ligital resources

EDITION

J Jyotsna Rao
ELSEVIER
Quick Review Series for
BDS ist Year
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Quick Review Series for
BDS 1st Year
With Last 25 Years’ Solved Questions

THIRD EDITION

J Jyotsna Rao
BDS, MDS (Osm), PGcor (Mahe), FIsor
Director, SRS Dental Exams Academy, Bengaluru
Ex-Professor, Department of Oral and Maxillofacial Surgery
The Oxford Dental College, Hospital and Research Centre
Bengaluru, INDIA

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ELSEVIER
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Quick Review Series for BDS 1st Year, 3e, J Jyotsna Rao

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 Foreword

Govt. Dental College & Hospital

(Affiliated to KNR University of Health Sciences)
Afzalgunj, Hyerabad 500 012
Dr. P. Bal Reddy mos
Principal, Professor & Head of the Department College. 246019360
Deparment of Oral & Maxillofacial Surgery Mobile: 9440058399
Govt. Dental College & Hospital
Atzalgunj, Hyderabad Date: 14.11.2013.

I am extremely happy to pen a few words about this conscientiously written book.
This book of Quick Review Series for BDS 1st Year authored by ex-professor Dr J Jyotsna Rao is presented with such a
systematic approach that it demonstrates her consummate skill in preparing students for examinations. It is good to see that
she has shared her vast experience in academics with the students through this book.
When going through the pages of this book, I found that the author has made a sincere attempt to revise the book in depth
and provide more useful information in various subject areas of Ist year BDS as per new regulations of the DCI to fulfill the
long-term need of a concise quick review book with best standards, simple language and in-depth explanation of every subject.
Through questions and answers of various university examinations, this book is undeniably appropriate for exam-going
students who are craving for a thorough review of entire subjects in a short period.

Dr P BAL REDDY
Principal, Professor and Head
Department of Oral and Maxillofacial Surgery
Govt Dental College and Hospital
Hyderabad
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 aed Xs

Encouraged by the overwhelming response from student community and remarkable success of the first edition, we have
embarked upon the third edition of this book. This edition is definitely a great improvement over the second edition.
The outstanding feature of this book is incorporation of Index for easy reference to the answers which is first of its
kind among question banks book. This edition also contains unique addition of Practice Figures in General Anatomy
section and Viva Questions for each section, and a thorough revision has been made in the Dental Anatomy section as well.
The third edition continues to retain the primary objective of the previous editions, being a concise, informative and
reader-friendly compilation of all subjects of first year BDS with updation of latest question papers. It bridges the gap
between what students know and how much they have to present while writing answers in theory exams.
Refer the cover of the book to explore the online MCQs and solved papers, which we have painstakingly developed,
especially for you. Besides these, you will get access to the complimentary e-book also.
I feel all the improved features of this book, will definitely go a long way in helping candidates gain the necessary knowl-
edge and confidence to tackle the examinations successfully. But I believe that despite my best efforts, some imperfections are
bound to remain. I request the readers to evaluate this book critically and send their valuable suggestions for enhancement
of the contents, because only criticism leads to progress and improvements. These suggestions will be taken care of in subse-
quent editions of the book.
I wish my readers good luck and great fortune.

J Jyotsna Rao
drjjrao@gmail.com
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Foreword Vil
Preface ix

SECTION IA GENERAL ANATOMY

Topic 1 Osteology of Head and Neck
Topic 2 Scalp, Temple and Face
Topic 3 Side of the Neck 17
Topic 4 Back of the Neck 24
Topic 5 Contents of the Vertebral Canal 27
Topic 6 Cranial Cavity 28
Topic 7 Contents of the Orbit 36
Topic 8 Anterior Triangle of the Neck 39
Topic 9 Parotid Region 46
Topic 10 Temporal and Infratemporal Fossa 52
Topic 11 Submandibular Region 61
Topic 12 Deep Structures of the Neck 66
Topic 13 Prevertebral Region 73
Topic 14 Mouth and Pharynx 74
Topic 15 Nose and Paranasal Sinuses 80
Topic 16 Larynx 86
Topic 17 Tongue 90
Topic 18 Ear 94
Topic 19 Eyeball 96
Topic 20 Regional Anatomy of Neck 98
Topic 21 Brain 99
Topic 22 Miscellaneous 101

SECTION IB GENERAL HISTOLOGY 103

Topic 1 General Histology 105

SECTION IC EMBRYOLOGY 117

Topic 1 Some Preliminary Considerations 119
Topic 2 Spermatogenesis and Oogenesis 119
Topic 3 Formation of Germ Layers 120
Topic 4 Further Development of Embryonic Disc 120
Topic 5 Pharyngeal Arches 121
Topic 6 Face, Nose and Palate 124
Topic 7 Alimentary System 126
Topic 8 Elementary Genetics 128
Topic 9 Miscellaneous 128
Contents

SECTION ID PRACTICE FIGURES IN ANATOMY 131

Viva Questions 155

SECTION IT PHYSIOLOGY 159

Topic 1 Cell Structure and Function 161
Topic 2 Types of Tissues 161
Topic 3 Blood 162
Topic 4 Cardiovascular System 175
Topic 5 Respiration 189
Topic 6 Digestive System 196
Topic 7 Vitamin Metabolism 211
Topic 8 Excretory System and Body Fluids 214
Topic 9 Endocrine Glands and Reproduction 221
Topic 10 Nerve 240
Topic 11 Muscle 241
Topic 12 Nervous System 243
Topic 13 Special Senses 252

Viva Questions 257

SECTION III BIOCHEMISTRY 259

Topic 1 Chemistry and Metabolism of Carbohydrates 261
Topic 2 Chemistry and Metabolism of Amino Acids and Proteins 271
Topic 3 Chemistry and Metabolism of Lipids 280
Topic 4 Metabolism of Inorganic Substances 287
Topic 5 Biological Oxidation 291
Topic 6 Water, Electrolyte and Acid-Base Balance 292
Topic 7 Enzymes 294
Topic 8 Bile 299
Topic 9 Haemoglobin and Porphyrins 300
Topic 10 Urine 301
Topic 11 Organ Function Tests 301
Topic 12 Hormones 301
Topic 13 Nutrition and Diet 302
Topic 14 Vitamins 302

Viva Questions 309

SECTION IVA ORAL HISTOLOGY 311

Topic 1 Development of Face and Oral Cavity 313
Topic 2 Development and Growth of Teeth 316
Topic 3 Enamel 320
Topic 4 Dentine 329
Topic 5 Pulp 336
Topic 6 Cementum 342
Topic 7 Periodontal Ligament 347
 Contents

Topic 8 Bone (Maxilla and Mandible) 352

Topic 9 Oral Mucous Membrane 355
Topic 10 Salivary Glands 364
Topic 11 Tooth Eruption 369
Topic 12 Shedding of Deciduous Teeth 372
Topic 13 Temporomandibular Joint 373
Topic 14 Maxillary Sinus 374
Topic 15 Histochemistry of Oral Tissues 376

SECTION IVB DENTAL ANATOMY 379

Topic 1 Introduction to Dental Anatomy 381
Topic 2 Development and Eruption of Teeth 387
Topic 3 Primary (Deciduous) Teeth 392
Topic 4 General Consideration in the Physiology of Permanent Dentition 393
Topic 5 Orofacial Complex: Form and Function 396
Topic 6 Permanent Maxillary and Mandibular Incisors 397
Topic 7 Permanent Canines: Maxillary and Mandibular 403
Topic 8 Permanent Maxillary Premolars 409
Topic 9 Permanent Mandibular Premolars 414
Topic 10 Permanent Maxillary Molars 417
Topic 11 Permanent Mandibular Molars 423
Topic 12 Dento-osseous Structures 427
Topic 13 Temporomandibular Joint, Muscles, Teeth and their Functions 431
Topic 14 Occlusion 435
Topic 15 Miscellaneous 436

Viva Questions 44]

SECTION V MULTIPLE CHOICE QUESTIONS 445

Section I General Anatomy, General Histology and Embryology 447
Section II Physiology 455
Section II Biochemistry 458
Section IV Oral Histology and Dental Anatomy 461

SECTION VI PREVIOUS YEARS’ QUESTION BANK 469

Section 1A General Anatomy 471
Section 1B General Histology 481
Section 1C Embryology 482
Section 2 Physiology 483
Section 3 Biochemistry 494
Section 4A Oral Histology 503
Section 4B Dental Anatomy 510
515

@ =, Online university exam patterned MCQs and solved papers

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GENERAL
ANATOMY
Topic 1 Osteology of Head and Nek... ecceeeeeeeeereeeeee reece teeneeteeeeeetaeeenea 3
Topic 2 Scalp, Temple And Face... cececccceeeeeeeeeeeeeeeeeeeeeeeeeeeneeseeeeeesiaeeenea 8
Topic 3 Side of the N€CK..0..... cece eer renee renee een eetenee seer etaeeeeieeeteneee 17
Topic 4 Back of the N@CK........ ccc ceeececeeeeeeeeeeeeeencaeeeeneeeseeeeesaaeseeeeeeneeeeseeeetias 24
Topic 5 Contents of the Vertebral Camal ...........cccecceeeeeeeeeeeeeeeneeeeeeeeeeeneeenaas 27
Topic 6 Cranial Cavity ...... ccc eeeeceeeer enter eines eeeneeeeneeeesiaeeeicaeseeieeeseneeesiaeeenas 28
Topic 7 Contents of the Orbit... ee cece ceeeeeeeeeeeeeeeeeeeeeeecaeseeneeeeeneeeeeeeenias 36
Topic 8 Anterior Triangle of the N@CK............cccccccceeeseeeeeeeesnneeeesesneeeeeeseneeeees 39
Topic 9 Parotid REGION. ............::ccccccecceceeeee cece cece eeceeaeaeeaeeeeeeeeeeeeeeeseteeesiaaeeaees 46
Topic 10 Temporal and Infratemporal FOSSA ............cccccceeeeesseeeeeeeseseeeeeeesseeeees 52
Topic 11 Submandibular REGiON..........c eee cece cece cesses eeneeetaeeeeneeeseeeee 61
Topic 12 Deep Structures of the N@CK.......cececeeeeeereeeeeeetneeeeeneeeeeeeeeeeneeeeaas 66
Topic 13 Prevertebral REQiON...........:c:cccceeceeceeeeeeeeeeeceeeeeaeeeeeeeeeeeeeeeeeeeeeseenineaees 73
Topic 14 Mouth and Pharyinx.........cccccccccecceeeeeeeeeeeececcneecaeeeeeeeeeeeeeeeeeeeeesiaaeeaees 74
Topic 15 Nose and Paranasal SINUSES ...0......::cceeeeeeceeeeeeeeeeeeeeeneeeeeeeeeteneeeeaas 80
Topic 16 LANYINX 2c c cece eee e cece ee cee e cee ae eee eeeeeeee eee c ce aaaaaeeaeeeeeeeeeeeeeeeseeecesisaeeaees 86
Topic 17 TOMQUE.........cccceecceeeeceeeeee cee eeecee cette eee caeaaaaeaeeeeeeeeeeeeseececneaeeaeeeeeeeeess 90
Topic 18 EAN oo. eee eee teen eee ee enter eee ne ee etree nett eeeenaaaeeeeceeeeeeeenaaeeeeseennaeeeesnneeeees 94
Topic 19 Eyeball oo... ... ec cce cee ceeeecececceceeae eee eeeeeeeeee sees ca eaaaeeaeeeeeeeeeeeeeeeseeseesieaaeeaees 96
Topic 20 Regional Anatomy of N6éCk ...........:ccccccsecceeeeeeceeeeeseceeeeseseneeeesssneeeees 98
Topic 21 BUI eee eect eect tenet errr ne ee eee eae eee eeeea nae ee ee aeeeeeeenaaeeeeseenaeeeeenaeeeees 99
Topic 22 MiSCeEIANCOUS....... cece eeeeeee eee ennne eee eeeenaae eee teeeeeeeee eaters eeennaeeeeenenaees 101
This page intentionally left blank
GENERAL ANATOMY

OSTEOLOGY OF HEAD AND NECK

SHORT ESSAYS

Q.1. Enumerate any four structures passing through The inferior constrictor muscle consists of two parts:
foramen magnum. 1. The thyropharyngeus
2. The cricopharyngeus
Ans.
Their attachments are as follows:
The structures passing through the foramen magnum are as
follows: The thyropharyngeus arises from:
1. The oblique line on the lamina of the thyroid cartilage,
Through the anterior part:
including the inferior tubercle.
1. Apical ligament of dens
2. The inferior cornua of the thyroid cartilage.
2. Vertical brand of cruciate ligament
3. Membrane tectoria The cricopharyngeus arises from the cricoid cartilage
behind the origin of the cricothyroid muscle.
Through the subarachnoid space:
All the constrictors of the pharynx are inserted into a
1. Spinal accessory nerves
median raphe on the posterior wall of the pharynx.
2. Vertebral arteries
3. Sympathetic plexus around the vertebral arteries
Nerve Supply
4. Posterior spinal arteries
5. Anterior spinal artery All muscles of the pharynx, except the stylopharyngeus are
supplied by the motor fibres derived from the cranial acces-
Through the posterior part:
sory nerve through the branches of the vagus. The inferior
1. Lowest part of medulla oblongata
constrictor receives an additional supply from the external
2. Three meninges
and recurrent laryngeal nerves.
Q.2. Give the attachments, nerve supply and
actions of inferior constrictor muscles. Action of Inferior Constrictor Muscles of Pharynx
Ans. The inferior constrictors of the pharynx bring about the
third stage of deglutition or swallowing.

SHORT NOTES

Q.1. Dens. 1. Second cervical vertebra called axis is identified by the

presence of the dens or odontoid process, which is a strong,
Ans. tooth-like process projecting upwards from the body.
7) Quick Review Series: BDS 1st Year

2. The dens is usually believed to represent the centrum or

body of the atlas, which has fused with the centrum or
body of the axis.
Greater cornua
3. The superior surface of the body of cervical vertebra is
fused with the dens and is encroached upon on each side
Lesser cornua
by the superior articular facets.
4. The dens articulates anteriorly with the anterior arch of
the atlas, and posteriorly with the transverse ligament of
the atlas (Fig. 1A.1.1).
Fig. 14.1.2 Hyoid bone.
Apex of dens

For transverse
ligament of atlas

2. It develops from second and third branchial arches.

3. At rest, it lies at the level of the third cervical vertebra
behind and the base of the mandible in front.
4. The hyoid bone consists of
a. the central part, called the body and
b. two pairs of cornua, the greater and the lesser.
5. It is suspended in position by muscles and ligaments.
The hyoid bone provides attachment to the floor of the
Fig. 1A.1.1 Dens. mouth and to the tongue above, to the larynx below, and
to the epiglottis and pharynx behind.
Q.2. Maxilla.
Q.4. Mastoid groove.
Ans.
Ans.
Maxilla is the second largest bone of the face. The whole of
the upper jaw is formed by two maxillae, and each maxilla The mastoid part of the temporal bone lies just behind the
contributes in the formation of face, nose, mouth, orbit, the external acoustic meatus. It is continuous anterosuperiorly
infratemporal and pterygopalatine fossae. with the squamous temporal bone. A partially obliterated
squamomastoid suture may be visible just in front of and
Features parallel to the roughened area of muscular insertions known
as mastoid groove.
Each maxilla has a body and four processes.
Q.5. Auditory tube.
Body of maxilla Ans.
The body of maxilla is pyramidal in shape, with its base The auditory tube connects the middle ear with the naso-
directed medially towards the lateral wall of the nose and pharynx anteriorly (Fig. 1A.1.3). The sulcus tube which is a
the apex is directed laterally towards the zygomatic process. groove between the posteromedial margin of the greater
It has four surfaces and encloses a large cavity known as the wing of the sphenoid and the petrous temporal bone lodges
maxillary sinus. the cartilaginous part of the auditory tube. Posteriorly, the
The four processes of maxilla are as follows: groove leads to the bony part of the auditory tube, which lies
1. The frontal within the petrous temporal bone.
2. Zygomatic
3. Alveolar
4. Palatine processes.
Aditus to antrum
Q.3. Hyoid bone. Auditory tube Mastoid antrum
Ans. ANTERIOR POSTERIOR

1. The hyoid bone is U-shaped and is situated in the Middle ear Mastoid air cells
Mastoid process
anterior midline of the neck between the chin and the
thyroid cartilage (Fig. 1A.1.2). Fig. 1A.1.3 Auditory tube.
 General Anatomy

Q.6. Deep cervical fascia. Ans.

Ans. The jugular foramen is large and elongated, placed at the

posterior end of the petro-occipital suture.
Deep Cervical Fascia (Fascia Coli)
The jugular foramen transmits the following structures:
The deep fascia of the neck is condensed to form the
Through the anterior part
following layers:
1. Inferior petrosal sinus
1. Investing layer
2. Meningeal branch of the ascending pharyngeal artery
Pretracheal layer
WN

Prevertebral layer Through the middle part

Carotid sheath 1. IX, X and XI cranial nerves
AMP

Buccopharyngeal fascia
Through the posterior part
Pharyngobasilar fascia. 1. Internal jugular vein
2. Meningeal branch of the occipital artery.
Investing layer
It lies deep to the platysma muscle and surrounds the neck The glossopharyngeal notch near the medial end of
like a collar. It forms the roof of the posterior triangle of the the jugular foramen lodges the inferior ganglion of the
neck. glossopharyngeal nerve.
Q.8. Foramen lacerum.
Pretracheal layer
Ans.
The importance of this fascia is that it encloses and suspends
the thyroid gland and forms its false capsule. A fibrous The foramen lacerum is a short, wide canal, 1 cm long. Its
band from this is attached to the cricoid cartilage known as lower end is bounded posterolaterally by the apex of the
ligament of Berry. petrous temporal, medially by the basiocciput and the body
of the sphenoid, and anteriorly by the root of the pterygoid
Prevertebral layer process and the greater wing of the sphenoid bone.

It lies in front of the prevertebral muscles, and forms the
floor of the posterior triangle of the neck.
Carotid sheath
It is a condensation of the fibroareolar tissue around the
main vessels of the neck. These are the common and internal
carotid arteries and internal jugular vein and the vagus
nerve.
Buccopharyngeal fascia
This fascia covers the superior constrictor muscle externally
and extends on to the superficial aspect of the buccinator
muscle.
The structures passing through the foramen lacerum are as
follows:
1. During life the lower part of the foramen is filled with
cartilage, and no significant structure passes through the
whole length of the canal, except for the meningeal
branch of the ascending pharyngeal artery and an
emissary vein from the cavernous sinus.
2. The upper part of the foramen is traversed by the inter-
nal carotid artery with venous and sympathetic plexuses
around it.
3. The nerve of the pterygoid canal, leaves the foramen by
entering the pterygoid canal in the anterior wall of the
foramen lacerum.
Q.9. Zygomatic arch.

Pharyngobasilar fascia Ans.

1. The zygomatic arch is formed by the temporal process
This fascia is especially thickened between the upper border
of superior constrictor and the base of the skull. It lies deep of the zygomatic bone in anterior one-third and the
to the pharyngeal muscles. zygomatic process of the temporal bone in posterior
two-thirds.
Q.7. Jugular foramen. 2. The arch is separated from the side of the skull by a gap.
3. The anterior end of the upper border is called the jugal
Or
point. The posterior end of the zygoma is attached to
Name any four structures passing though jugular the squamous temporal bone by anterior and posterior
foramen. roots.
Quick Review Series: BDS 1st Year

4. Two projections are visible in relation to these roots. One 2. Lateral border: It gives insertion to thyrohyoid muscle
is articular tubercle or tubercle of the root of zygoma at anteriorly.
its lower border and the other one is the mandibular or
articular fossa and is known as postglenoid tubercle. Ends

Q.10. Superior orbital fissure. 1. Anterior end: It unites with the body by synchondrosis.
2. Posterior end: It ends in a tubercle.
Ans.
Q.12. Surgical importance of pterion.
1. The superior orbital fissure is situated at the posterior part
of the junction between the roof and lateral wall of the orbit. Or
2. It is an oblique, roughly triangular space bounded
above by the lesser wing, below by the greater wing and Give the formation of pterion and structures
medially by the body of the sphenoid. related deep to it.
3. The lower border is marked by a small projection, which Ans.
provides the attachment to the common tendinous ring
1. The anterior part of the floor of temporal fossa is
of Zinn. The ring divides the fissure into three parts.
crossed by an H-shaped suture where four bones;
Q.11. Greater horn of hyoid. frontal, parietal, sphenoid and temporal adjoin each
Ans. other. This area is termed as the pterion.
2. It lies 4 cm above the midpoint of the zygomatic arch
Hyoid bone is a U-shaped bone suspended by stylohyoid or 4 cm above the zygoma and 2.5 cm behind the
ligaments and lies in front of the neck between the base of frontozygomatic suture.
mandible and the thyroid eminence (Fig. 1A.1.2). 3. The middle meningeal vein, the anterior division of the
Hyoid bone has following parts: middle meningeal artery and the stem of the lateral
1. Body sulcus of the brain lie deep to the pterion.
2. Two greater cornua Q.13. Name four arteries related to ramus of
3. Two lesser cornua. mandible.
Greater cornu or greater horn of hyoid bone projects Or
backwards on each side as a long slender process from the
Give the four arteries related to ramus of mandible.
lateral ends of the body.
Ans.
It possess: two surfaces: upper and lower,
two borders: medial and lateral and The four arteries related to ramus of the mandible are as
two ends: anterior and posterior. follows:
1. Mental vessels
Surfaces 2. Inferior alveolar vessels
Upper surface 3. Mylohyoid vessels
4, Masseteric vessels.
Gives origin to
1. Middle constrictor muscle of pharynx medially Q.14. List out four structures passing through
2. Hyoglossus muscle laterally. superior orbital fissure.

Gives insertion to Ans.

1. Stylohyoid near the junction of greater cornua with the Structures passing through superior orbital fissure are as
body. follows (Fig. 1A.1.4):
Gives attachment to 1. Superior and Inferior ophthalmic vein
1. Fibrous loop anchoring the central tendon of digastric . Lacrimal nerve
muscle to the hyoid bone.
WN

. Frontal nerve
. Recurrent meningeal branch of ophthalmic artery
Lower surface . Trochlear nerve
It has no attachments. Oculomotor nerve
SND

. Nasociliary nerve
Borders . Abducent nerve.

1. Medial border: It gives attachment to thyrohyoid Q.15. Name the muscles attached to greater cornua
membrane. of hyoid bone.
 General Anatomy

Trochlear nerve Lesser wing of sphenoid

Common tendinous ring

Recurrent meningeal branch of ophthalmic artery:
Lacrimal nerve
Frontal nerve
Superior ophthalmic nerve
Upper and lower divisions of oculomotor nerve
Nasociliary nerve
Abducent nerve
Inferior ophthalmic vein

Greater wing of sphenoid

Fig. 14.1.4 Structures passing through superior orbital fissure.

Ans. The middle meatus of nose lies beneath the middle conchae
engaging the structures like, the ethmoidal bulla hiatus
The medial border of the greater cornua provides attach-
semilunaris and infundibulum.
ment to the following muscles:
1. Thyrohyoid membrane The openings in the middle meatus of nose are as follows:
2. Stylohyoid muscle 1. The opening of the frontal air sinus in the anterior part
3. Digastric pulley. of the hiatus semilunaris.
2. The opening of the maxillary air sinus located in the
The lateral border of the greater cornua provides insertion
posterior part of the hiatus semilunaris.
to:
3. The opening of the middle ethmoidal air sinus is present
1. The thyrohyoid muscle
at the upper margin of the bulla.
2. The investing fascia.
Q.19. Give the attachments of pterygomandibular
Q.16. Structures passing through foramen ovale.
raphe and name the muscle attached to it.
Ans.
Ans.
The foramen ovale is large and oval in shape. It is situated
posterolateral to the upper end of the posterior border of the The pterygomandibular raphe is attached immediately
lateral pterygoid plate. behind the third molar tooth in continuation with the
origin of the superior constrictor.
The foramen ovale transmits the following:
The muscles attached to it are as follows:
1. Mandibular nerve
2. The lesser petrosal nerve 1. Superior constrictor muscle of pharynx
2. The buccinator muscle.
3. The accessory meningeal artery
4. An emissary vein connecting the cavernous sinus with Q.20. Ligaments attached to the mandibular
the pterygoid plexus of veins surface.
5. The anterior trunk of the middle meningeal vein.
Ans.
Q.17. Structures passing through anterior condylar
canal. Ligaments attached to the mandibular surface are as follows:
1. Sphenomandibular ligament
Ans. 2. Lateral ligament of temporomandibular joint.
1. The hypoglossal or anterior condylar canal pierces Q.21. Enumerate any four structures passing
the bone anterosuperior to the occipital condyle, and is through foramen magnum.
directed laterally and slightly forwards.
2. It transmits the hypoglossal nerve, the meningeal branch Ans.
of ascending pharyngeal artery, and an emissary vein con- The foramen magnum transmits the following structures:
necting the sigmoid sinus with the internal jugular vein. 1. Lowest part of medulla oblongata
2. Three meninges
Q.18. Openings in the middle meatus of the nose.
3. Spinal accessory nerves
Ans. 4. Vertebral arteries.
Quick Review Series: BDS 1st Year

Q.22. Name the contents of pterygopalatine fossa.
Ans.
Contents of pterygopalatine fossa are as follows:
1. Third part of the maxillary artery and its branches
2. Maxillary nerve and its two branches, zygomatic, and
posterior superior alveolar.
3. Pterygopalatine ganglion and its numerous branches
containing fibres of the maxillary nerve mixed with.

SCALP, TEMPLE AND FACE

LONG ESSAYS

Q.1. Enumerate the layers of scalp. Give their blood 5. The pericranium is the fifth layer of the scalp and is
supply, nerve supply and lymphatic drainage. loosely attached to the surface of the bones, but is firmly
adherent to their sutures where the sutural ligaments
Ans.
bind the pericranium to the endocranium.
The scalp is made up of five layers:
1. Skin Arterial Supply of Scalp and Superficial Temporal
Superficial fascia Region
wy

Deep fascia (epicranial aponeurosis or galea aponeurotica)

The scalp has a rich blood supply (Fig. 1A.2.1) derived
Loose areolar tissue
from both the internal and the external carotid arteries, the
ae

Pericranium.
two systems anastomose over the temple.
The skin is thick and hairy outermost layer of the scalp. In front of the auricle, the scalp is supplied from before
a

It is adherent to the epicranial aponeurosis through the backwards by the following:

dense superficial fascia. It contains large number of se- 1. Supratrochlear
baceous glands and is richly supplied by blood vessels. 2. Supraorbital
2. The superficial fascia is the second layer of scalp which 3. Superficial temporal arteries.
is more fibrous and dense in the centre than at the pe-
The first two are branches of the ophthalmic artery, which
riphery. It binds the skin to the adjacent aponeurosis,
is a branch of the internal carotid artery. The superficial
and provides the proper medium for passage of vessels
temporal is a branch of the external carotid artery.
and nerves to the skin.
Behind the auricle, the scalp is supplied from before
3. The deep fascia, i.e. the epicranial aponeurosis or galea
backwards by the following:
aponeurotica, is the third layer of scalp which is freely
1. Posterior auricular
movable on the pericranium along with the overlying
2. Occipital arteries.
adherent skin and fascia.
The occipitofrontalis muscle has two bellies, occipital Both are the branches of the external carotid artery.
and frontal, both of which are inserted into the epicra-
nial aponeurosis.
Anteriorly, it receives the insertion of the frontalis, Supratrochlear nerve
Supratrochlear artery
posteriorly it receives the insertion of the occipitalis Supraorbital artery
and is attached to the external occipital protuberance, Zygomaticotemporal
and to the highest nuchal lines in between the occipital nerve
bellies. Auriculotemporal Superficial temporal
nerve ye artery
On each side the aponeurosis is attached to the superior
| Pinna
temporal line, but sends down a thin expansion, which hase Sri) Posterior auricular
passes over the temporal fascia and is attached to the Lesser occipital DY artery
zygomatic arch. nerve
4. The fourth layer of the scalp is made up of loose areolar Greater occipital Occipital artery
tissue which extends anteriorly into the eyelids; posteri- nerve
Third occipital nerve
orly to the highest and superior nuchal lines and on
each side to the superior temporal lines. Fig. 14.2.1 Scalp showing arterial and nerve supply.
 General Anatomy

Lymphatic Drainage
1. Preauricular or parotid lymph nodes: This group of
lymph nodes drains the anterior part of the scalp. Zygomaticotemporal
nerve
2. Posterior auricular or mastoid and occipital lymph nodes:
The posterior part of the scalp drains in to this group of Zygomatic nerve
lymph nodes.
Infraorbital Maxillary nerve

Nerve Supply Pterygopalatine

ganglion
The scalp and temple are supplied by 10 nerves on each side.
Out of these, five nerves (four sensory and one motor) enter the Posterior
superior
scalp in front of the auricle. The remaining five nerves (again Anterior alveolar
four sensory and one motor) enter the scalp behind the auricle. superior nerve
alveolar Superior
Nerves of the scalp and nerve dental
superficial temporal regions plexus

Fig. 1A.2.2 Maxillary nerve and its branches.

Front of auricle Behind the auricle

It gives of meningeal branches to the dura mater of the

Sensory nerves Motor nerves
1. Supratrochlear 1. Temporal branch
middle cranial fossa.
2. Supraorbital branches of facial nerve
Within the pterygopalatine fossa:
3. Zygomaticotemporal
4. Auriculotemporal nerve 1. Ganglionic branches to join pterygopalatine ganglion
2. Zygomatic nerve:
a. Zygomaticotemporal
Sensory nerves Motor nerve b. Zygomaticofacial
1. Posterior division of great auricular 1. Posterior auricular
3. Posterior superior alveolar nerve
nerve (C2, C3), from cervical plexus branch of facial
2. Lesser occipital nerve (C2), nerve Within the floor of the orbit:
from cervical plexus
3. Greater occipital nerve (C2), dorsal ramus
1. Middle superior alveolar nerve
4. Third occipital nerve (C3), dorsal ramus 2. Anterior superior alveolar nerve
On the face:
Q.2. Describe the maxillary nerve under the follow-
1. Inferior palpebral branch
ing headings: origin, course, branches, distribution
2. Lateral nasal branch
and applied anatomy.
3. Superior labial branch.
Ans.
The posterior, middle and anterior superior alveolar
The maxillary nerve is a sensory nerve originating from ante- nerves enter the maxilla, and they form the superior dental
rior border of the trigeminal ganglion. It leaves the cranial plexus to supply the teeth of the upper jaw. Also they supply
cavity through the foramen rotundum and enters the pterygo the maxillary air sinus.
palatine fossa. It then enters the orbit through the inferior
orbital fissure. The nerve is accompanied by the infraorbital Ganglionic Branches
artery. The part of this nerve in the floor of the orbit is called
1. Sensations from the pharynx, nose, palate and orbit are
infraorbital nerve. In the floor of the orbit the nerve passes
carried by these fibres.
within the infraorbital canal. It then passes through the
2. It also receives secretomotor fibres through the nerve of
infraorbital foramen and enters the face and terminates by
the pterygoid canal to supply the lacrimal gland.
dividing into the following peripheral branches:
1. Inferior palpebral branch
Zygomatic Nerve
2. Lateral nasal branch
3. Superior labial branch. 1. It is a branch of maxillary nerve. It enters the orbit, and
divides into zygomaticofacial and zygomaticotemporal
Branches of maxillary nerve in detail are as follows
branches.
(Fig. 1A.2.2):
2. Zygomaticofacial nerve passes through the foramen of
Within the cranial cavity: the zygomatic bone to supply skin of malar region.
Quick Review Series: BDS 1st Year

3. Zygomaticotemporal nerve enters the scalp and supplies The sensory root commences from the anterior border of
the skin of the temporal region and anterior quadrant of the trigeminal ganglion. The motor root of the mandibular
scalp. It carries parasympathetic fibres to the lacrimal nerve lies deep to the trigeminal ganglion.
nerve to supply lacrimal gland.
Mandibular Nerve (Fig. 1A.2.3)
Posterior Superior Alveloar Nerve
Course
1. It enters the maxilla through an opening on the poste-
1. The two roots pass through the foramen ovale and enter
rior wall of maxilla. It supplies the mucous membrane
the infratemporal fossa. Just below the foramen ovale,
of maxillary air sinus. It joins superior dental plexus.
the two roots unite to form the main trunk of the man-
2. The posterior superior alveolar nerve via this plexus
dibular nerve.
supplies the molar teeth of the upper jaw and related
gum of the maxilla.

Middle Superior Alveolar Nerve

1. It is formed within the infraorbital canal, i.e. on the roof
Nervous
of maxillary air sinus. spinosus
2. Its branches specifically supply the premolar teeth and
sometimes join the superior dental plexus. Auriculotemporal
nerve
Anterior Superior Alveolar Nerve
1. It is a branch of infraorbital part of maxillary nerve,
which passes downwards into the anterior part of maxil-
lary sinus. It divides into dental and nasal branches. Lingual nerve
2. The dental branch forms the superior dental plexus by
Nerve to
joining posterior superior and middle superior alveolar mylohyoid
nerves. Through this plexus it supplies the incisor and
. Inferior alveolar nerve
canine teeth of the upper jaw. The nasal branch supplies Mylohyoid
lower half of lateral wall of nose.
Mental nerve
Palpebral Branches
They supply skin of the lower eyelid and related conjunctiva.
Anterior belly
Nasal Branches of digastric

They supply the skin on the lateral side of external nose. Fig. 1A.2.3 Mandibular nerve. Mpt, nerve to medial pterygoid;
Mas, masseteric nerve; Temp, nerve to temporalis and Lot,
nerve to lateral pterygoid.
Superior Labial Branches
They supply skin and mucous membrane of the lip and
cheek.
2. The main trunk is medially related to the tensor veli pala-
tini muscle and laterally related to lateral pterygoid mus-
Applied Anatomy cle. The otic ganglion is situated on the medial side of the
nerve trunk. After a short course, the trunk of the nerve
During trigeminal neuralgia pain along the course of all divides into two divisions: (a) anterior and (b) posterior.
branches of trigeminal nerve including maxillary nerve.
During cavernous sinus thrombosis, this nerve may be com- Branches of Mandibular Nerve
pressed by blood clot.
Branches from main trunk
Q.3. Describe the course, branches and distribu-
1. Meningeal branch
tion of mandibular division of trigeminal nerve.
2. Nerve to medial pterygoid.
Ans.
Branches from anterior division
Mandibular nerve is the largest of the three divisions of the
trigeminal nerve. It is a mixed nerve carrying both sensory 1. Deep temporal
and motor roots. 2. Lateral pterygoid
 General Anatomy

3. Masseteric mandible and sphenomandibular ligament behind the tem-

4. Buccal. poromandibular joint, running behind the superficial tem-
poral vessels. It pierces the upper border of the parotid gland
Branches from posterior division and crosses the zygomatic arch and then it enters the tempo-
ral fossa (Fig. 1A.2.4).
1. Auriculotemporal
2. Lingual
3. Inferior alveolar. Middle meningeal artery
Auriculotemporal
Branches of mandibular nerve and their distribution in Mandibular nerve
detail are as follows: nerve

Branches from the main trunk

1. Nervous spinosus or meningeal branch:

It enters the skull through the foramen spinosum along
with the middle meningeal artery and supplies the dura
mater of the middle cranial fossa.
2. Nerve to medial pterygoid muscle:
It supplies the medial pterygoid muscle and then it en-
ters the otic ganglion. Through this ganglion it supplies
Fig. 1A.2.4 Auriculotemporal nerve.
tensor tympani and tensor veli palatini muscles.

Branches from the anterior division

1. The anterior division is mainly motor, and it has some
sensory fibres.
2. The anterior division gives the following branches:
a. Nerve to masseter:
It crosses above the tendon of the lateral pterygoid
muscle. It is accompanied by the artery to masseter. It
then passes through the mandibular notch. It supplies
masseter muscle and temporomandibular joint.
b. Nerve to lateral pterygoid muscle:
This branch enters the medial surface of lateral
pterygoid muscle.
c. Nerve to temporalis (deep temporal nerves):
They are two in number emerging from the upper
border of the lateral pterygoid muscle and are
accompanied by deep temporal arteries. They supply
deep surface of temporalis.
d. Buccal nerve:
It gives the following branches:
1. Auricular branches to supply external ear
2. Temporal branches to supply the skin of the temporal
region
3. Glandular branches to supply the parotid gland
4. Branch to the temporomandibular joint.
2. Inferior alveolar nerve (Fig. 1A.2.5)
It is a mixed nerve arising from posterior division of the
mandibular nerve in the infratemporal fossa.
Course: It emerges below the lower border of the lateral ptery-
goid muscle accompanied by the inferior alveolar artery and
is situated posterior to lingual nerve. The nerve passes
Lateral pterygoid muscle

It is sensory nerve which passes between the two

heads of the lateral pterygoid accompanied by the
buccal artery. This nerve supplies the skin and mu- Inferior alveolar nerve

cosa of the cheek. Inferior alveolar artery

Branches from the posterior division

The posterior division of the mandibular nerve is mainly
sensory and with few motor fibres, it gives rise to the follow-
ing nerves: Incisive
nerve
1. Auriculotemporal nerve
This nerve has double roots of origin, which unite to form a Mental nerve
single nerve which passes backwards and lies deep to the
lateral pterygoid muscle. Further, it passes between neck of Fig. 1A.2.5 Inferior alveolar nerve.
Quick Review Series: BDS 1st Year

downwards deep to the sphenomandibular ligament. It enters Origin

the mandibular foramen and passes within the mandible.
It originates from the external carotid artery just above the
It supplies the pulp and periodontium of mandibular teeth.
greater horn of the hyoid bone within the carotid triangle.
It terminates within the mandible as:
1. Incisive nerve Course
2. Mental nerve—emerging through the mental foramen.
It passes upwards and grooves the submandibular gland and
Branches of inferior alveolar nerve are as follows: then turns downwards lateral to the submandibular gland
1. Nerve to mylohyoid — this nerve is given off before the and reaches the lower border of the mandible (Fig. 1A.2.6).
inferior alveolar nerve enters the mandibular foramen. It pierces the stylomandibular ligament.
It pierces the sphenomandibular ligament. It is accom-
panied by artery to the mylohyoid and this nerve termi-
nates by supplying the anterior belly of the digastric and
mylohyoid muscles.
2. Branches to supply molar and premolar teeth and re-
lated gum. These branches form inferior dental plexus.
3. Incisive branch — it passes within the incisive canal
supplying incisors and canine teeth. Angular artery
4. Mental branch — mental nerve emerges through the men-
tal foramen and supplies soft tissues of lower lip and chin.
Lateral nasal artery
3. Lingual nerve
Ascending / /
It arises within the infratemporal fossa from the posterior palatine Superior labial artery
division of the mandibular nerve.
Inferior labial artery
External
Course: It is joined by the chorda tympani branch of the fa- carotid artery
Submental artery
cial nerve within the infratemporal fossa and emerges along
‘Tonsillar artery
the lower border of the lateral pterygoid muscle. It lies in Facial artery
front of the inferior alveolar nerve and vessels. The nerve is
Fig. 1A.2.6 Course of facial artery.
superficially situated medial to the mandibular third molar
covered only by the oral mucous membrane. It then crosses
the hyoglossus muscle and loops around the submandibular 1. It enters the face by winding around the base of the
duct, terminates by supplying the mucous membrane of the mandible, and by piercing the deep cervical fascia, at the
anterior two-thirds of the tongue. anteroinferior angle of the masseter muscle where it can
Branches of lingual nerve are as follows: be palpated and is called ‘anaesthetist’s artery.
2. First it runs upwards and forwards to a point 1.25 cm lateral
Branches to supply
to the angle of the mouth. Then it ascends by the side of the
1. The mucous membrane of the floor of the mouth
nose up to the medial angle of the eye, where it terminates
2. The gums of the mandible
by supplying the lacrimal sac; and by anastomosing with
3. The mucous membrane of the anterior two-thirds of
the dorsal nasal branch of the ophthalmic artery.
tongue.
3. The facial artery is very tortuous and lies between the
Communications of the lingual nerve superficial and deep muscles of the face.
It communicates with:
Branches of the facial artery in the neck are as follows
1. Chorda tympani nerve within the infratemporal fossa
(Fig. 1A.2.7):
2. Submandibular ganglion and hypoglossal nerve, when it
1. Ascending palatine artery
lies on the hyoglossus
2. Tonsillar artery to supply the palatine tonsil
3. The inferior alveolar nerve rarely.
3. Glandular branches to supply the submandibular gland
Q.4. Describe the origin, course, relation and and submandibular lymph glands
branches of facial artery. 4. Submental artery.
Ans. Branches on the face are as follows:
The facial artery is the main artery of the face where it is The anterior branches on the face are large and named as follows:
located within the muscles of facial expression. The artery is 1. Inferior labial artery to supply the lower lip
tortuous in its facial course. 2. Superior labial artery to supply the upper lip and nose
 General Anatomy

3. Lateral nasal artery

Supraorbital 4. Muscular branches to the muscles of facial expression.
artery
Supratrochlear Applied Anatomy
<1 artery
During injury of the face bleeding from the facial artery
XN Transverse can be stopped by compressing the artery against the lower
= facial artery
border of mandible. In the lips branches of the facial artery
Lateral nasal
co artery are found nearer to the mucous membrane than to the skin.
Hence, injuries caused by the teeth on the mucous membrane
Superior
labial artery of the mouth may develop hidden hematomas. The labial
Inferior labial
branches of the facial artery of both sides are communicating
artery around the mouth. This communication forms anastomosis
between the external carotid arteries of both sides.
Fig. 1A.2.7 Branches of facial artery on the face.

SHORT ESSAYS

Q.1. Facial artery. Actions

Or 1. It compresses the cheek against the teeth thereby

Origin, course, relation and branches of facial artery.
Ans.
Refer to the answer of Long Essay Q. 4.
Q.2. Buccinator muscle.
Ans.
The buccinator muscle also known as trumpet muscle
is the chief muscle of the cheek. This muscle is covered by
the buccopharyngeal fascia and buccal pad of fat. It is
pierced by the parotid duct opposite to maxillary second
molar.
Origin
1. From lateral surface of alveolar processes of the maxilla
and mandible at the level of the third molar tooth
2. From anterior border of pterygomandibular raphe.
Insertion
All the fibres converge at the angle of the mouth and fuse
with the fibres of the orbicularis oris.
Nerve Supply
Buccal branch of the facial nerve supplies the buccinators muscle.
Applied Anatomy
prevents the food accumulation within the vestibule
of the mouth during mastication and also helps in
sucking.
2. It helps to blow the cheek.
Q.3. Cutaneous innervation of face.
Or
Mention the sensory nerve supply to the face.
Ans.
Sensory Nerve Supply of the Face
1. The trigeminal nerve is the chief sensory nerve of the
face.
2. The skin over the angle of the jaw and over the parotid
gland is supplied by the great auricular nerve (C2, C;).
3. The trigeminal nerve also supplies sensory innervations
to eyeball, the oral cavity, palate, cheeks, gums, teeth and
anterior two-thirds of tongue and the supratentorial
part of the dura mater including that lining the anterior
and middle cranial fossae.
The following branches of ophthalmic division of trigeminal
nerve supply scalp up to vertex, forehead, upper eyelid,
conjunctiva, small part of lower eyelid and root, dorsum and
tip of nose:
1. Supratrochlear nerve
. Supraorbital nerve
wh

. Lacrimal nerve
During the facial nerve injury, the paralysis of the buccinator . Infratrochlear nerve
Ue

muscle leads to inability to blow the cheek. . External nasal nerve.

1 Quick Review Series: BDS 1st Year
Maxillary division of trigeminal nerve
1. Infraorbital nerve
2. Zygomaticofacial nerve
3. Zygomaticotemporal nerve.
These branches supply upper lip; side and ala of nose;
most of the lower eyelid; upper part of cheek and anterior
part of temple.
Mandibular division of trigeminal nerve
1. Auriculotemporal nerve
2. Buccal nerve
3. Mental nerve.
This division supplies lower lip; chin; lower part of cheek;
lower jaw except over the angle; upper two-thirds of lateral
surface of auricle; and side of head.
Cervical plexus
1. Anterior division of great auricular nerve (C, Cs)
2. Upper division of transverse (anterior) cutaneous nerve
of neck (C3, C3).
They supply the skin over the angle of the jaw and over
the parotid gland. Lower margin of the lower jaw.
Q.4. Connections, course and distribution of chorda
tympani.
Ans.
1. In the vertical part of the facial canal, the chorda tym-
pani nerve arises about 6 mm above the stylomastoid
foramen and runs upwards and forwards in a bony canal
then enters the middle ear and runs forwards in close
relation to the tympanic membrane (Fig. 1A.2.8).
2. It leaves the middle ear by passing through the
petrotympanic fissure, it then passes medial to the spine
of the sphenoid and enters the infratemporal fossa
where it joins the lingual nerve through which it is
distributed.
3. It carries preganglionic secretomotor fibres to the sub-
mandibular ganglion for supply of the submandibular
VII nerve
Otic ganglion
(Facial nerve) Mandibular nerve
Auriculotemporal Masseteric
IX nerve
Chorda tympani
Fig. 1A.2.8 Distribution of mandibular nerve (V3).
and sublingual salivary glands and taste fibres from the
anterior two-thirds of the tongue.
Q.5. Give a short account of paris, relation and
nerve supply of lacrimal gland.
Ans.
1. Lacrimal gland is a serous gland which is ‘J’ shaped,
being indented by the tendon of the levator palpebrae
superioris muscle situated chiefly in the lacrimal fossa
on the lateral part of the roof of the bony orbit and
partly on the upper eyelid. Small accessory lacrimal
glands are found in the conjunctival fornices.
2. The parts of lacrimal gland are as follows:
a. A palpebral part: smaller and superficial, lying within
the eyelid
b. An orbital part: which is larger and deeper.
3. About a dozen of its ducts pierce the conjunctiva of the
upper lid and open into the conjunctival sac near the
superior fornix. Most of the ducts of the orbital part
pass through the palpebral part.
4. The gland is supplied by the lacrimal branch of the
ophthalmic artery and by the lacrimal nerve. The nerve
has both sensory and secretomotor fibres.
The course of secretomotor fibres is as follows:
Lacrimatory nucleus
Nerves sdermadio
Geniculate ganglion
Greater petrosal nerve
Nerve of pterygoid canal
Pterygopalatine ganglion
Relay
Zygomatic and zygomaticotemporal nerve
Lacrimal nerve
Lacrimal gland
The lacrimal fluid secreted by the lacrimal gland flows
into the conjunctival sac where it lubricates the front of
the eye and the deep surface of the lids. Most of the fluid
evaporates. The rest is drained by the lacrimal canaliculi.
When excessive, it overflows as tears.
 General Anatomy

SHORT NOTES

Q.1. Platysma. Q.4. Facial vein.

Ans. Ans.

1. Platysma is one of the muscles of neck.
2. It originates from the upper parts of pectoral and
deltoid fasciae and fibres run upwards and medially.
3. Anterior fibres get inserted to the base of the mandible
and posterior fibres to the skin of the lower face and lip,
and may be continuous with the risorius.
4. Actions of platysma are as follows:
a. Releases pressure of skin on the subjacent veins
b. Depresses the mandible
c. Pulls the angle of the mouth downwards as in horror
or surprise.
Q.2. Buccinator.
Ans.
Buccinator is the muscle of the cheek.
Origin
1. Upper fibres, from maxilla opposite molar teeth
2. Lower fibres, from mandible, opposite molar teeth
3. Middle fibres, from pterygomandibular raphe.
Insertion
1. Upper fibres, straight to the upper lip.
2. Lower fibres, straight to the lower lip.
3. Middle fibres decussate before passing to the lips.
Actions
1. Flattens cheek against gums and teeth.
2. Prevents accumulation of food in the vestibule.
Q.3. Bell’s palsy.
1. The facial vein is the largest vein of the face with no
valves.
2. It begins as the angular vein at the medial angle of the eye.
3. It is formed by the union of the supratrochlear and su-
praorbital veins. The angular vein continues as the facial
vein, running downwards and backwards behind the
facial artery but with a straighter course.
4. It crosses the anteroinferior angle of the masseter, pierces
the deep fascia, crosses the submandibular gland, and
joins the anterior division of the retromandibular vein
below the angle of the mandible to form the common
facial vein. The latter drains into the internal jugular vein.
Q.5. Facial artery.
Ans.
1. The facial artery (facial part) is the chief artery of the
face. It is a branch of the external carotid artery given off
in the carotid triangle just above the level of the tip of
the greater cornua of the hyoid bone.
2. In its cervical course, it passes through the submandibu-
lar region, and finally enters the face.
3. The anterior branches on the face are as follows:
a. Inferior labial — to the lower lip.
b. Superior labial — to the upper lip and the anteroin-
ferior part of the nasal septum.
c. Lateral nasal — to the ala and dorsum of the nose.
d. The posterior branches are small and unnamed.
Q.6. Orbicularis oculi.
Ans.
Orbicularis oculi is explained in Table 1A.2.1.

Ans. Table 1A.2.1 Orbicularis oculi

Infranuclear lesions of the facial nerve are known as Bell’s Muscle Origin Insertion Action
palsy. The features of Bell’s palsy are as follows: 1. Orbital Part of medial Concentric Closes lids
1. The face becomes asymmetrical and is drawn up to the part palpebral liga- rings return to tightly; protects
normal side. ment and adjoin- the point of eye from bright
. The affected side is motionless. ing bone origin light
kwh

. Wrinkles disappear from the forehead. 2. Palpebral Lateral part of Lateral palpe- Closes lids gen-
The eye cannot be closed. part medial palpebral __ bral raphe tly; blinking
. Any attempt to smile draws the mouth to normal side. ligament
DAw

. During mastication, food accumulates between the 3. Lacrimal Lacrimal fascia Upper and Dilates lacrimal
teeth and the cheek. part and lacrimal bone lower eyelids sac; supports
the lower eyelid
7. Articulation of labials is impaired.
Quick Review Series: BDS 1st Year

Q.7. Deep facial vein.

Ans. Yo My 1_skin
—Superficial fascia
1. Deep connections of the facial vein include a communi- Epicranial aponeurosis
cation between the supraorbital and pterygoid plexus Loose connective tissue
Pericranium
through the deep facial vein, which passes backwards
over the buccinator. Dura mater
2. The facial vein communicates with the cavernous sinus Fig. 1A.2.10 Layers of scalp.
through these connections.
3. Infections from the face can spread in a retrograde
direction and cause thrombosis of the cavernous sinus. passes over the temporal fascia and is attached to the
This is especially likely to occur in the presence of infec- zygomatic arch.
tion in the upper lip and in the lower part of the nose.
Q.11. Palatine aponeurosis.
Q.8. Palpebral ligament.
Ans.
Ans.
The posterior border of the hard palate provides attachment
The palpebral fascia of the two lids forms the orbital septum. to the palatine aponeurosis.
Its thickenings form tarsal plates of tarsi in the lids and the
Q.12. Nasolacrimal apparatus.
palpebral ligaments at the angles.
Or
Q.9. Dangerous area of scalp.
Name the structures forming lacrimal apparatus.
Ans.
Ans.
Infections from the face can spread in a retrograde direction
and cause thrombosis of the cavernous sinus. This is likely to The structures concerned with secretion and drainage of the
occur in the presence of infection in the upper lip and in the lacrimal or tear fluid constitute the lacrimal apparatus. It is
lower part of the nose. This area is, therefore, called the dan- made up of the following parts:
gerous area of the face (Fig. 1A.2.9). . Lacrimal gland and its ducts
Whe

. Conjunctival sac
. Lacrimal puncta and lacrimal canaliculi
ON . Lacrimal sac
Te

. Nasolacrimal duct.
Q.13. Levator palpebrae superioris.
Ans.
Levator palpebrae superioris muscle is an eye opener (or)
dilator muscle.

Origin
Fig. 1A.2.9 Dangerous area of the face.
It originates from the following:
1. Inferior surface of the lesser wing of the sphenoid bone
Q.10. Epicranial aponeurosis. 2. Orbital surface of the body of the sphenoid bone
anterior to the optic foramen.
Ans.
1. The epicranial aponeurosis or galea aponeurotica is the Insertion
third layer of scalp and is freely movable on the pericra-
It expands towards the upper eyelid and divides into super-
nium along with the overlying and adherent skin and
ficial and deep layers, which are inserted to:
fascia (Fig. 1A.2.10).
1. Orbital septum and palpebral ligaments (medial and
2. Anteriorly, it receives the insertion of the frontalis; pos-
lateral)
teriorly, it receives the insertion of the occipitalis and it
2. Superior tarsal plate
is attached to the external occipital protuberance, and to
3. Skin of the upper eyelid.
the highest nuchal lines in between the occipital bellies.
On each side the aponeurosis is attached to the superior The smooth muscle fibres of the levator palpebrae
temporal line, but sends down a thin expansion, which superioris is called as Muller’s muscle.
 General Anatomy

The aponeurosis of this muscle divides the lacrimal gland The cervical branches of facial artery are as follows:
into palpebral and orbital parts. 1. Ascending palatine artery
2. Tonsillar artery
Nerve Supply 3. Glandular branches
4. Submental artery.
1. Upper division of the oculomotor nerve.
2. Sympathetic fibres from T, segment of the spinal cord Q.15. Give the formation and termination of ante-
supplies the smooth muscle fibres of the muscle. rior facial vein.

Actions Ans.
It elevates the upper eyelid. Facial (anterior facial) vein, corresponds in general, to the
facial artery. The facial vein takes its origin from the junction
Applied Anatomy of the veins of the forehead and nose. Its upper part is
Paralysis of the muscle causes ptosis (drooping of the upper termed the angular vein and accompanies the angular artery.
eyelid). Paralysis of the smooth muscle fibres of this muscle The angular vein receives the frontal vein, the supraorbital
causes pseudoptosis (Horner’s syndrome). vein and veins from the lower lid and from the bridge of
the nose. From the inner corner of the eye, the facial vein
Q.14. Name the cervical branches of facial artery.
descends in a fairly straight line to the lower border of the
Ans. mandible.

LONG ESSAY

Q.1. Describe the boundaries and contents of Boundaries

subclavian triangle.
Anterior: posterior border of sternocleidomastoid
Ans.
Posterior: anterior border of trapezius
The subclavian triangle is a small lower part of posterior
Inferior or base: middle one-third of clavicle
triangle of neck. The posterior triangle is a space on the side
of the neck situated behind the sternocleidomastoid muscle Apex: lies on the superior nuchal line where the trapezius
(Fig. 1A.3.1). The posterior triangle of neck is subdivided by and sternocleidomastoid meet.
the inferior belly of the omohyoid into
1. A larger upper part, called the occipital triangle Roof
2. A smaller lower part, called the supraclavicular or the
The roof is formed by the investing layer of deep cervical fascia.
subclavian triangle.
Floor

The floor of the posterior triangle is formed by the preverte-

bral layer of deep cervical fascia, covering the following

4
Trapezius
muscles (Fig. 1A.3.2):
Sternocleidomastoid
1. Splenius capitis
2. Levator scapulae
Posterior triangle (occipital part) 3. Scalenus medius and occasionally scalenus posterior.
Superior belly of omohyoid
Inferior belly of omohyoid
The contents of subclavian triangle are listed in Table 1A.3.1.
Posterior triangle
Nerves
(Subclavian part)
Clavicle
1. Three trunks of the brachial plexus emerge between
Fig. 14.3.1 Posterior triangle of the neck. the scalenus anterior and medius, and carry the axillary
Quick Review Series: BDS 1st Year

passes over the serratus anterior in the medial wall of the

axilla and gives branches to the digitations of the muscle.
3. The nerve to the subclavius (C5, C6) descends in front
Splenius capitis of the brachial plexus and the subclavian vessels, to
reach the deep surface of the subclavius muscle. As it
Levator scapulae runs near the lateral margin of the scalenus anterior,
sometimes it gives off the accessory phrenic nerve, which
joins the phrenic nerve in front of the scalenus anterior.
> Trunks of branchial plexus
4. The suprascapular nerve (C5, C6) arises from the upper
Scalenus anterior trunk of the brachial plexus and crosses the lower part
Scalenus medius
Scalenus posterior
of the posterior triangle. It passes backwards over the
shoulder to reach the scapula. It supplies the supraspi-
Subclavian artery natus and infraspinatus muscles.
Subclavian vein
Fig. 1A.3.2 Floor of the posterior triangle of neck. Vessels

1. The subclavian artery passes behind the tendon of the

scalenus anterior and the subclavian vein passes in front
Table 1A.3.1 Contents of subclavian triangle of the tendon.
Nerves a. Three trunks of brachial plexus 2. The suprascapular artery is a branch of the thyrocervical
b. Nerves to serratus anterior (long thoracic, C5, C6, C7) trunk which passes laterally and backwards behind the
clavicle.
c. Nerves to subclavius (C5, C6)
3. The transverse cervical artery is also a branch of the
d. Suprascapular nerves (C5, C6)
thyrocervical trunk. It crosses the scalenus anterior, the
Lymph — A few members of the supraclavicular chain phrenic nerve, and the upper trunks of the brachial
nodes
plexus, the nerve to the subclavius, the suprascapular
nerve and the scalenus medius. At the anterior border of
the levator scapulae it divides into superficial and deep
sheath around them (Fig. 1A.3.3). The sheath contains
branches.
the brachial plexus and the subclavian artery.
2. The nerves to serratus anterior (long thoracic, C5, C6,
Lymph Nodes
C7) arise by three roots. The roots from C5 and C6 pierce
the scalenus medius and join the root C7. The nerve A few members of the supraclavicular chain.

Suprascapular nerve
Dorsal scapular nerve

Nerve to subclavius

Long thoracic nerve

Musculocutaneous nerve Upper subscapular nerve

Nerve to latissimus dorsi
Lower subscapular nerve
Medial pectoral nerve
Axillary nerve Medial cutaneous nerve of arm
Medial cutaneous nerve of forearm
Lateral root
and medial root Radial nerve Ulnar nerve
of median nerve Median nerve

Fig. 1A.3.3 Brachial plexus.

 General Anatomy

SHORT ESSAYS

Q.1. Carotid sheath. Relations

Or 1. The ansa cervicalis lies embedded in the anterior wall of

the carotid sheath.
Brief account of carotid sheath and its contents.
2. The cervical sympathetic chain lies behind the sheath,
Or attached to the prevertebral fascia.
3. The sheath is overlapped by the anterior border of the
Formation, attachments, relation and contents of
sternocleidomastoid, and is fused to the first three layers
carotid sheath.
of the deep cervical fascia.
Ans.
Q.2. Describe torticollis.
Carotid Sheath Ans.
Carotid sheath is a condensation of the fibroareolar tissue Torticollis or wryneck is a deformity as a result of spasm or
around the main vessels of the neck, namely (Fig. 1A.3.4): contracture of the muscles supplied by the spinal accessory
1. The common carotid artery nerve, namely the sternocleidomastoid and trapezius. In this
. Internal carotid artery deformity the head is bent to one side and the chin points to
hd

. Internal jugular vein the opposite side.

WwW

. The vagus nerve.

Bm

Depending on the causes, there are many varieties of torticollis,

as follows:
1. Rheumatic torticollis, due to exposure to cold or draught
Ansa cervicalis 2. Reflex torticollis, due to inflamed or suppurating cervical
lymph nodes, which irritate the spinal accessory nerve
3. Congenital torticollis, due to birth injury
4. Spasmodic torticollis, due to central irritation.
Internal jugular vein
Q.3. General investing layer of deep cervical fascia.

Common carotid artery

Ans.

Deep Cervical Fascia (Fascia Coli) (Fig. 14.3.5)

Vagus nerve
The deep fascia of the neck is condensed to form the following
layers:
1. Investing layer
Os ympatthetic trunk
2. Pretracheal layer
Fig. 1A.3.4 Carotid sheath with its contents (sectional view). 3. Prevertebral layer

Pretracheal fascia
a Investing 9g fascia
Sternocleidomastoid
Trachea
Platysma Carotid sheath
External jugular vein Oesophagus
% Fused prevertebral
and buccopharyngeal fasciae
Prevertebral fascia

Longus cervicis

Fig. 1A.3.5 Transverse section through the neck showing general investing fascia.
Quick Review Series: BDS 1st Year

4. Carotid sheath The supraclavicular space is traversed by:

5. Buccopharyngeal fascia a. The external jugular vein
6. Pharyngobasilar fascia. b. The supraclavicular nerves
c. Cutaneous vessels, including lymphatics.
Investing Layer of Deep Cervical Fascia
Q.4. Give the attachments, nerve supply and
It lies deep to the platysma, and surrounds the neck like a actions of sternocleidomastoid.
collar. It forms the roof the posterior triangle of the neck.
Ans.
Attachments The sternocleidomastoid and trapezius are large superficial
Superiorly muscles of the neck.
1. External occipital protuberance Attachments
2. Superior nuchal line
3. Mastoid process Attachments of sternocleidomastoid are as shown in Fig. 1A.3.1.
4. Base of the mandible.
Origin
Between the angle of the mandible and the mastoid
process, the fascia splits to enclose the parotid gland. 1. The sternal head arises from the superolateral part of
the front of the manubrium sterni.
inferiorly 2. The clavicular head arises from the medial one-third of
the superior surface of the clavicle. It passes deep to the
. Spine of scapula
sternal head, and the two heads blend below the middle
whe

. Acromion process
of the neck. Between the two heads there is a small
. Clavicle
triangular depression of the lesser supraclavicular fossa,
. Manubrium.
Be

overlying the internal jugular vein.

The fascia splits to enclose the suprasternal and supracla-
vicular spaces. Insertion

Posteriorly It is inserted (a) by a thick tendon into the lateral surface of

1. Ligamentum nuchae
2. Spine of the seventh cervical vertebra.
Anteriorly
1. Symphysis menti
2. Hyoid bone.
Both above and below the hyoid bone, it is continuous
with the fascia of the opposite side.
Other Features
1. The investing layer of deep cervical fascia splits to en-
close the following structures:
a. Muscles—trapezius and sternocleidomastoid
b. Salivary glands—parotid and submandibular
c. Spaces—suprasternal and supraclavicular.
2. It also forms pulleys to bind the tendons of the digastric
and omohyoid muscles. The suprasternal space contains:
a. The sternal heads of the right and left sternocleido-
mastoid muscles
b. The jugular venous arch
c. Alymph node
d. The interclavicular ligament.
the mastoid process, from its tip to the superior border, and
(b) by a thin aponeurosis into the lateral half of the superior
nuchal line of the occipital bone.
Nerve Supply
1. The motor supply is by the spinal accessory nerve.
2. Proprioception by branches from the ventral rami of C2.
Blood Supply
Arterial supply one branch each from superior thyroid ar-
tery and supra scapular artery and two branches from the
occipital artery. Veins follow the arteries.
Actions
1. When one muscle contracts:
a. It turns the chin to the opposite side.
b. It can also tilt the head towards the shoulder.
2. When both muscles contract together:
a. They draw the head forwards, as in eating and in
lifting the head from a pillow.
b. With the longus colli, they flex the neck against resistance.
c. The reverse action in forced inspiration.
 General Anatomy

Relations v. Phrenic
vi. Ansa cervicalis
The sternocleidomastoid is enclosed in the investing layer of
g. Lymph nodes
deep cervical fascia, and pierced by the accessory nerve and
i. Deep cervical.
by the four sternocleidomastoid arteries. It has the following
relations: Q.5. Give the formation, course and termination of
1. Superficial external jugular vein.
Skin
Ans.
TS

. Superficial fascia with platysma muscle

. Superficial lamina of the deep cervical fascia The external jugular vein lies deep into the platysma (Fig. 1A.3.6).
. External jugular vein 1. It is formed by the union of the posterior auricular vein
mein

. Superficial cervical lymph nodes lying along the vein with the posterior division of the retromandibular vein.
. Nerves 2. It begins within the lower part of the parotid gland,
i. Great auricular crosses the sternocleidomastoid obliquely, pierces the
ii. Transverse or anterior cutaneous anteroinferior angle of the roof of the posterior triangle,
iii. Medial supraclavicular nerves and opens into the subclavian vein.
g. The parotid gland overlaps the muscle. 3. Its tributaries are (a) the posterior external jugular vein,
2. Deep (b) the transverse cervical vein; (c) the suprascapular
a. Bones and joints vein and (d) the anterior jugular vein. The oblique
i. Mastoid process above jugular vein connects the external jugular vein with the
ii. Sternoclavicular joint below internal jugular vein across the middle one-third of the
b. Carotid sheath anterior border of the sternocleidomastoid.
c. Muscles
i. Sternohyoid Superficial Retromandibular vein
ii. Sternothyroid temporal vei
iii. Omohyoid
iv. Three scalene
v. Levator scapulae
vi. Splenius capitis
vii. Longissimus capitis
viii. Posterior belly of digastric
d. Arteries
i. Common carotid Common facial
ii. Internal carotid External
vein

iii. External carotid

iv. Sternomastoid arteries two from the occipital Anterior jugular
vein
artery, one from the superior thyroid, one from
the suprascapular Fig. 1A.3.6 External jugular vein.
v. Occipital
vi. Subclavian Q.6. Boundaries and contents of posterior triangle.
vii. Suprascapular
viii. Transverse cervical Ans.
e. Veins The posterior triangle is the space on the side of the
i. Internal jugular neck situated behind the sternocleidomastoid muscle
ii. Anterior jugular (Fig. 1A.3.1). The posterior triangle is bounded:
iii. Facial
Anteriorly by: posterior border of sternocleidomastoid.
iv. Lingual
f. Nerves Posteriorly by: anterior border of trapezius.
i. Vagus
Inferiorly or base by: middle one-third of clavicle.
ii. Accessory
iii. Cervical plexus Apex lies on the superior nuchal line where the trapezius and
iv. Upper part of brachial plexus sternocleidomastoid meet (Table 1A.3.2).
 Quick Review Series: BDS 1st Year

Table 1A.3.2 Contents of the posterior triangle

Content Occipital triangle Subclavian triangle
Nerves 1. Spinal accessory nerve 1. Three trunks of brachial plexus
2. Four cutaneous branches cervical plexus: 2. Nerve to serratus anterior (long thoracic, C5, C6, C7)
a. Lesser occipital (C2) 3. Nerve to subclavius (C5,C6)
b. Great auricular (C2,C3) 4. Suprascapular nerve (C5, C6)
c. Anterior cutaneous nerve
d. Supraclavicular nerves (C3, C4)
3. Muscular branches:
a. Two small branches to the levator scapulae (C3, C4)
b. Two small branches to the trapezius (C3, C4)
c. Nerve of rhomboideus (C5)
4. Upper part of the brachial plexus
Vessels 1. Transverse cervical artery and vein 1. Third part of subclavian artery and subclavian vein
2. Occipital artery 2. Suprascapular artery and vein
3. Commencement of transverse cervical artery and termination
of the corresponding vein
4. Lower part of external jugular vein
Lymph Along the posterior border of the sternocleidomastoid, more A few members of the supraclavicular chain
nodes in the lower part, the supraclavicular nodes and a few at the
upper angle the occipital nodes

SHORT NOTES

Q.1. Occipital artery. 5. Buccopharyngeal fascia

6. Pharyngobasilar fascia.
Ans.
The applied anatomy of the deep cervical fascia:
Occipital artery commences from the external carotid artery 1. Parotid swellings are very painful due to the unyielding
just above the greater horn of the hyoid bone. It commences nature of the parotid fascia.
opposite to the commencement of the facial artery. 2. The thyroid gland and all thyroid swellings move with
Branches include the following: deglutition because the thyroid is attached to the larynx
1. Sternocleidomastoid branches—upper and lower by the suspensory ligaments of Berry.
Mastoid artery 3. Division of the external jugular vein in the supraclavicu-
wy

Muscular branches lar space may cause air embolism and consequent death
Descending branch—superficial and deep branches because the cut ends of the vein are prevented from
ae

Meningeal branches—supply the dura mater of the retraction and closure by the fascia, attached firmly to
posterior cranial fossa the vein.
6. Branches to supply posterior surface of the auricle and Q.3. Suprasternal space.
posterior quadrant of scalp.
Ans.
The terminal part of the artery supplies posterior quad-
rant of the scalp. The investing layer encloses two fascial spaces:
1. Supraclavicular space
Q.2. Cervical fascia. 2. Suprasternal space.
Ans. Near the lower part of the midline of the neck, the fascia
splits to enclose a space called suprasternal space (space
The deep cervical fascia of neck is condensed to form the
of Burn’s).
following layers:
1. Investing layer Within the suprasternal space, the following structures are
2. Pretracheal layer present:
3. Prevertebral layer 1. Jugular venous arch communicating two anterior
4. Carotid sheath jugular veins

. Lymph node
wh
. Sternal origin of the sternocleidomastoid muscle
. Interclavicular ligament
Ue
. Suprasternal ossicles.
Q.4. Pretracheal fascia.
Ans.
1. Importance of this fascia is that it encloses and suspends
the thyroid gland and forms its false capsule. Superiorly
it extends up to the hyoid bone. Inferiorly it extends into
the thorax and joins the fibrous pericardium.
2. Laterally, it fuses with the carotid sheath and through
this sheath it is continuous with the investing layer of
deep cervical fascia.
3. Medially, it divides and encloses the thyroid gland. It
forms the false capsule for the thyroid gland.
4. The posterior capsule of the thyroid is thin and hence
enlargements of the thyroid are directed posteriorly.
5. The pretracheal fascia invests the infrahyoid muscles.
This fascia is attached to the thyroid and cricoid carti-
lages as the suspensory ligament of Berry. This ligament
binds the thyroid gland to the larynx.
Q.5. External jugular vein.
Or
Formation of external jugular vein.
Ans.
External jugular vein commences near the angle of the man-
dible by the union of the posterior division of retroman-
dibular vein and posterior auricular vein.
Its course is as follows:
1. It passes downwards within the superficial fascia and
runs superficial to the sternocleidomastoid.
2. It is accompanied by great auricular nerve and pierces
the investing layer of deep cervical fascia at the lower
part of roof of the posterior triangle.
3. It terminates by joining the subclavian vein, about 4 cm
above clavicle. The vein is provided with valves.
4. Tributaries of EJV are as follows:
a. Suprascapular vein
b. Transverse cervical vein
c. Posterior jugular vein
d. Anterior jugular vein.
Rarely, common facial vein may terminate in it.
Q.6. Contents of carotid sheath.
Ans.
Carotid sheath is a condensation of the fibroareolar tissue
around the main vessels of the neck namely: the common
and internal carotid arteries and internal jugular vein and
the vagus nerve.
General Anatomy
The carotid sheath encloses the following:
1. The internal carotid artery
2. Common carotid artery
3. Internal jugular vein
4. The vagus nerve.
Q.7. Root value of brachial plexus.
Ans.
Brachial plexus is a network of nerves to supply the upper limb.
Formation
Ventral rami of C5, C6, C7, C8 and T, nerves join the plexus.
Branches
Branches are formed from root, trunk and cords.
Branch from the roots
Nerve to join phrenic nerve (C5)
1. Dorsal scapular nerve or nerve to rhomboids (C5)
2. Long thoracic nerve of Bell (nerve to serratus anterior
(C5, C6, C7)
3. Nerve to scalene muscles and longus colli muscles (C5,
C6, C7, C8, T1).
Branches from the trunks
The upper trunk gives the following:
1. Suprascapular nerve (C5, C6)
2. Nerve to subclavius (C5, C6).
Branches from the cords
1. Branches of lateral cord
a. Lateral pectoral nerve (C5, C6, C7)
b. Musculocutaneous nerve (C5, C6, C7)
c. Lateral root of median nerve (C5, C6, C7).
2. Branches of medial cord
a. Medial root of median nerve (C9T1)
b. Medial pectoral nerve (C8T1)
c. Medial cutaneous nerve of forearm (C8T1)
d. Medial cutaneous nerve of arm (C8T1)
e. Ulnar nerve (C8T1) (C7).
3. Branches of posterior cord
a. Upper subscapular nerve (C5, C6)
b. Thoracodorsal nerve (C6, C7, C8)
. Lower subscapular nerve (C5, C6)
an
. Axillary nerve (C5, C6)
e. Radial nerve (C5, C6, C7, C8 T1).
Q.8. Spinal part of accessory nerve.
Ans.
1. Accessory nerve (XI cranial nerve) is a motor nerve. It
has a cranial part and a spinal part.
9) Quick Review Series: BDS 1st Year

2. The spinal part emerges from the lateral surface of the
upper five cervical segments of the spinal cord.
COURSE
Intracranial course
1. The spinal part has five roots. They unite to form spinal
accessory, it passes upwards into the foramen magnum
and enters the posterior cranial fossa.
2. It then passes laterally towards the jugular foramen.
Within this foramen it unites with the cranial part. At
the lower part of the foramen it separates and leaves the
jugular foramen.
Extracranial course
1. After emerging from jugular foramen it passes back-
wards and laterally deep to internal jugular vein.
2. It is accompanied by the sternocleidomastoid branch of
the occipital artery and passes deep into the posterior
belly of digastric and sternocleidomastoid and enters
the posterior triangle.
3. It then passes deep into the trapezius muscle and termi-
nates by forming subtrapezial plexus by uniting with C3
and C4 nerves. This plexus supplies trapezius muscle.
4. Muscular branches to the sternocleidomastoid and the
trapezius are the branches of the spinal part of accessory
nerve.

BACK OF THE NECK

LONG ESSAYS

Q.1. Axillary nerve.
Ans.
Axillary nerve is one of the two large terminal branches
of the posterior cord of brachial plexus (Fig. 1A.4.1). The
axillary nerve (C5, C6) supplies nothing in axilla, only its
name having been changed from circumflex to axillary.
Course
From its origin, it passes backwards between subscapularis
and teres major through the quadrangular space where it
lies in contact with the surgical neck of the humerus, just
below the capsule of the shoulder joint.
Branches
1. Muscular branches to supply the deltoid and teres
minor muscles.
2. Articular branch to supply the shoulder joint.
3. Cutaneous branch to supply the upper lateral cutaneous
nerve of arm.
4. Axillary nerve gives a branch to the shoulder joint and
divides into:

Suprascapular nerve

’ ’
Superior transverse
Suprascapular Scapular ligament

Anterior branch Posterior branch

It supplies deltoid, and _It gives off the motor nerve to
a few terminal twigs teres minor, then winds around
pierce the muscle and __ the posteroid border of deltoid
To skin on lateral
reach the skin. and becomes cutaneous nerve
part of deltoid
of the arm. It supplies a few of
Axilla
the posterior fibres of deltoid.
Posterior circumflex
humeral artery
Applied Anatomy
1. The nerve may be injured during downward dislocation
Circumflex of shoulder joint.
scapular artery Radial nerve 2. It may be injured during fracture of surgical neck of
Fig. 14.4.1 Axillary nerve (circumflex nerve). humerus.
 General Anatomy

3. Injury to the nerve paralyses the deltoid muscle. This

Sternocleidomastoid
causes fat shoulder.
4. Injection of drugs like penicillin when wrongly injected Splenius capitis oF
may paralyse the nerve.
Q.2. Mention boundaries of suboccipital triangle. Trapezius
Describe the contents of triangle.
Ans.

The suboccipital triangle is a muscular space situated deep

in the suboccipital region.
Fig. 14.4.3 Roof of suboccipital triangle.
Boundaries (Fig. 1A.4.2)
Laterally: Longissimus capitis and occasionally the splenius
capitis.

f Floor
Ue
: Rectus capitis
1. Posterior arch of atlas
2. Posterior atlanto-occipital membrane.
Rectus capitis posterior minor
osterior major ss
° Suboccipital Muscles
Obliquus capitis
inferior Atlas Suboccipital muscles are described in Table 1A.4.1.
Contents of suboccipital triangle are as follows:
1. Dorsal ramus of nerve C1 (suboccipital nerve)
Fig. 1A.4.2 Boundaries of suboccipital triangle. 2. Third part of vertebral artery
3. Suboccipital plexus of veins.

Dorsal Ramus of First Cervical Nerve

Superomedially: Rectus capitis 7 posterior: major
‘ muscle It emerges between the posterior arch of the atlas and
supplemented by the rectus capitis posterior minor the vertebral artery, and soon gives rise to branches, which
Superolaterally: Superior oblique muscle supply the four suboccipital muscles and the semispinalis
capitis. The nerve to the inferior oblique gives off a commu-
Interiorly: Inferior oblique muscle nicating branch to the greater occipital nerves.
Roof (Fig. 14.4.3) It crosses the suboccipital triangle and pierces the
semispinalis capitis and trapezius muscles to ramify on
Medially: Dense fibrous tissue covered by the semispinalis the back of the head reaching up to the vertex. It supplies the
capitis semispinalis capitis in addition to the scalp.

Table 1A.4.1 Suboccipital muscles: Origin, insertion, nerve supply and actions

Muscle Origin Insertion Nerve supply Actions

Rectus capitis Spine of axis Lateral part of the area Suboccipitalnerve 1. Mainly postural
posterior major below the inferior nuchal or dorsal ramus Cl 2. Acting alone it turns the chin to the same side
line 3. Acting together the two muscles extend the head
Rectus capitis Posterior medial part of the area below Suboccipital nerve 1. Mainly postural
posterior minor tubercle of atlas the inferior nuchal line or dorsal ramus Cl 2. Extend the head
Obliquus capitis Transverse process Lateral area between the Suboccipitalnerve 1. Mainly postural
inferior or inferior of atlas nuchal lines or dorsal ramus Cl 2. Extend the head
oblique 3. Flex the head laterally
Obliquus capitis Spine of axis Transverse process of Suboccipital nerve 1. Mainly postural
inferior or inferior atlas or dorsal ramus Cl 2. Turns chin to the same side
oblique
Quick Review Series: BDS 1st Year

Vertebral Artery (Fig. 14.4.4) Anterior communicating artery

An Anterior cerebral artery
It is the first and largest branch of the first part of the Ophthalmic artery
Middle
subclavian artery. cerebral artery
Vertebral artery chiefly supplies to the brain, out of its Anterior choroidal artery
four parts; only the third part appears in the suboccipital Posterior communicating artery
triangle. This part appears at the foramen transversarium of Posterior cerebral artery
the atlas, grooves the atlas, and leaves the triangle by passing Internal
deep to the lateral edge of the posterior atlanto-occipital carotid artery
Foramen
membrane. Third part gives muscular branches to the magnum
muscles of the suboccipital region.

Suboccipital Plexus of Veins

Vertebral artery
It lies in and around the suboccipital triangle and drains the:
. Muscular veins
whe

. Occipital veins
. Internal vertebral venous plexus
. Condylar emissary vein. Subclavian artery
Be

It itself drains into the deep cervical and vertebral plexus

of veins. Fig. 1A.4.4 The vertebral artery and its branches.

SHORT NOTES

Q.1. Vertebral artery. Second part: Precostal anastomosis

Ans. Third part: Spinal branch of first cervical inter segmental
artery
1. Vertebral artery is the first branch of subclavian artery,
and arises from the upper convexity of the subclavian Fourth part: Preneural anastomosis.
artery (Fig. 1A.4.5).
2. Vertebral artery supplies the visual area of the cerebrum, Commencement
hindbrain, the spinal cord and suboccipital muscles.
It commences from the first part of the subclavian artery and
terminates at the lower border of the pons where the arteries
A UL {-——Posterior communicating artery of both the sides unite to form the basilar artery.
aN Posterior cerebral arter
a y
~~) ~~ Buperior cerebellar Branches of Vertebral Artery
jateral pontine artery
2 }+—~Branches of basilar artery
Labyrinthine | First part: Gives no branches.
anterior inferior artery
Cerebellar | Second part: Gives spinal branches to supply the spinal cord.
posterior inferior artery They enter the vertebral canal through the intervertebral
Cerebellar artery foramen.
Anterior spinal artery
Vertebral artery Third part: Gives muscular branches to the muscles of the
suboccipital region.
Posterior spinal artery

Fig. 14.4.5 The vertebral artery.

Fourth part: Gives the following branches:
1. Meningeal branches
. Posterior spinal artery
wh

It is divided into four parts according to its anatomical

. Anterior spinal artery
location as follows:
. Posterior inferior cerebellar artery
Um

First part: Dorsal part of seventh intersegmental artery . Medullary branches to supply to medulla oblongata.
 General Anatomy

Q.2. Styloid process. Q.3. Contents of suboccipital triangle.

Ans. Ans.
The styloid process is a long, slender and pointed bony pro-
cess projecting downwards, forwards and slightly medially Contents of suboccipital triangle are as follows:
from the temporal bone. It descends between the external 1. Third part of vertebral artery
and internal carotid arteries to reach the side of the pharynx. 2. Dorsal ramus of nerve Cl—suboccipital nerve
It is interposed between the parotid gland laterally and the 3. Suboccipital plexus of veins.
internal jugular vein medially.

CONTENTS OF THE VERTEBRAL CANAL

LONG ESSAYS

Q.1. Spinal dura mater. Q.2. Subarachnoid space.

Ans. Ans.
1. Subarachnoid space is a wide intraleptomeningeal
Posterior spinal artery, Subarachnoid space space between the pia and the arachnoid, filled with
Pia mater
Recurrent cerebrospinal fluid (CSF) (Fig. 1A.5.2).
meningeal 2. It surrounds the brain and spinal cord like a water cushion.
nerves
3. The spinal subarachnoid space is wider than the space
around the brain. It is widest below the lower end of the
spinal cord where it encloses the cauda equina.
QO Arachnoid Lumbar puncture is usually done in the lower widest part
mater
of the space, between third and fourth lumbar vertebrae.

Dura mater
Dura mater ‘Arachnoid mater
Fig. 14.5.1 The section of spinal cord. Pia mater
Subarachnoid space

1. Spinal dura mater is a thick, tough fibrous outermost

meningeal membrane, which forms a loose sheath
around the spinal cord (Fig. 1A.5.1). It is continuous
with the meningeal layer of the cerebral dura mater.
2. The spinal dura extends from the foramen magnum to
the lower border of the second sacral vertebra.
3. The dura gives tubular prolongations to the dorsal and
ventral nerve roots and to the spinal nerves as they pass
through the intervertebral foramina. Fig. 14.5.2 Subarachnoid space.
 Quick Review Series: BDS 1st Year

Topic 6 CRANI

LONG ESSAYS

Q.1. Enumerate dural venous sinus. Describe the . Transverse sinus

cavernous sinus in detail. Sigmoid sinus
Sphenoparietal sinus
Or
. Petrosquamous sinus
Describe cavernous sinus and its relations. . Middle meningeal sinus/veins.
Or B. Unpaired venous sinuses are as follows:
Classify dural venous sinuses. Describe in detail They are median in position.
the position, contents, tributaries and applied 1. Superior sagittal sinus
aspect of cavernous sinus. . Inferior sagittal sinus

wh
. Straight sinus
Ans.
. Occipital sinus
Venous sinuses of dura mater are venous spaces the walls of NDB Anterior intercavernous sinus
which are formed by dura mater (Fig. 1A.6.1). They have an . Posterior intercavernous sinus
inner lining of endothelium. They are devoid of muscle and . Basilar plexus of veins.
valves in their walls.
Venous sinuses receive venous blood from the brain, the Cavernous Sinuses
meninges and bones of the skull. Cerebrospinal fluid is
Each cavernous sinus is a large venous space situated in the
poured into some of them.
middle cranial fossa, on either side of the body of the sphe-
noid bone. Its interior part is divided into a number of spaces
Inferior sagittal sinus or caverns by trabeculae. The trabeculae are much less con-
Superior sagittal sinus spicuous in the living than in the dead. The floor of the sinus
Sigmoid sinus
Straight sinus > is formed by the endosteal dura mater. The lateral wall, roof
Confluence of
che
SCO
BK
y
a petrosal sinus
Basilar sinus
and medial wall are formed by the meningeal dura mater.
Sphenoparietal
Great cerebral
sinus
vein
Intercavernous
Right transverse Meningeal layer ohn
dura mater
sinus
Sigmoid sinus
Ss my isa\t EY
SY
SSS)
sinus

Ophthalmic vein
Endothelium —_~y
&- Hypophysis cerebri
Oculomotor nerve
Superior petrosal sinus Ch Trochlear nerve—o
Inferior petrosal sinus
Cavernous sinu Ophthalmic nerve Sphenoidal sinus
Pterygoid plexus of veins Maxillary nerve—_ ZO.
Mandibular nerve
Fig. 1A.6.1 Venous sinuses.
Abducent nerve Internal carotid artery

Fig. 14.6.2 Coronal section of middle cranial fossa showing the

The pressure of blood in the cranial venous sinuses is kept relations of the cavernous sinus.
constant as the sinuses communicate with veins outside the
skull through emissary veins.
There are 23 venous sinuses, of which 8 are paired and
Relations (Fig. 1A.6.2)
7 are unpaired.
Structures outside the sinus are as follows:
A. Paired venous sinuses are as follows:
Superiorly: Optic tract, optic chiasma, olfactory tract, internal
There is one sinus each on the right and left sides.
carotid artery and anterior perforated substance
1. Cavernous sinus
2. Superior petrosal sinus Inferiorly: Foramen lacerum and the junction of the body
3. Inferior petrosal sinus and greater wing of the sphenoid bone

Medially: Hypophysis cerebri and sphenoidal air sinus
Laterally: Temporal lobe with uncus
Anteriorly: Superior orbital fissure and the apex of the orbit
Posteriorly: Apex of the petrous temporal and the crus cere-
bri of the midbrain.
Structures in the lateral wall of the sinus, from above down-
wards, are as follows:
1. Oculomotor nerve: In the anterior part of the sinus,
leaves the sinus by passing through the superior orbital
fissure.
2. Trochlear nerve: Enters the orbit through the superior
orbital fissure, in the anterior part of the sinus.
3. Ophthalmic nerve: It divides into the lacrimal, frontal
and nasociliary nerves in the anterior part of the sinus.
4. Maxillary nerve: It leaves the sinus by passing through
the foramen rotundum.
5. Trigeminal ganglion: The ganglion and its dural cave
project into the posterior part of the lateral wall of the
sinus.
Structures passing through the centre of the sinus are as follows:
1. Internal carotid artery with the venous and sympathetic
plexus
2. Abducent nerve, inferolateral to the internal carotid artery.
The structures in the lateral wall and in the centre of the
sinus are separated from blood by the endothelial lining.
Tributaries or Incoming Channels
From the orbit
1. The superior ophthalmic vein.
2. A branch of the inferior ophthalmic vein or sometimes
the vein itself.
3. The central vein of the retina may drain either into the
superior ophthalmic vein or into the cavernous sinus.
From the brain
1. Superficial middle cerebral vein
2. Inferior cerebral veins from the temporal lobe.
From the meninges
1. Sphenoparietal sinus.
2. The frontal trunk of the middle meningeal vein may
drain either into the pterygoid plexus through the fora-
men ovale or into the sphenoparietal or cavernous sinus.
Draining Channels or Communications
The cavernous sinus drains into the following:
1. The transverse sinus through the superior petrosal sinus.
2. The internal jugular vein through the inferior petrosal sinus
and through a plexus around the internal carotid artery.
General Anatomy
3. The pterygoid plexus of veins through the emissary
veins.
4. The facial vein through the superior ophthalmic vein.
5. The right and left cavernous sinuses communicate
with each other through the anterior and posterior
intercavernous sinuses and through the basilar plexus
of veins.
All these communications are valveless, and blood can
flow through them in either direction.
Applied Anatomy
1. Thrombosis of the cavernous sinus may be caused by
sepsis in the dangerous area of the face, in the nasal
cavities, and in the paranasal air sinuses. This gives rise
to the following symptoms:
A. Nervous symptoms
a. Serve pain in the forehead in the area of distribution
of the ophthalmic nerve
b. Involvement of the third, fourth and sixth cranial
nerves resulting in paralysis of the muscles supplied.
B. Venous symptoms
Marked oedema of the eyelids, cornea and root of
the nose, with exophthalmos due to congestion of the
orbital veins.
2. A communication between the cavernous sinus and
the internal carotid artery may be produced by head
injury which results in the protrusion and pulsation
of eyeball with each heartbeat known as the pulsating
exophthalmos.
Q.2. Describe the pituitary gland in detail. Mention
its blood supply, development and relation.
Ans.
The hypophysis cerebri or pituitary gland is a small endo-
crine gland situated in relation to the base of the brain. It is
often called the master of the endocrine orchestra because it
produces a number of hormones that control the secretions
of many other endocrine glands of the body (Fig. 1A.6.3).
It lies in the hypophyseal fossa or sella turcica or pituitary
fossa, which is roofed by the diaphragma sellae. The stalk of
the hypophysis cerebri pierces the diaphragma sellae and is
attached above to the floor of the third ventricle.
The gland is oval in shape and measures 8 mm anteropos-
teriorly and 12 mm transversely. It weighs about 500 mg.
Relations
Superiorly
1. Diaphragma sellae
2. Optic chiasma
3. Tuber cinereum
4. Infundibular recess of the third ventricle.
Quick Review Series: BDS 1st Year

Trochlear nerve [IV] Abducent nerve [VI] Median eminence

Internal carotid artery Infundibular recess of third ventricle
Oculomotor nerve [III]
Pituitary gland Optic chiasma
Dura mater
ee
sellae

Mamillary body
Pars tuberalis Infundibulum

Pars posterior

Pars intermedia

Pars anterior

Fig. 14.6.4 A sagittal section of the hypophysis cerebri.

Ophthalmic division of trigeminal nerve [V,]

Maxillary division of trigeminal nerve [V,]
Neurohypophysis
Fig. 14.6.3 Pituitary gland and its relations.
1. Posterior lobe or neural lobe, pars posterior: It is smaller
than the anterior lobe and lies in the posterior concavity
of the anterior lobe.
2. Infundibular stem: It contains the neural connections of
inferiorly
the posterior lobe with the hypothalamus.
1. Irregular venous channels between the two layers of 3. Median eminence of the tuber cinereum: It is continuous
dura mater lining the floor of the hypophyseal fossa with the infundibular stem.
2. Hypophyseal fossa
3. Sphenoidal air sinus. Arterial Supply (Fig. 14.6.5)
The hypophysis cerebri is supplied by the following branches
On each side of the internal carotid artery.
The cavernous sinus with its contents. 1. One superior hypophyseal artery on each side
2. One inferior hypophyseal artery on each side.
Subdivisions Each superior hypophyseal artery supplies:
The gland has two main parts: adenohypophysis and neuro- 1. The ventral part of the hypothalamus
hypophysis, which differ from each other embryologically, 2. The upper part of the infundibulum
morphologically and functionally. 3. The lower part of the infundibulum through a separate
The adenohypophysis develops as an upward growth long descending branch, called the trabecular artery.
called the Rathke’s pouch from the ectodermal roof of the Each inferior hypophyseal artery divides into medial and
stomodeum. lateral branches, which join one another to form an arterial
The neurohypophysis develops a downward growth from
the floor of the diencephalon and is connected to the hypo-
thalamus neural pathways. Further subdivisions of each part
are given below. Capillary tufts in median eminence Superior hypophyseal
and in infundibulum 5
artery ype
Adenohypophysis (Fig. 14.6.4) Long portal vessels.
Trabecular artery to
1. Anterior lobe or pars anterior, pars distalis or pars glandu- lower infundibulum
Short portal vessels
laris: This is the largest part of the gland.
2. Intermediate lobe or pars intermedia: This is in the form
Capillary tufts in
of a thin strip that is separated from the anterior lobe by lower infundibulum
an intraglandular cleft, a remnant of the lumen of Anastomosis between superior
Rathke’s pouch. and inferior hypophyseal arteries
3. Tuberal lobe or pars tuberalis: It is an upward extension
of the anterior lobe that surrounds and forms part of Inferior hypophyseal artery

the infundibulum. Fig. 14.6.5 Arterial supply of the hypophysis cerebri.

 General Anatomy

ring around the posterior lobe. Branches from this ring sup-
ply the posterior lobe and also anastomose with branches
from the superior hypophyseal artery.
The anterior lobe or pars distalis is supplied exclusively by
portal vessels arising from capillary tufts formed by the su-
perior hypophyseal arteries. The long portal vessels drain the
median eminence and the upper infundibulum, and the
short portal vessels drain the lower infundibulum. The por-
tal vessels are of great functional importance because they
carry the hormone releasing factors from the hypothalamus
to the anterior lobe where they control the secretory cycles
of different glandular cells.
Venous Drainage
Short veins emerge on the surface of the gland and drain
into neighbouring dural venous sinuses. The hormones pass
out of the gland through the venous blood and are carried to
their target cells.
Histology and Hormones
Anterior lobe
1. Chromophilic cells (50%)
a. Acidophils/alpha cells (about 43% of cells)
i. Somatotrophs: Secrete growth hormone (STH,
GH)
ii. Mammotrophs (prolactin cells): Secrete lactogenic
hormone.
iii. Corticotrophs: Secrete ACTH
b. Basophils/beta cells (about 7% of cells)
i. Thyrotrophs: Secrete TSH
ii. Gonadotrophs: Secrete FSH
iii. Luteotrophs: Secrete LH or ICSH
2. Chromophobic cells (50%) represent the nonsecretory
phase of the other cell types or their precursors.
Intermediate lobe
It is made up of numerous basophil cells and chromophobe
cells surrounding masses of colloid material. It secretes the
melanocytes stimulating hormone (MSH).
Posterior lobe
It is composed of (a) a large number of non-myelinated
fibres—hypothalamo-hypophyseal tract and (b) modified
neurological cells, called pituicytes. They have many
dendrites, which terminate on or near the sinusoids.
The hormones related to the posterior lobe are (a) vasopressin,
(ADH) which acts on kidney tubules, and (b) oxytocin, which
promotes contraction of the uterine, and mammary smooth
muscle. These hormones are actually secreted by the hypothala-
mus, from where these are transported through the hypothalamo-
hypophyseal tract to the posterior lobe of the gland.

SHORT ESSAYS

Q.1. Tentorium cerebelli. Diaphragma sellae

covering hypophyseal fossa Anterior clinoid process
Ans. Optic nerve Internal carotid artery
Infundibulum Aperture for oculomotor nerve
The tentorium cerebelli is a tent-shaped fold of dura mater, Oculomotor nerve is Aperture for trochlear nerve
forming the roof of the posterior cranial fossa. It separates Trochlear nerve Attached margin of
Great cerebral vein LaN\ tentorium cerebelli
the cerebellum from the occipital lobes of the cerebrum Straight sinus Free margin of
and broadly divides the cranial cavity into supratentorial Superior petrosal tentorium cerebelli
and infratentorial compartments. The infratentorial sinus Attached margin of
compartment, in other words, is the posterior cranial fossa entorium cerebelli
containing the hindbrain and the lower part of the midbrain Tentorium ASS Transverse sinus within
(Fig, 1A.6.6). layers of tentorium
Opening of superior sagittal sinus
The tentorium cerebelli has a free margin and an attached
margin. The anterior free margin is U-shaped and free. The Fig. 14.6.6 Tentorium cerebelli seen from above.
ends of the ‘U’ are attached anteriorly to the anterior clinoid
processes. This margin bounds the tentorial notch, which is clinoid processes. Along the attached margin there are
occupied by the midbrain and the anterior part of the supe- the transverse and superior petrosal venous sinuses. The
rior vermis. The outer or attached margin is convex. Postero- trigeminal or Meckel’s cave (Fig. 1A.6.7) is a recess of dura
laterally, it is attached to the lips of the transverse, sulci on mater present in relation to the attached margin of the
the occipital bone and on the posteroinferior angle of the tentorium. It is formed by evagination of the inferior layer of
parietal bone. Anterolaterally, it is attached to the superior the tentorium over the trigeminal impression on the petrous
border of the petrous temporal bone and to the posterior temporal bone. It contains the trigeminal ganglion.
 Quick Review Series: BDS 1st Year

Trigeminal ganglion Greater wing of sphenoid

Superior petrosal sinus
Mandibular nerve
>Tentorium cerebelli 4
Maxillary nerve

ween nen--e Ophthalmic nerve

- ——~Trigeminal cave

Outer layer of dura mater

Inner layer of dura mater

Petrous temporal bone

Fig. 1A.6.7 Parasagittal section through the petrous temporal

bone and meninges to show the formation of the trigeminal cave. Ns 4
Cavernous sinus

!
The free and attached margins of the tentorium cerebelli ae
! .

cross each other near the apex of the petrous temporal bone.
}
i
~_ Motor root and
' “sensory root of
Anterior to the point of crossing there is a triangular area 1
{t trigeminal ganglion
that forms the posterior part of the roof of the cavernous ‘Trigeminal ganglion
sinus and is pierced by the third and fourth cranial nerves.
Xv
‘Greater petrosal nerve
The tentorium cerebelli has two surfaces. The superior ‘ Middle meningeal artery
‘
surface is convex and slopes to either side from the median \ ‘Petrous temporal bone
plane. The falx cerebri is attached to this surface, in the mid-
4
Squamous temporal bone
line; the straight sinus lies along the line of this attachment. Fig. 14.6.8 Superior view of the middle cranial fossa showing
The superior surface is related to the occipital lobes of the some of its contents.
cerebrum. The inferior surface is concave and fits the convex
superior surface of the cerebellum. The falx cerebri is
or Meckel’s cave. There are two layers of dura below the
attached to its posterior part.
ganglion. The cave is lined by pia-arachnoid so that the
Q.2. Cavernous sinus. ganglion along with the motor root of the trigeminal nerve
is surrounded by CSF. The ganglion lies at a depth of about
Or
5 cm from the preauricular point.
Cavernous sinus, its relations and tributaries.
Relations
Ans.
Refer to answer of Long Essays Q. 1. Medially:
1. Internal carotid artery
Q.3. Trigeminal ganglion in middle cranial fossa.
2. Posterior part of cavernous sinus.
Ans.
Laterally: Middle meningeal artery.
This is the sensory ganglion of the fifth cranial nerve. It is
Superiorly: Parahippocampal gyrus.
homologous with the dorsal nerve root ganglia of spinal
nerves. All such ganglia are made up of pseudounipolar Inferiorly:
nerve cells, with a T-shaped arrangement of their process; 1. Motor root of trigeminal nerve
one process arises from the cell body which then divides into 2. Greater petrosal nerve
a central and a peripheral process. 3. Apex of the petrous temporal bone
The ganglion is crescentic or semilunar in shape, with its 4. The foramen lacerum.
convexity directed anterolaterally. The three divisions of the
trigeminal nerve emerge from this convexity. The posterior Associated Root and Branches
concavity of the ganglion receives the sensory root of the nerve.
The central processes of the ganglion cells form the large
sensory root of the trigeminal nerve, which is attached to
Situation and Meningeal Relations (Fig. 14.6.8)
pons at its junction with the middle cerebellar peduncle.
The ganglion lies on the trigeminal impression, on the ante- The peripheral processes of the ganglion cells form three
rior surface of the petrous temporal bone near its apex. It divisions of the trigeminal nerve, namely the ophthalmic,
occupies a special space of dura mater, called the trigeminal maxillary and mandibular.

The small motor root of the trigeminal nerve is attached
to the pons superomedial of the sensory root. It passes under
the ganglion from its medial to the lateral side and joins the
mandibular nerve at the foramen ovale.
SHORT NOTES
Q.1. Falx cerebri.
Ans.
The falx cerebri is a large sickle-shaped fold of dura mater
occupying the median longitudinal fissure between the two
cerebral hemispheres (Fig. 1A.6.9).
It has two ends:
1. The anterior end is narrow and is attached to the crista galli.
2. The posterior end is broad and is attached along the
median plane to the upper surface of the tentorium
cerebelli.
Tentorium cerebelli
Tentorial notch Falx cerebri
Diaphragma sellae
Fig. 14.6.9 Falx cerebri.
The falx cerebri has two margins:
1. The upper margin is convex and is attached to the lips
of the sagittal sulcus.
2. The lower margin is concave and free.
The falx cerebri has right and left surfaces, each of which
is related to the medial surface of the corresponding cerebral
hemisphere.
Three important venous sinuses are present in relation to
this fold. The superior sagittal sinus lies along the upper
margin; the inferior sagittal sinus lies along the lower mar-
gin; and the straight sinus lies along the line of attachment
of the falx to the tentorium cerebelli.
Q.2. Meckel’s cave.
Ans.
The trigeminal or Meckel’s cave is a recess of dura mater
present in relation to the attached margin of the tentorium
General Anatomy
Blood Supply
The ganglion is supplied by twigs from the (a) internal carotid,
(b) middle meningeal and accessory meningeal arteries and
(c) by the meningeal branch of the ascending pharyngeal artery.
cerebelli. It is formed by evagination of the inferior layer of
the tentorium over the trigeminal impression on the petrous
temporal bone. It contains the trigeminal ganglion.
Q.3. Emissary vein.
Ans.
Emissary veins connect the extracranial veins with the intra-
cranial venous sinuses to equalize the pressure.
Example:
1. The parietal emissary vein passes through the parietal
foramen to the superior sagittal sinus.
2. The mastoid emissary vein passes through the mastoid
foramen to the sigmoid sinus.
Applied anatomy: Extracranial infections may spread
through these veins to intracranial venous sinuses.
Q.4. Cavernous sinus.
Ans.
1. Each cavernous sinus is a large venous space situated in
the middle cranial fossa on either side of the body of the
sphenoid bone. It is about 2 cm long and 1 cm wide.
2. Its interior part is divided into a number of spaces or
caverns by trabeculae.
3. The floor of the sinus is formed by the endosteal dura mater.
4. The lateral wall, roof and medial wall are formed by the
meningeal dura mater.
5. Anteriorly, the sinus extends up to the medial end of the
superior orbital fissure and posteriorly up to the apex of
the petrous temporal bone.
Q.5. Tentorium cerebelli.
Ans.
The tentorium cerebelli is a tent-shaped fold of dura mater,
forming the roof of the posterior cranial fossa. It separates
the cerebellum from the occipital lobes of the cerebrum and
broadly divides the cranial cavity into supratentorial and
infratentorial compartments.
Q.6. Diaphragma sellae.
Ans.
The diaphragma sellae is a small circular, horizontal fold of
dura mater forming the roof of the hypophyseal fossa.
EY’) Quick Review Series: BDS 1st Year
Anteriorly, it is attached to the tuberculum sellae. Posteri-
orly, it is attached to the dorsum sellae. On each
it is continuous with the dura mater of the middle cranial
fossa.
The diaphragma sellae has a central aperture through
which the stalk of the hypophysis cerebri passes.
Q.7. Hypoglossal nerve.
Ans.
Hypoglossal nerve/cranial nerve XII, as the name implies is
the nerve supplying muscles of tongue (glossal means
tongue) and is purely a motor nerve.
Branches of communication are as follows:
1. Vagus
2. Ventral ramus of first cervical nerve
3. Lingual nerve superior cervical ganglion of sympathetic
chain.
Branches of distribution are as follows:
1. To the three extrinsic muscles of tongue namely stylo-
glossus, genioglossus and hyoglossus and to four intrinsic
muscles namely superior longitudinal, inferior longitudi-
nal, transverse and vertical muscles.
2. It carries fibres of ventral ramus of first cervical, which
gets distributed as meningeal branch, superior limb of
ansa cervicalis, branch to thyrohyoid and geniohyoid
muscles.
Q.8. Superior sagittal sinus.
Ans.
The superior sagittal sinus occupies the upper convex, at-
tached margin of the falx cerebri (Fig. 1A.6.10).
It begins anteriorly at the crista galli by the union of tiny
meningeal veins. Here it communicates with the veins of the
frontal sinus and occasionally with the veins of the nose,
through the foramen caecum. As the sinus runs upwards
and backwards, it becomes progressively larger in size. It is
triangular in cross-section. It ends near the internal occipi-
tal protuberance by turning to one side, usually the right,
Superior sagittal sinus
Arachnoid granulations
Cerebral vein
Dipole
Internal table
Extradural space
(potential space)
Subarachnoid space
Fig. 1A.6.10 The superior sagittal sinus (cross-sectional view).
and becomes continuous with the right transverse sinus.
side, Sometimes the superior sagittal sinus becomes continuous
with the left transverse sinus. It generally communicates
with the opposite sinus. The junction of all these sinuses is
called the confluence of sinuses.
The superior sagittal sinus receives the following tributaries:
1. Superior cerebral veins
2. Parietal emissary veins
3. Venous lacunae, usually three on each side
4. Occasionally, a vein from the nose opens into the sinus
when the foramen caecum is patent.
Q.9. Middle meningeal artery.
Ans.
Middle meningeal artery is a branch of the first part of the
maxillary artery, given off in the infratemporal fossa. It is
transmitted through foramen spinosum. It supplies more of
bone and less of meninges. Middle meningeal artery supplies
only small branches to the dura mater. It is predominantly a
periosteal artery supplying bone and red bone marrow in the
dipole.
Within the cranial cavity, it gives off the following:
1. Ganglionic branches—to the trigeminal ganglion
2. A petrosal branch—to the hiatus for the greater petrosal
nerve
3. A superior tympanic branch—to the tensor tympani
4. Temporal branches—to the temporal fossa
5. Anastomotic branch that enters the orbit and anasto-
moses with the lacrimal artery.
Q.10. Name four emissary veins.
Ans.
Emissary veins connect the extracranial veins with the intra-
cranial venous sinuses to equalize the pressure.
Examples:
1. Parietal emissary vein
. Mastoid emissary vein
wh
. Emissary vein—passing through hypoglossal canal
. Condylar emissary vein
Um
. Two to three emissary veins passing through foramen
lacerum.
Q.11. Confluence of dural venous sinus.
Ans.
Superior sagittal sinus begins anteriorly at the crista galli by
the union of tiny meningeal veins. Here it communicates
with the veins of the frontal sinus and occasionally with the
veins of the nose, through the foramen caecum.
It ends near the internal occipital protuberance by turn-
ing to one side, usually the right, and becomes continuous
with the right transverse sinus. Sometimes the superior
sagittal sinus becomes continuous with the left transverse
 General Anatomy

sinus. It generally communicates with the opposite sinus. Q.14. Name structures in the lateral wall of cavern-
The junction of all these sinuses is called the confluence of ous sinus.
sinuses.
Ans.
Q.12. Name any four tributaries of cavernous sinus.
Structures in the lateral wall of the sinus, from above
Ans. downwards:
Tributaries or incoming channels of cavernous sinus are as 1. Oculomotor nerve
follows: . Trochlear nerve

wh
. Ophthalmic nerve
From the orbit: . Maxillary nerve
1. The superior ophthalmic vein

Ue
. Trigeminal ganglion.
2. A branch of the inferior ophthalmic vein or sometimes
the vein itself Q.15. Name the folds of dura mater present in the
3. The central vein of the retina. cranial cavity.
From the brain: Ans.
1. Superficial middle cerebral vein
2. Inferior cerebral veins from the temporal lobe. At places, the meningeal layer of dura mater is folded on it-
self to form partitions that divide the cranial cavity into
From the meninges: compartments that lodge different parts of the brain.
1. Sphenoparietal sinus.
2. The frontal trunk of the middle meningeal vein The folds are as follows:
may drain either into the pterygoid plexus through the 1. Falx cerebri
foramen ovale or into the sphenoparietal or cavernous 2. Tentorium cerebelli
sinus. 3. Falx cerebelli
4. Diaphragma sellae.
Q.13. Mention the major openings in diaphragm.
Q.16. Trigeminal ganglion in middle cranial fossa.
Ans.
The diaphragm has three large openings for the passage of Ans.
structure between thorax and abdomen (Fig. 1A.6.11). The Trigeminal ganglion is the sensory ganglion of the fifth
openings are as follows: cranial nerve (Fig. 1A.6.12). It is homologous with the
1. The aortic opening dorsal nerve root ganglia of spinal nerves. All such ganglia
2. The oesophageal opening are made up of pseudounipolar nerve cells with a T-shaped
3. The vena caval foramen. arrangement of their process; one process arises from the
cell body which then divides into a central and a peripheral
process.
Inferior vena cava
The ganglion is crescentic or semilunar in shape, with its
Oesophagus convexity directed anterolaterally. The three divisions of the
trigeminal nerve emerge from this convexity. The posterior
Caval opening Central tendon
(vertebral level TVIII)
concavity of the ganglion receives the sensory root of the
of diaphragm
nerve.

