. Secretin 1.5 L.
d. Erythropoietin c. Is important for normal control of respiration
d. Is activated when tidal volume is below 1.0 L
19. Recording basal body temperature is a test for:
a. Pregnancy 28. Basal ganglia are primarily concerned with:
b. Mensturation a. Sensory integration
c. Ovulation b. Short term memory
d. Menarche c. Control of movement
d. Endocrine control
20. Ovulation is associated with sudden rise in:
a. Prolactin 29. Excessive growth hormone secretion in adults causes:
b. Luteinizing hormone a. Acromegaly
c Oxytocin b. Gignatism
d Testosterone c. Graves Disease
d. Cretinism
21. The unique feature in mitochondria is:
30. Sexually transmitted diseases are best prevented by
a. Myosin
using:
b. Actin
a. IUD
c. DNA
b. Spermatocides
d. Prothrombin
c. Condom
22. Myelin sheath is produced by: d. RU 486
a. Axoplasm
31. Facilitated diffusion depends on:
b. Mitochondria
a. Activity of Na-K ATPase pumps
c. Schwann cell
b. Concentration gradient
d. Muscle cell
c. V-Max
23. Majority of clotting factors are produced in: d. Availability of carrier proteins
a. Liver 32. A plateau is present in action potential curve of:
b. Kidney a. Skeletal muscle fiber
c. Heart b. Vascular smooth muscle fiber
d. Brain c. SA node
24. Cell mediated immunity is due to: d. Cardiac muscle fiber
a. B-lymphocytes 33. Stroke volume output of heart is:
b. T-lymphocytes a. 5 L/Stroke
c. Neutrophils b. 3 L/Stroke
d. Eosinophils c. 70 mL/Stroke
25. In the heart, within physiological limits force of con- d. 170 mL/Stroke
traction is directly proportional to: 34. Insulin clearance test is used to determine:
a. Pacemaker activity a. Renal plasma flow
b. AV nodal delay b. Renal blood flow
c. Initial length of cardiac muscle c. pH of urine
d. Respiratory rate d. GFR

Answers: 17. b 18. a 19. c 20. b

21. c 22. c 23. a 24. b
25. c 26. c 27. b 28. c
29. a 30. c 31. d 32. d
33. c 34. d
 Physiology 433

35. Amount of air that moves in and out with each breadth 44. Tetany develops when there is fall in:
is: a. Ionic serum calcium level
a. Respiratory volume b. Protein bound serum calcium level
b. Tidal volume 45. Ovulation in a normal menstrual cycle usually occurs:
c. Inspiratory volume a. On about 14th day
d. Expiratory volume b. On about 28th day
36. Chemosensitive area of grain is mainly sensitive to: c. On the 1st day of bleeding phase
a. Carbon dioxide 46. Stretch of great vein results in increased heart rate. This
b. H+ ions relationship is explained by:
c. Carbonic acid a. Brain-bridge reflex
d. Oxygen b. Marey’s reflex
37. To perceive whole range of colours, there are: c. Starling’s law
a. 3 types of cones d. Laplace law
b. 5 types of cones 47. Cardiac output is measured by the following methods
c. 7 types of cones except:
d. Only single type of cone a. Dye-dilution method
38. Hormone oxytocin is secreted by: b. Thermo-dilution method
a. Pancreas c. Fick’s principle
b. Anterior pituitary gland d. Inulin clearance
c. Posterior pituitary gland 48. Following are the properties of cardiac muscle
d. Adrenal cortex except:
39. The main pituitary hormone in postovulatory phase is: a. Fatigue
a. Estrogen b. Excitability
b. Progesterone c. Conductivity
c. LH d. Contractility
d. FSH 49. The chemical agents increasing urination are called:
40. Safety center is located in: a. Anesthetics
a. Cerebral cortex b. Antidiuretics
b. Cerebellum c. Cathartics
c. Thalamus d. Diuretics
d. Hypothalamus 50. Inability of the kidney to respond to ADH results
41. Rise of plasma concentration of K+ ions can cause: in:
a. Heart block a. Nephrogenic diabetes
b. Inhibition of myocardial contractility b. Renal glycosuria
c. Both c. Diabetes insipidus
d. None d. Diabetes mellitus
42. Deficiency of glucose-6-phosphate dehydrogenase may 51. Disappearance of Nissl granules during nerve injury
lead to: is termed as:
a. Damage of RBC glutathione a. Chromatolysis
b. Hemolysis following consumption of some drugs b. Autolysis
c. Both c. Hemolysis
d. None d. Proteolysis
43. Lymph is rich in: 52. Following are the parts of muscle spindle except:
a. Antibodies a. Nuclear bag fibers
b. Proteins b. Nuclear chain fibers
c. Both c. Annulospiral ending
d. None d. Mossy fibers

Answers: 35. b 36. b 37. a 38. c

39. b 40. d 41. d 42. c
43. c 44. a 45. a 46. a
47. d 48. a 49. d 50. c
51. a 52. d
434 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

53. Somatosensory cortex corresponds to Broadmann’s 62. Shivering is initiated by stimulation of:
area number: a. Anterior hypothalamus
a. 3, 1, 2 b. Posterior hypothalamus
b. 4, 6 c. Paraventricular nucleus
c. 8 d. Preoptic area
d. 17 63. Growth hormone:
54. UMN includes: a. Affect almost all the tissues
a. Anterior horn cells b. Is a steroid hormone
b. Pyramidal cells c. Has a protein catabolic effect
c. Glial cells d. All of the above
d. Schwann cells 64. Which of the following substances is important in skeletal
55. Process of union of male and female gamete is called muscle contraction but not in smooth muscle contraction?
as: a. Actin
a. Luteinization b. Myosin
b. Implantation c. Myosin ATPase
c. Neutralization d. Troponin
d. Fertilization 65. Acromegaly:
56. Pancreatic lipase action is at pH: a. Occurs in children
a. 4.8 b. Causes enlargement of membranous bones
b. 7.34 c. Causes a person to become a giant
c. 8.6 d. Causes reduction in blood glucose level
d. 1.20 66. Saltatory conduction:
57. Antibodies are: a. Occurs in a myelinated fiber
a. Globins b. Has a faster rate of conduction
b. Hormones c. Requires lesser energy
c. Globulins d. All of the above
d. Histones 67. Goiter:
a. Means greatly enlarged thyroid gland
58. Approximate glomerular filtration rate is:
b. Caused due to iodine deficiency in diet
a. 80 mL/mt
c. Is due to excessive secretion of TSH
b. 200 mL/hr
d. All of the above
c. 15 mL/mt
d. 120 mL/mt 68. Plateau potential is not seen in:
a. Purkinje fibers of the heart
59. RBC maturation requires:
b. Smooth muscle fibers of gut
a. Folic acid
c. Cardiac muscle fibers
b. Iron
d. Skeletal muscle fibers
c. Zinc
d. All 69. Entire period of spermatogenesis (from genital cell to
sperm) is:
60. Testosterone increases: a. 8 days
a. Muscle mass b. 74 days
b. Bone length c. 700 days
c. Blood volume d. 2 days
61. Na+ – K+ pump 70. Function of placenta include:
a. Is an example of secondary active transport a. Endocrine function
b. Does not require energy b. Diffusion of nutrients and oxygen to fetal blood
c. Pumps two Na+ ions outward and three K+ ions c. Diffusion of carbon dioxide from fetal to maternal
inward with each cycle blood
d. Is an example of primary active transport mechanism d. All of the above

Answers: 53. a 54. b 55. d 56. b

57. c 58. d 59. b 60. a
61. d 62. b 63. a 64. d
65. c 66. d 67. d 68. d
69. b 70. d
 Physiology 435

71. Simple diffusion: c. GABA

a. Is a downhill process where no energy is required d. Serotonin
b. Possesses maximum rate beyond which the rate 79. Action potential in the nerve fiber is produced by:
cannot be increased a. Sodium influx
c. Requires energy b. Potassium influx
d. None of the above c. Calcium influx
72. Homeostasis: d. Chloride influx
a. Is the maintenance of constancy of internal environ- 80. Function of LH is:
ment a. Maintenance of placenta
b. Is essential for the normal functioning of cells b. Growth of follicle
c. Is mainly possible due to negative feedback mecha- c. Ovulation
nism d. Secretion of estrogen
d. All of the above 81. Which of the following is not recorded in ECG:
73. Milk ejection: a. Atrial depolarization
a. Is not affected by psychic factors b. Ventricular depolarization
b. Suckling stimuli from nipple increase it due to re- c. Ventricular repolarization
lease of oxytocin d. Atrial repolarization
c. Is caused due to release of vasopressin 82. A major function of surfactant is:
d. None of the above a. Decrease alveolar surface tension
74. Endocrine glands: b. Increase alveolar surface tension
a. Regulate metabolic functions c. Increase work of breathing
b. Secretes hormone directly into the blood d. Increase tendency of lungs to collapse
c. Are chemically steroids, proteins or amino acids 83. Calcitonin:
d. All of the above a. Increases plasma calcium levels
b. Increases parathormone levels
75. Aldosterone:
c. Decreases plasma calcium levels
a. Is a steroid hormone
d. None of the above
b. Is a very potent mineralocorticoid
c. Is synthesized from cholesterol 84. Somatosensory cortex lies in:
d. All of the above a. Frontal lobe
b. Temporal lobe
76. Polydypsia is: c. Occipital lobe
a. Excessive urine formation d. Parietal lobe
b. Excessive drinking of water
85. The neurotransmitter decreased in Parkinson’s disease
c. Decreased urine formation
is:
d. Decreased drinking of water
a. Dopamine
77. Normal sperm count is: b. Acetylcholine
a. 12 millions/mL of semen c. Serotonin
b. 10 millions/mL of semen d. All of the above
c. 20 millions/mL of semen 86. The center for light reflex is in:
d. 120 lakhs/mL of semen a. Pons
78. Neuromuscular transmitter is: b. Medulla
a. Epinephrine c. Cerebellum
b. Acetylcholine d. Midbrain

Answers: 71. a 72. d 73. b 74. d

75. d 76. b 77. c 78. b
79. a 80. c 81. d 82. a
83. c 84. d 85. a 86. d
436 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

VIVA-VOCE QUESTIONS FOR

PRACTICAL EXAMINATION

1. Name the scientist who had coined the term cell. 18. At birth all bone marrow is red but with age above 20
Ans. Robert Hooke. year red marrow gets slowly replace by yellow marrow.
2. Name the cells in which there is only cell membrane Which are the areas where this does not occur?
and no cell wall. Ans. Flat bones, cranium, ribs and vertebrae
Ans. Animal cell. 19. Name the tissues produces RBC and granulocytes.
3. Which is the major component of cell membrane? Ans. Myeloid
Ans. Phospholipid 20. Name the lymphoid tissues.
4. In which organelle does DNA replication occurs? Ans. Lymph nodes, thymus, spleen
Ans. Nucleus 21. What is normal erythroid : myeloid ratio?
5. Which organelle is known as powerhouse of the cell? Ans. 3:1
Ans. Mitochondrion
22. Name the stage of RBC development at which hemo-
6. At what temperature blood is stored? globin appears.
Ans. + 4°C Ans. Intermediate normoblast
7. Stored blood is rich in which of the ions. 23. What is the normal plasma level of Vit B l2?
Ans. Potassium ions Ans. 200 to 900 Hg/l
8. How much is resting membrane potential. 24. Name the vitamin whose deficiency produces a block
Ans. – 70mV in the metabolism of folic acid resulting in abnormal
9. How much is the volume of blood present in a human erythropoiesis.
adult? Ans. Vitamin B12
Ans. 5 liters
25. How much is the life span of RBC in healthy persons?
10. Name the blood which is free from formed elements. Ans. 120 days
Ans. Plasma
26. How much is the normal RBC count.
11. What is plasma minus fibrin? Ans. In males it is 5.5 million/mm3 of blood. In females it is
Ans. Serum 4.5 million/mm3 of blood
12. Name the condition in which the biconcavity of RBC 27. How much is the normal hemoglobin level?
is lost.
Ans. 15 g/100 mL of blood
Ans. Spherocytosis
28. How much is normal packed cell volume.
13. Name the protein which maintains the biconcave shape
Ans. 45 ml/100 ml of blood.
of RBC.
Ans. Spectrin 29. How much is normal mean corpuscular volume (MCV)?
14. Name the protein present on the cell membrane con- Ans. 80 to 94 fL
taining the blood group antigens. 30. How much is normal mean corpuscular hemoglobin
Ans. Glycophorin (MCH)?
15. At what time does erythropoiesis starts? Ans. 27 to 32 pg
Ans. 3rd week of intrauterine life 31. How much is normal mean corpuscular hemoglobin
16. At what period erythropoiesis occurs in the mesoderm concentrate (MCHC)?
of the yolk sack? Ans. 32 to 36 g/dL
Ans. From 3rd week to 3rd month 32. How much is normal value of ESR in Westergren’s
17. At what period erythropoiesis occurs in the liver and method?
spleen? Ans. In males it is 0 to 10 mm in males and in females it is
Ans. 3rd and 5th month of intrauterine life 0 to 5 mm
 Physiology 437

33. Name the enzyme which keeps iron in the ferrous state. 53. What does macrophages of the spleen bone marrow
Ans. Methemoglobin reductase are known as?
34. Name the class of compounds to which heme belongs. Ans. Reticulum cells
Ans. Protoporphyrins 54. What does macrophages of liver known as?
35. Which is the condition in which there is excess hemo- Ans. Kupffer’s cells
siderin in the body. 55. Where do the platelets gets stored?
Ans. Bronze diabetes Ans. Spleen
36. How many peptide chains are present in hemoglobin A? 56. How much is the normal platelet count?
Ans. Two alpha and two beta chains Ans. Normal platelet count is 1,50,000 to 4,00,000/mm3 of
37. How many peptide chains are present in hemoglobin F? blood
Ans. Two alpha and two gamma 57. How much is the critical count of platelet?
38. What is the name of β thalasesemia major. Ans. 40,000/mm3 of blood
Ans. Cooley’s anemia
58. What is the shape of activated platelets?
39. Name the anemia in which count of RBC is low, MCV Ans. Spherical
is low and reticulocyte count is high.
59. Which structure consists of alpha granules, dense
Ans. Hemolytic anemia.
granules and glycogen granules?
40. How much is the total WBC count? Ans. Platelets
Ans. 4000 to 11000 per cumm of blood
60. When platelets get activated, dense granules present
41. Which stain differentiates WBC into granulocyte and in them release which component?
agranulocyte?
Ans. ATP, ADP and serotonin
Ans. Romanowsky stain
61. Name the platelets which are developed from giant cells.
42. Which are the major components of granulocytes?
Ans. Megakaryocytes
Ans. Neutrophils
62. What is the normal life span of platelet?
43. What does the granules of basophils consists of?
Ans. 7 to 12 days
Ans. Histamine and heparin
44. During parasitic invasion and allergic conditions which 63. Name the cells which releases heparin.
cell shows rise in count. Ans. Mast cells
Ans. Eosinophils 64. How much is the clotting time according to Lee and
45. When a monocyte enters the tissue what it is known as? White method?
Ans. Tissue macrophage Ans. 9 to 11 min

46. Which cell form the first line of defense? 65. How much is the normal prothrombin time?
Ans. Neutrophils Ans. 14 to 16 seconds.
47. Which cell forms second line of defense? 66. Which agent is the carrier of albumin?
Ans. Monocytes Ans. Ceruloplasmin
48. Cell mediated immunity is achieved by which cells? 67. When and who discovered the blood grouping?
Ans. T—lymphocytes Ans. In 1900, Karl Landsteiner
49. Which cell mediates the humoral immunity? 68. Most of the antibodies of blood group are of which
Ans. B—Lymphocytes variety?
50. Which special type of lymphocytes are killer cells and Ans. IgM
natural killer cells? 69. In kernicterus bilirubin deposition occur in which part
Ans. T—Lymphocytes of the brain.
51. In AIDS which lymphocytes are destroyed. Ans. Basal ganglia.
Ans. Helper T lymphocytes 70. In classical hemophilia which coagulation factor is
52. Which cells mediates the non-specific immunity? deficient?
Ans. Neutrophils Ans. Factor VIII
438 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

71. Which clotting factor acts both in extrinsic as well as 88. In a healthy man how much liters of oxygen is stored
intrinsic pathways? in his myoglobin.
Ans. Factor V Ans. 1.5 litre
72. Name the anticoagulant commonly used in laborato- 89. Which enzyme is found in RBC, pancreas, renal tubular
ries. and gastric mucosa?
Ans. Citrate dextrose solution Ans. Carbonic anhydrase
73. Which epithelium lines the trachea? 90. What do you mean by hypercapnia?
Ans. Pseudostratified ciliated columnar Ans. Increase in carbon dioxide.
74. Which is the principle muscle of inspiration? 91. What do you meant by asphyxia?
Ans. Diaphragm Ans. Lack of oxygen and retention of carbon dioxide.
75. Name the muscles of expiration. 92. In which condition cyclic events of apnea and hyper-
Ans. Abdominal muscle and internal intercoastal muscles apnea are seen?
Ans. Cheyne-Stokes breathing
76. Name the cells which secrete surfactant.
Ans. Type II alveolar cells. 93. Name the disease to which cotton and jute workers are
predisposed to.
77. During normal breathing expiration is how much time
Ans. Byssinosis
longer than inspiration?
Ans. 1.4 times 94. Which is the best test for measuring ventilatory
efficiency?
78. How much is the tidal volume? Ans. Peak expiratory flow rate
Ans. 500 mL
95. Sweat glands are referred to as which type of glands.
79. How much is the respiratory minute volume for healthy Ans. Eccrine glands
man?
96. Which line divides each myofibril into a number of
Ans. 5 liter/min
compartment.
80. Name the reflex which is an important cause of rhyth- Ans. Z line
micity of respiration.
97. Name the scientist who had given theory of muscle
Ans. Hering-Breuer’s reflex
contraction.
81. What is the term for the complete collapse of lung? Ans. HE Huxley and AF Huxley
Ans. Atelectasis
98. Which type of contraction is known when a muscle is
82. Aortic body and carotid body are examples of which stimulated and gets prevented from shortening?
type of chemoreceptors? Ans. Isometric
Ans. Peripheral chemoreceptors
99. Which type of contraction is known when a muscle is
83. If there is stimulation of gyrus linguli what happens stimulated and allowed to shorten?
then? Ans. Isotonic
Ans. Cessation of respiration
100. Name the epithelium lining the olfactory area.
84. How much is the partial pressure of oxygen at arterial Ans. Pseudostratified columnar epithelium
end.
101. What is the term for the complete absence of smell
Ans. 95 mm Hg
sense.
85. How much is the partial pressure of carbon dioxide at Ans. Anosmia
arterial end?
102. Which is the end organ of taste sensation?
Ans. 40 mm Hg
Ans. Taste buds
86. How much time greater is the diffusion capacity of
103. What does normal eye is referred as.
carbon dioxide as compare to oxygen?
Ans. Emmetropic eye
Ans. 20 times.
104. By use of which lens myopia is corrected?
87. Transfer of oxygen and carbon dioxide across the
Ans. Concave lens
alveolar capillary membrane is by which law of
diffusion of gases. 105. By use of which lens astigmatism is corrected?
Ans. Fick’s law Ans. Cylindrical lens
 Physiology 439

106. Name the clinical condition common in old age in 116. If Babinski’s sign is negative what does this states?
which the lens becomes opaque and fails to transmit Ans. Patient is not suffering from pyramidal tract lesion.
light due to coagulation of lens protein. 117. Name the scientist who had introduces gate control
Ans. Cataract theory.
107. What are the end organs of vision? Ans. Melzack and Wall
Ans. Rods and cones 118. In oral cavity vitamin A deficiency leads to.
108. Name the blind spot in the retina. Ans. Enamel hypoplasia.
Ans. Optic disc 119. In oral cavity deficiency of vitamin C leads to.
109. Who have no green sensitive cones? Ans. Scorbutic gingivitis
Ans. Deuteranopes 120. From where does the ventricular muscle receive im-
pulses?
110. Name the chart used for testing color blindness.
Ans. Purkinje system
Ans. Ishihara
121. How much is the typical pulmonary artery systolic and
111. How many neurons does CNS have?
diastolic pressures.
Ans. 10 thousand million neurons. Ans. 24/9 mm of Hg
112. By which structure CSF from lateral ventricles com- 122. By which structure does the distribution of blood flow
municates into the third ventricle? mainly regulates.
Ans. Foramen of Monro Ans. Arterioles
113. By which structure CSF from third ventricle commu- 123. Name the gland which secretes calcitonin.
nicates into the 4th ventricle? Ans. Thyroid gland
Ans. Aqueduct of Sylvius
124. Which hormone inhibits the activity of osteoclasts?
114. Why nerve fibers of CNS do not regenerate? Ans. Calcitonin
Ans. They have neurilemma
125. Excess secretion of growth hormone during childhood
115. Which reflex is an important clinical test in neurology? leads to.
Ans. Plantar reflex Ans. Gigantism
440 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Additional Matter
Various Phases of Gastric Secretion Types of Threshold Substances

Name of the phase Control Name of threshold substances Examples

Cephalic phase It is purely under nervous control High threshold substances • Vitamins
• Glucose
Gastric phase It is under nervous and hormonal control
• Amino acids
Intestinal phase This phase is under the control of various
Low threshold substances • Urea
gastrointestinal hormones i.e. gastrin, entero­
• Uric acid
gastrone etc
• Phosphate
Various pH Values Non-threshold substances Creatinine

Substance pH value Various Muscles and their Characteristics

Gastric juice 0.9 to 1.2
Name of the muscles Characteristics
Bile juice in liver 8 to 8.6
Skeletal muscle Striated, voluntary, supplied by the somatic
Bile juice inside the gall bladder 8 to 8.3 nerves and consists of multiple nuclei
Saliva 6.35 to 6.85 beneath sarcolemma
Cardiac muscle Striated, involuntary and is supplied by the
Various Pouches and their Uses autonomic nerves
Smooth muscle Non-striated, involuntary and is supplied by
Name of the
autonomic nerves
pouch Use
Bickel’s It demonstrate role of hormone in gastric secretion Various Heart Sounds
pouch
Farrel and Ivy It demonstrate the role of hormones in both gastric Name of the
pouch and intestinal phases of the gastric secretion heart sound Important points

Heidenhain’s It demonstrate role of sympathetic nerve and First heart • Occur because of closure of atrioventricular
pouch hormonal regulation of gastric secretion after the sound valves (i.e. Mitral and tricuspid valves)
vagotomy • It is long, soft and low pitched and sound like
LUBB
Pavlov’s It demonstrate cephalic phase of gastric secretion • This is produced at the time of isometric con-
pouch traction and the earlier part of ejection period.

Normal Values of Intrapleural Pressure Second heart • It occur due to closure of the semilunar valves
sound (i.e. Pulmonary and aortic valves)
During start of inspiration and at end of expiration – 2 mm of Hg • This is short, sharp, high pitch and sounds like
DUBB
At end of inspiration and start of expiration – 6 mm of Hg • It is produced at the onset of diastole
At end of forced inspiration along with closed glottis – 70 mm of Hg Third heart This is produced at the time of rapid filling period
i.e. Muller’s maneuver sound and is inaudible by stethoscope
At end of forced expiration – 30 mm of Hg Fourth heart It is produced at the time of atrial systole and is
At end of forced expiration along with closed glottis + 50 mm of Hg sound inaudible
i.e. Valsalva maneuver
Events in the Cardiac Cycle
Information About Urine
Name of the
Normal urinary output is 1.15 lts event Important points

Increased urinary output is called as Polyuria Atrial systole • During this there is contraction in the atria and
small amount of blood enter the ventricles.
Reduced urinary output is called as Oliguria • AV valves are opened and semilunar valves
Stoppage of urine formation is called as Anuria are closed
• Its duration is 0.11 seconds
Proteins in urine is called as Proteinuria
Isometric • In this all of the valves get closed.
RBCs in urine is known as Hematuria
contraction • Pressure in the ventricles is elevated
Excess accumulation of urea and Creatinine Uremia • Its duration is 0.05 seconds
is known as
Contd...
Excess glucose in urine is called as Glucosuria
 Physiology 441

Contd... Contd...

Name of the Parasympathetic

event Important points Effector organ Sympathetic division division
Ejection period • Opening of semilunar valves occur. Gastrointestinal Causes inhibition It accelerates
• Contraction of ventricles occurs and blood tract motility
gets ejected in aorta and the pulmonary artery. Gastrointestinal They get decrease Increases
• Its duration is for 0.22 seconds secretion
Protodiastole • Closure of semilunar valves occurs. Sweat glands Secretion increases —
• Its duration is for 0.04 seconds Heart rate force It increases It decreases
Isometric • All valves get closed Blood vessels It contracts except heart It undergo dilation
relaxation • Pressure in ventricles decreases and skeletal muscle
• Its duration is for 0.06 seconds
Bronchioles They undergo dilation They undergo
Rapid and slow • All valves get opened. constriction
filling • Relaxation of ventricles occur and filling occur
• Its duration is for 0.3 seconds Various Receptors and Sensations
Various Actions and their Effects Receptors Sensation
Chronotropic action Effect on heart rate Free nerve ending Pain

Inotropic action Effect on force of concentration Krause’s end bulb Cold

Meissner’s corpuscles Touch
Dromotropic action Effect on conduction of impulse through heart
Merkel’s disc Touch
Bathmotropic action Effect on excitability of cardiac muscle
Pacinian corpuscles Pressure
Various Tissues on their Conduction Rates Ruffini’s end organ Warmth

Name of the tissue Conduction rate (m/sec) Various Hemophilias and their Deficiency Factors
SA node 0.05
Name of hemophilia Deficient factor
Atrial pathway 1
Classical hemophilia or Hemophilia A Factor VIII
AV node 0.02 – 0.05
Christmas disease or hemophilia B Factor IX
Purkinje system 4
Hemophilia C Factor XI
Bundle of His 1
Von Willebrand disease Von Willebrand factor
Ventricular muscle 1
Differential Leucocyte Count
Various Nerve Fibers and their Functions
Name of the nerve fiber Functions Neutrophils 50 to 70%

A alpha (myelinated) • Proprioception Lymphocytes 20 to 30%

• Fastest conduction is present Eosinophils 2 to 4%
A Beta (myelinated) • It is afferent for touch Monocytes 2 to 6%
A Gamma (myelinated) • Intrafusal muscle of spindle Basophils 0 to 1%
A Delta (myelinated) Afferent for thermal and pain
Site for Erythropoesis
B Fibers (myelinated) Autonomic preganglionic fibers
C Fibers (Unmyelinated) • Causes slowest conduction During intrauterine life
• It is afferent for pain Phase of life Site for erythropoiesis
• Postganglionic sympathetic fibers
Intravascular phase • Mesoderm of yolk sac
From 3rd week to 3rd month • Only stage when erythropoiesis
Various Effector Organs along with their Sympathetic occur inside blood vessels
and Parasympathetic Divisions
Hepatic phase In both liver and spleen
Parasympathetic From 3rd to 5th month
Effector organ Sympathetic division division Myeloid phase In red bone marrow
Ciliary muscle Leads to contraction Leads to relaxation From 5th month onwards
Pupil Leads to dilation Leads to In postnatal life
constriction From birth to 5 years All bones, i.e. flat and long bones
Salivary secretion It get decreased It get increase From 5 to 20 years All bones, i.e. flat and long bones
Contd... After 20 years Only flat bones
442 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Hormones Secreted by Pituitary Contd...

Anterior pituitary • Growth hormone Cutaneous receptors

• Thyroid stimulating hormone Visceral receptors They are the stretch receptors,
• Adrenocorticotropic hormone baroreceptors, chemoreceptors and
• Follicle stimulating hormone osmoreceptors
• Luteinizing hormone
Proprioceptors • Receptors in labyrinthine apparatus
• Prolactin
• Pacinian corpuscle
Posterior pituitary • Antidiuretic hormone • Golgi apparatus
• Oxytocin
Classification of Nerve Fibers
Important Values
♦♦ Depending on the structure
Average value of RBCs 4 to 5 millions/mm3 • Myelinated: They are covered by myelin sheath
RBCs in adult males 5 millions/mm3 • Non-myelinated: They are not covered by myelin
RBCs in adult females 4.5 millions/mm3 sheath
Total WBC count 4000 to 11000/mm3 ♦♦ Depending on distribution
• Somatic: They supply skeletal muscles
Normal platelet count 2,50,000/mm 3
• Autonomic or visceral: Supply various internal organs
Various Clotting Factors of body
♦♦ Depending on function
Factor I Fibrinogen • Motor or efferent
Factor II Prothrombin • Sensory or afferent
Factor III Thromboplastin ♦♦ Depending on chemical neurotransmitter
Factor IV Calcium • Adrenergic: It secrete nor-adrenaline
Factor V Labile factor (proaccelerin)
• Cholinergic: It secrete acetylcholine
♦♦ Depending on the diameter
Factor VI Presence is not proved
• A alpha or Type I
Factor VII Stable factor or proconvertin • A beta or Type II
Factor VIII Antihemophilic factor A • A delta or Type III
Factor IX Antihemophilic factor B • B fibers
Factor X Stuart prower factor • C fibers or Type IV
Factor XI Plasma thromboplastin antecedent Duration of Cardiac Cycle
Factor XII Hageman factor
Factor XIII Fibrin-stabilizing factor or Laki-lorand factor Systole
Isometric contraction 0.05 sec
Various Receptors Ejection period (rapid + slow) 0.22 sec
Cutaneous receptors Total duration of systole 0.27 sec
• Touch receptors • Meissner’s corpuscles and Merker’s disc Diastole
• Pressure receptors • Pacinian corpuscles
• Cold receptors • Krause’s end organ Protodiastole 0.04 sec
• Warm • Ruffini’s end organ Isometric relaxation 0.08 sec
• Pain or noci • Free nerve endings
Rapid filling 0.11 sec
receptors
Tele receptors • Hair cells of organ of Corti are the Slow filling 0.19 sec
receptors inside the ear Atrial systole 0.11 sec
• Rods and cones in retina are receptors
Total duration of diastole 0.53 sec
in the eye
Contd... Total duration of cardiac cycle 0.27 + 0.53 = 0.8 sec
 6
SECTION

Biochemistry

1. Carbohydrates: Chemistry, Metabolism and 10. Detoxification, Free Radicals and Antioxidants
Regulation 11. Organ Function Tests
2. Amino Acids and Proteins: Chemistry, 12. Vitamins
Metabolism and Regulation
13. Plasma Proteins
3. Proteins and Nucleic Acids: Chemistry,
14. Water, Electrolyte and Acid-Base Balance
Metabolism and Regulation
15. Cancer
4. Lipids: Chemistry, Metabolism and Regulation
16. Tissue Proteins and Body Fluids
5. Mineral Metabolism
6. Biological Oxidation Multiple Choice Questions as per DCI and
7. Enzymology Examination Papers of Various Universities

8. Hemoglobin and Porphyrin Viva-voce Questions for Practical Examination

9. Energy Metabolism and Nutrition Additional Matter

1. CARBOHYDRATES: CHEMISTRY,
METABOLISM AND REGULATION
Q.1. Classify carbohydrates with examples. Describe
anaerobic glycolysis pathway with energetics.
 (Nov 2009, 8 Marks)
Or
Classify carbohydrates with examples. Describe
anaerobic oxidation of glucose. (Dec 2010, 8 Marks)
Or
Write about glycolysis and its energetics.
 (Feb 2013, 10 Marks)
Or
Define and classify carbohydrates. Describe glycolysis
in detail. (Mar 2013, 8 Marks)
Or
Describe the various steps of glycolysis. Add a note on
its energetics. (Feb 2014, 8 Marks)
Ans. enzyme aldolase.
Classification of Carbohydrates
♦♦ Monosaccharides: They are polyhydroxy aldehydes
and ketones. When functional group is an aldehyde,
monosaccharides are known as aldoses, e.g. glyceraldehyde,
glucose. When functional group is keto monosaccharides
are known as ketoses, e.g. fructose and dihydroxyacetone.
• As based on number of carbon atoms monosaccharides
are known as trioses when they have 3 carbons,
tetroses when they have 4 carbons, pentoses when
they have 5 carbons, hexoses when they have
6 carbons.
♦♦ Oligosaccharides: It consists of a few monosaccharides
joined by glycosidic linkages between sugars. For example,
lactose, maltose and sucrose.
• Based on number of monosaccharide units present
in oligosaccharides are disaccharides, trisaccharides,
tetrasaccharides, etc.
Disaccharides are divided into two types:
1. Reducing disaccharides, e.g. lactose and maltose.
2. Non-reducing disaccharides:, e.g. sucrose.
♦♦ Polysaccharides: They are polymers of monosaccharide
units having the high molecular weight.
• They are subclassified into homopolysaccharide and
heteropolysaccharides. Homopolysaccharides are
constituted by simple sugars, e.g. glycogen or starch
made up of glucose. Heteropolysaccharides are made
up of mixture of simple sugars and their derivatives,
e.g. hyaluronic acid containing repeated units of
glucosamine and glucuronic acid.
Anaerobic Glycolytic Pathway
The pathway can be divided into three distinct phases:
1. Energy investment phase or priming stage.
2. Splitting phase.
3. Energy generation phase.
The Sequence of Reactions
Energy Investment Phase
♦♦ Glucose is phosphorylated to glucose-6-phosphate by
hexokinase or glucokinase. This is an irreversible reaction
dependent on ATP and Mg2+.
♦♦ Glucose-6-phosphate go for isomerization to give fructose
6-phosphate in the presence of enzyme phosphohexose
isomerase and Mg2+.
♦♦ Fructose 6-phosphate is phosphorylated to fructose
1,6-bisphosphate by phosphofructokinase (PFK). This is
an irreversible and regulatory step in glycolysis.
Splitting Phase
♦♦ The six carbon molecule of fructose 1,6-bisphosphate is
split to two three-carbon compounds, glyceraldehydes
3-phosphate and dihydroxyacetone phosphate by the
♦♦ The enzyme phosphotriose isomerase catalyses the
reversible interconversion of glyceraldehyde 3-phosphate
and dihydroxyacetone phosphate. Thus, two molecules
of glyceraldehyde 3-phosphate are obtained from one
molecule of glucose.
Energy Generation Phase
♦♦ Glyceraldehyde 3-phosphate dehydrogenase converts
glyceraldehyde 3-phosphate to 1,3-bisphosphoglycerate.
This step is involved in the formation of NADH + + H+ and
a high energy compound l,3-bisphosphoglycerate.
♦♦ The enzyme phosphoglycerate kinase acts on
1,3-bisphosphoglycerate resulting in the synthesis of
ATP and formation of 3-phosphoglycerate. Since ATP is
synthesized from the substrate without the involvement of
electron transport chain, phosphoglycerate kinase reaction
is reversible.
♦♦ 3-phosphoglycerate is converted to 2-phosphoglycerate
by phosphoglycerate mutase.
♦♦ High energy compound phosphoenol pyruvate is generated
from 2-phosphoglycerate by the enzyme enolase. This
enzyme requires Mg2+ or Mn2+ and is inhibited by fluoride.
♦♦ The enzyme pyruvate kinase catalyses the transfer of
high energy phosphate from phosphoenol pyruvate to
ADP leading to the formation of ATP. This reaction is
irreversible.
♦♦ The fate of pyruvate produced in glycolysis depends on
the presence or absence of oxygen in the cells.
♦♦ Under anaerobic conditions pyruvate is reduced by NADH
to lactate in presence of the enzyme lactate dehydrogenase.
♦♦ The NADH utilized in this step is obtained from the reaction
catalyzed by glyceraldehyde 3-phosphate dehydrogenase.
446 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ The formation of lactate allows the regeneration of NAD+

which can be reused by glyceraldehyde 3-phosphate
dehydrogenase so that glycolysis proceeds even in the
absence of oxygen to supply ATP.
♦♦ The occurrence of uninterrupted glycolysis is very
essential in skeletal muscle during strenous exercise
where oxygen supply is very limited. Glycolysis in
the erythrocytes leads to lactate production, since
mitochondria-the centers for aerobic oxidation are absent.
Brain, retina, skin, renal medulla and gastrointestinal tract
derive most of their energy from glycolysis.

Energetics of Anaerobic Glycolysis Pathway

During anaerobic condition when one molecule of glucose is
converted to two molecules of lactate there is a net yield of 2
molecules of ATP.

Enzyme Source No. of ATPs generated

Hexokinase - –1
Phospho-
- –1
fructokinase
1, 3-bisphos-
phoglycerate ATP 1×2=2
kinase
Pyruvate
ATP 1×2=2
kinase
Total 4–2 = 2

Q.2. Describe in brief on glycolysis.

 (Sep 2006, 4 Marks) (Apr 2008, 4 Marks)
 (Aug 2012, 4 Marks) (June 2010, 5 Marks)
Or
Define and classify carbohydrates with examples.
Explain oxidation of glucose. (Jan 2012, 8 Marks)
Ans. Glycolysis is defined as sequence of reactions converting
glucose to pyruvate or lactate with the production of
ATP.
The pathway can be divided into three distinct phases:
a. Energy investment phase or priming stage.
b. Splitting phase.
c. Energy generation phase.

Energy Investment Phase

♦♦ Glucose is phosphorylated to glucose-6-phosphate
by hexokinase or glucokinase (both are isoenzymes).
This is an irreversible reaction dependent on ATP
and Mg2+.
♦♦ Glucose-6-phosphate undergoes isomerization to give
fructose 6-phosphate in the presence of the enzyme
phosphohexose isomerase and Mg2+.
♦♦ Fructose 6-phosphate is phosphorylated to fructose
1,6-bisphosphate by phosphofructokinase (PFK). This is
an irreversible and regulatory step in glycolysis. Fig. 1:  Glycolysis

Splitting Phase
♦♦ The six-carbon molecules of fructose 1,6-bisphosphate
is split (hence the name glycolysis) to two three-
carbon compounds, glyceraldehydes 3-phosphate and
dihydroxyacetone phosphate by the enzyme aldolase.
♦♦ The enzyme phosphotriose isomerase catalyses the
reversible interconversion of glyceraldehyde 3-phosphate
and dihydroxyacetone phosphate. Thus, two molecules
of glyceraldehyde 3-phosphate are obtained from one
molecule of glucose.
Energy Generation Phase
♦♦ Glyceraldehyde 3-phosphate dehydrogenase converts
glyceraldehyde 3-phosphate to 1, 3-bisphosphoglycerate.
This step is involved in the formation of NADH++ H+ and
a high energy compound l, 3-bisphosphoglycerate.
♦♦ The enzyme phosphoglycerate kinase acts on 1,
3-bisphosphoglycerate resulting in the synthesis of ATP
and formation of 3-phosphoglycerate. This step is a good
example of substrate level phosphorylation, since ATP is
synthesized from the substrate without the involvement of
electron transport chain. Phosphoglycerate kinase reaction
is reversible, a rare example among the kinase reactions.
♦♦ 3-phosphoglycerate is converted to 2-phosphoglycerate
by phosphoglycerate mutase.
♦♦ The high energy compound phosphoenol pyruvate
is generated from 2-phosphoglycerate by the enzyme
enolase. This enzyme requires Mg2+ or Mn2+ and is inhibited
by fluoride.
♦♦ The enzyme pyruvate kinase catalyses the transfer of high
energy phosphate from phosphoenol pyruvate to ADP
leading to the formation of ATP. This step is also a substrate
level phosphorylation. This reaction is irreversible.
For classification of carbohydrates refer to Ans 1 of same chapter.
Q.3. Write a short note on gluconeogenesis.
 (Mar 2000, 5 Marks) (Jan 2012, 4 Marks)
 (Nov 2012, 3 Marks) (June 2010, 5 Marks)
 (May 2014, 5 Marks) (Dec 2014, 5 Marks)
Ans. Synthesis of glucose from non–carbohydrate compound
is known as gluconeogensis.
Substrates for gluconeogenesis are lactate, pyruvate,
glucogenic amino acids, propionate and glycerol.
Gluconeogenesis occurs mostly in liver and to some of
the extent in kidney matrix.
Reactions of Gluconeogenesis
♦♦ Conversion of pyruvate to phosphoenol pyruvate: It
occurs in two steps. Pyruvate carboxylase is a biotin
dependent mitochondrial enzyme which converts pyruvate
to oxaloacetate in the presence of ATP and carbon dioxide.
This enzyme leads to the regulation of gluconeogenesis.
Synthesis of oxaloacetate occurs in mitochondrial matrix.
From here it is transported to cytosol to get utilized in
gluconeogenesis. Because of the membrane impermeability,
it should not diffuse out of mitochondria and is converted
to malate and now it diffuse out of mitochondria to cytosol.
Biochemistry 447
Inside cytosol, oxaloacetate gets regenerated. Reversible
conversion of oxaloacetate and malate is catalyzed by
enzyme malate dehydrogenase. In cytosol, enzyme
phosphoenolpyruvate carboxylase leads to the conversion
of oxaloacetate to phosphoenolpyruvate.
♦♦ Conversion of fructose 1,6–biphosphate to fructose
6–phosphate: Phosphoenol pyruvate undergo reversal
of glycolysis till fructose 1,6–biphosphate is produced.
Enzyme fructose 1,6–biphosphatase leads to the conversion
of fructose 1,6–biphosphate to fructose 6–phosphate.
♦♦ Conversion of glucose-6–phosphate to glucose:
Glucose-6–phosphatase leads to the conversion of
glucose-6–phosphate to glucose. Presence or absence of
this enzyme in tissue determines whether tissue is capable
of contributing glucose to blood or not.
Overall Reaction for Gluconeogenesis
2 Pyruvate + 4ATP + 2GTP + 2NADH + 2H+ + 6H2O→Glucose +
2NAD+ + 4ADP + 2GDP + 6Pi + 6H+
Q.4. Write a short note on fate of glucose.
 (Mar 1998, 5 Marks)
Ans. Glucose after absorption into portal blood passes
systematic circulation through liver.
The fate of glucose is:
• Conversion of glucose to glycogen for storage in liver.
• Utilization of glucose for energy production by
oxidation.
• Utilization of glucose for synthesis of compounds
such as fatty acids.
Other with these above mechanism lead to release of
glucose by liver to blood by following means:
• Conversion of glucose to blood glucose.
• Synthesis of blood glucose by liver and kidney from
non-carbohydrate substances.
Q.5. Write a short note on mucopolysaccharides.
 (Jan 2012, 3 Marks)
Ans. Mucopolysaccharides are heteroglycans made up of
repeating units of sugar derivatives namely amino
sugars and uronic acids. These are more commonly
known as glycosaminoglycans (GAG).
• Acetylated amino groups, besides sulfate and
carboxyl groups are generally present in GAG
structure.
• Some of the mucopolysaccharides are found in
combination with proteins to form mucoproteins
or mucoids or proteoglycans. Mucoproteins may
contain up to 95% carbohydrate and 5% protein.
• Mucopolysaccharides are essential components of
tissue structure. The extracellular spaces of tissue
consist of collagen and elastin fibers embedded in a
matrix or ground substance. The ground substance
is predominantly composed of GAG.
• The important mucopolysaccharides include
hyaluronic acid, chondroitin 4-sulfate, heparin,
dermatan sulfate and keratan sulfate.
448 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Various Mucopolysaccharides
♦♦ Hyaluronic acid: This is found in the ground substance of
synovial fluid of joints and vitreous humor of eyes. It also
present as ground substance in connective tissue. It serves
as lubricant and shock absorbent in joints.
♦♦ Chondroitin sulfate: This is the constituent of mammalian
tissues. It has enormous capacity to retain water.
♦♦ Heparin: It is an anti–coagulant which occurs in blood,
lung, liver and kidney. It leads to the release of enzyme
lipoprotein lipase which clears turbidity of lipemic plasma.
♦♦ Dermatan sulfate: It is most commonly occur in skin. It
also provides transparency to cornea and maintains overall
shape of an eye.
Q.6. Write a short note on Cori’s cycle. (Apr 2010, 10 Marks)
Ans. Cori’s cycle is also known as lactic acid cycle.
Carl Cori and Gerty Cori had given the concept of Cori’s
cycle. Both of them were awarded by Nobel prize in year
1947.
Lactate is produced in skeletal muscles during anaerobic
oxidation of glucose.
Under anaerobic conditions, pyruvate is reduced to
lactate by lactate dehydrogenase. As plasma membrane
is permeable to lactate, lactate is carried from skeletal
muscle via blood to liver, where it get oxidized to
pyruvate. Pyruvate which is produced gets converted to
glucose by gluconeogenesis which is then transported to
skeletal muscle. So the cycle which involves synthesis of
glucose in liver from skeletal muscle lactate and reuse of
glucose which is synthesized by muscle for producing
energy is known as Cori’s cycle or lactic acid cycle.
Fig. 2:  Cori’s cycle or lactic acid cycle
Q.7. Write a short note on Krebs cycle.
 (Sep 1999, 5 Marks) (Mar 2009, 10 Marks)
Or
Write a short note on TCA Cycle.(Dec 2014, 10 Marks)
Or
Describe Krebs cycle with energetic and regulation.
 (Apr 2018, 10 Marks)
Ans. Also known a citric acid cycle, or tricarboxylic acid cycle.
• It is the most important metabolic pathway for the
energy supply to the body (See Fig. 3).
• Citric acid cycle is the final common oxidative path-
way for carbohydrate, fats and amino acid.
Formation of Citric Acid
4-carbon structure, i.e. oxaloacetate condensed with 2-carbon
structure, i.e. acetyl, CoA to form 6-carbon structure, i.e.
citrate. The reaction is catalyzed by enzyme citrate synthase.
Formation of Isocitrate
Citrate is isomerized to isocitrate by the enzyme aconitase. This
reaction is a two stage process. First stage is of dehydration,
i.e. one water molecule is removed from citrate forming cis,
aconitate. In second stage, hydration occur, i.e. one water
molecule is added to aconitate to form isocitrate.
Formation of Alpha-Ketoglutarate
♦♦ This reaction is a two-step process. Both the steps are
catalyzed by isocitrate dehydrogenase.
♦♦ In the first part of the reaction, isocitrate is dehyrogenated
to form oxalosuccinate. Oxalosuccinate undergoes
spontaneous decarboxylation to form alpha-ketoglutarate.
♦♦ NADH generated at this step gets later oxidized in electron
transport chain and generate 3 ATPs.
♦♦ 6-carbon structure isocitrate undergoes oxidative
decarboxylation to form alpha-ketoglutarate which is a
5-carbon structure.
♦♦ In this reaction, one molecule of CO2 is liberated.
Formation of Succinyl-CoA
♦♦ Alpha-ketoglutarate through oxidative decarboxylation
and is catalysed by enzyme alpha-ketoglutarate dehydro­
genase to form succinyl-CoA.
♦♦ NADH generated at this step enters into electron transport
chain for generation of 3 ATPs.
♦♦ One molecule of CO2 is liberated in this step.
♦♦ The enzyme alpha-ketoglutarate dehydrogenase is
dependent on five co-factors, i.e. TPP, lipoamide, NAD+,
FAD and CoA.
Formation of Succinate
Succinyl-CoA is converted to succinate by succinate thiokinase.
This reaction is coupled with the phosphorylation of GDP to
GTP. This is a substrate level phosphorylation. GTP is converted
to ATP by phosphokinase enzyme.
GTP + ADP → GDP + ATP
Formation of Fumarate
Succinate is dehydrogenated to fumarate by succinate
dehydrogenase. The hydrogen atoms are accepted by FAD.
FADH2 then enters into ETC to generate 2 ATPs. The enzyme
is a flavoprotein. The succinate dehydrogenase is competitively
inhibited by malonate.
 Biochemistry 449

Fig. 3:  Citric acid cycle

Formation of Malate
Formation of malate from fumarate is catalysed by fumarase.

Regeneration of Oxaloacetate
♦♦ Malate is oxidized to oxaloacetate by malate dehydrogenase.
♦♦ The coenzyme is NAD+.
♦♦ NADH is generated in this step which enters the electron
transport chain, when 3 ATPs are produced.
♦♦ Oxaloacetate can further condense with another acetyl-
CoA molecule and the cycle continues.
♦♦ Oxaloacetate may be viewed as a catalyst which enters into
the reaction, causes complete oxidation of acetyl-CoA and
comes out of it without any change.

Generation of ATP in Citric Acid Cycle or Energetics of

Citric Acid Cycle
ATP
Reactions Coenzyme generated
Isocitrate to alpha-ketoglutarate NADH 3
Alpha-ketoglutarate to succinyl-CoA NADH 3
Succinyl-CoA to succinate GTP 1
Succinate to fumarate FADH2 2
Malate to oxaloacetate NADH 3 Fig. 4:  ATP generation in Krebs cycle

Total ATPs generated 12

450 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Regulation of Krebs Cycle Procedures

♦♦ Regulation in Krebs cycle is brought about either by 1. The patient who is scheduled for oral GTT is instructed to
enzymes or levels of ADP. eat a high carbohydrate diet for at least 3 days prior to the
♦♦ There are three enzymes which regulate Krebs cycle, test, and come after an overnight fast on the day of the test.
i.e. citrate synthase, isocitrate dehydrogenase and α– 2. A fasting blood glucose sample is first drawn.
ketoglutarate dehydrogenase. 3. Then 75 g of glucose (or 1.75 g per kg body weight)
♦♦ Following are the enzymes which regulate Krebs cycle: dissolved in 300 mL of water is given orally.
• Citrate synthase: It is inhibited by ATD, NADH, Acyl- 4. After giving glucose, blood and urine specimens are
CoA and succinyl-CoA. collected at half hourly intervals for at least 2 hours.
• Isocitrate dehydrogenase: It is activated by ADP and 5. Blood glucose content is measured and urine is tested for
inhibited by ATP and NADH glycosuria.
• α–ketoglutarate dehydrogenase: It is inhibited by 6. A curve is plotted for time against blood glucose
succinyl-CoA and NADH. concentration and is called glucose tolerance curve.
Availability of ADP is very important for Krebs cycle to Diagnostic Criteria for Oral Glucose Tolerance Test
proceed. (WHO 1999)
Q.8. Write a short note on glucose tolerance test.
Condition Plasma glucose concentration (mg/dL)
 (Aug 2016, 2 Marks) (Jan 2012, 3 Marks)
Ans. It is the test to measure the degree and duration of Impaired glucose
Normal tolerance Diabetes
hyperglycemia after giving a known amount of glucose.
  Ability of body to utilize glucose is done by measuring Fasting <110 <126 >126
its glucose tolerance. Two hours after <140 <200 >200
glucose intake
Types
1. Oral glucose tolerance. Intravenous Glucose Tolerance Test
2. Intravenous glucose tolerance. ♦♦ The intravenous glucose tolerance test is often used for
3. Cortisone stress glucose tolerance. persons with rnalabsorptive disorders or previous gastric
4. Multiple dose glucose tolerance. or intestinal surgery.
♦♦ Glucose is administered intravenously over 30 minutes
Utility using 20% glucose solution. A glucose load of 0.5 g/kg of
1. To detect the cause of abnormality of carbohydrate body weight is used.
metabolism.
Significance of Glucose Tolerance Test
2. To detect cause of symptomatic glucosuria.
3. To detect and confirm diabetes mellitus. ♦♦ Glucose tolerance test is not necessary in symptomatic
or in known cases of diabetic patients. In such cases,
determination of fasting or postprandial glucose is usually
sufficient for the diagnosis.
♦♦ Glucose tolerance test is most important in the investigation
of asymptomatic hyperglycemia or glycosuria such as renal
glycosuria and alimentary glycosuria.
♦♦ This test may give useful information in some cases of
endocrine dysfunctions.
♦♦ It is also helpful in recognizing milder cases of diabetes.

Interpretation
♦♦ Fasting plasma glucose level is <100 mg/dL in normal
persons. On taking oral glucose the concentration increases
and the peak value, i.e. <150 mg/dL is reached in less than
a hour which returns to normal by 2 hours. Glucose is not
detected in urine samples.
♦♦ In individuals with impaired glucose tolerance the fasting
as well as 2 hour glucose levels of plasma glucose levels
are elevated. These subjects solely develop frank diabetes.
Q.9. Write a short note on hypoglycemia. (Sep 2009, 5 Marks)
Ans. Hypoglycemia means decrease in the blood glucose level
Fig. 5:  Glucose tolerance curve below 45 mg/dL.

Causes
Hypoglycemia is caused due to the:
♦♦ Increase in the blood glucose level by the skeletal muscle.
♦♦ During insulinoma when there is increase secretion of
the insulin.
♦♦ In macrosomia, the insulin level in the infants is increased
due to which there is hypoglycemia.
Symptoms
As plasma glucose level falls, symptoms are palpitation,
sweating and nervousness. The neuroglycopenic symptoms
arise including hunger, confusion and congnitive abnormalities.
At even lower glucose level, lethargy, convulsions and
eventually death occurs.
Treatment
The onset for the hypoglycemic symptoms calls for the prompt
treatment with the glucose or glucose containing juices such as
orange juice.
Q.10. Write a short note an glycosuria. (Apr 2003, 4 Marks)
Ans. Glycosuria is the excretion of sugar in urine.
• Most common cause of glucose excretion in urine is
diabetes mellitus.
• It is the first line screening test for diabetes.
• Glucose does not appear in urine till plasma glucose
level exceeds renal threashold, i.e. 180 mg/dL.
• Due to aging renal threashold for glucose increases
marginally.
Types of Glycosuria
There are two types of glycosuria, i.e.
1. Renal glycosuria: It is a benign condition due to reduced
renal threashold for glucose. It is not related to diabetes.
2. Alimentary glycosuria: In some individuals blood glucose
level rises rapidly after taking meals resulting in spill of
glucose in meals. This is known as alimentary glycosuria.
It is seen in some normal people, patients with hepatic
diseases, hyperthyroidism and peptic ulcers.
Q.11. Describe carbohydrates and write in short about
diabetes mellitus and glycogen storage diseases.
 (Jan 2012, 11 Marks)
Or
Describe diabetes mellitus under following headings—
types, complications, treatment. (Oct 2016, 10 Marks)
Ans. Carbohydrates
For classification refer to Ans 1 of same chapter.
Function of Carbohydrates
♦♦ Carbohydrates are the main sources of energy in the body.
Brain cells and RBCs are almost wholly dependent on
carbohydrates as the energy source. Energy production
from carbohydrates will be 4 kcal/g.
♦♦ Storage form of energy: It is stored in the form of starch
and glycogen.
Biochemistry 451
♦♦ Excess carbohydrate is converted to fat.
♦♦ Glycoproteins and glycolipids are components of cell
membranes and receptors.
♦♦ Structural unit of many organisms: Cellulose of plants;
exoskeleton of insects, cell wall of microorganisms, muco-
polysaccharides as ground substance in higher organisms.
♦♦ The general molecular formula of carbohydrates is
Cn(H2O)n. Carbohydrates are polyhydroxy aldehydes or
ketones or compounds which yield these on hydrolysis.
Diabetes Mellitus
Diabetes mellitus is a metabolic disease due to absolute or
relative insulin deficiency. It is a common clinical condition.
Disease may be classified as follows (WHO recommendation,
1999):
♦♦ Type I Diabetes Mellitus [formerly known as Insulin-
dependent diabetes mellitus (IDDM)]
• About 5% of diabetic patients are of type 1.
• It is due to decreased insulin production. Circulating
insulin level is very low.
• These patients are dependent on insulin injections.
• Onset is usually below 30 years of age, most commonly
during adolescence.
• They are more prone to develop ketosis.
♦♦ Type 2 Diabetes Mellitus [formerly known as non-insulin
dependent diabetes mellitus; (NIDDM)]
• About 95% of the patients belong to this type.
• The disease is due to the decreased biological response
to insulin, otherwise called insulin resistance. So there
is a relative insulin deficiency. Circulating insulin level
is normal or mildly elevated or slightly decreased.
• Type 2 disease is commonly seen in individuals above
40 years.
• These patients are less prone to develop ketosis.
Metabolic Derangements in Diabetes
♦♦ Deragements in Carbohydrate metabolism: Insulin
deficiency decreases the uptake of glucose by cells. The
insulin dependent enzymes are also less active. Net
effect is an inhibition of glycolysis and stimulation of
gluconeogenesis leading to hyperglycemia.
♦♦ Derangements in Lipid metabolism:
• Fatty acid breakdown leads to high free fatty acid
levels of plasma and consequent fatty liver.
• More acetyl-CoA is now available which cannot
be efficiently oxidized by TCA cycle, because the
availability of oxaloacetate is limited. The stimulation
of gluconeogenesis is responsible for the depletion of
oxaloacetate.
• The excess of acetyl-CoA therefore, is diverted to
ketone bodies leading to ketogenesis.
♦♦ Derangements in Protein metabolism: Increased break­
down of proteins and amino acids for providing substrates
for gluconeogenesis is responsible for muscle wasting.
452 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Clinical Presentations in Diabetes Mellitus Dietary Management and Exercise

♦♦ When the blood glucose level exceeds the renal threshold, ♦♦ Diabetic patient is advised to take low calories, high
glucose is excreted in urine (glucosuria). protein and fiber rich diet.
♦♦ Due to osmotic effect, more water accompanies the glucose ♦♦ Take carbohydrates in the form of starch and complex
(polyuria). sugar.
♦♦ To compensate for this loss of water, thirst center is ♦♦ Avoid refined sugars.
activated, and more water is taken (polydypsia). ♦♦ Reduce fat intake to meet nutritional requirements of
♦♦ To compensate the loss of glucose and protein, patient will unsaturated fatty acids.
take more food (polyphagia). ♦♦ Exercise helps in maintaining blood sugar in Type II
♦♦ The loss and ineffective utilization of glucose leads to diabetes mellitus patients.
breakdown of fat and protein. This would lead to loss of Hypoglycemic Drugs
weight.
♦♦ Often the presenting complaint of the patient may be Oral hypoglycemic drugs, i.e. sulfonylureas and biguanides
chronic recurrent infections such as boils, abscesses, are used.
etc. Any person with recurrent infections should be Insulin
investigated for diabetes.
Two types of insulin preparations are used, i.e. long-acting and
Complications of Diabetes Mellitus short-acting.
1. Short-acting insulin is unmodified and its action remains
Acute Complication
for 6 hours.
♦♦ Diabetic ketoacidosis: As oxaloacetate is diverted for 2. Long-acting insulins are modified ones and act for several
gluconeogenesis, the TCA cycle cannot consume all the hours which depends on its type of preparation.
acetyl—CoA. Hence more acetyl—CoA is converted to
ketone bodies. This leads to accumulation of ketone bodies Glycogen Storage Diseases
in blood (ketonemia). The presence of ketone bodies Following table enlist the glycogen storage diseases.
in urine (ketonuria) is assessed by Rothera’s test. The
Disease Deficient enzyme Salient features
accumulation of acidic ketone bodies lowers the plasma
pH. So, metabolic acidosis occurs. The condition is called Type I Glucose-6- Fasting hypoglycemia;
diabetic ketoacidosis. Smell of acetone in the breath is Von Gierke disease phosphsatase Hepatomegaly
noticed. If not treated promptly and properly, the condition Type II Lysosomal maltase Liver, heart and muscle
may be fatal. Patient may become unconscious, comatose Generalized affected; death before 2
and die. glycogenosis; years
Type III Debranching Highly branched dextrin
Chronic Complications Pompe’s disease enzyme accumulates;
♦♦ Vascular diseases: Atherosclerosis in medium sized Limit dextrinosis hepatomegaly
vessels, plaque formation and consequent intravascular Type IV Branching enzyme Glycogen with little
thrombosis may take place. If it occurs in cerebral vessels, Cori’s disease branches; hepatomegaly
the result is paralysis. If it is in coronary artery, myocardial Amylopectinosis
infarction results. Type V Muscle Exercise intolerance
♦♦ Complications in eyes: Early development of cataract Anderson’s disease
of lens is due to the increased rate of sorbitol formation,
Type VI Phosphorylase Hypoglycemia
caused by the hyperglycemia. Retinal microvascular McArdle’s disease Liver
abnormalities lead to retinopathy and blindness.
Type VII Phosphorylase Accumulation of
♦♦ Neuropathy: Peripheral neuropathy with paresthesia
Hers disease Muscle PFK glycogen in muscles
is very common. Decreased glucose utilization and its
diversion to sorbitol in Schwann cells may be cause for Type VIII Liver -
neuropathy. Neuropathy may lead to risk of foot ulcers. Tarul’s disease Phosphorylase
kinase
Management in Diabetes Mellitus Type IX Glycogen synthase -
Lewis disease
Type I diabetic fail to secrete insulin, so they are treated by
exogenous insulin. Q.12. Write about classification of carbohydrates and its
Type II diabetics in their early stage are treated by diet functions. (Feb 2013, 5 Marks)
control, exercise and weight reduction but in later stages insulin Ans. For classification refer to Ans 1 of same chapter.
is required to control blood glucose. For functions refer to Ans 11 of same chapter.
 Biochemistry 453

Q.13. What are energy liberating metabolic pathways in our ♦♦ Depresses glycogen synthesis
body. Describe one of them. (Sep 2013, 10 Marks) ♦♦ Inhibits glycolysis.
Ans. Energy liberating metabolic pathways in our body are:
Cortisol or Hyperglycemic Hormone
1. Citric acid cycle
2. Cori’s cycle ♦♦ Increases blood sugar level
3. Glycolysis ♦♦ Increases gluconeogenesis
4. Gluconeogenesis ♦♦ Releases amino acids from the muscle.
5. Hexose monophosphate shunt Adrenaline or Epinephrine
6. Oxidative phosphorylation
♦♦ Increases blood sugar level
7. b-Oxidation of fatty acid.
♦♦ Promotes glycogenolysis
For citric acid cycle in detail refer to Ans 7 of same chapter. ♦♦ Increases gluconeogenesis
Q.14. How is blood glucose level regulated. (Sep 2013, 4 Marks) ♦♦ Favors uptake of amino acids.
Or Growth Hormone
Write on regulation of blood sugar. (Apr 2017, 5 Marks) ♦♦ Increases blood sugar level
Ans. Regulation of blood glucose level is also known as ♦♦ Decreases glycolysis
homeostasis of blood glucose. ♦♦ Mobilizes fatty acids from adipose tissue.
Q.15. What is Krebs cycle? Why it is so called? What is the
Regulation of Blood Glucose Level During Fasting
alternate name of the cycle? Justify the name. State very
After 2 to 2½ hours after meal, blood glucose level fall to briefly the steps of Krebs cycle. (Oct 2014, 8 Marks)
fasting level. It can go down further but this is prevented by Ans. Krebs cycle is the most important carbohydrate metabolic
processes which contribute glucose to blood. For the next 3 pathway for energy supply to body. It utilizes 2/3rd of
hours the glycogenolysis takes care of blood sugar level. Then total oxygen consumed by the body. About 65 to 70% of
gluconeogenesis take part. Liver supplies the glucose for ATPs are generated in Krebs cycle.
maintenance of blood glucose level. It is known as Krebs cycle because it was proposed by
Sir Hans Krebs. So the cycle is named after him. It is also
Regulation of Blood Glucose Level Post Prandially
known as tricarboxylic acid because at outset of the cycle,
After a meal, glucose get absorbed from intestine and enter in tricarboxylic acids, i.e. citrate, cis-aconitate and isocitrate
blood. Rise in the blood glucose level also stimulate secretion of participates.
insulin through beta cells of islet of langerhans. Uptake of glucose It is also known as Krebs cycle or tricarboxylic acid (TCA)
by extrahepatic tissues except brain depends on insulin. Insulin also cycle or citric acid cycle.
helps conversion of glucose into glycogen or its conversion to fat. For krebs cycle in detail refer to Ans 7 of same chapter.
Role of Kidney in Blood Glucose Level Regulation Q.16. Write a short note on polysaccharides.
 (Feb 2013, 7 Marks)
♦♦ Filtration of glucose occurs continuously by glomeruli.
♦♦ Glucose is resorbed and return to the blood. Ans. Polysaccharides consists of repeat units of monosa-
ccharides or their derivatives which are held together
♦♦ If levels of glucose in blood exceed 160-180 mg/dL, glucose
by glycosidic bonds.
is excreted in urine. This value is renal threashold of glucose.
♦♦ Maximum ability of renal tubules to resorb glucose per Types
minute is known as tubular maximum for glucose (TmG).
Its value is 350 mg/min. Polysaccharides are of two types, i.e. homopolysaccharides and
 Also refer to Ans 19 of same chapter. heteropolysaccharides.

Role of Hormones in Regulation of Blood Sugar Homopolysaccharides

♦♦ Homopolysaccharides on hydrolysis yield a single type
Insulin
of monosaccharides. Their naming is done based on the
♦♦ It decreases blood glucose levels nature of monosaccharide unit.
♦♦ Favors synthesis of glycogen ♦♦ Homopolysaccharides are starch, inulin, glycogen and
♦♦ Promote glycolysis cellulose.
♦♦ Inhibit gluconeogenesis. ♦♦ Starch is the homopolymer which consists of D-glucose
units which are held together by α-glycosidic bonds. It
Glucagon
is also known as glucan. Starch has two polysaccharide
♦♦ Increases blood glucose contents, i.e. water soluble amylase and water insoluble
♦♦ Promotes glycogenolysis amylopectin. Amylopectin consists of few thousand
♦♦ Enhances gluconeogenesis glucose units which looked like a branched tree.
454 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ Inulin is a polymer fructose, i.e. fructosan. It is a low Significance of Krebs Cycle

molecular weight polysaccharide which is easily soluble in
♦♦ Krebs cycle provide energy in the form of ATP.
water. Inulin is not used by body. It is useful for assessing
♦♦ It provide substrate for respiratory chain. During course of
the kidney functions by measurement of glomerular
oxidation of acetyl–CoA in the cycle, reducing equivalents
filtration rate.
are formed; these enter the respiratory chain where ATPs
♦♦ Glycogen is also known as animal starch. Structure of
are generated in the process of oxidative phosphorylation.
glycogen is same as amylopectin. Glucose is the repeating
♦♦ Krebs cycle is the final common pathway for oxidation
unit in glycogen which is joined by glycosidic bond.
of carbohydrate, lipids and protein as glucose, fatty acids
♦♦ Cellulose consists of β-D-glucose units which are linked by
and many amino acids are all metabolized to acetyl-CoA
β-glycosidic bonds. Cellulose is not digested by humans
or intermediates of the cycle.
because of lacking of the enzyme which breaks β-glycosidic
♦♦ One passage of cycle oxidizes acetyl-CoA into two
bonds. Hydrolysis of cellulose produces disaccharide
carbon dioxide molecules. Major source of oxaloacetate is
cellobiose followed by β–D–glucose. Cellulose decreases
pyruvate. So carbohydrates are required for the oxidation
the absorption of glucose and cholesterol from intestine
of fats.
and also increasing the bulk of feces.
♦♦ It is an amphibolic pathway, i.e. it plays role in oxidative
Heteropolysaccharides and synthetic processes. Some metabolic pathways
end in the constituent of Krebs cycle, while other
♦♦ When polysaccharides consist of various different sugars or
pathways originate from the cycle, e.g. gluconeogenesis,
their derivatives they are known as heteropolysaccharides
transamination, fatty acid synthesis, porphyrin
or heteroglycans.
synthesis.
♦♦ Heteropolysaccharides are mucopolysaccharides.
♦♦ It act as a source of precursors of biosynthetic pathways,
♦♦ Mucopolysaccharides are heteroglycans made up of
e.g. heme is synthesized from succinyl-CoA and aspartate
repeating units of sugar derivatives namely amino sugars
from oxaloacetate. To counterbalance such loss and to keep
and uronic acids. These are more commonly known as
the concentration of 4 carbon units in the cell anaplerotic
glycosaminoglycans (GAG).
reactions are essential. This is known as anaplerotic role
• Acetylated amino groups, besides sulfate and carboxyl
of Krebs cycle. Anaplerotic reactions are influx reactions
groups are generally present in GAG structure.
which supply 4 carbon units to Krebs cycle.
• Some of the mucopolysaccharides are found in
combination with proteins to form mucoproteins or Energetics of Krebs Cycle
mucoids or proteoglycans. Mucoproteins may contain
During oxidation of acetyl-CoA via citric acid cycle, four
up to 95% carbohydrate and 5% protein.
reducing equivalents are produced. Oxidation of one
• Mucopolysaccharides are essential components of
NADH by electron transport chain is coupled with oxidative
tissue structure. The extracellular spaces of tissue
phosphorylation causes synthesis of 3 ATPs, while FADH2 leads
consist of collagen and elastin fibers embedded in a
to the formation of 2 ATPs. Above this, there is one substrate
matrix or ground substance. The ground substance is
level phosphorylation. So total of 12 ATPs are produced from
predominantly composed of GAG.
1 acetyl-CoA.
• The important mucopolysaccharides include hyalu-
ronic acid, chondroitin 4-sulfate, heparin, dermatan
Reactions Coenzyme ATP generated
sulfate and keratan sulfate.
♦♦ Hyaluronic acid consists of alternate units of D–glucuronic Isocitrate to alpha NADH 3
acid and N–acetyl-D–glucosamine. These molecules form ketoglutarate
disaccharide units which are held by β-glycosidic bond. Alpha-ketoglutarate to NADH 3
Hyaluronic acid is present in synovial fluid of joints and succinyl-CoA
vitreous humor of eyes. It also lubricates joints and act as
Succinyl-CoA to succinate GTP 1
shock absorber in joints.
♦♦ Chondroitin sulphate has repeating disaccharide Succinate to fumarate FADH2 2
units consists of D–glucuronic acid and N–acetyl-D– Malate to oxaloacetate NADH 3
galactosamine 4–sulfate.
♦♦ Heparin consists of alternating units of N–sulpho D– Total ATPs generated 12
glucosamine-6–sulphate and glucuronate 2–sulphate.
Heparin act as anti–coagulant. Q.18. Write about hormonal regulation of blood glucose.
♦♦ Dermatan sulfate occurs mainly in the skin.  (Sep 2015, 7 Marks)
Q.17. Explain in detail Krebs cycle and add a note on energetic Ans. In the hormonal regulation of blood glucose insulin
and significance. (Apr 2015, 8 Marks) decreases the blood glucose level, while the other
Ans. For Krebs cycle in detail refer to Ans 7 of same chapter. hormones oppose the action of glucose.

Maintainance of Blood Glucose in Fed State
Insulin
Normally, there is an increased blood glucose level shortly
after each meal, a postprandial hyperglycemia. Increased level
of circulating glucose releases insulin by b-cells of the lslets of
the Langerhans. This hormone reduces the blood glucose level
in a number of ways as follows:
♦♦ By stimulating the active transport of glucose across cell
membranes of muscle and adipose tissue by stimulating
GLUT-4 transporter but not the liver. Glucose is rapidly
taken up into liver as it is freely permeable to glucose via
GLUT-2 transporter.
♦♦ In the liver, insulin increases the use of glucose by glycolysis
by inducing the synthesis of key glycolytic enzymes, i.e.
glucokinase, phosphofructokinase, pyruvate kinase.
♦♦ Glucokinase is important in regulating blood glucose
after meal. Like hexokinase, glucokinase of the liver is not
inhibited by glucose-6-phosphate. Glucokinase increases
in activity whenever blood glucose concentration is higher
than normal levels and seems to be specifically concerned
with glucose uptake into the liver after a carbohydrate meal.
♦♦ In the muscle and liver, insulin stimulates glycogenesis
by stimulating glycogen synthase and thereby leading to
suppression of glycogenolysis.
♦♦ Insulin inhibits gluconeogenesis by suppressing the
action of key enzymes of gluconeogenesis, e.g. pyruvate
carboxylase, phosphoenolpyruvate carboxykinase,
fructose 1,6-bisphosphatase, glucose-6—phosphatase.
♦♦ In adipose tissue, glucose is converted to the glycerol
3—phosphate needed for the formation of triacylglycerol
(lipogenesis) and inhibits the lipolysis by inhibiting
hormone sensitive lipase.
♦♦ Insulin increases protein synthesis and decreases protein
catabolism, thereby decreases release of amino acids. All
these mechanisms are responsible for a drop in glucose
level (hypoglycemia).
Maintainance of Blood Glucose in Fasting State
Glucagon
Glucagon is the hormone produced by the α-cells of the Islets
of Langerhans of the pancreas. Glucagon opposes the actions
of insulin. It acts primarily in the liver as follows:
♦♦ In the liver, it stimulates glycogenolysis by activating
enzyme phosphorylase and inhibits glycogen synthesis.
♦♦ Unlike epinephrine, glucagon does not have an effect on
muscle phosphorylase due to lack of receptors.
♦♦ It exerts its effect on metabolic processes through
generation of cAMP.
♦♦ It enhances gluconeogenesis from amino acids and lactate
by inducing the action of key enzymes of gluconeogenesis.
Alanine is the predominant amino acid released from
muscle to liver by glucose alanine cycle. Lactate formed
by oxidation of glucose in skeletal muscle is transported
to the liver by lactic acid (Cori’s) cycle.
Biochemistry 455
Epinephrine or Adrenaline
♦♦ It is secreted by adrenal medulla. It stimulates glycogenolysis
in the liver and the muscle by stimulating phosphorylase
activity via cAMP.
♦♦ In muscle as a result of the absence of glucose-6–
phosphatase, glycogenolysis results with the formation of
lactate, whereas in the liver glucose is the main product
leading to increase in blood glucose.
Glucocorticoids
♦♦ These hormones are secreted by adrenal cortex which
causes increased gluconeogenesis, protein catabolism to
provide glucogenic amino acid for gluconeogenesis, activ-
ity of aminotransferase, hepatic uptake of amino acids for
gluconeogenesis, activity of enzymes of gluconeogenesis.
♦♦ It inhibit the utilization of glucose in extrahepatic tissues.
Thus, all the actions of glucocorticoids are antagonistic
to insulin.
Anterior Pituitary Hormones
♦♦ Growth hormone and ACTH antagonize the action of
insulin by elevating the blood glucose level.
♦♦ Growth hormone decreases glucose uptake in the muscle
and ACTH decreases glucose utilization by the tissue.
Thyroxine
♦♦ Thyroxine accelerates hepatic glycogenolysis with rise in
the blood glucose.
♦♦ It may also increases the rate of absorption of hexoses
from intestine.
Q.19. Explain in detail regulation of blood glucose. Add a
note on diabetes mellitus. (Apr 2015, 8 Marks)
Ans. For hormonal regulation of blood glucose in detail refer
to Ans 18 of same chapter.
Renal Control of Regulation of Blood Glucose
When blood glucose rises to relatively high levels, the kidney
also exerts a regulatory effect. Glucose is continuously filtered
by the glomeruli but is normally reabsorbed completely in renal
tubules. The capacity of the tubular system to reabsorb glucose
is limited to a rate of about 350 mg/min which is known as
tubular maximum for glucose (TmG). If the blood glucose level
is raised above 180 mg/100 mL, complete tubular reabsorption
of glucose does not occur and extra amount appears in the urine
causing glycosuria.
The 180 mg/100 mL is the limiting level of glucose in the
blood above which tubular reabsorption does not occur which is
known as renal threshold value for glucose. Thus, by excreting
extra amount of sugar in the urine during hyperglycemic state
and reabsorbing sugar during the hypoglycemic state, the
kidney helps in regulating the level of glucose in blood.
For diabetes mellitus in detail refer to Ans 11 of the same
chapter.
456 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.20. Describe various steps of TCA cycle, calculate number Number of

of ATPs synthesized. Give an account of various inhibi- ATP formed
tors of TCA cycle. (Feb 2016, 10 Marks) or consumed/
Ans. For various steps of TCA cycle and for calculation of glucose
Reactions Enzyme molecule
number of ATPs synthesized refer to Ans 7 of same
chapter. Glucose to glucose-6- Hexokinase, -1
phosphate glucokinase
Various inhibitors of TCA cycle Fructose 6–phosphate to Phosphofructokinase -1
fructose 1,6–bisphosphate –I
High ratio of ATP, acetyl-CoA and NADH will serve as signal
to inhibit the operation of cycle. Excess of ATP, acetyl-CoA Glyceraldehyde 3–phosphate Glyceraldehyde–3– +5*
to 1,3–bisphosphoglycerate phosphate
and NADH will occur when energy supply is sufficient for dehydrogenase
the cell.
1,3–bisphosphoglycerate to Phosphoglycerateki- +2
Following are the enzymes which are inhibited by above 3-phosphoglycerate nase
mentioned molecules which also lead to inhibition of TCA
Phosphoenolpyruvate to Pyruvate kinase +2
cycle. pyruvate
♦♦ Citrate synthetase is inhibited by ATP, NADH, acetyl-CoA
Total ATPs generated 12
and succinyl-CoA.
♦♦ Isocitrate dehydrogenase is inhibited by ATP and NADH. Net production of ATP in aerobic glycolysis = Number of ATP
♦♦ α–Ketoglutarate dehydrogenase is inhibited by ATP, produced minus number of ATPs consumed = 9–2 = 7
succinyl-CoA and NADH. It is assumed that NADH formed in glycolysis uses malate
shuttle to produce 5ATPs.
Q.21. Write briefly about glycosides. (Oct 2016, 2 Marks)
Total ATP per molecule of glucose under anaerobic glycolysis
Ans. Formation of glycosides occur when hemiacetal or
is 2.
hemiketal hydroxyl group of carbohydrates react with
hydroxyl group of another carbohydrate or a non– Regulation of Glycolysis
carbohydrate. The bond formed is known as glycosidic
Glycolysis is regulated at three steps which are irreversible.
bond and non–carbohydrate moiety is known as
These reactions are catalyzed by:
aglycone.
♦♦ Hexokinase and glucokinase
Monosaccharides are joined by glycosidic bonds to form ♦♦ Phosphofructokinase–I
disaccharides, oligosaccharides and polysaccharides. ♦♦ Pyruvate kinase
In disaccharides, the glycosidic linkage may be either α
or β which depends on configuration of an atom which
is attached to anomeric carbon of sugar.

Therapeutic Importance of Glycosides

♦♦ Glycosides are found in many drugs, e.g. in streptomycin
♦♦ Cardiac glycosides, i.e. digoxin and ouabain used in
treatment of congestive heart failure.
♦♦ Anthracycline glycosides, i.e. daunorubicin is used in
the treatment of leukemia and doxorubicin is used in the
treatment of cancers.
Q.22. Describe glycolysis with energetics and regulation.
 (Sep 2017, 10 Marks)
Or
Explain glycolysis with their energetic and regulation.
 (July 2016, 5 Marks)
Ans. For description of glycolysis refer to Ans 2 of same
chapter.

Energetics of Glycolysis
Under aerobic conditions, 7 molecules of ATP are produced as
per new concept, while in anerobic glycolysis only 2 molecules
of ATP are produced per mole of glucose. Fig. 6:  Regulation of glycolysis

Hexokinase and Glucokinase
♦♦ Inhibition of hexokinase is done by glucose-6–phosphate.
♦♦ Hexokinase prevents accumulation of glucose-6–
phosphate due to product inhibition.
♦♦ Glucokinase specifically phosphorylate glucose is an
inducible enzyme. Substrate glucose via involvement of
insulin induces glucokinase and its synthesis decrease in
response to glucagon.
Phosphofructokinase-I
♦♦ Phosphofructokinase-I is the regulatory enzyme in
glycolysis.
♦♦ This enzyme catalyses rate limiting committed step.
♦♦ It is an allosteric enzyme which is regulated by alloesteric
effectors.
♦♦ Phosphofructokinase-I is activated by AMP, fructose 6–
phosphate, fructose 2, 6–biphosphate and insulin.
♦♦ Phosphofructokinase-I is inhibited by ATP, citrate and
glucagon.
Pyruvate Kinase
♦♦ This enzyme is activated by fructose–1, 6–bisphosphate
feedforward stimulation and insulin.
♦♦ This enzyme is inhibited by ATP and glucagon.
Q.23. Mention the reference value of plasma glucose in fast-
ing and 2 hours postprandial state. List the hormones
released in fasting and fed state. Explain in detail blood
glucose maintenance in the fed state.
 (May 2017, 10 Marks)
Ans. Reference value of plasma glucose in fasting and 2 hours
postprandial state are as follows:
Reference value of plasma glucose in fasting is 70 to 100
mg/dL
Reference value of plasma glucose 2 hours postprandial
is 120 to 140 mg/dL.
Hormones Release in Fasting and Fed State
1. Hormones released in fasting state are:
• Glucagon
• Epinephrine or adrenaline
• Glucocorticoids
• Growth hormone and adrenocorticotropic hormone
(ACTH)
• Thyroxine
2. Hormones released in fed state is:
• Insulin
Blood Glucose Maintenance in the Fed State
In fed state blood glucose is maintained by insulin. Insulin
reduces blood glucose level in hyperglycemic condition.
Normally, there is an increased blood glucose level shortly
after each meal, a postprandial hyperglycemia. Increased level
of blood glucose releases insulin by β—cells of the Islet of the
Langerhans. This hormone reduces the blood glucose level in
a number of ways as follows:
Biochemistry 457
♦♦ By stimulating the active transport of glucose across cell
membranes of muscle and adipose tissue but not the
liver. Glucose is rapidly taken up into liver as it is freely
permeable to glucose.
♦♦ In the liver, insulin increases the use of glucose by
glycolysis by inducing the synthesis of key glycolytic
enzymes, i.e. glucokinase, phosphofructokinase, pyruvate
kinase.
♦♦ In the muscle and liver, insulin stimulates glycogenesis
by stimulating glycogen synthase and thereby leading to
suppression of glycogenolysis.
♦♦ Insulin inhibits gluconeogenesis by suppressing the
action of key enzymes of gluconeogenesis, e.g. pyruvate
carboxylase, phosphoenol pyruvate carboxykinase,
Fructose 1,6—bisphosphatase, glucose-6-phosphatase.
♦♦ In adipose tissue, glucose is converted to the glycerol
3-phosphate needed for the formation of triacylglycerol
(lipogenesis).
♦♦ Insulin increases protein synthesis and decreases protein
catabolism, thereby releasing amino acids. All these
mechanisms are responsible for a drop in blood glucose
level (hypoglycemia).
Fig. 7:  Role of insulin in regulation of blood glucose level
Q.24. Answer in brief reducing nature of sugars.
 (Sep 2017, 2 Marks)
Ans. Reducing property of sugar is attributed to free aldehyde
or keto group of anomeric carbon.
• On treatment with dilute aqueous alkalis, both
aldoses and ketoses change to enediols.
• Enediols are good reducing agents due to which they
form basis of benedict’s or Fehling’s test.
• So, alkali enolizes the sugar and causes them to be
strong reducing agents.
• Reducing effect is much more efficient in alkaline
medium as compared to acidic medium.
• In Benedict’s test enediol form of sugars reduces
cupric (Cu2+) ions of copper sulfate to cuprous
(Cu+) ions which form yellow precipitate of cuprous
hydroxide or red precipitate of cuprous oxide.
Q.25. Write about Krebs cycle and its importance.
 (Jan 2018, 5 Marks)
Ans. For Krebs cycle refer to Ans 7 in detail.
458 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Importance of Kreb Cycle

♦♦ Krebs cycle provides energy in the form of ATP.
♦♦ It is the final common pathway for the oxidation of
carbohydrates, lipids, and proteins as glucose, fatty acids
and many amino acids are all metabolized to acetyl-CoA
or intermediates of the cycle.
♦♦ It is an amphibolic process. It has a dual function; it
functions in both catabolism (of carbohydrates, fatty
acids and amino acids) and anabolism. Some metabolic
pathways end in the constituent of the krebs cycle,
while other pathways originate from the cycle, such as
gluconeogenesis, transamination, fatty acid synthesis and
heme synthesis.
♦♦ All major members of Krebs cycle from citrate to
oxaloacetate are glucogenic. They can give rise to glucose
by gluconeogenesis.
♦♦ Oxaloacetate and α-ketoglutarate, respectively serve as
precursors for the synthesis of aspartate and glutamate
by transamination which in turn is used for the
synthesis of other nonessential amino acids, purines
and pyrimidines.
♦♦ Mitochondrial citrate is transported to the cytosol, where
it is cleaved to provide acetyl-CoA for the biosynthesis of
fatty acids and steroids.
♦♦ Succinyl-CoA (intermediate of Krebs cycle) together with
glycine is used for the synthesis of heme.

Q.26. Write about Glycogenesis. (Jan 2018, 5 Marks)

 (Sep 2018, 5 Marks)
Ans. Glycogenesis is the pathway for the formation of
glycogen from glucose.
Glycogenesis needs energy from adenosine triphosphate
(ATP) and uridine triphosphate (UTP).
Glycogenesis occurs in both liver and muscle.

Reactions of Glycogenesis
Following are the steps of glycogenesis:
♦♦ Synthesis of uridine diphosphate glucose: Enzymes
hexokinase present in muscle and enzyme glucokinase
present in liver convert glucose to glucose-6–phosphate.
Enzyme phosphoglucomutase catalyses conversion of
glucose-6–phosphate to glucose-1–phosphate. Uridine
diphosphate glucose is synthesized from glucose
1–phosphate and uridine triphosphate by uridine
diphosphate–glucose pyrophosphorylase.
♦♦ Primer required to initiate glycogenesis: Small fragment
of pre–existing glycogen act as primer which initiate
glycogen synthesis.
♦♦ Synthesis of glycogen by glycogen synthase: Glycogen
synthase causes formation of 1,4–glycosidic linkages.
This enzyme lead to transfer of glucose from uridine
diphosphate glucose to nonreducing end of glycogen to
form α–1, 4 linkages.
Fig. 8:  Glycogenesis

♦♦ Formation of branches in glycogen: Formation of
branches is due to action of branching enzyme, i.e. glucosyl
α–4–6 transferase. This enzyme causes transfer of small
fragment of 5 to 8 glucose residues from nonreducing
end of glycogen chain to another glucose residue where
it is linked by α–1, 6 bond. Now this leads to formation of
a new nonreducing end, beside the existing one. Further
elongation and branching of glycogen occur by enzyme
glycogen synthetase and glucosyl 4–6 transferase.
So, final reaction of glycogen synthesis for addition of each
glucose residue is:
(Glucose)n + Glucose + 2 ATP → (Glucose)n + 1 + 2 ADP + Pi
The two ATPs which are utilized, out of these one is
needed for phosphorylation of glucose and other is needed for
conversion of uridine diphosphate to uridine triphosphate.
Q.27. Write very short answer on epimers. (Apr 2018, 2 Marks)
Ans. When two monosaccharides differ from each other in
their configuration around a single specific carbon atom,
they are referred to as epimer to each other.
For example, glucose and galactose are epimers with
regard to carbon 4, i.e. they differ in arrangement of - OH
group at 4th carbon.
Another example is glucose and mannose is epimers
with regard to 2nd carbon.
Q.28. Write very short answer on anomers.
 (Aug 2018, 2 Marks)
Ans. α and β cyclic forms of D-glucose are known as anomers.
The predominant form of glucose and fructose in a
solution are not an open chain. Rather, the open chain
D-Glucose
(open chain formula or
fisher projection
(<0–1% in solution)
Fig. 9: Formation of α and β anomers
Biochemistry 459
form of this sugar in solution cyclize into rings. An
additional asymmetric center is created when glucose
cyclizes.
Carbon–l of glucose in the open chain form becomes
an asymmetric carbon in the ring form and two ring
structures can be formed. These are:
• α –D – glucose
• β – D – glucose
The designation α means that the hydroxyl group attached to
C l is below the plane of the ring, β means that it is above the
plane of the ring. The C l carbon is called the anomeric carbon
atom and so, α and β forms are anomers.
Q.29. Write very short answer on optical activity.
 (Aug 2018, 2 Marks)
Ans. Ordinary light propagates in all the directions. But as
ordinary light is passed via Nicol prism, the plane of
polarized light vibrates in single direction only. This is
optical activity.
• Various organic compounds such or optical
isomers which undergo optical activity rotate
plane of polarized light either to the left or to
the right side.
• Levorotatory is the term which is given to the sub-
stances which rotate plane of polarized light to left.
• Dextrorotatory is the term given to the substances
which rotate plane of polarized light to right.
• Racemic mixture is the term given to equal concen-
tration of both levo and dextroforms which cannot
rotate the plane of polarized light.
Fig. 10: Optical activity
460 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

2. AMINO ACIDS AND PROTEINS: CHEMISTRY, METABOLISM AND REGULATION

Q.1. Classify amino acids on structural basis. Describe urea ornithine cycle in detail. (Nov 2009, 8 Marks)
Ans. Classification of Amino Acids on Basis of Structure

Name Symbol Structure Special group present

3 letters 1 letter
I. Amino Acids with Aliphatic Side Chains
1. Glycine Gly G

2. Alanine Ala A

3. Valine Val V Branched chain

4. Leucine Leu L Branched chain

5. Isoleucine lle I Branched chain

II. Amino Acids Containing Hydroxyl (—OH) Groups

6. Serine Ser S Hydroxyl

7. Threonine Thr T Hydroxyl

Tyrosine Tyr Y See under aromatic Hydroxyl

III. Sulfur Containing Amino Acids

8. Cysteine Cys C Sulfhydryl

Cystine — — Disulfide

Contd…
 Biochemistry 461

Contd…

Name Symbol Structure Special group present

3 letters 1 letter
9. Methionine Met M Thioether

IV. Acidic Amino Acids and their Amides

10. Aspartic acid Asp D β-carboxyl

11. Asparagine Asn N Amide

12. Glutamic acid Glu E γ-carboxyl

13. Glutamine Gin Q Amide

V. Basic Amino Acids

14. Lysine Lys K ε-Amino

15. Arginine Arg R Guanidino

16. Histidine His H Imidazole

VI. Aromatic Amino Acids

17. Phenylalanine Phe F Benzene or phenyl

18. Tyrosine Tyr Y Phenol

19. Tryplophan Trp W Indole

Contd…
462 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd…

Name Symbol Structure Special group present

3 letters 1 letter
VII. Imino Acid
20. Proline Pro P Pyrrolidine

Urea-Ornithine Cycle 5. Formation of urea and ornithine: In the last reaction

♦♦ Also known as urea cycle or ornithine cycle or Krebs- of urea cycle the liver hydrolytic enzyme arginase,
Henseleit cycle cleaves arginine to yield urea and ornithine.
♦♦ Urea is the end product of amino acid or protein metabolism. Ornithine is thus regenerated and can enter
♦♦ Nitrogen of amino acids gets converted to ammonia is toxic mitochondria again to initiate another round of the
to body. Ammonia gets converted to urea and get detoxified. urea cycle. The urea thus formed is excreted in the
♦♦ Urea is mainly synthesized in liver and transported to urine.
kidneys for excretion in urine.
♦♦ Urea synthesis is a five-step cyclic process with five
distinct enzymes. The first two enzymes are present in
mitochondria while the rest are localized in cytosol.
The sequence of reactions involved in biosynthesis of urea
is as follows:
1. Formation of carbamoyl phosphate: The biosynthesis
of urea begins with the condensation of carbon
dioxide, ammonia and ATP to form carbamoyl
phosphate, a reaction catalyzed by mitochondrial
carbamoyl phosphate synthetase-I (CPS-I). Formation
of carbamoyl phosphate requires two molecules of
ATP. One ATP serves as a source of phosphate and
second ATP is converted to AMP and PPi.
2. Formation of citrulline: Carbamoyl phosphate
donates its carbamoyl group to ornithine to form
citrulline and release phosphate in a reaction
catalyzed by ornithine transcarbamylase, a Mg2+
requiring mitochondrial enzyme. The citrulline so
formed now leaves the mitochondria and passes into
the cytosol of the liver cell.
3. Formation of argininosuccinate: The transfer of the
second amino group (from aspartate) to citrulline
occurs by a condensation reaction between the
amino group of aspartate and citrulline in the Fig. 11:  Urea cycle
presence of ATP to form argininosuccinate. This
reaction is catalyzed by argininosuccinate synthetase Energy Cost of Urea Cycle
of the liver cytosol, a Mg2+ dependent enzyme.
Four ATPs are consumed in the synthesis of each molecule of
4. Formation of arginine and fumarate: Argininosuc-
urea as follows:
cinate is cleaved by argininosuccinate lyase (arginine
succinase) to form free arginine and fumarate. The ♦♦ Two ATP are needed to make carbamoyl phosphate.
fumarate so formed returns to the pool of citric acid • One ATP serves as a source of phosphate A.
cycle intermediates. Though fumarate urea cycle is • Second ATP is converted to AMP + PPi.
linked with the citric acid cycle, the two Krebs cycles ♦♦ One ATP is required to make arginosuccinate.
together have been referred to as the Krebs bicycle. ♦♦ One ATP is required to restore AMP to ATP.
 Biochemistry 463

Significance or Importance of Urea Cycle ♦♦ Aspartic acid

♦♦ The toxic ammonia is converted into the harmless nontoxic ♦♦ Glutamic acid.
urea. Basic Amino Acid
♦♦ It disposes off two waste products, ammonia and carbon
dioxide. These are basic in solution and are diamino—monocarboxylic
♦♦ It forms semi-essential amino acid, arginine. acids, e.g.
♦♦ It participates in the regulation of blood pH which depends ♦♦ Lysine
upon the ratio of dissolved carbon dioxide, i.e. H2CO3 to ♦♦ Arginine
HCO3–. ♦♦ Histidine
Regulation of Urea Cycle Classification Based on Chemical Structure of Side
♦♦ Carbamoyl phosphate synthetase I is an allosteric regulatory Chain of Amino Acid
enzyme of urea cycle which is allosterically activated by According to this type of classification, amino acids are classified
N-acetylglutamate (NAG). NAG is synthesized from as:
acetyl—CoA and glutamate by NAG-synthase to activate 1. Aliphatic amino acids
CPS I. It has no other function.
2. Hydroxy amino acids
♦♦ The synthesis of NAG increases after intake of protein rich
3. Sulfur containing amino acids
diet, by argenine and during starvation, which ultimately
4. Dicarboxylic acid and their amides
increases formation of urea.
5. Diamino acids
Q.2. Describe classification and properties of amino acids 6. Aromatic amino acids
in brief. (Mar 2007, 4 Marks) 7. Imino acids or heterocyclic amino acids.
Or
Aliphatic Amino Acids
Write a short note on classification of amino acids.
 (Feb 2013, 7 Marks) Amino acids having aliphatic side chain, e.g.
Ans. Classification of Amino Acids ♦♦ Glycine
Amino acids are classified into five types on the basis of: ♦♦ Alanine
l. Chemical nature of the amino acid in the solution ♦♦ Valine
2. Structure of the side chain of the amino acids ♦♦ Leucine
3. Nutritional requirement of amino acids ♦♦ Isoleucine.
4. Metabolic product of amino acids
Hydroxy Amino Acids
5. Nature or polarity of the side chain of the amino acids.
Following is the classification of amino acids in detail: Amino acids having hydroxy group in the side chain, e. g.
♦♦ Threonine
Chemical Nature of Amino Acid in Solution
♦♦ Serine
According to this type of classification, amino acids are classified ♦♦ Tyrosine.
as follows:
♦♦ Neutral amino acids Sulfur Containing Amino Acids
♦♦ Acidic amino acids Amino acids having sulfur in the side chain, e.g.
♦♦ Basic amino acids. ♦♦ Cysteine
Neutral Amino Acids ♦♦ Methionine.

The amino acids which are neutral in solution are monoamino— Dicarboxylic Acid and their Amides
monocarboxylic acids (i.e. having one amino group and one
Amino acids having carboxylic group in their side chain, e.g.
carboxylic group), e.g. are:
♦♦ Glutamic acid
♦♦ Glycine ♦♦ Serine ♦♦ Phenylalanine ♦♦ Glutamine (amide of glutamic acid)
♦♦ Alanine ♦♦ Threonine ♦♦ Tyrosine ♦♦ Aspartic acid
♦♦ Valine ♦♦ Cysteine ♦♦ Tryptophan ♦♦ Aspargine (amide of aspartic acid).
♦♦ Leucine ♦♦ Methionine ♦♦ Aspargine
Diamino Acids
♦♦ Isoleucine ♦♦ Proline ♦♦ Glutamine
Amino acids having amino group (-NH2) in the side chain, e. g.
Acidic Amino Acid
♦♦ Lysine
These are acidic in solution and are monoamino dicarboxylic ♦♦ Arginine
acids, e. g. ♦♦ Histidine.
464 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Aromatic Amino Acids A deficiency of an essential amino acid impairs protein

synthesis and leads to a negative nitrogen balance (nitrogen
Amino acids containing aromatic ring in the side chain, e.g.
excretion exceeds nitrogen intake).
♦♦ Phenylalanine
♦♦ Tyrosine Nonessential Amino Acids
♦♦ Tryptophan.
Nonessential amino acids can be synthesized in human body
Imino Acids or Heterocyclic Amino Acids and are not required in diet, e.g.
One of the 20 amino acids, proline is an imino (—NH) acid not ♦♦ Glycine ♦♦ Alanine
an amino (-NH2) acid as are other 19. The side chains of proline ♦♦ Proline ♦♦ Tyrosine
and its α—amino group form a ring structure and thus proline ♦♦ Serine ♦♦ Cysteine
differs from other amino acids, in that it contains an imino ♦♦ Glutamic acid ♦♦ Aspartic acid
group, rather than an amino group. ♦♦ Glutamine ♦♦ Aspargine
Nutritional Classification of Amino Acids Metabolic Classification of Amino Acids
On the basis of nutritional requirement, amino acids are On the basis of their catabolic end products, the twenty standard
classified into two groups: amino acids are divided in three groups:
1. Essential or indispensable amino acids 1. Glucogenic amino acids: Those which can be converted
2. Nonessential or dispensable amino acids. into glucose. Fourteen out of the twenty standard amino
acids are glucogenic amino acids, e.g. glycine, alanine,
Essential Amino Acids serine, cysteine, aspartic acid, aspargine, glutamic acid,
Essential amino acids cannot be synthesized by the body and glutamine, proline, histidine, argentine, methionine,
must, therefore, be essentially supplied through the diet. Ten threonine, valine.
amino acids essential for humans include: 2. Ketogenic amino acids: Those which can be converted to
ketone bodies. Two amino acids—leucine and lysine are
♦♦ Phenylalanine ♦♦ Methionine exclusively ketogenic.
♦♦ Valine ♦♦ Histidine 3. Both glucogenic and ketogenic: Those which can be
♦♦ Threonine ♦♦ Arginine converted to both glucose and ketone bodies. Four amino
♦♦ Tryptophan ♦♦ Lysine acids—isoleucine, phenylalanine, tryptophan and tyrosine
♦♦ Isoleucine ♦♦ Leucine are glucogenic and ketogenic.

Among the ten essential amino acids; arginine and histidine
are known as semi—essential amino acids since these amino
acids are synthesized partially in human body and inadequate
to support growth of children.
Arginine and histidine become essential in diet during
periods of rapid growth as in childhood and pregnancy.
Classification Based on Nature or Polarity of Side Chain
of Amino Acid
According to this type of classification, amino acids are classified
into two major classes:
1. Hydrophilic or polar amino acids
2. Hydrophobic or nonpolar amino acids.

Properties of Amino Acids
Physical Properties
♦♦ Solubility: Mostly the amino acids are soluble in water
and insoluble in organic solvents.
♦♦ Melting point: Amino acids usually melt at high
temperatures mostly above 200°C.
♦♦ Taste: Amino acids can be sweet, tasteless or bitter.
♦♦ Optical properties: All amino acids except glycine posses
optical isomers because of presence of asymmetric α
carbon atoms.
♦♦ Amino acids as ampholytics: Amino acids consists of
both acidic, i.e. COOH and basic, i.e. NH2 groups. These
can donate or accept a proton, so amino acids are known
as ampholytes.
♦♦ Zwitter ion or dipolar ion: Zwitter ion is a hybrid molecule
which consists of positive and negative ionic groups.
Amino acids rarely exist in its neutral form with free
carboxylic and free amino groups. At strong acidic pH,
amino acid is positively charged but in strong alkaline
pH it is negatively charged. Each amino acid consists of
characteristic pH at which it carry both the positive and
negative charges and exist as Zwitter ion.
♦♦ Isoelectric pH is the pH at which the molecule exists as
zwitter ion and carries no net charge. So the molecule is
electrically neutral.
Chemical Properties
General reaction of amino acid occur mostly due to presence
of two functional groups, i.e. carboxyl (-COOH) and amine
(-NH2) group.
Reactions Because of –COOH Group
♦♦ Amino acids lead to the formation of salt along with bases
and esters with alcohol.
♦♦ Amino acids lead to decarboxylation and produce
corresponding amines.
♦♦ Carboxyl group of dicarboxylic amino acids react with
ammonia to form amide.
Reactions Because of –NH2 Group
♦♦ Amino groups act as base and combine with the acids to
form salt.
♦♦ α-amino acids react with ninhydrin and form purple, blue
or pink color complex. This reaction is used in quantitative
determination of amino acids.
Transamination
It is the transfer of amino group from an amino acid to keto
acid to form new amino acid which is an important reaction in
an amino acid metabolism.
Oxidative Deamination
Amino acids undergo oxidative deamination for liberation of
free ammonia.
Biochemistry 465
Q.3. What is transdeamination? Explain disposal of am-
monia from body. (Dec 2010, 8 Marks)
Ans. Transdeamination
• A mino group of most of the amino acids is re-
leased by a coupled reaction, transdeamination, i.e.
transamination followed by oxidative deamination.
• Transamination takes place in all the cells of the
body; the amino group is transported to liver as glu-
tamic acid which is finally oxidatively deaminated
in liver.
• Thus the two components of the reaction are physi-
cally, far away, but physiologically they are coupled.
Hence they term as transdeamination.
Disposal of Ammonia
♦♦ First line of defense (trapping of ammonia): Being highly
toxic, ammonia should be eliminated or detoxified, as and
when it is formed. Even very minute quantity of ammonia
may produce toxicity in central nervous system. The
intracellular ammonia is immediately trapped by glutamic
acid to form glutamine, especially in brain cells. The
glutamine is then transported to liver where the reaction is
reversed by the enzyme glutaminase. The ammonia thus
generated is immediately detoxified into urea.
♦♦ Transportation of ammonia: The final deamination and
production of ammonia is taking place in the liver. Thus
glutamic acid may be considered as the major transport form
of ammonia from the tissues to the liver. Glutamine and
asparagine are the transport forms of ammonia from brain.
♦♦ Final disposal: The ammonia from all over the body thus
reaches liver. It is then detoxified to urea by liver cells, and
then excreted through kidneys. Urea is the end product
of protein metabolism. Since mammals including human
beings excrete amino nitrogen mainly as urea, they are
referred to as ureotelic. Fishes excrete as ammonia, while
birds and reptiles as uric acid.
Q.4. Describe oxidative deamination of amino acids.
Describe the route for disposal of ammonia from body.
 (Nov 2012, 8 Marks)
Ans. Oxidative Deamination of Amino Acids
Oxidative deamination is the liberation of free ammonia
from the amino group of amino acids coupled with
oxidation. This takes place mostly in liver and kidney.
The purpose of oxidative deamination is to provide
NH3 for urea synthesis and α-keto acids for a variety of
reactions, including energy generation.
Role of Glutamate Dehydrogenase
In the process of transamination, the amino groups of most
amino acids are transferred to α-ketoglutarate to produce
glutamate. Thus, glutamate serves as a collection center for
amino groups in the biological system. Glutamate rapidly
undergoes oxidative deamination, catalyzed by glutamate
dehydrogenase (GDH) to liberate ammonia. This enzyme
is unique in that it can utilize either NAD+ or NADP+ as a
466 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

coenzyme. Conversion of glutamate to α-ketoglutarate occurs Role of Amino Acids

through the formation of an intermediate, α-iminoglutarate. ♦♦ The amino acids in the form of protein perform structural,
For disposal of ammonia refer to Ans 3 of same chapter. hormonal and catalytic functions.
Q.5. Describe urea cycle and write its disorder. ♦♦ The essential amino acids support infant growth or
 (Jan 2012, 8 Marks) maintain health in adult.
♦♦ Severe illness is caused by the genetic defects in the meta­
Ans. For urea cycle refer to Ans 1 of same chapter.
bolism of amino acids.
Disorders of Urea Cycle ♦♦ Some peptides act in the nervous system as neurotransmitter
and neuromodulators.
Diseases Enzyme deficit Features ♦♦ L-amino acid participate in nerve transmission and cell
Hyperammonemia Carbamoyl High NH3 levels growth.
Type I phosphate in blood, mental ♦♦ Amino acids are involved in endocrinology. Many
synthetase-I retardation principal hormones are amino acids.
Hyperammonemia Ornithine High level of ♦♦ Certain antibodies are peptides.
Type II transcarbamylase ammonia level in Q.7. Write about inborn errors of amino acid metabolism.
blood. Glutamine is  (Feb 2013, 5 Marks)
increased in blood,
Ans. Inborn Errors of Amino Acid Metabolism
urine and CSF
Following are the inborn errors of amino acid metabolism:
Hyperornithinemia Defective in the Elevated blood level
ornithine transporter of ammonia and
I. Defect in urea synthesis:
protein ornithinine. Urea 1. Hyperammonemia Type I and Type II: These are the
decrease in blood conditions where there is increase in blood amm­
onia leading to toxicity. The hyperammonia type
Citrullinemia Argininosuccinate It is autosomal
synthetase recessive. High blood I is cause due to deficiency in enzyme carba­moyl
levels of ammonia phosphate synthetase I. The hyperammonia type
and citrulline II is cause due to deficiency in enzyme ornithine
Argininosuccininc Argininosuccinate Arginosuccinate in
transcarbamylase.
aciduria lyase blood and urine. 2. Citrullinemia: This is caused due to deficiency
Frabile brittle tufted in enzyme argininosuccinate synthetase. High
hair are present blood levels of ammonia and citrulline are seen.
Hyperargininemia Arginase Levels of arginine get 3. Argininosuccinic aciduria: Caused due to defi-
increased in blood ciency in enzyme arginosuccinate lyase. Patient
and CSF. Instead of has friable brittle tufted hair.
arginine, cysteine and 4. Hyperargininemia: Caused due to deficiency in
lysine get lost in urine enzyme arginase.
II. Disorder of phenylalanine and tyrosine:
Q.6. Write a short note on essential amino acids. 1. Phenylketonuria: Caused due to deficiency of
 (Apr 2010, 5 Marks) (Jan 2012, 3 Marks) phenylalanine hydroxylase. It causes the accu-
 (June 2010, 2.5 Marks) mulation of phenylalanine in tissues and blood
Ans. Amino Acids and results in increase excretion of urine.
• Structural unit of protein. 2. Tyrosinemia type II: Caused due to deficiency of
tyrosine transaminase. This results in blockage
• Monomer or building block of protein.
of degradative pathway of tyrosine.
Essential Amino Acids 3. Alkaptonuria: Caused due to deficiency in en-
zyme homogentisate oxidase. Homogentiate
An “essential” or “indispensable” amino acid is defined as one
accumulate in tissues and blood and excreted
which cannot be synthesized by the organism from substances
in urine. The urine excreted has coke color.
ordinarily present in the diet.
4. Tyrosinosis: Caused due to deficiency of enzyme
In case of humans, nine essential amino acids are required fumary­l acetoacetate hydroxylase or maley­
for the optimal growth of the young and for the maintenance lacetoacetate isomerase. It causes liver failure,
of nitrogen equilibrium in the adult. rickets, renal tubular dysfunction, etc.
These nine essential amino acids are: Histine, methionine, 5. Albinism: Caused due to deficiency of tyrosinase
tryptophane, valine, phenylalanine, leucine, isoleucine, which is responsible for synthesis of melanin.
threonine and lysine, two amino acids, arginine and histidine III. Disorder of sulfur amino acids:
which are required for animals are “nutritionally semi-essential” 1. Cystinuria: In this carrier system get defective lead-
for humans because they may be synthesized in tissue at rates ing to the excretion of cystine, ornithine, arginine
inadequate to support the growth of children. and lysine. There is defect in renal reabsorption.

2. Cystinosis: In this there is impairment of cystine
utilization. Defect in lysosomal function is pri-
mary cause. Impairment of renal function is seen.
3. Homocystinuria: Caused due to defect in enzyme
cystathionine synthetase. It leads to thrombosis,
osteoporosis and mental retardation.
IV. Disorders of Glycine:
1. Glycinuria: Leads to defect in renal reabsorption.
2. Primary hyperoxaluria: Occurs due to deficiency
of glycine transaminase.
V. Disorders of Tryptophan:
1. Hartnup’s disease: Leads to defective intestinal
absorption.
VI. Disorders of Branched Chain amino acids:
1. Maple syrup urine disease: Caused due to defi-
ciency of enzyme branched chain α-keto acid
dehy­drogenase. The urine of affected individual
smells like maple urine.
2. Hypervalinemia: Caused due to deficiency of
enzyme valine transminase.
VII. Disorders of histidine:
1. Histidinemia: It is caused due to deficiency of
enzyme histidase.
VIII. Disorders of Proline:
1. Hyperprolinemia type I: It caused due to deficieny
of proline oxidase.
Q.8. Describe in brief urea cycle. (Sep 2007, 4 Marks)
 (Jan 2012, 4 Marks) (Aug 2011, 5 Marks)
Or
Write about urea synthesis in body. (Feb 2013, 5 Marks)
Or
Give short account of urea cycle. (Sep 2013, 5 Marks)
Or
Write on urea cycle and its importance.
 (Apr 2017, 5 Marks)
Or
Write a short note on urea cycle. (Oct 2016, 5 Marks)
 (Sep 2017, 5 Marks) (Aug 2016, 3 Marks)
Or
Describe urea cycle. (July 2016, 5 Marks)
Ans. Refer to Ans 1 of same chapter.
Q.9. Describe fate of amino acids in the body deamination,
transamination, transdeamination, decarboxylation,
transmethylation. (Oct 2014, 8 Marks)
Ans. Transamination
• Transamination is the transfer of an amino group
from an amino acid to a keto acid.
• Transaminases are the group of enzymes which
catalyzes the reaction.
• In transamination, there is exchange of one a-amino
group between one a-amino acid and another a-keto
acid and forming new a-amino acid.
Biochemistry 467
• Transamination is a reversible process.
• It undergoes both catabolism and anabolism of
amino acids.
• It is responsible for synthesis of non-essential amino
acids.
• It moves all amino acids towards the generation of
energy.
• Amino acids undergo transamination to finally
concentrate nitrogen in glutamate.
Transdeamination
♦♦ The amino group of most of the amino acids is released by
a coupled reaction, transdeamination, i.e. transamination
followed by oxidative deamination.
♦♦ Transamination takes place in all the cells of the body; the
amino group is transported to liver as glutamic acid which
is finally oxidatively deaminated in liver.
♦♦ Thus the two components of the reaction are physically far
away, but physiologically they are coupled. Hence, they
term as transdeamination.
Deamination
♦♦ Deamination is the removal of ammonia group from
amino acids.
♦♦ It causes the liberation of ammonia for urea synthesis.
♦♦ Deamination can be oxidative and nonoxidative.
Oxidative Deamination
♦♦ In oxidative deamination, there is liberation of free
ammonia from amino group of amino acids and it is
coupled with the oxidation.
♦♦ It occur in liver and kidney.
♦♦ It provides ammonia for synthesis of urea and α-ketoacids
for variety of reactions including generation of energy.
♦♦ Glutamate undergoes oxidative deamination which
is catalysed by glutamate dehydrogenase to liberate
ammonia. Enzyme glutamate dehydrogenase utilizes
either NAD+ or NADP+ as a coenzyme.
Nonoxidative Deamination
♦♦ Some amino acids are deaminated to liberate ammonia
without undergoing oxidation.
♦♦ Serine, threonine and homoserine undergo non-oxidative
deamination which is catalysed by PLP-dependent
dehydrases.
♦♦ Enzyme histidase act on histidine to liberate ammonia by
a nonoxidative deamination process.
Transmethylation
♦♦ Transfer of methyl group from active methionine to an
acceptor is known as transmethylation.
♦♦ Methionine has to be activated to S-adinosylmethionine
or active methionine to donate methyl group.
♦♦ Transmethylation is of great biological significance as
many compounds get functionally active after methylation.
468 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Decarboxylation one common product L—glutamate. This is important

because glutamate is the only amino acid whose α-amino
Decarboxylation of amino acids result in the formation of
group can be directly removed at a high rate by oxidative
amines. For example, serine is an amino acid which form
deamination.
ethanolamide on decarboxylation which is an amine.
♦♦ Since transamination reactions are readily reversible, this
Q.10. Write a short note on structure and properties of amino permits transaminases to function both in amino acid
acids. (Apr 2008, 5 Marks) catabolism and biosynthesis. L-glutamate produced by
Ans. transamination can be used as an amino group donor in
the synthesis of nonessential amino acids.
Structure of Amino Acids
♦♦ Serum levels of some of transaminases get elevated in
There are approximately 300 amino acids present in various some disease state and measurement of these are helpful
animal, plant and microbial systems, but only 20 amino acids in medical diagnosis, e.g. ALT and AST are important in
are involved in the formulation of proteins. diagnosis of liver and heart damage.
♦♦ All the 20 amino acids found in proteins have a carboxyl
Q.12. Write a short note on structural organization of protein.
group (-COOH) and an amino acid group (—NH2) bound
 (Oct 2014, 3 Marks)
to the same carbon atom called α—carbon.
Ans. Structural organization of proteins is divided in four
♦♦ Amino acids differ from each other in their side chains or
levels of organization, i.e.
R-groups attached to the α-carbon.
♦♦ The 20 amino acids of proteins are often referred to as the 1. Primary structure
standard or primary or normal amino acids. 2. Secondary structure
♦♦ The standard amino acids have been assigned three letters 3. Tertiary structure
abbreviations and one letter symbol, e.g. amino acid 4. Quaternary structure.
glycine has abbreviated name Gly and symbol letter G. Primary Structure
♦♦ All the amino acids found in proteins are exclusively of
L—configuration. ♦♦ Primary structure denotes the number and sequence of
For properties of amino acid refer to Ans 2 of same chapter. amino acids in the protein.
♦♦ It is maintained by covalent bonds of peptide linkages.
Q.11. Write a short note on transamination.
 (Apr 2015, 3 Marks) ♦♦ Primary structure of protein is responsible for its function.
Or
Write briefly about transamination. (Oct 2016, 2 Marks)
Or
Answer in brief about transamination and its signifi-
cance. (Sep 2017, 2 Marks)
Ans. Transamination is the transfer of an amino group from
an amino acid to a keto acid.
• Transaminases are the group of enzymes which Fig. 12:  Primary structure
catalyzes the reaction.
• In transamination there is exchange of one a-amino Secondary Structure
group between one a-amino acid and another a-keto
acid and forming new a-amino acid. ♦♦ Secondary structure is the steric relationship of amino
• It is a reversible process. acids close to each other.
• It undergoes both catabolism and anabolism of ♦♦ There are two types of secondary structures, i.e α-helix
amino acids. and β-pleated sheet.
• It is responsible for synthesis of non-essential amino
acids.
• It moves all amino acids towards the generation of
energy.
• Amino acids undergo transamination to finally
concentrate nitrogen in glutamate.
All amino acids except lysine, threonine, proline and
hydroxy protine participate in transamination.

Significance of Transamination
♦♦ This reaction provides a mechanism for collecting the
amino groups from many different amino acids into Fig. 13:  Secondary structure
 Biochemistry 469

♦♦ α-helix is the spiral structure of protein and it has rigid Q.13. Write about biological importance of proteins.
arrangement of polypeptide chain.  (Feb 2013, 5 Marks)
♦♦ β-pleated sheet are composed of two or more segments Ans.
of fully extendable peptide chains. In β-pleated sheet,
the hydrogen bonds are formed between the neighboring Biological Importance of Proteins
segments of polypeptide chains. ♦♦ Proteins are the essence of life processes.
♦♦ They are the fundamental constituents of all protoplasm
Tertiary Structure
and are involved in the structure of living cell and in its
♦♦ Three dimensional arrangement of protein structure is function.
referred to as tertiary structure. ♦♦ Enzymes are made up of proteins.
♦♦ Tertiary structure is the compact structure with hydrophobic ♦♦ Many of the hormones are proteins.
side chains held interior, while the hydrophilic groups are ♦♦ The cement substances and the reticulum which bind or hold
on the surface of protein molecule. the cells as tissues or organs are made up partly of proteins.
♦♦ Hydrogen bonds, disulphide bonds, ionic interactions ♦♦ They execute their activities in the transport of oxygen
and hydrophobic interactions also contribute to tertiary and carbon dioxide by hemoglobin and special enzymes
structure of proteins. in the red cells.
♦♦ They function in the homeostatic control of the volume
of the circulating blood and that of the interstitial fluids
through the plasma proteins.
♦♦ They are involved in blood clotting through thrombin,
fibrinogen and other protein factors.
♦♦ They act as the defence against infections by means of
protein antibodies.
♦♦ They perform hereditary transmission by nucleoproteins
of the cell nucleus.
Q.14. Name the specialized products synthesized by tyrosine.
Fig. 14:  Tertiary structure
 (Aug 2016, 2 Marks)
Ans. Following are the specialized products synthesized by
tyrosine:
Quaternary Structure
• Catecholamines
♦♦ It results when the protein consisting of two or more – Dopamine
polypeptide chains are held together by noncovalent – Norepinephrine
forces. – Epinephrine
♦♦ Some of the proteins consist of two or more polypeptides • Melanin pigment
which are identical or unrelated. These are known as • Thyroxine
oligomers and possess quaternary structure.
♦♦ Individual polypeptide chains are known as monomers,
protomers or subunits.
♦♦ A dimer consists of two polypeptides, while a tetramer
has four polypeptides.
♦♦ Oligomer proteins play an important role in the regulation
of metabolism and cellular function.

Fig. 16:  Products synthesized by tyrosine

Q.15. Write a short note on tyrosine and its metabolism.

 (Sep 2017, 5 Marks)
Ans. Tyrosine is an aromatic amino acid. It is also classified
Fig. 15:  Quaternary structure under nonessential amino acid.
470 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Basically phenylalanine is converted to tyrosine.
Phenylalanine gets hydroxylated at para position by
phenylalanine hydroxylase to produce tyrosine in
the presence of coenzyme biopterin. Active form of
biopterin is tetrahydrobiopterin. In phenylalanine
hydroxylase reaction tetrahydrobiopterin is oxidized to
dihydrobiopterin reductase.
Tyrosine is incorporated into proteins and is involved in
synthesis of variety of biologically important compounds,
i.e. epinephrine, norepinephrine, dopamine, thyroid
hormones and melanin pigment.
Metabolism of Tyrosine
Phenylalanine metabolism is initiated by its oxidation to
tyrosine which then undergoes oxidative degradation. Thus,
catabolic pathway for phenylalanine and tyrosine is same as
follows:
♦♦ The first step is the hydroxylation of phenylalanine
to tyrosine, a reaction catalyzed by phenylalanine
hydroxylase. This enzyme requires tetrahydrobiopterin
(H4-biopterin) as a cofactor. The cofactor is oxidized to
dihydrobiopterin (H2-biopterin) during this reaction.
Fig. 17:  Tyrosine metabolism
The dihydrobiopterin produced is reduced back to H4-
biopterin by dihydrobiopterin reductase.
♦♦ The next step is transamination of tyrosine with α–
ketoglutarate to P–hydroxyphenyl pyruvate, catalyzed by
tyrosine transaminase.
♦♦ P-hydroxyphenylpyruvate then reacts with O2 to form
homogentisate. This reaction is catalyzed by P-hydroxy—
phenylpyruvate hydroxylase is called as dioxygenase
because both atoms of oxygen become incorporated into
product.
♦♦ Homogentisate is then cleaved by oxygen to yield
4—maleylacetoacetate. This reaction is catalyzed by
homogentisate oxidase.
♦♦ 4—maleylcetoacetate is then isomerized to 4-fumarylace-
toacetate, by an enzyme maleylacetoacetate isomerase that
uses glutathione as a cofactor.
♦♦ Finally, 4—fumarylacetoacetate is hydrolyzed by
fumarylacetoacetate hydrolase to fumarate, a glucogenic
intermediate and acetoacetate, a ketogenic intermediate.
Phenylalanine and tyrosine are therefore, both glucogenic
and ketogenic.

Q.16. Mechanism for removal of nitrogen from amino acids.
 (Jan 2018, 5 Marks)
Ans. Removal of nitrogen from amino acids occurs via
oxidative deamination and transamination.
Transamination
For transamination in detail refer to Ans 11 of same chapter
Oxidative Deamination by glutamate Dehydrogenase
♦♦ The α-amino groups of most of the amino acids are
ultimately transferred to α–ketoglutarate by transamination
forming L–glutamate.
♦♦ L–glutamate undergoes oxidative deamination by action
of L–glutamate dehydrogenase which requires NAD+ or
NADP+ as an oxidizing agent.
♦♦ So the net removal of α-amino group to ammonia requires
combined action of glutamate transaminase and glutamate
dehydrogenase.
♦♦ Catabolically, it channel nitrogen from glutamate to
ammonia and anabolically it catalyzes amination of α–
ketoglutarate by free ammonia to form glutamate.
Q.17. Write short answer on nutritional classification of
proteins. (Apr 2018, 3 Marks)
Ans. From nutritional aspect, proteins are classified into three
categories, i.e.
1. Complete proteins: These proteins consist of all
ten essential amino acids in required proportion
by human body to promote good growth, e.g. egg
albumin, milk casein.
2. Partially incomplete proteins: They are partially
lacking one or more essential amino acids and hence
can promote moderate growth, e.g. wheat and rice
proteins.
3. Incomplete proteins: They completely lack one
or more essential amino acids. Hence they do not
promote growth at all, e.g. gelatin (lacks trypsin),
zein (lacks trypsin and lyseine).
3. PROTEINS AND NUCLEIC ACIDS:
CHEMISTRY, METABOLISM AND
REGULATION
Q.1. Describe briefly mechanisms of translation and
transcription of genetic code. (Aug 2005, 7.5 Marks)
Ans. The sequence of nucleotides or nitrogenous bases in
mRNA molecules which enclose the information for
protein synthesis is called “genetic code.”
Transcription (Synthesis of mRNA)
♦♦ The process of synthesis of RNA from DNA is called as
transcription.
♦♦ This process evolves an enzyme called as RNA polymerase
which attaches with DNA strand and unwind the two
strands at a specific point. One of the two strands of DNA
acts as a template for RNA synthesis.
Biochemistry 471
Mechanism of Transcription
It involves three steps, i.e.
1. Initiation
2. Elongation
3. Termination
Initiation
♦♦ Initiation of transcription causes binding of RNA
polymerase to DNA template at the promoter site. The
sigma factor enables RNA polymerase to recognize and
bind to promoter sequences. Promoters are characteristic
sequences of DNA which are different in both prokaryotes
and eukaryotes.
♦♦ Promoter sequences direct RNA polymerase to initiate
transcription at a particular point called as start point or
initiation site.
♦♦ Unlike the initiation of replication, transcriptional
initiation does not require a primer.
Promoters in Prokaryotes
♦♦ Pribnow box: It has nucleotide sequence TATAAT and is
found in 10 base pairs from start point.
♦♦ The 35 region: It has nucleotide sequence TTGACA. It is
called as 35 sequence as it is found in 35 base pairs away
from start point.
Elongation
♦♦ As the promoter region is recognized and is bound by
RNA polymerase, i.e. holoenzyme, local unwinding of
DNA helix continues.
♦♦ Now RNA polymerase synthesizes a transcript of DNA
sequence and short piece of RNA is made. As with
replication, transcription is always in the 5’ to 3’ direction.
The first base is usually a purine nucleotide.
♦♦ By the time 10 nucleotides have been added, the sigma
factor dissociates. The elongation phase is said to begin
where the transcript exceeds ten nucleotides in length.
♦♦ Sigma is now released and the RNAP, i.e. core enzyme
should be able to move along the template stand and
continues elongation of the transcript. The process of
elongation of the RNA chain continues until a termination
signal is reached.
Termination
In prokaryotes, termination of transcription occurs by one of
the two well-characterized mechanisms:
1. Rho-dependent
2. Rho-independent
Rho-Dependent Termination
Rho-dependent termination need a protein factor known
as rho (ρ) which recognizes termination signal and has an
ATP-dependent helicase activity which displaces the RNA
polymerase from template resulting in termination of RNA
synthesis.
472 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 18:  Process of transcription in prokaryotes. A. Recognition of promoter by sigma factor; B. Bnding of core enzyme and starts the
synthesis of RNA; C. Elongation continues until termination region is reached; D. Termination of transcription by Rho factor; E. Newly
syntherized RNA (primary transcript)

Rho-Independent Termination In eukaryotic cells, termination is less well defined. It is

Rho-independent termination brought about by the formation
of a secondary structure (hairpin loop) in the newly synthesized
RNA, which removes the RNA polymerase from DNA template,
resulting in the release of transcript.
This hairpin loop structure is followed by a sequence of four
or more uracil residues, which also are essential for termination.
The RNA transcript ends within or just after then.
believed that it is similar to that described for rho-independent
prokaryotic termination.
Transcription in Eukaryotes
The description of RNA synthesis in prokaryotes is applicable
to eukaryotes even though the enzyme involved and regulatory
signals are different.

Eukaryotic RNA Polymerase
ln contrast to prokaryotes eukaryotic cells have three RNA
polymerases I, II and III found in nucleus. Each of these RNA
polymerase is responsible for the transcription of different sets
of genes.
1. RNA Polymerase I: It catalyzes the synthesis of ribosomal
RNA.
2. RNA Polymerase II: It catalyzes the synthesis of mRNA
and small nuclear RNAs (snRNA).
3. RNA Polymerase III: It catalyzes the synthesis of tRNA.
Besides the three nuclear RNA polymerases, in eukaryotic
cell, a fourth type of RNA polymerase is found in mitochondrial
matrix known as mitochondrial RNA polymerase (mtRNAP).
Similar to prokaryotic RNA polymerase, mtRNA polymerase
catalyzes the synthesis of all the three types of RNA, i.e. mRNA,
tRNA and rRNA.
Fig. 19:  Translation
Biochemistry 473
Eukaryotic Promoter Sites
Each type of eukaryotic RNA polymerase uses different
promoters. These are:
1. Hogness box or TATA box: It is a stretch of six nucleotides
and located 25 nucleotides upstream of the transcription—
starting point.
2. CAAT box: It is stretch of eight nucleotides and located
about 75 nucleotides upstream of the transcription starting
point.
3. GC box: It is a stretch of six nucleotides and is located about
90 nucleotides upstream of the transcription starting point.
Translation (Protein Synthesis)
“It is the process by which genetic information present in mRNA
directs the orders of specific amino acid to form a polypeptide
or protein.”
474 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Steps of Translation ♦♦ The acceptor arm: This arm is capped with a sequence
♦♦ Stage 1: Activation of amino acids: Amino acids are CCA. The amino acid is attached to the acceptor arm.
activated by attaching amino acid to a tRNA in first stage of ♦♦ The anticodon arm: This arm, with the three T specific
protein synthesis. Each of the 20 amino acids is covalently nucleotide bases, is responsible for the recognition of triplet
attached to a specific tRNA at the expense of ATP codon of mRNA. The codon and anticodon are comple­
energy using Mg2+ dependent, aminoacyl tRNA mentary to each other.
synthetases. ♦♦ The D arm: It is so named due to the presence of
♦♦ Stage 2: Initiation: The mRNA which consists of codons dihydrouridine.
for the protein to be synthesized binds to the smaller ♦♦ The TψC arm: This arm contains a sequence of
ribosomal subunits and to the initiating aminoacyl tRNA. ribothymidine (T) and pseudouridin (ψ, Psi).
The large ribosomal subunit then binds to form an initiation ♦♦ The variable arm: This arm is the most variable arm
complex. The initiating aminoacyl tRNA base pairs because it vary in size. It is found between anti-codon
with the mRNA codon AUG and signals the beginning and Tψ C arm.
of polypeptide synthesis. This process which requires
GTP is promoted by cytosolic proteins known as initiation
factors.
♦♦ Stage 3: Elongation: The nascent polypeptide is lengthened
by covalent (peptide bond) attachment of successive
amino acid units, each carried to the ribosome and
correctly positioned by its tRNA, which base pairs
to its corresponding codon in the mRNA. Elongation
requires elongation factors. The binding of each incoming
aminoacyl tRNA and the movement of ribosome along the
mRNA are facilitated by GTP as each residue is added to
the growing polypeptide.
♦♦ Stage 4: Termination and ribosome recycling: Completion
of the polypeptide chain is signaled by a termination codon
in the mRNA. The new polypeptide is released from the
ribosome aided by release factors, and the ribosome is
recycled for another round of synthesis.
♦♦ Stage 5: Folding and post-translational processing:
In order to achieve its biologically active form, the
new polypeptide must fold into its proper three-
dimensional configurations. Before or after folding, the
new polypeptide may undergo enzymatic processing,
including removal of one or more amino acids (usually
form the amino terminus), addition of acetyl, phosphoryl,
methyl, carboxyl, or other groups to certain amino acid
residues, proteolytic cleavage; and/or attachment of Fig. 20:  Structure of tRNA
oligosaccharides or prosthetic groups.
Q.2. Write short note on tRNA. (Nov 2009, 3 Marks) Function of tRNA
Ans. Transfer RNA molecule contains 74–95 nucleotides with It carry amino acids in an activated form to ribosome for
a molecular weight of about 25,000. synthesis of proteins.
In eukaryotic cells, 10 to 20% of nucleotides of tRNA may
Q.3. Write short note on DNA. (Dec 2010, 5 Marks)
be modified and are known as unusual nucleotides. For
 (Aug 2011, 6 Marks) (June 2010, 5 Marks)
example:
• Dihydrouridine (D): In this one of double bond of Ans. DNA is a polymer of deoxyribonucleotides.
the base is reduced. • It is composed of monomeric units namely
• Ribothymidine (T): In this methyl group is added to deoxyadenylate (dAMP), deoxyguanylate (dGMP),
uracil to form thymine. deoxycytidylate (dCMP) and deoxythymidylate
• Pseudouridine (φ): In this uracil is added to ribose (dTMP).
by carbon–carbon bond rather than nitrogen bond. • The double helical structure of DNA was proposed
by James Watson and Francis Crick in 1953.
Structure of tRNA • The structure of DNA double helix is comparable to a
tRNA contains mainly four arms, each arm contains base twisted ladder. The salient features of Watson-Crick
paired stem. model of DNA are as follows:

1. DNA is a right handed double helix. It consists
of two polydeoxyribonucleotide chains (strands)
twisted around each other on a common axis.
2. Two strands are anti-parallel, i.e. one strand runs
in the 5’ to 3’ direction while the other in 3’ to 5’
direction.
3. Width of a double helix is 20 Aº.
4. Each turn of the helix is 34 Aº with 10 pairs of
nucleotides, each pair placed at a distance of
about 3.4 A°.
5. The two strands are held together by hydrogen
bonds formed by complementary base pairs. The
A-T pair has 2 hydrogen bonds while G—C pair
has 3 hydrogen bonds. The G—C is stronger by
about 50% than A = T.
6. The complementary base pairing in DNA helix
proves Chargaff’s rule. The content of adenine
equals to that of thymine (A = T), and guanine
equals to that of cytosine (G = C).
Q.4. Write short note on DNA replication.
 (Nov 2012, 3 Marks)
Ans. Replication of DNA
During cell division, each daughter cell gets an exact copy
of the genetic information of the mother cell. This process of
copying the DNA is known as DNA replication.
In the daughter cell, one strand is derived from the mother
cell; while the other strand is newly synthesised. This is called
semi-conservative type of DNA replication.
Stages of Replication
The process of replication can be divided into three stages:
1. Initiation
2. Elongation
3. Termination.
Initiation
♦♦ Initiation of DNA replication involves unwinding of two
complementary DNA strands and formation of replicating
fork.
♦♦ Unwinding occurs at a single, specific site at a particular
DNA sequence on circular DNA of prokaryotes. The site is
called the origin of replication. 'Ori' where active synthesis
occur. This region is called replicating fork.
♦♦ Replication of double-stranded DNA is bidirectional.
♦♦ In eukaryotes, replication begins at multiple sites
composed almost exclusively of A–T base pairs along the
DNA helix and is referred to as a consensus sequence.
Steps of Initiation
♦♦ First of all DNA A protein recognizes and binds to the ’ori'
of the DNA and successively denatures the DNA.
♦♦ DNA B protein (helicase) then binds to this region and
unwinds the parental DNA, and form a ’V’ where active
synthesis occurs. This region is called the replicating fork.
Biochemistry 475
♦♦ The stress produced due to unwinding by helicase is
released by topoisomerases by cutting either one or both
DNA strands.
♦♦ The single stranded binding (SSB) protein stabilizes the
separated strands and prevents their reassociation.
♦♦ To initiate the DNA synthesis by DNA polymerase III, it
requires RNA primer. The RNA primers are short pieces
of RNA (some 5-50 nucleotides in length) formed by the
enzyme primase (RNA polymerase) using DNA as a
template.
Fig. 21:  Replicating fork
Elongation
♦♦ As RNA primer has been synthesized at each of the
replicating forks, a DNA polymerase III initiate the synthesis
of new DNA strand by adding deoxyribonucleotide to the
3’ end of the RNA primer. Thus, DNA polymerase III can
synthesize a new chain only in the 5’ to 3’ direction. Both the
DNA strands are synthesized simultaneously but in opposite
direction, one is in direction towards the replication fork, the
other in a direction away from the replication fork.
♦♦ The DNA chain which runs in the 3’ → 5’ direction is copied
by polymerase III as a continuous strand, requiring one
primer. This new strand is known as the leading strand.
♦♦ The DNA chain which runs in the 5' → 3' direction is copied
by polymerase III as a discontinuous manner because
synthesis can only proceed in the 5’ to 3’ direction. This
new strand is known as the lagging strand. This requires
numerous RNA primers. As the replication fork moves,
RNA primers are synthesized at specified intervals. These
RNA primers are extended by DNA polymerase III into
short pieces of DNA called Okazaki fragments.
♦♦ Upon completion of lagging strand synthesis, the
RNA primers are removed from fragments by DNA
polymerase I. DNA polymerase I also fills the gaps that
are produced by removal of the primer leaving only a
nick. It cannot join two polynucleotide chains together;
an additional enzyme DNA ligase is required to perform
this function. This enzyme catalyzes the formation of a
phosphodiester bond to seal the Okazaki fragments.
476 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Termination
Termination sequences, e.g. ‘ter', direct termination of replication.
A specific protein, ter binding protein, binds these sequences and
prevents the helicase (DNA B protein) from further unwinding
of DNA and facilitates the termination of replication.
Proofreading
♦♦ DNA is copied by DNA polymerase with high fidelity
(accuracy). Incorrect nucleotides are incorporated with a
frequency of one in 108-1012 bases, which could lead to
mutation. But the error ratio during replication is kept at
a very low level by specific process. This process is known
as proofreading.
♦♦ Mismatches occur more frequently but do not lead to stable
incorporations because all the three DNA polymerases
have 3’ to 5’ exonuclease activity (proofreading activity).
♦♦ DNA polymerase I and II are known to excise mismatched
nucleotides before the introduction of the next nucleotide.
Eukaryotic Replication
DNA replication in eukaryotic organisms resembles that in
prokaryotic cells and proceeds by a mechanism similar to
that of prokaryotic replication but is not identical. Certain
differences are there such as multiple origins of replication is
the hallmark feature of eukaryotic cell. There are five types of
DNA polymerases present in eukaryotes, i.e.
♦♦ DNA polymerase α: It leads to synthesis of RNA primer
for both leading and lagging strands of DNA.
♦♦ DNA polymerase β: It is involved in repair of DNA.
Function of this enzyme is comparable with DNA
polymerase I which is found in prokaryotes.
♦♦ DNA polymerase γ: It takes part in replication of
mitochondrial DNA.
♦♦ DNA polymerase δ: This enzyme is responsible for
replication on leading strand of DNA. This enzyme also
posses proof reading activity.
♦♦ DNA polymerase ε: This is involved in DNA synthesis
on lagging strand and also in the proof reading function.
Q.5. Write brief on genetic codon. (Jan 2012, 6 Marks)
Or
Write short note on genetic code. (Oct 2014, 3 Marks)
Ans. The three nucleotide base sequences in mRNA that act
as code words for amino acids in protein constitute the
genetic code or codon.
Genetic code determines the sequence of amino acids in
proteins.
The codons are composed of four nucleotide bases, i.e.
purines which are adenine (A) and guanine (G) and the
pyrimidines which are cytosine (C) and uracil (U).
These four bases produce 64 combinations of three base
codons. Nucleotide sequence of the codon on mRNA is
written from 5’ –end to 3’ end.
The three codons, i.e. UAA, UAG, UGA do not code
for the amino acids and act as stop signals in protein
synthesis. These three codons are also known as
termination codons or non-sense codons.
Codons AUG and at times GUG are the chain initiating
codons.
Features of the Genetic Code
♦♦ Triplet codons: The codes are on the mRNA. Each codon
is a consecutive sequence of three bases on the mRNA, e.g.
UUU codes for phenylalanine.
♦♦ Non-overlapping: The codes are consecutive. Therefore,
the starting point is extremely important. The codes
are read one after another in a continuous manner, e.g.
AUG,CAU, GCA, etc.
♦♦ Non-punctuated: There is no punctuation between the
codons. It is consecutive or continuous.
♦♦ Degenerate: 61 codons stand for the 20 amino acids. So
one amino acid has more than one codon., e.g. serine
has 6 codons; while glycine has 4 codons, This is called
degeneracy of the code.
♦♦ Unambiguous: Though the codons degenerate, they are
unambiguous; or without any doubtful meaning. That is,
one codon stands only for one amino acid.
♦♦ Universal: The codons are the same for same amino acid
in all species; same for “Elephant and E.coli”. The genetic
code has been highly preserved during evolution.
♦♦ Terminator codons: There are three codons which do not
code for any particular amino acids. They are “nonsense
codons” more correctly termed as punctuator codons or
terminator codons. They put “full stop” to the protein
synthesis. These three codons are UAA, UAG, and UGA.
♦♦ Initiator codon: In most of the cases, AUG acts as the
initiator codon. In a few proteins, GUG may be the initiator
codon.
Q.6. Write short note on types of RNA. (Jan 2012, 3 Marks)
Or
Describe in brief structure and function of RNA.
 (Aug 2012, 4 Marks)
Ans. The 3 distinct types of RNAs with their respective cellular
composition are as follows:
1. Messenger RNA (mRNA): 5–70%
2. Transfer RNA (tRNA): l0–20%
3. Ribosomal RNA (rRNA): 50–80%
• Besides the three RNAs referred above, human
cells contain small nuclear RNA (snRNA),
heterogeneous nuclear RNA (hnRNA) and small
nuclear cytoplasmic RNA (ScRNA).
• RNAs are synthesized from DNA and are
involved in the process of protein biosynthesis.
RNAs vary in their structure.
Messenger RNA (mRNA)
Structure of mRNA
♦♦ mRNA consists of about 5-10% of total cellular RNA.
♦♦ mRNA is synthesized in nucleus as heterogeneous RNA
(hnRNA), which are processed into functional mRNA.

♦♦ mRNA carries the genetic information in the form of
codons. Codons are a group of three adjacent nucleotides
that code for the amino acids of protein.
♦♦ In eukaryotes mRNAs have some unique characteristics,
e.g. the 5’ end of mRNA is "capped" by a 7-methyl-
guanosine triphosphate.
♦♦ The cap is involved in the recognition of mRNA in
protein biosynthesis and it helps to stabilize the mRNA
by preventing attack of 5’-exonucleases.
♦♦ A poly (A) “tail” is attached to the other 3’—end of mRNA.
This tail consists of series of adenylate residues, 20-250
nucleotides in length joined by 3' to 5’ phosphodiester
bonds.
♦♦ The function of poly A tail is not fully understood, but it
seems that it helps to stabilize mRNA by preventing the
attack of 3’-exonuclease.
♦♦ If the mRNA codes for only one peptide, the mRNA
is monocistronic. If it codes for two or more different
polypeptides, the mRNA is polycistronic. In eukaryotes
most mRNA are monocistronic.
Transfer RNA (tRNA)
Refer to Ans 2 of same chapter.
Ribosomal RNA (rRNA)
♦♦ RNA of ribosome is known as rRNA.
♦♦ Ribosome is a cytoplasmic nucleoprotein which acts as
machinery for synthesis of proteins.
♦♦ Ribosome is a spheroidal particle which consists of a large
and small nucleoprotein subunit.
♦♦ Eukaryotic ribososmes consists of 60S and 40S subunits.
Each subunit consists of one or more strand of rRNA and
various numerous protein molecules.
♦♦ 60S subunit consists of 28S rRNA, 5S rRNA and 5.8S rRNA,
the 40S subunit contains 18S rRNA.
Functions of RNA
Type of RNA Function
mRNA It carry genetic information from DNA to cytosol,
where it is used for synthesis of proteins
tRNA It serves as “adaptor” molecule which carry specific
amino acid to site of protein synthesis
rRNA • In association with the protein, it serves as site
for protein synthesis.
• It provides catalytic activities
Hn RNA This serves as precursor for mRNA
Sc RNA This RNA is involved in recognition of signal
sequence on protein synthesis on membrane bound
ribososmes.
Sn RNA It involves in excising introns and splicing axons
Q.7. Write short note on nucleic acids.( June 2010, 5 Marks)
Ans. Nucleic acids are the polymers of nucleotides which are
held by 3’ and 5’ phosphate bridges.
Biochemistry 477
• Nucleic acids are macromolecules present in all
living cells in combination with protein to form nu-
cleoproteins. The protein is usually protamine and
histone. Genetic information is encoded in nucleic
acid molecule.
• Nucleic acids are built up by the monomeric units,
i.e. nucleotides.
• Nucleic acids are of two types, i.e. deoxyribonucleic
acid (DNA) and ribonucleic acid (RNA).
• DNA is present in nuclei and small amount are also
present in mitochondria whereas 90% of RNA is
present in cell cytoplasm and 10% in nucleolus.
• Nucleic acids serve as repositories and transmitters
of genetic information.
Functions of Nucleotides
Nucleotides carry out various biological functions, i.e.
♦♦ They are activated precursors of DNA and RNA.
♦♦ In addition to their roles as the subunit of nucleic acids,
nucleotides have a variety of other functions in every cell
as:
• They act as energy carriers, e.g. ATR GTP, CTP and
UTP.
• Components of enzyme cofactors, e.g. adenine
nucleotide are component of three major coenzymes
NAD+, FAD+ and CoA.
• Chemical messengers, e.g. cAMP, and cGMP.
One of the most common is adenosine 3`, 5'-cyclic
monophosphate (cAMP), serves regulatory functions
in virtually every cell.
• Activator of metabolic intermediates: Nucleotides
are needed for activation of intermediates in many
biosynthetic pathways, e.g. UDP-glucose and CDP—
diacylglycerol are precursors for glycogen and
phospholipid synthesis.
Q.8. Write on biological importance of nucleotides.
 (May 2014, 5 Marks)
Ans. Following is the biological importance of nucleotides:
• They are the building blocks or monomeric units in
the nucleic acid structure.
• They are the structural components of various co-
enzymes of B-complex vitamins e.g. FAD, NAD+,
NADP+, etc.
• Nucleotides are the carriers of high energy interme-
diates during biosynthesis of carbohydrates, lipids
and proteins.
• They are involved in the energy reactions of the cell.
• They control several metabolic reactions by acting
as allosteric regulators.
• Cyclic AMP and cyclic GMP are the second mes-
sengers in hormone function.
Q.9. Write about structure and functions of DNA.
 (Jan 2018, 5 Marks) (Sep 2015, 7 Marks)
 (Sep 2018, 5 Marks)
478 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Ans. Structure of DNA each other. Wherever adenine occurs in one chain,
Primary Structure of DNA thymine is found in the other; similarly wherever
guanine occurs in one chain cytosine is found in the
• DNA is a very long, thread like macromolecule
other.
made up of a large number of deoxyribonucleotides;
each composed of a nitrogenous base, a sugar and • The DNA double helix or duplex is held together
phosphate group. by two forces: hydrogen bonding between comple-
• The sugar in a deoxyribonucleotide is deoxyribose. mentary base pairs and base stacking interactions.
• The nitrogenous base purines in DNA are adenine • The Watson-Crick structure is also referred to as
(A), and guanine (G) and pyrimidines are thymine B-form DNA or B-DNA. The B—form is the most
(T) and cytosine (C). stable structure of DNA under physiological condi-
• In a deoxyribonucleotide, the C-l carbon atom of tions. The structured variants that have been well
deoxyribose is bonded to N-1 of pyrimidine or N-9 characterized are the A-form and Z-form.
of purine by N- glycosidic linkage. The backbone of
DNA consists of many deoxyribonucleotides linked
covalently by 3’,5’ phosphodiester bonds.
• The sequence of bases along a polynucleotide chain
is not restricted in any way; the precise sequence of
bases carries the genetic information. The resulting
long, unbranched DNA chain has polarity.
• One end of the chain has a 5’—phosphate group and
the other a 3’—hydroxy group that is not linked to
another nucleotide. The base sequence located along
the resulting DNA chain is written from 5’ end of
the chain to the 3’ end (5’—>3’ direction).
Secondary Structure of DNA
In 1953, James Watson and Francis Crick postulated a
three dimensional model of DNA structure.
• It consists of two helical DNA chains vound around
the same axis to form a right handed double helix.
• The hydrophilic backbones of alternating
deoxyribose and phosphate groups are on the
outside of the double helix facing the surrounding
water. The purine and pyrimidine bases of both
strands are sacked inside the double helix with their
hydrophobic ring structures very close together and
perpendicular to the long axis.
• Each nucleotide base of one strand is paired with a Fig. 22:  Structure of DNA
base of the other strand. Watson and Crick found
thatA (Adenine) bonds specifically to T (Thymine)
Functions of DNA
and G (Guanine) bonds to C (Cytosine). Adenine is
always paired with thymine in DNA by formation DNA is the store of genetic information. Genetic information
of two hydrogen bonds: guanine is always paired stored in DNA serves two functions:
with cytosine by formation of three hydrogen bonds. 1. It is the source of information for synthesis of all protein
The balance pairing of the two strands creates a molecules of the cell.
major groove and minor groove on the surface of 2. It provides the information inherited by daughter cells
the duplex.
or offspring.
• The two strands of DNA are anti–parallel, their 3’,
5’— phosphodiester bonds run in the opposite struc- Q.10. Write similarity and differences between DNA and
ture of DNA directions. Adjacent bases are separated RNA. (Feb 2016, 2 Marks)
by 3.4Å along the helix axis and the helical structure Or
repeats after ten residues on each chain, that is at
intervals of 34Å. The diameter of the helix is 20Å. Answer in brief on similarities and differences between
• The two antiparallel polynucleotide chains of double DNA and RNA. (May 2017, 2 Marks)
helical DNA are not identical in either base sequence Ans. Following are the similarities and differences between
or composition. Instead they are complementary to DNA and RNA:
 Biochemistry 479

Similarities between RNA and Differences between RNA and Degradation of cAMP
DNA DNA It undergoes rapid hydrolysis which is catalysed by enzyme
DNA and RNA are made up of DNA is double-stranded, RNA is phosphodiesterase to 5’ AMP which is inactive.
monomers called nucleotides single-stranded
DNA and RNA both contain DNA contains a pentose sugar Functions of cAMP
pentose sugars deoxyribose, RNA contains the ♦♦ It acts as second messenger for the most of polypeptide
pentose sugar Ribose. A pentose hormones.
is a 5-carbon sugar molecule
♦♦ It enhances the degradation of storage fuels like fat and
DNA and RNA both have 3 DNA is limited to the nucleus, glycogen by stimulating lipolysis, glycogenolysis. cAMP
nitrogenous bases: Adenine, RNA is made in the nucleus, but serve regulatory function in every cell.
Cytosine and Guanine can travel outside of it
♦♦ It inhibits aggregation of blood platelets.
DNA and RNA both have a DNA has a nitrogenous base ♦♦ cAMP increases the secretion of acid by gastric mucosa.
phosphate groups in their called Thymine, but RNA does
nucleotides. Sometimes called not. Instead, RNA has uracil. In Q.12. Write short note on cAMP as second messenger.
phosphoric acid DNA thymine pairs with adenine,  (Apr 2015, 3 Marks)
but in RNA uracil pairs with Or
adenine
Write briefly about second messenger.
They both have the base pair of There is only one type of DNA  (Oct 2016, 2 marks)
Guanine and Cytosine but 3 kinds of RNA (messenger,
Ans. cAMP act as second messenger for many of the
transfer and ribosomal RNA)
polypeptide hormones.
They are both necessary for the RNA synthesis does not require ♦♦ Once cAMP is produced it elicit biochemical responses as
cell to produce proteins a primer strand in contrast to
a second messenger.
DNA synthesis
♦♦ cAMP activates protein kinase A. Protein kinase A is a
Direction of both RNA and DNA DNA synthesis is semi­ heterotetramer which consists of two regulatory subunits
synthesis is conservative while RNA
(R) and two catalytic subunits (C). cAMP binds to inactive
5’ → 3’ synthesis is fully conservative
protein kinase and lead to the dissociation of R and C
Hydrolysis of No exonuclease activity has been subunits.
pyrophosphatetakes place in recorded in RNA polymerase.
  4cAMP + R2C2 →  R2 (4 cAMP) + 2C
both the cases DNA polymerase has both 3’ →
5’and 5’ → 3’ exonuclease activity   (Inactive)     (Inactive)  (Active)
Phosphodiester linkage takes Active subunit (C) catalyses phosphorylation of proteins.
place just as during DNA It is the phosphoprotein which leads to biochemical
synthesis. The nucleophilic attacks response.
of 3’–OH terminus is common ♦♦ Various hormones which use cAMP as second messenger
are calcitonin, chorionic gonadotropin, corticotrophin,
Q.11. Write about cyclic AMP. (Dec 2014, 5 Marks) epinephrine, follicle stimulating hormone, glucagon,
Ans. It is represented as cAMP. luteinizing hormone, melanocyte stimulating hormone,
♦♦ It is also known as second messenger since it acts as second norepinephrine, parathyroid hormone, thyroid stimulating
messenger for the most of polypeptide hormones. hormone and vasopressin.
♦♦ It is a ubiquitous nucleotide. Q.13. Name four biologically important nucleotides.
♦♦ cAMP contains adenine, ribose and a phosphate linkage.  (Aug 2016, 2 Marks)
♦♦ ATP is converted to cyclic AMP by enzyme adenylate Ans. Biologically important nucleotides are:
cyclase. ♦♦ ATP or Adenosine triphosphate
♦♦ cAMP is hydrolysed by phosphodiesterase to 5’- AMP. ♦♦ ADP or Adenosine diphosphate
Action of Cyclic AMP ♦♦ cAMP or Cyclic Adenosine 3’, 5’ monophosphate
♦♦ GTP or Guanosine triphosphate
♦♦ It elicits biological responses as second messenger. ♦♦ GDP or Guanosine Diphosphate
♦♦ cAMP activates protein kinase A. Protein kinase A is a ♦♦ cGMP or Cyclic Guanosine 3’, 5’ monophosphate
heterotetramer which consists of two regulatory subunits ♦♦ UDP or Uridine diphosphate
(R) and two catalytic subunits (C). cAMP binds to inactive ♦♦ CTP or Cytidine triphosphate
protein kinase and lead to the dissociation of R and C ♦♦ CDP or Cytidine diphosphate
subunits.
Q.14. Write a short note on gout. (Dec 2010, 5 Marks)
   4cAMP + R2C2 →  R2 (4 cAMP) + 2C
 (Feb 2014, 3 Marks) (Feb 2016, 3 Marks)
   (Inactive)     (Inactive)  (Active)
Active subunit (C) catalyses phosphorylation of proteins. It Or
is the phosphoprotein which leads to biochemical response. Answer in brief on gout. (May 2017, 2 Marks)
480 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Or
Write short answer on gout. (Aug 2018, 5 Marks)
Ans. Gout is a disease that results from an overload of uric
acid in the body. This overload of uric acid leads to
the formation of tiny crystals of urate that deposit in
tissues of the body, especially the joints. When crystals
form in the joints, it causes recurring attacks of joint
inflammation (arthritis).
• Gout is considered a chronic and progressive disease.
• Chronic gout can also lead to deposits of hard lumps
of uric acid in the tissues, particularly in and around
the joints and may cause joint destruction, decreased
kidney function, and kidney stones (nephrolithiasis).
Causes
♦♦ Hyperuricemia is the underlying cause of gout. This can
occur for a number of reasons, including diet, genetic
predisposition, or underexcretion of urate, the salts of
uric acid.
♦♦ Renal underexcretion of uric acid is the primary cause of
hyperuricemia.
Classification of Gout
Gout is of two types, i.e. primary gout and secondary gout.
Primary Gout
This is an inborn error of metabolism because of overproduction
of uric acid. In this there is increase level of uric acid which
is associated with increased synthesis of purine nucleotides.
Enhanced synthesis of purine nucleotides occur due to defective
enzymes of purine nucleotide biosynthesis, i.e. PRPP synthetase,
PRPP glutamyl amidotransferase, HGPRTase. Lack of feedback
regulation of purine nucleotide synthesis and Lesch-Nyhan
syndrome leads to primary gout.
Symptoms of Primary Gout
♦♦ Patients with primary gout often show deposition of urate
as tophi (clusters of urate crystals) in soft tissues that affect
the joints and leads to painful arthritis.
♦♦ Kidneys are also affected, since excess urate is also
deposited in the kidney tubules and leads to renal failure.
Secondary Gout
♦♦ Secondary gout results due to variety of diseases that cause
an elevated destruction of cells or decreased elimination
of uric acid.
♦♦ Elevated destruction of cells is accompanied by increased
degradation of nucleic acids to uric acid which occurs in
cancers (leukemia, polycythemia, lymphoma etc) psoriasis
and hypercatabolic states (starvation, trauma etc.)
♦♦ There is decreased elimination of uric acid occurs in chronic
renal disease due to reduced glomerular filtrate rate.
Treatment of Gout
♦♦ Gout can be treated by a combination of nutritional therapy
and drug therapy.
♦♦ Foods especially rich in nucleotides and nucleic acids such
as liver or coffee and tea, which contain the purines caffeine
and theobromine, are withheld from the diet. Restriction
of alcohol intake is also advised.
♦♦ Major improvement occurs after use of the drug allopurinol,
an analog of hypoxanthine which inhibits xanthine oxidase
competitively, the enzyme responsible for converting
purines into uric acid. This leads to reduced formation of
uric acid and accumulation of xanthine and hypoxanthine,
which are more soluble and thus easily excreted.
Q.15. Answer in brief mutation. (Sep 2017, 2 Marks)
Ans. Mutation is defined as change in the DNA structure of
genes.
• Substances which induce mutation are known as
mutagens.
• Changes which occur inside DNA during mutation
are reflected in replication, transcription and transla-
tion.
• Mutations in germ cells are transmitted to next
progeny and may give rise to inherited diseases.
• Mutations may sometime result in serious diseases
such as cancer, sickle cell anemia, etc.
Causes of Mutations
♦♦ Errors in replication: If a mismatch base pair is not
corrected during proof reading and post replication repair
system.
♦♦ Error due to the recombination events.
♦♦ Due to spontaneous changes in DNA, e.g. deamination of
cytosine to uracil or spontaneous depurination.
♦♦ Environmental factors such as chemical mutagens and
irradiation, e.g. ultraviolet light or ionizing radiation can
lead to alteration in structure of DNA.
Types of Mutations
Mutations are of two type, i.e.
1. Point mutation
2. Frameshift mutation
Point Mutation
♦♦ It consists of replacement of one base pair by another
which leads to point mutation. Point mutation is divided
into two parts, i.e.
1. Transition: In transition, a purine is replaced by
another purine or a pyrimidine is replaced by another
pyrimidine.
2. Transversion: They are characterized by replacement
of purine by pyrimidine or vice versa.
♦♦ Point mutation can lead to silent mutation, missense
mutation and nonsense mutation. These three are the
consequences of point mutation.
Frameshift Mutation
♦♦ These mutations occur when either one or more base
pairs are inserted or are deleted from DNA which leads
to insertion or deletion frameshift mutations.

♦♦ In deletion frameshift mutation, deletion of a single
nucleotide from coding strand of a gene leads to altered
reading frame in mRNA. As there is no punctuation
in reading of codons, translating machinery does noit
recognize that a base is missing. There frameshifts result in
production of entirely different protein after transcription
and translation.
♦♦ Insertion frameshift mutation can be of one or two
nucleotides. Insertion of nucleotide in genes leads to severe
frameshift mutation, e.g. thalassemia.
♦♦ If number of nucleotides involves in deletion or insertion
is three or multiples of three, frameshift does not occur,
instead an abnormal protein is synthesized.
4. LIPIDS: CHEMISTRY, METABOLISM
AND REGULATION
Q.1. Describe β-oxidation of palmitic acid (18 carbons) along
with its energetics. (Nov 2009, 8 Marks)
Or
Describe beta-oxidation of fatty acids in brief.
 (Dec 2010, 10 Marks)
Or
Give an account of metabolism of fat with particular
reference to beta-oxidation. (Feb 2014, 8 Marks)
Or
Write about β-oxidation of fatty acids.
 (Sep 2015, 7 Marks)
Or
Write on beta-oxidation of fatty acids and its energetics
 (Apr 2017, 5 Marks)
Ans. Beta-oxidation of Fatty Acids
This process is known as β-oxidation, because the
oxidation and splitting of two carbon units occur at the
β-carbon atom. The oxidation of the hydrocarbon chain
occurs by a sequential cleavage of two carbon atoms
(Fray Knoop, 1904).
β-oxidation can be defined as oxidation of fatty acids on
the β carbon atom.
Stages of β-Oxidation
β-oxidation of fatty acids consists of three stages, i.e. fatty
acid activation, Transport of acyl CoA in mitochondria and
β-oxidation proper in mitochondrial matrix.
Fatty Acid Activation
♦♦ It occurs in the cytosol.
♦♦ Fatty acids are activated to acyl-CoA by enzyme thiokinases
or acyl-CoA synthetases. During this reaction, two high
energy phosphates are utilized, since ATP is converted to
pyrophosphate (PPi).
Biochemistry 481
♦♦ Enzyme pyrophosphatase leads to hydration of PPi
to phosphate (Pi). The immediate elimination of
pyrophosphate makes this reaction totally irreversible.
Transport of Acyl-CoA in Mitochondria
Inner mitochondrial membrane is impermeable to fatty acids.
A special carnitine carrier system transport activated fatty acids
from cytosol to mitochondria.
Activated long chain fatty acids are carried across the inner
mitochondrial membrane by carnitine, (β-hydroxy γ-trimethyl-
ammonium butyrate) formed from lysine and methionine in
liver and kidney. This occurs in four steps as follows:
1. The acyl group of acyl-CoA is transferred to the carnitine to
form acylcarnitine. This reaction is catalyzed by carnitine
acyltransferase-I (CAT-I) which is located on the cytosolic
face of inner mitochondrial membrane.
2. Acylcarnitine is then transported across the inner
mitochondrial membrane by an enzyme translocase.
3. The acyl group is transferred back to CoA in the
mitochondrial matrix by the enzyme carnitine acyl
transferase-II (CAT-II), located on the inside of the inner
mitochondrial membrane.
4. Acyl-CoA is reformed in the mitochondrial matrix with
liberation of carnitine which is returned to the cytosolic
side by the translocase in exchange for an incoming acyl-
carnitine.
β-Oxidation Proper
After penetration of acyl-CoA in mitochondria, it undergoes
β-oxidation.
Each cycle of β-oxidation, liberate a two carbon unit acetyl
CoA which occur in sequence of four reactions, i.e.
1. Oxidation: Acyl-CoA undergoes dehydrogenation by an
FAD dependent flavoenzyme, acyl-CoA dehydrogenase.
There is formation of double bond between α and β
carbons.
2. Hydration: Enoyl-CoA hydratase causes hydration of
double bond to form β-hydroxyacyl CoA.
A
482 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
B
Figs 23A and B:  Carnitine transport system
(CAT I: Carnitine acyltransferase-I; CAT II: Carnitine acyltransferase-II)
3. Oxidation: β-hydroxyacyl CoA dehydrogenase catalyzes
second oxidation and generates NADH. Now there is
formation of β-ketoacyl CoA.
4. Cleavage: So now the final reaction of β-oxidation is
liberation of two carbon fragment, acetyl-CoA from acyl
CoA. This happens by thiolytic cleavage catalysed by
β-ketoacyl CoA thiolase.
New acyl-CoA having two carbons less than the original,
reenters the β-oxidation cycle. This continues till fatty acid gets
completely oxidized.
Summary of β Oxidation of Palmitoyl CoA
Palmitoyl CoA + 7CoASH + 7FAD + 7NAD+ + 7H2O→8 acetyl
CoA + 7FADH2 + 7NADH + 7H+
Beta-oxidation of fatty acids
Palmitoyl CoA undergo 7 cycles of β-oxidation to yield
8 acetyl-CoA. Acetyl-CoA can enter citric acid cycle and get
completely oxidized to carbon dioxide and water.
Energetics of Beta-oxidation (ATP Yield)
♦♦ Complete β-oxidation of palmitoyl CoA (16 carbon acid)
occurs through 7 cycles of β-oxidation yielding finally 8
acetyl-CoA, 7 FADH2 and 7 NADH.
♦♦ 2.5 ATPs are generated when each of these NADH is
oxidized by respiratory chain.
♦♦ 1.5 ATPs are formed for each FADH2.
♦♦ The oxidation of acetyl-CoA by the citric acid cycle yields
10 ATPs. Therefore, the number of ATPs formed in the
oxidation of palmitoyl-CoA is:
• 10.5 ATPs from the 7 FADH2
• 17.5 ATPs from the 7 NADH
• 80 ATPs from the oxidation of 8 molecules of acetyl-
CoA in TCA cycle.
• Total of 108 ATPs.
♦♦ Two high energy phosphate bonds are consumed in the
activation of palmitate in which ATP is split into AMP
and PPi.
♦♦ Thus, the net yield from the complete oxidation of
palmitate is 108 ATPs minus 2ATPs = 106 ATPs.
 Previous calculations were made assuming that NADH
produces 3 ATPs and FADH2 generates 2 ATPs. This will
amount to a net generation of 129 ATPs per palmitate
molecule. Recent studies show that these old values are
wrong, and net generation of ATPs is only 106.
Regulation of Beta-oxidation of Fatty Acids
Rate limiting step in β-oxidation pathway is formation of
acyl-carnitine which is catalysed by enzyme carnitineacyl
transferase-I (CAT-I). This is an allosteric enzyme. Malonyl-CoA
is an inhibitior of CAT-I.
- In well fed state due to increase in level of insulin,
concentration of malonyl-CoA increases which inhibits
CAT-I and leads to decrease in fatty acid oxidation.
- In starvation due to increase in level of glucagon
concentration of malonyl-CoA decreases and stimulates
fatty acid oxidation.

Fig. 24:  Overall process of b-oxidation
Fig. 25:  Regulation of b-oxidation of fatty acids
Q.2. Write briefly on beta-oxidation. (Mar 2008 3 Marks)
Or
Write a short note on beta-oxidation.
 (Jan 2012, 5 Marks)
Or
Write a short note on beta-oxidation of fatty acids.
 (Sep 2015, 5 Marks)
Ans. Refer to Ans 1 of same chapter.
Q.3. Describe β-oxidation of palmitic acid along with its
energetics. Write a note on essential fatty acids.
 (Nov 2012, 8 Marks)
Ans. For β-oxidation of palmitic acid refer to Ans 1 of same
chapter.
For essential fatty acids refer to Ans 7 of same chapter.
Q.4. Describe lipoproteins in brief. (Apr 2008, 4 Marks)
Or
Biochemistry 483
Write a short note on lipoproteins.
 (Mar 2013, 3 Marks)
Or
Write very short answer on lipoproteins.
 (Aug 2018, 2 Marks)
Ans. Lipoproteins are large water soluble complexes formed
by combination of lipid and protein which transport
insoluble lipids through the blood between different
organs and tissues.
 It consist of lipid core which contain nonpolar
triacylglycerol and cholesterol ester which is surrounded
by the single layer of amphipathic phospholipids and
free cholesterol molecules with some proteins.
 Here protein components are referred to as an
apoprotein or apolipoprotein.
Class of Lipoprotein
Lipoproteins are classified into four major classes according to
their physical and chemical properties. These are:
1. Chylomicrons
2. Very low density lipoproteins
3. Low density lipoprotein (LDL)
4. High density lipoprotein (HDL)
• The above lipoprotein complexes consist of different
proportion of lipids and proteins. Density of these
lipoproteins is inversely proportional to triacylglycerol
content. Increase in density decreases diameter of
particle.
• Chylomicrons consist of 1% protein and 99%
triacylglycerol have lowest density.
• High density lipoprotein consists of 50% proteins and
50% of lipid. It has highest density.
• Triacylglycerol is the most predominant lipid in
chylomicrons and VLDL. Cholestrol is predominant
lipid in LDL. Phospholipid is predominant lipid in
HDL.
484 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Site of Synthesis and Functions of Lipoproteins • Sitosterol decreases the intestinal absorption of
exogenous and endogenous cholesterol and there
Name of Site of by lower the blood cholesterol level.
lipoprotein synthesis Function
Q.6. Describe in brief classification of lipids.
Chylomicrons Intestine It transport dietary lipids from
intestine of the peripheral tissues  (Mar 2006, 4 Marks)
Or
VLDL Liver It transport triacylglycerol from
liver to peripheral tissues Write a short note on classification of lipids.
LDL Plasma VLDL It transport cholesterol from liver  (Feb 2013, 6 Marks)
to peripheral tissues Ans. Lipids are regarded as organic substances relatively
HDL Liver and It transport free cholesterol from soluble in water, soluble in organic solvents (alcohol,
intestine peripheral tissues to liver ether, etc.) actually or potentially related to fatty acids
and is utilized by living cells.
Importance Lipids are broadly classified as simple, complex, derived
and miscellaneous.
♦♦ To transport and deliver lipid to tissue.
♦♦ To maintain structural integrity of cell surface and sub Simple Lipids
cellular particles like mitochondria and microsomes.
♦♦ Lipoprotein function increase in severe diabetes mellitus, These are the esters of fatty acids with alcohol. Simple lipids
atherosclerosis, etc. hence it is of diagnostic importance. are of two types, i.e.
1. Fats and oils (triglycerides): These are esters of fatty acid
Q.5. Write about biomedical importance of fats in the diet. with glycerol. As they are uncharged, they are known as
 (Apr 2003, 6 Marks) neutral fat. Fat we eat are mostly triglycerides. Fat in liquid
Ans. •  The high concentration of polyunsaturated fatty state is known as oil.
acids in the lipids of gonads are important in 2. Waxes: True waxes are esters of fatty acid with high
reproductive functions. molecular weight monohydric long chain alcohols other
• They are best reserve of food material in the human than glycerol.
body.
• They act as insulator for the loss of body heat. Complex Lipids
• They act as a padding material for protecting internal These are the esters of fatty acid with alcohols which consists
organs. of additional groups, i.e. phosphate, nitrogenous base,
• Deficiency of essential fatty acids causes skin lesions, carbohydrate, protein, etc. Complex lipids are subdivided into:
abnormal pregnancy and lactation in adult females, ♦ Phospholipids: Lipids consisting of phosphoric acid and
fatty liver, kidney damages. frequently a nitrogenous base. This is in addition to alcohol
• Absence of dipalmitoyl lecithin (DPL) in premature and fatty acids. Phospholipids are classified on the basis of
fetus produces respiratory distress syndrome type of alcohol present in them as glycerophospholipids
(hyaline membrane disease). and sphingophospholipids.

Fig. 26:  Classification of lipids


• Glycerophospholipids: They consist of glycerol as
alcohol, e.g. lecithin, cephalin
• Sphingophospholipids: Sphingosine is the alcohol
present in this group, e.g. sphingomyelin
♦ Glycolipids: Lipids which consists of fatty acid,
carbohydrate and nitrogenous waste are known as
glycolipids. Since alcohol is sphingosine, so they are known
as glycosphingolipids.
♦ Lipoproteins: They are formed by the combination of lipid
with a prosthetic group protein, e.g. chylomicrons, VLDL,
LDL, HDL
♦ Other complex lipids: Sulfolipids, aminolipids and
lipopolysaccharides are complex lipids.
Derived Lipids
Derived lipids consist of products which are derivative
obtained on hydrolysis of group I and group II lipids which
posses characteristics of lipid. Derived lipids include glycerol,
other alcohols, fatty acids, mono and diacylglycerol, lipid
soluble vitamins, steroid hormone, hydrocarbons and ketone
bodies.
Miscellaneous Lipids
They consists of large number of compounds which posses
characteristics of lipids, e.g. carotenoids, squalene, etc.
Q.7. Write short note on essential fatty acids.
(Nov 2009, 3 Marks) (Jan 2012, 6 Marks) (Aug 2016, 3 Marks)
Ans. Fatty acids that cannot be synthesized by the body and
should be supplied in the diet are known as essential
fatty acids.
Chemically, they are polyunsaturated fatty acids, namely
linoleic acid and linolenic acid. Arachidonic acid if
becomes essential, if its precursor linoleic acid is not
provided in the diet in sufficient amount.
Functions of Essential Fatty Acids
Essential fatty acids are required for:
♦♦ Proper membrane structure and function
♦♦ Essential fatty acid is required for transport of cholesterol
♦♦ Formation of lipoproteins
♦♦ Prevention of fat
♦♦ They are also needed for the synthesis of another important
group of compounds namely eicosanoids.
Deficiency of Essential Fatty Acids
Deficiency of essential fatty acids results in phrynoderma or
toad skin is characterized by the presence of horny eruptions
on the posterior and lateral parts of limbs, on the back and
buttocks, loss of hair and poor wound healing.
Q.8. Write in brief on HDL. (Jan 2012, 6 Marks)
Ans. HDL is the full form for high density lipoprotein
Biochemistry 485
Metabolism of HDL
♦♦ HDL get synthesized and secreted from liver as disk
shaped nascent HDL particles which consist primarily of
phospholipids, free cholesterol and apo A–l as the main
apolipoproteins together with apo C—II and Apo E.
♦♦ These above mentioned nascent HDL particles are nearly
devoid of cholesterol ester and triacylglycerol.
♦♦ As nascent HDL is secreted into the plasma, enzyme
synthesized by liver, i.e. lecithin-cholesterol acyltransferase
(LCAT) get binds to nascent HDL.
♦♦ Nascent HDL picks up cholesterol from other lipoproteins
and from cell membrane of peripheral tissue. Cholesterol
picked up by nascent HDL is converted to cholesterol esters
by the action of LCAT in the presence of its activator Apo
A–I inside HDL particle.
♦♦ As cholesterol in HDL gets esterified by LCAT activity,
it makes a concentration gradient and takes up free
cholesterol from tissues and from other lipoproteins.
♦♦ Now nascent HDL fills with cholesterol ester and they
become spherical in shape. These spherical HDL which is
enriched in cholesterol ester now enter the liver. In liver,
the cholesterol esters get degraded to cholesterol which
get utilized for synthesis of bile acids and lipoproteins or
excreted into bile as cholesterol.
Fig. 27:  Metabolism of HDL
Functions of HDL
♦♦ HDL is the main transport form of cholesterol from
peripheral tissue to liver which is later excreted through
bile. This is called reverse cholesterol transport by HDL.
♦♦ The only excretory route of cholesterol from the body is
the bile.
♦♦ Excretion of cholesterol needs prior esterification with
PUFA. Thus PUFA will help in lowering of cholesterol in
the body, and so PUFA is antiatherogenic.
Clinical Significance
Level of HDL in serum is inversely related to the incidence of
myocardial infarction. As it is “antiatherogenic” or “protective”
486 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
in nature, HDL is known as “good cholesterol” or “highly
desirable lipoprotein” in common parlance. It is convenient to
remember that “H” in HDL stands for “Healthy”. HDL level
below 35 mg/dL increases the risk, while level above 60 mg/dL
completely protects the person from coronary artery diseases.
Q.9. Write a short note on cholesterol. (Dec 2010, 5 Marks)
Ans. Cholesterol is exclusively found in animals and is the
most abundant animal sterol.
• It is distributed in all cells and is a major component
of cell membranes and lipoproteins.
• Cholesterol was first isolated from bile.
• It has one hydroxyl group at C3 and a double bond
between C5 and C6. An 8 carbon aliphatic side chain
is attached to C17. Cholesterol contains a total of 5
methyl groups.
• It is found in association with fatty acids to form
cholestrol esters.
Properties and Reactions
♦♦ Cholesterol is an yellowish crystalline solid.
♦♦ The crystals, under the microscope, show a notched
appearance.
♦♦ It is insoluble in water and soluble in organic solvents such
as chloroform, benzene, ether, etc.
♦♦ Several reactions given by cholesterol are useful for its
qualitative identification and quantitative estimation.
These include Sallowski’s test, Liebermann-Burchard
reaction and Zak’s test.
Functions of Cholesterol
♦♦ Cholesterol acts as an insulating cover for the transmission
of electrical impulses in the nervous tissue.
♦♦ It performs several other biochemical functions which
include its role in membrane structure and function in
the synthesis of bile acids, sex and cortical hormones and
vitamin D.
Q.10. Write on cholesterol synthesis. (Aug 2011, 6 Marks)
Or
Write down in detail about biosynthesis of cholesterol.
 (Jun 2010, 10 Marks)
Ans. About 1g of cholesterol is synthesized per day in adults.
• Almost all the tissues of the body participate in
cholesterol biosynthesis.
• The largest contribution is made by liver, intestine,
skin, adrenal cortex, reproductive tissue, etc.
• Acetate of acetyl-CoA provides all the carbon atoms
in cholesterol.
• The reducing equivalents are supplied by NADPH,
while ATP provides energy.
• For the production of one mole of cholesterol, 18
moles of acetyl-CoA, 36 moles of ATP and 16 moles
of NADPH are required.
Synthesis of Cholestrol
1. Synthesis of HMG-CoA
2. Formation of mevalonate (6C)
3. Production of isoprenoid units (5C)
4. Synthesis of squalene (30C)
5. Conversion of squalene to cholesterol (27C).
Acetyl-CoA (2C)
↓
HMG-CoA (6C)
↓
Mevalonate (6C)
↓
Isoprenoid units
↓
(5C; building blocks)
↓
6 units condense
Squalene (30C)
↓
Lanosterol (30C)
↓
Cholesterol (27C)
1. Synthesis of β-hydroxy β -methylglutaryl-CoA (HMG-
CoA): Two moles of acetyl-CoA condense to form
acetoacetyl-CoA. Another molecule of acetyl-CoA is then
added to produce HMG-CoA.
2. Formation of mevalonate: HMG-CoA reductase is the
rate limiting enzyme in cholesterol biosynthesis. This
enzyme is present in endoplasmic reticulum and catalyses
the reduction of HMG-CoA to mevalonate. The reducing
equivalents are supplied by NADPH.
3. Production of isoprenoid units: In a three step reaction
catalysed by kinases, mevalonate is converted to 3-phospho-
5-pyrophosphomevalonate which on decarboxylation
forms isopentenyl pyrophosphate (IPP). The latter
isomerizes to dimethylallyl pyrophosphate (DPP). Both
IPP and DPP are 5-carbon isoprenoid units.
4. Synthesis of squalene: IPP and DPP condense to produce a
10-carbon geranyl pyrophosphate (GPP). Another molecule
of IPP condenses with GPP to form a 15-carbon farnesyl
pyrophosphate (FPP). Two units of farnesyl pyrophosphate
unite and get reduced to produce a 30-carbon squalene.
5. Conversion of squalene to cholesterol: Squalene undergoes
hydroxylation and cyclization utilizing O2 and NADPH and
gets converted to lanosterol. The formation of cholesterol
from lanosterol is a multistep process with a series of
about 19 enzymatic reactions. The penultimate product
is 7-dehydrocholesterol which on reduction finally yields
cholesterol.
Q.11. Describe in brief significance of cholesterol.
 (Aug 2012, 4 Marks)
Ans. Significance of Cholesterol
• Heart diseases: Level of cholesterol in blood is
related to the development of atherosclerosis. Ab-

normality of cholesterol metabolism may lead to
cardiovascular accidents and heart attacks.
• Cell membranes: Cholesterol is a component of
membranes and has a modulating effect on the fluid
state of the membrane.
• Nerve conduction: Cholesterol is a poor conductor
of electricity, and is used to insulate nerve fibers.
• Bile acids and bile salts: The 24 carbon bile acids
are derived from cholesterol. Bile salts are important
for fat absorption.
• Steroid hormones: 21-carbon glucocorticoids,
19-carbon androgens and 18-carbon estrogens are
synthesized from cholesterol.
• Vitamin D: It is synthesized from cholesterol.
Q.12. Write briefly on fatty liver and lipotropic factors.
 (Sep 2009, 5 Marks)
Ans. Hormones that are derivatives of amino acids, polypeptides or
Fatty Liver
Liver is not a fat storage organ. In some conditions there is
excessive accumulation of fat mainly triacylglycerols in liver
which leads to fatty liver.
Causes of Fatty Liver
There are two main causes of fatty liver, i.e.
1. Increased synthesis of triacylglycerol
2. Impairment of lipoprotein synthesis
Increased Triacylglycerol Synthesis
As free fatty acids get mobilized from adipose tissue and their
influx in the liver is higher than their utilization. This causes
overproduction of triacylglycerol and they get accumulate
inside the liver. Various conditions such as diabetes mellitus,
starvation, alcoholism and high fatty diet are associated with
increase in mobilization of fatty acids which leads to fatty liver.
Alcohol is also one of the important factor which inhibit fatty
acid oxidation, promotes fat synthesis and its deposition.
Impaired Synthesis of Lipoproteins
Synthesis of very low density lipoproteins actively occur
inside the liver. Formation of VLDL needs phospholipids and
apoprotein B. Causation of fatty liver by impaired lipoprotein
synthesis can be due to:
♦♦ Defect in phospholipid synthesis
♦♦ Block in apoprotein formation
♦♦ Failure in formation or secretion of lipoprotein.
Lipotropic Factors
Lipotropic factors are the substances deficiency of which leads
to fat, i.e. triacylglycerol to accumulate in the liver.
Lipotropic factors prevent the accumulation of fat in liver.
Various important lipotropic factors are choline, betaine,
methionine and inositol. Apart from these folic acid, vitamin
B12, glycine and serine also serve as lipotropic factors to some
extent.
Biochemistry 487
Choline is the main lipotropic factor and various other
lipotropic agents act by producing choline in the body. For
example, betaine and methionine possessing methyl groups
are donated to ethnolamine to form choline.
Choline is needed for formation of phospholipid, lecithin
which in turn is an essential component of lipoprotein. Formation
of lipoprotein is important for disposal of triacylglycerol.
Vitamin B12 and folic acid can also produce lipotropic effect
as they lead to formation of methionine from homocysteine.
Q.13. Write about mechanism of hormone actions.
 (Feb 2013, 5 Marks)
Ans. Mechanism of Hormone Actions
Hormone act in two ways:
Mechanism of Action of Peptide Hormones
proteins are formed of large molecules. These being insoluble
in lipids cannot enter the target cell. These act at the surface
of target cell as primary messengers and bind to cell surface
receptor forming hormone receptor complex. Mechanism of
hormone action involves following steps:
1. Hormone is called as first messenger attaches to the cell
surface receptor protein on the outer surface of plasma
membrane of the target cell forming hormone receptor
complex.
2. Thic complex activates the enzyme adenylyl cyclase.
3. Adenylyl cyclase catalyses the conversion of ATP to cyclic
AMP on the inner surface of plasma membrane.
4. Cyclic AMP (cAMP) serves as the ‘second messenger’ or
intracellular hormone mediator delivering information
inside the target cells. This activates appropriate cellular
enzyme system by cascade effect and induces the cell
machinery to perform its specialized function.
5. Ca2+ ions may be involved along with cyclic AMP.
6. Cyclic AMP has a very short existence. It is rapidly
degraded by cyclic AMP phosphodiesterase.
• Water soluble hormones (amines, peptides, proteins
and glycoproteins) exert their control through cyclic
AMP. These are quick acting hormones, i.e. they
produce immediate effect.
Mechanism of Action of Steroid Hormones
Steroid hormones and thyroid hormones do not bind to
cell surface receptors. Being lipid soluble these are able to
enter the cells and their nuclei and influence the gene action.
The hormone binds to receptors forming hormone receptor
complex. It binds to the transcription factors that in turn
binds to DNA and particular gene or genes are activated.
Their transcription leads to the synthesis of a specific protein
to influence the metabolism of recipient cell. Thus peptide
hormones activate existing enzymes in the cell, while steroid
hormones bring about the synthesis of new enzymes. Steorid
hormones act slowly than peptides but have a more sustained
effect on metabolism.
488 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.14. Define lipids. Give their classification in detail. Also

write down the functions of lipids.
 (June 2010, 10 Marks)
Ans. Lipids are defined as compounds which are relatively
insoluble in water, but freely soluble in nonorganic
solvents like benzene, chloroform, ether, hot alcohol,
acetone, etc.

Classification of Lipids
Refer to Ans 6 of same chapter.

Functions of Lipids
♦♦ They are the storage form of energy.
♦♦ Lipids such as phospholipids and cholesterol are the
structural component of biomembranes.
♦♦ Lipids such as prostaglandins and steroid hormones are
metabolic regulators.
♦♦ Amphipathic lipids function as surfactants, detergents and
emulsifying agents.
♦♦ It function as electric insulators in neurons.
♦♦ Subcutaneous fat provides insulation against changes in
external temperature.
♦♦ It provide contour and shape to body.
♦♦ It protect internal organs by providing cushioning effect.
♦♦ It absorb fat soluble vitamins.
♦♦ It improve taste as well as palatability to food.
Q.15. Describe fatty acid synthesis. (Mar 2013, 8 Marks)
Ans. De Novo, i.e. new synthesis of fatty acid occur in liver,
kidney, adipose tissue and lactating mammary glands.
• Enzyme for the synthesis of fatty acids is located in
cytosomal fraction of cell.
• Acetyl-CoA acts as a source for carbon atoms during
synthesis of fatty acids.
• NADPH gives reducing equivalents during synthe-
sis of fatty acids.
• ATP gives energy for fatty acid formation during
synthesis of fatty acids.
• Major fatty acid synthesized de novo is palmitic acid
which is the 16 carbon saturated fatty acid.
Fatty acid synthesis occur in following steps which
are as follows:

Step I: Carboxylation of Acetyl-CoA

♦♦ Starting step in the fatty acid synthesis is carboxylation of
acetyl-CoA which leads to the formation of malonyl-CoA.
♦♦ Acetyl-CoA carboxylase is the rate-limiting enzyme.
♦♦ Biotin is necessary for this reaction. Biotin is allosterically
regulated and the major effectors being citrate (positive)
and palmitoyl-CoA (negative).
♦♦ Elongation of the fatty acid occurs by addition of 2-carbon
atoms at a time. But the 2-carbon units are added as
3-carbon, malonyl units. The whole reaction sequence
occurs, while the intermediates are bound to acyl carrier
protein (ACP). Fig. 28:  Fatty acid synthesis

Step II: Three-Carbon and Two-Carbon Units are Added
♦♦ II-A: Acetyl transacylase catalyzes the transfer of the
acetyl group (2-carbons) to the cysteinyl SH group of the
condensing enzyme (CE) of the other monomer of the fatty
acid synthase complex.
♦♦ II-B: One molecule of acetyl-CoA (2-carbon) and one
molecule of malonyl-CoA (3-carbon) bind to the fatty acid
synthetase complex. Malonyl transacylase transfers the
malonyl group to the SH group of the acyl carrier protein
of one monomer of the enzyme.
Step III: Condensation
The acetyl (2-carbon) and malonyl (3-carbon) units are
condensed to form beta-ketoacyl-ACP or acetoacetyl ACP
(4-carbon). During this process one carbon is lost as CO2. The
enzyme is called condensing enzyme.
Step IV: Reduction
Acetoacetyl ACP is reduced by NADPH dependent beta-keto-
acyl reductase to form beta-hydroxy fatty acyl ACP.
Step V: Dehydration
It is then dehydrated by a dehydratase (DH) to form enoyl-ACP
otherwise known as (alpha-beta unsaturated acyl-ACP).
Step VI: Second Reduction
Enoyl ACP is again reduced by enoyl reductase (ER) utilizing
a 2nd molecule of NADPH to form butyryl ACP. The butyryl
group (4-carbon) is now transferred to the SH group of the
condensing enzyme on the other monomer and a 2nd malonyl-
CoA molecule binds to the phosphopantothenyl SH group.
The sequence of reactions, namely condensation, reduction,
dehydration and reduction (steps II, IV, V, VI) are repeated.
The cycles are repeated a total of seven times, till the 16-carbon
palmitic acid is formed.
Step VII: Palmitic Acid is Released
Thioesterase or deacylase activity releases palmitate from
multienzyme complex. The end point is palmitic acid
(16-carbon) in liver and adipose tissue. In lactating mammary
gland end products are capric acid (10-carbon) and lauric acid
(12-carbon).
Q.16. Write about biomedical importance of phospholipids. enzyme lipoprotein lipase and triacylglycerol lipase.
(Sep 2015, 7 Marks)
Ans. Following is the biomedical importance of phospholipids:
• Phospholipids participate in the lipoprotein com-
plexes which are thought to constitute the matrix
of cell walls and membranes, myelin sheath and of
such structures as mitochondria and microsomes. In
this role, they impart certain physical characteristics:
• Unexpectedly high permeability towards certain
nonpolar (hydrophobic) molecules.
• Lysis by surface active agents—detergents, bile
salts, etc.
Biochemistry 489
• Certain enzymes require tightly bound phospho-
lipids for their actions, e.g. mitochondrial enzyme
system involved in oxidative phosphorylation.
• It play an essential part in the blood coagulation
process. Required at the stage of:
– Conversion of prothrombin to thrombin by ac-
tive factor X.
– Possibly also in the activation of factor VIII by
activated factor IX.
– Platelets provide the chief source of phospho-
lipids and that part of total lipid content of the
platelets which contributes to intrinsic blood
coagulation process and is called as platelet
factor 3.
• Lecithin lowers the surface tension of water and
aids in emulsification of lipid water mixtures, a
prerequisite in digestion and absorption of lipids
from gastrointestinal tracts.
• Exogenous triglycerides is carried as lipoprotein
complex, chylomicrons in which phospholipids
takes an active part.
• Endogenous triglycerides are carried from liver
to various tissues as lipoprotein complex Pre-β-
lipoprotein (VLDL), phospholipid is required for
the formation of the lipoprotein complex.
• Probably phospholipid help to couple oxidation with
phosphorylation and maintain electron transport
enzymes in active conformation and proper relative
positions.
• Choline acts as a lipotropic agent as it can prevent
formation of fatty liver. As lecithin it can provide
choline and acts as lipotropic agent.
• Phospholipids are in some way implicated in the
mechanism of secretion is suggested by the observa-
tion that phospholipids, specially phosphatidic acid
and phosphoinositides turnover is proportional to
the rate of secretion of cells liberating such products
as hormones, enzymes, mucins and other proteins.
• Phospholipids of membrane are hydrolyzed by
phospholipase A2 and provide unsaturated fatty
acid, arachidonic acid which is utilized for synthesis
of prostaglandins and leukotrienes.
• Phospholipids of myelin sheaths provide the insula-
tion around the nerve fibers.
• They are required as a cofactor for the activity of the
Q.17. Write briefly about atherosclerosis.
 (Oct 2016, 2 Marks)
Ans. Atherosclerosis is characterized by hardening and
narrowing of arteries due to deposition of lipids mainly
cholesterol, free and esterified lipids.
• Deposition of cholesterol and other lipids in the inner
arterial wall leads to the formation of plaque (sticky
deposit) and results in the endothelial damage and
narrowing of the arterial lumen.
• Hardening and narrowing of coronary arteries result
in coronary heart disease.
490 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Cause of Atherosclerosis ♦♦ Moderate consumption of alcohol and exercise appears to

♦♦ Age: Aging causes changes in the blood vessel wall because
of decreased metabolism of cholesterol. As age advances
elasticity of the vessel wall decreases and formation of
plaques increases. Plaques are composed of smooth muscle
cells, connective tissue, lipids and debris that accumulate in
the inner side of the arterial wall. Formation of plaque leads
to narrowing of the lumen and leads to atherosclerosis.
♦♦ Sex: Males are affected more than females, female
incidence increases after menopause. Reason behind this
is male sex hormone is atherogenic or conversely female
sex hormones might be protective.
♦♦ Genetic factor: Hereditary genetic derangement of
lipoprotein metabolism leads to high blood lipid level and
causes familial hypercholesterolemia.
♦♦ Hyperlipidemia: Increased levels of total serum cholesterol,
triacylglycerol, low density lipoprotein are associated with
increased risk of atherosclerosis.
♦♦ Hypertension: It is the major risk factor in patients over 45
years of age. It acts probably by mechanical injury of the
arterial wall due to increased blood pressure.
♦♦ Cigarette smoking: Ten cigarettes per day increase the risk
three—fold due to reduced level of HDL and accumulating
carbon monoxide that may cause endothelial cell injury.
♦♦ Diabetes mellitus: The risk is due to the coexistence of
other risk factors, such as obesity, hypertension, and
hyperlipidemia.
♦♦ Minor or soft risk factors: These include lack of exercise,
stress, obesity, high caloric intake, diet containing large
quantities of saturated fats, use of oral contraceptive,
alcoholism and hyperuricemia, etc.
Prevention of Atherosclerosis
♦♦ Eat a low fat diet that contains mainly unsaturated fat with
low cholesterol content.
♦♦ Natural antioxidants, such as vitamin E, C or β-carotene
may decrease the risk of cardiovascular disease by
protecting LDL against oxidation.
have a slightly beneficial effect by raising the level of HDL.
♦♦ Drug therapy, e.g. lovastatin, clofibrate, cholestyramine
inhibits cholesterol synthesis.
Q.18. Write very short answer on essential fatty acids.
 (Apr 2018, 2 Marks)
Ans. Fatty acids which cannot be synthesized in the body and
therefore should be supplied in the diet are known as
essential fatty acids.
Chemically essential fatty acids are the polyunsaturated
fatty acids, i.e. linoleic acid and linolenic acid.
Arachidonic acid becomes essential fatty acid when
its precursor linoleic acid is not provided in the diet in
sufficient amount.
Functions of Essential Fatty Acids
Essential fatty acids are required for:
♦♦ Membrane structure and function
♦♦ Transport of cholesterol
♦♦ Formation of lipoproteins
♦♦ Prevention of fatty liver
♦♦ Synthesis of eicosanoids.
Deficiency of Essential Fatty Acids
♦♦ Deficiency of essential amino acids leads to phrynoderma
or toad skin. This is characterized by the presence of horny
eruptions on the posterior and lateral parts of limbs and
on the back and buttocks. There is also loss of hair and
poor sound healing.
♦♦ Impaired lipid transport and fatty liver can occur.
♦♦ Decrease in efficiency of biological oxidation.
Q.19. Write about hyperlipidemia. (Sep 2018, 5 Marks)
Ans. Hyperlipidemia refers to increased plasma levels of
cholesterol (hypercholesterolemia) and triacylglycerols
(hypertriacylglycerolemia or hypertriglyceridemia).
Hyperlipidemia is synonymous with hyperlipoproteine-
mia.
Frederickson’s Classification for Hyperlipidemia

Hyperlipo- Increased
proeinemia plasma Increased Probable metabolic
type lipoprotein plasma lipid defect Risk of atherosclerosis Suggested treatment
I Chylomicrons Triacylglycerols Deficiency of Can increase Take low fat diet
lipoprotein lipase
IIa LDL Cholestrol Deficiency of LDL Very high Low cholesterol fat diet
receptor (in coronary artery)
IIb LDL and VLDL Triacylglycerols Overproduction of Very high Low cholesterol fat diet
and cholestrol apolipoprtein E (in coronary artery)
III IDL Triacylglycerols Abnormality in Very high Low fat and low calorie diet;
and cholestrol apolipoprtein E (in peripheral vessels) clofibrate
IV VLDL Triacylglycerols Overproduction of Can or cannot increase Low fat and low calorie diet; niacin
triglycerides
V Chylomicrons Triacylglycerols – Can or cannot increase Low fat and low calorie diet; niacin
and VLDL

Description
♦♦ Type I: It occurs due to familial lipoprotein lipase
deficiency. Enzyme defect leads to increase in plasma
chylomicron and triacylglycerol levels.
♦♦ Type IIa: It is also called as hyperbetalipoproteinemia
and occurs due to defect in LDL receptors. This disorder
is mainly characterized by hypercholesterolemia.
♦♦ Type IIb: Both LDL as well as VLDL elevated with rise
in plasma cholesterol. It is due to overproduction of
apolipoprotein B.
♦♦ Type III: It is also known as broad beta disease and is
characterized by appearance of broad β band which
corresponds to intermediate density lipoprotein (IDL)
during electrophoresis.
♦♦ Type IV: This occurs because of overproduction of
endogenous triacylglycerols with concomitant rise in
VLDL.
♦♦ Type V: In this both chylomicrons as well as VLDL get
raised. It is a secondary condition.
5. MINERAL METABOLISM
Q.1. Write the role of fluorine in dental care.
 (Sep 2009, 5 Marks)
Ans. Fluorine is an essential trace element.
Source
Fluoride is solely derived in humans from “drinking water”
Requirement—1 ppm.
Role in Dental Care
Improved Crystallinity
Fluoride increases the size of crystal and leads to less strain
in crystal lattice. This takes place when there is conversion
of amorphous calcium phosphate into crystalline hydroxy­
phosphate.
Void Theory
Incorporation of fluoride leads to formation of larger and more
stable crystals. Fluoride replaces hydroxyl ion from the center
of calcium triangle. It forms strong covalent interaction forces
with calcium, thereby decreasing the dimension of this axis.
Hydroxyapatite crystals are known to have inherent voids
due to missing hydroxyl groups which makes it unstable.
In hydroxyapatite crystal hydroxyl group is present slightly
above or below the plane formed by calcium ion. To maintain
symmetry equal number of hydroxyl ions should be present
on both the sides of calcium plane. At times when hydrogen
of adjacent hydroxyl groups point towards each other, this
results in stearic interference resulting into the elimination of
one hydroxyl group, thereby forming a void in the place. Voids
in the crystal decreases the stability and increases chemical
reactivity. When these voids are filled by fluoride, the stability of
Biochemistry 491
the crystal increases and the reactivity decreases greater stability
of the crystal impart lower solubility and greater resistance to
dissolution in acids.
Acid Solubility
Fluorapatite or fluoridated hydroxyapatite is less soluble than
hydroxyapatite and have greater stability.
Enzyme Inhibition
Fluoride has enolase inhibition effect and it also inhibits glucose
transport. Enolase is a metalloenzyme that requires a divalent
cation for its activity; fluoride due to its increased reactivity
forms a complex with this cation thus inhibits the enzyme. It
also inhibits nonmetalloenzymes like phosphatases thus leading
to reduced acid production.
Suppressing the Flora
Stannous fluoride is a potent suppressor of the bacterial growth
because it oxidizes the thiol group present in bacteria and
inhibits bacterial metabolism.
Antibacterial Action
Concentration of fluoride above 2 ppm in solution progressively
decreases the transport of uptake of glucose into cells of oral
streptococci and also reduces ATP synthesis.
Decreasing Free Surface Energy
Fluoride incorporated in enamel by substitution of hydroxyl
ions reduces the free surface energy and thus indirectly reduces
the deposition of pellicle and subsequent plaque formation.
Desorption of Protein and Bacteria
Hydroxyapatite crystals are amphoteric with both positive and
negative receptor sites. Acidic protein group binds protein and
bacteria to calcium site and basic to phosphate site. Fluoride
inhibits the binding of acidic protein to hydroxyapatite thereby
displaying its beneficial effects.
Alteration in Tooth Morphology
Dentition in fluoridated communities showed a tendency
towards rounded cusps, shallow fissures due to selective
morphology inhibition of ameloblasts.
Q.2. Write a short note on fluorine. (Sep 2001, 5 Marks)
 (May/June 2009, 5 Marks) (Dec 2010, 3 Marks)
Ans. Fluorine is a trace element.
Sources
For humans, drinking water is the main sources of fluorine.
Daily Requirements
Fluorine is present in small amount in normal bones and teeth
1-2 ppm per day or 1.5 to 4 mg/day.
492 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Physiological Functions
♦♦ Fluoride in trace quantities is essential for the development
of teeth and bones.
♦♦ Fluoride ions inhibit the metabolism of oral bacterial
enzymes and diminish the local production of acids which
are important in production of dental caries.
♦♦ Fluorine forms a protective layer acid, resistant fluo­
roapetite with hydroxyapetite crystals of the enamel.
Fluoride Deficiency
Drinking water which consists of less than 0.5 ppm of fluoride
is associated with the development of dental caries in children.
Fluoride Excess
Excess of fluoride lead to fluorosis.
♦♦ Level of fluoride more than 2 ppm leads to chronic
intestinal upset, gastroenteritis, loss of appetite and loss
of weight.
♦♦ Excessive intake of fluorine mainly 5 ppm in children leads
to mottling of enamel and discoloration of teeth. Teeth
become weak, rough with characteristic brown or yellow
patches on their surface. These manifestations are known
as dental fluorosis.
♦♦ Level of fluoride, i.e. more than 20 ppm is toxic which
produce alternate areas of osteoporosis, osteosclerosis
with brittle bones. Hypercalcification, increase in density
of bone of limbs, pelvis and spine are the characteristic
features. Ligaments of spine and collagen of bone become
calcified. This is also known as skeletal fluorosis.
♦♦ Advanced fluorosis is characterized by joint defects;
especially genu valgum. Individuals become crippled
and cannot perform their routine work due to stiff joints.
Q.3. Write a short note on fluorine metabolism.
 (Apr 2010, 5 Marks)
Ans. Distribution
It occurs in many tissues like bones, teeth and kidney.
It remains mostly in extracellular water. The amount
of fluorine in the soft tissues are very low and do not
increase with diet.
Absorption
Soluble fluorides are rapidly absorbed from the small intestine.
Excretion
It is excreted in the urine, in the sweat and by the intes­tinal
mucosa.
Q.4. Write a short note on absorption and functions of
calcium and phosphate ions. (Mar 2009, 5 Marks)
Ans. Calcium
Absorption of Calcium Ion
Calcium is absorbed in duodenum by energy dependent active
process. Following are the factors which influences absorption:
A. Factors promoting calcium absorption:
• Vitamin D induces synthesis of calcium binding
protein in intestinal epithelial cells and promotes the
calcium absorption.
• Parathyroid hormone enhances calcium absorption
through increased synthesis of cholesterol.
• Acidity is favorable for calcium absorption.
• Lactose promote calcium uptake via intestinal cells.
• Arginine and lysine facilitate absorption of calcium.
B. Factors inhibiting calcium absorption:
• Phytates and oxalates lead to the formation of
insoluble salts and interfere with the absorption of
calcium.
• High content of dietary phosphate leads to the
formation of insoluble calcium phosphate and prevent
uptake of calcium.
• Free fatty acids react with calcium to form insoluble
calcium soaps.
• Alkaline condition is unfavorable for calcium absorp­
tion.
• High content of dietary fiber interfere with calcium
absorption.
Functions of Calcium Ion
♦♦ Calcium is necessary for the activation of clotting enzymes
in the plasma, it also causes activation of enzymes involved
in producing inflammatory response.
♦♦ Calcium ion controls membrane excitation and calcium
ion influx occur during the excitation of nerve and muscle.
♦♦ It is bound to the cell surface and leads to stabilization of
membrane and also causes intercellular adhesion.
♦♦ It causes muscular contraction, i.e. excitation–contraction
coupling.
♦♦ It is also needed in excitation–secretion coupling process.
Phosphate
Phosphate Absorption
♦♦ Phosphate absorption occurs from the jejunum.
♦♦ Inorganic phosphorus in duodenum and in other parts
of small intestine get absorbed by active transport and
passive diffusion.
♦♦ Calcitriol promote uptake of phosphate along with calcium.
♦♦ There is optimum absorption of phosphorus and calcium
when ratio between calcium and phosphorus is between
1:2 and 2:1.
Physiological Functions
♦♦ It is essential for the formation and development of bones
and teeth along with calcium.
♦♦ It is required for the formation of energy rich compounds,
such as ATP.
♦♦ It is required in the absorption of glucose by phosphoryla­
tion.
♦♦ It form coenzymes, such as NADP, ADP, AMP and B6-
PO4, etc.
♦♦ It functions in the buffering system in cells.

Q.5. Write briefly on calcium and phosphate metabolism.
 (Mar 2001, 5 Marks)
Ans. Calcium Metabolism
Following is the calcium metabolism:
Calcium Absorption
Calcium is absorbed in duodenum by energy dependent active
process. Following are the factors which influences absorption:
A. Factors promoting calcium absorption:
• Vitamin D induces synthesis of calcium binding
protein in intestinal epithelial cells and promotes the
calcium absorption.
• Parathyroid hormone enhances calcium absorption
through increased synthesis of cholesterol.
• Acidity is favorable for calcium absorption.
• Lactose promote calcium uptake via intestinal cells.
• Arginine and lysine facilitate absorption of calcium.
B. Factors inhibiting calcium absorption:
• Phytates and oxalates lead to the formation of
insoluble salts and interfere with the absorption of
calcium.
• High content of dietary phosphate leads to the
formation of insoluble calcium phosphate and prevent
uptake of calcium.
• Free fatty acids react with calcium to form insoluble
calcium soaps.
• Alkaline condition is unfavorable for calcium absorp-
tion.
• High content of dietary fiber interfere with calcium
absorption.
Excretion of Calcium
Calcium is excreted in feces as well as in urine. In feces, it is
excreted through exfoliated gastrointestinal tract cells and in
urine, it is excreted as calcium phosphate and calcium chloride.
Regulation of Calcium Level
The regulation of blood calcium level took place through three
hormones:
1. Parathormone: It is secreted by parathyroid gland and
its main function is to increase the blood calcium level by
mobilizing calcium from bone. Parathormone maintains
blood calcium level by following actions on bones, kidney
and gastrointestinal tract (GIT).
a. By increasing reabsorption of calcium from bones.
b. By decreasing excretion of calcium through kidneys.
c. By increasing absorption of calcium from GIT.
2. 1, 25-dihydroxycholecalciferol: It is a steroid hormone
synthesized from vitamin D by means of hydroxylation
reactions in liver and kidneys. The main action is to
increase the blood calcium level by increasing calcium
absorption from small intestine. The main actions of 1,
25-dihydroxycholecalciferol are:
a. It increases the absorption of calcium from intestine. It
does this by increasing formation of calcium-binding
Biochemistry 493
proteins in intestinal epithelial cells. These proteins
act as carrier proteins for facilitated diffusion by
which calcium ions are transported. The proteins
remain in cells for several weeks after 1, 25-dihydroxy-
cholecalciferol has been removed from body, thus
causing prolonged effect on calcium absorption.
b. It increases the synthesis of calcium-induced ATP in
intestinal epithelium.
c. It increases the synthesis of alkaline phosphates in
intestinal epithelium.
3. Calcitonin: It is secreted by parafollicular cells of thyroid. It
is a calcium lowering hormone. It decreases blood calcium
level by decreasing reabsorption. It reduces blood calcium
level by acting on bone, kidney and intestine.
a. On bones: It facilitates deposition of calcium on bones.
It suppresses the activity of osteoclasts which are
responsible of calcium from bones.
b. On kidney: It increases excretion of calcium through
urine by inhibiting reabsorption of calcium from renal
tubules.
c. On intestine: It prevents the absorption of calcium
from intestine into blood.
Other Hormones Involved in Calcium Metabolism
♦♦ Growth hormone: It increases absorption of calcium from
intestine and enhances protein synthesis in bone.
♦♦ Insulin: It is an anabolic hormone which favors bone
formation.
♦♦ Sex hormones: These hormones increases calcium
absorption, decreases calcium excretion and enhances
bone mineralization. Estrogen has direct effect on bone
resorption.
♦♦ Prolactin: It increases calcitriol production and increases
calcium absorption during lactating period.
♦♦ Thyroid hormone: It increases in levels of thyroid
hormone which is accompanied by osteoporosis and
hypercalcinuria.
Phosphate Metabolism
Following is the phosphate metabolism:
Absorption
♦♦ Phosphate absorption occurs from the jejunum.
♦♦ Inorganic phosphorus in duodenum and in other parts
of small intestine get absorbed by active transport and
passive diffusion.
♦♦ Calcitriol promote uptake of phosphate along with
calcium.
♦♦ There is optimum absorption of phosphorus and calcium
when ratio between calcium and phosphorus is between
1:2 and 2:1.
Distribution and Fate
♦♦ Approximately 3 mg/kg/day of phosphorus ion enter inside
the bone with equal amount leaving via reabsorption.
494 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Inorganic phosphorus in plasma get filtered in glomeruli
of which 85 to 95% become reabsorbed actively in proximal
convoluted tubule. Excretion of phosphate in urine:
• Increases by vitamin D excess, hyperparathyroidism
and high phosphate diet.
• Decreases by growth hormone, during lactation,
hypoparathyroidism and low phosphate diet.
Q.6. Write a short note on calcium.
 (Nov 2012, 3 Marks) (Jan 2012, 3 Marks)
Ans. Total calcium in the human body is about 1 to 1.5 kg.
Sources of Calcium
Best sources: Milk and the milk products
Good sources: Beans, leafy vegetables, fish, cabbage, egg yolk.
Daily Requirement of Calcium
Adult men and women: 800 mg/day
Women during pregnancy, lactation and post menopause: 1.5
g/day
Children (1 to 18 years): 0.8 to 1.2 g/day
Infants (less than 1 year): 300 to 500 mg/day
Absorption of Calcium
Absorption is taking place from the first and second part of
duodenum. Absorption requires a carrier protein, helped by
calcium-dependent ATPase.
Factors Affecting Absorption of Calcium
♦♦ Vitamin D: Calcitriol induces the synthesis of the carrier
protein in the intestinal epithelial cells, and so facilitates
the absorption of calcium.
♦♦ Parathyroid hormone: It increases calcium transport from
the intestinal cells.
♦♦ Acidity: It favors calcium absorption.
♦♦ Phytic acid: It is present in cereals. It reduces uptake of
calcium. Cooking reduces phytate content.
♦♦ Oxalates: They are present in leafy vegetables which cause
formation of insoluble calcium oxalates; so absorption is
reduced.
Functions of Calcium
♦♦ Activation of enzymes: Calmodulin is a calcium binding
regulatory protein. Calmodulin can bind with 4 calcium
ions. Calcium binding leads to activation of enzymes.
Calmodulin is a part of various regulatory kinases.
♦♦ Muscles: Calcium mediates excitation and contraction of
muscle fibers. Upon getting the neural signal, calcium is
released from sarcoplasmic reticulum. Calcium activates
ATPase; increases reaction of actin and myosin and
facilitates excitation-contraction coupling.
♦♦ Nerves: Calcium is necessary for transmission of nerve
impulses from pre-synaptic to post-synaptic region.
♦♦ Secretion of hormones: Calcium mediates secretion of
insulin, parathyroid hormone, etc. from the cells.
♦♦ Coagulation: Calcium is known as factor IV in blood
coagulation cascade. Prothrombin contains gamma-
carboxy glutamate residues which are chelated by Ca2+
during the thrombin formation.
♦♦ Bone and teeth: Bulk quantity of calcium is used for bone
and teeth formation. Bones also act as reservoir for calcium
in the body.
Q.7. Describe functions and clinical importance of calcium.
 (Aug 2012, 4 Marks)
Ans. For function of calcium refer to Ans 6 and for clinical
importance of calcium refer to Ans 11 of same chapter.
Q.8. Describe nutritional importance of minerals in brief.
 (Mar 2007, 4 Marks) (Apr 2010, 3.5 Marks)
Ans. The mineral elements are supplied by the diet. Minerals
play important role in body function.
Calcium
♦♦ Calcium along with phosphorus is essential for the
formation and development of bones and teeth.
♦♦ Ionized calcium is required in blood coagulation process.
♦♦ It regulates the excitability of nerve fibers.
Phosphorus
As constituent of body cells of soft tissues such as muscles,
liver, etc.
♦♦ It requires for absorption of glucose.
♦♦ It requires for the formation of energy compound such
as ATP.
Magnesium
It combined with calcium and phosphorus in complex salt of
bone. It functions as a cofactor for oxidative pho­sphorylation.
Others
♦♦ Sodium, potassium and chlorine are involved mainly in
the maintenance of acid-base balance and osmotic control
of water metabolism.
♦♦ Sodium ion is involved in initiating and maintaining the
heart beat.
Trace Elements
♦♦ Iodine is required for thyroxine formation.
♦♦ Iron and copper are required for hemoglobin formation.
♦♦ Zinc is a constituent of carbonic anhydrase and insulin.
♦♦ Cobalt is a constituent of vitamin B12.
Q.9. Write a short note on fluoride—function, deficiency
and excess. (Nov 2009, 3 Marks)
Ans. For functions refer to Ans 1 of same chapter.
Deficiency of Fluoride
Fluoride deficiency is a disorder which may cause increased
dental caries and possibly osteoporosis due to a lack of
fluoride in the diet.

Excess of Fluoride
♦♦ Excessive intake of fluoride is harmful to the body.
♦♦ An intake above 2 ppm in children causes mottling of
enamel and discoloration of teeth. The teeth are weak and
become rough with characteristic brown or yellow patches
on their surface. These manifestations are collectively
referred to as dental fluorosis.
♦♦ An intake of fluoride above 20 ppm is toxic and causes
pathological changes in the bones.
♦♦ Hypercalcification, increasing the density of the bones
of limbs, pelvis and spine, are the characteristic features.
Even the ligaments of spine and collagen of bones get
calcified.
♦♦ Neurological disturbances are also commonly observed. The
manifestations described here constitute skeletal fluorosis. In
the advanced stages, the individuals are crippled and cannot
perform their daily routine work due to stiff joints. This
condition of advanced fluorosis is referred to as genu valgum.
Q10. Describe in brief albinism/dental fluorosis.
 (Jan 2012, 4 Marks)
Ans. Albinism
• The Greek word, albino means white. Albinism is
an autosomal recessive disease with an incidence of
1 in 20,000 population.
• Tyrosinase is completely absent leading to defective
synthesis of melanin.
• The ocular fundus is hypopigmented and iris may
be gray or red. There will be associated photophobia,
nystagmus.
• The skin has low pigmentation, and so skin is sensi-
tive to UV rays. Skin may show presence of naevi
and melanomas. Hair is also white.
Dental Fluorosis
♦♦ Intake of excessive amount of fluoride, i.e. 3 to 5 ppm in
childhood leads to dental fluorosis or mottled enamel.
♦♦ The enamel of teeth looses its lusture and become rough.
♦♦ Chalky white patches with yellow or brown staining are
found over the surface of teeth.
♦♦ Enamel becomes weak and in several cases there occurs
a profound loss of enamel with pitting which gives both
surfaces a corroded appearance.
Q.11. What is the importance of calcium in body? Describe
the role of hormones in regulation of blood calcium
level. Add a note on osteoporosis.
 (May/June 2009, 15 Marks)
Ans. Importance of Calcium in Body
• Development of bones and teeth: Calcium with
phosphate is required for the formation as well as
physical strength of the skeletal tissue. Bones serve
as reservoir of calcium.
• Muscle contraction: Calcium undergoes interaction
with troponin C and triggers the muscle contraction.
It activate ATPase and mediates the excitation and
contraction of muscle fibers.
Biochemistry 495
• Coagulation of blood: Calcium is also known as
factor IV in blood coagulation mechanism. Various
reactions in blood coagulation process depend on it.
• Nerves: Calcium leads to transmission of nerve
impulses from pre-synaptic region to post-synaptic
region.
• Membrane integrity and permeability: Calcium
influences the structure of membrane and leads to
transportation of water and several ions across it.
• Activation of enzyme: Calcium causes activation
of enzymes such as lipases, ATPase and succinate
dehydrogenase. Calcium also binds with calmodulin.
This complex activates enzymes such as adenylate
cyclase and calcium dependent protein kinases.
• Release of hormones: Calcium facilitates release of
various hormones such as insulin, calcitonin, etc.
Role of Hormones in regulation of blood calcium level
Following hormones regulates the blood calcium level, i.e.
♦♦ Calcitriol
♦♦ Parathyroid hormone
♦♦ Calcitonin.
Calcitriol
Physiological active form of vitamin D is known as Calcitriol.
Calcitriol causes the synthesis of calcium binding protein in
intestinal cells. This protein causes the increase in intestinal
absorption of calcium. Now the blood calcium level is increased.
The hormone stimulates the calcium intake by osteoblasts of
bone which leads to calcification of bone.
Parathyroid Hormone
♦♦ Action of parathyroid on bone: It leads to decalcification
of bone. Parathyroid hormone increases the activity of
pyrophosphatase and collagenase enzyme. These enzymes
cause the bone resorption. Demineralization increases the
blood calcium level.
♦♦ Action on kidney: Parathyroid increases the calcium
reabsorption by kidney tubules. This elevates blood
calcium levels.
♦♦ Action on intestine: Action of parathyroid hormone on
intestine is indirect. It increases the intestinal absorption
of calcium by promoting synthesis of calcitriol.
Calcitonin
Calcitonin promotes calcification by increasing the activity of
osteoblasts. It decreases bone resorption and increases excretion
of calcium in urine. It decreases the blood calcium levels.
Osteoporosis
♦♦ Osteoporosis leads to demineralization of bone causing
progressive loss in bone mass.
♦♦ Elderly women over the age of 60 years are at risk of
osteoporosis.
♦♦ Mostly it occurs in postmenopausal women.
♦♦ It leads to frequent bone fractures which causes disability.
496 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ It occurs because the ability of calcitriol from vitamin D
is decreased with age in postmenopausal women which
causes osteoporosis.
♦♦ Deficiency of sex hormones also leads to the development
of osteoporosis.
♦♦ In the treatment of osteoporosis estrogen is given along
with calcium supplementation.
Q.12. Write a short note on metabolism of Fe (Iron).
 (June 2010, 5 Marks)
Ans. Iron consumed in the diet is either free iron or heme iron.
• Nonheme iron bound to organic acids or proteins
and is absorbed in ferrous (Fe2+) state in mucosal cell.
• Gastric acid in diet convert bounded nonheme com-
pound of the diet in free ferric (Fe3+) ions.
• The free ferric ions are reduced with ascorbic acid
and glutathione of food to more soluble ferrous (Fe2+)
form which is readily absorbed.
• After absorption ferrous form is oxidized in mucosal
cells to ferric by enzyme ferroxidase which combines
with apoferritin to form ferritin. Ferritin is the tem-
porary form of storage iron.
• Heme of food is absorbed by mucosal intestinal cells.
It is subsequently broken down and iron is released
with the cells.
Q.13. Give short account of Iron. (Sep 2013, 5 Marks)
Ans. Iron is a trace element present in the body.
• Its total content is 3 to 5 g.
• Approximately 70% of iron occurs in erythrocytes
of blood as a part of hemoglobin.
• Heme consists of iron and is the constituent of some
proteins, such as hemoglobin, myoglobin, catalase,
peroxidase, etc.
• Other proteins which consist of nonheme iron are
transferring, ferritin and hemosiderin.
Dietary Requirement
Here dietary requirement is expressed on the basis of single day:
♦♦ Man: 10 mg.
♦♦ Woman: 18 mg.
♦♦ Pregnant and lactating woman: 40 mg.
Sources
♦♦ Richest source is meat, i.e. liver, heart and kidney
♦♦ Good sources are leafy vegetables, pulses, fish, cereals,
apple, dry fruits and jaggery.
Absorption
Iron is absorbed in stomach and duodenum. In a normal
individual 10% of dietary iron is absorbed.
Transport and Storage
It is present in foods in ferric form which is bounded to proteins
or organic acids. The acid medium is provided by gastric HCl,
the Fe2+ is released from foods. Ascorbic acid and cysteine
convert ferric iron to ferrous form. Iron in ferrous form is soluble
and is readily absorbed.
Biochemical Functions
♦♦ Iron proceeds in its function by the compounds in which
it resides, i.e. hemoglobin and myoglobin. They require
transport of oxygen and carbon dioxide.
♦♦ Cytochrome and certain nonheme proteins are necessary
for electron transport chain and oxidative phosphorylation.
♦♦ Iron associates with immunocompetence of body.
♦♦ Iron also resides with peroxidase which is a lysosomal
enzyme which causes phagocytosis. Iron helps peroxidase
in phagocytosis.
Q.14. Write a short note on calcium metabolism.
 (Feb 2013, 7 Marks) (Oct 2016, 5 Marks)
Ans. Following is the calcium metabolism:
Calcium Absorption
Calcium is absorbed in duodenum by energy dependent active
process. Following are the factors which influences absorption:
A. Factors promoting calcium absorption:
• Vitamin D induces synthesis of calcium binding
protein in intestinal epithelial cells and promotes the
calcium absorption.
• Parathyroid hormone enhances calcium absorption
through increased synthesis of cholesterol.
• Acidity is favorable for calcium absorption.
• Lactose promote calcium uptake via intestinal cells.
• Arginine and lysine facilitate absorption of calcium.
B. Factors inhibiting calcium absorption:
• Phytates and oxalates lead to the formation of
insoluble salts and interfere with the absorption of
calcium.
• High content of dietary phosphate leads to the
formation of insoluble calcium phosphate and prevent
uptake of calcium.
• Free fatty acids react with calcium to form insoluble
calcium soaps.
• Alkaline condition is unfavorable for calcium
absorption.
• High content of dietary fiber interfere with calcium
absorption.
Excretion of Calcium
Calcium is excreted in feces as well as in urine. In feces, it is
excreted through exfoliated gastrointestinal tract cells and in
urine, it is excreted as calcium phosphate and calcium chloride.
Regulation of Calcium Level
The regulation of blood calcium level took place through three
hormones which are as follows:
1. Parathormone: It is secreted by parathyroid gland and
its main function is to increase the blood calcium level by
mobilizing calcium from bone. Parathormone maintains
blood calcium level by following actions on bones, kidney
and GIT.
 Biochemistry 497

a. By increasing reabsorption of calcium from bones.
b. By decreasing excretion of calcium through kidneys.
c. By increasing absorption of calcium from GIT.
2. 1, 25-dihydroxycholecalciferol: It is a steroid hormone
synthesized from vitamin D by means of hydroxylation
reactions in liver and kidneys. The main action is to
increase the blood calcium level by increasing calcium
absorption from small intestine. The main actions of 1,
25-dihydroxycholecalciferol are:
a. It increases the absorption of calcium from intestine.
It does this by increasing formation of calcium-
binding proteins in intestinal epithelial cells.
These proteins act as carrier proteins for facilitated
diffusion by which calcium ions are transported.
The proteins remain in cells for several weeks after
1, 25-dihydroxycholecalciferol has been removed
from body, thus causing prolonged effect on calcium
absorption.
b. It increases the synthesis of calcium-induced ATP in
intestinal epithelium.
c. It increases the synthesis of alkaline phosphates in
intestinal epithelium.
3. Calcitonin: It is secreted by parafollicular cells of thyroid. It
is a calcium lowering hormone. It decreases blood calcium
level by decreasing reabsorption. It reduces blood calcium
level by acting on bone, kidney and intestine.
a. On bones: It facilitates deposition of calcium on bones.
It suppresses the activity of osteoclasts which are
responsible of calcium from bones.
b. On kidney: It increases excretion of calcium through
urine by inhibiting reabsorption of calcium from renal
tubules.
c. On intestine: It prevents the absorption of calcium
from intestine into blood.
Other Hormones Involved in Calcium Metabolism
♦♦ Growth hormone: It increases absorption of calcium from
intestine and enhances protein synthesis in bone.
♦♦ Insulin: It is an anabolic hormone which favors bone
formation.
♦♦ Sex hormones: These hormones increases calcium
absorption, decreases calcium excretion and enhances
bone mineralization. Estrogen has direct effect on bone
resorption.
♦♦ Prolactin: It increases calcitriol production and increases
calcium absorption during lactating period.
♦♦ Thyroid hormone: It increases in levels of thyroid
hormone which is accompanied by osteoporosis and
hypercalcinuria.
Q.15. Write briefly about biological role of iron.
 (Feb 2016, 2 Marks)
Ans. Following is the biological role of iron:
• It exerts its functions via compounds in which it is
present. Hemoglobin and myoglobin are needed for
transport of oxygen and carbon dioxide.
• Cytochromes and various nonheme proteins are
needed for electron transport chain as well as oxida-
tive phosphorylation.
• Peroxidase which is a lysosomal enzyme is needed
for phagocytosis as well as killing of bacteria by
neutrophils.
• Iron is associated with the effective immunocompe-
tence of the body.
Q.16. Mention normal serum sodium and potassium levels.
 (Aug 2016, 2 Marks)
Ans.
System of
Normal serum international units Conventional
analysis (SI units) units
Serum sodium level 136 to 146 mmol/L 136 to 146 mEq/l
Serum potassium level 3.5 to 5 mmol/L 3.5 to 5 mEq/l
Q.17. Describe the biochemical functions, dietary requirements,
sources and metabolism of calcium.
 (Aug 2016, 10 Marks)
Ans.
Biochemical Functions of Calcium
♦♦ Development of bones and teeth: Calcium with phosphate
is needed for the formation and physical strength of
skeletal tissue. Bones in dynamic state serve as reservoir
for calcium.
♦♦ Contraction of muscle: Interaction of calcium with
troponin C triggers muscle contraction. Calcium also
causes activation of ATPase. It also increases interaction
between actin as well as myosin.
♦♦ Coagulation of blood: Some reactions in blood clotting
process depends on calcium, i.e. factor IV.
♦♦ Nerve transmission: Calcium leads to transmission of
nerve impulses.
♦♦ Membrane integrity and permeability: Calcium influences
the structure of membrane as well as transport of water and
several ions across it.
♦♦ Enzyme activation: Calcium is needed for direct activation
of enzymes such as lipase, ATPase and succinate dehydro­
genase.
♦♦ Calmodulin mediated action of calcium: Calmodulin is
calcium binding regulatory protein. Calcium calmodulin
complex activate some enzymes, e.g. adenylate cyclase and
calcium dependent protein kinases.
♦♦ As intracellular messenger: Various hormones exert their
action via mediation of calcium. Calcium is regarded as
second messenger for such hormonal action. Calcium also
serves as third messenger for some hormones. Antidiuretic
hormone act through cAMP and then by calcium.
♦♦ Release of hormones: Release of various hormones,
i.e. insulin, parathyroid hormone and calcitonin from
endocrine glands is facilitated by calcium.
498 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Dietary Requirements of Calcium
♦♦ Adult men and women: 800 mg/day
♦♦ Women during pregnancy, lactation and postmenopause:
1.5 g/day
♦♦ Children (1 to 18 years): 0.8 to 1.2 g/day
♦♦ Infants (less than 1 year): 300 to 500 mg/day
Sources of Calcium
Best sources: Milk and the milk products
Good sources: Beans, leafy vegetables, fish, cabbage, egg yolk.
Metabolism of Calcium
For metabolism of calcium refer to Ans 14 of same chapter.
Q.18. Answer in brief about fluorosis. (Sep 2017, 2 Marks)
Or
Write very short answer on fluorosis.
 (Aug 2018, 2 Marks)
Ans. Fluorosis means the excessive amount of fluoride.
• Level of fluoride more than 2 ppm leads to chronic
intestinal upset, gastroenteritis, loss of appetite and
loss of weight.
• Excessive intake of fluorine mainly 5 ppm in children
leads to mottling of enamel and discoloration of
teeth. Teeth become weak, rough with characteristic
brown or yellow patches on their surface. These
manifestations are known as dental fluorosis.
• Level of fluoride, i.e. more than 20 ppm is toxic which
produce alternate areas of osteoporosis, osteoscle-
rosis with brittle bones. Hypercalcification, increase
in density of bone of limbs, pelvis and spine are the
characteristic features. Ligaments of spine and col-
lagen of bone become calcified. This is also known
as skeletal fluorosis.
• Advanced fluorosis is characterized by joint defects;
especially genu valgum. Individuals become crip-
pled and cannot perform their routine work due to
stiff joints.
• Because of increase breakdown of bone matrix,
excretion of hydroxyproline in urine is enhanced.
Prevention of Fluorosis
♦♦ Provide water which has normal limits of fluoride.
♦♦ Intake of jowar is restricted.
♦♦ Vitamin C supplementation is given.
♦♦ Fluoride containing toothpaste should be avoided.
Q.19. Write very short answer on osteoporosis.
 (Apr 2018, 2 Marks)
Ans. Osteoporosis is characterized by demineralization of
bone which results in the progressive loss of bone mass.
It occurs in elderly individuals but predominantly it
occurs in postmenopausal women. It leads to frequent
bone fractures which causes disability.
Etiology
It is believed that ability to produce calcitriol from vitamin D
decreases with age mainly in postmenopausal women. Immobile
individuals decreases bone mass, while those on regular exercise
increases bone mass. Deficiency of sex hormones mainly in
women is implicated in the development of osteoporosis.
Treatment
♦♦ Administer estrogen with calcium supplementation to
postmenopausal decreases chances of fractures.
♦♦ In elderly people, high dietary intake of calcium is
recommended, i.e. 1.5 g/day.
6. BIOLOGICAL OXIDATION
Q.1. Write a short note on ETC. (Dec 2010, 3 Marks)
Or
Write a short note on electron transport chain.
 (Mar 2013, 3 Marks)
Ans. Electrons present inside the mitochondria participate in
sequential oxidation reduction reaction of various redox
centers in enzyme complexes of mitochondria. Transfer
of electrons occurs from higher potential to lower
potential. Flow of electrons occurring via successive
dehydrogenase enzymes together known as electron
transport chain.
 Energy rich carbohydrates, fatty acids and amino acids
undergo metabolic reactions and oxidized to carbon
dioxide and water. Reducing equivalents from various
metabolic intermediates are transferred to coenzymes
NAD+ and FAD to produce NADH and FADH2. These
two reduced coenzymes pass via electron transport
chain or respiratory chain and finally reduce to oxygen
to water. The passage of electrons via electron transport
chain is associated with the loss of free energy. A part
of this free energy is utilized to generate ATP from ADP
and Pi.
 ETC is organized into five distinct complexes, i.e.
1. Complex I: NADH–CoQ reductase or NADH-
dehydrogenase complex
2. Complex II: Succinate-Q-reductase
3. Complex III: Cytochrome reductase
4. Complex IV: Cytochrome oxidase
5. Complex V: ATP synthase.
Complexes I, II, III and IV are electron carriers, whereas
complex V is responsible for ATP production.
 Five distinct carriers take part in the electron transport
chain. These carriers are responsible for the transfer of
electrons from a given substrate to ultimately combine
with proton and oxygen to form water.

Fig. 29:  Electron transport chain
I. Nicotinamide Nucleotides
Two coenzymes, i.e. NAD+ and NADP+ derived from vitamin
niacin, NAD+ is more actively involved in the electron
transport chain. Reduction of NAD+ occur to NADH + H+ by
dehydrogenases along with the removal of two hydrogen atoms
from the substrate. The substrates include glyceraldehyde-3-
phosphate, pyruvate, isocitrate, α—ketoglutarate, and malate.
AH2 + NAD+ → A + NADH + H+
2. Flavoproteins
Enzyme NADH dehydrogenase is a flavoprotein with FMN as
the prosthetic group. Coenzyme FMN receives two electrons
and a proton which form FMNH2. NADH dehydrogenase is a
complex enzyme which is closely associated with nonheme iron
proteins or iron–sulphur (FeS) proteins
NADH + H+ + FMN → NAD+ + FMNH2
3. Iron–Sulfur Proteins
Iron–sulfur proteins exist in either oxidized or in the reduced
state. About half a dozen of iron–sulfur proteins connect with
the respiratory chain are identified. Mechanism of action of
iron–sulfur protein in electron transfer chain is not clear.
4. Coenzyme Q
Coenzyme Q is also called as ubiquinone. This is a quinone
derivative with a variable isoprenoid side chain. The
mammalian tissues possess a quinone with 10 isoprenoid units,
which are known as coenzyme Q10 (CoQ10). Q—cycle facilitates
switching from ubiquinol, a two electron carrier, to cytochrome
c, a single electron carrier.
5. Cytochromes
Cytochrome c is a small conjugated protein containing 104
amino acids and a heme group. It is a central member of electron
transport chain with an intermediate redox potential. The iron of
heme in cytochromes is alternately oxidized (Fe3+) and reduced
(Fe2+), which is essential for the transport of electrons in the
electron transport chain.
The electrons are transported from coenzyme Q to
cytochromes b, c1, c, a and a3 in an orderly manner.
The property of reversible oxidation—reduction of heme
iron present in cytochromes allows them to function as effective
carriers of electrons in electron transfer chain. In the final stage of
Biochemistry 499
electron transport chain the transported electrons, free protons
and the molecular oxygen combine to produce water.
Free energy is utilized to generate ATP from ADP and Pi at
the following sites:
1. Oxidation of FMNH2 by CoQ
2. Oxidation of cytochrome b by cytochrome c1
3. Cytochrome oxidase reaction.
The respiratory chain or electron transfer chain can be
blocked by site-specific inhibitors like rotenone, amytal
piericidin, pierecidin A, antimycin A, 2,3—dimercaptopropanol
(BAL), sodium azide, cyanide and carbon monoxide, etc.
Q.2. Write a short note on biological oxidation.
 (Dec 2009, 5 Marks)
Ans. Biological oxidation is defined as the transfer of electrons
from reduced coenzymes through respiratory chain to
oxygen.
• Biological oxidation is exergonic.
• Example is interconversion of ferrous ion to ferric
ion.
• During biological oxidation, the reacting chemical
systems move from higher energy level to a lower
one and there is liberation of energy.
• It provides energy for the aerobic metabolism. The
energy is released when electrons are transferred
from fuel molecules to oxygen.
• It effect the transfer of energy in controlled way.
• Energy released during biological oxidation is
trapped as ATP.
• Formation of ATP from ADP and Pi is known as
phosphorylation, as phosphorylation is coupled
with biological oxidation, it is known as biological
oxidative phosphorylation.
• Electron lost in oxidation is accepted by acceptor
which is said to be reduced.
7. ENZYMOLOGY
Q.1. Describe in brief classification of enzymes.
 (Jan 2012, 6 Marks) (May 2014, 5 Marks)
 (Dec 2014, 5 Marks)
Or
Write briefly about enzyme definition and classifica-
tion. (Feb 2016, 2 Marks)
500 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Ans. Definition of Enzyme

Enzymes are biological catalyst produced by living tissues.
They are proteins that have the property of accelerating specific
chemical reactions without being consumed in the process.

Classification of Enzymes
In 1964, according to International Union of Biochemistry and
molecular biology (IUBMB) enzymes are classified on the basis
of their function, i.e.
♦♦ EC 1: Oxidoreductases: These are the enzymes which
catalyze oxidation–reduction reaction, e.g. lactate
dehydrogenase, glucose–6–phosphate dehydrogenase and
cytochrome oxidase.
♦♦ EC 2: Transferases: These are the enzymes which catalyze
transfer of group such as amino, carboxyl, methyl or Fig. 30:  Effect of enzyme concentration on enzyme velocity
phosphoryl, etc. from one molecule to another, e.g.
aspartate aminotransminase, alanine aminotransaminase Concentration of Substrate
and hexokinase.
♦♦ EC 3: Hydrolases: Enzymes of this class catalyze the cleavage Increase in the concentration of substrate gradually increases
of C–O, C–N, C–C and some another bonds with addition of the velocity of an enzyme reaction within the limited range of
water, e.g. lipase, α-amylase, trypsin, lactase, sucrose, pepsin. substrate levels. When velocity is plotted against the substrate
♦♦ EC 4: Lyases: Enzymes catalyze the cleavage of C–O, concentration, a rectangular hyperbola is obtained. Graph
C–N and C–C bonds by means other than hydrolysis or demonstrates three phases of reaction:
oxidation, giving rise to compound with double bond Enzyme kinetics and km value: Enzyme (E) and substrate
or catalyze reverse reaction, by addition of group to a (S) both of them combine with each other and form an unstable
double bond, e.g. aldolase, argininosuccinase, carbonic enzyme–substrate complex (ES) for the formation of product (P).
anhydrase.
♦♦ EC 5: Isomerases: Enzymes involved in all the isomerization
reactions, e.g. phosphoglucomutase, triphosphate
isomerase and phosphohexose isomerase
♦♦ EC 6: Ligases: Enzymes catalyzing the synthetic reactions
of linking together of two compounds, e.g. glutamine
synthetase, pyruvate carboxylase and DNA ligases.
In above mentioned classification each class is subdivided
into many subclasses which are further divided. A four digit
enzyme commission (EC) number is assigned to each enzyme
representing the class (first digit), subclass (second digit),
sub–subclass (third digit) and the individual enzyme (fourth
digit). For an instance an example is given, i.e. enzyme alcohol
dehydrogenase is given code as 1.1.1.1, this means alcohol
dehydrogenase is first enzyme of subclass 1, sub–subclass 1
and of the class 1.
Q.2. Classify enzymes. Describe factors affecting rate of
reaction. (Dec 2004, 7.5 Marks) Fig. 31:  Effect of substrate concentration on enzyme velocity
Or
Describe factors affecting enzyme activity in brief.
 (Sep 2006, 4 Marks)
Here in this above equation K1, K2, K3 represent the velocity
Ans. Classification: Refer to Ans 1 of same chapter.
constants for their respective reactions.
Factors Affecting Rate of Reaction/Enzymes Activity Km is the Michaelis–Menten constant which is given by the
Concentration of an Enzyme formula:

As there is increase in the concentration of an enzyme, velocity

of the reaction proportionately increases. This property of an
enzyme is used in determining the serum enzymes for the Now following equation is obtained after the proper algebraic
diagnosing of diseases. manipulation:
 Biochemistry 501

Vmax[S] velocity is maximum. At neutral pH in the range of 6 to 8, most

V= of the enzymes of higher organism show optimum activity.
Km[S]
Where,
V is measured velocity
Vmax is maximum velocity
Km is Michaelis—Menten constant
S is substrate concentration
Km or the Michaelis—Menten constant is defined as substrate
concentration which produce half—maximum velocity in an
enzyme–catalysed reaction. This clearly indicates that half of
enzyme molecules get bound to substrate molecules when the
substrate concentration equals to Km value.
Km value is a constant and characteristic feature of a given
enzyme. This is main representative for measuring the strength
of ES complex. A low Km value should be indicative of a strong
affinity between enzyme and substrate, but a high Km value
shows weak affinity between them. Km value does not depend
on concentration of an enzyme.
Fig. 33:  Effect of pH on enzyme velocity
Effect of Temperature
♦♦ Velocity of an enzyme reaction enhances with increase Effect of Product Concentration
in temperature till maximum and then declines. A bell-
Enzyme velocity decreases by the accumulation of reaction
shaped curve is usually seen.
products. For various enzymes, the product combine with
♦♦ Mostly the enzymes have optimum temperature of 40 to 45°C.
the active site of enzyme and leads to the formation of loose
However, few of the enzymes, e.g. venom phosphokinases,
muscle adenylate kinase are active even at 100°C. complex, this inhibits the enzyme activity. This inhibition is
♦♦ As enzymes are exposed to higher temperature, i.e. more prevented by a quick removal of products formed in the living
than 50°C denaturation occur which cause derangement system.
in the native structure of protein and active site is seen.
Effect of Activators
♦♦ Majority of enzymes become deactivated at high
temperatures, i.e. above 70°C. Some enzymes need inorganic metallic cations such as Mg2+,
Mn2+, Zn2+, Ca2+,Co2+,Cu2+,Na+, K+, etc. for their optimum activity.
Very rarely anions are needed for the enzyme activity.
There are two categories of enzymes which need metals for
their activity, i.e. metal activated enzymes and metalloenzymes.
1. Metal-activated enzymes: Here metal is not tightly held by
an enzyme and should be exchanged easily by other ions.
e.g. ATPase is activated by Mg2+ and Ca2+ ions. Enolase is
activated by Mg2+ ions.
2. Metalloenzymes: Such enzymes hold metals tightly which
are not readily exchanged, e.g. alcohol dehydrogenase,
carbonic anhydrase, alkaline phosphatase, carboxypepti-
dase, etc.
• Phenol oxidase (copper)
• Pyruvate oxidase (manganese)
• Xanthine oxidase (molybdenum)
• Cytochrome oxidase (iron and copper)
Fig. 32:  Effect of temperature on enzyme velocity
Effect of Time
Effect of pH Under optimum conditions of pH and temperature, time require
Enzyme activity is influenced by increase in the hydrogen ion for an enzyme reaction is less. The time required for completion
concentration (pH). Normally, curve obtained here is of bell- of an enzyme reaction increases with the changes in temperature
shaped. Each enzyme consists of an optimum pH at which and pH from its optimum.
502 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Effects of Physical Agents of the gastrointestinal tract present in the plasma

are known as secretory enzymes. All other plasma
Physical agents, such as light rays can inhibit or accelerate
enzymes associated with metabolism of the cell are
various enzyme reactions, e.g. activity of salivary amylase is
increased by red and blue light, but on other hand it is inhibited collectively referred to as constitutive enzymes.
by ultraviolet rays. Various Enzymes in Diagnosis of Diseases
Q.3. Write a short note on clinical importance of Isoenzyme.
S. Serum Concentration Concentration
 (Dec 2010, 5 Marks) No. enzyme increased in decreased in
Ans. The enzymes that occur in a number of different forms 1. Amylase Acute pancreatitis, Liver disease
and differ each other chemically, immunologically and parotitis, diabetes
electrophoretically are called as Isoenzymes or isozymes.
2. SGPT Liver diseases -
  The clinical importance of these isoenzymes includes
3. SGOT Heart attack -
the diagnosis of various diseases which includes:
4. Alkaline Rickets, Paget’s -
Clinical Importance of Lactate Dehydrogenase phosphatase disease, hyperpara-
thyroidism, kidney
Lactate dehydrogenase (LDH) isoenzyme analysis is used in diseases
the following clinical situations:
5. Acid Cancer of prostrate -
♦♦ Significance of LDH1 and LDH2 occurs within 24 to 48 phosphatase
hours after myocardial infarction. 6. Lactate Heart attack and liver -
♦♦ Predominant elevation of LDH 2 and LDH 3 occur in dehydrogenase disease
leukemia. LDH3 is main isoenzyme elevated in malignancy
of many tissues. Q.5. Define and classify enzymes. Explain enzyme
♦♦ Elevation of LDH5 occurs after damage to liver or skeletal inhibition. (Jan 2012, 8 Marks)
muscle.
Or
Clinical Importance of Creatine Kinase Define and classify enzymes. Explain enzyme
♦♦ CK1 may be elevated in neonates mainly in the damaged inhibition with examples. (Mar 2013, 8 Marks)
brain or in very low birth weight newborn. Or
♦♦ Increased level of CK2 in blood is characteristic of damage
Write short answer on enzyme inhibition.
of heart tissue from myocardial infarction as cardiac tissue  (Apr 2018, 5 Marks)
is only tissue which has mixed CK2 isoenzyme.
Or
♦♦ Elevated levels of CK3 in serum occur in all types of
dystrophies and myopathies. Write on enzyme inhibition. (July 2016, 5 Marks)
 (Sep 2018, 5 Marks) (Jan 2018, 5 Marks)
Clinical Importance of Alkaline Phosphatase Ans. For definition and classification refer to Ans 1 of same
♦♦ Increase in α2-heat labile alkaline phosphatase is chapter.
suggestive of hepatitis. Enzyme Inhibition
♦♦ Increase in pre β-alkaline phosphatase is indicative of
bone diseases. Enzyme inhibitor is defined as a substance which binds with
the enzyme and brings about a decrease in catalytic activity
Q.4. Write a short note on diagnostic importance of of that enzyme. The inhibitor may be organic or inorganic in
enzymes. (Dec 2010, 3 Marks) (Aug 2011, 6 Marks) nature. There are three broad categories of enzyme inhibition:
Ans. Estimation of enzyme activities in biological fluids is of 1. Reversible inhibition.
great clinical importance. Enzymes in the circulation are 2. Irreversible inhibition.
divided into two groups: 3. Allosteric inhibition.
l. Plasma specific or plasma functional enzymes:
Various enzymes are normally present in the plasma Reversible Inhibition
and they have specific functions to perform. These The inhibitor binds non-covalently with enzyme and the enzyme
enzyme activities are higher in plasma than in the inhibition can be reversed if the inhibitor is removed. The
tissues. They are mostly synthesized in the liver and reversible inhibition is further subdivided into:
enter the circulation, e.g. lipoprotein lipase, plasmin, 1. Competitive inhibition
thrombin, choline esterase, ceruloplasmin, etc. 2. Noncompetitive inhibition
2. Nonplasma specific or plasma nonfunctional
enzymes: These enzymes are either absent or present Competitive Inhibition
at a low concentration in plasma compared to their The inhibitor which closely resembles the real substrate is
levels found in the tissues. The digestive enzymes regarded as a substrate analogue. The inhibitor competes with
 Biochemistry 503

substrate and binds at the active site of the enzyme but does not non-competitive inhibitor generally binds with the enzyme as
undergo any catalysis. As long as the competitive inhibitor holds well as the ES complex. For non-competitive inhibition, the Km
the active site, the enzyme is not available for the substrate to value is unchanged, while Vmax is lowered.
bind. In competitive inhibition, the Km value increases, whereas
Vmax remains unchanged. The enzyme succinate dehydrogenase
(SDH) is a classical example of competitive inhibition with
succinic acid as its substrate.

Fig. 35:  Noncompetitive inhibitor where Km is unaltered,

whereas Vmax is decreased

Examples of Noncompetitive Inhibitors

Fig. 34:  Competitive inhibitor where Vmax is unaltered ♦♦ Ethanol or certain narcotic drugs are noncompetitive
whereas Km is decreased inhibitor of acid phosphatase.
♦♦ Trypsin inhibitors occur in soyabean and raw egg white,
Examples of enzymes with their substrates and competitive inhibit activity of trypsin noncompetitively.
inhibitors
Irreversible Inhibition
Significance of
Enzyme Substrate Inhibitor inhibitor ♦♦ In this inhibitors bind covalently with enzymes and
inactivate them which is now irreversible.
Xanthine Hypoxanthine, Allopurinol Used in gout to
oxidase xanthine decrease excess
♦♦ Irreversible are inhibitors which are toxic substances and
production of can be made naturally or man made.
uric acid from ♦♦ Example for irreversible inhibition is iodoacetate
hypoxanthine is an irreversible inhibitor of enzymes like papain
Monoamine Catecholamines Ephedrine, Elevates and glyceraldehydes–3–phosphate dehydrogenase.
oxidase amphetamine catecholamine Iodoacetate get combine to sulfhydryl groups at active site
levels of these enzymes and make them inactive.
Dihydrofolate Dihydrofolic Aminopterin, For treatment ♦♦ Suicide inhibition is the type of irreversible inhibition
reductase acid amethopterin of leukemia and in which inhibitor binds to active site of an enzyme and
and other cancer carry the first few catalytic activities of normal enzyme
methotrexate reaction. Instead of being transformed into a normal
Acetylcholine Acetylcholine Succinyl Indicated in product inhibitor is converted to a very reactive compound
esterase choline surgery for which combines irreversibly with enzyme leading to its
muscle relaxation, irreversible inhibition. Here enzyme literally commits
in anesthetized suicide. These inhibitors act as drugs, e.g. penicillin,
patients
aspirin, etc.
Antimetabolites Allosteric Inhibition
These are the chemical compounds which block the metabolic In some multienzyme systems, the first enzyme of the sequence
reactions by producing inhibitory action on the enzymes. is the regulatory enzyme and has distinctive characteristics.
Antimetabolites are the structural analogues of substrates and ♦♦ It is inhibited by the end product of the multienzyme
so are the competitive inhibitors. They are used in the treatment system whenever the end product of such metabolic
of cancer, gout, etc. They are also called as antivitamins as they reaction produced in excess of the cell’s needs. The end
block biochemical actions of vitamins leading to deficiencies. product of the pathway acts as a specific inhibitor of the
first or regulatory enzyme in the pathway.
Noncompetitive Inhibition
♦♦ The whole enzyme system thus slows down to bring the
The inhibitor binds at a site other than the active site on the rate of production of its end product back into balance
enzyme surface. This binding impairs the enzyme function. The with the cell’s needs. This type of regulation is called
inhibitor has no structural resemblance with the substrate. The feedback inhibition.
504 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
For example, first enzyme δ-aminolevulinic acid synthase is
an allosteric enzyme in heme synthesis is inhibited by its end
product heme.
Q.6. Write a short note on properties of enzymes.
 (Dec 2009, 5 Marks)
Ans. Properties of Enzymes
a. Solubility: Enzymes as proteins are soluble in water
or dilute salt solution.
b. Molecular weight: Enzymes have increased
molecular weight
c. Enzymes are charged molecules: Due to the
presences of amino acids, each enzyme has a charge.
The charge depends on the pH of the solution. At
very low pH the amino acids are fully protonated
and there is a positive charge on the proteins; as pH
is increased, the protein losses a proton to neutralize
the OH- group and become a zwitter ion charges.
As more alkali is added, the NH3+ group gives its
H+ and protein becomes positively charged.
d. Enzymes have buffering capacity: They are
amphoteric molecules, i.e. behave both as acids and
bases. They act as buffer. At pKa they make the most
efficient buffer.
e. Each enzyme has a specific Isoelectric pH: It is
the pH at which the net charge on protein equal to
zero so they do not move in an electric field. Above
isoelectric pH negatively charged can move in an
electric field. Below isoelectric pH positive charged
and can move under an electric field.
f. Denaturation: When proteins are heated, or subjected
to extremes of temperature, high salt, organic solvents,
etc. the noncovalent bonds break, changing the native
structure to random coil. This unfolding of protein
is due to loss of secondary, tertiary and quaternary
structure. It does not affect the primary structure.
g. Absorption spectra: Enzymes are proteins which
give maximum absorption at 280 nm (due to their
content of aromatic amino acids).
Q.7. Write a short note on clinically important enzymes.
 (Aug 2011, 5 Marks)
Ans. Enzymes in biological fluids, i.e. plasma or serum are of
clinical importance and help in diagnosis.
Clinically important enzymes are divided into two
groups, i.e.
1 Plasma specific or plasma functional enzymes.
2 Nonplasma specific or plasma nonfunctional
enzymes.
Plasma Specific Enzymes
♦♦ Various enzymes are normally present in plasma and they
perform specific functions.
♦♦ Activity of plasma specific enzymes is higher in plasma
than in tissues.
♦♦ These enzymes are in plasma than in tissues.
♦♦ They are mostly synthesized in liver and enter in the
circulation. For example, lipoprotein lipase, plasmin,
thrombin, choline, esterase, ceruloplasmin etc.
♦♦ Default in liver function or genetic disorders decrease the
activities of plasma functional enzymes.
Nonplasma Specific Enzymes
♦♦ These enzymes are either totally absent or present at low
concentrations in plasma as compared to the tissues.
♦♦ Digestive enzymes of gastrointestinal system in plasma
are known as secretory enzymes.
♦♦ Other plasma enzymes which are associated with
metabolism of cell are known as constitutive enzymes.
♦♦ Activation of these enzymes is important for diagnosis and
prognosis of various diseases.
Interpretations of Enzymes
♦♦ Normal serum level of enzyme indicates the balance
between synthesis and release of routine cell turnover.
♦♦ High serum level or low serum level of enzyme indicates
the cellular damage, increased cellular turnover and
proliferation of cells.
Q.8. Write short note on isoenzymes. (Feb 2014, 3 Marks)
Ans. •  Isoenzymes are also known as isozymes.
• Multiple forms of an enzyme which catalyses the
same reaction are known as isoenzymes.
• Isoenzymes have different physical and chemical
properties which includes structure, electrophoretic,
immunological properties, Km and Vmax values, pH
optimum and degree of denaturation.
Isoenzymes of Lactate Dehydrogenase
♦♦ Lactate dehydrogenase have five isoenzymes, i.e. LDH1,
LDH2, LDH3, LDH4, LDH5.
♦♦ All the above isoenzymes are separated by electrophoresis.
♦♦ LDH1 is positively charged and fastest in electrophoretic
mobility, while LDH5 is the slowest of all.
♦♦ Isoenzymes of lactate dehydrogenase have diagnostic
value in heart and liver related disorders.
♦♦ In healthy individual, activity of LDH2 is higher than
LDH1 in serum.
♦♦ In myocardial infarction, LDH1 is greater than LDH2
within 12–24 hours after infarction.
♦♦ Increased activity of LDH5 in serum is indicator of liver
diseases.
Isoenzymes of Creatinine Phosphate
♦♦ Creatine kinase catalyses interconversion of phospho-
creatine to creatine.
♦♦ Creatine kinase has three isoenzymes, i.e. CPK1, CPK2,
CPK3.
♦♦ In healthy individuals, CPK2 is undetectable.
♦♦ CPK2 increases in serum after myocardial infarction within
6-18 hours.