Ophthalmic nerve [V,]

% Maxillary nerve [V,]
Mandibular nerve [V.]
i Trigeminal ganglion
#- Facial nerve [VII]
#Vestibulocochlear nerve
¥ Glossopharyngeal nerve
(‘Vagus nerve [X]
Oesophageal hiatus
Hypoglossal nerve [XI]
(vertebral level TX)

Fig. 1A.6.11 The diaphragm. Fig. 1A.6.12 The middle cranial fossa showing trigeminal ganglion.
Quick Review Series: BDS 1st Year

CONTENTS OF THE ORBIT

LONG ESSAY

Q.1. Write about origin, insertion nerve supply and The inferior oblique arises from the orbital surface of the
action of muscles of eyeball. maxilla, lateral to the lacrimal groove.
The levator palpebrae superioris arises from the orbital
Ans.
surface of the sphenoid bone, anterosuperior to the optic canal.
The extraocular muscles are as follows:
Insertion
Voluntary Muscles The recti are inserted into the sclera, a little posterior to the
limbus.
1. Four recti
The tendon of the superior oblique passes through a
a. Superior rectus
fibrocartilaginous pulley attached to the trochlear fossa of the
b. Inferior rectus
frontal bone. It is inserted into the sclera behind the equator to
c. Medial rectus
the eyeball, between the superior rectus and the lateral rectus.
d. Lateral rectus
The inferior oblique is fleshy throughout. It passes later-
2. Two obliqui
ally, upwards and backwards below the inferior rectus and
a. Superior oblique
then deep to the lateral rectus. The inferior oblique is
b. Inferior oblique
inserted close to the superior oblique a little below and
3. The levator palpebrae superioris elevates the upper
posterior to the latter.
eyelid.
The fat tendon of the levator splits into:
Involuntary Muscles a. Superior or voluntary lamella
b. Inferior or involuntary lamella.
1. The superior tarsal muscle is the deeper portion of
the levator palpebrae superioris. It is inserted on the The superior lamella of the levator is inserted into the
upper margin of the superior tarsus. It elevates the anterior surface of the superior tarsus and into the skin
upper eyelid. of the upper eyelid. The inferior lamella is inserted into the
2. The inferior tarsal muscle extends from the fascial sheath upper margin of the superior tarsus.
of the inferior rectus and inferior oblique to the lower
margin of the inferior tarsus. It possibly depresses the Nerve supply
lower eyelid. 1. The superior oblique is supplied by the IV cranial or
3. The orbitalis bridges the inferior orbital fissure. Its trochlear nerve (SO4).
action is uncertain. 2. The lateral rectus is supplied by the VI cranial or
The voluntary muscles are miniature ribbon muscles, abducent nerve (LR6).
having short tendons of origin and long tendons of insertion. 3. The remaining five extraocular muscles—superior,
inferior and medial recti; inferior oblique and levator
palpebrae superioris—are all supplied by the ITI cranial
Origin and Insertion of Voluntary Muscles
or oculomotor nerve.
Origin
Actions
The four recti arise from a common annular tendon or
tendinous ring that is attached to the orbital surface of the 1. The movements of the eyeball are as follows:
apex of the orbit. a. Around a transverse axis
The lateral rectus has an additional small tendinous head, i. Upward rotation or elevation (33°)
which arises from the orbital surface of the greater wing of ii. Downward rotation or depression (33°)
the sphenoid bone lateral to the tendinous ring. b. Around a vertical axis
The superior oblique arises from the body of the sphenoid, i. Medial rotation or adduction (50°)
superomedial to the optic canal. ii. Lateral rotation or abduction (50°)
 General Anatomy

c. Around an anteroposterior axis Table 1A.7.1 Actions of individual muscles

i. Intortion Muscle Action in primary position
ii. Extortion
1. Superior oblique Depression
The rotatory movements of the eyeball upwards,
Adduction
downwards, medially or laterally are defined in terms
of the direction of movement of the centre of the Intortion
pupil. The tortions are defined in terms of the direc- 2. Inferior oblique Elevation
tion of movement of the upper margin of the pupil Adduction
at 12 o'clock position. Extortion
d. The movements given previously can take place in 3. Inferior rectus Elevation
various combinations.
Adduction
2. Actions of individual muscles are listed in Table 1A.7.1.
3. Single or pure movements are produced by combined Intortion

actions of muscles. Similar actions get added together, 4. Superior rectus Elevation
while opposing actions cancel each other, enabling pure Adduction
movements. Intortion
a. Upward rotation or elevation: By the superior rectus 5. Medial rectus Only adduction
and the inferior oblique
6. Lateral rectus Only abduction
b. Downward rotation or depression: By the inferior
rectus and the superior oblique
c. Medial rotation or adduction: By the medical rectus,
the superior rectus and the inferior rectus 4. Combined movements of the eyes: The movements of the
d. Lateral rotation or abduction: By the lateral rectus, the two eyes are harmoniously coordinated and are called
superior oblique and the inferior oblique conjugate ocular movements. These movements are
e. Intortion: By the superior oblique and the superior usually horizontal or vertical, but oblique conjugate
rectus movements may also occur. The dissociated movements
f. Extortion: By the inferior oblique and the inferior rectus. of the two eyes are called as disjunctive movements.

SHORT ESSAYS

Q.1. Lateral rectus muscle of eyeball. Insertion

Ans. Lateral rectus is inserted to the corresponding surface of the
sclera, behind the corneal margin at 6.8 mm away from the
There are four recti muscles of eyeball, namely:
corneal margin.
1. Superior
2. Inferior
3. Medial Nerve Supply
4. Lateral recti. The abducent nerve supplies the lateral rectus.
The lateral rectus arises by two heads, one from the upper
and one from the lower aspect of the lateral part of the com- Action
mon tendinous ring. The lateral rectus moves the cornea horizontally and laterally.
The following structures pass between the two origins of the Q.2. Positions, connections and branches of ciliary
lateral rectus: ganglion.
1. Upper and lower division of the oculomotor nerve
2. Nasociliary nerve Ans.
3. Abducent nerve.
The ciliary ganglion is very small ganglion present in the
From the origin, the recti muscles widen forwards to orbit. Topographically, the ganglion is related to nasociliary
form the cone of muscles. nerve, branch of ophthalmic division of trigeminal nerve
Quick Review Series: BDS 1st Year

but functionally it is related to oculomotor nerve. This Superior orbital fissure communicates orbit and middle
ganglion has no secretomotor fibres. cranial fossa.

Roots Boundaries
It has three roots: Superior—lesser wing of sphenoid
1. Sensory
2. Sympathetic Inferior—greater wing of sphenoid
3. Motor. Medial—body of the sphenoid
Only the motor root fibres relay to supply the intraocular Lateral—frontal bone.
muscles.
1. Sensory root is from the long ciliary nerve.
Structures Passing through the Superior Orbital
2. Sympathetic root is by the long ciliary nerve from plexus
Fissure
around ophthalmic artery.
3. Motor root is from a branch to inferior oblique muscle. A common tendinous ring divides the fissure into three
These fibres arise from Edinger—Westphal nucleus, join parts:
oculomotor nerve and leave it via the nerve to inferior 1. Structures passing lateral to the ring are as follows:
oblique to be relayed in the ciliary ganglion. a. Lacrimal nerve
b. Frontal nerve
Branches c. Trochlear nerve
d. Superior ophthalmic vein
The ganglion gives 10-12 short ciliary nerves containing
e. Recurrent branch of lacrimal artery.
postganglionic fibres for the supply of constrictor or sphinc-
2. Structures passing within the ring are as follows:
ter pupillae for narrowing the size of pupil and ciliaris
a. Upper division of oculomotor nerve
muscle for increasing the curvature of anterior surface of
b. Nasociliary nerve
lens required during accommodation of the eye.
c. Lower division of the oculomotor nerve
Q.3. Boundaries and structures passing through d. Abducent nerve.
superior orbital fissure. 3. Structure passing medial to the ring:
a. Inferior ophthalmic vein.
Ans.

SHORT NOTES

Q.1. Ciliary ganglion. Q.2. Nasociliary nerve.

Ans.
Ciliary ganglion is pinhead in size and is situated near the
apex of orbit. This ganglion is topographically related to
trigeminal nerve, but functionally it is related to oculomotor
nerve.
Ans.
Nasociliary nerve is one of the terminal branches of the oph-
thalmic division of the trigeminal nerve. It begins in the lateral
wall of the anterior part of the cavernous sinus. It enters the
orbit through the middle part of the superior orbital fissure.

Roots The branches of nasociliary nerve are as follows:

1. A communicating branch to the ciliary ganglion
Motor . Two or three long ciliary nerves
wh

Nerve to inferior oblique. This is the parasympathetic root . The posterior ethmoidal nerve
to supply sphincter pupillae and ciliaris. . The infratrochlear nerve
Um

1. Sensory—nasociliary nerve . The anterior ethmoidal nerve is the larger terminal

2. Sympathetic—internal carotid plexus to supply dilator branch of the nasociliary nerve.
pupillae.
In the nasal cavity, it lies deep to the nasal bone and gives
off two internal nasal branches, and finally, it emerges at the
Branches
lower border of the nasal bone as the external nasal nerve,
There are 15-20 short ciliary nerves. which supplies the skin of the lower half of the nose.
 General Anatomy

Q.3. Extraocular muscles. Nerve Supply

Ans.
The extraocular muscles are as follows:
1. Voluntary muscles
2. Involuntary muscles.
Voluntary Muscles
Voluntary muscles include the following:
1. Four recti: (a) superior rectus, (b) inferior rectus,
(c) medial rectus and (d) lateral rectus
2. Two obliqui: (a) superior oblique and (b) inferior oblique
3. The levator palpebrae superioris.
Involuntary Muscles
1. The superior tarsal muscle is the deeper portion of the
levator palpebrae superioris. It is inserted on the
upper margin of the superior tarsus. It elevates the upper
eyelid.
2. The inferior tarsal muscle extends from the fascial sheath
of the inferior rectus and inferior oblique to the lower
margin of the inferior tarsus. It possibly depresses the
lower eyelid.
3. The orbitalis bridges the inferior orbital fissure. Its
action is uncertain.
Q.4. Oblique muscles of eyeball.
It is supplied by trochlear nerve.
Action
Superior oblique muscle rotates the eyeball downwards and
laterally.
Inferior Oblique Muscle
Inferior oblique muscle originates from upper surface of
floor of the orbit, lateral to the lacrimal groove, and inserts
into lateral surface of the sclera behind the equator.
Nerve Supply
Inferior division of the oculomotor nerve.
Action
Inferior oblique muscle rotates the cornea upwards and laterally.
Q.5. Branches of nasociliary nerve.
Ans.
The branches of nasociliary nerve are as follows:
1. A communicating branch to the sensory root of ciliary
ganglion
2. Two or three long ciliary nerves, which supply the eyeball
. Posterior ethmoidal nerve
ies]

Ans. 4. Infratrochlear nerve, which supplies medial portion of

the eyelids and conjunctiva
Superior Oblique Muscle 5. Anterior ethmoidal nerve, which divides into medial
and lateral nasal branches.
Origin
Q.6. Actions of oblique muscles of eyeball.
Orbital surface of the body of the sphenoid above and me-
dial to optic foramen and inferior surface of lesser wing of Ans.
the sphenoid bone. Actions of oblique muscles of eyeball are as follows:
It is a rounded muscle that gives rise to a tendon. 1. Superior oblique muscle rotates the eyeball downwards
The tendon winds round the fibrocartilaginous pulley-like
and laterally.
trochlea and expands and inserts on the superior rectus 2. Inferior oblique muscle rotates the cornea upwards and
muscle.
laterally.

ANTERIOR TRIANGLE OF THE NECK

LONG ESSAYS

Q.1. Describe the origin, course, relations and The maxillary artery is the large terminal branch of the
branches of maxillary artery. external carotid artery. It leaves ECA at about right angle
passing almost horizontally between the ramus of the
Ans. mandible and the sphenomandibular ligament. It has a
ti Quick Review Series: BDS Ist Year

Deep temporal
Pharyngeal artery
Artery of pterygoid canal Infraorbital artery
Anterior tympanic Sphenopalatine
deep auricular Third part of maxillary artery
Superficial temporal Posterior superior alveolar
First part of maxillary artery << oN} Greater palatine
Masseteric artery on lateral pterygoid muscle Branches to maxillary
sinus and upper teeth

oe
Middle meningeal
Accessory meningeal Middle superior alveolar
Second part of maxillary artery
Inferior alveolar
Pterygoid artery Leys Buccal artery

External carotid artery

Branch to mylohyoid

Fig. 14.8.1 The maxillary artery and its relations.

wide territory of distribution and supplies the following nerve, and then along the lower border of the lateral
structures (Fig. 1A.8.1): pterygoid.
1. The external and middle ears, and the auditory tube . The second (pterygoid) part rans upwards and forwards
The dura mater superficial to the lower head of the lateral pterygoid.
wh

The upper and lower jaws . The third (pterygopalatine) part passes between the two
The muscles of the temporal and infratemporal regions heads of the lateral pterygoid and through the pterygo-
The nose and paranasal air sinuses maxillary fissure, to enter the pterygopalatine fossa
NDR

The palate where it lies in front of the pterygopalatine ganglion.

The root of the pharynx.
Course and Relations
In front of the ramus of the mandible, the artery passes up-
wards across the lower part of the lateral pterygoid crossing
either superficial or deep to the lower head of this muscle
(Fig, 1A.8.1).
The maxillary artery is divided into three parts by the lateral
pterygoid muscle as follows (Fig. 1A.8.2):
1. The first (mandibular) part runs horizontally forwards,
first between the neck of the mandible and the spheno-
mandibular ligament, below the auriculotemporal
Branches of First Part of the Maxillary Artery
The first part of maxillary artery, ie. when it (Table 1A.8.1)
lies medial to the mandible, gives off the following
branches:
1. The deep auricular artery supplies the external acoustic
meatus, the tympanic membrane and the temporoman-
dibular joint.
. The anterior tympanic branch supplies the middle ear
including the medial surface of the tympanic membrane.
. The middle meningeal artery is given off in the infratem-
poral fossa. It supplies only small branches to the dura

Masseteric artery
Deep temporal artery

Middle and accessory

meningeal artery
Sphenopalatine artery
Anterior tympanic in Artery of pterygoid canal
Deep auricular artery ——\\ Pharyngeal artery
Superficial temporal artery (orc artery
aes palatine artery
Maxillary artery
Posterior superior alveolar artery
Buccal artery

Posterior auricular vo Pterygoid artery

So oc alveolar artery
_ to lingual nerve
External carotid artery
toni artery

Fig. 1A.8.2 Maxillary artery and its branches.

 General Anatomy

Table 1A.8.1 Branches of mandibular (first) part of the maxillary BRANCHES OF THIRD PART OF THE MAXILLARY
artery and their distribution ARTERY
Branches of Foramen Distribution The third or the terminal part or the pterygopalatine portion
maxillary artery transmitting
of the maxillary artery lies against the posterolateral aspect
(first part)
of the maxilla and passes deep between the two heads of
Deep auricle artery Foramen in the Skin of the external acoustic
floor of the eae earner ae lateral pterygoid muscle to enter pterygopalatine fossa where
eererralraconencal ti tympanic ao it gives off the following branches (Table 1A.8.3):
Pete 1. The posterior superior alveolar artery arises just before
Anterior tympanic — Petrotympanic Inner surface of tympanic the maxillary artery enters the pterygomaxillary fissure.
artery lanenerninee ene Descending on the posterior surface of the maxilla
it gives off branches that enter canals in the bone to
Middle meningeal Foramen More of bone and less of :
artery spinosum meninges fifth and seventh supply the molar and premolar teeth, and the maxillary
nerves, middle ear, tenser sinus.
tympani . The infraorbital artery also arises just before the maxil-
Accessory Foramen ovale Main distribution is lary artery enters the pterygomaxillary fissure. Through
meningeal artery extracranial to pterygoids the inferior orbital fissure it enters the orbit and runs
Inferior alveolar Mandibular Lower teeth and mylohyoid forwards mn relation to the floor of the orbit, first in
artery muscle the infraorbital groove and then in the infraorbital
canal emerging on the face through the infraorbital
foramen. It gives off some orbital branches to the struc-
mater. It is predominantly a periosteal artery supplying tures in the orbit and the anterior superior alveolar
the bone and red bone marrow in the dipole. branches to the incisor and canine teeth. After emerg-
4. The accessory meningeal artery enters the cranial cavity ing on the face, the infraorbital artery gives branches
through the foramen ovale. Apart from the meninges it to the lacrimal sac, the nose and the upper lip. The
supplies structures in the infratemporal fossa. remaining branches of the third part arise within the
5. The inferior alveolar artery rans downwards and for- pterygopalatine fossa.
wards medial to the ramus of the mandible, enters the . The greater palatine artery runs downwards in the greater
mandibular canal in which it rans downwards and for- palatine canal to emerge on the posterolateral part of the
wards supplying teeth and surrounding bone and then hard palate through the greater palatine foramen. It then
gives off a small branch through the mental foramen to runs forwards near the lateral margin of the palate to
anastomose with other vessels on the face. Before enter- reach the incisive canal through which some terminal
ing the mandibular canal, the artery gives off a lingual
branch to the tongue and a mylohyoid branch

BRANCHES OF SECOND PART OF THE Table 1A 8.3 Branches of third part (pterygopalatine)
MAXILLARY ARTERY of the maxillary artery

The second part of the maxillary artery, while it is related Branch of Foramen Distribution
maxillary artery transmitting
to lateral pterygoid muscle, mainly gives off its so called (third part)
muscular branches (Table 1A.8.2). . :
: : Posterior superior Alveolar canals Upper molar and premolar
The deep temporal branches (anterior and posterior) ascend alveolar artery in body of teeth and gums, maxillary
on the lateral aspect of the skull deep to the temporalis muscle. Paella ene
Branches are also given to the pterygoid muscles and to the
i . Infraorbital arter Inferior orbital © Lower orbital muscles, lacri-
masseter. A buccal branch supplies the buccinator muscle. y fissure mal sac, maxillary sinus, up-
per incisors and canine teeth
Table 1A 8.2 The branches of second (pterygoid) part of the Greater palatine Greater palatine Soft palate, tonsil, palatine
mazillary artery artery canal glands mucosa upper gums
5 ea Pharyngeal Pharyngeal Root of nose and pharynx,
Branch of maxillary artery Distribution (palatovaginal) auditory tube, sphenoidal
Deep temporal artery Temporalis muscle canal sinus
Pterygoid artery Masseteric artery Lateral and medial pterygoid Artery of pterygoid Pterygoid canal Auditory tube, upper phar-
muscles canal ynx, middle ear
Masseter muscle Sphenopalatine Sphenopalatine Lateral and medial walls of
Buccal artery Buccinator muscle (terminal part) foramen nose and various air sinuses
Uy) Quick Review Series: BDS 1st Year

branches enter the nasal cavity. Branches of the artery Floor

supply the palate and gums. Within the greater palatine
canal it gives off the lesser palatine arteries that emerge
on the palate through the lesser palatine foramina and
run backwards supplying the soft palate and tonsil.
4. The pharyngeal branch runs backwards through pha-
ryngeal or palatovaginal canal. It supplies part of the
nasopharynx, the auditory tube and the sphenoidal air
sinus.
5. The artery of the pterygoid canal runs backwards in the
pterygoid canal and supplies the pharynx, the auditory
tube and the tympanic cavity.
6. The sphenopalatine artery passes medially through the
sphenopalatine foramen to enter the cavity of the nose.
It gives off posterolateral nasal branches to the lateral
wall of the nose and to the paranasal air sinuses, and
posterior septal branches to the nasal septum.
Q.2. Describe the boundaries and contents
carotid triangle of neck.
Ans.
The boundaries of the carotid triangle are as follows
(Fig. 1A.8.3):
Anterosuperiorly: Posterior belly of the digastric muscle and
the stylohyoid.
Anteroinferiorly: Superior belly of the omohyoid.
Posteriorly: Anterior border of the sternocleidomastoid muscle.
Roof
1. Skin
2. Superficial fascia containing (a) the platysma, (b) the
cervical branch of the facial nerve and (c) the transverse
cutaneous nerve of the neck
3. Investing layer of deep cervical fascia.
It is formed by the parts of (a) the thyrohyoid muscle (b) the
hyoglossus and (c) the middle and inferior constrictors of
the pharynx.
Carotid Triangle Contents
The contents of the carotid triangle are as follows (Fig. 1A.8.4):
1. Arteries
a. The common carotid artery with the carotid sinus
and the carotid body
b. Internal carotid artery
c. The external carotid artery with its superior thyroid,
lingual, facial, ascending pharyngeal and occipital
branches.
2. Veins
a. The internal jugular vein
b. The common facial vein draining into the internal
of the jugular vein
c. A pharyngeal vein that may end either in the internal
jugular vein or in the common facial vein
d. The lingual vein.
3. Nerves
a. The vagus running vertically downwards
b. The superior laryngeal branch of the vagus, dividing
into the external and internal laryngeal nerves
c. The spinal accessory nerve running backwards over
the internal jugular vein
d. The hypoglossal nerve running forwards over the
external and internal carotid arteries
e. The sympathetic chain runs vertically downwards
posterior to the carotid sheath.
4. Lymph nodes
The deep cervical lymph nodes are situated along the in-
ternal jugular vein and include the jugulodigastric node
below the posterior belly of the digastric and the jugulo-
omohyoid node above the inferior belly of the omohyoid.

Digastric, posterior
belly

External carotid artery

Superior 4 Hyoid bone Styloid . process Accessory nerve
carotid Omohyoid, superior Internal carotid artery
triangle yore sup
belly Glossopharyngeal nerve
Pharyngeal branch of vagus
Inferior Sternohyoid
carotid Outline of carotid triangle
triangle Sternocleidomastoid Hypoglossal nerve
Superior laryngeal
branch of vagus
Internal laryngeal nerve
Vagus nerve
External laryngeal nerve 3
Superior thyroid artery
: an Inferior root of
Superior root of ansa cervicalis
ansa cervicalis

Ansa cervicalis

Fig. 1A.8.3 The boundaries of the carotid triangle. Fig. 1A.8.4 The contents of the carotid triangle.
 General Anatomy

SHORT ESSAYS

Q.1. Lingual artery. angle of the roof of the posterior triangle and opens into the
subclavian vein (Fig. 1A.8.6).
Ans.
The tributaries of external jugular vein are as follows:
1. The lingual artery arises from the external carotid artery
1. The posterior external jugular vein
opposite to the tip of the greater cornu of the hyoid
2. The transverse cervical vein
bone.
3. The suprascapular vein
2. Its course is divided into three parts by the hyoglossus
4. The anterior jugular vein.
muscle (Fig. 1A.8.5).
a. The first part lies in the carotid triangle. It forms a
characteristic upward loop that permits free move- Superficial Retromandibular vein
ments of the hyoid bone. temporal vei
b. The second part lies deep to the hyoglossus along the
upper border of hyoid bone. It is superficial to the
middle constrictor of the pharynx.

Middle Deep lingual artery

constrictor

CN Xxil Common facial

vein
External

Anterior jugular
vein

Fig. 1A.8.6 External jugular vein.

The oblique jugular vein connects the external jugular

External carotid
Geniohyoid
artery Dorsal lingual
Hyoglossus arteries9 Sublingual branch
Fig.1A.8.5 The course of lingual artery.
c. The 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 horizon-
tally forwards on the undersurface of the tongue as
the fourth part.
3. 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.
Q.2. External jugular vein.
Ans.
The external jugular vein begins in the substance of parotid
gland. It is formed by union of the posterior auricular vein
with the posterior division of the retromandibular vein. It
begins within the lower part of the parotid gland, crosses the
sternocleidomastoid obliquely, pierces the anteroinferior
vein with the internal jugular vein across the middle
one-third of the anterior border of the sternocleidomastoid.
The external jugular vein usually terminates in the subcla-
vian vein, but sometimes it may end in the internal jugular vein.
The external jugular vein is examined to assess the venous
pressure, as the right atrial pressure is reflected in it because
there are no valves in the entire course of this vein.
Q.3. Give the formation relations and branches of
ansa cervicalis.
Or
Location, formation and distribution of ansa cervi-
Calis.
Ans.
Ansa cervicalis or ansa hypoglossi is a thin nerve loop
that lies embedded in the anterior wall of the carotid sheath
over the lower part of the larynx (Fig. 1A.8.7). It supplies the
infrahyoid muscles.
Ansa cervicalis is formed by a superior and an inferior root.
e The superior root is the continuation of the descending
branch of the hypoglossal nerve.
e The inferior root or descending cervical nerve is derived
from second and third cervical spinal nerves.
rv) Quick Review Series: BDS Ist Year

Hypoglossal nerve Apart from its terminal branches to the thyroid gland, it
Ventral ramus of C1 gives one important branch, the superior laryngeal artery,
Communication to hypoglossal nerve
which pierces the thyrohyoid membrane in company with
To muscles of tongue Ventral ramus of C2
To geniohyoid Ventral ramus of C3
the internal laryngeal nerve. The superior thyroid artery also
To thyrohyoid
gives a sternocleidomastoid branch to that muscle and a
Superior root of
Inferior root of ansa cervicalis cricothyroid branch that anastomoses with the artery of the
(descending cervicalis)
ansa cervicalis opposite side in front of the cricovocal membrane.
To superior belly
of omohyoid
To sternohyoid To inferior belly of omohyoid Lingual Artery
To sternothyroid
The lingual artery arises from the external carotid artery op-
Fig. 14.8.7 Ansa cervicalis. posite the tip of the greater cornu of the hyoid bone. The
hyoglossus muscle divides its course into three parts.
The first part lies in the carotid triangle. It forms a character-
The inferior root descends and winds around the internal istic upward loop that permits free movements of the hyoid bone.
jugular vein and then continues anteroinferiorly to join the The second part lies deep to the hyoglossus along the
superior root in front of the common carotid artery. upper border of hyoid bone. It is superficial to the middle
constrictor of the pharynx.
Distribution of Ansa Cervicalis The third part is called the arteria profunda linguae or
Distribution of ansa cervicalis is as follows: the deep lingual artery that runs upwards along the anterior
1. Superior root: Supplies the superior belly of the omohyoid. border of the hyoglossus and then horizontally forwards on
2. Ansa cervicalis: Supplies the sternohyoid, sternothyroid the undersurface of the tongue as the fourth part.
and the inferior belly of the omohyoid. In its vertical course, it lies between the genioglossus medi-
ally and the inferior longitudinal muscle of the tongue laterally.
Q.5. Name any four branches of external carotid
artery given in the carotid triangle. Facial Artery
Ans. The facial artery or the external maxillary artery arises from
The external carotid artery gives the following branches in the external carotid just above the tip of the greater cornu of
the carotid triangle (Fig. 1A.8.8): the hyoid bone.
1. Superior thyroid It has two parts:
Lingual 1. The first part runs upwards in the neck as cervical part.
wy

Facial 2. The second part runs on the face as facial part.

Ascending pharyngeal
The cervical part of the facial artery gives off the following
we

Occipital branches.
branches:
Superior Thyroid Artery 1. Ascending palatine
2. Tonsillar
The superior thyroid artery arises from the external carotid 3. Submental
artery just below the level of the greater cornua of the hyoid 4. Glandular branches for the submandibular salivary
bone. It runs downwards and forwards and passes deep to gland and lymph nodes.
the three long infrahyoid muscles to reach the upper pole of
the lateral lobe of the thyroid gland. The chief branches of artery on the face are the labial arteries:
1. Superior labial
2. Inferior labial.
External carotid artery.
Styloid process Accessory nerve
The terminal portion of the facial artery is the angular artery.
Internal carotid artery
Glossopharyngeal nerve
Pharyngeal branch of vagus
Occipital artery Occipital Artery
Outline of carotid triangle
Hypoglossal nerve The occipital artery arises from the posterior surface of the
Superior laryngeal
Internal laryngeal nerve branch of vagus external carotid artery, at about the same level as the facial
External laryngeal nerve Vagus nerve artery. Close to its origin it is crossed by the hypoglossal
Superior thyroid artery Inferior root of
Superior root of
nerve. In the carotid triangle, the artery gives two sterno-
ansa cervicalis
ansa cervicalis cleidomastoid branches. The upper branch accompanies the
Ansa cervicalis
accessory nerve, and the lower branch arises near the origin
Fig. 1A.8.8 Branches of external carotid artery. of the occipital artery.
 General Anatomy

SHORT NOTES

Q.1. Lingual artery. Contents of posterior part of the triangle are as follows:
1. Superficial structures are (a) lower part of the parotid
Ans.
gland and (b) the external carotid artery before it enters
The lingual artery arises from the external carotid artery the parotid gland.
opposite the tip of the greater cornu of the hyoid bone. 2. Deep structures, passing between the external and
It chiefly supplies the tongue. internal carotid arteries are (a) the styloglossus, (b) the
Its course is divided into three parts by the hyoglossus stylopharyngeus, (c) the glossopharyngeal nerve, (d) the
muscle. The first part lies in the carotid triangle. It forms a pharyngeal branch of the vagus nerve, (e) the styloid
characteristic upward loop, which is crossed by the hypo- process and (f) a part of the parotid gland.
glossal nerve during surgical removal of the tongue, the first 3. Deepest structures include (a) the internal carotid
part of the artery is ligated before it gives any branch to the artery, (b) the internal jugular vein and (c) the vagus
tongue or tonsil. nerve.
Q.2. Ansa cervicalis. Q.5. Name branches of external carotid artery.
Ans.
Ans.
This is a thin nerve loop that lies embedded in the anterior
wall of the carotid sheath over the lower part of the larynx. The external carotid artery gives off eight branches, which
It supplies the infrahyoid muscles. It is formed by a superior may be grouped as follows (Fig. 1A.8.9):
and an inferior root. Superior root is derived from first 1. Anterior branches
cervical nerve, and the inferior root is derived from second a. Superior thyroid
and third cervical spinal nerves. b. Lingual
c. Facial
Q.3. Anterior jugular vein. 2. Posterior branches
a. Occipital
Ans.
b. Posterior auricular
This is a small vein, beginning in the submental region 3. Medial branches
below the chin. It descends in the superficial fascia about a. Ascending pharyngeal
1 cm from the median plane. About 2.5 cm above the 4. Terminal branches
sternum, it pierces the investing layer of deep fascia to enter a. Maxillary
the suprasternal space where it is connected to its fellow of b. Superficial temporal.
the opposite side by the jugular venous arch. The vein then
turns laterally, runs deep to the sternocleidomastoid just
above the clavicle and ends in the external jugular vein at
the posterior border of the sternocleidomastoid. Superficial temporal artery
Posterior Middle temporal artery
Q.4. Contents of the digastric triangle.
auricular artery Transverse facial artery
Ans. Occipital artery
Maxillary artery
Ascending palatine branch
Descending branch Tonsillar branch
Contents of anterior part of the digastric triangle are as Facial artery
follows: Submental branch
Sternocleidomastoid branch
1. Structures superficial to mylohyoid are as follows: Ascending 4 Lingual artery
a. Superficial part of the submandibular salivary gland. pharyngeal artery
The facial vein and the submandibular lymph nodes 4+- Superior thyroid artery
Internal carotid artery
are superficial to it and the facial artery is deep to it. External carotid artery
b. Submental artery. Common carotid artery
c. Mylohyoid nerve and vessels. Sternocleidomastoid
2. Structures superficial to the hyoglossus seen without branch
disturbing the mylohyoid and the submandibular gland
are (a) the submandibular salivary gland, (b) the inter- Common carotid artery
mediate tendon of the digastric and the stylohyoid and
(c) the hypoglossal nerve. Fig.1A.8.9 External carotid artery and its branches.
46 Quick Review Series: BDS 1st Year

Q.6. Mention the branches of lingual artery. Q.7. Action and insertion of posterior cricoaryte-
noid muscle.
Ans.
Ans.
Branches of three parts of lingual artery are as follows:
Posterior cricoarytenoid is a triangular muscle. It originates
First part: Suprahyoid artery.
from the posterior surface of the lamina of the cricoid carti-
Second part: Dorsal lingual arteries to supply tongue, tonsil lage. Its fibres pass upwards and laterally and are inserted into
and palate. posterior aspect of muscular process of the arytenoid cartilage.
Third part: Sublingual artery to supply sublingual salivary
Actions
gland. This artery communicates with submental artery.
The lingual artery of both sides anastomose along the tip of Posterior cricoarytenoids are the only muscles which abduct
the tongue. the vocal cords.

LONG ESSAYS

Q.1. Describe the gross anatomy of the parotid External Features of the Parotid Gland (Fig. 14.9.1)
gland and add a note on nerve supply.
The gland is pyramidal in shape. The apex of the pyramid is
Or directed downwards, and the base or superior surface forms
the upper end of the gland.
Describe the relations, blood supply, nerve supply
and applied anatomy of the parotid gland. The four surfaces of the gland are as follows:
1. Superior (base of the pyramid)
Or
2. Superficial
Describe the external features, relations and nerve 3. Anteromedial
supply of the parotid gland. 4. Posteromedial.
Ans. The surfaces are separated by three borders:
1. Anterior
There are three pairs of large salivary glands, namely
2. Posterior
1. Parotid gland
3. Medial.
2. Submandibular gland
3. Sublingual gland. The apex overlaps the posterior belly of the digastric and
the adjoining part of the carotid triangle and the cervical
The parotid gland is the largest of the salivary glands
branch of the facial nerve.
weighing about 15 g. It is situated below the external
acoustic meatus, between the ramus of the mandible and
Auriculotemporal n. and
the sternocleidomastoid muscle. The gland overlaps the superficial temporal vessels
masseter muscle anteriorly. Temporal and
The parotid capsule is formed by the investigating layer
of the deep cervical fascia. The fascia splits to enclose the
gland. The superficial lamina is thick and adherent to the Transverse facial a.
gland. The deep lamina is thin and is attached to the styloid Parotid duct
Buccal branches
process, the mandible and the tympanic plate. A thickened Sternocleidomastoid
Masseter
portion of the deep lamina, extending between the styloid Marginal mandibular br.
Retromandibular v-
process and the mandible, forms the stylomandibular Great auricular n.
Submandibular gland
ligament, which separates the parotid gland from the Cervical br.

submandibular salivary gland. Fig. 1A.9.1 External features of the parotid gland.

The superior surface or base forms the upper end of the
gland, which is small and concave, where the temporal
branches of the facial nerve, the superficial temporal vessels
and the auriculotemporal nerve traverse the parotid gland
and cross the zygomatic arch subcutaneously.
The superficial surface is the outer surface of the parotid gland
and is covered with skin and superficial fascia containing the
anterior branches of the great auricular nerve. The preauricular
or superficial parotid lymph nodes may occur on its surface.
From the anterior edge of this superficial part, the parotid, the
Stensen’s duct passes forwards across the masseter muscle.
The anteromedial surface is grooved by the posterior
border of the ramus of the mandible. It is related to the
masseter, the lateral surface of the temporomandibular joint,
the posterior border of the mandible, the medial pterygoid
and the emerging branches of the facial nerve.
The posteromedial surface is related to (a) the mastoid
process, with the sternocleidomastoid and the posterior
belly of the digastric and (b) the styloid process. The external
carotid artery enters the gland through this surface.
Borders
The anterior border separates the superficial surface from
the anteromedial surface and extends from the anterior part
of the superior surface to the apex.
The following structures emerge at the anterior border:
1. The parotid duct
2. Most of the terminal branches of the facial nerve
3. The transverse facial vessels.
The accessory parotid gland lies along the parotid duct
close to this border.
The posterior border separates the superficial surface
from the posteromedial surface. It overlaps the sternocleido-
mastoid muscle.
The medial edge or border separates the anteromedial
surface from the posteromedial surface. It is related to the
lateral wall of the pharynx.
Deep Siructures of the Parotid Gland (Fig. 1A.9.2)
1. Arteries:
a. The external carotid artery enters the gland through
its posteromedial surface.
b. The maxillary artery leaves the gland through its
anteromedial surface.
c. The superficial temporal vessels emerge at the anterior
part of the superior surface.
d. The posterior auricular artery may arise within the gland.
2. Veins: The retromandibular vein is formed within
the gland by the union of the superficial temporal and
maxillary veins. In the lower part of the gland, the vein
divides into anterior and posterior divisions that emerge
at the apex (lower pole) of the gland.
General Anatomy
Superficial
temporal vessels
Maxillary a.
Auriculotemporal n.
Styloid process
Int. jugular v.
Facial n.
Stylohyoid m.
Retromandibular v.
Ext. jugular v.
Occipital
Int. carotid
Int. jugular v.
Ext. carotid a.
Fig. 14.9.2 Deep structures of the parotid gland.
3. Nerves: The facial nerve enters the gland through the
upper part of its posteromedial surface and divides into
its terminal branches within the gland and appear on
the surface at the anterior border.
4. Parotid lymph nodes.
Parotid Duct
Parotid duct is about 5 cm long and emerges from the mid-
dle of the anterior border of the gland. It runs forwards and
slightly downwards on the masseter. At the anterior border
of the masseter, it turns medially and pierces the buccal pad
of fat and the buccinator and opens into the vestibule of the
mouth opposite the crown of the maxillary second molar
tooth.
Blood Supply
The parotid gland is supplied by the external carotid artery and
its branches. The veins drain into the external jugular vein.
Nerve Supply
1. Parasympathetic nerves are secretomotor. They reach
the gland through the auriculotemporal nerve. The pre-
ganglionic fibres begin in the inferior salivatory nucleus;
pass through the glossopharyngeal nerve, its tympanic
branch, the tympanic plexus and the lesser petrosal
nerve; and relay in the otic ganglion. The postganglionic
fibres pass through the auriculotemporal nerve and
reach the gland.
2. Sympathetic nerves are vasomotor and are derived from
the plexus around the external carotid artery.
3. Sensory nerves to the gland come from the auriculotem-
poral nerve, but the sensory fibres of the great auricular
nerve (C2) innervate the parotid fascia.
48 Quick Review Series: BDS 1st Year

Lymphatic Drainage or fundus of the meatus, the two roots, sensory and
motor fuse to form a single trunk, which lies in the
Lymph drains first to the parotid nodes and from there to
petrous temporal bone.
the upper deep cervical nodes.
4. The course of the nerve can be divided within the canal
Applied Anatomy into three parts by two bends.
a. The first part is directed laterally above the vestibule.
1. Parotid swellings are very painful due to the unyielding b. The second part runs backwards in relation to the
nature of the parotid fascia. medial wall of the middle ear, above the promontory.
2. Mumps is an infectious disease of the salivary glands c. The third part is directed vertically downwards be-
(usually the parotid) caused by a specific virus. hind the promontory.
Viral parotitis or mumps characteristically does not sup-
The sharp first bend is also called the genu at the junction
purate. Its complications are orchitis and pancreatitis.
of the first and second parts. The geniculate ganglion of the
3. A parotid abscess may be caused by spread of infection
nerve is so called because it lies on the genu. The second
from the oral cavity. An abscess may also form due to
bend is gradual and lies between the promontory and the
suppuration of the parotid lymph nodes draining an
mastoid antrum.
infected area. A parotid abscess is best drained by hori-
In its extracranial course, the facial nerve crosses the
zontal incisions known as Hilton’s method.
lateral side of the base of the styloid process, enters the
4. The facial nerve is preserved during parotidectomy; by
posteromedial surface of the parotid gland, runs forwards
removing the gland in superficial and deep parts sepa-
through the gland and behind the neck of the mandible. It
rately, the plane of cleavage is defined by tracing the
divides into its five terminal branches, which emerge along
nerve from behind forwards.
the anterior border of the parotid gland.
5. Mixed parotid tumour is a slowly growing lobulated pain-
Branches and distribution of the facial nerve are as
less tumour without any involvement of the facial nerve.
follows (Fig. 1A.9.3):
Malignant change of such a tumour is indicated by pain,
1. Within the facial canal
rapid growth, fixity with hardness, involvement of the
a. Greater petrosal nerve
facial nerve and enlargement of the cervical lymph nodes.
b. The nerve to the stapedius
Q.2. Describe the course of the facial nerve. Write c. The chorda tympani
its applied aspects.
Or
Lacrimatory and superior salivatory nuclei
Give an account on extracranial course relations Nucleus of tractus solitarius
and branches of the facial nerve. Add a note on its Sensory root Lacrimal nerve
applied anatomy. Y Internal auditory meatus Lacrimal gland
Greater petrosal
Or
oo
Describe extracranial course of the facial nerve Deep petrosal
under the following headings: exit from cranial
horda tympani
cavity, course in neck and parotid gland, branches,
distribution and applied aspects.
Ans.

Facial nerve is the VII cranial nerve, which is the nerve of the
Submandibular
second branchial arch. ganglion
To stylohyoid Sublingual gland
Course and Relations Cervical Submandibular gland
Marginal mandibular
1. The facial nerve is attached to the lateral surface of
Fig. 1A.9.3 Distribution of facial nerve branches.
brainstem close to caudal border of the pons by two
roots, motor and sensory.
2. The sensory root is also called the nervus intermedius. 2. The branches of facial nerve at its exit from the stylo-
3. The two roots run laterally and forwards, along with the mastoid foramen
eighth nerve to reach the internal acoustic meatus. In the a. Posterior auricular
meatus, the motor root lies in a groove on the eighth b. Digastric
nerve, with the sensory root intervening. At the bottom c. Stylohyoid
 General Anatomy

. Terminal branches within the parotid gland
a. Temporal
b. Zygomatic
c. Buccal
d. Marginal mandibular
e. Cervical
. Communicating branches with adjacent cranial and
spinal nerves
A. Branches of facial nerve within the facial canal
a. Greater petrosal nerve
i. It is a branch of nervus intermedius and is
known as the nerve of tear secretion.
ii. The greater petrosal nerve joins deep petrosal
nerve near foramen lacerum and passes forwards
through pterygoid canal as nerve of pterygoid
canal and emerges into pterygopalatine fossa
and enters pterygopalatine ganglion, where it
relays secretomotor fibres.
iii. The taste fibres and sympathetic fibres pass
through ganglion together with the sensory fibres
of the maxillary nerve.
iv. It is secretomotor to glands of palate, pharynx
and nose and has a few taste fibres for the
scattered taste buds on the oral surface of the
palate.
b. The nerve to the stapedius: It arises opposite the pyra-
mid of the middle ear and supplies the stapedius
muscle. It damps excessive vibrations of the stapes
caused by high-pitched sounds. In paralysis of the
muscle, even normal sounds appear too loud, and it
is known as hyperacusis.
c. The chorda tympani arises in the vertical part of
the facial canal about 6 mm above the stylomastoid
foramen. It runs upwards and forwards in a bony
canal. It enters the middle ear and runs forwards in
close relation to the tympanic membrane. It leaves
the middle ear by passing through the petrotym-
panic fissure. It then passes medial to the spine of
the sphenoid and enters the infratemporal fossa.
b. The digastric branch arises close to the posterior auricu-
lar nerve and supplies the posterior belly of the digastric.
c. The stylohyoid branch, which may arise with digastric
branch, supplies the stylohyoid muscle.
3. Terminal branches within the parotid gland
a. The temporal branches cross the zygomatic arch and
supply
i. the auricularis anterior,
ii. the auricularis superior,
ili. the intrinsic muscles on the lateral side of the ear,
iv. the frontalis,
v. the orbicularis oculi and
vi. the corrugator supercilii.
b. The zygomatic branches run across the zygomatic
bone and supply the orbicularis oculi.
c. The buccal branches are two in number. The upper
buccal branch runs above the parotid duct and the
lower buccal branch below the duct. They supply
muscles in that vicinity.
d. The marginal mandibular branch runs below the an-
gle of the mandible deep to the platysma. It crosses
the body of the mandible and supplies muscles of the
lower lip and chin.
e. The cervical branch emerges from the apex of the
parotid gland and runs downwards and forwards in
the neck to supply the platysma.
Applied Aspects of Facial Nerve
The symptoms according to level of injury of facial nerve are
shown in Fig. 1A.9.4.
Symptoms according to level of injury of facial nerve
1. A lesion higher up in the facial canal, above the origin of
the chorda tympani causes facial paralysis, a loss of taste
in anterior part of the tongue.
Internal auditory meatus

Chorda tympani joins the lingual nerve through Internal auditory Geniculate ganglion
which it is distributed. It carries (a) preganglionic meatus Greater petrosal nerve
secretomotor fibres to the submandibular ganglion
for supply of the submandibular and sublingual 2, 3, 4, 5 of above Nerve to stapedius
salivary glands and taste fibres from the anterior 3, 4, 5 of above
two-thirds of the tongue.
Chorda tympani
B. The branches of facial nerve at its exit from the
stylomastoid foramen Stylomastoid
a. The posterior auricular nerve arises just below Only 5 foramen
the stylomastoid foramen. It ascends between the of above
mastoid process and the external acoustic meatus
and supplies
i. the auricularis posterior,
Cervical Marginal mandibular
ii. the occipitalis and
iii. the intrinsic muscles on the back of the auricle. Fig. 14.9.4 Level of injury of facial nerve and its symptoms.
Quick Review Series: BDS 1st Year
2. A lesion still higher above the origin of the nerve to
stapedius results in hyperacusis. These are all lesions of
the lower motor neuron (infranuclear).
3. A typical upper motor neuron lesion (supranuclear)
paralyses the lower part of the face but not the upper
SHORT ESSAYS
Q.1. Extracranial course of facial nerve.
Ans.
In its extracranial course, the facial nerve after leaving the
skull through the stylomastoid foramen crosses the lateral
side of the base of the styloid process and enters the postero-
medial surface of the parotid gland, runs forwards through
the gland and divides into its five terminal branches that
emerge along the anterior border of the parotid gland.
Branches and Distribution
1. Branches of facial nerve at its exit from the stylomas-
toid foramen:
a. The posterior auricular nerve arises just below the
stylomastoid foramen and supplies (a) the auricula-
ris posterior, (b) the occipitalis and (c) the intrinsic
muscles on the back of the auricle.
b. The digastric branch arises close to the posterior au-
ricular nerve. It is short and supplies the posterior
belly of the digastric.
c. The stylohyoid branch, which may arise with digastric
branch, is long and supplies the stylohyoid muscle.
2. Terminal branches within the parotid gland:
a. The temporal branches cross the zygomatic arch and
supply (a) the auricularis anterior, (b) the auricularis
superior, (c) the intrinsic muscles on lateral side of
the ear, (d) the frontalis, (e) the orbicularis oculi and
(f) the corrugator supercilii.
b. The zygomatic branches run across the zygomatic
bone and supply the orbicularis oculi.
c. The buccal branches are two in number. The upper
buccal branch runs above the parotid duct and the
lower buccal branch below the duct. They supply
muscles in that region.
d. The marginal mandibular branch runs below the
angle of the mandible deep to the platysma. It crosses
the body of the mandible and supplies muscles of the
lower lip and chin.
e. The cervical branch emerges from the apex of the
parotid gland and runs downwards and forwards in
the neck to supply the platysma.
3. Communicating branches: For effective coordination
between the movements of the muscles of the first,
(forehead and orbicularis oculi). The upper part of the
facial nerve nucleus that innervates upper musculature
is supplied by the cerebral cortex of both sides whereas
the lower part which innervates lower face receives only
contralateral cortical fibres.
second and third branchial arches, the motor nerves of
the three arches communicate with each other. The fa-
cial nerve also communicates with the sensory nerves
distributed over its motor territory.
Q.2. Connections, course and distribution of
chorda tympani.
Ans.
The chorda tympani arises in the vertical part of the facial
canal about 6 mm above the stylomastoid foramen. It runs
upwards and forwards in a bony canal and enters the middle
ear and runs forwards in close relation to the tympanic
membrane. It leaves the middle ear by passing through the
petrotympanic fissure. It then passes medial to the spine of
the sphenoid and enters the infratemporal fossa. Here, it
joins the lingual nerve through which it is distributed.
It carries (a) preganglionic secretomotor fibres to the
submandibular ganglion for supply of the submandibular
and sublingual salivary glands and (b) taste fibres from the
anterior two-thirds of the tongue.
Q.3. Beginning, course, termination and relations
of parotid duct.
Ans.
Parotid duct is thick walled and is about 5 cm long. It
emerges from the middle of the anterior border of the gland.
It runs forwards and slightly downwards on the masseter.
Here its relations are as follows:
Superiorly,
1. Accessory parotid gland
2. Upper buccal branch of the facial nerve and the trans-
verse facial vessels.
Inferiorly,
The lower buccal branch of the facial nerve.
At the anterior border of the masseter, it turns medially
and pierces (a) the buccal pad of fat, (b) the buccopharyn-
geal fascia and (c) the buccinator.
The duct runs forwards for a short distance between the
buccinator and the oral mucosa. Finally, it turns medially
and opens into the vestibule of the mouth opposite the max-
illary second molar tooth.
 General Anatomy

Q.4. Describe structures passing through the pa- 2. Within the canal, the course of the nerve can be divided
rotid gland. into three parts by two bends (Fig. 1A.9.6).
a. The first part is directed laterally above the vestibule.
Or
b. The second part runs backwards in relation to the
Structures passing through parotid gland. medial wall of the middle ear, above the promontory.
c. The third part is directed vertically downwards
Ans.
behind the promontory.
Refer to the answer of Long Essays Q.1.
The first bend at the junction of the first and second
Q.5. Intrapetrous part of facial nerve. parts is sharp. It lies over the anterosuperior part of the
Ans. promontory and is also called the genu. The second bend is
gradual, and lies between the promontory and the mastoid
1. The two roots of the facial nerve sensory and motor, fuse antrum. The facial nerve leaves the skull by passing through
to form a single trunk at the bottom or fundus of the me- the stylomastoid foramen.
atus which lies in the petrous temporal bone (Fig. 1A.9.5).
Canal for facial nerve

Second part runs backwards

First part passing laterally
Superior vestibular area Canal for facial nerve
qj to mastoid antrum

Transverse crest Geniculate ganglion

Pyramid
Inferior vestibular area
Promontory Third part runs downwards
Cochlear area
Foramen singulare

Fig. 1A.9.5 Features seen on the fundus of the left internal Stylomastoid foramen
acoustic meatus.
Fig. 1A.9.6 Course of facial nerve.

SHORT NOTES

Q.1. Parotid duct. Q.3. Chorda tympani.

Or Ans.

Parotid duct opening.
Ans.
Parotid duct is thick walled and is about 5 cm long. It
emerges from the middle of the anterior border of the gland.
It runs forwards and slightly downwards on the masseter.
It opens into the vestibule of the mouth opposite the crown
of the maxillary second molar tooth.
Q.2. Facial nerve.
Ans.
This is the seventh cranial nerve. It is the nerve of the second
branchial arch. The facial nerve leaves the skull by passing
through the stylomastoid foramen and supplies motor
innervation to the muscles of face.
The chorda tympani arises in the vertical part of the facial
canal about 6 mm above the stylomastoid foramen. It leaves
the middle ear by passing through the petrotympanic fissure.
It then passes medial to the spine of the sphenoid and enters
the infratemporal fossa where it joins the lingual nerve
through which it is distributed.
It carries (a) preganglionic secretomotor fibres to the
submandibular ganglion for supply of the submandibular
and sublingual salivary glands and (b) taste fibres from the
anterior two-thirds of the tongue.
Q.4. Nerve supply to parotid gland.
Ans.
1. The parasympathetic nerves are secretomotor. They
reach the gland through the auriculotemporal nerve.
The preganglionic fibres begin in the inferior salivatory
Quick Review Series: BDS 1st Year

nucleus; pass through the glossopharyngeal nerve, its
tympanic branch, the tympanic plexus and the lesser
petrosal nerve and relay in the otic ganglion. The post-
ganglionic fibres pass through the auriculotemporal
nerve and reach the gland.
2. Sympathetic nerves are vasomotor and are derived from
the plexus around the external carotid artery.
3. The auriculotemporal nerve supplies sensory nerves to
the gland but the parotid fascia is innervated by the
sensory fibres of the great auricular nerve (C2).
2. The maxillary artery leaves the gland through its antero-
medial surface.
3. The superficial temporal vessels emerge at the anterior
part of the superior surface.
4. The posterior auricular artery may arise within the
gland.
Q.6. List the branches of facial nerve soon after its
emergence through the stylomastoid foramen.
Ans.

Q.5. Name the arteries seen in the substance of Branches of facial nerve at its exit from the stylomastoid
parotid gland. foramen are as follows:
1. Posterior auricular
Ans.
2. Digastric and
1. The external carotid artery enters the gland through its 3. Stylohyoid.
posteromedial surface.

TE
INFRATEM

LONG ESSAYS

Q.1. Name the muscles of mastication. Describe

the origin, insertion, nerve supply actions and
relations of any one of them.

Or

Describe the muscles of mastication under the

following headings: names of the muscle attach-
ments, nerve supply and action. Masseter
muscle
Or

Name the muscles of mastication. Give their

attachments, nerve supply and action.
Fig.1A.10.1 The masseter muscle.
Ans.

The muscles of mastication are as follows:

1. The masseter Origin
2. The temporalis
It has three layers:
3. The lateral pterygoid
4. The medial pterygoid. 1. Superficial layer arises from anterior two-third of
lower border of zygomatic arch and adjoining zygo-
matic process of maxilla.
Masseter Muscle
2. Middle layer arises from anterior two-third of deep
The masseter muscle is quadrilateral in shape and covers surface and posterior one-third of lower border of
lateral surface of ramus of mandible (Fig. 1A.10.1). zygomatic arch.
 General Anatomy

3. Deep layer arises from deep surface of zygomatic Action

arch. Superficial fibres pass downwards and backwards
1. Elevates mandible.
at 45°, middle and deep fibres pass vertically
2. Posterior fibres retract the protruded mandible.
downwards.
3. Helps in side to side grinding movements.
Insertion
Lateral Pterygoid Muscle
1. Superficial layer is inserted into lower part of lateral
The lateral pterygoid muscle is a short, conical muscle and
surface of ramus of mandible.
has upper and lower heads (Fig. 1A.10.3).
2. Middle layer is inserted into middle part of ramus.
3. Deep layer is inserted into upper part of ramus and
coronoid process of the mandible.

Nerve Supply
The masseteric nerve, a branch of anterior division of man-
dibular nerve, supplies the masseter muscle.

Action

It elevates mandible to close the mouth.

Lateral Superior head></
Temporalis Muscle pterygoid Inferior head
Medial pterygoid
Temporalis muscle is a fan-shaped muscle, filling the temporal
fossa (Fig. 1A.10.2).
Fig. 1A.10.3 The lateral and medial pterygoid muscles.
Origin
The temporalis muscle arises from temporal fossa and tem-
poral fascia. The fibres converge and pass through gap deep Origin
to zygomatic arch.
1. Upper head (small) arises from infratemporal surface
Insertion and crest of greater wing of sphenoid bone.
2. Lower head (larger) arises from lateral surface of
Temporalis muscle inserts into margins and deep surface of lateral pterygoid plate and the fibres run backwards and
coronoid process and anterior border of ramus of mandible. laterally and converge for insertion.

Nerve supply Insertion

Two deep temporal branches from anterior division of 1. Pterygoid fovea on the anterior surface of neck of
mandibular nerve. mandible.
2. Anterior margin of articular surface of temporoman-
dibular joint.
Insertion is posterolateral and at a slightly higher level
than origin.

Nerve supply
Temporalis
muscle A branch from anterior division of mandibular nerve,
supplies the lateral pterygoid muscle.

Action

1. Along with suprahyoid muscles it helps in depressing

the mandible to open the mouth.
2. Lateral and medial pterygoids protrude the mandible.
3. Left lateral pterygoid and right medial pterygoid turn
Fig. 1A.10.2 The temporalis muscle. the chin to left side.
LY’) Quick Review Series: BDS 1st Year

Medial Pterygoid Muscle Action

The medial pterygoid muscle is quadrilateral in shape and 1. Depress mandible to open mouth, with suprahyoid
has a small superficial and a large deep head. muscle.
2. Lateral and medial pterygoid muscles protrude the
Origin mandible.
1. Superficial head (small slip): From tuberosity of maxilla 3. Left lateral pterygoid and right medial pterygoid turn
and adjoining bone. the chin to left side as part of grinding movements.
2. Deep head (quite large): From medial surface of lateral
pterygoid plate and adjoining process of palatine bone. Relations of Lateral Pterygoid
The fibres run downwards, backwards and laterally. The lateral pterygoid may be regarded as the key muscle of
this region, and its relations are as follows:
Insertion
Superficially lateral pterygoid is related to the following:
Roughened area on the medial surface of angle and adjoin- 1. Masseter
ing ramus of mandible, below and behind the mandibular 2. Ramus of the mandible
foramen and mylohyoid groove. 3. Tendon of the temporalis
4. The maxillary artery.
Nerve supply
Deep relations of lateral pterygoid are as follows:
Nerve to medial pterygoid, branch of main trunk of man- 1. Mandibular nerve
dibular nerve. 2. Middle meningeal artery
3. Sphenomandibular ligament.
Action
Deep head of the medial pterygoid structures emerging at the
1. Elevates mandible. lower border are as follows:
2. Helps protrude the mandible. 1. Lingual nerve
3. Right medial pterygoid with left lateral pterygoid turns 2. Inferior alveolar nerve.
the chin to left side.
Structures passing upwards deep to it are as follows:
Q.2. Give an account of lateral pterygoid muscle.
1. The middle meningeal artery.
Or
Structures passing through the gap between the two heads are
Describe lateral pterygoid muscle and its relations. as follows:
Ans. 1. The maxillary artery enters the gap
2. The buccal branch of the mandibular nerve comes out
The lateral pterygoid muscle is a short, conical muscle and through the gap.
has upper and lower heads (Fig. 1A.10.3).
Structure surrounding the lateral pterygoid is as follows:
Origin 1. The pterygoid plexus of veins.

1. Upper head (small): Arises from infratemporal surface Q.3. Describe the mandibular nerve under following
and crest of greater wing of sphenoid bone. headings: origin, roots fibres, its contents, termina-
2. Lower head (larger): Arises from lateral surface of tion and relations.
lateral pterygoid plate and the fibres run backwards and
Or
laterally and converge for insertion.
Describe the mandibular nerve under following
Insertion headings: formation, course, relations, branches
1. Pterygoid fovea on the anterior surface of neck of the and its distribution.
mandible Or
2. Anterior margin of articular surface of temporoman-
dibular joint. Give an account of origin, course, relations and
branches of mandibular nerve. Add a note on its
Insertion is posterolateral and at a slightly higher level applied anatomy.
than origin.
Ans.
Nerve Supply
Mandibular nerve is the largest of the three divisions of the
A branch from anterior division of mandibular nerve. trigeminal nerve. It is the nerve of the first branchial arch
 General Anatomy

and supplies all structures derived from the mandibular of
first branchial arch. It has both sensory and motor fibres.
Origin, Course and Relations
Mandibular nerve originates in the middle cranial fossa through
a large sensory root and a small motor root (Fig. 1A.10.4).
The sensory root arises from the lateral part of the trigeminal
ganglion and leaves the cranial cavity through the foramen
ovale.
The motor root lies deep to the trigeminal ganglion and
to the sensory root. It also passes through the foramen ovale
to join the sensory root just below the foramen thus forming
the main trunk. The main trunk lies in the infratemporal
fossa, on the tensor veli palatini, deep to the lateral ptery-
goid. After a short course, the main trunk divides into a
small anterior trunk and a large posterior trunk.
Masseteric nerve
Masseteric nerve emerges at the upper border of the lateral
pterygoid just in front of the temporomandibular joint,
passes laterally through the mandibular notch accompany-
ing the masseteric vessels and enters the deep surface of the
masseter. It also supplies the temporomandibular joint.
Deep temporal nerves
There are two deep temporal nerves, anterior and posterior
that pass between the skull and the lateral pterygoid and
enter the deep surface of the temporalis. The anterior nerve
is often a branch of the buccal nerve. The posterior nerve
may arise in common with the masseteric nerve.
Nerve to lateral pterygoid
Nerve to lateral pterygoid enters the deep surface of the
muscle. It may be an independent branch or may arise in
common with the buccal nerve.

ww
Posterior deep temporal
Lesser petrosal Masseteric
Nerve to tensor tympani
Anterior deep temporal Branches from the posterior trunk
Lateral pterygoid
Auriculotemporal Buccal Auriculotemporal nerve
Chorda tympani Medial pterygoid
Auriculotemporal nerve arises by two roots that run back-
. Lingual
Inferior alveolar 9 wards, encircle the middle meningeal artery and unite to
form a single trunk. Behind the neck of the mandible, it
Mylohyoid. Submandibular
ganglion
turns upwards and ascends on the temple behind the super-
ficial temporal vessels.
Fig. 1A.10.4 Mandibular nerve. 1. The auricular part of the nerve supplies the skin of the
tragus and the upper parts of the pinna, the external
acoustic meatus and the tympanic membrane.
Branches 2. The temporal part supplies the skin of the temple in
Branches from the main trunk
addition.
3. The auriculotemporal nerve also supplies the parotid
Meningeal branch or nervus spinosus gland (secretomotor and also sensory) and the tem-
It enters the skull through the foramen spinosum with the poromandibular joint.
middle meningeal artery and supplies the dura mater of the
middle cranial fossa. Lingual Nerve
Lingual nerve is one of the two terminal branches of the pos-
Nerve to medial pterygoid
terior division of the mandibular nerve. It is sensory to the
Nerve to medial pterygoid arises close to the otic ganglion anterior two-thirds of the tongue and to the floor of the
and supplies the medial pterygoid from its deep surface. This mouth. The fibres of the chorda tympani, a branch of facial
nerve gives a motor root to the otic ganglion, which does not nerve, which is secretomotor to the submandibular and sublin-
relay and supplies the tensor veli palatini and the tensor gual salivary glands and gustatory to the anterior two-thirds of
tympani muscles. the tongue, are also distributed through the lingual nerve.

Branches from the anterior trunk Course and relations

Buccal nerve
Buccal nerve is the only sensory
sion of the mandibular nerve.
heads of the lateral pterygoid,
wards, and supplies the skin and
to the buccinator. It also supplies
molar and premolar teeth.
branch of the anterior divi-
It passes between the two
runs downwards and for-
mucous membrane related
the labial aspect of gums of
It begins 1 cm below the skull. It runs first between the ten-
sor veli palatini and the lateral pterygoid and then between
the lateral and medial pterygoid. 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 down-
wards and forwards between the ramus of the mandible and
the medial pterygoid. Next, it lies in direct contact with the
Quick Review Series: BDS 1st Year
mandible, medial to the third molar tooth between the ori-
gins of the superior constrictor and the mylohyoid muscles.
It soon leaves the gum and runs over the hyoglossus deep to
the mylohyoid. Finally, it lies on the surface of the genioglos-
sus deep to the mylohyoid. Here it winds around the sub-
mandibular duct and divides into its terminal branches.
Inferior alveolar nerve
Inferior alveolar nerve is the larger terminal branch of the
posterior division of the mandibular nerve. It runs vertically
downwards lateral to the medial pterygoid and to the sphe-
nomandibular ligament. It enters the mandibular foramen
and runs in the mandibular canal accompanied by the infe-
rior alveolar artery.
Branches
1. The mylohyoid branch contains all the motor fibres of
the posterior division. It arises just before the inferior
alveolar nerve enters the mandibular foramen, runs in
the mylohyoid groove and supplies the mylohyoid mus-
cle and the anterior belly of the digastric.
2. Within the mandibular canal the inferior alveolar nerve
gives branches that supply the lower teeth and gums.
3. The mental nerve emerges at the mental foramen and
supplies the skin of the chin, and the skin and mucous
membrane of the lower lip.
4. The incisive branch supplies the labial aspect of gums of
canine and incisor teeth.
Q.4. Describe origin, course relations and distribu-
tion of lingual nerve.
Ans.
Refer to the answer of Long Essays Q.3.
Q.5. Mention boundaries and contents of infratem-
poral fossa.
Ans.
The infratemporal fossa lies below the skull and behind the
body of the maxilla and lateral pterygoid plate. It communi-
cates with the pterygopalatine fossa through the pterygo-
maxillary fissure.
Boundaries
1. The roof is formed medially by the infratemporal
surface of the greater wing of the sphenoid and by a
small part of the squamous temporal bone. Laterally,
the roof is incomplete where the infratemporal fossa
communicates with the temporal fossa through the gap
deep to the zygomatic arch. The roof formed by greater
wing is pierced by the foramen ovale and by the foramen
spinosum.
2. The floor is open.
3. The medial wall is formed by the lateral pterygoid plate
and the pyramidal process of the palatine bone.
4. The lateral wall is formed by the ramus of the mandible.
5. The anterior wall is formed by the infratemporal or
posterior surface of the maxilla and by the medial sur-
face of the zygomatic bone.
6. The posterior wall is open.
Communications
1. Superiorly—with cranial cavity
2. Inferiorly with—parapharyngeal space
3. Medially with—pterygopalatine fossa.
The anterior and medial walls are separated in their up-
per parts by the pterygomaxillary fissure through which the
infratemporal fossa communicates with the pterygopalatine
fossa. The upper end of the pterygomaxillary fissure is con-
tinuous with the anterior part of the inferior orbital fissure
through which the infratemporal fossa communicates with
the orbit.
Contents of infratemporal fossa are as follows:
1. Mandibular nerve and its branches
. Maxillary artery and its branches
wh
. Maxillary vein and its tributaries
Chorda tympani nerve
. Pterygoid plexus of veins
NDB
. Muscles of mastication
. Otic ganglion.
Q.6. Describe the movements of temporomandibu-
lar joint and mention the muscles producing these
movements. What are the factors responsible for
its stability?
Or
Describe temporomandibular joint.
Or
Describe the articulating surfaces, ligaments and
movements of temporomandibular joint.
Or
Describe the temporomandibular joint under the
following headings: type of joint, articular sur-
faces, ligaments, nerve supply, movements and
muscles producing movement.
Or
Describe the temporomandibular joint under the
following headings: articulating bones and articu-
lating surfaces, capsule, intra-articular disc, liga-
ments, movements with muscles producing it and
applied anatomy.
Ans.

Temporomandibular joint (TMJ) is a synovial joint of the
condylar variety.
Articular Surfaces
The upper articular surface is formed by:
1. The articular eminence and
2. Anterior part of the mandibular fossa.
The inferior articular surface is formed by
1. The head of the mandible: The articular surfaces are
covered with fibrocartilage. The joint cavity is divided
into upper and lower parts by an intra-articular disc.
Ligaments
The ligaments of TMJ are as follows:
1. The fibrous capsule
2. The lateral ligament
3. The sphenomandibular ligament
4. The stylomandibular ligament.
The fibrous capsule is attached above the articular tuber-
cle, the circumference of the mandibular fossa and the squa-
motympanic fissure; and below the neck of the mandible.
The capsule is loose above the intra-articular disc and tight
below it. The synovial membrane lines the fibrous capsule
and the neck of the mandible.
The lateral or temporomandibular ligament reinforces and
strengthens the lateral part of the capsular ligament. Its
fibres are directed downwards and backwards. It is attached
above the articular tubercle and below the posterolateral
aspect of the neck of the mandible.
The sphenomandibular ligament is an accessory ligament.
It is attached superiorly to the spine of the sphenoid and
inferiorly to the lingula of the mandibular foramen. It is a
remnant of the dorsal part of Meckel’s cartilage.
The stylomandibular ligament is another accessory liga-
ment of the joint. It is attached above to the lateral surface of
the styloid process and below to the angle and posterior
border of the ramus of the mandible.
It represents a thickened part of the deep cervical fascia,
which separates the parotid and submandibular salivary
glands.
Articular Disc
The articular disc is an oval fibrous plate that divides the
joint into an upper and a lower compartment. The upper
compartment permits gliding movements, and the lower
rotatory as well as gliding movements. The disc has a conca-
voconvex superior surface and a concave inferior surface.
The periphery of the disc is attached to the fibrous capsule.
The disc is composed of an anterior extension, anterior
thick band, intermediate zone, posterior thick band and
bilamellar region. The disc represents the degenerated
primitive insertion of lateral pterygoid.
General Anatomy
Relations
Lateral:
1. Skin and fasciae
2. Parotid gland
3. Temporal branches of the facial nerve.
Medial:
1. The tympanic plate separates the joint from the internal
carotid artery.
2. Spine of the sphenoid, with the upper end of the sphe-
nomandibular ligament.
3. The auriculotemporal and chorda tympani nerves.
4. Middle meningeal artery.
Anterior:
1. Lateral pterygoid
2. Masseteric nerve and vessels.
Posterior:
1. The parotid gland separates the joint from the external
auditory meatus
2. Superficial temporal vessels
3. Auriculotemporal nerve.
Superior:
1. Middle cranial fossa
2. Middle meningeal vessels.
Inferior: Maxillary artery and vein.
Blood Supply
Branches from superficial temporal and maxillary arteries.
Veins follow the arteries.
Nerve Supply
Auriculotemporal nerve and masseteric nerve.
Movements
The movements at the joint can be divided into those be-
tween the upper articular surface and the articular disc, i.e.
meniscotemporal compartment and those between the disc
and the head of the mandible, i.e. meniscomandibular com-
partment. Most movements occur simultaneously at the
right and left temporomandibular joints.
In forward movement or protraction of the mandible, the
articular disc glides forwards over the upper articular sur-
face, the head of the mandible moving with it. The reversal
of this movement is called retraction.
In slight opening of the mouth or depression of the mandi-
ble, the head of the mandible moves on the undersurface of the
disc like a hinge. In wide opening of the mouth, this hinge-like
movement is followed by gliding of the disc and the head of the
mandible, as in protraction. At the end of this movement, the
head comes to lie under the articular tubercle. These movements
are reversed in closing the mouth or elevation of the mandible.
Quick Review Series: BDS 1st Year
Chewing movements involve side-to-side movements of the
mandible. In these movements, the head of right side glides
forwards along with the disc as in protraction, but the head of
the left side merely rotates on a vertical axis. As a result of this,
the chin moves forwards and to left side (the side on which no
gliding has occurred). Alternate movements of this kind on the
two sides result in side-to-side movements of the jaw.
Muscles Producing Movements
Depression is brought about mainly by the lateral pterygoid.
The digastric, geniohyoid and mylohyoid muscles help
when the mouth is opened wide or against resistance.
During contraction, the lateral pterygoid rotates the head
of the mandible and opens the mouth. During wide opening,
it pulls the articular disc forwards. So movement occurs in
both the compartments. It is also done passively by gravity.
Elevation is brought about by the masseter, the tempora-
lis and the medial pterygoid muscles of both sides. These are
antigravity muscles.
SHORT ESSAYS
Q.1. Articular disc.
Ans.
Refer to the answer of Long Essays Q.6.
Q.2. Buccinator muscle.
Ans.
Buccinator is the muscle of the cheek.
Origin
1. Upper fibres, from maxilla opposite molar teeth
2. Lower fibres, from mandible opposite molar teeth
3. Middle fibres, from pterygomandibular raphe.
Insertion
1. Upper fibres, straight to the upper lip.
2. Lower fibres, straight to the lower lip.
3. Middle fibres decussate before passing to the lips.
Actions
1. Flattens cheek against gums and teeth
2. Prevents accumulation of food in the vestibule.
Q.3. Inferior alveolar nerve.
Ans.
Refer to the answer of Long Essays Q.3.
Protrusion is done by the lateral and medial pterygoids.
Retraction is produced by the posterior fibres of the tem-
poralis. It may be resisted by the middle and deep fibres of
the masseter, the digastric and geniohyoid muscles.
Lateral or side-to-side movements, e.g. turning the chin
to left side are produced by left lateral pterygoid and right
medial pterygoid and vice versa.
Applied Anatomy
1. Dislocation of mandible: During excessive opening of the
mouth, or during a convulsion, the head of the mandi-
ble of one or both sides may slip anteriorly into the in-
fratemporal fossa, as a result of which there is inability
to close the mouth.
2. Derangement of the articular disc may result from any
injury, like overclosure or malocclusion. This gives rise
to clicking and pain during movements of the jaw.
3. In operations on the joint, the facial nerve should be
preserved with care.
Q.4. Pterygopalatine ganglion.
Ans.
1. Pterygopalatine or sphenopalatine ganglion is the larg-
est parasympathetic peripheral ganglion that lies in the
pterygopalatine fossa just below the maxillary nerve, in
front of the pterygoid canal and lateral to the spheno-
palatine foramen (Fig. 1A.10.5).
2. Topographically, it is related to the maxillary nerve, but
functionally it is connected to the facial nerve.
3. It serves as a relay station for secretomotor fibres to the
lacrimal gland and to the mucous glands of the nose, the
paranasal sinuses, the palate and pharynx.
Connections
1. The motor or parasympathetic root of the ganglion is
formed by the nerve of the pterygoid canal. It carries
preganglionic fibres that arise from neurons present
near the superior salivatory and lacrimatory nuclei, and
reach the ganglion. The fibres relay on the ganglion, and
postganglionic fibres arise to supply secretomotor
nerves to the lacrimal gland and to the mucous glands
of the nose, the paranasal sinuses, the palate and the
nasopharynx.
2. The sympathetic root is also derived from the nerve of
the pterygoid canal. It contains postganglionic fibres
arising in the superior cervical sympathetic ganglion
and passing through the internal carotid plexus, the

Lacrimal nerve
Lacrimal gland
Fig. 1A.10.5
deep petrosal nerve and the nerve of the pterygoid canal
to reach the ganglion. The fibres pass through the gan-
glion without relay and supply vasomotor nerves to the
mucous membrane of the nose, the paranasal sinuses,
the palate and the nasopharynx.
. The sensory root comes form the maxillary nerve. Its
fibres pass through the ganglion without relay. They
emerge in the following branches:
a. Orbital branches pass through the inferior orbital fis-
sure and supply the periosteum of the orbit and the
orbitalis muscle.
b. Palatine branches: The greater or anterior palatine
nerve descends through the greater palatine canal
and supplies the hard palate and the lateral wall of
the nose. The lesser or middle and posterior palatine
nerves supply the soft palate and the tonsil.
c. Nasal branches enter the nasal cavity through the
sphenopalatine foramen. The lateral posterior supe-
rior nasal nerve, about six in number, supply the
posterior part of the superior and middle conchae.
The medial posterior superior nasal nerves, two or
three in number, supply the posterior part of the roof
of the nose and of the nasal septum. The nasopala-
tine nerve descends up to the anterior part of the
hard palate through the incisive foramen.
d. The pharyngeal branch passes through the palatino-
vaginal canal and supplies the part of the nasophar-
ynx behind the auditory tube.
e. Lacrimal branch: The postganglionic fibres pass back
into the maxillary nerve to leave through its zygo-
matic nerve and its zygomaticotemporal branch, a
communicating branch to lacrimal nerve to supply
the secretomotor fibres to the lacrimal gland.
Q.5. Muscles of mastication.
Ans.
Refer to the answer of Long Essays Q.1.
General Anatomy
Communicating branch between zygomatic and lacrimal nerve
Zygomatic nerve
Maxillary nerve
Foramen rotundum
Sphenopalatine foramen
aa Pterygopalatine ganglion
Greater petrosal nerve
t+ Nerve of pterygoid
Deep petrosal nerve canal
Lesser palatine nerve
Greater palatine nerve
Pterygopalatine ganglion.
Q.6. Styloid process of temporal bone.
Ans.
The styloid process with its attached structures is called the
styloid apparatus.
The structures attached to the process are as follows:
1. The stylohyoid, styloglossus and stylopharyngeus muscles.
2. The stylohyoid and stylomandibular ligaments.
The five attachments resemble the reins of a chariot.
1. The styloid process is a long, slender and pointed bony
process projecting downwards, forwards and slightly
medially from the temporal bone.
2. It descends between the external and internal carotid
arteries to reach the side of the pharynx. It is interposed
between the parotid gland laterally and the internal
jugular vein medially.
3. The styloglossus muscle arises from the tip and adjacent
part of the anterior surface of the styloid process as well
as from the upper end of the stylohyoid ligament. During
swallowing, it pulls the tongue upwards and backwards.
4. The stylopharyngeus muscle arises from the medial sur-
face of the base of the styloid process. Along with the
glossopharyngeal nerve it passes between the external
and internal carotid arteries, enters the pharynx through
the gap between the superior and middle constrictors. It
helps to lift the larynx during swallowing and phonation.
5. The stylohyoid ligament extends from the tip of the
styloid process to the lesser cornu of the hyoid bone.
Q.7. Attachments, relations, nerve supply and action
of lateral pterygoid muscle.
Or
Give the attachment, relations and nerve supply of
lateral pterygoid muscle.
Ans.
Refer to the answer of Long Essays Q.2.
Quick Review Series: BDS 1st Year
SHORT NOTES
Q.1. Lingual nerve.
Ans.
Lingual nerve is one of the two terminal branches of the
posterior division of the mandibular nerve. It is sensory to
the anterior two-thirds of the tongue and to the floor of the
mouth. The fibres of the chorda tympani are also distributed
through the lingual nerve.
Q.2. Jugular foramen.
Ans.
The jugular foramen is large and elongated, with its long axis
directed forwards and medially. It is placed at the posterior
end of the petro-occupital suture.
The jugular foramen transmits the following structures:
1. Through the anterior part
a. Inferior petrosal sinus
b. Meningeal branch of the ascending pharyngeal
artery
2. Through the middle part IX, X and XI cranial nerves
(glossopharyngeal, vagus and accessory nerves)
3. Through the posterior part
a. Internal jugular vein
b. Meningeal branch of the occipital artery.
The glossopharyngeal notch near the medial end of the
jugular foramen lodges the inferior ganglion of the glosso-
pharyngeal nerve.
Q.3. Auriculotemporal nerve.
Ans.
This nerve has two roots of origin. Between the two roots the
middle meningeal artery passes. The two roots unite to form
a single nerve. It passes backwards and lies deep to the lateral
pterygoid muscle. It passes between the neck of the mandi-
ble and sphenomandibular ligament. It pierces the upper
border of the parotid gland. It crosses the zygomatic arch
and then it enters the temporal fossa.
Branches
1. Auricular branches to supply external ear
2. Temporal branches to supply the skin of the temporal
region
3. Glandular branches to supply the parotid gland.
4. Branch to the temporomandibular joint
Q.4. Inferior alveolar nerve.
Ans.
Refer to the answer of Long Essays Q.3.
Q.5. Muscles of mastication.
Ans.
Refer to the answer of Long Essays Q.1.
Q.6. Stylomandibular ligament.
Ans.
The stylomandibular ligament is an accessory ligament of
the temporomandibular joint. It represents a thickened part
of the deep cervical fascia, which separates the parotid and
submandibular salivary glands. It is attached above to the
lateral surface of the styloid process and below to the angle
and posterior border of the ramus of the mandible.
Q.7. Temporomandibular joint movements.
Ans.
Movements of temporomandibular joint are:
. Depression
WwW Ne
. Elevation
Te
. Protraction
. Retraction
. Side-to-side movement.
The articular disc divides the joint into two compart-
ments, namely superior and inferior.
1. Elevation and depression: These movements occur in
mainly the inferior compartment. The head of mandible
rotates on the articular disc. This movement occurs in
the transverse axis.
2. Protraction and retraction: These movements occur
mainly in the superior compartments. The articular disc
moves in anteroposterior direction up to the articular
tubercle and borders of the mandibular fossa.
3. Side-to-side movement: Head of mandible and articular
disc of one side move forwards. But on the opposite side
the head of mandible does not move forwards; instead it
moves transversely.
Q.8. Pterygoid plexus of veins.
Ans.
Pterygoid plexus of veins lies around and within the lateral
pterygoid muscle. The tributaries of the plexus correspond
to the branches of the maxillary artery. The plexus is drained
by the maxillary vein, which begins at the posterior end of
the plexus and unites with the superficial temporal vein to
form the retromandibular vein.
The plexus communicates with
1. The inferior ophthalmic vein through the inferior or-
bital fissure,
 General Anatomy

2. The cavernous sinus through the emissary veins and 2. The anterior tympanic branch supplies the middle ear
3. The facial vein through the deep facial vein. including the medial surface of the tympanic membrane.
3. The middle meningeal artery supplies more of bone and
Q. 9. Pterygomandibular raphe.
less of meninges, V and VII nerves, middle ear and
Ans. tensor tympani.
4. The accessory meningeal artery enters the cranial cavity
The pterygomandibular raphe is attached immediately
through the foramen ovale. Apart from the meninges, it
behind the third molar tooth in continuation with the origin
supplies structures in the infratemporal fossa.
of the superior constrictor muscle of the pharynx. It is
5. The inferior alveolar artery runs downwards and for-
formed by the interdigitation of fibres from two muscles,
wards medial to the ramus of the mandible to reach the
namely buccinator and superior pharyngeal constrictors.
mandibular foramen.
Q.10. Name any four branches of first part of maxil-
Q.11. Lateral pterygoid plate.
lary artery.
Ans.
Ans.
1. The lateral pterygoid plate is directed backwards and
The first part, ie. the mandibular part of maxillary artery
laterally.
runs horizontally forwards, first between the neck of the
2. It has medial and lateral surfaces and a free posterior border.
mandible and the sphenomandibular ligament, below the
. The lateral surface forms the medial wall of the infra-

ies]
auriculotemporal nerve, and then along the lower border of
temporal fossa.
the lateral pterygoid.
4. The lateral and medial surfaces give origin to pterygoid
Branches of the first part of the maxillary artery are as follows: muscles.
1. The deep auricular artery supplies the external acoustic 5. The posterior border sometimes has a projection called
meatus, the tympanic membrane and the temporoman- the pterygospinous process, which projects towards the
dibular joint. spine of the sphenoid.

SUBMANDIBULAR REGION
LONG ESSAYS

Q.1. Write about the origin, insertion and relations Origin

of mylohyoid muscle.
The mylohyoid muscle arises from mylohyoid line on the
Ans. inner surface of the mandible, as shown in Fig. 1A.11.1.
The mylohyoid is a fat, triangular muscle belonging to the
Insertion
suprahyoid group of muscles. Table 1A.11.1 gives an account
of mylohyoid muscle. The mylohyoid muscle extends almost transversely towards
the midline where the anterior fibres insert with the muscle
on the other side into a median raphe.
Table 1A.11.1 The mylohyoid muscle The posteriormost fibres insert upon the body of the
hyoid bone, and the two muscles together form a diaphragm
Nerve
below the geniohyoid muscle constituting the floor of the
Origin Insertion supply Actions
mouth, as shown in Fig. 1A. 11.1.
Mylohyoid 1. Anteriorand Nerveto 1. Elevates floor of
line of middle fibres mylohyoid mouth during first Superficial and deep relations of mylohyoid muscle are as
mandible into median stage of deglutition follows (Fig. 1A.11.2):
raphe 1. Superficially it is in contact with the following:
2. Posterior 2. Helps in depression a. Anterior belly of the digastric
fibres: body of mandible, and el- b. Superficial part of the submandibular salivary gland
of hyoid bone evation of hyoid c. Mylohyoid nerve and vessels
bone
d. Submental branch of the facial artery.
 Quick Review Series: BDS 1st Year

Mylohyoid line Mental spines

Sublingual fossa
b. The genioglossus with its superficial relations,
namely:
i. The sublingual salivary gland
ii. The lingual nerve
iii, The submandibular duct
iv. The lingual artery
v. The hypoglossal nerve
Free posterior Q.2. Describe submandibular gland. Add a note on
Submandibular 9
margin
Greater horn its innervation.
fossa Body of hyoid
Fig. 1A. 11.1 Mylohyoid muscle. Ans.

Submandibular salivary gland is one of the major salivary

glands, situated in the anterior part of the digastric triangle.
The gland is about the size of a walnut and is roughly
Posterior belly J-shaped. It is indented by the posterior border of the
of digastric
stylohyoid ISS mylohyoid which divides it into a large part superficial to the
muscle that fills the digastric triangle and a small part lying
External carotid peetiee
Internal carotid
Mylohyoid
deep to the muscle.
Hyoid bone

Superficial Part
It has three surfaces, namely
Fig. 1A.11.2 Superficial relations of mylohyoid muscle. 1. Inferior
2. Lateral
3. Medial surfaces.
2. Deep or above the mylohyoid it is in contact with the
following (Fig. 1A.11.3): The gland is partially enclosed between two layers of deep
a. Hyoglossus with its superficial relations, namely cervical fascia (Fig. 1A.11.4). The superficial layer of fascia
i. The styloglossus covers the inferior surface of the gland and is attached to
ii. The lingual nerve the base of the mandible. The deep layer covers the medial
iii. The submandibular ganglion surface of the gland and is attached to the mylohyoid line of
iv. The deep part of the submandibular salivary the mandible.
gland Superficially, the submandibular gland is crossed by the
yv. The submandibular duct facial vein and sometimes by the marginal mandibular
vi. The hypoglossal nerve branch of the facial nerve. The large submandibular lymph
vii. The vena comitants hypoglossi nodes lie along the superficial upper border of the gland.

Lingual nerve
Submandibular duct
Outline of
sublingual gland Styloglossus

—— Stylohyoid ligament

——- Glossopharyngeal
nerve
Submandibular
ganglion

Lingual artery
Geniohyoid Re” Hypoglossal nerve
muscle os Hyoid bone

Deep part of
Hyoglossus submandibular gland
muscle
Fig. 1A.11.3 Deep relations of mylohyoid muscle.
 General Anatomy

In the terminal part of its course, the duct lies immediately

Mylohyoid line below the mucosa of the floor of the mouth and opens at the
Deep lamina Mandibular sublingual caruncle or papilla just lateral to the frenulum.
of rascia\ canal
Submandibular 4
gland 4 Submandibular Blood Supply and Lymphatic Drainage
: fossa
Greater cornua of / The blood supply is through the facial artery. The veins drain
hyoid bone \ =o" Base of mandible into the common facial or lingual vein. Lymph passes to
"Superficial lamina submandibular lymph nodes (Fig. 1A.11.5).
of fascia

Fig. 1A.11.4 Cervical fascia covering submandibular gland. Nerve Supply

Submandibular gland is supplied by branches from the sub-
Deep Part mandibular ganglion.
This part is smaller in size and lies deep to the mylohyoid These branches convey the following:
and superficial to the hyoglossus and the styloglossus. Poste- 1. Secretomotor fibres
riorly it is continuous with the superficial part around the 2. Sensory fibres from the lingual nerve
posterior border of the mylohyoid. Anteriorly it extends up 3. Vasomotor sympathetic fibres from the plexus on the
to the sublingual gland. facial artery.

Relations
The secretomotor pathway begins in the superior salivary
nucleus. Preganglionic fibres pass through the sensory root
Superficial or the inferior surface of submandibular gland is of the facial nerve, the geniculate ganglion, the facial nerve,
covered by the following: the chorda tympani and the lingual nerve to reach the sub-
1. Skin mandibular ganglion. Postganglionic fibres emerge from the
Platysma ganglion and enter the submandibular gland.
wy

Cervical branch of the facial nerve Sympathetic fibres from the superior cervical ganglion reach
Deep fascia this gland either by the way of other nerves or along the vessels.
ae

Facial vein Stimulation of parasympathetic fibres produces watery

6. Submandibular lymph nodes. secretion from these glands, while the stimulation of sympa-
The lateral surface is related to the following: thetic fibres is said to produce a viscid one.
1. The submandibular fossa on the mandible
2. Insertion of the medial pterygoid Medial pterygoid
3. The facial artery.
The medial surface may be divided into three parts:
1. The anterior part is related to the mylohyoid muscle,
nerve and vessels. Facial artery
2. The middle part is related to the hyoglossus, styloglos-
sus, lingual nerve, submandibular ganglion and the
hypoglossal nerve.
3. The posterior part is related to the styloglossus, stylohy-
. Submandibular gland
oid ligament, glossopharyngeal nerve and the wall of the
Investing fascia
pharynx.
Anteroinferior part
Inferiorly it overlaps the stylohyoid and the posterior of masseter
belly of the digastric.
Medial
Submandibular Duct (Wharton’s Duct) pterygoid

Wharton’s duct is a thin-walled duct, which is about 5 cm

long and emerges at the anterior end of the deep part of the
gland and runs forwards on the hyoglossus, between the
lingual and hypoglossal nerves. The submandibular duct is Submandibular gland
in immediate contact with the sublingual gland, lying at first Investing fascia
-
below and then medial to it and may receive a major sublin-
gual duct (Bartholin’s duct) before it opens into the mouth. Fig. 1A.11.5 Vascular supply of submandibular gland.
CYS) Quick Review Series: BDS Ist Year

SHORT ESSAYS

Q.1. Otic ganglion. Q.2. Submandibular ganglion.

Ans. Ans.
1. Otic ganglion is a peripheral parasympathetic ganglion 1. This is a parasympathetic peripheral ganglion. It is a
that relays secretomotor fibres to the parotid gland relay station for secretomotor fibres to the submandibu-
(Fig. 1A.11.6). lar and sublingual salivary glands.
2. Topographically, it is related to the mandibular nerve, 2. Topographically it is related to the lingual nerve, but
but functionally it belongs to glossopharyngeal nerve. functionally it is connected to the chorda tympani
branch of the facial nerve.
3. The fusiform ganglion lies on the hyoglossus muscle just
above the deep part of the submandibular salivary
Semilunar gland, suspended from the lingual nerve by two roots.
ganglion. Minor petrosal 4. The motor or parasympathetic fibres pass from the lingual
WW) nerve nerve to the ganglion through the posterior root. These
SS Otic ganglion are preganglionic fibres that arise in the superior salivatory
nucleus and pass through the facial nerve, the chorda
Auriculotemporal
nerve
tympani and the lingual nerve to reach the ganglion. The
fibres relay in the ganglion. Postganglionic fibres for the
Tympanic nerve
submandibular gland reach the gland through five or six
Glossopharyngeal
branches from the ganglion (Fig. 1A.11.7).
nerve . Postganglionic fibres for the sublingual and anterior
ul

lingual glands re-enter the lingual nerve through the

anterior root and travel to the gland through the distal
Parotid gland
part of the lingual nerve.
. The sympathetic fibres are derived from the plexus around
a

Fig. 1A.11.6 The otic ganglion. the facial artery. It contains postganglionic fibres arising in
the superior cervical ganglion. They pass through sub-
mandibular ganglion without relay and supply vasomotor
fibres to the submandibular and sublingual glands.
3. Size and location: It is 23 mm in size and is situated just 7 . Sensory fibres reach the ganglion through the lingual nerve.
below the foramen ovale in the infratemporal fossa. It
lies medial to the mandibular nerve and lateral to the
tensor veli palatini.
4. The motor or parasympathetic root is formed by the
lesser petrosal nerve. The preganglionic fibres are
derived from the inferior salivary nucleus and pass
» Semilunar
through the IX nerve, its tympanic branch, the ganglion
tympanic plexus—the lesser petrosal nerve—to reach Lingual
Lingual nerve |
the ganglion. The postganglion or secretomotor fibres
pass through the auriculotemporal nerve to the 1 nerve
Facial
parotid gland. nerve
5. The sympathetic root is derived from the plexus on the Chorda
tympani
middle meningeal artery. It contains postganglionic
fibres arising in the superior cervical ganglion. The Sublingual
Submandibular
fibres pass through the ganglion without relay and reach gland ganglion
the parotid gland via the auriculotemporal nerve. They
Submandibular
are vasomotor in function. gland
6. The sensory root comes from the auriculotemporal
nerve and is sensory to the parotid gland. Fig. 1A.11.7 Submandibular ganglion and its branches.
 General Anatomy

Q.3. Give the origin, insertion and nerve supply of (Fig. 1A.11.8). Anterior belly runs downwards and back-
digastric muscle. wards whereas the posterior belly runs downwards and
forwards. Table 1A.11.2 gives an account of digastric
Ans.
muscle.
The digastric muscle is one of the suprahyoid muscles
containing two bellies united by an intermediate tendon
Table 1A.11.2 Details of digastric muscle
Styloid Mastoid
Origin Insertion Nerve supply Actions
process process
1. Anterior Both heads 1. Anterior 1. Depresses
belly from meet at the belly by mandible
digastrics intermediate nerve to when mouth is
fossa of tendon that mylohyoid opened widely
mandible _perforates 2. Posterior or against
2. Posterior SH and is belly by resistance; it is
Stylohyoid muscle belly from held by the facial nerve secondary to
Posterior belly of mastoid hyoid bone lateral pterygoid
digastric muscle notch of 2. Elevates hyoid
Hyoid bone temporal bone
bone
Anterior belly of
digastric muscle Mylohyoid muscle
Fig.1A.11.8 Digastric muscle (origin and insertion).

SHORT NOTES

Q.1. Otic ganglion. Function: Supports and elevates the floor of oral cavity and
depresses mandible when hyoid bone is fixed.
Ans.
Q.4. Hyoglossus muscle.
It is a peripheral parasympathetic ganglion that relays sec-
retomotor fibres to the parotid gland. It is 23 mm in size Ans.
and is situated just below the foramen ovale in the infra-
temporal fossa. Topographically, it is intimately related to Hyoglossus is a muscle of tongue (Fig. 1A.11.9). See
the mandibular nerve, but functionally it belongs to the Table 1A.11.3 for details.
glossopharyngeal nerve.
Q.2. Digastric muscle. Lingual nerve

Ans.
Refer to the answer of Short Essays Q.3.
Q.3. Mylohyoid muscle.
Ans.
Mylohyoid muscle is a fat, triangular muscle, and two mylo-
hyoids from either side form the floor of the oral cavity.
Origin: Mylohyoid line of mandible.
Insertion: Median raphe and adjacent part of hyoid bone.
Hypoglossal nerve

Innervation: Nerve to mylohyoid from the inferior alveolar Hyoglossus Muscle

branch of mandibular nerve (V3). Fig. 1A.11.9 Hyoglossus muscle and its relations.
 Quick Review Series: BDS 1st Year

Table 1A.11.3 The hyoglossus muscle The submandibular lymph nodes are larger and more
Origin Insertion Nerve supply Actions numerous than the submental. They form a chain of three to
eight nodes situated largely along the upper border of the
Whole length Side of tongue Hypoglossal Depresses
of greater between stylo- (XII) nerve tongue, makes
submandibular gland.
cornua and glossus and dorsum convex, Some of these nodes are constant. The largest and the
lateral part of _ inferior longi- retracts the pro- most constant node is close to the point at which the facial
body of hyoid tudinal muscle truded tongue artery crosses the mandible. It is known as the Stahr’s lymph
bone; fibres of tongue node.
run upwards These nodes receive the efferent vessels from the buccal
and forwards
and mandibular nodes, along the facial vein and artery, and
therefore, drain a large part of the face either directly or
indirectly.
Q.5. Submandibular duct.
Q.7. Relations of hyoglossus muscle.
Ans.
Ans.
Submandibular duct or Wharton’s duct is a thin-walled duct,
about 5 cm long. It arises from the anterior end of the deep part Relations of hyoglossus muscle are as follows:
of the gland and runs forwards on the hyoglossus, between the 1. Superficial: Styloglossus, lingual nerve, submandibular
lingual and hypoglossal nerves. At the anterior border of the ganglion, deep part of the submandibular gland, sub-
hyoglossus, the duct is crossed by the lingual nerve. It opens on mandibular duct, hypoglossal nerve and veins accompa-
the floor of the mouth, on the summit of the sublingual papilla nying it
and at the side of the frenulum of the tongue. 2. Deep: (a) Inferior longitudinal muscle of the tongue,
(b) genioglossus, (c) middle constrictor of the pharynx,
Q.6. Submandibular lymph nodes.
(d) glossopharyngeal nerve, (e) stylohyoid ligament and
Ans. (f) lingual artery.

DEEP STRUCTURES OF THE NECK

LONG ESSAY

Q.1. Thyroid gland. Describe the thyroid gland. Add a note on blood
supply and histology.
Or
Or
Describe thyroid gland under the following
headings: Describe the thyroid gland under the following
headings: position and parts, relations, supply,
a. Coverings
lymphatic drainage and development of gland.
b. Parts and relations
c. Blood supply Ans.
d. Applied aspect
The thyroid is an endocrine gland, situated below and lateral
Or to the thyroid cartilage.
Describe anatomy of thyroid gland. Give its surgi-
Development
cal importance.
The thyroid develops from a median endodermal thyroid
Or
diverticulum. The lower end of the diverticulum enlarges to
form the gland. The rest of the diverticulum remains narrow
Give an account of gross anatomy and histology of
and is known as the thyroglossal duct. Most of the duct soon
thyroid gland. How is it developed?
disappears. The position of the upper end is marked by
Or the foramen caecum of the tongue, and the lower end often
 General Anatomy

persists as the pyramidal lobe. The gland becomes functional Lobe of

thyroid gland
during third month of development.

Parts Suspensory ligament

of Berry
The gland consists of right and left lateral lobes that are
joined to each other by the isthmus. A third, pyramidal, Ascending branch
% Gi" inferior thyroid artery
lobe may project upwards from the isthmus or from one of
the lobes. ag Superior parathyroid
Accessory thyroid glands are sometimes found as small “\\weak part of capsule

detached masses of thyroid tissue in the vicinity of the lobes Fig. 1A.12.1 Capsule of thyroid.
or above the isthmus.

Thyroid Gland and its Relations (Fig. 1A.12.2)

Situation and Extent
1. The gland lies against vertebrae C5, C6, C7 and
embracing the upper part of the trachea.
2. Each lobe extends from the middle of the thyroid
cartilage to the fourth or fifth tracheal ring.
3. The isthmus extends from the second to the fourth
tracheal ring.
Dimensions and Weight
Each lobe measures about 5 cm X 2.5 cm X 2.5 cm, and the
isthmus 1.2 cm X 1.2 cm; the gland weighs roughly about
25 g. However, it is larger in females than in males, and further
increases in size during menstruation and pregnancy.
Capsules of Thyroid (Fig. 1A.12.1)
1. The peripheral condensation of the connective tissue of
the gland forms the true capsule. A dense capillary
plexus is present deep to the true capsule; hence the
thyroid is removed along with the true capsule during
operations to avoid haemorrhage.
2. The false capsule is derived from the pretracheal layer of
the deep cervical fascia. It is thin along posterior border
of the lobes, but thick on the inner surface of the gland
where it forms a suspensory ligament (of Berry), which
connects the lobe to the cricoid cartilage
The lobes are conical in shape having the following:
T1,
1. An apex
2. A base
3. Three surfaces, lateral, medial and posterolateral
4. Two borders, anterior and posterior.
The apex is directed upwards and slightly laterally. It is
limited superiorly by the attachment of the sternothyroid to
the oblique line of the thyroid cartilage.
The base is on level with the fourth or fifth tracheal ring.
The lateral or superficial surface is convex and is covered
by (a) the sternohyoid, (b) the superior belly of the omohy-
oid, (c) the sternothyroid and (d) the anterior border of the
sternocleidomastoid.
The medial surface is related to (a) trachea and oesophagus,
(b) inferior constrictor and cricothyroid and (c) external
laryngeal and recurrent laryngeal nerve.
The posterolateral or posterior surface is related to the
carotid sheath and overlaps the common carotid artery.
The anterior border is thin and is related to the anterior
branch of the superior thyroid artery.
The posterior border is thick and rounded and separates
the medial and posterior surfaces. It is related to (a) the in-
ferior thyroid artery, (b) the anastomosis between superior
and inferior thyroid arteries, (c) the parathyroid glands and
(d) the thoracic duct only on the left side.

Sternothyroid
Sternohyoid Recurrent laryngeal nerve
Sternocleidomastoid

Position of
ligament of Berry
Parathyroid gland
Common carotid artery

Internal jugular vein

Prevertebral fascia-——* Vagus nerve

Oesophagus
= syinoatnate trunk

Fig. 1A.12.2 Thyroid gland and its relations.

Quick Review Series: BDS 1st Year

Arterial Supply (Fig. 1A.12.3)

The thyroid gland is supplied by the superior and inferior
thyroid arteries. The superior thyroid artery is a branch of Superior thyroid
artery and vein
the external carotid artery. At the upper pole of the lobe, it
Middle thyroid
divides into anterior and posterior branches. The anterior vein
branch descends on the anterior border of the lobe and con-
tinues along the upper border of the isthmus to anastomose
with its fellow of the opposite side. The posterior branch de-
scends on the posterior border of the lobe and anastomoses hyrocervical
trunk
with the ascending branch of the inferior thyroid artery. Left vagus nerve
The inferior thyroid artery is a branch of the thyrocervi-
Left recurrent
cal trunk that arises from the subclavian artery. It reaches the laryngeal nerve
lower pole of the gland and gives off branches to adjacent
Fig. 1A.12.4 Venous drainage of thyroid gland.
structures. The artery divides into 4-5 glandular branches
that pierce the fascia separately to reach the lower part of the
gland. One ascending branch anastomoses with the poste-
rior branch of the superior thyroid artery and supplies the
parathyroid glands. The middle thyroid vein is a short, wide channel which
emerges at the middle of the lobe and soon enters the inter-
nal jugular vein.
External
Superior thyroid
artery
The inferior thyroid veins emerge at the lower border of
laryngeal nerve the isthmus. They form a plexus in front of the trachea and
drain into the left brachiocephalic vein.
Anterior
branch Posterior branch
A fourth thyroid vein (of Kosher) may emerge between
the middle and inferior veins and drain into the internal
Ascending branch jugular vein.
of inferior thyroid artery
Scalenus anterior
Anastomosing Lymphatic Drainage
Vertebral vessels
branch
Inferior thyroid artery Lymph from the upper part of the gland reaches the upper
Outline of
thyroid gland Transverse deep cervical lymph nodes either directly or through the
cervical artery
Recurrent prelaryngeal nodes. Lymph from the lower part of the gland
Suprascapular artery
laryngeal nerve Thyrocervical trunk drains to the lower deep cervical nodes directly and also
.
Middle
. Subclavian artery
through the pretracheal and paratracheal nodes.
cervical ganglion
Carotid sheath
Nerve Supply
Fig. 1A.12.3 Arterial supply of thyroid gland.
Nerves are derived mainly from the middle cervical ganglion
and partly also from the superior and inferior cervical
The superior thyroid artery supplies the upper one-third ganglia.
of the lobe and the upper half of the isthmus and the inferior
thyroid artery supplies the lower two-thirds of the lobe and Histology and Function
the lower half of the isthmus.
The thyroid gland is made up of the following two types of
Sometimes, the thyroid is also supplied by the lowest secretory cells.
thyroid artery (thyroidea ima artery) which arises from
1. The follicles of the gland are lined by follicular cells.
the brachiocephalic trunk or directly from the arch of the
During active phase the lining of the follicles is columnar,
aorta. Accessory thyroid arteries arising from tracheal and
while in resting phase it is cuboidal. Follicles contain
oesophageal arteries also supply the thyroid.
the colloid in their lumina. Follicular cells secrete triio-
dothyronine and tetraiodothyronine (thyroxin) which
Venous Drainage (Fig. 1A.12.4)
stimulate basal metabolic rate and somatic and psychic
The superior, middle and inferior thyroid veins drain the growth of the individual.
thyroid gland. 2. Parafollicular cells (C cells) are fewer and light cells lie
The superior thyroid vein which emerges at the upper pole in between the follicles. They secrete thyrocalcitonin
ends either in the internal jugular vein or in the common which promotes deposition of calcium salts in skeletal
facial vein. and other tissues and tends to produce hypocalcaemia.
 General Anatomy

Applied Anatomy 4. Benign tumours of the gland may displace and even
compress neighbouring structures like the carotid
1. Remnants of the thyroglossal duct may form thyroglossal
sheath, the trachea, etc.
cysts or a thyroglossal fistula.
5. Malignant growths tend to invade and erode neighbour-
2. Any swelling of the thyroid gland (goitre) moves with
ing structures. Pressure symptoms and nerve involve-
deglutiton.
ment are common in carcinoma of the glands.
3. Hypothyroidism causes cretinism in infants and
myxedema in adults.

SHORT ESSAYS

Q.1. Scalenus anterior muscle. Transverse process of atlas

Or
Transverse process of axis
Give the origin, insertion and superficial relations Anterior tubercle of
of scalenus anterior muscle. transverse process Levator
scapulae
Ans. Sternocleidomastoid
Scalenus
There are three scalene muscles: medius
Scalenus
1. The scalenus anterior anterior Scalenus
2. The scalenus medius posterior
3. The scalenus posterior. Clavicle
Scapula
The scalenus anterior is a key muscle of the lower part of Subclavian
the neck because of its intimate relations to many important vein Lower trunk of
structures in this region. It is described in Table 1A.12.1. First rib — brachial plexus
Relations of scalenus anterior are as follows (Fig. 1A.12.5): Second rib Subclavian artery
Anteriorly, the muscle is covered by sternocleidomastoid Fig. 1A.12.5 Relations of scalenus anterior muscle.
deep to this and on the scalenus anterior lie the following
structures:
Anteriorly: 8. Subclavian vein
1. Phrenic nerve 9. Branches of superior thyroid and suprascapular arteries
2. Prevertebral fascia 10. Clavicle.
3. Transverse cervical, suprascapular and ascending cervi- Posteriorly:
cal vessels 1. Scalenus medius
4. Lateral part of carotid sheath containing the internal 2. Second part of subclavian artery
jugular vein 3. Roots of brachial plexus.
5. Descends cervicalis
. Inferior belly of omohyoid Lateral side:
a

7. Anterior jugular vein 1. Trunks of brachial plexus.

Medial side:
1. Thyrocervical artery
Table 1A.12.1 The scalenus anterior muscle
2. Vertebral artery
3. Ascending cervical artery.
Origin Insertion Innervation action
Q.2. Blood supply of thyroid gland.
From anterior Anterior rami 1. Anterolateral flexion of
tubercles transverse of C4 to C7 cervical spine Ans.
processes of cervical 2. Rotates cervical spine to
vertebrae C3 to C6 Opposite side The thyroid gland is supplied by the superior and inferior
into scalene tubercle 3. Elevation of the first rib thyroid arteries. The superior thyroid artery is a branch of
and adjoining ridge on during inspiration the external carotid artery. At the upper pole of the lobe, it
the superior surface 4. Stabilizes the neck along divides into anterior and posterior branches. The anterior
of the first rib with other muscles
branch descends on the anterior border of the lobe and
70 Quick Review Series: BDS 1st Year

continues along the upper border of the isthmus to anasto- A fourth thyroid vein (of Kosher) may emerge between
mose with its fellow of the opposite side. The posterior the middle and inferior veins and drain into the internal
branch descends on the posterior border of the lobe and jugular vein.
anastomoses with the ascending branch of the inferior
Q.3. Styloid process of temporal bone.
thyroid artery.
The inferior thyroid artery is a branch of the thyrocervi- Ans.
cal trunk which arises from the subclavian artery. It reaches
The styloid process is a long, slender and pointed bony pro-
the lower pole of the gland and gives off branches to adja-
cess projecting downwards, forwards and slightly medially
cent structures. The artery divides into 4-5 glandular
from the temporal bone (Fig. 1A.12.6). It descends between
branches which pierce the fascia separately to reach the
the external and internal carotid arteries to reach the side of
lower part of the gland. One ascending branch anastomoses
the pharynx. It is interposed between the parotid gland later-
with the posterior branch of the superior thyroid artery and
ally and the internal jugular vein medially.
supplies the parathyroid glands.
The styloid process with its attached structures is called
The superior thyroid artery supplies the upper one-third
the styloid apparatus. The structures attached to the process
of the lobe and the upper half of the isthmus and that the
are the stylohyoid, styloglossus and stylopharyngeus muscles,
inferior thyroid artery supplies the lower two-thirds of the
and the stylohyoid and stylomandibular ligaments. The five
lobe and the lower half of the isthmus.
attachments resemble the reins of a chariot.
Sometimes, the thyroid is also supplied by the lowest thy-
roid artery (thyroidea ima artery) which arises from the
brachiocephalic trunk or directly from the arch of the aorta. Styloid process
Styloglossus
Accessory thyroid arteries arising from tracheal and oe-
sophageal arteries also supply the thyroid.
Stylohyoid
Stylohyoid Stylopharyngeus
Venous Drainage ligament
The superior, middle and inferior thyroid veins drain the
Hyoid bone
thyroid gland.
Superior and
The superior thyroid vein which emerges at the upper pole middle constrictors
ends either in the internal jugular vein or in the common
Fig. 1A.12.6 Styloid process.
facial vein.
The middle thyroid vein is a short, wide channel which
emerges at the middle of the lobe and soon enters the inter- The apparatus is of diverse origin:
nal jugular vein. The styloid process and the stylohyoid ligament and
The inferior thyroid veins emerge at the lower border of muscle are derivatives of the second branchial arch, the
the isthmus. They form a plexus in front of the trachea, and stylopharyngeus is derived from the third arch and the
drain into the left brachiocephalic vein. styloglossus from occipital myotomes.

SHORT NOTES

Q.1. Oesophagus.
Ans.
Airway
The oesophagus is a muscular food passage, about 25 cm in Laryngeal inlet
, ,

length. It is a downward continuation of the pharynx begin- Epiglottis

aryngopharynx
ning at the lower border of the cricoid cartilage and passes Inferior
downwards behind the trachea, traverses the superior and pos- constrictor
terior mediastinum of the thorax and ends by opening into the muscle

cardiac end of the stomach in the abdomen (Fig. 1A.12.7). Thyroid cartilage
Cricoid cartilage
Q.2. Thyroid gland.
Ans.
1. The thyroid gland is an endocrine gland, situated in the
lower part of the front and sides of the neck against Fig. 1A.12.7 Oesophagus.
 General Anatomy

vertebrae C5, C6, C7 and T1 embracing the upper part
of the trachea.
2. On an average the gland weighs about 25 g.
3. The gland consists of right and left lobes joined to
each other by the isthmus. A third, pyramidal, lobe may
project upwards from the isthmus.
Functions of thyroid gland:
1. Regulates the basal metabolic rate.
2. Stimulates somatic and psychic growth.
3. Plays an important role in calcium metabolism.
Q.3. Styloid process.
Ans.
1. The styloid process is a long, slender and pointed bony
process projecting downwards, forwards and slightly
medially from the temporal bone.
2. It descends between the external and internal carotid
arteries to reach the side of the pharynx.
3. It is interposed between the parotid gland laterally and
the internal jugular vein medially.
Q.4. Accessory nerve.
Ans.
1. Accessory nerve is the XI cranial nerve. It has two roots,
cranial and spinal. The cranial root is accessory to the
vagus and is distributed through the branches of the
latter (Fig. 1A.12.8). The spinal root has a more inde-
pendent course.
2. The cranial root is special visceral (branchial) efferent,
arises from the lower part of the nucleus ambiguus and
is distributed through the branches of the vagus to
the muscles of the palate, the pharynx, the larynx and
possibly the heart.
3. The spinal root is also special visceral efferent. It arises
from a long spinal nucleus situated in the lateral part of
the anterior grey column of the spinal cord extending
between segments C1 to C5. Its fibres supply the sterno-
cleidomastoid and the trapezius muscles.
Q.5. Thyroglossal duct.
Ans.
1. The thyroid develops from a median endodermal thy-
roid diverticulum which grows down in front of the
neck from the floor of the primitive pharynx.
2. The lower end of the diverticulum enlarges to form the
gland. The rest of the diverticulum remains narrow and
is known as the thyroglossal duct.
3. Most of the duct soon disappears; the position of the
upper end is marked by the foramen caecum of the tongue,
and the lower end often persists as the pyramidal lobe.
Q.6. Stylohyoid ligament.
Ans.
The stylohyoid ligament extends from the tip of the styloid
process to the lesser cornu of the hyoid bone. It is derived
form second branchial arch.
Q.7. Recurrent laryngeal nerve.
Or
Recurrent laryngeal nerve of right side.
Or
Recurrent laryngeal nerve in the neck.
Ans.
1. Right and left recurrent laryngeal nerves are the branches
of vagus nerve (Fig. 1A.12.9).

Levator scapulae

Trapezius Superficial branch of Superior Superior

transverse cervical artery thyroid parathyroid
artery gland
Accessory nerve [X|]

Inferior Inferior
Rhomboid minor thyroid parathyroid
artery gland
Rhomboid major

Thyrocervical
Left trunk
subclavian Right recurrent
artery laryngeal nerve

Left recurrent
laryngeal nerve

Fig. 1A.12.8 The accessory nerve (XI cranial nerve). Fig. 1A.12.9 Recurrent laryngeal nerve.
yp.) Quick Review Series: BDS Ist Year

2. The right recurrent laryngeal nerve arises from the va-
gus in front of the right subclavian.
3. It supplies the following:
a. All intrinsic muscles of the larynx, except the crico-
thyroid.
b. Sensory nerves to the larynx below the level of the
vocal cords.
c. Cardiac branches to the deep cardiac plexus.
d. Branches to the trachea and oesophagus.
e. To the inferior constrictor.
4. The left recurrent laryngeal nerve arises form the vagus
in the thorax. Its distribution is similar to that of the
right nerve.
Q.8. Jugulodigastric lymph node.
Ans.
The jugulodigastric node is a member of the anterosuperior
group of cervical lymph nodes. It lies below the posterior
belly of the digastric, between the angle of the mandible and
the anterior border of the sternocleidomastoid. It is the main
node draining the tonsil.
Q.9. Isthmus of thyroid ligament.
Ans.
1. The isthmus of thyroid connects the lower parts of the
two lobes.
2. It has
(A) Two surfaces:
a. anterior surface and
b. posterior surface;
(B) Two borders:
a. superior border and
b. inferior border.
3. The anterior surface is covered by
a. the right and left sternothyroid and sternohyoid
muscles,
b. the anterior jugular veins and
c. fascia and skin.
The posterior surface is related to the second to fourth
tracheal rings.
4. The upper border is related to the anastomosis between
the right and left superior thyroid arteries.
5. At the lower border, inferior thyroid veins leave the gland.
Occasionally, the isthmus is absent.
Q.10. Blood supply of thyroid gland.
Ans.
2. Inferior thyroid artery
3. Arteria thyroidea ima.
Superior Thyroid Artery
Superior thyroid artery is the first branch of external carotid
artery. It divides into branches along the upper pole of the
gland and supplies:
1. Lobe of thyroid gland.
2. A branch to anastomose with the artery of the opposite
side.
3. A branch to supply lower part of pyramidal lobe.
Inferior Thyroid Artery
Inferior thyroid artery is a branch of thyrocervical trunk of
subclavian artery. It passes deep to the common carotid
artery and reaches the posterior surface of the thyroid lobe.
Arteries supplying trachea and oesophagus are also
supplying the thyroid gland. So when all thyroid arteries are
ligated, the gland gets its blood supply through the tracheal
and oesophageal arteries.
Arteria Thyroidea IMA (Neubauer’s Artery)
This artery is occasionally present. It usually arises from the
arch of aorta, rarely it may arise from the brachiocephalic
artery. It runs upwards in the midline of neck to the isthmus
of the gland.
Q.11. Formation of internal jugular vein.
Or
Formation and termination of internal jugular vein.
Ans.
Internal jugular vein is the largest vein of the head and neck
which drains venous blood from the brain and most struc-
tures of the head and neck.
Development: The anterior cardinal vein.
Commencement: The vein commences at the lower border
of the jugular foramen as the downward continuation of the
sigmoid sinus.
Course: It passes downwards and medially within the neck.
It is found within the carotid sheath. It reaches the level of
medial end of the clavicle.
Termination: It ends by joining the subclavian vein to form
the brachiocephalic vein behind medial end of the clavicle.

Thyroid gland is highly vascular. Q.12. Name any four structures related to medial
surface of thyroid gland.
Arterial supply of thyroid gland is by the following:
1. Superior thyroid artery Ans.

The medial surface of thyroid is related to the following:
1. Two tubes, trachea and oesophagus.
2. Two muscles, inferior constrictor and cricothyroid.
3. Two nerves, external laryngeal and recurrent laryngeal.
Q.13. Name any four structures attached to the
styloid process.
SHORT ESSAY
Q.1. Atlanto-occipital joint.
Ans.
1. Atlanto-occipital joint is a synovial joint of the ellipsoid
variety. It articulates above with the occipital condyles
and below with the superior articular facets of the atlas
vertebra.
2. The ligaments of the atlanto-occipital joint are as follows:
a. The fibrous capsule (capsular ligament) surrounds the
joint. It is thick posterolaterally and thin anteromedially.
b. The anterior atlanto-occipital membrane extends from
the anterior margin of the foramen magnum above to
the upper border of the anterior arch of the atlas below.
Laterally, it is continuous with the anterior part of the
capsular ligament, and anteriorly, it is strengthened by
the cordlike anterior longitudinal ligament.
c. The posterior atlanto-occipital membrane extends
from the posterior margin of the foramen magnum
above to the upper border of the posterior arch of
SHORT NOTES
Q.1. Atlantoaxial joint.
Ans.
Atlantoaxial joint consists of the following:
1. A pair of lateral atlantoaxial joints between the inferior
facets of the atlas and the superior facets of the axis.
These are plane joints.
2. A median atlantoaxial joint between the dens (odontoid
process) and the anterior arch and transverse ligament
of the atlas. It is a pivot joint. The joint has two separate
synovial cavities—anterior and posterior.
General Anatomy
Ans.
The structures attached to the styloid process are as
follows:
1. The stylohyoid, styloglossus and stylopharyngeus muscles
2. The stylohyoid and stylomandibular ligaments.
PREVERTEBRAL REGION.
the atlas below. Laterally, it is continuous with the
posterior part of the capsular ligament.
Arterial and Nerve Supply
The joint is supplied by the vertebral artery and by the first
cervical nerve.
Movements: They are ellipsoid joints and permit move-
ments around two axes. Flexion and extension (nodding)
occur around a transverse axis. Slight lateral flexion is
permitted around an anteroposterior axis.
a. Flexion is brought about by the longus capitis and the
rectus capitis anterior muscles.
b. Extension is done by the rectus capitis posterior major
and minor, the obliquus capitis superior, the semispina-
lis capitis and the upper part of the trapezius.
c. Lateral bending is produced by the rectus capitis, the
semispinalis capitis, the splenius capitis, the sterno-
cleidomastoid and the trapezius.
3. Movements: The three joints exhibit rotatory move-
ments that take place around a vertical axis. The rotatory
movements are brought about by the obliquus capitis
inferior, the rectus capitis posterior major and the
splenius capitis of one side, acting with the sternocleido-
mastoid of the opposite side.
Q.2. Vertebral artery.
Ans.
Vertebral artery arises from the first part of the subclavian
artery and ends in the cranial cavity by supplying the brain.
 Quick Review Series: BDS 1st Year

It is one of the two principal arteries which supply the 2. Cranial branches
brain and is divided into four parts. It supplies brain, spinal . Meningeal branches

ep
cord, the meninges, the surrounding muscles and bones . The posterior spinal artery
. The anterior spinal artery
Branches of vertebral artery are as follows:
. The posterior inferior cerebellar artery

oan
1. In the neck
. Medullary arteries.
a. Cervical spinal branches
b. Muscular branches to deep muscles of the neck

MOUTH AND PHARYNX

LONG ESSAYS

Q.1. Describe anatomy of the palatine tonsil. Give The medial surface is covered by stratified squamous epi-
its surgical importance. thelium continuous with that of the mouth. It contains
about 12-15 tonsillar crypts. The largest of these is called the
Or
intratonsillar cleft.
Give an account of the position, relations, blood The lateral surface is covered by a sheet of fascia which
supply and development of palatine tonsil. Add a forms the capsule of the tonsil. The capsule is an extension
note on its applied anatomy. of the pharyngobasilar fascia. It is only loosely attached to
the muscular wall of the pharynx, but anteroinferiorly the
Or
capsule is firmly adherent to the side of the tongue. This firm
Give an account of the position, relations and blood attachment keeps the tonsil in place during swallowing. Just
supply of palatine tonsil. Add a note on development. behind the firm attachment, the tonsillar artery enters the
Ans.
tonsil by piercing the superior constrictor.
The palatine vein or external palatine or paratonsillar
The palatine tonsil is an almond-shaped lymphoid tissue vein descends from the palate in the loose areolar tissue
that occupies the tonsillar fossa between the palatoglossal on the lateral surface of the capsule, and crosses the tonsil
and palatopharyngeal arches visible through the mouth before piercing the wall of the pharynx. The vein may be
(Fig, 1A.14.1). injured during removal of the tonsil or tonsillectomy.
The palatine tonsil has: The bed of the tonsil is formed from by:
e Two surfaces—medial and lateral, 1. the pharyngobasilar fascia,
e Two borders—anterior and posterior and 2. the superior constrictor and palatopharyngeus muscles,
© Two poles—upper and lower. 3. the buccopharyngeal fascia,

| Tours tubarius
YS

l
Nasal cavity
Torus levatorius
2 (folds overlying levator veli palatini)
le. Fold overlying
Palatoglossal fold (margin of Lae
oropharyngeal isthmus) (| Ce || palatopharyngeal
alatopharyngeal sphi
sphincter
ee Salpingopharyngeal fold
XY Palatine tonsil
Palatopharyngeal arch
4 (overlies palatopharyngeus muscle)
Kigeee Laryngeal inlet
aN Trachea
ernEN Oesophagus

Fig. 1A.14.1 The palatine tonsil

 General Anatomy

4. in the lower part the styloglossus and Lymphatic Drainage

5. the glossopharyngeal nerve.
Still more laterally there is facial artery with its tonsillar
and ascending palatine branches. The internal carotid artery
is 2.5 cm posterolateral to the tonsil. The anterior border is
related to the palatoglossal arch with its muscle.
The posterior border is related to the palatopharyngeal
arch with its muscle. The upper pole is related to the soft pal-
ate, and the lower pole, to the tongue.
The plica triangularis is a triangular vestigial fold of mu-
cous membrane covering the anteroinferior part of the ton-
sil. The plica semilunaris is a similar semilunar fold that may
cross the upper part of the tonsillar sinus.
The intratonsillar cleft is the largest crypt of the tonsil. It
is present in its upper part. It is sometimes wrongly named
the supratonsillar fossa. The mouth of the cleft is semilunar
in shape and parallel to the dorsum of the tongue. It repre-
sents the internal opening of the second pharyngeal pouch.
A peritonsillar abscess or quinsy often begins in this cleft.
Arterial Supply of Tonsil (Fig. 1A.14.2)
Maxillary
Lymphatics drain to the jugulodigastric node.
Nerve supply: Glossopharyngeal and lesser palatine nerves.
Histology
The palatine tonsil is situated at the oropharyngeal isthmus.
Its oral aspect is covered with stratified squamous non-
keratinized epithelium, which dips into the underlying tissue
to form the crypts. The lymphocytes lie on the sides of the
crypts in the form of nodules.
Development
The epithelium over the tonsil develops from ventral part of
second pharyngeal pouch. The lymphocytes are mesodermal
in origin.
Q.2. Describe external features, muscles, nerve
supply and blood supply of soft palate.
Ans.
Soft palate is a movable, muscular fold, suspended from
the posterior border of the hard palate which separates the
nasopharynx from the oropharynx (Fig. 1A.14.3).

Superficial
Choanae Pharyngeal tonsil
temporal Greater palatine

Palatine tonsil
Pharyngeal recesses
Ascending Tonsillar Torus levatorius:
phary
haryn
nggeal branches Salpingopharyngeal fold
Ascending
Oropharyngeal isthmu Palatine tonsil
palatine Palatopharyngeal arch
Dorsal linguae Lingual tonsil
Piniform fossa
Laryngeal inlet
External

) tt
carotid
——

Fig. 1A.14.2 Arterial supply of the palatine tonsil. Oesophagus

es

Fig. 1A.14.3 The soft palate.

Tonsil has rich blood supply derived from the following:
1. The facial artery (tonsillar branch) is the main source of
It has two surfaces, anterior and posterior. The anterior
arterial supply of tonsil.
(oral) surface is concave and is marked by a median raphe.
2. Other sources are as follows:
The posterior surface is convex and is continuous with the
a. Ascending palatine branch of facial artery
floor of the nasal cavity superiorly.
b. Dorsal lingual branches of the lingual artery
It has two borders—superior and inferior. The superior
c. Ascending pharyngeal branch of the external carotid
border is attached to the posterior border of the hard palate,
artery
blending on each side with the pharynx. The inferior border
d. The greater palatine branch of the maxillary artery.
is free and binds the pharyngeal isthmus; a conical projec-
tion hanging from its middle is called the uvula. From each
Venous Drainage
side of the base of the uvula, two curved folds of mucous
One or more veins leave from the lower part of the deep membrane extend laterally and downwards. The anterior
surface of the tonsil, pierce the superior constrictor and join fold is called the palatoglossal arch or anterior pillar of fauces.
the palatine, pharyngeal or facial veins. It contains the palatoglossus muscle and reaches the side of
76 Quick Review Series: BDS 1st Year

the tongue at the junction of oral and pharyngeal parts. This Oral cavity Tensor veli
fold forms the lateral boundary of the oropharyngeal isth- palatini muscle
mus or isthmus of fauces. The posterior fold is called the
palatopharyngeal arch or posterior pillar of fauces. It contains
palatini muscle
the palatopharyngeal muscle and forms the posterior bound-
ary of the tonsillar fossa and merges inferiorly with the lat-
eral wall of the pharynx.
The parts of soft palate are as follows:
The palatine aponeurosis which is the flattened tendon of
the tensor veli palatini forms the fibrous basis of the palate.
Palatopharyngeus
Near the median plane the aponeurosis splits to enclose the muscle
musculus uvulae. The levator veli palatini and the palato-
\— Palatoglossus
pharyngeus lie on the superior surface of the palatine apo- muscle
neurosis. The palatoglossus lies on the inferior surface of the Hyoid bone
palatine aponeurosis.
Fig. 1A.14.4 Muscles of the soft palate.
The muscles of the soft palate are as follows: (Fig. 1A.14.4):
1. Tensor palati (tensor veli palatini)
2. Levator palati (levator veli palatini) Nerve Supply
3. Musculus uvulae
1. Motor nerves: All muscles of the soft palate except the
4. Palatoglossus
tensor veli palatini are supplied by the pharyngeal plexus.
5. Palatopharyngeus.
The fibres of this plexus are derived from the cranial part
Muscles of the soft palate are summarized in of the accessory nerve through the vagus. The tensor veli
Table 1A.14.1. palatini is supplied by the mandibular nerve.
Passavant’s ridge: Some of the upper fibres of the palato- 2. General sensory nerves are derived from (a) the middle
pharyngeus pass circularly deep to the mucous membrane of and posterior lesser palatine nerves, the branches of the
the pharynx, and form a sphincter internal to the superior maxillary nerve and (b) from the glossopharyngeal
constrictor. These fibres constitute Passavant’s muscle which nerve.
on contraction raises a ridge called the Passavant’s ridge on 3. Special sensory or gustatory nerves carrying taste sensa-
the posterior wall of the nasopharynx. When the soft palate tions from the oral surface are contained in the lesser
is elevated it comes in contact with this ridge, the two palatine nerves. The fibres pass through the greater pe-
together closing the pharyngeal isthmus between the trosal nerve to the geniculate ganglion of the facial nerve
nasopharynx and the oropharynx. and from there to the nucleus of the solitary tract.

Table 1A.14.1 Summary of muscles of soft palate

Muscle Origin Insertion Actions
Tensor veli 1. Lateral side of auditory tube Muscle descends, and flattens out to form the pala- 1. Tightens the anterior part soft
palatini 2. Adjoining part of the base of the _ tine aponeurosis which is attached to the following: palate
skull (greater wing and scaphoid 1. Posterior border of hard palate 2. Equalizes air pressure
fossa of sphenoid bone) 2. Inferior surface of palate behind the palatine crest between the middle ear and
the nasopharynx
Levator veli 1. Inferior aspect of auditory tube Muscle is inserted into the upper surface of the 1. Elevates soft palate and closes
palatini 2. Adjoining part of inferior surface palatine aponeurosis the pharyngeal isthmus
of petrous temporal bone 2. Opens the auditory tube
Musculus Posterior nasal spine and palatine Mucous membrane of uvula Pulls up the uvula
uvulae aponeurosis
Palatoglossus Oral surface of palatine aponeurosis Descends in the palatoglossal arch, to the side of Closes the oropharyngeal
the tongue at the junction of isthmus its oral and
pharyngeal parts
Palatopharyn- 1. Anterior fasciculus It is inserted into the following: Shortens pharynx during
geus 2. Posterior fasciculus 1. Posterior border of the lamina of the thyroid swallowing
cartilage
2. Wall of the pharynx and its median raphe
 General Anatomy

4. Secretomotor nerves are also contained in the lesser Blood Supply

palatine nerves. They are derived from the superior
salivatory nucleus and travel through the greater
petrosal nerve.
Movements and Functions of the Soft Palate
The palate controls both the pharyngeal and the oropharyn-
geal isthmus. Through these movements the soft palate plays
an important role in chewing, swallowing, speech, coughing,
sneezing, etc.
A few specific roles are as follows:
1. Itisolates the mouth from the oropharynx during chew-
ing, so that breathing is unaffected.
2. It separates the oropharynx from the nasopharynx dur-
ing the second stage of swallowing, so that food does not
enter the nose.
3. By varying the degree of closure of the pharyngeal isth-
mus, the quality of voice can be modified and various
consonants correctly pronounced.
4. During sneezing, the blast of air is appropriately divided
and directed through the nasal and oral cavities without
damaging the narrow nose. Similarly during coughing
it directs air and sputum into the mouth and not into
the nose.
Arteries
1. Greater palatine branch of maxillary artery. Ascending
palatine branch of facial artery.
2. Palatine branch of ascending pharyngeal artery.
Veins
They pass to the pterygoid and tonsillar plexuses of veins.
Lymphatics
Lymphatics drain into the upper deep cervical and retro-
pharyngeal lymph nodes.
Development of palate
The premaxilla or primitive is formed by the fusion of me-
dial nasal folds; the rest of the palate is formed by the shelf-
like palatine processes of maxilla and horizontal plates of
palatine bone. Most of the palate gets ossified to form the
hard palate. The unossified posterior part of fused palatal
process forms the soft palate.
Soft palate comprises epithelium, connective tissue and
muscles. Epithelium is from the ectoderm of maxillary
process. The muscles are derived from first, fourth and
sixth branchial arches and accordingly are innervated by
mandibular and vagoaccessory complex.

SHORT ESSAYS

Q.1. Oropharynx. Soft palate Choanae

Ans.
Oropharynx is the middle part of the pharynx situated
behind the oral cavity. Superiorly, it communicates with
the nasopharynx through the pharyngeal or nasopharyngeal
isthmus. In front, it communicates with the oral cavity
through the oropharyngeal isthmus or isthmus of fauces.
Below, it opens into the laryngopharynx at the level of
the upper border of the epiglottis. Behind, it is supported
by the body of the axis vertebra and the upper part of Laryngopharynx
the body of the third cervical vertebra. Its lateral wall pres-
ents the palatine tonsil which lies in the tonsillar fossa. Oropharyngeal
This fossa is bounded anteriorly by the palatoglossal arch, isthmus
and posteriorly by the palatopharyngeal arch. The posterior
wall of the oropharynx is formed posteriorly by the supe- Fig. 1A.14.5 Divisions of pharynx.
rior, middle and inferior constrictors of the pharynx
(Fig, 1A.14.5). the tubal tonsils and inferiorly, there is the lingual tonsil
There are several aggregations of lymphoid tissue that over the posterior part of the dorsum of the tongue.
constitute Waldeyer’s lymphatic ring in relation to the oro-
Q.2. Describe the features of the lateral wall of
pharyngeal isthmus. The most important aggregations are
nasopharynx.
the right and left palatine tonsils. Posteriorly and above,
there is the pharyngeal tonsil; laterally and above, there are Ans.
 Quick Review Series: BDS 1st Year
The lateral wall of the nasopharynx presents the following
features:
1. The pharyngeal opening of the auditory tube, at the
level of the inferior nasal concha.
2. The tubal opening bounded by the tubal elevation.
3. The salpingopharyngeal fold: A vertical fold of mucous
membrane running downwards from the posterior
SHORT NOTES
Q.1. Soft palate
Ans.
Soft palate is a movable, muscular fold, suspended from
the posterior border of the hard palate. It separates the
nasopharynx from the oropharynx, and is often looked upon
as traffic controller between the food and air passages.
The soft palate has two surfaces—anterior and posterior,
and two borders—superior and inferior.
Q.2. Nasopharynx.
Ans.
The cavity of the pharynx is divided into:
1. The nasal part, nasopharynx
2. The oral part, oropharynx
3. The laryngeal part, laryngopharynx.
Nasal part of pharynx (nasopharynx) is the upper part of
the pharynx situated behind the nose, and above the lower
border of the soft palate. It resembles the nose both structurally
as well as functionally; it is respiratory in function. Its walls are
rigid and non-collapsible, so that the air passage is kept patent.
It is lined by ciliated columnar epithelium. Its mucous mem-
brane is supplied by the pharyngeal branch of pterygopalatine
ganglion suspended by maxillary branch of trigeminal nerve.
Q.3. Palatine tonsil.
Ans.
The palatine tonsil occupies the tonsillar sinus or fossa be-
tween the palatoglossal and palatopharyngeal arches. It can be
seen through the mouth. It is almond-shaped lymphoid tissue
collection and has two surfaces medial and lateral; two bor-
ders, anterior and posterior and two poles, upper and lower.
Q.4. Muscles of soft palate.
Ans.
Muscles of the soft palate are as follows:
Tensor palati (tensor veli palatini)
>
Levator palati (levator veli palatini)
YON
Musculus uvulae
Palatoglossus
VR
Palatopharyngeus.
margin of the tubal elevation and gradually fading on
the side wall of the pharynx.
4. The levator veli palatine.
5. Behind the tubal elevation, there is a narrow vertical slit
that leads into the pharyngeal recess or lateral recess, or
fossa of Rosenmuller.
Q.5. Tensor palatine muscle.
Ans.
Tensor veli palatini is a thin, triangular muscle.
Origin
1. Lateral side of auditory tube.
2. Adjoining part of the base of the skull (greater wing and
scaphoid fossa of sphenoid bone).
Insertion
Muscle descends, converges to form a delicate tendon which
runs around the pterygoid hamulus, passes through the
origin of the buccinator, and flattens out to form the
palatine aponeurosis which is attached to:
1. Posterior border of hard palate.
2. Inferior surface of palate behind the palatine crest.
Functions
3. Tightens the soft palate, chiefly the anterior part.
4. Opens the auditory tube to equalize air pressure
between the middle ear and the nasopharynx.
Q.6. Pharyngobasilar fascia.
Ans.
The pharyngobasilar fascia forms the bed of the tonsil. The
posterior borer of medial pterygoid plate gives attachment
for pharyngobasilar fascia.
Q.7. Pharyngotympanic tube.
Ans.
Pharyngotympanic tube is the communicating passage
between the middle ear and nasopharynx and is directed
downwards, forwards and medially. It balances the
pressure inside the middle ear with that of the external
atmosphere.
Length: About 3.6 cm long. In infants the tube is shorter,
wider and more horizontal.
Direction: Downwards, forwards and medially.
 General Anatomy

Parts: Cartilaginous part, anterior two-third. Bony part, Position of palatopharyngeal sphincter
on deep surface of superior constrictor
posterior one-third.
(A
The bony part commences in the anterior wall of the
middle ear and terminates at the junction of the squamous
and petrous part of the temporal bone. It is somewhat
oval at cross-section. The junction between the bony and Superior constrictor
cartilaginous part is known as the isthmus. Middle constrictor

Q.8. Lymphatic drainage of tonsil. Inferior constrictor

Ans.
Oesophagus
Lymphatics from the tonsil pass to the jugulodigastric node.
Q.9. Superior constrictor of pharynx. Fig. 1A.14.6 Constrictor muscles of pharynx.
Ans.
3. Structures passing between the middle and inferior con-
The muscular wall of the pharynx is formed mainly by the
strictor are:
three pairs of constrictors superior, middle and inferior. a. Internal laryngeal nerve
The superior constrictor takes origin from the following: b. Superior laryngeal vessels.
1. Pterygoid hamulus. 4. Between the superior constrictor and the base of the
2. Pterygomandibular raphe. skull:
3. Medial surface of the mandible at the posterior end of a. Pharyngotympanic tube
the mylohyoid line, i-e. near the lower attachment of the b. Levator veli palatini muscle
pterygomandibular raphe. c. Ascending palatine artery
4. Side of posterior part of tongue. d. Ascending pharyngeal artery.
All the constrictors of the pharynx are inserted into a Q.12. Name the lateral relations of palatine tonsil.
median raphe on the posterior wall of the pharynx.
Ans.
Q.10. List the lymphatic nodules in Waldeyer’s ring. The lateral surface of palatine tonsil is covered by a sheet
Ans. of fascia which forms the capsule of the tonsil which is an
extension of the pharyngobasilar fascia (Fig. 1A.14.7).
In relation to the oropharyngeal isthmus, there are several ag-
Other structures related to the lateral surface of palatine
gregations of lymphoid tissue that constitute Waldeyer’s lym-
tonsil are as follows:
phatic ring. The most important aggregations are the right and
1. The palatine vein or external palatine or paratonsillar vein
left palatine tonsils usually referred to simply as the tonsils. Pos-
2. Superior constrictor muscle of pharynx
teriorly and above, there is the pharyngeal tonsil; laterally and
above, there are the tubal tonsils, and inferiorly, there is the lin-
Cartilaginous part of
gual tonsil over the posterior part of the dorsum of the tongue. pharyngotympanic tube
Tensor veli palatini
Palatopharyngeal
Q.11. Enumerate four relations of constrictor muscle Levator veli palatini sphincter
of pharynx.
Ans.

The three pairs of muscles of pharynx, namely, superior,

middle and inferior constrictors form the muscular wall
of pharynx (Fig. 1A.14.6). They are so arranged that the
inferior overlaps middle which in turn overlaps the superior.
Salpingopharyngeus
Relations of constrictor muscles of pharynx are as follows:
1. Structures lying deep to the inferior border of inferior Palatopharyngeal
constrictor are: Superior constrictor
a. Recurrent laryngeal nerve Palatine tonsil
Stylopharyngeus
b. Inferior laryngeal vessels.
2. Structures passing between the superior and middle Middle constrictor . .
Inferior constrictor
constrictor are:
a. Glossopharyngeal nerve
b. Stylopharyngeus muscle. Fig. 1A.14.7 The palatine tonsil.
 Quick Review Series: BDS 1st Year

3. Buccopharyngeal fascia 6. Internal carotid artery

4. Facial artery 7. Glossopharyngeal nerve
5. Ascending pharyngeal artery 8. Styloglossus and stylopharyngeus.

NOSE AND PARANASAL SINUSES

LONG ESSAYS

Q.1. Describe the lateral wall of nasal cavity. 2. The atrium of the middle meatus: The middle part of
lateral wall of nose.
Or
3. The conchae: The bony elevations in the posterior part.
Describe the features of the lateral wall of nose in
Spaces separating the conchae are called meatuses.
detail.
The skeleton of the lateral wall is partly bony, partly car-
Or tilaginous, and partly made up of only soft tissues as follows.
The following bones make up the bony part of lateral wall
Describe the lateral wall of nose under following
of nose (Fig. 1A.15.2):
headings: bone formation features, openings,
blood supply and nerve supply.
Ans.

The lateral wall of the nose is irregular due to the presence of

Superior concha
three shelf-like bony projections called conchae, which increase Middle concha
the surface area of the nose for effective air-conditioning of the Uncinate process of
Nasal bone— //#e tat
inspired air (Fig. 1A.15.1).
Lateral process of
The lateral wall separates the nose from: septal cartilage
1. The orbit above,
2. The maxillary sinus below and cartilage Medial pterygoid plate
3. The lacrimal groove and nasolacrimal canal in front. Minor alar.
of sphenoid bone
Perpendicular plate
cartilage of palatine bone
The lateral wall can be subdivided into three parts: Inferior concha
1. The vestibule: A small depressed area in the anterior
Fig. 1A.15.2 Bones of the lateral wall of the nasal cavity.
part of lateral wall of nose which is lined by modified
skin containing short, stiff, curved hairs called vibrissae.

Cranial cavity .
Nasal
Orbital plate Cribriform plate Crista galli
of frontal .
Frontal process of maxilla
WN

bone
.
Lacrimal
Middle
Orbital plate CO) ethmoidal
.
Labyrinth of ethmoid with superior and middle conchae
RUB

of ethmoidal cells .
Inferior nasal concha
SS )\ Bulla .
Perpendicular plate of the palatine bone (orbital +
ethmoidalis
vn
Perpendicular a 2
sphenoidal processes)
plate

Nasal cavities aa fe < If

<_ 7. Medial pterygoid plate.
The cartilaginous part is formed by the following:
Avion Uncinate 1. The superior nasal cartilage
process 2. The inferior nasal cartilage
Inferior concha bone
Oral cavit 3. Three or four small cartilages of the ala.
Palatine process of CO ¥
maxillary bone Vomer
The circular lower part is formed by fibrofatty tissue cov-
Fig. 1A.15.1 Coronal section through skull. ered with skin.

Conchae and Meatuses (Fig. 1A.15.3)
Opening of
J2€ Pharyngotympanic
tube
Nasopharynx
ase Soft palate
Inferior concha
Fig. 1A.15.3 The lateral wall of the nose—conchae.
The nasal conchae are curved bony projections directed
downwards and medially and are as follows:
1. The inferior concha is an independent bone.
2. The middle concha is a projection from the medial
surface of the ethmoidal labyrinth.
3. The superior concha is also a projection from the medial
surface of the ethmoidal labyrinth. This is the smallest
concha situated just above the posterior part of the
middle concha.
The passages beneath the overhanging conchae are known
as meatuses of the nose. Each meatus communicates freely
with the nasal cavity proper (Fig. 1A.15.4).
1. The inferior meatus lies beneath the inferior concha, and
is the largest of the three meatuses. The nasolacrimal
duct opens into it, the opening is guarded by the lacri-
mal fold, or Hasner’s valve.
2. The middle meatus lies underneath the middle concha.
It consists of the following:
a. A rounded elevation produced by the underlying middle
ethmoidal sinuses known as the ethmoidal bulla.
b. A deep semicircular sulcus below the bulla called the
hiatus semilunaris.
c. A short passage at the anterior end of the hiatus
known as the infundibulum.
Opening of middle ethmoidal
cells onto bulla ethmoidalis
Infundibulum opening of frontonasal
duct that drains the frontal sinus.
and anterior ethmoid cells
Opening of nasolacrimal duct
Fig. 1A.15.4 The openings in the lateral wall of the nose.
General Anatomy
d. An opening of the frontal air sinus in the anterior
part of the hiatus semilunaris.
e. The opening of the maxillary air sinus is located in
the posterior part of the hiatus semilunaris. It is often
represented by two openings.
f. The opening of the middle ethmoidal air sinus is
present at the upper margin of the bulla.
3. The superior meatus lies below the superior concha.
This is the shortest and shallowest of the three meatuses.
It receives the openings of the posterior ethmoidal air sinuses.
The sphenoethmoidal recess is a triangular fossa just
above the superior concha. It receives the opening of the
sphenoidal air sinus.
Arterial Supply of the Lateral Wall (Fig. 1A.15.5)
1. The anterior ethmoidal artery assisted by the posterior
ethmoidal and facial arteries supplies the anterosuperior
quadrant.
2. The anteroinferior quadrant is supplied by branches
from the facial and greater palatine arteries.
3. The posterosuperior quadrant is supplied by the
sphenopalatine artery.
4. The posteroinferior quadrant is supplied by branches
from the greater palatine artery.
Venous Drainage (Fig. 1A.15.6)
The veins form a plexus which drains anteriorly into the facial
vein; posteriorly, into the pharyngeal plexus of veins and
from the middle part, to the pterygoid plexus of veins.
Nerve Supply (Fig. 1A.15.7)
Both the general sensory and special sensory nerves supply
the nasal cavity.
1. General sensory nerves derived from the following
branches of trigeminal nerve are distributed to whole of
the lateral wall:
a. The anterosuperior quadrant is supplied by the ante-
rior ethmoidal nerve branch of ophthalmic nerve.
Opening to posterior ethmoidal
cells into lateral wall of superior meatus
Opening of sphenoidal sinus
into sphenoethmoidal recess
Opening of maxillary sinus in
floor of hiatus semilunaris
Quick Review Series: BDS 1st Year

d. The posteroinferior quadrant is supplied by the

anterior or greater palatine branch from the pterygo-
palatine ganglion suspended by the maxillary nerve.
External nasal 2. Special sensory nerves or olfactory nerves are distributed
artery from \ Y to the upper part of the lateral wall up to the superior
enero poi
concha.

Lymphatic Drainage (Fig. 1A.15.8)

lymphatics from the anterior half of the lateral wall pass to
the submandibular nodes, and from the posterior half, to the
Lateral branches of retropharyngeal and upper deep cervical nodes.
sphenopalatine artery

Alar branch of Inferior concha Deep cervical

Retropharyngeal and
lateral nasal artery Greater palatine artery upper deep pharyng
cervical nodes nodes

Fig. 1A.15.5 Arterial supply of the nasal cavities.

ty | Nasal vein in
# \\ foramen caecum
Drainage to cavernous
sinus in cranial cavity

Left jugular trunk

Internal jugular vein

Fig. 1A.15.8 Lymphatic drainage of the nasal cavities.

Drainage to Drainage to pterygoid
facial vein plexus in infratemporal fossa
Q.2. Describe maxillary air sinus and its relation.
Fig. 1A.15.6 Venous drainage of the nasal cavities.
Ans.

Anterior ethmoid
The maxillary sinus is the largest of all the paranasal sinuses
Olfactory bulb located in the body of the maxilla (Figs 1A.15.9,1A.15.10).
External nasal Olfactory nerve [I]
branch of Sphenopalatine foramen
anterior ethmoid Floor of anterior cranial fossa

Ethmoidal sinuses
Nasal septum

Middle concha. Middle ethmoidal sinus

Maxillary hiatus Maxillary sinus
Inferior concha Floor of nose
Posterior superior
lateral nasal nerves Upper tooth
Nasal branch of anterior Palate forming roof of mouth
superior alveolar nerve
of infraorbital nerve Fig. 1A.15.9 Coronal section through the nasal cavity and the
Fig. 1A.15.7 Nerve supply of the nasal cavity. maxillary sinuses.

Features of Maxillary Sinus

b. The anteroinferior quadrant is supplied by the anterior
superior alveolar nerve, branch of maxillary nerve.
c. The posterosuperior quadrant is supplied by the poste-
rior superior lateral nasal branches from the pterygo-
palatine ganglion suspended by the maxillary nerve.
The maxillary sinus is the first paranasal sinus to develop.
1. The maxillary sinus is pyramidal in shape, with its:
a. Base: directed medially towards the lateral wall of the
nose
 General Anatomy

Anterior ethmoidal 6. Venous drainage: The maxillary sinus drains in to the

sinuses
Frontal air sinus facial vein and the pterygoid plexus of veins.
Posterior ethmoidal sinus
7. Lymphatic drainage: Into the submandibular nodes.
8. Nerve supply: Infraorbital, and anterior, middle and poste-
Sphenoidal sinus
Maxillary sinus rior superior alveolar nerves innervate the maxillary sinus.
Q.3. Describe gross anatomy of nasal septum.
Ans.
Median osseocartilaginous partition between the two halves
of the nasal cavity is known as nasal septum. On either side,
it is covered by mucous membrane and forms the medial
Fig. 1A.15.10 Location of paranasal sinuses in the lateral wall wall of both nasal cavities (Fig. 1A.15.11).
of the nose. The bony part is formed almost entirely by: (a) the vomer,
and (b) the perpendicular plate of the ethmoid. Its margins
b. Apex: directed laterally into the zygomatic process of
receive contributions from the nasal spine of the frontal
the maxilla
bone, the rostrum of the sphenoid, and the nasal crests of
c. Roof: formed by the floor of the orbit
the nasal, palatine and maxillary bones.
d. Floor: formed by the alveolar process of the maxilla.
The cartilaginous part is formed by: (a) the septal cartilage
The floor lies about 1 cm below the level of the floor of
and (b) the septal processes of the inferior nasal cartilages.
the nose.
The cuticular part or lower end is formed by fibrofatty
2. The size of the sinus is variable, average measurements
tissue covered by skin, The lower margin of the septum is
are: height, 3.5 cm; width, 2.5 cm and anteroposterior
called the columella.
depth, 3.5 cm.
The central part of nasal septum is rarely strictly median;
3. It opens into the middle meatus of the nose in the lower
it is usually defected to one or the other side due to over-
part of the hiatus semilunaris, a second opening is often
growth of one or more of the constituent parts.
present at the posterior end of the hiatus. Both openings
The septum has (a) four borders, superior, inferior,
are near to the roof than the floor of the sinus.
anterior and posterior and (b) two surfaces, right and left.
4. The size of the opening is about 3-4 mm as it is over-
lapped by the following:
Arterial Supply (Fig. 14.15.12)
(a) from above, by the uncinate process of the ethmoid,
and the descending part of the lacrimal bone; 1. Anterosuperior part is supplied by the anterior ethmoidal
(b) from below, by the inferior nasal concha and artery.
(c) from behind, by the perpendicular plate of the 2. Anteroinferior part is supplied by the superior labial
palatine bone. It is still further reduced in size by branch of facial artery.
the thick mucosa of the nose. 3. Posteroinferior part is supplied by the sphenopalatine
5. Arterial supply: Facial, infraorbital and greater palatine artery.
arteries. 4. Posterior part is supplied by the posterior ethmoidal artery.

Nasal spine of frontal bone Cribriform plate of ethmoid

Nasal crest of nasal bone
Perpendicular plate of ethmoid

Septal cartilage

Rostrum of sphenoid
Septal process of inferior nasal cartilage

Columella

Fig. 14.15.11 The nasal septum.

Quick Review Series: BDS 1st Year

Nerve Supply (Fig. 14.15.18)

Septal branch of
anterior ethmoidal artery 1. General sensory nerves, arising from trigeminal nerve,
Septal branch of
are distributed to whole of the septum:
posterior ethmoidal artery a. The internal nasal branch of the anterior ethmoidal
nerve supplies the anterosuperior part of the septum.
b. The nasopalatine branch of the pterygopalatine ganglion
supplies the posteroinferior part of the septum.
c. The medial posterior superior nasal branches of
the pterygopalatine ganglion supplies the posterosu-
perior part.
2. Special sensory nerve or olfactory nerves are confined to
the upper part or olfactory area.

Lymphatic Drainage
Septal branch of
sphenopalatine
Posterior half of the nasal septum drains in to the retropha-
Terminal part of ryngeal and deep cervical nodes, while the anterior half
greater palatine artery drains into the submandibular nodes.
Septal branch from nasal
artery from superior labial artery

Fig. 14.15.12 The arterial supply of nasal septum.

Septal branch of
anterior ethmoidal nerve

Olfactory nerve [I]

The vestibule of the nasal septum or its anteroinferior (septal branches)
part contains anastomoses between the septal ramus of the
superior labial branch of the facial artery, branch of spheno-
palatine artery and of anterior ethmoidal artery which form
a large capillary network called the Kiesselbach’s plexus. This
is known as Little’s area and is the common site of bleeding
from the nose or epistaxis.

Venous Drainage
The veins form a plexus in the lower part of the septum or
Little’s area. The plexus drains anteriorly into the facial vein,
posteriorly through the sphenopalatine vein to pterygoid Nasopalatine nerve

venous plexus. Fig. 14.15.13 Nerve supply of the nasal septum.

SHORT ESSAYS

Q.1. Nasal septum. Q.3. Give the boundaries, relations and applied
anatomy of sphenoidal air sinus.
Ans.
Ans.
Refer to the answer of Long Essays Q. 3. Features of sphenoidal air sinus are as follows (Fig. 1A.15.14):
1. The right and left sphenoidal sinuses are located within
Q.2. Maxillary air sinus.
the body of the sphenoid bone. They are separated by a
Ans. septum. The two sinuses are usually unequal in size.
Each sinus opens into the sphenoethmoidal recess of the
Refer to the answer of Long Essays Q. 2. corresponding half of the nasal cavity.
 General Anatomy

Meningeal layer of dura mater 2. Each sinus is related superiorly to the optic chiasma
\ ey NS
ae if ~ . . and the hypophysis cerebri; and laterally, to the internal
Oculomotor nerve~__I4
7 \ I 7 Hypophysis cerebri
Trochlear nerve = i= 27 carotid artery and the cavernous sinus.
Cavernous sinus 7% a 3. Arterial supply: Posterior ethmoidal and internal carotid
Maxillary nerve
i (Vv Sphenoidal sinus arteries.
Mandibular nerv 4. Venous drainage: The sphenoidal sinus drains into
pterygoid venous plexus and cavernous sinus.
Internal carotid artery
Abducent nerve 5. Lymphatic drainage: To the retropharyngeal nodes.
Fig. 14.15.14 Sphenoidal air sinuses. 6. Nerve supply: Posterior ethmoidal nerve and orbital
branches of the pterygopalatine ganglion supply the
sphenoidal sinus.

SHORT NOTES

Q.1. Frontal sinus. Q.4. Maxillary sinus.

Ans.
Features of frontal sinus are as follows:
1. The frontal sinus lies in the frontal bone. It extends
upwards above the medial end of the eyebrow, and
backwards into the medial part of the roof of the orbit.
2. It opens into the middle meatus of nose at the anterior
end of the hiatus semilunaris either through the infun-
dibulum or through the frontonasal duct.
Q.2. Nasal septum.
Ans.
The median osseocartilaginous partition between the two
halves of the nasal cavity is known as the nasal septum. On
each side, it is covered by mucous membrane and forms the
medial wall of both nasal cavities.
The bony part is formed almost entirely by:
1. The vomer
2. The perpendicular plate of the ethmoid.
The cartilaginous part is formed by:
1. The septal cartilage
2. The septal processes of the inferior nasal cartilages.
The cuticular part or lower end is formed by fibrofatty
tissue covered by skin.
The lower margin of the septum is called the columella.
The septum has: (a) four borders, superior, inferior, ante-
rior and posterior and (b) two surfaces, right and left.
Q.3. Orbital nerve.
Ans.
Orbital nerve is a branch of maxillary nerve. The orbital
branches pass through the inferior orbital fissure, and supply
the periosteum of the orbit and the orbitalis muscle.
Ans.
The maxillary sinus is situated in the body of the maxilla,
and is the largest of all the paranasal sinuses.
The maxillary sinus is pyramidal in shape, with its:
1. Base: directed medially towards the lateral wall of the
nose.
2. Apex: directed laterally into the zygomatic process of the
maxilla.
3. Roof: formed by the floor of the orbit.
4. Floor: formed by the alveolar process of the maxilla.
It opens into the middle meatus of the nose through
ostium in the lower part of the hiatus semilunaris.
Q.5. Paranasal sinuses.
Ans.
Paranasal sinuses are air filled spaces present within some
bones around the nasal cavities. The sinuses are frontal, maxil-
lary, sphenoidal and ethmoidal. All of them open into the nasal
cavity through its lateral wall. The function of the sinuses is to
make the skull lighter and add resonance to the voice.
Q.6. Sphenopalatine ganglion.
Ans.
Sphenopalatine or pterygopalatine is the largest parasympa-
thetic peripheral ganglion located in the pterygopalatine
fossa just below the maxillary nerve, in front of the pterygoid
canal and lateral to the sphenopalatine foramen.
It serves as a relay station for secretomotor fibres to the
lacrimal gland and to the mucous glands of the nose, the
paranasal sinuses, the palate and pharynx.
Topographically, it is related to the maxillary nerve, but
functionally it is connected to the facial nerve through its
greater petrosal branch.
Quick Review Series: BDS 1st Year

Q.7. Blood supply of nasal septum. 3. The infundibulum is a short passage at the anterior end
of the hiatus.
Ans.
4. The opening of the frontal air sinus is seen in the ante-
The arterial supply of nasal septum is as follows: rior part of the hiatus semilunaris.
1. Anterosuperior part: supplied by the anterior ethmoidal
Q.9. Name the paranasal sinus openings into middle
artery.
meatus of the nose.
2. Posteroinferior part: supplied by the sphenopalatine artery.
3. Anteroinferior part: supplied by the superior labial Or
branch of facial artery.
Mention the paranasal sinuses opening into middle
4. Posterior part: supplied by the posterior ethmoidal artery.
meatus of the nose.
5. The opening of the maxillary air sinus is located in the
posterior part of the hiatus semilunaris. Ans.
6. The opening of the middle ethmoidal air sinus is present
The paranasal sinuses opening into middle meatus of the
at the upper margin of the bulla.
nose are as follows:
The anteroinferior part or vestibule of the septum con- 1. Frontal sinus
tains anastomoses between the septal ramus of the superior 2. Maxillary sinus
labial branch of the facial artery, branch of sphenopalatine 3. Middle ethmoidal air sinus.
artery, and of anterior ethmoidal artery which forms a large
Q.10. Name any four bony constituents of nasal
capillary network called the Kiesselbach’s plexus. This is a
septum.
common site of bleeding from the nose or epistaxis, and is
known as Little’s area. Ans.

Q.8. Middle meatus of nose. The bony part of nasal septum is formed almost entirely by
the following:
Ans.
1. The vomer
The middle meatus of nose lies underneath the middle concha. 2. The perpendicular plate of the ethmoid.
It presents the following features: Its margins receive contributions from the following:
1. The ethmoidal bulla is a rounded elevation produced by 1. The nasal spine of the frontal bone
the underlying middle ethmoidal sinuses. 2. The rostrum of the sphenoid
2. The hiatus semilunaris is a deep semicircular sulcus 3. The nasal crests of the nasal, palatine and maxillary
below the bulla. bones.

SHORT ESSAYS

Q.1. Vocal folds. attached anteriorly to the middle of the angle of the
thyroid cartilage on its posterior aspect and posteriorly
Or
to the vocal process of the arytenoid.
Vocal cords. 2. The space between the vocal folds is called rima glottidis
(Fig. 1A.16.2). It is limited posteriorly by an interaryte-
Or
noid fold of mucous membrane. The rima glottides has
Location, attachments and movements of vocal an anterior intermembranous part (three-fifths) and a
cords. posterior intercartilaginous part.
3. The rima is the narrowest part of the larynx. It is longer
Ans.
(23 mm) in males than in females (17 mm).
Vocal cords are two folds of mucous membrane on each side 4. The vestibular and vocal folds divide the laryngeal cavity
in the laryngeal cavity (Fig. 1A.16.1). into following three parts:
1. The upper fold is called the vestibular fold, and the a. The part above the vestibular fold is called the
lower fold is known as the vocal fold. The vocal fold is vestibule of the larynx.
 General Anatomy

Epiglottis b. The part between the vestibular and vocal folds is

called the sinus or ventricle of the larynx.
c. The part below the vocal folds is called the infraglottic
Aryepiglottic fold Laryngeal saccule part.

Movements of Vocal Folds

Middle part
of cavity Movements of the vocal folds affect the shape and size of the
Vestibule Vestibular fold (mucosa rima glottidis.
overlying vestibular 1. During quiet breathing or at rest, the intermembranous
Laryngeal ventricle ligament) part of the rima is triangular, and the intercartilaginous
part is quadrangular.
Infraglottic space Vocal fold 2. The glottis is reduced by the adduction of the vocal folds
Cricoid arch
mucosa overlying during phonation or speech.
vocal ligament
3. During forced inspiration, both parts of the rima are
Trachea triangular, so that the entire rima is lozenge-shaped; the
vocal folds are fully abducted.
4. The intermembranous part of the rima glottidis is
closed, but the intercartilaginous part is widely opened
Fig. 1A.16.1 Coronal section through larynx. during whispering.

Quadrangular membrane Epiglottis

Vestibular Vocal ligament

Epiglottis ligament

Vocal fold
Vestibular fold
Rima vestibuli
Aryepiglottic fold
Rima glottidis

Cuneiform tubercle Muscular process

Cricothyroid ligament
Corniculate tubercle of arytenoid
Interarytenoid fold Vocal process of arytenoid
Corniculate cartilage
A B
Fig. 1A.16.2 (A) Superior veiw through laryngeal inlet. (B) Superior view through larynx.

SHORT NOTES

Q.1. Vocal folds.

Ans. Epiglottis

Refer to the answer of Short Essays Q.1.

Vocal fold
Q.2. Rima glottidis. Vestibular fold : —
Ans. Aryepiglottic fold Rime glottis

Cuneiform tubercle
The space between the right and left vocal folds is the
Corniculate tubercle” Interarytenoid fold
rima glottides (Fig. 1A.16.3). It is limited posteriorly by
an interarytenoid fold of mucous membrane. The rima Fig. 1A.16.3 Sectional view of larynx showing rima glottidis.
Ft: Quick Review Series: BDS Ist Year

glottidis has an anterior intermembranous part (three-fifths)
and a posterior intercartilaginous part. The rima is the
narrowest part of the larynx. It is longer (23 mm) in males
than in females (17 mm).
Q.3. Cricoid cartilage.
Ans.
1. A ring-shaped cartilage which encircles the larynx below
the thyroid cartilage is known as the cricoid cartilage
(Fig. 1.16.4).
2. It is thicker and stronger than the thyroid cartilage and
has a narrow anterior part called the arch and a broad
posterior part, called the lamina.
3. The lamina projects upwards behind the thyroid cartilage,
and articulates superiorly with the arytenoid cartilages.
The inferior cornua of the thyroid cartilage articulates
with the side of the cricoid cartilage at the junction of the
arch and lamina.
Facet for
Cricoid articulation with
cartilage arytenoid cartilage
2. The anterior borders approach each other at an angle of
about 90° in the male and about 120° in the female.
3. The lower parts of the anterior borders of the right and left
laminae fuse to form a median projection called the laryn-
geal prominence. The upper part of the anterior borders
do not meet. They are separated by the thyroid notch.
4. The posterior borders are free and are prolonged
upwards and downwards as the superior and inferior
cornua or horns. The superior cornua is connected with
the greater cornua of the hyoid bone by the lateral
thyrohyoid ligament. The inferior cornua articulates
with the cricoid cartilage to form the cricothyroid joint.
5. The inferior border of the thyroid cartilage is convex in
front and concave behind. In the median plane, it is con-
nected to the cricoid cartilage by the conus elasticus.
Q.5. Thyrohyoid membrane.
Ans.
The thyrohyoid membrane is a fibroelastic ligament that
spans between the superior margin of the thyroid cartilage
below and the hyoid bone above (Fig. 1A.16.6).
Hyoepiglottic ligament

aC
Facet for
articulation with Lateral thyrohyoid ligaments
()

i
inferior horn of
thyroid cartilage Triticeal
WT cartilage

pat crea
ZYZe Aperture for

associated artery
Fig. 1A.16.4 Cricoid cartilage (anterolateral view). Thyrohyoid
membrane

Median thyrohyoid
ligament
Q.4. Thyroid cartilage.
Cricotracheal ligament
Ans.
1. The thyroid cartilage is V-shaped in cross-section. It
consists of right and left laminae. Each lamina is roughly Fig. 1A.16.6 Extrinsic ligaments of larynx.
quadrilateral (Fig. 1A.16.5).
1. Median thyrohyoid ligament—is the midline thickening
of membrane.
2. Lateral thyrohyoid ligament—is the thickening of the
Lateral thyroid ligaments
posterior border of the membrane.
Left lamina Right
lamina e Structures piercing thyrohyoid membrane are:
Superior Superior e Superior laryngeal arteries
thyroid notch horn
e Internal laryngeal nerve.
Superior
thyroid tubercle
Q.6. Cricothyroid muscle.

Oblique line
Ans.
Laryngeal
prominence Inferior horn The cricothyroid muscle is the only intrinsic muscle outside
Facet for cricoid the larynx, lying on its external aspect (Fig. 1A.16.7).
Inferior thyroid (Medial surface of horn)
It originates from the lower border and lateral surface of
notch Inferior thyroid tubercle
cricoid and its fibres pass backwards and upwards to cornua
Fig. 1A.16.5 Thyroid cartilage (anterolateral view). and lower border of thyroid cartilage.
 General Anatomy

Q.8. Paired cartilages of larynx.

Ans.

The skeleton or cartilages of larynx are as follows:

The larynx contains nine cartilages, of which three are un-
paired and three are paired. The paired cartilages of larynx are:
Vocal ligament 1. Arytenoid
2. Corniculate
3. Cuneiform.
Cricothyroid ligament
Median cricothyroid ligament Q.9. Give boundaries of rima glottidis.
Fig. 1A.16.7 Cricothyroid muscle. Ans.

The space between the right and left vocal folds is the rima
Actions: Tense the vocal cords and act as an adductor of glottidis; it is limited posteriorly by an interarytenoid fold of
the vocal cords. mucous membrane. The rima has an anterior intermembra-
Q.7. Nerve supply of larynx. nous part (three-fifths) and a posterior intercartilaginous
part. The rima is the narrowest part of the larynx. It is longer
Or (23 mm) in males than in females (17 mm).
Name sensory nerve supply of larynx.
Q.10. Name the intrinsic muscles of larynx.
Ans.
Ans.
Nerve Supply of Laryngeal Muscles (Fig. 1A.16.8) The intrinsic muscles of larynx are as follows (Fig. 1A.16.9A
All intrinsic muscles of the larynx are supplied by the recur- and B):
rent laryngeal nerve except for the cricothyroid which is 1. Cricothyroid
supplied by the external laryngeal nerve. . Posterior cricoarytenoid (triangular muscle)
Wh

. Lateral cricoarytenoid
. Transverse arytenoid (unpaired muscle)
Inferior vagal ganglion . Oblique arytenoid and aryepiglotticus
DU

Superior laryngeal nerve . Thyroarytenoid and thyroepiglottic.

Right vagus nerve Internal laryngeal nerve
External laryngeal nerve Q.11. Origin and insertion of posterior cricoaryte-
Thyrohyoid Left vagus nerve
membrane
noid muscle.

Ans.
Cricothyroid
muscle
Left recurrent The posterior cricoarytenoid muscle originates from the
Right recurrent
laryngeal nerve
laryngeal nerve posterior surface of the lamina of cricoid and its fibres run
Trachea
upwards and laterally and are inserted into the muscular
Fig. 1A.16.8 Nerve supply of larynx. process of arytenoid muscle.

Rima glottidis Vocal

ligaments

Transverse
arytenoid

Oblique
Cricothyroid arytenoid

muscle | straight Posterior

cricoarytenoid
Lateral cricoarytenoid
B
Fig. 1A.16.9A and B Intrinsic muscles of larynx.
Quick Review Series: BDS 1st Year

Q.12. Give the attachments, nerve supply and The dehiscence of Killian is a weak area between these
actions of inferior constrictor muscle. two parts.

Ans. Nerve supply: Pharyngeal plexus of nerves.

Inferior constrictor muscle originates from:
1. Thyroid cartilage (oblique line and inferior horn)
2. Cricoid cartilage Inferior constrictor muscle inserts into
pharyngeal raphe. Parts of the inferior constrictor are:
a. Thyropharyngeus
b. Cricopharyngeus.
Action of the constrictors of the pharynx: During deglutition,
they contract and cause peristaltic movement in the pharynx.
Thyropharyngeus has propulsive function whereas the
cricopharyngeus has a sphincteric function. Cricopharyn-
geal part relaxes during the contractions of the thyropha-
ryngeal part.

LONG ESSAYS

Q.1. Describe surface features of dorsum of the 3. The tongue has following external features:
tongue. How do you connect its epithelial innerva- a. Root
tion to its development? b. Tip
c. Body.
Or
The root of the tongue is attached to the mandible
Describe anatomy of tongue. Add a note on its and soft palate above, and to the hyoid bone below. In
development. between the two bones, it is related to the geniohyoid
and mylohyoid muscles.
Ans.
The tip of the tongue forms the anterior free end which,
1. The tongue is situated in the floor of the mouth. It has at rest, lies behind the upper incisor teeth.
an oral part that lies in the mouth, and a pharyngeal The body of the tongue has (a) a curved upper surface or
part that lies in the pharynx. The oral and pharyngeal dorsum and (b) an inferior surface.
parts are separated by a V-shaped sulcus terminalis The dorsum of the tongue is divided into (a) an oral
(Fig. 1.17.1). part or anterior two-thirds and (b) a pharyngeal part
2. The functions of tongue are taste, speech, mastication or posterior one-third, by a faint V-shaped groove, the
and deglutition. sulcus terminalis.
4. The inferior surface is covered with a smooth mucous
membrane, which shows a median fold called the frenulum
linguae. On either side of the frenulum there is a promi-
Oral part nence produced by the deep lingual veins. More laterally
(anterior two-thirds)
there is a fold called the plica fimbriata (Fig. 1A.17.2).
Terminal sulcus
5. The oral or papillary part of the tongue is placed on the
floor of the mouth. Its margins are free and in contact
Pharyngeal part with the gums and teeth. The superior surface of the
(posterior one-third) oral part shows a median furrow and is covered with
papillae which make it rough.
Root of tongue 6. The pharyngeal or lymphoid part of the tongue lies behind
the palatoglossal arches and the sulcus terminalis. Its
Inferior Hyoid bone posterior surface called the base of the tongue, forms the
surface
Mylohyoid muscle anterior wall of the pharynx. The mucous membrane is
Mandible
devoid of papillae, but has many lymphoid follicles that
Geniohyoid muscle
collectively constitute the lingual tonsil. Mucous glands
Fig. 1A.17.1 Paramedian sagittal section of the tongue. are also present.
 General Anatomy

Tip of tongue turned up 3. The filiform papillae or conical papillae cover the presul-
cal area of the dorsum of the tongue, and give it a char-
Plica fimbriata Frenulum acteristic velvety appearance. They are the smallest and
most numerous of the lingual papillae. Each is pointed
Deep lingual vein and covered with keratin.

Development of Tongue
Epithelium
1. Anterior two-thirds: From two lingual swellings and one
Orifice of Sublingual fold
tuberculum impar, which arise from the first branchial
submandibular on floor of mouth
duct on arch. It is supplied by lingual nerve (posttrematic) and
sublingual papilla chorda tympani (pretrematic).
Fig. 1A.17.2 The inferior surface of the tongue and the floor of 2. Posterior one-third: From cranial part of the hypobran-
the mouth. chial eminence, i.e. from the third arch. Therefore, it is
supplied by the glossopharyngeal nerve.
3. Posterior most part develops from the fourth arch. There-
7. The posteriormost part of the tongue is connected to fore, it is supplied by the vagus nerve (Table 1A.17.1).
the epiglottis by three folds of mucous membrane.
These are the median glossoepiglottic fold and the right
and left lateral glossoepiglottic folds. On either side of
Table 1A.17.1 Nerve supply of tongue
the median fold there is a depression called the vallecula.
8. Papillae of the tongue are projections of mucous mem- Nerve Anterior Posterior
brane or corium which impart the characteristic rough- supply of two-thirds one-third of Posterior most
tongue of tongue tongue part or vallecula
ness to anterior two-thirds of the tongue.
Sensory Lingual Glossopharyn- Internal laryngeal
There are three types of papillae on the tongue (Fig. 1A.17.3): taste chorda tym- geal, glosso- branch of vagus
1. The vallate or circumvallate papillae are situated imme- pani, except pharyngeal Internal laryngeal
diately in front of the sulcus terminalis and are vallate papillae including the branch of vagus
about 8-12 in number. They are large in size 1-2 mm vallate papillae
in diameter. Each papilla is a cylindrical projection
surrounded by a circular sulcus, and its walls are raised
above the surface. Q.2. Give an account of musculature of tongue and
2. The fungi form papillae are numerous near the tip and its development. Write briefly about lymphatic
margins of the tongue, but some of them are also scat- drainage of tongue.
tered over the dorsum. They are distinguished by their Ans.
bright red colour.
The tongue is a muscular organ. A middle fibrous septum
divides the tongue into right and left halves. Each half contains
four intrinsic and four extrinsic muscles (Fig. 1A.17.4):
1. Intrinsic muscles:
a. Superior longitudinal
b. Inferior longitudinal
c. Transverse
d. Vertical
2. Extrinsic muscles:
a. Genioglossus
b. Hyoglossus
c. Styloglossus
d. Palatoglossus.
Pharyngeal part
of tongue Intrinsic Muscles of the Tongue

Vallate papillae Foramen The intrinsic muscles occupy the upper part of the tongue,
caecum and are attached to the submucous fibrous layer and to the
Fig. 14.173 Papillae of the tongue. median fibrous septum. They alter the shape of the tongue.
 Quick Review Series: BDS 1st Year

Palatoglossus
Superior
longitudinal
Vertical
Transverse
Extrinsic | Styloglossus
Inferior
[Or Intrinsic
muscles
longitudinal muscles

Hypoglossus
Septum
Genioglossus
Septum

Fig. 14.174 The musculature of tongue.

1. The superior longitudinal muscle lies beneath the mucous
membrane. It shortens the tongue and makes its dorsum
concave.
2. The inferior longitudinal muscle is a narrow band lying
close to the inferior surface of the tongue between the
genioglossus and the hyoglossus. It shortens the tongue
and makes its dorsum convex.
3. The transverse muscle extends from the median septum
to the margins. It makes the tongue narrow and
elongated.
4. The vertical muscle is found at the borders of the
anterior part of the tongue. It makes the tongue broad
and flattened.
Extrinsic Muscles of the Tongue
The extrinsic muscles connect the tongue to the following:
1. Mandible via genioglossus
. Hyoid bone through hyoglossus
Nh
Genioglossus is a fan-shaped muscle which forms the
main bulk of the tongue. It arises from the upper genial
tubercle of the mandible. From here the fibres fan out and
run backwards. The upper fibres are inserted into the tip,
the middle fibres into the dorsum, and the lower fibres into
the hyoid bone. The upper fibres retract the tip, the middle
fibres depress the tongue, and the lower fibres pull the
posterior part of the tongue forwards and thus protrude
the tongue from the mouth.
This muscle if paralysed will fall back on the oropharynx
and block the air passage.
1. The tip of the tongue drains bilaterally to the submental
nodes.
2. The right and left halves of the remaining part of the
anterior two-thirds of the tongue drain unilaterally to
the submandibular nodes. A few central lymphatic drain
bilaterally to the same nodes.
3. The posterior one-third of the tongue drains bilaterally

. Styloid process via styloglossus to the jugulo-omohyoid nodes; these are known as the
Ww

. The palate via palatoglossus. lymph nodes of the tongue.

Bm

SHORT ESSAYS

Q.1. Nerve supply of tongue. palatoglossus is supplied by the cranial root of the
accessory nerve through the pharyngeal plexus.
Ans.
Nerve supply of the tongue is as follows: Sensory Nerves
1. The lingual nerve is the nerve of general sensation
Motor Nerves
and the chorda tympani is the nerve of taste for the
1. All the intrinsic and extrinsic muscles except the pala- anterior two-thirds of the tongue except vallate
toglossus are supplied by the hypoglossal nerve. The papillae.
 General Anatomy

2. The glossopharyngeal nerve is the nerve for both general
sensation and taste for the posterior one-third of the
tongue including the circumvallate papillae.
3. The posterior most part of the tongue is supplied by
the vagus nerve through the internal laryngeal branch
(Table 1A.17.1).
Q.2. Lymphatic drainage of tongue.
Or
Lymph vessels and lymph nodes draining
from tongue.
Ans.
Lymphatic Drainage (Fig. 1A.17.5)
1. The tip of the tongue drains bilaterally to the submental
nodes.
2. The right and left halves of the remaining part of the
anterior two-thirds of the tongue drain unilaterally to
the submandibular nodes. A few central lymphatics
drain bilaterally to the same nodes.
3. The posterior one-third of the tongue drains bilaterally
to the jugulo-omohyoid nodes; these are known as the
lymph nodes of the tongue (Fig. 1A.17.5).
Anterior 2/3 of tongue Posterior 1/3 of tongue
Venous Drainage
The arrangement of the vena comitantes/veins of the tongue
is variable. Two venae comitantes accompany the lingual
artery, and one vena comitantes accompanies the hypoglos-
sal nerve. The deep lingual vein is the largest and principal
vein of the tongue. It is visible on the inferior surface of
the tongue. These veins unite at the posterior border of the
hyoglossus to form the lingual vein, which ends either in the
common facial vein or in the internal jugular vein.
lymph
Innervation or Nerve Supply of the Tongue
(Fig. 1A.17.6)
Motor nerves
All the intrinsic and extrinsic muscles except the palatoglos-
sus are supplied by the hypoglossal nerve. The palatoglossus
supplies to the cranial root of the accessory nerve through
the pharyngeal plexus.
Sensory nerves
1. The lingual nerve is the nerve of general sensation and
the chorda tympani is the nerve of taste sensation
for the anterior two-thirds of the tongue except vallate
papillae.
2. The glossopharyngeal nerve is the nerve for both general
sensation and taste for the posterior one-third of the
tongue including the circumvallated papillae.
3. The posteriormost part of the tongue is supplied by the
vagus nerve through the internal laryngeal branch.

Chorda tympani Glossopharyngeal

Submental nodes >) | | | (from [VII]) nerve [IX]

SO >
Jugulo-omohyoid
lymph nodes Lingual nerve Hypoglossal
Submandibular nodes \ (from [V,]) nerve [XII]
Omohyoid muscle
Internal jugular vein
Occipital
Fig. 14.175 Lymphatic drainage. artery

Q.3. Describe in detail about blood supply and

innervation of tongue. Dorsal lingual vein
Deep lingual vein
Ans. Lingual artery
Common carotid artery
Arterial supply of tongue is chiefly derived from the lingual Internal jugular vein
artery, a branch of the external carotid artery. The root of Stenocleidomastoid branch
the tongue is also supplied by the tonsillar and ascending of occipital artery
pharyngeal arteries. Fig. 1A.17.6 Vascular and nerve supply of tongue.
CY) Quick Review Series: BDS Ist Year

SHORT NOTES

Q.1. Lingual nerve supply. Q.3. Relations of hyoglossus muscle.

Ans. Ans.
The lingual nerve is the nerve of general sensation for the Superficial relations of hyoglossus muscle are (a) styloglossus,
anterior two-thirds of the tongue. (b) lingual nerve, (c) submandibular ganglion, (d) deep
part of the submandibular gland, (e) submandibular duct,
Q.2. Lymphatic drainage of tongue.
(f) hypoglossal nerve and (g) veins accompanying it.
Ans. Deep relations of hyoglossus muscle are (a) inferior lon-
gitudinal muscle of the tongue, (b) genioglossus, (c) middle
Lymphatic drainage of tongue is as follows:
constrictor of the pharynx, (d) glossopharyngeal nerve,
1. The tip of the tongue drains bilaterally to the submental
(e) stylohyoid ligament and (f) lingual artery.
nodes.
Structures passing deep to posterior border of hyoglossus,
2. The right and left halves of the remaining part of the
from the above downwards include (a) glossopharyngeal
anterior two-thirds of the tongue drain unilaterally to
nerve, (b) stylohyoid ligament and (c) lingual artery.
the submandibular nodes. A few central lymphatics
drain bilaterally to the same nodes.
3. The posterior one-third of the tongue drains bilaterally
to the jugulo-omohyoid nodes; these are known as the
lymph nodes of the tongue.

SHORT ESSAY

Q.1. Give the position, nerve supply and development Anterior malleolar fold
of tympanic membrane. Pars flaccida

Ans.
AY Posterior
malleolar fold
1. Tympanic membrane is a thin, translucent partition
between the external acoustic meatus and the middle ear. Position of handle
of malleus
2. It is oval in shape, measuring 9 mm X 10 mm which is
placed obliquely at an angle of 55° with the floor of the Pars tensa
(outer surface)
meatus and faces downwards, forwards and laterally.
3. The tympanic membrane has outer and inner surfaces.
The outer surface of the membrane is lined by thin skin
and is concave (Fig. 1A.18.1). The inner surface provides Fig. 1A.18.1 Outer surface of the left tympanic membrane.
attachment to the handle of the mallets, which extends
up to its centre. The inner surface is convex (Fig. 1A.18.2).
6. The greater part of the tympanic membrane is tightly
4. The point of maximum convexity lies at the tip of the
stretched and is called the pars tense, the part between
handle of the malleus and is called the umbo. The mem-
the two-malleolar folds is loose and is called the pars
brane is thickened at its circumference, which is fixed to
flaccid.
the tympanic sulcus of the temporal bone on the tym-
panic plate. The pars flaccid is crossed internally by the chorda tym-
5. Superiorly, the sulcus is deficient, and the membrane is pani. This part is more liable to rupture than the pars tense.
attached to the tympanic notch. From the ends of the The membrane is held tense by the inward pull of the tensor
notch two bands, the anterior and posterior malleolar tympani muscle, which is inserted into the upper end of the
folds are prolonged to the lateral process of the malleus. handle of the malleus.
 General Anatomy

Short process and Middle ear

body of incus

Head of malleus
Head,
anterior process and
handle of malleus Lateral process and
handle of malleus

"~~ External acoustic meatus

Pars tensa
Cuticular layer of tympanic membrane

Chorda tympani

Fibrous layer
Mucous layer
Fig. 1A.18.2 Inner surface of the left tympanic membrane. Fig. 1A.18.3 Tympanic membrane as seen in section.

The tympanic membrane is composed of the following three Venous Drainage

layers (Fig. 1A.18.3):
a. The outer cuticular layer of skin.
b. The middle fibrous layer made up of superficial radiat-
ing fibres.
c. The deep circular fibres, which are minimal at the centre
and maximal at the periphery.
The fibrous layer is replaced by loose areolar tissue in the
pars flaccid. The inner mucous layer is lined by a low ciliated
columnar epithelium.
Blood Supply
1. The outer surface is supplied by the deep auricular
branch of the maxillary artery.
2. The inner surface is supplied by the anterior tympanic
branch of the maxillary artery and by the posterior tym-
panic branch of the posterior auricular artery.
Veins from the outer surface drain into the external jugular
vein. The veins from inner surface drain into the transverse
sinus and into the venous plexus around the auditory tube.
Lymphatic Drainage
lymphatics pass to the preauricular and retropharyngeal
lymph nodes.
Nerve Supply
1. Outer surface: The anteroinferior part is supplied by the
auriculotemporal nerve, and the posterosuperior part
by the auricular branch for the vagus nerve.
2. Inner surface: This is supplied by the tympanic branch of
the glossopharyngeal nerve through the tympanic
plexus.

SHORT NOTES

Q.1. Tympanic membrane. Ans.

Ans. The external ear consists of: (a) the auricle or pinna and
(b) the external acoustic meatus. The external auditory me-
A thin, translucent partition between the external acoustic
atus conducts sound waves from the concha to the tympanic
meatus and the middle ear is known as tympanic mem-
membrane.
brane. It is oval in shape, measuring 9 mm X 10 mm. It is
The meatus or canal is S-shaped and about 24 mm long,
placed obliquely at an angle of 55° with the floor of the
of which the medial two-thirds or 16 mm is bony, and the
meatus. It faces downwards, forwards and laterally.
lateral one-third or 8 mm is cartilaginous.
Q.2. External acoustic meatus.
Quick Review Series: BDS 1st Year

SHORT ESSAYS

Q.1. Give the development of retina. These muscles originate from the common tendinous
ring, which is situated around the superior, medial and infe-
Ans.
rior borders of the optic foramen.
1. The retina is derived from the layers of the optic cup
which is divisible into a larger posterior part that be- Origin
comes thick, and forms the retina proper (optical part of The lateral rectus muscle arises from lateral part of common
retina); and an anterior part that remains thin and tendinous ring by two heads, one from the upper and one from
forms an epithelial covering for the ciliary body and iris the lower aspect of the lateral part of the common tendinous ring.
(ciliary and radial parts of retina).
Between the two origins of the lateral rectus following
2. The outer wall of the posterior part of the optic cup re- structures are passing:
mains thin. Its cells form the pigmented layers of the retina. 1. Upper and lower division of the oculomotor nerve
3. The inner wall of the cup differentiates into matrix cell, 2. Nasociliary nerve
mantle and marginal layers as in the neural sheath. 3. Abducent nerve.
4. After giving origin to the cells of the mantle layers, the cells
of the matrix layers form the rods and cones, the cells of the From the origin, the rectus muscles widen forwards to
mantle layers form the bipolar cells, the ganglion cells and form the cone of muscles.
other neurons of the retina and also the supporting elements.
5. The axons of the ganglion cells grow into the marginal Insertion
layers to form the layers of nerve fibres. Then fibres grow Lateral rectus is inserted to the anterior half of the eyeball laterally.
into the optic stalk by passing through the coordinal fis-
sure. The optic stalk is then converted into the optic nerve. Nerve Supply
Q.2. Lateral rectus muscle of eyeball. The lateral rectus is supplied by the abducent nerve.
Ans.
Action
There are four rectus muscles namely (Fig. 1A.19.1):
The lateral rectus moves the cornea horizontally and laterally.
1. Superior rectus
2. Inferior rectus
Function
3. Medial rectus
4. Lateral rectus. Abduction of eyeball.

Levator palpebrae superioris Trochlea

Superior oblique

Superior oblique

Medial rectus
Superior rectus

Lateral rectus

Inferior oblique
Lateral rectus
Inferior rectus

Fig. 1A.19.1 Rectus muscles of eyeball.

 General Anatomy

SHORT NOTES

Q.1. Short ciliary nerve. Actions of oblique muscles of eyeball are as follows:
Ans. 1. Contraction of superior oblique directs the pupil down
and out.
2. Contraction of inferior oblique directs the pupil up
Sensory root
Nasociliary nerve
and out.
Long ciliary nerve 3. The functions of superior oblique muscle are depression,
abduction and medial rotation of eyeball.
4. The functions of inferior oblique muscle are elevation,
abduction and lateral rotation of eyeball.
Parasympathetic
(motor) root Q.3. Fascial sheath of eyeball.
ganglion
Ans.
Oculomotor nerve [III] Short ciliary nerve
Sensory fibres The fascial sheath of the eyeball (bulbar sheath) is a layer of
Sympathetic fibres
Parasympathetic preganglionic fibres fascia that encloses a major part of the eyeball (Fig. 1A.19.4).
Parasympathetic postganglionic fibres The eyeball can freely move within this sheath.
Fig. 1A.19.2 Short ciliary nerve. The sheath gives off a number of expansions:
1. A tabular sheath
The postganglionic parasympathetic fibres from ciliary gan- 2. The medial check ligament
glion are distributed to the eyeball through short ciliary nerves 3. The lateral check ligament.
and they innervate the sphincter pupillae and ciliary muscles Facial sheath of eyeball or bulbar fascia is firmly
(Fig. 1A.19.2). attached posteriorly, to the sclera around the point of
The ciliary ganglion gives 10-12 short ciliary nerves con- entrance of the optic nerve into the eyeball; anteriorly, to
taining postganglionic fibres for the supply of constrictor or the sclera near the edge of the cornea; additionally, as
sphincter pupillae for narrowing the size of pupil and ciliaris the muscles approach the eyeball, the investing fascia
muscle for increasing the curvature of anterior surface of surrounding each muscle blends with the fascial sheath of
lens required during accommodation of the eye. the eyeball as the muscles pass through and continue to
Q.2. Actions of oblique muscles of eyeball. their point of attachment.
A specialized lower part of the fascial sheath of the
Ans. eyeball is called the suspensory ligament of the eye or
The oblique muscles of eyeball are in the superior and the suspensory ligament of Lockwood, it supports the
inferior parts of the orbit (Fig. 1A.19.3). eyeball.

Levator palpebrae superioris

Periosteum
Suspensory ligament Suspensory
-
ligament

Superior oblique
sac

Lateral
check
ligament

Periorbita

Fascial sheath

Inferior oblique Lateral rectus

Lateral rectus
muscle
Inferior rectus

Fig. 1A.19.3 Oblique muscles of eyeball. Fig. 1A.19.4 The fascial sheath of the eyeball.
Quick Review Series: BDS 1st Year

REGIONAL ANATOMY
OF NECK
LONG ESSAY

Q.1. Cervical sympathetic chain. 1. Superior cervical ganglion

Ans. This is the largest of the three ganglia. It is spindle-shaped,
and about 2.5 cm long. It is located just below the skull,
The cervical part of the sympathetic trunk is located on
opposite the second and third cervical vertebrae. It is formed
each side of the cervical part of the vertebral column, behind
by the fusion of the upper four cervical ganglia. It marks the
the carotid sheath and in front of the prevertebral fascia
superior extent of sympathetic trunk.
(Fig. 1A.20.1). It is connected to each cervical spinal nerve
by a gray ramus communicans. There are no white rami Its branches pass to the following:
communications in the cervical ganglion region. a. The internal and external carotid arteries forming plex-
uses around these vessels.
To internal Superior cervical b. Cervical spinal nerves C1 to C4 through gray rami com-
carotid plexus ganglion municantes.
c. The pharyngeal branches take part in the formation of
To carotid body the pharyngeal plexus.
and sinus
d. The heart as superior cardiac nerves: the left superior cer-
vical cardiac branch goes to the superficial cardiac plexus
To external while the right branch goes to the deep cardiac plexus.
carotid plexus
Superior cardiac nerve 2. Middle cervical ganglion
Gray ramus communicans It is the second ganglion inferior to the superior cervical
Middle cervical ganglion ganglion along the course of the sympathetic trunk. The
middle cervical ganglion is very small and encountered at
Inferior cervical
ganglion about the level of cervical vertebra C6. Branches from this
ganglion pass to the following:
Middle and inferior
cardiac nerves
a. Cervical spinal nerves C5 and C6 through gray rami
communicantes.
b. The heart as middle cardiac nerves which is the largest
of the sympathetic cardiac branches. It goes to the deep
cardiac plexus.
Fig. 1A.20.1 Cervical part of the sympathetic trunk.
c. Tracheal and oesophageal branches.
d. Thyroid branches accompany the inferior thyroid artery to
Cervical sympathetic chain is related: the thyroid gland. They also supply the parathyroid glands.
1. Anteriorly to
3. Inferior cervical ganglion
a. Internal carotid artery
b. Common carotid artery At the lower end of the cervical part of the sympathetic trunk
c. Carotid sheath the inferior cervical ganglion is formed by the fusion of the
d. Inferior thyroid artery seventh and eighth cervical ganglia, which becomes very large
2. Posteriorly to when it combines with the first thoracic ganglion and forms
a. Prevertebral fascia the cervicothoracic ganglion (stellate ganglion). The inferior
b. Longus capitis and cervicis muscles cervical ganglion is situated anterior to the neck of first rib and
the transverse process of cervical vertebra C7, and posterior to
2 Transverse processes of the lower six cervical vertebrae.
the first part of the subclavian artery and the origin of the ver-
tebral artery. Branches from this ganglion pass to the following:
Ganglia
a. Spinal nerves C7 to T1 through gray rami communicantes
Along the course of the sympathetic trunk in the cervical b. The vertebral artery, forming a plexus associated with
region three ganglia, i.e. superior, middle and inferior this vessel
cervical ganglia, are usually described. c. The heart as inferior cardiac nerves.
 General Anatomy

This ganglion also receives white rami communicantes 2. Injury to cervical sympathetic trunk produces Horner’s
from thoracic spinal nerve T1 and, occasionally, from T2. syndrome, which is characterized by the following:
. Ptosis (i.e. drooping of the upper eyelid)

ae
Clinical Anatomy . Miosis (i.e. constriction of the pupil)
. Anhydrosis (i.e. loss of sweating on that side of the face)
1. The head and neck are supplied by sympathetic nerves

ofa
. Enophthalmos (ie. retraction of the eyeball)
arising from the upper four thoracic segments of the
. Loss of the ciliospinal reflex (i-e. pinching the skin on
spinal cord. Most of these preganglionic fibres pass
the nape of the neck) does not produce dilatation of
through the stellate ganglion to relay in the superior
the pupil which normally takes place.
cervical ganglion.

LONG ESSAY

Q.1. Describe superolateral surface of cerebrum. 2. The inferolateral border

3. The medial orbital border
Ans.
4. The medial occipital border.
1. The cerebrum is made up of two cerebral hemispheres
which are incompletely separated from each other by Three poles
the median longitudinal fissure. 1. Frontal pole, at the anterior end
2. The two hemispheres are connected to each other across 2. Occipital pole, at the posterior end
the median plane by the corpus callosum. Each hemi- 3. Temporal pole, at the anterior end of the temporal
sphere contains a cavity, called the lateral ventricle. lobe.

Each cerebral hemisphere has the following external features: Each cerebral hemisphere is divided into four lobes:
Three surfaces 1. Frontal
1. The superolateral surface 2. Parietal
2. The medial surface 3. Occipital
3. The inferior surface. 4. Temporal.

Four borders The lobes are best appreciated on the superolateral

1. The superomedial border surface as in Figure 1A.21.1.

Central sulcus Superomedial border

Posterior ramus
of lateral sulcus
\/ Parieto-occipital sulcus

Frontal
lobe

Occipital Pole

Preoccipital notch

Inferolateral border

Fig. 1A.21.1 Superolateral surface of cerebrum.

Quick Review Series: BDS 1st Year

Sulci and gyri of superolateral surface are as follows
(Fig. 1A.21.2):
1. The lateral sulcus (fissure of Sylvius): The lateral sulcus is
a deep fissure that separates the frontal and temporal
lobes on the under surface of the brain and continues
onto the lateral surface and passes backwards, above the
temporal lobe.
2. Central sulcus: It is an oblique sulcus passing up from just
behind the opercula to indent the superior border of the
hemisphere just behind the midpoint. It is the only long
sulcus to pass over on to the medial surface of the hemi-
sphere and it separates frontal and parietal lobes.
3. The frontal lobe is further divided by the following sulci:
a. The precentral sulcus runs parallel to the central sul-
cus, a little in front of it. The precentral gyrus lies
between the two sulci.
b. The area in front of the precentral sulcus is divided
into superior, middle and inferior frontal gyri by the
superior and inferior frontal sulci.
c. The anterior horizontal and anterior ascending rami
of the lateral sulcus subdivide the inferior frontal
gyrus into three parts (pars orbitalis, pars triangula-
ris and pars opercularis).
4. The parietal lobe is further subdivided by the following
sulci:
a. The postcentral sulcus runs parallel to the central
sulcus, a little behind it. The postcentral gyrus lies
between the two sulci.
b. The area behind the postcentral gyrus is divided into
the superior and inferior parietal lobules by the in-
traparietal sulcus.
c. The inferior parietal lobule is invaded by the poste-
rior ramus of the lateral sulcus, and of the superior
and inferior temporal gyri which divide the inferior
parietal lobule into anterior, middle and posterior
parts. The anterior part is called the supramarginal
gyrus, and the middle part is called the angular gyrus.
5. The superior and inferior temporal sulci divide the tempo-
ral lobe into superior, middle and inferior temporal gyri.
6. The occipital lobe is further subdivided by the following
sulci:
a. The lateral occipital sulcus divides this lobe into the
superior and inferior occipital gyri.
b. The lunate sulcus separates these gyri from the
occipital pole.
c. The area around the parieto-occipital sulcus is the
arcus parieto-occipitalis. It is separated from the supe-
rior occipital gyrus by the transverse occipital sulcus.
The summary of sulci and gyri of the cerebrum on supero-
lateral surface is as follows:
1. Frontal lobe:
a. Sulci precentral
e Superior frontal
e Inferior frontal
b. Gyri precentral
e Superior frontal
e Middle frontal » Inferior frontal
2. Parietal lobe:
a. Sulci postcentral » Intraparietal
b. Gyri postcentral
e Superior parietal lobule
e Inferior parietal lobule
which is divided into three parts: (a) the anterior,
supramarginal; (b) the middle, angular and (c) the
posterior, over the end of interior temporal sulcus.

Precentral gyrus
Precentral sulcus Central sulcus
Superior frontal sulcus Postcentral gyrus
Inferior frontal sulcus Posicentral sulcus
Superior parietal lobule
Inferior parietal lobule

Arcus parieto-occipital
—— Parieto-occipital sulcus
Superior gyrus
Middle gyrus Intraparietal sulcus
Inferior frontal gyrus -Transverse occipital sulcus

Superior occipital gyrus

Lunate sulcus
Anterior ascending
Postcalcarine sulcus
anterior horizontal
Lateral occipital sulcus
and posterior rami of lateral sulcus
Inferior occipital gyrus
Inferior temporal sulcus
Superior temporal sulcus
Superior temporal gyrus Inferior temporal gyrus
Middle temporal gyrus

Fig. 1A.21.2 Sulci and gyri of suprolateral surface.

 General Anatomy

3. Temporal lobe: e Lunate

a. Sulci superior temporal e Superior and inferior polar
© Inferior temporal b. Gyri arcus parieto-occipitalis
b. Gyri superior temporal, with three transverse e Superior occipital
temporal gyri middle temporal e Inferior occipital
© Inferior temporal © Gyrus descendens.
4. Occipital lobe:
a. Sulci transverse occipital
e Lateral occipital

SHORT NOTE

Q.1. Central sulcus. and occipital poles. It runs on the superolateral surface
obliquely downwards and forwards and ends a little above
Ans.
the posterior ramus of the lateral sulcus.
The central sulcus begins at the superomedial border of the
hemisphere a little behind the midpoint between the frontal

MISCELLANEOUS
SHORT ESSAYS

Q.1. Radicular artery.
Ans.
1. The radicular arteries are derived from various parent
vessels depending on the levels like spinal branches of
the vertebral, ascending cervical, deep cervical, intercos-
tals, lumbar and sacral arteries.
2. As fetal growth proceeds most of the radicular arteries
disappear, those that remain form anastomoses with the
anterior and posterior spinal arteries, and are com-
monly known as booster or feeder vessels. The largest of
the feeder vessels is arteria radicularis magna (of Adam-
kiewicz).
3. Many of these radicular branches are small and end by
supplying the nerve roots. A few of them, which are
large, contribute blood to the spinal arteries.
4. One of the anterior radicular branches is very large and
is called the arteria reticularis magna. Its position is
variable. This artery may be responsible for supplying
blood to as much as the lower two-thirds of the spinal
cord.
The radicular arteries make important contributions to
reinforce the longitudinal trunks.
Q.2. Blood supply of long bone.
Ans.
Bone is a type of dense connective tissue. In the adult the
nutrient artery of the shaft of a long bone usually supplies
little more than the marrow.
The compact bone of the shaft and the cancellous bone
of the ends are supplied by branches from the periosteum,
especially numerous beneath muscular and ligamentous
attachments. Before union with the shaft, an epiphysis is
supplied from the circulus vasculosus of the joint.
Veins are numerous and large in the cancellous red
marrow bones (e.g. the basivertebral veins) and run with the
arteries in Volkmann’s canals in compact bone.
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 GENERAL
_ HISTOLOGY
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GENERAL HISTOLOGY

GENERAL HISTOLOGY
SHORT ESSAYS

Q.1. Histology of cartilage.
Ans.
1. Cartilage is a modified connective tissue. The cells of
cartilage are called chondrocytes. They lie in spaces
called lacunae present in the matrix. At first, the cells are
small and show the features of metabolically active cells.
As the cartilage cells mature they enlarge often reaching
a diameter of 40 jum or more.
2. The matrix consists of a homogenous ground substance
within which fibres are embedded.
3. The ground substance of cartilage is made up of com-
plex molecules containing proteins and carbohydrates.
These molecules form a meshwork, which is filled by
water and dissolved salts.
4. The collagen fibres present in cartilage are chemically
described as type II collagen, while fibrocartilage and
the perichondrium contain the normal type I collagen.
5. The three main types of cartilage can be recognized
depending on the number and variety of fibres in the
matrix. These are discussed in the following:
| Hyaline Cartilage (Fig. 1B.1.1)
1. Hyaline cartilage is so called because it is transparent
(hyalos: glass).
2. Its intercellular substance appears to be homogeneous,
but many collagen fibres are present in the matrix.
Fibrocartilage (Fig. 1B.1.2)
1. This type of cartilage is also called white fibrocartilage.
2. In sections it is seen as cartilage because it contains
typical cartilage cells surrounded by capsules.
3. The matrix is pervaded by numerous collagen bundles
amongst which there are some fibroblasts.

Fibrous layer

Cellular layer

Homogenous matrix

Lacunae
Chondrocyte

Territorial matrix

Fig. 1B.1.1 Hyaline cartilage. Fig. 1B.1.2 Fibrocartilage.

Quick Review Series: BDS 1st Year
Elastic Cartilage (Fig. 1B.1.3)
1. Elastic cartilage or yellow fibrocartilage is similar in
many ways to hyaline cartilage.
2. The main difference is that instead of collagen fibres the
matrix contains numerous elastic fibres, which form a
network.
Fibrous
layer
Cellular
layer
Elastic fibres
Ground substance
Q.3. Histology of bone.
Lacunae Ans.
Chondroblast
Fig. 1B.1.3 Elastic cartilage.
Q.2. Histology of hyaline cartilage.
Ans.
1. The hyaline cartilage is so called because it is transparent
(hyalos: glass). Its intercellular substance appears to be
homogeneous, but many collagen fibres are present in
the matrix. Examples: Trachea, larynx, etc. (Figs 1B.1.1,
1B.1.4).
2. In a histological section towards the centre of a mass
of hyaline cartilage the chondrocytes are large and are
usually present in groups of two or more. Groups of
cartilage cells are called cell nests.
3. Immediately around lacunae housing individual chon-
drocytes and around cells nests the matrix stains
deeper than elsewhere, giving the appearance of a
also be classified as cartilage bone or membrane bone.
capsule. This deep-staining matrix is newly formed
and called the territorial matrix or lacunar capsule.
Cancellous Bone (Fig. 1B.1.5)
The pale-staining matrix separating cell nests is the
interstitial matrix.
4. Towards the periphery of the cartilage the cells are small,
and elongated in a direction parallel to the surface. Just
under the perichondrium the cells become indistin-
guishable from fibroblasts.
5. There are numerous collagen fibres embedded in the
ground substance of hyaline cartilage. The ground sub-
stance resists compressive forces, while the fibres resist
tensional forces.
Pseudostratified ciliated
columnar cells
Serous acini
Mucous acini
Lamina propria
Hyaline cartilage
Trachealis muscle
Adventitia
Fig. 1B.1.4 Trachea exhibiting hyaline cartilage.
1. Bone is a modified connective tissue. It consists of
bone cells or osteocytes that are separated from
one another by a considerable amount of intercellular
substance.
2. The intercellular substance consists of a homogeneous
ground substance or matrix in which collagen fibres
and mineral salts like calcium and phosphorus are
deposited.
3. In addition to mature bone cells (osteocytes), two
additional types of cells, osteoblasts and osteoclasts, are
present in developing bone.
4. The unit of bone structure is called a lamellus. Bone
acquires thickness by stacking of lamellae over one
another. Between adjoining lamellae there are spaces
called lacunae. These spaces are occupied by cells of
bone (osteocytes).
5. Bone may be classified as:
a. Compact or cancellous bone
b. Lamellar or woven bone.
On the basis of the manner of its development, bone can
1. The bony plates or rods that form the meshwork of
cancellous bone are called trabeculae. Each trabecula is
made up of a number of lamellae between which there
are lacunae containing osteocytes.
2. Canaliculi, containing the processes of osteocytes,
radiate from the lacunae.
3. The trabeculae enclose wide spaces, which are filled
in by bone marrow. They receive nutrition from blood
vessels in the bone marrow.
 General Histology

Connective =
=—Osteon
tissue=)
Peripheral —
IN Periosteum
bone °BS) — of bone
Haversian ae

SSS
system
Matrix divided = Adipose Volkmann canal
with marrow cells
Trabeculae ——, Haemopoietic
of bone tissue
Haversian canal
Endosteum
Inner circumferential
lamellae
Fig. 1B.1.5 Structure of cancellous bone.
Endosteum

Compact Bone (Fig. 1B.1.6)

Fig. 1B.1.7 Longitudinal section of compact bone.
1. This type of bone is also made up of lamellae, and is
pervaded by lacunae containing osteocytes and by cana-
liculi. Most of the lamellae are arranged in the form
of concentric rings that surround a narrow Haversian Lamellar Bone
canal present at the centre of each ring.
1. The structure of any bone of an adult consists of
layers or lamellae; this kind of bone is called lamellar
bone.
2. Each lamellus is a thin plate of bone consisting of col-
lagen fibres and mineral salts deposited in a gelatinous
Periosteum ground substance. Between adjoining lamellae flattened
= = Ss Outer circumfer- spaces or lacunae are present.
SERS en ential lamellae 3. Each lacuna contains one osteocyte. Spreading out
a LA SN gy) 4} Concentric canal from each lacuna there are fine canals or canaliculi that

SoSH IR
Ss TRY. (%) Ses ESR 1— Qsteocytes communicate with those from other lacunae. The cana-
liculi are occupied by delicate cytoplasmic processes of
iss SS oan s l ms Interstitial
aE ON y K lamellae osteocytes.
SS oX
SF: Woven Bone
Seer} Blood vessel
Endosteum 1. The newly formed bone does not have a lamellar
Haversian canal structure; the collagen fibres are present in bundles that
Volkmann canal
appear to run randomly in different directions, interlac-
Fig. 1B.1.6 Structure of compact bone. ing with each other; hence this kind of bone is called
woven bone.
2. All newly formed bones are called woven bone. They are
2. The Haversian canal is occupied by blood vessels, nerve later replaced by lamellar bone.
fibres and some cells. One Haversian canal and the
Q.4. Histology of skeletal muscle.
lamellae around it constitute a Haversian system or
osteon. Ans.
3. Between adjoining osteons there are angular intervals
1. The skeletal muscle is a variety of muscle tissue present
that are occupied by interstitial lamellae. Near the sur-
mainly in the limbs and in relation to the body wall.
face of compact bone the lamellae are arranged parallel
Because of its close relationship to the bony skeleton it
to the surface; these are called cirumferential lamellae.
is called as the skeletal muscle.
When we examine longitudinal sections through compact 2. Microscopic examination of fibres of skeletal muscle
bone we find that the Haversian canals run predominantly shows prominent transverse striations. Skeletal muscle
along the length of the bone (Fig. 1B.1.7). The canals branch is, therefore, called as striated muscle.
and anastomose with each other. They also communicate 3. Skeletal muscle can normally be made to contract
with the marrow cavity and the external surface of the bone under our will; therefore, it is also called voluntary
through channels that are called the canals of Volkmann. muscle.
Quick Review Series: BDS 1st Year

Longitudinal
striations myofibrils

Sarcolemma
Nuclei
Endomysium

—+ Cross striations Sarcomere

Sarcoplasm
Fig. 1B.1.10 Sarcomere.
Z-line

Fig. 1B.1.8 Longitudinal section of skeletal muscle.

4. Skeletal muscle is made up essentially of long, cylindrical
‘fibres. The length of the fibres is highly variable, the
longest being as much as 30 cm in length. The diameter
of the fibres also varies considerably.
. Each ‘fibre’ is really a syncytium with hundreds of
nuclei along its length. The nuclei are elongated and lie
along the periphery of the fibre, just under the cell
membrane, which is called the sarcoplasm and is
filled with numerous longitudinal fibrils that are called
myofibrils (Fig. 1B.1.8).
. In transverse sections through muscle fibres (Fig. 1B.1.9),
prepared by routine methods, the myofibrils often
appear to be arranged in groups that are called the fields
of Conheim. The myofibrils are, in fact, distributed
uniformly throughout the fibre.
. Running across the middle of each I-band, there is a thin
dark line called the Z-band. The centre of the A-band is
traversed by a lighter band called the H-band (or H-zone).
Running through the centre of the H-band a thin dark line
can be made out. This is the M-band. The part of myofi-
bril situated between two consecutive Z-bands is called a
sarcomere (Fig. 1B.1.10).
10. In addition to myofibrils, the sarcoplasm of a muscle
fibre contains the usual cell organelles, which tend to
aggregate near the nuclei. Mitochondria are numerous.
ll. Muscles are surrounded by a network of connective
tissue fibres that support muscle fibres and unite them
with each other.
12. Individual muscle fibres are surrounded by delicate
connective tissue that is called the endomysium.
Individual fasciculi are surrounded by a stronger sheath
of connective tissue called the perimysium.
13. Connective tissue that surrounds the entire muscle is
called the epimysium.

Q.5. Histology of arteries.

Ans.
Blood vessels
Muscle fibres Basic structure of arteries is described in the following. The
Nuclei of muscle wall of an artery is made up of three layers (Fig. 1B.1.11):
fibres 1. The tunica intima: It is the innermost layer consisting
of (a) an endothelial lining, (b) the basal lamina, (c) a
Perimysium
delicate layer of subendothelial connective tissue and
(d) a membrane formed by elastic fibres called the
internal elastic lamina.
Fig. 1B.1.9 Transverse section of skeletal muscle. . Middle layer or the tunica media: Predominantly, it
consists of elastic tissue or smooth muscle. Some
connective tissue is usually present. On the outside the
7. The most striking feature of skeletal muscle fibres is the media is limited by a membrane formed by elastic fibres.
presence of transverse striations in them. After staining This is the external elastic lamina.
with haematoxylin, the striations are seen as alternate . The outermost layer or the tunica adventitia: This coat
dark and light bands that stretch across the muscle fibre. consists of connective tissue in which collagen fibres
. The dark bands are called A-bands, while the light bands are prominent. This layer prevents undue stretching or
are called I-bands. distension of the artery.
 General Histology

Endothelium
Tunica Subendothelial
(Tunica media) intima, connective tissue
Elastic fibre Internal elastic
lamina
Tunica Muscle fibre
Smooth muscle
media Collagen fibres
Lumen
External elastic
Endothelial cell
layer (tunica intima) Tunica S lamina
adventitia ‘Connective tissue
Tunica adventitia Vasa vasorum

Fig. 1B.1.13 Section of a muscular artery.

Fibroblast

Fig. 1B.1.11 Medium-size artery. Q.6. Histology of lymph node.

Ans.
Elastic and Muscular Arteries
1. Each lymph node consists of a connective tissue frame-
1. On the basis of the kind of tissue that predominates work and numerous lymphocytes, and other cells, that
in the tunica media, arteries are often divided into fill the interstices of the network (Fig. 1B.1.14).
elastic arteries (Fig. 1B.1.12) and muscular arteries 2. The lymph node is covered by a capsule consisting
(Fig. 1B.1.13). mainly of collagen fibres. Some elastic fibres and some
2. Elastic arteries include the aorta and the large arteries smooth muscle may be present. A number of septa or
supplying the head and neck (carotids) and limbs (subcla- trabeculae extend into the node from the capsule and
vian, axillary, iliac). The remaining arteries are muscular. divide the node into lobules.
3. The entire node is bean shaped, the concavity constitut-
Lumen ing a hilum through which blood vessels enter and leave
Endothelium the node. Several lymph vessels enter the node on its
Tunica
Subendothelial
er convex aspect. Usually, a single lymph vessel leaves the
onnective tissue
intimal é node through its hilum.
Internal elastic
lamina
4. A section through a lymph node at low magnification
Tunica Elastic fibres shows an outer zone, which contains densely packed
media Collagen fibres lymphocytes and therefore stains darkly. This part is the
Smooth muscle cortex.
fibres
Collagen fibres
Tunica
adventitia Vasa vasorum

Macrophage
Capsule
Fibroblast

Fig. 1B.1.12 Section of an elastic artery. Lymphoid follicle

Trabeculae
3. In muscular arteries, the media is made up mainly of
smooth muscle. This muscle is arranged circularly.
Between groups of muscle fibres some connective tissue Paratubular septa
is present; this may contain some elastic fibres.
4. There is not much difference in the intima of elastic and
Medullary cords
muscular arteries, except that the subendothelial con-
nective tissue contains more elastic fibres in the former. Medullary sinuses

Internal elastic lamina stands out distinctly from the Fig. 1B.1.14 Lymph node.
muscular media of smaller arteries.
The adventitia also does not show significant differences 5. Surrounded by the cortex, there is a lighter staining zone
in elastic and muscular arteries. in which lymphocytes are fewer; this area is the medulla.
Quick Review Series: BDS 1st Year
6. Within the cortex there are several rounded areas that
are called lymphatic follicles or staining germinal centre
surrounded by a zone of densely packed lymphocytes.
7. Within the medulla the lymphocytes are arranged in the
form of branching and anastomosing cords.
8. The cell population of a lymph node is made up of
lymphocytes. Both B- and T-lymphocytes are present in
lymph nodes.
Cells other than lymphocytes: Apart from lymphocytes and
plasma cells various other cells are present in a lymph node
as follows:
1. Fibroblasts
2. Macrophages
3. Endothelial cells
4. Pericytes.
Macrophages play an important role in the immune
response by phagocytosis of antigens and are, therefore,
referred to as immunologic accessory cells. Lining the
blood vessels of the node there are endothelial cells. The
lymph sinuses are also lined by endothelial cells. Pericytes
and smooth muscle cells are also present around blood
vessels.
Q.7. Histology of thymus.
Capsule
Incomplete septa
[emma
wl Se
Hassall’s
granules
Fig. 1B.1.15 Transverse Section of thymus.
Ans.
1. The thymus consists of right and left lobes that are
joined together by fibrous tissue. Each lobe has a con-
nective tissue capsule. Connective tissue septa passing
inwards from the capsule incompletely subdivide the
lobe into a large number of lobules (Fig. 1B.1.15).
2. Each lobule has an outer cortex and an inner medulla.
Both the cortex and medulla contain cells of two distinct
lineages as described in the following.
3. The thymus has a rich blood supply. It does not receive
any lymph vessels, but gives off efferent vessels.
The cells of thymus are as follows:
Epithelial cells (epitheliocytes): Epithelial cells of the thy-
mus are not phagocytic. The sheets of epithelial cells present
deep to the capsule, around septa and around blood vessels
form an effective blood—thymus barrier that prevents anti-
gens present in blood from reaching lymphocytes present in
the thymus. Epitheliocytes also promote T-cell differentia-
tion and proliferation.
Lymphocytes of thymus (thymocytes): In the cortex of each
lobule of the thymus, the reticulum formed by epithelial
cells is densely packed with lymphocytes.
Macrophages: Apart from epithelial cells and lymphocytes
the thymus contains a fair number of macrophages. They are
present subjacent to the capsule, at the cortico-medullary
junction and in the medulla. The subcapsular macrophages
are highly phagocytic.
Corpuscles of Hassall: These are small rounded structures
present in the medulla of the thymus. Each corpuscle has a
central core formed by epithelial cells that have undergone
degeneration. These cells ultimately form a pink staining
hyaline mass. Around this mass, there is a wall formed by
concentrically arranged epithelial cells.
Q.8. Histology of salivary gland.
Ans.
The major salivary glands include the parotid, submandibu-
lar and sublingual glands, and numerous small glands situ-
ated in the mucous membrane of the lips (labial glands),
cheeks (buccal glands), tongue (lingual glands) and palate
(palatine glands) (Figs 1B.1.16-1B.1.18).
Basic Histology of Salivary Glands
1. Salivary glands are compound tubulo-alveolar glands or
racemose glands. Their secretory elements also referred
to as end pieces or as the portio terminalis may
be rounded acini, or pear shaped alveoli, tubular or a
mixture of these tubuloacinar, tubuloalveolar.
2. The secretory elements lead into a series of ducts
through which their secretions are poured into the oral
cavity.
3. In sections through salivary glands a large number of
closely packed acini or alveoli are seen with ducts scat-
tered between them. These elements are supported by
connective tissue, which also divides the glands into
lobules and forms capsules around them.
4. Blood vessels, lymphatics and nerves run in the connec-
tive tissue, which may at places contain some adipose
tissue.
5. The cells lining the alveoli of salivary glands are usually
described either as serous or mucous.
 General Histology

Connective tissue septa ee 7 a ‘ve

Connective ti
tissue septa
Mucous acini Pry S Oe Serous acini
ES y ) Ce
Gia Fr SS Wes
“: fo 85 — we Interlobular duct
Connective tissue Se ‘a <aotfeet Intralobular duct
Intralobular duct
Blood vessels

Connective tissue

y Pee
<S ”
Fig. 1B.1.16 Mixed salivary gland (mucous predominant, e.g. Fig. 1B.1.18 Purely serous gland (parotid gland).
sublingual).

6. In sections stained with haematoxylin and eosin serous
cells stain darkly. They have rounded nuclei that lie to-
wards the base. In contrast, mucous cells stain very
lightly and, therefore, appear empty in fact, almost com-
pletely filled in by a mucoid material that stains very
poorly. This material pushes the nuclei towards the
basement membrane. The nuclei are flattened.
Connective tissue septa
SS Serous acini
Fig. 1B.1.17 Mixed salivary gland (e.g. submandibular gland).
7. An alveolus is typically made up of entirely serous cells
or mucous cells. In some cases mucous alveoli are cov-
ered on one or more sides by groups of serous cells that
are arranged in the form of crescents or demilunes. In
the parotid gland the alveoli are almost entirely serous,
only an occasional mucous alveolus being present.
10. Myoepithelial cells are present in relation to alveoli and
intercalated ducts of salivary glands. They may also be
seen in relation to larger ducts—intralobular and ex-
tralobular. These cells lie between the epithelial cells and
their basement membrane. The myoepithelial cells lo-
cated on alveoli are often branched stellate and may
form ‘baskets’ around the alveoli. Those located on the
ducts are fusiform and run longitudinally along them.
Myoepithelial cells are contractile; their contraction
helping to squeeze out secretion from alveoli.
11. Secretions produced in alveoli pass along a system of
ducts. The smallest ducts are called intercalated ducts.
They are lined by cuboidal or flattened cells. Intercalated
ducts open into striated ducts lined by columnar cells.
They are so called since the basal parts of the cells show
vertical striations. Striated ducts open into excretory
ducts, which are lined by simple columnar epithelium.
Q.9. Histology of lung.
Ans.
The lung substance is divided into numerous lobules
(Fig. 1B.1.19).
Alveolar wall
Adventitia
Smooth muscle

8. Serous cells are usually arranged in the form of rounded . Mucosal folds
acini. As a result each cell is roughly pyramidal having a
broad base and a narrow apex. Some microvilli and pi- s+ Pulmonary alveoli
nocytotic vesicles are seen at the apex of the cell. The tke
apical cytoplasm contains secretory granules that are Set OPN Ae na om
small, homogenous and electron dense.
Fig. 1B.1.19 Section of lung.
9. The cytoplasm also contains a well-developed Golgi
complex and abundant rough endoplasmic reticulum,
both features indicating considerable synthetic activity. 1. In the lung, the principal bronchus divides into second-
Mitochondria, lysosomes and microfilaments are also ary or lobar bronchi—one for each lobe. Each lobar
present. bronchus divides into tertiary or segmental bronchi.
Quick Review Series: BDS 1st Year

2. The segmental bronchi divide into smaller and smaller Vessels of the Lung
bronchi, which ultimately end in bronchioles. The lobu-
Within the lung the arteries end in an extensive capillary
lar bronchiole gives off a number of terminal bronchi-
network in the walls of alveoli. Plexuses of lymph vessels are
oles. Each terminal bronchiole ends by dividing into
present just deep to the pleura and in the walls of bronchi.
respiratory bronchioles (Fig. 1B.1.20).
Nerves of the Lung
Alveolar sac
The lungs receive autonomic nerves, both sympathetic and
Respiratory
parasympathetic, and include both afferent and efferent
bronchiole
fibres. Efferent fibres supply the bronchial musculature.
Vagal stimulation produces bronchoconstriction. Efferent
fibres also innervate bronchial glands.

Q.10. Histology of oesophagus.