Isoenzymes of Alkaline Phosphatase
♦♦ There are six isoenzymes of alkaline phosphatase.
♦♦ Most important isoenzymes of alkaline phosphatase are
α1-ALP, α2-heat labile ALP, α2-heat stable ALP, pre-β
ALP, γ-ALP.
♦♦ Increase in α2-heat labile ALP suggests hepatitis.
♦♦ Increase in Pre-β ALP suggests bone disease.
Isoenzymes of Alcohol Dehydrogenase
♦♦ It has two heterodimer isoenzymes, i.e. αβ1 and αβ2
♦♦ αβ1 is predominant in white Americans and Europeans
♦♦ αβ2 is predominant in Japenese and Chinese.
♦♦ Increased susceptibility to alcohol is seen in Japenese and
in Chinese because of αβ2.
Q.9. Write a short note on coenzyme.
 (Oct 2014, 3 Marks) (Sep 2015, 5 Marks)
Or
Write about coenzymes. (Sep 2015, 7 Marks)
Ans. Nonprotein, organic, low molecular weight and
dialyzable substance which is associated with enzyme
function is known as coenzyme.
Functional enzyme is referred as holoenzyme which is
made of protein part, i.e. apoenzyme and a nonprotein
part, i.e. coenzyme.
• Coenzyme is essential for the biological activity of
the enzyme.
• One molecule of coenzyme is able to convert a large
number of substrate molecules.
• Coenzymes are the second substrates or cosubstrates
because they have affinity with enzyme comparable
with that of substrate. During the enzymatic
reactions coenzyme undergo alteration which later
on regenerated.
• It participate in various reactions, such as transfer
of atoms of groups like aldehyde, keto, amino, etc.
• They play a decisive role in enzyme function.
• Most of the coenzymes are derivatives of B-complex
vitamins, the biochemical functions of B-complex
vitamins are exerted by coenzymes.
• Various substances which have no relation with
vitamins but function as coenzymes are known as
nonvitamin coenzyme, e.g. ATP, CDP, etc.
• Some coenzyme posses nitrogenous base, sugar
and phosphate these are known as nitrogenous co-
enzymes, e.g. NAD+, NADP+, FMN, etc.
Q.10. Write on classification of enzymes and their diagnostic
importance. (Apr 2017, 5 Marks)
Ans. For classification of enzymes refer to Ans 1 of same
chapter.
For diagnostic importance of enzyme refer to Ans 4 of
same chapter.
Q.11. Answer in brief diagnostic importance of serum enzymes.
 (Sep 2017, 2 Marks)
Biochemistry 505
Ans. Normal serum level of an enzyme is indicative of balance
its synthesis and release in routine cell turnover.
 Raised serum enzyme level can be due to cellular
damage, increased rate of cell turnover, proliferation of
cell, increased synthesis of enzymes, etc.
 Serum enzymes are easily used as markers to detect
the cellular damage which helps in diagnosis of disease.
Various Serum Enzymes Elevated in Respective Diseases
Elevated serum enzyme Name of the disease
Acid phosphatase Cancer of prostrate gland
Alkaline phosphatase Rickets and obstructive jaundice
Aldolase Muscular dystrophy
Amylase Acute pancreatitis
Creatinine phosphokinase Early marker in myocardial
infarction
Lactate dehydrogenase Heart attack and liver diseases
Serum glutamine pyruvate Liver diseases
transaminase (SGPT)
Serum glutamate oxaloacetate Heart attack
transaminase (SGOT)
5–nucleotidase Hepatitis
Q.12. Write about enzymes and their clinical significance.
 (Aug 2018, 10 Marks)
Ans. For definition and classification of enzymes refer to Ans
1 of same chapter.
For properties of enzymes refer to Ans 6 of same chapter.
For factors affecting enzyme activity refer to Ans 2 of
same chapter.
For enzyme inhibition refer to Ans 5 of same chapter.
For importance of enzyme refer to Ans 7 and Ans 4 of
same chapter.
8. HEMOGLOBIN AND PORPHYRIN
Q.1. Write a short note on transport of iron.
 (Dec 2010, 5 Marks)
Ans. Transport of iron includes three steps, i.e.
1. Transport of iron across brush border of enterocyte
2. Fate of iron in enterocyte.
3. Transport of iron in blood.
1. Transport of iron across brush border of enterocyte: In
diet iron is present as heme derived (from non-vegetarian
food) or nonheme derived (vegetarian food).
a. Absorption of heme iron: Heme iron is the iron
present in myoglobin, hemoglobin and related
compounds. From these compounds heme is released
by proteolytic enzymes in gut. From the lumen, heme
is transported inside the enterocyte across brush
border membrane by a heme transport protein. Inside
the cell, the ferrous iron (Fe2+) is released from heme
by enzyme hemeoxygenase.
506 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

b. Absorption of nonheme iron: Most of nonheme iron is

present ferric iron (Fe3+), whereas iron can be absorbed
more efficiently in ferrous form (Fe2+). Iron has got
tendency to form insoluble complexes with dietary
phytates, phosphates and dietary fibers.
Gastric HCI tends to break insoluble iron complex
apart and thus facilitates iron absorption. Ferrous
iron (Fe2+) is transported just across the brush border
by the iron transport protein or receptors present on
the cell membrane. Once inside the enterocyte, fate of
nonham ferrous iron is same as that of heme iron.
2. Fate of iron in the enterocyte: In the cytosol of enterocyte
the free ferrous iron has two fates:
i. A part of Fe2+ depending upon the body’s requirement
is actively transported across the basolateral membrane
of the enterocytes into the interstitium from where it
enters the blood.
ii. Rest of the ferrous iron is oxidized to ferric form and
bound to apoferritin. It is difficult to release iron from this
storage form and in general the ferritin stays in enterocyte
until the cell is sloughed off at the tip of villous.
3. Transport of iron in blood: Normally, the iron absorbed
in the blood bind with the betaglobulin (apotransferrin)
to form transferrin and is transported in this form in the
plasma. Iron combine loosely in the globulin apotransferrin
and can be released easily to enter any of the tissue cells
of any point in the body.
Q.2. What are the functions of hemoglobin? Give in brief
process of synthesis and breakdown of heme.
 (Aug 2012, 6 Marks)
Ans. Functions of Hemoglobin
• It facilitates transport of oxygen from lungs to tissues.
• It facilitates transport of carbon dioxide from tissues
to lungs.
• It acts as an acid-base buffer, as being a protein. It is
responsible for 70% of buffering power of blood.
• It has additional nitric oxide-binding site on the
β-chain which is increased by oxygen. So hemo-
globin binds with nitrous oxide in lungs and releases
it in tissues where it promotes vasodilatation. Fig. 36:  Synthesis of heme
Synthesis of Heme 2. Synthesis of porphobilinogen: Two molecules of
Heme is the most important porphyrin containing compound. d-aminolevulinate condense to form l porphobilinogen
It is primarily synthesized in the liver and the erythrocyte- (PBC) in the cytosol. This reaction is catalyszd by a Zn—
producing cells of bone marrow. Heme synthesis also occurs containing enzyme ALA dehydratase. lt is sensitive to
to some extent in other tissues. However, mature erythrocytes inhibition by heavy metals such as lead.
lacking mitochondria are a notable exception. Biosynthesis of 3. Formation of porphyrin ring: Porphyrin synthesis occurs
heme occurs in the following stages: by condensation of four molecules of porphobilinogen.
1. Formation of δ-aminolevulinate: Glycine, a nonessential The four pyrrole rings in porphyrin are interconnected by
amino acid and succinyl-CoA, an intermediate in the methylene bridges derived from a-carbon of glycine. The
citric acid cycle, are the starting materials for porphyrin interaction of two enzymes—namely uroporphyrinogen I
synthesis. Glycine combines with succinyl CoA to form synthase and uro­porphyrinogen III cosynthase results in
δ—aminoevuinate (ALA). This reaction is catalyzed by condensation of porphobilinogen followed by ring closure
a pyridoxal phosphate dependent d-aminolevulinate and isomerization to produce uroporphyrinogen III.
synthase occurs in the mitochondria. It is a rate-controlling 4. Uroporphyrinogen III under the enzyme uro­porphyrinogen
step in porphyrin synthesis. decarboxylase get converted to coproporphyrinogen

III. Then, coproporphyrinogen III under the enzyme
coproporphyrinogen oxidase get converted to protopor-
phyrinogen IX. Pro­topor­phyrinogen IX under the influence
of enzyme protoporphyrinogen oxidase get converted
to pro­toporphyrin IX. Protoporphyrin IX under enzyme
ferrochelatase get converted to hemesynthetase.
Breakdown of Heme
Fig. 37:  Breakdown of heme
Q.3. Write on Jaundice: Classification and evaluation.
 (Aug 2011, 6 Marks)
Or
Write short on classification of jaundice.
 (Aug 2011, 6 Marks)
Ans. Jaundice is a clinical condition characterized by yellow
color of sclera of eyes and skin.
For the sake of convenience to understand, jaundice is
classified into three major types: Hemolytic, hepatic and
obstructive.
Biochemistry 507
Hemolytic Jaundice
This condition is associated with increased hemolysis of
erythrocytes. This results in the overproduction of bilirubin
beyond the ability of the liver to conjugate and excrete the same.
It should, however be noted that liver possesses a large capacity
to conjugate about 3.0 g of bilirubin per day against the normal
bilirubin production of 0.3 g/day.
Evaluation
♦♦ Elevation in the serum unconjugated bilirubin.
♦♦ Excretion of urobilinogen in urine.
♦♦ Dark brown color of feces due to high content of
stercobilinogen.
Hepatic (Hepatocellular) Jaundice
This type of jaundice is caused by dysfunction of the liver due
to damage to the parenchymal cells. This may be attributed to
viral infection (viral hepatitis), poisons and toxins (chloroform,
carbon tetrachloride, phosphorus, etc.) cirrohosis of liver,
cardiac failure, etc. Among these, viral hepatitis is the most
common. Damage to the liver adversely affects the bilirubin
uptake and its conjugation by the liver cells.
Evaluation
♦♦ Increased levels of conjugated and unconjugated bilirubin
in the serum.
♦♦ Dark colored urine due to the excessive excretion of
bilirubin and urobilinogen.
♦♦ Increased activities of alanine transaminase (SGPT) and
aspartate transaminase (SGOT) released into circulation
due to damage to hepatocytes.
♦♦ The patients pass pale, clay colored stools due to the
absence of stercobilinogen.
♦♦ The affected individuals experience nausea and anorexia
(loss of appetite).
Obstructive (Regurgitation) Jaundice
This is due to an obstruction in the bile duct that prevents the
passage of bile into the intestine. The obstruction may be caused
by gallstones, tumors, etc. Due to the blockage in bile duct, the
conjugated bilirubin from the liver enters the circulation.
Evalution
♦♦ Increased concentration of conjugated bilirubin in serum.
♦♦ Serum alkaline phosphatase is elevated as it is released
from the cells of the damaged bile duct.
♦♦ Dark colored urine due to elevated excretion of bilirubin
and clay colored feces due to absence of stercobilinogen.
♦♦ The patients experience nausea and gastrointestinal pain.
Q.4. Write short account on jaundice. (Sep 2013, 5 Marks)
Ans. Jaundice is a clinical condition which is characterized
by yellowishness of sclera of eyes and skin.
♦♦ It occurs because of deposition of bilirubin because of its
elevated level in blood serum.
508 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Normal serum: Total bilirubin concentration ranges from
0.3 to 1.3 mg/dL, out of which 0.1 to 0.4 mg/dL is direct
bilirubin and 0.2 to 0.7 is indirect bilirubin.
♦♦ Term hyperbilirubinemia is often used to represent the
increased concentration of serum bilirubin.
 For classification and evaluation of jaundice in detail refer
to Ans 3 of same chapter.
Q.5. Write short answer on unconjugated and conjugated
bilirubin. (Aug 2016, 2 Marks)
Ans. Unconjugated bilirubin or indirect bilirubin: Bilirubin
in the bloodstream is usually in a free, or unconjugated,
state. Since bilirubin is lipophilic and so it is insoluble
in aqueous plasma, it is transported to liver by binding
noncovalently to plasma albumin. As albumin–bilirubin
complex enter the liver, bilirubin dissociate and is taken
by sinusoidal surface of hepatocytes by carrier mediated
active transport.
Conjugated bilirubin or direct bilirubin: Inside
the liver, hepatocytes convert insoluble bilirubin to
soluble bilirubin by conjugation with two molecules
of glucuronate supplied by UDP–glucuronate. This
complete reaction is catalyzed by bilirubin glucuronyl-
transferase which leads to the formation of water soluble
bilirubin diglucuronide.
Q.6. Write a short note on normal serum level and formation
of bilirubin. (May 2017, 5 Marks)
Ans. Normal serum levels of bilirubin
System of
Serum analysis of international units
bilirubin (SI units) Conventional units
Total bilirubin 5.1 to 22 µmol/L 0.3 to 1.3 mg/dL
Direct bilirubin 1.7 to 6.8 µmol/L 0.1 to 0.4 mg/dL
Indirect bilirubin 3.4 to 15.2 µmol/L 0.2 to 0.7 mg/dL
Formation of Bilirubin
♦♦ Hemoglobin is cleaved to a protein part globin and non–
protein part heme.
♦♦ Catabolism of heme is carried out in microsomal fraction
of cells by complex enzyme system known as heme
oxygenase in the presence of NADPH and O2. Heme
oxygenase cleaves methenyl bridges between two pyrrole
rings to form biliverdin. Simultaneously, ferric ion and
carbon monoxide are released as biliverdin is produced.
♦♦ Biliverdin’s methenyl bridges are reduced to methylene
group to form bilirubin. This reaction is catalyzed by
NADPH dependent soluble enzyme, i.e. biliverdin reductase.
♦♦ One gram of hemoglobin when become degraded it
producec 35 mg of bilirubin.
Q.7. Write briefly about normal levels of serum total bilirubin,
direct bilirubin and indirect bilirubin.
 (Oct 2016, 2 Marks)
Ans. Normal levels of serum: Total bilirubin, direct bilirubin
and indirect bilirubin are assessed in liver function tests.
Following are the normal levels:
System of
international units
Serum analysis (SI units) Conventional units
Total bilirubin 5.1 to 22 µmol/L 0.3 to 1.3 mg/dL
Direct bilirubin 1.7 to 6.8 µmol/L 0.1 to 0.4 mg/dL
Indirect bilirubin 3.4 to 15.2 µmol/L 0.2 to 0.7 mg/dL
9. ENERGY METABOLISM
AND NUTRITION
Q.1. Write short note on SDA. (Nov 2012, 3 Marks)
Or
Write short note on Specific dynamic action.
 (Sep 2007, 3 Marks)
Ans. Full form of SDA is Specific Dynamic Action.
• Specific dynamic action is defined as phenomenon of
extra heat production by the body, over and above
calculated caloric value, when food is metaliolized
by the body.
• It is also known as calorigenic action, thermogenic
action or thermic action of food.
• This is due to the expenditure of energy for digestion
and absorption of food.
• This energy is trapped from previously available
energy, so that the actual energy from the food is
lesser than that of theoretical calculation.
• Specific dynamic action can be considered as the
activation energy needed for a chemical reaction.
This activation energy is to be supplied initially.
• Suppose a person takes 250 g of carbohydrates; this
should produce 250 × 4 = 1,000 kcal. But before this
energy is trapped, about 10% energy (0 = 100 kcal) is
drawn from the reserves of the body. Thus net gen-
eration of energy is only 1000 minus 100 = 900 kcal.
• If the person wants to get 1,000 kcal, he should take
food worth 1,100 kcal. Thus additional calories,
equivalent to SDA has to be added in the diet.
• The values of SDA are: For proteins 30%, for lipids
15%, and for carbohydrates, 5%. This means that out
of every 100 grams of proteins consumed, the energy
available for doing useful work is 30% less than the
calculated value.
• Hence for a mixed diet, an extra 10% calories should
be provided to account for the loss of energy as SDA.
Significance of SDA
For utilizing of food by the body, certain amount of energy
is consumed from the body store. This is expenditure by the
body for utilizing the foodstuffs. SDA is the highest for proteins
and lowest for carbohydrates and for mixed diet, it is 10%. It
is therefore essential that an additional 10% calories should be
added to the total energy needs towards SDA and diet should
be planned accordingly.
 Biochemistry 509

Q.2. Write a short note on generation of ATP.
 (Mar 2005, 5 Marks)
Or
Write a short note on ATP. (Jan 2012, 5 Marks)
Ans. ATP is adenosine triphosphate. It is a nucleotide. It is
also known as energy coin of the cell because it is the
storage site for chemical energy which is stored in the
bond which is known as phospho disaster bond.
• Pure form of ATPs is generated in glycolysis, TCA
cycle, beta-oxidation and other pathways in a small
quantity. This cannot fulfill the normal requirement
of energy in cell, that’s why reducing equivalent like
NADH, FAD, GDP are being converted into ATP.
• The above reducing equivalent is finally converted
into pure ATPs in a complex pathway which is called
as chemo-osmotic mechanism which occur in mito­
chondria with the help of four steps:
a. Conversion of NADH into electron and hydro-
gen ions. (NADH is derived from metabolic
pathway, i.e. glycolysis, TCA cycle, etc.)
b. Transfer of electron from one protein to another
protein which are present in mitochondrial
membrane. For example, cytochrome oxidase,
FMN, etc.
c. Conversion of ADP → ATP by a knob like protein
known as ATP synthetase or ATPase.
d. Then ATP is transferred from mitochondrial
matrix to cytoplasm of cell which is utilized by
the various anabolic pathways.
Q.3. Write a short note on balance diet.
 (Oct 2007, 5 Marks) (Aug 2011, 5 Marks)
 (Apr 2008, 5 Marks)
Or
Write a short note on balanced diet. (Feb 2014, 3 Marks)
Or
Write on balanced diet. (Apr 2017, 5 Marks)
Ans. Balanced diet is defined as the diet which consists
of different types of food, possessing the nutrients—
carbohydrates, fats, proteins, vitamins and minerals in
a proportion to meet requirements of the body.
 A balanced diet supply little more of each nutrient than
the minimum requirement to withstand short duration
of leanness and keep the body in state of good health.
 Dietary pattern varies in different parts of the world.
 Balanced diet is generally developed according to the
following:
• Kinds of food produced
• Economic capacity
• Religion
• Customs
• Taste and habits of people
Indian Council of Medical Research (ICMR) has
suggested balanced diet for different age groups, sex
and under various occupations for physical activity.
Balanced Diet Suggested by ICMR

Adult man Adult woman Children Boys Girls

Sedentary Moderate Heavy Sedentary Moderate Heavy
Food item work work work work work work 1-3 years 4-6 years 10-12 years 10-12 years
Quantity gram per day Quantity gram per day Quantity gram per day
Cereals 460 520 670 410 440 575 175 270 420 380
Pulses 40 50 60 40 45 50 35 35 45 45
Leafy 40 40 40 100 100 100 40 50 50 50
vegetables
Others 60 70 80 40 40 50 20 30 50 50
vegetables
Roots and 50 60 80 50 50 60 10 20 30 30
tubers
Milk 150 200 250 100 150 200 300 250 250 250
Oil and fat 40 45 65 20 25 40 15 25 40 35
Sugar or 30 35 55 20 20 40 30 40 45 45
jaggery

When balanced diet is not consumed by the person for Write a short note on BMR. (Aug 2011, 5 Marks)
sufficient length of time, it leads to nutritional deficiencies
Or
known as malnutrition.
Q.4. Write briefly about basic metabolic rate (BMR ) Write a short note on basal metabolic rate.
 (Dec 2009, 5 Marks)  (Jan 2012, 5 Marks)
Or Or
510 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Define BMR. What are the factors that affect BMR.
 (May 2017, 5 Marks)
Or
Define BMR. (Apr 2018, 2 Marks)
Ans. Basic metabolic rate is defined as minimum amount of
energy required by the body to maintain life at complete
physical and mental rest in post absorptive state, i.e. 12
hours after last meal.
 Under basal conditions, body appears to be in rest state
but various functions under the body occur continuously
such as working of heart, conduction of nerve impulses,
reabsorption of renal tubules, etc.
 Normal value of BMR for adult man is 35-38 cal/sq.m/
hr and for adult woman it is 32-35 cal/sq.m/hr.
 Some of the authors represent BMR as cal/day. So, for
an adult man BMR is 1600 cal/day, while for an adult
women it is 1400 cal/day.
Factors Affecting BMR
The BMR differs among different individuals. It depends on
many factors as follows:
♦♦ Gender or sex: The BMR of males is slightly higher than
that of females. This is due to the greater proportion of
lean muscle mass in females.
♦♦ Age: In infants and growing children consists of lean
muscle mass, BMR is higher in them. In adults, there is
decrease in BMR, i.e. about 2% per decade of life.
♦♦ Nutritional state: BMR is low in starvation and under
nourishment as compared to wellfed state. Starvation
leads to an adaptive decrease in BMR which results from
a decrease in lean body mass.
♦♦ Body size or surface area: BMR is directly proportional
to the surface area of the subject. Larger the surface area
more will be the heat loss and equally higher will be the
heat production and BMR.
♦♦ Body composition: The BMR is proportionate to lean
body mass. Lean body mass is the body weight minus
nonessential (storage triacylglycerol) weight. Higher the
percentage of adipose tissue in the body, lower the BMR/
kg body weight.
♦♦ Endocrinological or hormonal state: Thyroid has stimula-
tory effect on metabolism of the body. So BMR is increased
in hyperthyroidism and decreased in hypothyroidism.
♦♦ Environmental temperature or climate: In colder climate,
BMR is higher and in tropical climates the BMR is
proportionally low.
♦♦ Disease states: Elevation of BMR is seen in various
infections, fever, burns and cancer.
Q.5. Write a short note on protein-energy malnutrition.
 (Mar 2013, 3 Marks)
Or
Write a short note on protein calorie malnutrition.
 (May 2014, 5 Marks)
Or
Write a short note on PEM. (Apr 2015, 3 Marks)
Ans. It is also known as protein calories malnutrition.
• Protein-energy malnutrition is the nutritional
disorder of developing countries.
• It is mostly seen in infants and preschool children.
• Forms of protein-energy malnutrition are Marasmus
and Kwarshiorkor.
Marasmus or Nonedematous PEM
♦♦ Meaning of marasmus is to waste.
♦♦ It occurs due to the deficiency of calories.
♦♦ It is caused due to early weaning and repeated infection.
♦♦ Symptoms include growth retardation, muscle wasting,
anemia and weakness.
♦♦ Child is irritable and feartful.
♦♦ Serum albumin of child is 2 to 3 g/dL.
♦♦ Serum cortisol is increased in marasmus.
Kwashiorkor or Edematous PEM
♦♦ Kwashiorkor occurs in a child when next baby is born.
♦♦ It occurs due to the deficiency of protein.
♦♦ It is caused due to starchy diet after weaning and it is also
precipitated by acute infection.
♦♦ Symptoms include stunted growth, edema, diarrhea,
discoloration of skin and hair, anemia, moon face and
apathy.
♦♦ Child is lethargic and apathetic.
♦♦ Serum albumin of child is less than 2 g/dL.
♦♦ Serum cortisol is decreased in kwashiorkor.
Q.6. What are the main constituents of diet? Give their
nutritional importance. (Sep 2013, 6 Marks)
Ans. Diet consists of a number of food items which taken
together to provide the body with right amount of
nutrients. Also eating of variety of foods is very important
because each food differs a little in the nutrients it
provides. Each nutrient has its own special work to do.
Main constituents of diet are: Cereals, protein foods,
protective vegetables and fruits, other vegetables and
fats, oils and sugars.
Nutritional Importance of Constituents of Diet
Cereals
It includes wheat, rice, maize, jowar, bajra, tapioca, potato,
sweet potato, etc. Enough cereals should be included in diet
to meet the protein need. They are also the main source of
carbohydrates which give energy to the body.
Protein Foods
This group includes milk and milk products (cheese, curd,
khoa, etc. nuts, pulses (dal, beans), eggs and meat. Food from
this group provides proteins and sufficient amount of food
from this group should be chosen.
Protective Vegetables and Fruits
This includes leafy green vegetables (sag, cabbage, etc.) yellow
or orange fruits and vegetables (carrot, papaya, mango, etc.)

and vitamin C rich fruits and vegetables (amla, orange, tomato,
cabbage, ber, guava, drumstick, and cauliflower and cashew
fruit). Fruits and vegetables from this group must be included
in the diet daily to provide minerals and vitamins to the body.
Other Vegetables
This includes flowers, fruits and stems of plants, brinjal, lady
finger, beans, peas, cucumber, gourds, onions, etc. Liberal
amounts of vegetables from this group ensures sufficient
intake of minerals and vitamins into the body.
Fats, Oils and Sugars
It includes butter, groundnut, ghee, vanaspati oil, nuts, and
animal fat from meat, sugar, honey and jaggery. Food from
this group gives energy and adds flavor and taste to the food.
Q.7. What are the daily calorie requirements of normal hu-
man being. Write in detail about human nutrition.
 (Feb 2013, 10 Marks)
Ans. There are wide variations in individual calorie require­
ment. Total calorie requirement for Indian at rest is:
For men: 38 to 40 kcal/hour/m2. Body surface area (BSA)
= 1500 to 2000 kcal/day.
For women: 33 to 35 kcal/hour/m2. Body surface area
(BSA) = 1200 to 1500 kcal/day.
Human Nutrition
Human nutrition process by which substances in food are
transformed into body tissues and provide energy for the full
range of physical and mental activities that make up human life.
The six classes of nutrients found in foods are proteins, fats,
carbohydrates, vitamins, minerals, dietary fiber and water.
Most of the foods contain all these constituents but in varying
proportion. Food can be classified on the basis of their
predominant function as:
♦♦ Energy yielding foods: These foods are rich in carbohydrates
and fat, e.g. cereals, sugars, oil.
♦♦ Body building foods: These foods are rich in proteins, e.g.
milk and its products, pulses, meat, etc.
♦♦ Protective foods: These foods are rich in proteins, vitamins
and minerals, e.g. milk, egg, green leafy vegetables, fruits
etc.
Proteins
Proteins are complex organic nitrogenous compounds. They are
indispensable constituents of the diet because they are the only
source of the amino acids which include essential amino acids.
Functions of Proteins
♦♦ They build up new tissues at the time of growth or
pregnancy and lactation.
♦♦ Proteins are essential for repair and maintenance of worn
out body tissues.
Biochemistry 511
♦♦ It provides the raw material for synthesis of certain
substances, e.g. antibodies, hemoglobin, enzymes,
hormones and plasma proteins.
♦♦ It provide 10–15% of the energy during emergencies such
as starvation, inadequate food intake.
Sources of Proteins
♦♦ Animal source: Milk and milk products, eggs, meat, fish, etc.
♦♦ Plant sources: Pulses, cereals, dry fruits, nuts, beans, etc.
Daily Requirements of Protein
The protein intake should be 1.0 g/kg body weight for an adult,
some of it in the form of animal protein. An extra amount of
protein (1.5–2 g/kg body weight) should be added in debilitating
diseases; children and in pregnant and lactating women.
Fats
Fats consist of fatty acids and contain carbon, hydrogen and
oxygen. They are concentrated sources of energy. 1 g of fat
yields approx 9 kcal of energy.
Functions of Fats
♦♦ Fats improve the flavor as well as taste of the food.
♦♦ They are essential for absorption of fat soluble vitamins
such as vitamins A, D, E and K.
♦♦ They provide support to body internal vital organs, such
as heart, kidneys, lungs, brain and liver.
♦♦ Stored fats beneath the skin provides insulation against
cold, i.e. prevents heat loss from the body.
♦♦ They provide essential fatty acids (EFA) which help in
growth promotion, maintenance of skin integrity and
reduce blood cholesterol.
Sources of Fats
i. Animal sources: Ghee, butter, fish, oils. In general, they are
poor sources of essential fatty acids but are good sources of
retinol and cholecalciferol (vitamins A and D, respectively).
ii. Plant sources: Groundnut, mustard, cotton seed, rape seed and
coconut oil. These are all rich sources of essential fatty acids.
When vegetable oils are hydrogenated, the liquid oils are
converted into semisolid and solid fat known as vanaspati oil,
ghee (e.g. dalda, rath, etc.). The disadvantage of hydrogenation
is that the content of the valuable ‘essential fatty acids’ present
in vegetable oils is drastically reduced. When natural fats are
treated with steam, alkalies, etc. the free fatty acid, and rancid
material present in oils are removed, the process is known as
‘refining’ and refined oils are produced. Refining improves the
quality and taste of oil. Refined oils are free from odor and color
and are as safe as raw oils.
Daily Requirements of Fats
The fat should provide at least 20% of the total energy in a day.
This could come to 10 to 20 g of fat per day. Young children
needs 25% extra amount of fats.
512 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Carbohydrates
Carbohydrates form the main bulk of diet and are the chief
source of energy. They are also essential for the oxidation of
fats and for the synthesis of various non-essential amino acids.
They are a cheap and readily obtainable food.
Sources of Carbohydrates
i. Starches: They are ‘complete sugar’, present in abundance
in cereals and millets, roots and tubers.
ii. Sugars:
a. Monosaccharides, e.g. glucose, fructose, galactose,
b. Disaccharides, e.g. sucrose, lactose and maltose.
iii. Cellulose or dietary fiber: This is the fibrous substance
lining fruits, vegetables and cereals. It is the indigestible
component of carbohydrate with hardly any nutritive value.
Daily Requirements of Carbohydrates
Carbohydrate intake should be in the range of 300-500 g
(between 50 to 70% of total energy intake). It should be sufficient
to prevent the need for protein breakdown to provide energy.
Vitamins
♦♦ Vitamins are complex, chemical organic substances of
high biological activity required by the body in very small
amounts in normal metabolism and act as a catalyst in
various body processes.
♦♦ They are not manufactured in the body in sufficient
amount, so they are to be supplied through the diet.
♦♦ Vitamins are divided into two major groups as:
i. Fat soluble vitamins—vitamins A, D, E and K; and
ii. Water-soluble vitamins—vitamins of B group (vitamin
B-complex) and vitamin C.
♦♦ They are indispensable for certain specific functions of the
body, in most cases their mode of action has been fairly
clearly defined.
♦♦ They do not contribute to the energy of the body they
mobilize energy.
♦♦ Deficiency of a vitamin can arise in two ways:
i. Primary deficiency, due to inadequate intake of vitamin
or its precursor over a prolonged period of time; or
ii. Conditioned deficiency arising on an adequate diet
through other factors which decrease absorption or
prevent release, or increase utilization or excretion.
Vitamin B-complex group consists of a series of water soluble
organic substances which are found in all cells (the important
ones are: Thiamine (B1), ribaflavin (B2), niacin (B4), pyridoxine
(B6), pantothenic acid, biotin, folic acid and cyanocobalamin
(B12). They are involved in the oxidation of the foodstuffs,
and are, therefore, indispensable for the normal functioning
of all tissues. Most members of this group of vitamin can be
synthesized by the intestinal bacteria.
Minerals
♦♦ Body contains about 50 minerals which serve various
specific functions in the body. The mineral constituents
of the body amount to 4.3–4.4% largely in the skeleton.
♦♦ The important minerals are calcium, phosphorus, iron,
sodium, potassium and magnesium.
♦♦ Some minerals are required by the body in very small
amounts, e.g. iodine, zinc, manganese, copper, cobalt and
fluorine. They form a part of every cell and fluid in the body
and are required for growth, repair and regulation of vital
body functions. Following are the examples of minerals:
i. Zinc is present in insulin and in many enzymes, its
deficiency causes skin ulcers, depresses immune
response and hypogonadal dwarfism.
ii. Copper occurs in blood combined with an α—globulin
forming the protein ceruloplasmin; its deficiency
causes anemia, changes in ossification and increases
serum cholesterol.
iii. Manganese is required in many enzyme systems.
♦♦ Conversely, some minerals produce toxicity when
present in the body in excess, e.g. iron overload causes
hemochromatosis; copper excess causes brain damage.
Dietary Fiber
♦♦ Carbohydrates such as pectin, cellulose, hemicellulose
and some noncarbohydrate substances such as lignin are
collectively called dietary fiber.
♦♦ It resists digestion and is found in vegetables, fruits and
grains.
♦♦ The fiber absorbs water which increases the bulk of the
intestinal contents and facilitates intestinal movements
and thus the defecation.
♦♦ Fibers also have a role in weight reduction and cholesterol
lowering.
♦♦ Its deficiency leads to constipation, cancer of colon, colonic
diverticulosis, hear; disease and gallbladder stones.
Sufficient fiber should be included in diet are:
♦♦ Whole cereals should be preferred to refined cereals.
♦♦ Whole pulses should be preferred to those from which the
husk has been removed.
♦♦ Fruits and vegetables that can be eaten with the skin intact
should be eaten as such.
Water
♦♦ Water is an essential requirement for life.
♦♦ It serves as the medium in which most of the chemical
activities in the body take place.
♦♦ More than 70% of the body weight is imply because of
the water it has.
♦♦ Loss of water upto 10% of total body water makes a person
feel extremely tired and fatigued.
♦♦ More than 20% loss may result in death.
♦♦ Water occurs in all natural food, most of it comes from
that we drink.
Q.8. Describe balanced diet chart for pregnant women.
 (July 2016, 5 Marks)
Ans. Besides the normal balanced diet, during pregnancy
additional food requirement is there which is as follows
in the diet chart for pregnant women.
 Biochemistry 513

Normal Balanced Diet Chart for Women by ICMR Q.10. Answer in brief on dietary fibers.
 (May 2017, 2 Marks)
Adult woman Ans. Dietary fiber is the name given collectively to indigestible
Sedentary Moderate Heavy carbohydrates present in foods.
Food item work work work  These carbohydrates consist of cellulose, pectin, gum
Quantity gram per day and mucilage.
Cereals 410 440 575  The dietary fiber is not digested by the enzyme of the
human gastrointestinal tract where most of the other
Pulses 40 45 50 carbohydrates like starch, sugars are digested and
Leafy vegetables 100 100 100 absorbed. Plant foods are the only sources of dietary
fiber. It is found in vegetables, fruits, and grains.
Others vegetables 40 40 50
Roots and tubers 50 50 60 Importance of Fiber
Milk 100 150 200 ♦♦ Water holding capacity: The dietary fibers have a property
Oil and fat 20 25 40
of holding water and swell like sponge with a concomitant
increase in viscosity. Thus, fiber adds bulk to the diet and
Sugar or jaggery 20 20 40 increases transit time in the gut (gastric emptying time)
due to high viscosity.
Additional Allowances During Pregnancy ♦♦ Physiological effects: Dietary fiber exerts its influence
along the entire gastrointestinal tract from ingestion to
Food item During pregnancy (g/day) Calories (kcal) excretion.
Cereals 35 118 ♦♦ Adsorption of organic molecules: The organic molecules
like bile acids, neutral sterols, carcinogens, and toxic
Pulses 15 118
compounds can be adsorbed on dietary fiber and facilitates
Milk 15 83 its excretion.
Fat - - ♦♦ Increases stool bulk: The fiber absorbs water and increases
Sugar 10 40 the bulk of the stool and helps to reduce the tendency
towards constipation by increasing bowel movements.
Total - 293
♦♦ Hypoglycemic effect of fiber: Recent studies have shown
that gum present in fenugreek seeds (it contains 40% gum)
Q.9. Mention four differences between kwashiorkor and are most effective in reducing blood sugar and cholesterol
marasmus. (Aug 2016, 2 Marks) levels.
Ans. Following are the differences between kwashiorkor and ♦♦ Hypocholesterolemic effects of fiber: Fiber has cholesterol
marasmus: lowering effect. Fiber binds bile acids and cholesterol,
increasing their fecal exertion, and thus, decreasing plasma
Features Kwashiorkor Marasmus
and tissue cholesterol level.
Age of onset 1 to 5 years Below 1 year
Cause Starchy diet after weaning, Early weaning and
Significance of Dietary Fiber in Medicine
precipitated by an acute repeated infection High fiber diet is associated with reduced incidence of a number
infection of diseases like:
Edema Present Absent ♦♦ Coronary heart disease (CHD)
Serum Hypoalbuminemia Normal or slightly ♦♦ Colon cancer
albumin decreased ♦♦ Diabetes
Serum Decreased Increased ♦♦ Diverticulosis
cortisol ♦♦ Hemorrhoids (piles)
Fatty liver Present Absent Adverse Effect of Dietary Fiber
Muscle Absent or mild Severe
Dietary fiber also has some adverse effects on nutrition by
wasting
binding some mineral elements and preventing their proper
Fat reserves Normal to mildly diminishing Absent absorption. Thus, high dietary fiber intake may lead to deficiency
Deficiency of Protein Calorie of mineral elements.
Growth Present Marked Q.11. Write on beneficial effects of fibers in diet.
retardation  (Sep 2018, 5 Marks)
Attitude Lethargic Irritable Ans. Following are the beneficial effects of fibers in diet:
Appetite Anorexia Normal ♦♦ Prevent constipation: Fibers maintain normal motility of
gastrointestinal tract and prevents constipation.
514 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Water holding capacity: The dietary fibers have a property
of holding water and swell like sponge with a concomitant
increase in viscosity. Thus, fiber adds bulk to the diet and
increases transit time in the gut (gastric emptying time)
due to high viscosity.
♦♦ Physiological effects: Dietary fiber exerts its influence
along the entire gastrointestinal tract from ingestion to
excretion.
♦♦ Adsorption of organic molecules: The organic molecules
like bile acids, neutral sterols, carcinogens, and toxic
compounds can be adsorbed on dietary fiber and facilitates
its excretion.
♦♦ Increases stool bulk: The fiber absorbs water and increases
the bulk of the stool and helps to reduce the tendency
towards constipation by increasing bowel movements.
♦♦ Hypoglycemic effect of fiber: Recent studies have shown
that gum present in fenugreek seeds (it contains 40% gum)
are most effective in reducing blood sugar and cholesterol
levels.
♦♦ Hypocholesterolemic effects of fiber: Fiber has cholesterol
lowering effect. Fiber binds bile acids and cholesterol,
increasing their fecal exertion, and thus, decreasing plasma
and tissue cholesterol level.
♦♦ Decreases GIT cancer: Low incidence of cancer of GIT in
vegetarians as compared to non-vegetarians is credited
to dietary fibers.
♦♦ Satiety value: Fibers in the diet add to weight of foodstuff
ingested and provide sensation of stomach fullness.
Q.12. What are macronutrients. (Aug 2018, 5 Marks)
Ans. Proteins, fats and carbohydrates are the macronutrients
and they form main bulk of food.
In an Indian dietary they contribute to total energy intake
in following proportions:
Proteins: 7 to 15%
Fats: 35 to 45%
Carbohydrates: 50 to 70%.
♦ Proteins, fats and carbohydrates are sometimes re-
ferred to as proximate principle. They are oxidized
in the body to yield energy which the body needs.
♦ Although proteins provide energy their primary
function is to provide essential and nonessential
amino acids for building of body proteins.
♦ Fats particularly the vegetable oils, besides being
concentrated source of energy provide essential fatty
acids which have a vitamin like function in the body.
Proteins
Proteins are complex organic nitrogenous compounds. They are
indispensable constituents of the diet because they are the only
source of the amino acids which include essential amino acids.
Functions of Proteins
♦♦ They build up new tissues at the time of growth or
pregnancy and lactation.
♦♦ Proteins are essential for repair and maintenance of worn
out body tissues.
♦♦ It provides the raw material for synthesis of certain
substances, e.g. antibodies, hemoglobin, enzymes,
hormones and plasma proteins.
♦♦ It provides 10–15% of the energy during emergencies such
as starvation, inadequate food intake.
Sources of Proteins
♦♦ Animal source: Milk and milk products, eggs, meat, fish, etc.
♦♦ Plant sources: Pulses, cereals, dry fruits, nuts, beans, etc.
Daily Requirements of Protein
The protein intake should be 1.0 g/kg body weight for an adult,
some of it in the form of animal protein. An extra amount of
protein (1.5–2 g/kg body weight) should be added in debilitating
diseases; children and in pregnant and lactating women.
Fats
Fats consist of fatty acids and contain carbon, hydrogen and
oxygen. They are concentrated sources of energy. 1 g of fat
yields approx 9 kcal of energy.
Functions of Fats
♦♦ Fats improve the flavor as well as taste of the food.
♦♦ Fats are essential for absorption of fat soluble vitamins
such as vitamins A, D, E and K.
♦♦ They provide support to body internal vital organs, such
as heart, kidneys, lungs, brain and liver.
♦♦ Stored fats beneath the skin provides insulation against
cold, i.e. prevents heat loss from the body.
♦♦ They provide essential fatty acids which help in growth
promotion, maintenance of skin integrity and reduce blood
cholesterol.
Sources of Fats
♦♦ Animal sources: Ghee, butter, fish, oils. In general, they are
poor sources of essential fatty acids but are good sources of
retinol and cholecalciferol (vitamins A and D, respectively).
♦♦ Plant sources: Groundnut, mustard, cotton seed, rape
seed and coconut oil. These are all rich sources of essential
fatty acids.
 When vegetable oils are hydrogenated, the liquid oils are
converted into semisolid and solid fat known as vanaspati oil,
ghee (e.g. dalda, rath, etc.). The disadvantage of hydrogenation
is that the content of the valuable ‘essential fatty acids’ present
in vegetable oils is drastically reduced. When natural fats are
treated with steam, alkalies, etc. the free fatty acid, and rancid
material present in oils are removed, the process is known as
‘refining’ and refined oils are produced. Refining improves the
quality and taste of oil. Refined oils are free from odor and color
and are as safe as raw oils.
Daily Requirements of Fats
The fat should provide at least 20% of the total energy in a day.
This could come to 10 to 20 g of fat per day. Young children
needs 25% extra amount of fats.

Carbohydrates
Carbohydrates form the main bulk of diet and are the chief
source of energy. They are also essential for the oxidation of
fats and for the synthesis of various nonessential amino acids.
They are cheap and readily obtainable food.
Sources of Carbohydrates
♦♦ Starches: They are ‘complete sugar’ present in abundance
in cereals and millets, roots and tubers.
♦♦ Sugars:
• Monosaccharides, e.g. glucose, fructose, galactose
• Disaccharides, e.g. sucrose, lactose and maltose.
♦♦ Cellulose or dietary fiber: This is the fibrous substance
lining fruits, vegetables and cereals. It is the indigestible
component of carbohydrate with hardly any nutritive
value.
Daily Requirements of Carbohydrates
Carbohydrate intake should be in the range of 300–500 g
(between 50 to 70% of total energy intake). It should be sufficient
to prevent the need for protein breakdown to provide energy.
10. DETOXIFICATION, FREE RADICALS
AND ANTIOXIDANTS
Q.1. Write a short note on detoxification.
 (June 2010, 5 Marks)
Ans. Detoxification refers to the series of biochemical
reactions occurring in the body to convert the foreign
compounds to nontoxic or less toxic and more easily
excretable forms.
 Detoxification reaction occurs most commonly in the
liver which consists of numerous enzymes. Kidney and
other organs are sometimes involved. Products formed
after detoxification is mainly excreted by kidneys.
Phases of Detoxification
There are two types of phases, i.e. Phase I and Phase II.
Phase I Reaction
In this, there is the alteration of foreign molecule to add a
functional group. These reactions form compounds with
decreased toxicity. Phase I reactions include hydroxylation,
oxidation, reduction, hydrolysis, dealkylation, epoxidation.
♦♦ Oxidative reaction: Oxidative reactions are either aromatic
or aliphatic. These reactions include sulfoxidation,
N-oxidation and epoxidation. Oxidation and detoxification
of alcohol is the function of liver. Alcohol dehydrogenase
oxidizes alcohol to aldehyde and aldehyde dehydrogenase
oxidizes aldehyde to acid.
♦♦ Reductive reaction: Nitro compounds are reduced
to amines, while aldehydes or ketones are reduced to
alcohols. Example is reduction of nitrobenzene to aniline.
Biochemistry 515
♦♦ Hydrolysis: In this addition of water splits the toxicant
into two fragments or small molecules. Hydroxyl group
is incorporated in one fragment and hydrogen atom in
another. Esters, amines, hydrazines, amides, glycosidic
bonds and carbamates are biotransformed by hydrolysis.
Phase II Reaction
♦♦ A xenobiotic which has undergone phase I reaction is
now a new metabolite which consists of reactive chemical
group, i.e. hydroxyl, amino, carboxyl and these metabolites
undergo additional biotransformation as phase II reaction.
♦♦ Phase II reactions are conjugation reactions, i.e. a molecule
normally present in the body is added to reactive site of
phase I metabolite. In most of the cases conjugation make
compounds nontoxic and excretable.
Q.2. Write a short note on antioxidant. (Aug 2012, 5 Marks)
Ans. Since free radicals produce the harmful/damaging effects,
so to stop the harmful effects of free radicals, aerobic cells
developed the antioxidant defense mechanisms.
A biological antioxidant may be defined as a substance that
significantly delays or inhibits oxidation of a substrate.
Antioxidants are the scavengers of free radicals.
Classification of Antioxidants
Based on the Location
♦♦ Plasma antioxidants, e.g. β-carotene, ascorbic acid,
bilirubin, uric acid, ceruloplasmin, transferrin.
♦♦ Cell membrane antioxidants, e.g. α-tocopherol.
♦♦ Intracellular antioxidants, e.g. superoxide dismutase,
catalase, glutathione peroxidase.
Based on the Nature and Action
♦♦ Enzymatic antioxidants, e.g. superoxide dismutase,
catalase, glutathione peroxidase, glutathione reductase.
♦♦ Nonenzymatic antioxidants:
a. Nutrient antioxidants, e.g. carotenoids, α-tocopherol,
ascorbic acid, selenium.
b. Metabolic antioxidants, e.g. glutathione, ceruloplasmin,
albumin, bilirubin, transferrin, ferritin, uric acid
Antioxidant Enzyme System
Antioxidant enzymes scavange the free radicals. Various
enzymes are:
♦♦ Superoxide dismutase: This enzyme converts superoxide
to hydrogen peroxide and is the first line of defense to
protect cells from the injurious effects of superoxide.
♦♦ Catalase: Hydrogen peroxide produced by superoxide
dismutase is metabolized by catalase
♦♦ Glutathione peroxidase: It detoxifies hydrogen peroxide
to water and reduced glutathione gets converted to
oxidized glutathione. Reduced glutathione can be
regenerated by the enzyme glutathione reductase utilizing
NADPH. The hexose monophosphate shunt is the major
source of NADPH.
516 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Nutrient Antioxidant ♦♦ The bilirubin is estimated by Van den Bergh reaction.

♦♦ Vitamin E: Vitamin E acts as an antioxidant and present Normal serum does not give a positive Van den Bergh
in all cellular membranes, and protects against lipid reaction.
peroxidation. ♦♦ When bilirubin is conjugated, the purple color is produced
♦♦ Vitamin C: It is the water soluble antioxidant in biological immediately on mixing with the reagent, the response is
fluids. It inhibts lipid peroxidation. said to be Van den Bergh direct positive.
♦♦ Carotenoids: b-carotene acts as an antioxidant in associa­ ♦♦ When the bilirubin is unconjugated, the color is obtained
tion with vitamin E and C. only when alcohol is added, and this response is known
♦♦ Selenium: In association with vitamin E it scavenges free as indirect positive.
radicals. It is also needed for functioning of an important ♦♦ If both conjugated and unconjugated bilirubin are
antioxidant, i.e. glutathione peroxidase. present in increased amounts, a purple color is produced
immediately and the color is intensified on adding alcohol.
Metabolic Antioxidant Then the reaction is called biphasic.
♦♦ Glutathione: It acts in biological antioxidant enzyme ♦♦ In hemolytic jaundice, unconjugated bilirubin is increased.
system. Reduced glutathione and hydrogen peroxide Hence, Van den Bergh test is indirect positive. In
are twin substrates for glutathione peroxidase. Reduced obstructive jaundice, conjugated bilirubin is elevated, and
glutathione regenerates from oxidized glutathione via Van den Bergh test is direct positive. In hepatocellular
participation of glutathione reductase and NADPH. jaundice, a biphasic reaction is observed because both
♦♦ Uric acid: It acts as scavenger of single oxygen and conjugated and unconjugated bilirubins are increased.
hydroxyl radicles.
Urinary Bilirubin
♦♦ Transferrin: It bind to iron and prevent iron-catalyzed
formation of free radical. ♦♦ Conjugated bilirubin is excreted in urine as it is water
♦♦ Ceruloplasmin: It inhibit iron and copper dependent lipid soluble, while unconjugated bilirubin not excreted in urine.
peroxidation. ♦♦ Bilirubin in urine is detected by Fouchet’s test and Gmelin’s
♦♦ Bilirubin: It protect albumin bound free fatty acid from test.
peroxidation.
Test Based on Serum Enzymes
Transaminases or Aminotransferases
11. ORGAN FUNCTION TESTS
Activity of two enzymes, i.e. serum glutamate pyruvate
Q.1. Write on liver function test. (May 2014, 5 Marks) transaminase (SGPT) or alanine transaminase and serum
 (Sep 2018, 5 Marks) (Jan 2018, 5 Marks) glutamate oxaloacetate transaminase (SGOT) or aspartate
Ans. Liver function tests are the biochemical investigations transaminase are used to assess the liver functions. SGPT is
for assessing the capacity of liver to carry out any of the a cytoplasmic enzyme and SGOT is a seen in cytoplasm and
functions it perform. mitochondria. Activity of both of these enzymes is low in
Liver function tests will help to detect the abnormalities normal serum. Serum SGPT and SGOT get increased when the
and the extent of liver damage. liver damage occur. SGPT is more sensitive and reliable as liver
function test. Normal value of SGPT is 5 to 40 IU/L. Normal
Classification of Liver Function Test value of SGOT is 5 to 45 IU/L.
♦♦ Group I: Tests of hepatic excretory function Clinical Interpretation
1. Serum-bilirubin: Total, conjugated and unconjugated
2. Urine-bile pigments, bile salts and urobilinogen. ♦♦ Alanine transaminase is useful in early diagnosis for
♦♦ Group II: Liver enzyme panel (markers of liver injury) evaluating severity and prognosis of paranchymal liver
1. Alanine amino transferase disease. Alanine transaminase rises to the levels which are
2. Aspartate amino transferase roughly parallel to the extent of hepatocellular damage.
3. Alkaline phosphatase ♦♦ In hepatitis, level of both alanine transaminase and
4. Gamma-Glutamyltransferase. aspartate transaminase get increased, its value rise upto
♦♦ Group III: Plasma proteins (test for synthetic function 500 to 1500 IU/L.
of liver) ♦♦ In obstructive jaundice increase in level of both the enzyme
1. Total proteins occurs but it does not exceed 200 to 300 IU/L.
2. Serum albumin: Globulin ratio ♦♦ In hemolytic jaundice levels of these enzymes remain
3. Prothrombin time. normal.
Serum Bilirubin Alkaline Phosphatase
♦♦ Normal range of serum bilirubin is 0.2 to 1 mg/dL. In This enzyme is derived from bone, liver, intestine and
this the conjugated bilirubin is 0.1 to 0.4 mg/dL and placenta and is excreted in the bile. Increase in serum alkaline
unconjugated is 0.2 to 0.7 mg/dL. phosphatase is associated with diseases of bone, liver and
 Biochemistry 517

pregnancy. In absence of bone disease and pregnancy elevated
alkaline phosphatase levels are an indicator of hepatobiliary
disease. Alkaline phosphatase also increases in liver cirrhosis
and hepatic tumors. Its normal value is 3–13 KA units/dL/100
mL.
Clinical Interpretation
♦♦ Greatest elevation occurs in obstructive jaundice. Enzyme
alkaline phosphatase is normally excreted through bile.
Obstruction to flow of bile leads to regurgitation of enzyme
in blood resulting in increased serum concentration.
♦♦ Slight to moderate increase is seen in hepatitis and
cirrhosis.
♦♦ In hemolytic jaundice normal serum alkaline phosphatase
values are seen.
phosphatase levels are an indicator of hepatobiliary disease.
Alkaline phosphatase also increases in liver cirrhosis and
hepatic tumors. Its normal value is 3–13 KA units/dL/100 mL.
Clinical Interpretation
♦♦ Greatest elevation occurs in obstructive jaundice. Enzyme
alkaline phosphatase is normally excreted through bile.
Obstruction to flow of bile leads to regurgitation of enzyme
in blood resulting in increased serum concentration.
♦♦ Slight to moderate increase is seen in hepatitis and
cirrhosis.
♦♦ In hemolytic jaundice normal serum alkaline phosphatase
values are seen.
γ–Glutamyltranspeptidase

γ–Glutamyltranspeptidase Measurment of γ–Glutamyltranspeptidase provides sensitive

index for assessing liver abnormality. This enzyme is elevated in
Measurment of γ–Glutamyltranspeptidase provides sensitive alcoholism and biliary obstruction. Its normal value is 10–15 U/l.
index for assessing liver abnormality. This enzyme is elevated in
alcoholism and biliary obstruction. Its normal value is 10–15 U/l. Q.3. Describe renal function tests. (July 2016, 5 Marks)
Q.2. Write about serum enzyme in diagnosis of liver func- Or
tion test. (Sep 2015, 7 Marks) Write on renal function test. (Apr 2017, 5 Marks)
Ans. Liver cells have various enzymes which are released in Ans. Renal function tests are also known as kidney function
circulation during liver damage. Following are the serum tests.
enzymes used to assess the liver function.
In order to assess kidney function several renal function
Transaminases or Aminotransferases tests are performed.
The various renal function tests have been divided into
Activity of two enzymes, i.e. serum glutamate pyruvate following groups:
transaminase (SGPT) or alanine transaminase and serum
glutamate oxaloacetate transaminase (SGOT) or aspartate Urine Analysis
transaminase are used to assess the liver functions. SGPT is
♦♦ Physical examination
a cytoplasmic enzyme and SGOT is a seen in cytoplasm and
♦♦ Chemical examination
mitochondria. Activity of both of these enzymes is low in
♦♦ Microscopic examination.
normal serum. Serum SGPT and SGOT get increased when the
liver damage occur. SGPT is more sensitive and reliable as liver Serum and Urine Markers of Renal Function
function test. Normal value of SGPT is 5 to 40 IU/L. Normal
value of SGOT is 5 to 45 IU/L. ♦♦ Serum creatinine
♦♦ Serum urea [or blood urea nitrogen (BUN)]
Clinical Interpretation ♦♦ Protein in urine (proteinuria)
♦♦ Alanine transaminase is useful in early diagnosis for ♦♦ Red blood cells in urine (hematuria).
evaluating severity and prognosis of paranchymal liver Estimation of Glomerular Filtration Rate (GFR)
disease. Alanine transaminase rises to the levels which are
roughly parallel to the extent of hepatocellular damage. ♦♦ Creatinine clearance test
♦♦ In hepatitis level of both alanine transaminase and ♦♦ Urea clearance test
aspartate transaminase get increased, its value rises upto ♦♦ Inulin clearance test.
500 to 1500 IU/L. Tests of Renal Tubular Function
♦♦ In obstructive jaundice increase in level of both the enzyme
occurs but it does not exceed 200 to 300 IU/L. ♦♦ Urine concentration test (water deprivation test)
♦♦ In hemolytic jaundice levels of these enzymes remain ♦♦ Urine dilution test (excess water intake test)
normal. ♦♦ Acid load test (urine acidification test)
♦♦ Phenolsulfonphthalein (PSP) test or phenol red test.
Alkaline Phosphatase
Urine Analysis
This enzyme is derived from bone, liver, intestine and placenta
and is excreted in the bile. Increase in serum alkaline phos- Routine urine examination is usually the first test undertaken to
phatase is associated with diseases of bone, liver and pregnancy. assess the renal function and very often it gives some important
In absence of bone disease and pregnancy elevated alkaline information like proteinuria, hematuria to do further renal
518 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

investigation. Its analysis, therefore, is important in evaluating ♦♦ Creatinine is freely filtered at the glomerulus and is not
kidney function. The standard urine analysis includes: reabsorbed by the tubules. A small amount of creatinine
♦♦ Physical examination: Assessment of volume, color, odor, is secreted by tubules. Because of these properties, the
appearance, specific gravity and pH creatinine clearance can be used to estimate the GFR.
♦♦ Chemical examination: Checking for the presence of ♦♦ Creatinine clearance is defined as the volume of plasma
protein, reducing sugar, ketone bodies, blood, bile salts (in mL) that would be completely cleared off creatinine
and bile pigments. per minute.
♦♦ Microscopic examination of urine: Checking for the ♦♦ The creatinine clearance is determined by collecting
presence of WBCs, RBCs and casts. urine over a 24 hour period and a sample of blood is
drawn during the urine collection period. The clearance
Serum Creatinine and Urea of creatinine from plasma is directly related to the GFR,
which is calculated as follows:
♦♦ Serum urea and creatinine are the markers of renal
function. Both these substances are primarily excreted Creatinine clearance = GFR = U × V
in the urine. Deterioration of renal function is therefore P
Where,
associated with increase in the serum levels of these
U is urinary creatinine (mg/dL)
substances.
♦♦ Creatinine is considered a better marker of renal function P is plasma creatinine (mg/dL)
than urea because urea is affected by dietary protein intake V is volume of urine excreted (mL/minute).
and liver function.
Clinical Interpretation
♦♦ An impaired glomerular filtration results in retention of
urea and creatinine which causes in elevation of blood ♦♦ The normal range for creatinine clearance is 90 to 120 mL/
urea (normal range 20–40 mg/dL) and creatinine (normal minute.
range 0.5–1.5 mg/dL). An increase of these end products ♦♦ A decreased creatinine clearance is a very sensitive
in the blood is called azotemia. indicator of a decreased glomerular filtration rate.
♦♦ The reduced filtration rate may be caused by acute or
Estimation of Glomerular Filtration Rate chronic damage to the glomerulus or any of its components.
♦♦ Reduced blood flow to the glomeruli may also produce a
These tests are performed to assess the glomerular filtration rate
decreased creatinine clearance.
(GFR). GFR provides a useful index of the status of functioning
glomeruli. Renal clearance tests are performed to determine Urea Clearance Test
GFR. ♦♦ Urea is the end product of protein metabolism.
♦♦ Urea clearance may also be employed as a measure of the
Clearance Test
GFR. But urea clearance is not as sensitive as creatinine
Clearance test is performed to assess the glomerular filtration clearance.
rate. ♦♦ Urea clearance is defined as the volume of plasma (in mL)
Clearance is defined as the volume of plasma (in mL) that that would be completely cleared off urea per minute.
could be completely cleared off a substance per minute and is ♦♦ It is calculated by the formula:
expressed as milliliter per minute. It may also be defined as Urea clearance = U × V
that volume of plasma (in mL) which contains the amount of P
Where,
the substance which is excreted by kidney in urine in 1 minute.
U is urinary urea (mg/dL)
Renal clearance (C) is calculated by using following formula:
P is plasma urea (mg/dL)
C=U×V V is volume of urine in mL excreted per minute.
P
Where, Clinical Interpretation
C: Renal clearance: GFR of a substance in mL/minute ♦♦ The normal value of urea clearance is 75 mL/minute.
U: Concentration of substance in urine (mg/100 mL) ♦♦ Urea clearance between 40-70 mL/min indicates mild
V: Volume of urine in mL excreted per minute impairment, between 20-40 mL/min indicates moderate
impairment and below 20 mL/min indicates severe
P: Concentration of substance in plasma (mg/100 mL). impairment of renal function.
Creatinine Clearance Test Inulin Clearance Test
♦♦ Creatinine clearance test is the renal function test which is ♦♦ Inulin clearance is the method of choice when accurate
based on the rate of excretion of creatinine by the kidneys. determination of GFR is required.
♦♦ Creatinine is an excretory product derived from creatine ♦♦ Inulin is a polysaccharide of fructose which is filtered
phosphate. The excretion of creatinine is not influenced by the glomerulus but not reabsorbed, secreted or
by metabolism or dietary factors. metabolically altered by the renal tubule.
 Biochemistry 519

♦♦ The normal value of inulin clearance is 120 mL/min ♦♦
♦♦ Inulin clearance is calculated by the following formula:
♦♦
Inulin clearance = U × V
P
Where, ♦♦
U is urinary inulin (mg/dL)
P is plasma inulin (mg/dL)
V is volume of urine in mL excreted per minute.
Tests of Renal Tubular Function
Q. 1. Write a short note on vitamin C.
♦♦ Assessment of the concentrating and diluting ability of the
kidney can provide the most sensitive means of detecting
early impairment in renal function.
♦♦ The ability to concentrate or dilute urine is dependent
upon renal tubular reabsorption function and presence
of antidiuretic hormone (ADH).
♦♦ The kidneys fail to concentrate urine either due to renal
tubular damage or due to ADH deficiency (endocrine
disorder).
♦♦ The urinary specific gravity and osmolality are used to
measure the concentrating and diluting ability of the
tubules.
♦♦ Various renal tubular function tests are water deprivation
test, urine dilution test, urine acidification test.
Q.4. Write very short answer on creatinine clearance test.
 (Apr 2018, 2 Marks)
Ans. Creatinine clearance test is the renal function test which
is based on the rate of excretion of creatinine by the
kidneys.
• Creatinine is an excretory product derived from
creatine phosphate. The excretion of creatinine is
not influenced by metabolism or dietary factors.
• Creatinine is freely filtered at the glomerulus and is
not reabsorbed by the tubules. A small amount of
creatinine is secreted by tubules. Because of these
properties, the creatinine clearance can be used to
estimate the GFR.
• Creatinine clearance is defined as the volume of
plasma (in mL) that would be completely cleared
off creatinine per minute.
• The creatinine clearance is determined by collecting
urine over a 24 hour period and a sample of blood is
drawn during the urine collection period. The clear-
ance of creatinine from plasma is directly related to
the GFR which is calculated as follows:
Creatinine clearance = GFR = U × V
P Write on functions of vitamin C and effects of its
Where,
U is urinary creatinine (mg/dL) Ans.
P is plasma creatinine (mg/dL)
V is volume of urine excreted (mL/minute). Sources of Vitamin C
♦♦
Clinical Interpretation
♦♦ The normal range for creatinine clearance is 90 to 120 mL/ ♦♦
minute.
A decreased creatinine clearance is a very sensitive
indicator of a decreased glomerular filtration rate.
The reduced filtration rate may be caused by acute or
chronic damage to the glomerulus or any of its components.
Reduced blood flow to the glomeruli may also produce a
decreased creatinine clearance.
12. VITAMINS
 (Sep 2001, 5 Marks) (Apr 2008, 3 Marks),
 (Mar 2008, 3 Marks) (Dec 2010, 3 Marks)
 (Sep 2013, 5 Marks) (Apr 2015, 3 Marks)
Or
Describe sources, absorption, storage, daily require­
ment, physiological and biochemical functions, deficiency,
symptoms and hypervitaminosis of vitamin C.
 (Nov 2009, 8 Marks)
Or
Write in detail about vitamin C giving its chemistry,
daily requirement, sources, history, physiological/
biochemical functions, etc. (Aug 2011, 11 Marks)
Or
Describe sources biological role and manifestation of
vitamin C deficiency. (Feb 2016, 3 Marks)
Or
Define vitamins. Write in detail about chemistry, bio-
chemical functions, history, daily requirement, etc. of
vitamin C. (Feb 2013, 10 Marks)
Or
Describe sources, biological role and manifestation of
vitamin C deficiency. (May 2017, 5 Marks)
Or
Describe sources, functions and deficiency disorders
of vitamin C. (July 2016, 5 Marks)
Or
Write on functions of vitamin C and scurvy.
 (Dec 2014, 5 Marks)
Or
deficiency. (Sep 2018, 5 Marks)
Citrus fruits, gooseberry (amla), guava, green vegetables
such as cabbage and spinach, tomato and potato.
High content of vitamin C is found in adrenal gland and
gonads.
520 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Absorption and Storage of Vitamin C
♦♦ Ascorbic acid is easily absorbed from the small intestine,
peritoneum and subcutaneous tissues.
♦♦ It is not stored in any particular organ and is spread
throughout the body.
Daily Requirements
♦♦ Recommended daily allowance of vitamin C is about 60
to 70 mg.
♦♦ Additional intake is needed for women during pregnancy
and lactation.
History
In the winter of 1556, there was a scurvy epidemic that plagued
in Europe. Little did the population know that the lack of fruits
and vegetables in those winter months had caused the outbreak.
While this was one of the earliest noted scurvy epidemics, not
much research was done in effort to cure this disease until
many centuries later. Jacques Cartier, an established explorer,
curiously noted that his sailors who had digested oranges,
limes, and berries did not get scurvy, and those who had the
disease recovered.
In 1742, James Lind, a British doctor, was the first person to
establish that there was a definite connection between the diet
and scurvy.
While this was used often at sea, its applicable daily dietary
benefits were not fully understood. In the late 1800s, infants
were dying from scurvy, and no one knew why. In the early
1900s, studies showed that the vitamin C found in the babies’
milk was being destroyed in the routine pasteurization of that
milk.
In 1912, studies showed that when scurvy was injected into
guinea pigs (one of the few animals who can contact the disease),
several doses of vitamin C cured the guinea pigs. In this present
day, the governments recommended daily allowance of vitamin
C, a mere 60 mg will only prevent the public from contracting
this horrible disease.
Chemistry of Vitamin C
♦♦ Ascorbic acid is a six carbon derivative and it closely
resembles monosaccharides in structure.
♦♦ The acidic property of vitamin C is due to the enolic
hydroxyl groups.
♦♦ It is a strong reducing agent.
♦♦ L-ascorbic acid undergoes oxidation to form dehydro­
ascorbic acid and this reaction is reversible.
♦♦ On hydration, dehydroascorbic acid is irreversibly
converted to 2, 3-diketogulonic acid which is inactive.
Physiological and Biochemical Functions
♦♦ Collagen formation: Vitamin C plays the role as coenzyme
in hydroxylation of proline and lysine, while protocollagen
get converted to collagen. The hydroxylation reaction is
catalyzed by lysyl hydroxylase and prolyl hydroxylase and
they get converted to hydroxyproline and hydroxylysine.
This reaction is dependent on vitamin C.
♦♦ Bone formation: Tissues of bone possess an organic
matrix, collagen and the inorganic calcium, phosphate,
etc. Vitamin C is essential for bone formation.
♦♦ Iron and hemoglobin metabolism: Ascorbic acid leads
to iron absorption by placing it in the ferrous form. This
is mainly caused by reducing the property of vitamin C.
♦♦ Tryptophan metabolism: Vitamin C is essential for the
hydroxylation of tryptophan enzyme hydroxylase to
hydroxytryptophan in the synthesis of serotonin.
♦♦ Tyrosine metabolism: Ascorbic acid is required for the
oxidation of p-hydroxyphenylpyruvate to homogentisic
acid in tyrosine metabolism.
♦♦ Folic acid metabolism: The active form of the vitamin
folic acid is tetrahydrofolate. Vitamin C is needed for the
formation of folic acid.
♦♦ Sparing action of other vitamins: Ascorbic acid is a strong
antioxidant. It spares vitamin A, vitamin E, and some
B-complex vitamins from oxidation.
♦♦ lmmunological function: Vitamin C enhances the
synthesis of immunoglobulins (antibodies) and increases
the phagocytic action of leukocytes.
♦♦ Synthesis of corticosteroid hormones: Since adrenal gland
possess high levels of ascorbic acid mainly in the period
of stress. So, it is believed that vitamin C is necessary for
hydroxylation reaction in the synthesis of corticosteroid
hormones.
♦♦ Preventive action on chronic diseases: As during normal
metabolism free radicals are constantly secreted, they cause
damage to proteins, lipids, DNA and cell membrane which
causes development of cancer, heart diseases and aging.
Since vitamin C is a strong biological antioxidant which
prevent these chronic diseases.
Symptoms of Vitamin C Deficiency
♦♦ Gross deficiency of vitamin C results in scurvy.
♦♦ In severe cases of scurvy, the gum becomes painful,
swollen, and spongy. Pulp is separated from the dentine
and finally teeth are lost. Wound healing may be delayed.
♦♦ In ascorbic acid deficiency, collagen is abnormal and the
intercellular cement substance is brittle. So capillaries are
fragile leading to the tendency to bleed even under minor
pressure. Subcutaneous hemorrhage may be manifested
as petechiae in mild deficiency and as ecchymoses or even
hematoma in severe conditions.
♦♦ In severe cases, hemorrhage may occur in the conjunctiva
and retina. Internal bleeding may be seen as epistaxis,
hematuria or malena.
♦♦ In the bones, the deficiency results in the failure of the
osteo­blasts to form the intercellular substance, osteoid.
Without the normal ground substance, the deposition
of bone is arrested. The resulting scorbutic bone is weak
and fractures easily. There may be hemorrhage into joint
cavities. Painful swelling of joints may prevent locomotion
of the patient.
♦♦ In vitamin C deficiency microcytic, hypochromic anemia
is seen.

Hypervitaminosis of Vitamin C
♦♦ Occasional large intakes of vitamin C may cause sto­mach
cramps, nausea, and diarrhea in some fasting subjects but
have no long-term adverse effects.
♦♦ It has been specifically proposed that megadoses of
vitamin C:
• Increase oxalate production (thereby increasing the
formation of renal stones).
• Competitively inhibit renal reabsorption of uric acid.
• Enhance the destruction of vitamin B12 in the gut.
Intensify the enteric absorption of nonhem iron, thus
leading to iron overload.
• Result in mutagenic effects.
• Increase in vitamin C catabolism that would persist
after returning to lower intakes of the vitamin.
Q.2. Write a short note on vitamin D.
 (Apr 2003, 5 Marks) (Dec 2010, 5 Marks)
 (Aug 2012, 5 Marks) (Oct 2014, 3 Marks)
Or
Describe in brief about vitamin D.
 (Apr 2008, 4 Marks) (Mar 2008, 3 Marks)
 (Apr 2010, 5 Marks) (Nov 2009, 3 Marks)
Or
Write in detail about vitamin D. (Aug 2011, 11 Marks)
Or
Describe sources, daily requirement, symptoms of
vitamin D deficiency. What is role of vitamin D in
calcium metabolism?
 (Aug 2012, 6 Marks) (Aug 2011, 20 Marks)
Or
Write on functions of Vitamin D and rickets.
 (Dec 2014, 5 Marks)
Ans. Vitamin D is also known as calciferol due to its role in
calcium metabolism and antirachitic factor.
Structure
Vitamin D is a steroid compound and there are two forms of
vitamin D, i.e.
1. Naturally produced vitamin D3 or cholecalciferol. It
is obtained from animal sources in diet or made in
skin by action of ultraviolet light from sunlight on
7–dehydrocholesterol.
2. Another is artificially produced from D2 or ergocalciferol.
This form is made in laboratory by irradiating plant sterol,
i.e. ergosterol.
Absorption and Transport
Dietary vitamin D is absorbed in duodenum along with lipids
and is transported to liver via chylomicron.
Formation of Vitamin D
7-dehydrocholesterol, an intermediate of a minor pathway
of cholesterol synthesis is available in the malpighian layer
Biochemistry 521
of epidermis. In the skin, ultraviolet light breaks the bond
to give rise the provitamin, secosterol. The cis double bond
between is then isomerized to a trans bond to form vitamin D3
or cholecalciferol.
So, vitamin D is called the “sun-shine vitamin”. As sun-shine
is less in winter months, vitamin deficiency is seen in winter.
Activation of Vitamin D
Vitamin D acts like a prohormone. The cholecalciferol
which is the inactive form is first transported to liver where
hydroxylation at 25th position occurs which is catalyzed by
enzyme hydrolase, to form 25-hydroxycholecalciferol. This is
the major storage form.
In the kidney, it is further hydroxylated at the 1st position
by α–hydroxylase enzyme. Thus 1, 25-dihydroxycholecalciferol
is generated. Since it contains three hydroxyl groups at 1, 3 and
25 positions, it is also called calcitriol. The calcitriol thus formed
is the active form of vitamin, it act as a hormone.
Biochemical Functions or Role of Vitamin D in Calcium
Metabolism
Calcitriol acts at 3 different levels (intestine, kidney and bone)
to maintain plasma calcium (normal 9–11 mg/dL).
1. Action of calcitriol on the intestine: Calcitriol increases
the intestinal absorption of calcium and phosphate. In the
intestinal cells, calcitriol binds with a cytosolic receptor
to form a calcitriol-receptor complex. This complex then
approaches the nucleus and interacts with a specific DNA
leading to the synthesis of a specific calcium binding
protein. This protein increases the calcium uptake by the
intestine.
2. Action of calcitriol on the bone: In the osteoblasts of
bone, calcitriol stimulates calcium uptake for deposition
as calcium phosphate. Thus calcitriol is essential for bone
formation.
3. Action of calcitriol on the kidney: Calcitriol is also
involved in minimizing the excretion of calcium and
phosphate through the kidney by decreasing their
excretion and enhancing reabsorption.
Sources
♦♦ Best sources for vitamin D are cod liver oil, fish oils and
sunlight induced synthesis of vitamin D3 in skin.
♦♦ Egg yolk and liver are good sources.
Daily Requirement
♦♦ Daily requirement of vitamin D is 400 IU or 10 µg of
cholecalciferol.
♦♦ In countries with good sunlight recommended daily
requirement is 200 IU or 5 µg of cholecalciferol.
Symptoms of Vitamin D Deficiency
Deficiency of vitamin D leads to rickets (rachitis) in growing
children and osteomalacia in adults.
522 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Rickets
♦♦ It is characterized by the formation of soft and pliable bones
due to poor mineralization and calcium deficiency. Due to
softness, the weight bearing bones are bent and deformed.
♦♦ Main features of the rickets are a large head with
protruding forehead, pigeon chest, bow legs, (curved
legs), knock knees and abnormal curvature of the spine
(kyphosis).
♦♦ Rachitic children are usually anemic or prone to infections.
Rickets can be fatal when severe.
♦♦ Rickets is characterized by low plasma levels of calcium
and phosphorus and high alkaline phosphatase activity.
Osteomalacia (Adult Rickets)
♦♦ Deficiency of vitamin D in adults causes osteomalacia. This
is a condition similar to that of rickets.
♦♦ Osteomalacia is characterized by demineralization of
previously formed bones, demineralization of bones makes
them soft and susceptible to fractures.
Renal Rickets (Renal Osteodystrophy)
♦♦ In chronic renal failure synthesis of calcitriol in kidney is
impaired. As a result, the deficiency of calcitriol occurs
which leads to hypocalcemia and hyperphosphatemia.
♦♦ It can be treated by oral or intravenous administration of
calcitriol (active form of vitamin D).
Vitamin D Resistant Rickets
♦♦ It is a disease which does not respond to the treatment
with vitamin D.
♦♦ There are various possible causes of this condition and all
involve a defect in the metabolism or mechanism of action
of 1,25-dihydroxycholecalciferol as follows:
• Due to defective vitamin D receptor
• Due to a defective 1, α-hydroxylase activity in kidney
• Due to liver disease and kidney failure as the
production of 25-hydroxycholecalciferol and
1,25-dihydroxycholecalciferol respectively will be
inefficient in the damaged tissue.
Hypervitaminosis D
♦♦ Vitamin D is stored mostly in liver and slowly metabolized.
♦♦ Among the vitamins, vitamin D is the most toxic in
overdoses.
♦♦ Toxic effects of hypervitaminosis D include demineraliza-
tion of bones (resorption) and increased calcium absorp-
tion from the intestine leading to elevated calcium in
plasma (hypercalcemia). Hypervitaminosis D may lead to
the formation of stones in kidneys (renal calculi).
♦♦ High consumption of vitamin D is associated with the loss
of appetite, nausea, increased thirst, loss of weight.
Q.3. Write a short note on vitamin A.
 (Mar 2000, 5 Marks) (Mar 2001, 5 Marks)
 (Mar 2009, 5 Marks) (Mar 2009, 5 Marks)
 (June 2010, 2.5 Marks) (Feb 2014, 3 Marks)
Or
Write a short note on sources and functions of vitamin A.
 (Oct 2007, 5 Marks)
Or
Write down source, requirement and action of vitamin
A. What is the effect of deficiency of vitamin A on hu-
man being. (Nov 2008, 5 Marks)
Ans. Vitamin A is a fat soluble vitamin.
Structure
Vitamin A contains of a single 6-membered ring with attached
11–carbon side chain is attached. Vitamin A is an alcohol
(retinol), but can be converted into an aldehyde (retinal), or an
acid (retinoic acid).
Active Form
♦♦ Vitamin A consists of three biologically active molecules
known as retinoids, i.e. retinol, retinal and retinoic acid.
♦♦ Each of these compounds are derived from plat precursor
molecule, i.e. β–carotene.
♦♦ β–carotene has two molecules of retinal linked at their
aldehyde ends also known as provitamin form of vitamin
A.
♦♦ Retinol and retinal are interconverted by enzyme retinal
aldehyde reductase. Retinoic acid is formed by oxidation of
retinal. Retinoic acid cannot be reduced to retinol or retinal.
Absorption Transport and Mobilization
♦♦ Dietary retinal esters are hydrolyzed by enzyme pancreatic
or intestinal brush border hydrolases in the intestine,
releasing retinol and free fatty acids.
♦♦ Carotenes get hydrolyzed by β–carotene 15-15’-dioxygenase
of intestinal cells and release two moles of retinal which is
reduced to retinol.
♦♦ Inside the intestinal mucosal cells, retinol get re-esterified
to long chain fatty acids, incorporated into chylomicrons
and transferred to the lymph. The retinol esters of
chylomicrons are taken up by the liver and stored.
♦♦ Transportation of retinol occurs in the circulation by the
plasma retinol binding protein.
♦♦ Many cells of target tissues contain a cellular retinol-
binding protein that carries retinol to the nucleus and
binds to the chromatin (DNA). It is here that retinol exerts
its f function in a manner analogous to that of a steroid
hormone.
Biochemical Functions or Actions of Vitamin A
♦♦ Vitamin A is needed for variety of functions, such as
vision, cell differentiation and growth, reproduction and
maintenance of epithelial cells.
♦♦ Retinol as well as retinoic acid function like steroid
hormones. Both of them regulate protein synthesis and are
involved in both cell growth and differentiation.
♦♦ Vitamin A maintains healthy epithelial tissue.
 Biochemistry 523

♦♦ Carotenoids function as antioxidants and reduce risk of Hypervitaminosis A

cancer initiated by free radicals and strong oxidants.
♦♦ The symptoms of hypervitaminosis A include nausea,
♦♦ Retinoic acid is found to be involved in glycoprotein
vomiting, diarrhea, loss of hair (alopecia), scaly and rough
synthesis, thus it is involved in the development and
skin, bone and joint pain, enlargement of liver, loss of
maintenance of ground substance in collagen tissue.
weight, etc.
Vitamin A is involved in synthesis of chondrotin sulfate.
♦♦ In pregnant women hypervitaminosis A can lead to
Dietary Sources congenital malformation in growing fetus.
♦♦ Plant sources: All pigmented (particularly yellow) vege­ Q.4. Give daily requirement, sources, symptoms and physi-
tables and fruits (e.g. sweet potatoes, carrots, pumpkins, ological role of Vitamin A deficiency. Add a note on
papayas, tomatoes, apricots, and peaches) and the leafy rhodopsin cycle. (Dec 2010, 15 Marks)
vegetables. Or
♦♦ Animal sources: Liver, milk, butter, eggs, kidney, fat of
Write short answer on biochemical functions of vitamin
muscle meats and fish liver oil.
A and add a note on Wald’s visual cycle.
Daily Requirements  (Apr 2018, 5 Marks)
Ans. For daily requirement, sources, symptoms, biochemical
♦♦ Infants—1,500 IU
functions or physiological role of Vitamin A deficiency
♦♦ Children—2,000-3,500 IU
refer to Ans 3 of same chapter.
♦♦ In man—5,000 IU
♦♦ In woman—4,000 IU Rhodopsin Cycle
♦♦ Pregnant and lactating women—8000 IU.
Rhodopsin cycle is also known as Wald’s visual cycle.
Deficiency of Vitamin A ♦♦ Rhodopsin is a conjugated protein which is present inside
Night blindness (Nyctalopia) the rods. It has 11-cis-retinal and protein opsin.
♦♦ Primary event in visual cycle when exposed to light is,
♦♦ Night blindness is one of the earliest symptoms of vitamin
isomerization of 11-cis-retinal to all-trans-retinal. This
A deficiency. This is characterized by the loss of vision in
leads to a conformational change in opsin which is
night (in dim or poor light) since dark adaptation time is
responsible for the generation of nerve impulse.
increased. Prolonged deficiency of vitamin A leads to an
irreversible loss of visual cells.
♦♦ Severe vitamin A deficiency causes dryness of cornea and
conjunctiva, a clinical condition termed as xerophthalmia
(dry eyes).
♦♦ If this situation remains for longer time, keratinization
and ulceration of cornea takes place. This results in the
destruction of cornea. The cornea becomes totally opaque
resulting in the permanent loss of vision (blindness), a
clinical condition termed as keratomalacia. Xerophthalmia
and keratomalacia are commonly observed in children.
♦♦ White opaque spots develop on either side of cornea in
vitamin A deficiency are known as Bitot's spots.

Effect on Skin and Epithelial Cells

♦♦ Vitamin A deficiency causes keratinization of epithelial
cells of skin which leads to keratosis of hair follicles, and
dry, rough, and scaly skin.
♦♦ Keratinization of epithelial cells of respiratory, urinary
tract makes them susceptible to infections.

Other Symptoms of Vitamin A Deficiency

♦♦ Failure of growth in children. Fig. 38:  Rhodopsin cycle
♦♦ Faulty bone modelling producing thick cancellous
(spongy) bones instead of thinner and more compact ones. ♦♦ All-trans-retinal gets immediately isomerized by retinal
♦♦ Abnormalities of reproduction including degeneration isomerase (of retinal epithelium) to 11-cis-retinal. Now
of the testes, abortion or the production of malformed this combines along with opsin to regenerate rhodopsin
offspring. and complete the visual cycle.
524 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ Moreover, the conversion of all trans-retinal to 11-cis
retinal is incomplete. So, most of the all-trans-retinal is
transported to the liver and converted into all—trans
retinol by an enzyme alcohol dehydrogenase.
♦♦ The all-trans-retinol undergoes isomerization to 11-cis
retinol which is then oxidized to 11-cis retinal to participate
in the visual cycle.
Q.5. Write a short note on fat soluble vitamin.
 (Apr 2010, 5 Marks) (Dec 2009, 5 Marks)
Or
Describe in brief fat soluble vitamins.
 (Jan 2012, 4 Marks)
Or
Write on fat soluble vitamins. (Apr 2017, 5 Marks)
Ans. Fat Soluble Vitamins
• The fat soluble vitamins are a polar hydrophobic
molecules.
• They have isoprene derivatives.
• Bile salts and fats are essential for their absorp-
tion.
• They are generally stored in liver.
• Normally, they are not excreted in urine.
• Fat soluble vitamins are vitamin A, D, E and K.
• Fat soluble vitamins function as coenzymes, hor-
mones and antioxidants.
• Fat soluble vitamins are toxic and even lethal when
they are taken in excessive quantities.
Following are some of the details of fat soluble vitamins
which are as follows:

Daily Deficiency
Name Active form Source requirements Functions manifestations
Vitamin A Retional, Fish liver oils, milk, 800–1,000 Retinal and retinol are involved in vision. Night blindness,
retinal, retinoic milk products, green retinol Retinoic acid regulates the expression xerophthalmia formation of
acid leafy vegetables, equivalents of gene during growth and development. Bitot’s spots, dry rough and
carrots, yellow and Antioxidant scaly skin. Retardation of
red fruits growth in children
Vitamin D 1,25-Dihydroxy- Cod liver oil, sunlight 200–400 IU Regulation of the plasma level of Rickets (in children),
(cholecalciferol) cholecalciferol induced synthesis calcium and phosphorus, calcification osteomalacia (in adults)
of vitamin D3 in skin, of bone
egg yolk
Vitamin E a-tocopherol Soya and corn oils, 8–10 mg Natural antioxidant and acts as a Hemolytic anemia,
(a-tocopherol) germ oil, fish oil, scavenger of free radicals. Protects the retrolental fibroplasia (RLF)
eggs, alfalfa RBCs from hemolysis. in premature infants
Prevents peroxidation of PUFA in cell
membrane
Vitamin K Phylloquinone Green leafy 70–140 mg Required for activation of blood clotting Hemorrhagic disorder,
(Vitamin K1) vegetables, factors. Required for g-carboxylation of increased clotting time
Menaquinone tomatoes, cheese, glutamic acid, carboxylation of glutamic
(Vitamin K2) meat, egg yolk acid residue in clotting and osteocalcin
proteins

Q.6. Write short note on vitamin B1. (Aug 2005, 5 Marks)
Or
Functions of vitamin B1 and effects of its deficiency.
 (Jan 2018, 5 Marks)
Ans. Vitamin B1 is also known as Thiamine.
Chemistry
Thiamine consists of pyrimidine ring and a thiazole ring which is
held by a methylene bridge. Alcohol group of thiamine is esterified
by the phosphate to form the coenzyme, i.e. thiamine pyrophos-
phate. Pyrophosphate moiety is donated by ATP and reaction is
catalyzed by an enzyme thiamine pyrophosphate transferase.
Recommended Dietary Allowance
Daily requirement of thiamine depends on the intake of
carbohydrate.
Daily intake of 1 to 1.5 mg/day is recommended for adults.
Dietary Sources
♦♦ Rich sources: Polishing rice, wheat jaw and yeast
♦♦ Good source: Cereals, pulses, nuts, oil, seeds
♦♦ Fair sources: Meat, fish, egg, milk, vegetables and fruits.
Biochemical Functions or Functions of Vitamin B1
♦♦ Vitamin B1 is required for carbohydrate metabolism.
♦♦ Thiamine pyrophosphate is the coenzyme involved
in various enzymatic reactions mainly for oxidative
decarboxylation and transketolase reactions as follows:
• Thiamine pyrophosphate is a coenzyme for
pyruvate dehydrogenase complex which catalyzes
conversion of pyruvate into acetyl-CoA by oxidative
decarboxylation. Acetyl-CoA is a precursor for
synthesis of neurotransmitter acetylcholine and also
for synthesis of myelin. So, thiamine is needed for
normal functioning of nervous system.

• Thiamine pyrophosphate is a coenzyme for α–
ketoglutarate dehydrogenase which catalyzes the
conversion of α–ketoglutarate to succinyl–CoA in
TCA cycle.
• Thiamine pyrophosphate is the coenzyme for an
enzyme transketolase, in pentose phosphate pathway
of glucose oxidation.
Deficiency of Vitamin B1
Deficiency of vitamin B1 results in a condition known as
beriberi. Deficiency of thiamine occurs in population who
consume exclusively polished rice as staple food. Polishing of
rice removes thiamine.
♦♦ The early symptoms of thiamine deficiency are anorexia,
nausea, mental confusion, peripheral neuritis, muscle
fatigue and irritability.
♦♦ Thiamine deficiency leads to three types of beriberi, i.e.
1. Dry beriberi
2. Wet beriberi
3. Infantile beriberi
Dry Beriberi (Neuritic Beriberi)
♦♦ It develops when the diet chronically contains slightly less
than the thiamine requirements.
♦♦ This form of beriberi is characterized primarily by
peripheral neuritis, severe muscular weakness and fatigue.
Other symptoms of dry beriberi include dry skin, mental
confusion and poor appetite.
Wet Beri-beri (Cardiac Beri-beri)
♦♦ It develops when the deficiency is more severe in
which cardiovascular system is affected in addition to
neurological symptoms.
♦♦ Wet beri-beri is characterized primarily by edema of
extremities, heart enlargement and cardiac insufficiency.
♦♦ Other symptoms include tachycardia or bradycardia and
palpitation.
♦♦ Both forms of beri-beri may overlap to a varying degree
and patients of beri-beri may die due to heart failure, if
not treated.
Infantile Beriberi
♦♦ Infantile beriberi is observed in breast fed infants born to
mother suffering from thiamine deficiency. The breast milk
of these mothers is deficient in thiamine.
♦♦ Infantile beriberi is characterized by cardiac dilation
(enlargement of heart), tachycardia, convulsions, edema
and gastrointestinal disturbances such as vomiting,
abdominal colic, etc. In acute condition, the infant may
die due to cardiac failure.
Wernicke-Korsakoff Syndrome
♦♦ It is also known as cerebral beriberi and mostly seen in
alcoholics.
Biochemistry 525
♦♦ In chronic alcoholics, the nutritional deficiencies result
from either poor intake of food or malabsorption of
nutrients from intestine.
 Wernicke-Korsakoff syndrome is characterized by
anorexia, nausea, vomiting, nystagmus, depression, ataxia,
loss of memory, mental confusion, peripheral paralysis,
muscular weakness, etc.
Q.7. Write a short note on vitamin B12 or write a short note
on cyanocobalamin. (Sep 2000, 5 Marks)
 (Sep 2007, 3 Marks) (Sep 2009, 5 Marks)
Ans. Vitamin B12 is also known as antipernicious anemia
vitamin.
Chemistry
Vitamin B12 has a complex corrin ring which is lniked to cobalt
atom held in the center of corrin ring by four coordination
bonds with nitrogen of pyrrole groups. Remaining coordination
bonds of cobalt are linked to nitrogen of dimethylbenzimidazole
nucleotide and sixth bond is linked to either methyl or (5’–
deoxyadenosyl) or hydroxyl group to form methylcobalamin,
adenosylcobalamin or hydroxycobalamin.
Active forms of vitamin B12 are methylcobalamin and
5-deoxyadenosylcobalamin.
Absorption, Transport and Storage
♦♦ Vitamin B12 from intestine needs an intrinsic factor, which
is a glycoprotein secreted by parietal cell of stomach.
♦♦ Intrinsic factor binds to dietary vitamin B12 to form
vitamin B12–intrinsic factor complex. This complex binds
to specific receptors on surface of mucosal cells of ileum.
♦♦ As the complex bind to the receptor, bound vitamin B12
gets released from complex and enters ileal mucosal cells
via Ca2+ dependent process.
♦♦ Vitamin inside the mucosal cells gets converted to its
main plasma transport form to methylcobalamin. Now it
is transported by vitamin B12 binding protein known as
transcobalamins, i.e. TC–I and TC–II.
♦♦ Methylcobalamin in excess is taken up by the liver and is
stored in deoxyadenosyl B12 form.
♦♦ Liver can store 4 to 5 mg of vitamin B12 in adults.
Functions
♦♦ Conversion of homocysteine to methionine: Vitamin
B12, as methylcobalamin is used in the conversion of
homocysteine to methionine. This is an important reaction
which involves N5–methyltetrahydrofolate from which
tetrahydrofolate is liberated. This metabolic step shows
the relation between vitamin B12 and folic acid.
♦♦ Isomerization of methylmanlonyl-CoA to Succinyl–CoA:
Degradation of odd chain fatty acids of certain amino acids
and pyrimidines produce effect or through mediation of
propionyl-CoA. This is converted to succinyl-CoA in the
presence of B12 coenzyme, deoxyadenosylcobalamin. The
reaction involves hydrogen transfer and intramolecular
rearrangement.
526 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Recommended Dietary Allowance
♦♦ Daily intake of 3µg/day is recommended in adults.
♦♦ For children the requirement is 0.5 to 1.5 µg/day.
♦♦ During pregnancy and lactation, the requirement is 4 µg/
day.
Dietary Sources
♦♦ Food of animal origin: Rich sources are liver, kidney, milk,
curd, eggs, fish, pork and chicken.
♦♦ Curd is better source than milk.
♦♦ Vitamin B12 is absent in foods.
♦♦ Humans obtain small amount of vitamin B12 from
intestinal flora.
Deficiency
Deficiency of vitamin B12 occurs due to decreased
absorption or due to decreased dietary intake. Deficiency
may lead to:
♦♦ Pernicious anemia: This occurs because of deficiency
of intrinsic factor in stomach which causes impaired
absorption of vitamin B12. This is also characterized by
megaloblastic anemia and low hemoglobin level along
with neurological disorders.
♦♦ Megaloblastic anemia: This is due to functional folate
deficiency. It occurs due to folate trap.
♦♦ Methylmalonic aciduria: As vitamin B12 is needed for
the conversion of methylmalonic acid to succinic acid,
individuals deficient in vitamin B12 excrete excess amount
of methylmalonic acid in urine.
♦♦ Neuropathy: In vitamin B12 deficiency, many of the
neurological symptoms appear due to progressive degeneration
of myelinated nerves. Degeneration of myelinated nerves is
due to accumulation of (L–methylmalonyl–CoA) which
impairs the myelin sheath formation.
Q.8. Write a short note on Vitamin K.
 (Mar 2007, 3 Marks) (Apr 2007, 5 Marks)
Ans. Vitamin K is the only fat soluble vitamin with the specific
coenzyme function. This is needed for the production
of blood clotting factors which are needed for blood
clotting.
Chemistry
There are two naturally occurring forms of vitamin K:
1. Vitamin K1 or phylloquinone derived from plant.
2. Vitamin K2 or menaquinones produced by microorganisms.
Both of these naturally occurring types have same general
activity.
Vitamin K3 or menadione is a synthetic product which is an
alkylated form of vitamin K2.
All the above mentioned three vitamins are naphthoquinone
derivatives.
Isoprenoid chain is present in vitamin K1 and K2.
Absorption, Transport and Storage
♦♦ Naturally occurring vitamin K derivatives are absorbed
in the presence of bile salts. It is transported to liver in the
form of chylomicrons where it is stored.
♦♦ Menadione or synthetic vitamin K is absorbed even
in the absence of bile salt passing directly in hepatic
portal vein.
Sources
♦♦ Excellent source: Cabbage, cauliflower, spinach and other
green vegetables
♦♦ Good sources: Tomato, cheese, dairy product, meat, egg
yolk, etc.
Recommended Dietary Allowance
Suggested RDA for an individual is 70 to 140 mg/day.
Functions of Vitamin K
♦♦ Vitamin K is required for blood coagulation. It leads to
activation of blood clotting factors, prothrombin, factor VII,
IX and X. These blood clotting proteins are synthesized in
liver in an inactive form, and are converted into their active
form by vitamin K-dependent carboxylation reaction. In
this, vitamin K-dependent carboxylase enzyme adds extra
carboxyl group at γ–carbon of glutamic acid residues of
inactive blood clotting factors.
♦♦ Vitamin K is also needed for carboxylation of glutamic acid
residues of osteocalcin which is a calcium binding protein
present inside the bone.
Deficiency Symptoms
♦♦ Vitamin K deficiency is associated with hemorrhagic
disease. In vitamin K deficiency, clotting time of blood
is increased. Due to deficiency of vitamin K there is lack
of active prothrombin in circulation. Individual bleeds
profusely even in minor injuries.
Hypervitaminosis K
If vitamin K is given in large doses it leads to hemolytic anemia
and jaundice mainly in infants.
Q.9. Write about role of different vitamins in healthy teeth.
 (Feb 2013, 5 Marks)
Ans. Vitamin C
• Role of this vitamin on the wholesome health of the
entire human body is well known. It is important for
growth, development, maintenance and recovery of
the oral tissues and bones.
• It helps the oral wounds to heal faster through its
beneficial effects on circulation and maintenance of
the blood vessels.
• Vitamins C helps the forming of collagen which is a
building component of the dentine.

Vitamin D
Helps in the absorption of calcium in the human body. Calcium
is found in the body in large measures and plays a role in the
growth and development of healthy teeth.
Vitamin A
♦♦ Structure of the enamel contains a substance called keratin,
which needs vitamin A in order to be created. Vitamin A
plays an important role in the human immunity and fight
against infections.
♦♦ Vitamin A helps in maturation of ameloblasts during
amelogenesis.
Vitamin K
Plays a role in the binding of calcium within the teeth. Leads to
better dental structure and helps the defense of the teeth against
the attack of acids.
Vitamin B
Deficit of vitamin B causes toothache, retraction of the gum
and tooth and gum sensitivity.
Q.10. Write a short note on scurvy. (Apr 2008, 5 Marks)
 (Aug 2011, 5 Marks) (Aug 2012, 4 Marks)
 (Oct 2016, 5 Marks)
Ans. Scurvy is caused due to deficiency of vitamin C.
Clinical Features
♦♦ Lassitude, anorexia, painful limbs and enlargement of
costochondral junction.
♦♦ Hair follicle rises above the skin and there are perifollicular
hemorrhages, i.e. tiny points of bleeding occurring around
the orifice of hair follicles with heaping of keratin like
material.
♦♦ Hemorrhage may occur in the joint, into nerve sheath under
the nails or conjunctiva. Petechial hemorrhage occurs in
buttocks, abdomen, legs, arms, ankle and nail beds. There
is also epistaxis, anemia and delayed wound healing.
♦♦ Scorbutic child usually assumes a frog like’ position and
this may reflect as subperiosteal hemorrhage.
Oral Manifestations
♦♦ In oral cavity it occurs in gingival and periodontal region.
♦♦ Interdental and marginal gingiva is bright red, swollen,
smooth, shiny surface producing an appearance known as
‘scurvy bad’. In fully developed scurvy, gingiva becomes
boggy, ulcerated and bleeds easily.
♦♦ Color changes to violaceous red.
♦♦ Typical fetid breath of the patient with fusospirochetal
stomatitis.
Q.11. Write a short note on vitamin E. (June 2010, 2.5 Marks)
Ans. Vitamin E is also known as tocopherol. It is a naturally
occurring antioxidant. Vitamin E is also known as
antisterility vitamin.
Biochemistry 527
Chemistry
♦♦ Vitamin E consists of eight naturally occurring tocopherols,
of which α–tocopherol is most active form.
♦♦ Tocopherols are the derivatives of 6–hydroxylchromane
ring with isoprenoid side chain. Antioxidant property is
mainly due to chromane ring.
Absorption, Transport and Storage
Vitamin E is absorbed from intestine along with dietary lipid. It
is incorporated in chylomicrons. Vitamin E is delivered to liver
via chylomicron. Liver can export vitamin E in VLDL to target
cells. In cells, tocopherols are distributed where anti–oxidant
activity is needed. Major site of vitamin E storage is adipose
tissue.
Dietary Sources
Rich sources: Vegetable oils
Good sources: Wheat gram oil, cotton seed oil, peanut oil, corn
oil and sunflower oil.
Also present in milk, meat, butter and egg.
Recommended Dietary Allowance
Daily consumption for man is 10 mg or 15I U
Daily consumption for woman is 8 mg or 12I U
Biochemical Functions
♦♦ It acts as a natural antioxidant by scavenging free radicals
and molecular oxygen.
♦♦ It is important for preventing polyunsaturated fatty acids
from peroxidation reaction.
♦♦ Vitamin E protects erythrocyte membrane from an oxidant.
It protects RBCs from hemolysis.
♦♦ Vitamin E is associated with reproductive functions and
prevents sterility. This vitamin preserves and maintains
germinal epithelium of gonads for proper reproductive
function.
♦♦ Vitamin E prevent liver from being damage by toxic
compound, i.e. carbon tetrachloride.
♦♦ This vitamin works along with other vitamins, i.e. vitamin
A, C and β-carotene, and delays the onset of cataract.
♦♦ High intake of vitamin E, i.e. 200 to 300 mg/day protects
the development of heart diseases. Vitamin E prevents the
oxidation of LDL since the oxidized LDL is implicated to
promote heart disease.
Deficiency of Vitamin E
Vitamin deficiency is associated with sterility, degenerative
changes in muscle, megaloblastic anemia and changes in central
nervous system.
Q.12. Write a short note on calcitriol. (June 2010, 5 Marks)
Ans. Calcitriol is also known as 1, 25-dihydroxycholecalciferol.
It is the hormonally active metabolite of vitamin D.
528 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

• It was first identified by Michael F Holick in 1971. Action of Calcitriol on Kidney

• It regulates the plasma levels of calcium and phos-
It involves in decreasing the excretion of calcium and
phate.
• It is synthesized in the skin by ultraviolet rays of phosphate via kidney by decreasing excretion and increasing
sunlight. reabsorption.
• Its synthesis is self regulated by the feedback mecha- Q.13. Write a short note on vitamin B-complex.
nism.
 (Jan 2012, 5 Marks)
Action of Calcitriol on Intestine Ans. Vitamin B complex referred to the supplements contain­
It increases the internal absorption of calcium and phosphate. ing all eight vitamin Bs, i.e.
In intestinal cells calcitriol bind with cytosolic receptor to form • Vitamin B1 (thiamine)
a calcitriol-receptor complex. This complex approaches nucleus • Vitamin B2 (riboflavin)
and interacts with specific DNA causing synthesis of calcium- • Vitamin B3 (niacin or niacinamide)
binding protein.
• Vitamin B5 (pantothenic acid)
Action of Calcitriol on Bone • Vitamin B6 (pyridoxine, pyridoxal, pyridoxamine)
In osteoblasts of bone, calcitriol stimulate calcium uptake for • Vitamin B7 (biotin)
deposition as calcium phosphate. So it is necessary for bone • Vitamin B9 (folic acid)
formation. • Vitamin B12 (cyanocobalamin).

Daily Deficiency
Name Active form Source requirements Functions manifestations

Water-soluble vitamins

Thiamine TPP Cereals, meat, nuts, 1.0–1.5 mg Coenzyme for oxidative decarboxyl- Beriberi, Wernicke-
(vitamin B1) green vegetables, eggs ation and transketolase reactions Korsakoff syndrome

Riboflavin FMN, FAD Yeast, germinating 1.3–1.7 mg Coenzyme for oxidation-reduction Cheilosis, glossitis
(vitamin B2) seeds, green leafy reactions dermatitis,
vegetables, milk, eggs, vascularization of
liver, meat cornea

Niacin NAD+ and NADP+ Yeast, legumes, liver, 15–20 mg Coenzyme for oxidation-reduction Pellagra
(vitamin B3) meat reactions

Pantothenic acid Coenzyme A, Wheat germs, cereals, 5–10 mg Acyl carrier Burning feet syndrome
(vitamin B5) (CoA-SH) yeast, liver, eggs

Pyridoxin PLP Yeast, unrefined 1.6–2 mg Coenzyme for transamination, Epileptic convulsions,
(vitamin B6) cereals, pulses, decarboxylation, non-oxidative dermatits, hypochromic
vegetables, meat, fish, deamination, trans-sulfuration microcytic anemia
egg yolk reactions

Biotin Biocytin (enzyme Liver, kidney, egg yolk, 150–300 mg Coenzyme for carboxylation Rare dermatitis
(vitamin B7) bound biotin) vegetables reactions

Folic acid Tetrahydrofolic Green leafy vegetable, 200 mg Carrier of one carbon unit. Synthesis Megaloblastic anemia,
(vitamin B9) acid (THF) liver, yeast of methionine, purines and pyrimidines neural tube defects

Cynocobalamin Methylcobalamin, Only animal origin, 3 mg Coenzyme for reactions: Pernicious anemia,
(vitamin B12) deoxyadenoslco- meat, egg, liver, fish Homocysteine to methioine. megaloblastic anemia,
balamin Methylmalonyl-CoA to succinyl-CoA neuropathy (dementia),
methylmalonic aciduria

Ascorbic acid Ascorbic acid Citrus, fruits, amla, 60–70 mg Antioxidant involved in hydroxylation Scurvy
(vitamin C) leafy vegetables, reactions in the synthesis collagen,
tomatoes steroid hormones, adrenaline, etc.
facilitates absorption of iron from
intestine
 Biochemistry 529

Q.14. Write on biochemical functions of water soluble vitamins. (May 2014, 5 Marks)
Or
Write on functions of water-soluble vitamins.
 (Dec 2014, 5 Marks)
Ans. Following are the biochemical functions of water-soluble vitamins:
Water soluble
vitamin Biological function
Vitamin C It acts as a coenzyme in hydroxylation of proline and lysine
It is required for the formation of bone
It enhances iron absorption by keeping it in ferrous form
It is essential for hydroxylation of tryptophan to hydroxytryptophane in synthesis of serotonin
It is a strong antioxidant and spare vitamin A, E and B-complex vitamins
Vitamin B1 (thiamine) Thiamine consist of enzyme thiamine pyrophosphate which activate enzyme pyruvate dehydrogenase which catalyzes
conversion of pyruvate to acetyl-CoA
Transketolase depends on thiamine pyrophosphate for its action in hexose monophosphate shunt.
Thiamine pyrophosphate plays an important role in the transmission of nerve impulse.
Vitamin B2 (riboflavin) Flavin coenzymes, i.e. FAD and FMN participate in many redox reactions which leads to the production of energy.
Vitamin B3 (niacin) The coenymes NAD+ and NADP+ are involved in oxidation-reduction reactions. They accept hydride ion and undergo
reduction in pyridine ring. This causes neutralization of positive charges
Vitamin B6 (pyridoxine) Pyridoxal phosphate is the coenzyme of vitamin B6 which is involved in transamination reaction and converts amino
acids to ketoacids.
Some α-amino acids leads to decarboxylation and form amine which is carried by enzyme decarboxylase which are
dependent on pyridoxal phosphatase.
Enzyme pyridoxal phosphate is required for the synthesis of δ-amino levulinic acid which is the precursor of heme
synthesis.
Pyridoxal phosphate is required by hydroxyl group of amino acids which undergo deamination.
Vitamin B7 (biotin) or Biotin act as a biotin-dependent pyruvate carboxylase causes the conversion of pyruvate to oxaloacetate
vitamin H
Pantothenic acid Its functions are carried out by coenzyme A or CoA. Coenzyme A is involved in the metabolism of carbohydrate, lipid
and protein
Folic acid Folic acid secretes tetrahydrofolate which is involved in one carbon metabolism
Vitamin B12 It causes the synthesis of methionine from homocysteine. It also carry out the isomerization of methymalonyl-CoA
(cyanocobalamin) to succinyl-CoA

Q.15. Write about biomedical importance of vitamin C.
 (Sep 2015, 7 Marks)
Ans. Following is the biomedical importance of vitamin C:
• Collagen formation: Vitamin C plays the role as
coenzyme in hydroxylation of proline and lysine,
while protocollagen get converted to collagen.
The hydroxylation reaction is catalyzed by lysyl
hydroxylase and prolyl hydroxylase and they get
converted to hydroxyproline and hydroxylysine.
This reaction is dependent on vitamin C.
• Bone formation: Tissues of bone possess an organic
matrix, collagen and the inorganic calcium, phos-
phate, etc. Vitamin C is essential for bone formation.
• Iron and hemoglobin metabolism: Ascorbic acid leads
to iron absorption by placing it in the ferrous form. This
is mainly caused by reducing property of vitamin C.
• Tryptophan metabolism: Vitamin C is essential
for the hydroxylation of tryptophan enzyme
hydroxylase to hydroxytryptophan in the synthesis
of serotonin.
• Tyrosine metabolism: Ascorbic acid is required
for the oxidation of p-hydroxyphenylpyruvate to
homogentisic acid in tyrosine metabolism.
• Folic acid metabolism: The active form of the vi-
tamin folic acid is tetrahydrofolate. Vitamin C is
needed for the formation of folic acid.
• Sparing action of other vitamins: Ascorbic acid is
a strong antioxidant. It spares vitamin A, vitamin E,
and some B-complex vitamins from oxidation.
• Immunological function: Vitamin C enhances the
synthesis of immunoglobulins (antibodies) and
increases the phagocytic action of leukocytes.
530 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.16. Define scurvy and role of vitamin C in it.
 (Sep 2017, 5 Marks)
Ans. Deficiency of ascorbic acid leads to scurvy.
Role of Vitamin C in Scurvy
♦♦ Vitamin C plays the role as coenzyme in hydroxylation
of proline and lysine, while protocollagen get converted
to collagen. The hydroxylation reaction is catalyzed by
lysyl hydroxylase and prolyl hydroxylase and they get
converted to hydroxyproline and hydroxylysine. This
reaction is dependent on vitamin C. If vitamin C is absent
or deficient, formation of collagen is abnormal or defective.
This causes delayed healing.
♦♦ In Vitamin C deficiency, collagen is abnormal and the
intercellular cement substance is brittle. So capillaries are
fragile leading to the tendency to bleed even under minor
pressure. Subcutaneous hemorrhage may be manifested
as petechiae in mild deficiency and as ecchymoses or even
hematoma in severe conditions.
♦♦ In the bones, the deficiency of vitamin C results in the
failure of the osteoblasts to form the intercellular substance,
osteoid. Without the normal ground substance, the
deposition of bone is arrested. The resulting scorbutic bone
is weak and fractures easily. There may be hemorrhage
into joint cavities. Painful swelling of joints may prevent
locomotion of the patient.
Q.17. Write short answer on rickets. (Aug 2018, 5 Marks)
Ans. Deficiency of vitamin D leads to demineralization of
bone in children which is known as rickets.
♦ Rickets word is derived from as old English word
wrickken which means to twist.
♦ Children suffering from rickets show bone
deformities due to incomplete mineralization which
lead to soft and pliable bones. Due to softness weight
bearing bones are bent and deformed.
♦ Main features of rickets are large head with
protruding forehead, pigeon chest, bow legs, knock
knees and abnormal curvature of spine.
♦ Rachitic children are anemic and prone to infections.
Rickets can be fatal when severe
♦ In rickets there is delay in tooth formation.
♦ Biochemically the plasma level of calcitriol is
decreased and alkaline phosphatase activity is
markedly elevated.
♦ Rickets occur due to low levels of vitamin D in
body or due to the dietary deficiency of calcium or
phosphorus or both.
♦ Adult rickets is the term given to osteomalacia which
occur due to deficiency of vitamin D in adults.
♦ Renal rickets is seen in the patients of chronic renal
failure. Occurrence of renal rickets is due to the
decreased synthesis of calcitriol in kidney.
♦ Vitamin D resistant rickets is the disease which
does not respond to treatment with vitamin D. Its
causes are defective vitamin D receptor, defective 1,
α – hydroxylase activity in kidney, etc.
13. PLASMA PROTEINS
Q.1. Write briefly about functions of albumin.
 (Feb 2016, 2 Marks)
Or
Answer in brief on functions of albumin.
 (May 2017, 2 Marks)
Ans. Following are the functions of albumin:
• Osmotic function: As albumin has high concentra-
tion and low molecular weight it contributes upto
80% of total plasma oncotic pressure. So albumin
plays important role in maintaining blood volume
as well as body fluid distribution.
• Transport function: Plasma albumin binds to
various biochemically important compounds and
transports them in circulation.
• Nutritive function: Albumin act as source of amino
acid for synthesis of tissue protein to limited extent
mainly during the nutritional deprivation of amino
acids.
• Buffering function: Of all the plasma proteins buff-
ering capacity of albumin is maximum.
• Blood–brain barrier: Albumin fatty acid complex
does not cross blood-brain barrier and so fatty acids
are not taken up by brain.
Q.2.
Write a short note on antibody. (Nov 2008, 5 Marks)
Ans.
Antibody is also known as immunoglobulin.
Immunoglobulins are γ-globulins known as antibodies.
All antibodies are immunoglobulins but all immuno-
globulins are not antibodies.
Antibodies are produced by plasma cells and to some
extent by lymphocytes.
Structure of Antibody
♦♦ All antibodies basically have two identical heavy chains
and two identical light chains which are held together by
disulfide linkages and the noncovalent interactions. Thus
antibody is a Y shaped tetramer.
♦♦ Each of the heavy chain consists of 450 amino acids, while
each light chain has 212 amino acids.
♦♦ Heavy chains of immunoglobulin are linked to carbohy-
drates and so immunoglobulins are known as glycopro-
teins.
♦♦ Each chain of immunoglobulin consists of two regions
named as constant and variable.
♦♦ Amino terminal half of light chain is the variable region,
i.e. VL whereas carboxy terminal half is constant region,
i.e. CL.
♦♦ In terms of heavy chain, approximately one quarter of
amino terminal region is variable heavy chain VH, while
 Biochemistry 531

remaining three quarter is constant heavy chain, i.e. CH–1, Various Types of Antibodies and their Functions
CH–2 and CH–3.
Name of
♦♦ Amino acid sequence of variable region of both light and
antibody Functions
heavy chain are responsible for the specific binding of
antibody with antigen. IgG It neutralizes bacterial toxins and bind to microorganisms
making them easier to phagocytize
♦♦ Each antibody has hinge region between CH–1 and CH–2
which allows better fit with antigen surface. IgA It prevent attachment of bacteria and viruses to mucous
membranes and helps to protect mucous surface from
♦♦ Variable regions of both light and heavy chains form
the antigenic attack
antigen binding site.
♦♦ Enzyme digestion splits antibody molecule into two IgM It promotes phagocytosis and causes lysis of antigenic
cells
fragments, i.e. fragment for antigen binding (Fab) and
crystallizable fragment or fragment for complement IgD It may function as an antigen receptor. There is no known
antibody function
binding (Fc).
IgE • It act as antiallergic and antiparasitic
- • It mediates immediate hypersensitivity by causing
release of histamine

14. WATER, ELECTROLYTE AND

ACID-BASE BALANCE

Q.1. Describe in brief acid-base regulation.

 (Dec 2010, 10 Marks)
Ans. Regulation of acid-base balance, regulation of hydrogen
ion concentration in the body fluids is actually meant.
There are three lines of defense in the body for regulating
acid-base balance which are follows:
a. Blood buffer
b. Respiratory mechanism
c. Renal mechanism.

Fig. 39:  Schematic structure of IgG to show basic structure of

Blood Buffer
immunoglobulin molecule The blood buffers are of three types, i.e.
1. Bicarbonate buffer
VH = Variable heavy chain; VL = Variable light chain;
2. Phosphate buffer
CH = Constant heavy chain; CL = Constant light chain 3. Protein buffer.

Types of Antibodies Bicarbonate Buffer System

♦♦ Antibodies are named as per their heavy chain, i.e. IgA, Sodium bicarbonate and carbonic acid is the predominant buffer
IgG, IgD, IgM and IgE. system of extracellular fluid mainly the plasma.
♦♦ There are two types of light chains, i.e. Kappa and Lambda Carbonic acid dissociates into hydrogen an bicarbonate ions.
found in antibodies. These differ in their structure in CL H2CO3 H+ + HCO3-
regions.
By law of mass action at equilibrium:
♦♦ An antibody consists of two kappa or two lambda chains
and does not consists of any mixture. Occurrence of Ka = [H+] [HCO3-]
Kappa chain is more common in humans as compared to   [H2CO3]
Lambda chains. Equation for bicarbonate buffer can be written as:
pH = pKa + log [HCO3-]
Functions of Antibodies
[H2CO3]
♦♦ Primary function of antibodies is to protect against So the general equation is referred as Henderson–Hasselbalch
infectious agents. equation for any buffer and can be written as:
♦♦ Antibodies can also act as an enzyme to catalyze the pH = pKa + log [Base]
synthesis of ozone which has microbicidal activity.
[Acid]
532 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

At the pH of blood ratio of bicarbonate to carbonic acid is 20:1.
So, bicarbonate concentration is much higher as compared to
carbonic acid in the blood. This is also known as alkali reserve
and responsible for effective burning of hydrogen ions which
are generated in the body. In normal conditions concentration
of bicarbonate and carbonic acid determine pH of the blood.
and are exchanged with sodium ion. Na + along with
bicarbonate ion is resorbed into the blood. By this acid are
eliminated from the body with simultaneous generation
of bicarbonate ion.
♦♦ H+ ion combines with noncarbonate base and get excreted
in urine.

Phosphate Buffer System Reabsorption of Bicarbonate

Sodium dihydrogen phosphate and disodium hydrogen
phosphate forms the phosphate buffer. It is an intracellular
buffer and is of less importance in plasma because of its low
concentration.
Protein Buffer System
Plasma proteins and hemoglobin forms the protein buffer
system of blood. The buffering capacity of proteins depends
on pK of ionizable groups of amino acids.
By this the blood bicarbonate is conserved with excretion of H+
ions. The normal urine become free of bicarbonate.
Excretion of Titratable Acid
Titratable acidity is the measure of acid excreted in urine by
kidney. This is assessed by titrating urine back to normal pH of
blood. Titratable acidity reflects H+ ions excreted in urine which
leads to fall of pH. The excreted hydrogen ions are buffered in
urine by phosphate buffer.

Respiratory Mechanism for Acid Base Regulation Excretion of Ammonium Ions

♦♦ Respiratory system is the rapid mechanism for maintaining This is the method to buffer hydrogen ions which are secreted
the acid-base balance. in tubular fluid. H+ ion get combine with ammonia to form
♦♦ Regulation occurs by regulating the concentration of ammonium ion. Renal tubular cells deamidate glutamine to
bicarbonate in the blood. glutamate and ammonia and the reaction is catalyzed by the
♦♦ Large amount of carbon dioxide is produced by cellular enzyme glutaminase.
metabolic activity which endangers acid-base equilibrium Ammonia liberated in this reaction diffuses in tubular lumen
of the body. and get combine to H+ ion to form ammonium ion. Ammonium
♦♦ In normal conditions all carbon dioxide get eliminated ions do not diffuse into tubular cells and are excreted in urine.
from the body via expired air through lungs. Ammonium is a major urine acid.
♦♦ Respiration is controlled by respiratory center, this center Q.2. Give a short account of acidosis. (Sep 2013, 5 Marks)
is sensitive to changes in the pH of blood. Decrease in pH Ans. Acidosis is an acid-base disorder. Acidosis means decline
leads to hyperventilation to remove carbon dioxide and in the pH of blood.
decreases carbonic acid concentration. Hyrdrogen ions are
eliminated as water. Types
♦♦ Respiratory mechanism is rapid but a short-term regulatory
♦♦ Respiratory acidosis, i.e. primary excess of carbonic acid
process as hyperventilation remains for a short time.
♦♦ Metabolic acidosis, i.e. primary excess of bicarbonate
Renal Mechanism for Acid Base Regulation
Causes
Kidneys regulate the acid-base balance by maintaining alkali ♦♦ Diabetic ketoacidosis and lactic acidosis
reserve. ♦♦ Respiratory acidosis in pneumonia
Enzyme carbonic anhydrase is the main component in renal ♦♦ Reduced glomerular infiltrate
regulation of acid and base which occur from following ♦♦ Addison’s disease
mechanisms: ♦♦ Diarrhea; When bicarbonate is excreted.
a. Excretion of H+ ions
b. Reabsorption of bicarbonate Respiratory Acidosis
c. Excretion of titratable acid ♦♦ In this excess of carbonic acid is present due to retention
d. Excretion of ammonium ions. of CO2.
♦♦ Acute form occurs due to broncheopneumonia or asthma.
Excretion of H+ ions
♦♦ Chronic form occurs due to chronic obstructive pulmonary
♦♦ Through kidney H+ ion is eliminated from the body. disease.
Excretion of H+ ion occur in proximal convoluted tubules ♦♦ In this renal compensation occur which generate more
and is coupled with regeneration of bicarbonate ions. bicarbonate and excrete more H+ ion.
♦♦ Carbonic anhydrase act as a catalyst in the production
of carbonic acid from carbon dioxide and water in renal Metabolic Acidosis
tubular cell. Carbonic acid then dissociate to H + ion ♦♦ In this excess of bicarbonate is present and occur due to
and HCO3- ion. H+ ions are secreted into tubular lumen the formation of acid or gain in base.
 Biochemistry 533

♦♦ Loss of acid is due to severe vomiting or gastric aspiration
which leads to the loss of chloride and acid.
♦♦ Hypokalemia is closely related to metabolic alkalosis.
This is because in alkalosis there is an attempt to conserve
hydrogen ions by kidney in exchange of K+.
♦♦ Respiratory center is depressed by high pH causing
hypoventilation.
♦♦ Metabolic acidosis is compensated by hyperventilation
of lungs which causes increase elimination of CO2 from
the body.
♦♦ Renal compensation sets in 3 to 4 days and H+ ions are
excreted as NH4+ ions.
Q.3. Write a short note on blood buffers. (May 2014, 5 Marks)
Ans. The shape of the titration curve of any weak acid is
described by the Henderson-Hasselbalch equation which
is important for understanding the buffer action and
acid-base balance in the blood and tissues of vertebrates.
• This equation is simply a useful way of restating the
expression for the dissociation constant of an acid.
• It is used to calculate pH in the buffer system.
• For the dissociation of a weak acid HA into H and A,
the Henderson- Hasselbalch equation can be derived
as follows:
General equation for the buffer is:
HA H+ A-
A represents any anion from the buffer.
-

Or HA is the undissociated acid from a buffer.

Answer in brief on blood buffers. (May 2017, 2 Marks) So by law of mass action, at equilibrium: (Ist equation)
Ans. Blood buffer act as a line of defense for regulating the K=[H+][A-]
body’s acid base balance and also to maintain the blood  [HA]
pH. Here K is the dissociation constant of acid HA.
Buffer is defined as the solution of a weak acid and its salt with Equation to represent H+ ion in a solution can be rewritten as
a strong base. (IInd equation):
Blood consists of three types of buffer systems, i.e.
[HA]
1. Bicarbonate buffer [H+] = K ×
[A-]

2. Phosphate buffer
 1
3. Protein buffer We know that pH = log
       [H+]
Bicarbonate Buffer By taking the reciprocals and logarithms (IIIrd equation):
♦♦ It is the most important buffer system in plasma.  1  1  A-
log = log + log
♦♦ It accounts for 65% of buffering capacity in plasma and [H+] K [HA]
40% of buffering action in the whole body.  1 
♦♦ Plasma bicarbonate concentration is 24 mmol/L. As log = pk
K
♦♦ Carbonic acid is the solution of carbon dioxide in water.
Its concentration is given by the product of pCO2 (40 mm IIIrd equation can be rewritten as:
Hg) and solubility constant of CO2(0.03). So concentration  [A-]
of carbonic acid is 1.2 mmol/L. pH = pK + log
[HA]
♦♦ At blood pH the ratio of bicarbonate to carbonic acid is 20:1.
♦♦ So the bicarbonate concentration is higher than carbonic Now from above equation it is evident that buffering capacity
acid which is referred to as alkali reserve. This alkali of buffer system is greatest when the amount of anions [A-] and
reserve leads to the buffering of hydrogen ions which are undissociated acid [HA] is same, i.e.
generated in the body.
[A-]  [A-]
= 1, or log
Phosphate Buffer System [HA]  [HA]

♦♦ It is an intracellular buffer. So, pH = pK. So most effective buffers in the body are those with
♦♦ Sodium dihydrogen phosphate and disodium hydrogen pK close to pH in which they operate.
phosphate constitute the phosphate buffer. ♦♦ This equation fits the titration curve of all weak acids and
♦♦ Its concentration in plasma is very low. enables us to deduce a number of important quantitative
Protein Buffer System relationships.
♦♦ Henderson-Hasselbalch equation also allows to:
♦♦ Plasma proteins and hemoglobin constitute the protein • Calculate pK, given pH and the molar ratio of proton
buffer system of blood. donor and acceptor.
♦♦ Buffering capacity of protein is depend on pK of ionizable • Calculate pH, given pK and the molar ratio of proton
group of amino acid. donor and acceptor.
Q.4. Write briefly about Henderson–Hasselbalch equation. • Calculate the molar ratio of proton donor and acceptor,
 (Feb 2016, 2 Marks) given pH and pK.
534 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.5. Describe metabolic acidosis. (July 2016, 5 Marks)
Ans. A fall in blood pH due to a decrease in bicarbonate levels
of plasma is called metabolic acidosis.
Causes
♦♦ Decrease in bicarbonate concentration is due to decrease
its utilization in buffering H + ions, loss in urine or
gastrointestinal tract or failure to be regenerated.
♦♦ Most important cause of metabolic acidosis is due to
excessive production of organic acids which combine with
bicarbonate ion and deplete the alkali reserve.
Metabolic Acidosis in Various Diseases
♦♦ Increased production of acids. In uncontrolled diabetes
mellitus and starvation, there is an excessive production
of acetoacetic acid and β–hydroxybutyric acid. These acids
are buffered by utilizing base component (i.e. HCO3) of
the bicarbonate buffer. Consequently, the concentration of
bicarbonate ions fall giving rise to bicarbonate deficit and
results in metabolic acidosis (ketoacidosis).
♦♦ Excessive loss of bicarbonate occurs in the urine in renal
tubular dysfunction and from gastrointestinal tract in
severe diarrhea.
Compensatory Mechanisms
Metabolic acidosis is compensated by:
♦♦ Increasing rate of respiration to wash out CO2 (hence
H2CO3) faster. Consequently, the ratio HCO3– : H2CO3 is
elevated.
♦♦ Increasing excretion of H+ ions as NH4+ ions.
♦♦ Increasing elimination of acid (H2PO4) in the urine.
All these compensatory mechanisms tend to reduce carbonic
acid to keep the pH in the normal range and a compensated
acidosis results.
15. CANCER
Q.1. Write a short note on oncogenes. (Dec 2010, 5 Marks)
Ans. Oncogenes are the genes which are capable of causing
cancer.
• Discovery of oncogenes were in tumor causing virus.
• Proto-oncogenes encode for growth regulating
proteins.
• Viral oncogenes were found to be closely similar to
various genes present in normal host cells known as
proto-oncogenes.
• The activation of proto-oncogenes to oncogenes is
an important step in carcinogenesis.
• Oncogenes encode for certain proteins, i.e.
oncoproteins. These proteins are altered versions
of their normal counterparts and are involved in
transformation and multiplication of cells.
• When oncogenes are expressed, they produce
mutated protein, e.g. growth factors, receptors,
transcription factors and other proteins involved
in cell proliferation. So various factors which cause
cancer may all act through their effects on proto–
oncogenes.
• Various products of oncogenes, such as growth factors
stimulate the proliferation of normal cells. They
regulate cell division by transmitting the message
across plasma membrane to interior of cell. It is believed
that growth factors play a key role in carcinogenesis.
Q.2. Write a short note on carcinogens. (Mar 2013, 3 Marks)
Ans. Group of chemicals which cause cancer in man and
animals collectively are known as carcinogens.
Carcinogens are a variety of external agents which are
divided into three groups:
1. Chemical carcinogens
2. Physical carcinogens
3. Biologic carcinogens.
Chemical Carcinogens
Depending upon the mode of action of carcinogenic chemicals,
they are divided into two groups:
1. Initiators of carcinogenesis
2. Promoters of carcinogenesis.
Initiators of Carcinogenesis
These are the chemical carcinogens which can initiate the
process of abnormal new growth of cells. These are further
classified into two subgroups:
Indirect Acting Carcinogens
Indirect acting carcinogens need prior metabolism to become
carcinogenic. One or more enzyme catalyzed reactions convert
procarcinogens to active carcinogens. This is called as metabolic
activation of procarcinogens. Examples of procarcinogens are:
♦♦ Aromatic hydrocarbons, e.g. benzo[a]pyrene, tobacco,
smoke, industrial and atmospheric pollutants.
♦♦ Aromatic amines, e.g. benzidine, β—naphthylamine, azo
dyes used in rubber industries.
♦♦ Naturally occurring products, e.g. aflatoxin B1.
♦♦ Inorganic compounds, e.g. vinyl chloride, asbestos, metals
like nickel, lead, chromium, etc.
♦♦ Nitrosamine compounds, e.g. dimethylnitrosamine,
Diethylnitrosamine found in whisky, new car interiors,
tobacco smoke.
Direct Acting Carcinogens
They do not need metabolic activation. These include mainly
various anticancer drugs, e.g. cyclophosphamide, nitrosourea,
acetylimidazole, etc.
Action of Chemical Carcinogens
Direct or indirect acting carcinogens are usually electrophiles,
i.e. they are deficient in electrons (free radicals). These free
radical carcinogens may covalently bind to purines, pyrimidines
and phosphodiester bonds of DNA leading to unrepairable
damage. This unrepaired damage causes mutations in DNA
and mutation in DNA can cause cancer.
 Biochemistry 535

Physical Carcinogens
Physical carcinogenic agent is radiant energy both ultraviolet
light and ionizing radiation, i.e. X–rays, α, β and γ rays.
These rays damage DNA which is the basic mechanism of
carcinogenicity with radiant energy.
♦♦ The main source of UV radiation is sunlight, others are UV
lamps, welders arcs, etc. In humans exposure of UV rays
can cause various forms of skin cancers.
♦♦ Ionizing radiation of all can cause skin cancer.
Action of Radiation
♦♦ Ultraviolet light and ionizing radiation differ in their
mode of action.
♦♦ UV rays damage the DNA by the formation of pyrimidine
dimers in DNA or by the formation of apurinic or
pyrimidine sites in DNA while ionizing radiations cause
the formation of highly reactive free radicals that can
interact with DNA leading to molecular damage.
Biologic Carcinogens
Biologic carcinogens are chiefly viruses, parasites and bacteria.
The role of viruses in the causation of cancer is more significant.
Oncogenic (carcinogenic) viruses contain either DNA or RNA
as their genome. The two types of carcinogenic viruses are:
♦♦ Mode of action of RNA Oncogenic virus: The RNA viruses
use RNA as the genome. The RNA gets copied by reverse
transcriptase to produce single strand of viral DNA. Single
strand of viral DNA is then copied to form another strand
of complementary DNA resulting in double stranded viral
DNA or provirus. The provirus is then integrated into the
DNA of the host cell genome and may transform the cell
into cancer cell.
16. TISSUE PROTEINS AND BODY FLUIDS
Q.1. Write very short answer on CSF. (Aug 2018, 2 Marks)
Ans. CSF
♦♦ CSF is also known as cerebrospinal fluid.
♦♦ It is a clear, colorless liquid which is formed inside the
cavities of brain and around the spinal cord.
♦♦ CSF originates inside the choroid plexus and return to
blood via arachnoid villi.
♦♦ 500 mL of cerebrospinal fluid is formed everyday.
Functions of CSF
♦♦ It serves as hydraulic shock absorber by diffusing the force
from hard blow to skull that can cause severe injury.
♦♦ CSF helps in regulating the intracranial pressure.