Ans.

bronchiole The wall of oesophagus has the following four layers:

Alveoli 1. Mucous membrane
2. Submucosa
Fig. 1B.1.20 Terminal bronchiole.
3. Muscle layer
4. An external adventitia.
Oesophagus does not have a serous covering except over
3. Each respiratory bronchiole ends by dividing into a few
a short length near its lower end.
alveolar ducts. Each alveolar duct ends in a passage—the
The structure of the oesophagus is as follows
atrium—which leads into a number of rounded alveolar
(Fig. 1B.1.21):
sacs.
4. Each alveolar sac is studded with a number of air sacs or
alveoli. The alveoli are blind sacs having very thin walls
through which exchange of gases takes place. Renal column
Renal Pyramid
As these bronchi divide into smaller ones, the following cortex » (medulla)
changes in structure are observed:
1. The cartilages in the walls of the bronchi become smaller
Major
and irregular in shape, cartilage is absent in the walls of calyces
bronchioles; this distinguishes a bronchiole from a Pelvis
bronchus. Minor
2. The amount of muscle in the bronchial wall increases. calyces
3. Some nonciliated cells present predominantly in termi-
nal bronchioles produce a secretion, which spreads over
the alveolar cells forming a film that reduces surface ten-
sion. These include the cells of Clara.
Ureter
The greater part of the surface of the lung is covered by a
Fig. 1B.1.21 Transverse Section of upper oesophagus.
serous membrane—the visceral pleura.
Deep to the pleura there is a layer of subserous connective
tissue. This connective tissue extends into the lung substance
Mucosa
along bronchi and their accompanying blood vessels, and
divides the lung into lobules. 1. The mucous membrane of the oesophagus shows
Numerous elastic fibres are present in the basal lamina several longitudinal folds.
and lamina propria. Elastic fibres passing between lung pa- 2. The mucosa is lined by stratified squamous epithelium,
renchyma and pleura prevent collapse of alveoli and small which is not keratinized. Occasional melanocytes and
bronchi during expiration. endocrine cells are present. A columnar epithelium
The pleura is lined by flat mesothelial cells that are sup- extends for some distance into the abdominal part of
ported by loose connective tissue rich in elastic fibres, blood the oesophagus.
vessels, nerves and lymphatics. Under parietal pleura, there 3. Finger-like processes or papillae of the connective tissue
is considerable adipose tissue. of the lamina propria project into the epithelial layer.

4. At the upper and lower ends of the oesophagus, the
lamina propria contains some tubulo-alveolar mucous
glands.
5. The muscularis mucosae is absent or poorly developed
in the upper part of the oesophagus. It is distinct in the
lower part of the oesophagus and is thickest near the
oesophagogastric junction. It consists chiefly of longitu-
dinal muscular fibres, but a few circular fibres are also
present.
Submucosa
The presence of compound tubulo-alveolar mucous glands
is the special feature of the submucosa. Especially, near the
lower end small aggregations of lymphoid tissue may be
present in the submucosa. Some plasma cells and macro-
phages are also present.
Muscle Layer
The muscle layer consists of circular and longitudinal layers.
The muscle fibres are partly striated and partly smooth. In the
upper one-third (or so) of the oesophagus, the muscle fibres
are entirely of the striated variety, while in the lower one-third,
all the fibres are of the smooth variety. Both types of fibres are
present in the middle one-third of the oesophagus.
The circular muscle fibres present at the lower end of the
oesophagus could possibly act as a sphincter guarding the
cardioesophageal junction.
The muscle layer of the oesophagus is surrounded by a
layer of dense fibrous tissue that forms an adventitial coat for
the oesophagus. The lowest part of the oesophagus is intra-
abdominal and has a covering of peritoneum.
Q.11. Histology of kidney.
Ans.
Kidney tissue consists of an outer part called the cortex and
an inner part called the medulla (Fig. 1B.1.22).
5 Stratified
foo SQuamMous epithelium
bea Lamina propria
Muscular mucosa
Submucosa
Fig. 1B.1.22 A coronal section through the kidney.
General Histology
The medulla is made up of triangular areas of renal tissue
that are called the renal pyramids. Each pyramid has a base
directed towards the cortex and an apex or papilla directed
towards the renal pelvis, and fits into a minor calyx. Pyra-
mids show striations that pass radially towards the apex.
The renal cortex consists of the following:
1. Tissue lying between the bases of the pyramids and
the surface of the kidney forming the cortical arches
or cortical lobules. This part of the cortex shows light
and dark striations. The light lines are called medullary
rays.
2. Tissue lying between adjacent pyramids is also a part of
the cortex. This part constitutes the renal columns.
3. Each pyramid is surrounded by a ‘shell’ of cortex. The
pyramid and the cortex around it constitute a lobe of
the kidney. This lobulation is obvious in the fetal kidney.
Kidney tissue is intimately covered by a thin layer of
fibrous tissue, which is called the capsule.
Q.12. Histology of hypophysis cerebri.
Ans.
The hypophysis cerebri is also called the pituitary gland
(Fig. 1B.1.23). The two parts—pars posterior and infundib-
ular stalk—are together referred to as the neurohypophysis.
The pars anterior, which is also called the pars distalis,
and the pars intermedia are both collectively referred to as
the adenohypophysis.
Posterior lobe
Intermediate
lobe
Anterior lobe
Fig. 1B.1.23 Hypophysis cerebri.
Adenohypophysis
Pars anterior: The pars anterior consists of cords of cells
separated by fenestrated sinusoids. Several types of cells,
responsible for the production of different hormones, are
present.
ae Quick Review Series: BDS 1st Year

Using routine staining procedures, the cells of the pars located in the hypothalamus. Situated between these axons
anterior can be divided into: (i) chromophil cells that have are supporting cells of a special type called pituicytes.
brightly staining granules in their cytoplasm and (ii) chro- The pars posterior of the hypophysis is associated with the
mophobe cells in which granules are not prominent. release of two hormones into the blood:
1. Vasopressin, antidiuretic hormone or (ADH): This
Chromophil cells are further classified as:
hormone controls reabsorption of water by kidney
1. Acidophil (alpha cells)
tubules.
2. Basophil cells (beta cells).
2. Oxytocin: It controls the contraction of smooth muscle
The acidophil cells are often called alpha cells and the of the uterus and also that of the mammary gland.
basophil cells are called beta cells. Q.13. Histology of thyroid.

Types of Acidophil Cells Ans.

1. Somatotrophs produce the somatropic hormone, which

is also called somatotrophin (STH) or growth hormone
(GH). This hormone controls body growth, especially
before puberty. Capsule
2. Mammotrophs or lactotrophs produce the mammo-
tropic hormone also called as mammotropin, prolactin Thyroid follicle

(PRL), lactogenic hormone (LTH), which stimulates the Septa

growth and activity of the female mammary gland dur-
ing pregnancy and lactation. Parafollicular cell

Types of Basophil Cells

1. The corticotrophs (or corticotropes) produce the corti-
cotropic hormone; this hormone, also called adreno-
corcotropin or ACTH, stimulates the secretion of some
hormones of the adrenal cortex.
2. Thyrotrophs (or thyrotropes) produce the thyrotropic
hormone (thyrotropin or TSH), which stimulates the
activity of the thyroid gland.
3. Gonadotrophs (gonadotropes or delta basophils) pro-
duce two types of hormones—each type having a differ-
ent action in the male and female.
a. In the female, the first of these hormones stimulates
the growth of ovarian follicles. It is, therefore, called
the follicle-stimulating hormone (FSH). It also stimu-
lates the secretion of oestrogens by the ovaries. In the
male, the same hormone stimulates spermatogenesis.
b. In the female, the second hormone stimulates the matu-
ration of the corpus luteum and the secretion by it of
progesterone. It is called the luteinizing hormone (LH).
In the male the same hormone stimulates the produc-
tion of androgens by the interstitial cells of the testes and
is called the interstitial cell-stimulating hormone (ICSH).
Pars tuberalis: The pars tuberalis consists mainly of undifferen-
tiated cells. Some acidophil and basophil cells are also present.
Pars intermedia: This is poorly developed in the human
hypophysis.
Fig. 1B.1.24 Thyroid gland.
1. The thyroid gland is covered by a fibrous capsule; the
septa extending into the gland from the capsule divide it
into lobules (Fig. 1B.1.24). Each lobule is made up of an
aggregation of follicles.
2. Each follicle is lined by follicular cells. The follicle has a
cavity, which is filled by a homogenous material called
colloid.
3. The spaces between the follicles are filled by a stroma
made up of delicate connective tissue in which there are
numerous capillaries and lymphatics.
4. Apart from follicular cells the thyroid gland contains
C-cells or parafollicular cells, which lie between the fol-
licular cells and the basement membrane (Fig. 1B.1.25).
They may also lie in the intervals between the follicles.
Connective tissue stroma surrounding the follicles
contains a dense capillary plexus, lymphatic capillaries
and sympathetic nerves.
Follicle Group of parafolli-
cells cular cells
Colloid Sinusoidal capillaries

Neurohypophysis
Parafollicular cells Follicle sectioned tangentially
Pars posterior: The pars posterior consists of numerous
unmyelinated nerve fibres, which are the axons of neurons Fig. 1B.1.25 Parafollicular cells.

SHORT NOTES
Q.1. Histology of cartilage.
Ans.
1. Cartilage is a modified connective tissue. The cells of
cartilage are called chondrocytes. They lie in spaces or
lacunae present in the matrix.
. The ground substance of cartilage is made up of com-
plex molecules containing proteins and carbohydrates.
These molecules form a meshwork, which is filled by
water and dissolved salts.
. The collagen fibres present in cartilage are chemically
described as Type II collagen.
Q.2. Histology of compact bone.
Ans.
1. Compact bone is made up of lamellae, and is pervaded
by lacunae containing osteocytes and by canaliculi.
. Most of the lamellae are arranged in the form of con-
centric rings that surround a narrow Haversian canal
present at the centre of each ring. The Haversian canal is
occupied by blood vessels, nerve fibres and some cells.
One Haversian canal and the lamellae around it consti-
tute a Haversian system or osteon.
. Longitudinal sections through compact bone shows that
the Haversian canals run predominantly along the
length of the bone (Fig. 1B.1.7).
. The canals branch and anastomose with each other.
They also communicate with the marrow cavity and
with the external surface of the bone through channels
that are called the canals of Volkmann. Blood vessels and
nerves pass through all these channels so that compact
bone is permeated by a network of blood vessels that
provide nutrition to it.
Q.3. Histology of lymph node.
Ans.
1. The lymph node is bean-shaped, the concavity consti-
tuting a hilum through which blood vessels enter and
leave the node.
. Each lymph node consists of a connective tissue frame-
work, and numerous lymphocytes, and other cells that
fill the interstices of the network.
. A section through a lymph node shows that the node
has an outer zone known as the cortex. Surrounded
by the cortex, there is a lighter staining zone in which
lymphocytes are fewer and is known as medulla.
. Within the cortex there are several rounded areas called
lymphatic follicles or staining germinal centre sur-
rounded by a zone of densely packed lymphocytes.
General Histology
5. Within the medulla the lymphocytes are arranged in the
form of branching and anastomosing cords.
The lymph node is covered by a capsule consisting mainly
of collagen fibres.
Q.4. Histology of thymus.
Ans.
1. The thymus consists of right and left lobes that are
joined together by fibrous tissue. Each lobe has a con-
nective tissue capsule. Connective tissue septa passing
inwards from the capsule incompletely subdivide the
lobe into a large number of lobules (Fig. 1B.1.15).
. Each lobule has an outer cortex and an inner medulla.
Both the cortex and medulla contain cells of two distinct
lineages.
. In the cortex of each lobule of the thymus, the reticulum
formed by epithelial cells is densely packed with
lymphocytes.
. Corpuscles of Hassall are small rounded structures pres-
ent in the medulla of the thymus. Each corpuscle has a
central core formed by epithelial cells that have under-
gone degeneration. These cells ultimately form a pink
staining hyaline mass. Around this mass there is a wall
formed by concentrically arranged epithelial cells.
Q.5. Histology of large-size artery.
Ans.
1 . In large-size arteries or elastic arteries, the media is
made up mainly of elastic tissue. The elastic tissue is in
the form of a series of concentric membranes that are
frequently fenestrated (Fig. 1B.1.12).
. In the aorta, which is the largest elastic artery, there may
be as many as 50 layers of elastic membranes. Between
the elastic membranes there is some loose connective
tissue. Some smooth muscle cells may be present. It is
relatively thin in large arteries, in which a greater pro-
portion of elastic fibres are present. These fibres merge
with the external elastic lamina.
Q. 6. Histology of submandibular gland.
Ans.
1 . Submandibular gland is one of the major salivary glands
(Fig, 1B.1.17).
2. In the submandibular gland some alveoli are serous
and some are mucous, which are frequently capped by
serous crescents.
. Mucous cells are usually arranged in the form of tubular
secretory elements. Crescents present in relation to
them are located at the ends of the tubules.
Quick Review Series: BDS 1st Year

4. The cells lining mucous cells tend to be columnar rather

than pyramidal. Their secretory granules are large and
yy TN
ill-defined. Rough endoplasmic reticulum and Golgi
complex are similar to those in serous cells. In the
submandibular glands, mucous acini are often capped
by serous demilunes.
Zona fasciculata
Q.7. Histology of parotid gland.

Ans.
Refer to the answer of Short Essays Q. 8. /! Zona reticularis

Q.8. Histology of kidney. ’ /Medulla

Ans.
Fig. 1B.1.26 Transverse Section of adrenal gland.
Refer to the answer of Short Essays Q.11.

Q.9. Histology of pituitary gland.

Ans.
Refer to the answer of Short Essays Q. 12.
Q.10. Histology of adrenal gland.
Ans.
1. Suprarenal glands are commonly called the adrenal
glands. Each suprarenal gland is covered by a connective
tissue capsule from which septa extend into the gland
substance (Fig. 1B.1.26).
2. The gland is made up of two functionally distinct parts:
a. The cortex
b. The medulla.
The volume of the cortex is about 10 times that of the
medulla.
. The suprarenal cortex is made up of cells arranged in
cords. Sinusoids intervene between the cords.
. On the basis of the arrangement of its cells the cortex
can be divided into three layers: (a) The outermost layer
is called the zona glomerulosa, (b) the next zone is called
the zona fasciculata and (c) the innermost layer of the
cortex is called the zona reticularis.
. The medulla is made up of groups or columns of cells
separated by wide sinusoids. The cells are columnar or
polyhedral and have a basophilic cytoplasm. Function-
ally, the cells of the suprarenal medulla are considered to
be modified postganglionic sympathetic neurons.
EMBRYOLOGY | J
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 EMBRYOLOGY

SOME PRELIMINARY CONSIDERATIONS,

SHORT NOTE

Q.1. Discuss about chromosome.

Satellite
Ans.

1. A typical chromosome is made up of two rod-shaped Secondary

constriction
structures or chromatids placed more or less parallel to Short arm of
each other (Fig. 1C.1.1). chromatid
2. The chromatids are united to each other at a light staining
area called the centromere or kinetochore.
3. Each chromatid has two arms, one on either side of the Centromere
centromere.
4. Each chromosome has a very large number of structures
called genes on it, which guide the performance of par- Long arm of
ticular cellular functions and in turn lead to the develop- chromatid
ment of particular features of a species or an individual.
5. Chromosomes are predominantly made up of a nucleic
acid called deoxyribonucleic acid (DNA).
6. Chromosomes control the development and functioning
of cells by determining what types of proteins will be
synthesized in them. Fig. 1C.1.1 Structure of a chromosome.

SPERMATOGENESIS AND
OOGENESIS:
SHORT NOTES

Q.1. Oogenesis. Q.2. Graafian follicles.

Ans. Ans.
In females, maturation from primitive germ cell to mature — At maturity, the follicle of 10 mm or more in diameter is known
gamete is called oogenesis, which begins before birth. as the tertiary follicle, vesicular follicle or Graafian follicle.
Quick Review Series: BDS 1st Year

Zona pellucida Antrum

Granulosa
Primary oocyte cells =, Theca
externa

Primordial follicle Maturing follicle

Graafian follicle

Fig. 1C.2.1 Graafian follicle showing different stages of development.

The Graafian follicle is surrounded by (Fig. 1C.2.1): 2. The theca externa, which gradually merges with the
1. The theca interna, which is composed of cells having ovarian stroma.
characteristics of steroid secretion, is rich in blood vessels.

FORMATION

SHORT NOTE

Q.1. Effects of fertilization. The phases of fertilization include the following:

Ans. Phase 1: Penetration of the corona radiata
The process by which male and female gametes fuse is Phase 2: Penetration of the zona pellucida
known as fertilization. It occurs in the ampullary region of
the uterine tube. Phase 3: Fusion of the oocyte and sperm cell membranes.

FURTHER D

SHORT ESSAY

Q.1. Formation, functions and fate of notochord.
Ans.
1. Prenotochordal cells invaginating in the primitive pit
move forwards until they reach the prechordal plate,
whose cells become intercalated in the hypoblast so that
for a short time the midline of the embryo consists
of two cell layers that form the notochordal plate
(Fig 1C.4.1).
 Embryology

2. As the hypoblast is replaced by endoderm cells Primitive pit and

neurenteric canal
moving in at the streak, cells of the notochordal plate
proliferate and detach from the endoderm. They then Connecting stalk
Amnion A
form a solid cord of cells—the definitive notochord
Wall of Allantois
that underlies the neural tube; serves as the basis for
yolk sac Notochord
the axial skeleton. Cloacal plate
Prechordal plate (membrane}
3. Elongation of the notochord is a dynamic process;
the cranial end forms first and caudal regions are Notochordal plate

added as the primitive streak assumes a more caudal

position. Intraembryonic
Endoderm
4. The notochord and prenotochordal cells extend crani- mesoderm
ally to the prechordal plate and caudally to the primitive Intraembryonic mesoderm
pit. At the point where the pit forms an indentation in
the epiblast, the neurenteric canal temporarily connects Extraembryonic
. mesoderm
the amniotic and yolk sac cavities. Endoderm
Notochord
Notochord underlies the neural tube and serves as the basis
Fig. 10.4.1 Schematic views and scanning electron micrographs
for the axial skeleton.
illustrating formation of the notochord.

SHORT NOTE

Q.1. Formation and fate of notochord. During further development, the plate detaches from
the endoderm and a solid cord known as notochord is
Ans.
formed.
Prenotochordal cells invaginate—in the primitive pit and The definitive notochord underlies the neural tube and
move forwards cephalad until they reach the prechordal serves as the basis for the axial skeleton.
plate. They intercalate in the endoderm as notochordal plate.

PHARYNGEAL ARCHES
SHORT ESSAYS

Q.1. Development of mandible. The mandible is also formed by membranous ossification

of mesenchymal tissue surrounding Meckel’s cartilage.
Ans.
Q.2. Development of thyroid.
The ventral portion of viscerocranium gives rise to the
mandibular process, which contains Meckel’s cartilage. Or
Mesenchyme around Meckel’s cartilage condenses and
ossifies by membranous ossification to give rise to the Development of thyroid gland and its anomalies.
mandible.
Ans.
Meckel’s cartilage disappears except in the sphenoman-
dibular ligament. 1. The thyroid gland appears as an epithelial proliferation
The dorsal tip of the mandibular process, along with that in the floor of the pharynx (Fig. 1C.5.1A) between the
of the second pharyngeal arch, gives rise to the incus, the tuberculum impar and the copula at a point known as
malleus and the stapes. the foramen cecum.
Quick Review Series: BDS 1st Year

Foramen cecum

Thyroglossal
duct
Pharyngeal
gut
Thyroid
Oesophagus thyroid gland gland

+ Trachea Pyramidal
Tongue Tracheal
Thyroid gland lobe of rings
thyroid gland B
A

Fig. 10.5.1 (A) Thyroid gland in the floor of pharynx. (B) Descending pathway of thyroid gland.

2. As the development progresses, the thyroid descends in 2. A thyroglossal fistula usually arises secondarily after
front of the pharyngeal gut (Fig. 1C.5.1B), hyoid bone rupture of a thyroglossal cyst and is connected to
and the laryngeal cartilages as a bilobed diverticulum. the outside by a fistulous canal, but may be present at
3. During this migration, the thyroid remains connected birth.
to the tongue by a narrow canal—the thyroglossal duct,
which disappears later. Q.3. Cartilage, arch, artery and muscular derivatives
4. It acquires a small median isthmus and two lateral lobes of first pharyngeal arch.
by the time it reaches its final position in front of the
trachea in the seventh week. Ans.
5. By the end of the third month, the thyroid begins to
function, at the time at which the first follicles contain- First pharyngeal arch (Fig. 10.5.3)
ing colloid become visible.
1. The first pharyngeal arch consists of a dorsal portion
Follicular cells produce the colloid that serves as a source known as the maxillary process, which extends forwards
of thyroxin and triiodothyronine. Parafollicular or C-cells beneath the region of the eye, and a ventral portion—
derived from the ultimobranchial body serve as a source the mandibular process—which contains Meckel’s
of calcitonin. cartilage.
. During further development Meckel’s cartilage disap-
Anomalies pears except for two small portions at its dorsal end that
1. Thyroglossal cyst is a cystic remnant of the thyroglossal persist and form the incus and malleus.
duct. It lies at any point along the midline of the . Mesenchyme of the maxillary process gives rise to the
neck, starting from base of the tongue up to the thyroid premaxilla, maxilla, zygomatic bone and part of the
isthmus (Fig. 1C.5.2). temporal bone through membranous ossification.
The mandible is also formed by membranous ossifica-
tion of mesenchymal tissue surrounding Meckel’s
cartilage. The first arch also contributes to formation of
Body of tongue -
Foramen cecum the bones of the middle ear.
Thyroglossal cyst . Musculature of the first pharyngeal arch includes the
muscles of mastication (i.e. the temporalis, masseter
Epiglottis
and medial and lateral pterygoids), anterior belly of
Hyoid bone the digastric, mylohyoid, tensor tympani and tensor
palatine.
Thyroid cartilage . The nerve supply to the muscles of the first arch is
provided by the mandibular branch of the trigeminal
Cricoid cartilage nerve. Since mesenchyme from the first arch also
contributes to the dermis of the face, sensory supply
to the skin of the face is provided by ophthalmic,
maxillary and mandibular branches of the trigeminal
Fig. 10.5.2 Location of thyroglossal cyst. nerve.
 Embryology

Tuberculum impar
Lateral lingual swelling Body of tongue
Terminal sulcus,

Copula
(hypobranchial aryngeal "NN
eminence)
Arytenoid swellings
Epiglottal
swelling

5 weeks 5 months

Fig. 1C.5.3 Pharyngeal arches (ventral portion).

SHORT NOTES

Q.1. Derivatives of first pharyngeal arch. Or

Ans. Derivatives of second pharyngeal arch (muscles).
The derivatives of first pharyngeal arch, ie. mandibular arch Or
are listed in Table 1C.5.1 and shown in Fig. 1C.5.4.
Derivative of mesoderm of second pharyngeal arch.
Table 1.5.1 Derivatives of first pharyngeal arch Ans.
Pharyngeal The derivatives of second pharyngeal arch, i-e. hyoid arch are
arch Nerve Muscles Skeleton listed in Table 1C.5.2.
Mandibular Mandibular Muscles of masti- Quadrate carti-
arch division of cation (temporalis, lage incus;
trigeminal masseter; medial Meckel’s carti- Table 1.5.2 Derivatives of second pharyngeal arch
nerve and lateral ptery- lage, malleus, Pharyn-
goids); mylohyoid; anterior ligament gealarch Nerve Muscles Skeleton
anterior belly of of malleus, sphe-
Hyoid arch Vii facial Facial muscles of expres- Stapes, styloid
digastric; tensor nomandibular
nerve sion (buccinator, auricu- process, stylo-
palatine, tensor ligament, portion
laris; frontalis, platysma, hyoid ligament,
tympani of mandible
orbicularis oris, orbicu- lesser horn
laris oculi); posterior and upper por-
Malleus belly of digastric; stylo- tion of body of
hyoid; stapedius hyoid bone

Meckel’s cartilage
I—-Styloid process Q.3. Structures developed from third pharyngeal arch
fo Stylohyoid ligament
Ans.
4 M Lesser horn of hyoid bone
<x Greater horn of hyoid bone Structures developed from third pharyngeal arch are listed
Body of hyoid bone
in Table 1C.5.3.

Thyroid cartilage Table 1.5.3 Derivatives of third pharyngeal arch

Cricoid cartilage
Pharyngeal
Tracheal rings arch Nerve Muscles Skeleton

Fig. 1C.5.4 The first pharyngeal arch derivatives. Third arch Glossopha- Stylopharyngeus Greater horn and
ryngeal lower portion of
Q.2. Derivatives of second pharyngeal arch. body of hyoid bone
ivy) Quick Review Series: BDS 1st Year

Q.4. Derivatives of third endodermal pouch pharynx. gland, while the ventral wing forms the thymus, as shown in
the previous figure.
Ans.
The third and fourth pouches are characterized at their dis- Q.5. Formation and fate of first pharyngeal pouch.
tal extremity by a dorsal and a ventral wing (Fig. 1C.5.5). Ans.

1. The first pharyngeal pouch forms a_ stalk-like

diverticulum—the tubotympanic recess—which comes
in contact with the epithelial lining of the first pharyn-
Palatine geal cleft—the future external auditory meatus.
tonsil 2. The distal portion of the diverticulum widens into a
Parathyroid
gland (inferior)
saclike structure—the primitive tympanic or middle ear
Thymus cavity—and the proximal part remains narrow, forming
Parathyroid the auditory tube.
gland (superior)
Q.6. Give persistent structures of fibrous envelope
of Meckel’s cartilage.

Fig. 10.5.5 Derivatives of third pharyngeal pouch. Ans.

During further development Meckel’s cartilage disappears

In the fifth week, epithelium of the dorsal wing of the except for two small portions at its dorsal end that persist
third pouch differentiates into the inferior parathyroid and form the incus and malleus.

FACE, NOSE AND PALATE

SHORT ESSAYS

Q.1 Development of face. 2. Maxillary prominences can be distinguished lateral to

the stomodeum, and mandibular prominences can be
Or
distinguished caudal to this structure.
Frontonasal process of embryo. 3. The frontonasal prominence, formed by proliferation of
mesenchyme ventral to the brain vesicles, constitutes the
Ans.
upper border of the stomodeum.
1. At the end of the fourth week, facial prominences con- 4. Under inductive influence of the ventral portion of the
sisting primarily of neural crest-derived mesenchyme forebrain on both sides of the frontonasal prominence,
appear (Fig. 1C.6.1). local thickenings of the surface ectoderm—the nasal or
olfactory placodes—originate.
Frontonasal 5. During the fifth week, the nasal placodes invaginate
rominence
to form nasal pits. They create a ridge of tissue that
surrounds each pit and forms the nasal prominences.
Nasal pit Eye Nasal pit The prominences on the outer edge of the pits are the
Maxillary Lateral nasal lateral nasal prominences and those on the inner edge
prominence prominence are the medial nasal prominences (Fig. 1C.6.2).
Mandibular Medial nasal
prominence Nasolacrimal prominence 6. During the following 2 weeks the maxillary promi-
groove nences continue to increase in size and grow medially,
stomodeum compressing the medial nasal prominences towards the
Fig. 1C.6.1 Facial prominences. midline.
 Embryology

Lateral nasal Table 1.6.1 Structures contributing to formation of the face

prominence
Name of the prominence Structures formed
Medial nasal
prominence Frontonasal Forehead, bridge of nose,
Maxillary medial and lateral nasal
prominence Eye
prominences
Mandibular.
prominence Nasolacrimal Maxillary Cheeks, lateral portion of upper lip
Philtrum
A groove p Medial nasal Philtrum of upper lip, crest and tip
of nose
Fig. 1C.6.2 Development of face.
Lateral nasal Alare of nose
Mandibular Lower lip

The upper lip is formed by the two medial nasal promi-

nences and the two maxillary prominences.
The lower lip and jaw form from the mandibular prom-
inences that merge across the midline.
Initially, the maxillary and lateral nasal prominences are
separated by a deep furrow—the nasolacrimal groove.
The maxillary prominences enlarge to form the cheeks
and maxillae.
10. The nose is formed from five facial prominences; the
frontal prominence gives rise to the bridge; the merged
medial nasal prominences provide the crest and tip;
and the lateral nasal prominences form the sides (alare)
(Fig. 1C.6.3).
Maxilla with
Philtrum of lip_ four incisor teeth
Intermaxillary segment
Primary
palate
Fused
Maxillary
palatal
process
plates
Fig. 10.6.3 Formation of maxillary process (5-week-old embryo).
11. As a result of medial growth of the maxillary promi-
nences, the two medial nasal prominences merge not
only at the surface but also at a deeper level forming the
intermaxillary segment, which is composed of:
a. a labial component, which forms the philtrum of the
upper lip;
b. an upper jaw component, which carries the four
incisor teeth and
c. a palatal component, which forms the triangular
primary palate.
The intermaxillary segment is continuous with the rostral
portion of the nasal septum, which is formed by the frontal
prominence. Structures contributing to the formation of
face are explained in Table 1C. 6.1.
Q.2. Give the development of palate and associ-
ated anomalies.
Ans.
1. The primary palate is derived from the intermaxillary
segment.
. The main part of the definitive palate is formed by two
shelves-like outgrowths—the palatine shelves—from
the maxillary prominences.
. During the sixth week of development outgrowths
appear and are directed obliquely downwards on each
side of the tongue.
. In the seventh week, the palatine shelves ascend to attain
a horizontal position above the tongue and fuse, forming
the secondary palate (Fig. 1C.6.3).
. Anteriorly, the palatine shelves fuse with the triangular
primary palate, and the incisive foramen is the midline
landmark between the primary and secondary palate.
. At the same time as the palatine shelves fuse the nasal
septum grows down to join with the cephalic aspect of
the newly formed palate.
. The anomalies associated with development of palate
are as follows:
a. Cleft lip and cleft palate are common defects that
result in abnormal facial appearance and defective
speech.
b. Cleft palate results from a lack of fusion of the
palatine shelves, which may be due to smallness of
the fusion process itself or failure of the tongue
to drop from between the shelves because of micro-
gnathia (Fig. 1C.6.3).
c. The frequency of isolated cleft palate is much lower
than that of cleft lip around 1 in 2500 births, occurs
more often in females (67%) than males and is not
related to maternal age.
d. Anticonvulsant drugs, such as phenobarbital and
diphenylhydantoin, given during pregnancy increase
the risk of cleft palate.
Quick Review Series: BDS 1st Year

SHORT NOTES

Q.1. Hare lip or cleft lip. The posterior border of the hard palate provides attachment
to the palatine aponeurosis.
Ans.
Q.4. Development of palate.
Cleft lip and cleft palate are common defects that result in
abnormal facial appearance and defective speech. Ans.
Median cleft lip is a rare abnormality caused by incom-
1. The primary palate is derived from the intermaxillary
plete merging of the two medial nasal prominences in the
segment.
midline.
2. The main part of the definitive palate is formed by two
Most cases of cleft lip and cleft palate are multifactorial.
shelf-like outgrowths from the maxillary prominences
Cleft lip, approximately 1 in 1000 births, occurs more
known as palatine shelves, which appear in the sixth
frequently in males (80%) than in females; its incidence
week of development and are directed obliquely down-
increases slightly with maternal age and varies among
wards on each side of the tongue.
populations.
3. During seventh week the palatine shelves ascend to at-
Q.2. Cleft palate. tain a horizontal position above the tongue and fuse,
forming the secondary palate.
Ans.
In the Ventral view of palate, lip and nose (Fig. 1C.6.4)
1. Cleft palate results from a lack of fusion of the palatine 4. Anteriorly the shelves fuse with the triangular primary
shelves, which may be due to smallness of the fusion palate, and the incisive foramen is the midline landmark
process itself or failure of the tongue to drop from between the primary and secondary palates.
between the shelves because of micrognathia. 5. At the same time, as the palatine shelves fuse the nasal
2. Cleft lip and cleft palate are common defects that result septum grows down and joins with the cephalic aspect
in abnormal facial appearance and defective speech. of the newly formed palate.
3. The frequency of isolated cleft palate is much lower than
that of cleft lip (1/2500 births), occurs more often in
Primary Incisive
females (67%) than males and is not related to maternal palate foramen
age.
4. Anticonvulsant drugs, such as phenobarbital and diphe-
nylhydantoin, given during pregnancy increase the risk
of cleft palate.
Q.3. Palatine aponeurosis. Uvula
Ans. Fig. 10.6.4 Ventral view of palate, lip and nose.

ALIMENTARY SYSTEM
SHORT ESSAY

Q.1. Development of tongue. swelling—the tuberculum impar. These three swellings

originate from the first pharyngeal arch (Fig. 1C.7.1).
Ans.
2. A second median swelling called the copula or
1. At approximately 4 weeks, the tongue appears in embryo in hypobranchial eminence is formed by mesoderm of the
the form of two lateral lingual swellings and one median second, third and part of the fourth arch.
 Embryology

. A third median swelling formed by the posterior part of
the fourth arch.
. As the lateral swellings increase in size, they overgrow
the tuberculum impar and merge, forming the anterior
two-thirds or body of the tongue; sensory innervation
to this area is by the mandibular branch of the trigemi-
nal nerve.
. The posterior part, or root, of the tongue originates
from the second, third and part of the fourth pharyngeal
arch. The sensory innervation to this part of the tongue
supplied by the glossopharyngeal nerve indicates that
tissue of the third arch overgrows that of the second.
. The extreme posterior part of the tongue is innervated
by the superior laryngeal nerve, reflecting its develop-
ment from the fourth arch.
7. Some of the tongue muscles probably differentiate in
situ; but most are derived from myoblasts originating in
occipital somites. Thus, tongue musculature is inner-
vated by the hypoglossal nerve.
. The general, sensory innervation of the tongue is easy to
understand:
a. The body is supplied by the trigeminal nerve—the
nerve of the first arch.
b. The root is supplied by the glossopharyngeal and
vagus nerves—the nerves of the third and fourth
arches, respectively.
c. Special sensory innervation (taste) to the body of the
tongue is provided by the chorda tympani branch of
the facial nerve.

Tuberculum impar
Lateral lingual swelling Body of tongue
Terminal sulcus

Copula
(hypobranchial Laryngeal "NN
eminence)
Arytenoid swellings

swelling

Fig. 1C.71 Pharyngeal arches involved in development of tongue.

SHORT NOTES

Q.1. Give a detailed account of development of milk Dental lamina

teeth. Oral epithelium Mesenchyme jaw
é iD Zz Permanent
Dental bud
Ans. tooth bud
Inner | Dental
1. By the sixth week of development the basal layer of the Dental Outer! epithelium
epithelial lining of the oral cavity forms a C-shaped A. Bud stage papilla Cap stage
structure—the dental lamina—along the length of the
upper and lower jaws. Ameloblasts
Stellate
2. This lamina subsequently gives rise to 10 dental buds in :
reticulum
Odontoblasts
each jaw, which form the primordia of the ectodermal Enamel
components of the teeth. Dentine
3. The deep surface of the buds invaginates, resulting in Dental pulp
the cap stage of tooth development. As the dental cap Root sheath
grows and the indentation deepens, the tooth takes on
C. Bell stage D. Advanced Bell stage
the appearance of a bell (bell stage).
4. Mesenchymal cells of the papilla adjacent to the inner Fig. 10.7.2 Developmental stages of a tooth bud.
dental layer differentiate into odontoblasts, which later
produce dentine; the remaining cells of the dental 5. Epithelial cells of the outer dental epithelium differenti-
papilla form the pulp of the tooth. ate into ameloblasts, which produce long enamel prisms
Quick Review Series: BDS 1st Year

that are deposited over the dentine. The contact layer Q.2. Describe the structure of tooth (labelled
between the enamel and dentine layers is known as the diagram only).
enamel—dentine junction.
Ans.
6. Formation of the root of the tooth begins when the
dental epithelial layers penetrate into the underlying The structure of tooth is explained in Fig. 1C.7.3.
mesenchyme and form the epithelial root sheath.
7. Cells of the dental papilla lay down a layer of dentine
continuous with that of the crown. Mesenchymal cells
on the outside of the tooth and in contact with dentine
of the root differentiate into cementoblasts and produce
a thin layer of specialized bone—the cementum.
8. Outside of the cemental layer, mesenchyme gives rise to »\ ligament
the periodontal ligament, which holds the tooth firmly
in position and functions as a shock absorber.
—Bone of
With further lengthening of the root, the crown is = socket
gradually pushed through the overlying tissue layers into the
oral cavity. The eruption of deciduous or milk teeth occurs
Fig. 10.73 The structure of tooth: (A) before birth; (B) after eruption.
6-24 months after birth (Fig. 1C.7.2).

SHORT NOTE

Q.1. Karyotype and any two clinical features of each chromosome individually. Classification of chromo-
Turner syndrome. somes in this way is called karyotyping.
Ans.
Example: Turner syndrome: It is characterized by the absence
Individual chromosomes differ from one another in total of ovaries (gonadal dysgenesis) and short stature. Other com-
length, in the relative length of the two arms and in various monly associated abnormalities are webbed neck, lymphoe-
other characteristics; these differences enable us to identify dema of the extremities, skeletal deformities and a board chest.

MISCELLANEOUS
SHORT NOTES

Q.1. Development of pituitary gland. b. A downward extension of the diencephalon—the

infundibulum.
Ans.
2. Rathke’s pouch appears as an evagination of the oral cav-
1. The hypophysis or pituitary gland develops from two ity when the embryo is approximately 3 weeks old, and
completely different parts (Fig. 1C.9.1): subsequently grows dorsally towards the infundibulum.
a. An ectodermal outpocketing of the stomodeum During further development, cells in the anterior wall of
immediately in front of the buccopharyngeal mem- Rathke’s pouch increase rapidly in number and form the
brane known as Rathke’s pouch and anterior lobe of the hypophysis or adenohypophysis.
 Embryology

3. Asmall extension of this lobe—the pars tuberalis-grows
along the stalk of the infundibulum and eventually sur-
rounds it. The posterior wall of Rathke’s pouch develops
into the pars intermedia.
The infundibulum gives rise to the stalk and the pars
nervosa or posterior lobe of the hypophysis (neurohy-
pophysis). It is composed of neuroglial cells. In addition,
it contains a number of nerve fibres from the hypotha-
lamic area.
Q.2. Development of thyroid gland.
Ans.
The thyroid gland appears as an epithelial proliferation
in the floor of the pharynx between the tuberculum impar
and the copula at a point known as the foramen cecum. As a
bilobed diverticulum, the thyroid descends in front of the
pharyngeal gut. During this migration the thyroid remains
connected to the tongue by a narrow canal called the thyro-
glossal duct, which disappears later. (Fig. 1C.5.1).
As the development progresses the thyroid gland descends
in front of the hyoid bone and the laryngeal cartilages. It
acquires a small median isthmus and two lateral lobes by
the time it reaches its final position in front of the trachea
in the seventh week. By the end of the third month the
thyroid begins to function at the time at which the first
follicles containing colloid become visible (Fig. 1C.9.2).
Follicular cells produce the colloid that serves as a source
of thyroxin and triiodothyronine. Parafollicular or C-cells
derived from the ultimobranchial body serve as a source
of calcitonin.
Q.3. Development of parathyroid gland.
Ans.
1. In the fifth week of embryonic development, epithelium
of the dorsal wing of the third pharyngeal pouch dif-
ferentiates into the inferior parathyroid gland.
. Epithelium of the dorsal wing of the fourth pharyngeal
pouch forms the superior parathyroid gland.
. When the parathyroid gland loses contact with the
wall of the pharynx, it attaches itself to the dorsal
surface of the caudally migrating thyroid as the superior
parathyroid gland.

Lumen of
Infundibulum diencephalon Optic chiasma

Pars
tuberalis

Pharyngeal’ a
hypophysis
: Anterior
Sphenoid lobe Pe Nats
“ 7 Pars intermedia
Rathke’s Fal ——Notochord nervosa
A cavity B Cc
pouch

Fig. 1C.9.1 Development of pituitary gland.

Tongue Foramen
Foramen cecum cecum
Hyoid
bone
Thyroglossal
uci
: Ate Pharyngeal

‘ Thyroi
\_ Thyroid
y: >A a
Oesophagus thyroid gland gland
MM
i: T Trachea . Tracheal
Pyramidal
Tongue lobe of rings
Thyroid gland
thyroid gland B
A

Fig. 10.9.2 Development of thyroid gland.

This page intentionally left blank
 PRACTICE Or
FIGURES IN| ;—
_ ANATOMY
This page intentionally left blank
PRACTICE FIGURES
IN ANATOMY

. Bregma
. Superior and inferior temporal lines

WN
. Sagittal suture
sn

Lambda
emote

NOOR
. Lambdoid suture
s--

. Coronal suture
. Parietal foramen
<o

F - Frontal bone
P - Parietal bone

Fig. 1D.1A Norma verticalis.

. Coronal suture
OONDATRWNH=

. Parietal bone
. Temporal bone
. Occipital bone
. Mastoid process
. External auditory meatus
Mandible
Maxilla
Frontal bone

Fig. 1D.1B Norma lateralis.

ik) Quick Review Series: BDS 1st Year

. Sagittal suture

=
. Lambda

DOaARWN
. External occipital protuberance
. Occipital bone
. Mastoid process
. Inferior nuchal line
. Superior nuchal line

OMAN
. Parietal bone
. Lambdoid suture

1. Dangerous area of face

Fig. 1D.2 Dangerous area of face.

1. Temporal
2. Zygomatic
3. Buccal
4, Mandibular
5. Cervical

Fig. 1D.3 Facial nerve—branches.

 Practice Figures in Anatomy

. Common tendinous ring

ONONRWNH=
. Optic canal
. Optic nerve
Ophthalmic artery
. Inferior ophthalmic vein
. Lacrimal nerve
. Frontal nerve
. Superior ophthalmic nerve
9. Trochlear nerve
10. Oculomotor nerve (superior inferior division)
11. Nasociliary nerve
12, Abducent nerve

. Pterion

=
Ooahwonhd
. Asterion
. Parietal bone
. Frontal bone
. Squamous part of temporal bone
. Greater wing of sphenoid

Fig. 1D.5 Skull-lateral view.

Mandibular foramen
PSEDONAARWN>

Inferior alveolar nerve in mandibular foramen

Lingual nerve
. Sublingual fossa
. Submandibular fossa
Mylohyoid groove
Condyle
. Coronoid
Ramus of mandible
. Angle of the mandible
a3

Body of the mandible

Q

Fig. 1D.6 Ramus of mandible—medial surface.

Quick Review Series: BDS 1st Year

. Apical ligament

=
OahwWNnhd
. Alar ligament
. Transverse ligament of atlas
. Scalenus anterior
. Levator scapulae
. Splenius cervicis
. Membrane tectoria

ON
. Ligamentum nuchae
. Obliquus capitis inferior

OahuwoNnnaAoe
. Rectus capitis posterior major

ao
. Spine
. Lamina

aw
. Vertebral canal
. Foramen transversarium

aoa
. Superior articular facet
. Dens

. Anterior longitudinal ligament

=
. Rectus capitis anterior

WN
. Transverse ligament of atlas
be -----ee

. Levator scapulae

Ooh
. Oblique capitis superior
iB
¢,
‘

. Rectus capitis posterior minor

. Ligamentum nuchae
>

ON
‘.

. Posterior tubercle
/ 9. Posterior arch
‘ 10. Transverse process
11. Foramen transversarium
ene 12. Superior articular facet
13. Anterior arch
14. Anterior tubercle

Fig.1D.8 Atlas.

Skin and sub-

cutaneous tissue = [Scalp Loose sub-
Galea aponeurotic Fat aponeurotic
tissue

Dura
Pericranium

Fig. 1D.9 The scalp (S: skin, C: connective tissue, A: aponeurosis, L: loose areolar tissue, P: pericranium).
 Practice Figures in Anatomy

. Lateral nasal

=
. Superior labial

wh
. Inferior labial
. Facial artery

Oak
. Transverse facial artery
. Superficial temporal artery

. Supraorbital

SOCMONMOARWN=
. Supratrochlear
. Angular vein
. Maxillary vein
. Deep facial vein
. Facial vein
Common facial vein
External jugular vein
Posterior auricular
a3 Retromandibular vein
. Superficial temporal vein

Ophthalmic division (V1)

DNODARWN>

Supraorbital
Supratrochlear
Infratrochlear
External nasal
Infraorbital
Maxillary division (V2)
Mandibular division (V3)
9. Mental
10. Buccal
11. Third occipital (C3)
12. Greater occipital (C2)
13. Lesser occipital (C2)
14. Auriculo-temporal
15. Great auricular (C2,3)

Fig. 1D.12 Cutaneous nerves of face.

Quick Review Series: BDS 1st Year

1. Pterygomandibular raphe
2. Superior pharyngeal constrictor
3. Buccinator

Fig. 1D.13 Pterygomandibular raphe.

1. Lacrimal gland
a. Orbital portion
b. Palpebral portion
2. Lacrimal vessels and nerve
3. Orbital septum
1 4. Lateral horn of levator aponeurosis

Fig. 1D.14 Lacrimal gland.

1. Lacrimal puncta
2. Lacrimal canaliculi
3. Lacrimal sac
3 4. Nasolacrimal duct
4 5. Middle meatus
NN 6. Lacrimal fold
Tht —*4 7. Inferior meatus
; / mS 8. Lacrimal gland
Maxillary 4 pi ° 9. Lacrimal ducts
‘. sinus 1 NS. . .
_ / [sss _ 10. Conjunctival sac

Fig. 1D.15 Lacrimal apparatus.

 Practice Figures in Anatomy

1. Sternomastoid
2. Upper trunk
3. Lower trunk
4. Subclavian artery and vein
5. Pectoralis major
6. Deltoid
7. Delto-pectoral triangle
8. Middle trunk

Fig. 1D.16 Subclavian triangle.

1. Internal carotid artery

2. External carotid artery
3. Common carotid artery
A. Internal jugular vein
5. Vagus nerve
6. Sympathetic trunk
7. Ansa cervicalis

1. Occipital artery
2. Splenius capitis
3. Sternomastoid
4. Scalenus medius
5. Inferior belly of omohyoid
6. External jugular vein
7. Subclavian artery
8. Anterior jugular vein
9. Clavicle
10. Superior nuchal line
11. Semispinalis capitis
12. Levator scapulae
13. Lymph node
14. Transverse cervical artery
15. Suprascapular nerve
16. Suprascapular artery and vein
17. Subclavian vein (behind clavicle)

Fig. 1D.18 The posterior triangle—boundaries and floor.

Zt) Quick Review Series: BDS 1st Year

1. Superficial temporal
2. Transverse facial
3. Maxillary
4. Posterior auricular
5. Occipital
6. Ascending pharyngeal
, oo f 7. Facial
a t
foe
> i ss
a \J ear 4 8 8. Lingual
i
iON 9. Superior thyroid
ON
N, \
1
ot
RS
\ 9
yy yy a
NN
.

Fig. 1D.19 External carotid artery.

1. Sternocleidomastoid
2. Trapezius
3. Omohyoid
4. Subclavian triangle
5. Occipital triangle

1. Posterior belly of digastric

2. Anterior belly of digastric
3. Superior belly of omohyoid
4. Sternocleidomastoid
5. Posterior triangle
6. Inferior belly of omohyoid
7. Trapezius

Fig. 1D.21A Posterior triangle—boundaries.

 Practice Figures in Anatomy

Lesser occipital nerve

ONOaARWnsa
Greater auricular nerve
Transverse cutaneous nerve of neck
Sternocleidomastoid muscle
Posterior triangle
Spinal accessory nerve
Levator scapulae muscle
Trapezius muscle

Fig. 1D.21B Posterior triangle of the neck—contents.

1. Stylopharyngeus muscle
2. Stylohyoid muscle
3. Styloglossus muscle
4. Stylohyoid ligament
5. Stylomandibular ligament

. Intercavernous sinus
OONDATRWNH=

. Cavernous sinus
. Inferior petrosal sinus
. Marginal sinus
Right sigmoid sinus
. Right transverse sinus
Confluence of sinuses
. Left sigmoid sinus
. Left transverse sinus

Fig. 1D.23 Dural venous sinuses.

i929 Quick Review Series: BDS 1st Year

. Cavernous sinus

ONOATRWNH=
. Pituitary gland
. Internal carotid artery
. Ill Nerve

N.
IV Nerve
. Ophthalmic nerve (V1)
VI Nerve
. Maxillary nerve (V2)

Fig. 1D.24A Cavernous sinus.

. Anterior intercavernous sinus

Fenmenaogce
. Posterior intercavernous sinus
. Superficial middle cerebral vein
. Inferior cerebral vein
. Hole for stalk of pituitary body
Ophthalmic veins
. Sphenoparietal sinus
. Middle meningeal sinus
Cavernous sinus
Emissary sphenoidal foramen
- AS

. Foramen ovale
Foramen spinosum
. Superior petrosal sinus
33

. Inferior petrosal sinus

. Free margin of tentorium

agaraepreanown

. Tentorial notch
. Tentorium cerebelli
. Left transverse sinus
. Straight sinus
. Midbrain cut
. Right transverse sinus

Fig. 1D.25 Tentorium cerebelli—superior view.

 Practice Figures in Anatomy

--
“ ~ S,
“ew iitt AON,
a“oe
Ys iy
N.
sO
‘. N
fy " .
if I ‘
ff i AN
ff u ‘
if " 1
{ foneons, H
ily “S if
if
i X
\ ¥
Anterior communicating artery

ONOOARWN
i?
pd? Internal carotid artery
tf?
ae
if Anterior cerebral artery
te
it
rt
. Middle cerebral artery
ri
it
tt
Posterior communicating artery
tt
tt . Posterior cerebral artery
vt
it . Basilar artery
yl
yt
AA
wa
. Vertebral artery
,\
yy)
A
‘

Fig. 1D.26 Circle of Willis.

a. Superior sagittal sinus

b. Falx cerebri
c. Inferior sagittal sinus
d. Diaphragma sellae
e. Straight sinus

Fig. 1D.27A Falx cerebri.

1. Superior sagittal sinus

ql
lee

2. Falx cerebri
"1

3. Inferior sagittal sinus

\
\
\
1
!
J
!
t
!
L

Fig. 1D.27B Falx cerebri.

i) Quick Review Series: BDS 1st Year

(A) Branches of maxillary artery (first part)

A1 Deep auricle artery
A2 Anterior tympanic artery
A3 Middle meningeal artery
A3 and A4 A4 Accessory meningeal artery
A2——\\ ft AS Inferior alveolar artery

Ati———* ‘I ttit .
(B) Branch of maxillary artery
\ iV B1 Deep temporal artery
\ ws / ] B2 Pterygoid artery
\ x Z B3 Masseteric artery
7 B4 Buccal artery
Wot Ss B2
WN - AS (C) Branch of maxillary artery (third part)
‘ Sta C1 Posterior superior alveolar artery
4 ese C2_ Infraorbital artery
! XY C3 Sphenopalatine (terminal part)
C4 Pharyngeal artery
C5 Artery of pterygoid canal

Fig. 1D.28 Branches of maxillary artery.

. Submandibular triangle

=
OoahkwWhd
. Anterior belly of digastric muscle
. Carotid triangle
. Superior belly of omohyoid muscle
. Muscular triangle
. Posterior belly of digastric muscle
. Sternocleidomastoid muscle
ON

. Clavicle

Fig. 1D.29 Contents of carotid triangle.

ee

Inferior labial artery

aohwn-a

. Superior labial artery

oo

. Lateral nasal artery

. Angular vessels
. Dorsal nasal artery

Fig. 1D.30 Facial artery.

 Practice Figures in Anatomy

. Facial artery

=
. External carotid artery

Oak
wns
. Lingual artery
. Vena comitans of lingual artery
. Geniohyoid
. Position of sublingual gland
. Genioglossus

ON
. Dorsalis linguae artery
N

Fig. 1D.31 Lingual artery.

Superior roots of ansa cervicalis

A To superior belly of omohyoid
=

A To sternohyoid
wonh

A To sternothyroid
N

=|

A4 To inferior belly of omohyoid

Hypoglossal nerve
>

B1 Ventral ramus of C1
B2
‘.

Ventral ramus of C2
B3 Ventral ramus of C3
Inferior root of ansa cervicalis (descending cervicalis)

Fig. 1D.32 Ansa cervicalis.

Supraorbital vein
-serwaogp

Supratrochlear vein
Angular vein
Superficial temporal vein
Maxillary vein
Retromandibular vein
Deep facial vein
Facial vein
Common facial vein
Posterior auricular vein
k. External jugular vein

Fig. 1D.33 External jugular vein.

i? Quick Review Series: BDS 1st Year

ee”
freee
1. Cervical
iy 2. Buccal

All 3. Mandibular
ih 4. Temporal
ay
“it

1,

Fig. 1D.34 Branches of facial nerve on face.

1. Facial nerve (VII)

2. Retromandibular
vein
1 3. External carotid artery
3 Branches of facial nerve:
T. Temporal branch
Z. Zygomatic branch
B. Buccal branch
‘ M. Mandibular branch
©) an C. Cervical branch
3—_H/ V “7s

Weer
~ ti 7
' “3
i
yi c
Fig. 1D.35 Structures within parotid gland.

$e 1. Parotid duct
Zw 2. Masseter muscle
3. Parotid gland

Fig. 1D.36 Parotid duct—relations.

 Practice Figures in Anatomy

1. Masseter muscle

Fig. 1D.37 Masseter muscle.

1. Condyloid process
2. Lateral pterygoid muscle
3. Coronoid process
4. Temporalis
5. Inferior temporal line
6. Superior temporal line

Fig. 1D.38 Temporalis muscle.

Deep head of medial pterygoid

N@OoORWN>

Insertion of lateral pterygoid into pterygoid fovea

Articular disc
Fibrous capsule
Superficial head of medial pterygoid
Pterygomaxillary fissure
Upper and lower head of lateral pterygoid

Fig. 1D.39 Lateral pterygoid muscles.

iE) Quick Review Series: BDS 1st Year

. Submental lymph nodes

=
. Anterior belly of digastric

DoaABRWNH
. Mylohyoid
. Hyoglossus
. Posterior belly of diagastric
. Pulley
. Facial artery
7 a

-OOaAN
. Nerve to mylohyoid
. Submental artery
fie . Masseter
Dy h

a3
opt

. Hyoid bone
/
/

Fig. 1D.40 Relations of mylohyoid muscle.

/ yoTN
NON
{ Pry Ny \
| VV 1
\ VASA
SS NTN 4 }
\ Nin ~7 & so |
\ we oN, a co /
\. w\ NN “7 Uf fy 1. Mandible (lower border)
NL 5 YN saan Ue Ya 2. Anterior belly of digastric muscle
~AY SOS. 3 Oe Yo (from digastric fossa of mandible)
\ en (/) ee 3. Intermediate tendon held by
\ i 7a “>> ( fibrous pulley to hyoid bone
1 Ss e 47 \ 4. Hyoid bone
\ \ 5. Posterior belly of digastric muscle
{ \ (mastoid notch of temporal bone)
' \
\,

Fig. 1D.41 Digastric muscle.

if
1 Ss ‘. “\
\ \ 7
NY 7
*\ Y Vo" 7

fy wee 77 “ 1. Styloglossus muscle

a —. ™ —_——— .
he er, TNT \~ 2. Submandibular gland
/ \ YY \ 3. Hyoglossus muscles
5—_+ } > ~~ \ 4. Geniohyoid muscle
Ve! ~~ \ 5. Mandible
SN 2 6. Submandibular
duct
eaNON \\
\ Sy, at 3
MP ee
oe
4
Fig. 1D.42 Submandibular gland.
 Practice Figures in Anatomy

. Semilunar ganglion

=
. Minor petrosal nerve

NOOO
fh WDM
. Otic ganglion
. Auriculotemporal nerve
. Tympanic nerve
. Glossopharyngeal nerve
. Parotid gland

Fig. 1D.43 Otic ganglion.

Semilunar ganglion

ONOaARWN>
Lingual nerve
Facial nerve
Chorda tympani
Submandibular ganglion
Submandibular gland
Sublingual gland
Lingual nerve

Fig. 1D.44 Submandibular ganglion.

wo

10

8 a“ <
(
oA
(TAN sy Oesophagus
7: on ay -)
PSEDONAARWN>

Prevertebral fascia
“xX
YY
fore
C2 ‘7 y,
474
—
x
x N xs)
NTA
N ~\
“Y
\ Carotid sheath
Z 7 4s “7 7s \ N \
Thyroid gland
Trachea
\ \ Na oN3 \ \ Omohyoid
4
i oyft ia
fo ftonert
eI
yyday4 \y\Vy 4\ Sternocleidomastoid
ly Cv O A--—~ XN 11 Sternohyoid
\ 1! (C™~->> \ | }

WAG FO GB Y
Sternothyroid
\ | | POTN Yuan? aot. I i /
Recurrent laryngeal nerve
oo

Parathyroid gland
,

3 N \N J) oo } SZ 7} /
\ ~ & / NC We) y
NNSA Ty Dem TT Tn er
N VL sly v4
N Sy yo \ 7
2———= 41 a

Fig. 1D.45 Thyroid gland and its relations.

Quick Review Series: BDS 1st Year

. Tensor aponeurosis

=
. Pterygoid hamulus

wh
. Palatopharyngeus
. Palatoglossus

oak
. Musculus uvulae
. Levator veli palatini

Fig. 1D.46 Muscles of the soft palate.

Mylohyoid

ONOOARWNH>
Hyoglossus
Thyrohyoid
Trachea
Oesophagus
Superior constrictor pharynx
Middle constrictor pharynx
Inferior constrictor pharynx

mf
11
19 12
rin
. Orbital plate of frontal bone

Vac | A eaA |
\ _-——~ -_—--~ I
ONOARwWNS

. Orbital plate of ethmoidal labyrinth

booet NN SN Perpendicular plate
i Obit YOOV\APZASY orbit \ | Nasal cavities
2—+- +L NY) I ASG 11 Palate
VA PYAyN UL M7444
+ +10
VON wLs¥~\\ Il tye S 4] Nasal septum
3S {=~ =e 9 Inferior concha
- 7 me EN OS ~ {\ . Ostium
ge A H ra \ | 8 Middle concha
Vo re dE Zt jf Ethmoidal sinuses
\ oS Maxillary | 1 \\ Wk ( 1 | Maxillary oN (
ero
aoa

- y sinus 7! ly by sinus,7° “ . Superior concha

\ \ 7 i-—+|-7—3 XN / / . Crista galli
SNe OY TT TIT TN NSS LZ . Cranial cavity, cribriform plate
\ / \ 7
\\ | 5 6 7 i //

Fig. 1D.48 Coronal section through skull.

 Practice Figures in Anatomy

. Opening of posterior ethmoidal cells

SCOMNMATMA
. Opening of sphenoidal sinus

WN
. Bulla ethmoidalis
. Opening of maxillary sinus
. Hiatus semilunaris
. Opening of nasolacrimal duct
Opening of frontal sinus as infundibulum
Opening of middle ethmoidal cells
Vestibule
Opening of anterior ethmoidal cells

=
1. Olfactory bulb
2. Posterior superior lateral nasal nerve
3. Pterygopalatine ganglion
4. Pharyngeal nerve
5. Lesser palatine nerve
6. Greater palatine nerve
7. Anterior ethmoidal nerve
8. Internal and external nasal nerve
9. Posterior inferior lateral nasal nerves

Fig. 1D.50 Nerve supply of nasal cavity.

1. Posterior ethmoidal artery

2. Sphenopalatine artery
3. Greater palatine artery
4. Anterior ethmoidal artery
5. Twigs from facial artery

Fig. 1D.51 Arterial supply of nasal cavity.

Quick Review Series: BDS 1st Year

pp ~
'
1!
'
I
wens ee Or. oy Ye 1. Ethmoidal sinuses
(Oy! 0; 2. Nasal septum
he oad /O-——1 3. Middle ethmoidal sinus
g— oO. thon 4, Maxillary sinus
9 ror ‘ “oO 5. Floor of nose
~ if ee 6. Palate forming roof of mouth
corr “aN ft Oc 3 7. Floor of anterior cranial fossa
10 PogrnOr
it ee
tad let ‘ 4' 8. . Orbi
Orbit
v4 ‘ot to oes, ——-4 9. Superior concha
Pm ws pe EN 10. Middle concha
40 NA gy ae ns 11, Maxillary hiatus
soe Te 12. Inferior concha

yee ped
Fig. 1D.52 Maxillary sinuses.

1 aN -

Ss)
~ ~
9 / ‘ SNy 3
i / / I| ‘ 1, . Meningeal
Meningeal llayer
ayer ofof d dura it
mater
/z / 2. Oculomotor nerve
3—_L’ ~\)) JAily Sey 10 3. Trochlear nerve
,—_}, C / ses, 4. Cavernous sinus
/a / / ([7TN fo \ 5. Maxillary nerve
KO) + a) \y \ \ 6. Mandibular nerve
° / c (o il Vy rv. ? 7. Abducent nerve
/Y> VA / ol | \ \ | 8. Internal carotid artery
)) y / i _ Ses] 9. Sphenoidal sinus
6 Yo ti—— es Y 10. Hypophysis cerebri
= _o ~~ ~
Cy oT
t 7 8
NL?

Fig. 1D.53 Sphenoidal air sinuses.

1. Vallecula
2. Epiglottis
3. Median glossoepiglottic fold
4. Lingual follicles
5, Foramen caecum
6. Vallate papillae
7. Foliate papillae
8. Fungiform papillae
9. Filiform papillae
10. Area for internal laryngeal nerve (X)
11. Lateral glossoepiglottic fold
12. Palatine tonsil
13. Area for glossopharyngeal nerve (IX)
14. Area for lingual nerve (V3) with chorda tympani (VII)

Fig. 1D.54 Tongue—external features.

 Palatoglossus

SOBNAARONA
Hyoglossus
Genioglossus
Geniohyoid and mylohyoid
Hyoglossus
. Styloglossus
. Superior pharyngeal constrictor
Stylopharyngeus
. Stylohyoid ligament
. Middle pharyngeal constrictor

=
Fig. 1D.55 Musculature of the tongue.

SO ‘ ‘ 1. Anterior malleolar fold

\ \ 2. Pars flaccida
‘ 3. Posterior malleolar fold
4. Position of handle of malleus
5. Pars tensa (outer surface)

1. Short process and body of incus

2. Head, anterior process and handle of malleus
3. Pars tensa
4. Chorda tympani

Inner surface

Fig. 1D.56 Tympanic membrane.

 . Levator palpebrae
. Superior rectus
. Optic nerve
Ae % ‘ 4 . Inferior oblique
4,
feat ‘ie sy al
Alte
th ig Wak G7 . Inferior rectus
as, a
Lae teOT We
“iguin Ge S L PRL
OAT, 7,
u z4 awl 7 . Optic nerve
piiuia fe re fof,
yt aah ae afs AG 5
WihaAL aE Be 4,
“Lt at 72% Superior rectus
. Levator palpebrae
. Lateral rectus
. Superior oblique
é
ut ae BMGT
nlyextih
ag pw 1 Soa WLTe a, . Medial rectus
HEhy Wee, Set. Myler
hel by fy Ny
oe, be. “ & 4 07116,47
% 7, ee
ON Ngee AGU yt 8
ey vy hee 4. GOTT ES 777, 1 ga e
Ve SE ole Lag ooo

Fig. 1D.57 Muscles of the eyeball.

GENERAL ANATOMY

VIVA QUESTIONS

. What is bregma? 15. Ascending palatine artery is a branch of which artery?

Ans. Bregma is the name given to the junction of the coronal and Ans. Facial artery.
sagittal sutures.
16. Arterial supply of submandibular gland is through which branch
. What is ‘pterion’? of External Carotid Artery?
Ans. Pterion is a point of articulation of four skull bones namely Ans. Facial artery.
frontal, parietal, sphenoid and temporal bones.
17. Which artery is the major blood supplier of hard palate?
. Which bone divides lateral part of middle cranial fossa and
Ans. Greater (anterior) palatine artery.
posterior cranial fossa?
Ans. Petrous temporal bone. 18. Facial artery is a branch of which artery?
Ans. External carotid artery.
. Name a skull bone with which the maxilla does not articulate.
Ans. Temporal bone. 19. Which nerve is accompanied by superior thyroid artery?
. Which is the highest point on skull? Ans. External laryngeal nerve.
Ans. Vertex.
20. Where does the common carotid artery divide into ICA and ECA?
. Name a foramen present on the external surface of mandible. Ans. The common carotid artery divides into ICA and ECA near
Ans. Mental foramen. thyroid cartilage.

. Among foramen rotundum, ovale and lacerum in the base of 21. Name the actions of head that result due to constriction of
skull, which one is the most posteriorly present? sternocleidomastoid muscle.
Ans. Foramen lacerum. Ans. Bending the head to same side and rotation of head to
opposite side.
Where is mental foramen located?
Ans. Mental foramen is located on the labial surface of mandible 22. Name any one of the parts of posterior triangle of neck.
between the roots of first and second premolars. Ans. Occipital triangle.
The palatine bone furnishes the link between which bones?
23. Which muscle is supplied by ansa cervicalis?
Ans. Maxilla and the sphenoid bone.
Ans. Sternohyoid muscle.
10. Lingual surface of mandible gives attachment to which ligaments,
name any one?
24. What is the action of digastric muscle?
Ans. Elevates the hyoid bone.
Ans. Sphenomandibular ligament.
11. The carotid artery may be palpated at which region on neck? 25. Isthmus of thyroid gland is present across which tracheal rings?
Ans. Thyroid cartilage. Ans. Second to fourth tracheal rings.

12. Which vessel facilitates the arterial supply of trachea? 26. Give another name for pachymeninx.
Ans. Inferior thyroid artery. Ans. Arachnoid mater.

13. First part of vertebral artery is related to which structure? 27. The spinal dura extends from the foramen magnum to the lower
Ans. Stellate ganglion. border of which vertebra?
Ans. Second sacral vertebra.
14, Pulsations felt in the suprasternal space are probably due to which
artery? 28. The spinal cord ends at the lower border of which vertebra?
Ans. Inferior thyroid artery. Ans. First lumbar vertebra (L1).
Quick Review Series: BDS 1st Year

29. Lumbar puncture is usually done in between which vertebrae? 49. Where is the origin of maxillary artery?
Ans. Third and fourth lumbar vertebrae (L3 and L4). Ans. Neck of condyle.

30. What do you call the pia mater which continues below the spinal 50. The inferior dental artery (inferior alveolar) is a branch of which
cord? artery?
Ans. Filum terminale. Ans. Maxillary artery.

31. Name the foramen through which the mandibular nerve passes. 51. Middle meningeal artery is a branch of which artery?
Ans. Foramen ovale. Ans. Maxillary artery.

32. Which structure may be encountered, when the needle for infe- 52. How is the middle meningeal artery related to pterion?
rior alveolar nerve block passes more posterior at the level of Ans. Middle meningeal artery gives an interior branch which runs
mandibular foramen? deep to the pterion.
Ans. Parotid gland. 53. Name one of the branches of second part of maxillary artery.
33. All the muscles of soft palate are supplied by laryngeal plexus,
Ans. Deep temporal artery.
except one muscle; name it. 54. Name the main arterial trunk which is supplying the infratempo-
Ans. Tensor veli palatini. ral fossa.
Ans. Maxillary artery.
34. Infraorbital nerve leaves pterygopalatine fossa through which
foramen? 55. Which veins form the retromandibular vein?
Ans. Inferior orbital fissure. Ans. Superficial temporal and maxillary veins.

35. Name the ganglion which does not contain postganglionic para- 56. Where does the duct of parotid gland open?
sympathetic fibres. Ans. The duct of parotid gland opens in buccal vestibule opposite
Ans. Geniculate ganglion. maxillary second molar.

36. Name the muscle of palate, which works around hamular notch 57. Lymph from middle part of lower lip drains directly into which
and forms a tendon. nodes?
Ans. Tensor palatine. Ans. Submental nodes.

37. How are the two lateral walls of the orbit located? 58. During removal of submandibular gland which nerve gets injured?
Ans. Perpendicular to each other. Ans. Hypoglossal nerve.

38. Supratrochlear and supraorbital nerves are branches of which nerve? 59. Which nerve supplies submandibular gland?
Ans. Frontal nerve. Ans. VII nerve.

39. What is uveal tract of the eyeball? 60. Which branch of facial artery leaves the submandibular gland,
Ans. Vascular coat. runs forwards anteriorly over the mylohyoid muscle and branches
into deep and superficial branches?
40. Name the blood supply of cornea.
Ans. Submental artery.
Ans. Cornea is an avascular structure.
61. Which complication results from damage to internal laryngeal
41. Auriculotemporal nerve is secretomotor to which salivary gland?
nerve?
Ans. Parotid gland. Ans. Anaesthesia of larynx.
42. Which salivary gland is purely serous? 62. Which complication results from damage to external laryngeal
Ans. Parotid gland. nerve?
43. Name the ganglion which lies just below the foramen ovale. Ans. Loss of timbre of voice.
Ans. Otic ganglion. 63. Lymph from tonsils drains into which group of nodes?
44. Which gland is supplied by secretomotor fibres from inferior Ans. Jugulodigastric group of nodes.
salivary nucleus?
64. Which artery is the main arterial supply of the tonsil?
Ans. Parotid gland. Ans. Facial artery.
45. How many terminal branches of facial nerve emerge along the 65. Which is the main nerve supply of palatine tonsils?
anterior border of parotid gland? Ans. Glossopharyngeal nerve.
Ans. Five.
66. Which is the narrowest part of Gastro Intestinal Tract?
46. Name the muscles which are fan shaped?
Ans. Pharyngoesophageal junction.
Ans. Middle constrictor and temporalis muscles.
67. Which is true of tonsils?
47. Which structure associated with the Temporo Mandibular Joint
Ans. Drained by jugulodigastric lymph nodes.
is fibrous, saddle shaped and separates the condyle and the tem-
poral bone? 68. The oesophagus commences at which level?
Ans. Articular disc (meniscus). Ans. Lower end of cricoid.
48. Transverse facial artery is a branch of which artery? 69. From where does the primary germ layer endoderm is derived?
Ans. Superior temporal artery. Ans. Yolk sac.
 General Anatomy

70. Name the posterior boundary of carotid triangle. 85. In adults, haemopoiesis takes place in which tissues?
Ans. Sternocleidomastoid muscle. Ans. Bone marrow and lymphoid tissues.

71. Which paranasal sinus is formed before birth? 86. Auditory cortex lies in which lobe of the brain?
Ans. Maxillary sinus. Ans. Temporal lobe.

72. Name the nerve of third branchial arch. 87. What connects the right and left hemispheres of the brain?
Ans. Glossopharyngeal nerve. Ans. Corupus callosum.

73. Which nerve supplies sphenoidal air sinus? 88. Which is not a part of brain stem?
Ans. Posterior ethmoidal nerve. Ans. Cerebellum.

74. Tongue develops from which all structures? 89. Which is separated by the Sylvian fissure of cerebrum?
Ans. Tongue develops from tuberculum impar, hypobranchial Ans. Temporal and frontal lobes.
eminence and lingual swellings.
90. In which lobe primary motor area for speech is located?
75. When does the natural drainage from the infected maxillary air Ans. Frontal lobe.
sinus best?
91. Who is the father of modern anatomy?
Ans. Lying on the unaffected side.
Ans. Andreas Vesalius.
76. Name the extrinsic muscles that aid in depressing the tongue.
92. Which is related to the ducts of Bellini?
Ans. Genioglossi and hyoglossi muscles.
Ans. Kidney.
77. Which is the main arterial supply to the tongue?
93. Posterior most part of stomach is
Ans. Lingual artery.
Ans. Fundus.
78. Which muscle of tongue runs from dorsum of tongue to ventral
94. At which level the oesophagus commences?
surface?
Ans. Lower end of cricoids.
Ans. Verticalis muscle.
95. Which does not form the right border of heart?
79. Which is the safety muscle of tongue?
Ans. Ascending aorta.
Ans. Genioglossus muscle.
96. What is the functional unit of lung?
80. Which is the prime muscle in floor of the mouth?
Ans. Alveoli.
Ans. Mylohyoid muscle.
97. Where does the McBurney’s point locate?
81. In fetal circulation, the shunt between pulmonary trunk and Ans. Caecum.
aorta is called
Ans. Ductus arteriosus. 98. Through which foramen, the lesser peritoneal sac communi-
cates with the greater peritoneal sac?
82. What is the other name of the auditory tube? Ans. Epiploic foramen.
Ans. Eustachian tube and pharyngotympanic tube.
99. Name the endocrine glands which are without the influence of
83. Which branchial arches form the tongue? pituitary gland.
Ans. Tongue is formed from first, third and fourth branchial arches. Ans. Adrenal cortex, parathyroid and islets of Langerhans.

84. Where are the ‘sound sensitive’ hair cells of the inner ear located? 100. Which gland has minimum role to lead basic life?
Ans. Organ of Corti. Ans. Adrenal medulla.
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PHYSIOLOGY |=
—
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PHYSIOLOGY

SHORT NOTES

Q. 1. Mitochondria. 4. Aerobic metabolism occurs in mitochondria. They

contain enzymes and coenzymes that help in the
Ans.
formation of ATP, which provides energy for body
1. Mitochondria are one of the cell organelles present in a needs.
typical animal cell are distributed throughout cell cyto-
plasm and are oval or elongated in appearance. Q.2. Derivatives of cholesterol and their impor-
. The size, shape and number of mitochondria vary from cell tance.
to cell, measuring about 5-12 jum in length and 0.5-1 jum Ans.
in width. The number of mitochondria present in a cell is
related to the degree of activity exhibited by it. The normal level of cholesterol in blood is 150-250 mg%.
. They are double-layered membrane organelles. The inner Liver is the main site of the breakdown of cholesterol and
lining is thrown into folds called cristae to form complete yields important products like bile acids, provitamin D,; and
or incomplete partitions within the mitochondria. precursors for the synthesis of steroid hormones.

TYPES
OF TISSUES
SHORT NOTE

Q. 1. Epithelial tissues. 2. Transitional

3. Compound.
Ans.

Epithelial tissue is basically cellular in nature and intercellular Simple Epithelium

substance is restricted to the binding material between cells.
1. Simple epithelium is present all over the body and is
Three different types of epithelial tissue are as follows: made of a single layer of cells usually resting on a base-
1. Simple ment membrane.
Quick Review Series: BDS 1st Year

2. Depending on its physical appearance, it is classified as:
squamous, cuboidal, columnar or ciliated epithelium.
The functions of simple epithelium are:
1. Filtration of substance in the Bowman’s capsule
Diffusion of gases in lung alveoli
YN
Example: Transitional epithelium is present in the pelvis
of the kidney, ureters and proximal urethra; and seems to
prevent reabsorption of excretory products.
Stratified Epithelium or Compound Epithelium
1. It is multilayered and the upper layers are horny due

Absorption of substances in the intestine to the presence of keratin. The intermediary region con-
Movement of mucus in the respiratory tract
tains flattened cells and deeper layers exhibit polyhedral
ae

Secretion of juices in glands. cells.

Transitional Epithelium
It consists of cells arranged in 3-5 layers. The upper layer
of cells is made up of flattened cells, which may have two
nuclei, but deeper layers are made of polyhedral cells.
2. The thickness of stratified epithelium varies in different
parts of the body.
Example: The outer protective covering of the skin. It is non-
keratinized in cornea.

LONG ESSAYS

Q. 1. Enumerate plasma proteins giving normal val- Albumin

ues. Explain any five functions of plasma protein.
Albumin content of plasma is 4—4.5 g%.
Ans. It forms the major bulk of plasma proteins and has a
molecular weight of 69,000.
Plasma contains various proteins referred to as plasma pro-
teins. These proteins have several important physiological
Globulin
functions.
It has a relatively higher molecular weight of 130,000. Vari-
Important plasma proteins are as follows:
ous types of globulins have been identified like alpha, beta
1. Albumins — 48 g/L, 4.8 g%, 70,000 mol. wt.
and gamma globulin. The prothrombin which helps in the
2. Globulins — 23 g/L, 2.3 g%, 21,000 —150,000 mol. wt.
coagulation is a beta globulin. The gamma globulin plays an
3. Fibrinogen — 3 g/L, 0.3 g%, 340,000 mol. wt.
important role in antibody formation.
Normal A/G ratio —1.5:1
Fibrinogen
Other physiological important plasma proteins are as follows:
1. Prothrombin This protein is required for coagulation of blood. The chem-
Angiotensinogen ical nature of clot is fibrin, which is formed from fibrinogen.
Wh

Complement system Fibrinogen and prothrombin are utilized in the clotting.

Kinin system
Other blood clotting factors Functions of Plasma Proteins
Fibrinolytic system
SND

1. Colloidal osmotic pressure: This is responsible for pre-

Lipoproteins
venting fluid exit from the capillaries. It is 25 mmHg.
Haptoglobin
Albumin being the major plasma protein primarily
9. Fetuin
influences the colloidal osmotic pressure.
10. o,-antitrypsin
2. Protective or immune function: The gamma globulins
11. Proteins C and $
produce antibodies, which form an essential defence
12. Transport proteins like
mechanism. The gamma globulins are known as immu-
a. Transferrin
noglobulins, which are of five types, namely, IgA, IgG,
b. Ceruloplasmin
IgD, IgE and IgM.
c. TBG, TBPA and CBG.
3. Coagulation: Fibrinogen, prothrombin and antihaemo-
The important plasma proteins are discussed. philic globulin are important plasma proteins involved

in the clotting of blood. Various other clotting factors
also belong to globulins.
4. Transport media: Certain substances like CO, some of
the hormones, metals, drugs, dyes, etc. bind themselves
with albumin, alpha and beta globulins, and are trans-
ported in the circulation to different parts of body by
plasma proteins.
5. Erythrocyte sedimentation rate: ESR is influenced by
the fibrinogen content of plasma.
6. Viscosity: It is one of the factors that maintain the
normal blood pressure. Plasma proteins and RBCs
contribute about 50% each to total viscosity of blood.
Fibrinogen and globulins due to their high molecular
weight and irregular shape contribute to viscosity of
blood.
7. Buffer mechanism: Plasma proteins act as buffers and
maintain acid—base balance in the body.
8. Protein reserve: Plasma proteins act as protein reserve of
the body. During starvation or emergency, cells of the
reticuloendothelial system break them into amino acids,
which are subsequently used for the synthesis of cell
protein.
Q. 2. Classify WBCs and describe their function
with diagrams.
Ans.
White blood cells or leucocytes are the largest of all formed
elements in the blood. They are larger than erythrocytes and
contain a nucleus. Normal leucocyte count varies from 4000
to 11,000 cells/cu mm of blood. In children the WBC count
ranges from 18,000 to 25,000 cells/cu mm of blood. The life
span of white cells is very short and ranges from a few hours
to 2-3 days.
Based on the shape, size and appearance of the white cell
the leucocytes are of five different types.
Depending on the presence or absence of granules in the
cytoplasm the leucocytes are classified into the following:
1. Granulocytes
2. Agranulocytes
The granulocytes are the cells which contain granules in
their cytoplasm; and the cells which do not contain granules
are called agranulocytes.
Granulocytes
Based on staining property and characteristics of granules
in the cytoplasm, the granulocytes are further classified as
follows:
1. Neutrophils
2. Eosinophils
3. Basophils.
Neutrophils
1. They constitute 60-70% of the total leucocyte count.
Physiology
2. They have a multilobed nucleus and the number of
lobes usually range from three to five. Cytoplasm con-
tains fine granules, which take neutral stain.
3. Neutrophils exhibit phagocytosis and their count in-
creases in acute infections like pneumonia, appendicitis,
tonsillitis, abscesses or boils.
4. Physiologically, an increase in the neutrophil count is
observed during menstruation, pregnancy and muscu-
lar exercise.
5. Neutrophil granules contain many enzymes like myelo-
peroxidase and proteases, which help in the destruction
of invading microorganisms. The process of phagocyto-
sis includes the mechanisms such as chemotaxis, opso-
nization, ingestion and degranulation.
6. The neutrophils also release thromboxanes, leukotri-
enes. The latter increase the vascular permeability
and cause migration of more neutrophils to the site
of inflammation.
7. Reduced count of neutrophils is known as neutropenia.
Examples: typhoid, malaria, aplastic anaemia and under
the influence of various drugs.
Eosinophils
1. They have usually a bilobed nucleus and show the pres-
ence of relatively large granules, which take an acido-
philic or orange stain.
2. Normal eosinophil count ranges from 2 to 5%.
3. Increase in eosinophil count is known as eosinophilia.
Examples: allergic conditions and in parasitic infestations.
4. Decrease in eosinophil count constitutes eosinopenia
and can be seen in acute pyogenic infections, ACTH or
steroid therapy.
5. They also show mild phagocytosis.
Basophils
1. The nucleus in these cells is usually bilobed and cyto-
plasm contains coarse blue granules.
2. Their normal count ranges from 0 to 1%.
3. Basophils release heparin, which is an anticoagulant.
It also releases histamine and this occurs specially in
hypersensitivity reactions such as anaphylactic shock.
4. The basophil count increases in polycythaemia and
chronic myeloid leukaemia.
Agranulocytes
They are of two types, namely
1. Lymphocytes
2. Monocytes.
Lymphocytes
1. These cells have a large oval or rounded nucleus, and
there is a thin strip of clear nongranular cytoplasm
between the nucleus and cell membrane.
Quick Review Series: BDS 1st Year

2. The differential lymphocyte count ranges from 20 to Agglutinogen means antigen and agglutinin means anti-
30%. These cells show a significant increase in chronic body.
infections like tuberculosis.
Karl Landsteiner law states:
3. Lymphocytes are responsible for providing immunity to
1. If an agglutinogen is present on the red cells of blood,
the body.
the corresponding agglutinin must be absent from the
4. There are two functionally distinct types namely “T’
plasma.
lymphocytes and ‘B’ lymphocytes. They are involved in
2. If the agglutinogen is absent, the corresponding aggluti-
immune and defence mechanisms.
nin must be present.
Monocytes
Classical ABO System
1. These are the largest white cells (15 jum) and have a
kidney-shaped nucleus, which is eccentric in location. 1. This is based on the presence of two antigens A and B on
the cell membrane of RBC. Thus, there are four blood
One side of the cell shows larger amount of non-granular
cytoplasm. groups — A, B, AB and O.
2. ‘A has two subunits Al and A2. So in all, there are six
2. The normal monocyte count is 3-8%.
blood groups — Al, A2, B, A1B, A2B and O.
3. Monocytes are phagocytic in function and they are the
second line of defence in the body. 3. In ABO system, the combinations between agglutinogen
4. The monocytes leave the circulation and enter the and agglutinin are as given in the Table 2.3.1.
tissues as tissue macrophage.
Table 2.3.1 Antigen—antibody combinations
Total and differential leucocyte count is a common inves-
tigation in diseases. Group Antigen Antibody
A A antigen Anti-B
Functions of leucocytes are as follows:
B B antigen Anti-
1. Phagocytosis: It is a process by which leucocytes engulf
bacteria and foreign material in an attempt to eliminate AB AandB No antibodies
infection. Neutrophils and monocytes have this ability. 0 No antigens Anti-A and anti-B
2. Antiallergic effect: Eosinophils inhibit histamine release
during allergic conditions; hence, their count increases This combination is natural and not acquired.
in allergy.
3. Antibody formation: Lymphocytes are mainly responsi- Rh Group System
ble for the antibody formation, giving immunity to the
1. Landsteiner and Weiner discovered this group in 1940.
body.
2. When red cells of rhesus monkey were injected into a
4. Heparin production: Basophils produce heparin, which
rabbit it responded by producing antibodies against
prevents intravascular clotting.
rhesus RBC. When the serum of a rabbit was mixed with
5. Trephine formation: Leukocytes help in the formation of
human RBC, it was found agglutination occurred in
trephines from plasma proteins, which are needed for
85% and no agglutination in 15% of the people. Persons
the growth and repair of tissues.
with agglutination are called Rh +ve and persons with
Q. 3. What is the basis for classification of blood no agglutination are called Rh —ve.
groups and what are the uses of blood grouping? 3. There are three antigens — C, D and E. D is the most
Add a note on Rh +ve blood. important of these all. So, Rh antigen is called D antigen
Ans.
and the antibody is called anti-D antibody. Usually,
Rh —ve people do not have anti-D antibodies.
Several blood group systems were discovered. The most 4. There are three genotype combinations — DD, Dd and dd.
important of all these systems are as follows: 5. DD, Dd are Rh +ve and dd is Rh —ve. Antibodies to D
1. ABO system antigen develop only when Rh —ve individual is given
2. Rh system Rh+ blood or Rh+ fetal RBC enter accidentally Rh -ve
3. MNS system mother. Hence, these antibodies are not natural but are
acquired.
In all these blood group systems, blood typing is made
based on the presence or absence of a specific agglutinogen Distribution of Rh Antigen
on the surface of the red cell membrane. These groups have
RH +ve Rh —ve
a great clinical, medicolegal and genetical interest.
For routine use only the ABO and Rh systems are used. Caucasian 85% 15%
Orientals 95% 5%
The MNS system is mainly used for medicolegal purposes.

Significance of Rh Grouping
1. During the first transfusion of Rh +ve blood to an Rh —ve
person, usually complications do not arise but antibodies
are produced. During subsequent transfusion antibodies
developed react with Rh +ve cells and produce a reaction.
Hence, Rh +ve blood should not be transfused to Rh —ve
persons.
2. When the father is Rh +ve, the mother is Rh —ve and the
fetus is Rh +ve, then the fetal RBC may enter the moth-
ers blood and stimulate antibody production in the
mother. This is normally possible at the time of first de-
livery and so usually complications do not arise during
the first pregnancy. But antibodies develop in this case.
Complications appear only during subsequent preg-
nancy. During second pregnancy, these antibodies cross
through the placenta, enter the fetus and produce hae-
molysis. This may lead to the death of the fetus or if
survived may suffer from haemolytic disease of the new-
born (HDN) or erythroblastosis fetalis. The frequency of
occurrence in pregnancies other than first one is 1 in 22.
The fetus shows the following features:
1. Jaundice due to haemolysis. This may lead to kernicterus.
2. Immature blast cells in the peripheral blood (erythro-
blastosis).
. Oedema of the fetus (hydrops fetalis).
we
4. Haemolytic anaemia.
Prevention
1. By marriage counselling and compulsory Rh typing to
all the newly married couples.
2. Rh-ve mother with Rh +ve fetus anti-D antibodies are
given immediately after first delivery to neutralize the
antigens that would have entered the mother’s blood.
So, complications will not arise during the second
pregnancy.
3. To minimize stillbirths, Rh —ve blood is infused into the
abdominal cavity of the fetus in the uterus. The cells are
absorbed into the circulation. These are not attacked by
the anti-Rh antibodies.
4. Women of marriageable age with Rh —ve group should
not be transfused with Rh +ve blood.
MNS System
In 1921, Landsteiner and Levine discovered this blood group
system. The M and N factors depend on two minor genes
— Mand N. The M and N antigens usually do not produce
a significant titre of antibodies and so can be ignored during
transfusions. They are antigenic to rabbits and agglutinating
sera can be prepared by injecting human M and N cells into
rabbits. Each person carries two of the genes of the M and N
group.
AMM child cannot have an NN father, and vice versa.
This system is used in parental dispute. However, that blood
Physiology
grouping can never prove that the suspected person is the
actual father. They can only show that he could or could not
possibly have been the father.
Genotype Phenotype
MM M
NN N
MN MN
Importance of Blood Groups
1. To avoid reactions during transfusions of blood.
2. Medicolegal cases like disputed parentage and to find out
the criminals. In disputed parentage it is useful to rule
out the parentage but is not useful for confirmation.
3. Research purposes as some blood groups are associated
with a high incidence of certain diseases.
4. Anthropological and ethnological purpose.
5. For matching the tissues during organ transplantation.
6. For preventing development of HDN.
Q. 4. Describe the mechanism of coagulation of
blood.
Or
Describe intrinsic and extrinsic pathway of blood
coagulation.
Ans.
Blood is in a fluid state while in circulation. If there is an
injury to the vessels, blood comes out, loses its fluid nature
and becomes gelatinous or semisolid. This change in the
physical consistency of blood, which is accompanied by cer-
tain physicochemical changes, is known as coagulation.
Stages of Coagulation
Stage 1: Inactive procoagulants become active and finally
there is formation of prothrombin activator.
Stage 2: Conversion of prothrombin to thrombin.
Stage 3: Conversion of fibrinogen to fibrin.
Process of Clotting
The clotting factors are proenzymes, which are activated
during clotting and in each step the reaction is amplified.
This is known as cascade mechanism.
Injury to the blood vessel exposes collagen and the nega-
tively charged surface of the endothelium. This causes plate-
lets adhesion and aggregation on the damaged endothelial
surface. This is followed by the release of platelet contents,
such as ADP, vasoconstrictors, platelet factor III, etc. The
adhesion and aggregation give temporary haemostatic plug.
The release of platelet factor IT] activates the clotting process.
Quick Review Series: BDS 1st Year
Generation of Prothrombin Activator
The first step in the clotting process is the formation of acti-
vated factor X, which is also called prothrombin activator.
It is formed in two ways:
1. Intrinsic pathway (within the blood)
2. Extrinsic pathway (from tissues).
Intrinsic pathway
In intrinsic pathway, formation of prothrombin activator
is initiated by platelets, which are within the blood itself
(Flowchart 2.3.1).
Injury to blood vessel and exposure of collagen
\
Factor XII comes in contact with collagen and is
converted in to XIla (activated factor)
XIla converts XI to XJa
Xia converts IX to [Xa
IXa converts X to Xa
Xa reacts with platelet phospholipid and
Factor V to form prothrombin activator.
Flowchart 2.3.1 Intrinsic pathway of blood coagulation.
The exposure of collagen and the negative charge on the
injured surface causes the activation of Hageman’s factor
(XII). This is the beginning of sequential events in the
coagulation of blood. The activated XII acts as an enzyme
and converts XI to XI activated factor. This activation also
requires high molecular weight kininogen and kallikrein.
The activated XI factor, in the presence of Ca** activates
IX into activated factor IX (activated Christmas factor). In
this step, calcium is first required for the activation. Acti-
vated Christmas factor converts Stuart factor into its active
form, through the activation of factor VIII (AHG) in the
presence of Ca** and phospholipid of platelet factor III.
Activated Stuart factor is also known as prothrombin ac-
tivator. It causes the conversion of prothrombin to throm-
bin, in the presence of activated proaccelerin (activated
factor V), Ca** and phospholipid. Thrombin acts as an
enzyme protease and converts fibrinogen to fibrin.
Extrinsic pathway
In extrinsic pathway, formation of prothrombin activator is
initiated by tissue thromboplastin (Flowchart 2.3.2).
Injury to blood vessel and release of thromboplastin
(Factor IJ)
{
Activation of VII to VIla
|
VIla activates X to Xa
|
IXa forms prothrombin activator
Flowchart 2.3.2 Extrinsic pathway of blood coagulation.
This reaction needs Factor V, tissue thromboplastin and
calcium ions.
Formation of prothrombin activator in extrinsic path-
way occurs when blood comes in contact with the injured
tissues. The damaged cells release phospholipid from the
cell membrane. The tissue phospholipid shows clot pro-
moting activity through the activation of VII factor in the
presence of Ca*~. The activated factor VII converts factor X
into activated factor X, in the presence of altered proaccel-
erin (activated factor V), Ca** and phospholipid. The steps
leading to the formation of fibrin are identical to those
described in the intrinsic pathway.
Formation of Fibrin (Role of Fibrin-Stabilizing Factor)
Blood coagulation basically involves the conversion of
soluble plasma protein fibrinogen to insoluble fibrin clot
by the enzyme thrombin. Initially, fibrin is formed as
soluble monomer. This is followed by the cross linking of
fibrin threads into fibrin polymer by the action of factor
XIII (fibrin-stabilizing factor) and thrombin. Fibrin
polymer is an insoluble clot. Calcium ions are needed for
the polymerization of fibrin. The fibrin polymer appears
as strands of meshwork in which the red cells and serum
are trapped. The red colour of clot is due to the trapped
red cells.
Q. 5. Describe the mechanism of coagulation of
blood. Mention different anticoagulants and mech-
anism of action.
Ans.
For the mechanism of coagulation of blood, refer to answer
to Long Essay Question 4.
Various anticoagulants and their mechanism of action are
as follows:
Salts
Citrates, oxalates, fluorides and EDTA (ethylenediaminetet-
raacetic acid) are called chelating agents, as they bind to

calcium. Since calcium is required for many steps in the pro-
cess of coagulation, the removal of calcium in the blood by
these salts, results in prevention of clotting.
Heparin
1. It is naturally occurring anticoagulant, secreted by mast
cells and basophils, and is also present in many tissues
like lungs and liver.
2. It is a negatively charged sulphated polysaccharide and
requires antithrombin factor III for its anticoagulant
activity. It also combines with heparin cofactor and
shows anticoagulant action.
3. Heparin inhibits thrombin action. It also inhibits the
formation of prothrombin activator, as it blocks the
action of factor IX.
4. Heparin is widely used in clinical practice and laborato-
ries as an anticoagulant. It can be used as an anticoagu-
lant both in vivo and in vitro.
5. Heparin action is inhibited by protamine sulphate,
which is a positively charged polypeptide obtained from
fish sperm.
Dicoumarol
It is a Vit. K antagonist, as it competitively inhibits the
action of vitamin K in the liver. Vit. K is required for the
synthesis of prothrombin, factors VII, IX and X, and admin-
istration of dicoumarol blocks the synthesis of these clotting
factors. Dicoumarol can be effective as anticoagulant only in
vivo.
Q. 6. What is erythropoiesis and where does it
occur? Give stages of erythropoiesis and require-
ment of each stage.
Ans.
Erythropoiesis is a process by which mature RBCs are pro-
duced from precursor stem cells.
e The time period required: 5-10 days
e Important sites from where erythropoiesis can take place
are as follows:
1. Mesoderm of yolk sac > during first 3 months of fetal
life
2. Liver and spleen — during 3-6 months of fetal intra-
uterine life
3. Red bone marrow — in the rest of the period of fetal
life and in postnatal period
a. From birth until adulthood, the entire bone mar-
row is involved in blood cell production. From
adulthood onwards, only the red bone marrow is
capable of producing blood cells.
b. In the adult, the shaft of long bones is occupied by
the yellow fatty tissues. Red bone marrow at the
ends of long bones, flat bones like skull, membra-
nous bones like sternum, vertebrae, pelvis and
Physiology
ribs are active sites of blood cell production in
adult.
c. Although liver and spleen have lost the function
of producing blood cells in adult, they are capable
of forming cells when there is prolonged stimulus
(extramedullary haemopoiesis).
The stages of erythropoiesis are as follows:
1. Haemocytoblast (stem cell)
. Proerythroblast
Wh
. Early normoblast
. Intermediate normoblast
. Late normoblast
DU
. Reticulocyte.
Haemocytoblast or Stem Cell
Uncommitted and Pluripotent Cell
1. The stem cell in the red bone marrow is uncommitted
and pluripotent; that means it can give rise to erythroid
or myeloid series.
2. About 75% of bone marrow cells belong to myeloid se-
ries and the remaining 25% only is the erythroid series.
3. When these stem cells divide they give rise to committed
stem cells, part of the new cells that are formed, become
uncommitted multipotent, so that their number remains
constant. More white cells producing stem cells are
present, since they have a short life period.
Commitied and Unipotent Cell
The stem cell, which enters the erythroid series, becomes
unipotent, committed stem cell.
Proerythroblast
The precursor cell is large (up to 18-20 um in size), nucleus
is single and large nucleolus is present. The cell shows active
proliferation.
Early Normoblast
The cell size is reduced; it is around 16-18 jum. The nucleus
condenses and chromatin threads appear. Nucleoli disap-
pear and the cell continues to show active proliferation.
Intermediate Normoblast
Nucleus further condenses. The cell size is also reduced and
is around 12-14 um. The cytoplasm shows the synthesis of
haemoglobin, and hence, it takes both acidic and basic stains
(polychromatophilic). The cell mitosis stops at this stage.
Late Normoblast
The cell size further reduces to 10-12 um. Nucleus is pushed
to the periphery, and at the end of this stage, it is extruded
out by a process called pyknosis. The cytoplasm shows
greater synthesis of haemoglobin.
Quick Review Series: BDS 1st Year
Reticulocyte
After the extrusion of nucleus, the reticulocyte is formed and
released into the circulation. The cell size becomes 7.2 jum.
The cytoplasm has a fine reticulum, which is the nuclear
remnant of RNA.
Within 24-48 hours, haemoglobin synthesis is completed
and they mature into red cells in the circulation. Normal
count of reticulocyte is 1% of red cell count.
Erythrocyte
Both reticulocytes and erythrocytes are present in the
peripheral circulation. The red cell, which is formed from
reticulocyte, exhibits its normal morphology.
Regulation of Erythropoiesis
Erythrocytes are mainly concerned with O, transport and its
delivery to the tissue. Hence, normal levels must be main-
tained. About 1% of the total RBC gets destroyed in 24 hours.
There will be a complete turn over of RBC once in 4 months.
Erythropoiesis is regulated by various factors. These factors
are as follows:
1. Lack of O,
Inadequate supply of O, to tissues is an important factor for
the regulation of erythropoiesis.
2. Nutrients
a. Carbohydrates — required for energy supply
b. Fats — required for cell membrane
c. Proteins — good quality proteins are required for
i. synthesis of globin of Hb
ii. cytoplasmic enzymes and
iii. stroma proteins.
3. Minerals
i. Iron: It is required in ferrous state for the synthesis of the
heme of Hb, and deficiency of iron causes microcytic
and hypochromic anaemia. Iron requirements are more
in growing children and pregnant and lactating women.
Normaliron requirements:
Adult male — 10 mg/day
Children — >10 mg/day
Adult female — 20 mg/day
Pregnancy and lactating — 40 mg/day
ii. Copper: Copper is required for biosynthesis of Hb. It
oxidizes ferrous to ferric and facilitates transport of iron
in blood in ferric state. Copper deficiency causes micro-
cytic normochromic anaemia.
iti. Cobalt: It is required as a component of Vit. B,». Action
may be similar to that of Cu and Mn. Large doses of
cobalt cause polycythaemia. Large doses impair tissue
respiration and produce anoxia. This may lead to
polycythaemia.
iv. Manganese: Manganese is required in very small quan-
tities. It also has a role in Hb synthesis.
4, Vitamins
The two important vitamins required are Vit. B,, and folic
acid. These are called maturation factors and are required
for DNA synthesis. These are required for the following:
1. Multiplication and maturation of RBC.
2. Vit. By: is absorbed from the ileum and requires intrin-
sic factor for its absorption.
These two vitamins are required for the conversion of
proerythroblast to early normoblasts in the bone mar-
row. Americans call this as megaloblast. In vitamin B,,
and folic acid deficiency, megaloblast accumulates in
bone marrow; hence, the name megaloblastic anaemia.
When there is specific absence of the intrinsic factor, this
is referred to as pernicious anaemia. Other B-complex
vitamins like Bg, riboflavin, pantothenic acid and nico-
tinic acids are also required. Vit. C is also required as the
deficiency of this causes bleeding. Riboflavin and Vit. C
deficiency cause normocytic normochromic anaemia.
3. Hormones
a. Erythropoietin (EP): It stimulates the RBC pro-
duction.
b. Thyroid hormones: Required for maintaining me-
tabolism and maturation. Hypothyroidism is associ-
ated with anaemia mainly macrocytic type and
hyperthyroidism is associated with polycythaemia.
c. Adrenal cortex: Addison’s disease is associated with
anaemia and the Cushing’s syndrome. Glucocorti-
coid hormones stimulate secretion of EP from the
kidney.
d. Sex hormones: Androgen increases and oestrogen
decreases the EP production from the kidney. Hence,
there is sex difference in the RBC count.
e. Growth hormone: Stimulates erythropoietin secre-
tion.
f. TSH, ACTH and prolactin: Increase the production
of EP and RBCs.
g. Any factor or clinical condition that causes inade-
quate supply of O, stimulates EP production.
h. Other substances: Cyclic AMP, NAD, NADP, angio-
tensin, noradrenaline, serotonin, PGE, ADH stimu-
late erythropoiesis.
i. IGFI: Stimulates EP production.
4. Neural
Stimulation of the hypothalamus causes an increase in
RBC production. This may be mediated through ante-
rior pituitary or hypoxia due to vasoconstriction.
Q. 7. Define blood pressure. What is the normal
blood pressure? Describe the regulation of blood
pressure.
Or

Define blood pressure. What is the normal blood
pressure? Describe the regulation of BP.
Ans.
The blood pressure provides the driving force for circulation
of blood. It has been defined as the lateral pressure exerted
by the blood on the wall of blood vessels.
Systolic Pressure
It is the maximum pressure during systolic phase of the
cardiac cycle and in healthy adults it ranges from 100 to
140 mmHg, the average being 120 mmHg.
Diastolic Pressure
It is the maximum pressure during ventricular diastole and
its normal range is 60-90 mmHg, with an + average value of
80 mmHg in adults.
The difference between the systolic and the diastolic pres-
sure is called the pulse pressure and it is about 40 mmHg.
Mean pressure = Diastolic pressure + 1/3 Pulse pressure
Regulation of Blood Pressure
It involves both the neural and the chemical (hormonal)
mechanisms. Following are the two different types of regula-
tions that occur in our body:
1. Short-term regulation
It brings about the immediate adjustment of the blood
pressure through reflex mechanisms.
2. Long-term regulation
It occurs over a longer period of time and involves the
renal mechanism, which maintains body fluid volume.
This is brought about by the hormones.
Short-term Regulation
To understand this mechanism, a consideration of the
vasomotor centre is essential. It is situated on the floor
of IV ventricle near cardiac centre and is composed of
pressor and depressor areas. Subsidiary centres have also
been identified in the spinal cord. The vasomotor centre
has an intrinsic activity, which persists even after all affer-
ent inputs are removed. This centre sends a constant sym-
pathetic discharge of impulses to the arteries and arteri-
oles through the thoracolumbar outflow and maintains
partial constriction of the vessels (sympathetic tone). In
addition to the vasomotor centre, it has been observed
that impulses from cerebral cortex, hypothalamus and
limbic lobe also influence the sympathetic tone.
Sinoaortic Reflex
The carotid sinus and the arch of aorta contain receptors,
which respond to alterations in blood pressure. They are
called the baroreceptors, and play an important role in the
regulation of blood pressure. The carotid sinus is supplied
Physiology
by the sinus nerve and the aortic arch is supplied by the
vagus nerve. Increased pressure stimulates these receptors;
impulses are carried to the vasomotor and cardioinhibitory
centre, producing a fall of blood pressure and reduction of
heart rate. Reverse changes are observed, when there is a fall
of blood pressure.
Since the sinus nerve and the vagus are involved in the
adjustment of the blood pressure, they are called the buffer
nerves. Section of these nerves results in a rise of blood pressure,
which indicates abolition of the reflex regulation of BP. Chemo-
receptors are present in the carotid and aortic body, and their
hypoxic stimulation also produces a rise of blood pressure.
Reflex from left ventricle: Distension of the left ventricle
or increase in the left ventricular pressure results in a reflex
fall of blood pressure.
Reflex from Lungs (Fig. 2.3.1)
Pulmonary vascular congestion or distension of pulmonary
capillary bed causes a reflex fall of heart rate and blood pres-
sure.
Coronary chemoreflex: Injection of veratridine, phenylbigu-
anide in to left coronary artery results in a reflex fall of blood
pressure.
Cushing’s reflex: Rise of intracranial tension produces isch-
aemic stimulation of medullary vasomotor centre, causing a
rise of blood pressure and bradycardia.
Reflex from higher centres: The vasomotor centre is also influ-
enced by higher centres (hypothalamus, limbic lobe, cerebral
cortex) due to emotional excitement and stress. This activates
sympathetic system causing a rise in BP and heart rate.
Hormones: Certain hormones like catecholamines, serotonin
and angiotensin II, cause vasoconstriction and increase the
blood pressure.
Long-term Regulation
This is mainly influenced by the renal mechanism, which
plays an important role in the regulation of extracellular
fluid (ECF) volume. Antidiuretic hormone and aldosterone
regulate the water and electrolyte balance, which maintain
the ECF volume.
Q. 8. What is haemoglobin? Describe the types,
functions and fate of haemoglobin.
Ans.
Haemoglobin is the red colour pigment present in the red
blood cell. It is a chromoprotein with a molecular weight of
645,000.
Normal concentration of haemoglobin
1. In adult male: 14-18 g%
2. In adult female: 12-16 g%
3. In children: 18-22 g%
ivi')) Quick Review Series: BDS 1st Year

Emotion Stress
(+) | \°

HIGHER CENTRES Cerebral cortex

Hypothalamus

Direct
effect
VASOMOTOR CENTRE
ypoxia
Medulla 4) Rise in CO,

Baroreceptors Chemoreceptors
1. Carotid sinus 1. Carotid body
2. Aortic sinus 2. Aortic body (+)
Left ventricle
distension

Fig. 2.3.1 Reflex regulation of arterial blood pressure.

The functions of this pigment are as follows: 3. In thalassaemia, there is deficient synthesis of a and
1. To carry respiratory gases both oxygen and carbon 8 chains.
dioxide 4. Haemoglobin §S(sickle cell anaemia): It is an abnormal
2. Helps in acid-base regulation Hb, formed from a mutant gene and inherited as a trait
3. Transport of NO (nitric oxide) from lungs to the tissues in a population. It is common in West African popula-
causing vasodilation. tion. The red cells are sickle shaped and this shape pro-
vides osmotic resistance to the red cell against malarial
Structure of Haemoglobin infection. The haemolysis of sickle cells when occurs,
gives sickle cell anaemia.
1. Haemoglobin contains two parts namely heme and
globin.
Fate of Haemoglobin (Fig. 2.3.2)
2. There are 4 subunits in each haemoglobin molecule.
3. A single molecule of Hb consists of 4 protoporphyrin Destruction of RBCs in reticuloendothelial tissue
IX molecules + 4 ferrous iron atoms (Fe**) + 4 poly-
peptide chains.
Straight chain haemoglobin (choleglobin) is liberated
4. The heme is made of protoporphyrin and iron, while
globin consists of 4 polypeptides, and each one is Formation of biliverdin (green colour)
attached to one subunit of heme. Thus, there are 4 iron
Converted to bile pigments
atoms in each haemoglobin.
Bilirubin (yellow colour)
5. In adult haemoglobin, the globin polypeptides are
arranged in two pairs and they are called a, and B2.
Circulated in plasma in the protein-bound form
6. In the fetus, the haemoglobin is different from the adult
haemoglobin. The B unit is replaced by 6 (delta) unit in
the globin molecule which results in greater diffusion of Bilirubin conjugates with glucuronic acid in the liver <——

oxygen from maternal circulation to fetal circulation. Bacteria act on bilirubin

7. The fetal haemoglobin is replaced by the adult type soon in intestine, which results
: : along
after birth. in formation of enterohepatic
Bilinogens circulation
A lot of them re-enter
Types of Haemoglobin Some amount is liver and ultimately
excreted as get excreted as
1. Adult Hb: Hb A type (adult haemoglobin) has 2 « and
2 B chains. stercobilinogen urobilinogen
along with faeces through kidneys
2. Fetal Hb: Hb F type (fetal haemoglobin) has 2 a and
2 8 (delta) units. Fig. 2.3.2 Fate of haemoglobin.
 Physiology

SHORT ESSAYS

Q. 1. Rh incompatibility. Q. 2. Mention the functions of plasma proteins.

Ans. Ans.
Mismatched blood transfusion leads to incompatibility reac- The functions of plasma proteins are as follows:
tions like agglutination and subsequent haemolysis of the 1. Colloidal osmotic pressure: It is 25 mmHg. Albumin
donor cells. being the major plasma protein primarily influences
the colloidal osmotic pressure. This is responsible for
The clinical reactions of incompatibility may be exhibited as
preventing fluid exit from the capillaries.
follows:
2. Antibody formation: Antibodies form an essential de-
1. Inapparent haemolysis: Mild reaction where injected
fence mechanism. This virtue is attributed to the gamma
blood cells may be destroyed within a few days without
globulins. The gamma globulins are known as immuno-
producing any other symptom.
globulins and are of five types, namely, IgA, IgG, IgD,
2. Posttransfusion jaundice: If the rate of haemolysis is
IgE and IgM.
rapid, the accumulation of unconjugated bilirubin in
3. Coagulation: Plasma proteins like fibrinogen and pro-
blood produces jaundice, which gradually disappears.
thrombin are involved in the clotting of blood. Various
3. Severe incompatibility reaction: Produces massive intra-
other clotting factors also belong to globulins.
vascular agglutination leading to death within minutes.
4. Transport media: Certain substances bind themselves
4. Erythroblastosis fetalis: A condition seen in the newborn
with albumin, alpha and beta globulins, and are
infants due to incompatibility between the Rh blood
transported.
group of mother and fetus. Rh +ve blood should not be
Example: The transport of hormones, metals, drugs,
given to Rh —ve recipient. This would result in the forma-
dyes, etc.
tion of Rh antibodies, which endanger future transfusion.
5. Erythrocyte sedimentation rate: The fibrinogen content
If the mother is Rh —ve, and the fetus is Rh +ve, during the of plasma influences ESR.
first pregnancy the mother’s plasma is sensitized. In the later 6. Viscosity: Due to their high molecular weight and ir-
pregnancies, the fetal RBC would trigger the production of regular shape, the fibrinogen and globulins contribute
enormous Rh antibodies in the mother. They cross placental to viscosity of the blood.
barrier and destroy the fetal RBC. This may result in stillbirth 7. Buffer mechanism: Plasma proteins act as buffers and
or the newborn developing severe jaundice (icterus gravis maintain acid—base balance.
neonatorum). The destruction of the fetal RBC can also 8. Protein reserve: Plasma protein constitutes protein re-
give rise to the appearance of the erythroblasts in the blood serve of the body. During emergency, cells of the reticu-
leading to a condition known as erythroblastosis fetalis. To loendothelial system break them into amino acids.
prevent such Rh incompatibility the mother should be Subsequently, these are used for the synthesis of cell
immunized with anti-Rh antibodies. protein.

SHORT NOTES

Q. 1. Plasma proteins. 2. Globulin: It constitutes about 2.5 g of plasma proteins

and has a relatively higher molecular weight of
Ans.
130,000. Various types of globulins have been identi-
Plasma proteins are specific proteins present in plasma and fied like alpha, beta and gamma globulins. The latter
are of three different types: plays an important role in antibody formation. Pro-
1. Albumin thrombin, which helps in the coagulation, is a beta
2. Globulin globulin.
3. Fibrinogen. 3. Fibrinogen: Blood coagulation requires this protein.
1. Albumin: It forms the major bulk of plasma proteins The chemical nature of clot is fibrin, which is formed
and has a molecular weight of 69,000. Albumin content from fibrinogen. Fibrinogen and prothrombin are uti-
of plasma is 4—4.5 g%. lized in the clotting.
Quick Review Series: BDS 1st Year

There are various methods by which plasma proteins 2. They are larger than erythrocytes, contain a nucleus and
can be isolated, like do not contain haemoglobin.
a. half or full saturation with ammonium sulphate or 3. Normal leucocyte count varies from 4000 to
b. by electrophoresis. 11,000 cells/cu mm of blood.
4. Depending up on shape, size and appearance of the
Q. 2. Plasma.
white blood cells, they are of five different types.
Ans. 5. Leucocytes are classified into the following:
a. Granulocytes
Plasma is the fluid part of blood in which formed elements
b. Agranulocytes
are suspended. The relative quantity of plasma and cells is in
Granulocytes are
the ratio of 55:45.
i. neutrophils,
ii. eosinophils and
Composition iii. basophils.
Plasma contains the following: Agranulocytes are
1. Water (91-92%) and solid substances (both organic and i. lymphocytes and
inorganic) (8-9%). il. monocytes.
2. Inorganic constituents are less than 1% and are mostly Q. 6. Neutrophils.
chlorides, carbonates and phosphates of sodium, potas-
sium and calcium. Small amounts of iron, copper and Ans.
iodide are also present. 1. Neutrophils constitute 60-70% of the total leucocyte
3. Organic substances form the major bulk of solids count.
present in plasma, and they are as follows: 2. They have a multilobed nucleus and the number of
a. Plasma proteins (6.5-8 g%) lobes usually ranges from three to five.
b. Glucose (80-120 mg%) 3. Cytoplasm contains violet or pink coloured fine granules.
c. Cholesterol and lipids (150-250 mg%) 4. Neutrophils exhibit phagocytosis and their count in-
d. Non-protein nitrogenous (NPN) substances like creases in acute infections. They form the first line of
urea, uric acid, creatine, creatinine, etc. defence in the body.
e. Hormones, enzymes and blood pigments.
Q. 7. Rh factor.
Q. 3. Bile pigments.
Ans.
Ans.
1. Landsteiner and Weiner (1940) identified another ag-
1. Bile pigments are the breakdown products of haemo- glutinogen in red cells called Rh factor, as it was isolated
globin; the pigments are biliverdin (green colour) and in Rhesus monkey.
bilirubin (yellow colour). 2. It is present in more than 85% individuals and those
2. They are excreted through faeces as stercobilinogen and having it are called Rh +ve.
urine as urobilinogen. 3. It differs from agglutinogens A and B in that no corre-
3. When serum/plasma concentration of bilirubin exceeds sponding agglutinin exists in plasma.
2 mg%, it results in jaundice. 4. Six subtypes of Rh factor, ie. C,c,D,d,E,e have been de-
Q. 4. Iron. scribed; amongst them D is most common and strongly
antigenic. It is, therefore, essential that in addition to blood
Ans. groups, Rh factor should also be determined and Rh +ve
1. Iron is a metal, necessary for erythropoiesis. blood should not be transfused to an Rh —ve recipient, to
2. Iron is needed for synthesis of: avoid hazards during subsequent transfusion.
a. haemoglobin, 5. Rh factor determination is done by observing agglutina-
b. myoglobin and tion of red cells with the anti-D sera.
c. enzymes, like catalase. Q. 8. Bleeding and clotting time.
3. Normal requirement of iron in adults is 12-15 mg/day
and the requirement is more in pregnant and reproduc- Ans.
tive women.
BLEEDING TIME
Q. 5. Leucocytes.
1. The time taken for the arrest of bleeding is known
Ans.
as bleeding time. The arrest of bleeding is due to the
1. Leucocytes are commonly known as white blood cells. formation of platelet plug.
 Physiology

Bleeding time normally ranges from 2 to 5 minutes. Q. 11. Physiology of clotting.

This can be determined by pricking the ear lobe or the
Ans.
fingertip.
Bleeding time is prolonged in purpura due to platelet 1. Blood coagulation basically involves the conversion of
deficiency. soluble plasma protein fibrinogen to insoluble fibrin
clot by the enzyme thrombin.
Clotting Time 2. Fibrin is initially formed as soluble monomer, which is
followed by the cross-linking of fibrin threads into fibrin
1. The time taken for the appearance of fibrin threads is polymer by the action of factor XIII (fibrin-stabilizing
known as the clotting time. factor) and thrombin.
The normal duration is 3-8 minutes. 3. The fibrin polymer is an insoluble clot which appears as
Deficiency of clotting factors leads to increased clotting strands of meshwork, in which the red cells and serum
time. Example, haemophilia. are trapped. The red colour of clot is due to the trapped
Q. 9. Anticoagulants. red cells.

Ans. Q. 12. Mention any four types of anaemia.

1. The substances which prevent the clotting of blood are Ans.

known as anticoagulants. Anaemia is due to a reduction of red cells or subnormal level
2. Uses: of haemoglobin, which consequently affects the supply of
a. For storage of blood in blood banks. oxygen to the tissues. Anaemia by itself is a symptom of
b. For therapeutic purposes to prevent intravascular some underlying disorder.
clotting, i.e. thrombosis.
c. For laboratory purposes to maintain fluid state of Some of the common types of anaemia are as follows:
blood. 1. Nutritional anaemia due to certain specific deficiency in
3. Anticoagulants are classified as follows based on the the diet:
usage: a. Pernicious anaemia due to Vit. B,, deficiency.
b. Megaloblastic anaemia due to lack of folic acid.
c. Hypochromic anaemia due to iron deficiency.
2. Haemolytic anaemia results from excessive breakdown
of RBC. It may be seen in the following conditions:
In vivo anticoagulants In vitro anticoagulants a. Diseases like malaria
(used inside the body) (used outside the body) b. Sickle cell anaemia and thalassaemia due to the
E.g. Heparin, dicoumarol, E.g. Sodium citrate 3.8%, presence of abnormal haemoglobin.
EDTA double oxalate of K* 3. Aplastic anaemia due total suppression of bone marrow
and ammonium as in:
a. Excessive use of certain drugs like sulpha drugs or
chloramphenicol
b. Exposure to X-ray radiation
Q. 10. Haemophilia.
c. Malignant disease of the bone marrow.
Ans.
Q. 13. Four functions of plasma proteins.
1. Haemophilia is a clotting disorder in which there is a
Ans.
haemorrhagic tendency due to the deficiency of clotting
factors VIII (AHG) and IX (Christmas factor). The functions of plasma proteins are as follows:
It is a genetic disorder, transmitted as X-linked recessive 1. Maintenance of colloidal osmotic pressure.
character; the males suffer from the disease and females 2. Formation of antibodies, which acts as an essential de-
carry the disorder. fence mechanism in the body.
There are two types of haemophilia: 3. The plasma proteins like fibrinogen and prothrombin
a. Haemophilia A or classical haemophilia: It results promote coagulation of blood.
due to the deficiency of VIII factor, antihaemophilic 4. They act as transport media for various substances like
globulin (AHG). The clotting time is abnormally hormones, metals, drugs, dyes, etc.
prolonged. 5. The fibrinogen content of plasma influences erythrocyte
b. Haemophilia B or Christmas disease: Christmas dis- sedimentation rate (ESR).
ease is also an X-linked disorder resulting from the 6. The fibrinogen and globulins contribute to viscosity of
deficiency of factor IX. the blood.
Quick Review Series: BDS 1st Year
7. Plasma proteins act as buffers and maintain acid-base
balance.
8. Plasma protein constitutes protein reserve of the body
during emergency.
Q. 14. What are the functions of lymphocytes?
Ans.
1. The differential lymphocyte count ranges from 20
to 30%.
2. There are two functionally distinct types of lymphocytes
namely “T’ lymphocytes and ‘B’ lymphocytes.
3. Lymphocytes are responsible for defence mechanisms
providing immunity to the body.
Q. 15. What are the structural and functional differ-
ences between adult and fetal haemoglobin?
Ans.
Haemoglobin is the red colour pigment present in the red
blood cell. It is a chromoprotein with a molecular weight of
645,000.
Structure of Haemoglobin
1. Haemoglobin contains two parts namely heme and
globin.
2. The globin polypeptides are arranged in two pairs and
are called a, and 8, adult haemoglobin.
3. In the fetus, the haemoglobin is different from the adult
haemoglobin. The (B unit is replaced by 6 (delta) unit in
the globin molecule, which results in greater diffusion of
oxygen from maternal circulation to fetal circulation.
4. Adult Hb: Hb A type (adult haemoglobin) has 2 & and
2 B chains.
5. Fetal Hb: Hb F type (fetal haemoglobin) has 2 & and 26
(delta) units.
Q. 16. Aplastic anaemia.
Ans.
Aplastic anaemia occurs due to total suppression of bone
marrow, as in the following:
1. Excessive use of certain drugs like sulpha drugs or chlor-
amphenicol
2. Exposure to X-ray radiation
3. Malignant disease of the bone marrow.
Q. 17. Erythroblastosis fetalis.
Ans.
1. Erythroblastosis fetalis is an Rh incompatibility reaction
seen in newborn infants.
2. If the mother is Rh —ve and the fetus is Rh +ve, during
the first pregnancy the mother’s plasma is sensitized.
3. In the later pregnancies, the fetal RBC would trigger the
production of enormous Rh antibodies in the mother.
They cross placental barrier and destroy the fetal RBC.
This may result in stillbirth or the newborn developing
severe jaundice (icterus gravis neonatorum).
4. The destruction of the fetal RBC can also give rise to the
appearance of the erythroblasts in the blood leading to
erythroblastosis fetalis.
5. To prevent such Rh incompatibility the mother should
be immunized with anti-Rh antibodies.
Q. 18. Pernicious anaemia.
Ans.
1. Pernicious anaemia is also known as Addison’s anaemia
or Biermer’s anaemia.
2. Occurs due to deficiency of intrinsic factor, which helps
absorption of Vit. B},—the extrinsic factor from intes-
tine.
3. Clinical features: Generalized weakness, sore painful
tongue, numbness/tingling of extremities.
a. Tongue is ‘beefy red’ in colour and characteristically
shows glossitis, glossodynia and glossopyrosis. There
is gradual atrophy of papillae of tongue resulting in a
‘bald’ tongue, which is often referred to as Hunter’s
glossitis or Moeller’s glossitis (oral findings).
b. Laboratory diagnosis: RBC count < 1 million.
c. Bone marrow studies reveal immature red cells or
megaloblasts.
Q. 19. Purpura.
Ans.
A reduction in platelet count results in purpura. It is
a bleeding disorder in which haemorrhagic tendency
increases.
1. Nonthrombocytopenic purpura: It is due to defect of
capillaries. Example: increased permeability, fragility.
2. Thrombocytopenic purpura: Decreased number of
platelets.
3. Primary thrombocytopenic purpura, also known as
Werlhof disease, is of unknown aetiology.
4. Cessation of bleeding depends on physical blockage of
severed capillaries by platelets, which depends on num-
ber of platelets.
5. Treatment is splenectomy.
Q. 20. Hazards of blood transfusion.
Ans.
Hazards of incompatible transfusion are as follows:
. Agglutination
ee
. Haemolysis
Bw
N
. Fever and chills
. Jaundice, due to increased bile pigments resulting from
RBC destruction
. Renal failure
nD UI
. Uraemia, coma and death.
 Physiology

Q. 21. Platelets. 3. The life span of platelets is about 4—7 days. The cells are
destroyed in the spleen.
Ans.
4. Variations in count: An increase in count is observed in
1. Platelets are small, biconvex, non-nucleated cells, usu- (a) haemorrhage, (b) splenectomy and (c) Hodgkin’s
ally found in clustres in a dried film. disease. A reduction in platelet count is known as
2. The average size of platelets is 2.5 jum and their thrombocytopenia, which is seen in (a) splenomegaly,
count ranges from 250,000 to 300,000 cells/cumm (b) aplastic anaemia, (c) acute infections and (d) leu-
of blood. kaemias.

CARDIOVASCULAR SYSTEM
LONG ESSAYS

Q. 1. What is cardiac cycle? Describe events occur- Atrial Systole

ring during normal cardiac cycle.
1. Atrial systole is further divided into two phases:
Or Dynamic phase — 0.05 sec
Adynamic phase — 0.05 sec
Define cardiac cycle. Explain the mechanical
2. Right atrial systole starts just before left atrial systole.
changes during cardiac cycle.
3. Duration is 0.10 sec.
Ans. 4. Atrial systole contributes only 20% to ventricular filling.
Cardiac cycle is defined as the sequence of cyclical events Throughout the atrial systole due to pressure gradient the
that take place in the heart during each beat. blood flows from the atria into the ventricles
The duration of cardiac cycle is 0.8 sec, with the heart rate
of 75 beats per minute (bpm). Atrial Diastole
With greater heart rate, duration of cardiac cycle is
1. It can be divided into the first 0.30 sec, which coincides
shortened.
with the ventricular systole, and the later 0.40 sec, which
With lesser heart rate, duration of cardiac cycle is
synchronizes with the ventricular diastole.
prolonged.
2. Duration is 0.7 sec.
The events in the right and left chambers of heart occur
3. In the beginning of atrial diastole the A—V valves are
almost simultaneously. Since there are two types of cham-
closed because of a fall in the pressure on the atrial side
bers, there are two types of cycles:
and a rise in the intraventricular pressure. During this
1. Atrial cycle
phase, veins pour in their blood into the atria.
2. Ventricular cycle
4. When the 0.3 sec of atrial diastole is over, the A-V valves
Each cycle is divided into two main phases: open as the pressure in the ventricles falls. So, blood
from the atria rushes into the ventricles throughout the
latter part of atrial diastole (0.4-0.8 sec). This contrib-
utes to 80% of ventricular filling.
1. Atrial cycle 2. Ventricular cycle
a. Atrial systole a. Ventricular systole
Ventricular Cycle
= 0.10 sec = 0.30 sec
b. Atrial diastole b. Ventricular diastole This is also divided into two main phases:
— 0.70 sec = 0.50 sec 1. Ventricular systole (VS)
2. Ventricular diastole (VD).
Atrial Cycle
Ventricular Systole
It is divided into two main phases:
1. Atrial systole (AS) 1. Right ventricle starts earlier than left ventricle
2. Atrial diastole (AD). 2. Duration of ventricular systole is 0.3 sec.
176 Quick Review Series: BDS 1st Year

3. Just when ventricular systole is about to start, the A-V 3. Ventricular filling
valves on both sides close. Closure of A—-V valves her- a. Protodiastole
alds the onset of systole and produces the first heart i. Duration is 0.04 sec.
sound. So, the first sound indicates the onset of ven- ii. During this phase ventricular ejection has almost
tricular systole. stopped.
4. The interval between the first and the second heart iii. Pressure in the vessels exceeds the ventricular
sounds denotes the duration of ventricular systole. pressure, and this phase ends with the closure of
semilunar valves, which causes the second heart
Ventricular systole is divided into three subphases:
sound.
1. Isovolumetric contraction phase
b. Isovolumetric relaxation phase
2. Maximum ejection
i. Duration is 0.06 sec.
3. Reduced ejection.
ii. At the end of protodiastole semilunar valves close
and A-V valves are also closed before.
Isovolumetric Contraction Phase
iii. The ventricles are relaxing as closed cavities;
1. Duration is 0.05 sec. by this time the atria are getting filled and in-
2. During this interval the semilunar valves of the pulmo- tra-atrial pressure builds up. This opens the
nary artery and the aorta remain closed. A—V valves A-V valves ending this phase. Blood flows into
are already closed. As the blood is incompressible and the ventricles starting the stage of ventricular
the ventricles are contracting as closed cavities, there filling.
is no change in the volume of the ventricle; hence c. Ventricular filling
pressure ‘P’ rises and it is known as isovolumetric i. Duration is 0.40 sec.
phase. ii. This is divided into three subphases:
3. At the end of this phase, the rising intraventricular pres- e First rapid-filling phase
sure forces the semilunar valves to open, initiating the e Slow filling phase
ejection of blood from the ventricle into the aorta or e Second rapid-filling phase
pulmonary artery. This starts the ejection phase.
First Rapid-Filling Phase
Maximum Ejection Phase 1. Duration is 0.10 sec.
1. Duration is 0.10 sec. 2. Due to a high-pressure gradient, 70% of ventricular fill-
2. During this phase, the intraventricular pressure reaches ing takes place.
peak levels due to the maximum force of contraction. 3. During this phase, there is a sudden flow of blood from
Pressure gradient between the ventricles and corre- the atria into the ventricles. This causes vibration of the
sponding vessels is maximum. Hence, maximum blood ventricular myocardium resulting in the production of
flows into the vessels during this phase. the third heart sound.

Slow Filling Phase

Reduced Ejection Phase
1. Duration is 0.20 sec.
1. Duration is 0.15 sec.
2. During this phase the pressure gradient becomes less 2. As the pressure gradient is less, only 10% of ventricular
due to decreased force of contraction. Hence, the
filling takes place during this phase.
blood flow from the ventricles into the corresponding
Second Rapid-Filling Phase
vessels becomes less. Right ventricular ejection starts a
little earlier than the left ventricular one and finishes 1. Duration is 0.1 sec.
later. 2. This synchronizes with AS.
3. At the end of the systole, semilunar valves close due to 3. Due to a high-pressure gradient, 20% of ventricular
the pressure gradient between the vessels and the ven- filling takes place.
tricles. Closure of semilunar valves produces the second 4. During this phase the fourth heart sound is produced.
heart sound.
During each cardiac cycle the following events also take
place.
Ventricular Diastole
1. Change in pressure in the heart chambers and vessels
Ventricular diastole starts just before the closure of semilu- (aorta and pulmonary artery)
nar valves. VD is divided into: 2. Change in the volume of blood present in the chambers
1. Protodiastole of the heart
2. Isovolumetric relaxation phase. 3. Production of arterial and venous pulse.

4. Causation of EKG
5. Production of heart sounds
6. Production of apical impulse or apex beat.
Q. 2. Draw and label a diagram of normal ECG.
Describe the various waves in ECG.
Or
Define electrocardiogram. Draw a neat diagram
and briefly describe different waves. What is the
significance of P-R interval?
Ans.
1. Electrocardiogram (ECG) is graphical recording of the
summated electrical activity from the heart during a
cardiac cycle (Fig. 2.4.1).
2. ECG shows five deflections, out of which three are con-
ventionally termed as positive waves (upward) and two
deflections are called negative waves (download).
Fig. 2.4.1 Normal ECG.
3. Each beat of the heart will result in a complex of waves
called PQRST complex.
4. The baseline is called isoelectric or isopotential line.
5. ‘P’ wave is the first +ve wave, as it is above isoelectric
line.
6. Q wave is a small —ve wave after ‘P’ wave.
7. There is a +ve wave called ‘R’ wave, which is the first
+ve wave after P wave.
8. S wave is the —ve defection after R.
9. J point is the point of intersection of the end of ‘S’ wave
with the isoelectric line.
10. T wave is +ve wave after ‘S’ wave.
11. Sometimes, in some leads another + ve wave is obtained
after ‘T’ wave. It is called ‘U’ wave.
‘P’ Wave: It represents atrial depolarization. Normal dura-
tion is 0.08-0.12 sec. Normal voltage is 0.1-0.3 mV. P wave
represents normalcy of the atrial myocardium. It undergoes
changes with the diseases of the atria as follows:
1. Atrial hypertrophy—‘P’ wave becomes large or bifid.
2. Atrial flutter—Abnormal ‘P’ waves called ‘F’ waves.
3. Atrial fibrillation—Abnormal ‘P’ waves called ‘f waves.
4. Atrial ectropic (or) atrial tachycardia—Inverted ‘P’
wave. ‘QRS’ Complex: This represents ventricular
Physiology
depolarization, i.e. the normalcy and integrity of the
ventricular myocardium. Normal duration is 0.08-
0.12 sec. Normal voltage 1-3 mv. ECG from the left
ventricle will have more amplitude than that from the
right ventricular ECG.
‘Q’ Wave: Represents the septal depolarization and is absent
in right ventricular leads. This is present in all the bipolar
leads as both electrodes are active.
‘R Wave: It is due to the potential travelling to the apex of
the ventricle. Peak of ‘R wave is the safest period as the ven-
tricle is in absolute refractory period at this time and so does
not respond to any external stimulus. Hence, cardioversion
is done by applying DC shock during this period.
‘S’ Wave: It is due to the potential travelling to the base of the
ventricles. RS complex is prominent in right ventricular
leads.
P-R Interval: It refers to the time interval between the be-
ginning of ‘P’ wave to the beginning of ‘Q’ or ‘R’ wave. This
represents A-V conduction time. (Time taken by the im-
pulse to travel from S—A node to the ventricle.) Normal
duration is 0.12-0.21 sec.
P_R interval is prolonged in:
1. 1°H Block — Eg. Digital toxicity
2. 2°H Block — E.g. Wenckebach phenomenon.
P-R interval is shortened in:
1. Wolf—Parkinson—White syndrome (WPW syndrome)
2. Lown-Ganong-Levine syndrome (LGL syndrome).
P-R Segment: The region between the end of P wave and
beginning of ‘Q’ wave. This denotes the time interval be-
tween completion of atrial depolarization and beginning of
ventricular depolarization.
“T’ Wave: Represents ventricular repolarization. Normal du-
ration is 0.27 sec. Voltage varies from 0.2 to 1 mV. It is nor-
mally a +-ve wave. Peak of “T’ wave is the vulnerable period
or dangerous period, as any stimulus during this period
would cause arrhythmias.
‘U’ Wave: Caused by delayed repolarization of the intraven-
tricular conduction system (Purkinje fibres) or papillary
muscle mostly seen in V; to V, leads.
S-T Segment: It denotes the interval between the end of the
S wave and the beginning of T wave. It indicates the comple-
tion of depolarization of the ventricle. It is normally on the
isoelectric line. A displacement of 1mm above or below the
isoelectric line is within the normal limits. This is abnormal
in current injury like myocardial infarction, ischaemia, etc.
S-T Interval: Denotes the interval between the end of ‘S’ and
the end of “T’ wave, normal up to 0.32 sec.
Q-T Interval: Denotes the interval between the begin-
ning of Q wave and the end of T wave. The normal is
Quick Review Series: BDS 1st Year

0.4 sec. It denotes the time taken by ventricular depolar-
ization and repolarization. Normally, the beginning of
ventricular systole coincides with the summit of R wave
and ends with the completion of t wave. So R-T interval
denotes the duration of ventricular systole. Q-T interval
is shortened in hypercalcaemia and prolonged in hypo-
calcaemia.
Abnormalities in S-T-T changes
S—T segment and ‘T’ waves are usually altered together in the
following conditions:
1. Myocardial infarction and ischaemia
Endocrine disorders affecting the heart
why
nucleus ambiguus of the vagus. This is also called car-
dioinhibitory centre.
2. These fibres supply to the following:
a. S—A node (the right vagus)
b. A-V node (the left vagus)
c. Atria
3. They do not supply to the ventricles.
4. Under resting conditions the vagus exhibits tonic in-
hibitory effect on the heart. This is referred to as vagal
tone.
5. ACh released from vagal nerve endings decreases nor-
adrenaline release from the sympathetic nerve endings
by presynaptic inhibition.

Cardiac arrhythmias, in general

Sympathetic Nerves
Electrolyte imbalance, mainly K~ levels
Awe

Toxic effects of drugs, e.g. digitalis, quinidine
Myocarditis — inflammation of the myocardium.
Clinical Application of ECG
It is very useful in the diagnosis, assessment of the prognosis
and management of the following conditions:
1. Myocardial infarction and ischaemia
Cardiac arrhythmias
YN
1. Sympathetic nerve fibres come from T\-T; lateral horns.
They synapse in superior middle and inferior cervical
ganglia. Postganglionic fibres from these ganglia supply
the entire heart.
2. Sympathetic fibres exhibit a minimal tonic stimula-
tory effect under a resting state by releasing nor-
adrenaline.
3. Neuropeptide-Y released from the sympathetic fibres
decrease the release of ACh from vagus by presynaptic

Electrolyte imbalance
inhibition. This is an insignificant effect. However, dur-
Myocarditis and cardiomyopathies
ing stressful states the sympathetic tone dominates over
DVR

Endocrine disorders
the parasympathetic tone.
Assessment of toxic effects of drugs acting on the heart
4. The heart is under the action of two opposing influ-
Conduction defects
ences—the parasympathetic trying to restrain and
SN

Chamber hypertrophy.
sympathetic trying to stimulate. The normal function
of the heart depends on the algebraic sum of these
Cardiac Monitoring
influences.
A continuous recording of ECG is obtained by using a cath-
ode ray oscilloscope during Regulation of the Heart Rate
1. Cardiac surgery
Heart beats at a rate of 70-80/min regularly under resting
Thoracic surgery
conditions. This is automatic and does not require nerves.
Pe WN

In treatment of cardiac arrhythmias

However, this heart rate is variable in both physiological and
AW

Acute myocardial infarction

Postoperative intensive care
All emergencies.
Q. 3. Draw a labelled diagram to depict innervation
of heart. Explain how heart rate is regulated.
Ans.
Cardiovascular system is supplied by nerves belonging to
autonomic nervous system. Parasympathetic and sympa-
thetic nerves of autonomic nervous system supply the heart.
They have reciprocal inhibitory effect and exert opposite
effects on the heart.
Parasympathetic Nervous Supply by Vagus
1. Heart is supplied by the cardiac branch of the vagus.
The cell bodies for these nerve fibres are present in the
stressful conditions under the influence of neural and hor-
monal mechanisms.
Neural Regulation
Role of Nerves
Both parasympathetic and sympathetic nerves supply to the
heart (Fig. 2.4.2).
Parasympathetic Nerve (Vagus)
1. Right and left vagi supply to S—A node, atria and A-V
node. Under resting conditions the vagus exerts an in-
hibitory effect on S—A node and atrial activity. This is
referred to as vagal tone.
2. When vagi are cut or atropin is administered, tachycar-
dia (160/min) is seen as the inhibition is released.
 Physiology

Nucleus ambiguus C) Superior, middle, inferior cervical

Neuropeptide ‘Y’ ganglia
CIC
(Cardioinhibitory centre) Sympathetic nerve fibres
Decreases the Vagus
release of NA Norepinephrine (NA) Neuropeptide
vy
from —_— ACh

sympathetic { B, receptors
nerve endings M, receptor Decreases the
* Cyclic AMP release of ACh
4K+ efflux, decrease in from
Cat+ influx Ca++ and Nat entry parasympathetic
endings
Hyperpolarization of ‘P’ - Acceleration of the heart rate _
cells -Increase in force of contraction

Slowing of near rate

Fig. 2.4.2 Nerve supply of heart.

3. Vagal tone is high in athletes and so HR is 60/min. 4. Mechanism of sympathetic nerve is depicted in Flow-
4. Stimulation of the vagus results in a decrease in HR. The chart 2.4.2.
cell bodies of the vagus are present in the cardioinhibi-
tory centre.
5. Mechanism of parasympathetic nerve is depicted in Stimulation of sympathetic nerve
Flowchart 2.4.1.

Release of noradrenaline

Vagal stimulation !
Acts on B-receptors
Release of ACh
'
Cyclic AMP generated acts on ‘P’ cells
Acts on ‘P’ cells of S-A node
Pacemaker potential shifts to left
Hyperpolarization of P cells takes place !
HR increase

Pacemaker potential shifts to right Flowchart 2.4.2 Mechanism of sympathetic nerve.

HR decrease
Q. 4. What is normal heart rate? Describe varia-
Flowchart 2.4.1 Mechanism of parasympathetic nerve. tions of heart rate, effect of baroreflex and chemo-
reflex on heart rate, and hormonal regulation of
heart rate.

Sympathetic nerve Ans.

1. Sympathetic nerve supplies the entire heart.
2. Under resting conditions it exerts only a minimal excit-
atory effect on the heart, which is not an important one.
This facilitatory effect is called sympathetic tone.
3. Stimulation of sympathetic nervous system results in an
increase in HR. Sympathetic nerve fibres are influenced.
by VMC and the cardioacceleratory centre.
1. The normal resting HR varies from 60 to 80 bpm.
2. Heart rate is subjected to a considerable variation de-
pending on the various factors within the body and
operating from external environment.
3. But the fluctuations are regulated and maintained in
the normal range by various neural and humoral
mechanisms.
Quick Review Series: BDS 1st Year

Physiological Variations of Heart Rate 10. Sleep

1. Age During sleep the heart rate is minimal due to a low meta-
bolic rate.
Heart rate in infants is high 140-150/min. As one grows up,
the normal range is reached around puberty. This is due to
Cardiovascular Reflexes
an increase in vagal tone with age.
Cardiovascular reflexes not only primarily influence BP, but
2. Surface area they also have an effect on HR.
HR is inversely proportional to the surface area.
Effect of Barorefilex and Chemorefiex on Heart
HR « i Rate
SA
Example: A mouse HR is 600/min and an elephant HR is 1. When baroreceptors are activated, nucleus tractus soli-
tarius (NTS) is stimulated, which in turn stimulates the
40/min.
nucleus ambiguus. Vagal tone increases and HR falls.
3. Sex 2. When chemoreceptors are activated, inspiratory centre
is activated. This inhibits nucleus ambiguus. Vagal tone
Females have a higher HR compared to males of the same
age. This may be due to a high sympathetic tone in females. decreases and HR rises. If the inspiratory centre is inhib-
ited by other mechanisms while the chemoreceptors are
This may also be due to less surface area or due to less vagal
activated then there will be bradycardia or sometimes
tone in females.
asystole.
4, Emotions 3. Resting vagal tone is of reflex origin and is dependent on
the baroreceptor reflex arc.
In anger, excitement and fear an increase in HR is seen.
Hormonal Regulation of Heart Rate
5. Environmental Temperature
Increase in temperature increases the HR. Changes in blood 1. Adrenaline
temperature can directly act on the SA node and increase Increases the heart rate — This has a direct effect on the
the HR. beta receptors of the heart — cyclic AMP increases HR
For every 1°F rise in temperature, HR increases 10 bpm 2. Noradrenaline
and for every 1°C rise in temperature HR increases 20 bpm. Produces reflex bradycardia. It should increase the HR
by direct action. It not only has effect on the heart but
6. Metabolic Rate also constricts the blood vessels, thereby increasing BP
An increase in the metabolic rate increases the HR—when and this overcomes the first effect.
BMR is high, metabolism of the heart in general and S-A 3. Vasopressin
node in particular are high—which leads to tachycardia. It behaves like noradrenaline. It increases BP and pro-
Example: In hyperthyroidism—BMR and HR are high. duces a reflex bradycardia. It does not have any effect on
In hypothyroidism—BMR and HR are low. the heart.
4. Thyroxin
7. Posture It increases body metabolism in general, and metabo-
lism of the heart, in particular, so S—A nodal activity and
When an individual stands up venous return is decreased
and this leads to a diminished cardiac output, which in turn heart rate increase, e.g.
diminishes the blood pressure. This increases the heart rate a. Hypothyroidism — | HR
by Marey’s reflex. b. Hyperthyroidism — T HR
Q. 5. What is cardiac output? Mention factors
8. Respiration affecting cardiac output. Add a note on venous
During inspiration HR increases and during expiration HR return.
falls. This is referred to as sinus arrhythmia. This is normal
Ans.
in children and is also seen in some adults.
Cardiac output (CO) is defined as the volume of blood
9, Barometric Pressure ejected by each ventricle per minute (Fig. 2.4.3). It is also
An increase in atmospheric pressure usually causes a de- referred to as minute volume.
crease in the heart rate. The mechanism is not clearly under- Normal value in adult male: 5—6 L/m. It is less in females
stood. It may be a reflex bradycardia. than male.
Example: High altitude low atmosphere pressure— HR is high. It can be calculated from the stroke volume and the heart
Deep sea divers high atmosphere pressure—HR is low. rate.
 Physiology

CO = Stroke volume X heart rate Intrinsic factors

70 X 80 = 5600 mL/min
Frank-Starling phenomenon
Stroke volume is the volume of blood ejected by each ven- 1. The Frank—Starling phenomenon explains the relation
tricle per beat. between the length of the muscle fibre and the con-
Cardiac output is regulated by the following factors: tractility.
a. Stroke volume 2. According to this phenomenon, the force of contrac-
b. Heart rate tion is directly proportional to the initial length of the
c. Peripheral resistance muscle.
3. The initial length of the muscle fibre depends on the end
The relation between cardiac output and these factors is as diastrolic volume (EDV) preload.
follows: 4. Any increase in the EDV stretches the ventricular myo-
cardium, increasing the length of the muscle fibre. It is a
:
Cardiac Stroke
output (CO) = 220ke
vorume vol *x Heart
eae rat lifesaving device in heart failure.
Peripheral resistance
Post-extrasystolic potentiation
Stroke volume = Myocardial contractility <
End diastolic volume 1. The beat following the extra systole is stronger than the
normal, due to intracellular accumulation of Catt
So, basically cardiac output is regulated by the following four ions.
factors (Fig. 2.4.3): 2. During an extra systole the stroke volume is less than the
normal, with the resultant increase in the end diastolic
volume before the next beat is initiated. This would en-
Heart rate Preload sure a correction of the stroke volume on a beat-to-beat
(chronotropic) Cardiac (EDV)
basis.
Myocardial output Afterload
contractility (peripheral
(Inotropic) resistance)
Force-frequency relation
Fig. 2.4.3 Factors affecting cardiac output. 1. An increase in frequency of heart beat increases contrac-
tility. The staircase phenomenon explains this.
2. The increase in contractility is due to accumulation of
Starling (1910) first studied the interrelationship of these intracellular Ca** ions.
factors and their influence on cardiac output on an experi-
mental setup called heart-lung preparation. Extrinsic factors
Cardiac output is directly proportional to the stroke vol- Neural factors
ume and the heart rate, and inversely proportional to the
1. Norepinephrine is released from nerve endings of sym-
peripheral resistance.
pathetic nerve fibres, which supply the heart.
2. This acts through 8, receptors and increase the cyclic
Stroke Volume
AMP levels. This in turn increases the intracellular
It is mainly dependent on: Ca** concentration, which increases the myocardial
1. Myocardial contractility contractility.
2. End diastolic volume. 3. ACh is released from the nerve endings of parasympa-
thetic nerve fibres (vagus), which supply the heart. ACh
Myocardial Contractility (Inotropic Effect) acts through M, receptors and cause hyperpolarization
of the S-A nodal and myocardial cells. As a result the
force of contraction decreases.
Myocardial contractility is influenced by
Hormones

1. Epinephrine and norepinephrine have a similar effect as

’
Intrinsic factors
Y
Extrinsic factors
that of sympathetic nerve fibres on the heart and so in-
crease the contractility of the myocardium.
1. Frank—-Starling phenomenon 1. Neural 2. Glucagon increases the myocardial contractility by
2. Post-extrasystolic potentiation 2. Hormonal increasing cyclic AMP without mediating through
3. Force-frequency relation 3. Ions B-receptors.
4. Drugs 3. Thyroxin increases the myocardial contractility by in-
5. Other factors creasing the metabolic rate.
 Quick Review Series: BDS 1st Year
4. Insulin has an inotropic effect on the myocardium.
5. Cortisol increases the inotropic effect and has a permis-
sive role with catecholamines.
Tons
a. Na* and K* decrease the myocardial contractility by
different mechanisms.
b. Ca** ions increase the contractility and the response is
proportional to the concentration of the intracellular
Ca** ions.
Drugs
1. Beta-blockers, e.g. propranolol, decrease the myocardial
contractility.
2. Calcium channel blockers, e.g. verapamil, increase the
myocardial contractility.
3. Theophylline and caffeine: Cause increase in the myo-
cardial contractility.
4. Digitalis: Blocks Na-K ATPase and increases the myo-
cardial contractility.
5. Quinidine: Decreases excitability and prolongs the
refractory period leading to a decrease in myocardial
contractility.
6. Barbiturates: Decrease excitability and myocardial con-
tractility.
Other factors
1. End diastolic volume (preload) (EDV)
a. It is the volume of blood present in the ventricle at
the end of a diastole.
b. The stroke volume is directly proportional to the end
diastolic volume.
c. An increase in EDV increases the length of cardiac
muscle fibre, which in turn increases the myocardial
contractility.
d. EDV is dependent on the following:
i, Venous return
ii. Ventricular compliance
iii. Diastolic pause
iv. Atrial systole
Venous return: All the factors that increase VR increase EDV.
Ventricular compliance: It compromises the myocardial
contractility and the stroke volume.
Diastolic pause: Diastolic pause is directly proportional to
EDV within physiological limits.
Atrial systole: Atrial systole normally contributes 20% of
ventricular filling during resting. Its contribution may in-
crease during exercise. Atrial systole influences EDV.
Heart Rate (Chronotropic Effect)
The heart rate and cardiac output are directly related. An
increase in the heart rate increases cardiac output by the
following means.
1. As multiplying factor: When the heart rate is 70/min with
a stroke volume of 70 mL/beat, then CO is 4.9 L/ min.
When the heart rate doubles without a change in
stroke volume, CO doubles to 9.8 L/min. So, all the
factors that increase the heart rate increase cardiac
output.
2. An increase in the heart rate increases the force of con-
traction, which can be explained based on the staircase
phenomenon. With an increase in the heart rate intra-
cellular Cat * content increases, which, in turn causes an
increase in the force of contraction.
The relation between the heart rate and cardiac out-
put is linear up to 180 bpm. Beyond this level, venous
return is compromised and so cardiac output tends
to fall.
3. Venus return (VR): It is the volume of venous blood that
returns to the right atrium through the systemic veins
in 1 min. VR always matches with cardiac output in all
physiological conditions.
Peripheral Resistance
A sudden increase in peripheral resistance due to arteriolar
constriction increases the pressure in aorta and decreases
venous return, the immediate effect is drop in CO known as
‘Anrep’ effect.
Q. 6. What is normal arterial blood pressure and
physiologic variations? Describe role of sinoaortic
mechanism of regulation of blood pressure.
Ans.
Arterial blood pressure can be defined as the lateral pressure
exerted by the moving column of blood on the walls of the
arteries.
In normal adult the blood pressure is 120/80 mmHg.
Systolic blood pressure is 120, with a range of 60-140 mmHg.
Diastolic blood pressure is 80, with range of 60-90 mmHg.
Physiological Variations in Arterial Blood Pressure
Blood pressure values vary in the same individual, depend-
ing on the following physiological factors.
Diurnal
Blood pressure values fluctuate in a rhythmic fashion
called circadian rhythm. In a particular person the pres-
sure is minimum in the early hours and highest in the
afternoon.
Age
Blood pressure values vary with age of the person.
At birth, systolic BP is 40-60 mmHg.
15th day 70 mmHg systolic
12th year 105 mmHg systolic
 Physiology

* BP
17th year 120 mmHg systolic
60th year 160 mmHg |
Stimulation of baroreceptors
Sex (carotid sinus and aortic arch)

Females have 5 mmHg less than males of the same age. This f
NTS stimulation
is due to sex hormones. After menopause the values are the
same for both sexes.
Inhibition of VMC Stimulation of CIC
Surface Area (RVLM) (nucleus ambiguus)

BP is proportional to the surface area. So in obese people BP |

SNS Vagus
is more.
| f
Digestion + Symp. toneSN tone *

Intake of food and its digestion increase the systolic BP by Adrenal medulla Heart
Blood vessels
about 10 mmHg due to a sympathetic stimulation.
DBP falls slightly due to vasodilatation in the GIT. { f f
Vasodilatation Catecholamine Bradycardia
Venodilatation secretion \
Sleep
Fig. 2.4.4 Baroreceptor reflex in response to increased BP.
During quite undisturbed sleep systolic BP may fall by about
20 mmHg. This is due to a low metabolic rate.
In disturbed sleep BP may rise. This is due to cortical \ BP
stimulation of VMC.
Inhibition of baroreceptors
Posture (carotid sinus and aortic arch)

BP is variable with posture of the body. In the standing pos-

Nucleus tractus
|
ture SBP is low and DBP is more. In the lying posture it is solitarius inhibited
just the reverse.
Q. 7. Explain regulation of blood pressure brought Stimulation of vasomotor Inhibition of cardioinhibitory
centre (RVLM)
about by baroreceptor mechanism. centre (nucleus ambiguus)

Ans. SNS Vagus

The reflex mechanisms that participate in the regulation or

+ Sympathetic + Vagal tone
BP are the follows: tone |
1. Baroreceptor reflexes
2. Chemoreceptor reflexes Blood vessels
—
Adrenal medulla Heart
3. Cushing’s reflex.
Tach di
Vasoconstriction Catecholamine aenyearcia
Baroreceptor Reflexes (Marey’s Reflex) Venoconstriction secretion *

Baroreceptors are mechanoreceptors and respond to stretch.
Important baroreceptor reflexes are as follows:
1. Carotid sinus reflex
2. Aortic arch reflex.
When BP increases baroreceptors present in the carotid
sinus are stimulated and there is an increase in the number
of impulses through the sinus nerve (Fig. 2.4.4).
Cardioinhibitory centre (CIC) and nucleus tractus soli-
tarius (NTS) are stimulated. NTS in turn inhibits vasomotor
centre (VMC) through internuncial neuron and stimulates
CIC. Vagal tone increases and sympathetic tone decreases.
This leads to vasodilation, decreased cardiac output,
creased heart rate and a fall in BP.
Fig. 2.4.5. Baroreceptor reflex in response to decreased BP.
This is also called Marey’s reflex. In this, the heart rate is
inversely proportional to BP. This relation is called Marey’s law.
When BP decreases baroreceptors present in the carotid
sinus are inhibited and the net effect is as follows (Fig. 2.4.5):
t Peripheral resistance
? Myocardial contractility
} Heart rate (tachycardia)
+ BP
This mechanism is a short-term regulatory mechanism
de- and is highly adaptable. The working range of BP is 60-160
mmHg. Above or below this range, this mechanism is not
er Quick Review Series: BDS 1st Year

useful. Whereas, in hypertension, the baroreceptor reflex 3. When a large quantity of blood is present it increases
mechanism is reset at a higher level to maintain BP at SBP and also there is a greater stretching of the vessel
elevated levels. walls, and, therefore, a greater recoil. So, DBP also
increases.
Q. 8. What is systolic, diastolic and pulse pres-
sure? Give account of factors that maintain blood
Elasticity of the Vessel Wall
pressure.
1. The elasticity of the arterial wall influences distension of
Ans.
the arteries during the ventricular systole and the subse-
Systolic BP (SBP) is defined as the maximum BP in the quent recoil during diastole.
arteries attainable during systole. 2. The distension of the aorta minimizes the rise in SBP.
Normal value is 120 + 20 mmHg. The recoil acts like an accelerator pump to the heart and
Diastolic BP (DBP) is defined as the minimum pressure this facilitates diastolic BP.
that is obtained at the end of the ventricular diastole. 3. In arteriosclerosis, where arteries undergo a narrowing
Normal value ranges from 60 to 90 mmHg. of the lumen and the wall becomes hard, the elasticity is
Pulse pressure (PP) is the difference between systolic and lost. This is usually seen in old age.
diastolic pressure. It is an index of cardiac output. 4. A decrease in the elasticity increases SBP and decreases
DBP.
PP = SBP — DSP = 40 mmHg
5. Since there is an increase in the peripheral resistance
Factors maintaining blood pressure are as follows: along with a loss of elasticity due to involvement of the
1. Cardiac output peripheral vessels, diastolic BP either rises or does not
Circulating blood volume change. So, in old age the force which distends the wall
YN

Elasticity of the vessel wall now drives the blood increasing BP. Hence SBP increases
Viscosity of blood more than DBP
ae

Peripheral vascular resistance.
Cardiac Output
1. Cardiac output (CO) is defined as the volume of blood
ejected by each ventricle per minute. It is also referred to
as minute volume.
2. Normal value in adult male is 5-6 L/m. It is less in
females than male.
3. It can be calculated from the stroke volume and the
heart rate.
CO = Stroke volume X heart rate
70 X 80 = 5600 mL/min
4. Cardiac output causes a rise in systolic blood pressure;
hence, any increase in CO proportionately raises SBP.
5. The ejected blood also causes stretching of the aortic
wall, which recoils during diastole causing a rise in DBP.
6. All the factors that alter the elasticity of the vessel wall
indirectly influence SBP and DBP.
Viscosity of Blood
1. Viscosity means the thickness of the fluid. Blood is
4.5 times viscous than water. So, naturally more pressure
is required to push the blood in the circulatory system.
2. When the viscosity of blood increases it offers more
resistance. So, it mainly affects DBP and also SBP.
High viscosity, e.g. polycythaemia, acidosis, dehydration.
Low viscosity, e.g. anaemia, nephritis.
Peripheral Vascular Resistance
1. PR depends on the following:
. Velocity of blood
wre

In other words, CO also causes a rise in DBP. . Viscosity of blood

BP = CO X PR . Elasticity of the vessel wall
. Lumen of the vessel
mona

There is a direct relation between cardiac output and
blood pressure.
Circulating Blood Volume
1. The arterial system along with the venous system and
the heart is compared to a closed system with elastic
tubes. Any fluid in such a system can exert significant
pressure only if the fluid fills the system to its capacity.
2. Unless normal blood volume is there the arterial system
is not filled properly and BP falls. Example:
Haemorrhage — Blood volume | BP |
Cushing’s syndrome — Blood volume f BP f
. Length of the vessel
. Extravascular compression
2. Peripheral vascular resistance is defined as the resistance
offered to the flow of blood by the blood vessels.
3. This is contributed by smooth muscle tone of the arteri-
oles, in particular small arteries, capillaries and venules.
4. PR is affected by the calibre or diameter of the lumen of
blood vessel. In general, it is inversely proportional to
the radius of the vessel.
5. Longer the vessel more would be the resistance, and vice
versa. An increase in the velocity of blood flow and vis-
cosity of blood would increase the peripheral resistance.

6. The muscular vascular bed offers maximum resistance
due to high extra vascular compression by the skeletal
muscle, and next is the skin vessels. Cutaneous vascular
resistance is due to the sympathetic constrictor tone.
BP = CO X PR
So, a greater PR increases BP, in general, and DBP, in
particular.
7. Peripheral resistance in a normal healthy young adult is
20 mmH¢/L/min.
As BP = CO & PR any rise in PR increases the blood
pressure.
8. PR is directly proportional to the velocity of the blood
flow and viscosity of blood, and indirectly proportional
to radius of the vessel and the elasticity of the vessel wall.
9. Peripheral resistance is increased in:
a. Old age due to (a) sclerosis of arteries and (b) de-
creased production of NO (nitric oxide), which
opposes the vasomotor tone.
b. Atherosclerosis due to (a) loss of elasticity and
(b) narrowing of blood vessels.
10. Peripheral resistance is decreased in (a) beri beri (B1 de-
ficiency) due to peripheral neuropathy, which decreases
the vasomotor tone causing vasodilatation and (b) hyper-
thyroidism due to vasodilatation.
Q. 9. Define the terms cardiac output and cardiac
index. Describe briefly any one method of measur-
ing cardiac output that can be safely used in man.
What are the factors that influence cardiac output?
Ans.
Cardiac output is defined as the volume of blood ejected
by each ventricle per minute. It is also known as minute
volume.
Normal value in adult male = 5-6 L/m. It is less in
females than male.
It can be calculated from the stroke volume and the heart
rate.
CO = Stroke volume X heart rate
70 X 80 = 5600 mL/min
Cardiac index (CT): It refers to the cardiac output expressed
per square metre of the body surface area. In a normal adult
male the body surface area is 1.7-1.8 m?.
So Cl = CO/SA = 5.6/1.7 L/min/m? =3 L/min/m?.
Normal value: 2.8 + 0.31 L/min/m? = 2.5-3.1 L/min/m7?.
Since the cardiac output quantitatively is a function of
the body surface area, Cl is a better parameter for comparing
the cardiac output of the people of the same age and sex.
Determination of Cardiac Output by Dilution
Technique
1. Various diluents used are as follows:
a. T-1824 (Evans blue)
b. Indocyanine green
Physiology
c. Coomassie blue
d. Isotopes *’P, Fe, !°'1
e. Small amount of cold sterile saline (thermodilution)
2. The diluent chosen should strictly satisfy the following
criteria:
a. It should not affect the heart and cardiac output.
b. It should not leave the circulation easily.
c. It should not be toxic to the body.
d. It should be easy to estimate the concentration of the
diluent in the body.
3. Principle: The output of the heart is equal to the amount
of the indicator injected divided by its average concen-
tration in the arterial blood after a single circulation
through the heart. In the body, as the blood is circulating,
time factor during which the mean concentration of the
diluent attained also is to be taken into consideration.
Dye Dilution Technique (Fig. 2.4.6)
1. A known amount of the commonly used dye. Example:
T-1824 (Evans blue) is injected into the peripheral vein
(antecubital) and the arm is kept up for a while to fa-
cilitate the flow of the dye towards the heart.
2. From the moment the dye is injected the blood samples
are collected from the peripheral artery at the rate of
one sample for every 2 sec for about 45 sec.
3. The concentration of the dye in each sample is estimated
and the values are plotted on a semilog paper taking con-
centration of the dye on Y-axis and the time on X-axis.
4. First the concentration of the dye goes on increasing and
reaches a peak, and then declines. The concentration once
again starts rising before it reaches the base line. The sec-
ond rise in the concentration of the dye is due to recircula-
tion of the dye. When the falling phase is extrapolated, it
cuts the time base giving the time for a single circulation
of the dye. This time depends on cardiac output.
t
Qg Exercise
s oN
Ss
FS]
2 | Resting
©
3 |!
a
Qo
9
Cc
oO
1
20 40 60
Time (sec)
Fig. 2.4.6 Recording of CO by dye dilution technique.
5. The mean concentration of the dye can be obtained
either by integrating the values (dye concentration) or
from the knowledge of the area of the curve.
6. The dilution of the dye has occurred to give the mean
concentration when the blood has flowed over an inter-
val of ‘? seconds.
Quick Review Series: BDS 1st Year

7. Cardiac output can be calculated by using the following

formula: Flow in 20 sec = ot
Amount of the dye injected = 5 mg
15
Mean concentration of the dye over a period of 40 sec
= 1.5 mg/L
CO (flow in 1 min) = > x ©" = 10 Lmin
.
Flow in 40 sec = —
5 15 x20
1.5

x
CO (flow in 1 min) = 5X60 = 5 L/min Advantages
1.5 x 40
1. This method gives more accurate values.
During exercise 2. It can be done even in exercise and does not involve
cardiac catheterization.
Amount of dye injected = 5 mg. Mean concentration of the 3. Nowadays the arterial concentration of the dye is esti-
dye over a period 20 sec = 1.5 mg/L. Mean concentration of mated by placing densitometer or oximeter in contact
the dye over a period of 20 sec = 1.5 mg/L. with the ear lobe directly.

SHORT ESSAYS

Q. 1. What are heart sounds? How are they pro- Third Heart Sound
duced? Mention their clinical significance.
1. It is produced due to the rapid rush of blood from the
Ans. atria into ventricles during the rapid-filling phase.
2. It may occasionally be heard in children or in normal
1. During each cardiac cycle, four heart sounds are produced.
individuals after muscular exercise.
Among them only the first and second heart sounds are
3. This sound has a short duration (0.1 sec).
heard clearly. The third heart sound can be heard in some
4. Its existence can be recorded by the phonocardiograph.
individuals but the fourth sound is inaudible.
2. All the four heart sounds can be recorded graphically
with the help of a phonocardiograph. Fourth Heart Sound

It is produced due to the contraction of atrial muscle during

First Heart Sound the second rapid filling phase of ventricles. This sound is not
1. Itis produced at the beginning of the ventricular systole heard can only be recorded by the phonocardiograph.
and is also known as the systolic sound.
2. The following factors contribute to the production of Clinical Significance of Heart Sounds
first heart sound:
1. In the valvular lesions and septal defects alteration in the
a. Closure of A—V valves
nature of heart sounds or the presence of associated
b. Contraction of ventricular muscle
murmurs can be seen.
c. Mediastinal vibrations
2. A graphical recording (phonocardiogram) provides sig-
3. It is better heard in the fifth left intercostal space. It is
nificant and useful information about the underlying
dull and low pitched, and prolonged with a duration of
defect. They can be detected by auscultation of the chest.
0.15 sec.
Q. 2. What are the properties of cardiac muscle?
Second Heart Sound
Ans.
1. It is also known as the diastolic sound. It is produced
after the protodiastolic period of cardiac cycle. The electrical and mechanical properties of cardiac muscle
2. The second sound is due to the sudden closure of semi- are as follows:
lunar valves. 1. Excitability
3. Itis auscultated in the second intercostal space on either 2. Conductivity
side of the sternum. It is sharp, high pitched and has a 3. Contractility
duration of 0.12 sec. 4. Rhythmicity.

Excitability
The ability of any tissue to respond to a stimulus is called
excitability, and being an excitable tissue the cardiac
muscle exhibits this property. Excitability is increased
by the stimulation of sympathetic or catecholamine ad-
ministration, while vagal stimulation or acetylcholine
inhibits it.
Conductivity
This property is exhibited by each individual muscle fibre
but is highly developed in a specialized conducting system of
myocardium known as the junctional tissue.
Contractility
Cardiac muscle is contractile in nature and shows certain
characteristics on stimulation.
Rhythmicity
The cardiac muscle can generate its own impulse. The sino-
atrial node has the highest rhythmicity (70/min).
Q. 3. Explain origin and spread of cardiac impulse.
Ans.
1. The conducting system or junctional tissue of the heart
is responsible for the origin of cardiac impulse and its
propagation through the entire myocardium.
2. The components of the conducting system of the heart
consists of the following:
a. S-A node
b. A-V node
c. Internodal tracts
d. Bundle of His with its right and left branches
e. Purkinje fibres
3. Apart from these some persons have abnormal short
circuiting fibres. These are as follows:
a. James fibres
b. Mahaim fibres
c. Accessory bundle of Kent
SHORT NOTES
Q. 1. Pacemaker.
Ans.
1. Pacemaker is the region that sets the pace at which
the heart has to beat in a unit time. Normally, S-A
node (sinoatrial node) acts as a pacemaker in human
heart.
Physiology
Origin of Cardiac Impulse
The origin of cardiac impulses is myogenic in nature. The car-
diac impulse of heart beat originates in the myocardium itself.
It has been shown that the S-A node is the site of origin of
cardiac impulse. So, it is called a natural pacemaker of the heart.
Spread of Cardiac Impulse
Atrial Activation
1. The impulse originates in the S—A node and travels to
the atrial myocardium in a radial direction, like a ripple
in a pond.
2. The conduction velocity in the S-A node is 0.05/sec. It
spreads to the left atrium via the common musculature,
which encircles them.
3. Impulse can also reach the left atrium through Bach-
mann’s bundle.
4. Conduction velocity of the impulse in the atrium is 1 m/sec.
About 0.1 sec is taken for the completion of depolarization
of both atria.
5. Impulse is conducted to A-V node either through the
atrial muscle or through the internodal tracts.
6. A-V node is the only connecting muscular bridge be-
tween the atrial and ventricular musculatures. Through
the A-V node, conduction of an impulse is delayed and
conduction velocity is 0.05 m/sec. The delay is called
A-V nodal delay. It gives sufficient time for the atria to
complete the contraction.
Ventricular Activation
1. From the A-V node the impulse travels through the
bundle of His (conduction velocity 1 m/sec) and starts
stimulating the ventricular myocardium.
2. The midportion of interventricular septum on the left
side is the first region in the ventricle to get stimulated.
3. From this side it passes through the septum to the right side
and then the impulse spreads to the apex on either side.
4. In the ventricle, the impulse is conducted by Purkinje
fibres at a maximum velocity of 4 m/sec. The ventricular
muscle fibres conduct the impulse at a rate of 1 m/ sec.
2. The sinoatrial node, which is the pacemaker of the
heart, generates the impulse due to the development of
pacemaker potential.
3. The excitation of pacemaker is transmitted to other
regions of the heart by a specialized conducting system
known as the junctional tissue of heart.
if:t:3) Quick Review Series: BDS 1st Year

Q. 2. Sinoaortic node. 3. Greater the venous return, greater will be the end dia-
stolic volume, which will increase the force of contrac-
Ans.
tion of the ventricle and increase the cardiac output.
1. S—-A node (sinoatrial node) is a crescentic band situated
Q. 6. Baroreceptor.
in the wall of the right atrium just below and to the right
of the opening of SVC (superior vena cava). Ans.
2. It acts as a pacemaker.
The carotid sinus and the arch of aorta contain receptors,
3. Normal frequency of impulses generated by this region
which respond to alterations in blood pressure. They are
is about 60—90/min.
called the baroreceptors and play an important role in regu-
4. The sinoatrial node, which is the pacemaker of the
lation of blood pressure.
heart, generates the impulse due to the development of
pacemaker potential and is transmitted to other regions Q. 7. Cardiac cycle.
of the heart by a specialized conducting system known
Ans.
as the junctional tissue of heart.
1. During each heart beat certain electrical, mechanical,
Q. 3. Heart sounds.
pressure and volume changes occur in the atria and ven-
Ans. tricles, and they are repeated in subsequent beats. This
cyclic repetition of events constitutes the cardiac cycle.
1. During each cardiac cycle four heart sounds are pro-
2. The terms systole and diastole refer to the contraction
duced, but only the first and second heart sounds are
and relaxation, respectively. In normal individuals with a
heard clearly. The third heart sound can be heard in
heart rate of 75/min, the duration of each cycle is 0.8 sec.
some individuals but the fourth sound is inaudible.
3. An increase in the heart rate reduces the duration of the
2. All the four heart sounds can be recorded graphically
cardiac cycle and vice versa. Cardiac cycle consists of the
with the help of a phonocardiograph.
following:
3. First heart sound is produced due to closure of A-V
valve. It indicates beginning of ventricular systole with a Atrial systole 0.1 sec
duration of 0.12-0.16 sec and frequency of <40 cycles/ Ventricular systole 0.3 sec
sec and is best heard in the mitral and tricuspid areas. Atrial diastole 0.7 sec
4. Second heart sound is produced due to closure of S-L Ventricular diastole 0.5 sec
valve (semilunar valves). It indicates the beginning of Q. 8. Draw a labelled diagram of ECG.
ventricular diastole with a duration of 0.1-0.14 sec and
Ans.
frequency of >40 cycles/sec, and is best heard in the
aortic and pulmonary areas. It is graphical recording of the summated electrical activity
from the heart during a cardiac cycle. ECG shows five deflec-
Q. 4. ECG.
tions, out of which three are conventionally termed as posi-
Ans. tive waves (upward) and two deflections are called negative
waves (download). A typical ECG record from limb lead II is
1. A graphical recording of the electrical activity of heart
given in Fig. 2.4.7.
muscle is known as electrocardiogram.
2. It gives information about the rate, rhythm and conduc-
tivity of myocardium.
3. Clinically, the ECG is an essential investigation for the
diagnosis of the following conditions:
a. Any conduction defects
b. Any arrhythmias
c. Detection of myocardial infarction/ischaemia
P T
For all practical purposes of description the ECG
recorded from the standard bipolar limb lead II is taken in to I
!
Qt
|I
Ss I
be—+l |I
|

consideration. 1 ; ST segment
I | I 1
Q. 5. Venous return. 1
!_PRinterval |
1
I '
| ST interval
Ans.
I ' I
1. Continuous return of blood to the atria and ventricles ! QT interval!
from respective circulations is called venous return. Fig. 2.4.7 ECG. P-wave is due to depolarization of atria. QRS
2. Venous return to the heart determines the end diastolic vol- complex is due to depolarization of the ventricles. T-wave is due
ume of the ventricle, which forms the preload to the heart. to repolarization of ventricular musculature.
 Physiology

RESPIRATION
LONG ESSAYS

Q. 1. Describe factors determining oxygen uptake d. When Hb takes up ©, the two chains a, and B, move
in lung. away together from affinity a, and B,, and when O;is
given up they move closer. This is responsible for the
Ans.
increase or decrease in affinity of Hb to O,
1. Uptake of O, by the blood in the lungs is mainly 7. Blood remains for about 0.8 sec in the lung capillaries
favoured by O, pressure gradient: but it requires about 0.3 sec for complete oxygenation of
Inspired air — 150 mmHg Hb. It is saturated to 97%.
Alveolar air — 104 mmHg Q. 2. Describe transport of oxygen in blood.
Venous Blood — 40 mmHg
This pressure gradient favours the diffusion of O, from Ans.
the lungs into the venous blood. Oxygen is transported in the blood in two forms:
2. The other factors influencing diffusion of O2 from the 1. Dissolved form
lungs into the blood are as follows: 2. Combined form as HbO;.
a. Thickness of the alveolocapillary membrane
b. Area of the membrane
c. Diffusion coefficient of O, Dissolved form Combined form Total
3. Thickness of the alveolocapillary membrane: In pulmo- Arterial 0.30 mL/100 mL 19.7 mL/100 mL 20 mL 15.0
nary fibrosis the thickness of the membrane increases Venous 0.12 14.88 5.0 mL
and hence there is less diffusion.
4. Area of the membrane: In lung collapse or uneven venti-
Each gram of Hb can carry about 1.34 mL of O:. So
lation—perfusion ratio the area that takes part in gas
roughly arterial blood contains about 20 mL of O,/100 mL.
exchange is less.
This gives about 5 mL to the tissue. Hence, venous blood
5. Diffusion coefficient of O,: Diffusion coefficient depends
contains about 15 mL of O,/100 mL. A-V difference is
on the solubility and molecular weight of a gas.
20-15 = 5 mL of O,; 100 mL of blood delivers about 5 mL
Diffusion coefficient of:
of O,; to the tissue. Total O, delivered to the tissue in 1 minute
O, — 1.0
is 250 mL
CO, — 20.3
CO — 0.81
Compared to CO, the solubility of O, in H,O is 20 times ., o, (A—V)
0, 100
Coefficient
of O, utilization = ———_———_—_
less. So diffusion rate of O, is less than CO). Arterial content
6. Oxygenation of blood in the alveoli: _5 xX 100 _ 25%
a. When O, enters the blood it dissolves in plasma and
20
then diffuses into the RBC where it combines with
haemoglobin.
Therefore, only 25% of O, present in the blood is utilized
b. Hb contains ferrous atoms. Each iron atom can
by tissue. The rest of O, acts as a reserve, which may be mo-
combine with one molecule of O; (two atoms of
bilized during stressful conditions (e.g. exercise). In exercise,
oxygen).
the coefficient of O, utilization is 75%.
Hb, + 0, —> Hb, O,
Hb,O, + OQ, > Hb, 0, Q. 3. Describe mechanics of respiration.
Hb,O, + QO, > Hb ,0,
Ans.
Hb,O, + 0 > Hb,O,
c. The reaction between Hb and O, proceeds as above. Exchange of gases between the organism and environment is
When one molecule of O, combines with Hb, the af- known as respiration. Each respiratory cycle consists of two
finity of Hb to O, increases. And so further combina- phases:
tion with O, is facilitated. Because of this, O-D curve 1. Inspiration
is sigmoid in shape. 2. Expiration.
Quick Review Series: BDS 1st Year

Inspiration While the intrapleural pressure is always subatmospheric,

1. During inspiration, the thoracic cavity expands in three
dimensions, namely, vertical, transverse and anteropos-
terior.
2. The diaphragm is the main muscle of inspiration and its
contraction causes an increase in the vertical dimension.
3. About 70% of the increase in the thoracic cavity is pro-
duced by the contraction of diaphragm.
4. The external intercostals are another group of muscles
of inspiration. Their contraction causes an increase in
the anteroposterior and transverse dimensions of the
thorax.
5. The upper six pairs of ribs account for an increase in
the anteroposterior and transverse dimensions of the
thorax. The seventh to the tenth rib, are responsible
for an increase of transverse dimension only.
6. In forced inspiration certain accessory muscles like
pectoral and sternomastoid also take part.
Expiration
1. Normal expiration occurs passively and commences
after the inspiration. The chest wall recoils back to the
normal state.
2. During forced expiration, the internal intercostals and
the abdominal muscles contract. These changes in the
capacity of the thorax produce alterations in the intra-
pleural and intrapulmonary pressures.
Pressure Changes during Breathing
Pressure changes are seen in the lung and pleura during each
respiratory cycle.
Intrapleural Pressure
The intrapleural pressure is subatmospheric. At the onset of
inspiration it is -2.5 mmHg and during a normal inspiration
becomes -6.0 mmHg. However, during the forced inspira-
tion, it may fall down to -30 mmHg. During forced expira-
tion it may become slightly positive.
The pressure returns to the pre-inspiratory level in the
lungs during the expiration. The maintenance of a subatmo-
spheric pressure is essential for the expansion of lungs
during inspiration. Further, it also gives stability to the
alveoli by preventing its collapse during expiration.
the intrapulmonary pressure does not follow an identical
pattern and becomes slightly positive during expiration.
The difference between the intrapleural and intra-
alveolar pressure is known as transpulmonary pressure.
The change in the volume of lung per unit change in
transpulmonary pressure is known as compliance of lung.
Lung Compliance
Indicates the expansibility of the lungs and the relationship
between intrapulmonary pressure and volume.
: Volume increase AV
Compliance = A _—_—_ = —
Unit increase in alveolar pressure AP
The normal value of lung compliance in adults is 200 mL/
cmH,O. When the thoracic compliance, which includes the
lungs also, is measured, the compliance is reduced. It is 100
mL/cmH,0. This is due to the viscous resistance present in the
chest wall. The compliance is reduced in various clinical condi-
tions like bronchial asthma, pulmonary fibrosis, oedema of the
lungs, etc.
Q. 4. Discuss factors affecting transport and diffus-
ing gases.
Ans.
O, and CO, are transferred across the respiratory membrane
by diffusion. The diffusion of these gases mainly depends on
the pressure gradient.
Factors that influence diffusion of gases across the alveo-
locapillary membrane are as follows:
1. Alveolocapillary membrane
2. Pressure gradient
3. Solubility of gas
4. Molecular weight of gas.
Alveolocapillary Membrane
It has a definite thickness and permeability.
1. Thickness: 0.2-0.5 tm. Diffusion of a gas is inversely
related to thickness. To enter blood, Oy has to pass
through different layers like the monomolecular layer of
the surfactant:
. Thin layer of fluid lining the alveoli
op

. Alveolar epithelium
. Interstitial space
intrapulmonary Pressure
moAian

. Basement membrane
Pressure changes that take place in the alveoli are referred to . Capillary endothelium
as intrapulmonary pressure. Before the onset of inspiration . Plasma layer
the intrapulmonary pressure is equal to the atmospheric pres- g. RBC wall
sure. During inspiration it becomes negative (—1 to-2 mmHg) Increase in thickness of the alveolocapillary membrane
and facilitates air entry into the lungs. During expiration the is seen in
pressure becomes slightly positive (+1 to +2 mmHg) and a. the fibrosis of the lung
helps in the expulsion of air from the lungs. b. in pulmonary oedema.
 Physiology

2. Permeability of the membrane: Diffusion is directly mechanism is controlled by the respiratory centres situ-
related to permeability. ated in the brainstem. However, the activity of these cen-
Example: Permeability decreases in fibrosis. tres is influenced by nervous reflexes and alterations in
3. Surface area: Diffusion is proportional to surface area. the chemical composition of blood. Several components
In a normal adult male, total surface area available for of the respiratory centre have been identified and are lo-
gas exchange is 100-140 m”. cated at different levels of the brainstem. All of them are
bilateral, freely intercommunicate with each other and
Surface area decreases in various pathological conditions
have a homolateral control on the respiration.
of lung. Examples: (a) emphysema, (b) lung collapse, (c) the
1. Centres for neural regulation of respiration are present
surface area is less in aged persons and (d) lobectomy or
in brainstem and cerebral cortex.
pneumonectomy.
2. The brainstem centres are required for rhythmic respi-
ration during asleep or awake.
Pressure Gradient
3. The cerebral cortical centre is required for voluntary
Diffusion is better with a higher pressure gradient. alterations in respiration.
Diffusion « A P 4. The brainstem centres are present in the reticular for-
mation of pons and medulla oblongata. The centres
O, Pressure Gradient present in the pons are as follows:
104 mmHg (alveoli) > 4 mmHg (venous capillary blood) a. Pneumotaxic centre
b. Apneustic.
CO, Pressure Gradient
The centres present in the medulla oblongata are as follows:
45 mmHg (venous blood) — 40 mmHg (alveoli) 1. Inspiratory (dorsomedial group of neurons)
2. Expiratory (ventrolateral group of neurons).
Solubility of a Gas
Increase in solubility of a gas in H,O increases diffusion. Medullary Centres
Diffusion «= solubility They contain the dorsal and ventral group of neurons
Example: CO; can diffuse faster as its solubility is more than responsible for the spontaneous rhythmic discharge of
that of O, impulses. These centres are modified by the neurons in
the pons and vagal afferents.
Molecular Weight of the Gas
1 Dorsal Group
Diffusion « =————
Mol. wt.
It is situated near the nucleus tractus solitarius. It consists
Diffusion is inversely proportional to molecular weight. of mainly inspiratory neurons.

Transport of Oxygen Ventral Group

The O, delivery system consists of lungs, blood and CVS. O,
delivery to a particular tissue depends on the following:
1. Amount of O, entering the lungs
2. Adequacy of pulmonary gas exchange
3. Blood flow to the tissue
4. Capacity of the blood to carry Op.
Transport of Carbon Dioxide
CO, is transported from the tissues to the lungs. The delivery
of CO, to lungs depends on the following:
1. The blood ©; content
2. Number of RBC present in the blood
3. The amount of reduced Hb.
Q. 5. Describe nervous regulation of respiration.
Ans.
Normal respiration is involuntary and rhythmic in nature
consisting of alternate inspiration and expiration. This
It is present near the nucleus ambiguus. It includes both
inspiratory and expiratory neurons.
Apneustic Centre
The exact role of this centre in human beings in not well-
understood. It is present in the lower part of pons and con-
tinuously sends impulses to the inspiratory centre to activate it.
Pneumotaxic Centre
It is the highest component of respiratory centre and is
located in the upper part of the pons. This centre exercises a
control over the lower centres and maintains the normal
respiration.
The normal respiratory rhythm is present due to the activ-
ity of medullary centres. However, the respiratory drive comes
from the activity of apneustic centres. These centres are under
the inhibitory influence from pneumotaxic centre and vagi.
When mid-pontine section is made, the respiration becomes
Quick Review Series: BDS 1st Year

slow and deep. If in the same preparation the vagi are also cut, (+ or)
Higher Centre
it results in prolonged inspiration called apneusis. Cerebral cortex
(voluntary control)
At the peak of inspiration, the apneustic and inspiratory
centres convey impluses to the pneumotaxic centre, which (+) ys (-)
Central >| Respiratory Centres
inhibits their activity. It has also been suggested that vagal chemoreceptor (-) Vagus
afferents directly stimulate the expiratory centre to intimate 4
Vv
(+)
expiration. rr
(+) +)
Motor Neuron Pool
Hering—Breuer
inflation reflex

Respiratory Reflexes - Vv ‘J’ receptors

Peripheral Respiratory Muscles
The regulation of respiration involves certain neural and chemoreceptors 7
1. Carotid body Proprioceptors o
chemical mechanisms, which operate through various 2. Aortic body (muscle, tendon and joints)

reflexes as shown in the Fig. 2.5.1. A

Hering—Breuer Inflation Reflex O, lack, rise in

CO,, rise in Ht

The receptors for this reflex are located in the bronchioles

Fig. 2.5.1 Regulation of respiration through various reflexes.
and are innervated by the vagus nerve. This reflex operates
during hyperpnoea and not in normal quiet breathing.

Proprioceptors Higher Centres

Afferent impulses arising from these receptors in the mus- They are present in the cerebral cortex and are responsible
cles, tendons and joints stimulate respiration. The exact for voluntary respiration. Stimulation of certain areas in the
mechanism for this response is not clearly understood. cingulated gyrus results in an inhibition of respiration.

SHORT ESSAYS

Q. 1. What are the two types of dead space? How The subject is asked to take a deep breath of pure oxygen
are they determined? and expire steadily into a nitrogen meter. It can be seen that
in the first phase of expiration the N; concentration is zero
Ans.
since the air comes out from the air passages. In the second
The dead space is part of respiratory system in which in phase, N2 concentration rises since the air is coming from the
spite of air being present does not take part in exchange of alveoli and dead space.
gases. The dead space is equal to the volume of first phase and
midpoint of second phase. This is about 150 mL, as shown
There are two types of dead space, namely:
in the Fig. 2.5.2.
1. Anatomical dead space
2. Physiological dead space.

Anatomical Dead Space

1. Anatomical dead space denotes the air present in the air
N, Concentration (%)

passages not involved in the gaseous exchange.

2. During inspiration the tidal air enters into the respira-
tory tract. A certain part of it goes into the lung alveoli
and is responsible for the respiratory exchange of gases.
However, some of the inspired air remains in the upper
respiratory passages and does not take part in the gas-
eous exchange. This part of the respiratory tract is
known as the anatomical dead space and its total capac-
ity is about 150 mL. ° Expired volume

3. It can be determined by the single-breath nitrogen 0 DS

analysis. Fig. 2.5.2 Single-breath nitrogen analysis.
 Physiology

Physiological Dead Space 2. Examples:

a. Moderate to severe anaemia is the most common
The physiological dead space includes the anatomical dead
cause of anaemic hypoxia.
space and also additional alveolar areas where exchange of
b. In carbon monoxide poisoning, the oxygen uptake
gases does not take place. In normal individuals, these alveo-
by the haemoglobin is reduced and this can also
lar areas constitute an insignificant proportion, and, hence,
cause anaemic hypoxia, even though the haemoglo-
both the anatomical and physiological dead spaces are almost
bin content of blood is normal.
identical. However, when there is an unequal ventilation-
3. Some of the common features of this hypoxia are as
perfusion ratio as in lung fibrosis, the physiological dead
follows:
space may increase considerably.
a. Decreased oxygen carrying capacity of haemoglobin.
Q. 2. Classify hypoxia. Explain each type of b. Decreased arterial oxygen content.
hypoxia with examples. c. pO, in arterial blood, percentage saturation of hae-
moglobin and concentration of reduced haemoglo-
Or
bin are normal.
Mention the different types of hypoxia and explain
with suitable examples. Stagnant Hypoxia
Ans. 1. Stagnant hypoxia is primarily due to the cardiac failure
or circulatory shock.
Hypoxia is a condition in which the tissues suffer from
2. The blood oxygen content is normal but the speed
oxygen lack. Based on the cause of their production, four
of blood flow is reduced. Consequently, less oxygen is
different types of hypoxia are as follows:
delivered to the tissues.
1. Hypoxic hypoxia
3. Some of the common features of this hypoxia are:
2. Anaemic hypoxia
a. Cyanosis is observed.
3. Stagnant hypoxia
b. Increase in concentration of reduced haemoglobin in
4. Histotoxic hypoxia.
capillary blood.
Hypoxic Hypoxia
Histotoxic Hypoxia
1. In this type of hypoxia, the oxygen lack to the tissues is
1. It occurs in poisoning of tissues, any chemical which
due to the low partial pressure of oxygen in the arterial
inhibits the activity of the enzyme cytochrome oxidase,
blood.
results in the production of histotoxic hypoxia.
2. It can result from the following:
2. This condition is commonly seen in cyanide poisoning.
a. Low atmospheric tension, as at high altitudes
3. The common feature of this hypoxia is decrease in con-
b. Obstruction to the respiratory passages
centration of reduced haemoglobin in capillary blood.
c. Collapse of the lungs
d. Patent interventricular septum Effects of hypoxia, in general, are as follows:
3. Some of the common features of this hypoxia are as
If hypoxia is slow and moderate, the following effects are
follows:
observed in the subject:
a. Cyanosis is commonly seen.
1. Nervous system: There is mild headache, mental de-
b. Increase in concentration of reduced haemoglobin in
pression, impaired judgement, lack of self-control and
capillary blood.
euphoric tendency.
. Oxygen carrying capacity of haemoglobin is normal.
2. Circulation: The heart rate and blood pressure are
. Decreased arterial oxygen content.
moan

increased.
. Decreased percent saturation of haemoglobin.
3. Respiration: The rate of respiration is increased and
. Decreased pO, in arterial blood.
sometimes even periodic breathing may be observed.
4. Digestive system: Hypoxia is usually associated with a
Anaemic Hypoxia
feeling of nausea and vomiting. The subject also exhibits
1. Anaemic hypoxia is usually observed in conditions, a loss of appetite. Sudden severe hypoxia damages the
which reduce the oxygen carrying capacity of blood. brain cells producing unconsciousness and death.
iY) Quick Review Series: BDS 1st Year

SHORT NOTES

Q. 1. Surfactant.
Ans.
1. The surfactant is a phospholipid with a lipoprotein
component dipalmitoyl phosphatidyl choline secreted
by the type II cells of alveolar epithelium of lungs.
2. It reduces the surface tension of the fluid present in the
alveoli. Surface tension reducing property of the surfac-
tant can be noticed, especially during expiration and it
helps to prevent the collapse of the alveoli.
3. It also keeps the alveoli dry and prevents pulmonary
oedema.
4. Other functions of the surfactant are:
a. Increases the compliance of lungs
b. Reduces the work done during breathing
c. Reduces the airway resistance
Q. 2. Vital capacity.
Ans.
1. Vital capacity is the volume of air forcibly expired after
a deep inspiration.
VC = IRV + TV + ERV
where IRV is — Inspiratory reserve volume TV is >
Tidal volume
ERV is — Expiratory reserve volume
2. The normal range of vital capacity is between 3.5 and 4
litres.
3. There are several factors, which influence the vital ca-
pacity like sex, height, body surface area and posture.
Q. 3. Oxygen—haemoglobin dissociation curve.
Or
5. The dissociation curve shows that when pO; falls below
60 mmHg, there is a sharp decline in the percentage
saturation of Hb. This shows unloading of O, from the
Hb, which occurs at the tissues. When pO, increases
from 60 to 100 mmHg, the percentage saturation of Hb
shows only a marginal rise. The curve is almost flat in
that range. It can be seen that the Hb is 90% saturated,
even at pO, of 60 mmHg. The advantage of this is that
in mild hypoxia, which shows pO, fall in the alveoli
from 100 to 60 mmHg, the percent Hb saturation will
not be significantly affected.
Q. 4. Hypoxic hypoxia.
Ans.
In hypoxic hypoxia, the lack of oxygen to the tissues is due
to the low partial pressure of oxygen in the arterial blood,
which could result from low atmospheric tension as at high
altitudes, obstruction to the respiratory passages, collapse of
the lungs or patent interventricular septum. Cyanosis is
commonly seen in this type of hypoxia.
Q. 5. Hypoxia.
Ans.
1. Hypoxia is a condition in which the tissues suffer from
deficient oxygen supply.
2. Based on the cause of their production, four different
types of hypoxia have been identified.
a. Hypoxic hypoxia
b. Anaemic hypoxia
c. Stagnant hypoxia
d. Histotoxic hypoxia

Oxygen dissociation curve. Q. 6. Cyanosis.

Ans. Ans.

1. Oxygen dissociation curve is a graphical representation
of the percentage saturation of Hb with oxygen at differ-
ent partial pressures.
2. Blood is taken in a series of tonometers and exposed to
different partial pressures of O, at a temperature of
37°C. The percentage saturation of Hb at different O,
pressures is noted. The curve thus obtained is known as
the oxygen dissociation curve.
3. The oxygen dissociation curve has a sigmoid shape. Ata
tension of 100 mmHg, which exists in the alveoli, almost
98% of oxygen saturation of Hb occurs. This is the arte-
rial point.
4. The saturation of Hb is 70% at the O, tension
40 mmHg, which exists in the venous blood. This is
termed as the venous point.
1. Cyanosis is a clinical condition in which the skin and
mucous membrane acquire a bluish colouration.
2. It is seen in nailbeds, mucous membrane, earlobes, lips
and fingers due to the increased circulation of reduced
haemoglobin in the blood and is produced when the
amount of reduced Hb rises above 5 g%.
3. Cyanosis is observed in hypoxic and stagnant type of
hypoxia, but is absent in anaemic hypoxia, since the
haemoglobin content is already low.
4. Cyanosis can also be noticed on the exposed areas in
normal persons in moderate cold. The appearance of
cyanosis depends upon:
of a. Total amount of haemoglobin.
b. Content of reduced haemoglobin.
c. State of capillary circulation.

Q. 7. Apnoea.
Ans.
1. Apnoea is a temporary cessation of respiration.
2. Under normal physiological conditions, it occurs during
deglutition and after hyperventilation.
3. Individuals can also voluntarily stop breathing, as in the
breath holding test.
4. The different types of apnoea are as follows:
a. Deglutition apnoea
b. Voluntary apnoea
c. Vagal apnoea
d. Adrenaline apnoea
e. Hyperventilation apnoea
5. Prolonged apnoea results in the accumulation of CO, in
the blood, which stimulates the respiratory centre and
breathing automatically commences.
Q. 8. Artificial respiration.
Ans.
The restoration of respiration in certain conditions like
drowning, asphyxia, gas poisoning or electrocution where
the respiration stops is a lifesaving measure and has to be
done immediately.
Various methods employed for giving artificial respiration to
restore normal respiratory rhythm are as follows:
1. Mouth-to-mouth breathing: The subject is kept in
supine position and his or her neck is extended. If there
is any mechanical block to the respiratory passage, it has
to be cleared. The operator forcibly expires into the
mouth of the subject at a rate of 12-15 times per minute
till the normal respiration is restored.
2. Schaefer’s method: In this technique, the operator ap-
plies manual pressure on either side below the thoracic
cage and subsequently releases it. This procedure alters
the size of the thoracic cage and produces alternate
inspiration and expiration. This manipulation has also
to be done 12-15 times per minute.
3. Mechanical methods: They are employed when artifi-
cial respiration has to be sustained for a longer period of
time. In Drinker’s method, the thorax is enclosed in a
specially designed tank in which negative and positive
pressure changes are maintained alternatively. These
result in the expansion and contraction of the thoracic
cage, bringing about inspiration and expiration.
Q. 9. Chloride shift.
Ans.
1. About 70% of CO; is transported as bicarbonates. This
involves the migration of ions between the plasma and
red cells.
2. CQ, enters the tissue capillaries to form a simple physi-
cal solution, which subsequently diffuses across the
permeable red cell membrane.
Physiology
3. The red cells contain an enzyme carbonic anhydrase,
which catalyses the hydration of CO, to form H,COs,
which in turn dissociates into Ht and HCO;~.
4. The HCO; diffuses from the cell into the plasma and
produces an alteration in the Donnan’s electrochemi-
cal neutrality. This results in the shift of Cl” ions from
the plasma into the red cells. This shift of chloride
ions constitutes the chloride shift or Hamburger’s
phenomenon.
Q. 10. List the types of hypoxia.
Ans.
1. Hypoxia is a condition in which the tissues suffer from
oxygen lack.
2. Four different types of hypoxia have been identified
based on the cause of their production:
a. Hypoxic hypoxia
b. Anaemic hypoxia
c. Stagnant hypoxia
d. Histotoxic hypoxia
Q. 11. Respiratory centres.
Ans.
1. Centres for neural regulation of resipiration are present
in brainstem and cerebral cortex.
2. The brainstem centres are required for rhythmic respi-
ration during asleep or awake.
3. The cerebral cortical centre is required for voluntary
alterations in respiration.
4. The brainstem centres are present in the reticular for-
mation of pons and medulla oblongata.
The centres present in the pons are as follows:
a. Pneumotaxic centre
b. Apneustic
The centres present in the medulla oblongata are as follows:
a. Inspiratory (dorsomedial group of neurons)
b. Expiratory (ventrolateral group of neurons)
Medullary Centres
They contain the dorsal and ventral group of neurons
responsible for the spontaneous rhythmic discharge of
impulses. These centres are modified by the neurons in the
pons and vagal afferents.
Dorsal Group
It is situated near the nucleus tractus solitarius. It consists of
mainly inspiratory neurons.
Ventral Group
It is present near the nucleus ambiguus. It includes both
inspiratory and expiratory neurons.
Quick Review Series: BDS 1st Year

Apneustic Centre 2. This condition is usually seen in strangulation or ob-

struction of the respiratory passage by some foreign
The exact role of this centre in human beings in not well-
body.
understood. It is present in the lower part of pons and con-
3. The symptoms of asphyxia can be grouped into
tinuously sends impulses to the inspiratory centre to activate it.
following three stages, each with a duration of about
2 minutes:
Pneumotaxic Centre
a. Stage of hyperpnoea
It is the highest component of respiratory centre and is located b. Respiratory convulsions
in the upper part of the pons. This centre exercises a control c. Central depression
over the lower centres and maintains the normal respiration.
If asphyxia continues for 5-6 minutes, it may prove fatal.
Q. 12. Chemoreceptors.
Q. 14. Dyspnoea.
Ans.
Ans.
1. The chemical regulation of respiration is brought about
1. A condition in which there is difficulty in breathing is
by chemoreceptors.
known as dyspnoea. Example: bronchial asthma.
2. The chemoreceptors are of following types:
2. The appearance of dyspnoea is related to the dyspnoeic
a. Peripheral chemoreceptors
index, which depends on the breathing reserve. The
b. Central chemoreceptors
difference between maximum voluntary ventilation and
3. Alterations in the chemical composition of blood
pulmonary ventilation gives breathing reserve.
influence respiration, which acts on the peripheral and
central chemoreceptors and stimulate the respiration. MVV — PV x 100
3. Dyspnoeic index =
4. The peripheral chemoreceptors are present in the MVV
following: The normal value is about 90%; but if it falls below 70%,
a. Carotid body located in the upper part of the neck, at dyspnoea is observed physiologically. It occurs during
the bifurcation of the common carotid artery strenuous muscular exercise.
b. Aortic body situated near the arch of the aorta 4. The pathological conditions that can also lead to dys-
5. The central chemoreceptors are located on the ventral pnea are as follows:
surface of the medulla and are very sensitive to CO; . Obstruction to air passages
op

excess in the blood, which stimulates them. . Paralysis of respiratory muscles

. Pneumothorax
Q. 13. Asphyxia.
moAian

. Metabolic acidosis
Ans. . Left ventricular failure
. Lung emphysema
1. Asphyxia is a condition in which there is a sudden oxygen
lack and simultaneous accumulation of CO, in the body.

DIGESTIVE SYSTEM
LONG ESSAYS

Q. 1. Proteolytic enzymes of pancreas. 3. Composition: water — 99%, solids — 1%, both inorganic
and organic substances.
Ans.
a. Inorganic substances:
1. Pancreatic juice is a colourless, odourless, watery secre- i. HCO; concentration > 135-140 mEq/L (increases
tion isosmotic with that of plasma. with increased rate of secretion)
2. About 1-1.5 litres of pancreatic juice is secreted in ii, Cl” concentration — 10-15 mEq/L (inversely
24 hours. pH is 8-9, specific gravity is 1.010-1.018. related to HCO; concentration)
 Physiology

iii, Na** — 130 mEq/L Q. 2. Give in detail the functions of liver.

iv. Kt > 10-15 mEq/L
Ans.
b. Organic constituents:
i. Mucus Liver is the largest exocrine gland in the body, weighing
ii. Enzymes about 1.5 kg in an average adult. It is located in the abdomen
iii. Trypsin inhibitor in the right hypochondrium and a part of epigastric region.
4. The proteolytic enzymes of the pancreatic juice are as It has two lobes—right and left lobes. The bile from which is
follows: drained by right and left hepatic ducts, respectively.
. Trypsinogen
ap

. Chymotrypsinogen Functions of Liver

. Procarboxypeptidases 1. Storage function: Liver stores certain substances like pro-
. Proelastase
enn

tein, glycogen, Vits A, D, By, and folic acid. Iron is also

. Collagenase
Proteolytic enzymes are secreted in inactive state. The 2. Synthetic function: Various substances are synthesized.
inactive granules are activated in the duodenum, where
they act on various proteins.
Trypsinogen 3.
It is a long polypeptide chain with a molecular weight of
4.
25,000 and has 229 amino acids. Cleavage between fifth and
sixth amino acids produces trypsin. Activation occurs by
acid, enterokinase, MgSO,, CaCl, and trypsin itself. Trypsin
acts on polypeptide bonds located in the interior of protein
molecules. Therefore, it is an endopetidase.
Chymoirypsinogen
Molecular weight is 25,700 and has 248 amino acids. Cleav-
age between the 15th and 16th amino acids produces chy-
motrypsin. It is also an endopeptidase activated by trypsin
and enterokinase. Specially acts on peptide whose carboxyl
group is provided with tyrosine and phenylalanine.
Procarboxypeptidase A 5.
Activated to carboxypeptidase A by trypsin. It acts on termi-
nal peptide bonds of end products of chymotrypsin and
elastase digestion.
Procarboxypeptidase B
Activated to carboxypeptidase B by trypsin. It acts on
C-terminal peptide bonds of the end products of trypsin 6.
digestion. These two enzymes are exopeptidases, as they act
from the end of the molecules. The end products of all these
enzymes are dipeptides, tripeptides and amino acids.
7.
Proelastase
It is activated by trypsin to elastase and causes digestion of
elastin and other polypeptides. 8.
Collagenase
Digests collagen.
stored to some extent as ferritin.
Plasma proteins like albumin, fibrinogen, prothrombin,
etc. are synthesized. Glycogen, phospholipids, bile acids
and heparin are also synthesized by liver.
Secretory function: Bile acids and bile pigments are
secreted into the bile.
Metabolic function: It participates in carbohydrate,
protein and fat metabolism.
a. Carbohydrate metabolism
i. Glycogenolysis
ii. Glycogenesis
iii. Gluconeogenesis, etc.
b. Protein metabolism
i. Synthesis of triglycerides
ii. Deamination and transamination reactions
iii. Urea formation from nitrogen, etc.
c. Fat metabolism
i. Synthesis of triglycerides
ii. Synthesis of phospholipids
iii. Lipolysis and ketone production
Excretory function
a. Heavy metals like lead, bismuth and arsenic are
excreted by the liver.
b. Cholesterol and bile pigments are excreted into the
bile.
c. Drugs ingested are detoxified and excreted into bile.
d. Hormones like thyroid hormones and steroid hor-
mones are altered and excreted into the bile.
Haemopoietic function
a. In fetal life, the liver produces RBC.
b. RBCs are also destroyed, as it is a part of the RES
system.
Body defence
Kupffer cells lining the liver sinusoids belong to the
macrophage system and destroy the bacteria that enter
the portal blood.
Detoxification of various substances
a. Converts toxic substances into nontoxic substances, e.g.
benzoic acid is converted into hippuric acid by conjuga-
tion with glycine. Ammonia is converted to urea.
Quick Review Series: BDS 1st Year

b. Certain active substances are inactivated by degrada-
tion, e.g. epinephrine, barbiturates.
c. Certain substances are made water soluble by conju-
gation and excreted into the bile, e.g. bilirubin is
conjugated with glucuronic acid and forms bilirubin
diglucuronide.
9. Activation of Vit. D
The kidneys, liver and skin participate in the activation
of Vit. D.
Q. 3. Name phases of gastric secretion
describe in detail.
Ans.
1. Gastric juice is secreted continuously throughout the
day. During digestion a lot of juice is secreted compared
to resting state, during which a small amount of juice is
secreted.
2. Gastric secretion is divided mainly into two phases:
a. Digestive phase
b. Interdigestive phase (resting phase)
Digestive Phase
Both the neural and hormonal mechanisms control the
secretion of gastric juice during the digestive phase. Neural
control dominates in the cephalic phase, whereas hormonal
control dominates in the gastric phase.
The digestive phase is further divided into three different
phases:
a. Cephalic phase (initial reflex phase)
b. Gastric phase
c. Intestinal phase
Cephalic Phase (Fig. 2.6.1)
1. When the food is taken into the mouth, there is secre-
tion of gastric juice even before the food enters the
stomach. It is due to reflexes arising from the brain;
hence, the name cephalic phase.
2. Even the sight, smell or thought of food results in gastric
secretion. Impulses originate from the sensory endings
carried to the vagal nucleus, and secretor stimuli reach the
stomach via vagi. Integrity of the vagus nerve is impor-
tant for the cephalic phase of gastric secretion. Cephalic
phase of gastric secretion can be well-demonstrated by
oesophagostomy and Sham feeding.
3. Vagal stimulation increases gastric secretion by two
mechanisms. ACh secreted directly acts on the parietal
and chief cells. GRP released from some vagal fibres acts
on the G cells and stimulates gastrin secretion. This, in
turn, acts on the parietal and chief cells, and increase
HC] and pepsin production.
4. Physiological significance: Rate of production of gastric
juice during cephalic phase is high and rich in acid and
and
pepsin. Moreover, this is secreted when there is no food
in the stomach. This may damage gastric mucosa and
produce ulcers. Vagotomy abolishes this phase.
5. Cephalic phase is again divided into two phases:
a. Unconditioned reflex
b. Conditioned reflex (psychic phase)
Unconditioned reflex: When food is placed in the mouth, a
reflex secretion of gastric juice takes place. This is called un-
conditioned response.
Conditioned Reflex (Psychic Phase)
Smell, thought and sight of food itself brings about secretion
of gastric juice. This is an acquired reflex. The gastric secre-
tion produced during this phase is called psychic or appetite
juice, and is unrelated to the composition of the food.
Gastric Phase
1. This phase of secretion begins when the food enters the
stomach.
2. The gastric phase is controlled by both neural and
humoral mechanisms. Both mechanisms interact and
produce greater response.
3. During this phase the maximum amount of gastric juice
is secreted and is proportional to the protein content of
the diet.
Inhibition
1. When acid, fat and hyperosmolar solutions enter the
duodenum and proximal part of jejunum, secretin,
bulbogastrone, CCK—PZ and GIP are released. These
inhibit the release of gastrin and also inhibit acid secre-
tions by acting on the parietal cells.

‘wal cavity |__ Unconditioned

(taste) reflex ACh Direct Chief cell and »~ HCl and
a“ effect parietal cell enzyme

Sight, smell,
hearing of |__ Conditioned |
-
Comtex hype
=
cap —- [Gear ]—+ Gastin
+
food, thought reflex limbic system

Fig. 2.6.1 Neural mechanism during cephalic phase.

 Physiology

2. Two more unidentified hormones released from duode-
num in response to presence of fat and hyperosmolar
solutions inhibit acid secretion.
3. Enterogastric reflex: This is a reflex mechanism mediated
through the local nerve plexus. When blood enters the
duodenum it gets stretched. Local plexus is activated.
This inhibits through sympathetic nerve fibres both
gastric secretion and motility. Fat is the most potent
inhibitory stimulus.
Cerebral cortex, hypothalamus and limbic system influ-
ence gastric secretion.
Q. 4. Describe composition and functions of saliva.
Ans.
Composition of Saliva
Volume
1-1.5 L/24 hr at a rate of 1 mL/min. The rate of secretion is
maximum during sleep.
. Mucin: It is a glycoprotein produced by the mucous
acini of the salivary glands. It helps in food bolus
formation.
. Lysozymes: These are groups of enzymes which can
destroy bacteria present in the mouth.
. Blood group substances: Present in secretors in a concen-
tration of 20-30 mg/L
. Kallikrein: It is the enzyme present in the saliva. It acts
on alpha-2-globulin to produce bradykinin. It is a
polypeptide which causes vasodilatation.
. Nerve growth factor: A polypeptide produced from
the submaxillary salivary gland. It is useful for the
growth and maintenance of sympathetic and sensory
nerves.
. Immunoglobulin: IgA helps to fight against bacteria and
virus.
9. Sialogastrin: Gastrin-like substance present in saliva.
10. Lactoferrin: Binds iron and is bacteriostatic.
ll. Proline-rich proteins: Protect tooth enamel and bind
toxic tannins.

Osmolality Functions of Saliva

Hypotonic to plasma. 1. Lubrication of food (bolus formation): Saliva mixes

well with food. Mucus present in saliva acts as a lubri-
Constituents cant. Food will be made into a bolus, which can be easily
swallowed.
1. Water — 99%
. Solvent: To appreciate the sensation of taste, food has
2. Solids — 0.5%]
to be dissolved. Saliva acts as a solvent, dissolves the
3. Organic — 0.3%
food materials and helps in stimulating taste buds.
4. Inorganic — 0.2%
When taste buds are stimulated, sensation of taste is
appreciated.
Inorganic Constituents of Saliva
. Cleansing action: Continuous secretion of saliva washes
1. HCO;: Derived from blood and from metabolism of off the food residues, bacteria and desquamated epithe-
acinar cells 5-60 mEq/L. lial cells. Lysozymes present in the saliva destroy bacte-
Cl concentration 5-7 mEq/L derived from the blood, ria. Thus, saliva cleans the oral cavity and helps in oral
increases with increase in the flow of saliva. hygiene.
Na* concentration 5-100 mEq/L, increases with increase . Digestion: Alpha-amylase present in the saliva acts on
in the flow of saliva. starch and breaks down the interior — alphal-4-glu-
K* concentration exceeds that of plasma, 8-20 mEq/L cosidic linkages. Starch digestion is initiated in the
derived from blood. Increases with decreased rate of mouth but not completed because of lack of sufficient
flow of saliva. time.
Ca** concentration 2-4 mEq/L increases with an in- . Excretion: Saliva excretes Hg, Pb and K compounds.
crease in the flow of saliva. . Water balance: When water of the body is not adequate,
PO, concentration is twice that of the plasma, indepen- salivary secretion decreases. Mouth becomes dry. Thirst
dent of the flow rate. sensation is felt. When water is taken, water content
increases. Salivary secretion also increases.
Organic Constituents of Saliva . Speech: Saliva keeps the oral cavity moist and so aids in
speech.
1. Salivary enzyme: Ptyalin or salivary alpha amylase, acts
on starch and converts it into alpha limit dextrins and Q. 5. Enumerate any four functions of saliva. De-
maltose. scribe the nerve supply to salivary glands and
2. Lingual lipase: Produced by Ebner’s glands present on regulation of salivary secretion.
the dorsum of the tongue is active in stomach and can
digest as much as 30% of ingested triglycerides. Ans.
Quick Review Series: BDS 1st Year

Functions of Saliva Sympathetic nerve fibres

1. Lubricantion of food for swallowing (bolus forma- Noradrenaline

tion): Saliva mixes well with food. Mucous present in
saliva acts as a lubricant and makes the food bolus, a receptor B receptor
which can be easily swallowed.
2. Solvent: Food has to be dissolved to appreciate the Vasocon- Basket *cCat t Cyclic
sensation of taste. Saliva acts as a solvent and dis- striction cells is contraction level AMP
solves the food materials to help in stimulating taste | | | |
buds. When taste buds are stimulated, sensation of
+ Blood flow + Flow of * Secretion (transient action)
taste is appreciated. tothe gland — saliva
3. Cleansing action: Saliva cleans the oral cavity and helps
Fig. 2.6.3 Parasympathetic nerve supply.
in oral hygiene maintenance. Continuous secretion of
saliva washes off the food residues, bacteria and desqua-
mated epithelial cells. Lysozymes present in the saliva
destroy bacteria. The cardial part called inferior salivary nucleus provides
4. Digestion: Alpha-amylase present in the saliva acts on parasympathetic nerve fibres to acinar cells and blood
starch and breaks down the interior — alphal-4-glucosidic vessels of parotid gland. These fibres pass via the glossopha-
linkages. Starch digestion is initiated in the mouth but not ryngeal nerves.
completed because of lack of sufficient time. The superior part called superior salivary nucleus pro-
vides parasympathetic nerve fibres to the acinar cells, and
Nerve Supply to the Salivary Glands blood vessels of the submaxillary and sublingual glands.
These fibres pass through the facial nerve and the chorda
Both sympathetic and parasympathetic nerves supply to the tympanic nerve. Pain afferents from these glands run in the
glands. parasympathetic nerves.
Stimulation of the parasympathetic nerve fibres results in
Sympathetic Nerve Supply (Fig. 2.6.2) increased secretion of watery enzyme-rich saliva.

Regulation of Salivary Secretion

Salivary nucleus
Salivary secretion is exclusively regulated by neural mecha-
PSN fibres nisms, which is of two types:
1. Spontaneous
ACh VIP 2. Reflex secretion.

[7 Spontaneous Salivary Secretion

Acinus NO Kallikrein bradykinin
1. Saliva is secreted continuously; but the rate of salivary
Secretion | acoatstaton secretion is under the influence of various condi-
tions that are capable of stimulating or inhibiting the
Fig. 2.6.2 Sympathetic nerve supply.
process.
2. The continuous secretion of saliva in the absence of any
known stimulus is known as spontaneous salivary secre-
Fibres arise from T, and T,, and reach the superior cervical
tion (resting secretion).
ganglion. Postganglionic fibres start here and run along the
3. It is suggested that minute quantities of ACh are
blood vessels and supply to all the glands. They supply to:
released continuously into the gland, which can bring
1. Basket cells
about salivary secretion.
2. Blood vessels
4. Spontaneous salivary secretion can be blocked by meta-
3. Acinar cells.
bolic poisons like cyanide. This shows that the sponta-
Stimulation of sympathetic nerve fibres results in in- neous salivary secretion depends on the metabolic activ-
creased secretion of thick viscous saliva containing mucus ity of the salivary glands. This secretion keeps the oral
and enzymes. cavity always moist.

Parasympathetic Nerve Fibres (Fig. 2.6.3) Reflex Secretion of Saliva

These come from a nucleus present at the junction of the 1. This occurs in response to a stimulus. Saliva is secreted
medulla and pons near the tractus solitarius. reflexly in two ways.
 Physiology

2. Two types of reflexes involved in secretion of saliva are Inorganic substances

as follows: 1. HCO; concentration: 135-140 mEq/L, increases with
a. Unconditioned reflexes increased rate of secretion
b. Conditioned reflexes. 2. Cl concentration 10-15 mEq/L
3. Na* — 130 mEq/L
Unconditioned reflexes (inherent) 4. K* — 10-15 mEq/L.
Stimulation of the nerve in the mouth by the presence of
Organic constituents
food or other substances brings about a reflex salivary
secretion. This is called an unconditioned reflex. Whenever 1. Mucus
food material is placed in the mouth, it stimulates the 2. Enzymes
nerves and the impulses are carried by the glossopharyn- 3. Trypsin inhibitor.
geal, vagus and trigeminal nerves to the brain. Thus the
inferior and superior salivary nuclei are stimulated. The Enzymes
impulses are conveyed to the salivary glands and so salivary Proteolytic
secretion starts.
1. Trypsinogen
Conditioned reflexes (acquired)
. Chymotrypsinogen

wh
. Procarboxypeptidases
This is due to the stimulation of special senses other than . Proelastase
taste or due to thought, and is based on previous experience
Ue
. Collagenase
or training. Mere smell, sight or thought of food can bring
about a reflex salivary secretion. Augmented salivary secre- Lipolytic
tion is seen when: 1. Lipase
1. The secretory nerve fibres are stimulated repeatedly . Colipase
and the response to the second stimulus is more than
Wh

. Phospholipase-A2
the first stimulus. . Cholesterol esterase
2. Stimulation of parasympathetic followed by the sympa- . Lysophospholipase
thetic nerve stimulation. Salivary secretion increases.
Ru

. Bile salt activated lipase

3. Stimulation of sympathetic and parasympathetic nerve
fibres at a time increases salivary secretion. This Amylolytic
augmented response is due to interaction of the neu-
1. Pancreatic amylase
rotransmitters released.
Q. 6. Describe exocrine functions of pancreas. How Nucleolytic
are they regulated? 1. Ribonuclease
2. Deoxyribonuclease
Ans.

Pancreas has two portions: Proteolytic Enzymes

1. Endocrine Enzymes are secreted in inactive state and are activated in
2. Exocrine. the duodenum where they act on various proteins.
1. Trypsinogen: It is an endopetidase which acts specially
The endocrine part produces insulin, glucagon, pancre- on polypeptide bonds whose carboxyl group is provided
atic polypeptide (PP) and somatostatin. The exocrine part with arginine and lysine.
produces enzymes, HCO; and water. 2. Chymotrypsinogen: It is also an endopeptidase acti-
vated by trypsin and enterokinase. Specially acts on
Pancreatic Juice peptide whose carboxyl group is provided with tyrosine
and phenylalanine.
It is a colourless, odourless, watery secretion isoosmotic with
3. Procarboxypeptidase A: Activated to carboxypeptidase
that of plasma. About 1-1.5 L of pancreatic juice is secreted
A by trypsin. It acts on terminal peptide bonds of end
in 24 hours.
products of chymotrypsin and elastase digestion.
pH is 8-9.
Procarboxypeptidase B: Activated to carboxypeptidase B
Specific gravity: 1.010-1.018.
by trypsin. It acts on C-terminal peptide bonds of the end
Composition: products of trypsin digestion.
a. Water — 99% These two enzymes are exopeptidases as they act from
b. Solids — 1% inorganic and organic substances the end of the molecules. The end products of all
Quick Review Series: BDS 1st Year

these enzymes are dipeptides, tripeptides and amino
acids.
4. Proelastase: It is activated by trypsin to elastase, and
causes digestion of elastin and other polypeptides.
5. Collagenase: Digests collagen.
the vagal nerve ending causes a release of gastrin. This
directly acts on the pancreatic acinar cells and increase
acinar secretion (Fig. 2.6.4).

Nucleolytic Enzymes ACh

“\ Enzyme-rich
1. Ribonuclease: Acts on RNA and converts them into Vagus pancreatic
nucleotides. Lo secretion
2. Deoxyribonuclease: Acts on DNA and converts them GRP —+G cell —— Gastrin
into nucleotides.
Fig. 2.6.4 Vagal influence on pancreatic secretion.

Lipolytic Enzymes
1. Pancreatic lipase: Acts on fats and converts them into
free fatty acids, glycerol and monoglycerides.
2. Phospholipase A2: Phospholipase A2 acts on lecithin
and cephalin, and digests them into lysolecithin and
lysocephalin.
3. Cholesterol esterase: Digests cholesterol esters and
converts them into cholesterol and FFA.
Lecithin 45 Lysolecithin + FFA
4. Lysophospholipase: This acts on lysocephalin and lyso-
lecithin, and converts them into glyceryl-phosphoryl
choline and releases a FFA.
5. Bile salt-activated lipase: This digests esters of fat-soluble
vitamins.
Amylolytic Enzymes
Pancreatic amylase acts on starch and related polysaccha-
rides, and converts them into maltose, maltotriose
alpha-dextrins.
Regulation of Pancreatic Secretion
1. Pancreatic secretion is continuous throughout the di-
gestion of food. Both neural and hormonal mechanisms
regulate pancreatic secretion.
2. Cephalic phase is mainly controlled by neural mechanisms.
3. Gastric phase is controlled by both neural and hor-
monal factors.
Neural Regulation
Both sympathetic and parasympathetic nerves influence
pancreatic secretion.
4. Sympathetic nerves: They arise from the celiac plexus.
Stimulation of sympathetic nerves produces decreased
responses.
5. Parasympathetic nerves (vagal fibres): When stimulated,
results in increased pancreatic secretion rich in en-
zymes. This acts in two ways. ACh released directly
acts on the pancreatic acinar cells. GRP released from
Humoral Regulation
Hormones that regulate pancreatic secretion are:
1. CCK-PZ
2. Secretin
3. Gastrin
4. VIP
1. Cholecystokinin—pancreozymin (CCK-PZ): Fat, pro-
tein digested products and HCl when enter the duode-
num stimulate the release of CCK—PZ. This enters the
blood, reaches pancreas and stimulates the acinar cells,
thereby increasing enzyme secretion. Along with secre-
tin it also stimulates secretion of HCO; and H,O from
the centroacinar and duct cells.
2. Secretin: It is the first hormone to be discovered by Star-
ling and Bayliss (1902). HCl, peptones and fat digested
products in the duodenum stimulate the release of se-
cretin. Secretin acts on centroacinar and duct cells and
and increases HCO; and water secretion. Secretin released
from the duodenal mucosa enters the blood, reaches
pancreas and exerts its effect. HCO;~ enters the duode-
num and combines with HCl.
NaHCO-; + HCl—> NaCI + H,CO;
HC] gets neutralized. This is essential for the activity of
pancreatic enzymes, which require alkaline pH for their
optimum activity. Along with CCK-PZ, it also stimu-
lates enzyme secretion from the acinar cells.
3. Gastrin: This is produced by the pyloric antrum, duode-
num and in some conditions, pancreatic islet tumours.
Vagus, stretch of gastric mucosa, chemical products of
various foods, insulin, etc. stimulate gastrin secretion
from G cells. Gastrin stimulates pancreatic secretion
rich in enzymes.
4. Vasoactive intestinal polypeptide (VIP): It is produced
by the entire GIT. VIP stimulates pancreatic secretion
mainly rich in HCO™; and water, and to some extent
enzymes. It stimulates intestinal secretion of electrolytes
and water.
Gastrin stimulates pancreatic secretion rich in enzymes
(Fig. 2.6.5).
 Physiology

Functions of Calcium
Cephalic
phase -—> Vagus 1. It is required for the formation of the bones, teeth and
connective tissue elements. It is a component of inter-
—-» Vagus cellular cement substance.
— Gastrin . Excitability of nerves.