Collection of CSF
DNA Oncogenic Viruses
♦♦ DNA oncogenic viruses are classified into five subgroups, CSF is collected by the spinal puncture for biochemical analysis.
i.e. papovavirus, herpes viruses, adenoviruses, pox- Composition of CSF in Health and Disease
viruses, hepadnaviruses.
♦♦ Mode of action of DNA oncogenic virus: The DNA virus Name of Color and Total cell
infects the host cell. Then, DNA virus binds tightly to host disease appearance count Protein Glucose
cell DNA and causes alterations in gene expression of host In normal Clear and 0 to 5 × 15 to 45 45 to 85
cell DNA and thus causes cancer by altering the types of person colorless 106/l mg/dL mg/dL
protein made in cell. Viral oncoproteins bind to tumor Tubercular Opalescent It get It get It is low
suppressors and inactivate them. meningitis and slightly increased increased
yellow
RNA Oncogenic Viruses Bacterial Opalescent It is It is It is
♦♦ The RNA viruses use RNA as the genome. RNA oncogenic meningitis and turbid markedly markedly markedly
viruses are retroviruses as they contain the enzyme reverse increased increased decreased
transcriptase. All retroviruses are not oncogenic. The Subarachnoid Slightly Presence It is It is almost
examples of RNA oncogenic viruses are Rous sarcoma hemorrhage bloody color of RBC increased normal
and WBC
virus, Leukemia sarcoma virus, etc.
536 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

MULTIPLE CHOICE QUESTIONS

As per DCI and Examination Papers 1 Mark Each
of Various Universities

1. The reaction involving the conversion of succinyl-CoA
to succinate requires:
a. NADP+ b. GDP
c. NAD+ d. FAD
2. The nitrogenous base present in cephalin:
a. Ethanolamine b. Choline
c. Serine d. Sphingosine
3. The example of metalloprotein:
a. Mucin b. Siderophilin
c. Glutenin d. Vitellin
4. The ‘methyl donor’ with biochemically labile methyl
groups:
a. Active methionine b. Choline
c. Betaine d. All of the above
5. The molecular weight of hemoglobin:
a. 44,456 b. 54,456
c. 64,456 d. 74,456
6. Serum alkaline phosphatase activity is elevated in:
a. Rickets b. Hyperparathyroidism
c. Paget’s disease d. All of the above
7. The hormonal regulation of plasma calcium occurs by
the action of:
a. Calcitriol b. Parathyroid hormone
c. Calcitonin d. All of the above
8. Vitamin K regulates the synthesis of following ‘blood
clotting factors’:
a. VII, VIII, IX b. VII, IX, X
c. VII, X, IX d. VII, X, XI
9. Cancer is caused by the groups of:
a. Radiant energy b. Chemical compounds
c. Viruses d. All of the above
10. Transcription is the process of synthesis of:
a. RNA b. DNA
c. Protein d. All of the above
11. D-galactose and D-mannose are grouped as:
a. Anomers b. Enantiomers
c. Epimers d. Isomers
12. The following amino acid acts as a conjugating agent
in detoxification reaction:
a. Glycine b. Cysteine
c. Glutamine d. All of the above
13. The reaction involving the conversion of succinyl-CoA
to succinate requires:
a. NAD b. NADP
c. GDP d. FAD
14. The following trace element is involved in wound
healing:
a. Iron b. Copper
c. Zinc d. Selenium
15. Glycogen synthetase activity is depressed by:
a. Glucose b. Insulin
c. Cyclic AMP d. UDP-glucose
16. The tumor markers are:
a. Proteins b. Hormones
c. Enzymes d. All of the above
17. The substrate concentration at which an enzyme
exhibits half the maximum velocity is known as:
a. Vmax b. [S]
c. Km d. Keq
18. Normal serum level is:
a. 135-145 mEq/L b. 135-145 mg/dL
c. 120-130 mEq/L d. 120-130 mg/dL
19. Symptoms of scurvy are:
a. Poor healing of wounds
b. Loosening of teeth
c. Anemia
d. All of the above
20. Which of the pathway occurs in part in the mitochondria
and part in the cytosol?
a. Urea cycle
b. TCA cycle
c. Glycolysis
d. Oxidative phosphorylation

Answers: 1. b 2. a 3. b 4. d
5. c 6. d 7. d 8. b
9. d 10. a 11. c 12. d
13. c 14. c 15. c 16. d
17. c 18. a 19. d 20. a

21. The only glycerophospholipid having antigenic prop-
erty is:
a. Cephalin b. Lecithin
c. Plasminogen d. Cardiolipin
22. The reaction involving the conversion of succinyl-CoA
to suicinate requires:
a. NAD b. NADP+
c. GDP d. FAD
23. The example of phosphoprotein is:
a. Casein b. Mucin
c. Ovomucoid d. Globulin
24. The poor source of vitamin D is:
a. Eggs b. Milk
c. Butter d. Liver
25. Transaminase activity needs the coenzyme:
a. B6-PO4 b. NAD
c. FAD d. Coenzyme–Q
26. Sickle cell anemia results from a point mutation that
causes a replacement of:
a. Glutamate at position 6
b. Aspartate at position 6
c. Arginine at position 4
d. Glutamate at position 4
27. One molecule of FADH2 produces how many number
of ATPs:
a. 4 b. 1
c. 2 d. 3
28. The following are lipotropic factors except:
a. Betaine b. Choline
c. Methionine d. Leucine
29. Chaulmoogric acid is used in the treatment of:
a. Nephritis b. Diabetes mellitus
c. Leprosy d. Hepatitis
30. Which of the following is a storage and transport form
of fatty acid?
a. Cholesterol b. Triacylglycerol
c. Phospholipid d. Proline
31. Which of the following non-protein can act as an
enzyme?
a. DNA b. RNA
c. Phospholipid d. Glycolipid
32. Which of the following vitamin is involved in ETC?
a. Thiamine b. Folic acid
c. Riboflavin d. Cobalamin
Answers: 21. d 22. c 23. a 24. b
25. a 26. a 27. c 28. d
29. c 30. b 31. b 32. c
33. d 34. a 35. c 36. d
37. a 38. b 39. b 40. d
41. b 42. d 43. d 44. a
Biochemistry 537
33. D-Galactose and D-mannose are:
a. Enantiomers of each other
b. Isomers of each other
c. Anomers of each other
d. Epimers of each other
34. Normal serum sodium level is:
a. 135 -145 m Eq/L
b. 130-160 m Eq/L
c. 120-130 m Eq/L
d. 170-180 m Eq/L
35. The example of phosphoprotein is:
a. Mucin b. Globulin
c. Casein d. Ovomucoid
36. The number of double bonds present in arachidonic
acid:
a. One b. Two
c. Three d. Four
37. The amino acid containing sulphur is:
a. Methionine b. Threonine
c. Leucine d. Alanine
38. The example of chromoprotein:
a. Salmine b. Catalase
c. Zein d. Gliadin
39. Trypsin attack peptide linkages containing the amino
acid residue of:
a. Arginine b. Glycine
c. Tryptophan d. Serine
40. The BMR is higher than normal in:
a. Diabetes insipidus b. Leukemia
c. Polycythemia d. All of the above
41. One molecule of urea is synthesized at the expanse of
the molecules of ATP:
a. 2 b. 3
c. 4 d. 5
42. Salivary amylase is activated by:
a. Na+ b. K+
c. HCO3- d. Cl– ions
43. Gluconeogenesis does not occur in one of the tissues:
a. Kidney b. Liver
c. Heart d. Erythrocytes
44. The normal level of plasma calcium is:
a. 9–11 mg/dL b. 0.9-1.1 g/dL
c. 0.9–1.1 mg/dL d. 9–11 g/dL
538 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

45. Which of the following non-protein can act as an
enzyme?
a. DNA b. RNA
c. Phospholipid d. Glycolipid
46. The number of double bonds present in arachidonic
acid are:
a. One b. Two
c. Three d. Four
47. The amino acid containing hydroxyl group is:
a. Alanine b. Reucine
c. Threonine d. Methionine
48. Pellagra is caused by deficiency of which vitamin:
a. Thiamine b. Riboflavin
c. Niacin d. Pyridoxine
49. Which of the following is the storage and transport
form of fatty acid?
a. Cholestrol b. Triacylglycerol
c. Phospholipid d. Glycerol
50. Translation is the process of synthesis of:
a. RNA b. DNA
c. Protein d. All of the above
51. The following hormones have hyperglycemic effect
except:
a. Glucagon b. Insulin
c. Thyronine d. Epinephrine
52. Which of the following nucleotide base is not present
in codons?
a. Adenine b. Guanine
c. Thymine d. Cytosine
53. All are useful substances produced from cholesterol
except:
a. Vitamin D b. Bile salts
c. Bile pigments d. Cortisol
54. All of the following are nonessential amino acids
except:
a. Tyrosine b. Lysine
c. Valine d. Phenylalanine
55. The metal present in vitamin B12 is:
a. Copper b. Cobalt
c. Chromium d. Manganese
56. Protein present in muscles is:
a. Keratin b. Collagen
c. Actin d. Globulin
57. Following is an epimer of glucose:
a. Fructose b. Maltose
c. Galactose d. Lactose
58. The degree of unsaturation of fats is determined by:
a. Acid number b. Iodine number
c. Acetic number d. Saponification number
59. The protein part of enzyme is:
a. Isoenzyme b. Apoenzyme
c. Holoenzyme d. Coenzyme
60. Pellagra is due to the deficiency of:
a. Riboflavin b. Pyridoxine
c. Thiamine d. Niacin
61. Glycogenolysis is promoted by all of the following
except:
a. Insulin b. Glucagon
c. Epinephrine d. Corticosteroids
62. Some people “Eat and do not get fat” because:
a. Fat synthesis is defective
b. Absorption defect
c. Contain more brown adipose tissue
d. Fast metabolism
63. Brain detoxify ammonia by:
a. Urea formation
b. Glutamine formation
c. Asparagine formation
d. Creatine formation
64. Bilirubin is conjugated with:
a. Glycine b. Benzoic acid
c. Glucoronic acid d. Cysteine
65. Mutations are due to:
a. Change in base sequence of DNA
b. Change in base sequence of RNA
c. Change in nucleosides
d. Change in nucleotides
66. Hyaluronic acid consists of:
a. N-acetylglucosamine and glucoronic acid
b. N-acetylglucosamine-6-sulphate and glucoronic acid
c. D-glucosamine-N-sulfate and sulfate ester of
glucoronic acid
d. N-acetylglucosamine, galactose and sulfuric acid
67. Ketone bodies are synthesized in:
a. Kidney b. Muscle
c. Heart d. Liver

Answers: 45. b 46. d 47. c 48. c

49. b 50. c 51. b 52. c
53. c 54. a 55. b 56. c
57. c 58. b 59. b 60. d
61. a 62. d 63. b 64. c
65. a 66. a 67. d
 Biochemistry 539

68. Liver detoxify ammonia by: c. Topoisomerase

a. Urea formation b. Glutamine formation
c. Aspargine formation d. Creatine formation
69. The fate of bilirubin after conjugation is:
a. Metabolized in tissues
b. Excreted in urine
c. Converted into uribilinogen in intestine
d. Excreted as it is in feces
70. Point mutation is:
a. Change in single base
b. Deletion of single nucleotide
c. Insertion of single nucleotides
d. Insertion or deletion of more than one nucleotide
71. Immunity is due to the following protein:
a. Albumin b. Alpha globulins
c. Beta globulins d. Gamma globulins
72. The synthesis of glucose from fat is called as:
a. Glycolysis b. TCA
c. Gluconeogenesis d. Saponification
73. 50% of enzyme molecule are bound with substrate
molecules at a particular substrate combination is
denoted by:
a. Vmax b. Km
c. Both d. None
74. Amino acids are amphoteric in nature because:
a. They show ring structure
b. They show acidic property
c. They show basic property
d. None of the above
75. One of the following is factor IV in blood coagulation:
a. Sodium b. Calcium
c. Potassium d. Magnesium
76. Which one of the following enzyme is not involved in
replication?
a. Helicases
b. RNA polymerase
d. Single-stranded binding protein
77. Which of the following is not a saturated fatty acid?
a. Palmitic acid b. Stearic acid
c. Oleic acid d. Myristic acid
78. The normal serum bilirubin level is:
a. 0.2 to 1 mg/dL b. 1 to 2 mg/dL
c. 1 to 3.5 mg/dL d. None of the above
79. Vitamin K is also known as:
a. Tocopherol b. Riboflavin
c. Phylloquinone d. Axerophthol
80. The following trace element is involved in wound
healing:
a. Iron b. Copper
c. Zinc d. Selenium
81. Proteolytic enzymes are secreted as:
a. Holoenzymes b. Zymogens
c. Apoenzymes d. None of the above
82. Nitrogen base in cephalin is:
a. Choline b. Ethanolamine
c. Inositol d. Lipositol
83. Bence Jones proteins are excreted in:
a. Nephrotic syndrome b. Multiple myelomas
c. Nephritis d. Liver cirrhosis
84. Metal ions required for the activity of many enzymes
are called as:
a. Coenzyme b. Cofactor
c. Apoenzyme d. Isoenzyme
85. Active coenzymatic form of folic acid is:
a. Folate b. Dihydrofolate
c. Trihydrofolate d. Tetrahydrofolate
86. Diabetic ketoacidosis is prevented by:
a. Insulin injections
b. Carbohydrate diet
c. Antiketogenic substances
d. All of the above

Answers: 68. a 69. c 70. a 71. d

72. c 73. b 74. d 75. b
76. b 77. c 78. a 79. c
80. c 81. d 82. b 83. b
84. b 85. d 86. d
540 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

VIVA-VOCE QUESTIONS FOR

PRACTICAL EXAMINATION
1. Name the organic catalytic agents which are protein-
aceous in nature and are produced by living cells.
Ans. Enzymes
2. Which are the enzymes catalyzing same reactions and
yet having differences in both structure and composi-
tion between them?
Ans. Isoenzymes
3. How much is the BMR for adult healthy male?
Ans. 40 Kcal/sqm/hour
4. Which component is utilized as fuel by skeletal
muscles during rest and mild exercise?
Ans. Fatty acid
5. Which is the principal site of gluconeogenesis?
Ans. Liver
16. Which is the most basic amino acid?
Ans. Argenine
17. Name the fat soluble vitamins.
Ans. A, D, E and K
18. Name the water-soluble vitamins.
Ans. B and C
19. What is another name of vitamin A?
Ans. Retinol
20. Name the first vitamin to be discovered.
Ans. Vitamin B
21. Bitot’s spots, nyctalopia, follicular keratosis and xeroph-
thalmia are the features of which vitamin deficiency.
Ans. Vitamin A

6. What does human brain utilize as the one and only 22. Which vitamin is also known as antiinfective vitamin?
fuel? Ans. Vitamin A
Ans. Glucose 23. Deficiency of which vitamin leads to beriberi.
7. When glucose is converted into two molecules of py- Ans. Vitamin B
ruvic acid, how many ATP are generated? 24. Name the amino acid which is converted into niacin.
Ans. 8 ATPs Ans. Tryptophan
8. How many molecules of ATP are produced when 1 25. Name the vitamin which is known as vitamin H.
molecule glucose is completely oxidized to CO2 and Ans. Pyridoxine
H2O?
Ans. 38 ATPs 26. Name the vitamin which helps in healing of wound
and iron absorption.
9. How much is the value for plasma cholesterol? Ans. Vitamin C
Ans. 140 to 250 mg per 100 mL
27. Which vitamin is a steroid derivative?
10. Name the process by which fatty acids are catabolized.
Ans. Vitamin D
Ans. Beta-oxidation
28. What does active form of vitamin D known as?
11. How much is the normal plasma concentration of
Ans. 1,25-dihydroxycholecalciferol
ketone bodies?
Ans. 1 mg per 100 mL 29. Which vitamin is known for its antioxidant property?
Ans. Vitamin E
12. In which tissues synthesis of phospholipids does not
occur. 30. What is the another name of vitamin K?
Ans. In blood and skin Ans. Phylloquinone

13. Name the general formula of amino acids. 31. Give some examples of monosaccharides.
Ans. RCH NH2 COOH Ans. Glucose, fructose, galactose and mannose
14. Which amino acid is optically inactive? 32. Give some examples of disaccharides.
Ans. Glycine Ans. Sucrose, lactose and maltose
15. Name the amino acid which belongs to the ketogenic 33. Which is the major source of energy for muscles when
amino acid group. muscle tissue lacks oxygen?
Ans. Leucine Ans. Anaerobic glycolysis
 Biochemistry 541

34. Name the key enzymes of gluconeogenesis.
Ans. Pyruvate carboxylase, Phosphoenolpyruvate carboxy-
kinase, fructose 1,6-bisphosphotase and glucose-6-
phosphotase.
35. Polyuria, polydypsia, polyphagia and weight loss are
the cardinal symptoms of which of the disease.
Ans. Diabetes mellitus
36. How much is the total volume of saliva produced each
day in an adult.
Ans. 500 to 1500 mL.
37. Which is the major carbohydrate secreted in saliva?
Ans. Glucose.
38. Name the major salivary enzyme.
Ans. Alpha-amylase
39. Name the proteins with antibacterial activities in saliva.
Ans. Lysozyme, Immunoglobulin A, lactoferrin
40. Name the calcium-binding proteins in saliva.
Ans. Statherins, proline rich proteins
41. How much is the safety limit of fluoride in water?
Ans. 1 ppm
42. Name the nitrogen containing phospholipids.
Ans. Lecithin
43. Name the essential fatty acids.
Ans. Linoleic acid and linolenic acid
44. How many ATPs are yield by palmitic acid in Beta-
oxidation?
Ans. 129 ATPs
45. Name the test which helps in identifying ketone bodies
in urine.
Ans. Rothera’s test
46. Name the molecule synthesizing cholesterol.
Ans. Acetyl-CoA
47. How much is the normal urea level in blood?
Ans. 20 to 40 mg/dL
48. How much high energy bonds are produced per turn
of citric acid cycle?
Ans. 12
49. Which is the universal currency of energy?
Ans. ATP
50. How much is the daily requirement of calcium for adult.
Ans. 500 mg
51. Which form of iron is absorbed in the body.
Ans. Ferrous form
52. Name free radical scavenger enzyme systems.
Ans. Superoxide dismutase, glutathione peroxidase,
glutathione reductase
53. What are buffers?
Ans. Buffers are solutions which can resist changes in pH
when acid or alkali is added.
54. Which is the most important buffer system in plasma?
Ans. Bicarbonate carbonic acid system
55. By which linkage nucleotides are combined to produce
lengthy DNA molecule.
Ans. Phospho diester linkages
56. How base sequence in DNA is written?
Ans. 5’ to 3’ end
57. Which component is required for starting DNA syn-
thesis?
Ans. RNA primer
58. What is the shape of structure of tRNA?
Ans. Clover leaf
59. Name the base absent in DNA?
Ans. Uracil
60. Which virus leads to AIDS?
Ans. HIV I and HIV II
61. Name cancer suppressor genes.
Ans. Retinoblastoma and p53 gene.
62. Name the important liver function tests.
Ans. Serum bilirubin; urine bile pigments, bile salts, urobilino-
gen; alanine amino transferase; alkaline phosphatase;
serum total proteins; serum albumin
63. What is the normal value of plasma calcium?
Ans. 9 to 11 mg/dL
64. What is the normal value of ionized calcium in plasma?
Ans. 4 to 5 mg/dL
542 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Additional Matter
Effects of Insulin Contd...

Increased effects on • Glycolysis • HMP shunt Cytoplasm

• Glycogenesis • Cholesterol synthesis
• Lipogenesis • Gluconeogenesis
• Triglyceride synthesis • Glycogenesis
• Protein synthesis • Fatty acid synthesis
• Hexose monophosphate pathway • Glycolysis
(HMP) shunt • Cholesterol synthesis
Decreased effects on • Gluconeogenesis
• Glyconeogenesis
Various Cell Organelles and their Functions
• Lipolysis
• Protein degradation
Name of cell organelle Function
Cell membrane Provides permeability
Various Vitamins and their Antagonists
Lysosomes Digestion, detoxification and
Name of vitamin Antagonist phagocytosis

Vitamin B Pyrithiamine and oxythiamine Golgi bodies Sort the glycoproteins

Vitamin B6 Isoniazid Rough endoplasmic reticulum Synthesis of protein

Folic acid Aminopterin and methotrexate Smooth endoplasmic reticulum Lipid and glycogen synthesis

Vitamin K Dicoumarol, Heparin and Salicylates Ribosomes Synthesis of proteins

Biotin Biotin sulphonic acid, Desthiobiotin Mitochondria Produce as well as store energy
Powerhouse of the cell

Various Serum Enzymes Elevated and their Diseases

Classification of Antioxidants
Name of serum enzyme
elevated Disease associated ♦ In relation to lipid peroxidation
• Preventive antioxidants
Amylase In acute pancreatitis
–– Catalase
Alkaline phosphatase Rickets and obstructive jaundice –– Glutathione peroxidase
Acid phosphatase Cancer of prostrate –– Chain breaking antioxidants
Lactate dehydrogenase In both heart attack and liver diseases –– Superoxide dismutase
–– Vitamin E
Serum glutamic pyruvic Liver diseases
–– Uric acid
transaminase (SGPT) or
alanine transaminase
♦ According to their location
• Plasma
Serum glutamic-oxaloacetic Myocardial infarction and liver –– β-carotene
transaminase (SGOT) or disease
–– Ascorbic acid
aspartate transaminase
–– Bilirubin
Creatinine phosphokinase Myocardial infarction –– Uric acid
–– Ceruloplasmin
Various Metabolic Pathways and their Sites –– Transferrin
• Cell membrane
Name of metabolic pathway Site of occurrence –– α-tocopherol
Protein synthesis Ribosomes • Intracellular
Glycoprotein synthesis Golgi complex –– Superoxide dismutase
–– Catalase
• Citric acid cycle Mitochondria
–– Glutathione peroxidase
• Oxidative phosphorylation
• Fatty acid oxidation ♦ According to their nature and function
• Electron transfer • Enzymatic
• Synthesis of ketone bodies –– Superoxide dismutase
RNA synthesis Nucleolus –– Catalase
–– Glutathione peroxidase
Contd... –– Glutathione reductase
 Biochemistry 543

• Non–enzymatic Various Cofactors

Nutrient
Name of cofactor Activity of enzyme enhanced
–– β-carotene
–– α-tocopherol Zinc Alkaline phosphatase, carbonic anhydrase,
dehydrogenase
–– Ascorbic acid
Metabolic Copper Tyrosinase, cytochrome oxidase
–– Glutathione Magnesium Hexokinase, glucokinase, phosphofructokinase
–– Ceruloplasmin Potassium Pyruvate kinase
–– Albumin
Iron Peroxidase
–– Bilirubin
Manganese Glycosyl transferase and phosphatase
–– Transferrin
–– Ferritin
–– Uric acid Some Important Questions with their Answers

Various Inorganic Substances and their Normal Serum Name fat soluble vitamins A, D, E, K
Level Name water soluble vitamins B and C
Heat stable and light sensitive vitamins or Vitamin K and B12
Inorganic substance Normal serum level vitamins involved in electron transfer
Sodium 135 to 145 mEq/L Heat labile vitamins Vitamin C, folic acid,
biotin
Potassium 3.5 to 5 mEq/L
Anti-oxidant vitamins Vitamin A, E and C
Phosphorus 3 to 4.5 mg/dL
• Vitamins needed for tooth development A and D
Iron 50 to 150 µg/dL and calcification
Bicarbonate 24 to 30 mEq/L • Deficiency of vitamins causing enamel
hypoplasia
Calcium 9 to 11 mg/dL • Vitamins which undergo
Chloride 95 to 105 mEq/L hypervitaminosis
Gingiva affected commonly due to Vitamin C
deficiency of
Various Metabolic Pathways and their Rate Limiting • Vitamin stored in fat Vitamin D
Enzymes • Vitamin synthesized in skin
• Action of vitamin similar to hormone
Name of metabolic pathway Rate limiting enzyme Vitamin stored in liver A, D, K, B12 and folate
Glycolysis Phosphofructokinase Vitamin present in cereals Thiamine
Glycogenesis Glycogen synthase Water soluble vitamin synthesized in body Pantothenic acid
Vitamin present in animal food is Vitamin B12 and D
Glycogenolysis Phosphorylase
Deficiency of vitamin leading to raw beef Niacin
Gluconeogenesis Fructose 1,6 bisphosphatase tongue and bald tongue of Sandwith
Cholesterol synthesis and ketone HMG CoA reductase Magenta colored tongue is seen in Riboflavin
bodies deficiency of
Fatty acid synthesis Acetyl-CoA carboxylase Hunter’s glossitis seen in deficiency of Vitamin B12
Urea synthesis Carbamoyl phosphate synthetase Vitamin associated with neonatal jaundice Vitamin K
Vitamin associated with peripheral neuritis Vitamin B1, B12, B6
Citric acid cycle Isocitrate dehydrogenase
and E
Porphyrin synthesis Aminolevulinate synthase Vitamin needed for healing of wound Vitamin A and C
Bile acids 7 alpha hydroxylase Vitamin for energy releasing reactions Thiamin (B1)
 7
SECTION
Dental Anatomy
1. Introduction of Dental Anatomy
2. Tooth Numbering Systems
3. Chronology of Tooth Development
4. Form and Function of Orofacial Complex
5. The Primary (Deciduous) Dentition
6. Differences between Primary and Permanent
Dentition
7. The Maxillary and Mandibular Incisors
8. The Maxillary and Mandibular Canines
9. The Maxillary and Mandibular Premolars
10. The Maxillary and Mandibular Molars
11. Pulp Morphology
12. Occlusion
13. Review of Tooth Morphology
14. Temporomandibular Joint
Multiple Choice Questions as per DCI and
Examination Papers of Various Universities
Fill in the Blanks as per DCI and Examination
Papers of Various Universities
Viva-voce Questions for Practical Examination
Additional Matter
 • In humans the cusp are found in posterior teeth, i.e.
1. INTRODUCTION OF DENTAL ANATOMY molars and premolars and on incisal edges of canines.
• Canines have only one cusp.
Q.1. Write a short note on mamelons. (Apr 2015, 3 Marks) • Maxillary and mandibular first premolar has a large
 (Mar 2000, 5 Marks) (June 2010, 5 Marks) buccal cusp which is long and well formed with
 (Dec 2014, 2 Marks) non-functioning lingual cusp.
Or • Mandibular second premolar has three well formed
Answer in brief mamelons. (Oct 2016, 2 Marks) cusp, i.e. one large buccal cusp and two smaller
Ans. A mamelon is anyone of the three round protuberance lingual cusp.
found on the incisal ridge of newly erupted teeth. • Maxillary first molar has four well developed
• Each labial lobe of incisor terminates incisally in functioning cusp and one supplemental cusp. The four
rounded eminences known as Mamelons. large cusp are mesiobuccal, distobuccal, mesiolingual,
• Mamelons are prominent in newly erupted distolingual. The supplemental cusp is called as
permanent incisors. tubercle of Carabelli.
• Soon after eruption they are worn down by use • In maxillary second molar the distolingual cusp is
unless through misalignment, they escape incisal poorly developed and makes development of other
wear. three cusps dominant.
• Mamelons are not seen in cases of primary incisors.
Number of Cusps in Different Teeth
• In congenital syphilis central lobe or mamelon will
be absent congenitally. Tooth type Maxillary arch Mandibular arch
Incisor 0 0
Canine 1 1
Premolar 2 2 in first premolar
3 or 2 in second premolar
First molar 4 cusps and 1 5
accessory cusp
Second molar 4 4
Fig. 1:  Mamelon
Third molar 4 or 3 4 or 5

Q.2. Write a short note on cusp. (Aug 2011, 5 Marks)

Ans. Cusp Q.3. Write a note on oblique ridge.  (Sep 2006, 5 Marks)
• A cusp is an elevation or mound on the crown portion Ans. An oblique ridge is a ridge obliquely crossing occlusal
of tooth making up a divisional part of occlusal surface of maxillary molars and is formed by union of
surface. triangular ridge of distobuccal cusp and distal cusp ridge
• Each cusp represents the developmental lobe of a of mesiolingual cusp.
tooth.

Fig. 3:  Oblique ridge

• Oblique ridge is present on primary maxillary

Fig. 2:  Cusp
• Cusp divides the occlusal surface of posterior teeth.
• Cusps are named according to location on tooth
surface. Each cusp has four cuspal slopes and an apex.
second molar.
• Oblique ridge is prominent on permanent maxillary
first molar. It can also be present on maxillary second
and third molars.
548 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

• Oblique ridge is reduced in height in center of Define ridges. Explain oblique ridge and transverse
occlusal surface. ridge.  (May 2018, 2 Marks)
• Sometimes oblique ridge is crossed by a develop­ Or
mental groove that partially joins two major fossa
by means of its shallow sulcate grooves. Write short answer on ridges and grooves.
 (Aug 2018, 3 Marks)
Q.4. Write short note on nomenclature of teeth.
Ans. Ridge
 (Sep 2006, 5 Marks)
A ridge is any linear elevation on the surface of crown.
Ans. Nomenclature or the system of names is used to describe
or classify the material included in the dentistry. Ridges are named on the basis of their location or form.
Following are the types of ridges:
• The term mandibular refers to lower jaw or mandible
♦♦ Labial ridge: It is the ridge which runs cervicoincisally to
and the term maxillary refer to the upper jaw or
the center of labial surface of canines. The ridge extends
maxilla.
from cusp tip to cervical ridge of tooth. The ridge is promi-
• Deciduous tooth or milk tooth which is defined as one
nent in maxillary canines.
of the temporary teeth of a mammal that are replaced
by permanent teeth. The term primary can indicate a
first dentition and the term deciduous indicates the
first dentition is not permanent but not unimportant.
• The term succedaneous can be used to describe
successor dentition and does not suggest permance,
where the term permanent suggests a permanent
dentition.
• Application of nomenclature:
- Tooth numbers 1 to 8 indicating teeth in a
quadrant.
- Tooth surface related to the tongue (lingual),
cheek (buccal), lip (labial) and face (facial) apply Fig. 4:  Labial ridge
to the four quadrants. ♦♦ Buccal ridge: It is the ridge on buccal surface of tooth which
- The teeth away from the midline is called as run cervico-occlusally from buccal cusp tip to the cervical
distal and towards midline is called as mesial. line. The ridge is prominent in first premolar.
• Central incisor (first incisor), lateral incisor (second
incisor), canine (cuspid), first premolar (bicuspid),
second premolar (second bicuspid), Ist molar, IInd
molar, IIIrd molar. There are eight tooth names
included in each quadrant of dental arches, they
are repeated to include right, left, maxillary and
mandibular making a total of 32 teeth in all.

Q.5. Write a short note on ridge, fossa and groove. 

 (Sep 2007, 3 Marks)
Or
Write in short ridges and grooves. 
 (Oct 2007, 5 Marks) (Apr 2010, 5 Marks) Fig. 5:  Buccal ridge
Or ♦♦ Incisal ridge: It lie on the incisal portion of newly erupted
Write short note on grooves. (Nov 2010, 3 Marks) incisors where the incisal surface is round and merges with
mesio-incisal as well as disto-incisal angles and labial and
Or
lingual surfaces.
Describe briefly grooves.  (June 2010, 5 Marks)
Or
Write note on ridges. 
 (June 2010, 5 Marks) (Aug 2011, 5 Marks)
Or
Write about tooth ridges.  (June 2012, 10 Marks)
Or Fig. 6:  Incisal ridge
 Dental Anatomy 549

♦♦ Lingual ridge: It is the ridge on lingual surface of tooth ridge run vertically in cervicoincisal direction and in pos-
which run cervicoincisally from lingual cusp of canine terior teeth they run in buccolingual direction.
to the cervical region, thereby dividing lingual fossa into
two parts. This ridge is prominent in maxillary canines.

Fig. 10:  Marginal ridge

♦♦ Cusp ridge: It is the inclined surface which forms an angle

at cusp tip.

Fig. 7:  Lingual ridge

♦♦ Linguo-incisal ridge: It is a ridge which runs mesiodistally

on the lingual surface at incisal one-third.

Fig. 11:  Cusp ridge

♦♦ Triangular ridge: It is the ridge which descends from

cuspal tips of molars and premolars towards central part
of occlusal surface. In cross-section triangular ridges are
more or less triangular and are known as triangular ridge.
Naming of triangular ridge is done as per the cusp they
belong, e.g. triangular ridge of buccal cusp of mandibular
permanent first molar.

Fig. 8:  Linguo-incisal ridge

♦♦ Cervical ridge: It is a ridge which runs mesiodistally on

cervical third of buccal surface of crown. Presence of cervi-
cal ridge is the characteristic of all deciduous teeth which is
prominent on maxillary and mandibular first molars. In per-
manent dentition cervical ridge is noticeable on molar teeth.
Fig. 12:  Triangular ridge

♦♦ Transverse ridge: Transverse ridge is union of two triangu-

lar ridges crossing the occlusal surface of posterior tooth in
transverse direction. It is created when buccal and lingual
triangular ridges join, e.g. transverse ridge between buccal
and lingual cusps on premolar.

Fig. 9:  Cervical ridge

♦♦ Marginal ridge: This is a linear round border of enamel

which form mesial and distal margins of occlusal surfaces
on posterior teeth as well as mesial and distal margins of
incisors and canines lingually. In anterior teeth, marginal Fig. 13:  Transverse ridge
550 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Oblique ridge: It is the ridge which crosses occlusal surface
of maxillary molars occlusally. Oblique ridge extends from
triangular ridge of distobuccal cusp to distal cusp ridge of
mesiolingual cusp.
Fig. 14:  Oblique ridge
Distolingual cusp
Fig. 15:  Ridges and grooves
Grooves
These are sharply defined narrow and linear depressions.
Usually seperating lobes or major portion of a tooth formed
during the development of the tooth. These grooves are named
according to their location.
Various types of groove are:
♦♦ Buccal developmental groove: It is the groove separating
the buccal cusps on the occlusal aspect of molar teeth and
extending onto the buccal surface for a short distance.
♦♦ Central developmental groove: This groove separates the
occlusal aspect of posterior teeth.
♦♦ Lingual developmental groove: This groove separates
the lingual cusps on the occlusal aspect of mandibular
and maxillary molars as well as mandibular second
premolars. It extends to the lingual surface for a short
distance.
♦♦ Supplemental groove: These are shallow linear depression
usually less distinct and more variable than developmental
groove. It does not marks junction of lobs or major por-
tion of tooth.
Fossa
♦♦ A fossa is an irregular depression or concavity.
♦♦ Lingual fossa are on the lingual surface of incisors. Central
fossa are on the occlusal surface of molars.
♦♦ They are formed by convergence of ridges terminating
at the central point in the bottom of depression where
junction of grooves occurs.
♦♦ Triangular fossa are found on molars and premolars.
♦♦ They are sometimes found on the lingual surface of
maxillary incisor at edge of lingual fossa where marginal
ridges and cingulum meets.
♦♦ Central fossa is found on occlusal surface of molar teeth.
Fig. 16:  Fossa
Q.6. Write short note on dental formula. (Nov 2009, 5 Marks)
Ans. The number and type of teeth present in the oral cavity
in one half of the face (either left side or right side) in
primary dentition are expressed by the following formula.
In this formula each tooth is represented by its initial letter.
I for incisor, C for canine and M for molar.
• Each letter is followed by a horizontal line and the
number of each type of tooth is placed above the line
for maxilla and below the line for the mandible.
• The formula includes one side only. The above formula
should be read thus:
• Incisors: Two maxillary and two mandibular.
• Canines: One maxillary and one mandibular.
• Molars: Two maxillary and two mandibular.
So a total of 10 teeth are present on one side whether
right or left.
• Similarly for permanent dentition, the dental formula
is as follows:
• In this premolars have now been added to the formula.
• Once again as in the case of primary teeth, the formula
should be read as:
–– Incisors: Two maxillary and two mandibular.
–– Canines: One maxillary and one mandibular.
–– Premolars: Two maxillary and two mandibular.
–– Molars: Three maxillary and three mandibular.
So a total of 16 teeth are present on one side
whether right or left.
To understand dental anatomy, the nomenclature
should be read first.

Q.7. Write briefly on class, arch and set traits. 
 (Nov 2009, 5 Marks)
Ans. Traits are the characteristic features or attributes to
distinguish one form of dentition from the other form.
• Class trait: These traits are those which differentiate
four categories of teeth, i.e. incisors, canine, molars
and premolars, i.e. incisors are used for cutting,
canines for piercing, premolars for grinding and
molars for crushing.
• Arch trait: These traits are those which differentiate
maxillary teeth from mandibular teeth. Example is
maxillary first molar consists of cusp of Carabelli
while it is absent in mandibular first molar.
• Set trait: These traits are the features that differentiate
teeth in primary dentition from the teeth in
permanent dentition, e.g. primary teeth are white
in color while permanent teeth are yellowish white
in color.
Q.8. Define set trait, class and type trait. 
 (Nov 2010, 3 Marks)
Ans. For set trait and class trait refer to Ans 7 of same chapter.
Type trait: These traits differentiate teeth within one
class, i.e. differentiation of incisors but between maxillary
central or lateral incisors.
Q.9. What are line angles? Enumerate line angles for
mandibular lateral incisors.  (Feb 2013, 5 Marks)
Or
What are line angles. Enumerate line angles for
mandibular lateral incisors. 
 (May 2014, 5 Marks)
Ans. A line angle is an angle formed by union of two
surfaces.
Fig. 17:  Line angle for mandibular lateral incisor
Dental Anatomy 551
Line Angles for Mandibular Lateral Incisors
1. Mesiolabial line angle
2. Mesiopalatal/mesiolingual line angle
3. Distolabial line angle
4. Distopalatal/distolingual line angle
5. Labioincisal line angle
6. Linguoincisal line angle
Q.10. Describe elevation and depressions on crown. 
 (Dec 2010, 10 Marks)
Ans. Following are the elevations and depressions on the
surface of crown.
Elevations on Crown
Cusp: A cusp is an elevation or mound on the crown portion
of a tooth making up a divisonal part of the occlusal surface.
Fig. 18:  Cusp
Tubercle: A tubercle is a smaller elevation on the some portion
of the crown produced by an extraformation of enamel.
Deviations from the typical form are evident, e.g. cusp of
Carabelli is a tubercle.
Fig. 19:  Tubercle
Cingulum: A cingulum, or girdle is the lingual lobe of an
anterior tooth and makes up the bulk of the cervical third of
the lingual surface. Its convexity mesiodistally resembles a
girdle encircling the lingual surface at the cervical third.
Ridge: A ridge is any linear elevation on the surface of a tooth
and is named according to its location (e.g. buccal, incisal, or
marginal ridge).
552 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 20:  Ridge
Depression on Crown
Fossa: A fossa is an irregular depression or concavity. Lingual
fossae are on the lingual surface of incisors. Central fossae are
on the occlusal surface of molars. They are formed by the
convergence of ridges terminating at a central point in the bottom
of the depression where a junction of grooves occurs. Triangular
fossae are found on molars and premolars on the occlusal surfaces
mesial or distal to marginal ridges. They are sometimes found on
the lingual surfaces of maxillary incisors at the edge of the lingual
fossae where the marginal ridges and the cingulum meet.
Fig. 21:  Fossa
Sulcus: A sulcus is a long depression or valley in the surface of
a tooth between edges and cusps, the inclines of which meet at
an angle. A sulcus has a developmental groove at the junction
of its inclines.
Fig. 22:  Groove
Groove: A developmental groove is a shallow groove or line
between the primary parts of the crown or root. A supplemental
groove, less distinct, is also a shallow linear depression on the
surface of a tooth, but it is supplemental to a developmental
groove and does not mark the junction of primary parts.
Buccal and lingual grooves are developmental grooves found
on the buccal and lingual surfaces of posterior teeth.
Fig. 23:  Developmental groove Fig. 24:  Supplemental grooves
Pits: Pits are small pinpoint depressions located at the
junction of developmental grooves or at terminals of those
grooves. For instance, central pit is a term used to describe a
landmark in the central fossa of molars where developmental
grooves join.
Fig. 25:  Pit
Q.11. Write short note on trait categories.
 (June 2010, 5 Marks)
Ans. For describing the anatomy of tooth as well as
comparison of morphologic characteristics with the other
teeth, trait categories are introduced. Following are the
trait categories:
Set traits: These traits are the features that differentiate teeth
in primary dentition from the teeth in permanent dentition,
e.g. primary teeth are white in color while permanent teeth are
yellowish white in color.
Arch trait: These traits are those which differentiate maxillary
teeth from mandibular teeth. Example is maxillary first molar
consists of cusp of Carabelli while it is absent in mandibular
first molar.
Class traits: These traits are those which differentiate four
categories of teeth, i.e. incisors, canine, molars and premolars.

Example, incisors are used for cutting, canines for piercing,
premolars for grinding and molars for crushing.
Type traits: These traits differentiate teeth within one class,
i.e. differentiation of incisors but between maxillary central or
lateral incisors, e.g. mesiodistal width of maxillary permanent
central incisor is wider while the width of maxillary permanent
lateral incisor is narrow.
Q.12. Write about the definitions of ridge, cusp, fossa, pit
and groove.  (May/June 2009, 5 Marks)
Or
Define cusp, ridge, cingulum, fossa and pit. 
 (Aug 2012, 5 Marks)
Or
Define cusp and fossa.  (Dec 2014, 3 Marks)
Ans. Ridge: Ridge is defined as any linear elevation on the
surface of tooth.
Cusp: Cusp is defined as an elevation of crown of tooth
making up a divisional part of occlusal surface.
Fossa: Fossa is defined as a depression or a concavity
on lingual surface of anteriors and occlusal surface of
posteriors.
Pit: Pit is defined as small pin point depression located
at junction of two or more developmental grooves.
Groove: A groove is defined as a line separating the lobes
or primary part of crown or root.
Cingulum: Cingulum is defined as a mound on cervical
third of lingual surface of anterior teeth.
.13. Write short note on line angle.  (June 2010, 2 Marks)
Q
Ans. A line angle is formed by junction of two surfaces.
• A line angle is named by combination of its two
surfaces which join each other.
• Example is the junction of distal and buccal walls of
tooth is known as distobuccal line angle.
• Anterior tooth consists of six line angles and
posterior tooth consists of eight line angles.
Line angles of anterior teeth Line angles of posterior teeth
• Mesiolabial • Mesiobuccal
• Mesiopalatal or mesiolingual • Distobuccal
• Distolabial • Mesiolingual
• Distolingual or distopalatal • Distolingual
• Labioincisal • Mesio-occlusal
• Linguoincisal • Disto-occlusal
• Bucco-occlusal
• Linguo-occlusal
Q.14. Define cusp, fossa and cingulum with example. 
 (May 2014, 2 Marks)
Ans. Cusp: Cusp is defined as an elevation of crown of tooth
making up a divisional part of occlusal surface. Example,
premolars consists of two cusps, i.e. buccal cusp and
lingual cusp.
Dental Anatomy 553
Fossa: Fossa is defined as a depression or a concavity
on lingual surface of anteriors and occlusal surface of
posteriors, e.g. lingual fossa, triangular fossa, central
fossa.
Cingulum: A cingulum, or girdle, is the lingual lobe of
an anterior tooth and makes up the bulk of the cervical
third of the lingual surface. Its convexity mesiodistally
resembles a girdle encircling the lingual surface at the
cervical third, e.g. cingulum in maxillary central incisor.
Q.15. Write short note on developmental lobes. 
 (Oct 2014, 3 Marks)
Ans. Developmental lobe is one of the growth center during
development of crown.
• Developmental lobes appear as cusps and mamelons
on the tooth surface.
• Permanent anterior teeth develop from four lobes,
i.e. labial, lingual, mesial and distal.
• All primary incisors develop from a single lobe.
• Deciduous posteriors develop from 5 lobes, i.e. three
facial lobes and two lingual lobes.
• All premolars except mandibular second premolar
develop from four lobes, i.e. buccal, lingual, mesial
and distal.
• Second mandibular premolar develops from five
lobes, i.e. buccal, mesiolingual, distolingual, mesial
and distal.
• All first molars of maxillary and mandibular arches
develop from five lobes and rest all molars develop
from four lobes. Naming of lobes of molars are done
on the names of their cusps.
Various Permanent Teeth Along with their Number of Lobes
Name of the teeth Number of lobes
Maxillary and mandibular central incisors, lateral 4 lobes
incisors, canines
Maxillary first and second premolars and 4 lobes
mandibular first premolar
Mandibular second premolar 5 lobes
Maxillary and mandibular first molar 5 lobes
Maxillary and mandibular second and third 4 lobes
molars
Q.16. Write short note on line angles and point angles of
anterior teeth.  (Oct 2014, 3 Marks)
Ans. Line Angle
A line angle is formed by the union of two surfaces.
• Anterior teeth consists of six line angles, i.e.
1. Mesiolabial line angle
2. Mesiopalatal/mesiolingual line angle
3. Distolabial line angle
4. Distopalatal/distolingual line angle
5. Labioincisal line angle
6. Linguoincisal line angle.
554 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

triangular ridge of distobuccal cusp to distal cusp ridge

of mesiopalatal cusp.

Fig. 28:  Oblique ridge in maxillary first molar

Transverse Ridge
The ridge crosses occlusal surface of posterior teeth transversely
and forms when there is union of buccal and lingual triangular
ridges.

Fig. 26:  Line angle of anterior teeth

Point Angle
A point angle is formed by union of three surfaces.
• Anterior teeth consist of four point angles, i.e.
1. Mesio-labio-incisal point angle
2. Mesio-palato-incisal/Mesio-linguo-incisal point
angle
3. Disto-bucco-occlusal point angle Fig. 29:  Transverse ridge in mandibular first molar
4. Disto-palato-occlusal/Disto-linguo-occlusal Q.18. Define ridge and enumerate the type of ridges.
point angle.  (Sep 2015, 2 Marks)
Or
Enumerate ridges. (Sep 2018, 2 Marks)
Ans. Ridge is defined as any linear elevation on the surface
of crown and is named according to its situation.
Enumeration of Type of Ridges
1. Labial ridge
2. Buccal ridge
3. Incisal ridge
4. Lingual ridge
5. Linguo-incisal ridge
6. Cervical ridge
7. Marginal ridge
8. Cusp ridge
9. Triangular ridge
10. Transverse ridge
11. Oblique ridge
Q.19. Write short note on transverse and oblique ridge.
 (July 2016, 3 Marks)
Fig. 27:  Point angle of anterior teeth Ans. Transverse ridge
♦♦ Transverse ridge is the union of two triangular ridges
Q.17. Define oblique ridge and transverse ridge. crossing the occlusal surface of posterior tooth in trans-
 (Dec 2014, 2 Marks) verse direction.
Ans. Oblique Ridge ♦♦ It is created when buccal and lingual triangular ridges join.
Oblique ridge is the ridge which crosses occlusal surface ♦♦ Example is transverse ridge between buccal and lingual
of maxillary molars obliquely. The ridge extends from cusps on premolar.
 Dental Anatomy 555

Oblique Ridge on posterior teeth as well as mesial and distal margins of

♦♦ An oblique ridge is a ridge obliquely crossing occlusal
surface of maxillary molars and is formed by union of
triangular ridge of distobuccal cusp and distal cusp ridge
of mesiolingual cusp.
♦♦ Oblique ridge is present on primary maxillary second molar.
♦♦ Oblique ridge is prominent on permanent maxillary first
molar. It can also be present on maxillary second and
third molars.
♦♦ Oblique ridge is reduced in height in center of occlusal
surface.
♦♦ Sometimes oblique ridge is crossed by a developmental
groove that partially joins two major fossa by meAns of
its shallow sulcate grooves.
For diagrams of transverse and oblique ridge refer to Ans 17
of same chapter.
Q.20. Define ridge and grooves with examples.
 (Aug 2016, 2 Marks) (May 2017, 2 Marks)
Ans. Ridge
A ridge is defined as any linear elevation on the surface of a
crown and is named according to its situation.
Examples
♦♦ Labial ridge on labial surface of maxillary canines.
♦♦ Buccal ridge on buccal surface of first premolar.
♦♦ Incisal ridge on incisal portion of newly erupted incisors.
♦♦ Lingual ridge on lingual surface of maxillary canines.
♦♦ Cervical ridge on cervical third of buccal surface of crown
an all primary and permanent teeth.
♦♦ Transverse ridge between buccal and lingual cusps on
premolar.
♦♦ Triangular ridge of buccal cusp of mandibular permanent
first premolar.
Groove
incisors and canines lingually.
♦♦ Oblique ridge: An oblique ridge is a ridge obliquely cross-
ing occlusal surface of maxillary molars and is formed by
union of triangular ridge of distobuccal cusp and distal
cusp ridge of mesiolingual cusp.
2. TOOTH NUMBERING SYSTEMS
Q.1. Write a short note on tooth numbering system.
 (Sep 2005, 5 Marks) (Jan 2012, 10 Marks)
 (July 2016, 3 Marks) (Oct 2016, 3 Marks)
 (May 2017, 3 Marks)
Or
Write a notes on notation of teeth. (Apr 2007, 5 Marks)
 (Oct 2006, 5 Marks) (Sep 2009, 5 Marks)
Or
Write in short about tooth numbering systems.
 (Jan 2018, 5 Marks)
Or
Write very short answer on tooth numbering system.
 (Aug 2018, 2 Marks)
Ans. In clinical practice a short hand system of tooth notation
is necessary for recording data.
Tooth Numbering Systems
Universal System: ADA Recommended the Universal System
♦♦ Universal system of notation for primary dentition use
upper case letters.
♦♦ Universal system notation for primary dentition is as follows:
Right Left
A, B, C, D, E F, G, H, I, J

Groove is defined as sharply defined narrow and linear T, S, R, Q, P 0, N, M, L, K

depressions formed during the development of tooth usually Midsagittal plane
separating lobes or major portion of a tooth. ♦♦ In the universal notation system for the permanent
Example dentition, maxillary teeth are numbered from 1 to 16,
beginning with the right third molar.
Central developmental groove running mesiodistally on ♦♦ Universal notation system for mandibular teeth are num-
occlusal surface of molar separate the buccal and lingual cusps. bered from 17 to 32, beginning with the left third molar.
Q.21. Define line angle and point angle. ♦♦ Universal system notation for permanent dentition is as
 (Jan 2018, 1 + 1 Marks) follows:
Ans. Right Left
♦♦ Line angle: A line angle is formed by union or junction 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
of two surfaces.
♦♦ Point angle: A point angle is formed by junction or union 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
of three surfaces. Midsagittal plane
Q.22. Define marginal ridge and oblique ridge.
 (Jan 2018, 1 + 1 Marks) Zsigmondy/Palmer Notation
Ans. ♦♦ It is a four quadrant symbolic system.
♦♦ Marginal ridge: This is a linear round border of enamel ♦♦ Zsigmondy/Palmar notation system for primary dentition
which form mesial and distal margins of occlusal surfaces are as follows:
556 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Upper right Upper left Or

Write very short answer on FDI system of tooth
E D C B A A B C D E
notation. (May 2018, 2 Marks)
E D C B A A B C D E Ans.
Lower right Lower left
FDI Tooth Numbering System
Midsagittal plane
♦♦ It is also known as FDI notation system or two digit system
♦♦ Zsigmondy palmar notation system for permanent denti- or ISO 3950 notation or International numbering system.
tion are as follows: ♦♦ FDI is denoted as Federation Dentaire Internationale.
♦♦ The tooth numbering system is formed by special com-
Upper right Upper left mittee on uniform dental recording. The committee had
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 passed a resolution at FDI General Assembly meeting in
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 1970 at Bucharest, Romania.
♦♦ As per FDI, following criteria should meet FDI tooth
Lower right Lower left
notation system, i.e.
Midsagittal plane 1. It should be simple to teach and understand.
FDI System 2. It should be easy to pronounce.
3. It should be easily printable.
♦♦ Federation Dentair International proposed two digit system 4. It should be easily translated into computer output.
for both the primary and permanent dentition which has been 5. It should be easily adapted to standard charts which
adopted by the WHO and other organization such as IADR. are used in general practice.
♦♦ It is a two digit system, the first digit indicates the quadrant (1 ♦♦ In FDI system two digits are used, the first digit denotes
to 4) for permanent dentition and 5 to 8 for primary dentition. the quadrant and second digit denotes the tooth. That’s
♦♦ FDI system of tooth notation for primary teeth is as follows: why FDI name this as two digit system.

Right Left FDI Notation for Permanent Dentition

55 54 53 52 51 61 62 63 64 65 ♦♦ In this mouth is divided in four quadrants.
85 84 83 82 81 71 72 73 74 75 ♦♦ First digit represents the quadrant. Quadrants are 1 to 4
for permanent dentition.
Midsagittal plane
♦♦ Second digit represents the tooth in the particular quad-
♦♦ The FDI system of tooth notation for permanent teeth is rant. Each of the quadrant in permanent dentition has 8
as follows: teeth which are designated with numbers 1 to 8.
Right Left ♦♦ Two digits should be pronounced separately.
♦♦ FDI notation for permanent dentition is:
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
Right Left
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
Midsagittal plane
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Dane or Hederup System Midsagittal plane
♦♦ For permanent dentition
FDI Notation for Deciduous Dentition
8+7+ 6+ 5+ 4+ 3+ 2+ 1+ 1+ 2+ 3+ 4+ 5+ 6+ 7+ 8+
♦♦ Four quadrants are designated as 5 to 8 in clockwise
8–7–6–5–4–3– 2–1– 1–2–3–4–5– 6–7–8
direction.
♦♦ For deciduous dentition ♦♦ First digit represents quadrant from 1 to 5
♦♦ Second digit represents tooth in particular quadrant from
05+04+03+02+ 01+ 01+ 02+03+04+05 1 to 5
05–04–03–02–01– 01–02–03–04– 05– ♦♦ FDI notation for primary dentition is as follows:

Q.2. Write about FDI and Palmer tooth numbering system. Right Left
 (Nov 2008, 5 Marks) (Apr 2010, 5 Marks) 55 54 53 52 51 61 62 63 64 65
Or
85 84 83 82 81 71 72 73 74 75
Define FDI system of tooth nomenclature.
Midsagittal plane
 (Dec 2014, 3 Marks)
 Dental Anatomy 557

Advantages Upper right Upper left

♦♦ Followed internationally. E D C B A A B C D E
♦♦ Only notation which make cognitive, visual and computer E D C B A A B C D E
sense.
Lower right Lower left
♦♦ Used for verbal communication.
♦♦ Incorporated in computer languages. Midsagittal plane

Advantages
Palmer Tooth Numbering System
♦♦ The notation produces a graphical image of dentition,
It is also known as Zsigmondy-Palmer system or Symbolic
due to this presentation the anomalies such as edentulous
system or Quadrant system or Grid system or Angular System. spaces, etc. are represented using Zsigmondy cross.
♦♦ It is the oldest and one of the popular most system in use ♦♦ It is user friendly.
during 20th century. ♦♦ Quadrants can easily be identified by symbols.
♦♦ Hungarian dentist Adolf Zsigmondy develops it in 1861 ♦♦ Orthodontists use this system as it allow discussion of
and later on he modified the system for denoting primary particular tooth, which need treatment.
dentition in 1874. Corydon Palmer in 1870 invented the
system independently. Disadvantages
♦♦ In this system, oral cavity is divided into 4 sections which ♦♦ It is not compatible with computers as well as word pro-
are known as quadrants. cessing systems.
♦♦ Palmer system uses a unique ‘L’ shaped symbol or grid ♦♦ Verbal communication is very difficult.
for mentioning in which quadrant a particular specific ♦♦ Chances of error are there while designating the tooth.
tooth is present.
Q.3. Write about universal and FDI numbering systems. 
♦♦ Vertical line of symbol corresponds to patient’s midline
 (Jan 2012, 5 Marks)
and horizontal line corresponds to occlusal plane which
Or
separates upper as well as lower arches.
♦♦ Counting begins at midline and continue backwards. Describe universal tooth numbering system.
♦♦ Symbols denoting quadrants in Zsigmondy-Palmer system  (Aug 2011, 5 Marks)
in both deciduous and permanent teeth are as follows: Ans. Universal Tooth Numbering System
a. For maxillary right quadrant • Universal tooth numbering system was given by
b. For maxillary left quadrant Parreidt in year 1882.
c. For mandibular right quadrant • American Dental Association (ADA) officially
d. For mandibular left quadrant adapted it in year 1975.
• Universal tooth notation is widely used by dentists
Palmer Tooth Numbering System for Permanent Teeth in USA.
♦♦ Permanent teeth are represented by numerical 1 to 8 in all
Universal Numbering System for Permanent Teeth
four quadrants.
♦♦ Numbering starts from midline and go backwards. ♦♦ In permanent dentition numerical 1 to 32 denotes the teeth.
♦♦ Symbols represents the respective quadrants. ♦♦ Numbering of tooth starts from posterior most tooth in
♦♦ Following is the Zsigmondy-Palmer notation for upper right quadrant, i.e. right maxillary third molar
permanent dentition: which is denoted as #1 and ends at lower right quadrant,
i.e. right mandibular third molar which is denoted as #32.
Upper Right Upper Left ♦♦ Following is the universal tooth notation system for
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 permanent teeth.
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 Right Left
Lower Right Lower Left 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
MidSagittal plane 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
Midsagittal plane
Palmer Tooth Numbering System for Deciduous Teeth
♦♦ Deciduous teeth are represented by alphabets, i.e. upper Universal Numbering System for Deciduous Teeth
case English letters from A to E are used for representing ♦♦ Deciduous dentition is denoted by upper case english
primary teeth in all four quadrants. letters for each primary teeth.
♦♦ Numbering starts from midline and move backwards. ♦♦ Maxillary teeth are designated from letters A to J, A is right
♦♦ Following is the Zsigmondy palmer notation for maxillary second molar tooth while mandibular teeth are
permanent dentition: designated from K to T.
558 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ Following is the universal tooth notation system for

deciduous teeth: 3. CHRONOLOGY OF TOOTH DEVELOPMENT
Right Left
Q.1. Describe the importance of deciduous dentition in
A, B, C, D, E F, G, H, I, J humans. Describe chronology of permanent dentition.
T, S, R, Q, P O, N, M, L, K  (Mar 2006, 15 Marks) (Apr 2010, 15 Marks)
Midsagittal plane Ans. Importance of Deciduous Dentition in Humans
• Mastication of food: As primary occlusion gets
Advantages established, child is able to chew the food efficiently.
♦♦ The notation system is simple. For masticatory phenomenon neuromuscular co-
♦♦ Each tooth has different numerical or alphabetical denotion. ordination is required which is established during
♦♦ Verbal communication can easily be done. primary dentition stage by itself.
♦♦ It is compatible with computer. • Taking of proper diet: Deciduous teeth are the only
teeth present from six months to six years of age so
Disadvantages it is necessary to maintain them so that child can
♦♦ Difficult to memorize and needs practice. get comfortable functional occlusion. Child with the
♦♦ Graphical visualization is difficult. missing or decayed primary teeth feels difficulty in
For FDI notation refer to Ans 2 of same chapter. chewing the food and he/she may reject the food
which is difficult to chew.
Q.4. Write in detail about all tooth numbering systems. • Maintains normal facial appearance: A good
Define cusp, ridge, fossa and groove. maintained set of deciduous dentition contributes
 (Mar 2013, 8 Marks) to normal facial appearance as well as normal
Ans. For all tooth numbering systems refer to Ans 1 of same psychological and cognitive development of the
chapter. child. Prematurely lost or carious front teeth
Ridge: Ridge is defined as any linear elevation on the diminishes child’s self-confidence.
surface of tooth. • Provides clear speech: Anterior teeth are essential
Cusp: Cusp is defined as an elevation of crown of tooth for normal speech of some vowels such as ‘S’, ‘C’ etc.
making up a divisional part of occlusal surface. If teeth are lost they can lead to the defective speech
Fossa: Fossa is defined as a depression or a concavity on of the child.
lingual surface of anteriors and occlusal surface of posteriors. • Prevention of deciduous teeth from infection: It is
Groove: A groove is defined as a line separating the lobes important to treat dental caries and prevent primary
or primary part of crown or root. teeth from further periapical abscess formation
and possible complications because they can affect
Q.5. Enumerate the tooth numbering systems. underlying permanent tooth germs and may lead to
 (Sep 2018, 2 Marks) Turner’s hypoplasia, i.e. brown spots of crowns of
Ans. Following are the tooth numbering systems which are permanent teeth.
commonly used: • Maintenance of normal eruption of permanent
• Universal numbering system successors: As primary teeth are lost prematurely due
• Zsigmondy palmer system to caries or trauma the normal eruption schedule of
• FDI (Federation Dentaire Internationale) system permanent teeth gets which can lead to malocclusion.
Following are the other tooth notation systems: • Maintenance of space for normal eruption of permanent
• The Dane or Haderup system successor teeth: Primary teeth preserves the space for
• The reverse numeration system eruption of their permanent successor teeth. Adequate
• The Latin numeral system physiologic spacing in primary dentition leads to the
• The Metcalf system development of normal occlusal relations in permanent
• The Bosworth system dentition. If primary teeth lost prematurely, the adjacent
• The Crow system teeth migrate into the available space leading to a
• The US army system decrease in the arch length which causes a lack of space
• The US navy system in the arch for the erupting permanent successors and
• The Lowlands system results in the development of malocclusion.
• The Holland system
• The South African system Chronology of Permanent Dentition
• The French system ♦♦ Chronology consists of the following components, i.e.
• The Dutch system 1. First evidence of calcification of the tooth
• The Cincinnati system. 2. Crown completion of the tooth
 Dental Anatomy 559

3. Eruption of the tooth to developing teeth during surgery of children,

4. Root completion of the tooth especially related to cleft palate.
–– Chronology is of great importance because more –– Kronfeld’s table of chronology is most widely
precise information was needed to avoid injury accepted.

For Permanent Maxillary Teeth

First evidence of calcification
Tooth (months/year) (years) Enamel completed (years) Eruption (years) Root completed
Central incisor 3–4 months 4–5 years 7–8 years 10 years
Lateral incisor 10–12 months 4–5 years 8–9 years 11 years
Canine 4–5 months 4–5 months 11–12 years 13–15 years

1 3
First premolar 1 − 1 years 5–6 years 10–11 years 12–13 years
2 4

1
Second premolar 2−2 years 6–7 years 10–12 years 12–14 years
4

1
First molar At birth 2 –3 years 6–7 years 9–10 years
2

1
Second molar 2 –3 years 7–8 years 12–13 years 14–16 years
2

Third molar 7–9 years 12–16 years 17–21 years 18–25 years

For Permanent Mandibular Teeth

First evidence of calcification
Tooth (months/year) (years) Enamel completed (years) Eruption (years) Root completed
Central incisor 3–4 months 4–5 years 6–7 years 9 years
Lateral incisor 3–4 months 4–5 years 7–8 years 10 years
Canine 4–5 months 4–5 months 9–10 years 12–14 years

3
First premolar 1 –2 years 5–6 years 10–12 years 12–13 years
4

1 1
Second premolar 2 −2 years 6–7 years 11–12 years 13–14 years
4 2

1
First molar At birth 2 –3 years 6–7 years 9–10 years
2

1
Second molar 2 –3 years 7–8 years 11–13 years 14–15 years
2

Third molar 8–10 years 12–16 years 17–21 years 18–25 years

Q.2. Write short note on sequence of eruption of permanent
teeth.  (June 2010, 5 Marks)
Ans. Eruption of teeth occurs earlier in females.
• Mandibular teeth erupt earlier than maxillary teeth.
• Eruption sequence in maxillary arch is 6-1-2-4-3-5-
7-8 Or 6-1-2-4-5-3-7-8
• Eruption sequence in mandibular arch is 6-1-2-3-4-
5-7-8 Or 6-1-2-4-3-5-7-8
• First permanent tooth to erupt is first molar at the
age of 6 years.
• Mandibular central incisors erupt at age of 6 to 7
years followed by lateral incisors.
• Maxillary central incisor erupts at age of 7 to 8 year
and maxillary lateral incisors at age of 8 to 9 years.
• Mandibular canine erupt at age of 9 to 10 years while
maxillary canine erupts at age of 11-12 years.
• Premolars erupt at age of 10 to 12 years.
• Second molars erupt at the age of 12 years.
• Third molars erupt at the age of 17 to 21 years.
560 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.3. Write briefly on eruption sequence of deciduous and • Spaces that widen out from the area of contact
permanent teeth.  (Aug 2012, 5 Marks) labially or buccally and lingually are called labial
Ans. Eruption Sequence of Deciduous Teeth or buccal and lingual interproximal embrasures.
• Mandibular central incisor • Embrasures are continuous with the interproximal
• Maxillary central incisor spaces between the tooth.
• Maxillary lateral incisor
• Mandibular lateral incisor
• Maxillary and mandibular first molar
• Maxillary canine
• Mandibular canine
• Mandibular second molar
• Maxillary second molar.
According to Zsigmondy/Palmer notation of teeth,the Fig. 30:  Embrasure
order of eruption of primary teeth in one quadrant is
denoted as A B D C E. • Above the contact areas incisally and occlusally, the
spaces which are bounded by the marginal ridges
Eruption Sequence of Permanent Teeth as they join the cusps and incisal ridge are called as
the incisal or occlusal embrasures. Incisal or occlusal
♦♦ Maxillary and mandibular first molar.
embrasures, and the labial or buccal and lingual
♦♦ Mandibular central incisor
embrasures are continuous.
♦♦ Maxillary central incisor
• Fourth triangular space which is cervical to the
♦♦ Mandibular lateral incisor
contact area is filled with interdental or gingival
♦♦ Maxillary lateral incisor
papilla which is known as interproximal space or it
♦♦ Mandibular canine
is also referred to as gingival or cervical embrasure.
♦♦ Maxillary first premolar
♦♦ Mandibular first premolar Functions of Embrasures
♦♦ Maxillary second premolar
♦♦ They provide the spillway for escapement of food during
♦♦ Mandibular second premolar the mastication.
♦♦ Maxillary canine ♦♦ They reduce the forces on teeth during the reduction of
♦♦ Mandibular second molar hard food material.
♦♦ Maxillary second molar ♦♦ Prevents food from being entering in the contact area.
♦♦ Maxillary and mandibular third molar ♦♦ Provides self-cleansing action to teeth.
According to Zsigmondy/Palmer notation of teeth, the order of ♦♦ Protects gingiva from trauma.
eruption of permanent teeth in one quadrant is 6 1 2 4 5 3 7 8.
Applied Aspect
While giving the proximal restoration to teeth or if prosthesis is
4. FORM AND FUNCTION OF given over crown over or under contouring of proximal surface
OROFACIAL COMPLEX should strictly not be done because this results in food impaction.
Q.2. Write a note on interproximal space. 
Q.1. Write a short note on spillway space.  (Sep 2000, 5 Marks) (Mar 2009, 5 Marks)
 (Feb 2005, 5 Marks) (Mar 2000, 5 Marks) Ans. Interproximal Space
 (Sep 2003, 5 Marks) (Apr 2010, 5 Marks) • Interproximal space between the teeth are triangular-
Or shaped space.
Write a note on embrasures. (Apr 2007, 5 Marks) • Base of triangle is the proximal surface of the
 (Sep 2007, 5 Marks) (Apr 2008, 5 Marks) connecting teeth.
Or • Apex of the triangle is in the area of contact.
• Interproximal spaces are normally filled gingival
Write short note on embrasures. (Nov 2010, 3 Marks)
tissue (gingival papillae)
 (June 2010, 5 Marks) (Feb 2014, 3 Marks)
Or
Answer in brief embrasures. (Oct 2016, 2 Marks)
Or
Describe embrasures. (Apr 2017, 5 Marks)
Ans. Embrasures or Spillway Space
• When two teeth in the same arch are in contact, their
curvature adjacent to contact areas form V shaped
spaces called embrasures or spillway spaces Fig. 31:  Interproximal space

• Proper contact and alignment of adjoining teeth
allow proper spacing between them for the normal
bulk of gingival tissue attached to the bone and teeth.
• Gingival tissue helps to maintain these tissues against
trauma during mastication and invasion by bacteria.
• This arrangement allows sufficient bone tissue between
teeth and anchoring the teeth securely in the jaw.
• It also simplifies the problem of space for the blood
and nerve supply to the surrounding alveolar
process and other investing tissue of teeth.
• In case of gingival recession, interproximal space
transforms into a cervical embrasure as interdental
bone and interdental papilla do not fill up the space.
Q.3. Write a short note on interproximal contact between
teeth. (Mar 2006, 5 Marks)
Ans. As tooth erupts and takes its position in the dental arch, it
comes in contact with two adjacent teeth of the same arch
i.e. one mesial and one distal to it. Although the contact
between newly erupted teeth may be very small and
circumscribed, soon the contact becomes broader due
to proximal wear. So, the term contact area is preferred
to contact point.
Each tooth in dental arches except the last molars has
two contact areas i.e. the mesial and the distal. The 3rd
molar or the 2nd molar when 3rd molar is absent, is in
contact only with the tooth mesial to it.
Except for the maxillary and mandibular central incisors,
the mesial contact area of one tooth faces the distal contact
area of the adjoining tooth located mesial to it. The
maxillary and mandibular central incisors are the only
teeth that have their mesial surfaces facing each other.
Adjacent teeth should have tight contact with each
other. Proper contact relation between adjoining teeth
is important due to the following reasons:
• Since adjacent teeth are in contact with each other,
the whole dental arch functions as a single unit and
masticatory forces are well-distributed
• The combined anchorage of all teeth ensures occlusal
stability.
• Proper contact prevents food impaction, which can
lead to decay and periodontal problems.
• Tight contact between adjacent teeth helps to protect
the interproximal gingival tissue by diverting/
shunting food toward the buccal and lingual areas.
Clinical Significance of Contact Areas
If the contact between adjacent teeth is lost due to some reason
i.e. proximal caries, loss of a tooth, malocclusion, etc., food
is forced between the teeth and pathologic changes occur in
interdental gingival tissue which causes gingivitis. If this is
not corrected the inflammation may reach deeper periodontal
structures with loss of interdental alveolar bone causing
periodontitis. So it is very important to establish proper
proximal contact during crown prosthesis or during proximal
restoration of teeth or during treatment of malocclusion.
Dental Anatomy 561
Fig. 32:  Contact area
Q.4. Write short note on contact points. (June 2010, 5 Marks)
Ans. In the newly erupted teeth, contact is small in size and
is known as contact point.
• They are the crest of curvature on proximal surface
of two adjacent teeth in same dental arch which come
in contact with each other.
• Along with age due to constant rubbing of proximal
surface, the point become broad and is known as
contact area.
• Tooth consists of two contact points, i.e. mesial and
distal but in deciduous second molars only one
contact point is present, i.e. mesial.
• Position of contact point varies in every tooth.
Functions
1. It prevents impaction of food.
2. It helps in protection of interdental papilla
3. Provide stabilization to tooth in alveolus.
5. THE PRIMARY
(DECIDUOUS) DENTITION
Q.1. Write short note on occlusal surface of deciduous
maxillary second molar.  (Sep 2007, 2 Marks)
Ans. Following is the occlusal surface of deciduous maxillary
second molar tooth:
Occlusal Aspect
♦♦ Geometric shape of crown is rhomboidal.
♦♦ Buccopalatal dimensions are more than the mesiodistal
dimensions.
♦♦ Crown of the tooth shows lingual taper.
♦♦ Buccal outline of the crown is broad.
♦♦ Mesial outline is broader as compared to distal outline
because of distal convergence.
♦♦ Mesial and distal marginal ridges form mesial and distal
outlines.
♦♦ Occlusal surface of tooth is irregular.
♦♦ Mesiolingual line angle is obtuse and mesiolingual corner
is flat. This causes distal shift of mesiolingual cusp.
Occlusal Surface within its Boundaries
Cusps
♦♦ It consists of five cusps, i.e. mesiolingual, distolingual,
mesiobuccal, distobuccal and cusp of carabelli.
♦♦ Mesiolingual cusp is largest followed by mesiobuccal,
distobuccal, distolingual and cusp of carabelli.
♦♦ Mesiolingual and distolingual cusps are functional cusps.
562 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 33:  Occlusal surface of deciduous maxillary second molar

Ridges Q.2. Describe characteristic morphological features of

♦♦ Triangular ridge is prominent and extends from cusp tip deciduous and permanent canine teeth in maxillary
to central fossa. arch.  (Jan 2012, 10 Marks)
♦♦ Transverse ridge extends between mesiobuccal and Ans. Morphological Features of Deciduous Maxillary
mesiolingual cusps. Canine
♦♦ Ridge is formed by union of triangular ridge of distobuccal
and distal cusp ridge of mesiolingual cusp. Labial Aspect
♦♦ Marginal ridge is well developed and form mesial boundary. ♦♦ Shape of crown is roughly angular from the labial aspect.
♦♦ Distal marginal ridge is less developed and form distal ♦♦ Mesial outline from the labial aspect is convex from cervical
boundary. line to mesial contact area.
♦♦ Mesial outline is shorter than distal outline.
Fossae
♦♦ Distal outline from labial aspect is convex and extends
Three fossae are present, i.e. central fossa, mesial and distal from cervical line to distal contact area.
triangular fossa. ♦♦ Crest of curvature of cervical line is semicircular with
convexity facing root apex.
Grooves
♦♦ Incisal outline shows a long sharp cusp.
♦♦ Central developmental groove: It runs at bottom of sulcus
and connects mesial triangular fossa with central fossa.
♦♦ Buccal developmental groove: It runs buccally from cen-
tral pit in central fossa and separates mesiobuccal as well
as distobuccal cusps.
♦♦ Distal developmental groove: It lies at bottom of distal fossa.
♦♦ Lingual developmental groove: It separates mesiolingual
and distolingual cusps.
♦♦ Three supplemental grooves are seen radiating from
mesial pit, i.e. mesiobuccal triangular groove, mesiolingual
triangular groove and mesial marginal developmental
groove. Two grooves radiate from distal pit, i.e. distobuccal
triangular groove and distal marginal developmental groove.
Pits
♦♦ Central pit: It is located in deep part of central fossa.
♦♦ Mesial pit: It is located in deep part of mesial triangular fossa.
♦♦ Distal pit: It is located in deep part of distal triangular fossa. Fig. 34:  Deciduous maxillary canine-labial aspect
 Dental Anatomy 563

♦♦ The cusp is formed by two cuspal ridges, i.e. mesial cuspal Mesial Aspect
ridge and distal cuspal ridge which joins at an acute angle. ♦♦ Crown is wedge shaped when viewed from this aspect.
♦♦ Distal cuspal ridge is short and convex and have a steep- ♦♦ Labial outline from the lingual aspect is convex in cervical
inclination from cuspal tip. 1/3rd and flat in incisal and middle 1/3rd.
♦♦ Distal cuspal ridge is shorter than mesial cuspal ridge ♦♦ Lingual outline from mesial aspect is S shaped. It is convex
and is concave. Due to this variation the cusp of canine is at cingulum and concave at mesial marginal ridge and is
placed distally. convex at cuspal region.
♦♦ Labial surface has a ridge known as canine ridge which run ♦♦ Crest of curvature of cervical line is semicircular with
from cervical line to the cuspal tip and is placed distally. convexity facing cusp.
♦♦ A slender, long and single root is present which have a ♦♦ Mesial contact area is seen in middle one-third of crown.
blunt apex. A very slight distal inclination of root is seen
at apical one-third of root.
Lingual/Palatal Aspect
♦♦ Crown is diamond shaped when viewed from palatal
aspect.
♦♦ Mesiodistal width of crown is less when compared to labial
aspect, this is due to the palatal convergence of distal and
mesial sides of crown.
♦♦ Mesial ouline from lingual aspect is convex from cervical
line to mesial contact area.
♦♦ Distal outline from lingual aspect is convex and is more
rounded than mesial aspect.
♦♦ Crest of curvature of cervical line is semicircular with
convexity facing root apex.
♦♦ On incisal aspect a sharp cusp is evident which is formed by
mesial and distal cuspal ridges which joins at an acute angle.
♦♦ Lingual surface of the crown is irregular. Fig. 36:  Deciduous maxillary canine-mesial aspect
♦♦ Lingual surface has palatal fossa and prominent ridges, Distal Aspect
i.e. mesial marginal ridge and distal marginal ridge. Distal
♦♦ Crown appears to be wedge shaped when viewed from
marginal ridge is longer than mesial marginal ridge.
distal aspect.
♦♦ Cingulum appears to be prominent.
♦♦ Crest of curvature of cervical line is semicircular with
♦♦ Palatal ridge is placed distally and it extend from cuspal
convexity towards incisal ridge.
tip to the cingulum. Palatal ridge divide palatal fossa into
♦♦ Distal surface is smooth.
mesial palatal fossa and distal palatal fossa.
♦♦ Distal contact area lies in middle 1/3rd of crown.
♦♦ Root is same as on labial aspect. ♦♦ Root when viewed from the distal side is wider labio-
♦♦ Lingual surface of root is smooth with ridge extending lingually in cervical and middle one-third and tapers at
from cervical line to apex. incisal one-third.

Fig. 35:  Deciduous maxillary canine-lingual aspect Fig. 37:  Deciduous maxillary canine-distal aspect
564 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ Distal surface has a developmental depression in middle Describe various differences between permanent and
one-third and cervical one-third of root. deciduous dentition.  (Sep 2003, 15 Marks)
 (Sep 1999, 15 Marks)
Incisal Aspect
Or
♦♦ Crown appears to be of diamond shaped.
♦♦ Labiolingual width of the mesial half of crown is more Give differences between deciduous and permanent
than distal half. teeth.  (Mar 2008, 7.5 Marks) (June 2010, 10 Marks)
 (Feb 2013, 10 Marks) (Aug 2011, 10 Marks)
Or
Describe microscopic and macroscopic differences
between permanent and deciduous teeth. 
 (Sep 2009, 15 Marks)
Or
Describe morphological and histological differences
between permanent and deciduous dentition. 
 (Nov 2010, 6 Marks)
Or
Write short note on morphological differences between
deciduous and permanent dentition. 
Fig. 38:  Deciduous maxillary canine-incisal aspect  (Mar 2013, 3 Marks)
Or
♦♦ Labial outline of crown from this aspect is smoothly con-
vex and broad mesiodistally. A prominent canine ridge is Describe the differences in deciduous and permanent
seen in centre. dentition in detail. (May 2017, 10 Marks)
♦♦ Lingual outline from incisal aspect is narrow as compared Or
to labial aspect.
Describe differences between deciduous and
♦♦ Cingulum is prominent and is extended mesiodistally.
permanent teeth. (July 2016, 10 Marks)
♦♦ Mesial and distal outlines from incisal aspect appears to
Ans.
be broad.
  For morphological features of permanent maxillary Importance of Primary Dentition
canine refer to Ans 1 of chapter THE MAXILLARY AND ♦♦ Mastication of food: As primary occlusion gets estab-
MANDIBULAR CANINES. lished, child is able to chew the food efficiently. For
Q.3. Write very short answer on four differences between masticatory phenomenon neuromuscular co-ordination
is required which is established during primary dentition
deciduous and permanent canine.
stage by itself.
 (Aug 2018, 2 Marks)
♦♦ Taking of proper diet: Deciduous teeth are the only teeth
Ans. Following are the four differences between deciduous present from six months to six years of age so it is neces-
and permanent canine: sary to maintain them so that child can get comfortable
Deciduous canine Permanent canine functional occlusion. Child with the missing or decayed
primary teeth feels difficulty in chewing the food and he/
It is shorter in size It is larger in size
she may reject the food which is difficult to chew.
It is conical in shape It is less conical in shape ♦♦ Maintains normal facial appearance: A good maintained
Cusp tip is more pointed and sharp Cusp tips are less pointed set of deciduous dentition contributes to normal facial
It erupts at 19 months of age It erupts at 11 to 12 years of age appearance as well as normal psychological and cognitive
development of the child. Prematurely lost or carious front
teeth diminish child’s self-confidence.
♦♦ Provides clear speech: Anterior teeth are essential for
6. DIFFERENCES BETWEEN PRIMARY normal speech of some vowels such as ‘S’, ‘C’ etc. If teeth
are lost they can lead to the defective speech of the child.
AND PERMANENT DENTITION ♦♦ Prevention of deciduous teeth from infection: It is
important to treat dental caries and prevent primary
Q.1. Give importance of deciduous dentition. Give teeth from further periapical abscess formation and
difference between permanent and deciduous dentition. possible complications because they can affect underlying
 (Feb 2002, 16 Marks) (Mar 2009, 15 Marks) permanent tooth germs and may lead to Turner’s
Or hypoplasia, i.e. brown spots of crowns of permanent teeth.
 Dental Anatomy 565

♦♦ Maintenance of normal eruption of permanent successors:
As primary teeth are lost prematurely due to caries or
trauma the normal eruption schedule of permanent teeth
gets which can lead to malocclusion.
♦♦ Maintenance of space for normal eruption of permanent
successor teeth: Primary teeth preserves the space for
eruption of their permanent successor teeth. Adequate
physiologic spacing in primary dentition leads to the
development of normal occlusal relations in permanent
dentition. If primary teeth lost prematurely, the adjacent
teeth migrate into the available space leading to a decrease
in the arch length which causes a lack of space in the arch
for the erupting permanent successors and results in the
development of malocclusion.

Morphological (macroscopic) and histological (microscopic) differences in deciduous and permanent dentition
Features Primary/deciduous dentition Permanent dentition
General features
Number 20 teeth 32 teeth
In each jaw 10 teeth and in each quadrant 5 teeth In each jaw 16 teeth and in each quadrant 8 teeth
Teeth present 2 incisors, 1 canine, 2 molars in each quadrant 2 incisors, 1 canine, 2 premolars, 3 molars in each quadrant
Dental formula I 2/2 C1/1 M2/2 I 2/2 C1/1 PM2/2 M3/3
Duration of eruption Start from 6 months to 3 years Start from 6 years to end up at 12 years except for third molars
and its completion
Duration of dentition From 6 months to 6 years 12 years and beyond
Eruption sequence A B D C E Maxillary teeth: 6 1 2 4 3 5 7 or 6 1 2 4 5 3 7
A B D CE Mandibular teeth: 6 1 2 3 4 5 7
Macroscopic features
Crown
Size Small in dimensions Larger in dimension

Color Light in color. Appear bluish white. Darker in color yellowish, white or grayish white
Placement in jaws Placed perpendicular in relation to jaws Placed oblique in relation to jaws
Shape More bulbous Less bulbous
Cervical constriction More Less

Contd…
566 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd…
Morphological (macroscopic) and histological (microscopic) differences in deciduous and permanent dentition

Features Primary/deciduous dentition Permanent dentition

Cervical ridge On buccal aspect of deciduous crown is more Cervical ridge on permanent crown is flatter
prominent

Surface In deciduous anterior teeth facial surface is flat above In permanent teeth facial and lingual surfaces are flat
the level of cervical ridge till incisal surface. In posterior
teeth lingual surface is flat above the level of cervical
ridge till occlusal surface.

Incisors
Mamelons Deciduous incisors have no mamelons Newly erupted permanent incisors have mamelons

Cingulum In lingual surface it is more prominent and occupies It is less prominent

one third of crown length.

Contd…
 Dental Anatomy 567

Contd…

Morphological (macroscopic) and histological (microscopic) differences in deciduous and permanent dentition

Features Primary/deciduous dentition Permanent dentition

Crown width Deciduous incisors are wider mesiodistally than Permanent incisors are long cervicoincisally
cervicoincisally
Canine Conical in shape. Cusp tip is more pointed and sharp Less conical in shape and cuspal tips are less pointed
Premolar Absent Two premolars are present in each quadrant
Molar
Number 2 molars are present in each quadrant. 3 molars are present in each quadrant
Size Crown of second molar is larger than crown of first molar Crown of first permanent molar is larger than second and third molars
Shape Deciduous molars are more bulbous and are of bell Permanent molars are less bulbous
shaped
Occlusal Table Narrow Broad

Occlusal plane Flat More curved contour and more intricate design
Grooves Supplemental grooves are more Supplemental grooves are less
Cusps Short, sharp and pointed Blunt

Contact areas Contact areas between primary molars are flat, Contact areas between permanent molars are broad and situated
narrow and situated gingivally occlusally

Contd…
568 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd…

Morphological (macroscopic) and histological (microscopic) differences in deciduous and permanent dentition

Features Primary/deciduous dentition Permanent dentition

Upper first molar Has 3 cusps Has 4 cusps and 1 accessory cusp
Upper second Has 4 cusps and 1 accessory cusp Has 4 cusps
Molar
Lower first molar Has 4 cusps Has 5 Cusps
Lower second molar Has 5 cusps Has 4 cusps
Root
Crown root ratio Roots are longer when compared to size of crown Roots are not long as compared to size of crown.
Size Roots are long and more slender Roots are short and bulkier

Width Narrow mesiodistally Broad mesiodistally

Trunk It is much smaller It is larger

Labial inclination 10 degree of labial inclination is present. Labial inclination is absent

Contd…
 Dental Anatomy 569

Contd…

Morphological (macroscopic) and histological (microscopic) differences in deciduous and permanent dentition

Features Primary/deciduous dentition Permanent dentition

Furcation Level of furcation of root lies near to cervix Level of furcation lies 3 to 4 mm below the cervix.

Flaring Roots flare out from cervical area to their tips. Marked flaring of roots is absent.
Resorption Undergo physiologic resorption Physiologic resorption is absent.
Pulp
Pulp chamber Larger when compared to crown size. Smaller when compared to crown size
Pulpal outline Follows DEJ more closely Follows DEJ less closely
Pulp horn Pulpal horns are higher and closer to outer surface. Pulpal horns are lower and away from outer surface.
Root canals Root canals are ribbon like, follow thin tortuous and Root canals are well defined and less branching.
branching path.
Accessory canals Accessory canals in pulp chambers of primary molars Floor of pulp chambers do not have many accessory canals.
directly lead to inter-radicular furcation areas.
Apical foramen Wider Narrower
Microscopic/histologic features
Enamel
Thickness Thickness of dentin is half that of permanent teeth. Thickness is more over pulpal roof
Dentinal tubules Less regular More regular
Inter-globular dentin Absent Present beneath the mantle layer of dentin
Pulp
Blood supply Blood supply is abundant Blood supply is less
Nerve supply Less densely innervated, nerve fibers terminate near Densely innervated. Nerve fibers terminate among odontoblasts
odontoblastic zone as free nerve endings and even passes beyond predentin
Cementum Cementum is thin and is made up of only primary Cementum is thick and both primary and secondary cementum
cementum. are present.
Mineral content Enamel and dentin are less mineralized and less dense Enamel and dentin are more mineralized
Neonatal line Present in all primary teeth both in enamel and dentin Seen only in first molar.

Q.2. Describe importance of primary dentition. 
 (Jan 2012, 5 Marks) (May 2014, 2 Marks)
Ans. For importance of deciduous dentition refer to Ans 1 of
same chapter.
Q.3. Define set traits and arch traits and describe differences
between deciduous and permanent teeth. 
 (Nov 2010, 7.5 Marks)
Ans. Set trait: These traits are the features that differentiate teeth
in primary dentition from the teeth in permanent dentition.
Arch trait: These traits are those which differentiate
maxillary teeth from mandibular teeth.
For differences between deciduous and permanent teeth
refer to Ans 1 of same chapter.
570 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.4. Describe the differences between deciduous and permanent

dentition. Add a note on the importance of primary
dentition. List the sequence of eruption for primary and
permanent dentition. (Aug 2016, 10 Marks)
Ans. For differences between deciduous and permanent
dentition refer to Ans 1 of same chapter.
For importance of deciduous dentition refer to Ans 1 of
same chapter.
For sequence of eruption of primary and permanent
dentition refer to Ans 3 of chapter CHRONOLOGY OF
TOOTH DEVELOPMENT.

7. THE MAXILLARY AND

MANDIBULAR INCISORS
Fig. 39:  Maxillary central incisor-labial aspect
Q.1. Describe the morphology of permanent maxillary central
incisor. (Mar 2007, 8 Marks) (Sept 2009, 15 Marks) Lingual Aspect
Or ♦♦ Geometric shape of lingual aspect is trapezoidal.
Discuss morphology of permanent maxillary central ♦♦ Lingual surface of crown and root is narrower as compared
incisor. (May 2018, 10 Marks) to the labial surface. This is because of lingual convergence,
Ans. Following is the morphology of permanent maxillary i.e. mesial and distal walls taper towards lingual aspect.
central incisor: ♦♦ Due to the presence of lingual convergence, labial line
Five aspects describe the morphology of permanent angles are seen from lingual aspect.
maxillary central incisor ♦♦ Mesial outline is similar to mesial outline of labial aspect
only difference is that a portion of incisal wall can be seen
Morphology of Crown from lingual aspect.
♦♦ Distal outline is similar to distal outline of labial aspect
Labial Aspect only difference is that a portion of distal wall can be seen
♦♦ Geometric shape of the central incisor from labial aspect from lingual aspect.
is trapezoidal. ♦♦ From lingual aspect the cervical outline curves apically.
♦♦ Labial surface of maxillary central incisor is convex ♦♦ Lingual surface of maxillary central incisor is irregular
and smooth both mesiodistally and cervicoincisally. with convexities and a concavity.
Convexity lies near cervical third region and becomes ♦♦ Convexity which is found immediately below the cervical
flattened towards the mesial and incisal third of the line is known as cingulum while the central concavity is
crown. known as lingual fossa.
♦♦ Newly erupted incisors show three elevations at incisal
portion known as mamelons.
♦♦ From labial aspect, the mesial outline is straight and meets
at incisal edge forming a sharp angle known as mesioincisal
angle.
♦♦ Crest of curvature of mesial outline or mesial contact area
lies at incisal third of the crown near mesioincisal angle.
♦♦ From labial aspect, the distal outline is more convex and
meets at incisal edge forming a rounded angle known as
distoincisal angle.
♦♦ Crest of curvature of the distal outline or distal contact
area is higher towards the cervical line, at the junction of
incisal and middle third of the crown.
♦♦ Incisal outline is straight mesiodistally and is formed by
the incisal ridge.
♦♦ From labial aspect cervical outline is a semicircular
curvature towards the root. Fig. 40:  Maxillary central incisor- lingual aspect

♦♦ Cingulum is the convexity which encirlces the lingual
surface of anteriors at the cervical one third. Cingulum
forms the bulk of cervical third of the lingual surface.
♦♦ Cingulum is convex and smooth both cervicoincisally and
mesiodistally.
♦♦ Marginal ridges extend from cingulum forming the mesial
and distal borders of lingual fossa. The marginal ridge
extending mesially is known as mesial marginal ridge
while the marginal ridge extending distally is known as
distal marginal ridge.
♦♦ Usually two developmental grooves extend from cingulum
into the lingual fossa; especially on canines and maxillary
incisors.
♦♦ Lingual Fossa is a concavity in the center of lingual aspect
of all anterior teeth.
♦♦ Lingual fossa is bordered mesially by mesial marginal
ridge, distally by distal marginal ridge, cervically by
cingulum, and incisally by incisal ridge.
Mesial Aspect
♦♦ Geometric shape from this aspect is wedge shaped or
triangular.
♦♦ Base of the triangle lies at cervix while the apex of triangle
lies towards the incisal ridge.
♦♦ Mesial surface is convex labiolingually and cervicoincis-
ally. Less convexity is seen at the cervical area.
♦♦ Mesial contact area lies at incisal one third, immediately
beside the incisal edge.
Fig. 41:  Maxillary central incisor-mesial aspect
♦♦ From mesial aspect the labial outline is convex. It curves
smoothly from cervical line towards the incisal ridge and
the height of labial contour of crown is at the cervical third.
♦♦ From mesial aspect the lingual outline is irregular. A
convexity is formed by cingulum at the cervical portion
and a concavity is formed by lingual fossa towards at the
incisal portion. Height of lingual contour of the crown lies
at cervical third.
Dental Anatomy 571
♦♦ From mesial aspect the incisal outline is formed by a
rounded incisal ridge in a newly erupting tooth while a
flat incisal edge is seen in a functional tooth.
♦♦ From mesial aspect, the cervical line over mesial surface of
central incisor curves incisally approximately 3 to 4 mm.
♦♦ Incisal ridge is the rounded incisal portion of a newly
erupted incisor, which merges with the mesioincisal and
distoincisal angles and the labial and lingual surfaces.
♦♦ Angle formed by linguoincisal surface and labial surface
is known as incisal edge. It is not seen in newly erupted
incisor tooth.
Fig. 42:  Maxillary central incisor-distal aspect
Distal Aspect
♦♦ Geometric Shape from this aspect is wedge shaped or
triangular.
♦♦ Distal surface is just similar to mesial surface except
that the crown appears thicker towards the incisal
third.
♦♦ Distal contact area lies at the junction of incisal and middle
thirds of the crown.
♦♦ From distal aspect labial outline is convex from cervix to
the incisal ridge.
♦♦ From distal aspect lingual outline is concavo convex.
♦♦ From distal aspect the incisal outline is straight
♦♦ Curvature of cervical line is less, i.e. 1 mm shorter in extent
on distal surface as compared to mesial surface.
Incisal Aspect
♦♦ It is triangular in shape.
♦♦ Mesiodistal dimension of the crown is slightly greater than the
buccolingual dimension. Incisal ridge extending mesiodistally
provides an illusion of much greater mesiodistal dimension.
♦♦ Crown appears bulkier from incisal aspect.
♦♦ From incisal aspect the labial surface is more convex
cervically and flatter incisally.
♦♦ Cingulum forms a smaller convex arc and the crown tapers
rapidly from the labial surface towards the cingulum.
♦♦ Mesiolabial and distolabial line angles are prominent from
incisal aspect.
♦♦ Incisal edge is seen from this aspect which is sloping
lingually perpendicular to labiolingual bisecting line.
572 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Morphology of Root ♦♦ Root is narrow towards lingual aspect.

♦♦ Maxillary central incisor consists of single root. ♦♦ Apical root curvature is almost straight but at times labial
♦♦ Size of the root is 2 to 3 mm longer than the crown. curvature is seen.
♦♦ Root is cone shaped and evenly tapers towards the apex. ♦♦ Root apex is usually blunt.

Fig. 43:  Maxillary central incisor-incisal aspect

Q.2. Compare and contrast the morphology of permanent maxillary central incisor and lateral incisor. 
 (Mar 2000, 15 Marks)
Or
Differentiate permanent maxillary central and maxillary lateral incisor.  (Jan 2018, 5 Marks)
Ans.
Features Permanent maxillary central incisor Permanent maxillary lateral incisor
Crown
Labial Aspect

Mesiodistal width It is wider It is narrower

Cervicoincisal length Crown length is more Crown length is short
Mesial profile Mesial profile is straight Mesial profile is convex
Distal profile Distal profile is slightly convex Distal profile is more convex
Incisal ridge Incisal ridge is straight Incisal ridge is rounded and it slopes cervically towards
distal surface

Contd…
 Dental Anatomy 573

Contd…

Features Permanent Maxillary Central Incisor Permanent Maxillary Lateral Incisor

Incisal angles
Mesioincisal angle It is sharp It is rounded
Distoincisal angle It is rounded It is more rounded
Proximal contacts
Mesial contact It lies at Incisal 1/3rd It lies at junction of incisal and middle 1/3rd
Distal contact It lies at junction of incisal and middle 1/3rd It lies at middle 1/3rd
Incisal angles
Mesioincisal angle It is sharp It is rounded
Distoincisal angle It is rounded It is more rounded
Labial Surface It is convex slightly. Its convexity is more.
Lingual aspect

Labial Surface It is convex slightly. Its convexity is more.

Cingulum It is prominent. It is more prominent compared to central incisor.
Marginal ridge It is well developed and is prominent. Prominence is more as compared to central incisor
Lingual fossa It is deep It is well circumscribed and is more deeper as compared
to central incisor
Grooves Grooves are less in lingual fossa. Palatogingival groove is seen which is deep.
Lingual pits They are less common They are more common.
Mesial aspect

Labial and lingual contours Curvature of contours is more. Curvature of contours is less.
Height of contour It lies at cervical 1/3rd It lies at cervical 1/3rd
Contd…
574 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd…

Features Permanent Maxillary Central Incisor Permanent Maxillary Lateral Incisor

Incisal ridge It lies in line with the vertical root axis. It lies in line with the vertical root axis.
Curvature of cervical line Mesially curvature is 3.5mm while distally it is 2.5 mm Mesially curvature is 2.5mm while distally it is 1.5 mm
Distal aspect
Cervical Line Curvature is less when compared to mesial aspect. Curvature is less when compared to mesial aspect.
Distal Contact area It lies at incisal 1/3rd. It lies at middle 1/3rd.
Incisal aspect

Geometric form From incisal aspect it is triangular. From incisal aspect it is ovoid/rounded.
Dimensions Crown is wider mesiodistally when compared with Dimensions of crown are same mesiodistally and
labiolingual dimensions. labiolingually.
Root
Number Single root is present Single root is present
Size Root is thick in size Root is slender in size
Developmental groove It is absent. It can be present on mesial or distal surfaces of root.
Curvature It is straight. Curvature at labial and distal surfaces is at apical 1/3rd
is same.
Cross section of root at cervix It is triangular It is ovoid
Pulp horns From labial view 3 pulpal horns are seen. From labial view 2 pulpal horns are seen.
Pulp canals Single pulpal canal is present Single pulpal canal is present

Q.3. Write short note on type traits of mandibular inci- Ans. Here type traits of mandibular incisors means differen-
sors.  (July 2016, 3 Marks) tiating teeth within one class, i.e. differences between
mandibular central and mandibular lateral incisors.

Characteristics Mandibular permanent central incisor Mandibular permanent lateral incisor

Tooth nomenclature
Universal system Right is denoted as 25 and left is denoted as 26 Right is denoted as 26 and left is denoted as 23
Zsigmondy/ Right 1 ; Left 1 Right 2 ; Left 2
Palmer system
FDI system Right is denoted as 41 and Left is denoted as 31 Right is denoted as 41 and Left is denoted as 32
Chronology
Eruption 6 to 7 years 7 to 8 years
Root completion 9 years 10 years
Dimension Smallest tooth present in permanent dentition Slightly larger than permanent mandibular central incisor in
all dimensions
Contd…
 Dental Anatomy 575

Contd…
Characteristics Mandibular permanent central incisor Mandibular permanent lateral incisor
Crown
Labial aspect

Symmetry Bilaterally symmetrical Bilaterally asymmetrical

Mesial profile Straight Straight
Distal profile Straight Slightly curved
Proximal Both mesial and distal contact areas are at incisal third Level of both mesial and distal contact areas is at incisal
contacts third but they are located cervically as compared to
mandibular central incisor
Mesioincisal It is sharp and is right angled It is sharp and is right angled
angle
Distoincisal It is sharp and is right angled It is slightly rounded
angle
Incisal ridge It is straight It slope downwards distally
Lingual aspect

Marginal ridge It is ill-defined It is well-defined

Proximal surface

Contd…
576 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd…
Characteristics Mandibular permanent central incisor Mandibular permanent lateral incisor
Incisal aspect

Incisal ridge/edge It is at right angle to labiolingual bisecting line It is at angle to labiolingual bisecting line. This is twisted
labiolingually on root base for confirming mandibular arch
curvature
Cingulum Centered mesiodistally It is positioned distally
Root
Size Short and small Long and large
Developmental Present on mesial and distal surfaces. Groove is deep on Present on mesial and distal surfaces.
grooves distal surface
Pulp canals One or two are also possible One

cervical line to the cusp tip. This is known as labial

8. THE MAXILLARY AND ridge.
MANDIBULAR CANINES ♦♦ Mesial as well as distal contact area lie at different levels.
♦♦ In a newly erupted tooth, two shallow developmental
Q.1. Describe morphology of maxillary canines.  grooves separating the three labial lobes can be seen.
 (Feb 2002, 15 Marks) (June 2010, 10 Marks) ♦♦ From labial aspect mesially the outline is convex extending
Or from cervical area to the area where it joins the mesial cusp
Describe labial, mesial, distal, lingual and incisal slope. Maximum convexity of the mesial outline, i.e. at
aspect of maxillary canine. (Sep 2018, 5 Marks) mesial contact area is at the junction of incisal and middle
Ans. Following is the morphology of permanent maxillary one-third of the crown.
canine:

Morphology of Crown

Labial Aspect
♦♦ Geometric shape of the crown from labial aspect is
trapezoidal or pentagonal form.
♦♦ From this aspect, the maxillary permanent canine resem-
bles as premolar tooth.
♦♦ As compared to the maxillary central incisor the crown
of canine is smaller mesiodistally by 1 mm and at cervix
it is much narrower.
♦♦ Labial surface is generally smooth and convex except for
the shallow depressions mesially and distally dividing
the three lobes.
♦♦ Middle labial lobe shows more development than other
lobes and forms a linear elevation which extends from Fig. 44:  Maxillary canine-labial aspect

♦♦ From labial aspect distal outline is convex, but it gets
concave between cervical line and distal contact area.
Maximum convexity of the distal outline, i.e. at distal
contact area is at the middle of middle third of the
crown.
♦♦ From labial aspect, the incisal outline is made up by two
slopes which extends from mesial and distal contact areas
and meet the cuspal tip at midline. These slopes are known
as mesial and distal cuspal ridges.
♦♦ Mesial cusp ridge is concave while the distal cusp ridge is
longer and is slightly rounded.
♦♦ From labial aspect the cervical line is convex and point
apically.
Lingual Aspect
♦♦ Geometric shape of maxillary canine from this aspect is
trapezoidal or pentagonal.
♦♦ On lingual aspect, the cervical line is more convex and is
pointed apically.
Fig. 45:  Maxillary canine-lingual aspect
♦♦ Crown of maxillary permanent canine is narrower
labiolingually as compared to mesiodistally.
♦♦ At lingual surface the cervical portion consists of a large,
smooth, well-developed cingulum. Cingulum of maxillary
canine is pointed like a small cusp.
♦♦ Definite ridges are found on lingual surface of crown
below the cingulum and in between strongly developed
marginal ridges.
♦♦ A well-developed lingual ridge is seen which is confluent
with cusp tip.
♦♦ Shallow concavities are evident between this lingual
ridge and the marginal ridges, when these concavities are
present, they are called as mesial and distal lingual fossa.
♦♦ On cingulum the height of contour lies at cervical third.
Mesial Aspect
♦♦ Geometric shape of permanent maxillary canine from this
aspect is triangular or wedge-shaped.
♦♦ Mesial aspect generally shows greater bulk and labiolingual
measurement than any other of anterior teeth.
Dental Anatomy 577
♦♦ The entire labial outline from mesial aspect exhibits more
convexity from cervical line to the cusp tip.
♦♦ Cusp tip of maxillary canine does not lie in center
with the root. Cusp tip is placed labial to the vertical
root axis.
♦♦ Mesial contact area lies at the junction of incisal and middle
one-third of the crown cervicoincisally and labiolingually
it lies at the center.
♦♦ From mesial aspect, the labial outline is more convex due
to the presence of prominent labial ridge from cervical line
to cusp tip. Height of contour labially lies at cervical third.
Height of contour is located on cingulum.
Fig. 46:  Maxillary canine-mesial aspect
♦♦ As viewed from the mesial aspect, lingual outline is ‘S’
shaped. The course it follows is first the convexity of cin-
gulum at cervical third of crown, concavity of lingual fossa
which lies at the center, it becomes convex again at incisal
third. Height of contour lingually lies at cervical third.
Height of contour is located on cingulum.
♦♦ From mesial aspect the incisal outline forms a small arc
representing the cusp tip.
♦♦ At mesial aspect the cervical line is convex and it points
towards the cuspal tip.
Distal Aspect
♦♦ Geometric shape of permanent maxillary canine from this
aspect is triangular or wedge shaped.
♦♦ On the distal aspect, cervical line has less curvature
towards the cuspal ridge.
♦♦ Distal contact area lies at center of middle one third of
crown.
♦♦ Distal surface displays more concavity apical to distal
contact area.
♦♦ Distal marginal ridge is heavier and more irregular in
outline.
578 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 47:  Maxillary canine-distal aspect

Incisal Aspect ♦♦ Cusp tip lies labial to the center of the crown labiolingually
as well as mesial in the center mesiodistally.
♦♦ Geometric shape of permanent maxillary canine from this
♦♦ From incisal aspect labially the cervical portion is convex.
aspect is diamond shaped. ♦♦ From incisal aspect labial ridge appears to be prominent.
♦♦ From this aspect labiolingual dimension of crown appears Labial ridge is more convex at cervical third and gets
to be greater than the mesiodistal dimension. flattened at incisal third.
♦♦ Crown is asymmetrical with mesial half of crown smaller ♦♦ Lingual fossa, lingual ridge and marginal ridges which
than distal half. borders the lingual fossa are seen.

Fig. 48:  Maxillary canine-incisal aspect

Morphology of Root ♦♦ Mesial as well as distal surfaces are flat and have developmental
♦♦ Permanent maxillary canine consists of a single root. depressions which cover the major part of root.
♦♦ Root of maxillary permanent canine is longest of all teeth. ♦♦ Developmental depression over the distal surface is
♦♦ Shape of the root is conical. It is narrow mesiodistally and deeper as compared to developmental depression on
is wider labiolingually. mesial surface.
♦♦ Root of permanent maxillary canine has lingual convergence. ♦♦ At apical third of root distal curvature is present.
♦♦ Labial and lingual surfaces of root are smoothly convex. ♦♦ Root apex is usually blunt.
 Dental Anatomy 579

Q.2. Compare and contrast permanent maxillary canine with permanent mandibular canine. (Apr 2010, 15 Marks)
Or
Compare and contrast morphology of permanent maxillary and mandibular canine teeth. (Feb 2006, 15 Marks)

Ans.

Features Permanent maxillary canine Permanent mandibular canine

Chronology
Eruption Erupts at age of 11–12 years Erupts at age of 9–10 years
Root completion It occurs at age of 13–15 years It occurs at age of 12–14 years
Tooth nomenclature
Universal system Right side 6; left side 11 Right side 27; left side 22
Zsigmondy palmer system Right 3 ; Left 3 Right 3 ; Left 3
FDI system Right side 13; left side 23 Right side 43; left side 33
General features
Lobes Development is from 4 lobes. Development of middle Development is from 4 lobes. Development of middle
lobe is excellent over labial ridge. lobe is poor over labial ridge.
Size It is longest tooth of all the teeth and root is also It is second longest tooth of all the teeth and root is
longest. shorter by 1 mm.
Crown
Labial aspect

Mesiodistal width Mesiodistally crown is broad and short Mesiodistally crown is long and narrow
Labial surface More convex Convex
Cusp Well-developed, sharp Not so well developed
Cuspal ridges Mesial cuspal ridge is concave while distal is straight Both cuspal ridges are straight
Labial ridge Prominent Less prominent.
Outline of crown Mesial outline is convex Mesial outline is straight
Mesioincisal angle Less pronounced More pronounced
Tilt of crown It is upright over root base Crown is tilted distally over root base
Contact areas
Mesial contact At junction of incisal and middle 1/3rd It is just nearer to mesioincisal angle
Distal contact At center of middle 1/3rd At junction of incisal and middle 1/3rd

Contd…
580 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd…

Features Permanent maxillary canine Permanent mandibular canine

Lingual aspect

Lingual surface Irregular Smooth

Cingulum Well developed and is large Poorly developed and is smooth
Marginal ridges Well and strongly developed Less distinct and are thin
Lingual fossa It is more concave It is shallow and is smooth
Lingual ridge More prominent Less prominent
Mesial aspect

Crown bulk Labiolingually crown is bulky Labiolingually crown is less bulky

Labial outline More convex Less convex
Lingual outline Convexity is more near to cingulum concavity is more It shows lesser degree curvatures.
near lingual fossa.
Position of cuspal tip It lies labial to vertical root axis. It is lingually placed to vertical root axis
Incisal Edge Lingually sloped Labially sloped
Distal aspect
Cervical line Curvature is less Curvature is less
Crown bulk Labiolingually crown is bulky Labiolingually crown is less bulky
Labial outline More convex Less convex
Lingual outline Convexity is more near to cingulum concavity is more It shows lesser degree curvatures.
near lingual fossa.
Position of cuspal tip It lies labial to vertical root axis. It is lingually placed to vertical root axis
Incisal Edge Lingually sloped Labially sloped
Contd…
 Dental Anatomy 581

Contd…

Features Permanent maxillary canine Permanent mandibular canine

Distal aspect
Cervical line Curvature is less Curvature is less
Crown bulk Labiolingually crown is bulky Labiolingually crown is less bulky
Labial outline More convex Less convex
Lingual outline Convexity is more near to cingulum concavity is more It shows lesser degree curvatures.
near lingual fossa.
Position of cuspal tip It lies labial to vertical root axis. It is lingually placed to vertical root axis
Incisal Edge Lingually sloped Labially sloped
Distal aspect
Cervical line Curvature is less Curvature is less
Incisal Aspect

Dimension Crown is more bulkier labiolingually Crown is less bulkier labiolingually

Symmetry of crown Asymmetrical Symmetrical
Cuspal Tip Labiolingually it is labial to centre of crown and It lies in center or is lingually placed.
mesiodistally it is mesial to center.
Cuspal Ridges More prominent Less prominent
Root
Number Single root Single root but may be bifurcated.
Size Root is longest Root is 1–2 mm shorter when compared to maxillary
canine.
Apical curvature Apical 3rd shows distal curvature Apical 3rd sometimes shows mesial curvature
Developmental grooves Lies on both mesial and distal surfaces but is more Lies on both mesial and distal surfaces but is more
deeper over distal surface deeper over mesial surface

Q.3. Describe the morphology of permanent maxillary Or

canine and compare same with mandibular canine.  Describe the morphology of permanent mandi­bular
 (Feb/Mar 2004, 15 Marks) canine.  (Nov 2009, 10 Marks) (Aug 2011, 10 Marks)
Ans. For morphology of permanent maxillary canine refer to Ans. Following is the morphology of permanent mandibular
Ans 1 of same chapter.
canine:
For comparison of permanent maxillary canine with
permanent mandibular canine refer to Ans 2 of same Morphology of Crown
chapter.
Labial Aspect
Q.4. Describe in detail with help of diagram morphology
of permanent mandibular canine.  ♦♦ Geometric shape of permanent mandibular canine from
 (Sep 2005, 15 Marks) (Mar 2009, 15 Marks) labial aspect is trapezoidal or pentagonal.
582 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ Crown of mandibular canine appears longer as compared ♦♦ Cuspal tip is in line along with vertical root axis. Both the cusp
to maxillary canine. This is because the mesiodistal width ridges are straight. Mesial cusp ridge is shorter than distal.
of mandibular canine is narrow and contact areas are ♦♦ Cervical line, labially has semicircular curvature apically.
placed more incisally.
♦♦ Well defined mesioincisal and distoincisal angles are Lingual Aspect
present. ♦♦ Geometric shape is trapezoidal.
♦♦ Labial ridge extending from cervical area to the cusp tip ♦♦ Lingual surface is narrower as compared to labial surface
is less prominent. as the crown tapers lingually.
♦♦ Crown of permanent mandibular canine is tilted distally ♦♦ Lingual surface has less concavity and it is flattened.
over the base of root. This is due to the straight mesial ♦♦ Lingual fossa of permanent mandibular canine is shallow.
surface and curved distal surface. ♦♦ Lingual ridge is seen. Two small fossae are present, i.e.
♦♦ From labial aspect tooth appears like a lateral incisor if mesial and distal lingual fossae.
cusp tip is deteriorated. ♦♦ Lingual ridge is also less well-developed.
♦♦ Cingulum is poorly developed.
♦♦ Marginal ridges appear to be less prominent.

Fig. 49:  Mandibular canine-labial aspect

♦♦ From labial aspect, the mesial outline is straight. Mesial Fig. 50:  Mandibular canine-lingual aspect
outline is in line with the mesial outline of root, it joins the
Mesial Aspect
mesial cusp. Mesial contact area lies at incisal third near
to the mesioincisal angle. ♦♦ Geometric shape of mandibular permanent canine is
♦♦ From labial aspect, the distal outline is less convex. Distal triangular. Base of triangle lies at cervix while the apex
contact area is located more incisally. lies at cusp tip.

Fig. 51:  Mandibular canine-mesial aspect

 Dental Anatomy 583

♦♦ Cusp tip lies in the center or lingual to the straight root axis. ♦♦ Cingulum is smaller when compared to maxillary canine.
♦♦ From mesial aspect, labial outline appears to be less convex ♦♦ Cuspal tip and cuspal ridges has lingual inclination while
near to the cervical line. cuspal ridges of maxillary canine extend straight for bisect-
♦♦ From mesial aspect, lingual outline has a less convex ing mesial and distal contact areas.
cingulum as well as less concave lingual fossa.
♦♦ From incisal aspect the cusp tip appears to be thin and Morphology of Root
pointed. Cuspal ridge appears to be thin labiolingually ♦♦ Single root is commonly present but at times root
♦♦ Cervical line has more curvature incisally when compared bifurcation is seen.
to maxillary canine. ♦♦ It is shorter in size by l to 2 mm.
♦♦ Root is conical in shape. It is wider labiolingually and
Distal Aspect
thinner mesiodistally.
♦♦ Geometric shape of the crown is triangular or wedge ♦♦ Developmental depression is present on both mesial and
shaped. distal surfaces. Impression of developmental depression
♦♦ Curvature of cervical line is less over distal aspect. is more deeper on mesial surface of the root.
♦♦ Distal aspect is very much similar to mesial aspect. ♦♦ Root tip of mandibular canine is more pointed.
♦♦ Distal contact area is more cervically located than mesial ♦♦ Root is mostly straight and at times it may show mesial
contact area and lies at junction of incisal and middle third. curvature at apical third.
Q.5. Write four differences between deciduous and per-
manent maxillary canines. Describe its labial, lingual,
mesial, distal and incisal aspect in detail with diagram.
 (Apr 2017, 2 + 6 + 2 Marks)
Ans. Four differences between deciduous and permanent
maxillary canine.

Deciduous maxillary canine Permanent maxillary canine

Crown of deciduous maxillary
canine is wider mesiodistally in
comparison to their crown height
Deciduous maxillary canine is
more conical in shape
Cusp tip of deciduous maxillary
Fig. 52:  Mandibular canine-distal aspect canine is more pointed and sharp
Crown of permanent maxillary
canine is long as their
cervicoincisal height is greater
than mesiodistal width
Permanent maxillary canine is
less conical in shape
Cusp tip of permanent maxillary
canine is less pointed

Incisal Aspect Deciduous maxillary canine Deciduous maxillary canine is

is more constricted at cervical not so constricted at cervical
♦♦ Geometric shape of crown from incisal aspect is oval. portion of the crown portion of the crown
♦♦ Mesial outline of tooth is less curved as compared to
maxillary canine. For description of labial, lingual, mesial, distal and incisal
aspect of permanent maxillary canine with diagram refer to Ans
1 of same chapter.
Q.6. Describe labial, mesial, distal, lingual and incisal
aspect of permanent maxillary canine. Write about its
side identification. (Jan 2018, 8 + 2 marks)
Ans. For labial, mesial, distal, lingual and incisal aspect of
permanent maxillary canine along with diagrams refer
to Ans 1 of same chapter.

Side Identification of Permanent Maxillary Canine

♦♦ There is more faciolingual bulk present in mesial half.
♦♦ Distal cusp slope is longer than mesial cusp slope.
♦♦ Distal surface is more convex than mesial surface.
♦♦ Root apex often shows curvature.
♦♦ Developmental depression of root is deeper on distal
Fig. 53:  Mandibular canine-incisal aspect surface.
584 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ Height of contour of distal outline, i.e. distal contact area

9. THE MAXILLARY AND is broader and is slightly occlusally placed as compared
MANDIBULAR PREMOLARS to mesial contact area.
♦♦ From this aspect the occlusal outline is formed by the
Q.1. Describe morphology of permanent maxillary first cuspal tip as well as cuspal slopes of buccal cusp.
premolar. (Feb/Mar 2004, 15 Marks) ♦♦ Mesial cuspal slope is straight or sometimes concave
 (Sep 2007, 8 Marks) (Nov 2009, 10 Marks) whereas distal cuspal slope is more rounded.
♦♦ Mesial cuspal slope is longer than the distal cuspal slope.
Or ♦♦ Curvature of cervical line is slightly towards the root apex.
Describe and draw morphology of maxillary first
premolar.  (Sep 2002, 15 Marks) (Sep 2009, 15 Marks) Lingual Aspect

Or ♦♦ Geometric shape of crown is trapezoidal.

♦♦ Because of convergence of proximal walls towards smaller
Discuss with the help of diagram the morphology of
lingual cusp the lingual surface is narrower than buccal
maxillary first premolar.  (Sep 2005, 15 Marks)
surface.
Or ♦♦ Lingual aspect is smooth as well as more convex.
Describe the morphology of maxillary first premolar. ♦♦ Sometimes lingual ridge can be seen on lingual cusp.
♦♦ From lingual aspect the mesial, distal and cervical outlines
(Aug 2012, 10 Marks)
are same as in description of buccal aspect.
Ans. Following is the morphology of permanent maxillary
♦♦ Lingual cusp tip is pointed with mesial and distal cuspal
first premolar:
slopes meeting at right angles.
Morphology of Crown ♦♦ From lingual aspect buccal cusp tip along with its cusp
slopes is visible.
Buccal Aspect
♦♦ Geometric shape of crown is trapezoidal from buccal aspect.
♦♦ Middle lobe is strongly developed in permanent maxillary
first premolar.
♦♦ Continuous ridge from cusp tip to cervix on buccal surface
is known as ‘buccal ridge’.
♦♦ Buccal surface is convex. It also consists of the developmental
depressions on either side and buccal ridge demarcates
three lobes.
♦♦ From buccal aspect the mesial outline is slightly concave
near to cervical line and it becomes convex as it connects
the mesial cuspal slope.
♦♦ Height of contour of mesial outline, i.e. mesial contact area
lies occlusal to center of crown cervico-occlusally.
♦♦ From buccal aspect the distal outline is straight and joins
the distal cuspal slope.
Fig. 55:  Maxillary first premolar-lingual aspect

Mesial Aspect
♦♦ Geometric shape of crown is trapezoidal.
♦♦ Mesial surface of crown display both cusps. The cuspal
tips are within the confines of root trunk.
♦♦ Lingual cusp is smaller than buccal cusp by l mm or more.
♦♦ There is presence of concavity in center of the mesial
surface which is cervical to the contact area and is known
as mesial developmental depression. Mesial developmental
depression extends apically and crosses the cervical line and
meets the developmental depression between the two roots.
♦♦ Deep developmental groove which crosses mesial marginal
ridge is known as mesial marginal developmental groove.
♦♦ Mesial marginal groove extends from occlusal surface,
crosses marginal ridge and end at the mesial surface after
Fig. 54:  Maxillary first premolar-buccal aspect running a short distance.
 Dental Anatomy 585

Fig. 56:  Maxillary first premolar-mesial aspect

♦♦ Mesial contact area lies occlusal to the center of crown Occlusal Aspect
cervico-occlusally.
♦♦ Geometric shape of tooth from occlusal aspect is hexagonal.
♦♦ From mesial aspect the buccal outline is convex near
♦♦ The maxillary first premolar tooth is divided into six sides
cervical line and is straight as it reaches at buccal cusp tip.
as its geometric shape is hexagonal. The six sides are
♦♦ From mesial aspect the lingual outline is more convex from
Mesiobuccal, Mesial, Mesiolingual, Distolingual, Distal,
cervical line to tip of lingual cusp. Mesial contact area lies
Distobuccal.
at the center of middle third.
♦♦ Mesiobuccal aspect is slightly shorter as compared to
♦♦ Mesial marginal ridge forms the occlusal outline which is
distobuccal aspect.
slightly concave.
♦♦ Mesiolingual aspect is more shorter as compared to
♦♦ Triangular ridges of buccal and lingual cusp are also seen
distolingual aspect.
converging cervically toward the center of occlusal surface.
♦♦ From occlusal aspect the buccolingual dimensions are
♦♦ Crest of curvature of cervical line is slightly curved
occlusally. greater than mesiodistal dimensions.
♦♦ Two well developed cusps are present, i.e. buccal cusp
Distal Aspect and lingual cusp.
♦♦ Geometric shape is trapezoidal. ♦♦ Buccal cusp is located slightly distal to the midline while
♦♦ Distal surface is convex. the lingual cusp tip is placed mesial to midline.
♦♦ Distal marginal ridge is smooth and does not consist of ♦♦ Mesial contact area is less buccally placed as compared to
any grooves. distal contact area.
♦♦ Distal contact area lies at the same level as mesial contact ♦♦ Buccal outline from occlusal aspect is convex.
area. ♦♦ Lingual outline is convex too but dimensions are lesser
♦♦ Distal contact area is more broader and more buccally than buccal aspect.
placed buccolingually as compared to mesial contact area. ♦♦ Mesial as well as distal outlines are straight. Mesial outline
is bordered by mesial marginal ridge while distal outline
♦♦ Cervical line is straight.
is bordered by distal marginal ridge.
Occlusal Aspect within its Boundaries
Within the boundaries, occlusal aspect consists of:
Cusps and Cuspal Ridges
Permanent maxillary first premolar has two well developed
cusps, i.e. buccal cusp and lingual cusp.
Buccal Cusp
♦♦ It is longer and well formed.
♦♦ Mesiobuccal and distobuccal cuspal ridges are seen which
are well defined and form a relatively straight line.
♦♦ A well-defined buccal triangular ridge is present which
extends from tip of buccal cusp lingually to the central
developmental groove.
♦♦ Inclined planes at buccal cusp lie on either side of the
triangular ridge which slopes towards the central groove.
Fig. 57:  Maxillary first premolar-distal aspect
586 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Fig. 50:  Maxillary first premolar-occlusal aspect
Lingual Cusp
♦♦ It is smaller and shorter as compared to the buccal cusp.
♦♦ Mesiolingual and distolingual cusp ridges are seen which
are more curved and form a semicircular outline which
merges with the marginal ridges.
♦♦ Lingual triangular ridge is less prominent and extends
from tip of lingual cusp to the central groove.
♦♦ Inclined planes are present over either side of triangular
ridge.
Grooves
Permanent maxillary first premolar consists of four major
grooves, i.e.
1. Central groove: It runs in a mesiodistal direction and
divides occlusal surface evenly. Central groove lies at
bottom of central sulcus.
2. Mesiobuccal and distobuccal grooves: Central groove
is joined by two small grooves near mesial and distal
marginal ridge buccally which are known as mesiobuccal
and distobuccal developmental grooves.
3. Mesial marginal developmental groove: It extends from
central groove mesially and crosses the mesial marginal
ridge to reach the mesial surface.
4. At times, few supplementary grooves are also seen.
Pits
Permanent maxillary first premolar consists of two pits, i.e.
1. Mesial pit: It is formed due to converging of central
developmental groove, mesiobuccal developmental groove
and mesial marginal developmental groove.
2. Distal pit: It is formed due to converging of central develop-
mental groove as well as distobuccal developmental groove.
Marginal Ridges
Permanent maxillary first premolar consists of two marginal
ridges, i.e.:
1. Mesial marginal ridge: Mesial marginal developmental
groove notches the mesial marginal ridge.
2. Distal marginal Ridge: It is smooth.
Fossae
Permanent maxillary first premolar consists of two fossae, i.e.
1. Mesial triangular fossa: It is a small triangular depression
near mesial marginal ridge.
2. Distal triangular fossa: It is a shallow triangular depression
near distal marginal ridge.
Morphology of Root
♦♦ Permanent maxillary first premolar has two roots, i.e.
buccal and lingual roots.
♦♦ Both the roots are of nearly same length.
♦♦ Bifurcated root has a root trunk, i.e. undivided part of
the root
♦♦ Mesiodistally root is narrower and convex while bucco-
lingually it is broader and flattened.
♦♦ Bifurcation point is near to half of its length and is close
to cervical line over mesial aspect.
♦♦ From bifurcation point, both roots diverge outwards and
later on its apical ends converges towards each other.
♦♦ Developmental depression and groove is prominent over
mesial aspect of root.
♦♦ If single root form is present, it shows deep developmental
grooves and consist of two pulp canals.
♦♦ Apex of buccal root is sharp while apex of lingual root
is blunt.
♦♦ Both roots may have distal curvature at their apical ends.
Q.2. Compare and contrast the morphology of maxillary first
premolar and second premolar.  (Oct 2008, 4 Marks)
Ans.
 Dental Anatomy 587

Features Maxillary first permanent premolar Maxillary second permanent premolar

Crown
Buccal aspect

Width of crown Narrow at cervix Thicker at cervix

Height of crown Crown is large and long Crown is small and short
Cuspal tip Has sharp angle between cuspal slopes, i.e. 105° and Cuspal angle is 125°. It is less pointed and is blunt.
is more pointed
Slopes of buccal cusp Mesial slope is longer as compared to distal slope Distal slope is longer as compared to buccal slope
Buccal Surface It is more convex It is less convex
Lingual aspect

Lingual cusp Short and narrow as compared to buccal cusp Lingual cusp is of same length and width as buccal cusp
Crown length Appear shorter from lingual aspect. Appear longer from lingual aspect
Lingual surface Less convex More convex
Lingual convergence Crown tapers more towards lingual aspect. Crown tapers less towards lingual aspect.
Mesial aspect

Contd…
588 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd…

Features Maxillary first permanent premolar Maxillary second permanent premolar

Cuspal height Lingual cusp is short by 1–2 mm Both the cusps are of same height.
Intercuspal width Less More
Cusp tip More sharp Less sharp
Height of contour bucally Lies at cervical third Lies at cervical third
Height of contour lingually Lies at middle third Lies at middle third
Developmental It is present at centre of mesial surface. Absent
depression
Developmental grooves Mesial marginal developmental groove extend from No developmental groove crosses mesial marginal ridge
central groove of occlusal surface crosses mesial
marginal ridge to reach the mesial surface of crown
Contact areas It is narrow on mesial surface rather than on distal surface Both contact area are broader. Contact with posterior
teeth on both sides.
Distal aspect
Cervical line Less curved Less curved
Distal contact area Broader as compared to mesial Both contact areas are broader
Occlusal aspect

Shape Outline is hexagonal Outline is oval

Line angle Well defined buccal line angles Less pronounced buccal line angles
Occlusal table Smaller buccolingually Wider buccolingually
Cuspal tip location Lingual cusp tip is positioned from center to mesial Both cuspal tips are centered mesiodistally.
Mesiod ista l widt h of Wider distally than mesially Equally wide mesially and distally
crown
Buccolingual width of Crown is wider buccally than lingually Crown is wider buccally and lingually
crown
Marginal ridges Mesial marginal ridge is short Both marginal ridges are equally wide
Central developmental Long Short
groove
Supplementary groove Few supplementary grooves are present. Multiple supplementary grooves are present.
Root
Number Two roots, i.e. buccal and lingual One root
Size Roots are short Roots are long
Root form Long root trunk with bifurcation at middle third of root Conical root tapers evenly from cervix to apex
Developmental groove More deeper on mesial surface More deeper on distal surface
and depression
Variation Root is bifurcated but can be single or laminated Root form is less variable
Root canal Two canals One canal
 Dental Anatomy 589

Q.3. Write a short note on occlusal aspect of maxillary first ♦♦ Mesial contact area lies occlusal to the center of the crown
premolar.  (Sept 2006, 5 Marks) and placed cervico-occlusally.
Or ♦♦ From buccal aspect the distal outline is concave nearby
cervix and it becomes convex as it connects with occlusal
Write a short note on occlusal surface of maxillary first outline.
premolar.  (Aug 2011, 5 Marks) ♦♦ Distal contact area is broad and lies cervico-occlusally.
Or ♦♦ From buccal aspect the occlusal outline is presented by
buccal cusp. Buccal cusp tip is sharp.
Write short note on morphology of occlusal surface of
♦♦ Both the cuspal ridges, i.e. mesiobuccal and distobuccal
maxillary first premolar.  (May 2017, 3 Marks)
cusp ridges are slightly concave.
Or ♦♦ Mesial cusp ridge is shorter than the distal cusp ridge.
Write about occlusal aspect of permanent maxillary ♦♦ Cervical line is curved apically.
first premolar. Draw well labelled diagram for it.
Lingual Aspect
 (Jan 2018, 3+2 Marks)
Ans. Refer to Ans l of the same chapter. ♦♦ Geometric shape is trapezoidal.
♦♦ From lingual aspect, there is presence of marked lingual
Q.4. Describe the permanent mandibular first premolar. convergence of crown which leads to narrow lingual
 (Apr 2007, 15 Marks) surface.
Or ♦♦ Lingual sloping of occlusal surface is present because of
Describe the morphology of mandibular first premolar shorter lingual cusp. Due to this inclined planes of buccal
cusp buccal, triangular ridge, marginal ridge and mesial
in detail.  (July 2016, 10 Marks)
and distal fossae are seen.
Ans. Following is the morphology of permanent mandibular
♦♦ Tip of lingual cusp is pointed. Lingual cusp is in line with
first premolar:
buccal triangular ridge.
Morphology of Crown ♦♦ A mesiolingual developmental groove is present which
extend from mesial developmental groove of occlusal
Buccal Aspect surface to the lingual surface mesially.
♦♦ Geometric shape of tooth from buccal aspect is trapezoidal. ♦♦ Mesial, distal and cervical outline are same as seen in
♦♦ Crown of permanent mandibular first premolar seems to buccal aspect.
be broader with narrow cervix. ♦♦ From lingual aspect, the occlusal outline is formed by the
♦♦ Buccal aspect of tooth is convex. cusp tip of lingual cusp as well as cusp ridges of lingual cusp.
♦♦ Well developed middle buccal lobe is present. It is ♦♦ Notching of occlusal outline is seen by a groove which
passes in between mesial marginal ridge and mesiolingual
presented as a long buccal cusp and prominent buccal
cusp ridge.
ridge.

Fig. 60:  Mandibular 1st premolar-lingual aspect

Fig. 59:  Mandibular 1st premolar-buccal aspect Mesial Aspect

♦♦ Cusp tip of buccal cusp is pointed. Cusp tip is placed ♦♦ Geometric shape of crown is rhomboidal.
slightly mesial at center of the crown. ♦♦ Mesial surface is smooth and convex except a concavity
♦♦ From buccal aspect the mesial outline is convex. At cervical is present just above the cervical line which is known as
line the outline is slightly concave. mesiolingual developmental groove.
590 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ Buccal cusp tip is in line with straight root axis while the ♦♦ Buccal and lingual outlines are same as that of mesial aspect.
lingual cusp tip is in line with lingual outline of root. ♦♦ Occlusally, distal marginal ridge lies perpendicular to
♦♦ Sloping of mesial marginal ridge is present in lingual long axis of tooth.
direction. ♦♦ Distal marginal ridge is at higher level as compared to
♦♦ Mesial contact area lies occlusally in center of crown, and mesial marginal ridge.
lies in line with buccal cusp tip. ♦♦ Cervical line is nearly straight.
♦♦ Buccal outline from mesial aspect is convex from cervical
area to buccal cusp tip. Occlusal Aspect
♦♦ Lingual outline from mesial aspect is convex. ♦♦ Geometric shape is of diamond shape or circular.
♦♦ Buccally the height of contour lies at cervical third while ♦♦ Buccal outline is convex and bordered by mesial and distal
lingually the height of contour lies at middle third of crown.
slopes of buccal cusp.
♦♦ Occlusal outline from mesial aspect is concave.
♦♦ Mesial marginal ridge shows sloping in lingual direction. ♦♦ Lingual outline is convex with mesial and distal marginal
♦♦ Cervical line shows a slight curvature in occlusal direction. ridges converging towards lingual cusp.
Occlusal Aspect within its Boundaries

Fig. 61:  Mandibular 1st premolar-mesial aspect Fig. 63:  Mandibular 1st premolar-occlusal aspect

Distal Aspect Cusp and Cusp Ridges

♦♦ Geometric shape is rhomboidal. ♦♦ Permanent mandibular first premolar has two cusps, i.e.
♦♦ Distal surface is smooth but a small concavity is present buccal and lingual cusps.
just above the cervix. ♦♦ Buccal cusp is larger than lingual cusp. Buccal cusp
♦♦ Distal contact area is at the same level as mesial contact converges sharply towards lingual surface.
area. Distal contact area is broader than mesial contact area. ♦♦ Mesiobuccal and distobuccal cusp ridges are prominent as
compared to mesiolingual and distolingual cusp ridges.
♦♦ Buccal triangular ridge is long and well developed
whereas the lingual triangular ridge is shorter than buccal
triangular ridge.
Fossae
♦♦ Mandibular first premolar consists of two fossae, i.e. mesial
and distal fossa.
♦♦ Mesial fossa is small as well as straight. Shape of fossa is
linear and it extends buccolingually.
♦♦ Distal fossa is larger as compared to mesial fossa. Shape
of fossa is crescent.
Grooves
Following are the grooves:
1. Mesial developmental groove is situated in the mesial
Fig. 62:  Mandibular 1st Premolar-Distal Aspect fossa. It is short and extends buccolingually.
 Dental Anatomy 591

2. Distal developmental groove is situated in distal fossa. It ♦♦ From buccal aspect, distal outline is convex from cervical
is longer. area to contact area.
3. Mesiolingual developmental groove: It is a prominent
developmental groove. It extends between mesial mar-
ginal ridge and mesiolingual cusp ridge over the lingual
surface mesially.
Pit
Mesial and distal pits are present in mesial and distal fossa.

Marginal Ridges
♦♦ Mesial marginal ridge is short as compared to distal
marginal ridge. It is constricted and slopes sharply
lingually in cervical direction.
♦♦ Distal marginal ridge is prominent than mesial marginal
ridge.

Morphology of Root
Fig. 64:  Mandibular 2nd premolar-buccal aspect
♦♦ Mandibular premolar has a single root.
♦♦ Root is conical in shape and it tapers evenly from cervical ♦♦ Distal contact area lies at middle third of crown.
area to apex. ♦♦ From buccal aspect crown is short and bulky.
♦♦ Root is wider buccolingually in dimensions as compared ♦♦ Buccal surface is convex and smooth too.
mesiodistally. ♦♦ Buccal ridge is prominent and extends from cervical line
♦♦ Buccal and lingual surfaces of root are convex. Mesial and to cusp of buccal tip.
distal surfaces are flat. ♦♦ Tip of buccal cusp is blunt.
♦♦ Towards lingual surface root tapers acutely. ♦♦ Cervical line has slight apical curvature.
♦♦ Developmental depression is present on both mesial and
distal roots. Developmental depression on the mesial Lingual Aspect
surface is deeper than on the distal surface. ♦♦ Geometric shape of tooth from lingual aspect is trapezoidal.
♦♦ Apex of root is pointed. ♦♦ From lingual aspect crown appears bulky.
♦♦ Distal curvature is seen over apical third of root. ♦♦ Little bit of proximal surfaces are visible from this aspect.
Q.5. Write about occlusal aspect of permanent mandibular ♦♦ Small portion of buccal cusp is visible from this aspect.
first premolar.  (Nov 2008, 4 Marks)
Ans. Refer to Ans 4 of the same chapter.
Q.6. Describe in brief the morphological characteristics of
mandibular second premolar.  (Jan 2012, 10 Marks)
Or
Describe the morphology of maxillary second premolar
in detail.  (Aug, 2011, 15 Marks)
Or
Describe the morphology of mandibular second
premolar in detail with schematic presentation of its
occlusal anatomy. (Aug 2018, 10 Marks)
Ans. Following is the morphology of permanent mandibular
second premolar:

Morphology of Crown
Fig. 65:  Mandibular 2nd premolar-lingual aspect
Buccal Aspect
♦♦ From lingual aspect the occlusal outline is formed by
♦♦ Geometric shape of tooth from buccal aspect is trapezoidal. lingual cusp and cuspal ridges of lingual cusp.
♦♦ From buccal aspect, the mesial outline is convex from ♦♦ Mandibular premolar show variation as it presents two
cervical line to mesial contact area. types of cusp patterns i.e three cusp pattern and two cusp
♦♦ Mesial contact area lies at middle third of crown. pattern.
592 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Three cusp pattern has mesiolingual and distolingual
cusp including buccal cusp. Mesiolingual cusp is broader
than distolingual cusp. Two lingual cusps are divided by
lingual groove.
♦♦ Two cusp pattern has one lingual cusp which is more
prominent than mandibular first premolar.
Mesial Aspect
♦♦ Geometric shape of crown is rhomboidal.
♦♦ From mesial aspect the buccal outline is convex and the
crest of curvature is present at the middle third.
♦♦ From mesial aspect the buccal outline is less convex.
♦♦ At mesial surface slight inclination is present over the
base of root.
♦♦ Buccal cusp is blunt and lies buccally to vertical root axis.
♦♦ Mesial surface is smooth and convex.
♦♦ Mesial contact area lies at the junction of middle and
occlusal third.
♦♦ From mesial aspect the occlusal outline is concave.
Fig. 66:  Mandibular 2nd premolar-mesial aspect
Fig. 67:  Mandibular 2nd premolar-distal aspect
Distal Aspect
♦♦ Geometric shape from this aspect is rhomboidal.
♦♦ Distal surface is smooth and convex.
♦♦ From distal aspect, the mesial marginal ridge lies at higher
level as compared to distal marginal ridge.
♦♦ Distal contact area lies at the junction of middle and
occlusal third.
Occlusal Aspect
Occlusal aspect has variation in permanent mandibular second
premolar. Tooth has two cusp pattern, i.e.
Three Cusp Pattern or Y Groove Pattern
Geometric shape of crown is of square shaped.
Cusp and Cuspal Ridges
♦♦ Buccal cusp is the largest among the three cusps, then
mesiolingual cusp and distolingual cusp.
♦♦ Well developed lingual lobes are present.
♦♦ Each cusp shows well developed mesial and distal cusp
ridges. A triangular ridge is also seen which is sloping from
tip of cusp to the center of occlusal surface.
Fig. 68:  Mandibular 2nd premolar-occlusal aspect (Y-pattern)
Grooves
♦♦ Three developmental grooves are present which converges
at central pit and form a ’Y’ shaped pattern.
♦♦ Few supplementary grooves are present.
♦♦ Mesial developmental groove is long. It extends from
central pit mesiobuccally to the mesial triangular fossa.
♦♦ Distal developmental groove is a short. It extends from
central pit to the distal triangular fossa.
♦♦ Lingual developmental groove is centered over root. It
extends in a lingual direction between two lingual cusps
and ends on the lingual surface of the crown.
Pits
♦♦ Mesial pit is present in mesial triangular fossa.
♦♦ Distal pit is present in distal triangular fossa.
♦♦ Central pit is present in centre of occlusal surface.
 Dental Anatomy 593

Marginal Ridges ♦♦ Central developmental groove runs mesiodistally at

occlusal surface and ends mesially in mesial fossa and
Mesial and distal marginal ridges are present which are strongly
developed. distally in distal fossa.
♦♦ Mesiolingual and distolingual groove start from mesial
Fossae and distal pit and run in lingual direction. This is seen in
H type of pattern.
Mesial and distal triangular fossae are present.
Two Cusp Pattern Or U/H Groove Pattern: Pits
Geometric shape of crown is circular. ♦♦ Central pit is absent.
Cusp and Cusp Ridges ♦♦ Mesial pit is present in mesial triangular fossa
♦♦ Distal pit is present in distal triangular fossa
♦♦ Buccal and lingual cusps are present.
♦♦ Both cusps are well developed but buccal cusp is slightly Marginal Ridges
larger than lingual cusp.
♦♦ Both cusps have well developed mesial and distal cusp Mesial and distal marginal ridges are present which are strongly
ridges. developed.
♦♦ Triangular ridges are also present which converge occlusally.
Fossae
Both the fossae near marginal ridges are not triangular as in
three cusp pattern but are irregular in shape. The fossae are
known as mesial occlusal fossa and distal occlusal fossa.

Fig. 69:  U pattern
Grooves
♦♦ Central developmental groove is present which give rise to
two patterns, i.e. when U pattern is present central groove
is crescent shaped and when H pattern is present central
groove is straight connecting mesial and distal fossa.
Morphology of Root
♦♦ Broad and strong root is present which is longer than
mandibular first premolar tooth.
♦♦ Root is conical in shape and is single.
♦♦ Root is wider mesiodistally when compared buccolin-
gually.
♦♦ Buccal and lingual surface of root are convex while mesial
and distal surfaces are flat.
♦♦ Root apex is blunt.
♦♦ Root can be straight or it can show distal curvature too.
Q.7. Write in brief occlusal aspect of permanent mandibular
second premolar.  (Apr 2008, 7.5 Marks)
Ans. Refer to Ans 6 of same chapter.
Q.8. Describe the morphology of permanent maxillary first
premolar. Write arch traits of maxillary first premolar.
 (Feb 2013, 10 Marks)
Ans. For morphology of maxillary permanent first premolar
refer to Ans 1 of same chapter.
For arch traits of maxillary first premolar refer to the
table given in Ans 9 of same chapter.
Q.9. Describe the morphology of permanent mandibular
first premolar. Write arch traits of mandibular first
premolar.  (Feb 2013, 10 Marks)
Ans. For mandibular permanent first premolar refer to Ans 4
of same chapter.
For arch traits of mandibular first premolar refer to the
table.

Fig. 70:  H pattern

594 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Arch Traits of Mandibular Permanent First Premolar

Features Maxillary first permanent premolar Mandibular first permanent premolar

Tooth nomenclature
Universal system Right 4,5; left 12, 13 Right 28, 29; Left 20, 21
Zsigmondy/palmer system Right Left
FDI system Right 14,15; left 24, 25 Right 44, 45; left 34, 35
General features
Eruption Erupt before permanent maxillary canine Erupt after permanent mandibular canine
Lobes 4 lobes 4 lobes
Cusps Two cusps Two cusps
Roots Two roots One root
Size of cusp Both cusps are equal in size Lingual cusp is shorter and is non-functional
Crown
Buccal aspect
Buccal cusp tip Mesial and distal cuspal ridges at cusp tip meet Mesial and distal cuspal ridges at cusp tip meet at more
at sharp angle obtuse angle
Buccal ridge More prominent Less prominent
Buccal cusp slope Mesial cuspal slope is longer Distal cuspal slope is longer
Lingual aspect
Lingual convergence Marked lingual convergence is present Lingual convergence is slightly present
Mesial and distal aspect
Geometric form It is trapezoidal It is rhomboidal
Inclination of crown Crown is nearly upright on root base Crown show marked lingual inclination on root base
Cusp height Both cusps are of equal height Lingual cusp is small and short
Spacing of cusp tip Buccal and lingual cusps have wide spacing Buccal and lingual cusp are nearer

Q.10. Define and enumerate different type of traits. Describe
morphology of maxillary first premolar, including its
endodontic anatomy.  (Feb 2014, 8 Marks)
Ans. Following are the different types of traits:
1. Set trait.
2. Arch trait.
3. Class trait.
4. Type trait.
Set trait: These traits are the features that differentiate teeth in
primary dentition from the teeth in permanent dentition, e.g.
primary teeth are white in color while permanent teeth are
yellowish white in colour.
Arch trait: These traits are those which differentiate maxillary
teeth from mandibular teeth, e.g. maxillary first molar consists
of cusp of Carabelli while it is absent in mandibular first molar.
Class trait: These traits are those which differentiate four
categories of teeth, i.e. incisors, canine, molars and premolars,
e.g. incisors are used for cutting, canines for piercing, premolars
for grinding and molars for crushing.
Type trait: These traits differentiate teeth within one class,
i.e. differentiation of incisors but between maxillary central or
lateral incisors, e.g. mesiodistal width of maxillary permanent
central incisor is wider while the width of maxillary permanent
lateral incisor is narrow.
For morphology of maxillary first premolar refer to Ans 1 of
same chapter.
For endodontic anatomy of maxillary first premolar refer to
Ans 2 of chapter PULP MORPHOLOGY.
Q.11. Write short note on arch traits of mandibular premolars.
 (Dec 2014, 3 Marks)
Ans. Refer to Ans 9 of same chapter.
Q.12. Define traits. Describe the different types of traits. Give
a detail account of right mandibular second premolar
occlusal anatomy. (Oct 2016, 10 Marks)
Ans. A trait is a distinguishing characteristic, quality or attribute.
Different Types of Trait
Following are the different types of trait:
1. Set traits
2. Arch traits
3. Class traits
4. Type traits.
♦♦ Set trait: These traits are the features that differentiate teeth
in primary dentition from the teeth in permanent dentition.

e.g. primary teeth are white in color while permanent teeth
are yellowish white in color.
♦♦ Arch trait: These traits are those which differentiate max-
illary teeth from mandibular teeth, e.g. is maxillary first Ans. Introduction
molar consists of cusp of Carabelli while it is absent in
mandibular first molar.
♦♦ Class trait: These traits are those which differentiate four
categories of teeth, i.e. incisors, canine, molars and premo-
lars, e.g. incisors are used for cutting, canines for piercing,
premolars for grinding and molars for crushing.
♦♦ Type trait: These traits differentiate teeth within one class,
i.e. differentiation of incisors but between maxillary cen-
tral or lateral incisors, e.g. mesiodistal width of maxillary
permanent central incisor is wider while the width of Morphology of Crown
maxillary permanent lateral incisor is narrow. Buccal Aspect
For detail account of right mandibular second premolar
♦♦
occlusal anatomy refer to Ans 6 of same chapter. For
♦♦
diagram of occlusal anatomy of right mandibular second
premolar refer to figure 68 of Ans 6 of same chapter.
Q.13. Write differences between maxillary first premolar and ♦♦
mandibular first premolar tooth. (Feb 2016, 3 Marks)
♦♦
Or
Write the differences between maxillary and ♦♦
mandibular permanent first premolar. ♦♦
 (Sep 2018, 5 Marks)
Ans. For differences between maxillary first premolar and
mandibular first premolar tooth refer to Ans 9 of same
chapter.
10. THE MAXILLARY AND
MANDIBULAR MOLARS
Q.1. Describe morphology of permanent maxillary first
molar. (Sep 2003, 15 Marks) (Feb 1999, 15 Marks)
 (Mar 1998, 15 Marks) (Sep 2000, 15 Marks)
 (Oct 2006, 15 Marks) (Dec 2010, 10 Marks)
 (May/June 2009, 15 Marks)
Or
Describe with diagram the morphology of permanent
right first molar. (Oct 2007, 15 Marks)
 (Apr 2008, 15 Marks)
 (Apr 2010, 15 Marks)
♦♦
Or
Describe in detail with appropriate diagrams morphol- ♦♦
ogy of maxillary permanent first molar.
 (Apr 2015, 8 Marks) ♦♦
Or
♦♦
Discuss morphology of permanent maxillary first
molar. (Sept 2017, 10 Marks) ♦♦
Or
Dental Anatomy 595
Describe the morphology of buccal, lingual, mesial,
distal and occlusal aspect of permanent maxillary first
molor. (Jan 2018, 2 + 2 + 2 + 2 + 2 Marks)
• Maxillary first molar is normally the largest tooth
in maxillary area.
• It has four well developed functional cups and one
supplemental cusp called as cusp of carabelli.
• C rown of the tooth is wider buccolingually than
mesiodistally.
Following is the morphology of permanent maxillary
first molar:
Geometric shape of maxillary first molar is trapezoidal.
From buccal aspect, mesial outline is mostly straight except
that it become slight convex when it is connecting with
occlusal outline.
Mesial contact area lies at the junction of occlusal and
middle third of crown.
From buccal aspect, distal outline is convex from occlusal
surface to cervix.
Distal contact area lies in middle third.
From buccal aspect, occlusal outline is bounded by
mesiobuccal and distobuccal cusps as well as their slopes.
Fig. 71:  Maxillary 1st molar-buccal aspect
Slopes of mesiobuccal cusp meet at an obtuse angle while
slopes of distobuccal cusp meets at right angle.
Cervical line is irregular and it shows slight apical
curvature.
Buccal surface is convex in cervical and occlusal third
region and is slight concave in middle third.
Mesiobuccal cusp is wider while the distobuccal cusp is
pointed.
Buccal groove separates the buccal cusp and extends from
cervix to the buccal pit.
596 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Lingual Aspect ♦♦ Height of contour at buccal outline lies at cervical third.

♦♦ Geometric shape of crown is trapezoidal. ♦♦ From mesial aspect the lingual outline is convex.
♦♦ From lingual aspect mesial outline of crown is straight ♦♦ Height of contour at lingual outline lies at middle third.
while the distal outline is semicircular. ♦♦ Cusp of Carabelli makes outline more prominent.
♦♦ From lingual aspect two cusps are visible, i.e. mesiolingual ♦♦ Occlusal outline shows mesial aspect of mesiobuccal and
and distolingual cusp. mesiolingual cusp along with cusp of carabelli.
♦♦ Mesiolingual cusp is larger while distolingual cusp is ♦♦ Mesial contact area lies at junction of occlusal and middle
small and rounded. third of crown.
♦♦ Lingual developmental groove separates two lingual cusps ♦♦ From mesial aspect mesiobuccal, mesiolingual and fifth
and extend from occlusal aspect to lingual surface. cusps are visible.
♦♦ Tip of mesiolingual cusp is in line with long axis of lingual root.
♦♦ On mesial surface,s a shallow concavity is present cervical
to contact area and extends to cervical part of root trunk.
♦♦ Crest of curvature of cervical line is approximately 1 mm
towards the occlusal surface.
Distal Aspect
♦♦ Geometric shape of crown is trapezoidal.
♦♦ From distal aspect some part of buccal portion can be seen
because of slanting of crown distally.
♦♦ From distal aspect, lingual outline is smooth and convex.
♦♦ Distal marginal ridge is shorter than mesial marginal ridge.
♦♦ From distal aspect, distobuccal and distolingual cusps
are seen.
♦♦ Distal surface is smooth and convex but at cervical line a
concave area is present.
♦♦ Distal contact area lies at middle third of crown.
Fig. 72:  Maxillary 1st molar-lingual aspect ♦♦ Cervical outline is mostly straight.
♦♦ Cusp of Carabelli or the fifth cusp is present over
mesiolingual cusp.
♦♦ Fifth cusp is separated from mesiolingual cusp by groove.
♦♦ Cervical outline is almost straight.

Mesial Aspect
♦♦ Geometric shape of crown is trapezoidal.
♦♦ From mesial aspect the buccal outline is convex from cusp
tip to the cervix.

Fig. 74:  Maxillary 1st molar-distal aspect

Occlusal Aspect
♦♦ Geometric shape of tooth is rhomboidal.
♦♦ Buccolingual dimensions of crown are larger as compared
to mesiolingual dimensions.
♦♦ Taper of crown is more towards distal side.
♦♦ From occlusal aspect, buccal outline is convex.
♦♦ Lingual outline is more convex and rounded.
♦♦ Mesial outline is straight and longer.
Fig. 73:  Maxillary 1st molar-mesial aspect
♦♦ Distal outline is slightly convex.

Fig. 75:  Right maxillary 1st molar-occlusal aspect
Occlusal Surface within the Boundaries
Cusp and Cusp Ridges
♦♦ Tooth has four major cusps and a fifth cusp which is known
as cusp of carabelli.
♦♦ Mesiolingual cusp is the largest cusp, mesiobuccal is
second largest, distobuccal is third largest and distolingual
cusp is the smallest cusp.
♦♦ All the cusps has mesial and distal cuspal ridges.
♦♦ A triangular ridge is also present which slope towards
center of occlusal surface.
♦♦ A ridge is also present which obliquely crosses the occlusal
surface and is known as oblique ridge. Formation of
oblique ridge occurs by joining of triangular ridge of
distobuccal cusp and distal ridge of mesiolingual cusp.
Grooves
♦♦ Both supplemental and developmental grooves are present
on occlusal surface of permanent maxillary first molar.
♦♦ Buccal developmental groove starts from central pit in
central fossa and is continuous in between the two buccal
cusps.
♦♦ Central developmental groove run mesially from central
fossa to transverse ridge and end at mesial triangular fossa
and here it is joined by supplemental grooves.
♦♦ Transverse groove: It extends from central groove and run
distally crossing the oblique ridge to distal triangular fossa.
♦♦ Distal oblique groove: It extends from distal triangular
fossa lingually in between distolingual and mesiolingual
cusp for continuation as the lingual groove.
♦♦ Fifth cusp groove: It separates fifth cusp from mesiolingual
cusp.
♦♦ Supplementary grooves: Multiple supplementary grooves
are present at apex of mesial and distal triangular fossa. At
times, these multiple grooves may cross marginal ridges.
Dental Anatomy 597
Pits
Following pits are seen:
♦♦ Central pit: In central fossa, a pin point depression is
present which is known as central pit. Central pit give
rise to three developmental grooves, i.e. buccal, central
and transverse groove.
♦♦ Mesial pit: It lies at apices of mesial triangular fossa.
♦♦ Distal pit: It lies at the apex of distal triangular fossa.
Fossa
♦♦ Central fossa: It is the major fossa. It is bounded by
transverse, oblique and buccal cuspal ridges. It consists
of central pit at center.
♦♦ Distal fossa: It is also the major fossa. It is a depression
which lies distal to oblique ridge.
♦♦ Mesial triangular fossa: It is the minor fossa. Base of mesial
triangular fossa is formed by mesial marginal ridge and
apex by mesial pit.
♦♦ Distal triangular fossa: It is also the minor fossa. Its base
is formed by distal marginal ridge and apex by distal pit.
Marginal Ridges
Mesial and distal marginal ridges are present which are well
developed. Mesial marginal ridge is long and is at higher level
than distal marginal ridge.
Morphology of Root
♦♦ Maxillary first molar consists of three roots, i.e. mesiobuccal,
distobuccal and palatal root.
♦♦ Out of these three roots palatal root is largest, than is
mesiobuccal root and shortest is distobuccal root.
♦♦ Root trunk lies one-third of the root length.
♦♦ Root divides in three branches and the furcation level
of roots on mesial surface lies near to cervical line while
furcation level of roots on distal surface lies far away from
cervical line.
598 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ Palatal root is wide mesiodistally and is narrow buccoling­ ♦♦ From buccal aspect the occlusal outline shows three buccal
ually. Palatal root extends lingually and stretches beyond cusps, i.e. mesiobuccal, distobuccal and distal cusps.
the boundation of crown before bending in buccal direction ♦♦ From buccal surface almost all cusps are seen.
at apical third. ♦♦ Buccal surface is constituted by mesiobuccal and
♦♦ Mesiobuccal root is broader buccolingually. distobuccal cusps along with distal cusp.
♦♦ Mesiobuccal root is straight while the distobuccal root ♦♦ Mesiobuccal cusp is wide and sharp as compared to
has distal tilt. distobuccal cusp.
♦♦ All roots are seen from buccal as well as lingual aspect. ♦♦ Mesial and distal cusp ridges of both buccal cusps are flat
♦♦ From mesial aspect only palatal and mesiobuccal roots can and meet at an obtuse angle.
be seen. Since distobuccal root is smaller so it is not seen.
♦♦ From distal aspect, palatal and distal roots are prominent
while the mesiobuccal root is seen in background.
♦♦ A deep groove is present at start of bifurcation of two
buccal roots and extends towards cervix.
♦♦ A depression is present at bifurcation of palatal and
mesiobuccal root which run lingually at cervix.
♦♦ All three roots have round apices which are blunt.
Q.2. Describe the morphology of occlusal surface of
permanent maxillary first molar tooth. 
 (Sep 2009, 15 Marks)
Ans. Refer to Ans 1 of the same chapter.
Q.3. Describe the morphology of permanent mandibular
first molar. (Sep 1999, 15 Marks) (Mar 2001, 15 Marks)
 (Feb 2005, 15 Marks) (Nov 2008, 15 Marks)
 (Dec 2010, 10 Marks) (Nov 2010, 8 Marks)
 (Feb 2013, 15 Marks) (Jan 2012, 15 Marks)
Fig. 76:  Mandibular 1st molar-buccal aspect
Or
Describe the morphology of mandibular first molar. ♦♦ Mesiobuccal developmental groove separates the
 (June 2010, 10 Marks) mesiobuccal and distobuccal cusps. Mesiobuccal groove
Ans. Introduction runs till middle third of buccal surface and ends at buccal
Mandibular molars are larger than any other mandibular pit and is placed slightly mesial to bifurcation of root.
teeth. ♦♦ Distobuccal developmental groove separates distobuccal
and distal cusps and extends till middle third of buccal
• They are three in number on each side of mandible.
surface.
• Mandibular first molar is the largest tooth in the
♦♦ Lingual cusps are seen backwards and they lie at higher
mandibular arch.
level as compared to buccal cusps.
• It has five well developed cusp, i.e. two buccal, two
♦♦ Buccal surface is convex at occlusal third and cervical
lingual and one distal cusp.
third region.
• It has two well developed roots one mesial and one
♦♦ Cervical line is commonly regular and shows a dip apically
distal. at root bifurcation.
Following is the morphology of permanent mandibular
first molar: Lingual Aspect
♦♦ Geometric shape of tooth at lingual aspect is trapezoidal.
Morphology of Crown ♦♦ Mesial as well as distal aspect is similar to the buccal aspect.
Buccal Aspect ♦♦ Occlusal outline is formed by sharp lingual cusps and
their cuspal ridges.
♦♦ Geometric shape of mandibular first molar is trapezoidal.
♦♦ From lingual aspect both mesiolingual and distolingual
♦♦ From buccal aspect, mesial outline is convex but at cervix cusps are seen along with the small portion of distal cusp.
it is concave. ♦♦ From lingual aspect tapering of crown is seen which leads
♦♦ Mesial contact area lies at junction of occlusal and middle to narrowing of buccal surface.
third. ♦♦ A part of distal cusp as well as mesial and distal surfaces
♦♦ From buccal aspect distal outline is straight starting from of crown is visible from this aspect.
cervical line and it become convex at distal contact area. ♦♦ Tip of mesiolingual cusp is higher than distolingual cusp.
♦♦ Distal contact area lies at junction of occlusal and middle ♦♦ Lingual developmental groove run in between both the
third. lingual cusps and extends to a short distance.
 Dental Anatomy 599

♦♦ Lingual surface is smooth and convex in occlusal third and ♦♦ Mesial surface is smooth and convex but a shallow
flat in cervical third. concavity is seen just below contact area.
♦♦ A concavity is seen at center of lingual surface in middle ♦♦ Mesial contact area lies at junction of occlusal and middle
third part. third.
♦♦ Cervical line is irregular and show slight apical curvature ♦♦ Cervical line is almost straight with crest of curvature 1mm
at root bifurcation. towards occlusal surface.
Distal Aspect
♦♦ Geometric shape of tooth is rhomboidal from this aspect.
♦♦ Buccal outline shows slight convexity from cervix to distal
cusp tip.

Fig. 77:  Mandibular 1st molar-lingual aspect

Mesial Aspect
Fig. 79:  Mandibular 1st molar-distal aspect
♦♦ Geometric shape of tooth is rhomboidal from this aspect.
♦♦ From mesial aspect, buccal outline of crown is more convex ♦♦ Lingual outline is straight from cervix to middle third and
from cervix to middle third and it is slightly convex till flat slight convex from middle third to tip of distolingual cusp.
mesiobuccal cusp tip. ♦♦ Occlusal outline show distal convergence of crown and
♦♦ Height of buccal contour lies at cervical third. short distal marginal ridge. Distal marginal ridge lie
♦♦ From mesial aspect, lingual outline is evenly convex from lingual to centre of crown buccolingually.
cervix to mesiolingual cusp tip. ♦♦ Distal surface is smooth and convex. It is narrow as
♦♦ Height of lingual contour lies at middle third. compared to mesial surface.
♦♦ Occlusal outline presents sharp mesiolingual cusp tip ♦♦ Distolingual and distal cusps are visible which are present
which lies at higher level as compared to flat mesiobuccal in line.
cusp tip. ♦♦ Distobuccal cusp consists of distobuccal developmental
♦♦ From mesial aspect, mesiobuccal and mesiolingual cusps groove.
are seen. ♦♦ Distal contact area lies at junction of occlusal and middle
third.
♦♦ Cervical outline is almost straight.

Occlusal Aspect
♦♦ Geometric shape of tooth is roughly hexagonal from this
aspect.
♦♦ Mesiodistal width of crown is more than buccolingual
width.
♦♦ Crown shows convergence towards the distal side due to
which crown looks wider on mesial and narrow on distal side.

Occlusal Surface within its Boundaries

Cusp and Cusp Ridges
♦♦ Permanent mandibular first molar consist of four major
cusps which are mesiobuccal, distobuccal, mesiolingual
Fig. 78:  Mandibular 1st molar-mesial aspect and distolingual and a minor cusp, i.e. distal cusp.
600 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Fig. 80:  Mandibular 1st molar-occlusal aspect

♦♦ Of all the cusps, mesiobuccal cusp is the largest cusp, then Fossae
are mesiolingual as well as distolingual cusps which are
Permanent mandibular first molar consists of one major fossa
of same length, then is the distobuccal cusp and shortest and two minor fossae. Major fossa is central fossa and minor
of all is distal cusp. fossae are mesial and distal triangular fossa.
♦♦ Cuspal ridges of buccal and distal cusps are flat while those ♦♦ Central fossa: It is a circular depression which is visible
of lingual cusp are sharp. at center of occlusal surface between buccal and lingual
♦♦ Triangular ridge is present with all the cusps along with cusp ridges.
two inclined planes. Triangular ridges of lingual cusp are ♦♦ Mesial triangular fossa: It is a small depression whose base
well defined. is formed by mesial marginal ridge and apex by mesial pit.
Its sides consist of mesiobuccal and mesiolingual cusps.
Grooves
♦♦ Distal triangular fossa: It is a more smaller depression
♦♦ Four developmental grooves are present along with some compared to mesial triangular fossa. Its base is formed by
supplementary grooves. distal marginal ridge, apex by distal pit and sides consists
♦♦ Central developmental groove: It originates at central of distal slopes of distolingual cusp and distal cusp.
pit and run both mesially and distally and ends in mesial
and distal pits. Marginal Ridges
♦♦ Mesiobuccal developmental groove: It starts at central pit ♦♦ Mesial marginal ridge: Present on occlusal outline of
and extends between mesiobuccal and distobuccal cusps mesial aspect.
and ends on buccal surface. ♦♦ Distal marginal ridge: Present on occlusal outline of
♦♦ Distobuccal developmental groove: It starts at central pit distal aspect.
and extend between distobuccal and distal cusps and ends ♦♦ Mesial marginal ridge is longer and lies at higher level
on buccal surface. than distal marginal ridge.
♦♦ Lingual developmental groove starts at central pit and
extends in between mesiolingual and distolingual cusps Morphology of Root
and ends at lingual surface. ♦♦ Permanent mandibular first molar consists of two roots
namely mesial root and distal root.
Pits
♦♦ Both roots are of same length.
♦♦ Central pit is a narrow depression which is visible in ♦♦ Root trunk of tooth is short and bifurcation is near to cervix.
central fossa. ♦♦ Developmental depressions are present on buccal and
♦♦ Mesial pit is seen in mesial triangular fossa. lingual surfaces of root trunk which run from bifurcation
♦♦ Distal pit is seen in distal triangular fossa. to the cervix.
 Dental Anatomy 601

♦♦ Mesial root is straight upto half of its length and in its ♦♦ Central developmental groove run from central pit to
apical half it shows distal curvature. mesial and distal sides and end in mesial and distal pit.
♦♦ Slanting of distal root is present distally from root base. ♦♦ Buccal developmental groove begins at central pit and
♦♦ Developmental depressions over mesial and distal surface extend between mesiobuccal and distobuccal cusps and
lie over the whole length of roots. ends at buccal surface.
♦♦ Apex of mesial root is blunt while apex of distal root is sharp. ♦♦ Lingual developmental groove begins at central pit and
Q.4. Describe occlusal surface of permanent mandibular extend between mesiolingual and distolingual cusps and
second molar of right side?  (Mar 1995, 16 Marks) ends at lingual surface.
Ans Pits
Occlusal Aspect ♦♦ Central pit is a narrow depression which is visible in
♦♦ Geometric shape of crown is rectangular. central fossa.
♦♦ Mesiodistal width of crown is more than buccolingual ♦♦ Mesial pit is seen in mesial triangular fossa.
width. ♦♦ Distal pit is seen in distal triangular fossa.
♦♦ Tooth appears wider lingually as compared to buccal side. Fossae
♦♦ Mesial outline of crown is less rounded as compared to
distal outline. ♦♦ It consists of mesial and distal fossa.
♦♦ Near the mesiobuccal line angle cervically a prominence ♦♦ Mesial fossa is small depression adjacent to mesial
is seen. marginal ridge.
♦♦ Distal fossa is small depression adjacent to distal marginal
ridge.
♦♦ Both the fossae are equal in size.
Marginal Ridges
Mesial and distal marginal ridges are present which forms base
of mesial and distal triangular fossa.
Q.5. Write a note on cusp of carabelli. (Mar 2000, 5 Marks)
Or
Write in briefly on cusp of Carabelli. 
 (June 2010, 10 Marks)
Ans. Cusp of carabelli is also known as fifth cusp.
• It is the characteristic feature of lingual surface of
permanent maxillary first molar.
• Cusp of carabelli is present on the mesiolingual cusp.
• It can be well developed or can be graded down to
Fig. 81:  Mandibular second molar-occlusal aspect a series of grooves and depressions.
• If fifth cusp is well developed fifth cusp is separated
Occlusal Surface within its Boundaries from mesiolingual cusp by groove.
Cusp and Cusp Ridges • Cusp of carabelli is the supplemental cusp.
Q.6. Describe with diagram pit and groove pattern of per-
♦♦ The tooth consists of four cusps, i.e. mesiobuccal,
manent mandibular first molar.  (Mar 2009, 5 Marks)
distobuccal, mesiolingual and distolingual.
♦♦ Mesiobuccal and distobuccal cusps are of equal length. Ans. Refer to Ans 3 of same chapter.
♦♦ Buccal and lingual mesial cusps are larger than their Q.7. Write a short note on occlusal surface of maxillary first
counterparts. molar.  (Mar 2006, 5 Marks)
♦♦ Lingual cusp ridges are well defined while buccal cusp Or
ridges are more flattened. Write about occlusal aspect of permanent maxillary
♦♦ All the four cusps consist of triangular ridges which con- first molar.` (Feb 2013, 5 Marks)
verge in center of occlusal surface.
Ans. Refer to Ans 1 of the same chapter.
Grooves Q.8. Discuss briefly arch traits of molars and describe the
♦♦ Groove pattern of permanent mandibular second molar morphology of permanent mandibular first molar.
forms a plus mark ‘+’ in center of occlusal aspect dividing  (Mar 2006, 15 Marks)
it in four parts. Ans. Refer to Ans 1 of the same chapter.
602 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Features
Tooth nomenclature
Universal system
Zsigmondy/palmer system
FDI system
General features
Lobes
Cusps
Roots
Size of cusp
Dimensions of crown
Oblique ridge
Crown
Buccal aspect
Geometric form
Width of crown
Buccal cusps
Visibility of lingual cusp
Distal surface visibility
Developmental groove
Mesial contact area
Distal contact area
Buccal surface
Lingual aspect
Geometric form
Lingual convergence
Proximal surface visibility
Proximal aspect
Geometric form
Tilting of lingual crown
Proximal surfaces
Buccal cervical ridge
Occlusal aspect
Geometric form
Dimensions of crown
Lingual convergence
Mesiodistal width
Taper of crown
Buccolingual width
Cusps
Maxillary molars Mandibular molars
Right 1, 2, 3; left 14, 15, 16 Right 30, 31, 32; left 17, 18, 19
Right 6 , 7 , 8 ; left 6 , 7 , 8 Right 6 , 7 , 8 ; left 6 , 7 , 8
Right 16,17,18; left 26, 27, 28 Right 46, 47, 48; left 36, 37, 38
4 to 5 lobes. For development one lobe for each cusp 4 to 5 lobes. For development one lobe for each cusp
Three larger cusps, i.e. mesiobuccal, mesiolingual Four cusps., i.e. two buccal cusps and two lingual
and distobuccal one small cusp, i.e. distobuccal cusp. cusps.
An accessory cusp is present in first molar, i.e. cusp of First molar has five cusps, fifth cusp is known as distal
Carabelli cusp
Three roots, i.e. two buccal and one palatal Two roots, i.e. one mesial and one distal
Buccal cusps are unequal, i.e. mesiobuccal cusp is Both buccal cusps are equal in size.
larger than distobuccal cusp Both lingual cusps are equal in size
Lingual cusps are unequal, i.e. distolingual cusp is
smallest
Crown is wider buccolingually than mesiodistally Crown is wider mesiodistally than buccolingually
Present on occlusal aspect of maxillary molars It is absent
Trapezoidal Trapezoidal
Mesiodistal width is more compared to cervicoincisal width. Mesiodistal width is more compared to cervicoincisal width.
They are sharp They are blunt
A part of lingual cusp is seen from buccal aspect All lingual cusps are seen from buccal aspect
Visible Non-visible
Single buccal groove separating buccal cusps Two buccal grooves on first molar and one buccal groove
on second and third molar
At or near junction of occlusal and middle third At or near junction of occlusal and middle third
At middle third At middle third
Vertical Bend lingually from middle third
Trapezoidal Trapezoidal
At first molar no lingual convergence is seen while less Lingual convergence is present on first molar
lingual convergence is seen on second and third molars
Part of mesial surface is seen Part of both mesial and distal surfaces is visible
Trapezoidal Rhomboidal
Crown is upright at root base Crown is tilted lingually over root base
Distal surface is narrower than mesial Distal surface is narrower than mesial
Less prominent More prominent
Rhomboidal Quadrilateral
Buccolingual diameter is more than mesiodistal Mesiodistal diameter is more than buccolingual
Crown converges buccally in first molar Marked in all molars
Lingually it is greater as compared to buccal surface Mesiodistal dimension is more buccally than lingually
in first molar
Crown tapers from mesial to distal surface Crown tapers from mesial to distal surface
More mesially than distally More mesially than distally
First molar has five cusps while second and third molars First molar has five cusps while second and third molars
have four cusps have four cusps. At times third molar also have fifth cusp
Contd...
 Dental Anatomy 603

Contd...

Features Maxillary molars Mandibular molars

Accessory cusp Cusp of carabelli present over first molar No accessory cusp is present
Largest cusp Mesiopalatal cusp Mesiobuccal cusp
Size of lingual cusps Unequal Equal
Buccal cusp Sharp Blunt
Centric holding cusps Lingual cusp Buccal cusp
Primary cusp triangle Present in first molar Absent
Third molar appearance Like second molar Like first or second molar
Fossae Four fossae are present, i.e. two major fossae—central Three fossae are present, i.e. one major fossa—central
and distal Two minor fossae—mesial and distal
Two minor fossae—mesial and distal
Pattern of grooves No pattern Y or + pattern
Roots
Number Three roots are present, i.e. two buccal and one palatal Two roots are present, i.e. one mesial and one distal
Size Out of all roots palatal root is longest Both the roots are equal in size
Root Trunk It is long It is shorter

Q.9. Write in detail differences between deciduous and per-
manent teeth. Describe the occlusal aspect of maxillary
first molar.  (Dec 2012, 8 Marks)
Ans. For differences refer to Ans 1 of chapter DIFFERENCES
BETWEEN PRIMARY AND PERMANENT
DENTITION.
For occlusal aspect of maxillary first molar refer to Ans
1 of same chapter.
Q.11. Write short note on type traits of maxillary first
Q.10. Describe the morphology of permanent maxillary first
molar. Write arch traits of maxillary first molar.
Or
Describe the morphology of permanent mandibular
first molar. Write arch traits of mandibular first molar.
 (May 2014, 10 Marks)
Ans. For morphology of permanent maxillary first molar refer
to Ans 1 of same chapter. For morphology of permanent
mandibular first molar refer to Ans 3 of same chapter.
For arch traits of permanent maxillary molar and permanent
mandibular molar refer to Ans 8 of same chapter.
permanent molar.  (Dec 2014, 2 Marks)
Ans. Following are the type traits of maxillary first permanent
molar:

Features Maxillary Ist molar Maxillary IInd molar Maxillary IIIrd molar
General features
Size of tooth Largest of all Smaller as compared to first molar Smallest of all
Variability in shape Show least variability Has two shapes, i.e. rhomboidal and Show lot of variation
heart shaped
Lobes 5 4 Either 3 or 4
Cusps 5 4 Either 4 or 3
Crown
Buccal aspect
Width of crown Widest of all Width of crown is moderate In width it is smallest of all three
Height of buccal cusps Both cusps, i.e. mesiobuccal and Mesiobuccal cusp is slightly longer Mesiobuccal cusp is much longer than
distobuccal cusps are of same than distobuccal cusp distobuccal cusp
height
Height of the crown Distally height of crown is slightly Distally height of crown is much less Distally height of crown is much less as
less as compared to mesial as compared to mesial compared to mesial
Distal tilt of crown Crown is upright over root base It shows slight distal tilt It shows more distal tilt

Contd...
604 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd...

Features Maxillary Ist molar Maxillary IInd molar Maxillary IIIrd molar
Slanting of occlusal Horizontal It slant cervically from mesial surface It slant more cervically from mesial
surface towards distal surface surface towards distal surface
Buccal groove Long Short Shortest
Buccal pit It is more marked It is less marked It can be absent
Lingual aspect
Width of crown It is wider lingually as compared to It is narrower lingually as compared It is narrower on lingual surface as
buccal aspect to buccal aspect compared to buccal surface
Lingual convergence No lingual convergence is present Slight More
Distolingual cusp Always present Absent in three cusp type Absent
Cusp of Carabelli Present Rarely present Absent
Mesial aspect
Total cusps seen from 3, i.e. mesiobuccal, mesiolingual 2, i.e. mesiobuccal, mesiolingual 2, i.e. mesiobuccal, mesiolingual
mesial aspect and cusp of carabelli
Contact area Mesial contact area is narrower as Both contact areas are equally broad Mesial contact area is broad and distal
compared to distal contact area. contact area is absent
Distal aspect
Surface area Short Narrow and short Narrow and short
Occlusal aspect
Geometric shape Rhomboidal in shape Rhomboidal in shape Heart shaped
Oblique ridge More prominent Less prominent Variable
Size of distolingual cusp Large Small Smallest

Q.12. Give the chronology of right maxillary first permanent Q.13. Define cusp, fossa and groove. Write the differences
molar. Describe the occlusal aspect of it in detail with between permanent maxillary and mandibular first molar
diagram. (Apr 2017, 3+5+2 Marks) with well labeled diagrams.  (Sep 2018, 3 + 7 Marks)
Ans. Chronology of right maxillary first permanent molar Ans. Cusp: Cusp is defined as an elevation of crown of tooth
making up a divisional part of occlusal surface.
First evidence of calcification At birth Fossa: Fossa is defined as a depression or a concavity
Enamel completion 3 to 4 years
on lingual surface of anteriors and occlusal surface of
posteriors.
Eruption 6 to 7 years
Groove: A groove is defined as a line separating the lobes
Roots completed 9 to 10 years or primary part of crown or root.

For occlusal aspect of right maxillary first permanent molar Differences between Permanent Maxillary and Mandibular
along with diagram refer to Ans 1 of same chapter. First Molar with Well Labeled Diagrams

Characteristics Permanent maxillary Mandibular first molar

Synonym It is known as 6 year molar It is known as 12 year molar
Tooth nomenclature Right Left Right Left
Universal system 3 14 30 19
Zsigmondy/Palmer system 6 6 6 6
FDI system 16 26 46 36
Chronology
Eruption 6 years 6 to 7 years

Contd...
 Dental Anatomy 605

Contd...

Characteristics Permanent maxillary Mandibular first molar

Crown
Buccal aspect

Relative crown dimensions Crown is buccolingually broader than mesiodistally Crown is mesiodistally broader than buccolingually
Cusps It consists of two buccal cusps, i.e. mesiobuccal cusp It consists of three buccal cusps, i.e. mesiobuccal cusp,
and distobuccal cusp distobuccal cusp and distal cusp
Height of cusps Mesiobuccal cusp and distobuccal cusp are of same Mesiobuccal cusp is largest
height
Buccal surface It is relatively flat Buccal surface is convex and is inclined lingually
Crown height Crown height over distal is slightly lesser than on mesial Crown appears shorter due to its greater mesiodistal
width.
Crown is shorter at distal than mesial side
Buccal pit It is more pronounced, buccal groove often ends in It is commonly present. Dental caries may occur.
buccal pit. This is the most common site of caries Mesiobuccal developmental groove terminates in this
buccal pit
Mesial and distal outlines Mesial and distal crown outlines are nearly equal sized Mesial and distal outlines taper noticeably from contact
areas to cervical line
Lingual aspect

Lingual convergence Least or no lingual convergence present Marked lingual convergence is present

Number of cusps on lingual Two lingual cusps are present, i.e. mesiolingual and Two lingual cusps are present, i.e. mesiolingual and
aspect distolingual cusps. One accessory cusp is also present, distolingual cusps
i.e. cusp of Carabelli

Size of lingual cusps Lingual cusps are of different sizes, i.e. large mesiolingual Lingual cusps are of equal size
and small distolingual cusp.

Cusp of carabelli It is the additional cusp lingual to mesiolingual cusp. It It is not present
is the characteristic feature

Contd...
606 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd...

Characteristics Permanent maxillary Mandibular first molar

Occlusal aspect

Shape Rhomboidal Hexagonal with unequal size

Cusp of Carabelli Present Absent
Oblique ridge It is prominent and extend from mesiolingual to It is absent
distobuccal cusp
Fossae Two major and two minor fossae are present It consists of three fossae, i.e. one major and two
minor fossae
Roots
Number Three: Mesial, distal and lingual Two: mesial and distal
Length Lingual root is wider mesiodistally Both the roots are of same length

Cuspid: It is similar to but shorter than maxillary canine.

11. PULP MORPHOLOGY
Q.1. Describe in brief morphology of pulp cavities. 
 (Jan 2012, 5 Marks)
Ans. Pulp cavities of permanent teeth are as follows:
Pulp Cavities of Maxillary Teeth
Central incisor: It is shovel shaped coronally with three short
horns on coronal roof with point of triangle pointing lingually.
Lateral incisor: It is of spoon shape and is small coronally
changing to a round evenly tapering root to apex.
Cuspid: It has longest pulp with elliptical cross section
buccolingually and distally inclined apex.
First premolar: It has a large occluso cervical pulp chamber with
mesial concavity extending from root surface onto cervical third
of pulp chamber divides into two smooth funnel shaped roots.
Second premolars: It is similar coronally to first premolar,
except it has only one root.
Molar: They all are similar. There are three roots i.e. the lingual
is longest, distobuccal is shortest and straight, mesiobuccal is
curved and flattened buccolingually with mesial surface convex.
Pulps of Mandibular Teeth
Central incisor: It has smallest pulps in the dentition and is
long and narrow with flattened elliptical shape.
Lateral incisor: It is same as central incisor, only smaller in all
dimensions.
First premolar: It looks like small mandibular canine with
missing lingual pulpal hom.
Second premolar: The lingual horn is much smaller the buccal
horn and is about dimension of mandibular canine.
Molar: The mandibular molars are all similar. The cross-section
is rectangular with mesiodistal dimension greatest and displays
mesiobuccal prominence. The horn heights from highest to
lowest are mesiobuccal, distobuccal, distolingual. There are two
roots, distal is shorter, straighter and singular whereas mesial
is longer, curve and often double.
Q.2. Write a short note on endodontic anatomy of permanent
maxillary first premolar.  (Feb 2013, 5 Marks)
 (May 2014, 5 Marks)
Ans. Following is the endodontic anatomy of permanent
maxillary first premolar:
Pulp Chamber
♦♦ When seen in buccolingual section, pulpal chamber of
maxillary first premolar tooth is broad along with two
pulpal horns which point towards buccal cusp, i.e. buccal
pulp horn and lingual cusp, i.e. lingual pulpal horn.
♦♦ Both pulp horns are superimposed over each other and
appear blunt.
♦♦ Floor of pulpal chamber lies in coronal third of root.
♦♦ Pulpal chamber has two orifices, i.e. buccal and lingual.
 Dental Anatomy 607

Fig. 84:  Access cavity of permanent maxillary first premolar

Q.3. Write a short note on endodontic anatomy of permanent

Fig. 82:  Mesiodistal section and buccolingual section of permanent maxillary first molar.  (Feb 2013, 5 Marks)
maxillary first premolar Ans. Following is the endodontic anatomy of permanent
maxillary first molar:
Root Canals
Pulp Chamber
♦♦ The tooth consists of two roots which are mostly fused or
♦♦ Pulp chamber of permanent maxillary first molar is rhom-
at times partially fused.
boidal in shape.
♦♦ If roots are fused a groove is present which divide root as ♦♦ Buccolingual width of pulp chamber is more than mesio-
buccal and lingual roots. distal width.
♦♦ The tooth consists of two root canals which exit by two ♦♦ Pulpal chamber form four pulp horns, i.e. mesiobuccal,
separate apical foramina. distobuccal, mesiolingual and distolingual pulp horn.
♦♦ Both the canals taper toward apex. ♦♦ Floor of pulp chamber is located below cervical margin.
♦♦ Three openings in general of root canals are visible.

Fig. 85:  Pulp chamber and root canals in mesiodistal section of

permanent maxillary first molar
Fig. 83:  Pulp chamber and root canals in mesiodistal and
buccolingual section of permanent maxillary first premolar Root Canals
♦♦ The tooth consists of three roots and three canals, i.e.
Cross-section
mesiobuccal, distobuccal and palatal or lingual.
♦♦ At cervical level root canal is kidney shaped. ♦♦ At times, fourth canal can also be seen in mesiobuccal root.
♦♦ At mid root level two oval shaped canals are visible. ♦♦ Distobuccal canal is narrow as compared to mesiobuccal
♦♦ At apex both canals are round. canal and palatal is widest and longest.

Access Cavity Cross-section

At occlusal surface, in the center access cavity is oval shaped ♦♦ At cervical level root canal is rhomboidal with three canal
which provide access to buccal and lingual canals. orifices.
608 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ At mid root level palatal canal is round; distobuccal canal ♦♦ Tooth consists of four pulp horns.
is oval shaped and mesiobuccal canal is kidney shaped. ♦♦ Lingual pulp horns are long and lie at higher level while
buccal pulp horns are short and lie at lower level.
♦♦ Floor of pulp chamber lie below cervical margin.

Fig. 86:  Pulp chamber and root canals in mesiodistal section of Fig. 88:  Pulp chamber and root canals in mesiodistal section of
permanent maxillary first molar permanent mandibular first molar
Access Cavity
Root Canals
♦♦ Access cavity opening should be triangular with the round
corners which extend at mesiobuccal cusp tip, mesial
marginal ridge and the oblique ridge.
♦♦ When second mesiobuccal canal is present access cavity
is rhomboidal shaped.

Fig. 89:  Cross-section of permanent mandibular first molar

Fig. 87:  Access cavity of permanent maxillary first molar ♦♦ The tooth consists of two roots and three canals. In this,
mesial tooth has two root canals namely mesiobuccal canal
Q.4. Describe morphology of permanent mandibular first and mesiolingual canal.
molar from all aspects. Write a note on its endodontic ♦♦ Distal root canal is oval in shape. Sometimes distal root
anatomy.  (Oct 2014, 8 Marks) can show two canals.
Ans. For morphology of permanent mandibular first molar
refer to Ans 3 of chapter THE MAXILLARY AND Cross-section
MANDIBULAR MOLARS. ♦♦ At cervical level tooth is quadrilateral in shape.
Following is endodontic anatomy of permanent ♦♦ At mid-root level mesial canal is slight oval while distal
mandibular first molar: canal is long and oval shaped.

Pulp Chamber Access Cavity

♦♦ Pulp chamber of tooth is wider in its mesiolingual ♦♦ Access cavity opening should be trapezoidal with the
dimensions as compared to buccolingual dimensions. round corners. Towards mesial surface cavity is wide.
♦♦ When viewed from buccal and lingual aspects pulp ♦♦ When second distal canal is present access cavity is
chamber is rectangular in shape. rectangular shaped.
 Dental Anatomy 609

• Corresponding curve in maxillary arch is known as

compensating curve.
• Buccolingual curvature from one side to other side is
known as Monson’s curve.
♦♦ Overbite: It is normal, i.e. 1 to 2 mm.
♦♦ Overjet: It is 1 to 3 mm.
♦♦ Molar relationship: Mesiobuccal cusp of permanent
maxillary first molar occludes in mesiobuccal groove of
permanent mandibular first molar.
Q.2. Write note on curve of spee. (Sep 2000, 5 Marks)
 (Mar 2001, 5 Marks) (Feb 2005, 5 Marks)
 (Dec 2010, 5 Marks) (Feb 2013, 2 Marks)
Fig. 90:  Access cavity of permanent mandibular first molar
Or
Write about curve of spee  (May/June 2009, 5 Marks)
12. OCCLUSION Or
Write a short note on curve of spee and monsoon curve
Q.1. Write short note on occlusion. (Feb 1999, 5 Marks)
 (Sep 2007, 3 Marks) (April 2008, 10 Marks)
 (Feb 2005, 5 Marks) (Mar 2009, 5 Marks)
Ans.
Or
Write short answer on occlusion. (Aug 2018, 3 Marks) Curve of Spee

Ans. Occlusion is defined as the “static and dynamic contact ♦♦ Graf Von Spee and Ferdin were the first to discover curve
relationship between the occlusal surface of teeth during of spee. They had explained the relationship of mandibular
function” Glossary of prosthodontic terminology (GPT). teeth in sagittal plane.
♦♦ When viewing from the point which lies perpendicular
Occlusion in Primary Teeth to first molar a curvature of mandibular occlusal plane is
♦♦ Mesial surface of maxillary and mandibular central incisors present which starts at incisal edges as well as tip of lower
are in line with each other at the midline. canine and follow buccal cusp of premolars and molars,
♦♦ Maxillary central incisor occludes with mandibular central this curvature is continuous till ramus and is known as
incisor and the mesial third of the mandibular lateral incisor. Curve of Spee or Curve of Von Spee.
♦♦ Maxillary lateral incisor occludes with the distal two third ♦♦ The ideal curve of spee is aligned in a way that curvature
of the mandibular lateral incisor and the median portion should extend through condyles and form a segment of
of mandibular canine from tip of cusp. Maxillary canine circle with radius of 4 inches.
occludes with that portion of the mandibular canine distal to
the cusp tip and the mesial third of the mandibular first molar.
♦♦ M axillary first molar occludes with the distal third of
mandibular first molar and mesial portion of mandibular
second molar.
♦♦ Maxillary second molar occludes with the remainder of
the mandibular second molar.
♦♦ Distal surface of maxillary molar projecting slightly over
the distal portion of the mandibular second molar.

Occlusion in Permanent Teeth

Various features of occlusion in permanent dentition are:
♦♦ Overlap: In normally occluding dentition, maxillary teeth
are labial or buccal to mandibular teeth. Fig. 91:  Curve of spee
♦♦ Angulations: Permanent teeth will have buccolingual and
mesiodistal angulations. ♦♦ Depth of curve of spee is 1.5 mm. Maximum depth of curve
♦♦ Occlusion: With exception of mandibular central incisors is at second premolar region.
and maxillary third molars, each permanent tooth occludes ♦♦ This curve leads to normal functional protrusive
with two teeth. movements of mandible.
♦♦ Arch curvature: ♦♦ Curve of spee has clinical significance in relation to tooth
• Anteroposterior curvature in mandibular arch is guidance, i.e. canine incisal guidance, in orthodontics and
known as curve of spee. restorative dentistry.
610 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
♦♦ Increasing the curve of spee can compensate for smaller
maxillary anterior teeth, especially lateral incisors while
reducing the curve of spee can reduces the vertical overlap
of the tooth.
Curve of Monson
♦♦ Monson in 1932 has discovered a cusp which is known as
Curve of Monson.
♦♦ Monson has observed the occlusal plane which is three
dimensional spherical curve and involves right and left
incisors, cuspid, bicuspid, molars and condyles whose
centre lies at glabella.
♦♦ Curve of Monson is a segment of a sphere of 4 inches radius.
♦♦ As per Monson, all incisal edges as well as buccal cusps
of mandibular teeth are segment of this sphere and
masticatory forces converge at center, i.e. Glabella.
♦♦ The concept given by Monson was later on discarded by
Dempster et al. who proved that there is no convergence of
longitudinal axis of roots of teeth toward a common center.
Fig. 92:  Curve of monson
Q.3. Define occlusion. Describe the factors governing
occlusion.  (Mar 2007, 8 Marks) (Sep 2009, 5 Marks)
Or
Write about factors governing occlusion of teeth.
 (Aug 2012, 10 Marks)
Ans. Occlusion is defined as the “static and dynamic contact
relationship between the occlusal surface of teeth during
function” Glossary of prosthodontic terminology
(GPT).
Factors Governing Occlusion of Teeth
Factors governing occlusion are as follows:
Condylar Guidance
♦♦ Condylar guidance is defined as “the mechanical form
located in the upper posterior region of an articulator
which controls movement of its mobile member”. —GPT
8th Edition
♦♦ It is also called as first factor of occlusion.
♦♦ This is the only factor which can be recorded from the
patient.
♦♦ This is the mandibular guidance which is generated by
condyles traversing the contours of glenoid fossa.
♦♦ This is duplicated on the articulator. Extent of duplication
depends on articulators capability whether it is semi-
adjustable or fully-adjustable.
♦♦ Protrusive condylar guidance is taken by using protrusive
records while lateral condylar guidance is obtained by
Hanau’s formula.
♦♦ Condylar guidance is expressed in degrees.
♦♦ Increase in the condylar guidance increases the jaw separa-
tion during protrusion.
♦♦ This factor cannot be modified. All the other four factors
of occlusion should be modified to compensate the effects
of this factor.
♦♦ Shallow condylar guidance lead to less posterior tooth
separation in protrusion and requires teeth with short
cusps and flat fossa to achieve balanced occlusion than a
steep guidance.
Incisal Guidance
♦♦ It is defined as “the influence of the contacting surfaces
of the mandibular and the maxillary anterior teeth on
mandibular movements”. —GPT 8th Edition
♦♦ It is also called as second factor of occlusion.
♦♦ It is determined by the dentist and customized for patient
during anterior try-in.
♦♦ Incisal guidance acts as a controlling path for the move-
ment of casts in an articulator.
♦♦ It should be set depending upon the desired overjet and
overbite planned for the patient. If the overjet is increased;
then the inclination of the incisal guidance is decreased.
If the overbite is increased, then the incisal inclination
increases.
♦♦ Incisal guidance has more influence on the posterior teeth
than the condylar guidance, because the action of the in-
cisal inclination is closer to the teeth than the action of the
condylar guidance.
♦♦ The angle formed by this protrusive path to the horizontal
plane is called as the protrusive incisal path inclination or
the incisal guide angle. This influences the shape of the
posterior teeth.
♦♦ If the incisal guidance is steep, then steep cusps or a steep
occlusal plane or a steep compensatory curve is needed to
produce balanced occlusion.
Orientation of Occlusal Plane
♦♦ It is defined as “An imaginary surface which is related ana-
tomically to the cranium and which theoretically touches
the incisal edges of the incisors and the tips of the occluding
surfaces of the posterior teeth. It is not a plane in the true
sense of the word, but represents the mean curvature of
the surface”.—GPT

♦♦ It is established anteriorly by the height of the lower canine,
which nearly coincides with the commissure of the mouth
and posteriorly by the height of the retromolar pad.
♦♦ It is usually parallel to the ala-tragus line or Camper’s line.
♦♦ It can slightly be altered.
♦♦ Tilting the plane of occlusion beyond l0° is not advisable.
Compensating Curves
♦♦ It is defined as “The anteroposterior and lateral curvatures
in the alignment of the occluding surfaces and incisal edges
of artificial teeth which are used to develop balanced oc-
clusion”.—GPT
♦♦ It is an important factor for establishing balanced occlu-
sion and is determined by the inclination of the posterior
teeth and their vertical relationship to the occlusal plane.
♦♦ There are two types of compensating curves, namely:
1. Anteroposterior Compensating curves.
2. Lateral compensating curves.
 Curve of Spee, Wilson’s curve, and Monson’s curve are
associated with natural dentition.
 In complete dentures, compensating curves similar to these
curves should be incorporated to produce balanced occlusion.
Anteroposterior Compensating Curves
These are compensatory curves running in an anteroposterior
direction and helps in abtaining protrusive balance. They
compensate for the curve of Spee seen in natural dentition.
♦♦ Compensating curve for curve of spee
• Curve of Spee is defined as, “Anatomic curvature of
the occlusal alignment of teeth beginning at the tip of
the lower canine and following the buccal cusps of
the natural premolars and molars, and continuing to
the anterior border of the ramus as described by Graf
von Spee’—GPT
• It is an imaginary curve joining the buccal cusps of the
mandibular posterior teeth starting from the canine
passing through the head of the condyle.
• It is seen in the natural dentition and should be
reproduced in a complete denture.
• The significance of this curve is that when the patient
moves his mandible forward, the posterior teeth set
on this curve will continue to remain in contact. If the
teeth are not arranged according to this curve. There
will be disocclusion during protrusion of the mandible
(Christensen’s phenomenon).
Lateral Compensating Curves
These curves run transversely from one side of the arch to the
other. The following curves fall in this category:
♦♦ Compensating curve for Monson’s curve
• It is defined as “The curve of occlusion in which
each cusp and incisal edge touches or conforms to a
segment of a sphere of 8 inches in diameter with its
center in the region of the Glabella”.—GPT
• This curve runs across the palatal and buccal cusps of
the maxillary molars.
Dental Anatomy 611
• During lateral movement, the mandibular lingual
cusps on the working side should slide along the
inner inclines of the maxillary buccal cusp. In the
balancing side, the mandibular buccal cusps should
contact the inner inclines of the maxillary palatal cusp.
This relationship forms a balance, only if the teeth are
set following the Monson’s curve, then there will be
lateral balance of occlusion.
♦♦ Compensating curve for Anti-Monson or Wilson’s Curve
• It is defined as ‘A curve of occlusion which is convex
upwards’—GPT
• This curve runs opposite to the direction of the
Monson’s curve.
• It is followed when the first premolars are arranged,
so that they do not produce any interference to lateral
movements.
♦♦ Reverse curve
• It defined as “A curve of occlusion which in transverse
cross-section confirms to a line which is convex
upward”. GPT
• It improves the stability of the denture.
• It is explained in relation to mandibular posterior
teeth.
• The reverse curve was modified by Max Pleasure to
form the pleasure curve.
♦♦ Pleasure curve
• It is defined as “A curve of occlusion which in
transverse cross-section confirms to a line which is
convex upward except for the last molars”. —GPT
• It was proposed by Max. Pleasure to balance the
occlusion and increase the stability of the denture.
• Here, the first molar is horizontal and the second
premolar is buccally tilted.
• The second molar independently follows the
anteroposterior compensating curve and is lingually
tilted.
• This curve runs from the palatal cusp of the first
premolar to the distobuccal cusp of the second molar.
• The second molar gives occlusal balance and the
second premolar gives lever balance.
Cuspal Inclination
♦♦ It is defined as “The angle made by the average slope of
a cusp with the cusp plane measured mesiodistally or
buccolingually”. —GPT
♦♦ The mesiodistal cusps which lock the occlusion and
repositioning of teeth do not occur due to settling of the
denture base. So to prevent the locking of occlusion the
mesiodistal cusps are reduced during occlusal reshaping.
In the absence of mesiodistal cusps, the buccolingual cusps
are considered as a factor for balanced occlusion.
♦♦ In patients having shallow overbite, the cuspal angle
should be reduced to balance the incisal guidance, so that
the jaw separation will be less. Teeth with steep cusps will
produce occlusal interference in these cases.
612 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

♦♦ In patients with deep bite (steep incisal guidance), the jaw
separation is more during protrusion. Teeth with high cus-
pal inclines are required in these cases to produce posterior
contact during protrusion.
Q.4. Write short note on functions of teeth. 
 (Mar 2007, 8 Marks) (Apr 2010, 5 Marks)
Or
Write about tooth functions. (Jan 2012, 5 Marks)
Ans.
Chewing
Chewing is the main function of teeth. Teeth are part of the
digestive system; chewing is the first stage of the process of
digestion. Food needs to be broken down and chewed before
entering the digestive system so that the body can easily
absorb nutrients from them. In the absence of teeth, digestion
is hampered leading to significant disturbances in food
absorption. Depending on their position and type, teeth have
a role in shearing, tearing or grinding food.
Esthetics
Teeth, especially those located in visible areas, have an important
aesthetic role. The position, shape and shade of teeth have a
pronounced impact in shaping each individual personality.
Pronunciation
Teeth can help us pronounce accurately as they have an
important role in the pronunciation of consonants. When teeth
are missing (especially upper front teeth), the normal speech
can be severally affected.
Various Teeth and their Specific Functions
Q.5. Write a short note on curve of spee and leeway space
of Nance.  (Sep 2006, 5 Marks)
Or
Write short note on leeway space of Nance.
 (July 2016, 3 Marks) (Nov 2010, 2 Marks)
Or
Write short note on leeway space. (May 2014, 2 Marks)
Or
Write very short answer on leeway space of Nance.
 (Aug 2018, 2 Marks)
Ans. For curve of spee refer to Ans 2 of the same chapter.
Leeway Space of Nance
♦♦ Combined mesiodistal crown dimension of primary
canine and primary first and second molars is larger than
combined mesiodistal crown dimension of their successor,
i.e. permanent canine and first as well as second premolars.
So the amount of space gained by their difference in the
posterior segment is known as leeway space of Nance.
♦♦ Leeway space is seen in both the arches.
♦♦ Measurement of leeway space for maxillary and man-
dibular arches is:
1. For maxilla: Leeway space in each quadrant of maxilla
is 0.9 mm, so total leeway space in maxilla is 1.8 mm
2. For mandible: Leeway space in each quadrant of
mandible is 1.7 mm, so total leeway space in mandible
is 3.4 mm.
Significance of Leeway Space of Nance
♦♦ Leeway space is a favorable feature as it provides the
mesial movement of permanent molars.

Name of tooth Specific function

Incisors • They are used for biting, cutting and shearing
the food during mastication
• Maxillary and mandibular incisors act as cutting
blades
• They also play role in aesthetics and phonation
Canines • They assist permanent incisors and premolars
during mastication
• They are used for tearing the food
• They help in seizing, slicing and chewing the
food
• They exhibit prominent sexual dimorphism,
i.e. they are larger and longer in males as
compared to females
Premolars • They assist canine in tearing the food
• They grind the food along with molars
• Premolars provide support to the cheek near to
corners of mouth
• Premolars reinforce aesthetics at the time of Fig. 93:  Leeway space of Nance
smiling
♦♦ In mandibular arch leeway space is more as compared
Molars • Molars are used for trituration and comminution to maxillary arch. This is because as primary mandibular
of food
• Molars provide support to the cheeks
molars are wider than primary maxillary molars. Leeway
space differential between the two arches leads mandibu-

lar first molar to move mesially more than maxillary first
premolar. This arrangement leads to the change in molar
relationship from end on in early mixed dentition phase
to Class I relation in late mixed dentition phase.
Q.6. Describe overjet and overbite.  (June 2010, 5 Marks)
Or
Write short note on overjet and overbite.
 (Apr 2015, 3 Marks)
Ans. When the overlap of maxillary and mandibular teeth
is measured in sagittal plane between incisal edge of
maxillary incisor and labial surface of mandibular
incisor, it is known as overjet or horizontal overlap.
♦♦ Normal overjet is 1 to 2 mm.
♦♦ When the overlap of maxillary and mandibular teeth is
measured in vertical plane between incisal edge of maxil-
lary and mandibular incisors, it is known as overbite or
horizontal overbite or vertical overlap.
♦♦ Normal overbite is 2 to 3 mm.
♦♦ Overbite and overjet are such that they allow jaw function
without interference.
Fig. 94:  Overjet
Fig. 95:  Overbite
♦♦ Overbite should allow for posterior disto-occlusion during
protrusive movement of mandible.
Dental Anatomy 613
♦♦ Improper overjet in posterior segment leads to cheek bite.
♦♦ Excessive overjet and overbite in anterior segment affect
aesthetics.
♦♦ Excessive incisal overjet is often seen in deciduous denti-
tion. This excessive overjet is corrected by forward growth
of mandible.
Q.7. Write a short note on flush terminal plane. 
 (Oct 2008, 2 Marks) (Dec 2010, 2 Marks)
Ans.
♦♦ It is also known as straight terminal plane.
♦♦ Mesiodistal dimension of mandibular second molar is
greater than that of maxillary second molar, leaving the
distal surface of two teeth in same plane. This is known
as Flush terminal relationship.
♦♦ This is a normal feature of the deciduous dentition.
♦♦ Flush terminal plane is seen in 76% of children.
♦♦ Flush terminal plane is considered to be the ideal kind of
molar relationship in primary dentition.
♦♦ Significance of flush terminal plane relationship is that
it leads to normal eruption of maxillary and mandibular
permanent first molars and their occlusion.
Fig. 96:  Flush terminal plane relationship
Q.8. Write short note on centric relation. (Aug 2011, 2 Marks)
Ans. Centric relation is also known as centric jaw relation.
• Centric relation refers to the most posterior of
mandible relative to maxilla.
• It is the relationship of mandible to skull as it rotate
around the hinge axis before any of the translatory
movement of condyle begins.
• In centric relation, condyles get articulated with the
thinnest portion of articular disc and condyle disc-
complex is in an anteriosuperior position against
posterior slopes of articular eminence.
• Centric relation is independent of tooth position or
vertical dimension.
• In anterior teeth centric contact relation is minimum
or not present.
• In maxillary posteriors centric relation contacts may
coincide with centric occlusion contacts over cusp tips.
• In mandibular posterior teeth, cusp tip will coincide
and are slight mesial to centric occlusion marks on
marginal ridges and fossa.
614 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Q.9. Write short note on compensatory curves.  • Balanced occlusion is not present in natural
 (Oct 2016, 3 Marks) (Aug 2012, 4 Marks) dentition.
Or • Balanced occlusion affects the stability of denture.
• Balanced occlusion possess following characteristics,
Describe in brief compensating curves of dental arches. i.e.
 (Jan 2012, 5 Marks) (May 2014, 5 Marks) 1. Simultaneous contact of teeth occurs at the time
Or of protrusion.
Answer in brief compensatory curves. 2. Teeth present over working side glide evenly
 (Aug 2016, 2 Marks) against opposite teeth without any interference.
Ans. The compensatory curves are curve of spee, curve of 3. Contacts should present over the balancing
Monson and curve of Wilson. side, the contacts over balancing side should not
interfere with gliding movements of working
For curve of Spee and curve of Monson in detail refer to
side.
Ans 2 of same chapter.
Q.11. Define occlusion. Write in short about overjet and
overbite.  (Sep 2015, 1 + 4 = 5 Marks)
Ans. Occlusion is defined as the “static and dynamic contact
relationship between the occlusal surfaces of teeth during
function”. Glossary of prosthodontic terminology.
For overjet and overbite in detail refer to Ans 6 of same
chapter.
Q.12. Write short note on ugly duckling stage.
 (Apr 2015, 3 Marks)
Ans. It is also known as Broadbent phenomenon since H
Broadbent discovered it in 1937.
• It commonly occurs at the time of second transitional
Fig. 97:  Curve of Wilson period.
• It is seen at the age of 9 to 11 years or at the time
Curve of Wilson when canine erupt.
♦♦ Curve of Wilson is a mediolateral curve which contacts • Ugly duckling stage is indicative of unaesthetic
buccal and lingual cusp tips of each side of arch. appearance of child at this period of age.
♦♦ Generally posterior teeth in maxillary arch have slight • It is a self correcting anomaly. As canine erupts fully
buccal inclination while mandibular posterior teeth have the condition get correct by itself.
slight lingual inclination. If a line is drawn through buccal • Clinical significance of this stage is that the
and lingual cusp tips of both right and left posterior teeth orthodontic treatment should not be carried out
a curved plane of occlusion is observed. This curvature during this period.
is convex in maxillary arch and concave in mandibular
Events Occurring in Development of Ugly Duckling Stage
arch. When arches come in occlusion both these curvatures
match perfectly. This curvature in occlusal plane is seen
from frontal view and is known as curve of Wilson.
♦♦ Curve of Wilson permit mediolateral jaw movements
during mastication and provides easy access to occlusal
table as tongue lay food over the occlusal surfaces of teeth.
Q.10. Write short note on balanced occlusion.
 (May 2014, 2 Marks)
Or
Answer in brief balanced occlusion.
 (Oct 2016, 2 Marks)
Ans. Balanced occlusion is defined as “ Simultaneous contact
of maxillary and mandibular teeth on right and left sides
in anterior and posterior occlusal areas in centric and
eccentric positions, developed to lessen or limit tipping
or rotating of denture base in relation to supporting
structures”. GPT (Glossary of Prosthodontic terms)

Figs 98 (1 to 5):  Ugly duckling stage
Q.13. Answer in brief key of occlusion. (Feb 2016, 2 Marks)
Ans. Lawrence F Andrew’s had given six keys of normal
occlusion, which are:
• Key l: Molar relationship (inter-arch relationship)
• Key 2: Crown angulations (mesiodistal crown
angulations /mesiodistal tip)
• Key 3: Crown inclination (labiolingual crown
inclination, the labiolingual or buccolingual Torque)
• Key 4: Absence of rotations
• Key 5: Presence of tight contacts
• Key 6: Flat occlusal plane.
Key 1: Molar Relationship (Inter-arch Relationship)
♦♦ The mesiobuccal cusp of the maxillary first permanent
molar falls within the groove between the mesial and
middle cusps of the mandibular first permanent molar.
♦♦ The distal surface of the distal marginal ridge of the max-
illary first permanent molar contacts and occludes with
the mesial surface of the mesial marginal ridge of the
mandibular second permanent molar.
♦♦ The mesiolingual cusp of the maxillary first permanent
molar seats in the central fossa of the mandibular first
permanent molar.
Key 2: Crown Angulations (Mesiodistal Crown
Angulations/Mesiodistal Tip)
In the normal occluded teeth, the gingival portion of the long
axis of each crown is distal to the occlusion portion of that axis.
The degree of the angulation varies with each tooth type.
Key 3: Crown Inclination (Labiolingual Crown Inclination,
Labiolingual or Buccolingual “Torque”)
♦♦ The angle between a line is 90° to the occlusal plane, as
well as a line tangent to the middle of the labial or the
buccal surface of clinical crown, which is referred to as
crown inclination.
♦♦ Lingual crown inclination occurs in maxillary and man-
dibular posteriors.
♦♦ Positive or labial inclination in maxillary incisors.
Dental Anatomy 615
Key 4: Absence of Rotation
♦♦ In order to achieve correct occlusion, none of the teeth
should be rotated, molars and premolars occupy more
space in the dental arch than normal.
♦♦ Rotated incisors may occupy less space than those cor-
rectly aligned.
♦♦ Rotated canines adversely affect esthetics and may lead to
occlusal interference.
♦♦ There should be absence of rotation in both of the dental
arches to be called as normal occlusion.
Key 5: Presence of Tight Contacts
There should be tight contacts and absence of any spacing. Tight
contacts are an essential part to maintain the integrity of any
arch form, especially the dental arches.
Key 6: Flat Occlusal Plane
♦♦ The curve of Spee should be relatively slight or flat.
♦♦ The vertical distance between any tooth and a line joining
the most prominent cusp tip of the mandibular molar and
central incisor (curve of Spee) should not exceed 1.5 mm.
♦♦ An excessive curve of Spee restricts the amount of space
available for the upper teeth, which must then move
toward the mesial and distal, thus, preventing correct
intercuspation.
Q.14. Write short note on normal occlusion.
 (Jan 2012, 2 Marks)
Ans. Normal occlusion is a Class I relationship of the maxillary
and mandibular first molar in centric occlusion.
Normal occlusion is an absence of large or many facets,
bone loss, closed vertical dimension, crooked teeth,
bruxism, loose teeth and freedom from joint pain.
Features of Normal Occlusion in Permanent Dentition
♦♦ Overlap: In normally occluding dentition, maxillary teeth
are labial or buccal to mandibular teeth.
♦♦ Angulations: Permanent teeth will have buccolingual and
mesiodistal angulations.
♦♦ Occlusion: With exception of mandibular central incisors
and maxillary third molars, each permanent tooth occludes
with two teeth.
♦♦ Arch curvature:
• Anteroposterior curvature in mandibular arch is
known as curve of Spee
• Corresponding curve in maxillary arch is known as
compensating curve.
• Buccolingual curvature from one side to other side is
known as Monson’s curve.
♦♦ Overbite: It is normal, i.e. 1 to 2 mm.
♦♦ Overjet: It is 1 to 3 mm.
♦♦ Molar relationship: Mesiobuccal cusp of permanent
maxillary first molar occludes in mesiobuccal groove of
permanent mandibular first molar.
616 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
Q.15. Define occlusion. What is key of occlusion.
 (Apr 2017, 5 Marks)
Ans. Occlusion is defined as the “static and dynamic contact
relationship between the occlusal surface of teeth during
function” Glossary of prosthodontic terminology (GPT).
For Key of occlusion refer to Ans 13 of same chapter.
Q.16. Write a short note on types of dentition. Add a note on
Leeway space of Nance. (Sep 2017, 3 Marks)
Ans. Types of dentition
Humans consist of three types of dentition, i.e. primary,
mixed/transitional and permanent dentition.
Primary Dentition
Tooth start to erupt in oral cavity from 8 months and complete
by 30th month after birth when primary molars are in occlusion.
Once the primary dentition is established there are no significant
changes occur intraorally during primary dentition. There are
all over 20 deciduous teeth present.
Mixed or Transitional Dentition
This period starts from 6 years of age and last till 12 years of
age. It is a transition stage when primary teeth are exfoliated
in a sequential manner, followed by the eruption of their
permanent successors. In first transitional period, eruption of
permanent first molars and replacement of primary incisors by
the permanent incisors occur. The second transitional period
involves replacement of the primary molars and canines by the
permanent premolars and canine; respectively, and emergence
of second permanent molars.
Permanent Dentition
This stage is established by about 12 to 14 years of age excluding
the third molars.
For note on leeway space of Nance refer to Ans 5 of same
chapter.
Q.17. Define occlusion. Discuss molar relation, overjet and
overbite in permanent dentition. (May 2018, 3 Marks)
Ans. Occlusion is defined as the “static and dynamic contact
relationship between the occlusal surface of teeth during
function” Glossary of prosthodontic terminology (GPT)
For overjet and overbite refer to Ans 6 of same chapter
Molar Relation in Permanent Dentition
Molar relation of permanent teeth can be Class I, Class II or
Class III as described by Angle. Key teeth for this classification
are permanent first molars.
Class I Relation
♦♦ The mesiobuccal cusp of the maxillary first permanent
molar falls within the groove between the mesial and
middle cusps of the mandibular first permanent molar.
♦♦ The distal surface of the distal marginal ridge of the max-
illary first permanent molar contacts and occludes with
the mesial surface of the mesial marginal ridge of the
mandibular second permanent molar.
♦♦ The mesiolingual cusp of the maxillary first permanent
molar seats in the central fossa of the mandibular first
permanent molar.
♦♦ This is the normal molar relation.
Class II Relation
♦♦ In this mesiobuccal cusp of maxillary first molar is aligned
directly over embrasure area between mandibular second
premolar and first molar.
♦♦ Distobuccal cusp of maxillary first molar is in line with
mesiobuccal groove of mandibular first molar.
♦♦ Mesiobuccal cusp of mandibular first molar occludes
with the central fossa of maxillary first molar, while the
distolingual cusp of maxillary first molar occludes in the
central fossa area of mandibular first molar.
Class III Relation
♦♦ In this mandibular molars are mesial to maxillary molar as
compared to class I relation. So mesiobuccal cusp of maxil-
lary first molar is found to be situated over the embrasure
area between mandibular first and second molar.
♦♦ Distobuccal cusp of mandibular first molar is situated in
embrasure between maxillary second premolar and first
molar, whereas mesiolingual cusp of maxillary first molar
is situated in mesial pit of mandibular second molar.
Fig. 99  Molar relation in permanent dentition
Q.18. Write short answer on curve of S pee and curve of
Wilson. (Aug 2018, 3 Marks)
Ans. For curve of Spee refer to Ans 2 of same chapter.
For curve of Wilson refer to Ans 9 of same chapter.
13. REVIEW OF TOOTH MORPHOLOGY
Q.1. Describe and illustrate the status of dentition at the age
of 10 years. (Feb 2005, 1.5 Marks) (Sep 2007, 15 Marks)
 (Apr 2010, 15 Marks)
Or
A child of 10 years reports to you for examination.
Show with the help of diagram only the teeth which
are present in oral cavity and the teeth which will be
embedded in jaw with degree of calcification? 
 (Mar 2001, 15 Marks)
Ans. At 10 years it is a stage of late childhood. It is a school
stage.

Deciduous teeth present at the stage of 10 years:
1. Maxillary canine
2. Maxillary first molar
3. Mandibular first molar.
Fig. 100:  Dentition during 10 years of age
Permanent Dentition Present at the Stage of 10 Years
1. Maxillary and mandibular central incisor
2. Maxillary and mandibular lateral incisor
3. Maxillary and mandibular first molar.
The tooth of which crown formation is complete but with
calcification but root completion is not present.
1. Permanent maxillary and mandibular canine
2. Maxillary and mandibular first premolar
3. Maxillary and mandibular second premolar.
Q.2. Describe the status of dentition at the stage of 7 years.
 (Mar 2000, 15 Marks)
Ans. Age of 7 years is the stage of mixed dentition.
Deciduous dentition present at the stage of 7 years
1. Maxillary lateral incisor
2. Maxillary and mandibular canine
3. Maxillary and mandibular first molar
4. Maxillary and mandibular second molar.
Permanent maxillary dentition present at the age of 7 years
1. Central incisor: Eruption is started and root formation is
not completed.
2. Lateral incisor: It is embedded in the jaw, crown formation
and root formation is completed.
3. Canine: It is embedded in the jaw and root formation is
completed.
4. First and second premolar: Embedded in the jaw and root
is completed. Premolars erupt from the inner surface of
root of molars.
5. Molar does not consist of any deciduous predecessors, so
they are erupted directly from the dental lamina.
In first molar, the crown is completely erupted but the roots
are not completely formed.
Dental Anatomy 617
Permanent mandibular dentition present at the stage of 7 years
1. In mandible the central incisor completely erupts and the
root is completely formed.
2. Crown of lateral incisor is slightly erupted and root forma-
tion is incomplete.
3. Crown of canine is embedded in the jaw and root forma-
tion does not take place.
4. In first and second premolar crown formation is complete
but they are embedded in the jaw.
5. Crown formation of first molar is complete but the root
completion does not take place.
Fig. 101:  Dentition during 7 years of age
14. TEMPOROMANDIBULAR JOINT
Q.1. Write a short note on synovial joint. (Mar 2008, 2 Marks)
Ans. S ynovial joint is characterized by the presence of a
joint cavity filled with synovial fluid and is lined by the
synovial membrane which is enveloped by articular
capsule.
It permits free movement.
Components of Synovial Joint
1. Articular surface
2. Articular cartilage: It covers the articular surfaces
of articulating bone, made up of hyaline cartilage.
3. Synovial fluid: It is clear or pale yellow, viscous
fluid, slightly alkaline at rest.
- It maintains the nutrition of articular cartilage
- It provides lubrication to joint cavity to prevent
wear and tear.
4. Synovial membrane: It is a connective tissue
membrane, lines the fibrous capsule from inside. It
secretes synovial fluid and also liberates hyaluronic
acid.
5. Joint cavity: It accommodates the articular surfaces,
cartilage, synovial fluid and synovial membrane.
6. Capsule: It is fibrous capsule lined by synovial
membrane. It binds the articulating bones together.
618 Mastering the BDS Ist Year (Last 25 Years Solved Questions)
7. Articular disc or meniscus: A fibrocartilage disc
divides the joint, it increases the range of the
movement, e.g.
- Palanar joint: Joint between first rib and sternum.
- Hinge joint: Elbow, ankle and interphalangeal
joint.
- Condylar joint: Knee joint, temporomandibular
joint
- Saddle joint: Sternoclavicular, calcaneocuboid
joint
- Ball and socket joint: Hip joint, shoulder joint,
incudostapedius joint.
Q.2. Write a short note on components of TMJ. 
 (Nov 2010, 3 Marks) (Dec 2014, 2 Marks)
Or
Write briefly on components of TMJ.
 (Apr 2017, 2 Marks)
Or
Write a short note on anatomy of TMJ.
 (Sep 2017, 2 Marks)
Ans. Temporomandibular joint has two types of components:
1. Bone or hard tissue components
2. Soft tissue components.
Bone or Hard Tissue Components
The hard tissue components of TMJ are:
♦♦ Condyles of mandible: They are ovoid, convex pro-
cesses which are broader laterally and narrower medially.
Condyles are connected with the body of mandible by
narrow stalk on both the sides.
Fig. 102:  Components of temporomandibular joint
♦♦ Glenoid fossa of temporal bone: Articular surface of
temporal bone is situated on the inferior surface of squa-
mous part of temporal bone. It articulates with mandibular
condyle and is known as glenoid fossa.
♦♦ Articular eminence: It binds mandibular fossa anteriorly
and form anterior root of zygomatic process.
Soft Tissue Components
♦♦ Articular capsule: It is a thin part of dense cartilaginous
tissue which encloses joint cavity.
♦♦ Articular disc: It is a rough, oval, firm, thick plate of dense
fibrous cartilage which is located between condyle and
articulating surface of temporal bone. It divides joint into
superior and inferior compartments.
♦♦ Articular ligaments: TMJ has one major and three minor
ligaments. Temporomandibular is major ligament, while
sphenomandibular, stylomandibular and pterygoman-
dibular raphae are minor ligaments.
♦♦ Muscles: Muscle which is closest to the TMJ is lateral
pterygoid muscle. It helps in the protrusion of mandible.
Q.3. Enumerate the components of temporomandibular
joint. (Sept 2015, 2 Marks)
Ans. Following are the components of TMJ:
1. Bone or hard tissue components
a. Condyles of mandible
b. Glenoid fossa of temporal bone
c. Articular eminence
2. Soft tissue components
a. Articular capsule
b. Articular disc
c. Articular ligaments
d. Muscles.
Q.4. Write a short note on ligaments associated with tem-
poromandibular joint. (Aug 2016, 3 Marks)
Or
Answer in brief on ligaments of temporomandibular
joint. (May 2017, 2 Marks)
Ans.
Ligaments of Temporomandibular Joint
Following are the ligaments of temporomandibular joint:
Fibrous Capsule
♦♦ It is attached above to the articular tubercle, circumference
of mandibular fossa and squamotympanic fissure and
below the neck of mandible.
♦♦ It is loose above intra-articular disc and tight below it.
Temporomandibular Ligament or Lateral Ligament
♦♦ Temporomandibular ligament is a major ligament.
♦♦ It is the fan-shaped ligament which is present on the lateral
aspect of articular capsule.
♦♦ This ligament extends as thickening of capsule obliquely
in backward and downward direction from lateral aspect
of articular eminence to posterior part of condylar neck.
♦♦ This ligament has two parts, i.e. outer part and the inner
part.
♦♦ This ligament helps to prevent displacement of tempo-
romandibular ligament in both posterior and inferior
directions.
♦♦ Since temporomandibular joint is bilateral, temporoman-
dibular ligament prevent lateral displacement of one joint
and medial displacement of another joint.
Sphenomandibular Ligament
♦♦ Sphenomanbibular ligament is a minor ligament.
♦♦ This is a flat, thin band which is attached to the spine of
sphenoid bone above and to lingula of mandible to below.
 Dental Anatomy 619

♦♦ This ligament is the remnant of the dorsal part of Meckel’s Q.5. Draw well labeled diagram of TMJ. 
cartilage  (Jan 2018, 2 Marks)
♦♦ This ligament limits distension of mandible in inferior
Ans.
direction.

Fig. 104:  Well labeled diagram of TMJ

Q.6. Enumerate components of TMJ. Write about ligaments

and muscles of TMJ. (Sep 2018, 2 + 3 Marks)
Ans. Temporomandibular joint has two types of compo-
nents:
1. Bone or hard tissue components
Fig. 103:  Ligaments of temporomandibular joint
– Condyles of mandible
TMJ: Temporomandibular junction;TML: Temporomandibular
– Glenoid fossa of temporal bone
ligament; SML: Sphenomandibular ligament;
StML: Stylomandibular ligament – Articular eminence
2. Soft tissue components
Stylomandibular Ligament – Articular capsule
♦♦ Stylomandibular ligament is a minor ligament. – Articular disc
♦♦ It is the specialized band or free border of cervical fascia. – Articular ligaments
♦♦ It extends from apex of styloid process of temporal bone – Muscles
to posterior border of angle of mandible and ramus of For ligaments of TMJ refer to Ans 4 of same chapter.
mandible. Muscles of TMJ are the muscles of mastication. For details
♦♦ Along with the sphenomandibular ligament the stylo- refer to Ans 1 of chapter MASTICATION in Section ORAL
mandibular ligament limit excessive opening of mandible. PHYSIOLOGY.
620 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

MULTIPLE CHOICE QUESTIONS

As per DCI and Examination Papers 1 Mark Each
of Various Universities

1. Oblique ridge of maxillary Ist molar connects: 8. In FDI system of notation ‘64’ refers to:
a. Mesiobuccal to distopalatal a. Deciduous maxillary right first molar
b. Mesiopalatal to distobuccal cusp b. Deciduous maxillary left first molar
c. Mesial to distal cusp c. Deciduous mandibular right first molar
d. None of the above d. Deciduous mandibular left first molar
2. Elevation on the teeth surface are: 9. Acute angled cusps in permanent maxillary first molar
a. Cusp and ridge are:
b. Fossa and groove a. Distobuccal and mesiolingual
c. Both a and b b. Mesiobuccal and distobuccal
d. None of the above c. Mesiobuccal and distolingual
3. Eruption age of permanent maxillary canine is: d. Mesiolingual and distolingual
a. 9–10 years 10. For speech the essential component is:
b. 8–9 years a. Inspired air
c. 11–12 years
b. Expired air
d. 12–13 years
c. Heart beats
4. In ideal intercuspation, maxillary canine articulate d. Temperature
with:
11. All anterior teeth are formed by:
a. Mandibular canine and Ist premolar
a. 1 developmental lobe
b. Mandibular canine and lateral incisor
b. 2 developmental lobes
c. Mandibular Ist and 2nd premolar
c. 3 developmental lobes
d. Mandibular canine only
d. 4 developmental lobes
5. Cusp of Carabelli is seen on:
12. The first succedaneous tooth to erupt in oral cavity is:
a. Mandibular premolar
b. Mandibular canine a. Maxillary central incisor
c. Mandibular Ist molar b. Mandibular central incisor
d. Maxillary Ist molar c. Mandibular first molar
d. Mandibular canine
6. Eruption age of permanent maxillary central incisor is:
a. 6–7 years 13. Mesial contact area of permanent canine is at:
b. 7–8 years a. Middle third
c. 8–9 years b. Junction of incisal and middle third
d. 10–11 years c. Junction of middle and cervical third
d. None of the above
7. Curve passing through buccal and lingual tip of man-
dibular buccal teeth: 14. Mandibular first premolar erupts between:
a. Wilson curve a. 9–10 years
b. Curve of Spee b. 8–9 years
c. Monsoon curve c. 10–12 years
d. Anti-monsoon curve d. 11–12 years

Answers: 1. b 2. a 3. a 4. a
5. d 6. b 7. a 8. b
9. d 10. b 11. d 12. c
13. b 14. c
 Dental Anatomy 621

15. Which of the following are the functions of contact 22. The permanent mandibular second molar occludes
area? with:
a. Distribution of occlusal stresses a. Maxillary 1st and 2nd molar
b. Protection of periodontium b. Maxillary 2nd premolar and 1st molar
c. Stabilization of dental arches c. Maxillary 2nd and 3rd molar
d. All of the above d. Maxillary 1st and 2nd premolars
16. In FDI system of notation ‘45’ refers to: 23. Muscles of mastication are supplied by:
a. Permanent maxillary right second premolar a. First part of maxillary artery
b. Permanent maxillary left second premolar b. Facial artery
c. Permanent mandibular right second premolar c. Third part of maxillary artery
d. Permanent mandibular left second premolar d. Second part of maxillary artery
17. Major fossae on occlusal surface of permanent maxil- 24. Anterior marginal articular disc and capsule of TMJ is
lary first molar are: the site of insertion for:
a. Mesial and distal triangular fossa a. Masseter
b. Central and distal fossa b. Temporalis
c. Distal and distal triangular fossa c. Medial pterygoid
d. Central and mesial fossa d. Lateral pterygoid
18. In all of the following teeth mesial slope of buccal cusp 25. Lingual cusp of premolar develops from:
is shorter than distal slope except: a. Mesial lobe
a. Permanent mandibular canine b. Distal lobe
b. Mandibular first premolar c. Middle lobe
c. Maxillary second premolar d. Lingual lobe
d. Maxillary first premolar 26. Curve of spee touches each cusp and incisal edges to
19. Which of the following permanent tooth is bilaterally confirm to a segment of:
symmetrical when viewed from incisal aspect? a. Ellipse
a. Mandibular lateral incisor b. Square
b. Mandibular canine c. Sphere
c. Mandibular central incisor d. Rectangle
d. Maxillary central incisor 27. As compared to permanent dentition the pulp horn
20. The crown of primary upper second molar has: and chambers in deciduous teeth are:
a. 2 cusps a. High and small
b. 3 cusps b. High and large
c. 4 cusps c. Low and small
d. 5 cusps d. Low and large
21. Mesiolingual groove is seen in: 28. Teeth that have no distal contact are:
a. Maxillary 1st premolar a. Central incisor
b. Mandibular 1st premolar b. Deciduous canine
c. Maxillary 2nd premolar c. Permanent third molar
d. Mandibular 2nd premolar d. Both b and c

Answers: 15. d 16. c 17. b 18. d

19. c 20 d 21. b 22. a
23. d 24 d 25. d 26. c
27. b 28 c
622 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

FILL IN THE BLANKS

As per DCI and Examination Papers 1 Mark Each
of Various Universities

1. Junction of three surfaces of tooth is called as……………. 4. Eruption of primary tooth starts off……………………
Ans. Point angle Ans. At 6 months
2. Lingual lobe of an anterior tooth is known as……………
5. Principle jaw opening muscle is…………………………
Ans. Cingulum
Ans. Digastric muscle
3. Number of roots and root canals in permanent man-
dibular first molar is…………….
Ans. Two roots and three canals
 Dental Anatomy 623

VIVA-VOCE QUESTIONS FOR

PRACTICAL EXAMINATION

1. Name the system which is acceptable to computer
languages.
Ans. Universal system
2. Two digit system for primary or permanent dentition
is also known as.
Ans. FDI system
3. Who had proposed two digit system?
Ans. Dederation dentaire internationale
4. Name the linear elevation on the surface of a tooth.
Ans. Ridge
5. Which type of ridge descends from the tips of the cusps
of molars and premolars towards the central part of the
occlusal surface?
Ans. Triangular ridge
6. Which ridge is formed by the union of the triangular
ridge of the distobuccal cusp and the distal cusp ridge
of the mesiolingual cusp of maxillary molar?
Ans. Oblique ridge
7. Which is the one of the primary sections of formation
in the development of the crown?
Ans. Lobe
8. Which angle is formed by the junction of two surfaces?
Ans. Line angle
9. Which angle is formed by the junction of three surfaces?
Ans. Point angle
15. When does calcification of primary dentition begins.
Ans. 13 to 16 weeks
16. How much time does permanent tooth take for com-
plete formation?
Ans. 8 years
17. What is the sequence of permanent teeth eruption?
Ans. 6 – 1 – 2 – 4 – 3 – 5 – 7 – 8
18. In how much time does transition from primary to
permanent dentition begins?
Ans. 6 years
19. Who described the formation of permanent teeth oc-
curring in cluster?
Ans. Schour and Massaler
20. Which is the first tooth of the permanent dentition to
emerge through the gingiva?
Ans. First molar
21. Name other synonyms of primary teeth.
Ans. Deciduous, milk, temporary, baby
22. Name the tooth which is unique in that it has a crown
form unlike that of any permanent tooth?
Ans. Deciduous mandibular molar tooth
23. In which dentition the crowns of anterior teeth are
wider mesiodistally in comparison with their crown
lengths.
Ans. Deciduous dentition

10. Who had given the specifications used for carving 24. In which tooth mesial slope of the cusp is longer than
individual teeth for the permanent dentition. the distal slope.
Ans. GV Black Ans. Canine

11. Who had given the dental age assessment based on the 25. How is the cusp of the primary canine as compared to
basis of the number of teeth at each chronological age? permanent canine?
Ans. Demerjian Ans. Long and sharp

12. Who had given dental age assessment based on the 26. From the incisal aspect the crown of which tooth is
stages of formation of crowns and roots of teeth? diamond shaped.
Ans. Smith Ans. Primary canine

13. Who had given dental age assessment in the mixed
dentition based on the amount of resorption of roots
of primary teeth and amount of development of per-
manent teeth?
Ans. Proffit
14. Who had mentioned that tooth formation that may be
divided approximately into a number of stages that
covers continuously the development of teeth?
Ans. Nolla
27. Where does the bifurcation of the roots of the primary
first molar begins.
Ans. Cervical line
28. Which cusp of the maxillary first molar is most promi-
nent longest and sharpest?
Ans. Maxillary first deciduous molar
29. Crown of which primary molar resembles a permanent
maxillary premolar.
Ans. Maxillary first deciduous molar
624 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

30. Name the primary tooth which resembles the perma- 46. When does first evidence of calcification of maxillary
nent maxillary first molar. lateral incisor occurs.
Ans. Primary second molar Ans. 1 year
31. Name the tooth on which cusp of Carabelli’s of the 47. Which is the smallest tooth in the dental arch?
deciduous dentition is present. Ans. Mandibular central incisor
Ans. Primary maxillary second molar 48. When does first evidence of calcification of mandibular
32. Name the tooth who has a sharp and prominent me- central incisor occurs.
siolingual cusp which is almost entered lingually but Ans. 3 to 4 months
in line with the mesial root. 49. Which is the longest tooth in the mouth?
Ans. Primary first mandibular molar Ans. Maxillary canine
33. Name the largest cusp of the primary mandibular first 50. When does the first evidence of calcification of maxil-
molar. lary canine occur.
Ans. Mesiolingual Ans. 4 to 5 months
34. When the maxillary and mandibular primary teeth 51. When does the root completion of maxillary canines
occlude all the teeth occlude with two teeth in the op- occur.
posite jaw. Name the teeth which do not occlude with
Ans. 12 to 14 years
two teeth.
Ans. Mandibular central incisor and maxillary second molar 52. Name the anterior tooth most likely to have a bifurcated
root.
35. At what age does the separation of primary anterior Ans. Mandibular canine
teeth due to growth of the jaws is usually seen?
Ans. 4 to 5 years 53. When does the enamel completion of maxillary first
premolar occur.
36. Who had described the arrangement of natural teeth? Ans. 5 to 6 years
Ans. Graf von Spee
54. Name the distinguishing feature between the first and
37. In which animal triangular stage or tritubercular molars second maxillary premolar from the mesial aspect and
are seen. is present on the first premolar.
Ans. Dogs Ans. Mesial developmental groove
38. In whom quadritubercular molar are seen? 55. When does the first evidence of calcification of maxil-
Ans. Humans lary second premolar occur.
39. Which is the only tooth which is wider lingually than Ans. 2 to 2.5 years
buccally? 56. Name the largest tooth in the maxillary arch.
Ans. Maxillary first molar Ans. Maxillary first molar
40. Which is the most prominent teeth in the mouth? 57. Name the tooth which is considered to be the corner
Ans. Maxillary central incisor stone of the dental arches.
41. Which is the widest teeth mesiodistally among the Ans. First molars
anteriors? 58. Which root is the longest in the maxillary first molar
Ans. Maxillary central incisor tooth?
42. When does the first evidence of calcification of maxil- Ans. Lingual root
lary central incisor occur. 59. Which cusp is the smallest in the maxillary first molar
Ans. 3 to 4 months tooth?
43. When does enamel completion of the maxillary central Ans. Distobuccal root
incisor occur. 60. The cusp of Carabelli is usually found lingual to which
Ans. 4 to 5 years cusp of the maxillary first molar.
44. When does the root completion of maxillary central Ans. Mesiopalatal cusp
incisor occurs. 61. When does the enamel completion of maxillary first
Ans. 10 years molar occur.
45. Name the tooth that varies in form more than any other Ans. 3 to 4 years
tooth in the mouth with the exception of third molar. 62. When does root completion of maxillary first molar occur?
Ans. Lateral incisor Ans. 9 to 10 years
 Dental Anatomy 625

63. Name the tooth in the maxillary arch in which the 77. How mandibular canal is directed?
crown is wider mesially then distally and wider lin- Ans. Upward, backward and laterally
gually than buccally.
78. Name the triangular shallow fossa which lies posterior
Ans. Maxillary first molar
to the third molar.
64. The maxillary molar primary cusp triangle supposition Ans. Retromolar triangle
follows which of the hypothesis of tooth origin.
Ans. Cope-Osborn 79. What is the another name for discomalleolar ligament?
Ans. Pinto's ligament.
65. During what age root completion of the maxillary
second molar gets completed. 80. Name the otomandibular ligaments which connect the
Ans. 14 to 16 years middle ear and the temporomandibular joint.
Ans. Discomalleolar ligament and temporomandibular
66. During which age the first evidence of calcification of
ligament
maxillary third molar occurs.
Ans. 7 to 9 years 81. What does pantograph and kinesiograph used to record?
Ans. Mandibular movements
67. What is the shape of mandibular first molar when seen
from the occlusal aspect? 82. How much is the maximum opening of the TMJ?
Ans. Hexagonal Ans. 50 to 60 mm.
68. How is the form of mandibular first molar from buccal 83. How much is the maximum lateral opening in the
aspect? absence of TMJ muscle dysfunction?
Ans. Trapezoidal Ans. 10 to 12 mm.
69. Who had given the morphological categories used to 84. How much is the maximum protrusive movement?
describe the occlusal surfaces of mandibular molar Ans. 8 to 11 mm
which are based upon a topology?
Ans. Gregory and Hellman 85. Which of the two muscles partly cover the masseter
muscle?
70. What is the other name of maxillary sinus?
Ans. Platysma and risorius
Ans. Antrum of Highmore
86. Name the muscle which is the principle positioner of
71. Major portion of the canine fossa is directly above the
the mandible during elevation.
roots of which tooth.
Ans. Temporalis
Ans. Premolar
87. At what age group function occlusion is common?
72. Name the muscle whose some of the fibers originate
from maxillary tuberosity. Ans. Above age of 30 years
Ans. Medial pterygoid 88. If all of the teeth get extracted what happens to centric
73. Which are the two canals which open laterally into the occlusion.
incisive foramen. Ans. Centric occlusion gets lost
Ans. Foramina of Stensen and Foramina of Scarpa. 89. Name the tooth which consists of palatogingival
74. Name the structure to whom foramen of stensen accom­ groove.
modates. Ans. Maxillary lateral incisor
Ans. Nasopalatine nerves and vessels 90. If any of the molar has no occluding teeth, what is the
75. Which is the heaviest and strongest bone of the head? effect on its position.
Ans. Mandible Ans. It get extruded
76. Name the structure present between the condyle and 91. Name the teeth which most commonly show morpho-
the coronoid process. logical variations.
Ans. Mandibular notch Ans. Lateral incisors
626 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Additional Matter
Various Types of Dentitions Contd...

Type of dentition Meaning Longest crown present in the mandibular Mandibular canine
arch or the longest crown present inside (11 mm)
Monophyodont In this there is presence of one set of dentition
the oral cavity
for the entire life
Diphyodont In this there is presence of two sets of Maximum root length present inside Maxillary canine
dentition, e.g. humans maxillary arch or longest root present (17 mm)
inside the oral cavity
Polyphyodont In this there is presence of greater than two
sets of dentition Maximum root length present inside Mandibular canine
mandibular arch (16 mm)
Homodont In this all teeth have same without any
distinction such as central incisor or lateral Shortest tooth of all the dentition Maxillary second molar
incisor or premolars or molars or shortest tooth present inside the (6.5 + 11 mm)
maxillary arch
Heterodont In this, there is presence of various different
groups of teeth Shortest tooth present inside mandibular Second molar
Bunodont This dentition consists of various primitive arch (7 + 13 mm)
types of teeth which are seen in primates such Shortest crown present dentition or Maxillary second molar
as dogs, cats etc shortest crown present in the maxillary (6.5 mm)
Haplodont They are simplest cone form of teeth with arch
single root, e.g. crocodile Shortest crown present in mandibular Second molar
Triconodont This dentition is present in early mammals. In arch (7 mm)
this three of the cusps are arranged in line with Shortest root present in maxillary arch or Maxillary second molar
the largest cusp in center shortest root in oral cavity (11 mm)
Tritubercular In this three of the cusps are arranged in form Shortest root present in mandibular arch Central incisor
stage of triangle (12.5 mm)
Quadritubercular In this there is formation of the fourth cusp
Largest mesiodistal diameter of crown Maxillary central incisor
stage and an occlusal contact relationship between
present in anterior teeth
maxilla and mandible is established
Largest mesiodistal diameter of crown Mandibular first molar
Various Teeth Along with the Shapes of their Occlusal present in oral cavity
Surfaces Largest labiolingual diameter of crown Maxillary canine
present inside the anterior teeth
Shape of the occlusal
Largest labiolingual diameter of crown Maxillary first molar
Name of the tooth surface
present inside the oral cavity
Permanent maxillary first premolar Hexagonal
Largest mesiodistal diameter present Mandibular second
Permanent mandibular first premolar Diamond inside the deciduous dentition molar
Permanent mandibular second premolar Square Largest buccolingual diameter present Maxillary second molar
inside the deciduous dentition
Permanent maxillary first molar and Rhomboidal
deciduous maxillary second molar First succedaneous tooth which erupt in Mandibular central
oral cavity incisor
Permanent maxillary second molar Rhomboidal having more
obtuse angles First non-succedaneous tooth to erupt in Mandibular first molar
oral cavity
Permanent maxillary third molar Heart shape
Last succedaneous tooth to erupt in oral Maxillary canine
Permanent mandibular first molar Hexagonal/trapezoidal
cavity
Deciduous maxillary first molar Rectangular

Important Points to be Remember Various Teeth and their Lobes

Longest tooth present in the oral cavity • Maxillary canine
(10 + 17 mm)
• Mandibular canine
(11 + 16 mm)
Longest crown present in the maxillary Central incisor
arch (10.5 mm)
Name of teeth Lobes present
Permanent incisors 4
Permanent canines
Permanent premolars
Three cusp type mandibular second premolar 5

Contd... Contd...

Contd...
Name of teeth
Permanent maxillary first molar and
permanent mandibular first molar
Deciduous maxillary second molar and
deciduous mandibular second molar
Various other permanent molars
Deciduous incisors
Number of Line Angles and Point Angles in Various
Cavities
Total number of
Type of the cavity point angles
Type I
Type II
Type III
Type IV
Type V
Type VI
MOD
Various Developmental Grooves
Name of the tooth
Maxillary lateral incisor
Mandibular first premolar
Maxillary first premolar
Mandibular central incisor
Mandibular central incisors,
maxillary canines and Mesial root
of mandibular first molar
Maxillary first molar
Palatal root of maxillary first molar
Total number of occlusal contact
points present in dentition
Lobes present
5 Triangular and wedge shaped
5 Trapezoid with longest
4
1 Trapezoids with shortest
Total number of
line angles
4 8
6 11
3 6
6 11
4 8
Varies — • Permanent molars erupt in Angle’s class I occlusion
8 14
Grooves
It consists of palatogingival
groove which extends from
enamel to the cementum
of root
It consists of mesiolingual
developmental groove
It consists of mesial marginal
developmental groove
It also consists of deep
concavities on mesial
surface
It consists of maximum
numbers of developmental
grooves in its cingulum
Developmental depression
is seen on both mesial and
distal sides of root
It also consists of deep
concavities on distal surface
Largest root with facial and
lingual concavities
138
Dental Anatomy 627
About Geometric Lines
Geometric lines Position
Mesial and distal aspect of six
anterior teeth
• Labial and lingual aspect of six
uneven surface towards anterior teeth
occlusal or incisal surface • Buccal and lingual aspect of
posterior teeth
Proximal aspect of all maxillary
uneven surface towards posterior teeth
occlusal surface
Rhomboids Proximal aspect of all mandibular
posterior teeth
Baum’s Classification of Deciduous Molars
Flush • Distal surface of maxillary and mandibular second
terminal deciduous molars will erupt in single vertical plane
plane • Permanent molars erupt in flush or end on
relationship
Mesial • Distal surface of lower second deciduous molar is
step more mesial to distal surface of second deciduous
molar
Distal • Distal surface of mandibular second deciduous molar
step is distal to maxillary second deciduous molar
• Permanent molars erupt in Class II occlusion
Important Terms
Leeway space • This is the difference between total width of
primary canines and molars to total width of
permanent canine and premolars
• It is 1.8 mm in maxilla, i.e. 0.9 mm in each
side of arch
• It is 3.4 mm in mandible, i.e. 1.7 mm in each
side of arch
Group function It refer to multiple contact in lateral or eccentric
movements
Incisal guidance It refers to contact of anterior teeth during the
protrusive movements of the mandible
Supporting Lingual cusps of maxillary posterior teeth and
cusps buccal cusp of mandibular posterior teeth
Centric stop Areas of contact that a supporting cusp makes
with opposite teeth
Details About Various Angulations of Teeth
Anterior teeth with maximum Maxillary central incisor, i.e. 28°
faciolingual inclination
Anterior teeth with minimum Mandibular canine, i.e. 12°
faciolingual inclination
Posterior teeth with maximum Mandibular second molar, i.e. 20°
faciolingual inclination
Contd...
628 Mastering the BDS Ist Year (Last 25 Years Solved Questions)

Contd... In Mandibular Teeth

Posterior teeth with minimum Maxillary first premolar, i.e. 5° Name of the
faciolingual inclination tooth Mesial contact area Distal contact area
Anterior teeth with maximum Maxillary canine, i.e. 17° Central incisor Incisal third Incisal third
mesiodistal inclination
Lateral incisor Incisal third Incisal third
Anterior teeth with minimum Mandibular lateral incisor, i.e. 0°
mesiodistal inclination Canine Incisal third Cervical to junction of
Posterior teeth with maximum ° incisal and middle third
Mandibular second molars, i.e. 14
mesiodistal inclination Premolar Junction of occlusal Junction of occlusal
Posterior teeth with minimum Maxillary second premolar, i.e. 5 ° and middle third and middle third
mesiodistal inclination First molar Centre of middle third Centre of middle third
of crown of crown
Various Contact Areas Second and Centre of middle third Centre of middle third
third molar of crown of crown
In Maxillary Teeth

Name of the tooth Mesial contact area Distal contact area

Movements of Temporomandibular Joint
Central incisor Incisal third Junction of incisal
and middle third Name of the movement Action
Lateral incisor Junction of incisal Middle third Gliding movement Protrusion
and middle third
Hinge movement Slight opening of mouth
Canine Junction of incisal Middle third
and middle third Hinge movement followed • Wide opening of mouth
by gliding • At the time of opening of mandible
Premolars Cervical to junction of Cervical to junction
from the retruded contact position
occlusal and middle of occlusal and
third middle third Only hinge movement Movement from the retruded contact
First molar Cervical to junction of Middle third position till terminal hinge axis
occlusal and middle Head of unilateral side Chewing movement
third glide forwards and head of
Second and third Middle third of crown Middle third of crown contralateral side rotates
molar in vertical axis
 8
SECTION

Dental Histology

1. Development of Face and Oral Cavity 12. Shedding of Deciduous Teeth

2. Development and Growth of Teeth 13. Temporomandibular Joint
3. Enamel 14. Maxillary Sinus
4. Dentin 15. Histochemistry of Oral Tissues
5. Pulp
Multiple Choice Questions as per DCI and
6. Cementum
Examination Papers of Various Universities
7. Periodontal Ligament
Fill in the Blanks as per DCI and Examination
8. Alveolar Process
Papers of Various Universities
9. Oral Mucous Membrane
10. Salivary Gland Viva-voce Questions for Practical Examination

11. Tooth Eruption Additional Matter


1. DEVELOPMENT OF FACE
AND ORAL CAVITY
Q.1. Write short note on development of palate.
 (Aug 2012, 5 Marks) (Mar 2013, 3 Marks)
Ans. Palate develop from first pharyngeal arch and frontonasal
process.
• Palate is formed from three components, i.e.
a. The two palatal process: Palate like shelf grow
from the maxillary process
b. Primitive palate is formed from the frontonasal
process.
• Definitive palate is formed by the fusion of these
three parts as follows:
a. Each palatal process fuses with the posterior
margin of primitive palate.
b. Two palatal process fuse with each other in the
midline.
c. Medial edge of the palatal process fuse with
the free lower edge of the nasal septum thus
separating the two nasal cavity from each other
and from the mouth.
- At the later stage the mesoderm in the palate
undergoes intramembranous ossification to
form the hard palate.
- Ossification does not take place in the posterior
part which remains as the soft palate.
Fig. 1:  Palate after ossification
Q.2. Write short note on development of mandible.
 (Oct 2016, 3 Marks)
Ans.
♦♦ On the lateral aspect of Meckle’s cartilage, during sixth
week of embryonic development, a condensation of
mesenchyme occurs in the angle formed by the division
of the inferior alveolar nerve and its incisor and mental
branches.
♦♦ At 7th week, intramembranous ossification begins in this
condensation, forming the first bone of the mandible.
♦♦ From this center of ossification, bone formation spreads
rapidly anteriorly to the midline and posteriorly toward
the point where the mandibular nerve divides into its
lingual and inferior alveolar branches.
♦♦ Spread of new bone formation occurs anteriorly along the
lateral aspect of Meckle’s cartilage, forming a trough that
consists of lateral and medial plates that unite beneath
the incisor nerve.
♦♦ This trough of bone extends to the midline, where it comes
into approximation with a similar trough formed in the
adjoining mandibular process. The two separate centers of
ossification remain separated at the mandibular symphysis
until shortly after birth.
♦♦ The trough soon is converted into a canal as bone forms
over the nerve joining the lateral and medial plates.
♦♦ Similarly, a backward extension of ossification along the
lateral aspect of Meckel’s cartilage forms a gutter, and
converted into a canal that contains the inferior alveolar
nerve.
Fig. 2:  Development of mandible
♦♦ This backward extension of ossification proceeds in the
condensed mesenchyme to the point where the mandibular
nerve divides into the inferior alveolar and lingual nerves.
♦♦ From this bony canal, extending from the division of
the mandibular nerve to the midline, medial and lateral
alveolar plates of bone develop in relation to the forming
tooth germs so that the tooth germs occupy a secondary
trough of bone.
♦♦ This trough is partitioned, and thus the teeth come to
occupy individual compartments, which finally are
enclosed totally by growth of bone over the tooth germ.
In this way body of mandible is formed.
♦♦ Ramus of mandible develops by rapid spread of ossifi­
cation posteriorly into the mesenchyme of first arch,
turning away from Meckle’s cartilage.
♦♦ Thus by 10 weeks the rudimentary mandible is formed
almost entirely by membranous ossification.
632 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

♦♦ Further growth of mandible until birth is influenced ♦♦ Distal proliferation of dental lamina is responsible for
strongly by the appearance of three secondary cartilages, location of germs of permanent molars.
i.e. condylar cartilage, coronoid cartilage and symphyseal ♦♦ Successors of deciduous teeth develop from lingual
cartilage as well as the development of neural, alveolar and extension of free end of dental lamina opposite to enamel
muscular attachments. organ of each deciduous tooth.
♦♦ Dental lamina provides the arising of permanent molars
from its distal extension during development of jaws.
2. DEVELOPMENT AND Q. 3. Discuss and illustrate the various stages of development
GROWTH OF TEETH of tooth. (Sep 2002, 16 Marks)
Or
Q.1. Write a note on dental lamina.
 (Oct 2006, 2 Marks) (Apr 2007, 5 Marks) Describe process of development of tooth.
(Feb 2013, 5 Marks) (June 2010, 2 Marks)  (Sep 1999, 15 Marks) (Apr 2008, 15 Marks)
 (Oct 2008, 6 Marks)
Or
Or
Write short answer on dental lamina.
(May 2018, 3 Marks) Describe with diagram various stages of tooth
development. (Mar 2009, 5 Marks)
Ans. Dental Lamina
• Dental lamina is the band of the epithelium that has Or
invaded underlying ectomesenchyme along each of Explain various stages in development of tooth in detail
horse shoe shaped future dental arches. with suitable diagrams. (Feb 2016, 10 Marks)
• Dental lamina serves as primordium for ectodermal Ans. Tooth development is a continuous process. Following
portion of deciduous teeth. are the stages which take part in development of tooth.
• Later, during development of jaws primary molars
arise directly from distal extension of dental lamina.
Distal proliferation of dental lamina is responsible
for location of germs of permanent molars in ramus
of mandible and tuberosity of maxilla.
• Successors of deciduous teeth develop from lingual
extension or successional lamina of free end of dental
lamina opposite to enamel organ of each deciduous
tooth.
Q. 2. Describe development, function and fate of dental
lamina. (Sep 1997, 5 Marks) (Mar 2009, 5 Marks)
Ans. Development of Dental Lamina
Two or three weeks after the rupture of buccopharyn-
geal membrane, when the embryo is about six weeks
old, certain areas of basal cells of ectoderm proliferate
more rapidly than do cells of adjacent areas. This leads
to development of dental lamina.

Fate of Dental Lamina

♦♦ Total activity of dental lamina extend over the period
of 5 years. Any portion of dental lamina functions for
much briefer period elapses after initiation of tooth
development before dental lamina begins to degenerate at
that location.
♦♦ As the teeth continue to develop, they loose their Figs 3A to H:  Stages of tooth development
connection with dental lamina.
Bud Stage
♦♦ Remnants of dental lamina persist as epithelial pearls or
islands within the jaw as well as in gingiva. In bud stage the enamel organ consists of peripherally
located low columnar cells and centrally located polygonal
Functions of Dental Lamina
cells. Many cells of tooth bud and surrounding mesenchyme
♦♦ It serves as primordium for ectodermal portion of undergo mitosis. As the result of increased mitotic activity and
deciduous tooth. migration of neural crest cells into area of ectomesenchymal

condensation immediately subjacent to enamel organ is dental
papillae. The cells of dental papillae forms tooth pulp and
dentin. The condensed ectomesenchyme which surrounds
tooth bud and dental papillae is called as dental sac. The
cells in dental sac will form the cementum and periodontal
ligament.
Fig. 4:  Bud stage
(For colour version see Plate 20)
Cap Stage
♦♦ As the tooth bud proliferates it does not expand uniformly
into the larger sphere. The unequal growth in different
parts of tooth bud leads to cap stage which is characterized
by shallow invagination on deep surface of bud.
Fig. 5:  Cap stage
(For colour version see Plate 20)
♦♦ During cap stage the outer enamel epithelium consists of
peripheral cells which are cuboidal and cover convexity of
cap and are called as outer enamel epithelium.
♦♦ Cells in concavity of “cap” become tall columnar cell and
represent inner enamel epithelium.
♦♦ Outer enamel epithelium is separated from dental sac
while inner enamel epithelium from dental papilla by a
basement membrane.
Dental Histology  633
♦♦ Enamel organ may have a double attachment to the
overlying oral epithelium enclosing ectomesenchyme
known as enamel niche.
♦♦ Polygonal cells located in center of epithelial enamel organ,
between outer and inner enamel epithelia begin to separate
as more intercellular fluid is produced and form a cellular
network called as stellate reticulum. The stellate reticulum
is a cushion like consistency that may support and protect
the delicate enamel forming cells.
♦♦ Cells in centre of enamel organ are densely packed. These
cells form knob like extension which extends to underlying
dental papilla. This is known as enamel knot. Vertical
extension of enamel knot is known as enamel cord. As
enamel cord extends and meet outer enamel epithelium it
is known as enamel septum. Depression present at junction
of enamel septum and outer enamel epithelium is known
as enamel navel. Its shape is similar to shape of umbilicus.
Enamel knot and cord acts as reservoir of dividing cells
for growth of enamel organ. Enamel knot also plays an
important role as signaling center. It also determine the
shape of the tooth.
♦♦ Under organizing influence of proliferating epithelium
of enamel organ, the ectomesenchyme which is partially
enclosed by invaginated portion of inner enamel epithelium
proliferates. It condenses to form dental papilla, which is
formative organ of dentin and primordium of pulp.
♦♦ With the development of enamel organ and dental papilla
there is a marginal condensation in ectomesenchyme
surrounding enamel organ and dental papilla. The cells
of dental sac are important for the formation of cementum
and periodontal ligament.
Early Bell Stage
♦♦ As invagination of epithelium deepens and its margin
continues to grow, enamel organ assumes a bell shape.
♦♦ Junction of inner enamel epithelium and outer enamel
epithelium is known as cervical loop and is the area for
mitotic activity.
♦♦ Four different types of epithelial cells can be distinguished
on light microscopic examination of bell stage of enamel
organ. They are inner enamel epithelium, stratum
intermedium, stellate reticulum and outer enamel
epithelium.
♦♦ The inner enamel epithelium consists of single layer of
cells which differentiates to ameloblasts.
♦♦ Desmosomes connect inner epithelial cells with each other
and with the cells of stratum intermedium.
♦♦ A few layers of squamous cells form stratum intermedium
between inner enamel epithelium and stellate reticulum.
♦♦ Desmosomes and gap junction connect cells of stratum
intermedium to each other as well as to cells of inner
enamel epithelium and stellate reticulum.
♦♦ Cells of stratum intermedium are associated with protein
synthesis and transport of nutrients to ameloblasts.
Stratum intermedium regulates the formation of enamel.
♦♦ Cells of stellate reticulum are of star shaped, with long
processes which anastomose with those of adjacent cells,
634 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
outer enamel epithelium and stratum intermedium by
desmosomes.
♦♦ Stellate reticulum protect underlying inner enamel
epithelial cells.
♦♦ As a layer of dentin is laid down, inner enamel epithelial
cells cut off from their nutritional supply from dental
papilla. Before enamel formation begins stellate reticulum
disappears bringing capillaries closer in dental follicle close
to inner enamel epithelial cells for providing nutrition.
♦♦ Outer enamel epithelium has cuboidal cells which are
connected to adjacent cells by junctional complexes. As
stellate reticulum disappears before enamel formation, the
outer enamel epithelium is laid in folds. Between the folds
capillary loops provide rich nutritional supply for intense
metabolic activity of avascular enamel organ.
• Enamel organ of deciduous teeth in bell stage show
successional lamina and its permanent successor teeth
in bud stage.
• Invagination formed by enamel organ encloses dental
papilla. As inner enamel epithelium begins to form
enamel, the peripheral mesenchymal cells of dental
papilla differentiate in odontoblasts. First these cells
form cuboidal form and later on columnar form and
are liable to form dentin.
• Basement membrane separating enamel organ and
dental papilla before the formation of dentin is known
as membrane preformative.
• Dental sac show circular arrangement of fibers and
resembles as capsule.
Fig. 6:  Bell stage
(For colour version see Plate 20)
Advanced Bell Stage
♦♦ Advance bell stage usually is characterized by the
beginning of the mineralization and root formation.
♦♦ During advanced bell stage, boundary between inner
enamel epithelium and odontoblasts outline the future
DEJ.
♦♦ As odontoblasts start to differentiate they increase the
organic matrix of dentin along DEJ in region of future cusp.
♦♦ As first layer of dentin is laid down the short columnar
inner epithelial cells become functional ameloblasts, i.e.
become tall columnar cells which reverse their polarity.
♦♦ These ameloblasts produce organic matrix of enamel
against newly formed dentin. Matrix proceed pulpally
and apically and mineralizes later.
♦♦ This organic matrix mineralizes to form enamel.
♦♦ As enamel formation proceeds from dentinoenamel
junction towards outer surface, the ameloblasts move away
from dentin coronally and cervically.
♦♦ In addition the cervical portion of enamel gives rise to the
epithelial root sheath of Hertwig.
Fig. 7:  Advanced bell stage
(For colour version see Plate 20)
Q. 4. Write a short note on cap stage. 
 (Mar 2000, 5 Marks) (Feb/Mar 2004, 5 Marks)
(Nov 2009, 5 Marks) (Dec 2012, 3 Marks)
Or
Write short note on cap stage of odontogenesis.
(Sep 2017, 3 Marks)
Or
Draw neat and well labelled diagram for cap stage of
tooth development. (May 2018, 2 Marks)
Or
Write very short answer on cap stage.
 (Aug 2018, 2 Marks)
Ans. Refer to Ans 3 of the same chapter.
Q.5. Write a short note on bell stage. (Feb 2002, 5 Marks)
Or
Write briefly on bell stage. (Apr 2007, 5 Marks)
Ans. Refer to Ans 3 of the same chapter.
Q. 6. Write a short note on advanced bell stage of tooth
development.(Sep 1999, 5 Marks) (Nov 2008, 5 Marks)
 (Nov 2010, 3 Marks) (Aug 2011, 5 Marks)
Or
Write short note on advanced bell stage.
 (Apr 2015, 3 Marks)
 Dental Histology  635

Or
Describe advanced bell stage with well labelled
diagram. (Sep 2018, 3 + 2 = 5 Marks)
Ans. •  Advance bell stage usually is characterized by the
beginning of the mineralization and root formation.
• During advanced bell stage, the boundary between
inner enamel epithelium and odontoblasts outline
the future DEJ.
• As odontoblasts start to differentiate they increase
the organic matrix of dentin along DEJ in region of
future cusp. Matrix proceed pulpally and apically
and mineralises later.
• As first layer of dentin is laid down the short
columnar inner epithelial cells become functional Fig. 9:  Epithelial diaphragm (For colour version see Plate 21)
ameloblasts, i.e. become tall columnar cells which
reverse their polarity. • Inner enamel epithelial layer of root sheath influence
• These ameloblasts produce organic matrix of enamel formation of odontoblasts from outer portion of
against newly formed dentin. radicular dental papilla. These odontoblasts lead
• This organic matrix mineralizes to form initial layer to the formation of first layer of radicular dentin.
of enamel. • As the first layer of radicular dentin is laid down,
• As enamel formation proceeds from dentinoenamel Hertwig’s epithelial root sheath lost its continuity
junction towards outer surface, the ameloblasts and the cells of dental follicle or dental sac invade
move away from dentin coronally and cervically. double layer of Hertwig epithelial root sheath, root
• In addition the cervical portion of enamel gives rise sheath degenerates to form epithelial islands.
to the epithelial root sheath of Hertwig. • Now the root sheath move away and allow connective
tissue of dental follicle to come in contact with newly
formed radicular dentin. This causes differentiation
of cementoblasts from dental follicle which deposit
cementum on newly formed radicular dentin.
Q.8. Write a short note on enamel pearls. 
 (Feb 2002, 5 Marks)
Ans. If cells of epithelial root sheath remains adherent to dentin
surface, they may differentiate into fully functioning
ameloblasts and produce enamel, such droplets of enamel
are called as enamel pearls. They are sometimes found in
area of furcation of roots of permanent molars.

Fig. 8:  Advanced bell stage (For colour version see Plate 20)

Q.7. Write short note on Hertwig’s epithelial root sheath.