NY
ae
Gastric [-——» CCK-PZ . Release of neurotransmitters from the nerve endings.

Du WwW
phase }— Secretin Pancreatic . Excitation—contraction coupling in muscle tissue.
secretion . Muscular contraction — cardiac and skeletal muscles.
, H—>- Gastrin . Excitation-secretion coupling. Release of hormones and
Intestinal
h enzymes from endocrine and exocrine glands.
phase |e vip . Blood clotting mechanism.

on
. Activation of digestive enzymes.
Fig. 2.6.5 Pancreatic secretion during different phases of 9. Acts as a second messenger or third messenger in hor-
digestion.
monal action.
10. Participates in fertilization and cell proliferation.

Q. 7. What is normal serum calcium level and its Hormonal Regulation of Ca**
functions? Describe the hormone regulation of Plasma ionic Ca** levels are mainly regulated by the following:
serum calcium level. Add a note on tetany. 1. PTH
Ans. 2. 1,25-dihydroxycholecalciferol, a Vit. D; derivative.

1. Around 1100-1200 g of calcium is present in our body.

Ninety-nine percent of
present in the tissue and
2. ECF calcium is present
exists in two forms:
a. Non-diffusible
b. Diffusible.
Non-diffusible Form
1. It forms about 40%.
2. Bound to proteins.
3. It is physiologically inert.
Diffusible Form
1. It forms about 60%.
2. It exists in two forms:
a. Complex form
b. Ionic form
this is in the bones and rest is
ECF.
mainly in the blood where it
Mechanism of Action of PTH (Fig. 2.6.6)
When plasma ionic Ca** levels fall, PTH secretion increases.
This increases Cat* absorption from renal tubules and also
causes the release of Ca** from the bone matrix.
PTH also increases the formation of 1,25-DHCC. This in
turn increases the absorption of Ca** from the gut. Reverse
changes take place when the plasma ionic Ca** level falls.
Mechanism of action of Vitamin D: 1,25-dihydroxychole-
calciferol increases blood Ca** and phosphate levels by
acting on bone, GIT and the kidney.
On bone: 1,25-(OH), CC binds to a cytoplasmic receptor
and reaches the nucleus. Acting on DNA, it increases the pro-
duction of calcium-binding protein. This in turn increases
the entry of calcium into the cells. The increased intracellular
Cat* inhibits isocitrate dehydrogenase and pyrophospha-
tase. Lactic and citric acids accumulate. These have a solubi-
lizing effect on the bone. So, calcium is released.

Complex Form
Plasma ionic Ca*

-——
It exists as salts with PO,, HCO™; and citrates. They are dif-
fusible but are not ionized.
¥ Calcitonin PTH T
lonic Ca**
This form is physiologically active. Ionic Ca** in serum 5-6 a
Absorption of Ca* from Release of 11-25 DHCC
mg/100 mL. Total serum Cat* 9-11 mg/100 mL. Ca** in
renal tubules (AL of LH, Ca** from | |
the ECF is more than that in ICF. The concentration of DCT and CD) bone matrix
calcium in the ECF should be stabilized, as it plays a vital | | * Absorption
part in many aspects of cellular function. Daily requirement x trom gut
is 0.5 g. Children, pregnant women and lactating women * Plasma ionic Ca**
require more. Fig. 2.6.6 Mechanism of action of PTH on plasma Ca** levels.
yur} Quick Review Series: BDS 1st Year
On GIT: Acting on DNA, it increases the formation of cal-
cium-binding protein (calbindin) in the intestinal epithelial
cells. This protein increases the absorption of both Cat*
and phosphorus. Thus 1,25-(OH), CCF increases the serum
levels of both Ca** and P.
On renal tubules: 1,25-(OH), CCF increases reabsorption
of calcium and phosphate from the renal tubules. This effect
is insignificant.
Other hormones that influence calcium and phosphate
homeostasis are as given:
Thyroid hormones: (T4 and T3): lodinated thyroid hor-
mones stimulate the skeletal turnover and bone mineral
exchange. In physiological doses, thyroid hormones facili-
tate calcium deposition and bone growth. But in hyperthy-
roidism there is withdrawal of Ca** from bone due to
protein catabolism, and Ca** excretion also increases, so
there is no hypercalcaemia in hyperthyroidism. Mild osteo-
porosis is present.
Sex Hormones
Oestrogens favour bone formation and growth especially at
the time of puberty. estrogens elevate Ca** and PO, levels
followed by calcification and ossification of long bones. Oes-
trogens inhibit osteoclasts and stimulate osteoblasts.
Androgens stimulate the linear growth of bone and eventu-
ally at the end of adolescence are involved in the closure of the
epiphysis. These also have a similar effect as that of oestrogens.
Adrenal glucocorticoids: Physiological concentrations of
cortisol do not influence calcium homeostasis. But large
amounts of cortisol:
1. depress bone formation by inhibiting the synthesis of
vital protein matrix;
increase osteoclast formation;
wy
decrease Ca*~* absorption from the gut;
decrease renal tubular absorption of calcium and
ae
cause destruction of protein matrix.
Growth hormone: The skeleton is one of the major sites of
action of GH during active growth. GH increases the rate of
turnover of bone. It increases both calcium absorption from
the gut and renal tubular reabsorption of phosphate. This
causes a rise in the blood Ca** and PQ, level, which will get
deposited on to the bone.
Insulin: Insulin also influences the Ca** homeostasis. It fa-
cilitates the bone formation and growth. Insulin deficiency
causes excretion of Ca** into urine.
Hypocalcaemia leads to the following:
1. Tetany
2. Latent tetany.
Tetany: Clinical entity is due to a low ionic Ca** level in the
blood.
Clinical Features
1. Tingling and numbness in the extremities.
2. Stiffness of hands and feet due to increased contractile
state of skeletal muscles.
3. Muscular cramps and body convulsions due to in-
creased neuromuscular excitability.
4. Carpopedal spasm: Flexion at the elbow, at the wrist at
the metacarpophalangeal joints and extension at inter-
phalangeal joints. This is called obstetrician’s hand. The
feet are extended at the ankles and the toes plantar
flexed.
5. Laryngeal stridor: Muscles of the larynx close the glot-
tis. So air cannot enter and cyanosis develops. Suddenly
there is opening of the glottis due to muscle fatigue and
air enters with a crowing noise. Severe hypocalcaemia
may lead to respiratory paralysis and death.
Latent tetany: It is subclinical entity where subject will not
show the symptoms unless elicited.
Clinical Features
1. Trousseau’s sign: Obstetrician’s hand can be elicited by
applying the BP cuff over the arm and arrest the blood
flow temporarily.
2. Chovstek’s sign: A tap on the facial nerve near the sty-
lomastoid process causes a contraction of the facial
muscles on that side.
3. Erb’s sign: Application of galvanic current brings about
contraction of the hand muscles.
4. Carpopedal spasm appears on voluntary hyperventila-
tion. These signs are useful for diagnosing latent tetany.
Q. 8. Give a brief account of the composition and
functions of gastric juice.
Ans.
In humans, gastric secretion is continuous. In 24 hr, about
1.2-1.5 L of gastric juice is secreted.
During meals, secretion is the maximum and is minimum
during sleep . pH: 0.9-1.5, specific gravity — 1.002—1.004.
Composition of Gastric Juice
Gastric juice consists of mainly water, HCl, organic and in-
organic substances.
Water — 99.45%
Solids — 0.55% (organic + inorganic substances)
Inorganic substances: Na*, KT, Cl-, HCO™, PO,-, Ca*’, ete.
and HCl
Organic Substances
1. Mucus
a. Soluble form
b. Insoluble form
 Physiology

Intrinsic factor Digestion in the Mouth

ey

Blood group antigens

While food is chewed in the mouth before it is swallowed it
Enzymes
mixes with saliva. The chewed food is subjected to the diges-
SF

Mucus
tive action of a-amylase (ptyalin) that is present in the saliva.
a. Soluble mucus: Secreted by the neck cells, acts as a
This enzyme is active between pH of 4 and 11 (peak activity
vehicle for HCl and enzymes secreted by the gastric
is at 6.9 pH) and requires Cl” ions. This breaks down the 1-4
glands.
glycosidic linkages of starch and converts into alpha limit
b. Insoluble or visible mucus: It is a polymer of glycopro-
dextrins maltose and maltotrioses.
teins with a high viscosity, secreted by the surface
epithelial cells and forms a 0.5—2.5 mm thick layer. It Digestion in the Stomach
protects the gastric mucosa from the HCl.
2. Intrinsic factor: Secreted by the parietal cell. It is a gly- The action of salivary amylase on starch and glycogen con-
coprotein required for absorption of Vit. By. tinues in the stomach till the stomach pH drops below 4.
3. Blood group antigens: These substances are secreted
into gastric juice. Digestion in the Small Intestine
4. Enzymes In the upper part of the small intestine starch, glycogen
. Pepsin and limit dextrins are subjected to the action of pancre-
sp

. Renin atic amylase. This is very similar to salivary amylase in

. Gelatinase its action. It is also active between 4 and 11 pH and re-
. Lipase
moan

quires Cl” ions. The end products are oligosaccharides,

. Carbonic anhydrase
. Urease
Pepsin: Is an endopeptidase. It acts on denaturized proteins
and converts them into proteoses, peptones and a few amino
acids.
Renin: It is important in human infants produced by chief
cells. It acts on milk in the presence of Ca** and causes pre-
cipitation. It is absent in adult humans as its function is
taken by HCl and pepsin.
ie. di- and trisaccharides.
The di- and trisaccharides are subjected to further di-
gestion in the small intestine by the enzymes which are
present in the brush border of epithelial cells. Both 1-4
and 1-6 linkages are broken and all the di- and trisaccha-
rides are converted into monosaccharides. Other disac-
charides ingested along with food are also converted into
monosaccharides.
In mouth and stomach

Gelatinase: Causes digestion of gelatin.

Lipase: Acts chiefly on tributyrin and other low-molecular- o-Amylase . . .
weight triglycerides. Its origin in humans is not known. It is Starch ———> Dextrins + Oligosaccharides
om :
active between pH of 4 and 5 and is inactive below 2.5 pH. It rons (Maltose + Maltotriose)
is a weak fat-splitting enzyme and becomes important in Small intestine:
pancreatic deficiency. ot Amylase . . .
Starch ———-> Dextrins + Oligosaccharides
CI ions :
Carbonic anhydrase: Derived from the parietal cells shed (Maltose + Maltotriose)
into the lumen of the glands. o—Dextrinase
Dextrins Breaks 1-6 linkages (Maltose + Maltotriose)
Urease: Converts urea into ammonia.
Maltase
Maltose—_______—__>
sae Tinkages (Glucose + Glucose)
Q. 9. Explain how starch, sucrose and lactose are
hydrolysed in the gastrointestinal tract. Add a note Isomaltase
on glucose absorption. Isomaltose ————> (Glucose + Glucose)
Lactase
Ans. Lactose ———> (Glucose + Galactose)
Sucrase
Sucrose ———> (Glucose + Fructose)
Digestion and Absorption of Carbohydrates
Carbohydrates constitute the following:
1. Starch All the di- and trisaccharides are digested into monosac-
2. Animal glycogen charides mostly at the brush border of the epithelial cells.
3. Monosaccharides But to a minor extent they may be digested in the lumen also
4. Oligosaccharides like di- and trisaccharides by the enzymes from the shed epithelial cells.
Quick Review Series: BDS 1st Year
Absorption of Monosaccharides
The important monosaccharides are as follows:
1. Glucose
Galactose
wy
Fructose
Mannose
ae
Ribose.
Absorption of Glucose
1. It is mainly absorbed from the upper small intestine
(duodenum and upper jejunum).
2. Absorbed by active transport.
3. There is cotransport between glucose and Na* (Na*
facilitates glucose absorption). Glucose binds with a
specific transport protein that also requires sodium
binding before transport occurs. The sodium ion then
moves down its electrochemical gradient to the inte-
rior of the cell and pulls glucose or galactose along
SHORT ESSAYS
Q. 1. Describe the small intestine movements (any
one in detail).
Ans.
Small intestine includes three-fourths of gastrointestinal
tract, and consists of duodenum, jejunum and ileum.
The movements of small intestine are as follows:
1. Rhythmic segmental contractions
2. Peristaltic contractions
3. Pendular contractions
4. Villi movements.
Segmental Peristalsis or Segmental Contractions
1. The segmental contractions are the frequently occurring
movements in the small intestine.
2. It occurs in a small segment due to the contractions of
circular smooth muscle. The contraction is a result of
slow waves developed in the wall of the intestine.
3. The slow wave is formed due to the intrinsic nerve
plexus.
4. The frequency and amplitude of the slow wave is in-
creased by the parasympathetic stimulation, whereas
the slow wave development is inhibited by acetylcholine,
gastrin, CCK and motilin. Sympathetic stimulation, se-
cretin and glucagon.
5. The segmental contractions result when slow wave de-
polarization reaches the threshold level.
6. The slow waves show a gradient in its frequency, with
the highest rate at the duodenum (12/min) and lowest
with it. This is also referred to as secondary active
transport.
4. Along with glucose, water is also absorbed due to osmotic
influence. It is because of the previously mentioned fea-
tures to facilitate quick absorption of glucose and water.
Solutions containing glucose, NaCl are given for oral
hydration therapy for subjects with diarrhoea.
5. Glucose first diffuses through the unstirred layer to the
brush border. It is transported across the cell mem-
brane. Then finally it is extruded into the interstitial
fluid from where it enters the bloodstream.
6. Glucose absorption from the intestine is not dependent
on insulin.
7. Galactose competes for the same carrier and inhibits
glucose absorption by competitive inhibition.
8. Freshly released glucose from a disaccharide by brush
border enzyme is more rapidly absorbed than free
glucose.
9. Glucose does not exhibit TMG. Absorption is unlimited.
at the ileum (8/min). This facilitates the bolus to be
propelled aborally (Law of Intestine).
7. The segmental contractions involve ring-like regular
constrictions along the length of a segment of intestine.
The constricted part later relaxes and relaxed part con-
stricts. This process is repeated over and again.
8. This will cause the bolus to move back and forth within
the lumen of the intestine.
9. The functions of segmental contractions in the small
intestine are as follows:
a. The bolus mixes well with the digestive enzymes and
facilitates the completion of digestion.
b. The segmental contractions also cause exposure of
the digested food to the villi surface for absorption.
c. Finally, the occurrence of segmental contractions in
the proximal segment and inhibition in the distal
segment facilitates propulsion of bolus towards
colon.
Propulsive Peristalsis
The small intestine shows propulsive peristalsis only for a
few centimetres of length and rarely occurs. It is not signifi-
cant in small intestine, as segmental movements carry out
the propulsive function.
Pendular Contractions
Sometimes, the longitudinal muscle contractions give pen-
dular movements, which facilitate mixing of bolus with the
digestive enzymes.
 Physiology

Villi Movements centre located in the medullary reticular formation

The intestinal villi show forward and backward movements
due to the contractions of the smooth muscle in the villi; the
hormone villikinin stimulates the villi movements and they
facilitate absorption of digested food.
Q. 2. What is deglutition? Describe second stage in
detail.
Ans.
Deglutition or swallowing is a process by which chewed food
is emptied from the mouth into the stomach. It is initiated
voluntarily but is completed reflexly.
The process of deglutition is divided into three stages:
1. Oral phase or voluntary phase
2. Pharyngeal phase
3. Oesophageal phase.
PHARYNGEAL STAGE
1. It is a reflex process once initiated proceeds with unin-
terruption. This is called swallowing reflex. It involves a
series of automatic pharyngeal muscular contractions.
2. The sensitive receptors for this reflex are present in the
vicinity of the anterior and posterior pillars of faces and
the tonsils.
3. The impulses are carried by the sensory portions of tri-
geminal and glossopharyngeal nerves to the swallowing
closely associated with the tractus solitarius.
4. The motor impulses from the swallowing centre are car-
ried by the 5th, 9th, 10th and 12th cranial nerves. The
swallowing centre inhibits respiration, sneezing, cough-
ing and vomiting during pharyngeal stage.
5. Once the food bolus is presented to the pharynx, it
moves in four directions. But under the integrated ac-
tion of the swallowing centre food is propelled only into
the oesophagus.
6. Soft palate is pulled upwards closing the posterior nares.
This prevents the reflux of food into the nasal cavities.
7. The vocal cords of the larynx are strongly approximated
and the epiglottis swings backwards over the superior
opening of the larynx.
8. Entire larynx is pulled upwards and forward by the
muscles attached to the hyoid bone.
9. Respiration is arrested in any cycle. These processes pre-
vent entry of food into the larynx.
10. Persistent elevation of the tongue maintains high-pres-
sure gradient and prevents the bolus into the oral cavity.
11. Upward movement of the larynx stretches the opening
of the oesophagus and the pharyngo-oesophageal
sphincter relaxes.
12. The superior pharyngeal constrictor muscle contracts
giving rise to a rapid peristaltic wave passing downward
over the pharyngeal muscles into the oesophagus. This
results in propulsion of the food into the oesophagus.

SHORT NOTES

Q. 1. Proteolytic enzymes of pancreas. 1. Bile is formed in the liver. It is both secretory and excre-
tory in nature.
Ans.
2. The formation of bile in liver cells is a continuous pro-
Proteolytic enzymes of pancreas are as follows: cess, but its release into the duodenum is intermittent
1. Trypsinogen since it is stored in the gallbladder and released peri-
Chymotrypsinogen odically.
wy

Procarboxypeptidase 3. Bile has no digestive enzymes, yet it is considered along

Proelastase with other digestive juices, as it helps the digestion and
ae

Deoxyribonuclease. absorption of fats.

4. Bile salts are important secretory products and are
Functions formed from bile acids (taurocholic and glycocholic
acids) in the liver cells.
1. Protein digestion. Both trypsin and chymotrypsin act
5. Bile pigments formed during the breakdown of haemo-
on native proteins and split them into polypeptides.
globin are released in bile and excreted.
2. Carboxypeptidase splits the terminal amino acid to
form polypeptides. Q. 3. Peristalsis.
3. Elastase acts on elastin, which is not digested by gastric
Ans.
pepsin.
1. As a result of the electrical activity in the circular
Q. 2. Bile.
smooth muscle in the wall of the stomach the peristalsis
Ans. begins.
Quick Review Series: BDS 1st Year

2. This activity is called gastric slow waves. It starts from Functions Related to Blood
the body of the stomach and travels towards the pylorus,
1. Formation of blood cells during fetal life
where it becomes more powerful.
2. Destruction of RBC by reticuloendothelial cells of liver
3. Food entry into the stomach initiates the peristalsis at a
3. Synthesis of plasma proteins.
rate of three to four times per minute. This movement
helps in:
Metabolic Functions
a. Propulsion of food towards the pyloric end.
b. Breaking and mixing of food with the gastric juice. Carbohydrates
Q. 4. Saliva. 1. Conversion of fructose and galactose into glucose
2. Gluconeogenesis from glycogenic amino acids
Ans.
3. Glycogenesis.
1. About 1.5 L of saliva is secreted daily. It has pH ranging 4. Storage of glycogen.
from 6.8 to 7.2 and a specific gravity of 1.002—1.008.
2. It contains 99.5% water and the balance is made of solid Proteins
substances (both organic and inorganic). . Deamination of amino acids
a. Inorganic constituents are mostly chlorides, carbon-

Ne
. Urea formation
ates and phosphates of sodium, potassium and . Protein synthesis
calcium.

Bw
. Seat of specific dynamic action.
b. Organic substances form the major bulk of solids
and are as follows: Fats
i. Ptyalin (salivary amylase)
ii. Mucin 1. Formation of ketone bodies
iii. Lysozyme 2. Storage of fat
iv. Immunoglobulin IgA 3. Metabolism of cholesterol.
v. Blood group antigens
vi. Nerve growth factor Excretory Functions
3. Functions of saliva are mainly non-digestive in nature. It excretes bile pigments, bacterial toxins and heavy metals.
. Keeps the oral cavity moist and lubricated.
oe

. Saliva helps in mastication and deglutition of food. Storage

. Oral hygiene maintenance. Liver acts as a storehouse for glycogen, fat-soluble vitamins
oan

. Taste appreciation. and extrinsic factor.

. Facilitation of speech.
. Dilution of hot and irritant food.
emo

Excretion: Certain substances like urea, heavy met-
als and thiocyanate are excreted through saliva.
j. Water balance: It is maintained by regulating the
thirst mechanism through pharyngeal nerve endings.
k. Starch digestion: This is the only digestive function
of saliva and is due to ptyalin. It acts on the boiled
starch and converts it into maltose.
Q. 5. Movements of small intestine.
Ans.
The movements of small intestine are as follows:
1. Rhythmic segmental contractions
2. Peristaltic contractions
3. Pendular contractions
4. Villi movements.
Q. 6. List four functions of liver.
Ans.
Liver could be called the largest metabolic factory in the
body.
Defensive
1. It protects the body by various mechanisms
2. Detoxification
3. Antibody formation
4. Phagocytosis by Kupffer cells (reticuloendothelial cells).
Q. 7. List four functions of bile.
Ans.
Functions of bile are as follows:
1. Fat digestion: Bile salts help in the digestion of fats by
emulsification of lipids, which are broken into smaller
particles.
2. Absorption: Bile helps in absorption of digested lipids
and fat-soluble vitamins (A, D, E and K). Bile salts form
micelles with the digested fat and promote its absorption.
3. Stimulates peristalsis: It has a mild laxative effect,
which also helps in the expulsion of toxic substances
from the digestive tract.
4. Choleretic effect: Bile salts are reabsorbed through the
enterohepatic circulation and stimulate further secre-
tion of bile.

5. Maintains pH of duodenum: Acidity of the gastric con-
tents is neutralized by the sodium bicarbonate, which
facilitates the pancreatic digestion by maintaining an
alkaline reaction.
6. Excretion: The bile pigments and heavy metals are
excreted.
Q. 8. Bile salts.
Ans.
1. The bile salts are as follows:
a. The sodium taurocholate
b. Sodium glycocholate
2. Bile salts help in the digestion of fats by emulsification
of lipids, which are broken into smaller particles.
3. Bile salts form micelles with the digested fat and pro-
mote its absorption.
Q. 9. Regulation of salivary secretion.
Ans.
1. The secretion of saliva is controlled by:
a. Unconditioned reflex
b. Conditioned reflex
Unconditioned Reflex
Presence of food in the oral cavity evokes salivary secretion.
Conditioned Reflex
1. Conditioned reflex is acquired later in life. Smell, sight
or even thought of good food causes secretion of saliva.
2. The parasympathetic stimulation increases the secretion
of saliva. These fibres are stimulated either when food is
placed in the mouth or through the conditioned re-
flexes. The chorda tympani branch of the VII nerve
(facial) carries parasympathetic influence to the sub-
mandibular and sublingual glands. The tympanic
branch of the IX nerve (glossopharyngeal) carries para-
sympathetic fibres to the parotid gland.
3. The secretion of copious saliva is assisted by the libera-
tion of vasodilator peptides like VIP, kallikrein and bra-
dykinin by the salivary cells.
4. Sympathetic stimulation reduces the salivary secretion,
as it produces vasoconstriction of the vessels in the
gland.
Q. 10. Mastication.
Ans.
1. Mastication is a process of biting and grinding of teeth
by the movement of lower jaw against the upper set of
teeth.
2. This process is assisted by tongue, saliva and facial
muscles.
3. Mastication helps in converting the food into a soft bolus.
Physiology
Q. 11. Cephalic phase of gastric secretion.
Ans.
1. The cephalic phase of gastric secretion includes both the
unconditioned and the conditioned reflexes. This phase
of gastric secretion depends on the vagus.
2. The gastric secretion during the nervous phase is rich in
enzymes, particularly pepsin.
3. Unconditioned reflexes (inborn): When food enters the
oral cavity or passes through oesophagus certain reflexes
stimulate the gastric secretion. This response is abol-
ished if vagi are sectioned. Example: The sham feeding
experiment.
4. Conditioned reflexes (acquired): These reflexes are ac-
quired during life and training forms the basis for devel-
opment of such reflexes. Example: Pavlov, in his classical
experiment on dog, established a correlation between the
ringing of a bell and food. After a few days, the animal
gets conditioned to the sound of bell and associates it
with food. Subsequently, if the bell sound is heard, gas-
tric secretion commences even though food is not given.
Q. 12. Describe process of deglutition.
Ans.
1. The deglutition constitutes the act of swallowing of
food.
2. The centre is located in the medulla and is a reflex act,
which is mediated by the V, IX and X cranial nerves.
3. Deglutition is classically divided into following three
phases:
a. Oral phase: It constitutes the passage of food through
the oral cavity and is voluntary in nature. The masti-
cated food is pushed towards the pharynx by the
tongue.
b. Pharyngeal phase: It is involuntary and helps in the
passage of food through the pharynx. During this
phase various changes occur in quick succession and
their mechanism is so adjusted that food does not go
into the larynx or nasopharynx. Contraction of pha-
ryngeal muscles helps the propulsion of food into the
oesophagus.
c. Oesophageal phase: It is also involuntary. The bolus
passes through the oesophagus by rapid peristaltic
movements. The cardiac sphincter relaxes and bolus
enters the stomach.
Q. 13. Composition of pancreatic juice.
Ans.
Pancreas is a composite gland consisting of an exocrine
component and an endocrine part called islets of Langerhans.
The exocrine part consists of pancreatic acini, which are a
collection of cells that secrete pancreatic juice. Pancreatic
secretion is intermittent and about 1500 mL is secreted daily.
 Quick Review Series: BDS 1st Year

Composition of Pancreatic Juice Once the food bolus enters the pharynx
1. Water content around 97.5%. |
2. Solids — both organic and inorganic substances —
0,
Soft palate is pulled upwards closing the posterior nares.
make the balance of 2.5%. (This prevents the reflux of food into the nasal cavities)
a. Inorganic substances: Sodium bicarbonate is the
most important constituent in this group, though |
salts of : sodium and potassium e are also present.
: The vocal cords of the larynx are strongly approximated
b. Organic substances: Pancreatic juice contains several and the epiglottis swings backwards over the opening of
enzymes. the |
Various digestive enzymes are as follows: svanyas
i. Proteolytic enzymes: Trypsinogen |
Chymotrypsinogen Entire larynx is pulled upwards and forward by the mus-
Procarboxypeptidase cles attached to the hyoid bone
Proelastase
ii. Nuclease enzymes: Deoxyribonuclease |
C. Amylolytic enzymes: Pancreatic amylase Respiration is arrested at any cycle. These processes pre-
d. Lipolytic enzymes: Pancreatic lipase vent entry of food into the larynx
Phospholipase |

Q. 14. Pancreozymin. Upward movement of the larynx stretches the opening of

Ans.
. oo ,
1. Pancreatic secretion is controlled by two hormones:
a. Secretin
b. Pancreozymin
These hormones act through the circulation and their
action does not depend on nerves.
2. Pancreozymin (CCK-PZ): This hormone is polypep-
tide in nature and stimulates the secretion of pancreatic
juice, which is thick, viscid and has a high enzyme con-
tent. Secretion of pancreozymin is stimulated by the
a: : Flowchart 2.6.1
entry of semidigested food into the duodenum.
the oesophagus and the pharyngo-oesophageal sphincter
relaxes (upper oesophageal sphincter)
|
The superior pharyngeal constrictor muscle contracts,
producing a rapid peristaltic wave passing downward over
the pharyngeal muscles into the oesophagus
{
This results in propulsion of the food into the oesophagus
Events in pharyngeal stage of deglutition.
pnaryng 9 9

Q. 15. Pharyngeal phase of deglutition.
Ans.
1. Pharyngeal stage of deglutition is a reflex process. This
is called swallowing reflex.
2. Pharyngeal phase is involuntary and helps in the pas-
sage of food through the pharynx. During this phase
various changes occur in quick succession and their
mechanism is so adjusted that food does not go into
the larynx or nasopharynx. Contraction of pharyn-
geal muscles helps the propulsion of food into the
oesophagus.
3. The events in pharyngeal stage of deglutition are de-
picted in Flowchart 2.6.1.
Q. 16. Jaundice.
Ans.
1. Jaundice is a clinical condition resulting from the in-
crease of bile pigments in blood and extracellular fluid.
This produces a yellowish colouration of the skin and —_ Functions of gastric juice are as follows:
mucous membrane. The urine becomes deep yellow,
due to the increased excretion of bilirubin.
2. The normal content of the pigment in blood is 0.5 mg%
(0.5-2 mg%); but in jaundice, it is considerably higher.
3. Certain jaundice can be classified into three types de-
pending on its cause:
a. Haemolytic or prehepatic: In this condition there is
greater destruction of erythrocytes resulting in in-
creased production of bile pigments.
b. Infective or hepatic: Liver cells are not functioning
normally and as such excretion of pigments is re-
duced leading to their increased circulation in blood.
c. Obstructive or posthepatic: Bile formation is nor-
mal, but due to the obstruction of biliary passage the
pigments are not excreted, and this leads to a rise of
bile pigments in blood.
4. The treatment of various types of jaundice is based on
the correction of its underlying defect.
Q. 17. Functions of gastric juice.
Ans.
1. Protein digestion: Pepsinogen (parapepsin) is activated
by HCl into pepsin and it partially digests proteins.
 Physiology

Proteins Q. 18. Haemolytic jaundice.

|
Acid metaproteins
Ans.

The haemolytic jaundice is due to excess destruction of eryth-

|
Primary and secondary proteoses
rocytes resulting in increased production of bile pigments.
The haemolytic jaundice exhibits the following findings:
1. Increase in unconjugated bilirubin levels.
. No bilirubin or bile salts in urine.

wh
Peptones . Urobilinogen in urine is more.
Vit. K deficiency does not develop.
. Stools yellow or dark brown in colour.

2. Fat digestion: The role of gastric juice in fat digestion is
very insignificant.
3. Mucin effect: It forms a protective lining over the gastric
mucosa and prevents its damage by HCl.
4. Role of HCl in gastric juice: It has following functional
significance:
a. Causes activation of pepsinogen (optimum pH re-
quired is 2).
b. Acidic pH in the upper part of duodenum facilitates
iron absorption.
c. Converts sucrose into glucose and fructose.
d. Exerts bacteriolytic effect and prevents infection.
5. Haemopoiesis: Intrinsic factor helps in the absorption
of extrinsic factor (Vit. By), which is necessary for hae-
mopoiesis.
NDB
. Van den Bergh test is indirect positive.
. Normal serum alkaline phosphatase.
Q. 19. Gallbladder.
Ans.
1. The gallbladder releases the bile whenever food contain-
ing fat enters the duodenum.
2. In addition to storing and release of bile, the gallbladder
makes the bile concentrated. This is done by the active
reabsorption of Na*, HCO; and passive reabsorption of
water.
. The third function of the gallbladder is to release bile,
when fat reaches duodenum. The hormone CCK pro-
duces this effect. The release of bile from the gallbladder
also occurs, by the vagal activity.

VITAMIN METABOLISM
LONG ESSAY

Q. 1. Give an account of sources, daily requirement,

absorption and functions of Vit. D. . Increases the citrate content of bones, blood and other
tissues.
Ans.
. Promotes the growth of long bones and causes mineral-
The Vitamin D activity is due to 25-hydroxycholecalcif- ization of the ‘zone of provisional calcification.
erol, which is formed in the liver. Kidney produces the . Parathyroid hormone is produced only when there is an
most potent form of Vitamin D3, which is called 1,25- adequate supply of Vitamin D.
dihydroxycholecalciferol. . The deficiency of Vitamin D leads, to rickets in children
and osteomalacia in adults. In rickets, there is a defect
Source and Requirement
in endochondral growth and classification of bones.
The rich sources of Vitamin D are fish, egg yolk, butter, co- The disease is characterized by cranial deformity, en-
lostrum. The daily requirement of vitamin D in adults is 400 largement of the costochondral junction, kyphosis, bow
IU, but in children, during pregnancy and lactation, the daily legs, knock knee, pot belly and pelvic deformities. In
need increases considerably. osteomalacia, the bones become soft and prone to frac-
ture. Very high intake of Vitamin D leads to hypervita-
Functions
minosis, in which nausea, anorexia, constipation, poly-
1. Vitamin D promotes the absorption of calcium and uria and metastatic calcification are the common
phosphorus from the intestine. manifestations.
Quick Review Series: BDS 1st Year
SHORT ESSAYS
Q. 1. Fat-soluble vitamins and vitamin A.
Ans.
Q. 3. Vitamin
Vitamin A, D, E and K are the fat-soluble vitamins.
Ans.
Vitamin A
It is also known as retinol and antixerophthalmic vitamin.
Sources
Yellow coloured vegetables and fruits like carrots, corn, sweet
potato, tomatoes and spinach are rich sources of vitamin A.
Fish liver oil is probably the best source of the vitamin A. It
is also present in egg yolk, cheese, butter and whole milk.
Functions
Requirement
Adults and growing children require 5000 IU/day, and its
requirement increases in pregnancy and during lactation.
Functions
1. Vitamin A is necessary for the synthesis of visual pigments. Q. 4. Citric acid cycle.
2. It maintains the morphological and functional integrity Ans.
of the skin and mucous membrane.
3. Itis a growth factor and influences the activity of osteo-
blasts and osteoclasts in the bone.
4. Regulates biosynthesis of mucopolysaccharides.
Deficiency of Vitamin A Causes
1. Night blindness and xerophthalmia
2. Keratinization of the cornea leading to blindness
3. The formation of enamel in the teeth is defective.
Q. 2. Source and functions of Vitamin B12.
Ans.
Cyanocobalamin (B,2) is a crystalline compound containing
cobalt and phosphorus, and is also known as ‘extrinsic factor
of Castle’ or ‘antipernicious anaemia factor.
Source
Animal tissues are only source of this vitamin. It is present in
meat, liver, eggs, fish and milk.
Daily Requirement
The daily requirement is about 1-2 mg.
Functions
1. It acts as a coenzyme and is required for biochemical
processes.
2. It helps in the conversion of D-ribonucleotides to
D-deoxyribonucleotides.
C.
1. Vitamin C is also known as ascorbic acid.
2. Citrus fruits are a rich source of vitamin C; but beans,
green peas and tomatoes have also a good content of this
vitamin. Adrenal cortex, gonads and certain glandular
organs in the body contain vitamin C.
3. In adults, the daily requirement is about 75 mg and dur-
ing pregnancy, lactation, infections and toxic conditions
the requirement of vitamin C increases.
1. It is involved in cellular oxidation—reduction reactions.
2. Helps in the biosynthesis of serotonin from tryptophan.
3. Required for the functional activity of fibroblasts, osteo-
blasts and odontoblasts.
1. This cycle is seen under aerobic conditions and serves to
integrate carbohydrate, protein and lipid metabolism.
2. The enzymes for this cycle are located in the matrix of
mitochondria.
3. The condensation of acetyl CoA with oxaloacetic acid
forms citric acid, which initiates the reaction.
4. Citric acid is converted into ketoglutaric and succinic
acids.
5. Acetyl CoA is broken into CO, and water. The oxaloace-
tic acid, which is formed, is again utilized for the cycle.
6. During the process of breakdown, one molecule of glu-
cose produces 38 ATP molecules (Fig. 2.7.1).
Pyruvic acid
Acetyl Co-A
|
Oxaloacetic acid Citric acid
H,O
Succinic acid
Ketoglutaric acid
CO,
2
Fig. 2.7.1 Citric acid cycle.

Q. 5. Write in detail about balanced diet.
Ans.
1. Balanced diet contains all the proximate principles of
diet in appropriate quantity.
2. The ratio of carbohydrates, proteins and fats should be
4:1. The proteins should be able to supply all the essen-
tial amino acids.
3. The diet should also contain adequate amounts of vita-
mins, minerals and water.
SHORT NOTES
Q. 1. Essential amino acids.
Ans.
1. The amino acids which are not synthesized in the body
from food material or may be synthesized in very small
amounts, which are inadequate for the needs of the
body, and have to be supplied in the diet are known as
essential amino acids.
2. They are essential or indispensable components of diet.
3. These essential amino acids are phenylalanine, valine,
histidine, isoleucine, leucine, tryptophan, methionine,
arginine, lysine and threonine.
Q. 2. Ketone bodies.
Ans.
1. The metabolism of fats is greatly increased in starvation,
high protein diet and severe diabetes mellitus. This leads
to increased production of ketone bodies, i.e. acetone,
acetoacetic acid and beta-hydroxybutyric acid.
2. In ketonaemia, the blood level of ketone bodies is in-
creased while in ketonuria, the urinary excretion is
greatly increased.
Q. 3. BMR.
Ans.
1. The minimum energy production for the maintenance
of cell metabolism under basal conditions is known as
basal metabolic rate (BMR).
2. The normal BMR is 40 kcal/m? body surface area/hr. A
variation of =15% on either side is considered normal.
In female, the BMR is slightly lower.
3. The test is done by Benedict-Roth apparatus.
4. Significant alterations in BMR are indicative of thyroid
disorders.
Q. 4. Vitamin D.
Ans.
1. Source and requirement: the rich sources of vitamin D
are fish, egg yolk, butter, colostrum.
Physiology
4. An individual involved in moderate physical work re-
quires about 3000 kcal/day, for which the food intake
should have 400 g of carbohydrates and 100 g each of
protein and fats.
5. Persons involved in severe muscular work require a
greater calorie intake (3500-4000 kcal), while elderly
individuals with restricted physical activity have lower
daily requirement of about 2000 kcal.
2. The daily requirement of vitamin D in adults is 400 IU
but in children, during pregnancy and lactation, the
daily need increases considerably.
3. Vitamin D promotes the absorption of calcium and
phosphorus from the intestine.
Q. 5. Classification of enzymes.
Ans.
1. According to the International Union of Biochemistry (IUB
System) the enzymes are classified into six major groups:
. Oxidoreductases
op
. Transferases
. Hydrolases
moAian
. Lyases
. Isomerases
. Ligases
2. Each enzyme has a systematic code number with four
digits. The first digit indicates the major class, the sec-
ond and third digits indicate the subclasses, while the
fourth digit indicates the specific enzyme.
Q. 6. Classification of proteins.
Ans.
Proteins are classified on the basis of their composition,
structure and functions into:
1. Simple proteins
2. Conjugated proteins
3. Derived proteins.
Q. 7 Enzyme inhibition.
Ans.
1. Any agent, which causes denaturation of proteins will
inactivate the enzymes.
2. Specific inhibitors: These substances act on coenzymes,
inorganic ion activators or the site of enzyme action and
inhibit enzyme activity. Examples: cyanide, fluorides.
3. Nonspecific inhibitors: Certain substances like ferricya-
nide, mercury and arsenic destroy the sulphydryl groups
present in enzymes and inhibit their action.
ya) Quick Review Series: BDS 1st Year

Q. 8. Vitamin K. Q. 9. GTT.

Ans. Ans.

1. Vitamin K is also known as antihaemorrhagic vita-

Glucose tolerance test (GTT) is an essential investigation
min. The two naturally occurring vitamins are K,
for the assessment of metabolic disorders of glucose seen in
and K,.
diabetes mellitus.
2. Source and requirement: Dark green leafy vegetables,
spinach, cabbage, cauliflower, tomatoes, peas and soya- Q. 10. Cholesterol.
beans are some of the common sources of vitamin K,,
Ans.
while vitamin K, is commercially prepared from puri-
fied fish meal. It is a white, waxy material soluble in ether, chloroform, ben-
3. The daily requirement ranges between 1 and 2 mg. The zene, acetone or bile salt solution, and is only present in animal
human intestinal flora is able to produce small food. The normal blood cholesterol level is 150-250 mg%.
amounts of vitamin K, which is adequate for the body Deposition of cholesterol esters and other lipids in the arterial
needs. wall leads to atherosclerosis.

EXCRETORY SYSTEM AND BODY FLUIDS

LONG ESSAYS

Q. 1. Describe the nerve supply of urinary bladder Sympathetic Supply

and explain how contraction of detrusor muscle is
Ty to L, — The nerve is called presacral nerve or hypogas-
stimulated.
tric plexus.
Ans.
It supplies to:
The urinary bladder is supplied by following three different 1. the trigone of the bladder,
types of nerves (Fig. 2.8.1): 2. the internal sphincter,
1. Sympathetic 3. also to the seminal vesicles, ejaculatory ducts, vas defer-
2. Parasympathetic ens, etc.
3. Somatic.
Sympathetic afferents carry pain sensation from bladder due
to muscle spasm. When stimulated sympathetic efferents
produce:
Tl 12 Pelvic nerve 2
(nervi erigentes)
1. Contraction of the trigone
L| 1 3 . Contraction of the internal sphincter
Nh

. Contraction of seminal vesicles and ejaculatory ducts

ueWw

L| 2 4
. Inhibits detrusor muscle
Presacral . Inhibits sacral parasympathetic.
nerve

Sympathetics have a role in ejaculation and continence.

Pudendal Parasympathetic Supply

. nerve
Internal sphincter. S, to S,; — The nerve is called pelvic nerve or nervi erigentes.
It supplies to:
1. the detrusor and
External sphincter 2. the internal sphincter.
Parasympathetic afferents carry stretch and pain sensa-
Fig. 2.8.1 Nerve supply to the bladder. tion from the bladder.

Parasympathetic efferent: When stimulated they produce
contraction of the detrusor and inhibition of the internal
sphincter. These have role in bladder emptying (micturition
reflex).
Somatic Supply
S, to S, — The nerve is called pudendal nerve. Stimulation
of the pudendal nerve produces contraction of the external
sphincter.
Stimulation of contraction of detrusor muscle is as
follows:
1. At the time of micturition, pelvic afferents carry the
impulses from the stretch receptors present in the wall
of the bladder.
2. Due to stimulation of stretch receptors in the wall of the
bladder excitatory impulses are carried through the pel-
vic nerve (S2,S3 and S,) to the detrusor muscle present
in the wall of urinary bladder.
3. Internal urethral sphincter relaxes when detrusor mus-
cle is contracting and urine flows from the bladder into
the urethra.
4. Somatic afferent impulses inhibit the efferent or pelvic
excitatory nerves (S,, S; and S,) supplying the external
urethral sphincter so that it relaxes and the urine gets
voided from the body.
5. The complete voiding of the urine is facilitated by rein-
forcing impulses coming from pontine centres to the
spinal centres.
In adults, as the higher centres can regulate the activity of
the primary centres of spinal cord, the micturition is under
voluntary control.
Q. 2. Explain the formation of urine.
Ans.
Nephron is a functional and anatomical unit of the kidney.
Each kidney is made up of roughly about 1.5 millions of
nephrons. The length of each nephron varies between 45
and 65 mm. The total length of all nephrons comes around
40 miles.
Parts of Nephron
Each nephron is made up of two different parts:
Renal corpuscle Renal tubules
Glomerular capillaries | Proximal convoluted tubule (PCT)
and Loop of Henle (LH)
Bowman’s capsule Distal convoluted tubule (DCT)
Collecting duct
Physiology
Urine Formation
Normal urine output is 1.2-1.5 L/day and is related to the
fluid intake and environmental temperature. The essential
function of nephron is urine formation, which is achieved by
ultrafiltration of blood in the glomerulus. When it passes
through the tubule, its volume, composition and tonicity are
modified by the reabsorption and secretion of substance.
Approximately, 1800 L of blood flows to both the kidneys
in 24 hr. Out of this, 180 L of glomerular filtrate is formed.
The final urine output is about 1-2 L/day.
Formation of urine takes place in three steps:
1. Formation of glomerular filtrate
2. Reabsorption
3. Secretion.
Glomerular Filtration
It occurs in the glomerulus. The filtrate passes through the
glomerular capillary endothelium, basement membrane and
visceral layer of Bowman’s capsule, before reaching the tubu-
lar lumen.
Glomerular filtrate is a protein-free filtrate of plasma. The
endothelium shows permeability for neutral substances and
cations up to 8 nm size.
Filtration depends upon the glomerular hydrostatic pres-
sure (50 mmHg), colloidal osmotic pressure (25 mmHg)
and intracapsular pressure (15 mmHg). Hydrostatic pres-
sure provides the driving force for the filtration, while OP
and ICP oppose the process of filtration. The resultant of
these factors is termed as the effective filtration pressure
(EFP).
EFP = HP - (OP + ICP)
where HP is the glomerular hydrostatic pressure, OP is the
osmotic pressure and ICP is the intracapsular pressure in the
Bowman’s capsule.
Glomerular filtration rate (GFR) is the rate at which the
filtrate is formed and its normal value is 125 mL/min. On an
average, about 170 L of filtrate is formed daily, but the aver-
age urine output is 1.5 L, indicating that 99% of the filtrate
is reabsorbed in the renal tubule. As the filtrate passes
through the various segments of the renal tubule, there is
selective reabsorption of substances and products of tubular
secretion are added to it.
Changes Occurring in the PCT
While passing through PCT, the filtrate shows the following
changes:
1. When glomerular filtrate enters the proximal tubule it is
isotonic with plasma.
2. Glucose reabsorption: Glucose is completely reabsorbed
in the PCT by secondary active transport. In case if blood
glucose is above the normal threshold level (180 mg%),
Quick Review Series: BDS 1st Year
some glucose remains unabsorbed and appears in the
urine. This condition of glycosuria is a common mani-
festation in diabetes mellitus.
3. Amino acids: They are also completely reabsorbed in the
proximal tubule.
4. Substances like glucose and amino acids, which are
completely reabsorbed in the renal tubule are called
high threshold substances, while those partially reab-
sorbed like urea are called low threshold substances. The
constituents of the filtrate not absorbed are called non-
threshold substances.
5. Sodium and bicarbonate reabsorption: About 80% of
sodium is actively reabsorbed in the PCT, which is fol-
lowed. by a passive movement of Cl” ions and water.
This reabsorption of water is secondary to Na* trans-
port and is called the obligatory reabsorption.
6. Carbonic anhydrase plays an important role in the se-
cretion of H* ions and reabsorption of sodium. The
HCO; formed in the tubular cells is transferred to the
blood, where it combines with Nat to form NaHCO3.
7. Potassium reabsorption occurs in the PCT (65%) and as
well as in the thick segment of ascending limb of LH.
The secretion of potassium also takes place in the DCT
cells and they are excreted in the urine.
Changes in the Loop of Henle
1. Due to reabsorption of solutes, Na*, K* and 2 Cl” from
the thick ascending limb of renal medulla shows a
graded increase in tonicity from corticomedullary junc-
tion towards the inner medulla.
2. The descending limb is permeable to water and hence
the tubular filtrate in this region becomes hypertonic.
3. The U-shaped loop of Henle acts as a counter current
multiplier and is responsible for the hypertonicity of the
medullary interstitium, which is necessary for the con-
centration of urine.
4. The maintenance of medullary hypertonicity depends
on the vasa recta, which run parallel to the loop of
Henle. They act as counter current exchangers.
5. In the ascending limb of loop of Henle, solutes-
reabsorption makes the filtrate hypotonic.
Changes in the DCT
The filtrate that enters the DCT is always hypotonic, irre-
spective of the tonicity of the urine that is excreted.
The early part of the DCT cells show reabsorption of sol-
utes like Na* and Cl”, and they are not permeable to water.
The distal part of the DCT cells shows the actions of aldo-
sterone and vasopressin. Aldosterone causes Na* reabsorp-
tion in exchange for K* or H* secretion, while vasopressin
(ADH) action shows the reabsorption of water as it changes
the permeability of the cells in this segment.
About 5% volume reduction takes place in the DCT and
in the presence of hormone vasopressin the filtrate becomes
hypertonic and in its absence the filtrate is continued as hy-
potonic. In the DCT, the secretion of H* causes, more free H
ions in the filtrate. They are taken up by the phosphate buf-
fer (HPO,) present in the filtrate and ammonia secreted by
the DCT cells. Ammonia takes up the free H* and forms
ammonium and is excreted in the urine. These mechanisms
help to limit the pH of urine.
Collecting Ducts
1. The collecting ducts, which are in the cortical segment
show reabsorption of Na in response to aldosterone
action.
2. The collecting duct cells secrete H* and reabsorb
HCO, which helps in acid—base balance.
3. Water reabsorption also occurs in the collecting ducts,
which is influenced by the ADH. Excessive fluid intake
inhibits the secretion of ADH, resulting in water diure-
sis, due to the absence of water reabsorption in the DCT
and the collecting ducts.
The various mechanisms involved in the urine forma-
tion could briefly be summarized as follows:
4. Reduction in urine volume (water reabsorption).
5. Alteration in the composition of filtrate due to the
selective reabsorption and secretion of substances like
creatinine and uric acid.
6. Change in the tonicity due to the counter current
mechanism.
Composition of Urine
Inorganic constituents: They are sodium and potassium
chlorides, sulphates and phosphates. Certain metals and
trace elements may also be present.
Organic constituents: Urea is an important excretory prod-
uct. In normal individuals 20 to 30 g is excreted daily. Uric
acid, creatine, ammonia, hippuric acid, glucuronides and
urobilinogen are some other substances excreted in the
urine.
Abnormal Constituents
Proteins: Normal urine does not contain proteins; but in
certain renal diseases, albumin may be filtered in the Bow-
man’s capsule and excreted, producing albuminuria.
Glucose: Reduced renal threshold will also result in the
appearance of glucose in the urine, leading to glycosuria,
e.g. diabetes mellitus.
Ketone bodies: Acetone, acetic acid and beta hydroxybutyric
acid may be present in traces in normal urine, but are
significantly increased in advanced diabetes mellitus and
starvation.
Bilirubin: This pigment is excreted in jaundice and gives a
deep yellow colour to the urine.

Blood: It is present in acute nephritis, inflammation or in-
jury to the urinary tract, and its presence in the urine consti-
tutes haematuria.
SHORT ESSAYS
Q. 1. Juxtaglomerular apparatus.
Or
Describe the juxtaglomerular apparatus. What are
its functions?
Ans.
1. Juxtaglomerular apparatus is a specialized structure
consisting of three different types of cells as follows:
a. Juxtaglomerular cells (JG)
b. Macula densa
c. Lacis cells (mesangial cells)
i. Juxtaglomerular cells are the specialized smooth
muscle cells of the arteriolar walls.
ii. Macula densa are the specialized epithelial cells
lining the DCT.
iii. Lacis cells or the mesangial cells are present be-
tween the above two types of cells.
In the beginning region of the DCT, the tubular epithe-
lial cells get modified into columnar types known as
macula densa (MD).
The smooth muscles of the afferent arteriole get modi-
fied and proliferate in number and show some granules
in the cytoplasm that contain renin and are called juxta-
glomerular cells.
JG cells synthesize and release renin in response to vari-
ous stimuli.
Macula densa, juxtaglomerular cells together with some
mesangial cells present around are called juxtaglomeru-
lar apparatus.
Macula densa acts as a chemoreceptor and detects
the changes in the concentration of Na* and Cl” of
the luminal fluid of the tubule.
a. Glomerular mesangial cells
b. Extraglomerular mesangial cells
i. Glomerular mesangial cells are present between
the basal lamina and the capillary endothelial
cells.
ii. Extraglomerular cells are present between the
glomerulus and the tubule, and are referred to as
lacis cells.
Functions of mesangial cells are as follows:
a. They resemble pericytes of capillaries, exhibit con-
tractile activity, and influence GFR and blood flow
through the glomerulus.
Physiology
Porphyrins: They may be rarely detected in lead poisoning.
Amino acids: They are present in certain congenital meta-
bolic disorders.
b. Provide structural support to the glomerulus.
c. Exhibit phagocytic activity.
d. Secrete prostaglandins.
8. The functions of JGA are as follows:
a. Autoregulation of renal blood flow and GER.
b. The regulation of Na* balance and maintenance of
ECF volume and osmolality.
c. The regulation of the tonicity and arterial blood
pressure.
d. The electrolyte and fluid volume regulation.
e. Stimulates the secretion of aldosterone hormone
from the adrenal cortex.
f. It also stimulates the thirst centre.
Q. 2. What are the physiological changes that oc-
cur in the body when exposed to high tempera-
tures?
Ans.
Responses of body to hot environment are as follows:
Methods of heat loss
1. Convection
2. Radiation
oe Conduction
4 Evaporation of water
Sweat secretion
Panting in animals
Vasodilatation
Heat is lost from the body in several ways:
Convection
1. When the body or skin temperature is more compared
to surrounding atmosphere, heat is lost by convection to
the surroundings.
2. The air in immediate contact with the skin is warmed
up and the heated molecules move away and cooler ones
come in to take their place. These in turn are warmed
and so the process goes on. These air movements consti-
tute convection currents.
Quick Review Series: BDS 1st Year
Radiation
1. By radiation, heat is lost from the body to cooler objects
at a distance.
2. The magnitude of heat loss by radiation
i. the size of the body surface and
ii. the average temperature difference between the skin
and the surrounding objects.
3. The part played by radiation varies widely with cli-
matic conditions. In a temperate climate, a resting
person wearing ordinary clothes loses about 60% of
heat production by radiation. During work the per-
centage of the total heat loss, which is due to radia-
tion becomes smaller because the skin temperature
rises only slightly.
Conduction
Heat is lost from the body only when it is in contact with a
cooler object by conduction.
Evaporation of Water
Evaporation of sweat is the principal means of heat loss
when the body temperature tends to rise.
Water is lost by evaporation from the body by three different
mechanisms:
1. Insensible water loss
2. Panting
3. Sweating
Insensible Water Loss
It is called insensible water loss because it cannot be felt or
seen. It consists of:
1. Water lost from the skin.
2. Water lost from the lungs into the expired air.
Water lost from the skin (insensible perspiration): This con-
sists of the passage of water by diffusion through the epider-
mis. The fluid lost is not formed by sweat glands. It amounts
to 600-800 mL in 24 hours, equivalent to a heat loss of 400
kcal. It is independent of the environment conditions.
Water lost from the lungs: The expired air leaving the lungs
is saturated with water vapour at body temperature. This
water is derived by vaporization from the moist mucous
membranes of the respiratory passages. The amount of
water vapour taken up depends on the initial state of the
inspired air. When dry, inspired air takes up a good deal,
but when saturated with water vapour it takes up none
at all. Water lost from the lungs is 300 mL/day, equivalent
to a heat loss of 200 kcal.
Panting: This is an important mechanism in animals by
which water gets evaporated from the upper respiratory
tract, thereby effecting the heat loss from the body.
Sweating (thermal sweating): Exocrine sweat glands take
part in temperature regulation. When 1L of sweat is evapo-
rated 580 kcal of heat is lost. When the external air is not
only hotter than the body but is also saturated with water
vapour heat loss becomes impossible because the sweat
cannot evaporate.
As sweat comes from the blood, rapid sweating demands
a large cutaneous blood flow, and therefore, dilatation of the
skin blood vessels.
The vasodilation is brought about by the following:
1. A decreased vasomotor tone
2. An increase in pseudomotor activity (sweat gland
activity).
3. Reduction in heat gain.
Prevent heat gain
Behavioural changes like
Cooling the environment
Drinking cold water
Wearing thin loose garments to a minimum extent
Reducing food intake; foods with a minimum SDA are taken.
Heat gained can be reduced by remaining in cooler
environment and by wearing minimum clothing.
Q. 3. Explain micturition reflex.
Ans.
Micturition is defined as periodic complete voluntary emp-
tying of the bladder. It is basically a spinal reflex, but is influ-
enced by higher centres. The spinal and supraspinal centres
are concerned with the process of micturition.
Mechanism
1. When the bladder volume reaches to 450 mL (end filling
pressure of 6-10 cm H2Q) bladder gets stretched suffi-
ciently.
2. Stretch receptors present in the bladder muscle are acti-
vated. Sufficient number of impulse is conducted to the
spinal sacral centres (SS; S,) by parasympathetic af-
ferents. The impulses are relayed to the detrusor and to
the internal sphincter. The detrusor contracts and the
internal sphincter relaxes.
3. Once the detrusor is made to contract during micturi-
tion reflex the stretch receptors are activated, further
increasing the impulse traffic to and from spinal centre.
This causes stronger contraction of the bladder muscle,
making the reflex process stronger. Urine is pushed into
the urethra.
4. Impulses from the urethra are carried again by para-
sympathetic afferents which inhibit pudendal nerve,
so external sphincter relaxes. Urine rushes down the
urethra.

5. The sacral spinal micturition centre is influenced by
higher centres.
a. The higher centres that facilitate are as follows:
i. Posterior
ii. Pons
b. The centres that inhibit are as follows:
i. Cerebral cortex
ii. Midbrain
6. Sedentary people, females and people with poor toilet
facilities can inhibit micturition till the bladder volume
reaches 700 mL.
SHORT NOTES
Q. 1. Functions of kidneys.
Ans.
The functions of kidneys are as follows:
1. Formation of urine is an essential function.
2. Excretion of nitrogen- and sulphur-containing waste
products.
Removal of toxic substances.
YD
Regulation of fluid volume and its composition.
UR
Maintenance of acid-base equilibrium.
Regulation of blood pressure.
SND
Control of aldosterone secretion.
Stimulation of erythropoiesis by the release of erythro-
poietin.
Q. 2. Nephrons.
Ans.
Nephron is a functional and anatomical unit of the kidney.
Each kidney consists of about one million nephrons.
Nephrons are of two types:
1. Cortical nephrons: They constitute 85% of the neph-
rons and are located in the outer part of the cortex.
These nephrons are responsible for the formation of
urine.
2. Juxtamedullary nephrons: They are situated in the
deeper region of the cortex (corticomedullary junction)
and are responsible for the concentration of urine.
Q. 3. Juxtamedullary nephrons.
Ans.
1. Juxtamedullary nephrons are situated in the deeper re-
gion of the cortex (corticomedullary junction) and are
responsible for the concentration of urine.
2. They constitute 15% of the total nephrons.
3. They differ from cortical nephron in following aspects:
a. They are located in the deeper regions of renal cortex.
Physiology
7. The urine present in the posterior urethra in the male
is expelled by the contraction of the bulbocavernous
muscle. In females, it is drained by gravity.
8. During micturition, perineal muscles relax and abdom-
inal muscles contract, facilitating voiding.
9. Micturition can be inhibited voluntarily. This is called
continence.
10. Micturition begins in the fifth month of intrauterine life
and remains as a reflex process till 2 years. After that, it
comes under voluntary control.
b. Their loop of Henle descends into the inner medulla.
c. The efferent arteriole of glomerulus forms the vasa
recta, which act as counter current exchanger.
Q. 4. Glomerular filtration rate.
Or
What is GFR? What is its normal value?
Ans.
1. Glomerular filtration rate indicates the rate of filtration
of plasma in unit time.
2. The normal value of GFR is 125 mL/min +10 mL or
180 L/day. In females, it is 10% less than males.
3. Determination of GFR provides information about the
functional status of the kidneys.
4. Inulin can be used to determine GFR as it is completely
filtered in the glomeruli, is neither reabsorbed nor
secreted in the tubules, and is nontoxic. The rate of
excretion will be equal to the rate of filtration.
GFR = uv
P
where, U is urinary inulin concentration, V is the volume of urine
in mL/min and P is plasma inulin concentration in mg/mL.
5. In clinical practice, the creatinine clearance value is con-
sidered as it is endogenously produced unlike inulin.
Q. 5. Renal tubular function.
Ans.
Renal tubules bring about:
1. Reabsorption
2. Secretion
Reabsorption means return of substances from the filtrate
in the lumen of renal tubules back in to circulation.
Secretion means further addition of substances from the
circulation in to filtrate of renal tubules.
Quick Review Series: BDS 1st Year

Q. 6. Juxtaglomerular apparatus. Organic constituents: Urea is an important excretory prod-

uct. In normal individuals 20-30 g is excreted daily. Uric
Ans.
acid, creatine, ammonia, hippuric acid, glucuronides and
Juxtaglomerular apparatus (JGA) is a specialized structure urobilinogen are some other substances excreted in the
consisting of three different types of cells as follows: urine.
1. Juxtaglomerular cells — specialized smooth muscle cells
Q. 9. Ketone bodies.
of the arteriolar wall
2. Macula densa — specialized epithelial cells lining the DCT Ans.
3. Lacis cells (mesangial cells) — present between the
1. The metabolism of fats is greatly increased in starvation,
above two types of cells.
high-protein diet and severe diabetes mellitus. This
The functions of JGA are as follows: leads to increased production of ketone bodies, ie.
1. Autoregulation of renal blood flow and GFR. acetone, acetoacetic acid and beta-hydroxybutyric acid.
2. The regulation of Na* balance and maintenance of ECF 2. In ketonaemia, the blood level of ketone bodies is in-
volume. creased while in ketonuria, the urinary excretion is
3. The regulation of the tonicity and arterial blood greatly increased.
pressure.
Q. 10. Pathological constituents of urine.
4. The electrolyte and fluid volume regulation.
Ans.
Q. 7. Proximal convoluted tubule.
Pathological or abnormal constituents of urine are as
Ans.
follows:
1. Proximal convoluted tubule is the first component
Proteins: Normal urine does not contain proteins, but in
of the renal tubule, which continues down as loop of
certain renal diseases, albumin may be filtered in the Bow-
Henle.
man’s capsule and excreted, producing albuminuria.
2. It is lined by cuboidal epithelial cells, which exhibit mi-
crovilli on their free surface, giving it a brush border Glucose: It may be present in diabetes mellitus leading to
appearance. glycosuria. Reduced renal threshold will also result in the
3. Functions of proximal convoluted tubule are: appearance of glucose in the urine.
a. Around 65% of filtered fluid is absorbed.
Ketone bodies: Acetone, acetoacetic acid and beta-hydroxy-
b. H* and NH;3° are secreted.
butyric acid may be present in traces in normal urine but are
c. The consumed drugs are also secreted in the PCT.
significantly increased in advanced diabetes mellitus and
Q. 8. Composition of urine. starvation.
Ans. Bilirubin: This pigment is excreted in jaundice and gives a
deep yellow colour to the urine.
Normal urine output is 1.2-1.5 L/day and is related to the
fluid intake and environmental temperature. Normal spe- Blood: It is present in acute nephritis, inflammation or
cific gravity of urine is 1.010, but it may decrease in polyuria injury to the urinary tract, and its presence in the urine
or increase when the urine output is reduced. Urine has a pH constitutes haematuria.
of about 6 and is acidic in reaction.
Porphyrins: They may be rarely detected in lead poisoning.
Inorganic constituents: They are sodium and potassium chlo-
Amino acids: They are present in certain congenital meta-
rides, sulphates and phosphates. Certain metals and trace
bolic disorders.
elements may also be present.
 Physiology

1) (ee ENDOCRINE GLANDS AND REPR

LONG ESSAYS

Q. 1. Describe the regulation of normal glucose Glycogenolysis,

Gluconeogenesis Fasting state-70- __ Insulin |
level?
100 mg%. Blood - secretion
Ans. { + glucose level is low

Glucagon, 4
Homeostasis of Blood Glucose Level cortisol, GH, Net effect
Adrenaline, 1. / Uptake of glucose by
Blood glucose levels are maintained constantly within physi- Noradrenaline. tissue other than brain
Sym-N-system 2. Glycogenolysis and
ological limits. gluconeogenesis try to
During fasting (postabsorptive state, i.e. 12-14 hours af- maintain glucose level
ter the last meal) blood glucose level ranges between 70 and
Fig. 2.9.2 Maintenance of normal blood glucose level during
100 mg/100 mL, and in postprandial state it ranges between fasting.
120 and 140 mg/100 mL.
Blood sugar level is due to the balanced activity of follow-
4. Faintness, seizures and coma can occur at 20 mg/100
ing two sets of factors: mL. Hence, blood glucose levels must be maintained at
or above minimum levels.
Regulation of Blood Glucose during Fasting State
Blood glucose balance during fasting state is depicted in Regulation during Postprandial State (Fig. 2.9.3)
Fig. 2.9.1. 1. During postprandial period, blood glucose level in-
creases due to absorption of glucose from the intestine.
B\ Removal 2. Insulin secretion is stimulated. A GIT hormone GIP re-
Addition L leased during digestion also stimulates secretion of insulin.
O} 4. Glycogen formation in liver, 3. Insulin facilitates glucose entry into the cells. Some amount
1. Intestinal oO muscle and other tissues
absorption D je. Lipogenesis in adipose
of glucose is converted into glycogen, some part into lipid,
2. Glycogenolysis || tissue and some of it gets oxidized and provides energy.
in the liver L |} 3. Oxidation in the tissues
3. Gluconeogene- U_ | 4. Synthesis of other compounds
sis in the liver Cc like nucleic acids, glycoproteins,
Intestinal Postprandial state Glucagon, cortisol
and the kidney 0 etc.
absorption 120-140 mg%, blood :
$s 5. Excretion into urine when the : noradrenaline GH,
glucose level high
E blood sugar level increases sym-N-system
above renal threshold activit
+ + y
Fig. 2.9.1 Blood glucose balance. GIP secretion —+ + Insulin —~ Glucose
secretion uptake by
cells

Importance of Maintaining Minimum Normal
Blood Glucose Levels during Fasting (Fig. 2.9.2)
1. Blood sugar levels are maintained at a constant level for
much longer periods of starvation mainly due to gluco-
neogenesis occurring in the liver.
2. Brain uses only glucose for its energy requirements.
3. When the blood glucose level falls to low levels (<50
mg/100 mL), ie. below critical, level the function
brain is affected leading to the development of symp-
toms of hypoglycaemic shock.
Fig. 2.9.3 Regulation during postprandial state.
4. When the load of glucose is very heavy and the blood
sugar level increases above 180 mg/100 mL there is ex-
cretion of glucose into urine. This spillover of glucose
into urine is referred to as glycosuria.
5. The increased level of blood glucose is referred to as
hyperglycaemia.
of
Both these are abnormal conditions and do not occur in
a normal individual.
Quick Review Series: BDS 1st Year

Role of Hormones in the Homeostasis of Blood stimulate glycogenolysis and gluconeogenesis. By these
Glucose mechanisms, they tend to raise the blood glucose level.
Role of hormones in the homeostasis of blood glucose is Nervous Regulation
depicted in Fig. 2.9.4.
Stimulation of sympathetic nerves causes an increase in the
blood glucose level. The action is similar to epinephrine.
voor

Role of Kidney
Kidney also manufactures glucose by gluconeogenesis, but
Insulin | Glucagon, catecholamines, GH, this contribution in a normal person is minor.
cortisol, ACTH, TSH, T, and T,
Mnaoocrga

Disorders Associated with Blood Glucose

Fig. 2.9.4 Effect of hormones on blood glucose levels.
Insulin
1. This hormone is secreted by the beta cells of pancreatic
islets and plays an important role in regulation of blood
glucose levels.
2. A rise in the blood glucose level stimulates this hor-
mone. It enhances the uptake of glucose by the muscle,
liver and adipose tissue by enhancing the transport of
Homeostasis
The most important disorder is diabetes mellitus, which is
usually caused by the deficiency of insulin.
Q. 2. Mention hormones secreted by anterior pitu-
itary. Describe action of growth hormone. How is
hormone synthesis regulated?
Ans.
Anterior pituitary or adenohypophysis secretes three catego-
ries of hormones:
1. The prolactin-growth hormone family
. The glycoprotein hormone family
NY

glucose across the cell membrane. It stimulates glyco- . The pro-opiomelanocortin peptide family.
WwW

genesis and lipogenesis, and inhibits glycogenolysis, . The prolactin-growth hormone family consists of the
Re

gluconeogenesis and lipolysis. following:

3. It increases the activity of enzymes that participate in a. Growth hormone (GH)
glycolysis. Hence, it lowers blood glucose level. b. Prolactin (PRL)
The other hormones which rise the glucose levels are as c. Human placental lactogen (HPL)
follows: 2. The glycoprotein hormone family consists of the following:
1. Epinephrine and norepinephrine: Secreted by the adre- a. Thyroid stimulating hormone (TSH)
nal medulla in response to hypoglycaemia (low blood b. Follicular stimulating hormone (FSH)
glucose level). These stimulate glycogenolysis in liver c. Luteinizing hormone (LH)
and muscle, and increase the blood glucose and lactate 3. The pro-opiomelanocortin peptide family consists of
levels. These activate enzyme phosphorylase, which is following:
concerned in glycogenolysis. a. ACTH
2. Glucagon: This hormone is produced by alpha cells. A b. MSH
low blood glucose level stimulates the secretion of this c. B-LPH
hormone. It stimulates glycogenolysis and gluconeogen- d. Endorphins
esis in the liver. By these mechanisms, it increases the e. Enkephalins
blood glucose level. Actions of growth hormone are as follows:
3. Adrenal cortical hormones: These hormones stimulate Human growth hormone has the following effects:
gluconeogenesis in the liver. They also decrease the up- 1. On growth of skeleton, skeletal muscle and viscera
take of glucose by tissues. Adrenocorticotrophic hor- 2. On metabolism
mone (ACTH) increases the blood glucose level mainly a. Carbohydrate
through cortisol. The overall effect is an increase in the b. Protein
blood glucose level. c. Fat
4. Growth hormone: It stimulates gluconeogenesis, pre- d. Electrolytes
vent glucose uptake by tissue and stimulates glycoge- . On milk production — lactogenic effect
Ue

nolysis in the liver. Thus it increases blood glucose level. . On erythropoiesis

5. Thyroid hormones (T, and T;): Thyroid hormones . Lymphopoiesis
increase glucose absorption from the intestine. They . Gonad.
Dn
 Physiology

Action on Growth of Skeleton, Viscera and Action on Gonads

Skeletal Muscle
Growth hormone stimulates the growth of genitalia. In
1. The growth hormone is essential for growth of the body. dwarfs, genital organs are small.
2. GH stimulates the growth of the skeleton. It has specific
action on the epiphyseal cartilages and promotes chon- Regulation of GH Secretion (Fig. 2.9.5)
drogenesis. The effect of GH on the cartilage is indirect
The secretion of GH is not uniform.
and is mediated by somatomedin-C (insulin-like growth
factor-I).
Hypothalamus
3. GH also stimulates the growth of the viscera, e.g. liver,
kidney, thymus and alimentary canal. GHRH
4. GH increases the skeletal muscle mass. Short
loop
Action on Metabolism

1. On Proteins: GH is a protein anabolic hormone. It pro-

duces a positive nitrogen and phosphorus balance. GH Long loop
a. It decreases blood urea nitrogen (BUN)
acid levels.
and amino
|
Liver, kidney —»* Somatomedin
b. It increases the transport of neutral and basic amino (IGF-I)
acids into the cells. Fig. 2.9.5 Regulation of GH secretion.
c. It stimulates RNA synthesis, exerts its effect at ribo-
somal level and increases protein synthesis. 1. Regulation of GH secretion is mainly by feedback con-
2. On Carbohydrate Metabolism trol. GRH acts on anterior pituitary gland and stimu-
a. GH is diabetogenic, i.e. it increases blood glucose lates the secretion of growth hormone, which in turn
level. This is achieved by opposing the action of insu- increases IGF secretion from liver.
lin in muscle. 2. Increased IGF levels acts on hypothalamus to stimulate
b. It stimulates gluconeogenesis. the secretion of somatostatin, which on reaching ante-
c. GH prevents entry of glucose into the cells. It inhibits rior pituitary decreases the secretion of GH.
phosphorylation of glucose (glycolysis). So, blood 3. IGF also acts directly on anterior pituitary and exerts
glucose levels rise. inhibitory effect on the secretion of GH.
3. On Fat Metabolism 4. Some factors affecting GH secretion are explained in
a. GH is a ketogenic hormone causing lipolysis of adi- Fig. 2.9.6.
pose tissue, at the same time promoting lipogenesis
in the liver.
Hypoglycaemia
b. Lipolysis >t FFA —f Ketone bodies. Lipolysis is Physical exercise Stimulates
important because FFA thus produced can be used Fasting — Growth Hormone
up for energy production, thus sparing proteins for Amino acid
NREM sleep
body growth.
Thyroid hormones
4. Electrolytes: GH conserves PO’, Ca**, Na*, K‘,
Mg**, Cl-. All these are diverted to the site of active REM sleep _
mineralization. Hyperglycaemia __|!nhibits
FFA —+. Growth Hormone
Progesterone
Action on Milk Production Cortisol

GH has lactogenic activity. It helps in the maintenance of

milk secretion along with thyroxin and prolactin.
Disorders:

Action on Erythropoiesis Gigantism —before epiphyseal

Hypertunction< plates are fused
It stimulates erythropoiesis. It increases erythrocytes pro- Acromegaly —after epiphyseal plates
are fused
duction from the kidney.
Dwarf —Children
Action on Lymphocytes Hypofunction <<
Acromicria —Adults
It stimulates the growth of the lymphoid tissue and prolif-
eration of lymphocytes. Fig. 2.9.6 Factors affecting GH secretion.
224 Quick Review Series: BDS 1st Year

Q. 3. Name hormones of posterior pituitary gland. Regulation of ADH Secretion

Explain their action and regulation of secretion.
Two important factors that regulate ADH secretion are as
Ans. follows:
1. Neurohypophysis (posterior pituitary gland) develops 1. Osmolality
2. ECF volume.
from the floor of the third ventricle.
2. Histology: Consists of unmyelinated nerve fibres, pitui- Effect of osmolality on ADH secretion is shown in
cytes, mast cells, hyaline bodies (Herring bodies). Fig. 2.9.7.
3. Blood supply: Inferior hypophyseal artery.
4. Neurohypophysis secretes two peptide hormones
namely vasopressin (ADH) and oxytocin but they are
Hypertonic
actually formed from the supraoptic and paraventricu- | osmolality
lar nuclei of the hypothalamus as prohormones. Hor-
mones produced by the posterior pituitary gland are:
e ADH Stimulates the osmoreceptors
e Oxytocin. present near SON

Differences Between ADH and Oxytocin

Impulse is relayed to SON
1. ADH — end amino acids are arginine and glycine
2. Oxytocin — end amino acids are leucine and glycine ADH
and oxytocin are stored in neurohypophysis or posterior
Secretion of ADH
pituitary gland along with their specific neurophysins.
Inactivation takes place in the kidney and the liver.
H,O
2 absorption
Antidiuretic Hormone (ADH) or Vasopressin
Site of production — Supraoptic nucleus (SON) and para-
ventricular nucleus (PVN) Tonicity of the fluid
is restored
Transported by — Supraoptico-paraventricular-hypophy- a
seal tract to the posterior pituitary. The hormone is stored
along with specific neurophysin.
Hypotonic body fluid or plasma
Functions or actions of ADH are as follows: | osmolarity
1. It increases the reabsorption of H,O from DCT and col-
lecting duct.
2. It increases urea absorption from collecting ducts. Osmoreceptors inhibited
3. It promotes Na* reabsorption from the thick ascending
limb of loop of Henle.
4. It may decrease the blood flow to renal medulla, making SON inhibited
medullary interstitium more hypertonic.
5. It acts on blood vessels causing vasoconstriction and
increased blood pressure. No secretion of ADH

The above actions clearly suggest that ADH has a role in the
following: H,0 is excreted into urine
1. ECF volume regulation
2. Blood volume regulation
3. Blood pressure regulation. Tonicity of the fluid
is restored
Other Actions of ADH

1. On heart rate: Heart rate decreases secondary to increase Fig. 2.9.7 Effect of osmolality on APH secretion.
in BP.
2. On smooth muscle of GIT and urinary tract: ADH brings 3. Change in blood volume and BP also affects ADH
about contraction of smooth muscle and increases peri- secretion.
stalsis of GIT and detrusor contraction. TBP ) ADH secretion
3. It may produce hypoglycaemia. TBP + ADH secretion
 Physiology

J) Blood volume t ADH secretion 4. Iodination of tyrosine at cell interphase

t Blood volume ) ADH secretion
Other stimulants:
a. Morphine, nicotine, barbiturates
b. Stress like exercise, surgery, emotion, etc.
c. Angiotensin II and III
Oxytocin
Oxytocin means quick birth. It is produced by both SON and.
PVN and is transported by the supraoptico-paraventriculo-
hypophyseal tract to the posterior pituitary.
Actions or Functions of Oxytocin
1. Milk ejection: Due to neuroendocrinal reflex when a
baby is presented to breast gland suckling initiates nerve
impulses. These impulses reach PCN, stimulating secre-
tion of oxytocin. Oxytocin reaches breast gland by the
blood and brings about a contraction of myoepithelial
cells, resulting in milk ejection.
2. Facilitates parturition process: Oxytocin quickens the
process of labour. It increases the contraction of the
oestrogen primed uterus.
3. Increases sperm transport in female genital tract.
4. It is also produced in males, but its function is
unknown.
Clinical Application
1. Acceleration of labour process.
2. To control postpartum bleeding.
3. To relieve breast engorgement in lactating mother. No
disorder is associated with oxytocin.
Regulation
1. Impulses from breast gland increase secretion.
2. Impulses from the cervix and the vagina increase secre-
tion of oxytocin.
3. Emotions also influence the secretion of oxytocin.
Q. 4. Describe synthesis and action of thyroid hor-
mone. Add a note on hyperthyroidism.
5. Oxidative condensation of iodinated tyrosines to yield
T, and T;
a. Synthesis of thyroglobulin: Thyroid follicular
cells synthesize thyroglobulin and secrete it into
the lumen by exocytosis. This step is stimulated
by TSH.
b. Trapping of iodide: It is an active process. The
ratio between the thyroid and serum is 50:1. So
iodide is transported against electrochemical gra-
dient. Iodide is transported along with Na* and is
returned to ECF by Na* — K* pumps. TSH facili-
tates this step.
c. Oxidation of iodide to iodine: This occurs in the
presence of an enzyme called iodide peroxidase (IP).
Iodide is oxidized to iodine. This oxidized form is an
active form.
d. Iodination of tyrosine: The active iodine is added on
to tyrosine in the presence of tyrosine iodinase. This
becomes 3 monoiodotyrosine (MIT). When a second
iodine is added on the fifth position 3-5 di-iodoty-
rosine is formed (DIT). These steps take place in the
follicle between the cell and globulin interface. Thus,
thyroglobulin is iodinated in the lumen after it is
secreted.
e. Oxidative condensation: Condensation of 2 moles
of these derivatives takes place with the removal of
alanine.
DIT + DIT + T, + Alanine (Tetraiodothyronine)
DIT + MIT > T; + Alanine (Triiodothyronine)
Release of Thyroid Hormones
Thyroid follicular cells take up thyroglobulin by inten-
sive pinocytosis. T; and T, are released from the thyro-
globulin. These are secreted into the interstitial space by
exocytosis.
Actions (Functions) of Thyroid Hormones
Effect on Metabolism
. General metabolism
op

. Carbohydrate metabolism
Ans.
. Protein metabolism
aa

. Lipid metabolism
Biosynthesis and Secretion of Thyroid Hormones
Effect on Growth Differentiation
The follicular cells of thyroid have three functions:
1. Collect and transport iodides into the thyroglobulin. Effect on Other Systems
2. Synthesis of thyroglobulin.
3. They remove the thyroid hormones from the thyro- a. CNS e. Gonads i. Skin
b. CVS f. Vitamins j. Bones
globulin and secrete them into circulation.
c. Blood — g. Muscles k. Interaction between thy-
Biosynthesis of thyroid hormone takes place in five steps: roid hormones and cat-
1. Synthesis of thyroglobulin echolamines
2. Trapping of iodide d. GIT h. Mammary 1. Effect on other endo-
3. Oxidation of iodide to iodine gland crine glands
Quick Review Series: BDS 1st Year
Effect on Metabolism
1. General metabolism
a. Thyroid hormones primarily stimulate metabolism
of the tissue. These promote O, consumption and
heat production, i.e. calorigenesis.
b. It promotes O, consumption in all the tissues except
adult brain, testes, uterus, spleen, lymph nodes and
anterior pituitary.
c. This effect can be assessed by doing BMR.
d. In hypothyroidism, BMR is —30 to — 40%. In hyper-
thyroidism, BMR may go up to 100%.
2. Carbohydrate metabolism: It has a diabetogenic action:
a. Increases glucose absorption.
b. Increases gluconeogenesis.
c. Promotes glycogenosis (hepatic, cardiac and skeletal).
d. Accelerates insulin breakdown — increasing blood
glucose level.
e. There is an increase in peripheral utilization of
glucose.
f. Hyperthyroidism exhibits high blood glucose levels.
Hypothyroidism exhibits low blood glucose levels.
3. Protein metabolism
a. Normal levels stimulate both structural and func-
tional protein synthesis.
b. In large amounts as in hyperthyroidism, thyroid hor-
mones cause breakdown of proteins. K* excretion is
due to breakdown of tissue.
c. There is an increased excretion of N; into urine. So,
a negative nitrogen balance develops. Muscles be-
come thin and the subject loses weight.
4. Fat metabolism
a. Thyroid hormones promote cholesterol synthesis.
But at the same time promote hepatic breakdown
and biliary excretion of cholesterol.
b. In hypothyroidism blood cholesterol is high and in
hyperthyroidism blood cholesterol is low.
c. They cause lipolysis and thus increase the free fatty
acid levels in the blood. They also promote fatty acid
oxidation by the cells.
As the breakdown is greater than synthesis, thyroid hor-
mones lower the cholesterol level. This effect of thyroid
hormones is utilized therapeutically to reduce the blood
cholesterol level.
Body Growth and Tissue Differentiation
1. Thyroid hormones are required for normal growth and
growth differentiation from the first day of the new-
born.
2. GH requires thyroxin to exert its full effect on growth. T;
has direct growth promoting effect on several organs. It
also stimulates production of growth hormone and IGFs.
3. The deficiency of thyroid hormones in the newborn or
infant leads to dwarfism called cretinism.
Effect on Other Systems
Thyroid hormones influence the functions of various systems.
1. CNS
1. Thyroxin is essential for normal development of growth
and activity of CNS, though it does not increase oxygen
consumption.
2. In adult brain, the hormones stimulate branching of
dendrites, myelination and increases the number of
synapses.
3. In the fetus and the newborn thyroxin stimulates the
growth of the brain.
2. CVS
1. Thyroid hormone stimulates oxygen consumption of
cardiac muscle and maintains normal:
a. Heart rate
b. Force of contraction
c. Cardiac output
d. Blood pressure
2. They also maintain the blood flow to all the organs to
meet the oxygen requirement of these organs. Especially,
they increase cutaneous blood flow to dissipate heat.
3. Blood
Thyroid hormones stimulate erythropoiesis and are neces-
sary for maturation of RBC. So, in hypothyroidism, anaemia
develops. Due to concomitant decrease in Vit. Bj. metabo-
lism, megaloblastic type of anaemia is seen. In hyperthyroid-
ism, relative polycythaemia occurs.
4. GIT
Thyroid hormones stimulate:
a. Appetite and food intake
b. Motility
c. Secretions
Alteration in thyroid function affects the above functions.
In hypothyroidism there is constipation and loss of appetite,
and in hyperthyroidism, there is an increase in food intake
and diarrhoea due to an increase in GIT motility.
5. Gonads
Normal sexual development and gonadal function require
thyroxin.
6. Vitamins
Beta-carotenes are converted into vitamin A in the
presence of thyroxin. Thyroxin is necessary for activation
of B-complex vitamins, e.g. thiamine.
7. Muscle
Thyroid hormones maintain muscular strength. Excess
thyroxin breaks muscle proteins.

8. Mammary gland
Maintenance of milk secretion during lactation is influenced
by thyroxin.
Thyroid hormones restore even a declining secretion to
normal by stimulation of the breast tissue or may act through
the anterior pituitary or by increasing the blood flow.
9. Skin
Thyroid hormones maintain the normal texture of the skin.
10. Calcium and PO,
Thyroid hormones facilitate excretion of Cat* and PO.”
into urine. With large doses of T, and T;, Ca** and PO, are
mobilized from the bone and so hypercalcaemia and calci-
uria results. Because of protein mobilization and Ca** mo-
bilization from bones, some degree of osteoporosis is seen in
hyperthyroidism.
11. Interrelation Between Thyroid Hormones and
Catecholamines
Thyroid hormones sensitize the tissue to catecholamines by
increasing the number of receptors on the cells.
12. Effect on Other Endocrine Glands
Thyroid hormones stimulate the function of the most of the
other endocrine glands through metabolic rate.
Hyperthyroidism
In hyperthyroidism, there is an increased secretion of thy-
roid hormones. It may occur due to:
1. Primary Hyperthyroidism
a. Hyperactivity of the gland
b. Follicular carcinoma
c. Long-acting thyroid stimulator (LATS) (TSH recep-
tor antibody-TRAb)
2. Secondary Hyperthyroidism is due to increased secre-
tion of TSH from the pituitary. A severe form of hyper-
thyroidism with toxic effects is called thyrotoxicosis or
Graves’ disease.
Clinical Features of Graves’ Disease (thyrotoxicosis) are as
follows:
1. Goitre (enlargement of thyroid gland) is commonly
seen in between 30 and 50 years age group.
2. Exophthalmos — protrusion of eyeballs.
Loss of body weight.
»
4. Mental conditions — restlessness, emotional, anxiety,
highly irritable due to increased activity of sympatheti-
coadrenal system.
5. Fine hand tremors — caused due to increased activity of
the CNS due to increased secretion of catecholamines.
6. Polycythaemia — erythrocyte production increases.
7. Hypertension rise in systolic BP — due to sympathetic
effect.
Physiology
8. Hyperglycaemia — due to diabetogenic action of T, and
T;, glycogenolytic effect of catecholamine is also more.
9. Low cholesterol level — due to more destruction than
synthesis.
10. Intolerance to heat.
11. Skin soft, moist and warm — due to vasodilation and
increased sweat secretion.
Treatment
1. Medical
a. Antithyroid drugs
i. Carbimazole.
ii. Methimazole: These drugs inhibit T;, T, synthesis
by inhibiting iodination and coupling reactions.
iti. Propylthiouracil.
iv. Thiocyanates: This compound inhibits iodide
trapping by competitive inhibition leading to re-
duction in thyroxin synthesis.
v. lodine in large doses inhibits T;, T , secretion.
2. Surgical
a. Subtotal thyroidectomy to reduce the T;, T, secretion
b. Total thyroidectomy with replacement therapy
Q. 5. Give an account of secretion, function and
regulation of parathyroid hormone. Add a note on
tetany.
Ans.
Parathyroid gland is essential for life. There are four parathy-
roid glands in the posterior aspect of the thyroid—two on
superior and two on the inferior poles.
Development
Superior parathyroid glands develop from the fourth bran-
chial pouches (pharyngeal pouches) and inferior parathy-
roid glands develop form the third branchial pouches.
Histology
1. Chief cells produce parathyroid hormone.
2. Oxyphil cells represent senile chief cells.
Secretion
Hormone produced — parathyroid hormone (PTH).
Actions of PTH
1. Bones: PTH causes resorption of the bone by four dif-
ferent ways.
a. It increases the cyclic AMP levels: This causes entry
of Ca** into the cell.
The accumulated Ca** ++ inhibits isocitrate dehydro-
genase and pyrophosphatase; lactic and citric acids
accumulate. These have a solubilizing effect on bone.
So, Ca** is released.
Quick Review Series: BDS 1st Year

b. Cyclic AMP itself causes resorption of calcium. 2. Chovstek’s sign: A tap on the facial nerve—the stylo-
c. It increases the osteoclastic activity and number of mastoid process—causes a contraction of the facial
osteoclasts. muscles on that side.
d. It increases the formation of 1,25-dihydroxycholecal- 3. Erb’s sign: Application of galvanic current brings about
ciferol from 25-hydroxy cholecalciferol. contraction of the hand muscles.
1, 25-(OH), CCF binds to a cytoplasmic receptor and 4. Carpopedal spasm: Appears on voluntary hyperventi-
reaches the nucleus. Through DNA, it promotes the lation.
synthesis of calcium-binding protein. This increases
the entry of Ca** into bone cells. The increased in- These signs are useful for diagnosing latent tetany.
tracellular Ca** brings about the release of Ca**.
Q. 6. What are the hormones of adrenal cortex?
2. Kidney: PTH has a direct effect on the tubular absorption
Describe the action of glucocorticoids.
of Ca** and phosphate. It facilitates calcium absorption
from the ascending limb of LH and distal nephron, and Or
inhibits reabsorption of phosphate. This results in in-
Enumerate the adrenal cortical hormones. De-
creased blood Ca** levels and decreased phosphate levels. scribe briefly the action of glucocorticoids.
3. GIT: PTH increases absorption of calcium from the gut.
This acts through 1, 25-(OH), cholecalciferol. Ans.
4. PTH decreases the calcium content of milk, sweat and Adrenal gland or suprarenal gland is made up of:
GIT fluids.
1. Adrenal cortex—develops from mesoderm.
Regulation of PTH Secretion 2. Adrenal medulla—from neural crest.

Secretion of PTH is regulated by negative feedback mecha- Developmentally, structurally and functionally both are
nism operated by ionic Ca** level of blood. different.
t Blood Ca** level — | PTH secretion
Adrenal Cortex
{ Blood Ca** level — T PTH secretion
Adrenal cortex is essential for life. Its removal may lead to death.
Blood PO, Level
Adrenal cortical hormones have a role in the regulation of
f Blood PO, — PTH high; Low blood PO, — PTH secretion low metabolism of carbohydrates, fats, proteins and minerals.
1. Histologically, adrenal cortex consists of the following
Tetany three zones:
A low ionic Ca** level in the blood results in tetany. a. Zona glomerulosa
b. Zona fasciculata
Features of tetany are as follows:
c. Zona reticularis
1. Tingling and numbness in the extremities.
2. Zona glomerulosa secretes mineralocorticoids.
2. Stiffness of hands and feet due to increased contractile
3. Zona fasciculata and zona reticularis together secrete
state of skeletal muscles.
glucocorticoids and also sex hormones.
3. Muscular cramps and body convulsions due to in-
creased neuromuscular excitability. Various Hormones of Adrenal Cortex
4. Carpopedal spasm: Flexion at the elbow, at the wrist, at
1. Glucocorticoids: Most important among glucocorticoids
the metacarpophalangeal joints and extension at inter-
are:
phalangeal joints. This is called obstetrician’s hand. The
a. Cortisol
feet are extended at the ankles and the toes plantar flexed.
b. Corticosterone
5. Laryngeal stridor: Muscles of the larynx close the glottis.
2. Mineralocorticoids
So air cannot enter and cyanosis develops. Suddenly
a. Aldosterone
there is opening of the glottis due to muscle fatigue; air
b. Deoxycorticosterone
enters with a crowing noise. Severe hypocalcaemia may
3. Sex hormones
lead to respiratory paralysis and death.
a. Androgens (19-C)
Latent Tetany i. Dehydroepiandrosterone
i. Testosterone
It is subclinical entity. The subject will not show the symp-
b. Progestin-progesterone (21-C)
toms unless elicited.
c. Oestradiol (18-C)
1. Trousseaw’s sign: Obstetrician’s hand can be elicited by
applying the BP cuff over the arm and arrest the blood Sex hormones are produced in small quantities by adrenal
flow temporarily. cortex. They may not have a significant physiological role.

Action of Glucocorticoids
Two important glucocorticoids are secreted. These are:
a. Cortisol
b. Corticosterone
Cortisol is a more powerful glucocorticoid hormone than
corticosterone.
Actions of Cortisol
1. Carbohydrate metabolism
a. Cortisol is needed for normal carbohydrate
metabolism.
b. It is a hyperglycaemic agent and increases blood
glucose level by:
{ Peripheral utilization of glucose
t Gluconeogenesis and glycogenesis in liver.
Protein metabolism
a. It causes the breakdown of proteins, especially in the
lymphoid tissue, muscles and bone leading to:
i. Growth retardation
ii. Weight loss
iii. Wasting of muscles
iv. Thinning of skin
He
v. Osteoporosis due to a breakdown of bone matrix,
and creatinuria results.
b. In adrenal insufficiency, growth is retarded because
physiological amounts of cortisol are permissive to
the action of GH.
c. The amino acids released due to protein breakdown
are used for gluconeogenesis in the liver.
Fat metabolism
a. Cortisol increases the circulating FFA levels by caus-
ing lipolysis.
b. In excessive amounts, as in the Cushing’s syndrome,
there is redistribution of fat resulting in trunal obe-
sity with thin limbs.
Water and mineral metabolism
a. Promotes Na* retention and K* excretion.
b. In adrenal insufficiency a water load takes more time
for excretion.
c. In Cushing’s syndrome there is increased Na* and
water retention, so oedema develops.
d. Reabsorption of Na‘ increases water retention, so
blood volume and blood pressure gets increased.
Muscles
a. In adrenal insufficiency; there is muscular weakness
due to an increase in K* retention.
b. In Cushing’s syndrome muscle weakness is due to
enhanced protein catabolism.
Calcium and PO,” metabolism
a. Cortisol has a role in normal bone metabolism. Hy-
persecretion leads to impairment of chondrogenesis,
bone matrix formation and calcification.
Physiology
b. Cortisol breaks down the bone matrix, causes re-
lease of Cat* and PO,”, and their excretion into
urine. Hence, osteoporosis is seen in Cushing’s
syndrome.
. Permissive action: Small amounts of glucocorticoids
enhance the activity of other hormones.
a. The calorigenic action of catecholamines and gluca-
gon is enhanced.
b. The lipolytic, bronchodilatory and vasoconstrictor
effect of the catecholamines is enhanced.
c. In these conditions glucocorticoids themselves do
not have any effect; this type of effect is called per-
missive action.
. CVS: It has a positive inotropic effect on the heart and
increases the stroke volume.
. CNS
a. It increases the activity of neurons in CNS, so the
patient may have euphoria.
b. It will also increase the irritation of neurons. There is
decrease in electroconvulsive threshold. Example: In
Cushing’s syndrome the person becomes restless
and hyperexcitable. Fits can be easily provoked in
epileptics.
10. GIT
a. Administration of glucocorticoids leads to increased
gastric acidity and pepsin secretion.
b. Repeated glucocorticoid administration results in
peptic ulcer and promotes absorption of fats.
ll. Blood and fixed lymphoid tissue (spleen, thymus and
lymph nodes)
a. Glucocorticoids increase the destruction of eosino-
phils and lymphocytes inhibit “T’ cell proliferation
and modulate B cell function indirectly by their ef-
fect on “T’ cells and macrophages.
b. Fixed lymphoid tissues (spleen, thymus and lymph
nodes): Glucocorticoids depress the functions of
fixed lymphoid tissue by interfering with DNA and
RNA synthesis, i.e. mitosis declines. This leads to
lymphocytopenia. Because of lympholytic action,
it can be used for the treatment of lymphatic leu-
kaemia.
c. Blood volume: Maintains blood volume.
d. Glucocorticoids inhibit proliferative response of
monocytes to CSF. They inhibit phagocytic and cyto-
toxic effects of macrophages.
12. Anti-infammatory action: Glucocorticoids have anti-
inflammatory action in large doses. Inflammation is the
response of a living tissue to an injury.
The two reactions that take place during inflamma-
tion are:
a. Vascular reaction: Some vasoactive substances like
bradykinin, prostaglandin, leukotrienes, histamine,
‘H’ substance, etc. cause vasodilatation and increase
Quick Review Series: BDS 1st Year
the permeability. This results in exudation of pro-
tein-rich fluid causing local oedema.
b. Tissue reaction: It includes the release of various
proteolytic enzymes from the lysosomes, causing
damage to the tissue.
Glucocorticoids prevent both these reactions by the
following actions:
i. Stabilize the lysosomal membrane, thereby
prevent the release of proteolytic enzymes.
ii. Decrease the permeability of capillaries.
iii. Prevent migration of leucocytes into the inflamed
area.
iv. Suppress the immune system.
v. Prevent synthesis of PGs and their release.
vi. Exhibit antipyretic effect.
Thus, glucocorticoids act as asbestos against
fire, but these should be given along with specific
drugs. Otherwise, the infection spreads and
causes more harm.
13. Immunity and hypersensitivity
a. Immunity is resistance to infection. Glucocorticoids
do not inhibit but modify the immunity reactions by
suppressing antibody production.
b. They also modify the sequelae of antigen-antibody
reaction.
Glucocorticoids depress the formation of histamine
from histidine and suppress the hypersensitive reactions.
14. Autoimmunity: Sometimes body produces antibodies
against its own tissue. This is referred to as autoimmu-
nity. Glucocorticoids suppress the production of auto
antibodies and so are used in the treatment of autoim-
mune diseases, e.g. myasthenia gravis.
15. Action on stress: Stress is any situation which affects the
metabolic activity of the body. Glucocorticoids take part in
stress reaction and minimize the effect of stress on the body.
Q. 7 Describe uterine changes occurring during
normal menstrual cycle. Give physiological basis
of these changes.
Ans.
Menstrual cycle is defined as cyclical changes that take place
in the endometrium of the uterus during each month. The
duration of this cycle is 28 + 5 days. Similar cycles in ani-
mals are called oestrous cycles.
The uterus is made up of three different layers:
1. The outer serous layer formed by the visceral layer of the
peritoneum.
2. Middle myometrium made up of smooth muscle.
3. Inner endometrium consisting of mucosa.
This layer is further divided into two parts:
a. Stratum basale (basal one-third of endometrium),
which is in contact with myometrium, does not
change during each menstrual cycle.
b. Stratum functionale (the inner two-thirds of endo-
metrium), which is periodically sloughed off and
regenerated completely once in 1 month under the
influence of hormones.
The menstrual cycle is divided into the following three phases:
1. Menstrual bleeding phase
2. Proliferative phase
3. Secretory phase.
The cycle actually starts with proliferative phase but for
convenience, it is described starting from the bleeding phase.
1. Menstrual Bleeding Phase
This phase starts with the day of bleeding and lasts for 5 days.
Humourously, it is referred to as the crying of the uterus for
the baby. During this period, there is discharge from the
uterus, about 30-50 mL of menstrual fluid, which consists of:
a. Blood
b. Mucous shedded from the inner two-thirds uterine
mucosal layer
c. Unfertilized ovum.
This discharge is basically due to withdrawal of
hormones—oestrogen and progesterone. When there is no
fertilization, oestrogen and progesterone levels decline due to
degeneration of corpus luteum. The spiral arteries that supply
blood to the inner two-thirds of the mucosa undergo vaso-
constriction, with the result ischaemia and necrosis of endo-
metrium takes place. Mucosa gets sloughed off. Spiral arteries
open, producing bleeding. This spreads gradually to other
areas over a period of 5 days. Hence, this process takes about
5 days. Prostaglandins that are released also aid in this process.
Once there is sloughing off, regeneration starts. So, both de-
structive and regenerative processes take place simultaneously.
Women experience pain during this phase due to stimula-
tion of pain fibres either by chemicals released or by the
contraction of myometrium. Bleeding phase is seen only in
humans and in one species of monkey.
2. Proliferative Phase
After the menstrual flow only basal one-third of uterine mucosa
is left intact. During this phase regeneration starts under the
influence of oestrogen. Mucosal thickness increases. There is an
increase in the size of uterine glands. Along with these changes,
vascularity also increases. This phase lasts from the 6th to 14th
day and is associated with simultaneous development of graaf-
ian follicle. At about the 14th day ovulation takes place under
the influence of LH, which is secreted at a peak level due to the
positive feedback effect of the rising oestrogen levels.
3. Secretory Phase
This phase lasts from 15th to 28th day and begins with ovu-
lation. Following ovulation corpus luteum develops and

starts producing lot of progesterones and oestrogens under
the influence of LH. Under the influence of progesterone,
the endometrium shows further changes. The mucosa be-
comes further thickened; glands increase in size and start
secreting mucus. Vascularity further increases. This phase
represents the preparation of the endometrium to receive
the fertilized ovum.
If fertilization takes place the corpus luteum persists. This
continues to secrete oestrogen and progesterone, and so
menstrual cycles are suspended. Pregnancy takes place. If
there is no pregnancy, oestrogen and progesterone secretion
declines and the next cycle starts.
Q. 8. Functions of testosterone.
Ans.
It is the most important androgen secreted by the testes. It is
produced mainly by Leydig cells of the testes. Adrenal cortex
and ovary also produce it to some extent. About 4-9 mg/day
of testosterone is secreted in males.
Mechanism of Action
It combines with the cytoplasmic receptor and reaches DNA.
It acts on DNA, and stimulates mRNA and protein synthesis.
Synthesis of Testosterone
Cholesterol + pregnenolone — 17(OH) pregnenolone >
17(OH) progesterone — androstene, 3-17-dione — testos-
terone — dihydrotestosterone (in certain target tissue).
Metabolism
Small amount is converted into 17-ketosteroids and excreted
into urine.
Functions
1. Effects of Testosterone in the Fetus
a. Sex differentiation: Development of external genita-
lia is stimulated by dihydrotestosterone.
b. Descent of testes: Mullerian inhibitory substance
along with testosterone also causes descent of testes
from the abdomen up to the inguinal canal. From
inguinal canal further descent of testes into the scro-
tum is brought about by some unknown factors.
c. Testosterone also influences the brain at fetal stage so
that it develops male pattern.
2. On Accessory Sex Organs
Testosterone stimulates development and growth of the
male accessory organs like seminal vesicles, vas deferens,
prostate, penis and scrotum. This effect is more at the time
of puberty as a lot of testosterone is secreted at that time.
3. On Distribution of Body Hair
General body hair increases. Beard and moustache appear.
Scalp hair recedes. Baldness develops in those with a history
of heredity. Pubic hair appears and attains male pattern.
Physiology
4. On Skin
Skin becomes thicker. Sebaceous secretion increases and
thickens. Acne and black heads appear on the face.
5. On Voice
Voice becomes deeper and low-pitched. This is due to
the growth of the vocal cords and the larynx.
6. Mental Behaviour
Subject develops more aggressive, takes active interest in
the opposite sex.
7. Spermatogenesis
Testosterone is necessary for spermatogenesis at the time
of puberty. It is mainly responsible for spermatogonial
multiplication and so is required for the proliferative stage.
8. On Growth
It stimulates skeletal growth. At puberty the growth is
due to androgens. But it finally causes fusion of the
epiphyseal plates and arrests growth. Stimulates bone
matrix formation and calcium deposition. Testosterone
thus facilitates growth of the bone.
9. On Muscle Mass
Testosterone increases the muscle mass and muscle
power. This is due to protein synthesis. Muscle mass and
muscle power are more in male than in females. This ef-
fect of testosterone is utilized by sportsmen and debili-
tating old men to improve muscle strength and vigour.
10. On Male Pelvis
Testosterone has following specific effects on the pelvis:
a. It narrows the pelvic outlet and lengthens it.
b. Causes a funnel-like shape.
c. Greatly increases the strength of entire pelvis for load
bearing.
11. Metabolism
a. Protein metabolism: Testosterone causes a positive
nitrogen balance. It facilitates transport of amino
acids into the cell. It stimulates protein synthesis.
These proteins are incorporated into the muscle and
thereby cause increase in the muscle mass.
b. Electrolytes and H,O: Testosterone retains Na, Cl
and water by increasing reabsorption of these from
the distal tubules of the kidney, and Ca** and PO,
are also retained to a moderate extent.
12. On Erythropoiesis
Testosterone stimulates production of erythropoietin,
which in turn increases RBC counts. Hence, males have
higher RBC counts than females.
Applied Aspects
1. In old age testosterone or its derivatives are used to
improve muscle power and vigour.
2. Athletes use synthetic androgens to improve their mus-
cular performance, but it is harmful to use such;
3. Testosterone is used in old age to arrest osteoporosis
hormones for prolonged periods and improve the
strength of bones.
 Quick Review Series: BDS 1st Year
SHORT ESSAYS
Q. 1. Name the posterior pituitary hormones. Explain
action of any one of them.
Ans.
oo,
Hormones produced by the posterior pituitary gland are:
1. ADH
2. Oxytocin.
Difference Between ADH and Oxytocin
1. In ADH — end amino acids are arginine and glycine
2. In oxytocin — end amino acids are leucine and glycine.
Antidiuretic Hormone (ADH) or Vasopressin
1. Site of production — Supraoptic nucleus (SON) and
paraventricular nucleus (PVN)
2. Transported by — Supraoptico—paraventricular—
hypophyseal tract to the posterior pituitary. The hor-
mone is stored along with specific neurophysin.
3. Functions or actions of ADH are as follows:
a. It increases the reabsorption of H,O from DCT and
collecting duct.
b. It increases urea absorption from collecting ducts.
c. It promotes Na* reabsorption from the thick ascend-
ing limb of loop of Henle.
d. Effect on blood vessels: Vasoconstriction and BP.
Other actions of ADH are:
1. On heart rate: Heart rate decreases secondarily to in-
crease in BP.
2. On smooth muscle of GIT and urinary tract: ADH
brings about contraction of smooth muscle, increases
peristalsis of GIT and detrusor contraction.
3. It may produce hypoglycaemia.
Oxytocin
It is secreted by paraventricular nucleus of hypothalamus.
Oxytocin means quick birth. It is produced by both SON
and PVN, and is transported by the supraoptico—paraventri-
culo—hypophyseal tract to the posterior pituitary.
Actions or functions of oxytocin are as follows:
1. It brings about milk ejection: This is an example of neu-
roendocrinal reflex.
2. Oxytocin reaches breast gland by the blood and brings
about a contraction of myoepithelial cells, which results
in milk ejection.
3. Facilitates parturition process: Oxytocin quickens the
process of labour. It increases the contraction of the
oestrogen-primed uterus.
4. Increases sperm transport in female genital tract.
Clinical Application
1. Acceleration of labour process
2. To control postpartum bleeding
3. To relieve breast engorgement in lactating mother.
BOTs 8
Q. 2. Enumerate the actions of thyroxin.
Ans
The functions of thyroxin are as follows:
1. Calorigenic action: Thyroid hormone stimulates cell
metabolism, which results in heat production. The calo-
rigenic effect is responsible for the increased BMR in
hyperthyroidism.
. Growth and differentiation: Thyroxin, through its
metabolic action, stimulates the growth and differenti-
ation of tissues. The transition of cartilage into bone
and the myelination of neurons are also stimulated by
the hormone.
. Metabolic effects: Thyroxin stimulates metabolism of
carbohydrate, protein and fats, as described below:
a. Carbohydrates: Thyroxin increases the absorption of
glucose from the digestive tract and its utilization in
the tissues. It produces mild hyperglycaemia by stim-
ulating gluconeogenesis and glycogenolysis.
b. Proteins: In small amounts thyroxin has an anabolic
effect and helps in the protein synthesis, which pro-
motes physical growth. Whereas in larger amounts, it
causes a breakdown of tissue proteins, i.e. catabolic
effect and these are used in gluconeogenesis.
c. Fats: Thyroxin stimulates fat metabolism. It causes
the mobilization of stored fat and helps in its utiliza-
tion. In hypothyroidism the cholesterol content of
blood is increased.
. Action on bones: The bone growth and maturation re-
quire normal secretion of thyroxin. Deficiency of this
hormone in children produces stunted skeletal growth.
. Milk secretion: Thyroxin stimulates milk formation in
the mammary glands. In myxoedema, the lactation is
considerably reduced.
. Cardiovascular system: There is an increase in the
heart rate, cardiac output and blood pressure. Thyroxin
potentiates the action of epinephrine on the heart by
increasing the beta adrenergic receptors.
. Respiration: Increased metabolism results in the pro-
duction of CO,, which stimulates the respiration.
. Alimentary tract: Secretions of the digestive juices and
motility of the digestive tract are stimulated by thyroxin.
It also increases the absorption of digested food.
Nervous system: Thyroxin is necessary for the brain
development. It maintains mental alertness, and excess
may cause irritability and restlessness.

10. Skeletal muscle: Excessive secretion of the hormone
causes muscle weakness due to increased breakdown of
protein.
Q. 3. Describe the formation and functions of cor-
pus luteum.
Ans.
Formation of Corpus Luteum
1. Following ovulation the ruptured follicle gets filled with
blood and is called corpus hemorrhagicum. The granu-
losa cells and theca cells undergo hypertrophy.
2. The LH surge neutralizes the luteinization-inhibiting
factor and thereby initiating luteinization.
3. The granulosa and theca cells show fat droplets in their
cytoplasm and the structure appears yellow.
4. Granulosa cells contribute 80% and theca cells contrib-
ute 20% to the corpus luteum.
5. Corpus luteum starts producing high amounts of oes-
trogen and progesterone under the influence of LH.
6. If fertilization takes place, corpus luteum continues to
produce these hormones until the placenta takes over
this function.
7. If the fertilization has not occurred the corpus luteum
continues the production at high levels up to the 24th
day. From the 25th day the secretion of hormones de-
cline and reaches the basal level by 28th day.
8. The FSH and LH levels fall due to a negative feedback
effect. The corpus luteum degenerates and becomes
atretic called corpus albicans.
Functions of Corpus Luteum
1. Corpus luteum secretes oestrogen and progesterone.
2. Essential for maintenance of pregnancy and many other
changes associated with pregnancy.
3. Responsible for the endometrial changes during the se-
cretory phase of the menstrual cycle.
Q. 4. Explain the regulation of secretions of thyroid
hormones.
Ans.
1. Regulation of thyroid hormone secretion is brought
about by the negative feedback mechanism.
2. There is involvement of hypothalamo-pituitary-thyroid
axis.
3. Increase in the free form of hormone in circulation acts
on hypothalamus and anterior pituitary gland.
4. Acting on hypothalamus it: | TRH secretion. Acting on
anterior pituitary it: | TSH secretion
The net effect is | TSH secretion from anterior pituitary
gland, which in turn decreases thyroid hormones from the
gland.
Physiology
Regulation of Thyroid Hormone Production
(Fig. 2.9.8)
1. Role of hypothalamus: It produces a releasing hormone
called TRH, which acts on the anterior pituitary and
causes the release of TSH from the basophils.
2. Role of anterior pituitary: Basophils produce TSH, which
acts on the thyroid follicular cells and increases produc-
tion of T; and T,. This is mediated through cyclic AMP.
3. Role of circulating T; and T,: The circulating T; and T,
inhibit the secretion of TRH from the hypothalamus
and TSH from the anterior pituitary.
Stress
Cold *| Warm
*\ -
« Hypothalamus
4 TRH \
\
\
| Short loop
/
Long loop; /
/
Anterior pituitary
lo, TSH
l
Free T, T,
in circulation
Fig. 2.9.8 Regulation of thyroid hormone production.
4. Role of stress: Stress stimulates production of TRH
from hypothalamus.
5. Warm and cold: Warm environment inhibits and cold
environment stimulates TRH secretion.
6. Role of iodine: Iodine is necessary for the synthesis of
thyroid hormones. So, iodine stimulates the production
of T; and T, production. In iodine deficiency, there is a
compensatory enlargement of the gland, resulting in
swelling of the gland called goitre. High doses inhibit T,
and T, secretion.
7. Role of goitrogens: These substances produce goitre,
hence they are called goitrogens. Example: Thiocyanate
or oxozolidine are present in certain vegetables belong-
ing to Brassica group (cabbage). Goitrogens are present
as pro-goitrogens. These are activated to goitrogens.
They prevent the uptake of iodine by the thyroid gland.
Lithium, PAS, phenylbutazone and ethionamide inhibit
T3, T4 secretion.
8. Long-acting thyroid stimulator (LATS): This is a
gamma globulin produced by lymphocytes. This di-
rectly acts on the follicular cells and increases T; and T,
secretion.
234 Quick Review Series: BDS 1st Year

Q. 5. Family planning method for females.
Ans.
There are a number of antifertility methods which can be
successfully used in either sex to prevent pregnancy.
Methods Employed in Female
1. Oral contraceptives: They are synthetic steroids, which
contain progesterone and oestrogen, and are also known
as pill. They have to be taken orally for 21 days and dis-
continued for 5 days to allow menstruation. Increased
levels of progesterone inhibit the secretion of LH and
prevents ovulation.
. Rhythm method: It involves the determination of ovu-
lation time and coitus has to be avoided for 2-3 days
before and after ovulation. Since ovulation time varies
from cycle to cycle in the same person, the ideal safe
period to have coitus without the risk of conception
would be 1 week before or after menstruation.
. Intrauterine contraceptive device ([UCD): Foreign
bodies like copper “T’ or Lippe’s loop are inserted into
the uterine endometrium. They prevent conception by
preventing the implantation of fertilized ovum.
. Surgical method: They are the permanent methods and
tubectomy is the commonest. It prevents fertilization,
since the sperm cannot fuse with the ovum due to the
section of the fallopian tube.

SHORT NOTES

Q. 1. Myxoedema. Q. 3. Functions of calcium.

Ans. Ans.
1. Myxoedema is due to the deficiency of thyroxin secre- Some of the important functions of calcium are:
tion in adults (hypothyroidism). 1. Formation and growth of bones and teeth.
2. The following features are observed in this condition: . Blood coagulation.
AR wWh

a. Low BMR and increased blood cholesterol . For the action of intracellular enzymes.
Canna

b. Hoarse voice Transmission of nerve impulse.

c. Swollen face and myxoedematous skin due to the ac- Neurotransmitter release.
cumulation of mucopolysaccharides in the intersti- . Excitation—contraction coupling in muscle.
tial tissue . Contraction of muscles.
d. Thick dry skin with fall of hairs and yellow colour . Secretion of hormones.
due to the carotenaemia . Act as second messenger for hormone action.
. Mental dullness and sluggish response
Q. 4. Goitre.
oo

. Sexual atrophy and amenorrhoea in females

. Bradycardia Ans.
= Fg

Anaemia
. Increased sensitivity to cold 1. Goitre is a term used to denote the enlargement of
thyroid gland and could result from several causes.
Q. 2. Cretinism.
2. In Graves’ disease, it is produced by the action of
Ans. thyroid-stimulating antibodies on the gland.
3. Goitre can also be seen in:
1. Hypothyroidism in children is known as cretinism.
a. Iodide deficiency (endemic goitre).
2. It is characterized by the following manifestations.
b. Hypothyroidism caused by thyroid disease.
a. Delayed milestones in the growth of the child. The
c. Ingestion of naturally occurring goitrogens in large
usual signs of growth, ie. dentition, sitting, walking quantities for a longer duration, e.g. cabbage, turnip,
are delayed.
etc.
. Stunted growth and mental retardation are observed.
s

. The child is extremely dull and presents an idiotic Q. 5. Parathormone.

a

appearance.
Ans.
. Sexual development does not take place properly.
. Resistance to infection is reduced. 1. The parathormone is secreted by chromophobe cells
wo

. Face is puffy, with open mouth and protruding tongue. (chief cells) of parathyroid gland.
. Skin becomes thick and dry. 2. It is proteinaecious in nature and has a molecular weight
sr

. Pot belly due to the bulging of abdomen. of 9500.

 Physiology

Regulation of Secretion excretion of glucose into urine. This spill over of glucose
into urine is referred to as glycosuria.
The secretion of parathormone is regulated by blood cal-
2. Glycosuria occurs when blood glucose level exceeds re-
cium level. A fall in calcium level stimulates the hormonal
nal threshold of 180 mg%.
secretion, and rise in the level of calcium inhibits secretion.
Q. 8. Aldosterone.
Functions of Parathormone
Ans.
1. Increases the blood calcium levels due to the calcium
resorption from bones and reduced renal excretion. Aldosterone is the main hormone of mineralocorticoid
2. Effect on skeleton: Parathormone stimulates the activity group, and its absence leads to death within a period of
of osteoclasts, and the resultant release of calcium in- 2 weeks.
creases the blood calcium level.
3. Effect on kidney: Parathyroid hormone causes the Functions of Aldosterone
conversion of 25-hydroxycholecalciferol to 1,25-
dihydroxycholecalciferol (Vit. D3) in the kidney. This 1. Sodium reabsorption
active form of Vit. D is responsible for absorption of 2. Calcium reabsorption
calcium from the intestine and mobilization of Ca** 3. Water reabsorption.
ion from the bone. Q. 9. Ovarian hormones.
4. Reduction of phosphate level: Parathormone reduces
the intestinal absorption of phosphates and increases its Ans.
excretion by the kidney.
Female Sex Hormones
Clinical Disorders The ovary secretes:
1. Oestrogens
Altered secretion of parathormone may produce following
2. Progesterone
two clinical conditions:
3. Relaxin.
1. Hyposecretion (tetany)
2. Hypersecretion (osteitis fibrosa cystica).
Oestrogens
Q. 6. Insulin.
They are the main female sex steroids secreted from theca
Ans.
interna of Graafian follicle, corpus luteum and placenta.
Insulin is secreted by beta cells of islets of Langerhans. It is
proteinaecious in nature. Actions of oestrogen
1. Facilitates growth of Graafian follicles.
Functions of Insulin
2. It is responsible for development of female sex organs
1. Facilitates glucose entry in cells: This effect is observed and secondary sexual characters.
in muscles and adipose tissue. 3. During proliferative phase of uterus, it brings about all
2. Carrier mechanism in the cell wall is activated by the changes in the endometrium.
insulin. 4. It increases osteoblastic activity and collagen matrix,
3. Glucokinase activation. and facilitates linear growth of the body.
4. Causes fall in blood glucose level: Insulin has a hypogly- 5. It significantly lowers the plasma cholesterol levels.
caemic effect.
5. Glycogen storage in liver. Progesterone
6. Protein metabolism: Insulin is an anabolic hormone.
7. Fat metabolism: It inhibits the hormone sensitive lipase It is another sex steroid secreted by the corpus luteum and
enzyme and produces antilipolytic effect. It also inhibits placenta.
ketogenesis. Actions of progesterone are as follows:
Q. 7. Glycosuria. 1. Brings about progestational, i-e. secretory changes in the
endometrium of uterus.
Ans.
2. It causes development of alveoli in the mammary glands
1. When the load of glucose is very heavy and if the blood responsible for secretion of milk.
sugar level increases above 180 mg/100 mL, then there is 3. Responsible for thermogenic actions.
Quick Review Series: BDS 1st Year

Relaxin Q. 12. Hormones produced by the posterior pitu-

1. Itis secreted from the placenta and ovary, and the secre-
tion is significant during pregnancy.
2. It causes the relaxation of pubic symphysis and soften-
ing of pelvic ligaments, which facilitate childbirth.
Q. 10 Hormones regulating blood glucose.
Ans.
Role of hormones in the homeostasis of blood glucose levels
are as follows (Fig. 2.9.9):
1. Insulin: It lowers the blood glucose level. The action of
insulin is opposed by several hormones which rise the
blood glucose levels.
2. The hormones which rise the blood glucose levels are:
. Epinephrine and norepinephrine
TS
itary gland and one action of any one of them.
Ans.
Hormones produced by the posterior pituitary gland are as
follows:
1. ADH
2. Oxytocin.
Antidiuretic Hormone (ADH) or Vasopressin
Functions or actions of ADH are as follows:
1. It increases the reabsorption of H,O from DCT and col-
lecting duct.
2. It increases urea absorption from collecting ducts.
3. It promotes Na* reabsorption from the thick ascending

. Glucagon limb of loop of Henle.

Adrenal cortical hormones 4. On blood vessels: vasoconstriction and BP.
. Growth hormone
mean

Other actions of ADH are:

ACTH
1. On heart rate: Heart rate decreases secondary to in-
. Thyroid hormones (T, and T;).
crease in BP.
2. On smooth muscle of GIT and urinary tract: ADH
brings about contraction of smooth muscle, increases
peristalsis of GIT and detrusor contraction.
3. It may produce hypoglycaemia.
VOOrD

Oxytocin
Insulin Glucagon, Catecholamines, GH,
Cortisol, ACTH, TSH, T, and T,, It is secreted by paraventricular nucleus of hypothalamus.
mMnaoocrg

Oxytocin means quick birth. It is produced by both SON

and PVN and transported by the supraoptico-paraventri-
culo-hypophyseal tract to the posterior pituitary.
Actions or functions of oxytocin are:
Fig. 2.9.9 Effect of hormones on blood glucose levels. 1. It brings about milk ejection. This is an example of neu-
roendocrinal reflex.
Oxytocin reaches breast gland by the blood and brings
Q. 11. Hypothyroidism. about a contraction of myoepithelial cells, which results
Ans. in milk ejection.
2. Facilitates parturition process: Oxytocin quickens the
1. Hypothyroidism in children is known as cretinism. process of labour. It increases the contraction of the
2. Deficiency of thyroxin secretion in adults is known as oestrogen-primed uterus.
myxoedema. 3. Increases sperm transport in female genital tract.
1. Features of Cretinism
. Stunted physical growth Q. 13. Hormones produced by the adrenal cortex.
ap

. Mentally retarded — low IQ

Ans.
. Pot belly, enlarged tongue
. Delayed milestones Histologically, the cells of adrenal cortex are organized in
enn

. Peculiar cry (hoarse voice) three distinct layers or zones.

2. Features of Myxoedema 1. The zona glomerulosa (the outer region) secretes >
. Low BMR mineralocorticoids.
p

b. Cold, dry skin with coarse and sparse hair 2. The two inner zones (zona fasciculata and zona reticu-
c . Intolerance to cold hoarse voice laris) are considered as one functional unit, and they
e . Slow and sluggish mentation secrete glucocorticoids and androgens.
 Physiology

3. The most important among mineralocorticoids is aldo- These hormones are essential:
sterone. Its actions are as follows: 1. for the growth of accessory sex organs like the uterus,
a. Increases the sodium reabsorption. fallopian tube, and vagina;
b. Minimizes sodium loss from the body. 2. for the development of secondary sexual characteristics
4. The most important among glucocorticoids are cortisol like breast gland;
and corticosterone. The actions of cortisol are: 3. for the maintenance of pregnancy and changes in the
a. Permissive action of cortisol is required for certain body during pregnancy;
actions of growth hormone and glucagons. 4. as androgens are secreted only in traces; and
b. Metabolic actions: 5. as the hormone relaxin brings about the relaxation of
the pubic ligaments and softening of the cervix at the
Carbohydrate metabolism: It is a hyperglycaemic agent and
end of pregnancy.
increases blood glucose levels.
Protein metabolism: It enhances protein breakdown. Q. 17. List any four methods of contraceptives in
females.
Flat metabolism: It increases lipolysis in adipose tissue.
Ans.
Mineral metabolism: It increases sodium reabsorption.
Contraceptive methods employed in females are as follows:
Q. 14. Testosterone. 1. Oral contraceptives
Ans. 2. Rhythm method
3. Intrauterine contraceptive device JUCD)
Testosterone is the male sex steroid secreted by the intersti- 4. Surgical method — tubectomy is the commonest
tial cells of Leydig. method used.

Actions of Testosterone Q. 18. List four functions of oestrogen.

1. Gametogenesis or spermatogenesis Ans.
Development of male secondary sexual characteristics
Physiological actions of oestrogen are as follows:
3. Regulation of secretion of gonadotrophic hormones by 1. Oestrogens are responsible for puberty changes, which
anterior pituitary produce sexual maturity in females.
4. Anabolic and growth-promoting effects. 2. Action on Female Genitalia
Q. 15. Pregnancy tests. a. Oestrogens increase the size of the uterus and the
excitability of the uterine muscle.
Ans.
b. Endometrial proliferation.
There are various pregnancy tests and as stated earlier they 3. Oestrogen causes the enlargement of breast at the time
depend on the excretion of HCG in the urine. of puberty due to increased deposition of fat and stro-
mal tissue.
Aschheim—Zondek test 4. Metabolic Effects
These tests are based on the
Friedmann’s test a. Oestrogen has a significant action of lowering plasma
excretion of placental HCG
Male toad test
in the urine. cholesterol.
Immunological test b. They cause retention of Na* and H,0O in the body.
Q. 19. Testosterone.
Q.16. Functions of ovaries.
Ans.
Ans.
Testosterone is the male sex steroid and is the most impor-
Functions of ovaries are as follows:
tant androgen secreted by the interstitial cells of Leydig of
1. Oogenesis: Production of mature ova and their release
the testes.
into the peritoneal cavity.
2. Production of various hormones like
Functions
. Oestrogens
Tp

. Progesterone 1. Effects of testosterone in the fetus

. Androgens a. Sex differentiation
. Inhibin b. Descent of testes
moon

. Activin c. Testosterone also influences the brain at fetal stage so

. Relaxin that it develops male pattern
Quick Review Series: BDS 1st Year
2. On accessory sex organs:
Testosterone stimulates development and growth of the
male accessory organs like seminal vesicles, vas deferens,
prostate, penis and scrotum. This effect is more at the
time of puberty, as a lot of testosterone is secreted at that
time.
3. On voice: Voice becomes deeper and low-pitched.
4. Spermatogenesis: Testosterone is necessary for spermato-
genesis at the time of puberty.
Q. 20. Explain mechanism of action of oral contra-
ceptive pills.
Ans.
1. Oral contraceptives are synthetic steroids or sex hor-
mones (progesterone and oestrogen) given in different
combinations and are also known as pill.
2. The pill consists of large amounts of progesterone and
small amounts of oestrogen.
3. The probable mechanism of action of the combined pill
is that it may prevent:
a. the ovulation by inhibiting release of LH and FSH;
b. implantation by causing endometrial hypoplasia and
c. entry of the sperm into uterus by altering cervical
mucus.
Q. 21. Corpus luteum.
Ans.
1. After the release of ovum, the Graafian follicle develops
into corpus luteum during the second half of the men-
strual cycle.
2. The corpus luteum secretes progesterone and oestro-
gens due to the trophic action of LH.
3. If fertilization occurs, the corpus luteum remains func-
tional up to the third month of pregnancy, but in the
absence of fertilization, it degenerates and becomes cor-
pus albicans before the next menstrual cycle.
Q. 22. Acromegaly.
Ans.
1. Acromegaly is produced due to the hypersecretion of
the growth hormone in adult life (after the epiphyses
fuse).
2. Patients suffering from acromegaly have the following:
a. Prominent jaw bone and thickening of the skull
bones.
b. The hands and feet are greatly enlarged.
c. Muscular and visceral enlargements are also seen.
d. Blood sugar level rises.
Q. 23. Glucagon.
Ans.
1. Glucagon is secreted by alpha cells of the pancreatic is-
lets of Langerhans.
2. It is a low-molecular-weight protein. It is hyperglycae-
mic and lipolytic.
3. Glucagon produces the following physiological effects:
a. Glycogenolysis (breakdown of glycogen)
b. Gluconeogenesis in liver, which produces hypergly-
caemia
. Lipolytic effect due to breakdown of fats
aa
. Breakdown of tissue proteins, which are subsequently
used for the gluconeogenesis
. Inhibits gastric secretion
wo
. Reduces intestinal motility
. Increases force of cardiac contraction
maq
. Stimulates insulin secretion
Control of Secretion
1. The following conditions stimulate glucagon secretion:
a. Low blood sugar
b. Sympathetic stimulation
c. Starvation
2. It has also been observed that high blood glucose and
somatostatin inhibit the secretion of glucagon.
Q. 24. Gonadotropic hormone.
Ans.
1. Gonadotropic hormone is produced by the anterior pi-
tuitary.
2. Gonadotropins (FSH and LH) control reproduction in
both males and females.
3. In males, spermatogenesis and growth of accessory or-
gans, and in females, ovulation, menstrual cycle and devel-
opment of secondary sexual characteristics are all con-
trolled by gonadotropins or the hypothalamus indirectly.
4. Human chorionic gonadotropin (HCG) and pregnant
mare serum (PMS): These are placental gonadotropins.
HGG is produced in humans and PMS in mares. They
have mainly LH activity.
Q. 25. Posterior pituitary gland.
Ans.
1. Neurohypophysis (posterior pituitary gland): Devel-
ops from the floor of the third ventricle.
2. Histology: Consists of unmyelinated nerve fibres, pitui-
cytes, mast cells, hyaline bodies (Herring bodies).
3. Blood supply: Inferior hypophyseal artery.
4. Neurohypophysis secretes two peptide hormones namely
vasopressin (ADH) and oxytocin; but they are actually
formed from the supraoptic and paraventricular nuclei
of the hypothalamus as prohormones.
Q. 26. Dwarfism.
Ans.
1. Dwarfism is caused due to hyposecretion of growth
hormone (somatotropic hormone) in children.
 Physiology

2. In this condition, both the physical growth and the Q. 30. Thyroid function tests.
sexual development are retarded. However, the mental
Ans.
development is perfectly normal — a feature which
helps this condition to be differentiated from cretinism Various tests for thyroid function are as follows:
(hypothyroidism). 1. Estimation of BMR
. Estimation of protein in bound iodine
Q. 27. Gigantism.

WY
. Estimation of serum cholesterol level
Ans. . Radioactive iodine uptake (RAIU)

DoF
. Estimation of serum total thyroid hormone concentration
Increased secretion of growth hormone, during young age . Estimation of T;, T, and TSH levels
(before the epiphyses fuse) produces a clinical condition . Thyroid suppression test

ON
known as gigantism. In this disorder, individual becomes . Reflex time
unusually tall due to the accelerated skeletal growth. 9. TSH stimulation test
10. Scanning of thyroid gland
Q. 28. Tetany.
Q. 31. Safe period.
Ans.
Ans.
1. A reduction of parathormone secretion produces tetany.
1. The rhythm method of contraception is based on iden-
2. The manifestations are seen when blood calcium falls
tification of the fertile period of a cycle and to abstain
below 6 mg%.
from sexual intercourse during that period.
3. Clinical Features
2. Using basal body temperature during the menstrual cy-
a. Increased neuromuscular excitability: The fall in ionic
cle or cervical mucous method (Billing method) the
calcium results in muscular convulsions. If the fa-
fertile period can be noted. The rest of the cycle is taken
cial nerve is given a mild tap in front of the ear,
as a safe period.
twitching of facial muscles is produced (Chvostek’s
3. The period from 9th to 17th day of the cycle is consid-
sign).
ered as the fertile period. So, the rest of menstrual cycle
b. Carpopedal spasm: The arm is flexed at the elbow,
is considered as the safe period.
wrists and metacarpophalangeal joints, but the inter-
phalangeal joints are extended. The thumb moves Q. 32. Spermatogenesis.
towards the palm (Trousseau’s sign).
Ans.
c. Laryngeal spasm: Increased excitability of the laryn-
geal muscles produces a spasm, which leads to the 1. It is the process by which sperms are produced in the
blockage of respiratory passage and suffocation. seminiferous tubules. The spermatogenesis starts from
The cause of death in tetany is due to laryngeal puberty and continues throughout life.
spasm. 2. The stages of sperm formation are explained in Flow-
d. Intestinal and biliary colic: Powerful contraction of chart 2.9.1.
muscles in these regions may lead to severe pain.
The whole process of spermatogenesis takes about 74 days.
e. Erb’s sign: If galvanic current is passed in a motor
It is influenced by FSH and testosterone. A reduced scrotal
nerve, increased excitability is observed.
temperature (around 32°C) favours spermatogenesis.
Q. 29. Addison’s disease.

Ans. Spermatogonia

Hyposecretion of cortical hormones produces Addison’s

disease. Its common manifestations are:
'
Primary spermatocyte
1. Increased urine output due to the non-retention of
NaCl and water. |
Secondary spermatocyte
2. Hypovolaemia resulting in fall of blood pressure and
shock.
Acidosis due to the retention of H* ions. |
HY

Metabolic depression and fall of blood glucose level. Spermatid

De

Hypoglycaemia and muscular weakness.

Pigmentation of the skin due to the increased secretion |
Spermatozoa
of ACTH.
7. Poor response to stress. Flowchart 2.9.1 Stages of sperm formation.
240 Quick Review Series: BDS 1st Year

SHORT ESSAY

Q. 1. Types of nerve fibres. Erlanger and Gasser Classification

Ans. According to Erlanger and Gasser, the nerve fibres have been
classified on the basis of their thickness into A, B and C
The three types of classification of nerve fibres:
groups.
1. Erlanger and Gasser classification — based on diameter
The group A is further subdivided into A [a, B and y
and conduction velocity
types] (Table 2.10.1).
2. Numerical classification > only for sensory nerve fibres
3. Physioanatomical classification — based on function.

Table 2.10.1 Types of nerve fibres

Fibre type Fibre diameter (mm) Conduction velocity (m/sec) Function
A Myelinated
Aa 12-20 70-120 Somatic motor, proprioceptive
AB 5-12 30-70 Touch, pressure
Ay 3-6 15-30 Motor to muscle spindle
B Myelinated 2-5 12-30 Pain, temperature and touch
Unmyelinated <3 3-15 Preganglionic fibres of ANS
Dorsal root 0.4-1.2 0.5-2 Pain-reflex response
Sympathetic 0.3-1.3 0./-2.3 Postganglionic autonomic fibres

Numerical Classification Physioanatomical Classification

Sensory physiologists have classified afferent nerve fibres ac- On the basis of their function nerve fibres are of two types,
cording to their diameters and origin as depicted in Table namely
2.10.2:

Table 2.10.2 Numerical classification

Motor Sensory
Number Origin Size (um)
I 12-20
la Muscle spindle, annulospiral Somatic visceral Special sensory
Ib Golgi tendon organ
ll Muscle spindle secondary ending, touch, 5-12
pressure
Il Pain, temperature, some touch receptors 25
IV Pain and other receptors 0.1-0.3
 Physiology

SHORT ESSAY

Q. 1. Describe the neuromuscular junction (NMJ) tors) are present almost near the mouths of subneural
with the help of a diagram, and explain the mecha- clefts on the end plate membrane.
nism of transmission of nerve impulse across . In the synaptic knob, mitochondria and vesicles are
NMJ. present. Vesicles which are formed by the invagination
Ans.
of the membrane of the synaptic knob contain acetyl-
choline.
1. The junction between the nerve terminal and the mus-
cle fibre is known as neuromuscular junction. A typical TYPES OF NM JUNCTIONS (FIG. 2.11.2)
neuromuscular junction is seen only in the skeletal
1. Discrete type (emplaque): In this type, the terminal
muscles; smooth or cardiac muscles do not have such
structure (Fig. 2.11.1).
part of the nerve filament establishes contact at only one
point on the sarcolemma. Example: A fast-contracting
. Asmall thickened region of the sarcolemma in the mid-
muscle fibre where there is a propagated impulse.
point of the muscle fibre is called motor end plate,
. Engrappe type: In this type, the terminal part of the
which shows a small depression called synaptic gutter or
nerve filament establishes contact throughout the sarco-
synaptic trough.
. The axon terminal before it establishes contact with
lemma. Example: slow contracting muscles where there
is no propagated impulse.
muscle fibre, loses its myelin sheath and divides into a
number of filaments; the terminal part of each of these
filaments shows dilation called synaptic knob or sole
0° ° °° 06
foot.
. The synaptic knob fits into the gutter of the end plate. A
28 ©9 0000 Oo

small space between the synaptic knob and the gutter

a. Discrete type on b. En grappe type on slow-
wall is called synaptic cleft. The synaptic cleft is about fast muscle fibres contracting muscle fibres
20-30 nm and is filled with amorphous tissue (basal
Fig. 2.11.2 Types of NMJ in skeletal muscle.
lamina) in which acetylcholine esterase is present.
. The cell membrane of bulbous terminal of the nerve
fibre is called ‘the prejunctional membrane’, whereas Mechanism of Transmission at NMJ
that of muscle fibre is known as ‘the postjunctional
The sequence of events that take place during transmission
membrane’.
of nerve impulse across the NMJ are as follows (Fig. 2.11.3):
. The wall of the gutter is thrown into a number of folds
1. Depolarization of the synaptic knob occurs on arrival of
called subneural clefts. This increases the surface area.
the impulse at the terminal end of the nerve fibre.
Acetylcholine receptors (NM type of nicotinic recep-
. Voltage-gated Ca** channels are opened and Ca** ions
enter the synaptic knob. Vesicles move towards the ac-
tive zones and get attached to the membrane of the
Synaptic knob synaptic knob.
Synaptic gutter
. Rupture of vesicles takes place and ACh is released into
Vesicles the synaptic cleft.
Sarcolemma
a. Several hundred vesicles rupture per each impulse.
b. One vesicle contains 107 molecules of ACh.
. ACh combines with receptors present on the motor end
Basal lamina
plate. End plate has 10* pm? of receptors.
. Ligand—gated sodium and potassium channels on the
end plate open and the Na* enters the cell whereas K*
leaves the cell.
Dense bars
Subneural cleft . Development of the end plate potential (EPP), which
Fig. 2.11.1 Neuromuscular junction. produces depolarization of the adjacent sarcolemma.
Quick Review Series: BDS 1st Year

7. Action potential develops on sarcolemma due to open-

ing of voltage-gated Na* channels and is conducted
throughout the length of the muscle fibre.
8. This excitation process gets coupled with contraction.
Ca** is responsible for this coupling. Mg** opposes the
action of Ca** at NMJ, ie. it prevents the release of
ACh. On the nerve, both Ca** and Mg** have similar
Vesicle
effect (Fig. 2.11.4).
ACh that is released will be immediately destroyed in
two ways:
Site of a. Most of the acetylcholine is destroyed by the enzyme
+ AP acetylcholinesterase present in the NMJ.
trigger b. A small amount diffuses out of the synaptic cleft.

Na K+
| AP —Action potential
Ca* abil
MEPP — Motor end plate | Mg** | Excitability
potential
Cat
Mg** | Excitability
Fig. 2.11.3 Events at NMJ that lead to an AP in the muscle Fig. 2.11.4 Effect of Ca** and Mg** on nerve excitability.
membrane.

SHORT NOTES

Q. 1. Sarcomere. region is called A band. In the centre of the A band,

Ans.
1. The sarcomere is the contractile unit of a muscle fibre
(Fig. 2.11.5).
2. Under light microscope, it exhibits light and dark bands,
which produce the characteristic cross-striations of the
skeletal muscles.
3. Each sarcomere consists of a central dark region and
lateral lighter regions on either side. The central dark
there is a lighter zone called H zone. On either side of
the A band, there are lighter bands called I bands and in
the centre of I band, a dark Z line is present.
4. The sarcomere extends between two adjacent ‘Z’ lines
and its length ranges from 1.5 to 2 tm. The thin actin
filaments arise from the Z line and extend into the
A band.
Q. 2. Neuromuscular transmission.

Ans.

1. The motor nerve after entering the skeletal muscle di-

Z zZ AAA vides and redivides into branches, and each individual
a
a muscle fibre is supplied by one nerve fibre forming the
— | neuromuscular junction (Fig. 2.11.6).
—
Z Z Zz Zz 2. Synaptic knob or sole foot of the axon terminal fits into
Sarcomere Resting state a groove or depression on the muscle membrane form-
A ing the motor end plate.
Z Z 3. When the motor nerve is stimulated, acetylcholine is
Zz Z
— released prior to the release of this mediator, Ca*~ ions
a
a from the synaptic space enter into the terminal knobs.
Z 7 — 4. The acetylcholine released diffuses into the receptors
tLe Z z present in the motor end plate causing membrane depo-
Sarcomere Contracted state
larization and development of a local current, which is
Fig. 2.11.5 Structure of a sarcomere. termed as the end plate potential (EPP).
 Physiology

2. The muscle is not allowed to shorten in this type of

contraction.
Myelin sheath

Isotonic Contraction

1. In this type of contraction, the tension developed in the

muscle remains constant but the length is variable.
—Mitochondrion 2. In this type, the muscle is allowed to shorten and lift a
load.

Synaptic cleft
Q. 4. Saltatory conduction.
Ans.
Vesicle with the
neurotransmitter
Saltatory conduction in a myelinated nerve
Juctional folds 1. The term ‘saltatory’ is a Latin word, which means to leap.
Fig. 2.11.6 Neuromuscular junction.
2. The impulse conduction is faster in the myelinated fibres.
In myelinated fibres, the action potentials jump from one
node of Ranvier to the next node ahead, leaving the inter-
5. The EPP after attaining the threshold level gives rise to node. This is possible by the spread of current through
the propagated action potential leading to the muscle the axoplasm and ECF outside, forming a circular current
contraction. flow. This type of conduction in a myelinated axon is
called the saltatory conduction (Fig. 2.11.7).
Q. 3. What is isometric and isotonic contraction?

Ans. ECF
aN C Myelin sheath
1. The following two types of contractions are seen in skel-
Zt Z ZL.
etal muscle:
a. Isometric contractions “Se
Axoplasm
b. Isotonic contractions.
+
a: —_
Isometric Contraction DE DZ DE
1. In this type of contraction, the length of the muscle EFC
al
Direction of propagation
remains same but the tension or the force developed
increases. Fig. 2.11.7 Saltatory conduction in a myelinated nerve fibre.

Topic 12 NER

LONG ESSAYS

Q. 1 Draw a diagram to show different parts of =» Centre

reflex arc. Describe properties of reflex.
Dorsal root
ganglion .
Ans. Efferent limb
Afferent nerve
The reflex arc is shown in Fig. 2.12.1
The different parts or components of reflex arc are as Receptor f
follows: Muscle
1. Receptor (effector organ)

2. Afferent limb Fig. 2.12.1 Reflex arc.

3. Centre
yy) Quick Review Series: BDS 1st Year

4. Efferent limb 2. In the temporal summation, for one subthreshold stim-

5. Effector organ. uli, no response is obtained; but when several such
stimuli are applied at a rapid rate, then the response is
As the reflex arc contains at least one synapse, the proper- obtained.
ties of synapses hold good for reflexes as well.
The properties of reflexes are as follows: Occlusion
1. Occlusion means decline in the normally expected re-
After Discharge sponse. The reflex response that is obtained by stimulat-
1. Even after the cessation of the stimulus the reflex re- ing two afferent nerves together is less than the response
sponse continues to come for some more time; this is obtained when they are separately stimulated.
called after discharge. 2. This is due to the presence of common neurons in both
2. It is possible due to parallel and the reverberatory cir- groups.
cuits in CNS.
Subliminal Fringe
Habituation and Synaptic Fatigue “1. This is a partial state of excitation. The reflex response
1. When the stimulus is benign there will be response ini- that is obtained by stimulating two afferent nerves to-
tially, but as the stimulus continues, the intensity of re- gether is more than the response obtained when they are
flex response decreases and will disappear after some- stimulated separately.
time. This phenomenon is known as habituation. 2. This is due to some neurons which remain at subliminal
2. On continued stimulation, the reflex response obtained fringe when stimulated separately.
gradually gets lessened. It is said to be in fatigue. The
seat of fatigue is the synapse. Irradiation

1. When a threshold nociceptive stimulus is applied to a

Sensitization
forelimb, the animal withdraws that limb (flexion).
When the stimulus is dangerous one on the subsequent ex- When the strength of the stimulus is increased, the re-
posure to the same stimulus, the intensity of reflex response sponse spreads to the other limbs also and the animal
will be much more, which is just opposite to habituation. withdraws even the hind limbs.
2. This is due to irradiation of the impulses in the spinal
Synaptic Delay cord.
Due to various mechanisms involved in the synaptic trans-
Facilitation
mission like
1. release of neurotransmitter from the synaptic vesicles, 1. Some response is obtained when a stimulus is applied to
2. its passage through synaptic cleft, an afferent nerve. When second and third stimuli are
3. action on the postsynaptic region to elicit the response; applied immediately, the responses obtained are better
some of the time is lapsed at the synapse. This delay at than the first one. This is known as facilitation.
the synapse is called synaptic delay. 2. The first stimulus has given facilitatory effect to the sec-
ond and the third. This is due to beneficial effect.
For one synapse, a delay of 0.5 to 1 msec appears.
Inhibition
Summation
When a stimulus either diminishes or inhibits the effect of
Repeated or simultaneous stimulation of motor neurons another stimulus, it is known as inhibition.
with subminimal stimuli exhibit the phenomenon of sum-
mation. It is of two types: Rebound Phenomenon

Summation A reflex response that is diminished by stimulation of an

afferent nerve will attain full power when the stimulation
ceases. It is known as rebound phenomenon.
Spatial summation | Temporal summation
Reciprocal Innervation
1. In the spatial summation the stimuli is simultaneously Stimulation of an afferent fibre results in contraction of
applied to different presynaptic neurons, where the time the agonists and relaxation of the antagonists. This is called
of stimulation shall be same. reciprocal innervation.
 Physiology

Susceptibility to Hypoxia d. In the medulla, 80% of the fibres from both sides
cross over and descend, as the lateral corticospinal
Reflexes are susceptible to hypoxia and show a decreased
tract and end on the anterior horn cells present in the
response.
different segments throughout of the length of spinal
Q. 2. Describe pyramidal tract with the help of dia- cord.
gram from origin to termination. e. Till they reach the corresponding anterior horn cells
of the same side, the remaining 20% of fibres remain
Ans.
uncrossed, and they run down in spinal cord as ante-
1. Pyramidal tract is one of the important descending rior ventral corticospinal tract.
tracts that carry efferent impulse from the higher parts f. Most of these fibres cross the midline at different seg-
of CNS to spinal cord (Fig. 2.12.2). ments before ending on anterior horn cells of oppo-
2. Pyramidal tract is also known as the corticospinal tract. site side while some of them end in anterior horn
The term pyramidal tract has been given since the fibres cells of same side.
arise from pyramid-like structure in the medulla. The
tract is responsible for executing skilled, precise and Lesion of Pyramidal Tract
purposeful voluntary movements.
3. Origin 1. The internal capsule is common site for lesion of
a. The fibres of corticospinal tract or pyramidal tract the pyramidal tract and is usually due to vascular
arise from area 4, which represents the motor cortex, lesions.
area 6 (premotor area), area 2 (supplementary motor . The term hemiplegia is used clinically to describe this
area) 3, 1, 2 of sensory cortex and posterior parietal condition where the paralysis relates to the opposite-
lobe (areas 5 and 7). half of the body.
b. The fibres leave the cortex and enter the internal cap- . Some of common manifestations are as follows:
sule to occupy the genu and anterior two-thirds of a. Spastic paralysis
the posterior limb. b. Absence of superficial reflexes
c. From the internal capsule, they descend to the brain- c. Presence of ankle clonus
stem. In the pons and medulla, fibres go to the cra- d. Positive Babinski’s sign
nial nerve nuclei of the opposite side to form cortico- If hemiplegia is due to a lesion in the left motor cortex
pontine and corticobulbar fibres, respectively. involving Broca’s area, then speech may also be affected.

Q. 3. Add a note on hemisection of spinal cord.

Motor cortex Ans.

Areas 4 and 6 Midline : : : : :
1. A lesion involving one lateral half of the spinal cord is
p) termed as hemisection; a clinical condition equivalent to
SH Internal capsule hemisection of the spinal cord is called Brown-Sequard
syndrome.
2. Depending on the onset of this condition, the physio-
logical effects differ. If the onset is acute as occurs in the
case of an injury, then the typical features resembling
hemisection of the spinal cord develop immediately.
Medulla Medullary motor : :
q
decussation On the other hand, if the onset is slow the symptoms
Ventral Y/| Lateral appear gradually at a slower rate and involve several
corticospinal-4] ~— corticospinal segments.
_ 5o
; tract 3. Functional changes: Both in hemi- and complete tran-
j t
’e direc About 85% crossed section of the spinal cord, there are three stages in the
. . .

pyramidal
: pyramidal tract fibres
tract fibres functional changes:
Spinal cord
Anterior
a. Stage of spinal shock
horn cell b. Stage of reflex activity
c. Stage of reflex failure
nerve _ Neurons Skeletal Stages I and III are same for both hemi- and complete
muscle sections of spinal cord. The stage II features differ
in hemisection compared to complete section of the spinal
Fig. 2.12.2 Pyramidal tract. cord.
Quick Review Series: BDS 1st Year

Symptoms of Hemisection (Fig. 2.12.3) At the Level of Lesion

1. Stage of spinal shock (Stage I) On the same side
All the features of spinal shock are due to sudden with-
drawal of supraspinal facilitatory influences to motor neu- Sensory
rons of spinal cord. 1. There is a complete loss of sensation (anaesthesia)
During this stage motor neuron undergoes functional because of destruction of the posterior nerve root.
depression. 2. Sensations lost are pain, temperature, touch, tactile dis-
crimination, vibration, proprioception and stereognosis.

Motor (Fig. 2.12.4)

Lower-motor neuron type of paralysis occurs, as the anterior
Lesion on right side
nerve roots are damaged.

Loss of pain and temperature on

opposite side
Loss of position and touch on same side
|~Above the level of lesion

-—Lower motor neuron lesion

Fig. 2.12.3 Hemisection of spinal cord with right-side lesion. “Tat the level of lesion

|~Below the level of lesion

The features are as follows:
1. This stage lasts for about 6 weeks.
2. Due to damage to the ascending and descending tracts
there will be no sensations, reflexes and voluntary move- Motor nerve
ments in the effected parts.
Fig. 2.12.4 Motor effects of hemisection.
3. There is a loss of micturition and defaecation reflexes
and muscle tone.
4. | B.P, skin is cold and dry, and cyanosis may be must.
Vasomotor
2. Stage of reflex activity (Stage II)
Vasomotor paralysis occurs as the lateral horn cells are dam-
1. In stage II, the recovery of reflexes is because of regain-
ing of functional ability of spinal cord neurons without aged.
any influence of higher centre.
On the opposite side
2. In this stage as the spinal motor neurons LHCs and
AHCs recover their functional ability like micturition Sensory — usually not affected.
and defaecation, they become purely automatic. Motor — not affected.
3. Muscle tone is recovered whereas there will be no recov- Vasomotor — not affected.
ery of any voluntary movements or sensations, as dam-
age to tracts is permanent. Below the Level of Lesion

The stage II features differ in hemisection compared to On the same side

complete section of the spinal cord in stage II as the extensor
Sensory
activity is more; it is called paraplegia in extension.
Loss of fine touch, tactile discrimination pressure, stereog-
Symptoms of hemisection are as follows. nosis and kinaesthetic sensation due to cutting of the poste-
rior columns.
Above the Level of Section
A small area of the cutaneous hyperaesthesia is seen above Motor

the level on the same side of the lesion corresponding to the Upper motor neuron-type of paralysis is seen due to release
distribution of the next higher sensory nerve. This is due to from the effects of higher centres. When the section is at Cl,
irritation of the sensory fibres. No motor involvement on hemiplegia results and at the thoracic or lumbar regions,
both sides. monoplegia results.

Vasomotor
Temporary loss of vasomotor tone due to separation of the
lateral horn cells from the vasomotor centre. Later, the lateral
horn cells become active and vasomotor tone is regained.
On the Opposite Side
Sensory: Pain, temperature and crude touch are lost as the
crossed spinothalamic tracts are cut.
Motor: Usually the motor function is not affected, but some-
times some muscles are involved as there is damage to the
uncrossed pyramidal tract fibres.
Stage of Reflex Failure
1. It is mainly because of infections.
2. The activity of motor neurons is depressed by the toxins
liberated by bacteria, and results in loss of muscle tone
and all reflexes including micturition and defaecation.
3. There is a fall in BP.
Q. 4 Name any two ascending tracts of spinal cord.
Describe origin, course, termination and function
of any one.
Ans.
1. A tract is a bundle of nerve fibres located in the CNS. The
ascending tracts carry some sort of sensory information
from the spinal cord to the various higher centres.
2. They feed information with regard to disturbances in
internal and external environment to higher centres in
the form of coded electrical impulses.
There are various ascending tracts in the CNS. They are as
follows:
1. Dorsal columns or posterior columns:
a. Tract of gracilis (TG)
b. Tract of cuneatus (TC)
Lateral spinothalamic tract.
Wd
Anterior or ventral spinothalamic tract.
Dorsal spinocerebellar tract.
VR
Ventral spinocerebellar tract.
Spinotectal tract — takes part in spinovisual reflexes.
ND
Spino-olivary tract — considered to be a part of the
spino-cerebellar tract. It may carry reflex proprioception.
. Spinoreticular tract — it may activate reticular formation.
oO
9. Spinovestibular tract — it is concerned with postural
reflexes.
10. Spinopontine tract — function is not clear.
Dorsal Columns (Tract of Goll and Burdach/
Fasciculus Gracilis and Cuneatus)
Origin
1. The first-order neuron is in the posterior root ganglion;
the axons of these neurons after entering the spinal cord
Physiology
immediately enter the posterior white column of the
same side.
2. Fibres carrying sensation from the lower half of the body
occupy the medial-half and constitute tractus gracilis.
3. Fibres carrying sensation from the upper-half of the
body occupy the lateral-half and constitute tractus cu-
neatus.
4. Some descending collateral fibres of these two tracts
constitute the common tract.
5. The exact function of this tract is not clear.
Course
1. The two tracts ascend on the same side up to the me-
dulla, where they synapse in nucleus gracilis and nucleus
cuneatus. Some of the fibres terminate in the accessory
cuneate nucleus.
2. The second-order neuron starts here, and two types of
fibres take origin from here.
Two types of fibres arising from these nuclei are as follows:
Posterior Arcuate Fibres
1. These fibres take origin from the accessory cuneatus nu-
cleus and constitute the posterior external arcuate fibre.
2. These fibres do not cross but ascend on the same side
and carry unconscious tactile and proprioceptive sensa-
tions to the cerebellum.
Internal Arcuate Fibres
1. Most of the second-order fibres cross to the opposite
side and constitute internal arcuate fibres. These form
medial lemniscus.
2. The internal arcuate fibres carry conscious propriocep-
tion, fine touch, vibration, deep pressure and stereognosis.
3. The medial lemniscus ascends up to the thalamus where
they synapse in the posteroventrolateral nucleus of the
thalamus.
4. The third-order neurons originate here. These ascend
through the internal capsule, where they lie posterior to
the corticospinal tract.
Centres
1. The fibres reach the somatosensory areas I and II. The
somatosensory area I is 3, 1, 2 located in the postcentral
gyrus of the parietal cortex. Impulses are also fed to ar-
eas 5 and 7. The fibres end in the IV layer of the above
area. Contralateral half of the body is represented upside
down at the sensory areal.
2. Somatosensory area II is present in the superior wall of
the Sylvian fissure. The body regions are represented.
here from the head to the lower limbs anteroposteriorly.
Both ipsilateral and contralateral halves of the body
project sensation to this area.
yt: Quick Review Series: BDS 1st Year

Sensations Carried by Dorsal Columns ascend 1-3 segments forming the Lissauer’s tract before
they synapse with a small group of cells located at the
1. Conscious proprioception — joint position and move-
tip of the posterior grey horn. This group of neurons is
ment.
referred to as substantia gelatinosa of Rolando.
2. Unconscious exteroception and proprioception from
. The axons of these fibres cross to the opposite side
the upper-half of the body are carried out by tractus
through the anterior grey commissure and occupy a
cuneatus up to medulla. The latter through posterior
position in the lateral white column. This constitutes the
external fibres reach the cerebellum.
lateral spinothalamic tract.
3. Vibration sensation.
. The axons of some of the posterior root ganglion cells
4. Light touch (tactile sensation, discrimination and local-
also either terminate immediately or after ascending to
ization.
1-3 segments on a group of cells below the substantia
5. Stereognosis.
gelatinosa called nucleus centrodorsalis.
6. Pressure with fine gradations.
. The second-order neuron starts from this nucleus and
Functional deficiency is seen in the following: crosses to the opposite side through the ventral white
1. Subacute combined degeneration of the spinal cord commissure and occupy a position in the ventral white
Multiple sclerosis column. This tract is referred to as anterior spinotha-
Yd

Brown-—Sequard syndrome lamic tract.

Thalamic syndrome
Ve

Tabes dorsalis Course

Peripheral neuropathy
1. Both these tracts ascend into the medulla where they lie
SND

Complete section of the spinal cord

lateral to the medial lemniscus (Fig. 2.12.6).
Guillain-Barre syndrome
. Trigeminal fibres joining the spinothalamic fibres in
Q. 5. Trace course of spinothalamic tract. With help the upper part of the pons are called spinolemniscus.
of diagram label various parts and describe func- Trigeminal fibres are called trigeminal lemniscus.
tions of the same. . The spinal lemniscus and trigeminal lemniscus carry
sensation from contralateral half of the body and face,
Ans.
respectively. They join medial lemniscus in the pons.
Spinothalamic tracts (Anterolateral System): There are two . The medial lemniscus, the spinal lemniscus and the tri-
such tracts (Fig. 2.12.5): geminal lemniscus together constitute the great ascend-
1. Lateral spinothalamic tract ing sensory pathway.
2. Ventral (anterior) spinothalamic tract . The spinothalamic tracts synapse in the ventropostero-
lateral nucleus of the thalamus. The third-order neuron
originates here.
Sacral Lumbar Thoracic /
Cervical . The fibres pass through the posterior limb of the inter-
nal capsule and end in the somatosensory areas J and II.

Leg Trunk
SSA 3, 1,2
° Touch
1 Z Sacral Hand
ttz74, Pain

Anterior spinothalamic Lateral spinothalamic Thalamus (Ventropostero

lateral nucleus) VPL
tract tract
~ Collaterals to reticular
Fig. 2.12.5 Spinal cord showing spinothalamic and dorsal col- formation
umn fibres. Spinal lemniscus
Lateral spinothalamic tract
Dorsal root ganglion
Origin
1. The first-order neuron is located in the dorsal root Substantia
gelatinosa
ganglion for both lateral and ventral spinothalamic tracts.
Nociceptor
2. The axons of these neurons carrying pain and tempera-
ture immediately after entering into the spinal cord, Fig. 2.12.6 Lateral spinothalamic tract.
 Physiology

7. From the somatosensory area I, the sensations are car- Cerebral cortex area 3,1, 2
ried to the associated areas 5 and 7 of the parietal lobe
and also to supramarginal gyrus (area 40). 5 QO
Centres |
Somatosensory area I—-3, 1, 2 and sensory area []—-superior
wall of Sylvian fissure. = Internal capsule

— Ventroposteromedial
Sensations Carried Thalamus | nucleus
Ventroposterolateral
Lateral spinothalamic tract carries <=> Trigeminal lemniscus
nucleus
1. pain and | SGR,,Afibreg O@
2. temperature.
x
C fibres
Anterior spinothalamic tract carries Nucleus dorsocentralis
. crude touch,
crude pressure,
sexual sensation, Fig. 2.12.7 Pathway of pain sensation.
. bladder sensation,
. itching and
. tickle. Q. 7 Name the clinical difference between upper
Functional deficiency is seen in the following: motor neuron and lower motor neuron lesion.

1. Tabes dorsalis (neurosyphilis). Ans.

2. Syringomyelia — dilation of the central canal of the The clinical difference between upper motor neuron and
spinal cord, i.e. pain and temperature are lost but touch lower motor neuron lesions are given in Table 2.12.1.
is retained (dissociated anaesthesia).
.
Subacute combined degeneration of the spinal cord.
.
Brown-Sequard syndrome.
Du

Table 2.12.1 Clinical differences between upper motor neuron and

.
Complete section of the spinal cord.
lower motor neuron lesions
.
Anterolateral cordotomy — using special knife antero-
lateral spinothalamic fibres are cut. This is done in pa- Upper motor neuron lesion Lower motor neuron lesion
tients with intractable pain. 1. Damage to the motor tracts 1. Damage to anterior horn cell
7. Guillain-Barre syndrome (postinfective polyneuritis). above the anterior horn cell and below

Q. 6. Pathway of pain. 2. Muscle groups affected are 2. Very few individual muscles
more in number, never may be affected
Ans. individual muscle

1. Lateral spinothalamic tract carries the sensation of pain 3. Spastic type of paralysis 3. Flaccid type of paralysis
from the peripheral parts of the body to CNS (Fig. 2.12.7). 4. Deep reflexes in paralysed 4. Deep reflexes become
2. The pain fibres take origin from the receptors known as limbs are exaggerated hypoactive or absent
free nerve endings. 5. No muscular wasting or 5. Atrophy of paralysed
3. Through the dorsal nerve root the fibres enter the spinal atrophy muscles
cord and synapse in substantia gelatinosa of Rolando 6. Plantar reflex extensor 6. Plantar reflex is present-
present in the posterior horn. (Babinski) +ve other normal in the involved area,
4. The second-order fibres take origin from substantia ge- superficial reflexes lost all reflexes are lost.
latinosa and cross midline to reach opposite side and 7. Muscle tone increased 7. Muscle tone lost (atonia)
ascend up as trigeminal lemniscus to reach thalamus. (clasp-knife rigidity
5. These fibres ascend up and give collaterals to the reticu- 8. Electrical response normal 8. Electrical responses
lar formation. abnormal
6. The second-order fibres synapse in the ventropostero 9. On attempted voluntary 9. No voluntary movements
medial nucleus of thalamus. movement associated move-
7. The third-order fibres take origin from here and pass ments are present but no
voluntary movements
through the posterior limb of internal capsule to reach
cerebral cortex area no. 3, 1 and 2. 10. EMG normal 10. EMG shows fibrillations and
fasciculations
8. The thalamus is the highest centre for pain perception.
Quick Review Series: BDS 1st Year

SHORT ESSAYS

Q. 1. Pathway of pain and temperature from face. Receptors

Or
|
Fibres carrying pain take origin
Pathway of pain from face.
Ans. '
They merely pass through chief sensory nucleus in PONS
The pathway of pain from face is shown in Fig. 2.12.8.

SSA 3, 1, 2
'
Fibres descend down in CNS and synapse in
spinal nucleus of V nerve

Thalamus
Face
|
Second-order fibres take origin and crosses midline
Chief sensory
VPM nucleus
nucleus “Collaterals to reticular formation
Trigeminal lemniscus They ascend up as trigeminal lemniscus to
reach thalamus and synapse in VPM nucleus

'
Gasserian i
ganglion
i
Ws Spinal nucleus of
trigeminal nerve
From here third-order fibres take origin and
pass through internal capsule

Fig. 2.12.8 The pathway of pain from face.

Ends up in cerebral cortex area no. 3, 1 and 2
(centre for pain perception)
The pain sensation from face is carried by the trigeminal Flowchart 2.12.1 The path depicting the pain sensation from
nerve in the following path as depicted in Flowchart 2.12.1. face carried by the trigeminal nerve.

Q. 2. Formation of CSF.
5. Composition of CSF: It is an alkaline fluid which con-
Ans. tains:
1. Cerebrospinal fluid (CSF) is a clear colourless fluid pres- . Protein: 20-30%
. Glucose: 60 mg%
Tennanwees

ent in the ventricles of brain, central canal of spinal cord

and subarachnoid spaces of CNS. Kt, Ca ** and Cl ions
2. It is secreted by choroid plexus present in the third, .
Urea and creatinine
fourth and lateral ventricles. .
Functions of CSF are as follows:
3. It is absorbed into subdural venous sinuses through .
Protection of the brain by acting as a shock absorber.
arachnoid villi. .
Acts as a medium for exchange of substances be-
4. Its normal volume is 130-150 mL and rate of formation tween the nerves and blood.
is 0.2-0.3 mL/min, with daily turnover of secretion run- c. Nutritional supply to the brain.
ning from 500 to 550 mL. d. Provides buoyancy effect to brain.

SHORT NOTES

Q. 1. Reflex arc.
2. A nervous reflex is an involuntary action caused by the
Ans.
stimulation of a receptor at the end of an afferent nerve
1. Reflex arc is the structural basis of reflex action. axon.
 Physiology

3. The different parts or components of reflex arc in its c. Centre

simplest form are as follows: d. Efferent limb
. the receptor e. Effector organ
wep

. afferent limb
Q. 6. Name any four mechanoreceptors.
. centre
. efferent limb Ans.
ona

. effector organ
1. Mechanoreceptors are the receptors that respond to
Q. 2. Referred pain. mechanical energy like touch, pressure, vibration, etc.
2. They are present in almost all parts of body: In skin
Ans.
they are
Pain arising from visceral organs is not felt in the region of a. Merkel’s disc
viscera but is projected to a definite position on to the so- b. Meissner’s corpuscle (touch receptors)
matic structures called referred pain or visceral pain. c. Pacinian corpuscle, etc.
Example: Cardiac pain. In visceral regions there are
a. Baroreceptors
Q. 3. Lower motor neuron.
b. Volume receptors
Ans. c. Auditory receptors
1. Lower motor neuron is the anterior horn cell or the cor- Q. 7. Mention the names of ascending tracts. What
responding cranial nerve motor nuclei with its axon. are the sensations carried by them and where will
2. It is the final common efferent pathway for any part of they terminate?
the body.
Ans.
3. There are two types of lower motor neurons:
a. « (Alpha) motor neuron 1. Ascending tracts are, in general, sensory tracts.
b. y (Gamma) motor neuron 2. Some of the important ascending tracts are as follows:
i. (alpha) motor neuron supplies extrafusal muscle a. Tract of Goll and Burdach (posterior column tracts/
fibres. dorsal column tracts)
ii. (gamma) motor neuron supplies the contractile b. Lateral spinothalamic tract
part (polar ends) of intrafusal muscle fibres. c. Anterior spinothalamic tract
d. Spinocerebellar tracts
Q. 4. Hypothalamus.
3. They carry the sensations of the following:
Ans. . Fine touch
Op

. Pressure
1. The hypothalamus is a part of diencephalon.
.
Tactile localization and discrimination
2. It lies below the thalamus, and forms the floor and infe-
.
Proprioception
moan

rior part of the lateral walls of the third ventricles.

.
Stereognosis
3. Functions of hypothalamus are:
.
Vibration
a. Thermoregulation
g. Pain and temperature
b. Water metabolism
4. Most of these fibres end in the sensory cortex of the ce-
c. Food intake
rebral region.
d. Endocrine control
e. Role in biological clock and circadian rhythm. Q. 8. Functions of cerebellum.
f. Control of emotions
Ans.
g. Role in visceral and somatic function, etc.
Cerebellum is also called small brain, located posteroinferior
Q. 5. Reflex action.
to cerebral hemisphere.
Ans.
Functions of cerebellum are:
A nervous reflex is an involuntary action caused by the 1. Regulation of posture and equilibrium.
stimulation of a receptor at the end of an afferent nerve axon. 2. Coordination of movements.
Reflex arc is the structural basis of reflex action. The different 3. Regulation of automatic associated movements. Exam-
parts or components of reflex arc in its simplest form are: ple: Swinging of the arms while walking.
a. Receptor 4. Regulation of muscle tone.
b. Afferent limb 5. Regulates the movements of extraocular muscles.
Quick Review Series: BDS 1st Year
LONG ESSAYS
Q. 1. Describe visual pathway.
Ans.
Visual pathway starts with the retina and extends to the oc-
cipital cortex. The receptors for the vision are linked by a
chain of neurons with receiving and integrating centres in
the occipital lobes of cerebral cortex.
The visual pathway consists of three orders of neurons
like general sensory pathways:
1. First-order neuron — bipolar cell — equivalent to dor-
sal root Ganglion cell of spinal cord.
2. Second-order neuron — ganglion cell.
3. Third-order neuron — lateral geniculate nucleus. The
visual pathway consists of the following:
. Retina
ae
. Optic nerve
. Optic chiasma
wRoeAhn
. Optic tract
. Lateral geniculate nucleus
. Geniculocalcarine tract
. Visual cortex
Pe
1. Retina: Retina is a photosensitive screen that converts
light in to electrical impulses in the rods and cones, and
transmits them through the bipolar cells to the ganglion
cells whose axons converge on the optic disc and through
the optic nerve reach the optic chiasma.
2. Optic nerve: The optic nerve constitutes the fibres of
ganglion cells. The fibres from the temporal (outer)
part of retina are present in the lateral half of the
nerve and carry the impulses from the nasal field of
the same eye. The fibres from the nasal (inner) part of
the retina are present in the medial half of the nerve
and carry impulses from the temporal field of the
same eye.
3. Optic chiasma: This is formed by the crossing of medial
fibres of both the optic nerves. The crossed fibres join
with the uncrossed lateral fibres of the opposite side and
form optic tract.
4. Optic tract: The fibres from the nasal half of retina de-
cussate and pass to the optic tract of the opposite side.
Fibres from the temporal half do not cross and pass on
to the optic tract of the same side. Thus the optic tract
consists of one-half fibres from opposite optic nerve and
another half from the optic nerve of the same side. The
fibres run backwards towards the cerebral peduncle and
reach the lateral geniculate nucleus where they relay.
SPECIAL SENSES
5. Lateral geniculate nucleus (LGN): The LGN is a part
of thalamus and forms a subcortical relay centre for vi-
sual impulses. The next order of fibres that arise from
the LGN is referred as geniculo-calcarine tract or optic
radiation.
The LGN is divided into six layers of cells. The crossed.
fibres of the optic tract terminate in 1, 4 and 6 layers,
while the uncrossed fibres terminate in 2, 3 and 5 layers.
6. Optic radiation: The last relay of fibres starts from LGN
and pass through the posterior limb of the internal cap-
sule and form optic radiation. The optic radiation ter-
minates in primary visual area (area 17 of Brodmann)
and from there they pass to visual association areas 18
and 19.
7. Visual cortex: The primary visual cortex (Brodmann
area 17) is located on the medial surface of the occipital
lobe along the walls and lips of calcarine fissure. The left
half of the field of vision is represented in the visual
cortex of right hemisphere along the calcarine fissure
and vice versa.
Retina has definite localized representation, while macula
has the largest representation in the visual cortex. Primary
visual area 17 is concerned with perception of visual im-
pulses. Area 18 is concerned with the interpretation of im-
pulses and area 19 is concerned with the movement of eyes.
The effects of lesions on field of vision at different levels
of visual pathway are as follows:
1. Optic nerve (I)
The lesion of one optic nerve causes
a. total blindness or anopia in the corresponding eye
and
b. loss of light and accommodation reflex.
2. Optic chiasma: The defect depends upon the fibres in-
volved.
a. Crossed fibres (II): Usually, when these fibres get dam-
aged due to growing pituitary tumour they cause
bitemporal anopia.
b. Uncrossed fibres (III): When these fibres get damaged
due to aneurysm of the carotid arteries or due to di-
lated third ventricle, it results in binasal hemianopia.
3. Optic tract (IV): 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 homony-
mous hemianopia. The damage of fibres connecting the
optic tract with pretectal nucleus leads to loss of light
 Physiology

reflex with normal accomodation reflex known as Argyll Q. 2. What are primary tastes? Describe pathway of
Robertson pupil. sensation of taste.
4. Optic radiation
Ans.
a. The damage to medial fibres (VII): Results in hom-
onymous lower quadrant anopia. Taste is an example for chemical sensation. Tongue is mainly
b. The damage to the lateral fibres (VII): Results in responsible for taste sensation, though some taste buds are
homonymous upper quadrant anopia. present in the pharyngeal wall as well.
5. Visual cortex (VII + VIII): The damage to this results A large variety of taste sensations can be appreciated and
in homonymous hemianopia with macula sparing differentiated, but basically there are four primary taste sen-
(Fig. 2.13.1). sations:
Sweet: It is best appreciated at the tip of the tongue.

Left Right Left — Right Sour: It is appreciated on the sides.

Salt: This sensation is more appreciated on the anterior part
of dorsum.
Retina Bitter: It is related to the posterior part of the tongue.
4
Taste Pathway (Fig. 2.13.2)
1. The taste pathway is a bilateral pathway.
2. The sensory nerve fibres from taste buds travel by three
different nerves:
a. From the anterior two-thirds of the tongue fibres travel
via the chorda tympani branch of the facial nerve.
b. From posterior one-third of tongue the fibres travel
via glossopharyngeal nerve.
c. From other areas like pharynx, epiglottis and palate
the fibres travel via vagus.
3. On each side, the taste fibres in these three nerves unite
in the medulla to form tractus solitarius.
4. The second-order neurons take origin and about 85% of
the axons of these neurons cross to the opposite side and
Visual cortex join the medial lemniscus to end in the contralateral
Fig. 2.13.1 Effect of lesion on visual pathway at different levels. posteroventrolateral nucleus of thalamus along with
other general sensations, about 15% of the second-order

3, 1,2

In lesions of optic radiation or occipital cortex macula

Area 43
sparing takes place, ie. macula is not affected as it has a
larger area of representation and is also supposed to have a
va PVLN (Thalamus)
bilateral representation.
Injury to any part of the optic pathway causes visual de-
Cell bodies
fect, and the site and severity of the injury decides the nature
present
of defect. in different
1. The loss of vision in one visual field is referred as an- ganglia
opia. Taste centre in Posterior 1/3 IX
2. Loss of vision in one-half of the visual field is called inferolateral region nerve
hemianopia. of posterior central we Anterior 2/3rd
gyrus S Facial nerve
It is two types:
1. Homonymous hemianopia
2. Heteronymous hemianopia.
Bitter — Sait
Loss of vision in one quarter of the visual field is called
quadrant anopia. Fig. 2.13.2 Taste pathway.
Quick Review Series: BDS 1st Year

fibres ascend on the same side to end in the ipsilateral Taste buds
posteroventrolateral nucleus of thalamus.
5. The third-order neurons start here and are relayed to the
cerebral cortex at the foot of the posterior central gyrus
|
Tractus solitarius

|
(3, 1 and 2). This area corresponds with Brodmann’s area 43.

Disorders
Nucleus tractus solitarius
Ageusia — loss of taste sensation.
'
Byer

Hypogeusia — sense of taste is less.

Dysgeusia — disturbed sense of taste. Medial lemniscus
In adrenal cortical deficiency, sensitivity to taste is en-
hanced. '
PVL nucleus of thalamus
5. Taste blindness — In dilute solutions phenylthiocarbamide
(PTC) tastes sour to about 70% of the Caucasian popula-
tion (Europeans) but tasteless to other 30%. This defect is
Y
Inferolateral part of post central gyrus (Area 43)
referred to as taste blindness and is inherited as an autoso-
mal recessive trait (3, 1 and 2: foot of post central gyrus).

SHORT ESSAYS

Q. 1. What are the contents and functions of middle and gets attached to the handle of the malleus near its root.
ear? Explain tympanic reflex. This muscle is innervated by a branch of the V nerve.

Ans. ii. Staepedius: The smallest muscle innervated by the facial

nerve.
1. Middle ear or tympanic cavity is an air cavity in the
petrous part of the temporal bone and lies between the Functions of Ear Muscles
tympanic membrane laterally and promontory of the
1. Support ossicular chain.
medial wall. Tympanic membrane forms the outer wall.
2. Protect the inner ear from high-intensity sounds.
2. The structures present in the middle ear are as follows:
a. Ossicles: Functions of Middle Ear
i. Malleus
ii. Incus 1. Tympanic reflex: It can be activated either by sounds or
ili. Stapes one’s speech mechanism. When loud sounds are transmit-
. Small muscles ted through the ossicular system into the CNS, a reflex oc-
moan Ss

. Nerve fibres curs after a latent period of 40-80 m sec to cause contraction
. Ligaments of both the stapedius and the tensor tympani muscles. The
Air tensor tympani muscle pulls the handle of the malleus in-
. Blood vessels ward, while the stapedius muscle pulls the stapes outward.
These two forces oppose each other and thereby cause the
a. Ossicles entire ossicular system to develop a high degree of rigidity,
thus greatly reducing the ossicular transmission of the low-
The head of the malleus articulates with the body of the incus.
frequency sounds, mainly below 1000 Hz/sec. This is also
The incus in turn articulates with the head of the stapes. The
called tympanic reflex or attenuation reflex. This can reduce
stapes has a foot plate, which fits into the oval window. All the
the intensity of sound by as much as 30-40 dB.
three ossicles vibrate as a single unit, when the tympanic
This helps in the following:
membrane vibrates. The ossicles increase force of movement
a. Protecting the cochlea from damaging vibrations
by 1.32 times at oval window.
caused by excessive loud sound.
b. Small muscles b. It filters the low-frequency sounds in a loud environ-
ment, which removes a major share of background
There are two small muscles, namely
noise so that a person can concentrate on sounds
i. Tensor tympani
above 1000 Hz, which carry the pertinent informa-
ii. Stapedius
tion in voice communications.
i. Tensor tympani: It arises from the cartilaginous part of the c. It also decreases a person’s hearing sensitivity to his
pharyngotympanic tube and the adjoining sphenoid bone, or her own speech.

2. Middle ear chamber provides a route for dissipation of
the sound pressure waves after they have traversed the
inner ear. This makes the receptor cells receptive of fur-
ther stimulation.
3. Impedance matching: The middle ear has various
mechanisms by which the loss of sound energy is ade-
quately compensated. This is achieved by increasing the
sound energy level by several times at the oval window.
All these mechanisms combined together are referred to
as impedence matching. The middle ear achieves this by
following three mechanisms:
a. Area differences
b. Lever action
c. Buckling factor
Q. 2. Trace the pathway of taste with the help of a
diagram.
Ans.
Taste is an example for chemical sensation; the pathway of
taste is shown in Fig. 2.13.2.
1. The taste pathway is a bilateral pathway.
2. The sensory nerve fibres from taste buds travel by three
different nerves:
a. From the anterior two-thirds of the tongue fibres
travel via the chorda tympani branch of the facial
nerve.
b. From the posterior one-third of tongue the fibres
travel via glossopharyngeal nerve.
SHORT NOTES
Q. 1. Accommodation of eye or accommodation
reflex.
Ans.
1. It is the ability of the eyeball by which near objects are
clearly focused on the retina.
2. Accommodation can be achieved by four mechanisms:
a. Change in the length of the eyeball
b. Changing the curvature of the cornea
c. Moving the lens
d. Change in the curvature of the lens
3. When ciliary muscle contracts suspensory ligament is
slackened. Tension on capsule of lens is relaxed. As the lens
is elastic, anterior surface sprigs forward and lens becomes
more convex, especially in its central part. This brings near
objects into focus known as accommodation reflex.
Q. 2. Rods and cones.
Ans.
1. Rods and cones are the visual receptors. The rods are
more in the periphery of the retina while cones domi-
nate in the centre.
Physiology
c. From other areas like pharynx, epiglottis and palate
the fibres travel via vagus.
3. On each side the taste fibres in these three nerves unite
in the medulla to form tractus solitarius.
4. The second-order neurons take origin and about 85% of
the axons of these neurons cross to the opposite side and
join the medial lemniscus to end in the contralateral
posteroventrolateral nucleus of thalamus; about 15% of
the second-order fibres ascend on the same side to end in
the ipsilateral posteroventrolateral nucleus of thalamus.
5. The third-order neurons start here and are relayed to the
cerebral cortex at the foot of the posterior central gyrus (3,
1 and 2). This area corresponds with Brodmann’s Area 43.
Taste buds
|
Tractus solitarius
|
Nucleus tractus solitarius
'
Medial lemniscus
'
PVL nucleus of thalamus
Y
Inferolateral part of post central gyrus (Area 43)
2. Rods are responsible for dim light (scotopic) vision and the
photochemical substance present in them is rhodopsin.
3. Cones are stimulated by bright light (photopic) and also
help in the colour vision and acuity of vision. The pho-
tochemical present in cones is iodopsin.
Q. 3. Refractory error of eye.
Ans.
In a normal eyeball all the light rays emanating from an object
are brought to focus on the retina clearly but whenever there is
some abnormality either in the cornea or in the lens then the
light rays are not brought to focus on the retina exactly. These
defects are called refractive errors. A normal eye is called em-
metropic. When the light rays emanating from either distant or
near object are not focused it is referred to as ametropia.
Q. 4. Myopia.
Ans.
The near vision is normal in myopia, but light rays from
distant object are focused in front of the retina and the dis-
tant objects cannot be seen.
Quick Review Series: BDS 1st Year
This defect is corrected by biconcave lens (—), which pro-
duces divergence of rays and move the image focus towards
the retina.
Q. 5. Presbyopia.
Ans.
Presbyopia is the loss of accommodation power of the eye. It
occurs after the age of 40-45 years due to hardening of lens
and decrease in the elasticity of lens capsule. The subject will
have difficulty in reading at a close distance. The defect is
corrected by the use of convex lens.
Q. 6. Aqueous humour and its functions.
Ans.
1. It is the fluid present in the anterior and posterior
chambers of the eye and is secreted from the epithelial
cell lining of the ciliary body. Aqueous humour is
drained by the ciliary veins and the canal of Schlemm.
2. Its formation and drainage are a continuous process.
The composition of this fluid is identical to the CSE
3. Functions:
a. Provides nutrition to the cornea and lens
b. Removes metabolites
c. Acts as a reflective medium
d. Maintains intraocular tension
Q. 7. Colour blindness.
Ans.
1. Inability to distinguish colour is called colour blindness.
This is more common in males (8%) as compared to
females (0.4%).
2. Itis a genetic disorder inherited as a sex-linked recessive
character.
3. The following colour appreciation disorders are com-
monly seen:
a. Trichromatism — Perception of one primary colour
is subnormal.
b. Dichromatism — Complete loss of appreciation for
one colour.
c. Monochromatism — Perception of one primary
colour only is present. It is a rare condition.
d. Protanopia — Loss of red colour perception.
e. Deuteranopia — Absence of green colour perception.
f. Tritanopia — Loss of blue colour perception.
4. Several tests have been employed to determine colour
blindness.
a. Holmgren wool test
b. Ishihara’s chart
c. Eldridge-Green lantern test
Q. 8. Taste pathway.
Ans.
Impulses from anterior two-thirds of the tongue are carried by
the chorda tympani branch of the VII nerve (facial nerve) and
from the posterior one-third of the glossopharyngeal nerve.
Pharyngeal receptors are innervated by the vagus. Fibres from
these nerves end in the nuclei of tractus solitarius. The second-
order neurons relay from these nuclei, cross to the opposite
side and end in the posterior ventral nucleus of the thalamus.
A fresh relay starts from the thalamus and ends in the lower
part of the sensory cortex, where the centre for taste is located.
Q. 9. Sensation of smell.
Ans.
Sense of smell is not well-developed in man; but females have
a relatively better sense of olfaction. Receptors for smell are
situated in the posterosuperior part of nasal mucosa, over an
area of about 2.4 cm”. This region shows the presence of:
1. Olfactory cells
2. Sustentacular cells, which support the olfactory cells
3. Basal cells
4. Bowman’s gland, which secretes mucus.
Any substance which stimulates olfactory receptors should
be volatile and at least partly water or lipid soluble. Odour
enters into chemical combination with fatty substances present
in the cilia of the olfactory cells and alters cell permeability.
This generates the olfactory impulse, which is carried by the
olfactory nerve. The centre of the olfaction is present in the
limbic lobe, i.e. prepyriform cortex and periamygdaloid area.
Q. 10. Organ of Corti.
Ans.
1. The organ of the Corti which contains the auditory re-
ceptors is located on the basilar membrane of cochlea.
2. It consists of:
a. Inner and outer rods of Corti, which form an arch.
b. One row of hair cells within the arch (inner hair cells)
and three to five rows of similar cells outside (outer
hair cells).
c. Deiters’ cell.
d. Tectorial membrane, which overhangs the hair cells
in the endolymph.
e. Cochlear nerve fibres, which supply the hair cells in
its basal part.
Q. 11. Primary tastes.
Ans.
A large variety of sensations can be appreciated and differen-
tiated, but basically there are four primary taste sensations.
Sweet: It is better appreciated at the tip of the tongue.
Sour: It is appreciated on the sides.
Salt: This sensation is more anteriorly on the dorsum.
Bitter: It is related to the posterior part of the tongue.
PHYSIOLOGY

VIVA QUESTIONS

. Inside the cell, which substance contributes most to the osmolarity? 15. Which test should be done for a patient on coumarin (warfarin)
Ans. Potassium. therapy before any minor surgical procedures?
Ans. Prothrombin time (PT).
How is the osmolarity of Cerebro Spinal Fluid compared to
plasma? 16. What is normal myeloid/erythroid ratio?
Ans. The osmolarity of CSF is higher than that of plasma. Ans. 1:1000.

The composition of intracellular fluid mainly differs from that of 17. Name the anticoagulant of choice used in the blood bank.
extracellular, as it has Ans. Acid citrate dextrose solution.
Ans. Higher molar concentration of potassium. 18. What should be added to preserve blood for transfusion later?
What happens to the protein which leaks out of brain tissue? Ans. Add solution of sodium citrate.
Ans. The protein which leaks out of brain tissue flows through 19. Which cells have histamine present on their surface?
perivascular spaces. Ans. Mast cells.
As compared to extracellular fluid, CSF has more concentration 20. What produces the first heart sound?
of which element? Ans. Closure of the mitral and tricuspid valves produce the first
Ans. Chloride. heart sound.
The blood-brain barrier is relatively permeable to which gas? 21. Which vessels are seen with minimum blood pressure?
Ans. Carbon dioxide. Ans. Venules.
The lipoxins belong to which family of chemical mediators of 22. During inspiration when the diaphragm contracts, what happens
inflammation? to the intrapleural pressure?
Ans. Arachidonic acid metabolites. Ans. During inspiration the intrapleural pressure becomes more
negative.
Merkel’s cells act as what type of receptors?
Ans. Tactile receptors. 23. What is the major sign of hypoventilation?
Ans. Dyspnoea.
Name the syndrome that has 45 chromosomes.
Ans. Turner syndrome. 24. What do you call the volume of gas in the lungs at the end of
normal expiration?
10. Optic nerve is made up of axon cells in which layer of retina?
Ans. Functional residual capacity.
Ans. Ganglion layer of the retina.
25. Name the type of hypoxia one will suffer at high altitude.
11. Name the ganglion which is associated with the oculomotor
Ans. Hypoxic hypoxia.
nerve.
Ans. Ciliary ganglion. 26. The most important function of hydrochloric acid in the stomach is
Ans. Activation of pepsinogen.
12. In smooth muscle fibres, the ‘Ca’ binds to which proteins?
Ans. Calmodulin proteins. 27. Intrinsic factor, which helps in absorption of vitamin By, is produced by
Ans. Parietal cells of stomach.
13. Name the coagulation factor that is deficient in classical haemophilia.
Ans. Factor VIII. 28. Calcitonin is secreted by
Ans. Thyroid gland.
14, Name the clotting factor common to extrinsic and intrinsic
pathway. 29. Factors associated with vitamin K are
Ans. Factor V. Ans. II, VII, [IX and X.
Quick Review Series: BDS 1st Year

30. Oral change seen with vitamin A deficiency is 41. Which disease results due to deficiency of cortisol?
Ans. Enamel hypoplasia. Ans. Addison disease.

31. Enzymes which play an important role in calcification are 42. A child with stunted growth, with a stuffed belly and short stature
Ans. Alkaline phosphatase and pyrophosphatase. with mental retardation is suffering from the deficiency of which
hormone?
32. A decrease in the urine output is called
Ans. Thyroxine.
Ans. Oliguria.
43. What are nodes of Ranvier?
33. Test for estimating kidney function is
Ans. Regular interruptions in the myelin sheath in case of
Ans. Inulin test.
myelinated fibres are known as nodes of Ranvier.
34. Carbonic anhydrase in the kidney tubular cells is known to be
44. Where do you find the greater concentration of myelin in spinal
associated with which substance?
cord?
Ans. Bicarbonate.
Ans. It is found in greater concentration in the white matter of
35. What are the hormones secreted by the kidney? the spinal cord than in the grey matter.
Ans. Renin, erythropoietin and 1,25-dihydroxycholecalciferol.
45. Contractile element in myofibril is
36. The glomerular filtration rate of the human kidney may be deter- Ans. Sarcomere.
mined by measuring the plasma clearance of which substance?
Ans. Inulin. 46. Name the uses of electromyography.
Ans. Electromyography is used to study muscle activity.
37. In Conn disease, there is an excess of which hormone?
Ans. Aldosterone. 47. Which is the hunger centre of the brain?
Ans. Hypothalamus.
38. Which disease is a result of hypothyroidism in children?
Ans. Cretinism. 48. Respiratory centre is situated in which region?
Ans. Medulla oblongata.
39. Which condition is associated with a low concentration of ion-
ized calcium in the serum? 49. How do you test the middle ear deafness?
Ans. Tetany. Ans. Weber’s test.

40. During fear which hormone increases rapidly? 50. Name the light with the longest wavelength.
Ans. Epinephrine. Ans. Red light.
 _—
BIOCHEMISTRY| =
—
Topic 1 Chemistry and Metabolism of Carbohydrates «0.0.0... eee 261
Topic 2 Chemistry and Metabolism of Amino Acids and Proteins............. 271
Topic 3 Chemistry and Metabolism of Lipids «0.0.0... cece eeeteeeeteeeeeeees 280
Topic 4 Metabolism of Inorganic SUDStANCES. 0.0... ieee teeter eete teeter eeteeeeeee 287
Topic 5 Biological Oxidation «2.0... c eee cece eeeneeeeeeeeeeeeeeetaeeseaeeeeeeeeeeeeee 291
Topic 6 Water, Electrolyte and Acid-Base Balance ..............::::::cccceeeeeeeeeees 292
Topic 7
Topic 8
Topic 9
Topic 10 WING 0... eeeeeececeececeeceeeeceececaeaeeeeeaeeeuceeeeeeeeeeeesesesaesaeaaausdeeeeeeeeeeeneeeneeas 301
Topic 11 Organ FUNCTION TeSts ........ cece eeeeee renee eneeeeeeeeeeseeeeetaeeennaeesennees 301
Topic 12 (0) 9 0010)
8> ee 301
Topic 13 Nutrition and Diet ...........ccccccceceseeseceeeeeeeeeeeececesaeaeeeeaeseeeeeseeeeeeeeeeseeas 302
Topic 14 VITAMINS ..0....cceeececeeeeceeeeececaeaeaeaeaeseeceseeeeeeeeeeeesesaesaseasueeeeeeseseeeseneneas 302
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BIOCHEMISTRY

CHEMISTRY AN
OFC

LONG ESSAYS
Q. 1. Give the steps of glycolysis and its energetics. The sequence of reactions of glycolysis is shown in Fig. 3.1.1:
Or Glycogen Glucose
ATP, |Glucokinase
Describe the reactions of glycolysis. Mention its Mg?* } Hexokinase
Glucose 1-phosphate
significance. ADP.

Or Glucose 6-phosphate

Define glycolysis. Enumerate the reactions of path- Phosphohexose isomerase

way. Explain the energetics of pathway.
Fructose 6-phosphate
Or ATP.
Phosphofructokinase
Describe the anaerobic glycolysis in muscles and ADP
compute energetics. Fructose 1,6-bisphosphate

Ans. Aldolase

Glycolysis is defined as the sequence of reactions converting 3-Phosphoglyceraldehyde~+Dihydroxyacetone phosphate

glucose or glycogen to pyruvate or lactate, with the produc- Pi. Phosphotriose isomerase
tion of ATP. NAD*
Glyceraldehyde 3-phosphate dehydrogenase
Glycolysis is also known as Embden—Meyerhof pathway, NADH + H*
which takes place in all cells of the body. The enzymes re- 1, 3-Bisphosphoglycerate
ADP
quired for this pathway are present in the cytosomal fraction
He] Phosphoglycerate kinase
or extramitochondrial compartment of the cell. ATP
3-Phosphoglycerate

Phosphoglycerate mutase
If the process of glycolysis occurs
2-Phosphoglycerate
Mg?*
Enolase
H,O
1. In the presence of 2. In the lack of oxygen, Phosphoenolpyruvate
oxygen, it is known as it is known as anaerobic ADP: .
Mg?+ > Pyruvate kinase
aerobic glycolysis, e.g. glycolysis, e.g. it occurs in ATP:
only in skeletal muscle most of the tissues like liver, Pyruvate

kidney and erythrocytes Fig. 3.1.1 Reactions of glycolysis pathway.

Quick Review Series: BDS 1st Year
The glycolysis pathway can be divided into three distinct
phases:
1. Energy investment phase
2. Splitting phase
3. Energy generation phase.
ENERGY INVESTMENT PHASE
1. In the presence of ATP and Mg?* glucose is phosphory-
lated to glucose 6-phosphate by hexokinase or glucoki-
nase, which is an irreversible reaction.
2. In the presence of the enzyme phosphohexose isomerase
and Mg?* glucose 6-phosphate undergoes isomerization
to give fructose 6-phosphate.
3. Fructose 6-phosphate is phosphorylated to fructose
1,6-bisphosphate by an allosteric enzyme phosphofruc-
tokinase (PFK). This is an irreversible and regulatory
step in glycolysis.
SPLITTING PHASE
1. The fructose 1,6-bisphosphate (a hexose) is split to two
trioses, glyceraldehyde 3-phosphate and dihydroxyace-
tone phosphate by the enzyme aldolase, hence the name
glycolysis.
2. Since only glyceraldehyde 3-phosphate enters the glyco-
lytic pathway, the reversible interconversion of glyceral-
dehyde 3-phosphate and dihydroxyacetone phosphate is
catalysed by the enzyme phosphotriose isomerase. Thus,
two molecules of glyceraldehyde 3-phosphate are ob-
tained from one molecule of glucose.
ENERGY GENERATION PHASE (FIG. 3.1.2)
1. Glyceraldehyde 3-phosphate dehydrogenase oxidizes
glyceraldehyde 3-phosphate to 1,3-bisphosphoglycerate
in the presence of NAD* and inorganic phosphate (Pi).
2. The enzyme phosphoglycerate kinase acts on 1,3-
bisphosphoglycerate, resulting in the formation of
3-phosphoglycerate and synthesis of ATP. This step is a
good example of substrate-level phosphorylation be-
cause ATP is synthesized from the substrate without the
involvement of electron transport chain.
3. Phosphoglycerate mutase converts 3-phosphoglycerate
to 2-phosphoglycerate.
4. The enzyme enolase generates the high-energy com-
pound phosphoenol pyruvate from 2-phosphoglycerate.
This enzyme requires Mg?* or Mn?* and is inhibited by
fluoride.
An allosteric enzyme pyruvate kinase catalyses the trans-
fer of high-energy phosphate from phosphoenol pyruvate to
ADP, resulting in the formation of ATP. This step also is an
example of substrate-level phosphorylation and the reaction
is irreversible.
The metabolic fate of pyruvate produced in glycolysis de-
pends on aerobic or anaerobic conditions 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 catalysed by
glyceraldehyde 3-phosphate dehydrogenase. The formation of
lactate allows the regeneration of NAD*, which can be reused
by glyceraldehyde 3-phosphate dehydrogenase so that glycoly-
sis proceeds even in the absence of oxygen to supply ATP.
Pyruvate
NADH + H+
| Lactate dehydrogenase
NAD+
Lactate
Fig. 3.1.2 Energy generation phase.
The occurrence of uninterrupted glycolysis is very essen-
tial in skeletal muscle during strenuous exercise where oxy-
gen supply is very limited. Glycolysis in the erythrocytes
leads to lactate production because mitochondria, the cen-
tres for aerobic oxidation, are absent.
PRODUCTION OF ATP IN GLYCOLYSIS
The details of ATP generation in glycolysis are shown in
Table 3.1.1. Under anaerobic conditions, two ATP are synthe-
sized, while under aerobic conditions, eight or six ATPs are
synthesized — depending on the shuttle pathway that operates.
Table 3.1.1 Energy production in glycolysis pathway
Enzymes involved and method of ATP Number of ATPs
synthesis synthesized
Glyceraldehyde 3-phosphate dehydrogenase 6
[2 NADH, electron transport chain (ETC),
oxidative phosphorylation]
Phosphoglycerate kinase (substrate-level 2
phosphorylation)
Pyruvate kinase (substrate-level phosphoryla- 2
tion)
In the reactions catalysed by hexokinase and a
phosphofructokinase, two ATPs are con-
sumed
Net ATP synthesis in glycolysis in aerobic 8
condition
Q. 2. Outline the aerobic glycolytic pathway. Define
substrate-level phosphorylation. Give two exam-
ples.
Ans.
For aerobic glycolytic pathway, refer to the answer of Long
Essays Q. 1.

SUBSTRATE-LEVEL PHOSPHORYLATION
Synthesis of ATP from substrate without the involvement of
electron transport chain is known as substrate-level phos-
phorylation. The examples are as follows:
1. The enzyme phosphoglycerate kinase acts on
1,3-bisphosphoglycerate, resulting in the synthesis of
ATP and formation of 3-phosphoglycerate. This step in
the glycolytic pathway is a good example of substrate-
level phosphorylation.
2. The enzyme pyruvate kinase catalyses the transfer of
high-energy phosphate from phosphoenolpyruvate to
ADF, resulting in the formation of ATP. This step is also
a substrate-level phosphorylation.
Q. 3. Describe the citric acid cycle and its ener-
getics.
Ans.
1. The most important metabolic pathway for the energy
supply to the body is the citric acid cycle (Krebs cycle or
tricarboxylic acid — TCA cycle).
2. This cycle not only supplies energy but also provides
many intermediates required for the synthesis of amino
acids, glucose, heme, etc.
3. About 65-70% of the ATP is synthesized in Krebs
cycle. The citric acid cycle is the final common oxi-
dative pathway for carbohydrates, fats and amino
acids.
4. Krebs cycle is the most important central pathway con-
necting almost all the individual metabolic pathways
either directly or indirectly.
CITRIC ACID CYCLE
1. It involves the oxidation of acetyl CoA to CO; and H,0.
2. It utilizes about two-thirds of total oxygen consumed by
the body.
3. The name TCA cycle is used because at the outset of the
cycle, tricarboxylic acids (citrate, cis-aconitate and isoci-
trate) participate.
4. The enzymes of TCA cycle are located in mitochondrial
matrix in close proximity to the electron transport
chain.
REACTIONS OF CITRIC ACID CYCLE
Oxidative decarboxylation of pyruvate to acetyl CoA by py-
ruvate dehydrogenase complex is a step, which is a connect-
ing link between glycolysis and TCA cycle.
The events of TCA cycle are shown in Fig. 3.1.3.
1. Formation of citrate
Krebs cycle or the citric acid cycle starts with the condensa-
tion of acetyl CoA and oxaloacetate catalysed by the enzyme
citrate synthase.
Biochemistry
2. and 3. Citrate isomerization to isocitrate
a. Citrate is isomerized to isocitrate by the enzyme aconitase.
b. It occurs in a two-stage reaction of dehydration fol-
lowed by hydration through the formation of an inter-
mediate — cis-aconitate.
4. and 5. Formation of a-ketoglutarate
a. The conversion or oxidative decarboxylation of isoci-
trate to oxalosuccinate and then to a-ketoglutarate is
catalysed by the enzyme isocitrate dehydrogenase (ICD).
b. The formation of NADH and the liberation of CO,
occur at this stage.
6. Conversion of «-ketoglutarate to succinyl CoA
a. This occurs through oxidative decarboxylation and
catalysed by a-ketoglutarate dehydrogenase complex.
b. This enzyme is dependent on five cofactors — TPP,
lipoamide, NAD*, FAD and CoA.
7 Formation of succinate
a. The enzyme succinate thiokinase converts succinyl CoA
to succinate.
b. This reaction is coupled with the phosphorylation of
GDP to GTP. This is a substrate-level phosphorylation.
GTP is converted to ATP by the enzyme phosphokinase.
8. Conversion of succinate to fumarate
a. Succinate dehydrogenase oxidizes succinate to fumarate.
b. FADH, is produced during this reaction.
9. Formation of malate
The conversion of fumarate to malate with the addition of
HO is catalysed by the enzyme fumarase.
10. Conversion of malate to oxaloacetate
a. Malate is oxidized to oxaloacetate by malate dehydrogenase.
b. At this stage the third and final synthesis of NADH occurs.
c. The oxaloacetate is regenerated, which can combine with
another molecule of acetyl CoA and continue the cycle.
The events of Krebs cycle may be summarized as follows:
Acetyl CoA + 3 NAD* + FAD + GDP + Pi + 2H,O >
2CO;,+ 3NADH + 3H* + FADH, + GTP + CoA
ENERGETICS OF CITRIC ACID CYCLE (FIG. 3.1.4)
1. During the process of oxidation of acetyl CoA through
citric acid cycle, four reducing equivalents are produced
(three as NADH and one as FADH,).
2. Oxidation of one NADH by electron transport chain
coupled with oxidative phosphorylation results in the
synthesis of three ATP, whereas FADH, leads to the for-
mation of two ATPs.
9X7) Quick Review Series: BDS 1st Year

Oo
I
CH,-C-COO-
Pyruvate
NAD+
Pyruvate
CoA-SH dehydrogenase
NADH + H+
co, oO
I
CH,-C-S CoA
Acetyl CoA
O CoA SH cu_coo
l — -
C-COO- :
Citrate
1 2
HO-C-COO-
|
NADH + H* CH,-COO- synthase ‘
Oxaloacetate CH,-COO H,O
NAD* Malate Citrate Aconitase
dehydrogenase CH_—coo-
HO-CH-COO- é 00-

Shia
L-Malate
¢H-COO-
« :
Cis-Aconitate
H,O
H,0 Fumarase Aconitase 2

H-C-COO- CH,-COO-
-O00C-C-H CH-COO-
Fumarate HO-CH-COO-
lsocitrate .
FADH i
, Gohydrogenase lsocitrate NAD
FAD dehydrogenase NADH +H
CH,-COO- CH,-COO-

CH,-COO- CH-COO-
Succinate O== C-COO -
mec! Succinate
conten thiokinase Isocitrate Oxalosuccinate
GDP CH,-COO- dehydrogenase
CH a-Ketoglutarate _
1 2
O=C-SCOoA dehydrogenase
CH,-COQ
2 co,

Succinyl CoA pe
NADHco +H NAD: = © COO
CoA SH o-Ketoglutarate
2

Fig. 3.1.3 The citric acid cycle or TCA cycle.

Dietary carbohydrates
(starch, sucrose, glucose)

Digestion and absorption Hormonal Glycolysis and TCA cycle

Glycogenolysis regulation Glucose — CO,, H,O
in muscles Glucose jn liver | Glycogenesis in
liver and kidney
Lactate
Synthesis of other
Gluconeogenesis —>- — monosaccharides and
Nee sugars
Amino acids,
glycerol, propionate HMP shunt for pentoses
and NADPH
Glycogenolysis Excreted into
Synthesis of fat
in liver urine when
Sources of blood blood glucose >180 mg/dL Utilization of
glucose blood glucose

Fig. 3.1.4 An overview of blood glucose homeostasis.

 Biochemistry

3. There is one substrate-level phosphorylation. 3. The concentration of blood glucose is dependent on

4. A total of 12 ATPs are produced from one acetyl CoA, as the quantity of glucose that enters the circulation
shown in Table 3.1.2. from various sources like dietary carbohydrates, gly-
cogenolysis, gluconeogenesis, etc. and the amount
Table 3.1.2 Energy production from Citric acid cycle that is utilized for different metabolic purposes like
Energy reaction ATPs synthesized Blycolysiss glycogenesis, fat synthesis, etc. as illus-
trated in Fig. 3.1.4.
SNADH > SNAD+ . 4. In the homeostasis of blood glucose, kidney plays a
PADI = all 2 special role:
Substrate phosphorylation (GTP) 1 a. Glucose is continuously filtered by the glomeruli,
Total ATPs for one acetyl CoA 12 reabsorbed and returned to the blood.
b. Glucose is excreted in urine. If the level of glucose in
Q. 4. Describe the regulation of blood glucose blood is above 160-180 mg/dL, it is known as glycos-
and write a note on disorders of blood glucose uria.
regulation. c. This value (160-180 mg/dL) is known as renal
Ans. threshold for glucose.
d. The maximum ability of the renal tubules to reab-
REGULATION OF BLOOD GLUCOSE LEVEL sorb glucose per minute is known as tubular max-
(HOMEOSTASIS OF BLOOD GLUCOSE) imum for glucose (TmG). The value for TmG is
350 mg per minute.
1. The blood glucose concentration in a healthy individual
is maintained within a narrow range.
2. The fasting blood glucose level in a postabsorptive state
ROLE OF HORMONES IN BLOOD GLUCOSE
HOMEOSTASIS (FIG. 3.1.5)
is 70-100 mg/dL (plasma glucose 80-120 mg/dL). Fol- a
lowing the ingestion of a carbohydrate meal, blood In the regulation of blood glucose concentration, hormones
glucose may rise to 120-140 mg/dL. play a significant role.

Blood glucose (mg/dL)

40 50 ~=—«60 70 80 90 100 110 120 130 140 150 160 170 180 190 200
!

Fasting Postprandial | Renal threshold

(<100 mg/dl) (<130 mg/dl) |
!
I
To urine
Hyperglycaemic effect Hyperglycaemic effect

Insulin Glucagon

Glucose uptake T Gluconeogenesist

Glycogenolysis *
Glycolysis *
Epinephrine
Glycogenesis 7 Glycogenolysis *
HMP shunt t Thyroxine
Lipid synthesis t Gluconeogenesist
Gluconeogenesis 4 Glucocorticoids
Glycogenolysis 4 Gluconeogenesis T
Glucose utilization *
(extrahepatic)
Growth hormone and ACTH
Glucose uptake 4
Glucose utilization \
Fig. 3.1.5 Hormonal regulation of blood glucose.
Quick Review Series: BDS 1st Year
1. Insulin
a. It is basically a hypoglycemic hormone that lowers in
blood glucose level through various means. It is an anti-
diabetogenic hormone.
b. Primarily, insulin lowers blood glucose level (hypoglyce-
mic) while the rest of the hormones oppose the actions
of insulin and increase the blood glucose level causing
hyperglycaemia.
2. Glucagon
a. Blood glucose concentration is elevated by glucagon.
b. It enhances gluconeogenesis and glycogenolysis.
c. Glucagon increases liver glucose 6-phosphatase and
phosphorylase activities and produces more glucose.
3. Epinephrine
a. This hormone is secreted by adrenal medulla.
b. By acting on both muscle and liver it brings about gly-
cogenolysis.
c. The net outcome is that epinephrine increases blood
glucose level.
4. Thyroxin
a. It is a thyroid hormone.
b. By stimulating hepatic glycogenolysis and gluconeogen-
esis, it elevates blood glucose level.
5. Glucocorticoids
a. These hormones stimulate protein metabolism and in-
crease gluconeogenesis.
b. The glucose utilization by extrahepatic tissues is inhib-
ited by glucocorticoids.
c. The overall effect of glucocorticoids is to elevate blood
glucose concentration.
6. Growth hormone and adrenocorticotropic
hormone (ACTH)
a. The anterior pituitary gland secretes growth hormone
and ACTH.
b. The uptake of glucose by certain tissues like muscle,
adipose tissue, etc. is decreased by growth hormone.
ACTH decreases glucose utilization.
c. The net effect of both these hormones is hyperglycae-
mic.
DISORDERS OF BLOOD GLUCOSE REGULATION
Hyperglycaemia
The term hyperglycaemia refers to an increase in the blood
glucose above the normal level. Excretion of glucose in urine
is known as glycosuria.
Hypoglycemia
1. When the blood glucose concentration falls below
45 mg/dL, the symptoms of hypoglycemia develop.
2. The symptoms include headache, anxiety, confusion,
sweating, slurred speech, seizures and coma, and, if not
corrected, death.
3. All these symptoms are directly and indirectly related to
the deprivation of glucose supply to the CNS, particu-
larly the brain.
Diabetes mellitus
Diabetes mellitus is a clinical condition characterized by in-
creased blood glucose level, ie. hyperglycaemia due to insuf-
ficient or inefficient (incompetent) insulin.
Based on the requirement of insulin for treatment, diabe-
tes mellitus is broadly divided into two groups:
1. Insulin-dependent diabetes mellitus (IDDM)
2. Non-insulin-dependent diabetes mellitus (NIDDM).
Insulin-dependent diabetes mellitus
1. IDDM, also known as type I diabetes or juvenile-onset
diabetes. IDDM accounts for about 10-20% of the
known diabetics.
2. It occurs mainly in childhood, particularly between 12
and 15 years of age.
3. This disease is characterized by almost total deficiency
of insulin because of the destruction of beta cells of
pancreas either due to drugs, viruses or autoimmunity.
The patients of IDDM require insulin therapy.
Non-insulin-dependent diabetes mellitus
1. NIDDM, also called type II diabetes or adult-onset dia-
betes, occurs in adults usually above 35 years.
2. It is the most common, 80-90%, among the diabetic
population.
3. It is less severe than IDDM.
4. The causative factors of NIDDM include genetic and
environmental.
Q. 5. Explain the glycogen synthesis in liver and its
hormonal regulation.
Ans.
Glycogen is the storage form of glucose in animals. It is
stored mostly in liver (6-8%) and muscle (1-2%).
Due to more muscle mass, the quantity of glycogen in
muscle (250 g) is about three times higher than that in the
liver (75 g).
GLYCOGENESIS
The synthesis of glycogen from glucose is glycogenesis. Gly-
cogenesis takes place in the cytosol, and requires ATP and
UTP besides glucose (Fig. 3.1.6).
 Biochemistry

The steps involved in glycogen synthesis are as follows: c. Uridine diphosphate glucose (UDPG) is synthesized
from glucose 1-phosphate and UTP by UDP-glucose
Glucose pyrophosphorylase.
ATP d. Pyrophosphate (PPi) produced in this reaction is hydro-
J Glucokinase
ADP lysed to inorganic phosphate (Pi) by pyrophosphatase.
Glucose 6-phosphate
This will ensure the optimal synthesis of UDPG.

Phosphoglucomutase
2. Importance of primer to initiate glycogenesis
Glucose 1-phosphate
UTP. A small fragment of pre-existing glycogen acts as a primer to
UDP-glucose
initiate glycogen synthesis. In the absence of glycogen primer,
PPi pyrophosphorylase
a specific protein — namely glycogenin — can accept glucose
UDP-glucose from UDPG.
—OH
Glycogen initiator
Glycogenin synthase 3. Glycogen synthesis by glycogen synthase
DP
Glycogen synthase is responsible for the formation of
Glycogen primer
1,4-glycosidic linkages. This enzyme transfers the glucose
13 UDP-Glucose
J Glycogen synthase from UDP glucose to the non-reducing end of glycogen to
13 UDP form a-1,4 linkages.
Elongation by
glycogen synthase 4. Formation of branches in glycogen
(forming « 1, 4-bonds)
The formation of branches is brought about by the action of
and
a branching enzyme glucosyl a-(4—-6) transferase. This en-
Branching by zyme transfers a small fragment of five to eight glucose resi-
glucosyl 4-6 transferase
(a 1, 6-bonds)
dues from the non-reducing end of glycogen chain (by
breaking o-1,4 linkages) to another glucose residue where it
Glycogen is linked by a-1,6 bond. This leads to the formation of a new
Fig. 3.1.6 Glycogen synthesis from glucose (glycogenesis). non-reducing end, besides the existing one. Glycogen is fur-
ther elongated and branched, respectively, by the enzymes
glycogen synthase and glucosyl 4—6 transferase.
1. Synthesis of UDP-glucose
The overall reaction of the glycogen synthesis for the
a. The enzymes hexokinase in muscle and glucokinase in addition of each glucose residue is (Glucose), + Glucose +
liver convert glucose to glucose 6-phosphate. 2 ATP — (Glucose) , » »+ 2 ADP + Pi. Of the two ATP
b. Phosphoglucomutase catalyses the conversion of glu- utilized, one is required for the phosphorylation of glucose
cose 6-phosphate to glucose 1-phosphate. while the other is needed for conversion of UDP to UTP.

SHORT ESSAYS

Q. 1. Oral glucose tolerance test.
Ans.
The diagnosis of diabetes can be made on the basis of indi-
vidual’s response to the oral glucose load, commonly known
as oral glucose tolerance test (OGTT) (Table 3.1.3).
PROCEDURE FOR GTT
Glucose tolerance test should be preferably conducted in the
morning (ideally from 9 to 11 am). A fasting blood sample is
drawn and urine should be collected. The subject is then
given 75 g of oral glucose dissolved in about 300 mL of wa-
ter, to drink in about 5 minutes. Blood and urine samples are
collected at 30 minute intervals for at least 2 hours. All blood
samples are subjected to glucose estimation while urine
samples are qualitatively tested for glucose.
INTERPRETATION OF GTT
The graphic representation of the GTT results is depicted in
Fig. 3.1.7.
The fasting plasma glucose level is <100 mg/dL in nor-
mal persons. On oral glucose load, the concentration in-
creases and the peak value (<150 mg/dL) is reached in less
than an hour, which returns to normal by 2 hours. Glucose
is not detected in any of the urine samples.
In individuals with impaired glucose tolerance, the fast-
ing (100-140 mg/dL) as well as 2 hour glucose levels (140-
200 mg/dL) of plasma glucose levels are elevated.
 Quick Review Series: BDS 1st Year

Table 3.1.3 Diagnostic criteria for oral glucose tolerance test monosaccharides are divided into different categories
(WHO 1985) based on the functional groups and the number of carbon
Plasma glucose concentration (mg/dL) atoms.
Condition Impaired glucose 1. Aldoses: When the functional group in monosaccha-
Normal tolerance Diabetes rides is an aldehyde, they are known as aldoses, for ex-
Fasting <110 <140 <200
ample glyceraldehydes and glucose.
2. Ketoses: When the functional group is a keto group,
2 hours after <160 >140 >200
they are referred to as ketoses, for example dihydroxyac-
glucose intake
etone and fructose.
Based on the number of carbon atoms, the monosaccha-
2507 rides are regarded as trioses (3C), tetroses (4C), pentoses
(5C), hexoses (6C) and heptoses (7C). These terms along
with functional groups are used while naming monosac-
charides. For instance, glucose is an aldohexose while fruc-
2007 tose is a ketohexose.
~ Markedly reduced glucose tolerance
3 Oligosaccharides
oD
E
> 1507 <— Reduced glucose Oligosaccharides (Greek: oligo, meaning few) contain 2-
g tolerance
oO
3
10 monosaccharide molecules.
Dm Based on the number of monosaccharide units present,
w
& the oligosaccharides are subdivided into disaccharides, tri-
@ 10075
a saccharides, etc.
Normal glucose tolerance The disaccharides are of two types:
1. Reducing disaccharides — for example maltose and
50-4
lactose.
2. Nonreducing disaccharides — for example sucrose and
trehalose.
T 1
0 1 2 Polysaccharides
n[--

ni-

Time (hours) Polysaccharides (Greek: poly, meaning many) are polymers

Fig. 3.1.7 Glucose Tolerance Curve of monosaccharide units with high molecular weight. They
are usually tasteless (non-sugars) and form colloids with
Q. 2. Classification of carbohydrates. water. Polysaccharides are of two types:
1. Homopolysaccharides — for example starch (glucan)
Ans.
cellulose, inulin (fructosan) and glycogen
2. Heteropolysaccharides—for example mucopolysac-
CLASSIFICATION OF CARBOHYDRATES
charides, hyaluronic acid and chondroitin sulphate.
Carbohydrates are often referred to as saccharides. They are
Q. 3. Structure and biomedical importance of
broadly classified into three groups based on the number of
disaccharides.
sugar units:
1. Monosaccharides Ans.
2. Oligosaccharides
Among the oligosaccharides, disaccharides are the most
3. Polysaccharides.
common. A disaccharide consists of two monosaccharide
Monosaccharides and oligosaccharides are sweet to taste, units, which may be similar or dissimilar, held together by a
crystalline in character and soluble in water, hence they are glycosidic bond. They are crystalline, water soluble and
commonly known as sugars. sweet to taste.
The disaccharides are of two types:
Monosaccharides
1. Reducing: Disaccharides with free aldehyde or keto
Monosaccharides (Greek: mono, meaning one) are often group — for example maltose and lactose.
referred to as simple sugars. They have the general for- 2. Non-reducing: Disaccharides with no free aldehyde or
mula C,(H,O),, and cannot be further hydrolysed. The keto group — for example sucrose and trehalose.