 (Mar 2001, 5 Marks) (Feb 1999, 5 Marks)
 (Sep 2005, 5 Marks) (Mar 2008, 2 Marks)
 (Oct 2014, 3 Marks)
Ans. •  Hertwig’s epithelial root sheath originates from the
cervical portion of enamel organ.
• It plays an important role in determining shape,
length, size and number of roots.
• It is a double layer of cells which consists of outer
enamel epithelium and inner enamel epithelium.
• Root sheath extend around dental papilla and
separate it from surrounding dental follicle all
through except the basal portion. Fig. 10:  Enamel pearl
636 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Q.9. Write a short note on ameloblasts.(Sep 1997, 5 Marks)
Ans. The inner enamel epithelium consists of single layer of
cells that differentiate prior to amelogenesis into tall
columnar cells called as ameloblasts.
Fig. 11:  Ameloblasts
(For colour version see Plate 21)
• These cells are also called as enamel forming cells.
They form unmineralized enamel.
• These cells are 4 to 5 micrometer in diameter and about
40 micrometer high.
• These elongated cells are attached to each other by
junctional complexes laterally and to cells in stratum
intermedium by desmosomes.
Q.10. Write a short note on early bell stage of tooth
development? (Feb/Mar 2006, 5 Marks)
Ans. Refer to Ans 3 of the same chapter.
Fig. 12:  Early bell stage
(For colour version see Plate 21)
Q.11. Enumerate the stages of tooth development. Draw
diagram of bud and cap stage of tooth development. 
 (Mar 2007, 4 Marks)
Ans. Refer to Ans 3 of the same chapter for stages of tooth
development.
Q.12. Enumerate the stages of tooth development. Write
about bud and early bell stage. (Sep 2007, 7.5 Marks)
Ans. Refer to Ans 3 of the same chapter.
Q.13. Write a short note on gubernacular canal.
 (Mar 2008, 2 Marks) (Dec 2010, 2 Marks)
 (Jan 2012, 2 Marks) (Feb 2013, 2 Marks)
Ans. Gubernacular canal may seen during the eruptive phase
of tooth eruption.
• In case of a tooth that replaces a deciduous tooth the
histological findings are slightly different.
• Dental follicle that surrounds the tooth is connected
to lamina propria of oral mucous membrane by a
strand of fibrous tissue called gubernacular cord.
• The cord of tissue is believed to be a remnant of the
dental lamina.
• When a dried skull is examined, holes are seen in
lingual aspect of deciduous tooth to accommodate
the gubernacular cord.
• These are gubernacular canals and act as pathways
for sucessional tooth to erupt.
• As the permanent tooth starts eupting through the
gubernacular canal, local osteoclastic activity is seen
around the canal to widen it so that tooth passes into
the oral cavity.
Fig. 13:  Gubernacular canal
Q.14. Enumerate morphologic and physiologic stages in
development of tooth. Describe bell stage in detail. 
 (Dec 2010, 10 Marks)
Or
Enumerate physiological and morphological stages in
development of tooth. Describe in detail bell stage of
development of tooth. (Dec 2014, 10 Marks)
Or
 Dental Histology  637

Enumerate morphological stages of tooth development. ♦♦ Histodifferentiation is observed during bell stage just
Describe bell stage in detail. (Aug 2012, 10 Marks) before formation and apposition of dentin and enamel.
Or ♦♦ At bell stage, the inner enamel epithelium influences
Enumerate physiological and morphological stages of adjacent cells of dental papilla which get differentiate into
development of tooth.  (July 2016, 3 Marks) odontoblasts. These odontoblasts laid down dentinal matrix.
♦♦ With formation of dentin cells of inner enamel epithelium
Ans. Morphologic Stages
differentiate into ameloblasts and enamel matrix is laid
• Bud stage down opposite to dentin.
• Cap stage ♦♦ Differentiation of epithelial cell proceed which is essential
• Early Bell stage for differentiation.
• Advanced Bell stage.
Physiologic Stages Morphodifferentiation
• Initiation ♦♦ Basic form and size of the future tooth, i.e morphology
• Proliferation of tooth is determined by morphodifferentiation or
• Histodifferentiation differential growth.
• Morphodifferentiation ♦♦ Dentinocemental junction and dentinoenamel junction
• Apposition. determine shape of crown and root.
For bell stage in detail refer to Ans 3 and Ans 6 of chapter ♦♦ Both the junctions get established before the formation
development of tooth. of hard tissue.
♦♦ As per the shape of dentinoenamel and dentinocemental
Q.15. Describe various morphological and physiologic stages
junction the ameloblasts, odontoblasts and cementoblasts
of tooth development. (Apr 2008, 15 Marks)
deposit enamel, dentin and cementum and thus provide
Ans. Morphologic Stages
the tooth its respective form and size.
• Bud stage
• Cap stage Apposition
• Early Bell stage
♦♦ Apposition refers to the deposition of matrix of dental
• Advanced Bell stage.
hard structures.
For morphologic stages in detail refer to Ans 3 of same ♦♦ This stage is characterized by certain periods of activity
chapter. and rest.
Ans. Physiologic Stages ♦♦ During appositional growth of enamel and dentin
• Initiation deposition of extracellular matrix occur in layers.
• Proliferation ♦♦ The stage consists of regular and rhythmic deposition of
• Histodifferentiation extracellular matrix which provides tooth its final shape.
• Morphodifferentiation Q.16. Write in brief on enamel knot and cord.
• Apposition.  (June 2010, 5 Marks)
Initiation Or
♦♦ Initiation of tooth development starts with beginning of Write about enamel knot, cord, septum and navel.
epithelial-ectomesenchymal interaction.  (Jan 2012, 5 Marks)
♦♦ Specific cells in horse shoe shaped dental lamina has Ans. Enamel knot: During cap stage, cells present in the centre
potential to form enamel organ of teeth by responding to of concavity of cap of enamel organ are densely packed.
the factors which induce tooth development. These cells form knob like extension which extends to
♦♦ Different teeth initiate at definite times. underlying dental papilla. This is known as enamel knot.
Enamel cord: Vertical extension of enamel knot is known
Proliferation as enamel cord.
♦♦ Initiation leads to the formation of enamel organ which Enamel septum: As enamel cord extends and meets outer
proliferates and the crown of tooth attain its final size as enamel epithelium it is known as enamel septum.
well as shape. Enamel navel: Depression present at junction of enamel
♦♦ Disturbance during proliferation stage produce entirely septum and outer enamel epithelium is known as enamel
different effects depending on the time and stage at which navel. Its shape is similar to shape of umbilicus.
disturbance occur. Enamel knot and cord acts as reservoir of dividing cells
for growth of enamel organ.
Histodifferentiation Enamel knot also plays an important role as signaling
♦♦ Cells continue to proliferate and undergo morphologic and center. It also determine the shape of the tooth.
functional changes. This is known as histodifferentiation. Enamel knot, cord, septum and naval are the transient
♦♦ During histodifferentiation, a cell loose some of its properties structures in tooth development or odontogenesis which
and restrict some of its functions and assume new function. disappears as enamel formation starts.
638 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Q.17. Write briefly on transient structures in odontogenesis.  Morphological stage Physiological stage
 (Aug 2012, 5 Marks) Dental Iamina Initation (of tooth germ)
Or Bud stage Proliferation (= cell division)
Write short note on transitory structures in tooth Cap stage Beginning of histodifferentiation
development. (Aug 2016, 3 Marks)
Bell stage Morphodifferentiation
Ans. Enamel knot, cord, septum and naval are the transient Histodifferentiation (prominent)
structures in tooth development or odontogenesis which
Early crown stage Apposition (formation of dentin and enamel)
disappears as enamel formation starts.
Late crown stage Continued apposition of dentin and enamel
For detail refer to Ans 16 of same chapter. (including enamel maturation)
Q.18. Enumerate stages of odonotgenesis and describe
advanced bell stage in detail. (Aug 2012, 10 Marks) For bell stage of development of tooth refer to Ans 3 and Ans
6 of same chapter.
Or
Enumerate various stages of tooth development. Q.20. Enumerate the morphological and histological stages
Describe in detail about advanced bell stage in detail. of development of tooth. Describe in detail about cap
 (Mar 2013, 8 Marks) and bell stage. Draw well labeled diagram of cap stage.
Ans. For enumeration of stage of odontogenesis refer to  (Sep 2015, 4 + 4 + 2 Marks)
Ans 14 of same chapter. Ans. Enumeration of morphological and histological stages
For description of advanced bell stage in detail refer to of tooth development
Ans 6 of same chapter.
Q.19. Corelate morphological and physiological stages of Morphological Stages
tooth development. Describe bell stage of development ♦♦ Bud stage
of tooth. (Feb 2014, 8 Marks) ♦♦ Cap stage
Ans. Both morphologic and physiological stages of tooth ♦♦ Early Bell stage
development take part in progressive development of ♦♦ Advanced Bell stage
teeth.
• The physiological stages overlap considerably Histological Stages
and many of physiological stages are continuous ♦♦ Initiation
throughout morphological stages of odontogenesis. ♦♦ Proliferation
• Initiation of tooth development starts with beginning ♦♦ Histodifferentiation
of epithelial-ectomesenchymal interaction. Specific ♦♦ Morphodifferentiation
cells in horse shoe shaped dental lamina have ♦♦ Apposition.
potential to form enamel organ of teeth by responding For cap and bell stages in detail refer to Ans 3 of same chapter.
to the factors which induce tooth development.
For diagram of cap stage refer to Ans 3 of same chapter.
• Proliferation results successively in bud, cap and
bell stages of tooth development. Any disturbance Q.21. Write short note on gubernacular cord.
in the proliferation will have effect on developed  (Apr 2015, 3 Marks)
tooth depending on the stage, i.e. bud, cap and bell Ans. Gubernaecular cord is also known as gubernaculum
at which the disturbance occur. dentis.
• Histodifferentiation is observed during bell stage • The fibrous extension of dental sac which connects
just before the formation of enamel and dentin the permanent tooth germ to oral mucosa is known
matrix. At bell stage, the inner enamel epithelium as gubernacular cord.
influences adjacent cells of dental papilla which get • Gubernacular cord is formed of fibrous tissue and
differentiate into odontoblasts. These odontoblasts may contain epithelial cells.
laid down dentinal matrix. With formation of • Gubernacular foramina are found lingual to anterior
dentin cells of inner enamel epithelium differentiate primary teeth and are the site of gubernacular cords
into ameloblasts and enamel matrix is laid down • It is also believed that gubernacular cord guides the
opposite to dentin. tooth in its eruptive movements.
• Morphodifferntiation is seen in bell stage and • After the eruption of deciduous teeth gubernacular
its peak activity is seen in advanced bell stage cord lie in the bony canals i.e. gubernacular canals.
as it provides basic form and size of the future For diagram refer to Ans 13 of same chapter.
tooth, i.e morphology of tooth is determined by
morphodifferentiation or differential growth. Q.22. Answer in brief stellate reticulum.
• Apposition refers to the deposition of matrix of  (Aug 2016, 2 Marks)
dental hard structures. The stage consists of regular Or
and rhythmic deposition of extracellular matrix Write very short answer on stellate reticulum.
which provides tooth its final shape.  (May 2018, 2 Marks)

Ans. Stellate reticulum is the layer of star shaped cells which
is present at center of enamel organ of cap and bell stage
of tooth development.
• Meaning of stellate is star shaped and meaning of
reticulum is branch like network.
• Cells of stellate reticulum are star shaped with long
processes that’s why it is known as stellate reticulum.
• These star shaped cells are connected to each other
and to cells of outer enamel epithelium and stratum
intermedium by the desmosomes.
• Stellate reticulum is a cushion like consistency
that may support and protect the delicate enamel
forming cells.
• As layer of dentin forms, inner enamel epithelial cells
deprive of nutritional supply from dental papilla.
• Stellate reticulum gets collapse before formation of
enamel during bell stage and bring capillaries in
dental follicle close to inner enamel epithelial cells
to provide nutrition.
Q.23. Define odontogenesis. Enumerate various physiological
stage of development of tooth. Describe advanced bell
stage with diagram. (Apr 2017, 1+2+5+2 Marks)
Ans. Odontogenesis: It is defined as complex process by
which tooth form from embryonic cells, grow and erupt
into the mouth or odontogenesis is defined as entire
process of tooth formation which include amelogenesis,
dentinogenesis and cementogenesis.
Enumeration of various physiological stages of
development of tooth.
• Initiation
• Proliferation
• Histodifferentiation
• Morphodifferentiation
• Apposition
For advance bell stage with diagram in detail refer to Ans 6 of
same chapter.
Q.24. Enumerate morphological stages of tooth development.
 (May 2017, 2 Marks)
Ans. Following are the morphological stages of tooth
development:
• Bud stage
• Cap stage
• Early bell stage
• Late bell stage.
Q.25. Write short answer on clinical consideration of
odontogenesis. (Aug 2018, 3 Marks)
Ans. Following is the clinical consideration of odontogenesis:
• Lack of initiation leads to the absence of either a
single tooth or multiple teeth, i.e. partial anodontia,
mainly the permanent lateral upper incisors, third
molars and lower second premolars are involved.
There can also be complete loss of all teeth, i.e.
anodontia. Moreover abnormal initiation can lead to
development of single or multiple supernumerary
teeth.
Dental Histology  639
• Teeth can develop in the abnormal locations, e.g.
in ovary or in hypophysis. In these mentioned
conditions tooth undergoes stages of development
similar to jaws.
• During vitamin A deficiency ameloblasts fail to
differentiate, since their organizing influence
over adjacent mesenchymal cells is disturbed and
osteodentin is formed.
• Various endocrine disturbances affect size or
form of crown of teeth if such effects occur in
morphodifferentiation, i.e. either in utero or in
first year of life. Size and the shape of root may be
altered by disturbances in later periods. Abnormal
curvatures in roots known as dilacerations can be
due to the trauma which is sustained at the time of
development of root.
• Disturbances during the morphodifferentiation can
affect form and the size of tooth without impairing
function of ameloblast or odontoblast. New parts
can be differentiated such as supernumerary cusps
or roots.
• Twinning, i.e. two similar teeth can be produced due
to splitting of one tooth germ.
• Fusion, i.e. teeth become fused which are produced
from two tooth germ joined together before
mineralization may occur.
• An abnormality in shape can lead to peg or
malformed tooth with enamel and dentin which are
normal in their structure.
• Peg shaped teeth or screw driver shaped tooth
with permanent maxillary central incisor showing
a notched incisal edge can be seen in individuals
born with congenital syphilis. This is also called as
hutchinson’s incisor.
• Various both genetic and environmental factors can
disturb normal synthesis and secretion of organic
matrix of enamel which lead to enamel hypoplasia.
• If organic matrix is normal but its mineralization
become defective, then enamel or dentin is
hypocalcified or hypomineralized. This occurs
because insult is produced to the cells which are
responsible for apposition stage of tooth development.
3. ENAMEL
Q.1. Mention physical and chemical properties of enamel.
Describe hypocalcifled structures of enamel.
 (Apr 2008, 5 Marks)
Ans. Physical Properties of Enamel
• On the cusps of human molars and premolars attain
a maximum thickness of about 2 to 2.5 mm.
• Because of its high content of mineral salts and their
crystalline arrangement enamel is highest calcified
tissue in the body.
• Structure and hardness of enamel render it brittle.
Specific gravity of enamel is 2.8.
640 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

• Enamel can act like a semi permeable membrane,

permitting complete or partial passage of certain
molecules.
• Color of enamel covered crown ranges from
yellowish white to grayish white.

Chemical Properties of Enamel

♦♦ Enamel consists 96% of inorganic and 4% of organic
substance and water.
♦♦ Enamel matrix mineralization begins immediately after
it is secreted. The enamel primary mineralization and
secondary mineralization increase mineral content in
relatively smooth curve.
♦♦ Chemical analysis of matrix of mature enamel indicate Fig. 14:  Enamel rods showing keyhole pattern
amino acid composition and is not closely related to keratin (For colour version see Plate 21)
and is different from collagen. Q.3. Write a short note on gnarled enamel. 
♦♦ Proteins can be isolated in several different functions, and  (Aug 2011, 2 Marks)
they contain generally high percentage of serine, glutamic Ans. •  G
 enerally rods are oriented at right angles to dentin.
acid and glycine. Near incisal edge or tips of cusps they change to an
♦♦ Enamel forming cells of developing teeth contain increasingly oblique direction until they are almost
polysaccharide-protein complex and an acid muco- vertical in region of edge or tips of cusps the rods
polysaccharide. are rarely straight. They follow a wavy course from
Answer of hypocalcified areas is given in Ans 11 of same dentin to enamel.
chapter. • The alternating clockwise and counterclockwise
deviation of rods from radial direction can be
Q.2. Write a short note on enamel rods.
observed at all levels of crown if discs are cut in
 (Sep 2017, 3 Marks) (Mar 2006, 5 Marks)
planes of general rod direction.
 (Apr 2010, 5 Marks) • If discs are cut in an oblique plane near dentin
Or in regions of cusps and incisal edges, the rod
Write short answer on enamel rods. (Aug 2018, 3 Marks) arrangement is more complicated.
Ans. Enamel Rods • Enamel rods forming the developmental pits and
• Enamel rods normally have a clear crystalline fissure on occlusal surface of molars and premolars,
appearance permitting light to pass through them. In converging in their outer course.
cross sections of human enamel, many rods appears
as fish scales.
• Number of enamel rods has been estimated as
ranging from 5 million in mandibular lateral incisors
to 12 million in maxillary first molars.
• Human enamel seems to contain rods surrounded
by rod sheaths and separated by inter-rod substance
following a pattern called as the key-hole pattern or
paddle shaped prism.
• When cut longitudinally section, pass through heads
or bodies of one row of rods and tails of adjacent
rows. Bodies of rods are nearer to the occlusal
and incisal surfaces where tail points cervically.
Generally rods are oriented at the right angles to Fig. 15:  Gnarled enamel (For colour version see Plate 21)
dentin surface. Near incisal edge or tip of cusps Q.4. Write a short note on enamel lamellae.
they follow oblique direction and vertical in region  (Mar 2000, 5 Marks) (Sep 1999, 5 Marks)
of edge or tips of cusps. (Aug/Sep 1998, 5 Marks) (Oct 2008, 2 Marks)
• Rods are rarely straight, they follow wavy course (May 2017, 3 Marks)
from dentin to enamel surface. Ans. Enamel Lamellae
• Change in direction of rods is responsible for • They are thin leaf like structures that extend from
appearance of Hunter-Schreger bands. These are enamel surface towards dentino enamel junction
alternating dark and light strips of varying width. (DEJ).
 Dental Histology  641

• They consist of organic material but with little

mineral content.
• Lamellae may develop in planes of tension, where
rods cross such a plane, a short segment of rod may
not fully calcify. If the disturbance is more severe a
crack may develop.
• If the crack occur in unerupted tooth or by organic
substances from oral cavity, if crack develop
after eruption, three types of lamellae can be
differentiated.
• Type A—Lamellae composed of poorly calcified
rod segments
• Type B—Lamellae consisting of degenerating cells
• Type C—Lamellae arising in erupted teeth where Fig. 17:  Enamel tuft
cracks are filled with organic matter, presumably (For colour version see Plate 22)
originating from saliva.
♦♦ Lamellae of Type A are restricted to enamel and of Type B Q.6. Write a short note on enamel lamellae and enamel tufts.
and Type C are restricted to the dentin.  (Sep 2003, 5 Marks)
♦♦ Lamellae extend in longitudinal and radial direction of Or
tooth from tip of crown toward cervical region. Write a note on enamel lamellae and enamel tufts.
♦♦ Enamel lamellae may be a site of weakness in tooth and
 (Oct 2006, 5 Marks) (Apr 2007, 5 Marks)
form a road of entry for bacteria and initiate caries.
Ans. The answer of enamel lamellae is given in answer no. 4
The answer of enamel tufts is given in answer no. 5
Q.7. Write a note on DEJ. 
 (Sep 1999, 3 Marks) (Apr 2010, 5 Marks)
Or
Write a short note on dentinoenamel junction. 
 (Mar 2008, 2.5 Marks)
Ans. DEJ appears as scalloped line. The convexities of scallop
are directed towards the dentin.
• Surface of dentin at DEJ is pitted. The pitted DEJ is
performed even before development of hard tissues
and is evident in arrangement of ameloblasts and
Fig. 16:  Enamel lamellae (For colour version see Plate 21) basement membrane of dental papillae.
• In microradiographs of ground sections a hypo
Q.5. Write a short note on enamel tufts. mineralized zone of 30 micrometre thickness
 (Mar 2001, 5 Marks) is sometimes demonstrated as DEJ. It is most
Or
prominent before mineralization is complete.
Answer in brief enamel tufts. (Aug 2016, 2 Marks) • DEJ has irregular shaped junction which provides
Ans. Enamel Tufts strength to the union in between enamel and dentin.
• They were so termed because they resemble tufts of
grass when viewed in ground section.
• An enamel tuft does not spring from a single small
area but is a narrow ribbon like structure the inner
end of which arises at dentin.
• Enamel tuft arises at DEJ and reach into enamel to
about 1/5 to 1/3 of the thickness.
• Tuft consists of hypocalcified enamel rods and intra-
prismatic substance.
• They extend in long axis of crown, so that they are
abundantly seen in horizontal and longitudinal
sections.
• Their presence and their development are consequence
of an adaptation to spatial condition in enamel. Fig. 18:  Dentinoenamel junction
642 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
• DEJ also prevent shearing of enamel while function­
ing.
• Scalloping of junction is seen more in occlusal
portion where masticatory stress are high.
Q.8. Write a short note on enamel organ. (Sep 1996, 5 Marks)
Ans. Enamel Organ
• The epithelial enamel organ originates from the
stratum epithelium of the primitive oral cavity.
• It has got four layers, i.e. outer enamel epithelium,
stellate reticulum, stratum intermedium and inner
enamel epithelium.
Outer Enamel Epithelium
♦♦ In the early stage of development of enamel organ the
outer enamel epithelium consists of a single layer of
cuboidal cells.
♦♦ Prior to the formation of hard structures, the regular
arrangement of outer enamel epithelium is maintained
only in the cervical part of the enamel organ.
♦♦ At the point of highest convexity of enamel organ cell of
the outer enamel epithelium are irregular in shape and
cannot be distinguish easily from the cells of outer portion
of stellate reticulum.
♦♦ Capillaries in the connective tissue surrounding the enamel
organ proliferate and protrude towards it.
Stellate Reticulum
♦♦ It is found between outer enamel epithelium and stratum
intermedium.
♦♦ It forms the middle part of enamel organ.
♦♦ Cells are star shaped with long processes.
♦♦ Cells are separated by intercellular substance.
♦♦ Structure of stellate reticulum renders it elastic and
resistant. It acts as buffer against physical forces.
♦♦ The size of stellate reticulum reduces in thickness to
decrease the distance between capillaries of dental sac
and ameloblasts.
Stratum Intermedium
♦♦ Cells of stratum intermedium are situated between the
stellate reticulum and inner enamel epithelium.
♦♦ These cells are flat to cuboid in shape.
♦♦ They are arranged in 1 to 3 layers. These cells contain
mitochondria, RER. Its function is unknown, but it is
believed that it playa role in production of enamel.
Inner Enamel Epithelium
♦♦ Cells of inner enamel epithelium are derived from the basal
cell layer of oral epithelium.
♦♦ The cells are tall, columnar and differentiates into
ameloblasts that produce enamel matrix.
Q.9. Describe life cycle of ameloblasts.
 (Mar 1998, 15 Marks) (Oct 2014, 8 Marks)
(Sep 2009, 15 Marks)
Or
Write in brief on life cycle of ameloblast.
 (Sep 2006, 5 Marks) (Nov 2008, 10 Marks)
(Aug 2011, 10 Marks)
Or
Write about life cycle of ameloblast.
 (Feb 2013, 10 Marks)
Or
Write short note on life cycle of ameloblasts.
 (Feb 2016, 3 Marks)
Ans. Life Cycle of Ameloblasts
There are six stages in life cycle of ameloblasts, namely:
1. Morphogenic
2. Organizing
3. Formative
4. Maturative
5. Protective
6. Desmolytic.
The differentiation of ameloblasts is most advanced
in region of incisal edges and tips of cusps. It is least
advanced in region of cervical loop.
Morphogenic Stage
♦♦ Ameloblasts interact between adjacent mesenchymal cells
which determine the shape of DEJ.
♦♦ During this stage, cells are short and columnar with large
oval nuclei which almost fill the cell body. Golgi apparatus
and centrioles are located in proximal end of cell and
mitochondria are dispersed in cytoplasm.
♦♦ During differentiation of ameloblasts, terminal bars appear
along with margin of mitochondria to basal region of cell.
♦♦ Terminal bars are points of close contact between cells.
Organizing Stage
♦♦ In this stage of development, inner enamel epithelium
interact with adjacent connective tissue cells which
differentiate to odontoblasts.
♦♦ This stage is characterized by change in appearance of cells
of inner enamel epithelium.
♦♦ Cells become longer and nucleus free zones and distal end
of cells become as long as proximal parts. During terminal
phase of organizing stage, the formation of dentin by
odontoblasts begin. The first appearance of dentin seems
to be critical phase in life cycle.
♦♦ As long as inner enamel epithelium is in contact with
connective tissue of dental papillae it receive nutrient
material from blood vessels of this tissue.
♦♦ When dentin forms it cut off ameloblasts from their original
source of nourishment. From then on they are supplied by
capillaries that surround and may penetrate inner enamel
epithelium.
♦♦ This reversal of nutritional source is characterized by
proliferation of capillaries of dental sac and by gradual
reduction and disappearance of stellate reticulum.
♦♦ Thus, distance between capillaries, stratum inter-medium
and ameloblasts layers shorten.
 Dental Histology  643

Fig. 19:  Life cycle of ameloblast

644 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Formative Stage
♦♦ Ameloblast enters formative stage after first layer of dentin
is formed.
♦♦ The presence of dentin is necessary for beginning of enamel
matrix formation.
♦♦ During formation of enamel matrix the ameloblasts retain
as same length and arrangement.
♦♦ There are changes in organization and number of
cytoplasmic organelles and inclusions which are related
to initiation of secretion of enamel matrix. The earliest
apparent change is development of blunt cell processes
on ameloblasts surface.
Maturative Stage
♦♦ Enamel maturation begins after most of thickness of
enamel has been formed in incisal and occlusal area. In
cervical parts of crown enamel matrix formation also
progresses at this time.
♦♦ During enamel matrix maturation these ameloblasts are
reduced in length and closely attached to enamel matrix.
♦♦ Cells of stratum intermedium use their cuboidal shape and
regular arrangement and assume spindle shape.
♦♦ During maturation the ameloblasts display microvilli at
distal extremities.
Protective Stage
♦♦ When the enamel is completely developed and fully
calcified the ameloblasts cease to be arranging in well
defined layer and can no longer be differentiated from
cells of stratum intermedium and outer enamel epithelium.
♦♦ These cell layers then form stratified epithelial covering of
enamel called as reduced enamel epithelium.
♦♦ The function of reduced enamel epithelium is to protect
mature enamel by separating it from connective tissue
until tooth erupts.
♦♦ If connective tissue comes in contact with enamel before
tooth erupts anomalies may develop
♦♦ If such condition occurs enamel may be resorbed or
covered by the layer of cementum.
♦♦ During this stage the epithelial enamel organ may interact
from cervical edge of enamel.
Desmolytic Stage
♦♦ Reduced enamel epithelium proliferates and induces
atrophy of connective tissue separating it from oral
epithelium so that fusion of two epithelia can occur.
♦♦ It is probable that epithelial cells release enzymes that are
able to destroy connective tissue fibers by desmolysis.
♦♦ If premature degeneration of reduced enamel epithe­lium
occurs it may lead to delayed eruption.
Q.10. Write short note on enamel coverings. 
 (Sep 2000, 5 Marks)
Ans. A delicate membrane called Nasmyth’s membrane
covers entire crown of newly erupted tooth but is
probably soon removed by mastication.
 This membrane is a typical basal lamina found
beneath most epithelia. It is visible with light microscope
because of its wavy course. This basal lamina is secreted
by ameloblasts when enamel formation is complete. It is
noted that cervical areas of enamel is covered by afibrillar
cementum. Finally, erupted enamel is normally covered
by pellicle, which is a precipitate of salivary proteins.
This pellicle reforms within hours after an enamel
surface is mechanically cleaned. Within a day or two
after pellicle is formed, it becomes colonized by micro-
organisms to form bacterial plaque.
Q.11. Describe hypocalcified areas of enamel.
 (Feb 1999, 15 Marks) (Feb/Mar 2004, 15 Marks)
 (Dec 2010, 5 Marks)
Or
Describe in detail the hypocalcified structures of
enamel. (Jan 2012, 10 Marks)
Or
Describe in detail with labelled diagrams hypocalcified
structures of enamel. (May 2014, 10 Marks)
Or
Enumerate hypoplastic areas of enamel. Describe in
detail any two hypoplastic areas of enamel. 
 (Dec 2014, 8 Marks)
Or
Enumerate and describe the hypocalcified structures
of enamel.  (July 2016, 10 Marks)
Or
Write short note on hypomineralized structures of
enamel. (May 2017, 3 Marks)
Ans. Following are the hypocalcified areas of the enamel:
• Enamel Lamellae
• Enamel Tufts
• Enamel Spindle
• Surface Structures:
- Perikymata
- Rod End
- Cracks.
• Enamel Lamellae: The enamel lamellae are described
in the Ans 4.
• Enamel Tufts: The enamel tufts are described in Ans 5.
• Enamel Spindle:
- A few dentinal tubules extend from DEJ into
enamel for several millimeters. These are called
as enamel spindles.
- The direction of spindles is just right angle to
dentin.
- In ground sections of dried tooth the organic
content of spindles disintegrates and is replaced
by air and spaces which appear dark in
transmitted light.

Q.12. Write a note on neonatal line. 
Fig. 20:  Enamel spindle
(For colour version see Plate 22)
• Enamel spindles originate from odontoblastic
Q.13. Write a note on incremental line of retzius and enamel
processes which engaged them between cells of
inner enamel epithelium before laid down of dentin
or enamel.
• Largest number of enamel spindles is found in cusp
region.
Surface Structures
Following are the surface structures:
a. Perikymata: They are transverse grooves. They are
continuous around the tooth and usually lie parallel
to each other and to CEJ. Ordinarily there are about
30 perikymata per millimeter in region of CEJ. Their
course is regular, but in cervical region it is irregular.
They are believed to be the external manifestations
of striae of retzius.
– At times Perikymata are referred to as imbrication
lines of pickerel.
– Perikymata are more in cervical ragion as
compared to occlusal and incisal region.
b. Rod Ends: They are concave and vary in depth and
shape. They are shallowest in cervical region and
deepest near incisal or occlusal edges.
Fig. 21:  Perikymata or imbrication lines on surface of enamel
Dental Histology  645
c. Cracks: They are the outer edges of lamellae. They
extend from varying distance along the surface, at
right angle to DEJ from which they originate. They
are evenly spaced.
 (Jan 2012, 2 Marks) (May 2014, 2 Marks)
Ans. In deciduous teeth enamel develops partly before and
partly after birth. The boundary between two portions
of enamel in deciduous tooth is marked by attentuated
incremental line of retzius. This is known as neonatal
line or neonatal ring. The prenatal enamel is better
developed than postnatal enamel because prenatal
enamel is developed in protective environment and has
a better supply of nutrients.
Perichymatas are present in the postnatal enamel.
lamellae. (Sep 2005, 5 Marks)
Or
Write short note on incremental lines of enamel.
 (Nov 2010, 2 Marks)
Ans. Incremental Lines of Retzius
• Incremental lines of retzius appear as brown bands
in ground section of enamel.
• In longitudinal sections, they extend from DEJ to
outer surface of tooth in an upward and outward
direction.
• They illustrate the incremental pattern of the enamel,
i.e. the successive apposition of layers of enamel
during formation of enamel.
• Incremental lines run obliquely in cervical region to
reach the surface.
• In transverse section of tooth the incremental line of
retzius appears as concentric circle.
• The incremental line has been attributed to periodic
breathing of enamel rods, to variation in basic
organic structures.
• They are believed to be the external manifestations
of perikymata.
• Enamel is formed by incremental or appositional
growth pattern where the lines actually represent the
period of quiescence/rest and the space between the
lines represent periods of active enamel formation.
• Rhythmic pattern of enamel formation can be altered
leading to prolonged resting period. This causes
broadening of incremental lines making them more
accentuated.
• Neonatal line is an accentuated incremental line seen
in deciduous teeth and in first permanent molar
which separate enamel before and after birth.
• Accentuated incremental lines can also be patho-
logical due to metabolic and systemic disturbances
i.e. exanthematous fever which affects formation
of enamel.
For Enamel Lamellae refer to Ans 4 of the same chapter.
646 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Fig. 22:  Incremental line of Retzius
(For colour version see Plate 22)
Q.14. Describe clinical consideration of enamel. 
 (Sep 1997, 5 Marks)
Ans. •  Hypoplasia which is manifested by pitting furrowing
or even total absence of the enamel.
• Hypocalcification in the form of opaque or chalky
areas or normally countered enamel surface.
• They are caused by systemic local, or hereditary
factors.
• Hypoplasia of systemic origin is termed as
chronologic hypoplasia because in this area enamel
was formed during systemic disturbance. Teeth
most frequently affected are incisors, canine and
first molars.
• Hypoplasia of local factor may be due to infection
of pulp and periapical tissue.
• The hereditary type of enamel hypoplasia is
probably a generalized disturbance of ameloblast.
• Systemic hypocalcification of enamel is so called
mottled enamel.
• If the injury occurs in the formative stage of enamel
development, local hypocalcification occurs.
• The hereditary type of hypocalcification is
characterized by the formation of normal amount
of enamel matrix, does not fully mature.
Q.15. Enumerate the hypocalcified structure of enamel.
Describe life cycle of ameloblast.(Feb 2005, 15 Marks)
 (Feb 2006, 7.5 Marks) (Apr 2010, 5 Marks)
Ans. For hypocalcified structure refer to Ans 11 and for life
cycle of ameloblast refer to Ans 9 of same chapter.
Q.16. Write a short note on Tome’s processes and Tomes
granular layer.
 (Feb 2005, 5 Marks) (Dec 2012, 3 Marks)
Or
Write a note on Tomes granular layer and Tome’s
process.  (Oct 2006, 2 Marks)
Or
Answer in brief on Tome’s process.
 (Feb 2016, 2 Marks)
Ans. Tome’s Process
• Tome’s process is a small, pyramidal cytoplasmic
extension present at distal end of ameloblast which
is partly delineated from rest of the cell by distal
junctional complex.
• Tome’s process secretes enamel from two sites, i.e.
proximal end which form inter rod enamel while
the distal end forms the enamel rod.
• As first layer of enamel is produced Tome’s process
have only proximal portion and secreted enamel is
rodless. As layer of enamel is formed ameloblasts
move away from dentin which causes development
of distal portion of Tome’s process.
• Distal portion of Tome’s process penetrates the
enamel and extend to first layer of enamel.
• Cytoplasm of Tome’s process is within the
continuation with body of ameloblasts.
• As more and more enamel is formed distal portion
of Tome’s process lengthens as do enamel rods.
• Shape of distal end of ameloblasts changes when
outer portion of enamel is formed.
• In last phases of amelogenesis ameloblast loose distal
portion of Tome’s process.
• For Tomes Granular layer refers to Ans 3 of Chapter
DENTIN.
Q.17. Give the list of hypocalcified structures of enamel. Write
about any two of them shortly. (Mar 2007, 4 Marks)
Or
Enumerate hypocalcified structures of enamel. Discuss
three in detail. (Mar 2013, 8 Marks)
Ans. Refer to Ans 11 of the same chapter.
Q.18. Define amelogenesis and describe the life cycle of
ameloblast in detail. 
 (Sep 2006, 15 Marks) (Nov 2009, 10 Marks)
Ans. Amelogenesis is the formation of enamel on teeth and
occurs during the formation of crown during advanced
bell stage of tooth development after dentinogenesis,
which is the formation of dentin. Since dentin must be
present for enamel to be formed, this prerequisite is
an example of the biologic concept, termed reciprocal
induction.
 Amelogenesis is considered to have three stages.
The first stage is known as the pre secretory phase, and
the second stage is Known as the secretory stage and
third stage is brown as maturation stage. Proteins and
an organic matrix form a partially mineralized enamel
in the secretory stage. The maturation stage completes
enamel mineralization.
For life cycle refer to Ans 10 of the same chapter.
Q.19. Write a note on hypocalcified areas of enamel.
 (Oct 2007, 5 Marks)
Or
Write a short note on hypocalcified areas of enamel.
 (Apr 2015, 3 Marks)
Ans. Refer to Ans 11 of the same chapter.

Q.20. Enumerate stages of life cycle of ameloblasts and
describe amelogenesis. (Nov 2010, 7.5 Marks)
Or
Discuss amelogenesis. (Jan 2012, 10 Marks)
Ans. There are six stages in life cycle of ameloblasts, namely:
1. Morphogenic
2. Organizing
3. Formative
4. Maturative
5. Protective
6. Desmolytic.
The differentiation of ameloblasts is most advanced
in region of incisal edges and tips of cusps. It is least
advanced in region of cervical loop.
Amelogenesis
Generally two processes are involved in the development of
enamel, i.e. organic matrix formation and mineralization.
Formation of Enamel Matrix
♦♦ Ameloblasts start their secretory activity when a layer of
dentin is laid down.
♦♦ Ameloblasts lose their projections which had penetrated
basal lamina separating it from predentin. Islands of
enamel matrix are deposited along predentin.
♦♦ As enamel deposition continues the thin layer of enamel
is formed along dentin.
♦♦ Amelogenin is the major component of enamel matrix
proteins which undergo extracellular degradation by
proteolytic enzymes.
♦♦ Ameloblastin and enamelin are other important proteins
of enamel matrix. They help in nucleation and growth of
crystals.
♦♦ Tuftelin is other protein which helps in cell signaling.
♦♦ Amelotin which is a new protein helps in enamel
formation.
Development of Tome’s Process
♦♦ Tome’s process is basically a pyramidal, cytoplasmic
extension at the distal part of each ameloblast which is partly
delineated from the cell by the distal junctional complex.
♦♦ Tome’s process consists of microfilaments, secretory
granules, microtubules, mitochondria and lysosomes.
♦♦ Enamel secretion occurs at two sites in the Tomes’ process i.e.
the proximal end of the Tome’s process which contributes to
the formation of inter-rod enamel and distal end of Tome’s
process contributes to the formation of the rod.
♦♦ When the first layer of enamel is laid down, Tomes’ process
consists only of the proximal portion and the initial enamel
is rodless.
♦♦ As soon as the first layer of enamel forms, ameloblasts
move away from the surface of the dentin which leads to
development of distal portion of Tomes’ process.
♦♦ Extension from the distal terminal bar apparatus to the
surface enamel is the proximal portion of the Tome’s
process, while the distal portion is an outgrowth of the
proximal portion.
Dental Histology  647
♦♦ Distal portion of Tome’s process penetrates in enamel and
extends up to the first layer of enamel.
♦♦ Cytoplasm of the Tome’s process remain continuous with
that of body of ameloblasts.
♦♦ Formation of the inter-rod substance occurs first by the
proximal end of the Tome’s process.
♦♦ Inter-rod substance surrounds the pit into which the distal
portion of the Tomes’ process secretes the rod.
♦♦ As more of enamel is being formed, the distal portion of
the Tome’s process lengthens, as do the enamel rods. The
long axes of the ameloblasts lie at a considerable angle to
the direction of rods.
♦♦ Though the rod and inter-rod enamel are identical in
their composition, they differ in the orientation of their
crystallites. This arrangement means that no enamel rod
is related to a single ameloblast.
Mineralization and Maturation of Enamel Matrix
As soon as enamel matrix get calcified removal of organic
material and water occurs. It takes place in two stages, i.e.
♦♦ Immediate partial mineralization in which mineralization
occurs in matrix segments and the interprismatic substance
as they are laid down. No matrix vesicles are seen in
enamel formation.
♦♦ Maturation: It is characterized by gradual completion of
mineralization. It starts from height of crown and progress
cervically. At each level, maturation seems to begin at
dentinal end of rods. Maturation begins before matrix has
reached its full thickness. The advancing front is at first
parallel to DEJ and later to outer enamel surface. Following
this pattern the occlusal and incisal regions reach maturity
level ahead of cervical regions. Tuftelin and other proteins
regulate enamel mineralization by binding to specific
surfaces of crystal and inhibiting further deposition.
Crystal size increase further after tooth eruption due to
ion exchange with saliva.
Q.21. Write short note on Nasmyth’s membrane.
 (Jan 2012, 5 Marks)
Ans. It is also known as primary enamel cuticle.
• It is a membrane like structure covering entire
crown of newly erupted teeth except cervical area
of the tooth.
• It is basically lost due to mastication.
• It is an organic covering which is 1 µm thick.
• It is secreted by ameloblasts as enamel formation
is complete.
• It resembles like basal lamina.
Q.22. Enumerate the structures of enamel in detail.
 (Nov 2010, 8 Marks)
Ans.
Structures of Enamel
Enamel is composed of:
♦♦ Enamel Rods: Refer to Ans 2 of same chapter
♦♦ Striations
♦♦ Hunter-Schreger Bands
648 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
♦♦ Incremental line of retzius: Refer to Ans 13 of same chapter
♦♦ Aprismatic Enamel
♦♦ Perikymata: Refer to Ans 11 of same chapter
♦♦ Enamel caps, broachs and pits
♦♦ Enamel lamellae: Refer to Ans 4 of same chapter
♦♦ Enamel Tufts: Refer to Ans 5 of same chapter
♦♦ Enamel Spindles: Refer to Ans 11 of same chapter
♦♦ Enamel Cuticle/Naysmyth’s membrane: Refer to Ans 21
of same chapter
♦♦ Neonatal Line: Refer to Ans 12 of same chapter.
Striations
♦♦ Each enamel rod is built up of segments separated by dark
lines that give it a striated appearance.
♦♦ The cross striations demarcates rod segments and become
more visible by the action of mild acids.
♦♦ The striations are more pronounced in enamel, i.e.
insufficiently calcified.
♦♦ The cross striations seen in light microscope is suggested
to be due to a diurnal rhythm in the enamel formation and
that in these areas rods show varicosities and variations
in composition.
♦♦ These diurnal being formed every 24 hours parallel to
secretory phase of ameloblast.
Hunter-Schreger Bands
♦♦ They are the optical phenomenon which is produced due
to the changes in direction of enamel rods.
Fig. 23:  Hunter-Schreger bands
♦♦ Hunter-Schreger bands are alternating dark and light
zones of varying intensity under oblique reflected light.
♦♦ These are the curved bands having concavity which faces
towards the root and commence near DEJ.
♦♦ These bands are viewed in inner two third of enamel
thickness.
♦♦ It is suggested that these alternating light and dark bands
may represent portion of enamel having variation in
calcification and differ slightly in permeability or having
difference in organic material content.
♦♦ If an oblique section is made by cutting middle part of the
rods, they pass from cut surface to the right and to left
in alternating discs. Disc which coincide with obliquely
directed light allow light to pass through the rods. These
areas absorb light and appear as dark bands also called as
para zones. In discs where rods run in opposite direction,
light reflecting from sides of the rods produce light bands
known as dia zones.
♦♦ When ground sections are viewed and the light is allowed
to fall on opposite side, position of light and dark bands
is reversed which confirm that it is purely an optical
phenomenon.
♦♦ Angle between dia zone and para zone is 40 degree.
♦♦ These bands are functional adaptation to occlusal
masticatory forces.
Aprismatic Enamel
♦♦ Structureless layer of enamel which is approximately 30
µm thick.
♦♦ Found commonly on the cervical areas and less commonly
on cusp tips.
♦♦ It is very heavily mineralized.
♦♦ It occurs due to absence of Tome’s process on ameloblasts
in final stages of enamel formation.
♦♦ In this region apatite crystals are parallel to each other and
are perpendicular to incremental line of retzius.
Enamel Caps, Broaches and Pits
Small elevations 10–15 µm across or depressions are also found
particularly on lateral surfaces. The caps are thought to result
from the enamel deposition on the top of small deposits of non
mineralizable debris late in development. The focal holes result
from the loss of cap and underlying material by abrasion and
attrition.
Larger surface elevations, enamel brochs, 30–50 µm in
diameter, also occur occasionally and consist of radiating groups
of crystals. They seem to be more common in premolars but are
of unknown origin.
In cervical areas where the reduced enamel epithelium
persists for sometime after eruption the small pits are seen
within perikymata. These are the impression of the ameloblast
ends and are 1–1.5 µm in depth.
Q.23. Write physical and chemical properties of enamel.
Describe in detail about structure of enamel. 
 (Feb 2013, 10 Marks)
Ans. For physical and chemical properties refer to Ans 1 of
same chapter.
For structure of enamel refer to Ans 22 of same chapter.
Q.24. Write about enamel spindles and enamel tufts. 
 (May/June 2009, 5 Marks)
Or
Describe briefly enamel spindles.
 (June 2010, 5 Marks)
Or
Write short note on enamel spindles.
 (Sep 2017, 2 Marks)
Ans. For enamel spindle refer to Ans 11 of same chapter. For
enamel tufts refer to Ans 5 of same chapter.

Q.25. Write about surface structures of enamel.
 (Aug 2012, 5 Marks)
Ans. Following are the surface structures:
• Perikymata
- They are transverse groove like structures.
- They are continuous around the tooth and
usually lie parallel to each other and to CEJ.
- Ordinarily there are about 30 Perikymata per
millimeter in region of CEJ.
- Their course is regular, but in cervical region it
is irregular.
- They are believed to be the external manifestations
of striae of retzius.
- At times perikymatas are referred as imbrications
lines of Pickril.
- Perikymatas are more in number in cervical
region as compared to occlusal and incisal areas.
• Enamel Caps and Brochs
- Ultrastrucuturiy enamel is uneven. It shows pits
as well as elevations.
- Pits are about 1–1.5 µm in diameter. Pit
represents the ends of ameloblasts.
- Small elevations of about 10–15 µm are present
which occur due to deposition of enamel over
organic debris. These are known as enamel caps.
- Larger enamel elevations measure approximately
30–50 µm in width and are known as enamel
brochs.
Fig. 24:  Enamel caps
Fig. 25:  Enamel brochs
• Cracks
- They are the outer edges of lamellae and are
narrow fissure like structures.
Dental Histology  649
- They extend from varying distance along the
surface, at right angle to DEJ from which they
originate.
- They are evenly spaced.
- Some of them are less than a millimeter in length,
some are long and few reaches to occlusal or
incisal surface.
Q.26. Write short note on Hunter-Schreger bands. 
 (Aug 2012, 5 Marks) (May 2014, 2 Marks)
Ans. Refer to Ans 22 of same chapter.
Q.27. Enumerate the types of enamel lamellae. Write its
clinical significance. (Sep 2015, 3+2= 5 Marks)
Ans. Enumeration of types of enamel lamellae:
Type A: Lamellae composed of poorly calcified rod
segments
Type B: Lamellae consisting of degenerated cells
Type C: Lamellae arising in erupted teeth where cracks
are filled with organic matter, presumably originating
from saliva.
Clinical Significance of Enamel Lamellae
♦♦ Enamel lamellae may be a site of weakness in a tooth and
may form a road of entry for bacteria that initiate caries.
♦♦ Enamel lamellae are also susceptible for cracking.
Q.28. Enumerate physical properties of enamel.
 (Sep 2015, 2 Marks)
Ans. Enumeration of physical properties of enamel
• Color: Enamel is slightly yellow to grayish white
in color.
• Hardness: Hardness of enamel is 343 KHN.
• Brittleness: Enamel is highly brittle due to less tensile
strength.
• Thickness: Thickness of enamel is maximum at cusp
tip or incisal edge and thinnest at cervix.
• Permeability: Enamel is semipermeable
• Density: Density of enamel decreases from surface
to DEJ and from incisal to cervical region.
• Refractive index: Enamel is birefringent. Its refractive
index is 1.62.
• Solubility: Enamel is soluble in acids.
• Specific gravity: It is 2.8.
Q.29. Write the composition of enamel.
 (Jan 2018, 2 Marks) (Sep 2015, 2 Marks)
Or
Write short note on composition of enamel.
 (Oct 2016, 3 Marks)
Ans. Following is the composition of enamel:
I. Composition of enamel by weight
96% inorganic substances
1% organic substances
3% water.
II. Composition of enamel by volume
89% inorganic substances
2% organic substances
9% water.
650 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Organic substances are amelogenins and enamelins • Arrangement of enamel rod in permanent teeth in
Inorganic substances are calcium phosphate, calcium their occlusal one third region is similar to deciduous
carbonate, magnesium, potassium, sodium and fluoride. tooth. But in cervical region of permanent tooth, rods
deviate from the horizontal in an apical direction.
Q.30. Write short note on structures arising from dentino
• Rods follow wavy course from dentin to enamel
enamel junction. (Aug 2016, 3 Marks)
surface.
Ans. Structures arising from dentino enamel junction are: • Enamel rods forming developmental pit and fissures
• Enamel tufts: For details refer to Ans 5 of same converge in their outward course.
chapter
• Enamel spindles: For details refer to Ans 11 of same
chapter
• Incremental lines of Retzius: For details refer to Ans
13 of same chapter
• Hunter-Schreger bands: For details refer to Ans 22 of
same chapter.
Q.31. Define amelogenesis and list stages in life cycle of
ameloblast. (Sep 2017, 2 Marks)
Ans. Amelogenesis is the formation of enamel on teeth and
begins when the crown is forming during the advanced
bell stage of tooth development after dentinogenesis or
amelogenesis is defined as process of production and
development of enamel. A B

Stages in Life Cycle of Ameloblast Fig. 26:  Direction of enamel rods. A. In deciduous tooth;
B. In permanent tooth
There are six stages in life cycle of ameloblasts, namely:
1. Morphogenic stage Q.35. Enumerate hypocalcified structures of enamel. Write
2. Organizing stage composition of an enamel. Describe enamel lamellae
3. Formative stage and incremental line of Retzius with well labeled
4. Maturative stage diagram. (Sep 2018, 2 + 2 + 3 + 3 =10 Marks)
5. Protective stage Ans. For enumeration of hypocalcified structures of enamel
6. Desmolytic stage. refer to Ans 11 of same chapter.
Q.32. Enumerate stages of amelogenesis.  (Apr 2017, 2 Marks) For composition of enamel refer to Ans 29 of same chapter.
Ans. Enumeration of stages of amelogenesis For enamel lamellae with diagram refer to Ans 4 of same
• Presecretory stage chapter.
• Secretory stage For incremental lines of Retzius refer to Ans 13 of same
• Maturation stage chapter.
Q.33. Enumerate hypocalcified areas of enamel.
 (Jan 2018, 2 Marks)
Ans. Enumeration of hypocalcified areas of enamel 4. DENTIN
• Enamel lamellae
• Enamel tufts Q.1. Describe the structure of dentin. (Feb 1999, 15 Marks)
• Enamel spindle
• Surface structures Or
– Perikymata Write in brief on structure of dentin.
– Rod ends  (Sep 2006, 5 Marks)
– Cracks Ans. Structure of Dentin
Q.34. Write very short answer on direction of enamel rods. • Dentinal matrix of collagen fibers are arranged in
 (May 2018, 2 Marks) the random network. The bodies of odontoblast are
Ans. Generally enamel rods are oriented at right angle to arranged in layer of pulpal surface of dentin.
dentin surface. • Structure of dentin consist of:
• In cervical and central parts of deciduous tooth – Dentinal tubules
crown, enamel rods are horizontal. Near the incisal – Peritubular dentin or intratubular dentin
edge or tip of cusps they change gradually to an – Intertubular dentin
increasingly oblique direction and they are almost – Predentin
vertical in region of incisal edge or tip of cusps. – Odontoblasts processes.
 Dental Histology  651

1. Dentinal Tubules ♦♦ This dentin is formed by cell body of odontoblasts and it

They are found throughout normal dentin and are characteristic consists of organic components as well as apatite crystals.
of it. Its organic part is formed by Type IV collagen fibrils which
♦♦ They follow gentle curve coarse in crown less so in root are arranged perpendicular to dentinal tubules.
where they resembles ‘S’ shaped. ♦♦ Hydroxyapatite crystals are deposited with their long axis
♦♦ These tubules end perpendicular to dentinoenamel oriented parallel to collagen fibers.
junction and dentinocemental junction. Near the root tip
and along incisal edges and cusps, tubules are almost
straight.
♦♦ Near the pulpal surface of dentin the number per square
mm varies between 50,000 and 90,000.
♦♦ A few dentinal tubules extend through DEJ into enamel
for several mm and are called as enamel spindle.

Fig. 28  Intertubular and intertubular dentin

4. Predentin
♦♦ It is first form dentin and is not mineralized.
♦♦ It is located adjacent to pulp tissue.
♦♦ As the collagen fibers undergo mineralization at predentin
Fig. 27:  Dentinal tubules
junction, predentin becomes dentin and new layer of
(For colour version see Plate 22)
predentin forms circumpulpally.
2. Peritubular Dentin or Intratubular Dentin
♦♦ It is the zone of hypermineralized dentin which surrounds
the dentinal tubule.
♦♦ It is known as intratubular dentin as it is formed by
deposition along inner aspect of dentinal tubules.
♦♦ It differ from intertubular dentin in its composition that it
is 5 to 12% more mineralized and lacks collagenous fibrous
matrix as compared to intertubular dentin.
♦♦ Width of peritubular dentin is highest near DEJ and
decreases in pulpward direction.
♦♦ Apatite crystals of peritubular dentin are more compact
and smaller as compared to intertubular dentin.
♦♦ A thin organic membrane which is rich in glycosaamino-
glycans known as lamina limitans seen over inner aspect
of peritubular dentin. Fig. 29:  Predentin
♦♦ Space between odontoblastic process and peritubular (For colour version see Plate 22)
dentin is known as periodontoblastic space. This space
consists of dentinal fluid, movement of which make basis 5. Odontoblast Processes
of dentinal sensitivity. ♦♦ They are cytoplasmic extensions of odontoblasts. They
3. Intertubular Dentin reside in peripheral pulp.
♦♦ Major bulk of dentin lie between the dentinal tubules, i.e. ♦♦ They are largest in diameter near pulp and taper to
between zones of peritubular dentin known as intertubular approximately micrometer further into dentin.
dentin. ♦♦ It is appropriate to consider that some odontoblast
♦♦ It is less mineralized as compared to peritubular dentin. processes traverse thickness of dentin.
♦♦ Thickness of intertubular dentin is highest at DEJ where ♦♦ Odontoblast process divides near DEJ and may extend to
the dentinal tubules are widely separated. enamel in enamel spindles.
652 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Q.2. Write a short note on secondary dentin. 

 (Feb 2002, 5 Marks) (Aug/Sep 1998, 5 Marks)
Or
Write very short answer on secondary dentin.
 (May 2018, 2 Marks)
Ans. Secondary dentin is a narrow band of dentin bordering
the pulp and representing that the dentin is formed after
root completion.
• Secondary dentin contains fewer tubules than
primary dentin. Secondary dentin forms more
slowly than primary dentin.
• It is not formed uniformly and appears in great
amount in roof and floor of coronal pulp chamber,
where it protects pulp from exposure in older
teeth.
• Continuous deposition of secondary dentin causes
small pulp chamber as well as narrow pulp canal.
Fig. 31:  Tome’s granular layer
(For colour version see Plate 23)
Q.4. Write a short note on reparative dentin. 
 (Mar 2006, 5 Marks) (Oct 2007, 5 Marks)
Ans. If by extensive abrasion, erosion, caries or operative
procedures the odontoblast processes are exposed or cut,
odontoblasts die or if they live produce reparative dentin.
• Odontoblast that are killed are replaced by the
migration of undifferentiated cells arising in deeper
regions of pulp to dentin interface. The origin of new
odontoblasts is from cells in cell rich zone.
• Both the remaining and the newly differentiated
odontoblasts then begin deposition of reparative
dentin or tertiary dentin or response dentin or
reactive dentin.
• Reparative dentin is characterized as having fewer
and more twisted tubules than normal dentin.
• Reparative dentin seals the dentinal tubules to their
ends.

Fig. 30:  Secondary dentin

(For colour version see Plate 22)

Q.3. Write a note on Tome’s granular layer. 

 (Mar 1996, 5 Marks)
Or
Answer in brief on Tome’s granular layer.
 (May 2017, 2 Marks)
Ans. When dry ground sections of root dentin are visualized in
transmitted light, a zone adjacent to cementum appears
granular and is known as Tome’s granular layer.
• This zone increases slightly in amount from
DEJ to root apex and is believed to be caused by
Fig. 32:  Reparative dentin
coalescing and looping of terminal portion of (For colour version see Plate 23)
dentinal tubules.
• The cause of development of this zone is similar to Q.5. Enumerate functions of dentin. Describe dentinogenesis
branching and beveling of tubules at DEJ. in detail. (Apr 2010, 5 Marks)
• In the crown extensive branching of odontoblast Or
processes occurs, and in the root there is branching Write short note on dentinogenesis.
and coalescing of adjacent processes.  (May 2017, 3 Marks)

Ans. Functions of Dentin
• Dentin provides the bulk and general form of tooth.
• It determines the shape of the crown, including
the cusps and ridges, and the number and size of
the roots.
• Dentin is necessary for formation of enamel matrix.
• Reparative dentin prevents entry of bacteria or their
toxic products as well as chemical substances from
restorative materials.
Dentinogenesis
♦♦ Dentin is a vital tissue and is laid down throughout life.
♦♦ Dentinogenesis is a two phase sequence in that collagen
matrix is first formed and then calcified. Dentinogenesis
begins at the tips of cusps after the odontoblasts have been
differentiated and begin collagen production.
♦♦ As odontoblasts differentiates they change from ovoid to
columnar shape, and their nuclei become basally oriented
at early stage of development.
♦♦ One or several processes arise from apical end of the cell
in contact with basal lamina.
♦♦ The length of odontoblast then increases approximately
to 40 micrometer, although its width remains constant.
♦♦ Proline appears in RER and Golgi apparatus. The proline
then migrates into cell processes and is emptied into
extracellular collagen matrix of predentin.
♦♦ As the matrix formation continues, the odontoblasts
processes lengthens, as does dentinal tubules. Initially
daily increments of approximately 4 micrometer of dentin
are formed. This continues until the crown is formed and
the teeth erupt and move to occlusion.
♦♦ After root development is complete, dentin formation may
decrease further.
♦♦ The odontoblast secrete both collagen and other
components of extracellular matrix.
♦♦ After collagen matrix is formed the mineralization of
dentin begins.
♦♦ The earliest crystal deposition is in the form of fine plates
of hydroxyapatite on surfaces of collagen fibers and ground
substance.
♦♦ Crystal in collagen fibers are arranged in regular fashion.
The crystal deposition appears to take place radially from
common centers in a so called spherulite form. These are
seen at first site of calcification of dentin.
♦♦ General calcification process is gradual, but peritubular
region is highly mineralized at very early stage.
Q.6. Describe the process of dentinogenesis and mention in
brief age changes seen in dentin. (Sep 2003, 15 Marks)
Or
Write briefly on age changes in dentin.
 (Apr 2007, 5 Marks) (Apr 2008, 10 Marks)
Or
Write short note on age changes in dentin.
 (Feb 2016, 3 Marks)
Ans. Dentinogenesis is given in Ans 5 of the same chapter.
Dental Histology  653
Age Changes in Dentin
♦♦ Vitality of dentin: Since the odontoblast and its processes
are the integral part of dentin so dentin is the vital tissue.
• Capacity of dentinal tissue to react to physiologic
and pathologic stimuli, dentin must be considered
as a vital tissue.
♦♦ Reparative dentin: Refer to Ans 4 of the same chapter.
♦♦ Dead tracts: Refer to Ans 9 of the same chapter.
♦♦ Sclerotic dentin or transparent dentin: In case of caries,
attrition, abrasion, erosion or cavity preparation, sufficient
stimuli are generated to cause collagen fibers and apatite
crystals to begin appear in the dentinal tubules.
In such cases blocking of the tubules may be considered a
defensive reaction of dentin.
Dentin in which the tubules are occluded become
transparent. Sclerosis reduces the permeability of dentin
and may help prolong pulp vitality.
♦♦ Translucent dentin: Due to aging dentinal tubules get
completely occluded by peritubular dentin. Contents of
occluded tubules have same refractive index as that of
intertubular dentin. Occluded tubule appears translucent in
ground section. Its formation starts from root towards cervix.
Q.7. Write a note on dentinal tubules.
 (Sep 1999, 5 Marks)
Or
Write short answer on dentinal tubules.
 (May 2018, 3 Marks)
Ans. D entinal tubules are found throughout normal
dentin and are characteristic of it.
• Course of dentinal tubules follows a gentle curve
in crown, less so in root where it resembles gentle
S in shape.
• Near the root tip and along incisal edges and cusps,
tubules are almost straight.
• Over their entire length they exhibit minute,
relatively regular secondary curvatures which are
sinusoidal in shape.
• Tubules are further apart in peripheral layers and
more closely packed near pulp.
• Near the pulpal surface of dentin the number per
square mm varies between 50,000 and 90,000.
• A few dentinal tubules extend through the DEJ
into enamel for several mms. These are termed as
enamel spindles.
Q.8. Write a note on interglobular dentin.
 (Mar 1997, 5 Marks)
Or
Classify dentin. Discuss interglobular dentin.
 (Sep 2017, 3 Marks)
Ans. For classification of dentin refer to Ans 17 of same
chapter.
Interglobular Dentin
Sometimes mineralization of dentin begins in small globular
areas that fails to coalesce into a homogeneous mass. This results
in zones of hypomineralization between the globules. These
zones are known as globular dentin or interglobular space.
654 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

♦♦ This dentin forms in the crowns of teeth in the circumpulpal • Loss of odontoblasts may also occur in teeth
dentin just below the mantle dentin, and it follows the containing vital pulp as a result of caries, attrition,
incremental pattern. abrasion, cavity preparation or erosion.
♦♦ The dentinal tubules pass uninterruptedly through • Where reparative dentin seals dentinal tubules at
interglobular dentin. their pulpal ends, dentinal tubules fill with fluid or
♦♦ In dry ground sections some of the globular dentin may be gaseous substances.
lost, and a space results that appears black in transmitted • In ground sections such groups of tubules may
light. entrap air and appear black in transmitted and white
in reflected light.
• The dead tracts demonstrate decreased sensitivity
and appear to a greater extent in older teeth.
Q.10. Describe various type of dentin which take part in
protection of pulp. How dentin differs from ena­mel
in composition? (Mar 2001, 15 Marks)
Ans. Types of Dentin which Take Part in Protection of Pulp
♦♦ Primary Dentin
Primary dentin can be divided into.
• Mantle dentin: It is first formed dentin in the crown.
–– It lies underlying the DEJ in crown and granular
layer in root. It is 20 microns thick.
Fig. 33:  Interglolular dentin –– It is composed mainly of Type III collagen fibers
(For colour version see Plate 23) which are argyrophilic and are known as Von
Korff’s fibers.
Q.9. Write a short note on dead tracts.  –– This dentin differs from remaining portion of
 (Mar 1998, 5 Marks) (Sep 2002, 5 Marks) primary dentin in following ways:
 (Oct 2007, 5 Marks) (Nov 2009, 5 Marks) - This dentin is less mineralized.
 (June 2010, 5 Marks) (Dec 2014, 3 Marks) - It consists of large collagen fibers which are
Or oriented perpendicular to DEJ.
- It undergoes mineralization in presence of
What are dead tracts. Draw a well labelled diagram.
 (Sep 2015, 3 + 2 = 5 Marks) matrix vesicles.
- This dentin show branching of dentinal tubules.
Or - Mantle dentin show few defects as compared
Write short answer on dead tracts. (Aug 2018, 3 Marks) to circumpulpal dentin.
Ans. Dentinal areas are characterized by the degenerated • Circumpulpal dentin: It forms the remaining primary
odontoblasts processes which give rise to dead tracts. dentin or bulk of the tooth. Circumpulpal dentin
• In dried ground sections of normal dentin the formed before root completion.
odontoblast processes degenerate and empty tubules –– The collagen fibers in circumpulpal dentin are
are filled with air. They appear black in transmitted much smaller and are more closely packed.
and white in reflected light. –– Circumpulpal dentin may contain slightly more
mineral than mantle dentin.
♦♦ Secondary Dentin
• Secondary dentin is a narrow band of dentin bordering
the pulp.
• Secondary dentin is formed after the root completion.
• This dentin contains fewer tubules than primary
dentin.
• Secondary dentin formed more slowly and not
uniformly.
• It protects the pulp from exposure in older teeth.
♦♦ Tertiary Dentin
• Tertiary dentin takes part in protection of pulp by
reparative process.
• Secondary dentin protects the pulp of older teeth
Fig. 34:  Dead tract (For colour version see Plate 23) from exposure.
 Dental Histology  655

Difference between Composition of Enamel and Dentin • The dentinal tubules are enlarged by destructive
action of the microorganism.
Composition Enamel Dentin • Dentin sensitivity or pain may not be a symptom
By weight • 96% Inorganic • 70% inorganic of caries until the pulp is infected and respond by
substances substances process of inflammation leading to toothache.
• 1% organic • 20% organic substances
• Caries, operative procedure, abrasion, erosion
substances • 10% water
• 3% water stimuli stimulate the reparative dentin production.
• Teeth with deep penetrating carious lesion can be
By volume • 89% Inorganic • 47% inorganic treated by pulp capping.
substances substances
• 2% organic • 32% organic substances Q.13. Write a short note on theories of dentin sensitivity.
substances • 21% water  (Oct 2014, 3 Marks) (Sep 2005, 5 Marks)
• 9% water  (Oct 2008, 2 Marks) (Nov 2008, 10 Marks)
Organic • Amelogenins • Collagen Type I and II  (Aug 2011, 10 Marks) (Aug 2012, 5 Marks)
substances • Enamelins • Phosphoproteins  (Feb 2014, 3 Marks)
• Carboxyglutamate
Or
containing proteins
• Acidic glycoproteins Write about theories of pain transmission in dentin.
• Plasma proteins  (Nov 2008, 10 Marks)
• Lipids Or
• Growth related factors
Inorganic • Calcium phosphate • Calcium phosphate
Write about pain sensation theories of dentin.
substances • Calcium carbonate (hydroxyapatite) small  (Aug 2012, 5 Marks)
• Magnesium crystals Or
• Potassium • Trace amount of fluoride
• Sodium and carbonate
Write on theories of dentin sensitivity.
• Fluoride  (Apr 2017, 5 Marks)
Ans. There are three basic theories of pain conduction through
Q.11. Describe hypocalcified area in dentin. dentin.
 (Sep 2009, 5 Marks) • Direct neural stimulation: In this theory stimuli reach
Ans. Hypocalcified Area in Dentin from nerve ending in the dentinal tubule and they
are directly stimulated causing sensitivity or pain.
• Contour lines: Occasionally some of the incremental
• Fluid or hydrodynamic theory: It is most popular theory.
lines are accentuated because of disturbances in
- Various stimuli such as heat, cold, air blast
the matrix and mineralization process. These lines
desiccation or mechanical or osmotic pressure
represent hypocalcified bands with X-ray.
affect fluid movement in the dentinal tubules.
• Neonatal line: Neonatal line separates the prenatal
- This fluid movement stimulates pain mechanism
and postnatal dentin.
in the tubules by the mechanical disturbance
- This line reflects the abrupt changes in environ­
of the nerve, thus nerve endings may act as
ment that occurs at birth.
mechanoreceptor.
- The dentin matrix formed prior to birth is usually
• Transduction theory: In this theory the odontoblast
of better quality than formed after birth, and a process is the primary structure excited by the
neonatal line may be a zone of hypocalcification. stimulus and that impulses are transmitted to the
• Interglobular dentin: Refer to Ans 9 of same chapter. nerve endings in the inner dentin.
• Predentin: Predentin is located adjacent to the pulp - This theory is not popular since there are no
tissue. neuro­transmitter vesicles in the odontoblast
- It is first formed dentin and is not mineralized. process to facilitate synapse.
- As predentin is mineralized it becomes dentin
and a new layer of predentin is formed. Q.14. Write a notes on reparative dentin and dead tracts.
 (Feb 2005, 5 Marks)
Q.12. Describe clinical consideration of dentin. 
Or
 (Aug/Sep 1998, 5 Marks)
Ans. Cells of the exposed dentin should not be insulted by Write short note on reparative dentin and dead tract. 
bacterial toxins, strong drugs, undue operative trauma  (Aug 2011, 5 Marks)
or irritating restorative materials. Ans. For reparative dentin refer to Ans 4 of the same chapter.
For dead tracts refer to Ans 9 of the same chapter.
• Rapid penetration and spread of caries in the dentin
is the result of the tubules. Q.15. Describe the process of dentinogenesis and mention in
• Dentinal tubules provide a passage for invading brief age changes seen in dentin. (Feb 2006, 15 Marks)
bacteria and their products, through either a thin Ans. For dentinogenesis refer to Ans 5 of the same chapter.
or thick dentinal layers. For age changes refer to Ans 6 of the same chapter.
656 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Q.16. Write short note on primary and secondary dentin. 
 (Mar 2006, 5 Marks)
Or
Discuss primary and secondary dentin. Draw a well
labelled diagram for it. (Jan 2018, 3 + 2 Marks)
Ans. •  Primary dentin: Primary dentin can be divided into:
i. Mantle dentin: It is first formed dentin in the crown.
– It is underlying the DEJ in crown and
granular layer in root. It is 20 microns thick.
– It is composed mainly of Type III collagen
fibers which are argyrophilic and are known
as Von Korff’s fibers.
– This dentin differs from remaining portion
of primary dentin in following ways:
- This dentin is less mineralized.
- It consists of large collagen fibers which
are oriented perpendicular to DEJ.
- It undergoes mineralization in presence of
matrix vesicles.
- This dentin show branching of dentinal
tubules.
- Mantle dentin show few defects as com-
pared to circumpulpal dentin.
ii. Circumpulpal dentin: It forms the remaining
primary dentin or bulk of the tooth. Circumpulpal
dentin formed before root completion.
- Collagen fibers in circumpulpal dentin are
much smaller and are more closely packed.
- Circumpulpal dentin may contain slightly
more mineral than mantle dentin.
• Secondary dentin
- Secondary dentin is a narrow band of dentin
bordering the pulp.
- Secondary dentin is formed after the root
completion.
- This dentin contains fewer tubules than primary
dentin.
- Secondary dentin formed more slowly and not
uniformly.
- It protects the pulp from exposure in older teeth.
Fig. 35:  Secondary dentin
(For colour version see Plate 22)
Q.17. Write notes on type of dentin.
 (Oct 2006, 2 Marks) (Dec 2012, 3 Marks)
Or
Write about types of dentin. (Jan 2012, 5 Marks)
Or
Write the classification of dentin. (Sep 2015, 2 Marks)
Or
Answer in brief types of dentin. (Aug 2016, 2 Marks)
Ans.
On Basis of Location
♦♦ Intertubular dentin: It is found around and in between
dentinal tubules.
♦♦ Intratubular dentin: It is found and formed within
dentinal tubules.
♦♦ Mantle dentin: It is formed initially in the crown and outer
coronal dentin.
♦♦ Circumpulpal dentin: It lies nearest to pulp and is formed
in crown after mantle dentin has been deposited.
On Basis of Pattern of Mineralization
♦♦ Globular dentin: It is formed from calcospherites.
♦♦ Interglobular dentin: It is a hypomineralized dentin
between mantle and circumpulpal dentin. It is normally
found in coronal dentin.
♦♦ Tomes granular layer: It is the hypomineralized layer in
root dentin.
♦♦ Sclerotic dentin: This dentin is hypermineralized. It
occludes intertubular dentin.
On Basis of Developmental Pattern
♦♦ Primary dentin: It is formed prior to and during active
eruption.
♦♦ Secondary dentin: It is formed when tooth first comes
into occlusion.
♦♦ Tertiary dentin: It is formed as a result of pathologic
response. It can be reactionary or reparative.
Q.18. Write notes on secondary dentin. (Oct 2006, 5 Marks)
Ans. Refer to Ans 16 of the same chapter.
Q.19. Write short note on osteodentin. (Sep 2006, 5 Marks)
Ans. Osteodentin is an atypical dentin that develops due
to deficiency of vitamin A. The ameloblast is not
differentiated properly, as a result the proliferation of
mesenchymal cells is disturbed and atypical dentin is
formed known as osteodentin.
Q.20. Write notes on Tome’s granular layer and Tome’s
process. (Sep 2007, 2.5 Marks)
Ans. For Tome’s granular layer refer to Ans 3 of the same
chapter and for Tome’s process refer to Ans 16 of chapter
ENAMEL.
Q.21. Enumerate hypocalcified structures of enamel. Write
about types of dentin. (Apr 2008,7.5 Marks)
Ans. For hypocalcified structures of enamel refer to Ans 11
of chapter ENAMEL.
For types of dentin refer to 17 of the same chapter.

Q.22. Draw diagram of dead tract and diffuse calcification. 
 (Mar 2008, 2.5 Marks)
Or
Draw a well labelled diagram of dead tract.
(Jan 2018, 2 Marks)
Ans. may prolong pulp vitality.
Fig. 36:  Dead tract
(For colour version see Plate 23)
Fig. 37: Diffuse calcification
(For colour version see Plate 23)
Q.23. Write briefly on transparent dentin. (Oct 2007, 5 Marks)
Or
Write short note on transparent dentin.
 (Jan 2012, 2 Marks)
Ans. Transparent dentin is also known as sclerotic dentin.
• In cases of caries, attrition, abrasion, erosion or
cavity preparation, sufficient stimuli are generated
to cause collagen fibers and apatite crystals to begin
appearing in dentinal tubules.
• In such cases blocking of the tubules may be
considered a defensive reaction of the dentin.
• Apatite crystals are initially only sporadic in dental
tubules but gradually the tubules become filled with
the fine meshwork of crystals.
• Gradually the tubule lumen is obliterated with
minerals, which appears very much like peritubular
dentin.
Dental Histology  657
• Refractive indices of dentin in which the tubules
are occluded are equalized and such areas become
transparent.
• Transparent dentin can be observed in the teeth of
elderly people, specially in the roots.
• Sclerosis reduces the permeability of the dentin and
• Mineral density in this area of dentin is greater as
shown radiographically.
• It appears transparent or light in transmitted light
and dark in reflected light.
Fig. 38:  Transparent dentin
(For colour version see Plate 23)
Q.24. Write short note on Von-Korff’s fibers.
 (Sep 2017, 2 Marks) (Jan 2012, 2 Marks)
Ans. Von Korff’s fibers are argyrophilic or silver stained
collagen fibers.
• They are mainly seen in the mantle dentin.
• They consist of mainly Type III collagen.
• These are larger collagen fibers which are oriented
perpendicular to DEJ.
• Recent ultrastructural studies indicate that these
fibers do not undergo silver staining rather than
ground substance take the silver stain.
Q.25. Write short note on lamina limitans.
 (Jan 2012, 2 Marks)
Ans. A thin organic membrane rich in glycosaminoglycans is
called as lamina limitans.
• It is observed on the inner aspect of peritubular
dentin.
• It is similar to the lining of lacunae in cartilage and
bone.
Q.26. Write physical and chemical properties of dentin.
Describe in detail about structure of dentin.
 (Dec 2010, 10 Marks)
Ans.
Physical Properties
♦♦ In the teeth of young individuals the dentin is light
yellowish in color, becoming darker with age.
♦♦ Unlike enamel, which is very hard and brittle, dentin
is viscoelastic and subject to slight deformation. It is
658 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
somewhat harder than bone but considerably softer than
enamel.
♦♦ Dentin hardness varies slightly between tooth types and
between crown and root dentin.
♦♦ Dentin is somewhat harder in its central part than near the
pulp or on its periphery.
♦♦ Dentin of primary teeth is slightly less hard than that of
permanent teeth.
♦♦ Lower content of mineral salts in dentin renders it more
radiolucent than enamel.
Chemical Properties
♦♦ Dentin consists of 70% inorganic material, 20% organic
material and 10% water by weight, and 45%, 33% and 22%
respectively by volume.
♦♦ Organic substance consists of collagenous fibers embedded
in the ground substance of mucopolysaccharides
(proteoglycans and glycosaminoglycans).
♦♦ Type I collagen is the principal type of collagen found in
the dentin.
♦♦ The important constituents of the ground substance
are the proteoglycans—chondroitin sulphates, decorin
and biglycan glycoproteins—dentin sialoprotein (DSP),
osteonectin, osteopontin; phosphoproteins—dentin
phosphoprotein (DPP) d-carboxyglutamate containing
proteins (Gla-proteins) are phospholipids.
♦♦ The protein of dentin matrix and bone are similar, but
dentin sialoprotein and dentin phosphoprotein are present
only in dentin.
♦♦ In addition, the matrix contain growth factors like
transforming growth factor (TGF) fibroblast growth
factor (FGF), insulin like growth factors (IGFs) and bone
morphogenic proteins (BMPs). The matrix components
have important roles to play in mineralization of dentin.
♦♦ The inorganic component consists of hydroxyapatite, as
in bone, cementum and enamel.
♦♦ Each hydroxyapatite crystal is composed of several
thousand unit cells. The unit cells have a formula of 3Ca3
(PO4)2.Ca(OH)2. The crystals are plate shaped and much
smaller than the hydroxyapatite crystals in enamel.
♦♦ Dentin also contains small amounts of phosphates,
carbonates, and sulfates. The crystals are poor in calcium
but rich in carbon when compared to enamel.
Q.27. Write a short note on dental lymph.
 (Oct 2008, 3 Marks) (Dec 2010, 3 Marks)
 (Mar 2013, 3 Marks)
Ans. Dental lymph is a fluid which is present in the
periodontoblastic space in dentin.
• It is a transudate of extracellular fluid, mainly cytoplasm
of odontoblastic processes, from the dental pulp via
the dentinal tubules.
• Dental lymph, apparently nourishes teeth, keeps
them supplied with the mineral salts which make
them hard and impervious to bacteria and bits of
food which cause decay.
• Malnutrition is one of the factors which disturbs this
protective activity of the dental lymph.
Q.28. Write short note on intertubular dentin.
 (June 2010, 2 Marks)
Ans. The main body of dentin is composed of intertubular
dentin.
• It is located between dentinal tubules or between
zones of peritubular dentin.
• It is highly mineralized.
• It is made up of Type I collagen fibrils of diameter
50–200 nm which are arranged at right angles to
dentinal tubules.
Q.29. Write short note on contents of dentinal tubule.
 (Feb 2013, 2 Marks)
Ans. Odontoblastic process is the primary occupant of the
dentinal tubule.
• Fine cytofilaments are most characteristic finding.
• Microtubules are cytoskeletal features of odonto­
blastic processes.
• Beside odontoblastic processes other cellular
processes found in dentinal tubules are nerve fibers.
• Nerve endings are variable feature of dentinal
tubules.
• Some nerve endings in dentinal tubules have
singular enlargements while other have alternating
dilations and constrictions with odontoblastic
processes.
• Dentinal tubule has an organic coating or inner
lining which consists of glycosaminoglycans. This
layer is also known as lamina limitans.
Q.30. Write short note on physical properties of dentin.
 (May 2014, 2 Marks)
Ans. For physical properties of dentin refer to Ans 26 of same
chapter.
Q.31. Write about the tertiary dentin. (Feb 2013, 5 Marks)
Ans. Tertiary dentin is also known as irregular secondary
dentin or reactive dentin or reparative dentin.
• Tertiary dentin is formed in response to stimuli, i.e.
attrition, abrasion, erosion, cavity preparation, etc.
• Tertiary dentin is deposited on the pulpal surface of
dentin only in affected area.
• Appearance of tertiary dentin varies as it is formed
only by odontoblasts which are directly affected by
stimulus and depends on intensity and duration of
stimulus.
• Tertiary dentin is subclassified as reactionary or
reparative dentin.
• Difference between the reactionary and reparative
dentin is former is deposited by preexisting
odontoblasts and later by newly differentiated
odontoblast like cells.
• Cells forming the tertiary dentin line its surface
or become included in dentin. When the cells are
included in dentin the dentin is known as osteodentin.
• Tertiary dentin is different from other forms of
dentin that in tertiary dentin, dentin phosphophoryn
is not present.
 Dental Histology  659

Q.32. Enumerate hypocalcified structures of dentin. Q.35. Write briefly on composition of dentin.
 (Sep 2015, 2 Marks)  (Apr 2017, 2 Marks)
Ans. Following are the hypocalcified structures in dentin: Ans. Following is the composition of dentin:
1. Contour lines ♦♦ Composition of dentin by weight
2. Neonatal line • 70% inorganic substances
3. Interglobular dentin • 20% organic substances
4. Predentin. • 10% water
For details refer to Ans 11 of same chapter. ♦♦ Composition of dentin by volume
• 47% inorganic substances
Q.33. Define dentinogenesis. Describe the types of dentine • 32% organic substances
with well labeled diagrams. (Oct 2016, 10 Marks) • 21% water
Ans. Dentinogenesis is defined as process of dentin formation  Organic substances are Collagen Type I and Type II,
during development of teeth. phosphoproteins, carboxyglutamate containing proteins, acidic
glycoproteins, plasma proteins, lipids, growth related factors.
Types of Dentin
 Inorganic substances are calcium phosphate (hydroxyapa-
♦♦ On basis of location tite) small crystals, trace amount of fluoride and carbonate.
• Intertubular dentin: For details refer to Ans 1 of same Q.36. Enumerate the theories of dentin sensitivity.
chapter  (Oct 2016, 2 Marks)
• Intratubular dentin or peritubular dentin: For details refer Or
to ans1 of same chapter Enumerate theories of dentin hypersensitivity.
• Mantle dentin: For details refer to Ans 10 of same
 (Jan 2018, 2 Marks)
chapter
Ans. Enumeration of theories of dentin sensitivity or dentin
• Circumpulpal dentin: For details refer to Ans 10 of
hypersensitivity.
same chapter.
• Direct neural stimulation or direct innervation theory
♦♦ On basis of pattern of mineralization
• Fluid or hydrodynamic theory
• Globular dentin: It is formed from calcospherites
• Transduction theory.
• Interglobular dentin: For details refer to Ans 8 of same
chapter Q.37. Write classification of dentin. Write in short about pain
• Tomes granular layer: For details refer to Ans 3 of same transmission theories of dentin.
chapter  (Sep 2018, 2 + 3 = 5 Marks)
• Sclerotic dentin: For details refer to Ans 23 of same Ans. For classification of dentin refer to Ans 17 of same chapter.
chapter. For pain transmission theories refer to Ans 13 of same
♦♦ On basis of developmental pattern chapter.
• Primary dentin: For details refer to Ans 16 of same
chapter
• Secondary dentin: For details refer to Ans 16 of same 5. PULP
chapter
• Tertiary dentin: For details refer to Ans 32 of same Q.1. Write a short note on composition of pulp.
chapter  (Feb/Mar 2004, 5 Marks) (Mar 2009, 5 Marks)
Q.34. Enumerate the types of dentin. (Apr 2017, 2 Marks) Ans. Pulp composed of:
Ans. Enumeration of types of dentin • Odontoblasts
• Cell free zone or Weil’s zone
♦♦ On basis of location
• Cell rich zone.
• Intertubular dentin
• Odontoblasts: Refer to Ans 3 of same chapter.
• Intratubular dentin • Cell free zone: It is a space in which the odontoblast
• Mantle dentin may move pulp ward during tooth development
• Circumpulpal dentin and later to the limited extent in functional teeth.
♦♦ On basis of pattern of mineralization • Cell rich zone: This layer is composed principally
• Globular dentin of fibroblasts and undifferentiated mesenchymal
• Interglobular dentin cells. The latter are distinctive because they lack a
• Tomes granular layer ribosome studded ER and have mitochondria with
• Sclerotic dentin discernable cisternae. During early dentinogenesis
♦♦ On basis of developmental pattern there are many young collagenous fibers in this zone.
• Primary dentin Besides this the pulp also consists of intercellular
• Secondary dentin substance, fibers, defense cells, blood vessels, lymph
• Tertiary dentin vessels, nerves and nerve endings.
660 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Fig. 39:  Pulp
Q.2. Describe structure of pulp. (Aug/Sep 1998, 15 Marks)
Or
Write a short note on anatomy of pulp.
 (Apr 2007, 5 Marks)
Ans. The structure of pulp consists of:
• Intercellular substance
• Fibroblasts
• Fibers
• Undifferentiated mesenchymal cells
• Odontoblasts
• Defense cells
• Blood vessels
• Lymph vessels
• Nerves
• Nerve endings
• Intercellular substance: It is dense and gel like in
nature. It is composed of both glycosaminoglycans
and proteoglycans. During early development the
chondroitin A, chondroitin B and hyaluronic acid is
present in abundance. Glycoproteins are present in
the ground substance. As the pulp ages it consists of
less amount of this substance. The ground substance
lands support to cells of pulp and also serves as
means for transport of nutrients from blood vessels
to cells and vice versa.
• Fibroblasts: They are most numerous type cells in
the pulp.
- They have stellate shape and extensive processes
that contact and are joined by intercellular
junction to the processes of other fibroblasts.
- In young pulp the cell divides and are active
in protein synthesis whereas in older pulp
they appear rounded or spindle shape with
short processes and exhibit fewer intercellular
organelles and are called as fibrocytes.
- The fibroblasts of pulp, in addition to forming
the pulp matrix also have capability of ingesting
and degrading this same matrix.
• Fibers: Fibers may appear scattered throughout the
coronal or radicular pulp or they may appear in
bundles.
- These are termed as diffuse or bundle collagen
depending on their appearance and their
presence may relate to environmental trauma.
• Undifferentiated mesenchymal cells: They are the
primary cells in very young pulp, but few are seen
in pulps after root completion.
- They are found along the pulp vessels, in cell
rich zone and scattered throughout the central
pulp.
- They are believed to be the totipotent cells and
when need arises they may become odontoblasts,
fibroblasts and macrophages.
• Odontoblasts: Refer to Ans 3 of same chapter.
• Defense cells: Refer to Ans 4 of same chapter.
• Blood vessels: The pulp organ is extremely vascu-
larized.
- Pulp organ is supplied by superior alveolar and
inferior alveolar arteries and also drain by same
veins in maxilla and mandible.
- Some small diameter arterioles are present which
are known as “Pre Capillaries”.
• Lymph vessels: The larger lymph vessels have an
irregular shaped lumen composed of endothelial
cells surrounding by an incomplete layer of
pericytes.
- They are further characterized by absence of RBC
and presence of lymphocytes.
- Those draining anterior teeth pass to submental
lymph nodes and of posterior teeth pass to sub-
mandibular and deep cervical lymph nodes.
• Nerves: The majority of nerves that enter pulp are
nonmyelinated.
- The nonmyelinated nerves are found in close
association with blood vessels of pulp and many
are sympathetic in nature.
The large myelinated fibers mediate the
sensation of pain that may be caused by external
stimuli. The peripheral axons form a network of
nerves located to cell rich zone called as parietal
layer of nerves or Plexus of Rashkow.
• Nerve endings: Substances like substance P, 5HT,
vasoactive intestinal peptide, somatostatin and
prostaglandin as well as Ach and norepinephrine
throughout the pulp.
- The majority of putative transmitters have
been shown to affect vascular tone and modify
excitability of nerve endings.
Q.3. Write a short note on odontoblast.
 (Feb/Mar 2004, 5 Marks) (Sep 2000, 5 Marks)
Ans. Odontoblasts are second most prominent cells in the pulp
which resides adjacent to predentin with cell bodies in
pulp and cell processes in the dentinal tubules.
• They have a constant location near predentin in
“odontogenic zone of pulp”.

• The cell bodies of odontoblasts are columnar in
appearance with large oval nuclei which fill basal
part of the cell.
Fig. 40:  Odontoblasts
• Immediately adjacent to nucleus basally is RER and
Golgi apparatus.
• Further towards the apex of cell appears an
abundance of RER. Near the pulpal predentin
junction the cell cytoplasm is devoid of organelles.
• At cellular junction the cell constrict to diameter of
3 to 4 micrometer where the cell process enters the
predentinal tubules. The process of cell contains
no endoplasmic reticulum but during the early
period of dentinogenesis it does contain occasional
mitochondria and vesicles.
• The form and arrangement of bodies of odontoblasts
are not uniform throughout pulp. They are most
cylindrical and tall columnar in crown, more cuboid
in middle of root, close to apex odontoblasts are
ovoid and spindle shaped.
Q.4. Write note on defense cells of pulp. 
 (Sep 1999, 5 Marks) (Sep 2006, 5 Marks)
 (Jan 2012, 2 Marks)
Ans. Defense Cells of Pulp
• The cells which are important for defense of pulp
are histiocytes or macrophages, mast cells and
plasma cells. In addition there are blood vascular
elements such as neutrophil, basophil, lymphocytes
and monocytes.
• The above blood vessel elements emigrate from
pulpal blood vessel and develop characteristic in
response to inflammation.
• Histiocyte or macrophage is an irregular shaped
cell with short blunt processes. These cells are
Dental Histology  661
usually associated with small blood vessels and
capillaries. Both lymphocytes and eosinophills are
found extravascularly in the normal pulp during
inflammation they increase in number.
• Mast cells are also seen along vessels in inflamed
pulp. Their number increases during inflammation
of pulp.
• Plasma cells are seen during inflammation of pulp.
In it the chromatin of nucleus give cart wheel
arrangement. The plasma cell performs the function
of production of antibodies.
Q.5. Enumerate all functions of human dentinal pulp.
Describe in detail structural elements of pulp.
 (Mar 2008, 5 Marks)
Or
List four functions of pulp. (Aug 2016, 2 Marks)
Ans. Functions of Dentinal Pulp
• Inductive function: The primary role of pulp analge
is to interact with oral epithelium cells which cause
differentiation of dental lamina and enamel organ
formation.
– Pulp analge also interacts with developing
enamel organ as it determines particular type
of tooth.
• Formative function: Pulp organ cells produce dentin
which surrounds and protect the pulp.
• Nutritive function: Pulp nourishes the dentin through
odontoblasts and their processes and by means of
blood the vascular system of pulp.
• Protective function: Sensory nerves in the tooth
respond with pain to all stimuli. The nerve also
initiates the reflexes that control circulation in the
pulp. The sympathetic function is reflex, providing
stimulation to visceral motor fibers terminating on
muscles of blood vessels.
• Defensive or reparative function: It responds to
irritation whether mechanical, thermal, chemical
or bacterial by producing reparative dentin and
mineralizing affected tubules.
– P u l p h a s m a c r o p h a g e s , l y m p h o c y t e s ,
neutrophils, monocytes, plasma and mast cells
all of which aid in the process of repair of pulp.
For structural elements of dental pulp refer to Ans 3 of
same chapter.
Q.6. Describe histology of pulp tissue.
 (Mar 2000, 15 Marks) (Apr 2010, 15 Marks)
Ans. Answer refer to Ans 2 of same chapter.
Q.7. Write a note on pulp stones.
 (Feb 2006, 5 Marks) (Oct 2014, 3 Marks)
Or
Write a short note on denticles.
 (Sep 2005, 5 Marks) (Jan 2012, 2 Marks)
 (Feb 2013, 5 Marks) (Nov 2010, 3 Marks)
Or
662 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Describe pulp stones. (Aug 2011, 5 Marks) ♦♦ They appear as concentric circles or calcified tissue. In
Or center of these concentric layers of calcified tissue there
maybe remnants of necrotic and calcified tissue.
Answer in brief pulp stones. (Aug 2016, 2 Marks) ♦♦ Pulp stones are classified as free, attached and embedded
depending on their relation to dentin of the tooth.
Ans. Pulp Stones
• Free denticles: They are entirely surrounded by pulp
• Pulp stones or denticles, are nodular calcified masses tissue.
appearing in either or both the coronal and root • Attached denticles: They are partly fused with dentin.
portion of pulp organ. • Embedded denticles: They are entirely surrounded by
• They often develop in teeth that appear to be quite dentin.
normal in other aspects. They have been seen in ♦♦ All above denticles form free in pulp and later to become
functional as well as embedded unerupted teeth. attached or embedded as dentin formation progresses.
• Pulp stones are classified according to their ♦♦ The size of pulp stone increases as the age advances.
structures as: Q.8. Write a note on age changes in dental pulp. 
– True denticles  (Sep 2003, 5 Marks) (Dec 2010, 5 Marks)
– False denticles (Feb 2013, 5 Marks) (Feb 2014, 3 Marks)
(May 2014, 5 Marks)
True Denticles
Or
Write short note on age changes of pulp.
 (Sep 2017, 3 Marks)
Or
Describe age changes in pulp. (Dec 2014, 3 Marks)
Or
Write very short answer on age changes of pulp.
 (Aug 2018, 2 Marks)
Ans. Age Changes in Dental Pulp
• The cells are characterized by decrease in size and
number of cytoplasmic organelles.
• The fibroblasts in aging pulp exhibit less perinuclear
Fig. 41:  True pulp stone cytoplasm and posses long thin cytoplasmic processes.
(For colour version see Plate 24) • As age advances fibroblasts may result leading to
increase in collagen fiber content in pulp organ.
♦♦ The remnants of epithelial root sheath induce the cells of • Collagen increase is noticed in the medial and
pulp to differentiate into odontoblasts which then form adventitial layers of blood vessel as well.
the dentin masses called as true pulp stones. • The increase in collagen fiber may be more apparent
♦♦ They are rare and found near the apical foramen. than actual being attributed to decrease in size of pulp.
• Pulp Stones: (See Ans 7 of same chapter).
False Denticles
• Diffuse calcifications appear as irregular calcific
deposits in pulp tissue, usually following collagenous
fibrous bundles or blood vessels. These calcifications
are found in root canal. The diffuse calcification are
also characterized as dystrophic calcification.
Q.9. Enumerate the function of pulp. Describe the regressive
changes of pulp. (Feb. 2006, 7.5 Marks)
Ans. For functions refer to Ans 5 of the same chapter. For
regres­sive changes of pulp refer to Ans 8 of the same
chapter.
Q. 10. Write a short note on functions of pulp.
 (Mar 2007, 3 Marks) (June 2010, 8 Marks)
 (July 2016, 3 Marks) (Aug 2012, 5 Marks)
Or
Fig. 42:  False pulp stone Describe the functions of pulp shortly.
(For colour version see Plate 24)  (Mar 2007, 4 Marks)

Or
Write short answer on functions of pulp.
 (May 2018, 3 Marks)
Ans. Refer to Ans 5 of the same chapter.
Q.11. Write note on pulp fibrosis. (Mar 2007, 2.5 Marks)
Ans.
• In aging pulp accumulation of diffuse fibrillar
components and bundles of collagen fibers appears.
Fiber bundles appear arranged longitudinally
in bundles in radicular pulp and more diffuse
arrangement on coronal area.
• The increase in fiber in pulp organ is generalized
throughout the organ.
• Vascular changes occur in aging pulp organ.
• Atherosclerotic plaque may appear in pulpal vessels.
• Calcifications in the wall of blood vessels are found
more often in region near the apical foramen.
• Outer diameter of vessel walls becomes greater, as
collagen fibers increase in the medial and adventitial
layer.
Fig. 43:  Denticles (For colour version see Plate 24)
Q.12. Write in short regarding the structure and function of
pulp. (Sep 2007, 8 Marks)
Ans. For structure refer to Ans 2 and for function refer to
Ans 5 of same chapter.
Q.13. Describe the cellular elements of dental pulp. 
 (Oct 2007, 15 Marks)
Ans. The cellular elements of dental pulp are:
• Intercellular substance
• Fibroblasts
• Fibers
• Undifferentiated mesenchymal cells
• Odontoblasts
• Defense cells
For above cells refer to Ans 1 of same chapter.
• Odontoblasts: Refer to Ans 3 of same chapter
• Defence cells of pulp: Refer to Ans 4 of same chapter.
Q.14. Enumerate cells of pulp. Describe histology of each
cell type. (Oct 2008, 7.5 Marks)
Dental Histology  663
Ans. Cells of the pulp are as follows:
• Undifferentiated mesenchymal cells: Refer to Ans 3 of
same chapter
• Odontoblasts: Refer to Ans 3 of the same chapter
• Defense cells: Refer to Ans 4 of the same chapter.
Q.15. Write about pulp at periphery. (Nov 2008, 5 Marks)
Ans. Peripherally pulp is circumscribed by the specialized
odontogenic region composed of:
• The odontoblasts
• The cell free zone (Weil’s zone)
• The cell rich zone
For details refer to Ans 1 of the same chapter.
Fig. 44:  Pulp at periphery (For colour version see Plate 24)
Q.16. Write about histology and functions of pulp.
 (May/June 2009, 10 Marks)
Ans. For histology of pulp tissue refer to Ans 2 and for
functions refer to Ans 5 of same chapter.
Q.17. Write short note on cell free zone of weil.
 (Aug 2011, 2 Marks)
Ans. It is also known as cell free zone.
It is a free space in between odontoblastic and cell rich
zone.
• Cells are absent in this zone.
• Few collagen fibers run through Weil’s zone.
• There are two opinions of researchers about the zone.
First is that the odontoblast move pulpward in this
zone during tooth development and another is that
this zone is an artifact.
Q.18. Write about cells of pulp. (Jan 2012, 5 Marks)
Or
Answer in brief cells of dental pulp.
 (Oct 2016, 2 Marks)
Ans. Pulp consists of following cells, i.e.
• Fibroblasts
• Undifferentiated mesenchymal cells
• Defense cells, i.e. histiocytes, macrophages, mast
cells, dendritic cells and plasma cells. In addition
664 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

neutrophils, eosinophils, basophils, lymphocytes ♦♦ Cell free zone consists of network of nerve fibers which lost
and monocytes are also seen. their myelin sheath and are known as Plexus of Rashkow.
For fibroblasts refer to Ans 2 of same chapter.
For undifferentiated cells refer to Ans 2 of same chapter. Cell Rich Zone
For defense cells refer to Ans 4 of same chapter. ♦♦ It is situated below the cell free zone.
Q.19. Enumerate the cells of pulp. Write the age changes of ♦♦ Cell rich zone is the narrow zone having high density of
pulp (any two). (Sep 2015, 2+3 = 5 Marks) cells rich capillary network.
Ans. Enumeration of Cells of Pulp ♦♦ This zone is seen in both coronal and radicular pulp.
1. Fibroblasts ♦♦ Cell rich zone has fibroblasts, undifferentiated mesen-
2. Undifferentiated mesenchymal cells chymal cells, macrophages, immunocompetent cells and
3. Odontoblasts young collagen fibers.
4. Defense cells ♦♦ Cell rich zone act as a reservoir for replacing destroyed
a. Histiocytes or macrophages odontoblasts.
b. Dendritic cells
c. Mast cells Pulp Core or Pulp Proper
d. Plasma cells
♦♦ Connective tissue located in center of coronal and radicular
e. Blood vascular elements, i.e. neutrophils,
pulp is known as pulp core.
eosinophils, basophils, lymphocytes, monocytes
5. Pulpal stem cells. ♦♦ This is a core of loose connective tissue with rich cellular
For age changes in pulp (any two) refer to Ans 8 of same elements and also consists of large nerves and blood vessels
chapter. which branches towards the peripheral pulp area.
♦♦ In the younger pulp, core consists of more of cells while
Q.20. Enumerate zones of dental pulp. (Sep 2015, 2 Marks)
in older pulp more of fibrous components are present.
Ans. Histologically four distinct zones of pulp are seen:
1. Odontoblastic zone Q.22. Enumerate cells of pulp. Add a note on functions of
2. Cell free zone pulp. (Jan 2018, 2 + 3 Marks)
3. Cell rich zone Ans. Enumeration of cells of pulp
4. Pulp core or pulp proper. 1. Fibroblasts
Q.21. Write short note on zones of pulp. 2. Undifferentiated mesenchymal cells
 (Feb 2016, 3 Marks) 3. Odontoblasts
Or 4. Defense cells
Answer in brief zones of pulp. (May 2017, 2 Marks) a. Histiocytes or macrophages
Ans. Histologically four distinct zones of pulp are seen: b. Dendritic cells
A. Odontoblastic zone c. Mast cells
B. Cell free zone d. Plasma cells
C. Cell rich zone e. Blood vascular elements, i.e. neutrophils,
D. Pulp core or pulp proper. eosinophils, basophils, lymphocytes, monocytes
Odontoblastic Zone 5. Pulpal stem cells
For functions of pulp refer to Ans 5 of same chapter.
♦♦ This zone is present at the periphery of pulp and contains
cell bodies of odontoblasts. Q.23. Enumerate regressive changes of pulp. Write functions
♦♦ Cell bodies of odontoblasts lie in continuous row near the of pulp. (Sep 2018, 3 + 2 = 5 Marks)
dentinal end of pulp. Ans. Enumeration of regressive changes of pulp.
♦♦ Many of the nerve fibers enter odontoblastic zone and get • Pulp stones or denticles
terminated between the odontoblasts. • Diffuse calcification
♦♦ Odontoblastic layer as well as subodontoblastic nerve • Size: As age advances there is decrease in pulp size
network combines to form sensory complex which envelop due to continuous secondary dentin deposition.
the central pulp core.
• Cellular and fibrous components: With ageing
Cell Free Zone fibrous component becomes more prominent and
there is reduction in number of cells.
♦♦ Below the odontoblastic zone a layer of 40 µ is seen which
does not consists of cells. This layer is known as zone of • Changes in blood supply and innervations: There is
Weil or sub odontoblastic layer. decrease in blood supply and there is degeneration
♦♦ Cell free zone is prominently seen in the coronal pulp. of myelinated and unmyelinated axons.
♦♦ Cell free zone decreases in size when dentin formation • Decrease in sensitivity and healing potential.
occurs at rapid rate. For functions of pulp refer to Ans 5 of same chapter.

6. CEMENTUM
Q.1. Write a short note on cementum.
 (Mar 2001, 5 Marks) (Feb/Mar 2004, 5 Marks)
Ans. Cementum is the mineralized dental tissue covering the
anatomic roots of human teeth.
• It begins at cervical portion of tooth to CEJ and
continues to apex.
• Cementum furnishes a medium for attachment of
collagen fibers that bind the tooth to surrounding
structure.
• Cementum is light yellow in color.
• On dry basis, cementum consists of 45 to 50%
inorganic substances, 50 to 55% organic substances
with water. The inorganic portion consists of calcium
and phosphorus in form of hydroxyapatite.
• Cementum has highest fluoride content of all the
mineralized tissues.
• The organic portion of cementum consist of type I
collagen and protein polysaccharides.
• Cementum formation in developing tooth is
preceded by deposition of dentin along inner aspect
of Hertwig’s epithelial root sheath.
• Breaks occur in epithelial root sheath allowing
newly form dentin to come in direct contact with
connective tissue of dental follicle. Cells derived
from this connective tissue are responsible for
cementum formation.
• Cementum also performs various functions which
are:
1. It furnishes a medium for attachment of collagen
fibers that bind tooth to alveolar bone.
2. It serves as major reparative tissue for root
surface.
3. It may also be viewed as tissue that makes
functional adaptation of teeth possible.
Q.2. Describe anatomy, histology and functions of
cementum. (Feb 2002, 15 Marks)
Ans. can be repaired, by deposition of new cementum.
Anatomy of Cementum
In general, the cementum is of two types:
1. Acellular cementum.
2. Cellular cementum.
Fig. 45:  Cementum
Dental Histology  665
• Cementum is thinnest at the cemento enamel junction
(CEJ) and is thickest towards the apex.
• The apical foramen is surrounded by cementum.
Sometime cementum extend to inner wall of dentin
for short distance and so lining of root canal is formed.
• In decalcified specimen of cementum collagen fibrils
make up the bulk of organic portion of tissue.
• Cementum is generally light yellow in color and is
avascular.
• The dentin surface upon which the cementum is
deposited is smooth in permanent teeth and is called
as cementodentinal junction.
• Relation between cementum and enamel at cervical
region of teeth is known as cementoenamel junction.
Histology of Cementum
♦♦ Structure of cementum consists of cementoblast which
synthesize collagen and protein polysaccharide, which
make up organic matrix of cementum.
♦♦ Uncalcified matrix of cementum is called cementoid.
♦♦ Cementoblast have numerous mitochondria, well formed
golgi apparatus and large amount of granular endoplasmic
reticulum.
♦♦ Connective tissue fibers are embedded in cementum
and serve to attach the tooth to surrounding bone. These
embedded portions are sharpey’s fiber.
♦♦ The cementum also consists of cementocytes which
contain few endoplasmic reticulum which are dilated
and mitochondria which are sparse. This suggests that
cementocytes are either degenerating or active cells.
♦♦ Beside this cementum consists of incremental lines which
consist of less collagen fibers and more ground matrix.
These lines separate acellular and cellular cementum.
Functions of Cementum
♦♦ Cementum furnishes a medium for attachment of collagen
fiber that bind to alveolar bone.
♦♦ Continuous deposition of cementum is of considerable
functional importance.
♦♦ Cementum serves as major reparative tissue for root
surface. Damage to root such as fracture and resorption
♦♦ Cementum may also be viewed as tissue that makes
functional adaptation of teeth possible. The deposition
of cementum in an apical area can compensate for loss of
tooth substance from occlusal wear.
Q.3. Write a short note on cellular and acellular cementum.
 (Sep 2009, 5 Marks)
Or
Write about cellular and acellular cementum.
 (Feb 2013, 10 Marks)
Ans.
Acellular Cementum
♦♦ It is also known as primary cementum.
♦♦ This is the first formed cementum and covers cervical two
third of root.
666 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
♦♦ Since rate of formation of this cementum is slow this allows
sufficient time to cementoblasts to move away due to
which these cells are not entrapped in matrix and primary
cementum is acellular.
♦♦ In the ground section acellular cementum appear
structureless without any entrapped cells.
♦♦ In this incremental lines can be seen as dark lines which
run parallel to root surface and are close to each other
because of slow deposition.
♦♦ Sharpey’s fibers can be seen as fine striations which lie
perpendicular to root surface. Sharpey’s fibers are more
in acellular cementum as compared to cellular cementum
but they are less distinct in acellular cementum as they
become fully mineralized.
♦♦ Inner most portion of cementum of 15 to 20µ adjacent
to dentin consists of only collagen fibers secreted by
cementoblasts. So this part is known as primary acellular
intrinsic fiber cementum.
♦♦ Remaining part of cementum consists of fibers secreted by
periodontal ligament fibroblasts, so this part is known as
primary acellular extrinsic fiber cementum. This is because
primary cellular cementum is formed by extrinsic fibers
because it is secreted after formation of PDL.
A cellular cementum.
Figs 46A and B:  (A) Cellular cementum and
(B) Acellular cementum (For colour version see Plate 24)
Cellular Cementum
♦♦ Cellular cementum is also known as secondary cementum
because it is formed after acellular extrinsic fiber
cementum.
♦♦ It is formed in apical one third portion of root.
♦♦ It is of two types i.e. cellular mixed fiber cementum and
cellular intrinsic fiber cementum.
♦♦ Cellular mixed fiber cementum forms bulk of secondary
cementum and occupies apical interradicular regions while
cellular intrinsic fiber cementum is present in middle and
apical third areas.
♦♦ Cellular mixed fiber cementum helps to reshape the root
surfaces in physiologic and pathologic drifting of teeth in
tooth socket while cellular intrinsic fiber cementum form
as a result of repair and regeneration process.
♦♦ Rate of cellular cementum deposition is faster which leads
to entrapment of cementoblasts in matrix and they remain
as resting cementocytes in mineralized cementum.
♦♦ Cells which are incorporated in this cementum are
cementocytes which lie in lacunae.
♦♦ A cementocyte consists of many cell processes or canaliculi
which radiates from its cell body. These processes can
branch and anastomose with neighboring cells. Most of
these processes are directed to PDL from where they derive
nutrition while some are directed inward also.
♦♦ Cellular cementum also show incremental lines of Salter
which run parallel to root surface and are far apart due
to increase thickness of each increment which is due to
faster deposition.
♦♦ Cellular cementum always consists of peripheral layer of
cementoid which is lined by cementoblasts.
♦♦ At light microscopic level lacunae in deep layers of
cementum appear to be empty suggesting of degeneration
of cementocytes present in these layers.
Q.4. Write short note on cementocytes.(Feb 1999, 6 Marks)
Or
Write notes on cementocytes. (Mar 2007, 2.5 Marks)
Ans. Cementocytes are the cells that are incorporated into
• Cementocytes are spider like cells.
• Cementocytes are similar to osteocytes.
• They lie in lacunae.
• A typical cementocyte has numerous cell processes
or canaliculi, radiating from its cell body.
Fig. 47:  Cementocytes
(For colour version see Plate 25)
 Dental Histology  667

• These processes may branch and anastomose with Q.6. Write short note on cementoenamel junction. 
those of neighboring cells.  (July 2016, 3 Marks) (Nov 2008, 5 Marks)
• Most of the processes are directed towards the Or
periodontal surface of cementum.
Write short note on types of CEJ. (Oct 2014, 3 Marks)
• Cytoplasm of cementocytes in deeper layer of
cementum contains few organelles. Or
• Endoplasmic reticulum appears dilated and Write about cementoenamel junction.
mitochondria are sparse.  (Sep 2015, 5 Marks)
• These characteristics indicate that cementocytes are
Or
either degenerating or marginally active cells.
• In deeper layer cementocytes show signs of Write in brief about types of cementoenamel junction. 
degeneration such as cytoplasmic clumping and  (May 2017, 2 Marks)
vesiculation. Ans. Relation between cementum and enamel at cervical
• In more deeper layer of cementum lacunae appear region of teeth is called as cementoenamel junction.
empty and suggesting complete degeneration of
cementocytes.
Q.5. Write note on Sharpey’s fiber.  (Mar 1998, 5 Marks)
 (Feb/Mar 2004, 5 Marks) (Feb 2006, 5 Marks)
Or
Write short note on Sharpey’s fibers. 
 (Jan 2012, 5 Marks) (May 2014, Marks)
Or
Write very short answer on Sharpey’s fibers. 
 (Aug 2018, 2 Marks) (May 2018, 2 Marks)
Ans. Sharpey’s Fibers
• Discrete bundles of collagen fibers which are seen Fig. 49:  Butt junction  (For colour version see Plate 25)
in tangential section, these bundles are known as
sharpey’s fiber. Types of Cementoenamel Junction
• Sharpey’s fibers makes up the substantial portion ♦♦ End-to-end approximating junction (Butt Junction): In
of cementum. approximately 30% of all teeth cementum meets the
• When cementum remains relatively thin these cervical end of enamel in a relatively sharp line.
sharpey’s fibers crosses the entire thickness of ♦♦ Overlapping junction
cementum. • The cementum overlapping the enamel:
• With further apposition of cementum the large part
In approximately 60% of teeth, cementum overlaps
of fiber is incorporated in cementum.
the cervical end of enamel for short distance.
• Cemental surfaces with actively mineralizing fronts
This occurs when the enamel epithelium degenerates
have numerous small openings that correspond to
at its cervical termination permitting connective tissue
site where individual sharpey’s fibers enter the tooth.
to come in direct contact with enamel surface which
• The openings represent unmineralized core of fibers.
produce a laminated, electron dense, reticular material
termed as afibrillar cementum.

Fig. 48: Sharpey’s fibers Fig. 50:  Cementum overlapping enamel junction
(For colour version see Plate 25) (For colour version see Plate 25)
668 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
• Enamel overlapping cementum junction
Recent observations by researchers by optical microscopy
showed fourth type of junction known as enamel
overlapping cementum junction.
Fig. 51:  Enamel overlapping cementum junction
(For colour version see Plate 25)
♦♦ The absence of connecting enamel and cementum (Gap Junction)
In about 10% of teeth enamel and cementum do not meet.
In such cases there is no cemento enamel junction. This
occurs when enamel epithelium in cervical portion of roots
delayed in the separation from dentin. In this case dentin
is an external part of the surface of the root.
Fig. 52:  Gap junction (For colour version see Plate 25)
Q.7. Write a note on hypercementosis.
 (Nov 2010, 3 Marks) (Aug 2012, 5 Marks)
Or
Write short answer on hypercementosis.
 (May 2018, 3 Marks)
Ans. Hypercementosis is an abnormal thickening of
cementum.
• It may be diffuse or circumscribed.
• It may affect all teeth of dentition or single tooth or
even a part of one tooth.
• If overgrowth improves the functional qualities of
cementum it is termed as cementum hypertrophy.
• If overgrowth occur in nonfunctional teeth or if it
is not correlated with increase function it is termed
as hyperplasia.
Cementum Hypertrophy
♦♦ In localized hypertrophy a spur or prog like extension of
cementum may be formed.
♦♦ This condition is found in teeth that are exposed to great
stresses.
♦♦ That prog like extensions provide a large surface area for
attaching fibers.
Hyperplasia
♦♦ Hyperplastic cementum covering the enamel drops in
dentin occasionally is irregular and sometime contains
round bodies.
♦♦ Excementosis localized hyperplastic cementum which are
knob like projection around degenerated epithelial rests.
♦♦ Extensive hyperplasia of cementum is occasionally
associated with chronic peripheral inflammation. Here
hyperplasia is circumscribed and surrounds the root like
cuff.
♦♦ Hyperplasia of cementum in nonfunctioning teeth is
characterized by reduction in number of Sharpey’s fibers
embedded in root.
♦♦ Cementum is thicker around the apex of all teeth and in
the furcation of multi rooted teeth.
♦♦ In some cases an irregular overgrowth of cementum can
be found with spike like extension and calcification of
Sharpey’s fibers and some cementicles.
Fig. 53:  Cemental hyperplasia
Q.8. Describe clinical consideration of cementum.
 (Aug/Sep 1998, 5 Marks) (Mar 2009, 5 Marks)
Or
Write in brief clinical consideration of cementum.
 (Aug 2011, 10 Marks)
Ans. Clinical Consideration of Cementum
• Cementum is more resistant to resorption than bone,
and for this reason that orthodontic tooth movement
is made possible.
• In careful orthodontic treatment, cementum
resorption is minimal or absent but bone resorption
leads to tooth migration.
• Cementum resorption can occur after trauma or
excessive occlusal forces.
• After resorption damage is usually repaired by
formation of cellular or acellular or both cementum.
 Dental Histology  669

• In most cases of cemental repair the outline of root Write short answer on cellular cementum.
is re-established, this is called as anatomic repair.  (Aug 2018, 3 Marks)
• In some cases of repair the outline of alveolar bone Ans. For cellular cementum refer to Ans 3 of same chapter.
follows that of root surface so that a functional For classification of cementum refer to Ans 17 of same
relationship will result, this change is called as chapter.
functional repair.
Q.11. Write short note on DE Junction and CE Junction.
• Transverse fracture of the root may occur after
 (Oct 2007, 5 Marks)
trauma, and these may heal by formation of new
Ans. For DEJ refer to Ans 7 of ENAMEL chapter and for CEJ
cementum.
refer to Ans 6 of the same chapter.
• The PDL pockets, plaque and its by products can
cause numerous alteration in the physical, chemical Q.12. Write a note on cementogenesis.(Sep 2007, 2.5 Marks)
and structural characteristic of cementum. Ans. Cementum is the hard tissue that is deposited on the
• The surface of pathologically exposed cementum surface of dentin.
becomes hypermineralized because of incorporation
of calcium, phosphorus and fluoride from oral
environment.
Q.9. Write a short note on anatomic and functional repair.
 (Sep 2005, 5 Marks)
Ans.
Anatomic Repair
♦♦ In most cases of cemental repair outline of root is
re-established known as anatomic repair.
♦♦ In cementum the resorbed area is filled completely by
cementum and continuity of root surface periodontal
attachment is re-established.

Functional Repair
♦♦ In some cases of cemental repair outline of alveolar bone
follows that of root surface so functional relationship will
result known as functional repair. Fig. 55:  Differentiation of cementoblasts
(For colour version see Plate 26)
♦♦ In cementum the resorbed area is filled partially and there
is a presence of bay like defect over the root surface. In
functional repair the alveolar bone create a bony projection
for establishing normal physiologic width of periodontal
attachment.

Fig. 54:  Anatomic and functional repair

Q.10. Write in short cellular cementum.(Apr 2007, 5 Marks)

Fig. 56:  Cementum deposition (For colour version see Plate 26)
Or
Write short note on cellular cementum.
 (Oct 2016, 3 Marks) (Nov 2009, 5 Marks)
Or
Classify cementum. Discuss cellular cementum.
 (Sep 2017, 3 Marks)
Or
• Once the root dentin formation has been initiated,
the Hertwig’s epithelial root sheath fragments into
a network which allows the ectomesenchymal cells
of dental follicle to pass through and contact the
root dentin.
• These follicular cells differentiate into cementoblasts
and are responsible for cementum formation.
670 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

• Cementoblasts have numerous mitochondria, Q.14. Describe afibrillar and intermediate cementum.
well formed golgi apparatus and large amount of  (Feb 2013, 5 Marks)
granular endoplasmic reticulum. Ans.
• Cementoblasts synthesize collagen and protein
polysaccha­rides which are made up of organic Afibrillar Cementum
matrix of cementum. ♦♦ It is the cementum without collagen fibrils.
• After some cementum matrix is laid down, its ♦♦ It is seen over the enamel near the CEJ.
mineralization begins. ♦♦ Though the cementum is called as afibrillar, it contains
• The uncalcified matrix is called as cementoid.
fiber in its matrix but they lack characteristic collagen
• Calcium and phosphate ions present in tissue fluids
periodicity.
are deposited into the matrix and are arranged as
♦♦ If afibrillar cementum remains in contact with connective
unit cells of hydroxyapetite.
tissue cells for long time, the fibrillar cementum with
• Mineralization of the cementoid is the highly
collagen fibrils get deposited on its surface and thickness
ordered event.
of cementum which overlies enamel increases.
• As the new layer of cementoid is formed, the old
one calcifies. Intermediate Cementum
• Connective tissue fibers from the PDL pass between
the cementoblasts and cementum, these fibers serve ♦♦ It is also known as hyaline layer of Hopewell Smith
to attach the tooth to surrounding bone. ♦♦ Sometimes dentin gets separated from cementum by zone
• Their embedded portions are known as Sharpey’s called as intermediate cementum.
fibers. ♦♦ It does neither exhibit characteristics of cementum nor
Q.13. Write a note on cells of cementum.(Oct 2008, 3 Marks) of dentin.
♦♦ It is also known as hyaline layer, this is because it appears
Or to be structureless.
Write short note on cementoblast and ceme­ntocytes. ♦♦ It is prominently visible in apical two-thirds of roots of
 (Feb 2013, 2 Marks) (May 2014, 2 Marks) molars and premolars.
Ans. Following are the cells of cementum: ♦♦ This layer represents areas where cells of Hertwig’s
• Cementoblasts epithelial sheath get entrapped in rapidly deposited dentin
• Cementocytes or cementum matrix.
Cementoblasts ♦♦ This layer is considered to be of dentinal origin.

♦♦ They synthesize collagen and protein polysaccharides Q.15. Write short note on junctions of tooth.
which make up the organic matrix of the cementum.  (Jan 2012, 2 Marks)
♦♦ These cells have numerous mitochondria, a well Ans. Following are the junctions of tooth:
formed golgi apparatus and large amounts of granular • Dentinoenamel junction (DEJ)
endoplasmic reticulum. - It is the junction between enamel and dentin
♦♦ These cells secrets the cementum. which is scalloped in shape.
- The concavities of scallope faces towards the
Cementocytes dentin while concavities faces towards the
Refer to Ans 4 of the same chapter. enamel.
- Membrana preformativa is seen between enamel
and dentin at the time of tooth development.
During calcification this membrane disappear
and interface is known as dentinoenamel
junction.
• Predentin Pulp junction: This is formed by dense
collagenous fibers and is present between uncalcified
dentin and pulp.
• Dentin-Predentin junction: Dentin-predentin
junction is the junction between dentin and
predentin.
• Cementoenamel Junction (CEJ)
- Junction between cementum and enamel
at cervical region of tooth is known as
cementoenamel junction.
Fig. 57:  Cementoblast and cementocyte - It is of clinical importance during root scaling
(For colour version see Plate 26) procedures.
 Dental Histology  671

• Cementodentinal Junction (CDJ) Q.17. Write about types of cementum. (Jan 2012, 5 Marks)
- Apical area of cementum where it joins Ans. Following are the types of cementum:
the internal root canal dentin is known as • Based on cellularity:
cementodentinal junction. – Acellular cementum: Cementum present with­
- Its width is 2–3 µm. out the cells.
- It is smooth junction between dentin and – Cellular cementum: Cementum consisting of
cementum. cells.
- Its clinical importance is that when RCT is • Based on time of origin:
performed the filling material should end up at – Primary cementum: First formed cementum. It
CEJ.
is acellular. It consist of PDL.
Q.16. Write differences between cellular and acellular – Secondary cementum: It forms after tooth
cementum. (Aug 2016, 3 Marks) (Dec 2014, 2 Marks) reaches occlusal plane.
 (May 2017, 3 Marks) • Based on presence of collagen fiber:
Or – Afibrillar cementum: Cementum does not
Write differences between cellular and acellular consist of fibers.
cementum. (Sep 2018, 2 Marks) – Fibrillar cementum: Cementum consisting of
Ans. fibers.
• Based on origin of cementum matrix fibers:
S. – Extrinsic cementum: Cementum consisting of
No. Acellular cementum Cellular cementum
matrix fibers derived from periodontal ligament.
1. Located from cervical to apical Located in apical third and – Intrinsic cementum: Cementum consisting of
third furcations matrix fibers derived from cementoblasts.
2. It is formed earlier and is Formed later and during – Mixed fiber cementum: Cementum containing
known as primary cementum repair and is known as both extrinsic and intrinsic matrix fibers.
secondary cementum
Q.18. Describe afibrillar cementum. (Dec 2014, 5 Marks)
3. It consists of noncollagenous Noncollagenous proteins
Ans. When cementoblasts come under contact with enamel
protein-tenascin, fibronectin are present
and osteocalcin are absent they produce laminated, electron dense, reticular
material known as afibrillar cementum.
4. Growth factors TGF β and IGF Growth factors are seen
• It is seen over the enamel near cementoenamel
are not seen
junction.
5. Proteoglycans, i.e. versican, These proteoglycans are • This cementum is named as afibrillar but it consists
decorin, biglycan and lumican seen in the matrix
of fibers in its matrix, but the fibers lack main
were not identified in the
matrix. characteristic of collagen fibers i.e. 64 nm banding.
• If afibrillar cementum comes in contact with the
6. Cementoid is usually absent Cementoid is seen on the connective tissue cells for the long time, fibrillar
surface
cementum with collagen fibrils may subsequently
7. It contains only extrinsic fibers Contains only intrinsic get deposited on its surface and thickness of
of the periodontal ligament fibers produced by cementum which overlie enamel increases.
formed by fibroblast cementoblast
• It does not play any role in tooth attachment since
8. Probably the only type of May be absent in single it lack collagen fibers.
cementum in single rooted rooted teeth • It is also known as coronal cementum since it can
teeth
be seen on occlusal fissures and other sites where
9. Its main function is anchorage Main function is adaptation break in reduced enamel epithelium has occurred.
and repair
Q.19. Define cemental hypertrophy and cemental hyperplasia.
10. It is formed slowly It is formed rapidly  (Sep 2015, 2 Marks)
11. Incremental lines are closer to Incremental lines therefore Ans. Cemental hypertrophy: When excessive deposition of
each other further apart cementum improves the function of tooth, it is known
12. Cementocytes are not seen Cementocytes, viable as cemental hypertrophy.
to varying degrees and Cemental hyperplasia: Excessive deposition of
depths seen cementum in a nonfunctional tooth is known as cemental
13. Cementoblasts are suggestive Cementoblast suggested hyperplasia.
to be derived from hertwig to be derived from inner
epithelial root sheath cells of dental follicle Q.20. Write briefly on cemental repair. (Apr 2017, 2 Marks)
Ans. Resorption of cementum occurs after trauma or excessive
14. Cementocytes do not express Cementoblasts express
occlusal forces. But as resorption is ceased, damage
parathormone receptors parathormone receptor
get repaired either by formation of cellular or acellular
672 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

cementum or by alternate formation of both of them ♦♦ Noncollagenous proteins present are alkaline phosphatases,
which is known as cemental repair. osteonectin, osteocalcin, sialoprotein, osteopontin,
Cemental repair is of two type, i.e. anatomic repair and proteoglycans and growth factors (BMP, PDGF, FGF).
functional repair. These proteins help in regeneration and remineralization
In most cases of repair former outline of root surface has of cementum.
tendency to re-establish which is known as anatomic ♦♦ Polypeptides, i.e. cementum derived attachment
repair. protein and cementum derived growth factor is
In cases where thin layer of cementum is deposited expressed in cementum matrix. These promote
on surface of deep resorption, root outline is not attachment of Mesenchymal cells and also play role in
reconstructed and a bay like recess remains. In these cementogenesis.
areas sometimes periodontal space is restored to its   For cementoenamel junctions along with their diagrams
normal width by formation of bony projection so proper refer to Ans 6 of same chapter.
functional relationship will occur. Outline in such cases
Q.23. Write any four differences between dentin and
follows root surface which is known as functional repair.
cementum. (Sep 2018, 2 Marks)
Q.21. Write differences in cementum and bone. Ans. Following are the four differences between dentin and
 (Apr 2017, 2 Marks) cementum:
Ans. Following are differences between cementum and bone:
Feature Dentin Cementum
Features Cementum Bone
Composition • 45% inorganic material • 67% inorganic Composition • 70% inorganic • 45% inorganic
• 33% organic material material substances material
• 22% water • 33% organic material • 20% organic • 33% organic material
substances • 22% water
Non- Cementum attachment Cementum attachment • 10% water
collagenous protein present; protein absent;
proteins fibromodulin as well as fibromodulin as well as Dentinal Present Absent
lamican are present lamican are absent tubules

Rate of 0.005 to 0.01 µm per day 1 to 2 µm per day Cementocytes Absent Present
apposition and
cementoblasts
Vascularity Avascular Vascular
Incremental • Incremental lines of • Incremental lines of
Nerve supply Lacks nerve supply Rich nerve supply
lines dentin are known as cementum are known
Ability to Limited Effective incremental lines of as incremental lines
remodel Von Ebner. of Salter.
Resistance It is resistant Resorbs quickly under • These lines reflect • Incremental lines
to resorption hormonal influences the daily rhythmic, separate the cellular
recurrent deposition and acellular
of dentin matrix as cementum into
Q.22. Classify cementum. Write composition of cementum. well as a hesitation layers which indicate
Describe cementoenamel junction in detail. Draw well in the daily periodic formation.
labeled diagrams of CEJs. formative process.
 (Jan 2018, 2 + 2 + 4 + 2 Marks)
Ans. For classification of cementum refer to Ans 17 of same
chapter.
7. PERIODONTAL LIGAMENT
Composition of Cementum
Q.1. Describe briefly the cellular elements of PDL.
Cementum consists of:
 (Mar 2000, 15 Marks)
♦♦ Inorganic components – 45 to 50%
Ans. Following are the cellular elements of periodontal
♦♦ Organic components and water – 50 to 55%
♦♦ Inorganic portion consists of calcium and phosphate in ligament:
form of hydroxyapatite crystals. Other trace elements are • Synthetic cells, i.e. fibroblasts, osteoblasts and
copper, iron, fluoride, magnesium, sodium, zinc, silica cementoblasts
and potassium are present in varying amounts. Fluoride • Resorptive cells, i.e. osteoclasts, fibroblasts and
ions are present in highest concentrations in cementum as cementoclasts
compared to any another hard tissue of body. • Progenitor cells
♦♦ Organic portion consists of Type I collagen which forms • Epithelial cell rest of malassez
90% of organic matrix. Small amount of other types of • Defense cells, i.e. mast cells, eosinophils and
collagen present are Type III, V, VI, XII, XIV. macrophages
 Dental Histology  673

Synthetic Cells Progenitor Cells

Fibroblasts ♦♦ Progenitor cells have small, close face nucleus with scanty
cytoplasm.
♦♦ It is the primary cell of periodontal ligament.
♦♦ In periodontal ligament, they found to be of highest
♦♦ Fibroblasts originate from ectomesenchyme of dental
number near blood vessels.
papilla and dental follicle.
♦♦ Progenitor fibroblasts are small, less polarized, have less
♦♦ Fibroblasts have extensive cytoplasm and abundant
RER and Golgi bodies.
organelles which are associated with protein synthesis
♦♦ Cells of osteoblast type have high level of alkaline
and secretion. Its nucleus occupies whole volume of cell.
phosphatase.
♦♦ Fibroblasts of periodontal ligament form an organizational
♦♦ These cells in periodontal ligament are responsible
pattern and they synthesize and shape proteins of
for tissue homeostasis and lead to the generation of
extracellular matrix in which collagen fibers form bundles
cementoblasts, osteoblasts and fibroblasts.
which get inserted in bone and tooth as sharpey’s fibers.
♦♦ Role of fibroblasts is to produce collagen and elastin, Epithelial Rest of Malaseez
connective tissue proteins, glycoproteins and glycosa-
minoglycans which are present in ground substance of ♦♦ They are the remnants of epithelium of H ertwig’s
periodontal ligament. epithelial root sheath.
♦♦ Fibroblasts also secrete a family of enzymes known as ♦♦ These cells are arranged in clumps and are closely packed.
matrix metalloproteinases. ♦♦ Their nucleus is prominent and scanty cytoplasm is present.
♦♦ Fibroblasts lead to the remodeling of PDL fibers. ♦♦ They are less numerous in older individuals and more in
♦♦ Fibroblasts of PDL have cilia. children.

Osteoblasts Defense Cells

♦♦ These cells cover the periodontal surface of alveolar bone. These are macrophages, mast cells and eosinophils.
♦♦ Osteoblasts are cuboidal in shape with round nucleus
present at the basal end of the cell. Macrophages
♦♦ They are the bone forming cells which lines the socket. ♦♦ They lie adjacent to blood vessels in periodontal ligament.
♦♦ Osteoblasts are in contact with underlying osteocytes by ♦♦ In periodontal ligament they phagocytose the dead cells
cytoplasmic processes. and secrete growth factors which regulate proliferation of
adjacent fibroblasts.
Cementoblasts
♦♦ Cementoblasts are of cuboidal shape and have large Mast Cells
vesicular nucleus. ♦♦ It is a round or oval shaped cell.
♦♦ Cementoblasts deposit cellular cementum. ♦♦ Mast cell releases histamine which plays role in inflam-
♦♦ They have basophilic cytoplasm and cytoplasmic matory reaction.
processes. Its nuclei are folded and are of irregular shape. ♦♦ Mast cells also play an important role in regulating
♦♦ They show gap junctions and desmosomes. endothelial and fibroblast cell population.
Resorptive Cells Eosinophils
Osteoclasts ♦♦ They are occasionally seen in periodontal ligament.
♦♦ Osteoclasts are large and multinucleated. ♦♦ They possess granules which contain crystalloid structures.
♦♦ These cells resorb the bone. ♦♦ They can undergo phagocytosis.
♦♦ These cells consists of eosinophilic cytoplasm, at times Q.2. Describe the functions of periodontal ligament.
they occupy bay in the bone known as Howship’s lacunae.  (Aug/Sep 1998, 5 Marks) (Feb 2002, 6 Marks)
♦♦ Part of plasma membrane which lie adjacent to bone is  (Apr 2007, 5 Marks)
resorbed and lie in folds which is known as ruffled border. Or
♦♦ A zone of specialized membrane which lie close to the
bone, its underlying cytoplasm is devoid of organelles Write short note on functions of periodontal ligament.
known as clear zone.  (Nov 2010, 3 Marks) (Aug 2011, 5 Marks)
 (May 2017, 2 Marks)
Fibroblasts
Or
These cells degenerate collagen by fibroblast phagocytosis
Write briefly on four functions of PDL.
which leads to fast turnover of collagen in PDL.
 (Apr 2017, 2 Marks)
Cementoclasts Ans. Following are the functions of periodontal ligament:
♦♦ These cells resemble like osteoclasts. • Supportive
♦♦ They are seen in normal functioning periodontal ligament. • Sensory
674 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

• Nutritive ♦♦ Eruptive: Cells, vascular elements and extracellular matrix

• Homeostatic
• Eruptive.
♦♦ Supportive
• Whenever a tooth is moved in its socket the PDL that
is found around the root get compressed and provides
support to the tooth.
• The numerous collagen fibers that occur in PDL act as
cushion to withstand force of mastication.
• The role of collagen fibers are restricted to.
–– Attaching the cementum that is fused to dentin
from the root to alveolar bone
–– Acting as a cushion.
♦♦ Sensory: The PDL is richly innervated and has an
excellent proprioceptive mechanism, thus the PDL helps
in identifying the slightest amount of force that is applied
to the tooth.
• This mechanism has a protective effect on tooth,
as well as on supporting structures. It consists of
Ruffini’s endings which posses the proprioception
which helps in localization of pain. PDL also consists
of free nerve endings with tree like ramification
which are responsible for carrying pain sensation and
performing mechanoceptor function.
♦♦ Nutritive: The PDL has got blood vessels, which provide
anabolites and other substances which are required by the
cells of ligament, by the cementocytes and by the more
superficial osteocytes of alveolar bone during functional
demand and in normal physiologic process.
• The blood vessels are also concerned with removal
of catabolites.
♦♦ Homeostatic: It is evident that the cells of PDL have
the capacity to resorb and synthesize the extracellular
substance of the connective tissue of the ligament, alveolar
bone and cementum.
• If the balance between synthesis and resorption is
disturbed, the quality of the tissue will be changed.
• This will result in progressive destruction and loss of
extracellular substance of periodontal ligament.
• This loss is more prominent on bony side than on the
cementum side.
• This will lead to loss of attachment between tooth such
as occurs in scurvy when vitamin C is absent from diet.
proteins of periodontal ligament causes eruption of tooth.
Periodontal ligament provides space and acts as medium
for cellular remodeling and causes eruption of tooth.
Q.3. Describe the function and structure of principal fibers
of PDL. (Apr 2008, 10 Marks)
Or
Describe the principal fibers of periodontal ligament.
Discuss about the functions of periodontal ligament.
 (Feb 2005, 15 Marks)
Or
Describe the principal group of periodontal ligament
fibers with their corresponding structures.
 (Oct 2006, 15 Marks)
Or
What are the functions of periodontal ligament.
Describe principal group of periodontal ligament
fibers. (Aug 2011, 10 Marks)
Or
Discuss the various principal group of periodontal
ligament and write a note on function this ligament.
 (Apr 2015, 8 Marks)
Or
Write functions of periodontal ligament. Describe
principal group fibers of periodontal ligament.
 (July 2016, 10 Marks)
Ans. Principal Fibers of Periodontal Ligament/
Dentoalveolar Group of Fiber
• Fiber bundles which exit the cementum and alveolar
bone proper to form periodontal ligament are known
as principal fibers.
• Principal fibers of periodontal ligament are named
according to their location with respect to the tooth.
• They consist of five differently oriented principal
fiber groups which are named according to their
origin and insertion in dentoalveolar process.
For functions of periodontal ligament refer to Ans 2
of same chapter.

Fiber group Origin Location of attachment Insertion Function

Apical At cementum around Apex of root to fundic proper In the apex of socket It resists the vertical force
apex of root
Oblique At cementum Apical third of root to adjacent Run obliquely in coronal direction It resists vertical masticatory
alveolar bone and are inserted in alveolar bone forces and intrusive forces.
Horizontal At cementum, apical Midroot to adjacent alveolar They run at right angle to long axis It resists horizontal as well as
to alveolar crest bone proper of tooth and are inserted in bone tipping forces
which lie apical to alveolar crest
Alveolar crest At cementum below Cervical root to alveolar crest It run outward and downward and It resists vertical and intrusive
the CEJ of alveolar bone proper are inserted in alveolar crest. forces
Inter-radicular At cementum Between roots to alveolar They are inserted in inter-radicular It resists vertical and lateral
bone proper septum movement

Fig. 58: Horizontal alveolar and oblique group of fibers
(For colour version see Plate 26)
Fig. 59: Apical group of fibers
(For colour version see Plate 26)
Fig. 60: Inter-radicular group of fibers
(For colour version see Plate 26)
Q.4. Enumerate the fibers bundles of PDL and write in detail
about function of PDL. (Feb 2002, 16 Marks)
Ans. Enumeration of fiber bundles of PDL
a. Apical
b. Oblique
c. Horizontal
d. Alveolar crest
e. Inter-radicular.
For functions of periodontal ligament in detail refer to
Ans 2 of same chapter.
Dental Histology  675
Q.5. Write note on cell rests of Malassez. (Feb 1999, 5 Marks)
Or
Write in short on cell rests of Malassez. 
 (Oct 2007, 5 Marks) (Jan 2012, 2 Marks)
 (Aug 2011, 2 Marks)
Ans. The PDL contains epithelial cells which are formed close
to the cementum.
• These cells were described by Malassez in 1889 and
are the remnants of Hertwig’s epithelial root sheath.
• Electron microscope studies show that the epithelial
rest cells exhibit tonofilaments.
• They attached to each other by desmosomes.
• The epithelial rest cells are separated from other
connective tissue cells by a basal lamina.
• Their physiologic role in the functioning PDL is
unknown.
• When certain pathologic conditions are present
the cells of the epithelial rests can undergo rapid
proliferation and produce a variety of cysts and
tumors that are unique in the jaws.
Q.6. Describe clinical consideration of periodontal
ligament. (Oct 2001, 3 Marks)
Ans. Following are the clinical considerations of periodontal
ligament:
• Proprioception in periodontal ligament leads to
positional awareness, i.e. periodontal infection is
easily localized by the patient.
• Epithelial cell rest of Malaseez in PDL can sometime
form into periapical cysts.
• Thickness of periodontal ligament is maintained
by functional movements of tooth. PDL is thin if
tooth is functionless and is thick if tooth have heavy
occlusal loads. For restorative dentistry this change
is of importance.
• Acute trauma to PDL, accidental blow and rapid
mechanical separation may lead to fracture or
resorption of cementum, the adjacent alveolar bone is
resorbed and PDL is widened and tooth become loose.
• Orthodontic tooth movements depend on resorption
and formation of bone and PDL. If orthodontic tooth
movement is within the physiologic limits, initial
compression of PDL on pressure side is compensated
by bone resorption while on tension side bone
apposition occur. Application of large forces lead
to necrosis of PDL.
• Periodontitis is a chronic inflammatory disease of
periodontium. It is caused by dental plaque and its
toxic products, which destroy PDL tissue. Result
of this process is formation of periodontal pockets,
tooth mobility and tooth loss.
Q.7. Enumerate the principal fibers of periodontal ligament.
Describe in detail the cells of periodontal ligament.
 (Sep 2005, 15 Marks)
Ans. Enumeration of principal fibers of PDL
• Apical group
• Oblique group
676 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
• Horizontal group
• Alveolar crest group
• Inter-radicular group.
For cells of periodontal ligament refer to Ans 1 of same
chapter.
Q.8. Enumerate various cells of periodontal ligament and
discuss in detail about each cell.
 (Mar 2006,15 Marks)
Ans. For details refer to Ans 1 of same chapter
Q.9. Enumerate the functions of periodontal ligament.
Describe the principal fibers of periodontal ligament.
 (Oct 2006, 7.5 Marks)
Or
Enumerate the functions of periodontal ligament.
 (Sep 2018, 2 marks)
Ans. Enumeration of functions of periodontal ligament
• Supportive function
• Sensory function
• Nutritive function
• Homeostatic function
• Eruptive function.
For principal fibers of periodontal ligament refer to
Ans 3 of same chapter.
Q.10. Enumerate functions of pulp. Write about principal
fibers of periodontal ligament. (Sep 2007, 7.5 Marks)
Or
Discuss the principal fibers of periodontal ligament in
detail enumerate functions of pulp. 
 (Dec 2012, 8 Marks)
Ans. Enumeration of Functions of Pulp
• Inductive function
• Formative function
• Nutritive function
• Protective function
• Defensive or reparative function
For principal fibers of periodontal ligament in detail refer
to Ans 3 of same chapter.
Q.11. Write short note on oxytalan fibers. (Nov 2010, 2 Marks)
Ans. Oxytalan fibers are the type of immature elastic fibers.
• They consist of microfibrillar component only.
• These fibers are approximately 0.5 µm to 2.5 µm in
diameter.
• They can be demonstrated in the light microscope
in tissue stained by certain special stains used to
color elastic fibers.
• In the ultrastructure, fibers are believed to be
oxytalan resemble developing elastic fibers.
• Orientation of oxytalan fibers is that they run in axial
direction one end being embedded in bone and other
in the wall of blood vessel.
• In cervical region they follow course of gingival and
trans-septal fibers.
• Within the periodontal ligament proper, these fibers
are longitudinally oriented, crossing the oblique
fibers perpendicularly. In the vicinity of the apex
they form a complex network.
• Function of the oxytalan fibers is that they may play
a part in supporting the blood vessel of periodontal
ligament.
• Oxytalan fibers are founded to be thicker and and more
numerous in teeth that are subjected to high loads.
Thus, these fibers may have a role in tooth support.
Q.12. Describe in detail the principal group of periodontal
ligament fibers. (June 2010, 10 Marks)
Or
Describe in brief principle fibers of periodontal
ligament. (Dec 2010, 5 Marks) (Jan 2012, 5 Marks)
 (Apr 2008, 10 Marks) (May 2014, 5 Marks)
Or
Write short note on principal group of fibers in
periodontal ligament.
 (Feb 2013, 2 Marks) (Feb 2013, 5 Marks)
Ans. Refer to Ans 3 of same chapter.
Q.13. What is periodontium? Write in detail about fibers of
periodontal ligament. (May/June 2009, 15 Marks)
Or
What is periodontium? Describe fibers of periodontal
ligament.  (Aug 2012, 10 Marks)
Or
Write short note on fibers of PDL.
 (Oct 2016, 3 Marks)
Ans. Periodontium is a connective tissue organ which is
covered by epithelium that attaches the teeth to bone of
jaws and provides continually adapting apparatus for
support of teeth during function.
It consists of two mineralized tissues and two fibrous
tissues. Alveolar bone and cementum forms mineralized
components and periodontal ligament and lamina
propria of gingiva which consists of gingival group of
fibers form fibrous component of periodontium.
Fibers of Periodontal Ligament
Fibers of peridontal ligament are collagen fibers accessory fibers
and oxytalan fibers.
Collagen Fibers
These fibers are also known as principal fibers of periodontal
ligament. For details refer to Ans 3 of same chapter.
Accessory Fibers
It includes gingival fibers and trans-septal fibers.
♦♦ Gingival group of fibers are:
• Dento-gingival group: These fibers are multiple and
extend from cervical cementum to lamina propria of
free and attached gingiva.

• Alveologingival group: They radiate from bone of
alveolar crest and extend to to lamina propria of free
and attached gingiva.
• Circular group: These small groups of fibers form
a band around neck of tooth interlacing with other
group of fibers in free gingiva and help in binding of
free gingiva to tooth.
• Dentoperiosteal group: They run apically from
cementum over periosteum of outer cortical plates of
alveolar process, these fibers insert in alveolar process
or the vestibular muscle and floor of mouth.
♦♦ Trans-septal fibers: They run interdentally from cementum
just apical to base of junctional epithelium of one tooth over
alveolar crest and insert in comparable region of cementum
of adjacent tooth. Togetherly these fibers constitute trans­
septal fiber system collectively forming an interdental
ligament which connect all teeth of arch.
Oxytalan Fibers
♦♦ These fibers are present inside the periodontal ligament.
♦♦ These fibers run in an axial direction and their one end
is embedded in cementum or bone and other end in the
wall of blood vessel.
♦♦ These fibers play a part in supporting blood vessels of PDL.
♦♦ These fibers are more thick and numerous in teeth which
are subjected to high loads.
Q.14. Enumerate principle fibers of PDL. (Dec 2014, 2 Marks)
 (Aug 2018, 2 Marks)
Or
Enumerate principle group of periodontal ligament.
 (Sep 2018, 2 Marks)
Ans. Enumeration of principal fibers of PDL
• Apical group
• Oblique group
• Horizontal group
• Alveolar crest group
• Inter-radicular group.
Q.15. Enumerate functions of periodontal ligament principle
group fibers. (Sep 2015, 2 Marks)
Ans. Enumeration of functions of periodontal ligament of
principle group of fibers:
a. Supportive
b. Sensory
c. Nutritive
d. Homeostatic
e. Eruptive.
For details refer to Ans 2 of same chapter.
Q.16. Answer in brief fibroblast. (Feb 2016, 2 Marks)
Or
Write very short answer on fibroblast.
 (May 2018, 2 Marks)
Ans. Fibroblast is the principle cell of connective tissue.
• Fibroblasts originate from undifferentiated
mesenchymal cells.
Dental Histology  677
• They are the most numerous cells of connective tissue.
• Fibroblasts are fixed cells and they are nonmobile.
• Resting fibroblast is an elongated or spindle shaped
cell with little cytoplasm and flattened nucleus
containing condensed chromatin. Active fibroblasts
are oval, having pale staining nucleus and a great
amount of cytoplasm. When seen from the surface,
the cell shows branching process.
• Fibroblasts become very active when there is need to
lay down collagen fibers, e.g. in wound healing. When
need arises, fibroblasts undergo division, give rise to
more fibroblasts and are regarded as specialized cells.
Fig. 61:  Fibroblast
• Fibroblasts form specialized focal contacts with
components of extracellular matrix. In such a focal
contact, they are also known as fibronexus.
• Fibroblast is the predominant cell in the periodontal
ligament. These fibroblasts origin in part from the
ectomesenchyme of investing layer of dental papilla
and from the dental follicle and are different from
cells in connective tissue in a number of aspects.
• Fibroblasts near alveolar bone are derived from
perivascular mesenchyme.
Functions
♦♦ Fibroblasts undergo connective tissue formation.
♦♦ Fibroblasts undergo remodeling of periodontal ligament.
♦♦ Fibroblasts undergo wound repair.
♦♦ Fibroblasts also secrete biological active molecules such as
proteinases, cytokines, growth factors and inflammatory
mediators. It includes IL-1,6,8 tumor necrosis factor α,
Progtaglandin E2. platelet derived growth factor, insulin
like growth factor-1, transforming growth factor β,
vascular endothelial growth factor, basic fibroblast growth
factor, hepatocyte and keratinocyte growth factor.
Q.17. Define periodontium. What are the structures which
constitute periodontium. Discuss the principal fibers
of periodontal ligament. Add a note on functions of
periodontal ligament. (Aug 2016, 10 Marks)
Ans. Periodontium is a connective tissue organ which is
covered by epithelium that attaches the teeth to bone of
jaws and provides continually adapting apparatus for
support of teeth during function.
678 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Structures Constituting Periodontium ♦♦ Epithelial cell rest of Malassez

♦♦ Defense cells, i.e. mast cells, eosinophils and macrophages
1. Fibrous tissues
• Gingiva For principal fibers of periodontal ligament along with their
• Periodontal ligament diagrams refer to Ans 3 in detail.
2. Mineralized tissues Q.20. Write very short answer on cementicles.
• Cementum  (May 2018, 2 Marks)
• Alveolar bone Ans. Cementicles are the calcified bodies which are sometimes
For principal fibers of periodontal ligament refer to Ans 3 of found in periodontal ligament.
same chapter. • Cementicles represent areas of dystrophic calcifica-
For functions of periodontal ligament refer to Ans 7 of same chapter. tion.
Q.18. List fibers of periodontal ligament and gingiva. • Cementicles are seen in older individuals.
• Cementicles may remain free in connective tissue,
 (Sep 2017, 2 Marks) can fuse into large calcified masses or they can be
Ans. joined with the cementum.
Fibers of Periodontal Ligament • As cementum becomes thick with advancing age, it
can envelop these bodies.
Fibers of periodontal ligament are divided into three types, i.e. • When they adhere to cementum, they form exce-
1. Principle fibers of periodontal ligament or dentoalveolar mentoses.
group of fibers • Origin of cementicles is not clear but it is possible
• Apical that degenerated epithelial cells form nidus for their
• Oblique calcification.
• Horizontal
• Alveolar crest
• Inter-radicular 8. ALVEOLAR PROCESS
2. Accessory fibers: It consists of gingival fibers and trans­
septal fibers Q.1. Describe histology and function of alveolar bone.
• Gingival fibers  (Sep 2002, 15 Marks)
–– Dentogingival group Ans. Alveolar bone is the part of maxilla and mandible which
–– Alveologingival group supports roots of teeth. It consists of alveolar bone proper
–– Circular group and supporting alveolar bone.
–– Dentoperiosteal group
• Trans–septal group Histology of Alveolar Bone
3. Oxytalan fibers Alveolar process is divided into two parts i.e.
1. Alveolar bone proper
Fibers of Gingiva
• Lamellated bone
♦♦ Dentogingival fibers • Bundle bone
♦♦ Longitudinal fibers 2. Supporting alveolar bone
♦♦ Circular fibers • Cortical plates
♦♦ Alveologingival fibers • Spongy bone
♦♦ Dentoperiosteal fibers
♦♦ Trans-septal fibers Alveolar Bone Proper
♦♦ Semicircular fibers Alveolar bone proper when viewed microscopically consists
♦♦ Transgingival fibers partly of lamellated and partly of bundle bone.
♦♦ Interdental/interpapillary fibers
Lamellated Bone
♦♦ Vertical fibers
♦♦ Lamellated bone is arranged roughly parallel to surface of
Q.19. Enumerate the cells of periodontal ligament. Describe adjacent marrow spaces.
principle fibers of periodontal ligament. Draw well ♦♦ It also consists of haversian systems, osteon and canaliculi.
labeled diagram of principle fibers of PDL. ♦♦ Each osteon consists of concentric layers or lamellae of
 (Jan 2018, 2 + 5 + 3 Marks) osseous tissue which surrounds central haversian canal.
Ans. ♦♦ Between the adjoining osteons, angular intervals are
Enumeration of Cells of Periodontal Ligament present occupied by interstitial lamellae.

Following are the cells of periodontal ligament: Bundle Bone

♦♦ Synthetic cells, i.e. fibroblasts, osteoblasts and cementoblasts ♦♦ Alveolar bone consists of perforating fibers from PDL.
♦♦ Resorptive cells, i.e. osteoclasts, fibroblasts and cementoclasts Perforating fibers are sharpey’s fibers. Sharpey’s fibers are
♦♦ Progenitor cells bundle of collagen fibers present in alveolar bone.
 Dental Histology  679

♦♦ Sharpey’s fibers lie perpendicular to bone. Osteoblast

♦♦ Bundle bone consists of few fibers which appear dark in ♦♦ Osteoblasts are round or polygonal in shape.
routine Hematoxylin and Eosin stained sections. ♦♦ They lie over the outer surface of bone.
Supporting Alveolar Bone ♦♦ They are uninucleated whose nucleus is eccentrically
placed.
It consists of cortical plates and spongy bone. ♦♦ Osteoblasts secrete type I collagen as well as the non-
collagenous matrix of bone.
Cortical Plates
♦♦ Osteoblast contains prominent Golgi apparatus, rough
♦♦ This part consists of compact bone histologically. endoplasmic reticulum, mitochondria, nucleoli and many
♦♦ Outer surface of cortical plate is covered by periosteum and secretory vesicles and vacuoles.
different types of lamellae, i.e. circumferential, concentric, ♦♦ Osteoblasts secrete cytokine which regulate cellular
interstitial. metabolism.
♦♦ Compact bone of alveolar process contains osteons with ♦♦ They have high levels of alkaline phosphatase which create
radiating lamellae accentuated by lacunae which contain an alkaline environment for bone formation.
osteocytes in living bone. ♦♦ As osteoblasts secrete the organic matrix of bone, it is at
♦♦ Haversian and Volkmann’s canals form a continuous first devoid of minerals salts, it is called osteoid tissue.
system of nutrient canals which radiate throughout the
Osteocytes
bone.
♦♦ Haversian canals extend through the long axis of the bone ♦♦ Resting osteoblasts are known as osteocytes.
and Volkmann’s canal enter haversian canal at right angles. ♦♦ As osteoblasts secret extracellular matrix, they become
♦♦ Osteocytes are present in many of the lacunae and provide small in size and are known as osteocytes.
maintenance and viability to the bone. ♦♦ Osteocytes lie in osteocytic lacunae.
♦♦ Outer cortical plate shows numerous openings known as ♦♦ Osteocytes are interconnected with each other by the
Volkmann’s canals. cytoplasmic processes.
♦♦ Osteocytes help in calcium homeostasis by mobilizing
Spongy Bone calcium in and out of bone matrix.
♦♦ Histologically spongy bone is cancellous bone.
Osteoclasts
♦♦ It consists of irregular, interlacing bony trabeculae or plates
of bone with bone marrow spaces between them. ♦♦ Osteoclasts are cells that resorb bone and tend to be large
♦♦ Cancellous bone contains osteocytes in inner part and and multinucleated but can also be small or mononuclear.
osteoblasts and osteoclasts on outer surface of trabeculae. ♦♦ Multinucleated osteoclasts are formed by the fusion of
♦♦ Bone marrow contains blood forming elements, osteogenic circulating monocytes.
cells and adipose tissues. ♦♦ These multinucleated cells exhibit eosinophilic cytoplasm.
♦♦ Supporting bone of maxilla is filled with marrow tissue ♦♦ The cell body is irregularly oval or club-shaped and may
which consists of immature red blood cells and leucocytes. show many branching processes.
♦♦ Osteoclasts are found in bay like depression in the bone
called Howship’s lacunae.
♦♦ Osteoclast has prominent mitochondria, lysosome,
vacuoles and little rough endoplasmic reticulum. Their
nuclei have condensed chromatin and single nucleus.
♦♦ Osteoclasts are the physiological giant cells.
♦♦ Osteoclasts consist of four zones, i.e.
1. Ruffled border: Part of osteoclast causing resorption
is known as ruffled border, it is made up of finger
like processes which extend in part of bone which
has to be resorbed. It consists of tightly packed
microvilli. Ruffled border provides large surface area
for resorption.
2. Sealing zone: This zone is present in outer region of
Fig. 62:  Alveolar bone ruffled border. It forms close contact with the bone
(For colour version see Plate 27) and create microenvironment in which resorption take
place without liberating hydrolytic enzymes produced
Cells Present in Alveolar Bone
by cell. This prevents adjacent tissue from damaging.
Histologically three types of cells are seen in bone i.e. osteoblasts, 3. Basolateral zone: It is an area which receives regulatory
osteocytes and osteoclasts. signals from adjacent cells.
680 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

4. Secretory zone: From this region the resorbed products ♦♦ It is known as bundle bone because bundles of principal
and degraded bone matrix is pushed out of the cell. fibers continue inside the bone as sharpey’s fibers.
It consists of numerous mitochondria, abundant ♦♦ Bundle bone consists of few fibrils as compared to
golgi complex, rough endoplasmic reticulum and lamellated bone because of this, it appears dark in routine
lysosomes. Hematoxylin and Eosin stained sections.
♦♦ Formation of bundle bone is in areas of recent bone
Functions of Alveolar Bone apposition.
♦♦ It provide house to the roots of teeth. ♦♦ Bundle bone show lines of rest.
♦♦ Provide anchorage to the roots of teeth. ♦♦ Radiographically bundle bone is known as lamina dura
♦♦ Helps in movement of tooth for better occlusion. due to its increased radiopacity.
♦♦ It absorbs and distributes occlusal forces created during
tooth contact.
♦♦ It supply various vessels to PDL.
♦♦ It supports deciduous teeth and protect budding
permanent teeth.
♦♦ Eruption of deciduous and permanent teeth is organized
by alveolar bone.
Q.2. Write a note on alveolar bone. (Mar 2001, 5 Marks)
Or
Write short note on alveolar bone. 
 (Nov 2009, 5 Marks) (Nov 2010, 5 Marks)
 (Dec 2014, 4 Marks) (May 2017, 3 Marks)
Or
Write briefly on alveolar bone. (Aug 2012, 5 Marks) Fig. 63:  Parts of alveolar bone—Proximal view
Or
List parts of alveolar bone with diagrammatics
representation. (Sep 2017, 2 Marks)
Or
Write very short answer on parts of alveolar bone.
 (Aug 2018, 2 Marks)
Ans. Alveolar bone is also known as alveolar process.
Alveolar bone may be defined as that part of the maxilla
and the mandible that forms and supports sockets of the
teeth.
Alveolar bone is divided into two parts i.e.
1. Alveolar bone proper
– Lamellated bone
– Bundle bone
2. Supporting alveolar bone
– Cortical plates Fig. 64:  Alveolar bone from occlusal view
– Spongy bone
Cribriform Plate
Alveolar Bone Proper
♦♦ Alveolar bone proper which forms inner wall of socket
Alveolar bone proper when viewed microscopically consists which is perforated by many of the openings which carry
partly of lamellated and partly of bundle bone. branches of interalveolar nerves and blood vessels in PDL.
This is known as cribriform plate.
Lamellated Bone
♦♦ Cribriform plate is a compact bone.
Lamellae of this bone are arranged parallel to the surface of
adjacent marrow spaces while others form haversian system. Interdental Septum
♦♦ Bone between the teeth is known as interdental septum.
Bundle Bone ♦♦ Interdental septum consists mainly of cribriform plate.
♦♦ It is the bone which consists of principal fibers of ♦♦ The interdental and inter-radicular septa contain the
periodontal ligament anchored in it. perforating canals of Zukerkandl and Hirschfeld (Nutrient

Canals) which house the interdental and inter-radicular
arteries, veins, lymph vessels and nerves.
Supporting Alveolar Bone
This part is a bone that surrounds the alveolar bone proper and
gives support to the socket.
The alveolar process or bone consists of two parts:
Cortical Plates
♦♦ This part consists of compact bone and forms the outer
and inner plates of the alveolar processes.
♦♦ Cortical plates are continuous with the compact layers of
the maxillary and mandibular body.
♦♦ Cortical plates are much thinner in maxilla than in the
mandible. They are thickest in the region of molar and
premolar in mandible.
♦♦ In the maxilla, the outer cortical plate is perforated by
many small openings for blood and lymph vessels passage.
♦♦ In lower jaw the cortical bone of the alveolar process is
dense.
♦♦ Bone which underlies gingiva is known as cortical plate.
Cortical plate is a compact bone.
Spongy Bone
♦♦ This part fills the area between the cortical plates and the
alveolar bone proper.
♦♦ According to the radiographs spongiosa of alveolar process
is divided into two main types, i.e.
1. In type I spongy bone, the interdental and inter-
radicular trabeculae are regular and horizontal in
ladder like arrangement.
2. Type II spongy bone, shows irregularly arranged,
numerous, delicate interdental and inter-radicular
trabeculae.
♦♦ Type I is common in mandible and Type II is common in
maxilla.
♦♦ Marrow spaces present in alveolar bone may consists of
hemopoietic marrow but mainly they have fatty marrow.
♦♦ In condylar process, angle of mandible, maxillary
tuberosity and in various other isolated foci, hematopoietic
cellular marrow is found.
Q.3. Write a note on bundle bone in detail.
 (Sep 1998, 6 Marks) (Sep 1999, 5 Marks)
 (Mar 2000, 5 Marks)
Or
Write in short on bundle bone. (Apr 2007, 5 Marks)
Or
Describe briefly bundle bone. (June 2010, 5 Marks)
Ans. Bundle bone: Bundle bone is that bone in which the
principal fibers of the periodontal ligament are anchored.
• The term ‘’bundle bone” was chosen because the
bundles of the principal fibers continue into the bone
Sharpey’s fibers.
• Bundle bone is characterized by the scarcity of the
fibrils in the intercellular substance.
Dental Histology  681
• These fibers are arranged at right angles to Sharpey’s
fibers.
• Bundle bone contains fewer fibrils than does
lamellated bone.
• Bundle bone appears dark in routine hematoxylin
and eosin stained section.
• In some areas the alveolar bone proper consists
mainly of bundle bone.
• Bundle bone contains more calcium salt per unit area
than other types of bone tissues.
• It is formed in the areas of recent bone apposition.
• Bundle bone show lines of rest.
• Radiographically bundle bone is known as lamina
dura due to its increased radiopacity. Increased
radiopacity is due to the presence of thick bone
without trabeculae that X–rays must penetrate.
Q.4. Write a note on resting and reversal lines of bone.
 (Sep 2003, 5 Marks)
Or
Write about resting and reversal lines.
 (May/June 2009, 5 Marks) (June 2010, 2 Marks)
Ans. Resting and reversal lines appear during reconstruction
of alveolar bone.
Resting Line
Bone is laid down rhythmically and there are periods of active
deposition and quiescence which leads to formation of regular
parallel incremental lines known as resting lines. Resting lines
are formed in the period of quiescence. Resting line is regular.
Reversal Line
The cement line which consists of little or no collagen and is
strongly basophilic due to its high content of glycoproteins
and proteoglycans, marks the limit of bone erosion prior to
formation of osteon and is known as reversal line. Reversal
line is highly irregular as it is formed by scalloped outline of
Howship’s lacunae. Old and the new bone is separated by this
distinct curved hematoxophilic line, i.e. reversal line with its
convexity facing the old bone. Reversal lines are the indicators
of continuous remodeling of bone.
Fig. 65:  Resting lines of bone (For colour version see Plate 27)
682 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Q.5. Write a note on cells of bone. 3. Basolateral zone: It is an area which receives regulatory
 (Feb 2006, 2.5 Marks) (Dec 2010, 2 Marks) signals from adjacent cells.
Ans. The cells of bone are osteoblast, osteocytes and osteoclast. 4. Secretory zone: From this region the resorbed products
and degraded bone matrix is pushed out of the cell. It
Osteoblast consists of numerous mitochondria, abundant golgi
♦♦ Osteoblasts are round or polygonal in shape. complex, rough endoplasmic reticulum and lysosomes.
♦♦ They lie over the outer surface of bone.
♦♦ They are uninucleated whose nucleus is eccentrically
placed.
♦♦ Osteoblasts secrete type I collagen as well as the non-
collagenous matrix of bone.
♦♦ Osteoblast contains prominent Golgi apparatus, rough
endoplasmic reticulum, mitochondria, nucleoli and many
secretory vesicles and vacuoles.
♦♦ Osteoblats secrete cytokine which regulate cellular
metabolism.
♦♦ They have high levels of alkaline phosphatase which create
an alkaline environment for bone formation.
♦♦ As osteoblasts secrete the organic matrix of bone, it is at
first devoid of minerals salts, it is called osteoid tissue.
Fig. 66:  Osteoblast, osteocyte, osteoclast
Osteocytes (For colour version see Plate 27)

♦♦ Resting osteoblasts are known as osteocytes. Q.6. Write shortly about incremental lines of enamel,
♦♦ As osteoblasts seceret extracellular matrix, they become dentin, cementum and alveolar bone.
small in size and are known as osteocytes.  (Mar 2007, 3 Marks)
♦♦ Osteocytes lie in osteocytic lacunae. Or
♦♦ Osteocytes are interconnected with each other by the Write about incremental lines of enamel, dentin and
cytoplasmic processes. cementum. (Nov 2008, 10 Marks)
♦♦ Osteocytes help in calcium homeostasis by mobilizing Ans. For incremental lines of enamel refer to Ans 13 of chapter
calcium in and out of bone matrix.
ENAMEL.
Osteoclasts
Incremental Lines of Dentin
♦♦ Osteoclasts are cells that resorb bone and tend to be large
♦♦ They are also known as incremental lines of von Ebner.
and multinucleated but can also be small or mononuclear.
♦♦ Multinucleated osteoclasts are formed by the fusion of These incremental lines or imbrication lines appear as fine
circulating monocytes. lines or striations in dentin.
♦♦ These multinucleated cells exhibit eosinophilic cytoplasm. ♦♦ They run at right angles to dentinal tubules.
♦♦ The cell body is irregularly oval or club-shaped and may ♦♦ These lines reflect the daily rhythmic, recurrent deposition
show many branching processes. of dentin matrix as well as a hesitation in the daily
♦♦ Osteoclasts are found in bay like depression in the bone formative process.
called Howship’s lacunae. ♦♦ The course of the line indicates growth pattern of the dentin.
♦♦ Osteoclast has prominent mitochondria, lysosome,
vacuoles and little rough endoplasmic reticulum. Their
nuclei have condensed chromatin and single nucleus.
♦♦ Osteoclasts are the physiological giant cells.
♦♦ Osteoclasts consist of four zones, i.e.
1. Ruffled border: Part of osteoclast causing resorption
is known as ruffled border, it is made up of finger like
processes which extend in part of bone which has to be
resorbed. It consists of tightly packed microvili. Ruffled
border provides large surface area for resorption.
2. Sealing zone: This zone is present in outer region of
ruffled border. It forms close contact with the bone
and create microenvironment in which resorption take
place without liberating hydrolytic enzymes produced Fig. 67:  Incremental lines of von Ebner
by cell. This prevents adjacent tissue from damaging. (For colour version see Plate 27)

Incremental Line of Cementum
♦♦ They are also known as incremental lines of Salter.
♦♦ Incremental lines separate the cellular and acellular
cementum into layers which indicate periodic formation.
♦♦ Incremental lines can be best seen in decalcified specimen
prepared for light microscopic observation.
Fig. 68:  Incremental lines of Salter
(For colour version see Plate 27)
Incremental Lines of Alveolar Bone
♦♦ Incremental lines of bone are known as resting lines.
♦♦ Bone is laid down rhythmically and there are periods of
active deposition and quiescence which leads to formation
of regular parallel incremental lines known as resting lines.
♦♦ Resting lines are formed during period of rest.
♦♦ For diagram refer to Ans 6 of same chapter.
Q.7. Write short note on osteoclast.
 (Apr 2007, 5 Marks) (Dec 2012, 3 Marks)
Or
Write about osteoclast cell. (Aug 2012, 5 Marks)
Or
Write in brief osteoclast. (Aug 2016, 2 Marks)
Or
Answer in brief on osteoclast.  (May 2017, 2 Marks)
Or
Write short answer on osteoclast.(May 2018, 3 Marks)
Ans. mineral salts.
• Osteoclasts are cells that resorb bone and tend to be
large and multinucleated but can also be small or
mononuclear.
• Multinucleated osteoclasts are formed by the fusion
of circulating monocytes.
• These multinucleated cells exhibit eosinophilic
cytoplasm.
• The cell body is irregularly oval or club-shaped and
may show many branching processes.
• Osteoclasts are found in bay like depression in the
bone called Howship’s lacunae.
Dental Histology  683
• Osteoclast has prominent mitochondria, lysosome,
vacuoles and little rough endoplasmic reticulum. Their
nuclei have condensed chromatin and single nucleus.
• Osteoclasts are the physiological giant cells.
Fig. 69:  Osteoclast
• Osteoclasts consist of four zones, i.e.
1. Ruffled border: Part of osteoclast causing
resorption is known as ruffled border, it is made
up of finger like processes which extend in part
of bone which has to be resorbed. It consists
of tightly packed microvilli. Ruffled border
provides large surface area for resorption
2. Sealing zone: This zone is present in outer
region of ruffled border. It forms close contact
with the bone and create microenvironment in
which resorption take place without liberating
hydrolytic enzymes produced by cell. This
prevents adjacent tissue from damaging
3. Basolateral zone: It is an area which receives
regulatory signals from adjacent cells.
4. Secretory zone: From this region the resorbed
products and degraded bone matrix is
pushed out of the cell. It consists of numerous
mitochondria, abundant Golgi complex, rough
endoplasmic reticulum and lysosomes.
Q.8. Write a note on predentin and osteoid tissue. 
 (Oct 2008, 3 Marks)
Ans. For predentin refer to Ans 1 of chapter DENTIN.
Osteoid Tissue
♦♦ Osteoid tissue is an organic matrix of bone devoid of
♦♦ It is formed by osteoblasts.
♦♦ It stains pink in routine hematoxylin and eosin stains.
♦♦ In area of bone formation, mineralization always lag
behind the production of bone matrix and therefore in such
areas a superficial layer of osteoid tissue is always seen.
Q.9. Write short note on lamina dura. (Jan 2012, 2 Marks)
Ans. Radiographically bundle bone is known as lamina dura
due to increased radiopacity. Increased radiopacity is
due to the presence of thick bone without trabeculations
that X–rays must penetrate. Lamina dura is the thin layer
of compact alveolar bone which lines the tooth socket.
684 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

• Lamina dura forms the continuous white or • Eruption of deciduous and permanent teeth is
radiopaque line around the root of the tooth. organized by alveolar bone.
• It is perforated by many small openings that carry
branches of intra-alveolar nerves and vessels to PDL Components of Alveolar Bone
and cementum of tooth. Components of alveolar bone includes:
• Thickened lamina dura at the apical region of a 1. Alveolar bone proper: It consists of lamellated bone and
developing tooth is a sign of tooth eruption. partly bundle bone
• Thinning or absence of lamina dura is seen in pulpal 2. Supporting alveolar bone
and periodontal diseases. a. Buccal and lingual cortical plates
Q.10. Describe woven bone. (June 2010, 3 Marks) b. Central spongy bone.
Ans. It is also known as immature bone.
Classification of Bone
• It is characterized by interwining of collagen fibers
which are oriented in many directions. I. Classification based on shape
• Bony spicules lengthen into longer anastomoting 1. Long bones
structures known as trabeculae. Trabeculae extends 2. Short bones
in a radial pattern and enclose blood vessels. This 3. Flat bones
early membrane bone is known as woven bone. 4. Irregular bones
• External to woven bone there is a condensation of 5. Sesamoid bones
mesenchyme known as periosteum. II. Classification based on development
• Woven bone consists of greater amount of 1. Endochondral bones
interfibrillar space which is filled by mineral crystals. 2. Intramembranous bones
• Woven bone has high proteoglycans content and III. Classification based on the microscopic structure
that is why it appears more blue when stained with 1. Mature bone
H&E stain. a. Compact bone
• Woven bone is enriched in bone acidic glycoprotein-75 b. Cancellous bone
and bone sialoprotein. 2. Woven or immature bone.
• Woven bone consists of low mineral density and Q.13. Write short note on alveolar bone proper.
high water content.
 (Oct 2016, 3 Marks)
Q.11. Write about concentric, interstitial and circumferential Ans. Alveolar bone proper consists of thin lamella of bone
lamellae of bone. (Jan 2012, 5 Marks) that surround the root of tooth and give attachment to
Ans. Concentric lamellae: Deep to circumferential lamellae, principal fibers of periodontal ligament.
the lamellae are arranged in concentric layers around the Alveolar bone proper when viewed microscopically
haversian canal. These are known as concentric lamellae. consists partly of lamellated and partly of bundle bone.
Haversian canal and concentric lamellae collectively are
known as osteon. Lamellated Bone
Interstitial lamellae: Adult bones between the osteons
Lamellae of this bone are arranged parallel to the surface of
consists of inetrstitial lamellae. Interstitial lamellae are
adjacent marrow spaces while others form haversian system.
the remnants of osteons. These are left behind during
remodeling. Bundle Bone
Circumferential lamellae: At periosteal and endosteal
♦♦ It is the bone which consists of principal fibers of
surfaces, the lamellae are arranged in parallel layers
periodontal ligament anchored in it.
which surrounds the bony surface and are known as
♦♦ It is known as bundle bone because bundles of principal
circumferential lamellae.
fibers continue inside the bone as sharpey’s fibers.
Q.12. Write the functions of alveolar bone. Write the ♦♦ Bundle bone consists of few fibrils as compared to
components of alveolar bone. Give the classification lamellated bone because of this, it appears dark in routine
of bone. (Sep 2015, 2+1+2 Marks) hematoxylin and eosin stained sections.
Ans. Functions of alveolar bone ♦♦ Formation of bundle bone is in areas of recent bone
• It provides house to the roots of teeth. apposition.
• Provide anchorage to the roots of teeth. ♦♦ Bundle bone show lines of rest.
• Helps in movement of tooth for better occlusion. ♦♦ Radiographically bundle bone is known as lamina dura
• It absorbs and distributes occlusal forces created due to its increased radiopacity.
during tooth contact.
• It supply various vessels to PDL. Cribriform Plate
• It supports deciduous teeth and protect budding ♦♦ Alveolar bone proper which forms inner wall of socket
permanent teeth. which is perforated by many of the openings which carry

branches of interalveolar nerves and blood vessels in PDL.
This is known as cribriform plate.
♦♦ Cribriform plate is a compact bone.
Interdental Septum
♦♦ Bone between the teeth is known as interdental septum.
♦♦ Interdental septum consists mainly of cribriform plate.
♦♦ The interdental and inter-radicular septa contain the
perforating canals of Zukerkandl and Hirschfeld (Nutrient
Canals) which house the interdental and inter-radicular
arteries, veins, lymph vessels and nerves.
Q.14. What is periodontium. Enumerate the hard and soft
tissue comprising of it. Describe alveolar bone in detail
with diagram. (Apr 2017, 1 + 2 + 5 + 2 Marks)
Ans. Periodontium is a connective tissue organ which is
covered by epithelium that attaches the teeth to bone of
jaws and provides continually adapting apparatus for
support of teeth during function.
Enumeration of Hard and Soft Tissue
Constituting Periodontium
♦♦ Hard tissue
• Cementum
• Alveolar bone
♦♦ Soft tissue
• Gingiva
• Periodontal ligament
For alveolar bone in detail along with diagram refer to Ans 2
and Ans 1 of same chapter.
Q.15. Describe histology of compact bone. Draw well labeled
diagram of histology of compact bone.
 (Jan 2018, 3 + 2 Marks)
Ans. ♦♦
Histology of Compact Bone
♦♦ Outer aspect of compact bone is surrounded by condensed
fibrocollagen layer, i.e. periosteum which has two layers:
1. Outer layer: Dense irregular connective tissue fibrous
layer.
2. Inner layer: Lies next to bone surface consisting of
bone cells their precursors and rich vascular supply.
♦♦ Inner surface of compact bone is covered by thin cellular
layer called as endosteum.
♦♦ At periosteal and endosteal surfaces, lamellae are arranged
in parallel layers surrounding bony surface known as
circumferential lamellae.
♦♦ Circumferential lamellae are of two types, i.e. outer
circumferential lamellae and inner circumferential
lamellae. Outer circumferential lamellae are present on
outer surface of bone just below periosteum and they
completely encircle the bone while inner circumferential
lamellae encircle marrow cavity.
♦♦ Deep to the circumferential lamellae, lamellae are arranged
as small concentric layers, i.e. concentric lamellae around
central vascular canal or haversian canal.
Dental Histology  685
Fig. 70:  Compact bone (transverse section)
♦♦ So, haversian canal and concentric lamellae are together
known as haversian system or osteon. Osteon is referred
to as basic metabolic unit of bone.
♦♦ A cement line of mineralized matrix which is strongly
basophilic delineates haversian system. This line marks
limit of bone erosion prior to formation of osteon, also
known as reversal line. The line is highly irregular.
♦♦ Bone is laid down rhythmically and there are periods of
active deposition and quiescence which leads to formation
of regular parallel incremental lines known as resting
lines. Resting line denotes the period of rest during bone
formation.
♦♦ Adjacent haversian canals are interconnected by Volkmann’s
canals which consisting of blood vessels.
Between the concentric lamellae are lacunae which consist
of osteocytes.
♦♦ Radiating canaliculi from lacunae connect haversian canal
with all lacunae present in an osteon.
♦♦ Older bone tissue is constantly replaced by new bone tissue.
Due to this fragments of older osteons are seen in areas
between osteons. These areas show lamellar arrangement of
bone, i.e. between lamellae are lacunae which are occupied
by osteocytes. Radiating from lamellae are canaliculi. These
lamellae are known as interstitial lamellae.
Q.16. Enumerate cells of bone. (Sep 2018, 2 Marks)
Ans. Cells of bone are:
• Osteoblast
• Osteocyte
• Osteoclast
9. ORAL MUCOUS MEMBRANE
Q.1. Write a note on lamina propria.
 (Mar 1998, 5 Marks) (Apr 2008, 5 Marks)
Ans. The connective tissue component of oral mucosa is
termed as lamina propria.
686 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

• Lamina propria is a connective tissue of variable Q.3. Enumerate the differences between oral mucosa of
thickness that supports the epithelium. lining and masticatory types. Describe histological
• It is divided into two parts papillary and reticular. features of hard palate. (Sep 1999, 15 Marks)
• Papillary portion is named for papillae and reticular Ans. The oral mucous membrane depending on their
portion for the reticular fibers. functional adaptation classified into masticatory, lining
• Papillary portion is between the epithelial ridges and specialized mucosa.
and reticular portion lies below it. The differences between lining and masticatory mucosa
• Reticular portion as well as the papillary portion are:
contains reticular fibers.
Lining mucosa Masticatory mucosa
• Two portions are not separate, they are continuous.
• Reticular zone is always present. The papillary zone Masticatory mucosa is keratinized Lining mucosa is nonkeratinized
may be absent in some areas such as the alveolar Masticatory mucosa is found Lining mucosa is found in lip,
mucosa when the papillae are either very short or on hard palate and gingiva cheek, vesicular fornix, soft
palate, floor of mouth and
lacking.
alveolar mucosa
• Interlocking arrangement of connective tissue
papilla, epithelial ridges and the finer unduelations Lining mucosa covers the Masticatory mucosa covers the
muscles bone
and projections found at base of each epithelial cell
increases area of contact between lamina propria and It is loosely attached to It is tightly bound to underlying
underlying structures structures
epithelium. This additional area leads to exchange
of material between epithelium and blood vessels It is stretchable to adapt the It is nonstretchable
in connective tissue. contraction and relaxation of
underlying muscles
• Ground substance present in lamina propria consists
of glycoproteins and proteoglycans. Turnover rate is fast Turnover rate is slow
• Cells such as fibroblasts, mast cells and macrophages Lamina propria is less dense Lamina propria is dense
are present in lamina propria. Distinct submucosa is present Submucosa can or cannot be
• Collagen fibers Type I and Type III are present in which vary in thickness present
lamina propria. Rete ridges are short and Rete ridges are long and narrow
• The lamina propria may attack to the periosteum of irregular
the alveolar above, or it may overlay the submucosa Epithelium is thick Epithelium is less thicker
in some region of mouth such as soft palate and floor
Three layers are seen, i.e. Four layers are seen, i.e. stratum
of the mouth.
stratum basale, stratum basale, stratum spinosum,
Q.2. Write a note on keratinization of epithelium.  intermedium, stratum stratum granulosum and stratum
 (Sep 2002, 5 Marks) (Mar 2009, 5 Marks) superficiale corneum
Ans. Keratinizing oral epithelium has four cell layer, i.e.
Histological Features of Hard Palate
stratum basal, stratum spinosum, stratum granulosum
and stratum corneum. ♦♦ Hard palate is covered by keratinized mucosa.
• Stratum basal undergoes mitosis and providing new ♦♦ Keratinized stratified squamous epithelium which lines
cells, the basal cells. the mucosa consists of four different layers, i.e. stratum
basale, stratum spinosum, stratum granulosum and
• New basal cell migrates and pushed upward.
stratum corneum.
• It is called as spinous cell just beyond the basal layer
in stratum spinosum.
• Spinous cell is larger than basal cell.
• In stratum granulosum, cells become wider and
contain basophilic keratohyalin granules, these cells
show signs of degradation of nucleus.
• In stratum corneum, the cells become keratinized
and squamated which are larger and flatter than
granular cells.
• The epithelial cells that ultimately keratinize are
called “keratocyte” or “keratinocytes”
• This whole process from the onset of determination
is called as “keratinization”.
• During the migration, basal cell undergoes chemical
and morphologic changes and forms a keratinized Fig. 71:  Anterolateral zone of hard palate
squama a dead cell “keratinocyte”. (For colour version see Plate 27)

♦♦ Due to functional adaptation, to bear with masticatory
stress, cells in hard palate show more dense tonofilaments,
increased number and length of desmosomes, etc.
♦♦ Epithelium connective tissue interface of hard palate is
irregular with many long regular epithelial ridges which
interdigitate with connective tissue papillae.
For description of oral mucous membrane of gingiva refer to
Ans 16 of same chapter.
Fig. 72:  Posterolateral zone of hard palate
(For colour version see Plate 28)
♦♦ Lamina propria is dense all through the hard palate, it is
thicker in anterior region as compared to posterior region.
♦♦ In the region of rugae the connective tissue core is dense
with interwoven collagen fibers. Incisive or palatine papilla
composed of dense connective tissue. This consists of
remnants of nasopalatine duct which is lined by pseudo-
stratified squamous epithelium.
♦♦ Frequently the ducts are surrounded by small, irregular
islands of hyaline cartilage.
♦♦ Structure of submucosa show variation in different regions of
palate. Submucosa is completely absent in the peripheral zone
of palate adjacent to the teeth, i.e. the gingival zone and in
the mid palatine raphae. In these regions, the lamina propria
is tightly bound to the periosteum of bone which is called
as mucoperiosteal attachment. In between the gingival zone
and mid palatine raphae, the palate has distinct submucosa.
♦♦ Submucosa in the anterior region of hard palate is filled
with adipose tissue and in posterior region with mucous
glands. So anterolateral part of hard palate is known as fatty
zone and posterolateral part is known as glandular gone.
♦♦ In spite of presence of thick submucosa in some regions,
mucosa of the hard palate is tightly fixed to the underlying
bone and is immobile. This is due to dense vertical band
of connective tissue which leads to attachment of mucosa
firmly to the periosteum of palatal bone. These dense bands
of connective tissue are at right angle to surface and divide
submucosa into compartments.
♦♦ At the junction of alveolar process and horizontal plate
of hard palate there is presence of loose connective tissue
which carries anterior palatine vessels and nerves.
Q.4. Classify and describe with the diagrams, oral mucous
membrane of gingiva. (Sept 2002, 16 Marks)
Ans. Oral mucous membrane of gingiva on the basis of
epithelial surface are of three types:
Dental Histology  687
1. Keratinized: In which the superficial cells form scales
of keratin and loose their nuclei.
- A stratum granulosum is present
- It is found in 15% of population.
2. Parakeratinization: In which the superficial cells retain
“pyknotic nuclei” and show some signs of being
keratinized.
- Stratum granulosum is generally absent.
- Gingiva is parakeratinized in 75% of people.
3. Nonkeratinized: In which the surface cells are nucleated.
- This mucous membrane does not show signs of
keratinization.
- Nonkeratinized gingiva is found in 10% of
people.
- Nonkeratinized epithelium contains basal layer,
stratum intermedium and stratum superficial.
Q.5. Write a note on lip. (Feb 1999, 5 Marks)
Or
Describe with diagram of lip. (Mar 2009, 5 Marks)
Ans. Lip
Lip is a muscular structure found on the opening of oral
cavity.
• Lip is covered by nonkeratinized, lining mucosa.
• Epithelium of mucosa of the lip is stratified
squamous nonkeratinized epithelium.
• Lamina propria of the mucosa consists of dense
connective tissue and has short, irregular papillae.
• Submucous layer connects the lamina propria to the
thin fascia of the muscles.
• Submucosa consists of strands of densely grouped
collagen fibers.
• There is loose connective tissue containing fat and
small mixed glands.
• Strands of collagen fibers limit the mobility of
mucous membrane.
• This prevents the mucous membrane of the lips
lodging between the biting surface of the teeth
during mastication.
• Minor mixed salivary glands are found in sub-
mucosa of lip.
Refer to Ans 6 of same chapter for diagram.
Q.6. Write a note on soft palate. (Feb 2002, 6 Marks)
Ans. Soft palate is found on the roof of oral cavity behind the
hard palate.
• Soft palate is covered by lining mucosa which is
nonkeratinized stratified squamous epithelium.
• Mucous membrane on the oral surface of the soft
palate is highly vascularized and reddish in color.
• Soft palate is differentiated from the pale color of
the hard palate by its reddish color.
• Epithelium may show presence of some taste buds.
• Epithelium connective tissue interface is irregular
with short and thick rete ridges and connective
tissue papillae.
688 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

• Lamina propria shows distinct layer of elastic fibers
separating it from submucosa.
• Papilla of connective tissue are few and are short.
• Submucosa consists of diffuse loose connective
tissue containing numerous mucous minor salivary
glands.
• Free-border of soft palate is replaced by nasal
mucosa with its pseudostratified ciliated columnar
epithelium.
Q.7. Write a short note on palatal mucosa.
 (Oct 2007, 5 Marks)
Ans. Palate forms the roof of oral cavity.
• Palate consists of two part:
1. Hard palate
2. Soft palate.
• For hard palate: Refer to Ans 3 of same chapter.
• For soft palate: Refer to Ans 6 of same chapter.
Q.8. Classify the oral mucous membrane and describe the
macroscopic and microscopic features of dorsum of
tongue. (Nov 2008, 15 Marks) (Nov 2009, 10 Marks)
Or
Define and classify mucous membrane. Describe in
detail about dorsum of tongue with well labelled
diagrams. (Aug 2011, 15 Marks)
Or
Give classification of oral mucous membrane. Write in
detail on dorsal surface of tongue. (Apr 2015, 8 Marks)
Or
Classify oral mucous membrane. Describe in detail
papillae of tongue. (June 2010, 15 Marks)
 (Feb 2014, 8 Marks) (Oct 2014, 8 Marks)
Ans. Oral Mucous Membrane
Lining of oral cavity is called as oral mucous membrane.
It consists of epithelium and connective tissue known as
lamina propria.
♦♦ Body and the base of the tongue differ widely in the
structure of the mucous membrane.
• A small depression or pit is present at the point where
two arms of ‘V’ meet. This depression is known as
foramen ceacum.
• Filiform papillae are cone shaped papillae which are
present on the dorsal surface. They are numerous.
• Fungiform papillae are present between the filiform
papillae on the dorsal aspect mainly on the tip and
lateral margins of tongue.
• Fungiform papillae appear as red round, projections.
• Circumvallate papillae are 8–12 large papillae which
lie anterior to sulcus terminalis.
• Circumvallate papillae are partly submerged. They
do not project above the surface of tongue and are
surrounded by a ‘V’ shaped sulcus.
• In the posterior region of anterior 2/3rd of tongue,
on the lateral margin foliate papillae are seen which
consists of series of folds forming clefts.
• Foliate papillae are rudimentary papillas in humans.
• Posterior l/3rd of the tongue has an irregular surface
with round projection, the lingual follicles consist of
lymphoid component.
• Mucous membrane lining the posterior 1/3rd does not
show papillae and is relatively smoother.

Classification of Oral Mucous Membrane

♦♦ On basis of functional criteria:
• Masticatory mucosa: Gingiva and hard palate. Fig. 73:  Dorsum of tongue
• Lining or reflecting mucosa: Lip, cheek, vestibular
fornix, alveolar mucosa, floor of mouth and soft
Microscopic Structure of Tongue
palate.
• Specialized mucosa: Dorsum of tongue and taste bud. ♦♦ Tongue is lined by stratified squamous epithelium with
♦♦ On basis of type of epithelium covering mucosa: short rete ridges.
• Keratinized mucosa: Hard palate, vermilion border of ♦♦ Lamina propria is thin and is loosely arranged.
lip, gingiva and some papillae of tongue
♦♦ Mucosa which lines the dorsal aspect of tongue is known
• Non-keratinized mucosa: Lining mucosa, in some
as specialized mucosa due to presence of taste buds.
areas of dorsal aspect of tongue, some parts of gingiva.
♦♦ Majority of epithelial lining is mostly keratinized.
Macroscopic Features of Dorsum of Tongue ♦♦ Lamina propria is tightly attached to the underlying
♦♦ Superficial surface of tongue is rough and irregular. muscle.
♦♦ A ‘V’ shaped line divides it into an anterior 2/3rd part or ♦♦ Minor salivary glands are seen in the anteroventral and
body and a posterior 1/3rd part or base. posterior regions.
 Dental Histology  689

Papillas of Tongue ♦♦ Connective tissue shows collagen fibers, fibroblasts and

rich capillary network.
Filiform Papillae
♦♦ They are red in color due to capillary network which is
♦♦ Filiform papillae are hair like or thread like projections visible through thin nonkeratinized epithelium.
which lie on dorsal surface of the tongue.
♦♦ Histologically, filiform papillae appear as cone shaped Circumvallate Papillae
structure.
♦♦ It is lined by stratified squamous epithelium with thick ♦♦ It lies in anterior two-third of tongue just anterior to sulcus
keratin over the surface. terminals.
♦♦ Central core of connective tissue supports the blood ♦♦ They are 10–12 in number.
vessels. ♦♦ Superficial surface of these papillae lies at the level of
♦♦ Taste buds are absent in these papillae. surface of tongue and a ‘V’ shaped sulcus is present all
♦♦ Mucosa between the filiform papillae is nonkeratinized. around the papillae separating them from the adjacent
portion of tongue.
♦♦ Epithelium lining the keratinized stratified squamous
epithelium at the superficial surface is non-keratinized on
lateral surface of circumvallate papillae.
♦♦ Taste buds are seen only on the lateral surface.
♦♦ Central portion of papillae is occupied by the connective
tissue.
♦♦ Circumvallate papilla consists of serous minor salivary
glands, i.e. von Ebner’s gland in the connective tissue
beneath it.
♦♦ Von Ebner glands secrete watery saliva into the ‘V’ shaped
trough around the papillae for flushing out the food
debris.

Fig. 74:  Filiform papillae

(For colour version see Plate 16)

Fungiform Papillae
♦♦ They are mushroom shaped structure.
♦♦ They project above the surface of the tongue.
♦♦ They are located between the filiform papillae.
♦♦ Epithelium covering the fungiform papillae is thin non-
keratinized stratified squamous epithelium.
♦♦ Superficial surface of papillae contains few taste buds.

Fig. 76:  Circumvallate papillae

(For colour version see Plate 16)

Q.9. Write note on dorsal surface of tongue.

 (Mar 2000, 5 Marks)
Or
Write short note on dorsal surface of tongue.
 (July 2016, 3 Marks)
Ans. Refer to Ans 8 of the same chapter.

Q.10. Enumerate the differences between keratinized and

nonkeratinized stratified squamous epithelium of
Fig. 75:  Fungiform papillae oral mucosa. Describe in detail the dorsum surface of
(For colour version see Plate 16) tongue. (Mar 1997, 15 Marks)
690 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Ans. which extend from basement membrane to epithelial

cells. At the epithelial surface tapered end of all cells end
Keratinized stratified Nonkeratinized stratified
squamaous epithelium squamous epithelium up in a small opening of 2 to 5µ known as taste pore by
which cells communicate to external part.
Stratum basale
Hemidesmosomes which In this layer hemidesmosomes
anchor this layer to basal are fewer and smaller.
lamina are more in number and
are larger.
Stratum spinosum
Cells in this layer are polygonal Cells in this layer are roughly
and show prickly appearance rounded and prickly appearance
is absent
More number of desmosomes Less number of desmosomes
present are present
Desmosomes occupy more Desmosomes occupy less
percentage of cell membrane percentage of cell membrane
More prominent intercellular Less prominent intercellular
spaces spaces Fig. 77:  Taste bud 
(For colour version see Plate 28)
Cytokeratin present are 1, 6, Cytokeratin present are 3, 14, 19
10, 16
Ultrastructural examination of taste buds reveals that they
In this layer size of cells is less In this layer size of cells is large contain a number of different cell types based on morphological
Less closely applied adjacent More closely applied adjacent features. There are four types of taste bud cells:
cell surfaces cell surfaces ♦♦ Type I cells (dark cells): They are most frequently
Tonofilaments are in bundles Tonofilaments do not remain in encountered taste bud cells. These cells are long and
and they remain more bundles and are less organized narrow and extend from base of taste bud to taste pore.
organized These electron dense cells have large vesicles with dense
Odland bodies are ovoid Odland bodies are round in core in apical cytoplasm. Nuclei is deeply indented and
having alternating electron shape with central electron dense irregularly shaped. 60% of total cell population belongs
dense and lucent areas core from which delicate radiating
to this group.
strands are observed
♦♦ Type II cells (light cells): These cells are oval shaped
Stratum granulosum and are characterized by the electronlucent cytoplasm
Distinct keratohyaline granules Stratum granulosum is absent having large, round or oval nuclei. These cells extend
are seen. from basement membrane to the taste pore. 30% of total
Stratum corneum cell population belongs to this group.
It consists of keratin flakes It consists of flattened cells ♦♦ Type III cells (intermediate cells): These cells are similar
in morphology to type II cells. These cells have apical
Superficial cells does not Surface cells consists of nucleus
consists of nucleus or and cytoplasmic organelles specializations which extend to taste pore. They consist
cytoplasmic organelles of vesicles with dense core in basal cytoplasm. These cells
are rarely seen in taste buds.
For dorsum of tongue refer to Ans 8 of same chapter. ♦♦ Type IV cells (basal cells): These cells are in contact with
basement membrane. These cells do not extend to the
Q.11. Write a note on taste buds.
taste pore and are most often known as basal cells. Initial
 (Sep 2000, 5 Marks) (Feb 2005, 5 Marks)
contact between the taste stimuli and taste receptor occur
 (Mar 2007, 2.5 Marks) (Apr 2008, 5 Marks)
in taste pore. A tight junction joins the apices of taste bud
 (Apr 2010, 5 Marks) (Dec 2010, Marks)
cell at base of the pore. Each of three types of taste bud cells
 (Dec 2012, 3 Marks) (Aug 2011, 2 Marks)
extend into taste pore has different apical structure which
 (Feb 2014, 3 Marks) (Dec 2014, 2 Marks)
consists of taste receptors, Type I cells have long finger like
Or
microvilli; Type II cells have short microvilli; Type III cells
Answer in brief structure of taste buds.
 (Feb 2016, 2 Marks) end as blunt, club shaped structures.
Or Q.12. Write a short note on gingival sulcus.
Write short note on taste bud. (Sep 2017, 3 Marks)  (Sep 2002, 5 Marks)
Ans. Taste buds Ans. Gingival sulcus or crevice is the name given to the
Taste buds are barrel shaped structures which consists invagination made by gingiva as it joins with the tooth
of 30 to 50 spindle shaped cells, modified epithelial cells surface.
 Dental Histology  691

• Gingiva does not join the tooth at the gingival margin. –– The musculature of the tongue is derived from
• It forms small enfolding known as “sulcus”. the occipital myotomes which are supplied by
• Sulcus extending from the free gingival margin to the hypoglossal nerve.
the dentogingival junction. –– Connective tissue develops from the local mes-
• Sulcus epithelium is nonkeratinized. enchyme.
• It lacks epithelial ridges and so form a smooth
interface with the lamina propria.
• It is thinner than the epithelium of gingiva.
• The sulcular epithelium is continuous with the
gingival epithelia and the attachment epithelium.
Q.13. Write a short note on zone of hard palate. 
 (Mar 2006, 5 Marks)
Ans.
♦♦ Gingival region: This region is found adjacent to the teeth.
♦♦ Mid-palatine raphae: This is the narrow zone in midline
of the hard palate which extends from incisive papilla
posteriorly.

Fig. 79:  Development of tongue

Q.15. Classify oral mucous membrane and describe the

microscopic features of cheek mucosa and hard palate.
 (Oct 2006, 7.5 Marks)
Ans. For classification refer to Ans 11 of the same chapter. For
microscopic features of hard palate refer to Ans 3 of the
same chapter.

Fig. 78:  Zones of hard palate

♦♦ Incisive papilla: This is an oval prominence which is seen

at extreme anterior region of hard palate immediately
behind maxillary central incisors covering oral opening
of an incisive canal.
♦♦ Anterolateral zone: It is also known as fatty zone. It lies
between mid palatine raphae and gingiva. It consists of
fat tissue in submucosa.
♦♦ Posterolateral zone: It is also known as glandular zone. It
lies between mid palatine raphae and gingiva. It consists Fig. 80:  Cheek mucosa
(For colour version see Plate 28)
of minor salivary glands in submucosa.
Q.14. Write short note on the development of tongue.  Microscopic Features of Cheek Mucosa
 (Mar 2006, 5 Marks) (Nov 2010, 3 Marks) ♦♦ Epithelium of cheek is stratified squamous nonkeratinized
 (Feb 2013, 5 Marks)
having 3 layers, stratum basale, stratum intermedium and
Ans. Epithelium stratum superficiale.
• The anterior 2/3 of tongue is formed by the fusion of ♦♦ Lamina propria consists of dense connective tissue and
–– Tuberculum Impar has short irregular papillae.
–– Two lingual swellings, i.e. from the first branchial ♦♦ Submucosa layer connects the lamina propria to the thin
arch. Therefore, it is supplied by lingual nerve
fascia of the muscle and consists of strands of densely
which is branch of mandibular nerve and chorda
grouped collagen fiber.
tympani.
♦♦ There is loose connective tissue containing fat and small
• Posterior 1/3 is formed from cranial half of the
mixed glands between the strands.
hypobranchial eminences, i.e. from third arch.
• Posteriomost part of tongue is derived from the Q.16. Classify oral mucous membrane. Describe morphology
fourth arch. This is therefore supplied by the vagus and histology of gingiva in detail.
nerve.  (Sep 2006, 15 Marks)
692 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Or
Define and classify oral mucous membrane. Describe
the macroscopic and microscopic structure of gingiva.
 (Feb 2016, 10 Marks)
Or
Write short note on gingiva. (Dec 2014, 5 Marks)
Or
Write a note on gingiva. (Sep 2000, 5 Marks)
 (Sep 2003, 5 Marks)
Or
Write a note on histology of gingiva.
 (Mar 2001, 5 Marks) (Apr 2008, 5 Marks)
Ans. For definition and classification refer to Ans 11 of the
same chapter.
Morphology of Gingiva/Macroscopic Structure of Gingiva
♦♦ Gingiva provides coverage to alveolar process and
completely surrounds neck of the tooth.
♦♦ It is tightly bound to buccal and lingual plates of alveolar
process.
♦♦ Gingiva extends from the dentogingival junction to
alveolar mucosa.
♦♦ It is pink in color with some degree of melanin pigmenta-
tion.
♦♦ Anatomically gingiva is divided into three parts, i.e.
marginal gingiva, interdental papilla and attached gingiva.
Marginal Gingiva
♦♦ Unattached portion of gingiva which surrounds the teeth
in collar like fashion is known as attached gingiva.
♦♦ Marginal gingiva follows a scalloped line on facial and
lingual surface of the teeth.
♦♦ Marginal gingiva forms the soft tissue wall of gingival
sulcus. It is separated from attached gingiva by a free
gingival groove.
Gingival Sulcus
It is a ‘V` shaped space seen around the tooth. Gingival sulcus is
bounded on one side by tooth surface on other side by marginal
gingiva.
Interdental Papilla
♦♦ Part of the gingiva which fills the interdental space between
two adjacent teeth is known as interdental papilla.
♦♦ It appears pyramidal or triangular from the facial and
lingual aspect along with its lateral borders. Tip of the
pyramid is formed by continuation of marginal gingiva
of adjacent teeth.
♦♦ In the posterior region interdental gingiva has a ‘tent’ shape.
♦♦ Facial as well as lingual portions of interdental papillae
forms the concave or valley like area which fits below the
contact area. The valley like area is known as col.
♦♦ Col or gingival col is lined by nonkeratinized epithelium.
Attached Gingiva
♦♦ Fine, resilient and immobile part of the gingiva which
tightly bounds to the alveolar bone is known as attached
gingiva.
♦♦ Attached gingiva extends from free gingival groove to
mucogingival junction.
♦♦ At the palatal surface, attached gingiva merges with palatal
mucosa.
♦♦ In maxilla width of attached gingiva ranges from 3.5–4.5 mm
while in mandible it is 3.3–3.9 mm.
♦♦ Surface of the attached gingiva is irregular. It consists of
some elevations and some depressions.
♦♦ Elevations and depressions of attached gingiva create
orange peel appearance which is known as stippling.
♦♦ Loss of stippling is the initial sign of gingival inflammation.
♦♦ Gingiva can show mild vertical depression in between the
alveolar bone eminences of adjacent teeth which are known
as interdental grooves.
Histology of Gingiva/ Microscopic Structure of Gingiva
In Oral Region
♦♦ Epithelium lining is keratinized or parakeratinized
stratified squamous epithelium and consists of four
layers, i.e. stratum basale, stratum spinosum, stratum
granulosum and stratum corneum. Gingival epithelium
is parakeratinized in 75% of people.
♦♦ A shallow ‘V’ shaped notch on the surface is seen which
corresponds to the heavy epithelial ridge which is known
as free gingival groove.
♦♦ Epithelial connective tissue interface is irregular with
numerous long and slender rete ridges. These rete ridges
interdigitate with long connective tissue papillae.
Sulcular Epithelium
♦♦ Sulcular epithelium consists of thin layer of non-
keratinized epithelium.
♦♦ Junction which lies in between epithelium and connective
tissue is flat and is devoid of rete ridges.
Junctional Epithelium
♦♦ It consists of stratified squamous epithelium which is of
l5 to 30 cell layer thickness at the cervical portion and 3 to
4 cell layer thick at the apical margin.
♦♦ It consists of flattened cells which lie parallel to the tooth
surface.
♦♦ Epithelial connective tissue interface is flat.
♦♦ Its characteristic feature is presence of basal lamina on
both sides, i.e. at the junction of epithelium and connective
tissue and also on the surface adjacent to the tooth.
Connective Tissue of Gingiva
♦♦ Connective tissue beneath the gingival epithelium consists
of lamina propria with two layes, i.e. papillary and reticular
layer.

♦♦ Gingiva consists of dense collagen fibers which are
arranged in bundles. These fiber groups are known as
secondary fibers of periodontal ligament or gingival fibers
of periodontal ligament.
♦♦ In addition to collagen fibers, oxytalan fibers and elastic
fibers are also present in gingival connective tissue.
♦♦ The gingival fibers include:
• Dentogingival: Extends from the cervical cementum
into the lamina propria of the gingiva. These groups
are most numerous.
• Alveologingival: The fibers arise from the alveolar
crest and extend into the lamina propria.
• Circular: A small group of fibers that circle the tooth
and interlace with the other fibers.
• Dentoperiosteal: These fibers run from the cementum
into the periosteum of alveolar bone.
• Interdental ligament: These are extended inter
proximally between adjacent teeth.
♦♦ Gingiva also contains some cells in epithelium other than
keratinocytes, i.e.
• Melanocytes: They are found in basal layer and give the
pigmentation of gingiva either pink, brown or black.
• Langerhans cells: These are involved in the immune
system.
• Merkel cell: These are specialized neural pressure
sensitive receptor cell.
• Lymphocytes: Also found in gingiva.
Fig. 81:  Gingiva (For colour version see Plate 28)
Q.17. Classify oral mucous membrane. Describe macroscopic
and microscopic structures of tongue. 
 (Mar 2008, 7.5 Marks)
Ans. For oral mucous membrane refer to Ans 8 of same
chapter.
Macroscopic Features of Tongue
For macroscopic features of dorsal surface of tongue refer to
Ans 8 of same chapter.
Macroscopic Features of Ventral Surface of Tongue
♦♦ Ventral aspect of the tongue consists of smooth mucous
membrane.
♦♦ Papillae are absent on ventral aspect of tongue.
♦♦ Lingual frenum joins the inferior surface to the floor of
the mouth.
Dental Histology  693
♦♦ On either side of lingual frenum, prominent lingual veins
are seen.
♦♦ Lateral part of ventral surface has two folds which are
known as plica fimbriata. They run forward and medially
to the tip of the tongue.
Microscopic Features of Tongue
For microscopic features of dorsal surface of tongue refer to
Ans 8 of same chapter.
Microscopic Features of Ventral Surface of Tongue
♦♦ Ventral aspect is lined by non-keratinized stratified
squamous epithelium.
♦♦ Mucosa is tightly bound to underlying musculature.
♦♦ Thin epithelium is present with short rete ridges.
♦♦ Lamina propria is thin and shows loose arrangement of
collagen fibers.
Q.18. Write about the histological features of vermilion
border of lip and buccal mucosa. (Mar 2008, 7.5 Marks)
Or
Write a note on histology of vermilion border of lip.
 (Feb 2006, 2.5 Marks)
Ans. Vermilion border of lip: Vermilion zone is the
transitional zone between skin of the lip and mucous
membrane of the lip. Line which separates skin from
vermilion zone is known as vermilion border.
Histology
♦♦ Skin on the outer surface of lip is covered by moderately
thick, keratinized stratified squamous epithelium with all
appendages i.e. hair follicles, sweat glands and sebaceous
glands.
♦♦ Transitional region is characterized by thick but mildly
keratinized epithelium and numerous densely arranged,
long papillae of lamina propria which reach deep into the
epithelium and carry large capillary loops close to surface.
♦♦ Inner aspect of lip is thicker nonkeratinized labial mucosa.
♦♦ Central most region of lip show orbicularis oris muscle.
Buccal Mucosa
♦♦ Buccal mucosa contains lining mucosa.
♦♦ Epithelium of cheek is stratified squamous nonkeratinized
having three layers, i.e. stratum basale, stratum inter­
medium and stratum superficiale.
♦♦ Lamina propria of the buccal mucosa consists of dense
connective tissue and has short irregular papillae.
♦♦ Submucus layer connects the lamina propria to the thin
fascia of muscles and consists of strands of densly grouped
collagen fibers.
♦♦ There is loose connective tissue containing fat and small
mixed glands between these strands.
♦♦ Mixed minor salivary glands in cheek are larger and
usually found between the bundles of buccinator muscle.
♦♦ Cheek, lateral to the corner of mouth may contain isolated
sebaceous glands called fordyce’s spots.
For diagram refer to Ans 20 of the same chapter.
694 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Fig. 82:  Vermilion border of lip (For colour version see Plate 28)
Q.19. Write in short gingival group of fibers.
 (Oct 2007, 5 Marks) (Mar 2009, 5 Marks)
Ans. Gingiva contains dense fibers of collagen, sometimes
refered to as gingival ligaments
• They are divided into the following major groups:
–– Dentogingival: It extends from the cervical
cementum to the lamina propria of the gingiva.
• Fibers of the gingival ligament constitute the most
numerous group of gingival fibers.
–– Alveologingival: The fibers arise from the alveo-
lar crest and extend into the lamina propria.
–– Circular: A small group of fiber that circles the
tooth and interlace with the other fibers.
–– Dentoperiosteal: These fibers can be followed
from the cementum into the periosteum of the
alveolar crest and of the vestibular and oral sur-
faces of alveolar bone.
Apart from above mentioned fibers there are also certain
fiber groups, i.e. interdental, semicircular, vertical and
transgingival fiber groups.
• Interdental fibers connect buccal and lingual papillae
• Vertical fibers run coronally from alveolar mucosa or
attached gingiva to marginal gingiva or interdental
papillae.
• Semicircular fibers connect cementum on one side
of tooth to opposite side opposite side after coursing
through free gingiva.
• Transgingival fibers pass from cementum of one
tooth to marginal gingiva of adjacent tooth merging
with circular and semicircular fibers.
Q.20. Write short note on epithelial attachment.
 (Nov 2009, 5 Marks)
Ans. The most superficial layer provides the actual attachment
of gingiva to tooth surface by means of a structural
complex known as epithelial attachment. The complex
consists of an inner basal lamina which is formed
and maintained by flat superficial cells which adhere
to tooth surface and to which cells are attached by
hemidesmosomes.
• Epithelial attachment is submicroscopic approxi-
mately 40 nm wide and is formed by the attachment
epithelium.
• Secondary attachment epithelium consists of cells which
are derived from oral epithelium forms an epithelial
attachment which is identical to primary attachment
epithelium, i.e. basal lamina and hemidesmosomes.
• At electron microscopic level both reduced
ameloblasts and gingival epithelial cells have
shown basal lamina on enamel and cementum.
Hemidesmosomes of these cells attach to basal
lamina in same manner as all the basal cells. This
basal lamina is known as internal basal lamina.
Q.21. Classify oral mucous membrane. Write about
specialized mucosa in detail. (Nov 2010, 8 Marks)
Or
Define and classify oral mucous membrane. Write in
detail about specialized mucosa.(Nov 2008, 15 Marks)
Or
Write short note on specialized mucosa.
 (Apr 2007, 5 Marks)
Ans. Moist lining of oral cavity is known as oral mucous
membrane.
For classification refer to Ans 8 of same chapter.
Specialized mucosa consists of dorsum of tongue and
taste bud.
For dorsum of tongue refer to Ans 8 and for taste bud
refer to Ans 11 of same chapter.
Q.22. Write in short vermilion border of lip.
 (Nov 2010, 5 Marks)
Or
Write about vermilion border of lip. Draw a well
labelled diagram of lip.  (Jan 2018, 3 + 2 Marks)
 Dental Histology  695

Ans. It is the transitional zone between the skin of the lip and
the mucous membrane of the lip.
• It is red zone.
• In this region, a transition between the keratinized
epithelium of the skin and the nonkeratinized
epithelium of oral mucosa occurs.
• It is seen only in humans.
• Skin on the outer surface of lip is covered by
moderately thick keratinized epithelium with thick
stratum corneum.
• The red appearance of the vermilion border is due to
epithelium being thin and the underlying connective
tissue being highly vascular.
• The transitional region is characterized by
numero­usly, dense arranged, long papillae of
lamina propria, reaching deep into the epithelium
and carrying large capillary loops close to the
surface.
• Transitional zone contains only the occasional
sebaceous glands, it is subject to drying and therefore
requires moistening by the tongue.
For diagram of lip refer to Ans 5 of same chapter.
Q.23. Write short note on ortho and parakeratinization.
 (Nov 2010, 2 Marks)
Ans. Both orthokeratinization and parakeratinization is seen
in stratum corneum.
Orthokeratinization
♦♦ Keratinization squamae are larger and flatter than
compared to granular cells.
♦♦ All the nuclei and the other organelles such as ribosomes
and mitochondria are disappeared.
♦♦ Layer is acidophilic and is histologically amorphous.
♦♦ Keratohyalin granules are disappeared.
♦♦ Cells consist of closely packed tonofilaments coated by
protein filaggrin. It is strongly cross linked by disulphide
bonds which give mechanical and chemical resistance.
♦♦ As the desmosomes become weaker and disappear the
cells of this layer desquamate or shed.
Parakeratinization
In this layer cells retain pyknotic as well as condensed nuclei
and other partially lysed cell organells till they undergo the
process of desquamation.
Q.24. Enumerate the derivatives of branchial arches and
pouches. Describe in detail development of tongue.
 (Dec 2012, 8 Marks)
Ans.

Branchial arch Skeletal Cartilage Bone Ligament Artery Nerve

First arch or Muscles of mastication, Meckle’s Zygomatic bone Anterior Maxillary artery Maxillary and
Mandibular mylohyoid, tensor veli cartilage maxilla, mandible, malleolar and contribution to mandibular
arch palati, tensor tympani part of temporal bone, ligament, external carotid artery divisions of
and anterior belly of spine of sphenoid, sphenomandi­ trigeminal nerve
digastric incus and malleus bular ligament
Second arch or Platysma, buccinator, Reichert’s Stapes, lesser horn Stylohyoid Stapaedial artery and Facial nerve
Hyoid arch Stapedius, Stylohyoid, cartilage and upper part of ligament small contribution to
posterior digastric body of hyoid, styloid facial artery
muscle, auricular process
muscle,muscles of facial
expression
Third arch Stylopharyngeous – Greater horn and lower – Proximal one-third of Glossopharyn
part of body of hyoid internal carotid artery geal nerve
and thymus and contribution
to common carotid
artery
Fourth arch Palatoglossus, intrinsic – Thyroid cartilage and – Proximal part of Vagal nerve
muscles of soft palate, epiglottis subclavian artery and and superior
pharyngeal constrictors, aortic arch laryngeal nerve
cricothyroid
Fifth arch – – Lower part of thyroid – – –
cartilage and laryngeal
cartilages
Sixth arch Intrinsic muscles of – Cricoid, arytenoids and – Proximal part of Vagus nerve
larynx except cricothyroid corniculate cartilage pulmonary artery, and recurrent
pulmonary artery and laryngeal nerve
ductous arteriosus
Post-branchial Sternocleidomastoid and – – – Tracheal cartilages Spinal
Arch trapezius accessary nerve
696 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Derivatives of Pharyngeal Pouches

Pouch
First Pharyngeal arch
Second Pharyngeal arch
Third Pharyngeal arch
Fourth Pharyngeal arch
Fifth Pharyngeal arch
Derivatives
Dorsal Ventral
Tubotympanic recess, auditory tube, tympanic cavity Obliterated by tongue
Endodermal lining proliferate to form tonsillar fossae and palatine tonsil Obliterated by tongue
Inferior parathyroid gland Thymus
Superior parathyroid gland
Ultimobranchial body and C cells of thyroid

For development of tongue refer to Ans 14 of same chapter.

Q.25. Write short note on nonkeratinocytes.
 (Apr 2017, 2 Marks) (Dec 2010, 2 Marks)
 (Jan 2012, 5 Marks) (May 2014, 5 Marks)
 (Aug 2016, 3 Marks)
Or
Write short answer on nonkeratinocytes.
 (May 2018, 3 Marks)
Ans. Epithelium consists of small population of cells which
do not possess cytokeratin filaments, so due to this these
cells are not able to keratinize. Such cells are known as
nonkeratinocytes.
• Nonkeratinocytes do not show mitotic activity and
undergo maturative changes or desquamate.
• Nonkeratinocytes are not attached in layers and do
not form desmosomal attachments with adjacent
keratinocytes.
• Nonkeratinocytes are dendritic and appear unstained
or clear in routine hematoxylin and eosin stain.
• Non-keratinocytes migrate to oral epithelium from
either neural crest or bone marrow.
• In oral epithelium nonkeratinocytes are melanocytes,
langerhans cell and Merkel cells. Inflammatory cells
often seen in certain regions such as lymphocytes are
considered as nonkeratinocytes.
Melanocytes
♦♦ Melanocytes are the melanin secreting cells and they reside
in the basal cell layer.
♦♦ These cells are derived from embryologic neural crest cells
and migrate to the epithelium.
♦♦ Each single melanocyte establishes its contact with 30 to
40 keratinocytes via their dendritic processes.
♦♦ Melanin produced by melanocyte is transferred via their
dendritic processes to adjacent basal keratinocytes which
store pigment in form of melanosomes.
♦♦ Melanin pigment present in connective tissue is
phagocytosed by macrophages and these cells are known
as melanophages.
♦♦ After staining by hematoxylin stain, these cells appear clear
cells or dendritic cells.
Langerhans Cell
♦♦ It is the clear or dendritic cell seen in upper layer of
skin and mucosal epithelium, restricted to zones of
orthokeratinization.
♦♦ Langerhans cell is the cell of hematopoietic origin
♦♦ Langerhans cell consists of convoluted nucleus and
characteristic rod like granules in cytoplasm known as
Birbeck granules.
♦♦ These cells penetrate epithelium from lamina propria and
are also involved in immune response.
♦♦ If antigenic challenge is produced by bacterial plaque,
these cells migrate to gingiva.
♦♦ These cells present antigen to specific helper T cells and
are known as antigen presenting cells.
Merkel Cells
♦♦ Merkel cells are seen among the basal cells.
♦♦ Merkel cells consist of nerve tissue immediately subjacent
and are presumed to be specialized neural pressure
sensitive receptor cells. Due to this merkel cells respond
to touch sensation.
♦♦ Merkel cells are commonly seen in masticatory mucosa.
♦♦ Unlike other nonkeratinocytes, these cells lack dendritic
processes.
♦♦ Under electron microscope the nucleus of cell shows deep
invagination and a characteristic rodlet. The cell consists
of electron dense granules which are located at the side
of cytoplasm in contact with axon terminals. Function of
these granules is unknown.
Inflammatory Cells
♦♦ Inflammatory cells such as lymphocytes are found at
various levels of epithelium.
♦♦ These cells are basically the transient which can pass via
epithelium to surface.
♦♦ Both keratinocytes and lymphocytes interact with each
other.
♦♦ Keratinocytes may activate lymphocyte via production of
interleukin – 1. Keratinocytes can also inhibit lymphocyte
proliferation too.
♦♦ Stimulated lymphocytes lead to production of gamma
interferons. These gamma interferons can stimulate
keratinocytes to express HLA–DR antigen.
Q.26. Write short note on keratinocytes and non-keratinocytes.
 (Feb 2013, 2 Marks)
Ans. Keratinocytes
Epithelial cells that ultimately get keratinize are called
as keratinocytes.

• These cells undergo cell division, maturate and
desquamate.
• These cells increase in volume during each successive
layer from basal to granular.
• These cornified cells are smaller in volume than
granular cells.
For nonkeratinocytes refer to Ans 25 of same chapter.
Q.27. Write short note on function of oral mucous membrane.
 (Feb 2013, 2 Marks) (May 2014, 2 Marks)
Ans. Following are the functions of oral mucous membrane:
• Defense: Structural integrity of oral epithelium is an
effective barrier for the invasion of microorganism.
Infection occurs if the epithelial integrity is broken
down which leads to bacterial attack. Oral mucous
membrane also secrets antibodies and has an
efficient humoral and cell mediated immunity.
• Protection: It helps in protection of the tissues by
mechanical forces which result due to mastication.
• Lubrication: Oral mucous membrane has numerous
salivary glands which keeps oral cavity moist, this
helps in prevention of oral mucosa from drying.
Moistness leads to easy speech, swallowing,
mastication and perception of taste.
• Sensory: It is sensitive to touch, pressure, pain and
temperature. Sensation of taste is unique sensation
and is felt in anterior 2/3rd of tongue.
Q.28. Classify oral mucous membrane. Give a detailed
account of microscopic features of tongue.
 (Feb 2013, 10 Marks)
Ans. For classification refer to Ans 8 of same chapter.
For microscopic features refer to Ans 17 of same chapter.
Q.29. Write a short note on Odland body.
 (Sep 2017, 2 Marks) (Dec 2010, 2 Marks)
Ans. In the stratum granulosum, the cell surface become
more regular and more closely applied to adjacent cell
surfaces. At the same time the lamellar granule, a small
organelle known as keratinosome or Odland body or
membrane coated granule forms in the upper spinous
layers and granular cell layers.
• Odland body is present in both keratinized and
nonkeratinized epithelium.
• In keratinizing epithelium the odland body appears
as ovoid membrane bound organelle of 0.25 µ in
length which consists of series of parallel internal
lamellae consisting of alternate electron lucent
and electro dense bands while in non–keratinized
epithelium odland bodies appear as spherical
membrane bound organelles of 0.2 µ diameter. This
structure has an electron dense core from which
delicate radiating strands are observed.
• The membrane coating granules are glycolipids. It
has an internal lamellated structures.
• Lamellar granules discharge their contents in the
intercellular space forming an intercellular lamellar
material, which contribute to the permeability
barrier.
Dental Histology  697
• The barrier forms at the junction of cornified and
granular layers.
Q.30. Write a short note on nerve supply and blood supply
of tongue. (Dec 2010, 2 Marks) (Feb 2013, 2 Marks)
(May 2014, 2 Marks)
Or
Write short note on nerve supply of tongue.
 (Jan 2012, 5 Marks)
Ans. Arterial Supply of Tongue
It is chiefly supplied by lingual artery and a branch of
external carotid artery.
Venous Drainage
♦♦ Deep lingual vein is largest and principal vein of tongue.
It is visible on inferior surface of tongue.
♦♦ The arrangement of veins of tongue is variable. Two venae
consist accompany lingual artery and one venae commits
the hypoglossal nerve.
♦♦ These veins unite at posterior border of hyoglossus to form
lingual vein which ends in internal jugular vein.
Nerve Supply
♦♦ Motor supply: All extrinsic and intrinsic muscles except
palatoglossal are supplied by hypoglossal nerve.
• Palatoglossal is supplied by cranial part of accessory
nerve.
♦♦ Sensory innervations
• Lingual nerve is general nerve of sensation and chorda
tympani is nerve for taste for anterior 2/3.
• For posterior 1/3 the glossopharyngeal nerve is nerve
for both general taste and sensation.
• Posterior most part is supplied by vagus nerve.
Q.31. Write about classification of oral mucous membrane
and describe vermilion border of lip. 
 (May/June 2009, 10 Marks)
Ans. For classification refer to Ans 8 of same chapter. For
vermilion border of lip refer to Ans 22 of same chapter.
Q.32. Classify oral mucosa. Discuss nonkeratinocytes.
 (June 2010, 10 Marks)
Ans. For classification refer to Ans 8 of same chapter.
For nonkeratinocytes refer to Ans 25 of same chapter.
Q.33. Write short note on keratohyalin granules.
 (June 2010, 2 Marks)
Ans. Keratohyaline granules are seen in the cytoplasm of
stratum granulosum cells.
• In keratinized epithelium size of granule is 0.1 to
1.5µ.
• Size and number of granules increases as cell moves
from granular layer.
• They are angular or irregular in shape.
• Keratohyaline granules are basophilic when stained
with H and E stain.
• These granules are related to the ribososmes.
• They consists of sulphur rich proteins, i.e. profilagrin
which form the matrix and bind keratin filaments
together.
698 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
• They also have involucrin and loricrin protein which
thickens the cell membrane and form resistant
cornified cell envelope.
Q.34. Classify oral mucous membrane. Describe in detail the
anatomy and histology of tongue.  (Aug 2012, 15 Marks)
Ans. For classification and histology of dorsal surface of
tongue refer to Ans 8 of same chapter. For histology of
ventral surface of tongue refer to Ans 17 of same chapter.
Anatomy of Tongue
Tongue is a muscular organ which lies in floor of mouth.
Tongue is divided into dorsal part (superior part) and ventral
part (inferior part).
Dorsal Part
♦♦ It is convex in all directions.
♦♦ A V shaped sulcus divides this surface into anterior two
third, posterior one third and posteriomost part.
♦♦ A small pit seen where the two arms of ‘V’ meet. This is
known as foramen caecum.
♦♦ Anterior two third of tongue is known as papillary part.
♦♦ Most numerous are fine pointed, cone shaped, i.e. filiform
papillae which are distributed all through the dorsal
surface.
♦♦ Fungiform papillae are distributed between the filiform
papillae. They are the round projections.
♦♦ Anterior to sulcus terminalis lies the 8 to 12 large papillae
known as circumvallate papillae.
♦♦ Circumvallate papillae are partly submerged and they
should not come above the surface of tongue. They are
surrounded by V shaped sulcus. margins of papillae lie
above the surface.
♦♦ At the border of anterior two third and posterior one third
of tongue over lateral margin lie the foliate papillae.
♦♦ Foliate papillae has series of folds and form clefts.
♦♦ Posterior one third is irregular and has rounded projections,
i.e. lingual follicles which has lymphoid component. So
posterior one third is known as lymphoid region.
Ventral Part
♦♦ Papilla are absent over inferior surface.
♦♦ It is attached to floor of mouth by loose lingual frenum.
♦♦ On both sides of lingual frenum lies the prominent lingual
veins.
♦♦ Inferior surface consists of lateral part which consists of
two folds known as plica fimbriata.
♦♦ Plica fimbriata run medial and forward to tip of tongue.
Q.35. Give classification of oral mucous membrane. Write
about characteristic features and histology of cheek
mucosa and gingiva. (Mar 2013, 8 Marks)
Ans. For classification refer to Ans 8 of same chapter.
Charactersitic Features of Cheek Mucosa
♦♦ Cheek mucosa is lined by non-keratinized epithelium.
♦♦ At interface between the epithelium and connective tissue
rete ridges are seen which are small and irregular.
♦♦ They interdigitate with few short irregular connective
tissue papillae.
♦♦ Lamina propria is thick and has less dense collagen fibers.
♦♦ Submucosa consists of mixed salivary glands, adipose
tissue, etc.
♦♦ Strands of dense connective tissue makes submucosa
which binds lamina propria to fascia covering the muscles.
Histology of Cheek Mucosa
For histology refer to Ans 15 of same chapter.
Characteristic Features and Histology of Gingiva
Refer to Ans 16 of same chapter.
Q.36. Write about the basal lamina. (Feb 2013, 5 Marks)
Or
Write short note on basal lamina. (Oct 2016, 3 Marks)
Ans. Ultrastructurally basement membrane is known as basal
lamina.
• Layer of basal lamina adjacent to basal cell is 45 nm
thick and appears electronlucent. This layer is known
as lamina lucida.
• Beneath the lamina lucida an electron dense layer of
55 nm thickness is seen which is known as lamina densa.
• Anchoring fibrils which consists of Type VII collagen
form loops and are inserted in lamina densa. Lamina
densa also consists of Type IV collagen which has
heparin sulphate in chicken wire configuration.
• Lamina lucida is a 20 to 40 nm wide glycoprotein layer
and it consists of type IV collagen and an antigen which
is bounded by an antibody KF – 1. Lamina lucida also
consists of laminins and bullous pemphigoid antigen.
Functions of Basal Lamina
♦♦ Structural attachment: Basal lamina provides attachment
between epithelium and connective tissue.
♦♦ Compartmentalization: Basal lamina isolates epithelial
and connective tissue.
♦♦ Filtration: Basal lamina transport materials from the
connective tissue.
♦♦ Tissue scaffolding: Basal lamina act as scaffold at the time
of regeneration of epithelium.
♦♦ Polarity induction: Epithelial cells get arranged in their
normal layers if they are supported by basal lamina.
Q.37. Define oral mucous membrane. Classify it on the basis
of functional criteria and keratinization. Enumerate
the functions of oral mucous membrane. Describe
the different epithelial layers of keratinized and non–
keratinized mucosa with well labeled diagrams.
 (Sep 2015, 1+3+2+4 Marks)
Ans. Moist lining of oral cavity is called as oral mucous
membrane. It consists of an epithelium and connective
tissue known as lamina propria.
For classification on basis of functional criteria and
keratinization refer to Ans 8 of same chapter.
 Dental Histology  699

Enumeration of Functions of Oral Mucous Membrane ♦♦ Basal cells consist of tonofilaments which are few in
1. Defense: Integrity of oral epithelium act as barrier for entry number.
of microorganisms. Stratum Intermedium
2. Lubrication: Secretion of salivary glands keeps the oral
cavity moist. Light Microscopic Features
3. Sensory: Oral mucous membrane is sensitive to touch, ♦♦ This layer consists of polyhedral cells which are located
pressure, pain and temperature. above the basal cell layer.
4. Protection: It protects deeper tissues from mechanical forces ♦♦ Cytoplasm of these cells takes eosinophilic stain and is
due to mastication. differentiated easily from basal cells which have basophilic
Different Epithelial Layers of Keratinized Mucosa cytoplasm.
♦♦ Cells consist of centrally placed round nucleus.
For details refer to Ans 42 of same chapter. ♦♦ Cells of stratum intermedium are larger as compared to
Different Epithelial Layers of Nonkeratinized Mucosa stratum spinosum and are closely apposed to each other.
These cells in contrast to stratum spinosum lack prickly
Nonkeratinized mucosa consists of three layers, i.e. stratum appearance.
basale, stratum intermedium and stratum superficiale.
Electron Microscopic Features
♦♦ There is increase in the size of cell and nucleus in stratum
intermedium of nonkeratinized epithelium.
♦♦ Nucleus consists of evenly distributed chromatin with 2 to
3 nucleoli and cytoplasm is rich in organelles for protein
synthesis.
♦♦ Tonofilaments found here are in unbundled form.
♦♦ Cells are attached to each other by desmosomes but with
of intercellular space are less.
♦♦ As the cells move superficially the number of desmosomes
decreases.
♦♦ Odland bodies are seen in this layer which is different
from odland bodies found in keratinized mucosa. In non-
keratinized epithelium odland bodies appear as spherical
membrane bound organelles of 0.2 µ diameter. This
Fig. 83:  Nonkeratinized mucosa (H and E Stain)
(For colour version see Plate 29)
structure has an electron dense core from which delicate
radiating strands are observed.
Stratum Basale ♦♦ Cells of this layer consist of intermediate keratin filaments
Light Microscopic Features but these filaments differ biochemically from those in
keratinizing mucosa and are sparsely distributed in cells.
♦♦ It consists of single layer of cuboidal cells.
♦♦ Basal cells have basophilic cytoplasm and centrally placed Stratum Superficiale
nucleus which is hyperchromatic and is larger occupying
Light Microscopic Features
one-third of cytoplasm.
♦♦ It is the most superficial layer of nonkeratinized mucosa.
Electron Microscopic Features ♦♦ It consists of few layers of flat nucleated cells.
♦♦ Basal cells consist of nucleus which occupy one third of ♦♦ Nucleus of these cells is flattened with long axis parallel
cell with evenly distributed chromatin and 2 to 3 nucleoli. to outer surface of epithelium.
♦♦ Since basal cells are involved in synthesis of proteins,
so their cytoplasm consists of rich cellular organelles Electron Microscopic Features
i.e. rough endoplasmic reticulum, mitochondria, golgi ♦♦ In this layer cells increase in their size.
complex, few lysosomes etc. ♦♦ Cells are flat with long axis parallel to epithelial surface.
♦♦ Basal cell layer consists of two populations of cells. ♦♦ Nucleus is flat and show pyknotic changes.
One population is serrated and heavily packed with ♦♦ Cells consist of less number of tonofilaments in unbundled
tonofilaments. These cells are adapted for the attachment.
form and lack keratohyaline granules.
Another population is non-serrated and is composed of
♦♦ Cytoplasmic organelles decrease in number.
slowly cycling stem cells. These cells undergo division
♦♦ Desmosomes decrease in size and number. Intercellular
and provide cells for maturing compartment.
♦♦ Basal cells attach to each other by the desmosomes and to contacts of desmosome become more condensed.
basement membrane by hemidesmosomes. ♦♦ Cells ultimately desquamate as do cornified squamae.
700 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Q.38. Write short note on dentogingival junction.
 (Feb 2016, 3 Marks)
Ans. Dentogingival junction is the junction between gingiva
and the tooth.
• Epithelium of gingiva which get attached to tooth is
known as junctional or attachment epithelium. Union
between junctional epithelium and tooth is known as
epithelial attachment.
• Firmness and mechanical strength is attributable to
connective tissue attachment.
• Dentogingival junction decreases the affect of mechanical
forces and bacterial attack.
Development of Dentogingival Junction
♦♦ As ameloblast completes the formation of enamel matrix,
they left a thin membrane on surface of enamel, i.e. primary
enamel cuticle.
♦♦ As primary enamel cuticle is formed, ameloblasts get
shorten and epithelial enamel organ is decreased to few
layers of flat cuboidal cells which is known as reduced
enamel epithelium.
♦♦ In normal circumstances reduced enamel epithelium
covers the complete enamel surface and extends to CEJ.
♦♦ At the time of eruption, tip of tooth approaches the oral
mucosa, reduced enamel epithelium and oral epithelium
meet and fuse.
♦♦ Epithelium which covers the tip of crown degenerates
in centre and crown emerges via this perforation in oral
cavity.
♦♦ Reduced enamel epithelium is attached to the part of enamel
which is not erupted. As tip of the crown get emerged
reduced enamel epithelium is known as primary attachment
epithelium and is in continuation with oral epithelium.
♦♦ Reduced enamel epithelium shortens to expose the crown
of tooth completely and get slowly replaced by oral
epithelium. Attachment epithelium is derived from oral
epithelium and is referred to as secondary attachment
epithelium.
Q.39. Write short note on junctional epithelium.
 (Aug 2016, 3 Marks)
Ans. The epithelium of gingiva which gets attached to the
tooth is known as junctional epithelium or attachment
epithelium.
• Junctional epithelium resembles to reduced enamel
epithelium in its structure.
• Junctional epithelium is a stratified squamous
epithelium which is 15 to 30 cell layer thick at
cervical portion and 3 to 4 cell layer thick at apical
margin.
• Epithelium connective tissue interface is flat.
• The most important feature which differentiates
junctional epithelium from other epithelium is
presence of basal lamina over the both sides, i.e. at
junction of epithelium and connective tissue and on
surface adjacent to tooth.
• Junctional epithelium is nondifferentiating, non­
keratinizing tissue which lacks gradient of change
in cell types.
• Junctional epithelium consists of intermediate
filaments which express cytokeratins such as 5,
14 and 19 these cytokeratins are expressed in non
differentiating tissues.
• Junctional epithelium extends till 2 mm on surface
of the tooth.
• The junctional epithelium has highest turnover
rate of 5 to 6 days, and that’s why it regenerates
rapidly.
• Junctional epithelium is highly permeable and
consists of large intercellular spaces, due to which
neutrophils have an easy passage in and out of
epithelium.
• Junctional epithelium also provides easy flow of
gingival crevicular fluid.
Q.40. Enumerate the zones of keratinized oral mucosa.
 (Oct 2016, 2 Marks)
Ans.
Enumeration of Zones of Keratinized Oral Mucosa
Following is the keratinized oral mucosa:
♦♦ Masticatory mucosa, i.e. gingiva and hard palate
♦♦ Vermilion zone.
Zones of Hard Palate
♦♦ Gingival region
♦♦ Palatine raphe
♦♦ Anterolateral area or fatty zone
♦♦ Posterolateral or glandular zone.
Q.41. What is junctional epithelium. Describe passive
eruption with diagram. (Apr 2017, 5 Marks)
Ans. The epithelium of gingiva which gets attached to the
tooth is known as junctional epithelium or attachment
epithelium.
Passive Eruption with Diagram
The separation of primary attachment epithelium from the
enamel is termed as passive eruption.
Crown exposure involving passive eruption and further
recession is described in four stages.
First Stage
Bottom of gingival sulcus lies in the region of enamel covered
crown for sometime and apical end of attachment epithelium
lie at cementoenamel junction. This relationship occurs in
deciduous tooth till one year of age before shedding and in
permanent teeth till 20 or 30 year of age. In this stage clinical
crown is shorter as compared to anatomic crown. (Part of
tooth covered by enamel is known as anatomical crown and
the part of tooth exposed to oral cavity is known as clinical
crown).
 Dental Histology  701

Fig. 84:  Stages of passive eruption

Second Stage Stratum Basale

During this stage attachment epithelium migrates apically and
get attach partly to enamel and partly to cementum. Bottom
of gingival sulcus lies on enamel. Downgrowth of attachment
epithelium along cementum is one facet of shift of dentogingival
junction. This stage of tooth exposure may persist at age of 40
years. In this stage still clinical crown is shorter as compared
to anatomic crown.
Third Stage
As apical migration of attachment epithelium progress gradually,
during this stage it is completely attached on cementum surface
with bottom of gingival sulcus at cementoenamel junction and
the enamel covered crown is exposed fully. So now anatomic
crown is completely exposed to oral cavity.
Light Microscopic Features
♦♦ This layer is made up of single layer of cuboidal cells. These
cells can synthesize DNA and undergo mitosis.
♦♦ Basal cells and the parabasal spinous cells are referred to
as stratum germinativum but only basal cells can divide.
♦♦ Basal cells have basophilic cytoplasm and centrally placed
nucleus which is hyperchromatic and is larger occupying
one-third of cytoplasm.
♦♦ Nucleus in basal cells is arranged perpendicular to the
basement membrane.

Fourth Stage
This stage represents the gingival recession. During this stage
the attachment epithelium migrates apically on surface of
cementum and bottom of gingival sulcus lies on cementum
surface exposing a part of root. During this stage clinical crown
is longer than anatomic crown. Rate of crown exposure and
recession vary in different persons. In some people fourth stage
occur during 20 years and in others at 50 years of age or older.
The above mentioned first two stages are physiological
while the third and fourth stages are either physiological or
pathological.
Q.42. Define and classify oral mucous membrane. Write in Fig. 85:  Keratinized mucosa (H and E stain)
(For colour version see Plate 29)
detail about keratinized epithelium.
 (May 2017, 10 Marks) Ultrastructure or Electron Microscopic Features
Ans. Moist lining of oral cavity is known as oral mucous
♦♦ Basal cells consist of nucleus which occupy one-third of
membrane.
cell with evenly distributed chromatin and 2 to 3 nucleoli.
For classification of oral mucous membrane refer to ♦♦ Since basal cells are involved in synthesis of proteins,
Ans 8 of same chapter. so their cytoplasm consists of rich cellular organelles
Keratinizing Epithelium in Detail i.e. rough endoplasmic reticulum, mitochondria, G olgi
complex, few lysosomes, etc.
Keratinized epithelium consists of four different layers, i.e. ♦♦ Basal cell layer consists of two populations of cells.
stratum basale, stratum spinosum, stratum granulosum and One population is serrated and heavily packed with
stratum corneum. tonofilaments. These cells are adapted for the attachment.
702 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Another population is non–serrated and is composed of
slowly cycling stem cells. These cells undergo division and
provide cells for maturing compartment.
♦♦ Basal cells attach to each other by the desmosomes and to
basement membrane by hemidesmosomes.
♦♦ Basal cells consists of tonofilaments which course toward
and in some way are attached to attachment plaques.
Stratum Spinosum
Light Microscopic Features
♦♦ Stratum spinosum consists of spinous cells which form
this layer. Spinous cells are irregularly polyhedral and are
larger as compared to basal cells.
♦♦ As these cells pass from basal layer to prickle cell layer
their basophilia decreases.
♦♦ Nucleus in spinous cells is centrally placed and is round
or ovoid in shape.
♦♦ These cells are also known as prickle cell layer as in
histological sections they have spiny or prickly appearance.
♦♦ On light microscopic examination it appears that cells are
joined by intercellular bridges.
♦♦ As cell matures in this layer, it moves superficially and
increases in size and cell become more flattened with
flattened nucleus.
Ultrastructure or Electron Microscopic Features
♦♦ Overall size of the cell and nucleus increases as it passes
to spinous cell layer.
♦♦ Nucleus of the cell consists of evenly distributed chromatin
with two to three nucleoli.
♦♦ On electron microscopic examination intercellular bridges
are the desmosomes and tonofibrils are the bundle of
tonofilaments.
♦♦ Desmosome attachment plaque consists of polypeptides
desmoglobin and plakoglobin. Intercellular spaces consist
of glycoprotein, glycosaminoglycans and fibronectin.
♦♦ Intercellular spaces of spinous cells in keratinizing epithelia
are large or distended, so desmosomes look prominent.
Stratum Granulosum
Light Microscopic Features
♦♦ Stratum granulosum consists of flat and wider cells which
are larger in size as compared to spinous cell layer.
♦♦ Stratum granulosum is named for the basophilic
keratohyalin granules that it contains. Cytoplasm of the
cells in this layer is filled with the basophilic granules
known as keratohyaline granules
♦♦ Nucleus of the cell is flat with long axis parallel to the
outer epithelium.
Ultrastructure or Electron Microscopic Features
♦♦ In this layer size of the cell increases.
♦♦ Cell is flat with long axis parallel to epithelial surface.
Nucleus of the cell is flattened and show pykonsis and
signs of degeneration.
♦♦ Cells show decrease in number of cytoplasmic organelles
because of protein synthesis.
♦♦ Amount of tonofilaments are found to be more in this
layer.
♦♦ In this layer cell surfaces are more regular and are more
closely applied to adjacent cell surfaces.
♦♦ In upper spinous and granular cell layers a new organelle is
seen known as odland body or keratinosome or membrane
coating granule.
♦♦ The odland body is a glycolipid which has an internal
lamellated structure. In keratinizing epithelium the odland
body appears as ovoid membrane bound organelle of
0.25 µ in length which consists of series of parallel internal
lamellae consisting of alternate electron lucent and electro
dense bands.
♦♦ Lamellar granules discharge their content in the intercellular
space forming an intercellular lamellar material which
contributes to permeability barrier. Barrier is formed at
the junction of granular and cornified cell layers.
♦♦ During differentiation, inner cell unit of cell membrane
thickens and form cornified cell envelope. Various proteins
contribute to this structure such as involucrin. This protein
provide constituents for cell membrane thickening and
make it resistsnt to the chemical solvents.
♦♦ Structure of desmosomes is maintained in this layer but
the intercellular contact layer of desmosomes becomes
more condensed.
♦♦ Cytoplasm of stratum granulosum cells shows
keratohyaline granules. In keratinized epithelium their
size ranges from 0.1 to 1.5 µ.
♦♦ Keratohyaline granules are angular or irregular and
are associated with ribosomes. These granules have
sulphur rich proteins fillagrin and loricrin which provide
and embedding matrix for tonofilaments and help in
aggregation of tonofilaments.
Stratum Corneum
Light Microscopic Features
♦♦ It is the most superficial layer found in the keratinized
epithelium.
♦♦ The layer is made up of keratinized squamae which are large
and flat as compared to the cells of stratum granulosum.
♦♦ This layer appears eosinophilic amorphous layer in
histological sections.
♦♦ Cells in this layer undergo degeneration.
♦♦ If the nucleus is completely absent in surface layer, pattern
of maturation is known as orthokeratinization but if there
is retention of pyknotic and condensed nuclei in all or some
of squames this is known as parakeratinization.
Ultrastructure or Electron Microscopic Features
♦♦ Ultrastructurally this layer composed of the cells which
resembles to hexagonal discs known as squames.
♦♦ All the nuclei and other organelles such as ribosomes and
mitochondria are disappeared.
♦♦ Keratohyalin granules are disappeared.
♦♦ Ultrastructurally cells of stratum corneum are composed
of densely packed filaments which develop from tonofila­

ments, altered and coated by basic protein of keratohyalin
granule known as filaggrin.
♦♦ Cross linking of tonofilaments by disulphide bonds
facilitate close packing of filaments and provide mechanical
and chemical resistance to this layer.
♦♦ Keratinized cell become compact and dehydrated and
cover greater surface area.
Fig. 86:  Desmosomes
• Ultrastructurally, they are circular or ovoid area of
0.2 to 0.5 µ in which plasma membrane of adjacent
cell remains in juxta position to each other with
distance of 25 to 30 nm.
• This space present between plasma membrane
consists of electron dense lamina known as
intercellular contact layer. This layer has protein
particles of 5 nm diameter which are arranged in
a row.
• Over the cytoplasmic side, plasma membrane of
each adjoining cell consists of thickening known
as attachment plaque and this consists of proteins
catenins, i.e. desmoplakin, plakoglobin and
plakophilin. This plaque serves as an attachment
site for cytoskeletal components which in case of
desmosomes are intermediate filaments.
• Tonofilaments which are present in cytoplasm of
each cell run in attachment plaque and loop out
again. These tonofilaments are not attached to
plasma membrane.
• This arrangement of tonofilaments dissipates
physical forces from attachment site throughout
the cell.
• Other smaller filaments which consists of protein
cadherins i.e. desmoglein and desmocollin attach
tonofilament to plasma membrane and penetrate cell
membrane. Such filaments are known as traversing
filaments. Interaction of cadherins with those
from adjacent cell result in dense line in middle of
intercellular space at desmosome
Dental Histology  703
♦♦ Cell surface and desmosomes are altered while the plasma
membrane remains denser and thicker.
♦♦ As the cell passes to superficial layer, desmosomes
degenerate resulting in desquamation of the cell.
Q.43. Write short note on desmosome. (Sep 2017, 3 Marks)
Ans. Desmosomes are the intercellular bridges or intercellular
junctions seen in epithelial cells.
• Traversing filaments from both the cells come and
attach to intercellular contact layer which helps in
retaining the attachment between cells.
• The desmosomes and tonofilament network form a
tensile supporting system for the epithelium.
• Intercellular spaces of spinous cells in keratinizing
epithelium are large or distended so desmosomes are
made more prominent and these cells give prickly
appearance.
• Size of desmosome is wider in prickle cell layer as
compared to basal cell layer.
• In granular layer cells desmosomes maintain their
structure while the intercellular contact layer of
desmosome becomes more condensed.
• Desmosomes become less distinct in stratum
corneum.
• As cell passes to superficial layer desmosomes tend
to degenerate which lead to desquamation of cell.
Q.44. Write short note on microscopic and macroscopic
features of hard palate. (Sep 2017, 3 Marks)
Ans.
Microscopic Features of Hard Palate
♦♦ Hard palate is covered by keratinized mucosa.
♦♦ Keratinized stratified squamous epithelium which lines
the mucosa consists of four different layers i.e. stratum
basale, stratum spinosum, stratum granulosum and
stratum corneum.
704 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
♦♦ Due to functional adaptation, to bear with masticatory
stress, cells in hard palate show more dense tonofilaments,
increased number and length of desmosomes, etc.
♦♦ Epithelium connective tissue interface of hard palate is
irregular with many long regular epithelial ridges which
interdigitate with connective tissue papillae.
♦♦ Lamina propria is dense all through the hard palate, it is
thicker in anterior region as compared to posterior region.
♦♦ In the region of rugae the connective tissue core is dense
with interwoven collagen fibers. Incisive or palatine papilla
composed of dense connective tissue. This consists of
remnants of nasopalatine duct which is lined by pseudo-
stratified squamous epithelium.
♦♦ Frequently the ducts are surrounded by small, irregular
islands of hyaline cartilage.
♦♦ Structure of submucosa show variation in different regions of
palate. Submucosa is completely absent in the peripheral zone
of palate adjacent to the teeth, i.e. the gingival zone and in
the mid palatine raphae. In these regions, the lamina propria
is tightly bound to the periosteum of bone which is called
as mucoperiosteal attachment. In between the gingival zone
and mid palatine raphae, the palate has distinct submucosa.
♦♦ Submucosa in the anterior region of hard palate is filled
with adipose tissue and in posterior region with mucous
glands. So anterolateral part of hard palate is known as fatty
zone and posterolateral part is known as glandular gone.
♦♦ In spite of presnce of thick submucosa in some regions,
mucosa of the hard palate is tightly fixed to the underlying
bone and is immobile. This is due to dense vertical band
of connective tissue which leads to attachment of mucosa
firmly to the periosteum of palatal bone. These dense bands
of connective tissue are at right angle to surface and divide
submucosa into compartments.
♦♦ At the junction of alveolar process and horizontal plate
of hard palate there is presence of loose connective tissue
which carries anterior palatine vessels and nerves.
Macroscopic Features of Hard Palate
♦♦ Hard palate is divided into various different zones i.e.
• Gingival region: This region is found adjacent to the
teeth.
Keratinized mucosa
It is also known as masticatory mucosa
It is nonstretchable
Its turnover rate is slow
Lamina propria is dense
Submucosa can or cannot present
Rete ridges are long and narrow
Thickness of epithelium is less
Four distinct layers are present, i.e. stratum basale, stratum
spinosum, stratum granulosum, stratum corneum
• Mid-palatine raphae: This is the narrow zone in
midline of the hard palate which extends from incisive
papilla posteriorly.
• Anterolateral zone: It is also known as fatty zone.
It lies between mid palatine raphae and gingiva. It
consists of fat tissue in submucosa.
• Posterolateral zone: It is also known as glandular
zone. It lies between mid palatine raphae and gingiva.
It consists of minor salivary glands in submucosa.
♦♦ Palatine rugae: They radiate outward from palatine
raphae in anterior region of hard palate. They are irregular
transverse palatine ridges known as palatine rugae. These
ridges play role in suckling in infants and also help in
backward movement of food during mastication.
♦♦ Fovea palatine: This is an elongated depression of few
millimeters deep in posterior part of palate on either side
of midline.
Q.45. Write short answer on histology of soft palate.
 (May 2018, 3 Marks)
Ans. Following is the histology of soft palate:
• Soft palate is lined by nonkeratinized stratified
squamous epithelium.
• Epithelium can show presence of few taste buds.
• Lamina propria is highly vascular.
• Epithelium connective tissue interface is irregular
with thick and short rete ridges and connective
tissue papillae.
• A distinct layer of elastic fibers is seen which
separate lamina propria from submucosa.
• Submucosa consists of diffuse loose connective tissue
consists numerous minor salivary glands.
Q.46. Classify oral mucosa. Differentiate between keratinized
and nonkeratinized mucosa with the help of diagram.
 (Aug 2018, 10 Marks)
Ans. For classification of oral mucosa refer to Ans 8 of same
chapter.
Differences between keratinized and non-keratinized
mucosa.
Nonkeratinized mucosa
It is also known as lining mucosa
It is stretchable, that it can adapt to the contraction and relaxation of
underlying muscles
Its turnover rate is high
Density of lamina propria is low
Distinct submucosa is present which vary in its thickness
Rete ridges are short and irregular
Thickness of epithelium is more.
Three layers are present, i.e. stratum basale, stratum intermedium,
stratum superficiale
Contd...

Contd...
Keratinized mucosa
Keratinized stratified squamous epithelium
Stratum basale
Hemidesmosomes which anchor this layer to basal lamina are more
in number and are larger
Stratum spinosum
Cells in this layer are polygonal and show prickly appearance
More number of desmosomes present
Desmosomes occupy more percentage of cell membrane
More prominent intercellular spaces
Cytokeratin present are 1, 6, 10, 16
In this layer size of cells is less
Less closely applied adjacent cell surfaces
Tonofilaments are in bundles and they remain more organized
Odland bodies are ovoid having alternating electron dense and
lucent areas
Stratum granulosum
Distinct keratohyaline granules are seen
Stratum corneum
It consists of keratin flakes
Superficial cells does not consists of nucleus or cytoplasmic
organelles
Fig. 87: Keratinized mucosa (H and E stain)
(For colour version see Plate 29)
Q.47. Define oral mucous membrane. Write functions and
classifications of oral mucous membrane. Describe
orthokeratinized stratified squamous epithelium with
well labeled diagram.
 (Sep 2018, 1 + 2 + 2 + 3 + 2 = 10 Marks)
Ans. For definition of oral mucous membrane refer to Ans 37
of same chapter.
For function of oral mucous membrane refer to Ans 37
of same chapter.
For classification of oral mucous membrane refer to
Ans 8 of same chapter.
Dental Histology  705
Nonkeratinized mucosa
Non-keratinized stratified squamous epithelium
In this layer hemidesmosomes are fewer and smaller
Cells in this layer are roughly rounded and prickly appearance is absent
Less number of desmosomes are present
Desmosomes occupy less percentage of cell membrane
Less prominent intercellular spaces
Cytokeratin present are 3, 14, 19
In this layer size of cells is large
More closely applied adjacent cell surfaces
Tonofilaments does not remain in bundles and are less organized
Odland bodies are round in shape with central electron dense core
from which delicate radiating strands are observed
Stratum granulosum is absent
It consists of flattened cells
Surface cells consists of nucleus and cytoplasmic organelles
Fig. 88: Nonkeratinized mucosa (H and E Stain)
(For colour version see Plate 29)
Orthokeratinized Stratified Squamous Epithelium
♦♦ Orthokeratinized stratified squamous epithelium is one
of the type of keratinized stratified squamous epithelium.
♦♦ Straum corneum layer represents the orthokeratinization.
♦♦ Orthokeratinized surface results when cells lost their nuclei
and cytoplasm has been displaced by large number of
keratin filaments. This pattern of maturation is known as
orthokeratinization.
♦♦ Orthokeratinized surface can only be produced when there
is well defined stratum granulosum.
706 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

♦♦ Surface of gingiva and palate consists of orthokeratinized

stratified squamous epithelium as they are associated with
masticatory function.
♦♦ Orthokeratinized stratified squamous epithelium consists
of all four layers of keratinized epithelium, i.e. stratum
basale, stratum spinosum, stratum granulosum and
stratum corneum.
10. SALIVARY GLAND
Q.1. Describe the microscopic features of serous and
mucous cells. Add a note on composition of saliva.
 (Sep 2005, 15 Marks)
Ans. Salivary glands contain serous and mucous cells.
Serous cells: Serous cells are specialized for all synthesis,
storage and secretion of proteins.
• Typical serous cell is pyramidal in shape. With its
broadbase resting on a thin basal lamina and its
narrow apex bordering on the lumen.

Fig. 89: Orthokeratinized stratified squamous epithelium

Q.48. Enumerate nonkeratinocytes. (Sep 2018, 2 Marks)

Ans. Following are the nonkeratinocytes: Fig. 90:  Serous acini (For colour version see Plate 29)
• Melanocytes • Spherical nucleus is located in the basal region of
• Langerhans cell the cell, occasionally binucleated.
• Merkel cells • Secretory granules are located in the apical cytoplasm.
• Inflammatory cells, i.e. lymphocytes and leucocytes • Basal portion of the cytoplasm is filled with ribosome-
Q.49. Write very short answer on zones of basement studded endoplasmic reticulum (RER), a closed
membrane. (Aug 2018, 2 Marks) system of membranous sacs or cisternae. Golgi
Ans. There are two zones of basement membrane i.e. clear apparatus is located apical on lateral to the nucleus.
zone or lamina lucida and dark zone or lamina densa. • Serous cells also contain a few peroxisomes
(microbodies), small organelles containing the
Clear Zone or Lamina Lucida enzyme catalase and other oxidative enzymes. Bundle
♦♦ Basement membrane is made up of clear zone just below of tonofilaments, associated with desmosomes and
epithelial cells. microfilaments may be seen in the cytoplasm.
♦♦ Lamina lucida is 20 to 40 nm wide glycoprotein layer which Mucous cells: Its structure differs from serous cell.
consists of Type IV collagen and an antigen bounded by
antibody KF – 1.
♦♦ Lamina lucida consists of laminins and bullous pemphigoid
antigen.
♦♦ Laminins along with type IV collagen promote epithelial
cell growth.

Dark Zone or Lamina Densa

♦♦ Basement membrane consists of dark zone beyond lamina
lucida and adjacent to connective tissue.
♦♦ Anchoring fibrils which consists of Type VII collagen form
the loops and are inserted to lamina densa. Collagen fibers
of Type I and II run via these loops.
♦♦ Lamina densa consists of Type IV collagen coated with
heparin sulfate in chicken wire configuration. Fig. 91:  Mucous acini (For colour version see Plate 30)

• Apex of the cell appears empty except for their
strands of cytoplasm forming a tubercular network.
The nucleus and a thin rim of cytoplasm are
compressed against the base of the cell.
• Mucous cell is seen to be filled with pale, electron-
lucent territory droplets.
• These droplets are usually longer than serous granules
and may be irregular on compressed in shape.
• Nucleus of the mucous cell is oval or flattened
in shape and located just above the basal plasma
membrane.
• The RER, mitochondria and other organelles are also
limited to a narrow band of cytoplasm.
Composition of Saliva
Saliva contain 99% of water 1% organic and inorganic substances.
Inorganic Contents of Saliva
Calcium and phosphate: They protect mineralized enamel
surface form dissolution. Calcium ion concentration in saliva is
1.5 mmol/L. Phosphate ion concentration is 5.6 mmol/L.
Fluoride: Fluoride promotes remineralization of teeth which
are decaying by dental caries.
Fluoride concentration is about 1.5 mM/L.
Hydrogen carbonate: It acts as buffering agent in saliva.
Concentration of hydrogen carbonate is 2.9 mM/L. It neutralizes
the acids released by bacteria.
Thiocyanate: Thiocyanate is oxidized by salivary peroxides and
it get converted to hypothiocyanate. Hypothiocyanate acts as an
antibacterial agent. Its concentration in saliva is about 2.5 mM/L.
Other Inorganic Components
♦♦ Sodium ions are in very less quantity in saliva. Its
concentrations increase along with the increase in flow rate.
♦♦ Potassium ions are the major inorganic ions in saliva, as
they are secreted throughout the ductal system.
♦♦ Other inorganic components such as lead, cadmium and
copper.
Organic Contents of Saliva
Organic contents of saliva are as follows:
Amylase: It constitute the major component of salivary proteins,
i.e. about 50%. Amylase digests the starch. Mostly salivary
amylase is secreted from parotid gland.
Proline-rich proteins: They constitute about 40 to 45% of
salivary proteins. They reside in the salivary pellicle. Pellicle
function as diffusion barrier, and slows the attacks by bacterial
acids and loss of dissolved calcium and phosphate ions.
Mucins: Mucus consists of large, heavily glycosylated proteins.
It forms 5–10% of salivary proteins. Mucous acts as diffusion
barrier against contact with noxious substances. It also act as a
lubricant foo minimizing shear stresses.
Lingual lipase: It is secreted by von Ebner’s glands as well as
parotid gland. It helps in the digestion of milk fat in newborns.
Dental Histology  707
Statherins: Statherin has very high affinity for calcium and
phosphate minerals. They stop precipitation of supersaturated
calcium phosphate in ductal saliva as well as in oral fluid.
Lysozyme: These enzyme play important role in antibacterial
action.
Lactoferrin: It has antibacterial properties. The oxidized
iron part of the lactoferrin oxidizes bacteria by formation of
peroxides which causes breakdown of cell membrane.
Histatins: They have antifungal properties. They also disrupt
the cell cycle and causes generation of reactive oxygen species.
Other Organic Components
♦♦ Various blood group antigens are secreted in the saliva.
♦♦ Sugars like glucose are secreted in the saliva.
♦♦ Steroid hormones like cortisol, estrogen and testosterone
are secreted in minimal quantities.
♦♦ Ammonia and urea are also present in very less quantities.
Q.2. Write a note on function of saliva.
 (Feb 2005, 5 Marks) (Sep 2007, 5 Marks)
 (Apr 2008, 5 Marks)
Or
Write short note on functions of saliva.
 (Nov 2009, 5 Marks), (Nov 2010, 5 Marks)
 (May/June 2009, 10 Marks) (Mar 2013, 3 Marks)
 (Dec 2014, 2 Marks)
Or
Write very short answer on functions of saliva.
 (Aug 2018, 2 Marks)
Ans.
Functions of Saliva
♦♦ Cleaning of mouth: Since saliva is watery it produces a
flushing action on the teeth which helps in removing the
food debris as well as non-adherent forms of bacteria which
collects over the teeth.
♦♦ Lubrication and deglutition: Saliva provides lubrication
to oral tissues by mucus and various other glycoproteins
which help provide lubrication at time of speech. It also
helps in formation of bolus which can easily slide into the
esophagus.
♦♦ Antimicrobial function: Saliva consists of various
components which produce antimicrobial activity. The
components are lysozyme, lactoferrin, histatins and salivary
peroxidases. Saliva also consists of immunoglobulin
such as IgA which provides antimicrobial action by
agglutinating certain microorganisms and preventing their
adherence to the oral mucosa.
♦♦ Buffering function: Saliva consists of bicarbonate ions
which neutralize the acids which are produced by bacteria,
these acids can cause dissolution of teeth and cause dental
caries. So due to its buffering action saliva dissolve the acid
and prevent caries.
♦♦ Digestive function: Saliva consists of digestive enzymes
such as amylase and lipase. These enzymes causes start
digestion of food from oral cavity, e.g. enzyme amylase and
708 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
lipase break starch into maltase and lipids into diglycerides
and free fatty acids.
♦♦ Mineralization: Tooth surface is always coated with saliva.
Since saliva consists of calcium and phosphate ions, they
increase the surface hardness of teeth which provide
resistance of teeth to demineralization.
♦♦ Taste: Saliva dissolves the food substances so that they can
be perceived by the receptors located in the taste buds.
♦♦ Tissue repair: Saliva consists of epidermal growth factor
and vascular endothelial growth factor which leads to
repair and regeneration of oral tissues.
♦♦ Excretion: Many substances from blood reaches saliva and
saliva is considered as the route of excretion.
Q.3. Write a short note on composition and function of
saliva. (Feb/Mar 2004, 5 Marks)
Or
Write a note on composition and function of saliva. 
 (Oct 2006, 5 Marks)
Or
Describe composition of saliva. (Feb 2013, 5 Marks)
Or
Write about saliva composition and function.
 (Feb 2013, 10 Marks)
Or
Write composition of saliva and enumerate functions
of saliva. (Sep 2018, 3 + 2 marks)
Or
Write functions and composition of saliva.
 (Aug 2018, 2 + 3 marks)
Ans. Refer to Ans 1 for composition and 2 for function of
saliva.
Q.4. Write note on saliva.
 (Sept 2000, 5 Marks) (Jan 2012, 5 Marks)
Ans. Refer to Ans 1 and 2 of the same chapter.
Q.5. Write a short note on properties and function of Saliva.
 (Sept 2002, 6 Marks)
Ans. Refer to Ans 2 of the same chapter.
Q.6. Write short note on parotid gland.(Feb 2002, 6 Marks)
Or
Write short note on serous gland (Oct 2016, 3 Marks)
Or
Write short note on light microscopic features of
serous salivary gland. (May 2017, 3 Marks)
Ans. Parotid gland is largest major salivary gland.
• Parotid gland is bilaterally paired major salivary
gland.
• Parotid gland is enclosed within a well formed
connective tissue.
• Location: Its superficial part lying in front of the
external ear and its deeper part lies behind ramus of
mandible filling the retero-mandibular fossa.
• Duct of parotid gland, i.e. Stenson’s duct open into
cavity on the buccal mucosa opposite the maxillary
second molar.
• Parotid gland is a fine serous gland.
• All acinal cells are similar in structure to serous cells.
• Electron microscopic study indicates that the serous
granules may have a dense central core.
• The intercalated ducts of the parotid are long and
branching and the pale staining striated ducts are
numerous and stand out conspicuously against more
densely stained acini.
• The connective tissue septa in the parotid contain
numerous fat cells.
Light Microscopic Structure of Parotid Gland or Serous Gland
Parotid gland is the largest salivary gland. It has a well-defined
capsule. Septa divide the gland into lobes and lobules.
♦♦ Secretory acini: Acini are purely serous in nature and
that’s why they are known as serous acini. Serous acini
are compound alveolar, small in size and rounded in
shape. They show very small lumen or mostly the lumen is
obliterated. Serous acinus is lined by small pyramidal cells
and their number within an acinus is more. Serous acini
stain dark. Serous acini are surrounded by thin contractile
myoepithelial (basket) cells.
♦♦ Serous cells: They are pyramidal in shape. They are small
in size compared to mucous cells. Serous cells stain dark
when stained with hematoxylin and eosin stain. Nuclei
are rounded and situated in center more toward basal part
of cell. Apical portion contains large number of secretory
granules, i.e. zymogen granules. Base of serous cell is
basophilic (blue) and apical portion is acidophilic (pink).
♦♦ Ducts: Interlobular ducts are present in the connective
tissue septa. These ducts may be lined by simple columnar
or pseudostratified columnar epithelium. The intralobular
ducts are seen between acini. The intercalated ducts are
lined by simple squamous to low cuboidal epithelium.
They are long and branching in parotid gland. The striated
ducts are lined by simple low columnar epithelium and
show basal striations. Striations are responsible for bright
eosinophilic (acidophilic) staining reaction of these ducts.
Adipose tissue may be seen among acini and smaller ducts.
In between the lobules in connective tissue septa aretrioles,
venules and interlobular excretory ducts are located.
Q.7. Write a short note or Stenson’s duct?
 (Feb 2002, 6 Marks)
Ans. Stenson’s duct is main excretory duct of parotid gland.
• Stenson’s duct carries the secretion of parotid gland
into the oral cavity.
• Stenson’s duct open into oral cavity on the buccal
mucosa opposite the maxillary second molar.
• Opening is usually marked by a small papilla.
• Main duct (Stenson’s duct) is formed by the union
of striated ducts, which are formed by smallest
intercalated ducts.
• Intercalated ducts found in terminal secretory unit, i.e.
serous acini in parotid gland and collect their secretion.

Q.8. Describe anatomy and physiology of submandibular
salivary gland. (Mar 2001, 15 Marks)
Or
Write a short note on submandibular salivary gland.
 (Sept 2002, 5 Marks)
Ans. Submandibular Gland
Fig. 92:  Submandibular salivary gland
(For colour version see Plate 30)
• Submandibular gland is the major salivary gland.
• It forms the major portion of saliva.
• Submandibular gland is enveloped by a well defined
capsule.
• Submandibular gland is bilaterally paired, well
defined, capsulated, submandibular gland is located
at the submandibular triangle behind and below
the mylohyoid muscle, with a small extension lying
above the mylohyoid.
• Its secretion reaches in the oral cavity by main
excretory duct, i.e. Wharton’s duct.
• This duct opens at the coruncula sublingualis.
• Coruncula sublingualis is a small papilla at the side
of the lingual frenum on the floor of the mouth.
• Submandibular gland is a mixed gland.
• It has both serous and mucous secretory units.
• Serous units are predominant.
• Mucosal terminal portions are capped by demilunes
of serous cells.
Q.9. Write a note on minor salivary gland.
 (Sept 2003, 5 Marks)
Ans. Minor salivary glands are located beneath the
epithelium in almost all parts of the oral cavity.
♦♦ They lack a distinct capsule.
♦♦ The secretory units open via short ducts directly into the
mouth.
• Labial and buccal gland:
–– These are glands of the lip and cheeks.
–– They are mixed glands.
–– They consist of mucous tubules with serous
demilunes.
–– Intercalated ducts open directly in mouth.
Dental Histology  709
• Glossopalatine gland:
–– These are pure mucous glands.
–– Principally localized in the region of the isthmus
in the glossopalatine fold.
• Palatine glands:
–– These are also pure mucous glands.
–– They consist of several granular aggregates in the
lamina propria of hard palate and in the submu-
cosa of soft palate.
–– Openings of the ducts on the palatal mucosa are
often large and easily recognizable.
• Lingual gland:
–– Glands of tongue can be divided into several
groups.
–– Anterior lingual glands are located near the apex
of tongue.
Anterior region - chiefly mucous
Posterior portion - mixed.
–– Posterior lingual mucous glands are located
lateral and posterior to the vallate papillae. They
are purely mucous. Their ducts open into the
dorsal surface of tongue.
–– The posterior lingual serous glands (von Ebner’s
glands) are purely serous gland located between
the muscle fibers of tongue below the vallate
papillae.
Q.10. Write note on mixed salivary gland.
(Feb 2006, 2.5 Marks) (Mar 2007, 2.5 Marks) (Apr 2008,
2.5 Marks) (Mar 2013, 3 Marks)
Ans. Salivary gland which contains both serous and mucous
acini called as mixed salivary gland.
♦♦ Mixed salivary glands are:
• Major mixed salivary gland
–– Submandibular salivary gland: It is located in
submandibular triangle. The main excretory
duct (Wharton’s duct) open at the coruncula sub
lingualis.
–– Sublingual salivary gland: It lies between the floor
of the mouth and mylohyoid muscles. Its ducts
open near the opening of submandibular duct.
• Minor mixed salivary glands are:
–– Labial salivary gland
–– Buccal salivary gland
–– Lingual salivary gland.
For more details refer to Ans 13 of same chapter
Q.11. Write briefly on functions of teeth.
 (Oct 2007, 5 Marks) (Apr 2010, 5 Marks)
Ans. The teeth form a part of the masticatory apparatus and
are fixed to the jaw.
• The permanent teeth are 32 in number and consist of
2 incisors, 1 canine, 2 premolar and 3 molar in each
half of each jaw.
- The shape of a tooth is adapted to its function
- The incisors are cutting teeth
- The canines are holding and tearing teeth
710 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
- Molars and premolars help in mastication, they
are grinding teeth
• Teeth also help in speech
• Teeth provide the shape of face.
Q.12. Write briefly major salivary gland. (Oct 2007, 5 Marks)
Ans. The major salivary glands are:
• Parotid: Refer to Ans 6 of the same chapter
• Submandibular: Refer to Ans 8 of the same chapter.
• Sublingual Salivary Gland:
- It is the smallest of all the major salivary glands.
- It is of almond shape.
- It lies in between the floor of mouth below
mucosa and above mylohyoid muscle.
- The duct of sublingual gland is Bartholin’s gland.
- Bartholin duct open near the submandibular
duct.
- It is a mixed gland.
- Mucous secretory units are greater in number
than serous units.
- Gland receives its blood supply from sublingual
and submental arteries.
- Lymphatic drainage of the gland is to subman-
dibular lymph node.
Q.13. Write about histology of mixed salivary gland.
 (Nov 2008, 5 Marks)
Ans. Or
♦♦ Mixed salivary gland consists of both serous and mucous
acini.
♦♦ At places mucous acini are capped by the serous acini
which present half moon appearance in some of the
sections. These are known as serous demilunes.
♦♦ Interlobular ducts are lined by simple columnar or
pseudostratified columnar epithelium.
♦♦ Intralobular ducts are seen in between acini.
♦♦ Striated ducts are large and branching and are present in
between acini.
♦♦ Striated ducts are lined by simple low columnar epithelium
and they show basal striations.
Fig. 93:  Mixed salivary gland  (For colour version see Plate 30)
Q.14. Write short note on demilunes. (Oct 2008, 2 Marks)
Or
Describe serous demilunes. (Aug 2011, 5 Marks)
Ans. The meaning of demilune is “Half moon”:
• In routine tissue preparation, the serous cells are
more removed from the lumen of acinus and are
shaped as demilunes, at periphery of mucus acinus.
• In routine H and E preparations, mucous acini have
a cap of serous cells which are thought to secrete into
the highly convoluted intercellular space between
mucous cells. Because of their appearance in histologic
sections, such caps are called as serous demilunes.
• Serous demilunes are the artifacts of the traditional
fixation method.
Formation of Demilune
The process of demilune formation can be explained by
expansion of mucinogen, a major component of secretory
granules, during routine fixation. This expansion increases
the volume of mucous cells and displaces serous cells from
their original position thus creating demilune effect. A similar
phenomenon is seen in intestinal mucosa.
Q.15. Write a short note on myoepithelial cell.
 (Dec 2010, 2 Marks) (June 2010, 5 Marks)
Or
Write on myoepithelial cell. (Apr 2017, 3 Marks)
Answer in brief myoepithelial cells. (Oct 2016, 2 Marks)
Or
Write short answer on myoepithelial cells.
 (Aug 2018, 3 Marks)
Ans. Myoepithelial cells are closely related to seceretory and
intercalated duct cells.
• They are stellate or spider like with a flattened
nucleus, scanty perinuclear cytoplasm and long
branching processes that embrace the secretory and
duct cells.
• In case of intercalated duct the myoepithelial cells
have a more fusiform shape and are elongated
with a few short processes. The processes in the
acini lie gutters hence the outline of acini appears
smooth but in the intercalated ducts the processes
run longitudinally on the surface creating a bulge.
• Their appearance is reminiscent of a basket cradling
the secretory unit, hence the term ‘basket cell”.
• Myoepithelial cells are similar to smooth muscle
cells but are derived from epithelium. These cells
are located around the terminal secretory units and
the first portion of duct system.
• They lie between the basal lamina or basement
membrane of the parenchyma cells and are joined
to the cells by desmosomes.
The myoepithelial cells actively can:
• Accelerate the initial outflow of saliva from the acini
• Reduce luminal volume

• Contribute to secretory pressure in acini
• Support the underlying parenchyma and reduce the
back permeation of fluid.
• Help salivary flow to overcome increase in peripheral
resistance to duct.
Fig. 94:  Myoepithelial cell
Q.16. Write about classification of human salivary glands
and histology of mixed salivary gland.
 (May/June 2009, 10 Marks)
Ans. Classification of Human Salivary Glands:
♦♦ Based on size
• Major salivary gland: Parotid, submandibular and
sublingual glands.
• Minor salivary gland: Group of small glands located
in oral mucosa.
♦♦ Based on location
• Extraoral: Three pair of major glands located outside
the oral cavity.
• Intraoral: Group of minor salivary glands widely
distributed in oral mucosa.
♦♦ Based on nature of secretion
• Serous: Parotid gland and Von Ebner’s gland
• Mucous: Sublingual gland and all minor salivary
glands except Von Ebner gland
• Mixed: Submandibular gland.
For histology of mixed salivary gland refer to Ans 13 of same
chapter.
Q.17. Write short note on serous and mucous acini.
 (Aug 2011, 5 Marks)
Ans. Serous Acini
• Serous acini are compound alveolar
• It is circular or rounded in shape
• It is smaller in size when compared to mucous acini
• It has less number of cells compared to mucous acini
• Lumen of serous acini is small
• Cells of serous acini are pyramidal in shape
• Nucleus in cells of serous acini is round in shape
and is placed at basal 1/3rd part of cell
• Apically the cytoplasm is eosinophilic in H and E
stained sections because of presence of zymogen
granules.
Dental Histology  711
Mucous Acini
• Mucous acini are compound tubular
• It is oval or tubular in shape
• It is larger in size when compared to serous acini
• It has more number of cells compared to serous acini
• Lumen of mucous acini is wide
• Cells of mucous acini are columnar in shape
• Nucleus in cells of mucous acini is flattened in shape
and is placed at basal plasma membrane of cell
• Apically the cytoplasm is empty in H and E stained
sections.
Q.18. Classify salivary glands. Describe the function and
composition of saliva. (Jan 2012, 15 Marks)
Ans. For classification refer to Ans 16 of same chapter.
For function of saliva refer to Ans 2 and for composition
of saliva refer to Ans 1 of same chapter.
Q.19. Classify salivary glands. Write in detail about ductal
system of salivary glands. (Feb 2014, 8 Marks)
Or
Classify and discuss ductal system of salivary glands.
 (Sep 2017, 10 Marks)
Ans. For classification refer to Ans 16 of same chapter.
Ductal System of Salivary Glands
♦♦ The ductal system of salivary gland consists of a hollow tube
which initially is connected to acinus and with other ducts.
♦♦ Ductal pattern of compound tubuloacinar gland has
intralobular ducts, i.e. intercalated ducts and striated
ducts. These ducts are seen inside the lobes connecting
acini. The intralobular ducts leads to interlobular duct,
i.e. excretory duct.
♦♦ Ductal system consists of secretory portion and excretory
portion. Secretory portion modify the saliva by ion exchange,
i.e. by intercalated and striated ducts and excretory portion
leads to transport of saliva, i.e. by excretory duct.
♦♦ Microscopically three ducts are identified, i.e. intercalated,
striated and excretory ducts.
Fig. 95:  Ductal system of salivary gland
Histology of Ductal System
Intercalated Ducts
♦♦ They are first element of intralobular ductal system.
♦♦ They are lined by a single layer of low cuboidal epithelial
cells with empty appearing cytoplasm.
712 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

♦♦ Cells of intercalated duct consists of few secretory granules, ♦♦ Intercalated ducts provide some secretory materials to
some rough endoplasmic reticulum, mitochondria and a saliva, i.e. lysozymes and lactoferrin.
round or oval centrally placed nucleus. ♦♦ Intercalated and striated ducts resorb some proteins.
♦♦ Intercalated ducts are supported by basement membrane ♦♦ Striated ducts provide glycoprotein and kallikrein to saliva.
and adjacent cells are attached to each other by inter- ♦♦ Striated duct modify electrolyte concentration of saliva.
cellular junctions. ♦♦ Excretory duct along with striated duct modify tonicity
♦♦ Myoepithelial cells are found between basal plasma of saliva.
membrane of lining cells and supporting basement ♦♦ Excretory duct releases mucin in saliva.
membrane. Q.20. Classify salivary gland. Add a note on mixed major
♦♦ They consist of lysozymes, lactoferin and various unknown salivary gland. (Apr 2015, 8 Marks)
components which are stored in their secretory granules.
Ans. Classification of salivary gland
All these components are contributed to saliva.
I. Based on size
Striated Duct 1. Major salivary gland: Parotid, submandibular and
sublingual glands
♦♦ Striated ducts are the next largest intralobular type and are
2. Minor salivary gland: Group of small glands in oral
located between intercalated ducts and excretory ducts.
mucosa. These are named according to their location
♦♦ Lumen of striated ducts is large and is lined by single layer
i.e. buccal, labial, lingual, palatine and glossopalatine.
of columnar cells.
II. Based on location
♦♦ Cells of striated duct has rounded nucleus which is
1. Extra oral: Three pairs of major salivary glands situated
centrally placed and abundant eosinophilic cytoplasm.
outside oral cavity
♦♦ Basal portion of cell produce striated appearance, hence it
2. Intra oral: Group of minor salivary glands distributed
is known as striated duct.
in oral mucosa
♦♦ Electron microscopy shows abundant large mitochondria
III. Based on nature of secretion
which is radially oriented and is located in portion of
1. Serous glands: Parotid and Von Ebner’s glands
cytoplasm between membrane infoldings. This combination
2. Mucous glands: Sublingual gland and all minor salivary
of mitochondira and infolding leads to striations.
glands except Von Ebner’s glands
♦♦ Apical part of plasma membrane show microvilli which
3. Mixed glands: Submandibular glands
project in the lumen.
♦♦ Few basal cells and oncocytes too are seen. Oncocytes have For note on major mixed salivary gland i.e. submandibular
dark eosinophilic granular cytoplasm. gland refer to Ans 8 of same chapter.
Q.21. Enumerate the functions of saliva.
Excretory Duct  (Sep 2015, 2 Marks)
♦♦ Striated ducts join each other to form large intralobular Or
ducts, i.e. excretory duct. List four functions of saliva. (Aug 2016, 2 Marks)
♦♦ These ducts increase in the size and consists of increasing
layers of connective tissue. Or
♦♦ As excretory ducts enlarges it consists of two layes, i.e. Enlist functions of saliva. (May 2017, 2 Marks)
mucosa and outer connective tissue adventitia.  (Jan 2018, 2 Marks)
♦♦ Mucosal epithelium consists of pesudostratified columnar Ans. Enumeration of functions of saliva:
epithelial cells. Occasional goblet cells and ciliated cells 1. Cleaning of mouth
can be seen. 2. Lubrication and deglutition
♦♦ Ductal epithelium undergoes a transition from stratified 3. Antimicrobial function
epithelium to cuboidal epithelium and finally to stratified
4. Buffering function
squamous epithelium.
5. Digestive function
♦♦ Excretory ducts also consist of tuft or brush cells with long
6. Mineralisation
stiff microvilli and apical vesicles.
7. Taste
♦♦ At times cells with pale cytoplasm and dense nuclear
8. Tissue repair
chromatin are visible towards base of duct epithelium
9. Excretion.
which are known as lymphocytes and macrophages.
♦♦ Dendritic cells are also seen with long branching processes Q.22. Write the difference between mucous and serous
which extend between epithelial cells. salivary gland acini with well labeled diagrams.
 (Sep 2015, 5 Marks)
Functions of Ductal System
Or
♦♦ Ductal system is a passage by which saliva is secreted by
acini and reaches oral cavity. Saliva secreted by acini is Write differences between mucous and serous acini.
known as primary saliva and it undergo modification by  (Apr 2017, 3 Marks)
various ducts to form secondary saliva. Or
 Dental Histology  713

Classify salivary gland. Discuss differences between • Saliva has a pH normal range of 6.2–7.6 with 6.7 being the
serous and mucous acini. (May 2018, 10 Marks) average pH. Resting pH of mouth does not fall below 6.3.
Ans. For classification of salivary gland refer to Ans 16 of same In the oral cavity, the pH is maintained near neutrality
chapter. (6.7–7.3) by saliva.
Difference between mucus and serous salivary gland acini • The saliva contributes to maintenance of the pH by
two mechanisms. First, the flow of saliva eliminates
Mucous acini Serous acini carbohydrates that could be metabolized by bacteria
They are compound tubular They are compound alveolar and removes acids produced by bacteria. Second, acidity
It is oval or tubular in shape It is circular or rounded in from drinks and foods, as well as from bacterial activity,
shape is neutralized by the buffering activity of saliva.
It is larger in size compared to It is smaller in size compared to
serous acini mucous acini Q.25. Write short note on antimicrobial properties of saliva.
It has more number of cells It has less number of cells  (Aug 2016, 3 Marks)
compared to serous acini compared to mucous acini Ans. Saliva consists of many antimicrobial substances i.e.
Lumen of mucous acini is wide Lumen of serous acini is small antibacterial agents lysozyme, lactoferrins, calprotectin,
Cells of mucous acini are Cells of serous acini are lactoperoxidase, immunoglobulins, chromogranin A,
columnar in shape pyramidal in shape cystatins, histatins, Von Ebner’s gland protein, Secretory
Nucleus is flattened in shape Nucleus is rounded in shape leukocyte proteinase inhibitor.
and is placed at basal plasma and is placed at basal 1/3rd • Antimicrobial properties of saliva are produced by
membrane of cell part of cell the serous secretor cells of both major and minor
Apically the cytoplasm is empty in Apically cytoplasm is salivary glands.
H and E stained sections eosinophilic in H and E stained • Some of the high molecular weight salivary
sections due to presence of glycoproteins aggregate specific strains of oral
zymogen granules microorganisms and prevent their adhesion to the
For diagram refer to Ans 1 of For diagram refer to Ans 1 of oral tissues which facilitate their oral clearance.
same chapter same chapter
• Acinar cells secrete peroxidase enzyme while ductal
system secrete thyocyanate, both these enzymes
Q.23. Answer in brief Von Ebner’s gland. establish bactericidal system in saliva.
 (Feb 2016, 2 Marks) • Enzyme salivary peroxidase in presence of hydrogen
Ans. Von Ebner’s glands are the minor salivary glands peroxidase and thiocyanate form hypothiocyanate
• They are the posterior lingual serous glands. ion which inhibits bacteria.
• They are the extensive group of purely serous glands • Lysozyme an antibacterial protein hydrolyzes
which are located in between muscle fibers of tongue polysaccharide of bacterial cell wall which leads to
below circumvallate papillae. lysis of bacteria.
• Ducts of these glands open in trough of vallate • Important group of defensive substances in saliva
papillae and rudimentary foliate papillae on side are immunoglobulins. Most prominent salivary
of tongue. immunoglobulin is IgA. Salivary immunoglobulins
• Secretions of Von Ebner’s gland wash the trough of can act primarily through their ability to inhibit the
vallate papillae and prepare taste receptors for new adherence of microorganisms to oral tissues.
stimulus. • Lactoferrin an iron binding protein is an antibacterial
• Von Ebner’s gland secretes antibacterial enzymes substance, in presence of specific antibody enhances
peroxidase and lysozyme. the inhibitory effect of antibody on microorganisms.
• Von Ebner’s gland also secretes an enzyme known • Antiviral action is caused by cystatins, mucins,
as lingual lipase which along with pancreatic lipids immunoglobulins and Secretory leukocyte pro­
help in the digestion of lipids. teinase inhibitor.
• Antifungal action is caused by histatins, chro­
Q.24. Answer in brief pH of saliva. (Feb 2016, 2 Marks) mogranin A and immunoglobulins.
Ans. pH of saliva shows great deal of variation and it falls in
Q.26. Enumerate ducts of salivary glands.
a narrow range for most of the individuals.
 (Jan 2018, 2 Marks)
• pH at which any particular saliva ceases to be saturated Ans.
with calcium and phosphate is referred to as critical pH.
Its value is 5.5. Below critical pH the inorganic content Enumeration of Ducts of Salivary Glands
of tooth starts dissolving. ♦♦ Intralobular ducts
• Bicarbonate ions in saliva provide buffering action. • Intercalated ducts
Bicarbonate ions neutralize the acids produced by • Striated ducts
bacteria which leads to dissolution of teeth and protect ♦♦ Interlobular ducts
teeth from dental caries and also maintains pH of saliva. • Excretory ducts
714 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Q.27. Write very short answer on striated duct of salivary
gland. (May 2018, 2 Marks)
Ans. Striated ducts receive saliva from intercalated ducts.
• Striated ducts form the largest portion of ductal
system which constitute intralobular component of
ductal system.
• Striated ducts are lined by a layer of tall columnar
epithelial cells with large, spherical, centrally placed
nuclei.
• Cytoplasm is abundant and eosinophilic and show
prominent striations at basal ends of the cells,
perpendicular to basal surface.
• Under electron microscope abundant large mito­
chondria, usually radially oriented, are located in
portion of cytoplasm between membrane infoldings.
Combination of infoldings and mitochondria
account for striations seen in light microscope.
• Striated ducts are site of electrolyte reabsorption
especially of sodim and chloride and secretion of
potassium and bicarbonate.
• Striated ducts modify the organic content of primary
saliva.
• Single layered epithelium of striated ducts consists of
simple cytokeratin intermediate filaments 8 and 18.
11. TOOTH ERUPTION
Q.1. Describe the process of eruption of teeth.
 (Sep 2000, 15 Marks)
Or
Define eruption and write about phases of eruption.
 (Nov 2008, 10 Marks)
Ans. Eruption means the axial or occlusal movement of the
tooth from its developmental position within the jaw to
its functional position in the occlusal plane. Eruption of
tooth involves following tooth movement:
1. Pre-eruptive tooth movement/phase.
2. Eruptive tooth movement/phase
3. Posteruptive tooth movement/phase.
Pre-eruptive Tooth Movement/Phase
When deciduous tooth germs first differentiate, they are very
small and a good deal of space is between them.
♦♦ This space is soon used because of rapid growth of the
tooth germ, and crowding results.
♦♦ Crowding is then relieved by growth of the jaws in length,
which permits drifting of the tooth germs. The drifting or
growth of the tooth germ, demand remodeling of the bony
wall of the crypt.
♦♦ Remodeling is achieved by the selective deposition and
removal of bone by osteoblastic and osteoclastic activity.
♦♦ Permanent teeth with deciduous predecessors also move
before they reach the position from which they will erupt.
♦♦ The permanent molars, which have no deciduous
predecessors, also exhibit movement of the upper
permanent molar, first have their occlusal surfaces facing
distally and swing around only when the maxilla is grown.
Eruptive Tooth Movement/Phase
During the phase of eruptive tooth movement, the tooth moves
from its position within the bone of the jaw to its functional
position in occlusion, and the principal direction of movement
is occlusal or axial.
♦♦ During the eruptive phase of tooth movement significant
development events occur that are associated with eruptive
tooth movement.
♦♦ They include the formation of roots, periodontal ligament
and dentogingival junction.
♦♦ Significant histological changes also occur in the tissues
overlying the eruptive tooth.
♦♦ Bone removal is necessary for permanent tooth to erupt.
♦♦ As the deciduous tooth erupts, the permanent tooth germ
becomes situated specially and is entirely enclosed by
bone, except for a small canal (Gubernacular canal) that is
filled with connective tissues and often contains epithelial
remnants of the dental lamina.
♦♦ This connective tissue mass is termed as the Gubernacular
cord. It may have a function in guiding the permanent
tooth as it erupts.
Posteruptive Tooth Movement/Phase
Posteruptive tooth movements are those that:
♦♦ Maintains the position of the erupted tooth while the jaw
continues to grow
♦♦ Compensate for occlusal and proximal wear.
• The principal movement is an axial direction.
• It is associated with condylar growth, which separates
the jaws and teeth.
• Bone deposition occurs at the alveolar crest and on
the socket floor.
• The movement to compensate occlusal and proximal
wear of the tooth is generally assumed that the
continuous deposition of cement around the apices
of the roots of the teeth is sufficient to compensate
for occlusal wear.
Wear also takes place at the contact points and to
maintain tooth content proximal drift takes place. The
drift is seen as a selective deposition and resorption
of bone on socket walls by osteoblast and osteoclast.
Figs 96A and B:  Tooth movement of anterior teeth

Figs 97A and B:  Tooth movement of posterior teeth
Mechanism of Tooth Movement
The mechanism that brings about tooth movement is a
combination of a number of factors:
♦♦ Bone remodeling: Bone remodeling theory supposes that
selective deposition and resorption of bone brings about
eruption.
♦♦ Root growth: The root growth theory supposes that the
proliferating root impinges on a fixed case, thus converting
an apically directed force into occlusal movement.
♦♦ Vascular pressure: The vascular pressure theory supposes
that a local increase in tissue fluid pressure in the periapical
region is sufficient to move the tooth.
♦♦ Periodontal ligament traction: The ligament traction
theory proposes that the cells and fibers of the ligament
pull the tooth into occlusion.
Q.2. Write a short note on theories of eruption.
 (Sep 2002, 6 Marks) (Sep 2009, 5 Marks)
Or
Write short note on theories of tooth eruption?
 (Mar 2006, 5 Marks) (Apr 2008, 5 Marks)
 (Feb 2016, 3 Marks)
Or
Write about theories of tooth movement.
 (May/June 2009, 5 Marks)
Or
Write short note on theories of eruption.
 (July 2016, 3 Marks)
Ans. Eruption means the axial or occlusal movement of the
tooth from its developmental position within the jaw to
its functional position in the occlusal plane.
Theories of Eruption
♦♦ Bone remodeling theory: Bone remodeling theory
supposes that selective deposition and resorption of bone
brings about eruption.
• Osteoblast and osteoclast both involve in bone
remodeling.
• The bone living cells, the osteoblast under hormonal
influence, secrete collagenase and proteolytic enzyme
Dental Histology  715
to remove osteoid layer and expose the newly
denuded mineralized bone surface, providing the
stimulus to attract osteoclast to the site.
♦♦ Root formation theory: The root formation theory
supposes that the proliferating root impinges on a fixed
case. Thus converting an apically directed force into the
occlusal movement.
♦♦ Vascular pressure theory: Vascular pressure theory
supposes that a local increase in tissue fluid pressure in
the periapical region is sufficient to move the tooth.
♦♦ Periodontal Ligament Traction Theory: The ligament
traction theory proposed that “the cells and fibers of
ligament pull the tooth into occlusion.”
♦♦ Periodontal ligament consists of myofibroblasts which
have contractile property.
♦♦ Fibroblasts get attached to one another and secrete a
protein known as fibronectin.
♦♦ Network of myofibroblasts and binding material is known
as fibronexus.
♦♦ Myofibroblasts contracts and the contractile forces created
by many other cells are combined because of intercellular
attachments.
♦♦ Now the combined forces are transferred through
fibronexus on collagen fibers bundles which are aligned in
an appropriate inclination by root formation which causes
tooth movement.
♦♦ As the axial movement begins, dental follicle above the
formed tooth structure make way for the tooth. Release
of the enzymes degenerate collagen fibers above the
erupting tooth.
♦♦ Reduced enamel epithelium combine with gingival
epithelium and this lead to the formation of soft tissue
channel in which the tooth enters and emerge in oral cavity
without causing bleeding.
♦♦ This theory is the most accepted theory of tooth eruption.
Q.3. Describe dental follicle periodontal ligament theory
of tooth eruption. (Sep 2005, 5 Marks)
Ans. Refer to Ans 2 of the same chapter.
Q.4. What do you understand by active and passive
eruption? Describe one of the theories of eruption of
teeth. (Mar 2006, 15 Marks)
Or
Define active and passive eruption. (Sep 2018, 2 Marks)
Ans. Active eruption: The actual movement of teeth towards
the occlusal plane is called as active eruption.
Passive eruption: The separation of the primary
attachment epithelium from the enamel surface is called
passive eruption.
Crown exposure which involves passive eruption and
further recession has been described in four stages that
may be physiologic or pathologic.
Stage I: This is physiologic stage. In this stage, the bottom
of gingival sulcus remains on anatomical crown, i.e. on
the enamel portion and apical end the attachment of
epithelium lies at the cementoenamel junction.
716 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Stage II: This is also physiologic stage. In this, the bottom
of gingival sulcus lies on the enamel but the apical end
of attachment of epithelium has shifted from cemento
enamel junction to the cementum.
Stage III: In this stage, anatomical crown is fully exposed
in oral cavity. The bottom of the gingival sulcus shift to
the cementoenamel junction. The epithelial attachment
also entirely shift on the cementum.
Stage IV or Gingival Recession: This stage represents
gingival recession. Recession can be defined as exposure
of the root surface by an apical shaped in the position
gingiva.
For theories of eruption refer to Ans 2 of the same chapter.
Q.5. Define eruption and shedding and describe the various
theories of eruption. (Sep 2006, 15 Marks)
Or
Define eruption and shedding. (Oct 2016, 2 Marks)
Ans. Eruption means the axial or occlusal movement of the
tooth from its developmental position within the jaw to
its functional position in the occlusal plane.
The physiologic process resulting in the elimination
of the deciduous dentition is called “shedding” or “
exfoliation”.
For theories of eruption refer to Ans 2 of the same
chapter.
Q.6. Write in brief bloodless eruption.(Sep 2006, 5 Marks)
Ans. 
♦♦ Bloodless eruption is explained by the periodontal
ligament traction theory.
♦♦ The ligament traction theory proposed that “the cells and
fibers of ligament pull the tooth into occlusion.”
♦♦ Periodontal ligament consists of myofibroblasts which
have contractile property.
♦♦ Fibroblasts get attached to one another and secrete a
protein known as fibronectin.
♦♦ Network of myofibroblasts and binding material is known
as fibronexus.
♦♦ Myofibroblasts contracts and the contractile forces created
by many other cells are combined because of intercellular
attachments.
♦♦ Now the combined forces are transferred through
fibronexus on collagen fibers bundles which are aligned in
an appropriate inclination by root formation which causes
tooth movement.
♦♦ As the axial movement begins, dental follicle above the
formed tooth structure make way for the tooth. Release
of the enzymes degenerate collagen fibers above the
erupting tooth.
♦♦ Reduced enamel epithelium combine with gingival
epithelium and this lead to the formation of soft tissue
channel in which the tooth enters and emerge in oral cavity
without causing bleeding.
♦♦ This theory is the most accepted theory of tooth eruption
Q.7. Write short note on periodontal ligament traction
theory. (Dec 2012, 3 Marks)
Or
Write short note on ligament traction theory.
 (Feb 2016, 3 Marks)
Ans. Refer to Ans 10 of same chapter.
Q.8. Theories of eruption. Write on any one in brief. 
 (Feb 2013, 5 Marks)
Ans. Theories of Tooth Eruption
As related to mechanism of tooth movement many of
the theories have been put forward for the explanation
of eruption. Following are the theories of tooth eruption:
• Bone remodeling theory
• Root formation theory
• Vascular pressure theory
• Periodontal ligament traction theory.
For periodontal ligament traction in detail refer to Ans
6 of same chapter.
Q.9. Write short note on active and passive eruption.
 (Aug 2011, 5 Marks)
Or
Answer in brief on active and passive eruption.
 (Feb 2016, 2 Marks)
Or
Write short answer on active and passive eruption.
(Aug 2018, 3 Marks)
Ans. For active and passive eruption refer to Ans 4 of same
chapter.
Q.10. Enumerate the different phases of eruption of teeth.
Describe in brief theories of tooth eruption.
 (Jan 2012, 10 Marks) (May 2014, 10 Marks)
Ans. Phases of Eruption of Teeth
• Pre-eruptive phase
• Eruptive phase
• Post-eruptive phase.
Theories of Tooth Eruption
As related to mechanism of tooth movement many of the
theories have been put forward for the explanation of eruption.
Following are the theories of tooth eruption:
♦♦ Bone remodeling theory
♦♦ Root formation theory
♦♦ Vascular pressure theory
♦♦ Periodontal ligament traction theory.
Bone Remodeling Theory
♦♦ Bone remodeling theory states that eruption of tooth is
due to selective deposition and resorption of bone which
occur around the developing tooth.
♦♦ The resorption of bone at site of pressure and deposition
of bone at site of tension results in tooth eruption.

♦♦ Pressure exerted by growing tooth germ in axial direction
leads to remodeling of bone which forms a path for
erupting tooth.
♦♦ Osteoblasts and osteoclasts both actively take part in bone
remodeling which causes tooth eruption.
♦♦ Osteoblasts secrete the collagenase and various other
proteolytic enzymes which leads to the dissolution of the
osteoid layer which expose the mineralized bone, this
attracts the osteoclasts which causes bone resorption.
Root Formation Theory
♦♦ Root formation theory states that eruption of tooth occurs
due to occlusal or axial movement of tooth because of the
formation of root.
♦♦ The occurrence of these two events provides the impression
that root formation leads to eruption of tooth.
♦♦ Various points which contradict the theory are:
• If root formation leads to pushing force for the
eruption of teeth, root has to form on a fixed base.
If this happens then only the root can exert force in
opposite direction. Histology of root formation does
not support this. Some investigators suggested that
cushion-hammock ligament act as a fixed base at apex
of forming tooth. But this concept is not accepted.
• In various developmental disorders tooth remain
rootless, but teeth erupt in oral cavity. This explains
that root formation occur with eruption might not the
only factor which influences eruption.
Vascular Pressure or Hydrostatic Theory
♦♦ Vascular pressure theory states that local increase in tissue
fluid pressure in periapical region of the tooth causes the
occlusal movement of the tooth.
♦♦ Periapical tissue has rich blood supply and consists of
many blood vessels. Active fluid movement from these
vessels in local periapical tissue leads to the swelling of
tissue. As periapical tissue is a closed space, swelling of
tissue leads to local increase in pressure which is exerted on
tooth and causes tooth eruption. As the pressure difference
is transient the theory is doubtful.
♦♦ Reduced eruption rate following the severity of blood
vessels to periapical region is observed. Role of vascular
eruption is not confirmed by this because lack of blood
supply affects other factors such as tissue growth which
leads to decrease in eruption rate.
Periodontal Ligament Traction Theory
♦♦ The ligament traction theory proposed that “the cells and
fibers of ligament pull the tooth into occlusion.”
♦♦ Periodontal ligament consists of myofibroblasts which
have contractile property.
♦♦ Fibroblasts get attached to one another and secrete a
protein known as fibronectin.
♦♦ Network of myofibroblasts and binding material is known
as fibronexus.
♦♦ Myofibroblasts contracts and the contractile forces created
by many other cells are combined because of intercellular
attachments.
Dental Histology  717
♦♦ Now the combined forces are transferred through
fibronexus on collagen fibers bundles which are aligned in
an appropriate inclination by root formation which causes
tooth movement.
♦♦ As the axial movement begins, dental follicle above the
formed tooth structure make way for the tooth. Release
of the enzymes degenerate collagen fibers above the
erupting tooth.
♦♦ Reduced enamel epithelium combine with gingival
epithelium and this lead to the formation of soft tissue
channel in which the tooth enters and emerge in oral cavity
without causing bleeding.
♦♦ This theory is the most accepted theory of tooth eruption
Q.11. Define eruption of tooth and describe various theories of
tooth eruption. (Aug 2011, 10 Marks) (Oct 2014, 8 Marks)
Or
Write about theories of tooth eruption.
 (Jan 2012, 10 Marks)
Ans. Eruption is defined as the axial or occlusal movement
of the tooth from its developmental position within the
jaw bone to its functional position in the occlusal plane.
For theories of tooth eruption refer to Ans 10 of same
chapter.
Q.12. Enumerate theories of eruption. (Dec 2014, 2 Marks)
 (Sep 2018, 2 marks) (Jan 2018, 2 Marks)
Or
Define tooth eruption. List theories of tooth eruption.
 (Sep 2017, 2 Marks)
Ans. Eruption means the axial or occlusal movement of the
tooth from its developmental position within the jaw to
its functional position in the occlusal plane.
Enumeration of theories of tooth eruption
• Bone remodeling theory
• Root formation theory
• Vascular pressure theory
• Periodontal ligament traction theory.
Q.13. Define eruption. Enumerate theories of eruption. Write
in detail about the most accepted theory for eruption.
 (Feb 2013, 15 Marks)
Ans. The movement of teeth from the developmental position
inside the jaw to their functional position in the oral
cavity is known as eruption.
Theories of Eruption
Following are the theories of eruption:
♦♦ Root formation theory
♦♦ Bone remodeling theory
♦♦ Vascular pressure theory
♦♦ Ligament traction theory.
Most Accepted Theory for Eruption
Ligament traction theory is the most accepted theory for
eruption.
For details refer to Ans 10 of same chapter.
718 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
12. SHEDDING OF DECIDUOUS TEETH
Q.1. Describe the process of shedding of deciduous tooth.
 (Sept 2003, 15 Marks)
Ans. Physiologic process resulting in the elimination of
the deciduous dentition is called “shedding” or “
exfoliation”.
• Shedding of deciduous teeth is the result of
progressive resorption of roots of teeth and their
supporting tissue, the periodontal ligament.
– Multinuclear cells similar to osteoclasts, i.e.
odontoclast.
– Pressure generated by the growing and erupting
permanent tooth.
Process / Mechanism of Resorption and Shedding
♦♦ Pressure from the erupting successional tooth plays a key
role in shedding because the odontoclasts appear at the
predicted sites of pressure.
♦♦ For resorption to begin the hormones and cytokines have
to disrupt the cementoblast surface.
♦♦ Odontoclast then attaches to the hard tissue surface
peripherally through the clear zone, thereby creating a
sealed space lined by the ruffled border of the cell. In this
way a microenvironment results.
♦♦ Membrane of the ruffled border acts as a proton pump,
adding hydrogen ions to the extracellular environment and
acidifying it so that mineral dissolution occurs.
♦♦ Broken minerals are engulfed by odontoclasts and are
digested inside cytoplasmic vacuoles.
♦♦ Primary lysosomes secrete their enzymatic contents into
same environment to degrade the organic matrix.
• Resorption occurs with the periods of activity followed
by rest.
• The pressure from erupting permanent successor
causes resorption of deciduous teeth. Other factors
also involves in tooth resorption.
• Another factor which plays an important role in
resorption of deciduous teeth apart from pressure
exerted by erupting successor is the forces of
mastication which are applied to the deciduous tooth.
• Forces of mastication are also capable of initiating
the resorption.
• With the increased growth of face as well as jaws,
there is increase in the size and strength of masticatory
muscles. Periodontal ligament does not withstand
the excessive force which leads to trauma to the
periodontal ligament and that initiate resorption.
♦♦ In case of periodontal ligament it has been demonstrated
that apoptotic cell death is involved. This form of cell
death involves shrinkage of the cells so that they can be
phagocytosed by neighboring cells.
Q.2. Describe in detail factors and mechanism of shedding
and complications of shedding of deciduous teeth. 
 (Nov 2010, 8 Marks)
Ans. Following are the factors in shedding of deciduous teeth:
Odontoclasts
♦♦ These are the multinucleated giant cells which lie in
resorption bays on dental hard tissue.
♦♦ Odontoclasts are derived from monocytes.
♦♦ Cytoplasm of odontoclasts is vacuolated and they have
ruffled border and multiple mitochondria which show
increase phosphatase activity.
♦♦ They can resorb all dental hard tissue including enamel.
Pressure
Pressure from underlying permanent teeth play an important
role in resorption. This causes weakening of supporting tissues
of primary teeth due to shortening of roots by resorption by
odontoclasts.
For mechanism of shedding refer to Ans 1 of same chapter.
Complications of Shedding of Deciduous Teeth
♦♦ Deciduous teeth remanents: At times roots of deciduous
teeth are not in path of eruption, these fragments instead
of being resorbed get embedded in jaws.
♦♦ Retained deciduous teeth
In some cases deciduous teeth does not undergo resorption
because of shedding time. The retention is due to:
• Impacted permanent teeth: At times permanent canine
are impacted which causes retention of deciduous
canine tooth.
• Congenital missing of underlying permanent tooth:
Permanent maxillary lateral incisors and mandibular
second premolars sometimes are congenitally missing
so the deciduous maxillary lateral incisors and
deciduous mandibular second molars may be retained
for the longer duration.
• Ankylosis of tooth: This occurs due to the union of
repairing cementum and adjacent bone. This lead to
the prevention of eruption of underlying permanent
successor.
♦♦ Submerged tooth: Deciduous tooth get ankylosed due
to trauma or repair, it exhibit movement when there is
an increase in height of alveolar bone. Due to this the
tooth appear at lower level when compared with adjacent
tooth. These submerged teeth should be extracted
since they lead to prevention of eruption of permanent
successor.
Q.3. Write short note on mechanism of shedding.
 (Mar 2013, 3 Marks)
Ans. Refer to Ans 1 of same chapter.
Q.4. Write short note on mechanism of resorption and
shedding. (Feb 2014, 3 Marks)
Ans. Refer to Ans 1 of same chapter.
Q.5. Write short note on odontoclast. (Aug 2016, 3 Marks)
Ans. Cells which are responsible for removal of dental hard
tissue are known as odontoclasts.

• Odontoclasts are probably derived from tartrate-
resistant acid phosphatase (TRAP) positive
circulating monocytes.
• Odontoclasts are commonly found on surfaces of
roots in relation to advancing pemanent tooth.
• Histologically odontoclasts are similar to bone
resorbing osteoclasts.
• Under light microscope odontoclasts are identified
as large, multinucleated cells which occupy the
resorption bays on surface of dental hard tissue.
Cytoplasm of cell is vacuolated and surface of the
cell adjacant to resorbing hard tissue forms ruffled
border.
• Under electron microscope ruffled border is seen
as extensive folding on cell membrane in the series
of invagination which are 2 to 3 µm deep, with
mineralized crystals under the depth of invagination.
Peripheral to ruffled border lies the clear zone in
which cytoplasm lack organelles but have numerous
filaments which consists of contractile proteins i.e.
actin and myosin.
• Clear zone represents the attachment apparatus of
odontoclasts.
• Cytoplasm of odontoclast consists of high content
of mitochondria and many vacuoles which are
concentrated at ruffled border.
• Odontoclasts fuse with each other to form multi­
nucleated giant cell as they attached to resorbing
surface.
Fig. 98:  Odontoclast
13. TEMPOROMANDIBULAR JOINT
Q.1. Write a short note on temporomandibular joint.
 (Feb/Mar 2004, 5 Marks) (Sep 2007, 3 Marks)
Or
Write briefly on temporomandibular joint. 
 (Oct 2007, 5 Marks)
Dental Histology  719
Ans. Temporomandibular joint (TMJ) on each side of head is
formed by articulation between the articular eminence
and anterior part of glenoid fossa of temporal bone above
and condylar head of mandible below.
• It is a synovial joint.
Parts of TMJ
Bony Structure
♦♦ Condyle of the mandible is composed of cancellous bone
covered by thin layer of compact bone.
♦♦ Roof of glenoid fossa consists of their compact layer of
bone.
♦♦ Articular eminence consists of spongy bone covered by a
thin layer of compact bone.
Fig. 99:  Temporomandibular joint
Articular Fibrous Covering
A thick layer of fibroelastic tissue containing fibroblast and
variable number of chondrocytes covers the condyle and
articular eminence.
The fibrous covering of mandibular condyle is thick and
consist of strong collagen fibers in superficial layer.
♦♦ Fibrous layer covering the articulating surface of temporal
bones is thin in glenoid fossa and thickens on the articular
eminence.
♦♦ Articular disc: TMJ contains fibrous articular disc that is
found between articular surfaces.
♦♦ It function as shock absorber. 
The disk is biconcave.
♦♦ The disk composed of dense fibrous tissue. Fibroblasts in
the disc are elongated and have flat cytoplasmic processes.
Synovial Membrane
The articular capsule is lined by synovial membrane.
♦♦ Synovial membrane form folds to form synovial villi that
is projecting into the joint spaces.
♦♦ Synovial membrane contains internal cells.
♦♦ A small amount of a clear, straw colored viscous fluid
(synovial fluid) is found in the articular spaces.
♦♦ It acts as lubricant and also as nutrient fluid. Secreted by
synovial cells.
Q.2. Write the capsular ligament of TMJ.
 (Sep 2002, 5 Marks) (Apr 2009, 5 Marks)
Ans. A joint capsule covers the TMJ
♦♦ The joint capsule is a fibrous elastic sac.
♦♦ Attachment of fibroelastic sac:
• Anteriorly: Attaches to the ascending slope of articular
eminence.
720 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
• Posteriorly: To the lips of the squamotympanic fissure.
• Superiorly: To the margins of the glenoid fossa.
• Inferiorly: To the neck of condyle of mandible.
–– The posterior capsule is highly vascular and
sometimes is called ‘Pis vasculosa’.
–– Parotid gland is usually found in the posterior
capsule of joint.
–– Lateral aspect of the capsule is strengthened by
temporomandibular ligament.
–– Anterior surface is ill defined.
–– Inner surface of capsule is smooth and glisten-
ing because of pressure of a synovial membrane
lining.
14. MAXILLARY SINUS
Q.1. Write a short note on histology and function of
maxillary sinus. (Feb 2002, 6 Marks)
Or
Draw well labelled diagram of histology of maxillary
sinus. Add a note on its functions.
 (Jan 2018, 3 + 2 Marks)
Ans. Maxillary sinus is the pneumatic space that is lodged
inside the body of the maxilla and that communicate
with the environment by way of the middle nasal
meatus and nasal vestibule.
• Base of pyramid is facing medially towards the nasal
cavity and the apex of which is pointed laterally
towards the body of zygomatic bone.
• The four sides are related to the surface of the maxilla
in the following manner:
a. Anterior, to the facial surface of the body.
b. Posterior, to the infratemporal surface.
c. Superior, to the orbital surface.
d. Inferior, to the alveolar and zygomatic processes.
Microscopic I Histological Features
Fig. 100:  Maxillary sinus (For colour version see Plate 31)
♦♦ Three microscopically distinct layers surround the space
of the maxillary sinus, the epithelial layer, basal layer and
subepithelial layer.
♦♦ The epithelium is pseudostratified columnar and ciliated
and is derived from the olfactory epithelium of middle
nasal meatus.
♦♦ In addition, there are basal cells, columnar nonciliated cells
and mucous producing, secretory goblet cells.
♦♦ Ciliated cells: The ciliated cells enclosed the nucleus and
electronlucent cytoplasm with numerous mitochondria
and enzyme containing organelles.
♦♦ The basal bodies, which serve as the attachment of ciliary
microtubules.
♦♦ Cilia are typically composed of 9+1 pair of microtubules.
♦♦ Cilia provide the motile apparatus.
• Goblet cell: They contain all the characteristic features
of secretary cells.
♦♦ Basal segment contains nucleus.
♦♦ Cytoplasm also contains RER and SER and the Golgi
apparatus, all of which are involved in the synthesis of
the secretory mucous substance.
Subendothelial gland: These are located in the subepithelial
layers of the sinus and reach the sinus lumen by way of excretory
duct.
♦♦ The subendothelial gland contain both serous and mucous
cells.
Myoepithelial cells: Surrounded the acini. It composed of
either both secretory cells or a pure population of cells or either
secretory types.
Functions of Maxillary Sinus
♦♦ Maxillary sinus help in both the functions olfactory as
well as respiratory.
♦♦ It causes humidification and warming of inspired air and
contribution to the olfactory.
♦♦ It is possible that if air is arrested in the sinus for a certain
time, it quickly reaches the body temperature thus protects
the internal structure, particularly the brain against
exposure of cold air.
♦♦ Other contribution in the response of voice, lightening of
skull weight, enhancement of the faciocranial resistance
to mechanical shock, and the production of bacteriocidal
lysozyme to nasal cavity.
Q.2. Write note on maxillary sinus.
 (Oct 2006, 2 Marks) (Oct 2007, 5 Marks)
 (Dec 2010, 5 Marks)
Or
Write short note on maxillary sinus. 
 (Apr 2007, 5 Marks) (Sep 2006, 5 Marks)
Ans. Refer to Ans 1 of the same chapter.
Q.3. Write notes on anatomy of maxillary sinus.
 (Sep 2007, 2.5 Marks)
Ans. It is the largest sinus which lies in body of maxilla, also
known as antrum of Highmore.
Shape and Boundaries
♦♦ Pyramidal base formed by lateral wall of nose.
♦♦ Apex pointing laterally in the root of the zygoma.
 Dental Histology  721

♦♦ Upper wall or roof is thin and forms floor of the orbit. Q.6. Describe functions of maxillary sinus.
♦♦ Floor of the sinus formed by alveolar process of maxilla.  (June 2010, 5 Marks)
♦♦ Anteriolateral wall of the antrum is formed by the canine Or
fossa. Write briefly on functions of maxillary sinus. 
♦♦ Posterior lateral wall separate the antrum from infra-  (Aug 2012, 5 Marks)
temporal fossa. Or
Give four functions of maxillary sinus. 
Ostium  (Oct 2016, 2 Marks)
♦♦ The antrum opens into the nasal cavity through a small Or
ostium in middle meatus. Write short note on functions of sinus of Highmore.
♦♦ It is 3–4 mm in diameter.  (Apr 2017, 2 Marks)
♦♦ Communication with other paranasal sinus through lateral Or
wall of the nose. Write short answer on functions of maxillary sinus.
♦♦ Lined byciliated epithelium and is also known as  (May 2018, 3 Marks)
schneiderian epitheliun. Or
Write short note on functions of maxillary sinus.
Relations  (Sep 2018, 2 Marks)
♦♦ Posterior superior alveolar nerve is situated at posterior Ans. Following are the functions of maxillary sinus:
wall. • It causes humidification and warming of inspired
♦♦ Infraorbital nerve at roof. air and contribution to the olfactory.
♦♦ Roots of maxillary posterior teeth at floor. • It is possible that if air is arrested in the sinus for a
certain time, it quickly reaches the body temperature
Nerve Supply thus protects the internal structure, particularly the
♦♦ Superior dental nerve brain against exposure of cold air.
♦♦ Infraorbital nerve • It lightens the weight of skull.
♦♦ Greater palatine nerve. • It enhances the faciocranial resistance to mechanical
shock.
Blood Supply • It leads to the production of bacteriocidal lysozyme
Internal maxillary artery via to nasal cavity.
• It acts as a resonating box for production of voice.
♦♦ Infraorbital artery
♦♦ Posterior superior dental artery Q.7. Write about definition and functions of maxillary sinus
♦♦ Anterior superior dental artery. with a brief note on its histology. (Aug 2012, 10 Marks)
Ans. Definition
Venous Drainage
Maxillary sinus is the pneumatic space which is lodged
Inferior ophthalmic vein inside the body of maxilla and that communicates with
Anterior facial vein. the environment by way of the middle nasal meatus and
the nasal vestibule.
Lymphatic Drainage • For functions refer to Ans 6 of same chapter.
• For histology refer to Ans 1 of same chapter.
Submandibular lymph node.
Q.4. Write the structure, histology and functions of
maxillary sinus. (Oct 2008, 5 Marks) 15. HISTOCHEMISTRY OF ORAL TISSUES
Ans. For structure refer to Ans 3 of same chapter. For
histology and functions of maxillary sinus refer to Q.1. Write notes on hematoxylin and eosin stain.
Ans 1 of same chapter. (Mar 1998, 5 Marks) (Mar 2009, 5 Marks)
(Feb. 2013, 2 Marks) (May 2014, 2 Marks)
Q.5. Write short note on microscopic features of maxillary
Or
sinus. (Feb 2013, 2 Marks)
Answer in brief on hematoxylin and eosin stain.
Or
 (Feb 2016, 2 Marks)
Write short note on histology of maxillary sinus lining. Ans. Hematoxylin stain is also called as H and E stain.
 (Aug 2016, 3 Marks) • Hematoxylin and eosin stain is the most popular
Or stain used in the histology.
Answer in brief histology of maxillary sinus. • The method involves application of basic dye, i.e.
 (May 2017, 2 Marks) hematoxylin which colour acidic structures with
Ans. For microscopic features refer to histology part of blue-purple colour and alcohol based Eosin-Y which
Ans 1 of same chapter. colour eosinophilic structures bright pink.
722 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Hematoxylin Ans. Equipment used for making ground sections includes a

laboratory lathe, a coarse and a fine abrasive lathe wheel,
♦♦ Hematoxylin is extracted from tree Hematoxylon
a stream of water directed onto the rotating wheel and a
campechianum. Oxidation of hematoxylin produces a
pan beneath to catch the water, a wooden block, some 13
coloured substance known as haematin which is a poor dye.
mm adhesive tape, Camel’s hair brush, ether, mounting
♦♦ This dye when used in combination of mordant it become
medium, microscopic slides and cover glasses.
powerful.
♦♦ Color of dye is red but it turns blue when the treated tissue Steps for Preparation of Ground Section
section is immersed in weak alkali such as water. This is
known as blueing. ♦♦ The coarse abrasive lathe wheel is attached to the lathe and
♦♦ Hematoxylin mainly stains the nucleus. water is directed onto the wheel.
♦♦ Tooth is held securely in the fingers and its labial surface is
Eosin applied firmly to that flat surface of rapidly rotating wheel.
♦♦ Tooth is ground down nearly to the level of desired section.
♦♦ It is the counter stain.
♦♦ Coarse wheel is now exchanged for a fine abrasive lathe
♦♦ It is the red dye which is formed by action of bromine on
wheel, and the cut surface of the tooth is ground again,
fluorescein.
until the level of desired section is reached.
♦♦ It is water and alcohol soluble.
♦♦ At this point a piece of adhesive tape is wrapped around
♦♦ Eosin is used to stain cytoplasm, muscle and collagen fibers.
the wooden block in such a way that the sticky side of the
Procedure of Hematoxylin and Eosin Staining tape is directed outward.
♦♦ Ground section of the tooth is whipped dry and then is
♦♦ Remove wax over the tissue with xylene. pressed onto the adhesive tape on one side of the wooden
♦♦ Rehydrate the tissue by immersing it in decreasing order block, it will stick fast.
of grades of alcohol ♦♦ With the block held securely in the fingers, the lingual
♦♦ Wash in water surface of the tooth is applied to the coarse abrasive lathe
♦♦ Stain with hematoxylin as per manufacturer’s instruction wheel, and the tooth is ground down to a thickness of about
♦♦ Differentiate in acid alcohol for 10 seconds 0.5 mm.
♦♦ Wash with water ♦♦ Then the coarse wheel is again exchanged for the fine
♦♦ Blueing is done by tap water or Scott’s water abrasive lathe wheel, and the grinding is continued till
♦♦ Rinse with water the section is as thin as desired.
♦♦ Stain with eosin
♦♦ The finished ground section is soaked off. Then it is dried
♦♦ Wash in running water
off for several minutes.
♦♦ Dehydrate by ascending grades of alcohol
♦♦ Drying for too long will result in cracking.
♦♦ Remove alcohol
♦♦ It is then mounted on a microscopic slide.
♦♦ Put tissue for clearing in Xylene.
♦♦ To do this, a drop of mounting medium is placed on the
slide, section is lifted with a Camel’s hair brush and is
placed on the drop, another drop of mounting medium is
put on top of the section, and a cover glass is affixed for
microscopic study.
Q.3. Write a note on preparation of ground section of canine.
 (Feb 2006, 2.5 Marks)
Ans. Refer to Ans 2 of the same chapter.
Q.4. Write a note on preparation of ground section of molar.
 (Sept 2007, 2.5 Marks) (Sep 2009, 5 Marks)
Ans. Uncalcified teeth can be studied without any loss of detail
by making their ground section.
Equipment requirement: Laboratory lathe, a coarse and
fine abrasive lathe wheel or arkansas stone and pumice
powder, a wooden block, adhesive tape, ether, mounting
medium, camel’s hair brush, microscope slides and cover
slides.
Fig. 101:  Hematoxylin and eosin stain Method: To make a ground section, teeth are cut with
(For colour version see Plate 31) laboratory lathe to which coarse abrasive wheel is
Q.2. Write a note on steps for preparation of ground section attached.
of incisor. • The coarse abrasive wheel is replaced by fine
 (Feb 2005, 5 Marks) (Apr 2010, 5 Marks) abrasive wheel and the ground surface of the cut

tooth is held firmly against the rotating wheel till
the desired section thickness is reached.
• To avoid abrading the fingers and sections flying
off, the sections are attached on to the wooden block
with the help of adhesive tape.
• To remove the adhesive, ground section is soaked
in ether and then dried, then section is mounted
on a slide.
• A drop of mountant is placed on the slide with
a camel’s hair brush, the section is put on the
mountant and a cover slip is placed on top of it.
• After hardening of the mountant the section is ready
to be examined under the microscope.
• After cutting the tooth into two, one side being held
securely between the fingers, it is grounded on the
Arkansas stone using a paste of pumice in water to
dissipate the heat produced.
• The section is grounded till the desired thickness
and then mounted in same way.
Q.5. Write a short note on Mallory stain.
 (Oct 2008, 2 Marks)
Or
Draw well labelled diagram of Mallory stain.
 (Sep 2018, 2 Marks)
Ans. It is a special stain used for staining the keratin layer.
After staining by Mallory stain, organelles appear as
follows:
• Keratin layer–Bright orange
• Granular layer–Violet
• Spinous cell layer–Violet
• Nucleous–Dark Violet
• Basal Cell Layer–Dark Violet
• Basement Membrane–Dark Violet
• Blood Vessel–Blue
• Fibroblast–Blue
• Muscle Fiber–Orange
• Ground Substance–Sky Blue.
Fig. 102:  Mallory stain
(For colour version see Plate 31)
Dental Histology  723
Q.6. Write short note on fixatives.
 (Dec 2010, 2 Marks) (Feb 2013, 2 Marks)
 (May 2011, 2 Marks)
Ans.
♦♦ Fixation is defined as the process which attempts to
preserve the tissues in a life like condition and prevent
autolysis of cells.
♦♦ It involves series of chemical events which stabilizes
proteins and tissue become resistant to damage during
processing and visualization.
♦♦ Fixatives are the chemical which causes fixation of tissue.
♦♦ Most commonly used fixative is 10% formalin.
♦♦ Fixatives are divided in three main groups:
1. Microanatomical
2. Cytological
3. Histochemical.
Microantomical Fixatives
They preserve anatomy of tissue with accurate relationship
of tissue layers. Fixatives of this group are Buffered formalin,
Gluteraldehyde, Zenker’s fluid, Acrolein etc.
Cytological Fixatives
They preserve the intracellular structures and inclusions.
Fixatives of this group are Carnoy’s fluid, Muller’s fluid,
Clarke’s fluid etc.
Histochemical Fixatives
They are used to demonstrate a particular substance. Fixatives of
this group are Absolute alcohol, formol saline, cold acetone, etc.
Q.7. Write short note on ground section.
 (Oct 2016, 3 Marks) (Dec 2014, 2 Marks)
Or
Write short note on ground section preparation.
 (Aug 2012, 5 Marks)
Or
Answer in brief ground section.  (Oct 2016, 2 Marks)
Ans.
♦♦ Decalcification of bone and teeth often obscures the
structures.
♦♦ Teeth in particular are damaged because tooth enamel,
being about 96% mineral substance, is usually completely
destroyed by ordinary methods of decalcification.
♦♦ Undecalcified teeth and undecalcified bone may be studied
by making thin ground sections of the specimens.
Steps of Making Ground Section
♦♦ Tooth is grinded by the use of laboratory lathe.
♦♦ Initial grinding is carried out by holding tooth in fingers
and pressing it against the rotating course abrasive wheel
of lathe.
♦♦ When the tooth become thin it is difficult to hold it with
the fingers, so it is tucked over the wooden block wrapped
with adhesive tape.
724 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
♦♦ Sticky side of the adhesive tape should be directed outward
while using.
♦♦ Tooth is sticked with adhesive tape over the wooden block
and is pressed to the rotating wheel of lathe so the tooth
become thin.
♦♦ Change the coarse wheel to fine wheel and continue
grinding till the section become sufficiently thin.
♦♦ Section removed from the adhesive tape is mounted over
the glass slide by mounting medium.
Q.8. Write briefly on methods of studying mineralized
tissue. (Aug 2012, 5 Marks)
Ans. For studying mineralized tissues following procedures
can be opted for i.e. decalcified sections and ground
sections.
Decalcified Sections
♦♦ Decalcification is the process through which the calcium is
removed from the mineralized tissue, this causes softening
of mineralized tissue to make thin sections.
♦♦ Enamel is not studied by this method because it is highly
mineralized and is lost completely by decalcification.
♦♦ Decalcification is done after fixation of tissue and before
tissue processing.
♦♦ Acids such as 5% nitric acid, 10% formic acid and
hydrochloric acids are used to decalcify the mineralized
tissues.
Procedure for Decalcification of Mineralized Tissue
♦♦ Mineralized tissue to be decalcified should be fixed in
10% formalin.
♦♦ Place the mineralized tissue in the container with acid of
choice, i.e. commonly used acid solution is 5% nitric acid.
♦♦ Solution should be changed everyday for few days and
specimen is tested for decalcification.
As demineralization occur the hard tissue specimens become
soft and yellowish and are easily penetrated by needle right upto
the centre when it get completely decalcified. The hard tissue
specimens are now treated like routine soft tissue specimens.
Ground Section
♦♦ Tooth is grinded by the use of laboratory lathe.
♦♦ Initial grinding is carried out by holding tooth in fingers
and pressing it against the rotating course abrasive wheel
of lathe.
♦♦ When the tooth become thin it is difficult to hold it with
the fingers, so it is tucked over the wooden block wrapped
with adhesive tape.
♦♦ Sticky side of the adhesive tape should be directed outward
while using.
♦♦ Tooth is sticked with adhesive tape over the wooden block
and is pressed to the rotating wheel of lathe so the tooth
become thin.
♦♦ Change the coarse wheel to fine wheel and continue
grinding till the section become sufficiently thin.
♦♦ Section removed from the adhesive tape is mounted over
the glass slide by mounting medium.
♦♦ As mounting is completed the ground section should be
studied under light microscope.
Q.9. Write short note on process of decalcified tissue
processing and staining. (Dec 2014, 3 Marks)
Ans. Processing of decalcified tissue
• Mineralized tissue to be decalcified should be fixed
in 10% formalin.
• Place the mineralized tissue in the container with
acid of choice, i.e. commonly used acid solution is
5% nitric acid.
• Solution should be changed everyday for few days
and specimen is tested for decalcification.
• As demineralization occur the hard tissue specimens
become soft and yellowish and are easily penetrated
by needle right up to the centre when it get
completely decalcified. The hard tissue specimens
are now treated like routine soft tissue specimens.
• After completion of decalcification, the tissue
should be washed thoroughly in running tap water
overnight.
• As the tissue gets decalcified routine tissue
processing steps are to be followed:
1. Dehydration: Water is removed from tissue so
that wax can penetrate the tissue and make it
hard enough so that it can be sectioned. In this
step ascending grades of alcohol are used, i.e.
70%, 75%, 80%, 90% and absolute alcohol are
used. Time is half an hour to two hours in each
grade of alcohol.
2. Clearing: Tissue is dipped in clearing agent so
that it appears clear. Xylene is the commonly
used clearing agent. Two changes of xylene are
done for 1 to 2 hours.
3. Impregnation: Tissue is immersed in molten
paraffin wax and is kept in wax bath which is
thermostatically operated for few hours. In this
step two changes of wax are made.
4. Embedding: Now tissue is removed from the
wax bath and is embedded in wax block. For
doing this Leuckhart’s L-shaped metallic pieces
are used to form square of desired size and
molten wax is poured in it. Impregnated tissue is
kept in centre using preheated forceps and wax
is allowed to harden. Tissue should be oriented
in right direction i.e. epithelium and connective
tissue are included in cutting surface of block.
5. Sectioning: As wax block is prepared it is
attached to microtome which cut sections at 3 to
5µm thickness. As thin section is obtained it is
spreaded on water bath. Glass slides which are
coated with the albumin and glycerine mixture
in centre are introduced in water. Thin section is
lifted on the slide and is dried for 15 min on slide
warmer. Albumin coagulate and fixes section
onto glass slide.

Staining of Decalcified Tissue
Now the decalcified tissue is subjected to routine steps of H
and E staining.
For details of H and E staining refer to Ans 1 of same chapter.
Q.10. Write short note on fixation. (Dec 2014, 2 Marks)
 (Feb 2016, 3 Marks)
Or
Answer in brief on fixation. (May 2017, 2 Marks)
Ans. Fixation is defined as the process which attempts to
preserve the tissues in a life like condition and prevent
autolysis of cells.
• It involves series of chemical events which stabilizes
proteins and tissue become resistant to damage
during processing and visualization.
• Fixatives are the chemical which causes fixation of
tissue.
• Most commonly used fixative is 10% formalin.
Aims
• It should preserve the tissue as like it has viability.
• Fixation should prevent the autolysis and putrefaction
of tissue as it is removed from the body.
• Fixation should ensure that as tissue is fixed it should
not change its shape and volume during processing.
Q.11. Write short note on decalcification. (Sep 2017, 2 Marks)
Ans. Decalcification is the process by which calcium in the
mineralized tissue is removed, so that tissue becomes
soft enough to make thin sections.
• Structure of all hard tissues i.e. bone, cementum
and dentin of body except enamel can be studied
in decalcified sections.
Dental Histology  725
• Enamel cannot be studied by this method, as it
is highly mineralized and is lost at the time of
decalcification.
• Decalcification is done between fixation and
processing step.
• Mineral acids such as nitric acid and hydrochloric
acid are used to decalcify bone and teeth. Frequently
used solution is 5% nitric acid. 10 to 15% of formic
acid is the best decalcifying agent.
Procedure
♦♦ Hard tissue should be fixed in neutral buffered formalin
for 24 hours.
♦♦ Keep the tooth in decalcification solution in a container.
♦♦ Change solution daily for few days and then specimen is
tested for completion of decalcification.
Methods to Check Decalcification
♦♦ Checking the consistency of tissue: When tooth is
completely decalcified, it becomes soft.
♦♦ Pressing of tissue with needle: If tooth becomes soft, it
allows pin to enter easily till centre of tooth.
♦♦ Chemical test: This test identifies calcium in decalcifying
solution in which specimen is kept. Add sodium hydroxide
or strong ammonia is added to 5 ml of decalcifying fluid, to
neutralize solution. Now add 5 ml of saturated ammonium
oxalate solution. Now check for turbidity. Absence of
turbidity after 5 min indicates that fluid is free from calcium
and so decalcification is complete. Turbidity is observed
because of precipitation of calcium. If precipitation is
observed after addition of sodium hydroxide, it is indicative
of large amount of calcium in the fluid.
726 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

MULTIPLE CHOICE QUESTIONS

As per DCI and Examination Papers 1 Mark Each
of Various Universities

1. Remnants of Meckle’s cartilage are: 9. Butt junction in cementoenamel junction seen in ...........
a. Stylohyoid and stylomandibular ligament cases.
b. Incus and malleus a. 10%
c. Condyle and coronoid process b. 30%
d. None of the above c. 60%
d. 90%
2. Which papillae does not contain taste buds?
a. Fungiform papillae 10. Dentin formed after root completion is called as:
b. Circumvallate papillae a. Tertiary dentin
c. Filiform papillae b. Reparative dentin
d. Foliate papillae c. Secondary dentin
d. Sclerotic dentin
3. Remnants of dental lamina are called as:
a. Bohn’s nodules 11. Mean volume of a single adult human pulp is:
b. Cementicles a. 0.01 cc
c. Epithelial rests of Malassez b. 0.02 cc
d. Cell rests of serres c. 0.03 cc
d. 0·04 cc
4. Enamel is derived from:
a. Endoderm 12. Mucosa covering gingiva and hard palate is called as:
a. Lining mucosa
b. Ectomesenchyme
b. Reflecting mucosa
c. Ectoderm
c. Specialized mucosa
d. All of the above
d. Masticatory mucosa
5. Enamel knot is seen in:
13. Enzyme in saliva causes cell wall lysis is:
a. Cap stage
a. Lactoferrin
b. Bell stage
b. Peroxidase
c. Bud stage c. Lysozyme
d. Any of the above d. Hyaluronidase
6. First hard tissue to be formed is: 14. Basic structural unit of enamel is called as:
a. Enamel a. Enamel sheath
b. Dentin b. Enamel cuticle
c. Cementum c. Enamel lamellae
d. Both (a) and (b) d. Enamel rod
7. New taste sensation is called as: 15. Dentinogenesis starts from which part of tooth:
a. Sour a. Cervical part
b. Umami b. Cusp tip
c. Bitter c. Root
d. None of the above d. Crown
8. Dentinoenamel junction is: 16. Cells of the pulp include all except:
a. Flat a. Fibroblast
b. Concave b. Osteoblast
c. Scalloped c. Odontoblast
d. Convex d. Plasma Cells

Answers: 1. d 2. c 3. d 4. c
5. a 6. b 7. b 8. c
9. b 10. c 11. b 12. d
13. c 14. b 15. b 16. b
 Dental Histology  727

17. The cells of enamel organ are important in the 25. Disturbance of saliva production from the parotid
formation of: gland is likely to result from damage to which of the
a. Dentin following ganglia:
b. Bone a. Gasserian
c. Enamel b. Geniculate
d. Cementum c. Otic
18. Incremental lines of enamel are called as: d. Pterygopalatine
a. Sauer e. Trigeminal
b. Lines of retzius 26. A 20-year-old man falls down and chips the incisal edge
c. Von ebner of his maxillary central incisor, reducing the length of
d. None of the above the crown. A dentist informs him that the tooth may
19. The projection of ameloblast into the enamel matrix erupt a little to compensate for the loss. This tooth
have been named: movement is likely to result in increase in size of which
of the following dental tissues:
a. Tome’s granular layer
a. Cementum
b. Tome’s process
b. Dentin
c. Dental lamina
c. Enamel
d. Basal lamina
d. Periodontal ligament
20. Overlap CEJ is seen in: e. Pulp
a. 10%
27. A patient complains of loss of taste, and a numb
b. 30%
sensation in the left half of his tongue, after removal
c. 60%
of his left lower wisdom tooth. Which of the following
d. None of the above
nerves is most likely to have been injured during
21. Cellular cementum is seen on: removal of this tooth:
a. Apical 1/3 rd a. Facial nerve
b. Apex b. Glossopharyngeal nerve
c. From cervical to apical 1/3rd c. Inferior alveolar nerve
d. None of the above d. Lingual nerve
22. Myoepithelial cells have contractile function because e. Mandibular nerve
they contain: 28. DEJ during tooth development is called as:
a. Prostaglandin a. Membrana preformativa
b. Histamine b. Basement membrane
c. Actin c. Lamina densa
d. Actin and myosin d. Lamina lucida
23. Fate of dental lamina is: 29. Hardest structure in human body is:
a. 5 days a. Cementum
b. 5 months b. Dentin
c. 5 years c. Bone
d. 50 years d. Enamel
24. Radiographically bundle bone is called as: 30. Chemical composition of dihydroxyapetite crystal is:
a. Alveolar bone a. Ca12PO4OH
b. Lamina dura b. 2CaPO
c. Spongy bone c. Ca10(PO4)6OH2
d. All of the above d. None of the above

Answers: 17. c 18. b 19. b 20. c

21. a 22. c 23. c 24. b
25. c 26. a 27. d 28. a
29. d 30. c
728 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

31. Hard tissue formation start at: c. Predentin

a. Bud stage d. Inter-tubular dentin
b. Advance Bell Stage 41. Blood vessels of pulp arises from:
c. Cap Stage
a. Inferior or superior alveolar artery
d. None of the above
b. External carotid artery
32. Pulp develop from: c. Supratrochlear artery
a. Dental papilla d. Facial artery
b. Enamel organ
42. Specialized mucosa is present in:
c. Dental follicle
d. Dental sac a. Gingiva
b. Tongue
33. Most accepted theory of eruption is: c. Floor of mouth
a. Pulp growth theory
d. Soft palate
b. Vascular pressure theory
c. Periodontal ligament traction theory 43. Gubernacular canal and gubernacular cord are seen in
d. Root growth theory relation to:
a. Permanent teeth
34. Unmineralized dentin is known as:
b. Succedaneous teeth
a. Predentin
b. Interglobular dentin c. Deciduous teeth
c. Tomes granular layer d. None of the above
d. None of the above 44. Which of the following is not an ectomesenchymal
35. Cartwheel appearance is seen in: derivative:
a. Epithelial cells a. Dentin
b. Mast cells b. Cementum
c. Giant cells c. Pulp
d. Plasma cells d. Enamel
36. Normal pH of saliva is: 45. The embryonic connective tissue under the oral
a. 5.5 b. 9.5 ectoderm is termed ectomesenchyme because:
c. 7.5 d. 8.5 a. It has both ectodermal and mesenchymal cells
37. …………… is temporary structure of enamel organ b. It has migrated neural crest cells in it
a. Enamel knot c. It has characteristic similar to ectodermal cells
b. Enamel cord d. None of the above
c. Both a and b 46. Cementoblasts divided from dental follicle are
d. Enamel cuticle involved in the formation of:
38. Commonly used fixative in laboratory is…………….. a. Cellular intrinsic fiber cementum
a. 10% formalin b. 15% alcohol b. Acellular extrinsic fiber cementum
c. 20% alcohol d. 10% alcohol c. Acellular intrinsic fiber cementum
39. Inorganic content of cementum is: d. Acellular mixed fiber cementum
a. Less than bone 47. Sclerotic dentin appears:
b. More than bone a. Transparent or light in transmitted light and dark
c. Equal to bone in reflected light
d. More than enamel b. Dark in transmitted light and transparent or light in
40. Dentinal tubules are absent in: reflected light
a. Interglobular dentin c. Transparent or light in transmitted light
b. Sclerotic dentin d. Dark in reflected light

Answers: 31. b 32. a 33. c 34. a

35. d 36. c 37. c 38. a
39. a 40. b 41. a 42. b
43. b 44. d 45. b 46. a
47. a
 Dental Histology  729

48. Nyasmyth’s membrane of primary enamel cuticle is 56. Exfoliation of deciduous tooth occurs by:
actually: a. Continuous resorption of roots
a. A thin layer of connective tissue derived from follicle. b. Alternate resorption and apposition
b. A thin layer of inner enamel epithelium which covers c. Continuous apposition only
newly erupted tooth d. None of the above
c. Basal lamina secreted by ameloblasts when enamel 57. The name of first branchial arch is:
formation is completed a. Maxillary
d. A derivative of pellicle b. Mandibular
49. Weil’s zone is also called as: c. Hyoid
a. Cell rich zone d. None of the above
b. Cell free zone 58. Bitter and sour taste sensations in posterior part of the
c. Odontoblastic zone tongue is mediated by:
d. All of the above a. Lingual nerve
50. Gnarled enamel is seen: b. Chorda tympani nerve
a. When cut in oblique plane at cervical region c. Glossopharyngeal nerve
b. When cut in longitudinal plane at cervical region d. None of the above
c. When cut in oblique plane near dentin in regions of 59. Disturbances during morphodifferentiation stage of
cusp and incisal edges teeth development will result in:
d. When cut in longitudinal plane near dentin in a. Changes in number of teeth
regions of cusp and incisal edges b. Ameloblastoma
51. Development of permanent teeth is initiated by: c. Changes in form and shape of tooth
a. Dental lamina d. Hypoplasia
b. Enamel organ 60. The Weil’s zone is also called as:
c. New teeth bud a. Cell rich zone
d. Successional lamina b. Cell free zone
52. In PDL, cell of epithelial origin are: c. Odontoblastic layer
a. Rest of Malassez d. All of the above
b. Fibroblasts 61. Enamel spindles are nothing but:
c. Cementoblasts a. Odontoblast processes which through dentinoenamel
d. None junction into the enamel
53. Type I alveolar bone is found in: b. Enamel rods which appear hypermineralized
a. Maxilla c. Part of dentinoenamel junction
b. Mandible d. Hypocalcified rod segments
c. Both 62. Contour lines of Owen are:
d. None a. Incremental lines of dentin
54. Osteoclasts are rich in: b. Accentuated incremental lines of dentin
a. Acid phosphatase c. Neonatal lines of dentin
b. Alkaline phosphatase d. Hypermineralized areas of dentin
c. Peroxidase 63. Collagen fibers are embedded into the cementum on
d. Dehydrogenase one side of periodontal space and alveolar bone on
55. The first hard tissue to form is: other are called as:
a. Enamel a. Sharpey’s fibers
b. Cementum b. Elastin fibers
c. Dentin c. Oxytalan fibers
d. All simultaneously formed d. Intermediate plexus

Answers: 48. b 49. b 50. d 51. d

52. a 53. b 54. a 55. c
56. a 57. d 58. c 59. c
60. b 61. a 62. b 63. a
730 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

64. Periodontal ligament contains epithelial cells which 72. Most calcified part of dentin is:
are: a. Intertubular dentin
a. Rest of Serres b. Interglobular dentin
b. Rest of Malassez c. Intratubular dentin
c. Inner enamel epithelium d. Peritubular dentin
d. Outer enamel epithelium 73. Dentin formed after root completion is known as:
65. Dentinoenamel junction has a scalloped border; the a. Primary
convexities of scallops are directed towards: b. Secondary
a. Enamel c. Tertiary
b. Dentin d. Sclerotic
c. All of the above 74. The fiber group without alveolar attachment:
d. None of the above a. Oblique
66. Excretory duct of parotid gland is: b. Horizontal
a. Wharton’s duct c. Trans-septal
b. Bartholin’s duct d. Dentoperiosteal
c. Stenson’s duct 75. The hypocalcified structure running from DEJ to
d. Duct of Ravinous enamel in a group is:
67. Taste buds are absent in: a. Spindle
b. Tufts
a. Filiform papillae
c. Lamellae
b. Fungiform papillae
d. Grooves
c. Circumvallate papillae
d. All of the above 76. The epithelium type seen in maxillary sinus is:
a. Stratified squamous
68. Enamel tuft consists of:
b. Keratocuboidal
a. Hypocalcified enamel rods and interprismatic
c. Pseudostratified
substance
d. Both (b) and (c)
b. Organic debris
c. Hypermineralized structures 77. The cartilage of first arch is:
d. All of the above a. Meckel
b. Reichart
69 Upper and lower lips are formed from which embryonic c. Laryngeal
processes:
d. Cricopharyngeal
a. Maxillary and mandibular
b. Maxillary and median nasal 78. Fordyce’s spots are collection of:
c. Maxillary, mandibular lateral nasal and median a. Sweat glands
nasal b. Lacrimal glands
d. Mandible and median nasal c. Salivary glands
d. Sebaceous glands
70. Neonatal line is absent in:
a. Deciduous 2nd maxillary molar 79. Plexus of Raschkow is present in:
b. Permanent 2nd maxillary molar a. Odontoblastic zone
c. Deciduous 1st mandibular molar b. Cell free zone
d. Permanent mandibular first molar c. Cell rich zone
d. Pulp proper
71. Unilateral cleft lip occurs due to failure of:
a. Fusion of lateral nasal process 80. Rest of malassez are remnants of:
b. Fusion of median and lateral nasal process a. HERS
c. Failure of fusion of median and lateral nasal process b. Oral mesoderm
d. Fusion of median nasal process with maxillary c. Dental papilla
process d. Oral endoderm

Answers: 64. b 65. b 66. d 67. d

68. a 69. b 70. a 71. c
72. a 73. d 74. c 75. c
76. b 77. a 78. b 79. a
80. a
 Dental Histology  731

81. Membrane present in dentinal tubule is: 90. Pericytes are the capillary associated cells present in
a. Lamina lucida pulp are:
b. Lamina densa a. Fibroblast
c. Lamina limitans b. Myoepithelial cells
d. Lamina dura c. Histiocytes
d. Nerve cell
82. Most accepted dentin sensitivity theory is:
a. Neuronal 91. Overjet is defined as:
b. Transduction a. Horizontal overlap
c. Hydrodynamic b. Vertical overlap
d. Traction c. Transverse plane discrepancy
d. All of the above
83. Perikymatas are external manifestations of:
a. Enamel rod 92. Enamel pulp is:
b. Incremental line of retzius a. Dental papilla
c. Cementum b. Stratum intermedium
d. Nasmyth membrane c. Stellate reticulum
d. Inner enamel epithelium
84. Incremental line of Salter is seen in:
a. Enamel 93. Maxillary sinus communicates with the environment
b. Cementum via the:
c. Dentin a. Superior nasal meatus
b. Middle nasal meatus
d. Pulp
c. Inferior nasal meatus
85. Weil’s zone of pulp is: d. None of the above
a. Cell rich zone
94. Permanent maxillary canine erupts by:
b. Cell free zone
a. 10 to 12 years
c. Cell degenerated zone
b. 9 to 10 years
d. Cell regenerated zone
c. 13 to 14 years
86. The fibers of periodontium which provide maximum d. 11 to 12 years
support to masticatory forces are:
95. Layer which is absent in nonkeratinizing epithelium is:
a. Trans-septal a. Stratum corneum
b. Oblique b. Stratum superficial
c. Apical c. Straitum intermedium
d. Horizontal d. Straitum basale
87. Primitive dentinoenamel junction is known as: 96. Structure nonevident at light microscopic level is:
a. Buccopharyngeal membrane a. Basal lamina
b. Membrana preformativa b. Dermis
c. Reduced enamel epithelium c. Lamina propria
d. Perikymata d. Epithelium
88. Organic lining of calcified tubule is also known as: 97. Periodontal ligament is thinnest at:
a. Lamina propria a. Apex
b. Lamina lucida b. Coronal third
c. Lamina limitans c. Middle third
d. Lamina densa d. Apical third
89. First appearance of tooth formation occurs at: 98. Neural crest cells arise from:
a. 6th week of IUL a. Midbrain
b. 2nd week of IUL b. Midbrain and 2 Rhombomeres
c. 4th week of IUL c. Hindbrain and 2 Rhombomeres
d. 9th week of IUL d. Notochord

Answers: 81. b 82. b 83. d 84. d

85. a 86. b 87. a 88. c
89. a 90. d 91. c 92. c
93. b 94. a 95. b 96. a
97. a 98. a
732 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

FILL IN THE BLANKS

As per DCI and Examination Papers 1 Mark Each
of Various Universities

1. The average diameter of enamel rod is …………………….. 17. Rounded protuberances found on incisal edge of a
Ans. 4 µm newly erupted permanent incisor are …………….
2. Incremental lines of enamel are known as …………… Ans. Mammelon
Ans. Incremental line of retzius 18. Merkel cells are believed to have …………..
3. A pulp stone entirely surrounded by dentin……………… Ans. Synaptic contacts
Ans. Embedded pulp stone 19. Shape of maxillary sinus is ……………………….
4. The average rate of formation of dentin per day is (in Ans. Pyramidal
microns)………………….. 20. Synonyms of sclerotic dentin ………………….
Ans. 3.5 µ
Ans. Transparent dentin
5. The uncalcified matrix of bone is called as…………………
21. Other name of bundle bone ……………….
Ans. Osteoid
Ans. Lamina dura
6. Inorganic content of fully developed enamel is
about………………….. 22. Salivary gland is which type of gland ……………..
Ans. 96% Ans. Compound exocrine gland
7. Weil’s zone in pulp organ is known as……………….. 23. Submerged tooth is …………………
Ans. Cell Free Zone Ans. Mandibular second molars
8. In most cases CEJ is of which type……………………… 24. Shape of maxillary sinus is …………………….
Ans. Overlapping Junction Ans. Pyramidal
9. S u p p o r t i n g c e l l s o f t a s t e b u d s a r e c a l l e d 25. Which tooth have three cusps………………………..
as………………………. Ans. Mandibular second premolars
Ans. Sustentacular Cell
26. The first primary tooth to erupt is ………………….
10. Osteoclasts are rich in……………………….. Ans. Mandibular central incisor
Ans. Acid phosphatase
27. Transverse ridge is the union of …………………….
11. Successional lamina gives rise to the formation Ans. Buccal and lingual triangular ridges
of………………….
Ans. Enamel organ 28. Tooth having longest root ………………………….
Ans. Maxillary canine
12. During amelogenesis, projections of ameloblasts into
the enamel matrix is known as………………… 29. Types of mandibular second premolars occlusally
Ans. Tome’s processes ……………………
Ans. 3 types
13. Organic lining of calcified dentinal tubule is known
as………………….. 30. Thickness of ground section of tooth should be ……….
Ans. Lamina Limitans Ans. 30-50 microns
14. Vermilion border of lip is …………………….. 31. Color of dead tracts in transmitted light is ……………
epithelium. Ans. Black
Ans. Keratinized stratified squamous epithelium
32. Oblique ridge in maxillary first molars joins which
15. Incremental lines of cementum are known as…………… cusps …………………………
Ans. Incremental lines of salter Ans. Mesio lingual and distobuccal
16. Serous gland on dorsum of tongue is called as 33. First formed component in tooth deposition is
………………. ………………………
Ans. Von-Ebner’s Glands Ans. dentin
 Dental Histology  733

VIVA-VOCE QUESTIONS FOR

PRACTICAL EXAMINATION

1. Skull bone is derived from which layer.
Ans. Ectomenix
2. Name the first bone to ossify in human body.
Ans. Clavicle
3. Which type of cartilage is condylar cartilage?
Ans. Secondary cartilage
4. At the time of development condylar head increases
by which types of growth.
Ans. Appositional and Interstitial growth
18. If a tooth develops at an abnormal location which stage
of tooth development get disturbed?
Ans. Initiation
19. Why accessory canals are formed?
Ans. Due to early removal of Hertwig’s epithelial root sheath
20. What do you mean by hypoplasia?
Ans. Disturbance in matrix formation.
21. Which is the hardest calcified tissue in human body?
Ans. Enamel

5. Name the structure by which cheeks are developed. 22. At which part of tooth the thickness of enamel is
highest?
Ans. Maxillary process
Ans. Cusp tip
6. Name the structure by which the bridge of nose is
23. How much is the thickness of enamel at cusp of molars
developed.
and premolars?
Ans. Frontonasal process
Ans. 2 to 2.5 mm
7. Name the first paranasal air sinus to develop.
24. How much is the inorganic content of enamel?
Ans. Maxillary sinus
Ans. 96%
8. Which structure is known as opening of thyroid 25. How much is the average diameter of enamel rod?
diverticulum.
Ans. 4 µm
Ans. Foramen Cecum
26. What is the direction fo enamel rods at cervical region?
9. Name the structure by which epiglottis is derived. Ans. Horizontal
Ans. Hypobranchial eminence
27. Which structure extends over full thickness of enamel
10. Name the structure by which primary palate is derived. from DEJ?
Ans. Globular process Ans. Enamel lamella
11. What is the function of primary epithelial band? 28. From which layer is the enamel derived?
Ans. It gives rise to dental lamina and vestibular lamina. Ans. Ectoderm
12. Name the structures by which the tooth germ is formed. 29. How much is the specific gravity of enamel?
Ans. Enamel organ, dental papilla and dental sac Ans. 2.8
13. When does development of first permanent molar is 30. Name the main bulk component of the tooth.
initiated? Ans. Dentin
Ans. At birth 31. At what age does the highest peak of dental caries occur?
14. What is the age at which last successional lamina forms? Ans. 13 years
Ans. 5 years 32. Name the mineralized structures of enamel.
15. In which of the layer of enamel organ alkaline Ans. Enamel rods, structureless enamel, perikymata lines,
phosphatase activity is high? Gnarled enamel
Ans. Stratum intermedium 33. What is the composition of dentin by weight?
16. Name the cells between which reciprocal induction is Ans. 20% organic and 70% inorganic
seen. 34. What is the shape of dentinal tubules?
Ans. Ameloblast and Odontoblast Ans. S shaped
17. Where does the cell rest of malaseez are seen? 35. What is interglobular dentin?
Ans. Periodontal ligament Ans. It is the dentin present between odontoblastic processes
734 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

36. Which is the collagen seen prominently in dentin? 56. Which is the most important property of periodontal
Ans. Type I collagen ligament?
37. What does incremental lines of dentin are known as? Ans. Proprioception
Ans. Lines of Von Ebner 57. What does incremental lines of cementum are known
38. What is secondary dentin? as?
Ans. It is the dentin formed after root completion Ans. Incremental lines of Salter

39. How do dead tracts appears? 58. Due to presence of which cells secondary cementum
Ans. They appear white in reflected light and dark in is known as cellular cementum?
transmitted light. Ans. Cementocytes
40. What are calcospherites? 59. Which is the commonest type of cementoenamel
Ans. They are isolated spheroid islands of enamel. junction.
Ans. Overlapping
41. How much is the average size of apical foramen in
maxillary teeth? 60. Which layer covers the intermediate cementum?
Ans. 0.4 mm Ans. Hyaline layer of Hopewell Smith.
42. How much is the average size of apical foramen in 61. Name the cementum which is predominantly involved
mandibular teeth? in the process of attachment with the periodontal
Ans. 0.3 mm ligament.
43. What is pulp? Ans. Acellular cementum
Ans. Pulp is a muscle tissue. 62. Which component in cementum regulates minerali­
44. How many pulp organs are present in huans? zation.
Ans. 52 Ans. Osteopontin
45. Where does cell body of odontoblast resides? 63. What is the composition of bone?
Ans. In pulp Ans. 67% organic and 33% inorganic
46. Name the cell free zone. 64. Name the bone which appears as sponge.
Ans. Zone of Weil Ans. Spongy bone
47. Which is the most abundant cell of the pulp? 65. By what alveolar bone proper is made of?
Ans. Undifferentiated Mesenchymal cell Ans. Bundle bone and lamellated bone
48. Name the nerve plexus of pulp. 66. What is lamina dura?
Ans. Plexus of Whatson Ans. It is the radiographic appearance of alveolar bone proper.
49. As the age advances what happens to the cell population 67. Where does the density of alveolar bone is more?
of pulp?
Ans. In anterior region of maxilla and mandible.
Ans. It decreases
68. How much is the distance between CEJ and crestal
50. How much is the total volume of permanent teeth pulp?
margin of alveolar bone?
Ans. 0.38 cc
Ans. 1.5 to 2mm
51. How much is the mean volume of single adult human
69. Which is the lining mucosa of oral cavity?
pulp.
Ans. Dorsum of tongue
Ans. 0.02 cc
52. Name the tissues which support and invest the teeth 70. Which epithelium lines the oral mucosa?
in maxilla and mandible. Ans. Stratified squamous epithelium
Ans. Periodontium 71. Which part of oral mucosa shows mucoperiosteal
53. Where is the width of PDL space higher? attachment.
Ans. Apex Ans. Gingiva
54. Name the types of collagen present in PDL. 72. What is the importance of hemidesmososmes?
Ans. Type I and Type III Ans. They provide adhesion between epithelium and
connective tissue
55. Name the fibers of PDL which prevent intrusion of
teeth. 73. Which layer of oral epithelium shows odland body?
Ans. Oblique fibers. Ans. Stratum spinosum
 Dental Histology  735

74. Which is the most prominent finding in stratum
granulosum.
Ans. Keratohyaline granules
75. Which type of collagen does basal lamina have?
Ans. Type IV collagen
76. Which papilla of tongue does not consists of taste bud?
Ans. Foliate papillae
77. Which cell of salivary gland shows zymogen granules?
Ans. Serous cell
78. Which cell consists of basket cell?
Ans. Myoepithelial cells
79. Which areas of oral cavity do not consists of salivary
glands?
Ans. Gingiva and anterior hard palate
80. How much saliva is produced by salivary glands?
Ans. 1200 ml
81. Which glands secrete lingual lipase enzyme?
Ans. Parotid and Von Ebner’s gland
93. Where does glenoid fossa is present?
Ans. In squamous part of temporal bone
94. What is the shape of maxillary sinus in adults?
Ans. Pyramidal
95. What do you mean by pneumatization of maxillary
sinus?
Ans. Expansion of sinus
96. Where does accessory ostia seen?
Ans. In posterior fontanelle
97. Name the membrane lining the maxillary sinus.
Ans. Schneiderian membrane
98. Name the epithelium which lines the sinus.
Ans. Pseudostratified columnar epithelial cell
99. What does apical surface of goblet cell have?
Ans. Microvilli
100. Which is the most commonly used fixative?
Ans. 10% neutral buffered formalin

82. How much is the optimum pH level of saliva? 101. Name the clearing agent.
Ans. 6.5 to 7.5 Ans. Xylene

83. Name the enzyme which plays major role in starch 102. Which is the embedding medium?
digestion. Ans. Paraffin wax
Ans. Amylase 103. Which is the mountant?
84. Name the widely accepted theory of eruption of tooth. Ans. DPX
Ans. Periodontal ligament traction theory 104. Name the instrument used to obtain the thin
85. Name the cell which resorbs dentin. sections.
Ans. Odontoclast Ans. Microtome
86. Name the most commonly retained primary tooth. 105. How much is the thickness of section obtained in
Ans. Maxillary lateral incisor routine tissue processing?
87. Name the first tooth which erupts in oral cavity. Ans. 3 to 5 µm
Ans. Deciduous mandibular central incisor 106. Which is the decalcifying agent used?
88. Odontoclasts originates from which cell. Ans. Nitric acid
Ans. Circulating monocytes 107. How much is the thickness of ground section?
89. What is ankylosis? Ans. 50 µm
Ans. It is the union of cementum and bone 108. Name the instrument used to get frozen sections.
90. Which is the most common congenitally missing tooth? Ans. Cryostat
Ans. Permanent upper lateral incisor 109. Which is the best method to demonstrate carbohy-
91. Which type of joint is temporomandibular joint? drates?
Ans. Synovial joint Ans. PAS method
92. Name the layer which covers the condyle. 110. Name the fixative used to demonstrate nucleic acid.
Ans. Lamina splendens Ans. Carnoy’s solution
736 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Additional Matter
Some Details About Histological Structures of Tooth

Enamel Dentin Cementum Bone

Derived from Ectoderm Ectomesenchyme Ectomesenchyme Mesoderm
Type of tissue Epithelial tissue Connective tissue Connective tissue Connective tissue
Cells which give origin Ameloblasts Odontoblasts Cementoblasts Osteoblasts
Cells leading to Odontoclasts Odontoclasts Odontoclasts Osteoclasts
degradation
Mineral content 96% 70% 45 to 50% 50 to 60%
Sensitivity Not present Present; only the pain is appreciable Not present Present
Blood and nutrition Avascular Absent. Dentinal fluid or dentinal It is avascular Vessels are present in the bone
supply lymph circulate in dentinal tubules

Various Stages of Tooth Development and Results of Various Types of Cementum and their Locations
their Disturbances
Type of cementum Location
Stages Disturbances Acellular afibrillar cementum Cervical cementum
Initiation • Lack of initiation lead to absence of single tooth Acellular extrinsic fiber cementum Cervical margin to apical third
or multiple teeth, i.e. anodontia. Maxillary lateral
incisor followed by third molars and mandibular Cellular intrinsic fiber cementum Middle, apical third and furcations
second premolars are commonly involved. Cellular mixed fiber cementum Apical inter-radicular regions
• Abnormal initiation can lead to development of
supernumerary teeth. Mesiodens is the most Cellular mixed stratified cementum Apical and furcation
common type of supernumerary teeth.
• Sometimes fused or geminated teeth are formed. Various Salivary Glands, their Ducts and Location
Histo­ • This stage has highest development in bell Name of the
differentiation stage of enamel organ. gland Name of its duct Opening of duct
• Dentinogenesis imperfecta occur in this stage
Parotid gland Stensen’s duct Duct opens near to maxillary
Morpho­ • Advanced bell stage occurs during second molar inside the
differentiation morphodifferentiation. This stage provides buccal mucosa
morphologic pattern or basic form and relative
size of future tooth. Submandibular Wharton’s duct Duct opens at the side of
• Talon cusp or root, twinning, loss of cusp or root, gland lingual frenulum
Hutchinson’s incisor Sublingual • Bartholin’s duct Duct open along sublingual
Apposition duct • Several minor fold
ducts

Various Structures Details of Various Potent Cells

Name of the Name of
structures Explanation the cell Details
Lamina limitans It is the organic lining of dentinal tubules Totipotent • These cells differentiate into embryonic and extra­
Lamina propria It is the connective tissue which supports cells embryonic cell types. These less can form a viable
epithelium organism
• Such cells are produced by the fusion of an egg
Lamina lucida They are the zone of basal lamina between
and sperm cell. Cells which get produced by the few
and lamina densa epithelial cells and the connective tissue
divisions of fertilized cells are also the totipotent cells
Tomes process Projection of ameloblasts in enamel matrix
Pluripotent • These cells are just like totipotent stem cells and
Tomes fibers Odontoblastic processes within dentinal cells they can give rise to all tissue types. These cells
tubules cannot produce an entire organism.
• These cells have potential to differentiate into any
Tomes layer It is the granular layer present inside the
of the three germ layers.
root due to coalescing and looping of the
• Examples of pluripotent stem cells are dental pulp
terminal protions of dentinal tubules adjacent
stem cells, embryonic stem cells
to cementum
Contd...
 Dental Histology  737

Contd... Various Papillae

Name of Name of the Details
the cell Details papillae
Multipotent • These cells have potential t differentiate into Foliate papillae It lies at lateral border of posterior part of tongue
cells multiple, but limited cell types. and consists of taste buds
• Examples of these cells are hematopoietic cell,
Filiform It is keratinized and is thread like. Taste buds are
mesenchymal stromal cells and bone marrow cells
papillae absent here
• Oligopotency is an ability of progenitor cells to
Fungiform This is mushroom shaped, round in shape and
differentiate into few cell types. This is the degree
papillae reddish in color. It consists of few taste buds
of potency.
• Examples are lymphoid or myeloid stem cells. Circumvallate It lies in front of V shaped sulcus terminalis. They
• Lymphoid cells give rise to various blood cells such papillae are 8 to 10 in number. They are largest in size ad
as B and T cells. have many taste buds
Unipotent • A unipotent cell is that one stem cell which has
capacity to differentiate into only one cell type. Sensations Over Lip and Oral Mucosa
• Example: Spermatogenic stem cell
Name of the
sensation Greatest Moderate Least
Various Taste Sensations and their Details Pain Lips, pharynx, Anterior Buccal mucosa
base of tongue and
Name of
tongue, teeth gingiva
the taste Associated
sensation Perceived at papilla Nerve mediated Heat Lips Anterior teeth Ventral tongue,
palate
Sweet Tip of the tongue Fungiform Chorda tympani
Cold Lips and Base and Dorsum of tongue
Salt Lateral border of Fungiform Chorda tympani
posterior ventral tongue and buccal
the tongue
palate mucosa
Sour Lateral border of Foliate Glossopharyngeal
Touch Lips, tip of Gingiva Base of tongue
the tongue
tongue and and buccal
Bitter Posterior part of Circumvallate Glossopharyngeal anterior mucosa
tongue palate
 9
SECTION

Oral Physiology

1. Vascular and Nerve Supply of Orofacial Region 4. Mastication

2. Calcium and Phosphorus Metabolism 5. Speech
3. Deglutition
 ♦♦
1. VASCULAR AND NERVE SUPPLY OF
OROFACIAL REGION
♦♦
Q.1. Answer in brief branches of mandibular nerve.
 (Feb 2016, 2 Marks)
Ans. Following are the branches of mandibular nerve:
Branches from Undivided Nerve
♦♦ Nervous spinosus: It re-enters the skull via foramen
spinosum along with middle meningeal artery to supply
dura mater and lining of mastoid cells.
♦♦ Nerve to medial pterygoid: It supplies medial pterygoid
muscle.
Branch from Anterior Division
♦♦ Massetric nerve supplies masseter muscle and temporo-
mandibular joint.
♦♦ Deep temporal nerve supplies temporalis muscle.
♦♦ Nerve to lateral pterygoid supplies to lateral pterygoid
muscle.
♦♦ Buccinator nerve supplies skin and mucous membrane
which is related to buccinator muscle.
Branch from Posterior Division
♦♦ Auriculotemporal nerve divides into following parts:
• Auricular part supplies to skin of tragus, upper part of
pinna, external acoustic meatus, tympanic membrane.
• Temporal part supplies to skin of temporal region.
• Auricular branch supplies to temporomandibular
joint.
• Parotid branch supplies to parotid gland.
Fig. 1:  Branches of mandibular nerve
Lingual: This nerve carry sensation from mucus membrane
of anterior two third of tongue and mucosa on lingual side
of mandible.
Inferior alveolar nerve: Inferior alveolar nerve along with
the inferior alveolar artery enters the mandibular foramen
to run anteriorly and downward below the teeth in
mandibular canal, till it reaches mental foramen. At mental
foramen the nerve terminates by giving off two branches,
i.e. incisive and mental. Various branches of inferior
alveolar nerve and their innervations are as follows:
• Mylohyoid nerve: This branch arises from inferior
alveolar nerve before it enters in mandibular foramen.
This nerve runs anteroinferiorly over the medial
surface of mandible to reach mylohyoid muscle. This
nerve pierces sphenomandibular ligament to supply
mylohyoid muscle and anterior belly of digastric
muscle.
• Alveolar branches: They supply the teeth. Nerve
twigs which arises from inferior alveolar nerve
corresponding to every tooth. These nerve twigs
enter the pulp of teeth via apical foramen present at
root tips.
• Incisive branch: This is one of the terminal branch of
inferior alveolar nerve. This branch runs anteriorly
in inferior alveolar canal to supply both canine and
incisors.
• Mental nerve: This is also the terminal branch of
inferior alveolar nerve. It comes out from inferior
alveolar nerve via mental foramen. Mental nerve
emerges through it and divides in three branches
which supply the skin over chin and skin as well as
mucus membrane of lower lip.
742 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)
Q.2. Write short note on inferior alveolar nerve.
 (Aug 2016, 3 Marks)
Ans. Inferior alveolar nerve is the largest branch of mandibular
nerve.
Inferior alveolar nerve along with the inferior alveolar
artery enters the mandibular foramen to run anteriorly
and downward below the teeth in mandibular canal, till
it reaches mental foramen. At mental foramen the nerve
terminates by giving off two branches, i.e. incisive and
mental. Various branches of inferior alveolar nerve and
their innervations are as follows:
• Mylohyoid nerve: This branch arises from inferior
alveolar nerve before it enters in mandibular
foramen. This nerve runs anteroinferiorly over the
medial surface of mandible to reach mylohyoid
muscle. This nerve pierces sphenomandibular
ligament to supply mylohyoid muscle and anterior
belly of digastric muscle.
• Alveolar branches: They supply the teeth. Nerve
twigs which arises from inferior alveolar nerve
corresponding to every tooth. These nerve twigs
enter the pulp of teeth via apical foramen present
at root tips.
• Incisive branch: This is one of the terminal branch of
inferior alveolar nerve. This branch runs anteriorly
in inferior alveolar canal to supply both canine and
incisors.
• Mental nerve: This is also the terminal branch of
inferior alveolar nerve. It comes out from inferior
alveolar nerve via mental foramen. Mental nerve
emerges through it and divide in three branches
which supply the skin over chin and skin as well as
mucus membrane of lower lip.
Q.3. List branches of inferior alveolar nerve.
 (Sep 2017, 2 Marks)
Ans. Following is the listing of branches of inferior alveolar
nerve:
• Mylohyoid nerve
• Alveolar or dental branch
• Incisive branch
• Mental nerve
2. CALCIUM AND
PHOSPHORUS METABOLISM
Q.1. Write short note on calcium metabolism.
 (Sep 2017, 3 Marks) (Feb 2016, 3 Marks)
Ans. Following is the calcium metabolism:
Calcium Absorption
Calcium is absorbed in duodenum by energy dependent active
process. Following are the factors which influences absorption:
A. Factors promoting calcium absorption
• Vitamin D induces synthesis of calcium binding
protein in intestinal epithelial cells and promotes the
calcium absorption.
• Parathyroid hormone enhances calcium absorption
through increased synthesis of cholesterol.
• Acidity is favorable for calcium absorption.
• Lactose promote calcium uptake via intestinal cells.
• Arginine and lysine facilitate absorption of calcium.
B. Factors inhibiting calcium absorption
• Phytates and oxalates lead to the formation of insoluble
salts and interfere with the absorption of calcium.
• High content of dietary phosphate leads to the
information of insoluble calcium phosphate and
prevent uptake of calcium.
• Free fatty acids react with calcium to form insoluble
calcium soaps.
• Alkaline condition is unfavorable for calcium
absorption.
• High content of dietary fiber interfere with calcium
absorption.
Excretion of Calcium
Calcium is excreted in feces as well as in urine. In feces, it is
excreted through exfoliated gastrointestinal tract cells and in
urine, it is excreted as calcium phosphate and calcium chloride.
Regulation of Calcium Level
The regulation of blood calcium level took place through three
hormones.
1. Parathormone: It is secreted by parathyroid gland and its
main function is to increase blood calcium level by mobilizing
calcium from bone. Parathor­mone maintains blood calcium
level by following actions, on bones, kidney and GIT:
a. By increasing reabsorption of calcium from bones.
b. By decreasing excretion of calcium through kidneys.
c. By increasing absorption of calcium from GIT.
2. 1, 25-dihydroxycholecalciferol: It is a steroid hormone
synthesized from vitamin D by means of hydroxylation
reactions in liver and kidneys. The main action is to
increase blood calcium level by increasing calcium
absorption from small intestine. The main actions of 1,
25-dihydroxycholecalciferol are:
a. It increases the absorption of calcium from in­testine.
It does this by increasing the formation of calcium-
binding proteins in intestinal epithelial cells. These
proteins act as carrier proteins for facilitated diffusion
by which calcium ions are transported. The proteins
remain in cells for several weeks after 1, 25-dihydroxy­
cholecalcif­erol has been removed from the body, thus
causing prolonged effect on calcium absorption.
b. It increases the synthesis of calcium-induced ATP in
intestinal epithelium.
c. It increases synthesis of alkaline phosphates in
intestinal epithelium.

3. Calcitonin: It is secreted by parafollicular cells of thyroid. It
is a calcium lowering hormone. It decreas­es blood calcium
level by decreasing reabsorption. It reduces blood calcium
level by acting on bone, kidney and intestine.
a. On bones: It facilitates deposition of calcium on bones.
It suppresses the activity of osteoclasts which are
responsible of calcium from bones.
b. On kidney: It increases excretion of calcium through
urine by inhibiting reabsorption of calcium from renal
tubules.
c. On intestine: It prevents the absorption of cal­cium
from intestine into blood.
Other Hormones Involved in Calcium Metabolism
♦♦ Growth hormone: It increases absorption of calcium from
intestine and enhances protein synthesis in bone.
♦♦ Insulin: It is an anabolic hormone which favors bone
formation.
♦♦ Sex hormones: These hormones increases calcium
absorp­tion, decreases calcium excretion and enhances
bone mineralization. Estrogen has direct effect on bone
resorption.
♦♦ Prolactin: It increases calcitriol production and increases
calcium absorption during lactating period.
♦♦ Thyroid hormone: It increases in levels of thyroid
hormone which is accompanied by osteoporosis and
hypercalcinuria.
3. DEGLUTITION
Q.1. Write a short note on deglutition. (Feb 2016, 3 Marks)
 (Mar 2007, 3 Marks) (Sep 2006, 5 Marks)
 (Dec 2010, 5 Marks) (Feb 2014, 3 Marks)
Or
Write on phases of deglutition. (Feb 2013, 5 Marks)
Or
Answer in brief stages of deglutition.
 (Aug 2016, 2 Marks)
Or
Write short answer on deglutition. (May 2018, 3 Marks)
Ans. Deglutition is defined as the act of swallowing.
Mechanism of deglutition or swallowing of food occurs
in following phases:
Preparatory Phase
♦♦ In this phase formation of bolus occur.
♦♦ Bolus is a round or oval shaped mass of food formed in
mouth after chewing.
Oral or Buccal Phase
♦♦ As bolus takes its position on dorsum of tongue, oral
phase begins.
♦♦ This phase is voluntary in character.
Oral Physiology  743
♦♦ Anterior part of tongue is raised and pressed against hard
palate by intrinsic muscles of tongue.
♦♦ The movement takes place from anterior to posterior side.
This pushes food bolus to oropharynx.
♦♦ Nasopharynx gets shut due to upward movement of soft
palate and forward movement of posterior pharyngeal
wall. This prevents regurgitation of food in nose.
Pharyngeal Phase
♦♦ This phase is involuntary in character.
♦♦ During this the food is pushed from oropharynx to lower
part of laryngopharynx, i.e. hypopharynx.
♦♦ Constrictors of pharynx move upward and forward and
propel bolus through pharynx by contractions.
♦♦ Simultaneously upper esophageal sphincter opens and
bolus enter esophagus.
♦♦ During this phase laryngeal vestibule closes due to move-
ment of epiglottis.
♦♦ Epiglottis move to horizontal position due to elevation of hyoid
bone and larynx as well as contraction of thyrohyoid muscle.
♦♦ Epiglottis directs the bolus in piriform sinuses around
opening of airway in esophagus.
Esophageal Phase
As food reaches the upper end of esophagus its sphincter contracts
and leads to peristaltic contractions which pass bolus to stomach.
Lower esophageal sphincter allows bolus in stomach.
Q.2. Describe in brief pharyngeal phase of deglutition.
 (June 2010, 5 Marks) (May 2014, 2 Marks)
Ans. Refer to Ans 1 of same chapter.
Q.3. Enumerate stages of deglutition. (Sep 2015, 2 Marks)
Ans. Following are the stages of deglutition:
1. Preparatory phase
2. Oral or buccal phase
3. Pharyngeal phase
4. Esophageal phase.
Q.4. Define deglutition. Enumerate phases of deglutition
and write the importance. (Sep 2018, 1 + 2 + 2 Marks)
Ans. Deglutition is defined as the act of swallowing.
Phases of Deglutition and Their Importance
Name of phase
of deglutition Importance of phase of deglutition
Preparatory In this phase, there is formation of food bolus
phase which is the preparatory event for swallowing
Oral or buccal In this phase, bolus is propelled from oral cavity
phase to pharynx
Pharyngeal In this phase, bolus is transported from
phase oropharynx into esophagus by a peristaltic
wave caused by contraction of pharyngeal
constrictor muscle
Esophageal In this phase, bolus moves down the length of
phase esophagus to stomach. This is an involuntary
phase. Esophagus helps to move food from
pharynx to stomach
744 Mastering the BDS Ist Year  (Last 25 Years Solved Questions)

Or
4. MASTICATION Describe muscles of mastication.( June 2010, 10 Marks)
Ans. The muscles of mastication are:
Q.1. Write a short note on muscles of mastication. 1. Temporalis.
 (Feb 2002, 6 Marks) (Feb/Mar 2004, 5 Marks) 2. Masseter.
 (Feb 2006, 5 Marks) (Dec 2010, 5 Marks) 3. Lateral pterygoid.
 (May 2017, 3 Marks) (July 2016, 3 Marks) 4. Medial pterygoid.

Muscles of mastication
S. No. Muscle Origin Insertion Nerve supply Action
1. Masseter a. Superficial layer: From anterior a. Superficial layer: Into lower Anterior division a. Elevates mandible to
2/3 of lower border of zygomatic part of lateral surface of of mandibular close the mouth to bite
arch adjoining zygomatic proc- ramus of mandible nerve b. It clenches the teeth
ess of maxilla b. Middle layer: Into middle
b. Middle layer: From anterior 2/3 part of ramus
of deep surface and posterior c. Deep layer: Into upper part
1/3 of lower border of zygomatic of ramus and coronoid
arch process of mandible
c. Deep layer: From deep surface
of zygomatic arch
2. Temporalis a. Temporal fossa a. Margins and deep surface Two deep a. Elevates mandible
b. Temporal fascia of coronoid process temporal b. Posterior fibers retract
b. Anterior border of branches from protruded mandible
protruded mandible anterior division of c. Helps in side to side
mandibular nerve grinding movement
3. Lateral a. Upper head: From intratemporal a. Pterygoid fovea on the A branch from a. Depresses mandible to
pterygoid surface and crest of greater anterior surface of neck of anterior division open mouth with supra-
wings of sphenoid mandible of mandibular hyoid muscle
b. Lower head: From lateral b. Anterior margin of nerve b. Lateral and medial ptery-
surface of lateral pterygoid plate articular disc and capsule goid protrude mandible
of temporomandibular c. Left lateral pterygoid and
joint right medial pterygoid turn
the chin to left side as a
part of grinding movement
4. Medial a. Superficial head: From Roughned area of Nerve to medial a. Elevates mandible
pterygoid tuberosity of maxilla and medial surface of angle pterygoid, branch b. Helps in protruding
adjoining bone and adjoining ramus of of the main trunk mandible
b. Deep head: From medial surface mandible below and behind of mandibular c. Right medial pterygoid with
of lateral pterygoid plate and mandibular foramen and nerve left lateral pterygoid turn
adjoining process of palatine bone mylohyoid groove the chin to left side

Q.2. Write a note on temporalis muscle. (Mar 2001, 5 Marks) 3. Lateral pterygoid.
Ans. Refer to Ans 1 of same chapter. 4. Medial pterygoid.
Q.3. Define occlusion. Write in detail about muscle of mas- Q.5. Define mastication and deglutition.
tication.  (Dec 2012, 8 Marks)  (Apr 2017, 2 Marks)
Ans. Occlusion is defined as the “static and dynamic contact Ans.
relationship between the occlusal of teeth during Mastication
function.” Glossary of prosthodontic terminology (GPT).
For muscles of mastication refer to Ans 1 of same chapter. It is defined as act of chewing food, and it consists of coordinated
function of various parts of oral cavity to prepare the food for
Q.4. Enumerate the muscles of mastication. swallowing and digestion.
 (Jan 2018, 2 Marks) (Sep 2015, 2 Marks)
Ans. Following are the muscles of mastication: Deglutition
1. Temporalis. Deglutition is the process by which food is passed in stomach
2. Masseter from oral cavity or deglutition is defined as the act of swallowing.
 Oral Physiology  745

process create sound. This sound is called as source

5. SPEECH excitation.
♦♦ It serves as an acoustic material from which speech sounds
Q.1. Write short answer on speech. (Aug 2018, 3 Marks) are later developed.
Ans. Speech is described as an overlaid process which is
secondary to vegetative functions. Resonation
Speech process consists of four mutually dependent ♦♦ Resonation is usually the third step in speech process.
divisions, i.e. ♦♦ Resonance provides a distinguishing quality which is the
1. Respiration characteristic of each voice.
2. Phonation ♦♦ Sounds get modified by selective alteration of both size
3. Resonation and shape of vocal tract.
4. Articulation ♦♦ Depending on the configuration of vocal tract, certain
These above mentioned process coordinate to produce frequencies are amplified whereas others are attenuated.
dynamic acoustic modulation of speech.
Articulation
Respiration
♦♦ Articulation is the fourth step in speech producing
♦♦ It is also known as power division. phenomenon.
♦♦ First step during speech producing phenomenon is respira- ♦♦ Articulators and articulatory valves are solely responsible
tion where the energy source for speaking is given by the
for this act.
respiratory system.
♦♦ Vocal organs are the articulators and the articulatory valves
♦♦ Exhaled airstream moves via resonating cavities and get
are the places at which airstream is modified to produce
shaped into discrete sounds.
speech sounds.
Phonation ♦♦ When vocal organs assume a certain position they produce
♦♦ Second step in speech phenomenon is phonation. sound, simultaneously articulatory valves stop, constrict
♦♦ Breath stream which is emitted from the lungs strikes to and narrow the airstream, thus producing speech sounds.
the vocal folds which are housed inside the larynx. ♦♦ So, articulation thus refers to placement and movement
♦♦ Phonation occurs due to vibratory activity of vocal folds. of lips, teeth, tongue, mandible and the soft palate as well
♦♦ Exhaled airstream get interrupted by vibratory pat- as associated structures at the time of speech to produce
tern of vocal folds, and air puffs emerging from this speech sound.
 Plate 1

Page 3, Q. 1: Nerves and vessels related to mandible Page 7, Q. 1: Venous drainage of scalp

Page 43, Q. 2: Branches of maxillary artery

Page 75, Q. 5: Arterial supply of pituitary gland

 Plate 2

Page 78, Q. 11: Branches of internal carotid artery

Page 82, Q. 3: Ciliary ganglion and its roots Page 88, Q. 8: Anatomy of pharynx

Page 100, Q. 6: Paranasal air sinuses Page 110, Q. 1: Arterial supply of tongue
 Plate 3

Page 111, Q. 1: Lymphatic drainage of tongue

Page 122, Q. 1: Gomphosis

Page 134, Q. 2: Arterial supply of spinal cord: A. Anterior view,

Page 131, Q. 1: Lateral spinothalamic tract B. Posterior view
 Plate 4

Page 135, Q. 4: Radicular arteries

Page 136, Q. 5: Lumbar puncture

 Plate 5

Page 136, Q. 6: Transverse section at midcervical region

Page 141, Q. 4: TS of medulla oblongata at the level of pyramidal decussation

Page 146, Q. 1: Floor of the fourth ventricle Page 148, Q. 3: Roof of fourth ventricle
 Plate 6

Page 153, Q. 8 and Page 156, Q. 11: Superolateral surface of cerebral hemisphere showing sulci and gyri

Page 159, Q. 2: Circle of Willis or circulous arteriosus

 Plate 7

Page 161, Q. 1: Lymphatic drainage of breast

Page 164, Q. 4: Wall and contents of axilla

Page 166, Q. 1: Boundaries of cubital fossa Page 167, Q. 1: Contents of cubital fossa
 Plate 8

Page 167, Q. 2: Biceps brachii muscle

Page 170, Q. 1: Mediastinal surface of left lung

 Plate 9

A B A B
Page 172, Q. 4: Right bronchopulmonary segment Page 172, Q. 5: Left bronchopulmonary segment
A. Costal aspect, B. Medial surface A. Costal aspect, B. Medial surface

Page 173, Q. 6: Mediastinal surface of right lung

Page 178, Q. 6: Internal structure of right atrium

 Plate 10

Page 182, Q. 1: Contents of femoral triangle

Page 185, Q. 2: Common peroneal nerve

 Plate 11

Page 188, Q. 1: External features and subdivisions of stomach Page 189, Q. 3: Structures forming stomach bed

Page 205, Q. 3: Mature Graafian follicle Page 219, Q. 4: Cleft palate

Page 229, Q. 3: Structures passing through

superior orbital fissure Page 232, Q. 8: Formation of cartilagenous model
 Plate 12

Page 232, Q. 8: Zones of differentiation of cartilage cells Page 233, Q. 8: Formation of bone collar

Page 233, Q. 8: Formation of periosteal bud Page 233, Q. 8: Formation of medullary cavity

Page 234, Q. 8: Formation of secondary ossification center

 Plate 13

Page 239, Q. 1: Various types of epithelium

Page 242, Q. 2: Hyaline cartilage Page 242, Q. 3: Elastic Cartilage

 Plate 14

Page 243, Q. 1: Compact bone Page 244, Q. 1: Cancellous bone

Page 244, Q. 1 and Q. 2: Cardiac muscle Page 245, Q. 3: Transverse section of muscle

Page 245, Q. 3: Longitudinal section of muscle Page 245, Q. 1: Muscular artery

 Plate 15

Page 246, Q. 1: Lymph node Page 247, Q. 2: Spleen

Page 247, Q. 3: Thymus Page 248, Q. 4: Tonsil

Page 248, Q. 1: Skin Page 249, Q. 1: Trachea

Page 249, Q. 2: Lung

 Plate 16

Page 250, Q. 2 and Page 689 Q. 8: Filiform papillae Page 250, Q. 2 and Page 689 Q. 8: Fungiform papillae

Page 251, Q. 2 and Page 689, Q. 8: Circumvallate papillae Page 252, Q. 5: Submandibular gland

Page 252, Q. 6: Taste but (H&E stain)

 Plate 17

B
A
Page 254, Q. 1A: Liver Page 254, Q. 1B: Liver

Page 254, Q. 2: Gallbladder (H&E stain)

Page 255, Q. 2: Urinary bladder (H&E stain) Page 255, Q. 3: Pancreas

 Plate 18

Page 256, Q. 1: Pitiutary gland adenohypophysis (pars distalis) Page 256, Q. 1: Pars nervosa

Page 256, Q. 2: Thyroid gland Page 257, Q. 4: Adrenal cortex

Page 258, Q. 2: Kidney Page 259, Q. 1: Autonomic ganglion

 Plate 19

Page 259, Q. 1: Testis

Page 260, Q. 2: Cerebellum Page 291, Q. 8: Neutrophils

Page 291, Q. 8: Eosinophils Page 291, Q. 8: Basophils

Page 291, Q. 8: Lymphocytes Page 291, Q. 8: Monocytes

 Plate 20

Page 294, Q. 14: Platelets

Page 633, Q. 3: Bud stage Page 633, Q. 3: Cap stage

Page 634, Q. 3: Bell stage Page 634, Q. 3 and Page 635, Q. 6: Advanced bell stage
 Plate 21

Page 635, Q. 7: Epithelial diaphragm Page 636, Q. 9: Ameloblasts

Page 636, Q. 10: Early bell stage Page 640, Q. 2: Enamel rods showing keyhole pattern

Page 640, Q. 3: Gnarled enamel Page 641, Q. 4: Enamel lamellae

 Plate 22

Page 641, Q. 5: Enamel tuft Page 645, Q. 11: Enamel spindle

Page 646, Q. 13: Incremental line of Retzius Page 651, Q. 1: Dentinal tubule

Page 651, Q. 1: Predentin Page 652, Q. 2 and Page 656, Q. 16: Secondary dentin
 Plate 23

Page 652, Q. 3: Tome’s granular layer Page 652, Q. 4: Reparative dentin

Page 654, Q. 8: Interglobular dentin Page 654, Q. 9 and Page 657, Q. 22: Dead tract

Page 657, Q. 22: Diffuse calcification Page 657, Q. 23: Transparent dentin
 Plate 24

Page 662, Q. 7: True pulp stone Page 662, Q. 7: False pulp stone

Page 663, Q. 11: Denticles Page 663, Q. 15: Pulp at periphery

A B
Page 666, Q. 3A: Cellular cementum Page 666, Q. 3B: Acellular cementum
 Plate 25

Page 666, Q. 4: Cementocytes Page 667, Q. 5: Sharpey’s fibers

Page 667, Q. 6: Butt junction Page 667, Q. 6: Cementum overlapping enamel junction

Page 668, Q. 6: Enamel overlapping cementum junction Page 668, Q. 6: Gap junction
 Plate 26

Page 669, Q. 12: Differentiation of cementoblasts Page 669, Q. 12: Cementum deposition

Page 675, Q. 3: Horizontal alveolar and oblique

Page 670, Q. 13: Cementoblast and cementocyte group of fibers

Page 675, Q. 3: Apical group of fibers Page 675, Q. 3: Inter-radicular group of fibers
 Plate 27

Page 679, Q. 1: Alveolar bone Page 681, Q. 4: Resting lines of bone

Page 682, Q. 6: Incremental lines of von Ebner

Page 682, Q. 5: Osteoblast, osteocyte, osteoclast

Page 683, Q. 6: Incremental lines of Salter Page 686, Q. 3: Anterolateral zone of hard palate
 Plate 28

Page 687, Q. 3: Posterolateral zone of hard palate Page 690, Q. 11: Taste Bud

Page 691, Q. 15: Cheek mucosa Page 693, Q. 16: Gingiva

Page 694, Q. 18: Vermilion border of lip

 Plate 29

Page 699, Q. 37: Nonkeratinized mucosa (H&E stain)

Page 701, Q. 42: Keratinized mucosa (H&E stain)

Page 706, Q. 1: Serous acini

 Plate 30

Page 706, Q. 1: Mucous acini

Page 709, Q. 8: Submandibular salivary gland

Page 710, Q. 13: Mixed salivary gland

 Plate 31

Page 720, Q. 1: Maxillary sinus

Page 722, Q. 1: Hematoxylin and eosin stain

Page 723, Q. 5: Mallory stain