Maltose
Maltose is composed of two a-D-glucose units held together
by a-(1-4) glycosidic linkage. The free aldehyde group pres-
ent on C, of second glucose is responsible for exhibiting all
the properties of aldehyde group like the osazones formation
(sunflower-shaped), reduction of cupric salts, etc.
Maltose or malt sugar (Cy,H2,O,,) is not found in free
form in the body. It is produced during the course of diges-
tion of starches by the enzyme amylase (pancreatic). Maltose
can be hydrolysed by dilute acid or the enzyme maltase to
liberate two molecules of a-D-glucose.
Sucrose
Sucrose (cane sugar) is mostly produced by sugar cane,
sugar beets and several ripe fruits. Sucrose is made up of
a-D-glucose and B-D-fructose. The two monosaccharides
are held together by a glycosidic linkage (a |-B2) between C;
SHORT NOTES
Q. 1. Glucose tolerance test (GTT).
Ans.
The GTT means glucose tolerance test. The diagnosis of dia-
betes can be made on the basis of individual’s response to
the oral glucose load, commonly referred to as oral glucose
tolerance test (OGTT).
In the normal persons, the fasting plasma glucose level is
<100 mg/dL; on oral glucose load, the concentration in-
creases and the peak value <150 mg/dL is reached in less
than an hour, which returns to normal by 2 hours. In indi-
viduals with impaired glucose tolerance, the fasting (100-
140 mg/dL) as well as 2 hour glucose levels (140-200 mg/dL)
of plasma glucose levels are elevated.
Q. 2. Glycosuria.
Ans.
Normal urine does not contain reducing substances in urine
that can be detected by the usual tests such as the Benedict’s.
Presence of detectable amount of glucose, fructose or pen-
tose is therefore abnormal and is called glycosuria.
Q. 3. What is glucosuria? Mention the normal renal
threshold for glucose.
Ans.
Normal urine does not contain reducing substances in urine
that can be detected by the usual tests like the Benedict’s.
Presence of detectable amount of glucose, fructose or pen-
tose is therefore abnormal and is called glycosuria.
Biochemistry
of a-glucose and C, of fructose. The reducing groups of
glucose and fructose are involved in glycosidic bond. There-
fore, there is no free aldehyde or keto group in sucrose, hence
sucrose is a non-reducing sugar and cannot form osazones.
The phenomenon by which the dextrorotatory sucrose is
converted to levorotatory mixture of glucose and fructose is
known as ‘inversion’ and sucrose is called the ‘invert sugar.
Lactose
Lactose is more commonly known as milk sugar because it is
the disaccharide found in milk. Lactose of milk is the most
important carbohydrate in the nutrition of mammals. Lac-
tose is composed of B-D-galactose and B-D-glucose held
together by B-(1-4) glycosidic linkage. The anomeric carbon
of C, glucose is free; hence lactose exhibits reducing proper-
ties and forms osazones of powder-puff or hedgehog shape.
It is hydrolysed by the intestinal enzyme lactase to glucose
and galactose.
Excretion of glucose in urine may occur
1. In emotional states.
2. Following anaesthesia or asphyxia.
3. In severe hyperthyroidism.
4. In diabetes mellitus.
The most common cause of glucosuria is however diabe-
tes mellitus. The glucose concentration of urine in this con-
dition may vary from 0.5% to 12.0%. There is also associated.
hyperglycaemia in conditions of diminished renal threshold
for glucose because of a defect in the reabsorption of glucose
levels. The condition is called renal glycosuria (glucosuria).
Fifteen percent of pregnant women also show glucosuria
without hyperglycaemia.
Q. 4. Glycolysis.
Ans.
Glycolysis is defined as the sequence of reactions converting
glucose (or glycogen) to pyruvate or lactate, with the pro-
duction of ATP.
Q. 5. Significance of glycolysis.
Ans.
The significance of glycolysis is as follows:
1. Under anaerobic conditions (lack of O2), pyruvate is
reduced by NADH to lactate in presence of the en-
zyme lactate dehydrogenase. The formation of lactate
allows the regeneration of NAD*, which can be reused
by glyceraldehyde 3-phosphate dehydrogenase so that
270 Quick Review Series: BDS 1st Year
glycolysis proceeds even in the absence of oxygen to
supply ATP.
2. The occurrence of uninterrupted glycolysis is very es-
sential in skeletal muscle during strenuous exercise
when oxygen supply is very limited.
3. Glycolysis in the erythrocytes leads to lactate production
because mitochondria — the centres for aerobic
oxidation — are absent.
4. Brain, retina, skin, renal medulla and gastrointestinal
tract derive most of their energy from glycolysis.
Q. 6. What is meant by substrate-level phosphory-
lation? Give one example.
Ans.
Refer to the answer of Long Essays Q. 2.
Q. 7 How many ATP molecules are produced
anaerobic glycolysis and aerobic glycolysis?
Ans.
Under anaerobic conditions, two ATPs are synthesized while,
under aerobic conditions, eight or six ATP are synthesized —
depending on the shuttle pathway that operates.
Q. 8. Citric acid cycle.
Ans.
The citric acid cycle (Krebs cycle or tricarboxylic acid [TCA]
cycle) is the most important metabolic pathway for the en-
ergy supply to the body. About 65-70% of the ATP is synthe-
sized in Krebs cycle.
Citric acid cycle essentially involves the oxidation of
acetyl CoA to CO, and H,O. This cycle utilizes about
two-thirds of total oxygen consumed by the body. The
name TCA cycle is used because at the outset of the cycle,
tricarboxylic acids (citrate, cis-aconitate and isocitrate)
participate.
Q. 9. Significance of TCA cycle.
Ans.
The citric acid cycle is the final common oxidative pathway
for carbohydrates, fats and amino acids. This cycle not only
supplies energy but also provides many intermediates re-
quired for the synthesis of amino acids, glucose, heme, etc.
Krebs cycle is the most important central pathway connect-
ing almost all the individual metabolic pathways (either di-
rectly or indirectly).
The enzymes of TCA cycle are located in mitochondrial
matrix, in close proximity to the electron transport chain.
Q. 10. Name four mucopolysaccharides in the body.
Or
List four examples of mucopolysaccharides.
Or
Name three glycosaminoglycans (mucopolysac-
cha-rides) in the body. Mention their significance.
Ans.
These are heteroglycans made up of repeating units of sugar
derivates, namely amino sugars and uronic acids.
GLYCOSAMINOGLYCANS
Mucopolysaccharides are more commonly known as glycos-
aminoglycans (GAG). Acetylated amino groups, besides sul-
phate and carboxyl groups, are generally present in GAG
structure.
The important mucopolysaccharides include the fol-
lowing:
1. Hyaluronic acid
. Chondroitin 4-sulphate
in
Nh
. Heparin
ueWw
. Dermatan sulphate
. Keratan sulphate.
SIGNIFICANCE OF MUCOPOLYSACCHARIDES
1. Hyaluronic acid: Hyaluronic acid is an important GAG
found in the ground substance of synovial fluid of joints
and vitreous humour of eyes. It serves as a lubricant and
shock absorbent in joints.
It is also present as a ground substance in connective
tissues and forms a gel around the ovum.
2. Chondroitin 4-sulphate: It is a major constituent of
various mammalian tissues bone, cartilage, tendons,
heart, valves, skin, cornea, etc.
3. Heparin: Heparin is an anticoagulant that occurs in
blood, lung, liver, kidney, spleen, etc. Heparin helps in
the release of the enzyme lipoprotein lipase, which
causes clearing of the turbidity of lipemic plasma.
Q. 11. Composition and functions of two homopoly-
saccharides.
Ans.
STARCH
Starch is the carbohydrate reserve of plants, which is the
most important dietary source for higher animals, includ-
ing man. High content of starch is found in cereals, roots,
tubers, vegetables, etc. Starch is a homopolymer composed.
of D-glucose units held by e-glycosidic bonds. It is known
as glucosan or glucan.
Starch consists of two polysaccharide components —
water-soluble amylose (15-20%) and a water-insoluble amy-
lopectin (80-85%).
INULIN
Inulin is a polymer of fructose, i.e. is fructosan. It occurs in
dahlia bulbs, garlic, onion, etc. It is a low-molecular-weight
 Biochemistry

(around 5000) polysaccharide, easily soluble in water. Inulin
is not utilized by the body. It is used for assessing kidney
function through measurement of glomerular filtration
rate (GFR).
Q. 12. What is cane sugar? Mention its composi-
tion.
Ans.
1. Sucrose is known as cane sugar and is the sugar of com-
merce, mostly produced by sugar cane and sugar
beets.
2. Sucrose is made up of a-D-glucose and B-D-fructose.
The two monosaccharides are held together by a glyco-
sidic bond a, —> BP, between C, of a-glucose and C, of
B-fructose.
3. The reducing groups of glucose and fructose are
involved in glycosidic bond, hence sucrose is a non-
reducing sugar and cannot form osazones.
Q. 13. What is milk sugar? Mention its composition.
Ans.
1. Lactose is more commonly known as milk sugar because
it is the disaccharide found in milk.
2. Lactose is composed of B-D-galactose and B-D-glucose
held together by B-(1-4) glycosidic bond.
3. The anomeric carbon of glucose is free; hence lactose
exhibits reducing properties and forms osazones, pow-
der-puff or hedgehog shape.
4. Lactose of milk is the most important carbohydrate in the
nutrition of young mammals. It is hydrolysed by the
intestinal enzyme lactase to glucose and galactose.
Q. 14. Name the key enzymes of gluconeogenesis.
Ans.
The key enzymes of gluconeogenesis are as follows:
1. Pyruvate carboxylase
2. Fructose 1,6-bisphosphatase
3. Glucose 6-phosphatase.
Q. 15. Mutarotation.
Ans.
1. Mutarotation is defined as the change in the specific
optical rotation representing the interconversion of a
and B forms of D-glucose to an equilibrium mixture.
2. The a and 8 anomers of glucose have different optical
rotations. The specific optical rotation of a freshly pre-
pared glucose (a anomer) solution in water is +112.2°,
which gradually changes and attains equilibrium with a
constant value of +52.7°.
3. In the presence of alkali, the decrease in optical rotation
is rapid. The optical rotation of B-glucose is +18.7°.
Mutarotation is summarized below:
a-D-Glucose—— Equilibrium mixture—— B-D-Glucose
+ 112.2° + 52.7° + 18.7°

Topic 2 CHEMISTRY AND M

OF AMINO ACIDS AND

LONG ESSAY

Q. 1. Describe the urea cycle and its disorders. Urea is synthesized in liver and transported to kidneys for
excretion in urine. Urea cycle is the first metabolic cycle that
Or
was elucidated by Hans Krebs and Kurt Henseleit (1932),
hence it is known as Krebs—Henseleit cycle.
Describe the urea cycle and list two disorders of
Urea has two amino (—NH,) groups—one derived
urea cycle.
from NH; and the other from aspartate. Carbon atom is
Ans. supplied by CO. Urea synthesis is a five-step cyclic pro-
Urea cycle is the process by which ammonia, a highly toxic cess, with five distinct enzymes. The first two enzymes are
substance, is converted to urea, a less toxic and water-soluble
present in mitochondria, while the rest are localized in
excretory product in the liver (Fig.3.2.1). cytosol.
y¥ey) Quick Review Series: BDS Ist Year

Carbamoyl phosphate
synthetase
NH, + CO, Carbamoyl phosphate
2ATP. N-acetylglutamate 2ADP - Pi
Mg?

Ornithine
transcarbamoylase

Ornithine

/
Urea
Citrulline

ATP L-Asparate
acid
Arginase

Arginosuccinic
H,O Mg’ | acid synthetase

AMP + PP

Arginosuccinate
Arginine

Fumarate
Arginosuccinase

Fig. 3.2.1 Urea cycle.

STEPS IN THE UREA CYCLE The second amino group of urea is added in this reaction.
1. Synthesis of carbamoyl] phosphate: This step occurs in Arginosuccinic acid
mitochondria, where carbamoyl phosphate synthase I synthetase
Citrulline + Aspartate Arginosuccinate
(CPS I) catalyses the condensation of NH,* ions with
ATP AMP + PP
CO, to form carbamoyl phosphate. This step consumes
two ATP and is irreversible as well as rate-limiting reac- 4, Cleavage of arginosuccinate: Arginosuccinase hydroly-
tion. CPS I requires N-acetylglutamate for its activity. ses arginosuccinate to arginine and fumarate. Arginine
CPS is the immediate precursor for urea. Fumarate enters
CO, + NH, N-Acetylghutamate Carbomoy] phosphate mitochondria and is metabolized to oxaloacetate
2ATP 2ADP + Pi through TCA cycle.
2. Formation of citrulline: Citrulline is synthesized from Arginosuccinase
carbamoyl phosphate and ornithine by ornithine trans- Arginosuccinate Arginine
carbamoylase. Carbamoyl group is transferred from Fumarate
carbamoyl phosphate to ornithine to produce citrulline.
Ornithine transcarbamoylase 5. Formation of urea: The enzyme arginase hydrolyses
Carbamoyl phosphate + Ornithine Citrulline
arginine to urea and ornithine. Ornithine, so regener-
Pi ated, enters mitochondria for its reuse in the urea cycle.
3. Synthesis of arginosuccinate: Citrulline condenses with
Arginase
aspartate in the presence of arginosuccinate synthase to Arginine Ornithine
produce arginosuccinate. This step requires ATP, which
H,0 Urea
is cleaved to AMP and pyrophosphate (PPi).
 Biochemistry

OVERALL REACTION AND ENERGETICS METABOLIC DISORDERS OF UREA CYCLE

The urea cycle consumes four ATPs and is irreversible. Two Metabolic defects associated with all the five enzymes of urea
ATPs are utilized for the synthesis of carbamoyl phosphate. cycle are listed in Table 3.2.1.
One ATP is converted to AMP and PPi to produce argino-
succinate, which equalizes to two ATPs. Hence four ATPs are
actually consumed. Table 3.2.1 Metabolic disorders of urea cycle

NH,.* + CO, + Aspartate + 3ATP — Urea + Fumarate + Metabolic disorder Deficient enzymes involved
2ADP + 2Pi + AMP + PPi Hyperammonaemia type | Carbamoyl phosphate synthase |
Hyperammonaemia type II Ornithine transcarbamoylase

REGULATION OF UREA CYCLE Citrullinemia Arginosuccinic acid synthase

Arginosuccinic aciduria Arginosuccinase
The first reaction catalysed by carbamoyl phosphate
Hyperargininemia Arginase
synthase I (CPS I) is rate-limiting reaction or committed
step in urea synthesis. CPS I is allosterically activated by
N-acetylglutamate (NAG).
Carbamoyl phosphate synthetase is dependent on The clinical symptoms associated with defect in urea cycle
N-acetylglutamate, which acts as allosteric activator for enzymes include vomiting, lethargy, irritability, ataxia and
the enzyme. mental retardation.
Induction of urea cycle enzymes occurs when delivery of All the disorders invariably lead to a build-up of ammo-
ammonia or amino acids to the liver is increased; thus, a nia in blood (hyperammonaemia), leading to toxicity. De-
high-protein diet or starvation results in the induction of pending on the specific enzyme defect, other metabolites of
enzymes of urea cycle. urea cycle also accumulate.

SHORT ESSAYS

Q. 1. Denaturation of proteins. CHARACTERISTICS OF DENATURATION

Ans. 1. The native helical structure of protein is lost.
2. The primary structure of a protein with peptide linkages
The phenomenon of disorganization of native protein struc- remains intact, i.e. peptide bonds are not hydrolysed.
ture is known as denaturation. Denaturation results in the . The protein loses its biological activity.
ies]

loss of secondary, tertiary and quaternary structure of pro- 4. Denatured protein becomes insoluble in the solvent in
teins. This involves a change in physical, chemical and bio- which it was originally soluble.
logical properties of protein molecules. 5. Denatured protein is more easily digested. This is due to
increased exposure of peptide bonds to enzymes. Cook-
AGENTS OF DENATURATION ing causes protein denaturation, and, therefore, cooked
protein food is more easily digested.
Physical Agents
6. Denaturation is usually irreversible.
. Heat
Q. 2. How is creatine-P synthesized?
whe

. Violent shaking
. X-rays Ans.
. UV radiation
Be

Creatine is present in the tissues (muscle, brain, blood, etc.)

as the high-energy compound phosphocreatine and as free
Chemical Agents
creatine.
Acids Three amino acids — glycine, arginine and methionine
Alkalies are required for creatine formation.
. Organic solvents (ether, alcohol) The first reaction occurs in the kidney, which involves the
. Salts of heavy metals (Pb, Hg) transfer of guanidino group of arginine to glycine, catalysed
Urea by arginine-glycine transaminase to produce guanidinoace-
. Salicylate tate (glycocyamine).
gy’) Quick Review Series: BDS Ist Year

S-adenosylmethionine (active methionine) donates methyl The conjugated proteins are subdivided into different
group to glycocyamine to produce creatine. This reaction groups as follows:
occurs in liver. Creatine is reversibly phosphorylated to phos- 1. Nucleoproteins are conjugated proteins having nucleic
phocreatine (creatine phosphate) by creatine kinase. It is acids as their prosthetic groups, e.g. protamines and
stored in muscle as high-energy phosphate. histones.
Nucleoprotein is present in every living cell as well as in
Q. 3. Substance formed from tyrosine.
viruses and bacteriophage, and is the essential constitu-
Ans. ent of the genes.
2. Proteoglycans and glycoproteins: Proteins conjugated
Tyrosine is the precursor for melanin.
with mucopolysaccharides are called ‘proteoglycans; e.g.
Melanin is the pigment of skin, hair and eye. The synthe-
gastric and salivary mucins, immunoglobulins, human
sis of melanin occurs in melanosomes present in melano-
chorionic gonadotropins, erythrocyte and lymphocyte
cytes— the pigment-producing cells.
cell membrane proteins
Tyrosinase hydroxylates tyrosine to form 3,4-dihydroxy-
3. Chromoproteins: The prosthetic group is a coloured
phenylalanine (DOPA). DOPA can act as a cofactor for ty-
compound; haemoglobin, flavoprotein and visual pur-
rosinase. DOPA is then converted to dopaquinone.
ple are a few examples.
The subsequent couple of reactions occur spontaneously,
4. Lipoproteins: Protein is combined with phospholipids,
forming leucodopachrome followed by 5,6-dihydroxyindole.
e.g. lipoproteins occur in milk, blood serum, egg yolk
The oxidation of 5,6-dihydroxyindole to indole 5,6-quinone
and others.
is catalysed by tyrosinase, and DOPA serves as a cofactor.
They are also important constituents of the cell mem-
This reaction, inhibited by tyrosine regulates the synthesis of
branes.
melanin, as shown in Fig. 3.2.2.
Q. 5. Primary and secondary structure of proteins.
Q. 4. What are conjugated proteins? Give three
examples. Ans.
Ans. Proteins are the polymers of L-alpha-amino acids. The
structure of proteins is rather complex, which can be divided
The conjugated proteins contain a non-protein moiety
into four levels of organization:
known as prosthetic group or conjugating group in addition
1. Primary structure: The linear sequence of amino acids
to amino acids.
forming the backbone of proteins (polypeptides).
2. Secondary structure: The spatial arrangement of pro-
tein by twisting of the polypeptide chain.
Tyrosine
3. Tertiary structure: The three-dimensional structure of
a functional protein.
oO
-~J Tyrosinase 4. Quaternary structure: Some of the proteins are com-
H,O. posed of two or more polypeptide chains referred to as
3, 4-Dihydroxyphenylalanine (DOPA) subunits. The spatial arrangement of these subunits is
0
~~ known as quaternary structure.
Tyrosinase
0
PRIMARY STRUCTURE OF PROTEIN
Dopaquinone
1. The primary structure of a protein is largely responsible
Nonenzymatic
for its function.
Leukodopachrome
2. Primary structure of a protein refers to the order and
sequence of amino acid residues.
5, 6-Dihydroxyindole 3. Some proteins are synthesized as single polypeptides
02 that are later cleaved into two or more chains, such as
Tyrosinase insulin. Then proteins have intrachain as well as inter-
Ho
chain disulphide linkages, as shown in Fig. 3.2.3.
Indole 5-6-quinone

Melanochrome
HjN-CH-CO-NH-CH-CO-NH-CH-CO—NH-CH-COOH
Melanin polymers
Black Ry Ro Ra Ry
Fig 3.2.2 Synthesis of melanin. Fig. 3.2.3 The primary structure of a protein.

4. A pure sample of a protein or a polypeptide is essential
for the determination of primary structure, which in-
volves three stages:
a. Determination of amino acid composition
b. Degradation of protein or polypeptide into smaller
fragments
c. Determination of the amino acid sequence.
SECONDARY STRUCTURE OF PROTEIN
1. The amino acids are located close to each other in their
sequence. Two types of secondary structures mainly
identified are a-helix and -sheet.
2. Secondary level of protein structure includes folding
and twisting patterns of polypeptide chains, i.e. the local
spatial arrangement of a polypeptide.
3. Secondary structures include o-helix and B-sheet struc-
tures:
o-HELIX
a-Helical structure was proposed by Pauling and Corey
(1951).
o-Helix is the most common spiral structure of protein
(Fig. 3.2.4). It has a rigid arrangement of polypeptide chain.
Fig. 3.2.4 Secondary structure of protein.
SHORT NOTES
Q. 1. Active methionine.
Ans.
Biochemistry
The salient features of a-helix are as follows:
1. The o-helix is a tightly packed coiled structure with
amino acid side chains extending outward from the
central axis.
. The a-helix is stabilized by extensive hydrogen bonding.
It is formed between H atom attached to peptide N, and
O atom attached to peptide C. The hydrogen bonds are
individually weak but collectively, they are strong
enough to stabilize the helix.
. All the peptide bonds except the first and last in a poly-
peptide chain participate in hydrogen bonding.
. Each turn of e-helix contains 3.6 amino acids and trav-
els a distance of 0.54 nm. The spacing of each amino
acid is 0.15 nm.
. a-Helix is a stable conformation formed spontaneously
with the lowest energy.
. The right-handed e-helix is more stable than left-
handed helix.
B-PLEATED SHEET (FIG. 3.2.5)
Fig. 3.2.5 -Pleated sheet.
This is the second type of structure proposed by Pauling
and Corey. B-Pleated sheets (or simply B-sheets) are com-
posed of two or more segments of fully extended peptide
chains. In the B-sheets, the hydrogen bonds are formed be-
tween, the neighbouring segments of polypeptide chain(s).
Q. 6. Describe urea cycle.
Ans.
Refer to the Answer of Long Essays Q. 1.
Methionine is an essential amino acid. It is glycogenic.
Methionine is particularly important as a donor of methyl
group in reactions known as transmethylation reactions.
276 Quick Review Series: BDS 1st Year

Active methionine: To act as methyl donor, the amino in the loss of secondary, tertiary and quaternary struc-
acid has to be first activated by ATP. ture of proteins.
2. This involves a change in physical, chemical and bio-
Activating enzyme
Methionine + ATP—————_-> active methionine + PP + P logical properties of protein molecules.
(Liver
Active methionine or adenosyl-S-methionine has the AGENTS OF DENATURATION
following structure: Physical agents: Heat, X-rays, UV radiation
CH Chemical agents: Acids, alkalies, organic solvents (ether,
3
alcohol), salts of heavy metals (Pb, Hg), urea, salicylate.
Adenine-ribose-S-CH, CH, CHNH, COOH
Q. 4. Classification of proteins.

The S~methyl bond is a high-energy bond. The methyl Ans.

group is hence labile and can be readily transferred to an Proteins are classified in several ways. Three major types of
acceptor. The activating enzyme is known as methionine- classifying proteins based on their function, chemical nature,
adenosyl transferase. solubility properties and nutritional importance are dis-
Q. 2. Essential amino acids. cussed here.

Or
A. FUNCTIONAL CLASSIFICATION OF PROTEINS
Name essential amino acids and discuss their
Based on the function they perform, proteins are classified in
functions.
the following groups
Ans. 1. Structural proteins, e.g. keratin of hair and nails, colla-
gen of bone.
Amino acids are grouped into two classes:
1. Essential amino acids
. Enzymes or catalytic proteins, e.g. hexokinase, pepsin.
Wh

. Transport proteins, e.g. haemoglobin, serum albumin.

2. Non-essential amino acids.
. Hormonal proteins, e.g. insulin, growth hormone.
Essential or indispensable amino acids: The amino acids
DUS

. Contractile proteins, e.g. actin, myosin.

which cannot be synthesized by the body and, therefore, . Storage proteins, e.g. ovalbumin, glutelin.
need to be supplied through the diet are called essential . Genetic proteins, e.g. nucleoproteins.
OmonN

amino acids. They are required for proper growth and main- . Defence proteins, e.g. snake venoms, immunoglobulins.
tenance of the individual. The 10 amino acids listed below . Receptor proteins, e.g. for hormones, viruses.
are essential for humans.
1. Arginine
B. PROTEIN CLASSIFICATION BASED ON
Valine CHEMICAL NATURE AND SOLUBILITY
WL

Histidine
SL PN AWA

Isoleucine This is a more comprehensive and popular classification of

Leucine proteins. It is based on the amino acid composition, struc-
Lysine ture, shape and solubility properties. Proteins are broadly
Methionine classified into three major groups.
Phenylalanine 1. Simple proteins: They are composed of only amino acid
Threonine residues.
. Tryptophan. a. Albumins: Soluble proteins present in serum, milk,
a

Of the ten listed above, two amino acids namely arginine
and histidine can be partly synthesized by adult humans,
hence these are considered as semiessential. Thus, eight amino
acids are absolutely essential while two are semiessential.
The nutritional importance of proteins is based on the
content of essential amino acids.
Q. 3. Denaturation of proteins.
Ans.
1. The phenomenon of disorganization of native protein
structure is known as denaturation. Denaturation results
egg, etc.
b. Globulins: Sparingly soluble proteins present in se-
rum, milk and egg.
c. Prolamines: Example, gliadin of wheat or zein of
maize.
d. Glutelins: Example, glutenin of wheat or oryzenin of
rice.
e. Scleroproteins: These are also found in bone carti-
lage and protective tissues like skin, nail, etc.
f. Histones: Example, nuclechistones.
2. Conjugated proteins: Besides the amino acids, these
proteins contain a non-protein moiety known as
 Biochemistry

prosthetic group or conjugating group, e.g. nucleo- and 3) can be identified by ultracentrifugation. HDL
proteins, lipoproteins, etc. particles transport cholesterol from peripheral tissues to
3. Derived proteins: These are the denatured or degraded liver (reverse cholesterol transport).
products of simple and conjugated proteins or those 5. Free fatty acids — albumin: Free fatty acids in the cir-
produced by change of peptide bonds. culation are in a bound form to albumin. Each molecule
of albumin can hold about 20-30 molecules of free fatty
They are further classified as primary and secondary
acids.
derived proteins.
Q. 6. Primary structure of protein.
C. NUTRITIONAL CLASSIFICATION OF PROTEINS
Ans.
The nutritive value of proteins is determined by the compo-
sition of essential amino acids. From the nutritional point of Proteins are the polymers of L-alpha-amino acids. The
view, proteins are classified into three categories: structure of proteins is rather complex, which can be divided
1. Complete proteins: Simple proteins conjugated with a into four levels of organization:
non-protien substance called as a prosthetic group are 1. Primary structure
referred to as conjugated proteins, e.g. nucleoproteins, 2. Secondary structure
glycoproteins, phosphoproteins, lipoproteins. 3. Tertiary structure
These proteins have all the 10 essential amino acids in 4. Quaternary structure.
the required proportion by the human body to promote Primary Structure: The linear sequence of amino acids
good growth, e.g. egg albumin, milk casein. forming the backbone of proteins (polypeptides) is known
2. Partially incomplete proteins: These proteins are par- as primary structure of proteins. The primary structure of a
tially lacking one or more essential amino acids and protein is largely responsible for its function.
hence can promote moderate growth, e.g. wheat and
rice proteins. Q. 7. Biological value of proteins.
3. Incomplete proteins: These proteins completely lack Ans.
one or more essential amino acids. Hence, they do not
promote growth at all, e.g. gelatin. Biological value is one of the methods employed to assess the
nutritive value of proteins.
Q. 5. Functions of lipoproteins. Biological value of certain food proteins are as follows:
Ans.
Lipoproteins are molecular complexes that consist of lipids Egg 94
and proteins, i.e. conjugated proteins.
Milk 84
1. They function as transport vehicles for lipids in blood
plasma. Fish 85
2. Lipoproteins deliver the lipid components (cholesterol, Meat 75
triacylglycerol etc.) to various tissues for utilization.
Rice 68
CLASSIFICATION OF LIPOPROTEINS AND THEIR Wheat 58
FUNCTIONS Soya bean 65
Five major classes of lipoproteins are identified in human
plasma, based on their separation by electrophoresis.
1. Chylomicrons: They are synthesized in the intestine Q. 8. What are zwitter ions?
and transport exogenous (dietary) triacylglycerol to Ans.
various tissues. They consist of highest (99%) quantity
of lipid and lowest (1%) concentration of protein. The name zwitter is derived from the German word, which
2. Very low-density lipoproteins (VLDL): They are pro- means hybrid. Zwitter ion (or dipolar ion) is a hybrid mol-
duced in liver and intestine, and are responsible for ecule containing positive and negative ionic groups.
the transport of endogenously synthesized triacylg- The amino acids rarely exist in a neutral form with free
lycerols. carboxylic (—COOH) and free amino —NH, groups. In
3. Low-density lipoproteins (LDL): They are formed from strongly acidic pH (low pH), the amino acid is positively
VLDL in the blood circulation. They transport choles- charged (cation), while in strongly alkaline pH (high pH), it
terol from liver to other tissues. is negatively charged (anion). Each amino acid has a charac-
4. High-density lipoproteins (HDL): They are mostly syn- teristic pH (e.g. leucine, pH 6.0) at which it carries both
thesized in liver. Three different fractions of HDL (1, 2 positive and negative charges, and exists as zwitter ion.
Quick Review Series: BDS 1st Year

Q. 9. What are nucleosides and nucleotides? Give 3. Neonatal tyrosinaemia

examples of each one.
The absence of the enzyme p-hydroxyphenyl-pyruvate di-
Ans. oxygenase causes neonatal tyrosinaemia. This is mostly a
temporary condition and usually responds to ascorbic acid.
1. Nucleic acids are the polymers of nucleotides. Nucleo-
tides are composed of a nitrogenous base, a pentose sugar
4, Alkaptonuria
and a phosphate. Nucleotides perform a wide variety of
functions in the living cells. The defective enzyme in alkaptonuria is homogentisate oxi-
2. The term nucleoside refers to base + sugar. Nucleotide dase in tyrosine metabolism.
is a nucleoside + phosphate. Alkaptonuria has great historical importance. It was first
3. The addition of a pentose sugar to base produces a nu- described by Lusitanus in 1649 and characterized in 1859.
cleoside. If the sugar is ribose, ribonucleosides are Garrod conceived the idea of inborn errors of metabolism
formed. Adenosine, guanosine, cytidine and uridine are from his observation on alkaptonuria.
the ribonucleosides of A, G, C and U, respectively.
4. If the sugar is a deoxyribose, deoxyribonucleosides are 5. Tyrosinosis or tyrosinaemia type |
produced. This is due to the deficiency of the enzymes fumarylaceto-
The term mononucleotide is used when a single phosphate acetate hydroxylase and/or maleylacetoacetate isomerase.
moiety is added to a nucleoside. Thus adenosine monophos- Tyrosinosis is a rare but serious disorder.
phate (AMP) contains adenine + ribose + phosphate.
6. Albinism
Example 1 of Nucleoside
Albinism (Greek: albino — white) is an inborn error due to
Base Ribonucleoside Ribonucleotide Abbreviation the lack of synthesis of the pigment melanin.
(5’-monophosphate) The most common cause of albinism is a defect in tyrosinase—
Adenine({A) Adenosine Adenosine 5’- AMP the enzyme most responsible for the synthesis of melanin.
monophosphate or
adenylate Q. 11. Name different types of RNA and their func-
tions.
Example 2 of Nucleoside Ans.
Base Deoxyribonucleoside Deoxyribonucleotide Abbreviation The three distinct types of RNAs with their respective
(5’-monophosphate) cellular composition are given below:
Adenine(A) Deoxyadenosine Deoxyadenosine 5’- dAMP 1. Messenger RNA (mRNA): 5-10%
monophosphate or 2. Transfer RNA (tRNA): 10-20%
deoxyadenylate 3. Ribosomal RNA (rRNA): 50-80%.
Q. 10. Name the inborn errors of metabolism in Besides the three RNAs referred above, human cells also
phenylalanine pathway and mention the enzymes contain small nuclear RNA (snRNA), which is involved in
that are missing in each case. RNA processing.
Ans. Messenger RNA (mRNA): The specific information required
for the synthesis of a given protein is present on the mRNA.
DISORDERS OF TYROSINE (PHENYLALANINE)
METABOLISM Transfer RNAs (tRNAs): They carry the amino acids and
hand over them to the growing peptide chain.
Several enzyme defects in phenylalanine/tyrosine degradation
leading to metabolic disorders are known. The deficient en- Ribosomal RNA (rRNA): The function of RNAs in ribo-
zymes and the respective inborn errors are discussed below: somes is not clearly known. It is believed that they play a
significant role in the binding of mRNA to ribosomes and
1. Phenylketonuria protein synthesis.
Phenylketonuria (PKU) is the most common metabolic disorder
Q. 12. Structure and functions of M-RNA.
in amino acid metabolism. The incidence of PKU is 1 in 10,000
births. It is due to the deficiency of the hepatic enzyme phenyl- Ans.
alanine hydroxylase caused by an autosomal recessive gene. The mRNA is synthesized in the nucleus (in eukaryotes) as
2. Tyrosinaemia type Il heterogeneous nuclear RNA (hnRNA). hnRNA on processing
liberates the functional mRNA, which enters the cytoplasm
This disorder — also known as Richner—Hanhart syndrome, to participate in protein synthesis. mRNA has high molecu-
is due to a defect in the enzyme tyrosine transaminase. lar weight with short half-life.
 Biochemistry

STRUCTURE OF M-RNA specific or unambiguous, e.g. UGG is the codon for

Cap Poly A tail
| Coding sequence
Gppp ~VWYWwn yw rr rr wrr—~ pp Ap ApApA-OH
ob _ _ _) LH _ 3)
The eukaryotic mRNA is capped at the 5°-terminal end by
7-methylguanosine triphosphate. It is believed that this cap
helps to prevent the hydrolysis of mRNA by 5’-exonucleases.
Further, the cap may be also involved in the recognition of
mRNA for protein synthesis.
The 3’-terminal end of mRNA contains a polymer of ad-
enylate residues (20-250 nucleotides), which is known
poly (A) tail. This tail may provide stability to mRNA, be-
sides preventing it from the attack of 3’-exonucleases.
mRNA molecules often contain certain modified bases
such as 6-methyladenylates in the internal structure.
FUNCTIONS
The specific information required for the synthesis of a given
protein is present on the mRNA.
Q. 13. Significance of blood urea estimation.
Ans.
In healthy people, the normal blood urea concentration is
10-40 mg/dL.
Blood urea estimation is widely used as a screening test
for the evaluation of kidney (renal) function.
Q. 14. Describe the features of genetic code.
Ans.
Definition: The three nucleotide (triplet) base sequences in
mRNA that act as code words for amino acids in protein,
constitute the genetic code or simply codons. The genetic
code may be regarded as a dictionary of nucleotide bases (A,
G, C and U) that determines the sequence of amino acids in
proteins.
1. The codons are composed of the four nucleotide bases,
namely the purines — adenine (A) and guanine (G),
and the pyrimidines — cytosine (C) and uracil (U).
These four bases produce 64 different combinations (4°)
of three base codons.
The nucleotide sequence of the codon on mRNA is writ-
ten from the 5’-end to 3’ end. Sixty-one codons code for
the 20 amino acids found in protein.
2. Characteristics of genetic code are as follows:
The genetic code is universal, specific, nonoverlapping
and degenerate.
4. Universality: The same codons are used to code for the
same amino acids in all the living organisms. Hence,
genetic code is appropriately regarded as universal.
5. Specificity: A particular codon always codes for the
same amino acid; hence the genetic code is highly
tryptophan.
6. Nonoverlapping: The genetic code is read from a fixed
| point as a continuous base sequence. It is nonover-
lapping, commaless and without any punctuations.
For instance, UUUCUUAGAGGG is read as UUU/
CUU/AGA/GGG. Addition or deletion of one or two
bases will radically change the message sequence in
mRNA.
7. Degenerate: Most of the amino acids have more than
one codon. The codon is degenerate or redundant, since
there are 61 codons available to code for only 20 amino
acids. For instance, glycine has four codons.
as Q. 15. Where is urea synthesized?
Ans.
Urea is synthesized in liver and transported to kidneys for
excretion in urine.
Q. 16. Name three conjugated proteins and discuss
their significance.
Or
Name four conjugated proteins and their signifi-
cance.
Ans.
Definition: Besides the amino acids, these proteins contain a
non-protein moiety known as prosthetic group or conjugat-
ing group.
Various conjugated proteins are as follows:
1. Nucleoprotein is present in every living cell and is the
essential constituent of the genes.
2. Lipoproteins are important constituents of cell mem-
branes.
3. Chromoproteins, e.g. haemoglobin, flavoprotein and
visual purple.
4. Metalloproteins: Fe, Co, Mn, Zn, Cu and Mg are some
of the metallic ions associated with proteins. The pro-
teins are usually enzymes and require metallic ions as
activators.
5. Glycoproteins: Protein conjugated with carbohydrates.
6. Phosphoproteins: Phosphoric acid attached to serine
and threonine moieties of a protein, e.g. casein of
milk.
7. Mucoproteins.
Q. 17. Protein-energy malnutrition.
Or
Protein—calorie malnutrition.
Ans.
Protein-energy malnutrition (PEM), sometimes called protein—
calorie malnutrition (PCM), is the most common nutritional
disorder of the developing countries. PEM is widely prevalent
Quick Review Series: BDS 1st Year
in the infants and preschool children. Kwashiorkor and maras-
mus are the two extreme forms of protein-energy malnutrition.
Kwashiorkor literally means sickness of the deposed child,
i.e. a disease the child gets when the next baby is born. It is
predominantly found in children between 1 and 5 years of
age. This is primarily due to insufficient intake of proteins.
Marasmus literally means ‘to waste’. It mainly occurs in
children under 1 year of age. Marasmus is primarily due to
the deficiency of calories.
Q. 18. Four functions of plasma proteins.
Ans.
Functions of plasma proteins are as follows:
1. Fluid exchange: Effective exchange of fluid between tis-
sue spaces and plasma is thus maintained. In this func-
tion albumin plays a greater role than globulins.
2. Buffering action: At pH 7.4 of blood, a plasma protein
acts as weak acid and combines with cations, mainly
CHEMISTRY AND METABOLISM OFLIPIDS)
LONG ESSAYS
Q. 1. Give an account of beta-oxidation of fatty ac-
ids, and give the energetics on oxidation of one
molecule of palmitic acid.
Or
Describe beta-oxidation of fatty acids and
energetics.
Or
Explain beta-oxidation of fatty acids. What is the
importance of this process?
Ans.
The fatty acids in the body are mostly oxidized by
B-oxidation. B-Oxidation may be defined as the oxida-
tion of fatty acids on the B-carbon atom. This results in
the sequential removal of a two carbon fragment, acetyl
CoA.
FATTY ACID OXIDATION: STAGES AND TISSUES
The B-oxidation of fatty acids involves three stages:
1. Activation of fatty acids occurring in the cytosol
2. Transport of fatty acids into mitochondria
3. B-Oxidation proper in the mitochondrial matrix.
sodium. This accounts for about 16 mEq/L (out of
143 mEq/L).
3. Reserve protein: The plasma protein can be taken up by
tissues and used for the building up of tissue proteins
and vice versa.
4. Transport: Insoluble substances like bilirubin, steroid
and other hormones, fatty acids and other lipids and
metals are transported in plasma in loose combination
with plasma protein.
Q. 19. Transamination.
Ans.
The transfer of an amino (-NH,) group from an amino acid
to a keto acid is known as transamination. This process in-
volves the interconversion of a pair of amino acids and a pair
of keto acids, catalysed by a group of enzymes called trans-
aminases (recently, aminotransferases).
Fatty acids are oxidized by most of the tissues in the body.
However, brain, erythrocytes and adrenal medulla cannot uti-
lize fatty acids for energy requirement.
The stages in B-oxidation of fatty acids are described in
Fig. 3.3.1.
its
B-OXIDATION OF FATTY ACIDS
Palmitoyl CoA (16 carbon) undergoes seven cycles to yield
eight acetyl CoA [activation; transport and B-oxidation
proper—(1) oxidation, (2) hydration, (3) oxidation and
(4) cleavage].
Fatty acid activation
Fatty acids are activated to acyl CoA by thiokinases or acyl
CoA synthetases. In this reaction, two high-energy phosphates
are produced because ATP is converted to pyrophosphate
(PPi). The enzyme inorganic pyrophosphatase hydrolyzes PPi
to phosphate (Pi). The immediate elimination of PPi makes
this reaction totally irreversible.
Transport of acyl CoA into mitochondria
The inner mitochondrial membrane is impermeable to
fatty acids. A specialized carnitine carrier system operates to
 Biochemistry

2. Hydration: Enoyl CoA hydratase brings about the hy-

l dration of the double bond to form B-hydroxyacyl CoA.
R—CH,—CH,—CH,—C—O-
Fatty acid 3. Oxidation: B-Hydroxyacyl-CoA dehydro genase cataly-
ses the second oxidation and generates NADH. The
ATP Mg? CoASH product formed is B-ketoacyl CoA.
AMP + PP Thiokinase 4. Cleavage: The final reaction in B-oxidation is the libera-
tion of a two-carbon fragment, acetyl CoA from acyl
CoA. This occurs by a thiolytic cleavage catalysed by
R—CH,—CH,—CH,—C—SCoA
B-ketoacyl CoA thiolase (or simply thiolase).
Acyl CoA

Cytosol The new acyl CoA, containing two carbons less than the
Il. Carnitine transport system original, re-enters the 3-oxidation cycle. The process contin-
UI
|
O
Mitochondrion ues till the fatty acid is completely oxidized.
The scheme of fatty acid oxidation discussed above cor-
po
R—CH,—CH,—CH,—C—SCoA responds to saturated (no double bond) and even carbon
Acyl CoA fatty acids. This occurs most predominantly in biological
2ATP w) Acyl CoA system.
dehydrogenase
Oxidation of palmitoyl CoA
|
R—CH,—CH = CH—C—SCoA The summary of 3-oxidation of palmitoyl CoA is shown
here under:
A? Trans-enoyl CoA
Enoyl CoA Palmitoyl Co A + 7 Co ASH + 7 FAD + 7 NAD* + 7 H,0
HO (2)) hydratase
— 8 Acetyl Co A + 7 FADH, + 7 NADH + 7 Ht

1 l Palmitoyl CoA undergoes seven cycles of B-oxidation to

R—CH,—CH—CH,—C—SCoA
yield eight acetyl CoA. Acetyl CoA can enter citric acid cycle
B-Hydroxyacyl CoA
and get completely oxidized to CO, and H,0.
SATP NAD+ B-Hydroxyacyl CoA
8) dehydrogenase
H,0 aN. NAD Hs Energetics of B-oxidation
gS

The ultimate aim of fatty acid oxidation is to generate en-

| | ergy. The energy (net 129 ATPs) obtained from the complete
R—CH,—C—CH,—C—SCoA
oxidation of palmitic acid (16 carbon) is given in Table 3.3.1.
B-Ketoacyl CoA

2CO,
CoAS ( : Thiolase Table 3.3.1 Energetics of palmitic acid oxidation
4
ATP
l l
R—CH,;—C—SCoA + CH;—C—SCoA Mechanism yield
Acyl CoA (-2C) Acetyl CoA B-Oxidation seven cycles 14
Fig. 3.3.1 Stages in B-oxidation of fatty acids. 7 FADH, [oxidized by electron transport chain (ETC); each
FADH, gives 2 ATPs], 7 NADH (oxidized by ETC, each
NADH liberates 3 ATPs)
From 8 acetyl CoA 21
Oxidized by citric acid cycle, each acetyl CoA provides 96
transport activated fatty acids from cytosol to the mito- 12 ATPs
chondria.
Total energy from one mole of palmitoyl CoA 131

B-Oxidation proper Energy utilized for activation (formation of palmitoyl CoA) -2

Each cycle of B-oxidation, liberating a two-carbon unit-
acetyl CoA, occurs in a sequence of four reactions men-
tioned below:
1. Oxidation: Acyl CoA undergoes dehydrogenation by an
FAD-dependent flavoenzyme, acyl CoA dehydrogenase.
A double bond is formed between a- and B-carbons
(i.e. two and three carbons).
Net yield of oxidation of one molecule of palmitate 129
Oxidation of odd-carbon chain fatty acids
The B-oxidation of saturated fatty acids containing odd num-
ber of carbon atoms proceeds in the same manner, as de-
scribed above for even carbon fatty acids. The only difference
Quick Review Series: BDS 1st Year
is that in the last and final B-oxidation cycle, a three-carbon
fragment is left behind (in place of two-carbon unit for satu-
rated fatty acids). This compound is propionyl CoA, which is
converted to succinyl CoA and metabolized.
Oxidation of unsaturated fatty acids
Because of the presence of double bonds, the unsaturated
fatty acids are not reduced to the same extent as saturated
fatty acids. Therefore, oxidation of unsaturated fatty acids, in
general, provides less energy than that of saturated fatty acids.
Most of the reactions involved in the oxidation of unsatu-
rated fatty acids are the same as found in the B-oxidation of
saturated fatty acids. However, the presence of double bonds
poses problem for B-oxidation to proceed. This is overcome
by two additional enzymes — an isomerase and an epimerase.
Q. 2. Name the different pathways of fatty acid oxi-
dation. How is palmitic acid oxidized in the body?
Write down the energetics.
Ans.
PATHWAYS OF FATTY ACID OXIDIZATION
Different pathways of fatty acid oxidation are as follows.
B-Oxidation of fatty acids
The fatty acids in the body are mostly oxidized by B-oxidation.
8-Oxidation may be defined as the oxidation of fatty acids on
the B-carbon atom. This results in the sequential removal of a
two-carbon fragment, acetyl CoA.
a-Oxidation of fatty acids
This is found to occur in the microsomal fraction of brain
and other tissues and plants. This particularly involves the
SHORT ESSAYS
Q. 1. Essential fatty acids.
Ans.
1. The fatty acids that cannot be synthesized by the body
and, therefore, should be supplied in the diet are known
as essential fatty acids (EFA).
2. Chemically, they are polyunsaturated fatty acids, namely
linoleic acid (18:2; 9, 12), linolenic acid (18:3; 9, 12, 15),
and arachidonic acid.
3. Essential fatty acids are required for the membrane
structure and function, transport of cholesterol, forma-
tion of lipoproteins, prevention of fatty liver, etc. They
hydroxy fatty acids, where the -OH is attached to the
a-carbon. One carbon is removed at a time starting from the
-COOH end. It does not require coenzyme A and does not
generate ATP.
w-Oxidation B
This is observed in the liver microsomal fraction. Medium-
chain-length fatty acids are usually involved. First an -OH is
added to the omega carbon, which is then further oxidized
to form an e-w-dicarboxylic acid. Now B-oxidation can
occur from either end.
Palmitic acid is oxidized by B-oxidation; it will run
through B-oxidation cycle seven times. Refer to the answer
of Long Essays Q. 1 for B-oxidation cycle.
Energetics of palmitic acid oxidation
If palmitic acid is oxidized, it will result in eight molecules of
acetate and will run through B-oxidation cycle seven times.
In each cycle of B-oxidation, energy can be obtained by re-
oxidation of the coenzymes FADH2 (step 2) and NADH +
H+ (step 4), the first yielding two ATPs and the second,
three ATPs. Thus, a total of five ATPs is realized when a fatty
acid runs through the cycle once.
Because palmitic acid runs seven times, energy by
B-oxidation 7X5 = 35 ATPs.
Each of the eight molecules of acetate when oxidized in
citric acid cycle will produce 8 X 12 = 96 ATPs
Total = 131 ATPs
In the initial activation step of fatty acid, one ATP is con-
verted to AMP + PP, resulting in loss of two energy-rich
phosphates. That is (—)2 ATPs.
Hence, the net gain = 129 ATPs.
are also needed for the synthesis of another important
group of compounds, namely eicosanoids.
4. The deficiency of EFA results in phrynoderma or toad
skin.
Q. 2. Cholesterol degradation.
Ans.
1. The steroid nucleus (the ring structure) of the choles-
terol cannot be degraded to CO, and H,0.
2. Cholesterol (50%) is converted to bile acids, excreted in
faeces, and serves as a precursor for the synthesis of ste-
roid hormones, vitamin D, coprostanol and cholestanol.
 Biochemistry

Cholesterol Cholesterol (27C)

NADPH + H+ Pregnenolone (21C)

+ O?
7-a-Hydroxylase
Progesterone (21C)
NADP*

Aldosterone (21C)
Cortisol (21C) Oestradiol (18C)
7-Hydroxycholesterol
Fig. 3.3.3 Outline of steroid hormone synthesis from cholesterol.
Several Several (Note: Numbers in the brackets represent the number of carbon
steps “SN. steps atoms).

“ we
Cholic acid Chenodeoxycholic A brief outline of steroid hormonal synthesis is given in
Glycine acid
Fig. 3.3.3.
; Taurine O
Taurine glycine SYNTHESIS OF VITAMIN D
Glycocholic 7-Dehydrocholesterol, an intermediate in the synthesis of
acid*
cholesterol, is converted to cholecalciferol (vitamin D;) by
. Tauro- or
Intestinal glycochenodeoxycholic ultraviolet rays in the skin.
bacteria acid*
Taurocholic Q. 3. Phospholipids (structures and functions).
Deoxycholic acid*
acid™* Intestinal Ans.
bacteria
PHOSPHOLIPIDS
Lithocholic acid**
These are complex or compound lipids containing phosphoric
Fig. 3.3.2 Synthesis of bile acids. (Note: “primary bile acids; acid, in addition of fatty acids, nitrogenous base and alcohol.
** secondary bile acids).
There are two classes of phospholipids:
1. Glycerophospholipids (or phosphoglycerides) that contain
SYNTHESIS OF BILE ACIDS (FIG. 3.3.2) glycerol as the alcohol.
The synthesis of primary bile acids takes place in the liver 2. Sphingophospholipids (or sphingomyelins) that contain
and involves a series of reactions. Colic acid and chenode- sphingosine as the alcohol.
oxycholic acid are the primary bile acids, and the former is
found in the largest amount in bile. Glycerophospholipids
1. On conjugation with glycine or taurine, conjugated bile Glycerophospholipids are the major lipids that occur in bio-
acids (glycocholic acid, taurocholic acid, etc.) are formed, logical membranes. They consist of glycerol 3-phosphate es-
which are more efficient in their function as surfactants. terified at its C, and C, with fatty acids. Usually, C, contains a
In the bile, the conjugated bile acids exist as sodium and saturated fatty acid, while C, contains an unsaturated fatty acid.
potassium salts, which are known as bile salts. 1. Phosphatidic acid: This is the simplest phospholipid. It
2. In the intestine, a portion of primary bile acids undergo does not occur in good concentration in the tissues. Basi-
deconjugation and dehydroxylation to form secondary bile cally, phosphatidic acid is an intermediate in the synthe-
acids (deoxycholic acid and lithocholic acid). These reac- sis of triacylglycerols and phospholipids (Fig. 3.3.4).
tions are catalysed by bacterial enzymes in the intestine. 2. Lecithins (phosphatidylcholine): These are the most
abundant group of phospholipids in the cell membranes.
SYNTHESIS OF STEROID HORMONES FROM
CHOLESTEROL
oO
Cholesterol is the precursor for the synthesis of all the five Il
classes of steroid hormones: QO CH,—-O—C-R,
I
1. Glucocorticoids (e.g. cortisol) R,—C—O—CH 9°
. Mineralocorticoids (e.g. aldosterone) I
CH—O-P—0”
wh

. Progestins (e.g. progesterone)

. Androgens (e.g. testosterone) O
Ue

. Oestrogens (e.g. oestradiol). Fig. 3.3.4 Phosphatidic acid.

93:7) Quick Review Series: BDS 1st Year

Chemically, lecithin is a phosphatidic acid with choline resultant compound is plasmalogen. Brain and muscle
as the base (Fig. 3.3.5). contain a good concentration (about 10% of phospho-
lipids) of plasmalogens (Fig. 3.3.9).

II Q — CH,—O—CH=CH-R,
T CHe—O—C—Ri
R,—C—O—CH 0
Rz-—C—O—CH 0 CH,
CH,—O—P—O—CH,—CH,—NH,
CH,—O—P—O—CH,—CH,—N*—CH,
o Ethanolamine
o- Choline H,
Fig. 3.3.9 Plasmalogen (phosphatidylethanolamine).
Fig. 3.3.5 Lecithin (phosphatidylcholine).

3. Cephalins (phosphatidylethanolamine): Ethanolamine Sphingomyelins

is the nitrogenous base present in cephalins (Fig. 3.3.6).
Sphingosine is an amino alcohol present in sphingomyelins
(sphingophospholipids). They do not contain glycerol at all.
9°
I Sphingosine is attached by an amide linkage to a fatty acid to
° CH,—O—C—R, produce ceramide. Sphingomyelins are important constitu-
R,—C—O—CH 9 ents of myelin, and are found in good quantity in brain and
nervous tissues.
CH,—O—P—O—CH,—CH,—N
| :
o- Ethanolamine
FUNCTIONS OF PHOSPHOLIPIDS
Fig. 3.3.6 Cephalin (phosphatidylethanolamine). Phospholipids constitute an important group of compound
lipids that perform a wide variety of functions.
4. Phosphatidylinositol (Fig. 3.3.7) 1. In association with proteins, phospholipids form the
1. The stereoisomer myo-inositol is attached to phos- structural components of membranes and regulate
phatidic acid to give phosphatidylinositol (Pi). membrane permeability.
2. This is an important component of cell membranes. 2. Phospholipids (lecithin, cephalin and cardiolipin) in the
The action of certain hormones (e.g. oxytocin and mitochondria are responsible for maintaining the con-
vasopressin) is mediated through Pi. formation of electron transport chain components and
thus cellular respiration.
Q
I 3. Phospholipids are essential for the synthesis of different
QO CH—O—C—R, lipoproteins and thus participate in the transport of lipids.
| 4. Accumulation of fat in liver (fatty liver) can be pre-
R,—C—O—CH 0 OH OH
| I vented by phospholipids; hence they are regarded as li-
CHOP"
potropic factors.
O 4H 5. Arachidonic acid, an unsaturated fatty acid, liberated
CH H from phospholipids serves as a precursor for the synthe-
myo -inositol sis of eicosanoids (prostaglandins, prostacyclins, throm-
Fig. 3.3.7 Phosphatidyl inositol. boxanes, etc.).
6. Phospholipids (phosphatidylinositol) are involved in
signal transmission across membranes.
5. Phosphatidylserine (Fig. 3.3.8): The amino acid serine
is present in this group of glycerophospholipids. Q. 4. Classification of lipids with two examples of
6. Plasmalogens: When a fatty acid is attached by an ether each class.
linkage at C, of glycerol in the glycerophospholipids, the
Ans.

9° CLASSIFICATION OF LIPIDS
I
QO CH,—O—C—R, Lipids are broadly classified into simple, complex, derived
R,—C—O—CH 9 and miscellaneous lipids, which are further subdivided as
follows:
CH,—O—P—0~CH,-CH—COO-
1. Simple lipids: These are esters of fatty acids with alco-
Oo NH,* hols. These are mainly of two types:
Serine
a. Fats and oils (triacylglycerols)
Fig. 3.3.8 Phosphatidyl serine. b. Waxes.
 Biochemistry

2. Complex (or compound) lipids: Esters of fatty acids
with alcohols containing additional groups such as
phosphate, nitrogenous base, carbohydrate, protein, etc.
They are further divided into:
a. Phospholipids
i. Glycerophospholipids: For example lecithin and
cephalin.
ii. Sphingophospholipids: For example sphingo-
myelins.
b. Glycolipids: For example cerebrosides and ganglio-
sides.
c. Lipoproteins: Macromolecular complexes of lipids
with proteins.
d. Other complex lipids: Sulpholipids, amino lipids
and lipopolysaccharides are among the other
complex lipids.
3. Derived lipids: They include glycerol and other alco-
hols, fatty acids, monoacylglycerols and diacylglycerols,
lipid-soluble vitamins, steroid hormones, hydrocarbons
and ketone bodies.
4. Miscellaneous lipids: These include a large number
compounds possessing the characteristics of lipids,
example carotenoids, squalene, hydrocarbons such
pentacosane (in beeswax), terpenes, etc.
5. Neutral lipids: The lipids that are uncharged are
ferred to as neutral lipids. These are mono-, di-, and
triacylglycerols, cholesterol and cholesteryl esters.
Q. 7. Name the ketone bodies. How are they formed?
Mention two causes of ketosis.
Or
Briefly give the pathway of ketogenesis. How is the
presence of ketone bodies in urine detected?
Ans.
KETOGENESIS
The synthesis of ketone bodies occurs in the liver. The en-
zymes for ketone body synthesis are located in the mitochon-
dria matrix. Acetyl CoA, formed by oxidation of fatty acids,
pyruvate or some amino acids are the precursors for ketone
bodies. Ketogenesis occurs through the following reactions
(Fig. 3.3.10):
1. Two moles of acetyl CoA condense to form acetoacetyl
CoA. This reaction is catalysed by thiolase.
2. Acetoacetyl CoA combines with another molecule of
acetyl CoA to produce B-hydroxy B-methylglutaryl CoA
of (HMG CoA). HMG CoA synthase, catalysing this reac-
for tion, regulates the synthesis of ketone bodies.
as
re-
Acetyl CoA Acetyl CoA

Q. 5. Digestion and absorption of triglycerols.

NO
CoA-SH «—] B-Ketothiolase
Ans.
1. Hydrolysis: Triacylglycerols undergo stepwise enzy- Acetoacetyl CoA
matic hydrolysis to finally liberate free fatty acids and
glycerol. The process of hydrolysis, catalysed by lipases, Acetyl CoA ™ HMG CoA synthase
is important for digestion of fat in the gastrointestinal
tract and fat mobilization from the adipose tissues. con sn]
2. Saponification: The hydrolysis of triacylglycerols by
3-Hydroxy-B-methylglutaryl CoA (HMG CoA)
alkali to produce glycerol and soaps is known as
saponification. Triacylglycerol + 3 NaOH Glycerol +
3 R-COONa (soaps). HMG CoA lyase
Acetyl CoA+~—
3. HMG CoA lyase cleaves HMG CoA to produce acetoac-
etate and acetyl CoA. Acetoacetate
4. Acetoacetate can undergo spontaneous decarboxylation Spontaneous
to form acetone. B-Hydroxybutyrate
co, NADH + H* dehydrogenase
5. Acetoacetate can be reduced by a dehydrogenase to
B-hydroxybutyrate.
NAD+
The carbon skeleton of some amino acids (ketogenic) is Acetone B-Hydroxybutyrate

degraded to acetoacetate or acyl CoA and, therefore, to ke- Fig. 3.3.10 Synthesis of ketone bodies (ketogenesis).
tone bodies. For example leucine, lysine, phenylalanine, etc.

Q. 6. Explain the beta-oxidation of fatty acids. What

is the importance of this process?
The ketosis is most commonly associated with starvation
Ans.
and severe uncontrolled diabetes mellitus. The presence of
Refer to the answer of Long Essays Q. 1. ketone bodies in urine is detected by Rothera’s test.
Quick Review Series: BDS 1st Year

SHORT NOTES

Q. 1. Fatty liver. 5. Mineralocorticoids regulate water and electrolyte bal-

ance, and androgens and oestrogens affect sexual devel-
Ans.
opment and functions.
1. The normal concentration of lipid (mostly phospho-
Q. 4. What are essential fatty acids? Name them.
lipid) in liver is around 5%. Liver is not a storage
organ for fat, unlike adipose tissue. However, in certain Ans.
conditions, lipids — especially the triacylglycerols —
accumulate excessively in liver, resulting in fatty liver. 1. The fatty acids that cannot be synthesized by the body,
2. Fatty liver may occur due to two main causes: and, therefore, should be supplied in the diet are known
a. Increased synthesis of triacylglycerols as essential fatty acids.
b. Impairment in lipoprotein synthesis. 2. Chemically, they are polyunsaturated fatty acids, namely,
linoleic acid, linolenic acid and arachidonic acid.
Q. 2. Cholesterol.
Q. 5. Ketone bodies.
Ans.
Or
1. Cholesterol literally means solid alcohol from bile. Cho-
lesterol is exclusively found in animals and is the most Name ketone bodies and two conditions in which
abundant animal sterol. they are excreted.
2. It is widely distributed in all cells and is a major compo-
nent of cell, membranes and lipoproteins. Cholesterol Ans.
(Greek: chole, meaning bile) was first isolated from bile. 1. The compounds, namely, acetone, acetoacetate, and
B-hydroxybutyrate (or 3-hydroxybutyrate) are known
FUNCTIONS OF CHOLESTEROL as ketone bodies.
1. Cholesterol functions as an insulating cover for the 2. Only the first two are true ketones, while -hydroxybutyrate
transmission of electrical impulses in the nervous tissue. does not possess a keto (C=O) group. Ketone bodies are
2. Cholesterol performs several other biochemical func- water soluble and energy yielding.
tions, which include its role in membrane structure and 3. They are excreted in the following conditions:
function, in the synthesis of bile acids, hormones (sex a. Starvation
and cortical) and vitamin D. b. Severe uncontrolled diabetes mellitus.

Q. 3. Derivatives of cholesterol and their impor-
tance.
Ans.
1. Cholesterol (50%) serves as a precursor for the synthesis
of steroid hormones, vitamin D, coprostanol and cho-
lestanol.
2. It is the precursor for the synthesis of all the five classes
of steroid hormones:
a. Glucocorticoids (e.g. cortisol)
b. Mineralocorticoids (e.g. aldosterone)
c. Progestins (e.g. progesterone)
d. Androgens (e.g. testosterone)
e. Oestrogens (e.g. oestradiol).
3. Glucocorticoids (e.g. cortisol, cortisone and corticoste-
rone) affect glucose, amino acid and fat metabolism in a
manner that is opposite to the action of insulin.
4. They promote the synthesis of glucose (gluconeogene-
sis), increase the circulating free fatty acids, and they
exhibit catabolic and anabolic effects on protein and
nucleic acid metabolism.
Q. 6. What is ketosis? List two causes of ketosis.
Ans.
1. When the rate of synthesis of ketone bodies exceeds the
rate of utilization, their concentration in blood in-
creases; this is known as ketonaemia.
2. This is followed by ketonuria—excretion of ketone bod-
ies in urine. The overall picture of ketonaemia and keto-
nuria is commonly referred to as ketosis.
3. Ketosis is most commonly associated with starvation
and severe uncontrolled diabetes mellitus.
Q. 7. Beta-oxidation.
Ans.
The fatty acids in the body are mostly oxidized by B-oxidation.
8-Oxidation may be defined as the oxidation of fatty acids on
the B-carbon atom. This results in the sequential removal of a
two-carbon fragment, acetyl CoA.
Q. 8. Fat metabolism.
Ans.
 Biochemistry

The metabolism of lipids or fats, comprises the metabolism of 2. Lipids are the constituents of membrane structure and
neutral fats or triglycerides, phospholipids, sterols and others. regulate the membrane permeability (phospholipids
and cholesterol).
Q. 9. Unsaturated fatty acids.
3. They serve as a source of fat-soluble vitamins (A, D, E
Ans. and K).
4. Lipids are important as cellular metabolic regulators
1. Unsaturated fatty acids contain one or more double
(steroid hormones and prostaglandins).
bonds. Both saturated and unsaturated fatty acids al-
most equally occur in the natural lipids. Q. 13. In which form are fats stored in our body?
2. Fatty acids with one double bond are known as mono- Where is fat stored?
unsaturated and those with two or more double
Ans.
bonds are collectively known as polyunsaturated fatty
acids. 1. Fats as stored fuel: Triacylglycerols are the most abun-
dant group of lipids that primarily function as fuel re-
Q. 10. Phenylketonuria.
serves of animals.
Ans. 2. The fat reserve of normal humans (men 20%, women
25% by weight) is sufficient to meet the body caloric
1. Phenylketonuria is the most common metabolic disor-
requirements for 2-3 months.
der in amino acid metabolism. The incidence of phenyl-
3. In the body they are present in the cytoplasm as well as
ketonuria is 1 in 10,000 births.
the cell wall, and are also in specialized areas in the body
2. It is due to the deficiency of the hepatic enzyme—
as depots of fat in which form energy is stored.
phenylalanine hydroxylase—caused by an autosomal
4. Nervous tissues are particularly rich in lipids. The sub-
recessive gene.
cutaneous fat serves the role of insulating against atmo-
Q. 11. Normal values of cholesterol. spheric heat and cold, and also helps in rounding off the
contours of the body.
Ans.
Q. 14. What are lecithins? Mention their physiolog-
Normal values of cholesterol are as follows:
ical importance.
Cholesterol, total 150-225 mg/dL
Ans.
HDL fraction 30-60 mg/dL
LDL fraction 80-150 mg/dL Lecithins (phosphatidylcholine): These are the most abun-
dant group of phospholipids in the cell membranes. Chemi-
VLDL fraction 20-40 mg/dL
cally, lecithin is a phosphatidic acid with choline as the base.
Q. 12. Name any four functions of lipids. a. Dipalmitoyl lecithin is an important phosphatidylcho-
line found in lungs. It is a surface-active agent and pre-
Ans.
vents the adherence of inner surface of the lungs due to
Lipids perform several important functions: surface tension.
1. They are the concentrated fuel reserve of the body (tria- b. Lysolecithin is formed by removal of the fatty acid either
cylglycerols). at C, or C; of lecithin.

METABOLISM OF INORGANIC SUBSTANCES,

LONG ESSAYS

Q. 1. What is the normal serum calcium level? How Or

is it regulated? Enumerate the physiological func-
tions of calcium.
Or
What is the normal blood calcium level? What
the factors that maintain this level?
Discuss the functions of calcium in human body
and explain the homeostasis of blood calcium.
Ans.
are The most abundant among minerals in the body is calcium.
The total content of calcium in an adult man is around
yA:T:) Quick Review Series: BDS 1st Year
1-1.5 kg. Around 99% of it is present in the bones and
teeth. A small fraction (1%) of the calcium is found outside
the skeletal tissue. Normal blood (serum) calcium level is
9-11 mg/100 mL or 5 mEq/L.
Calcium exists in the plasma in three fractions: ionized or
diffusible calcium, protein bound or nondiffusible and com-
plexed (citrate and phosphate).
About 5 mg/dL of calcium is in ionized form and is meta-
bolically active, and about 1 mg/dL is complexed with phos-
phate. Bicarbonate and citrate are the two forms which are
diffusible from blood to tissues, whereas protein-bound calcium
— 4 mg/dL is bound to blood proteins — is not diffusible.
Biochemical functions of calcium are as follows:
1. Formation and development of bones and teeth:
Calcium, along with phosphate, is essential for the for-
mation, and physical strength of bones and teeth. Bones
which are in a dynamic state serve as reservoir of Ca.
Osteoblasts induce the bone formation while osteoclasts
result in demineralization.
2. Contraction of muscle: Ca** triggers muscle contrac-
tion by interacting with troponin C. Calcium also acti-
vates ATPase and increases the interaction between actin
and myosin, facilitating excitation-contraction coupling.
Blood coagulation: Calcium is also known as factor IV.
Ionized calcium is required in blood coagulation pro-
cess and several reactions in the cascade of blood clot-
ting process are dependent on Ca?* (factor IV).
4, Nerve conduction: Ca’~ is necessary for the transmis-
sion of nerve impulse.
5. Membrane integrity and permeability: Ca’* influences the
membrane structure and transport of water and several ions
across it. Calcium regulates permeability of membranes.
6. Activation of enzymes: Ca** is needed for the direct activa-
tion of several enzymes, e.g. lipase (pancreatic), ATPase and
succinate dehydrogenase, and certain proteolytic enzymes.
7. Calmodulin-mediated action of Ca’t: Calmodulin
(molecular weight 17,000 Da) is a calcium-binding
regulatory protein. Calcium—calmodulin complex acti-
vates certain enzymes, e.g. adenyl cyclase, phospholipase
C, Ca?*-dependent protein kinases like pyruvate kinase
or phosphorylase kinase, etc.
8. Intracellular messenger: Certain hormones exert their ac-
tion through the mediation of Ca’* instead of cAMP. Cal-
cium is regarded as a second messenger for such hormonal
action, e.g. epinephrine in liver glycogenolysis. Calcium
serves as a third messenger for some hormones; e.g. antidi-
uretic hormone acts through cAMP and then through Ca**.
9. Release of hormones: Ca’ facilitates the release of cer-
tain hormones like insulin, parathyroid hormone, calci-
tonin from the endocrine glands.
PLASMA CALCIUM
Virtually there is no calcium in erythrocytes. Most of the
blood calcium is present in the plasma itself. The normal
concentration of plasma or serum Ca is 9-11 mg/dL (4.5-
5.5 mEq/L). About half of this (5 mg/dL) is in the ionized
form, which is functionally the most active. At least 1 mg/dL
of serum Ca is found in association with citrate or phosphate.
The other half of serum Ca (4-5 mg/dL) is bound to proteins,
mostly albumin and, to a lesser extent, globulin. Ionized and
citrate- (or phosphate-) bound Ca is diffusible from blood to
the tissues while protein bound Ca is nondiffusible.
Factors regulating plasma calcium levels are as follows:
. PTH (parathyroid hormone)
Whe
. Vitamin D or calcitriol
. Calcitonin
. Plasma proteins
Te
. Plasma phosphate.
Calcium is almost exclusively present in blood plasma or
serum. The hormones calcitriol, PTH and calcitonin are the
major factors that maintain homeostasis of the plasma cal-
cium within a range 9-11 mg/dL (Fig. 3.4.1).
Parathyroid hormone
PTH is secreted by parathyroid glands. Under the negative
feedback regulation of serum Ca**, PTH is released from
parathyroid glands. In fasting state, there is no absorption
from intestine; the normal plasma concentration of calcium
is maintained primarily by the action of PTH on mobiliza-
tion of calcium from bones (Fig. 3.4.1).
Intestine Ca PTH
[catia penn D
Calcitonin
calcitriol Plasma Ca
Bone Ca 9-11 mg/dL |}«—— Renal tubular Ca
PTH PTH
Fig. 3.4.1 Homeostasis of blood calcium.
Mechanism of action of PTH
PTH has three major independent sites of action: bone, kid-
ney and intestine. PTH binds to a membrane receptor pro-
tein on the surface of target cell and activates adenylate cy-
clase to liberate cAMP which, in turn, increases intracellular
calcium that promotes the phosphorylation of proteins and
finally brings about the biological actions. The prime func-
tion of PTH is to elevate serum calcium level.
Action on the bone: PTH causes decalcification or deminer-
alization of bone, a process carried out by osteoclasts. PTH-
stimulated increased activity of the enzymes pyrophosphatase
and collagenase results in bone resorption. Demineralization
ultimately leads to an increase in the blood Ca level. The ac-
tion of PTH on bone is quantitatively very significant to
maintain Ca homeostasis, which is being done at the expense
of loss of Ca from bone, particularly in dietary Ca deficiency.

Action on the kidney: PTH increases the Ca reabsorption or
decreases renal excretion of Ca*, resulting in rapid action of
PTH to elevate blood Ca levels. PTH promotes the produc-
tion of calcitriol or 1,25-dihydroxy-cholecalciferol (1,25
DHCC) in the kidney by stimulating 1-hydroxylation of
25-hydroxycholecalciferol.
Action on the intestine: PTH has the indirect action on the
intestine. It increases the intestinal absorption of Ca* by
promoting the synthesis of calcitriol.
Calcitriol
Calcitriol is nothing but physiologically active form of vita-
min D and is a hormone. Calcitriol induces a specific cal-
cium-binding protein in the intestinal mucosal cells, which
increases the intestinal absorption of calcium as well as
phosphate. Thus, blood Ca level is increased by calcitriol. By
acting independently on the bone, vitamin D increases the
number and activity of osteoblasts, and stimulates calcium
uptake by osteoblasts and promotes calcification or mineral-
ization and remodelling of bone.
Calcitonin
Calcitonin was reported in 1962 by Hirsch. It is secreted by
parafollicular cells of thyroid gland. The action of calcito-
nin on calcium metabolism is antagonistic to that of PTH.
Thus, by increasing the activity of osteoblasts, calcitonin
promotes calcification. Further, calcitonin decreases bone
resorption and increases the excretion of Ca into urine.
Q. 2. Write the dietary sources, factors influencing
absorption, biochemical functions and daily re-
quirements of calcium.
Ans.
DIETARY REQUIREMENTS OF CALCIUM
Adult males and females: 800 mg/day
Women during pregnancy, lactation 1.5 g/day
and postmenopause:
Children (1-18 years): 0.8-1.2 g/day
Infants (<1 year): 300-500 mg/day
SHORT ESSAYS
Q. 1. Functions of calcium.
Ans.
Biochemistry
DIETARY SOURCES
Best sources: Milk and milk products, especially cow milk.
Good sources: Beans, leafy vegetables, fish, cabbage, egg yolk.
ABSORPTION
The absorption of calcium mostly occurs in the first and
second parts of duodenum by an energy-dependent active
process. It is influenced by several factors.
Factors influencing absorption
Factors promoting Ca absorption
1. Vitamin D through its active form, calcitriol, induces
the synthesis of calcium-binding protein in the intesti-
nal epithelial cells and promotes Ca absorption.
2. Parathyroid hormone enhances Ca absorption through
the increased synthesis of calcitriol.
3. An acidic or low pH of intestine is more favourable for
Ca absorption.
4. Lactose promotes calcium uptake by intestinal cells.
5. The amino acids lysine and arginine facilitate increased
Ca absorption.
6. A high-protein diet favours its absorption.
Factors inhibiting Ca absorption
1. Phytates present in cereals and oxalates present in the
vegetables like cabbage and spinach form insoluble salts,
and interfere with Ca absorption.
2. High content of dietary phosphate prevents Ca uptake.
The dietary ratio of Ca and P—between 1:2 and
2:1—is ideal for optimum Ca absorption by intesti-
nal cells.
3. The free fatty acids react with Ca to form insoluble cal-
cium soaps. This is particularly observed when the fat
absorption is impaired as in sprue syndrome.
4. Alkaline condition (high pH) is unfavourable for Ca
absorption.
5. High content of dietary fibre interferes with Ca absorp-
tion.
For biochemical functions of calcium, refer to the answer
of Long Essays Q. 1.
Calcium is the most abundant among minerals in the
body. The total content of calcium in an adult man is
Quick Review Series: BDS 1st Year

about 1-1.5 kg. As much as 99% of it is present in the Q. 2. Regulation of serum calcium.
bones and teeth. A small fraction (1%) of the calcium is
Ans.
found outside the skeletal tissue, which performs a wide
variety of functions. For functions of calcium, refer to Factors regulating plasma calcium levels are discussed in
answer of Long Essays, Q. 1. Long Essays Q. 1.

SHORT NOTES

Q. 1. Importance of iodine. ii. Possibly essential trace elements: Nickel, vanadium, cad-
mium and barium.
Ans.
iii. Non-essential trace elements: Aluminium, mercury and
Iodine is mainly required for the synthesis of thyroid hor- silver.
mones, namely, thyroxin (T4) and triiodothyronine (T3),
which are involved in several biochemical functions. BIOLOGICAL ROLE OF IRON
Our body contains about 50 mg iodine and most of it
1. As a component of haemoglobin, myoglobin and cyto-
(80%) is present in the thyroid gland. Muscle, salivary
chromes, iron plays a key role in oxygen transport and
glands, and ovaries also contain some amount of iodine.
cellular oxidation.
Daily requirement as recommended by the National Re-
2. Iron is important in maintaining effective immunocom-
search Council (USA) is liberal intake of 100-200 1g.
petence of the body.
Sea water has highest iodine content. Seafood, fruits, veg-
etables, cereals and meat are good sources of iodine.
BIOLOGICAL ROLE OF ZINC
Q. 2. Normal value of serum calcium.
1. It is necessary to maintain the normal levels of vitamin A
Ans. in the serum.
The normal concentration of plasma or serum Ca is 2. It is essential for normal growth, reproduction and lon-
9-11 mg/dL (4.5-5.5 mEq/L). gevity of animals.
Q. 3. Four functions of calcium. Q. 6. Potassium balance.

Or
Functions of calcium in the body.
Ans.
The calcium is required for regulating a large number of cel-
lular activities, nerve and muscle function, hormonal action,
blood coagulation and cell motility.
Calcium, along with phosphate, is required for the forma-
tion (of hydroxyapatite) and physical strength of skeletal tissue.
Bones which are in a dynamic state serve as reservoir of calcium.
Q. 4. Name the hormones that regulate serum cal-
cium level.
Ans.
The hormones which regulate serum calcium levels are cal-
citriol, parathyroid hormone and calcitonin.
Q. 5. Name two trace elements and their biological
role.
Ans.
Trace elements are as follows:
i. Essential trace elements: Iron, copper, iodine, zinc, man-
ganese, fluorine, selenium and chromium.
Ans.
This is the principal action of the intracellular fluid. About
4 g potassium is present in normal diets. Its deficiency is
rare. Whole blood contains 200 mg/100 mL, but plasma
contains only 20 mg/100 mL (5 mEq/L). It is present in all
tissues.
Loss of potassium from tissues occurs in wasting dis-
eases and in severe dehydration. In severe diarrhoea and
vomiting also, potassium may be lost in large amounts.
Certain diuretics (e.g. acetazolamide or diamox) also in-
crease its urinary excretion. Tissue protein synthesis
causes an uptake of potassium, about 2 mg per each gram
of protein, and synthesis of glycogen in liver and muscle
will take up about 3-4 mg of potassium for each gram of
glycogen.
Q. 7. Describe the functions and deficiency of fluo-
rine.
Or
Functions of fluoride.
Or
Role of fluoride in prevention of dental caries.
 Biochemistry

Ans. Q. 9. Fluorosis.

Fluoride is necessary for normal development of teeth and Ans.

bones. It is protective against dental caries. It forms a protec-
tive layer of acid-resistant fluoroapatite with hydroxyapatite
of the enamel and prevents the tooth decay by bacterial ac-
ids. Further, fluoride inhibits the bacterial enzymes and re-
duces the production of acids.
Deficiency of fluoride: Drinking water containing less than
0.5 ppm of fluoride is associated with the development of
dental caries in children.
Q. 8. Dental fluorosis.
Ans.
Excessive intake of fluoride is harmful to the body. Intake of
fluoride more than 2 ppm (particularly > 5 ppm) in chil-
dren causes mottling of enamel and discolouration of teeth.
The teeth are weak and become rough with characteristic
brown or yellow patches on their surface. These manifesta-
tions are collectively referred to as dental fluorosis.
Intake of fluoride is harmful to the body. An intake above
2 ppm (particularly >5 ppm) in children causes mottling of
enamel and discolouration of teeth. The teeth are weak and
become rough with characteristic brown or yellow patches
on their surface. These manifestations are collectively re-
ferred to as dental fluorosis.
An intake of fluoride above 20 ppm is toxic and causes
pathological changes in the bones. Characteristic feature
of skeletal fluorosis is hypercalcification — increasing the
density of the bones of limbs, pelvis and spine. Even the
ligaments of spine and collagen of bones get calcified.
Neurological disturbances are also commonly observed.
The manifestations described 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.

BIOLOGICAL OXIDATION
SHORT ESSAY
Q. 1. Write briefly about electron transport chain. The reducing equivalents from various metabolic intermedi-
ates are transferred to coenzymes NAD* and FAD to produce
Ans.
NADH and FADH,, respectively. These two reduced coenzymes
The electrons in mitochondria participate in sequential oxi- pass through the ETC or respiratory chain and, finally, reduce
dation—reduction of various redox centres in enzyme com- oxygen to water. The passage of electrons through the ETC is
plexes of mitochondria. The electrons are transferred from associated with the loss of free energy. A part of this free energy
higher potential to lower potential. This flow of electrons is utilized to generate ATP from ADP and Pi.
occurring through successive dehydrogenase enzymes to- ETC is organized into five distinct complexes as follows
gether is known as electron transport chain (ETC). It is (Fig. 3.5.2):
located in inner membrane of mitochondria. 1. Complex I: NADH-CoQ reductase or NADH-—
The energy-rich carbohydrates, fatty acids and amino dehydrogenase complex
acids finally get oxidized to CO, and H;O after undergoing 2. Complex II: Succinate-Q-reductase
through a series of metabolic reactions. ETC represents the 3. Complex III: Cytochrome reductase
final stage of oxidizing the reducing equivalents derived 4. Complex IV: Cytochrome oxidase
from various metabolic intermediates to water (Fig. 3.5.1). 5. Complex V: ATP synthase.
The complexes I, II, III and IV are electron carriers,
whereas complex V is responsible for ATP production.
Carbohydrates i.
amino acids and Carbon dioxide + Water There are five distinct carriers that are sequentially ar-
fatty acids 40 ranged in the ETC, as shown in Fig. 3.5.2, which are respon-
NAN* 5 .
FAD ADP + Pi sible for the transfer of electrons from a given substrate to
ultimately combine with proton and oxygen to form water.

NADH +Ht
+H AP 1. NICOTINAMIDE NUCLEOTIDES
FADH, H,0
Among the two coenzymes NAD* and NADP* of vitamin
Fig. 3.5.1 Summary of biological oxidation. niacin, NAD* is more actively involved in the ETC. NAD* is
Quick Review Series: BDS 1st Year

a ATP ATP

Substrate NAD+ FMN CoQ Cyt b Cyt c, Cyt Cyt a Cyt a, 1/20,

C ) C ) 2Ht Ow y
NADH FMNH, ——
+H H,0
Fig. 3.5.2 Electron transport chain.

reduced to NADH + H®* by dehydrogenases with the re- 5. CYTOCHROMES

moval of two hydrogen atoms from the substrate. The sub-
Cytochrome c is a small conjugated protein containing 104
strates include glyceraldehyde-3-phosphate, pyruvate, isoci-
amino acids and a heme group. It is a central member of the
trate, a-ketoglutarate, and malate.
ETC with an intermediate redox potential. The iron of
heme in cytochromes is alternately oxidized (Fe**) and re-
2. FLAVOPROTEINS
duced (Fe?*), which is essential for the transport of elec-
The enzyme NADH dehydrogenase is a flavoprotein with trons in the ETC.
FMN as the prosthetic group. The coenzyme FMN receives The electrons are transported from coenzyme Q to cyto-
two electrons and a proton to form FMNH;. NADH dehy- chromes b, c, c, a and a; in an orderly manner.
drogenase is a complex enzyme closely associated with non- Fes <> Fe*
heme iron proteins or iron—sulphur (FeS) proteins.
The property of reversible oxidation—reduction of heme
NADH + H* + FMN—- NAD* + FMNH, iron present in cytochromes allows them to function as ef-
fective carriers of electrons in ETC. In the final stage of ETC,
3. IRON-SULPHUR PROTEINS the transported electrons, the free protons and the molecu-
The mechanism of action of iron-sulphur proteins in the lar oxygen combine to produce water.
ETC is not specific. Free energy is utilized to generate ATP from ADP and Pi
at the following three sites:
4. COENZYME Q 1. Oxidation of FMNH; by CoQ
2. Oxidation of cytochrome b by cytochrome c;
Coenzyme Q or ubiquinone is a quinone derivative with a
3. Cytochrome oxidase reaction.
variable isoprenoid side chain. The mammalian tissues pos-
sess a quinone with 10 isoprenoid units, which are known as The respiratory chain or ETC can be blocked by site-
coenzyme Qip (CoQip). specific inhibitors like rotenone, amytal piericidin, piericidin A,
The Q-cycle facilitates switching from ubiquinol, a two antimycin A, 2,3-dimercaptopropanol (BAL), sodium azide,
electron carrier, to cytochrome c, a single electron carrier. cyanide and carbon monoxide, etc.

Topic 6 WATER, EL
AND ACID-BAS
SHORT ESSAYS

Q. 1. Explain the role of kidney in acid-base The major renal mechanisms for the regulation of pH are
balance. as follows:
1. Excretion of H* ions
Ans. 2. Reabsorption of bicarbonate
3. Excretion of titratable acid (net acid excretion)
The kidneys have a highly significant role in the mainte-
4. Excretion of ammonium ions.
nance of acid-base balance or pH of extracellular fluid in the
body. These regulate the blood pH by maintaining the alkali 1. Excretion of H* ions: The only route through which the
reserve and excretion or reabsorption of the acidic or basic H?* ions can be eliminated from the body is kidney. The
substances, as required. The enzyme carbonic anhydrase has excretion of H* ions occurs in the proximal convoluted
a key role in the renal regulation of pH. tubules of the nephrons and is associated with the
 Biochemistry

regeneration of HCO;, as shown in Fig. 3.6.1. In the renal
tubular cell, carbonic anhydrase catalyses the production
of H,CO; from CO, and H,O. H,CO; then dissociates to
H* and HCO;- In exchange for Na*, the H* ions are se-
creted into the tubular lumen. Both Na* and HCO; are
reabsorbed into the blood. This is an effective mechanism
to eliminate acids (H*) from the body with a simultane-
ous generation of HCO;-. The bicarbonate adds up to the
alkali reserve of the body. The H* is excreted in urine af-
ter it combines with a non-carbonate base (Fig. 3.6.1).
Blood Tubular lumen
Renal
tubular
cell
The excreted H™ ions are actually buffered in the urine by
phosphate buffer. The acidic—basic phosphate pair is con-
sidered as urinary buffer.
4. Excretion of ammonium ions: This is one of the mech-
anisms to buffer H* ions secreted into the tubular fluid.
The H* ion combines with NH; to form ammonium
ion (NH,*), which is primarily excreted through distal
convoluted tubule. The enzyme glutaminase catalyses
deamidation of glutamine to glutamate and NH3. The
NHs, liberated in this reaction, diffuses into the tubular
lumen where it combines with H* to form NH,” ions,
which cannot diffuse back into tubular cells and, there-
fore, are excreted into urine.
NH,” is a major urine acid, about half to two-thirds of
body acid load is eliminated in the form of NH," ions.

Nat «— Nat L_ Nat Q. 2. What is the normal pH of the blood? Explain

various mechanisms by which it is regulated.
bW—» Ht
HCO; —_—
Ans.
Alkali Hydrogen ions
recovered to excreted Normal pH of blood plasma is maintained within a narrow
plasma range of 7.38-7.42. If the pH is below 7.38 the condition is
called acidosis, and if it is above 7.42 it is known as alkalosis.
In the body, three lines of defences have been developed
to regulate the body’s acid-base balance and maintain the
Fig. 3.6.1 Excretion of H* ions in renal regulation of blood pH.
blood pH (around 7.4):
I. Blood buffers (first line of defence)
2. Reabsorption of bicarbonate: This is primarily a mecha- II. Respiratory mechanism (second line of defence)
nism responsible to conserve the blood HCO; by prevent- III. Renal mechanism for pH regulation (third line of defence).
ing loss of HCO" through urine. The normal urine is al-
most free from HCO; as it is completely reabsorbed by BLOOD BUFFERS
proximal convoluted tubules. In this mechanism, there is The blood contains three buffer systems:
no generation of new bicarbonate or net excretion of H*. 1. Bicarbonate buffer
The net effect of this process is reabsorption of filtered 2. Phosphate buffer
bicarbonate by sodium—hydrogen exchanger (Fig. 3.6.2). 3. Protein buffer.
3. Excretion of titratable acid: Titratable acidity is a
measure of net acid excreted by the kidney. The term A buffer may be defined as a solution of a weak acid and
titratable acidity of urine means number of millilitres of its salt with a strong base. The buffering capacity is depen-
N/10 NaOH required to titrate 1 mL of urine to pH 7.4. dent on the absolute concentration of salt and acid. The
buffer resists the change in pH by the addition of acid or
alkali. It cannot remove H* ions from the body but tempo-
Blood Tubular lumen rarily acts as a shock absorbent to reduce the free H* ions.
Renal . Buffers can respond quickly in addition to acid or base; but
Pao Nees (itsred
cell y glomerulus) they do not serve to eliminate the acid from the body and are
also unable to replenish the body alkali reserve.
Nat Nat Nat For final elimination of acids, the respiratory and renal
HCO3 regulations are highly essential.
HCO; «~—— HCO; + H*—4—> H*
RESPIRATORY MECHANISM
Alkali { Hydrogen ions
HC!
recovered H,CO, excreted 260s Respiratory system provides a mechanism for rapid adjust-
to plasma CA
ment of acid-base balance by regulating the concentration
CO, +H,O of carbonic acid in the blood.
Carbonic anhydrase
Fig. 3.6.2 Reabsorption of bicarbonate from renal tubule. H,CO; <> CO, + H,O
yAT Quick Review Series: BDS 1st Year
A respiratory centre, located in the medulla of the brain,
controls the rate of respiration or the rate of removal of
CO,. This centre is highly sensitive to changes in the pH of
blood. When there is decrease in blood pH it results in hy-
perventilation to blow off CO:, thereby reducing the H,CO;
concentration. Simultaneously, the H* ions are eliminated
as H,0.
Since hyperventilation cannot proceed for long, respira-
tory control of blood pH is immediate but only a short-term
regulatory process.
RENAL MECHANISM FOR PH REGULATION
The kidneys have a highly significant role in the mainte-
nance of acid-base balance or pH of extracellular fluid in
the body. The kidneys regulate the blood pH by maintain-
ing the alkali reserve and excretion or reabsorption of the
acidic or basic substances, as situation demands. The en-
zyme carbonic anhydrase has a key role in the renal regu-
lation of pH.
The major renal mechanisms for the regulation of pH are
as follows:
1. Excretion of H* ions
2. Reabsorption of bicarbonate
3. Excretion of titratable acid (net acid excretion)
4. Excretion of ammonium ions.
SHORT NOTE
Q. 1. Importance of buffers in blood.
Ans.
A buffer may be defined as a solution of a weak acid and its
salt with a strong base.
The blood contains following three buffer systems:
1. Bicarbonate buffer system
2. Phosphate buffer system
3. Protein buffer system.
LONG ESSAY
Q. 1. Define an enzyme. How are enzymes classi-
fied? Describe the factors affecting enzyme-
catalysed reactions.
Ans.
1. Excretion of H* ions: Kidney is the only route through
which the H* can be eliminated from the body. This is an
effective mechanism to eliminate acids (H*) from the
body with a simultaneous generation of HCO;. The latter
adds up to the alkali reserve of the body. The Ht combines
with a non-carbonate base and is excreted in urine.
2. Reabsorption of bicarbonate: This mechanism is pri-
marily responsible to conserve the blood HCO; The
normal urine is almost free from HCO;
3. Excretion of titratable acid: Titratable acidity is a mea-
sure of acid excreted into urine by the kidney. Titratable
acidity reflects the H* ions excreted into urine, which
are actually buffered in the urine by phosphate buffer.
4. Excretion of ammonium ions: This is one of the mech-
anisms to buffer H* ions secreted into the tubular fluid.
The H* ion combines with NH; to form ammonium
ion (NH,*), which is primarily excreted through distal
convoluted tubule. The enzyme glutaminase catalyses
deamidation of glutamine to glutamate and NH3. The
NHs, liberated in this reaction, diffuses into the tubular
lumen where it combines with H* to form NH,” ions,
which cannot diffuse back into tubular cells and, there-
fore, are excreted into urine. NH,” is a major urine acid,
about half to two-thirds of body acid load is eliminated
in the form of NH,* ions.
The buffer resists the change in pH by the addition of
acid or alkali, and the buffering capacity depends upon
the absolute concentration of salt and acid. The buffer
cannot remove H* ions from the body but temporarily
acts as a shock absorbent to reduce the free H* ions. The
H* ions have to be ultimately eliminated by the renal
mechanism.
Enzymes can be defined as soluble, colloidal, biocatalysts
which are synthesized by living cells, but are capable of
acting independently of the cells and are specific in their
action.
 Biochemistry

Enzymes are broadly categorized as follows:

1. Intracellular enzymes: Enzymes are functional within

—
cells where they are synthesized.
2. Extracellular enzymes: Enzymes are functional outside

Velocity
the cell where they are synthesized, e.g. all the digestive
enzymes.
According to the IUB (International Union of Biochem-
istry) system (1964), enzymes are divided into six major
classes based on their function.
0
3. Oxidoreductases: Enzymes catalysing oxidation—reduction Concentration —+
reactions, e.g. lactate dehydrogenase (LDH; NAD), succi- Fig. 3.71 Effect of enzyme concentration on enzyme velocity.
nate dehydrogenase (FAD).
4. Transferases: Enzymes that catalyse the transfer of
functional groups other than hydrogen from one sub- 2. Concentration of substrate: With an increase in the
strate to another, e.g. hexokinase. concentration of substrate, the velocity of enzyme reac-
5. Hydrolases: Enzymes that bring about hydrolysis of tion gradually increases within the limited range of
compounds and then breaking the bond, e.g. acetyl cho- substrate levels. When velocity is plotted against the
line esterase. substrate concentration, a rectangular hyperbola is ob-
6. Lyases: Enzymes specialized in the addition or removal tained. The graph shows three distinct phases of the re-
of water, ammonia, CO,, etc. cleave bonds without add- action (Fig. 3.7.2).
ing water, e.g. aldolase.
7. Isomerases: Enzymes involved in all the isomerization
reactions, e.g. triose phosphate isomerase.

Velocity
—
8. Ligases: Enzymes catalysing the synthetic reactions of
linking together of two compounds, e.g. glutamine
synthetase.
Each class on its own represents the general type of reac-
tion brought about by the enzymes of that class. Each class
in turn is subdivided into many subclasses, which are fur-
ther divided. International Union of Biochemistry and Concentration of substrate
Molecular Biology (IUBMB) suggested a system of nomen- Fig. 3.72 Effect of substrate concentration on enzyme velocity.
clature of enzymes. A four-digit Enzyme Commission (EC)
number is assigned to each enzyme representing the class
(first digit), subclass (second digit), sub-subclass (third Enzyme kinetics and K,, value: The enzyme (E) and sub-
digit) and the individual enzyme (fourth digit); e.g. enzyme strate (S) combine with each other to form an unstable en-
code for alcohol dehydrogenase is 1.1.1.1, which means it is zyme-substrate complex (ES) for the further formation of
first enzyme of sub-subclass 1 of subclass 1 of the class 1. product (P).
FACTORS AFFECTING ENZYME ACTIVITY
EB +S===SES— +E +P
The various factors that influence the enzyme activity are as 2
follows:
1. Concentration of enzyme Here kj, k,, and k; represent the velocity constants for the
Concentration of substrate respective reactions; K,,, the Michaelis-Menten constant
wh

Effect of temperature (or Brig’s and Haldane’s constant), is given by the following
Effect of pH formula:
Effect of product concentration
PDR

Effect of activators or inhibitor.

. Concentration of enzyme: Concentration of the en-
zyme and the velocity of the reaction are directly pro-
portionate to each other. As the concentration of the The following equation is obtained after suitable alge-
enzyme increases, the velocity of the reaction propor- braic manipulation:
tionately increases (Fig. 3.7.1). In fact, this property of
enzyme is useful in determining the serum enzymes for
the diagnosis of diseases.
Quick Review Series: BDS 1st Year

where V is measured velocity

Vinax IS maximum velocity
K,, is Michaelis-Menten constant
S is substrate concentration

velocity
K,, or the Michaelis-Menten constant is defined as the
concentration of substrate to produce half-maximum veloc-
ity in an enzyme-catalysed reaction. It indicates that when

Enzyme
the substrate concentration equals the K,, value, half of the
enzyme molecules, i.e. 50%, are bound with the substrate
molecules.
K,n value is a constant and characteristic feature of a given
enzyme. It is important for measuring the strength of ES
complex. A low K,,, value indicates a strong affinity between
enzyme and substrate, whereas a high K,, value reflects a
weak affinity between them. Fig. 3.74 Effect of pH on enzyme velocity.
3. Effect of temperature: Velocity of an enzyme reaction
increases with increase in temperature up to a maxi- Each enzyme has an optimum pH at which the velocity is
mum and then declines. A bell-shaped curve is usually maximum. A bell-shaped curve is normally obtained for
observed (Fig. 3.7.3). pH versus enzyme velocity graph (Fig. 3.7.4). Around
neutral pH in the range of 6-8, most of the enzymes of
higher organisms show optimum activity.
5. Effect of product concentration: The enzyme velocity
decreases by the accumulation of reaction products. For
certain enzymes, the products combine with the active
site of enzyme and form a loose complex, which inhibits
velocity

the enzyme activity. This type of inhibition is generally

prevented by a quick removal of products formed in the
Enzyme

living systems.
6. Effect of activators: The inorganic metallic cations like
Mg?*, Mn?*, Zn?*, Ca?*, Co**, Cu2*, Na*, K*, etc. are
required for optimum activity of some of the enzymes;
e.g. chloride ions (CI) activate salivary amylase and Ca*
ions activate lipases. Two categories of enzymes requir-
ing metals for their activity are distinguished:
a. Metal-activated enzymes: The metal is not tightly held
Temperature (°C)
by the enzyme and can be exchanged easily with other
Fig. 3.73 Effect of temperature on enzyme velocity. ions, e.g. ATPase (Mg?* and Ca?*), enolase (Mg?*).
b. Metalloenzymes: These enzymes require certain
For most of the enzymes, the optimum temperature is 40— metal ions for their activity. The metals are tightly
45°C. However, a few enzymes, e.g. venom phosphokinases, held by the enzymes which are not readily exchanged,
muscle adenylate kinase are active even at 100°C. Majority of e.g. alcohol dehydrogenase, carbonic anhydrase, al-
the enzymes become inactive at higher temperature above kaline phosphatase, carboxypeptidase and aldolase
70°C. In general, when the enzymes are exposed to a tem- contain zinc.
perature above 50°C, denaturation leading to derangement in i. Phenol oxidase (copper)
the native structure of the protein and active site is seen. ii. Pyruvate oxidase (manganese)
4. Effect of pH: The enzyme activity is considerably influ- iii. Xanthine oxidase (molybdenum)
enced by increase in the hydrogen ion concentration (pH). iv. Cytochrome oxidase (iron and copper).

SHORT ESSAYS
Q. 1. Isoenzymes. Define isoenzymes. Name them (any three) and
Or give their clinical importance.
 Biochemistry

Ans. Ans.

Different molecular forms of the same enzyme synthesized For classification of enzymes, refer to the answer of Long
from different tissues are called isoenzymes or isozymes. Essays Q. 1.
They differ in their physical and chemical properties, such as Q. 3. Define competitive inhibition. Give three
the structure, electrophoretic and immunological proper- examples.
ties; Ky and Vinax Values, pH, relative susceptibility to inhibi-
tors and degree of denaturation. Or
Features and examples for competitive and feed-
ISOENZYMES OF LDH back inhibition.
LDH has five isoenzymes; all the forms are present in the Or
same individual. It is a tetramer with four subunits, which
may be either H (heart) or M (muscle) polypeptide chains. Explain the competitive inhibition of enzymes with
So five combinations of H and M chains are possible, form- examples.
ing five isoenzymes as follows: Ans.
LDH1 — Hz
The inhibitor, which is structurally similar to the substrate,
LDH2 — H;M
competes with the substrate for the active or binding sites
LDH3 — HM,
and thus diverts much of the enzyme to form the enzyme-—
LDH4 — VGH
inhibitor complex instead of enzyme-substrate complex. The
LDH5 — Mz
enzyme-inhibitor complex will not yield any products and
All the isoenzymes are seen in all persons in the popula- hence remains stable, thus preventing further enzyme activ-
tions. Normally, LDH2 concentration is greater than ity. This is known as reversible or competitive inhibition.
LDH1 in the blood. This pattern is reversed in myocardial This type of an inhibition can be reversed by adding ex-
infarction, which is known as flipped pattern. In myocar- cess of substrate, which will dislodge the inhibitor molecules
dial infarction, total LDH activity is increased, while LDH1 successfully from the enzymes.
isoenzyme is increased 5-10 times, which is of diagnostic The pharmacological action of several drugs is dependent
significance. on the ability of the drugs to inhibit one or other of the
Isoenzymes of LDH have immense value in the diagnosis enzymes responsible for the growth and multiplication of
of heart- and liver-related disorders. microorganisms.
Some examples of competitive inhibition are as follows:
ISOENZYMES OF CREATINE PHOSPHOKINASE 1. Malonate, oxalate and glutarate can inhibit succinate
Creatine kinase (CK) or creatine phosphokinase (CPK) ca- dehydrogenase—all of them resemble the substrate,
talyses the interconversion of phosphocreatine (or creatine succinic acid, in structure.
phosphate) to creatine. 2. Pressor amines like adrenaline and noradrenaline are
CPK exists as three isoenzymes. Each isoenzyme is a di- oxidized by monoamine oxidase. Ephedrine and am-
mer composed of two subunits — M (muscle) or B (brain) phetamine, which have similar structure as that of
or both. adrenaline and noradrenaline, inhibit the enzyme and
CPK1 — BB (brain) thus prolong the action of the pressor amines.
CPK2 — MB (heart) 3. Uric acid is formed by the oxidation of hypoxanthine by
CPK3 — MM (skeletal muscle). xanthine oxidase. In gout, uric acid accumulates in tis-
sues and causes symptoms. Allopurinol structurally re-
The earliest reliable indication of myocardial infarction is sembles hypoxanthine and by competitive inhibition
estimation of CPK2 (MB). decreases the formation of uric acid (Table 3.7.1).

ISOENZYMES OF ALKALINE PHOSPHATASE Feedback regulation: In a series of enzyme-catalysed reac-

tions of a metabolic pathway, the process of inhibiting the first
Alkaline phosphatase (ALP) has six isoenzymes. The most step by the final product is known as feedback regulation, e.g.
important ALP isoenzymes are a1-ALP, «2-heat-labile
in the series of reactions given below, A is the initial substrate;
ALP, «2-heat-stable ALP, pre-B-ALP, y-ALP, etc. Increase in
B, C and D are the intermediates; and E is the end product. In
a2-heat-labile ALP suggests hepatitis, whereas increased
a pathway catalysed by four different enzymes (E1, E2, E3, E4),
pre-B-ALP indicates bone diseases. the very first step (A — B catalysed by the enzyme E1) is most
Q. 2. Classification of enzymes. effective for regulating the pathway by the final end product E.
This type of control is called negative feedback regulation.
Or
E 1
E 2
E 3
E 4
Classification of enzymes with one example for
A—— B—>C——
D—— E
each class.
 Quick Review Series: BDS 1st Year

Table 3.7.1 Competitive inhibition of enzymes Some more examples of the enzymes with substrates and
Importance competitive inhibitors of biological significance are given in
Enzyme Substrate Inhibitor of inhibitor Table 3.7.1.
Xanthine Hypoxanthine = Allopurinol Used in the control
oxidase xanthine of gout to reduce ANTIMETABOLITES
excess production
These are the chemical compounds that block the metabolic
of uric acid from
hypoxanthine
reactions by their inhibitory action on enzymes. Antimetabo-
lites are usually structural analogues of substrates, and thus
Monoamine Catecholamines Ephedrine, Useful for elevating
are competitive inhibitors. They are in use for the treatment of
oxidase (epinephrine, amphetamine catecholamine
norepinephrine) levels cancer, gout, etc. The term antivitamins is used for the antime-
tabolites, which block the biochemical actions of vitamins,
Dihydrofolate Dihydrofolic Aminopterin, | Employed in the
reductase acid amethopterin, treatment of
causing deficiencies, e.g. sulphanilamide and dicumarol.
methotrexate leukaemia and
other cancers NONCOMPETITIVE INHIBITION
The inhibitor binds at a site other than the active site on the
enzyme surface. This binding impairs the enzyme function.
Feedback inhibition or end-product inhibition is a spe- The inhibitor has no structural resemblance with the sub-
cialized type of allosteric inhibition necessary to control strate. However, there usually exists a strong affinity for the
metabolic pathways for efficient cellular function. Aspartate inhibitor to bind at the second site. In fact, the inhibitor does
transcarbamoylase (ATCase) is a good example of an alloste- not interfere with the enzyme-substrate binding. But the ca-
ric enzyme inhibited by a feedback mechanism. talysis is prevented, possibly due to a distortion in the enzyme
Carbamoyl phosphate undergoes a sequence of reactions conformation.
for synthesis of the end product, CTP. When CTP accumu- The inhibitor generally binds with the enzyme as well as
lates, it allosterically inhibits the enzyme aspartate transcar- the ES complex. For noncompetitive inhibition, the K,, value
bamoylase by a feedback mechanism. is unchanged, while Vinax is lowered.
Heavy metal ions (Ag*, Pb?*, Hg?*, etc.) can noncom-
Q. 4. Competitive inhibition and noncompetitive
petitively inhibit the enzymes by binding with cysteinyl
inhibition.
sulphhydryl groups.
Ans.
Q. 5. Name five clinically important enzymes in
COMPETITIVE INHIBITION plasma. Indicate their normal values and clinical
significance.
The inhibitor (1), which closely resembles the real substrate
(S), is regarded as a substrate analogue. The inhibitor com- Ans.
petes with substrate and binds at the active site of the en- Estimation of enzyme activities in biological fluids (plasma/
zyme but does not undergo any catalysis. As long as the serum) is of great clinical importance. Certain enzymes are
competitive inhibitor holds the active site, the enzyme is not normally present in the plasma and have specific functions
available for the substrate to bind. to perform. They are mostly synthesized in the liver and
The relative concentration of the substrate and inhibitor enter the circulation, and are known as plasma-specific or
and their respective affinity with the enzyme determine the plasma-functional enzymes, e.g:
degree of competitive inhibition. The inhibition could be over- 1. Lipase
come by a high substrate concentration. In competitive inhibi- Normal value: 0.5-1.5 TU/L
tion, the K,, value increases whereas Vina. remains unchanged. Clinical significance: In acute pancreatitis and carcinoma
The enzyme succinate dehydrogenase (SDH) is a classical of pancreas plasma lipase levels are elevated and are
example of competitive inhibition with succinic acid as its decreased in liver disease, vitamin A deficiency and in
substrate. Malonic acid has structural similarity with suc- diabetes mellitus.
cinic acid and competes with the substrate for binding at the 2. Amylase
active site of SDH. Normal value: 80-180 units (Somogyi units/dL)
COOH Clinical significance: Plasma amylase is increased in
acute pancreatitis and in inflammatory conditions of
CH,COOH CH, the salivary glands. It is decreased in liver disease.
3. Alkaline phosphatase
CH,COOH COOH Normal value:
Succinic acid Malonic acid Adults: 1.5-5.0 units (Bodansky)
 Biochemistry

5-10 units (King—Armstrong) 4. Acid phosphatase

1.0-3.5 phenol units
Children: 5-14 units (Bodansky)
15-20 units (King—Armstrong)
4-12 phenol units
Clinical significance: Alkaline phosphatase is increased
in rickets, hyperparathyroidism, several diseases and
disorders involving bone and in obstructive jaundice.
Normal value: 0-2.5 units (King—Armstrong)
0-1.5 phenol units
Clinical significance: An elevation of its levels in plasma
is highly suggestive of prostatic carcinoma.
5. Isocitrate dehydrogenase: Its levels are increased in
plasma in liver disease.

SHORT NOTES

Q. 1. LDH isoenzymes. Ans.

Ans. Some enzymes are produced in an inactive form, which can

Different molecular forms of the same enzyme, synthesized
from different tissues are called isoenzymes. For isozymes of
LDH, refer to answer of Short Essays Q. 1.
Q. 2. Enzyme inhibition.
Ans.
be activated when required. Many of the digestive enzymes
and enzymes concerned with blood coagulation fall in this
category, and their activation is brought about by specifica-
tions or by other enzymes, which are proteolytic, e.g.:
Pepsinogen + H* ————————_> Pepsin

The process which makes the active site of the enzyme inef- Enterokinase
Trypsinogen ——______»- Trypsin
fective is known as enzyme inhibition. Enzyme inhibitor is a
substance which binds with the enzyme and brings about a
Q. 4. Give the enzyme and cofactors necessary for
decrease in catalytic activity of that enzyme.
transamination reaction.
There are three broad categories of enzyme inhibitions,
which are as follows: Ans.
1. Reversible inhibition or competitive inhibition, e.g. di-
Enzymes called ‘transaminases’ or ‘amino transferases’ catalyse
cumarol and vitamin K.
the transfer of the amino group of an amino acid to an a-keto
2. Irreversible inhibition or noncompetitive inhibition,
acid to form a new amino acid and a new keto acid. Amino
e.g. a variety of poisons like iodoacetate, heavy metals.
transferases are present in the liver, kidney and the brain.
3. Allosteric inhibition, e.g. allosteric enzymes.
The reaction is not confined only to the formation of ala-
Q. 3. What are proenzymes? Give two examples. nine and aspartic acid. Several other keto acids can be trans-
Mention their significance. aminated to form their corresponding amino acids.

SHORT NOTE

Q. 1. Normal value of bile acids. Various bile acids are hydroxy derivatives of cholanic acid.
They are synthesized in the liver from cholesterol, e.g.
Ans.
1. Cholic acid
Bile acids: 2. Deoxycholic acid
In hepatic: 1.93% 3. Chenodeoxycholic acid
In gall bladder: 9.14% 4. Lithocholic acid.
Quick Review Series: BDS 1st Year

HAEMOGLOBIN AND PORPHYRINS|

SHORT NOTES

Q. 1. Haemoglobin. period prior to its measurement. It is the best index of long-

term control of blood glucose levels.
Ans.
Normal concentration of HbA,, is 3-5% of total haemo-
Haemoglobin is a red blood pigment found in erythro- globin. In diabetics, it is elevated to as high as 15%.
cytes. Its functions are as follows:
1. Transport of O, from lungs to tissues Q. 3. Degradation of heme.
2. Excretion of CO, from tissues through the lungs. Ans.
Normal haemoglobin concentration in blood: Males:
Heme is degraded by a complex microsomal enzyme known
14-16 g/dL Females: 13-15 g/dL
as heme oxygenase. The end products of heme catabolism
Q. 2. Glycosylated form of haemoglobin. are bile pigments known as biliverdin (a green pigment) and
bilirubin (yellow pigment). Both of them are useless excre-
Ans.
tory products.
The nonenzymatic addition of any sugar residue to amino The entire degradation of heme is as shown in Fig. 3.9.1.
acids of protein is called glycation. Glucose-derived products
of normal adult haemoglobin refer to glycated or glycosyl- Q. 4. Haemoglobin — structure and synthesis.
ated haemoglobin (HbA,,). Ans.
Measurement of HbA,, is used for monitoring diabetes
control. It reflects mean blood glucose level over 2-month Haemoglobin is a tetrameric conjugated protein consisting
of globin — an apoprotein part and heme — the non-
protein part or prosthetic group. Four subunits of haemo-
Haemoglobin globin (Fig. 3.9.1), each one with a prosthetic heme group
| \ .Globin and the globin polypeptide are held together by noncova-
mino acid lent interactions primarily hydrophobic, ionic and hydro-
Heme pool
In gen bonds.
macrophage
NL lron
Biliverdine STRUCTURE OF GLOBIN (FIG. 3.9.2)
Biliverdine reductase
It consists of four polypeptide chains of two different mono-
Bilirubin
meric units. The common form of adult haemoglobin
(HbA,) is made up of two a-chains and two B-chains.
In blood { Bilirubin—albumin complex

STRUCTURE OF HEME
Bilirubin Heme is a porphyrin derivative known as protoporphyrin
In liver Bilirubin glucuronyl transferase IX, with iron at its centre.

Bilirubin diglucuronide (to bile)

Microbial enzymes (intestine)

SQ
Urobilinogen
Kidney /\ intestine
Intestine
and kidney } Urobilin Stercobilin
\
Urine Faeces

Fig. 3.9.1 Degradation of heme. Fig. 3.9.2 Structure of haemoglobin.

 Biochemistry

SHORT NOTES

Q. 1. Normal value of blood urea. Ketone bodies, i.e. acetone and acetoacetate are detected by
Rothera’s test, where nitroprusside in alkaline medium re-
Ans.
acts with keto group of ketone bodies to form a purple ring.
Normal value of blood urea is 15-40 mg/dL. Proteins in the urine are detected by sulphosalicylic acid
test and heat coagulation test. In sulphosalicylic acid test,
Q. 2. Write the tests to identify the following in
proteins get precipitated by sulphosalicylic acid, forming
urine:
protein-sulphosalicylate. Heat coagulation test is used for
a. Ketone bodies
the detection of albumin and globulins in the urine. This test
b. Proteins.
is based on the principle of denaturation of proteins fol-
Ans. lowed by coagulation.

SHORT NOTE

Q. 1. Normal value of serum alkaline phosphatase. 3-13 units (King—Armstrong)/dL

1.0-3.5 phenol units/dL
Ans.
Children: 5-14 units (Bodansky)/dL
Normal value of serum alkaline phosphatase in adults: 15-20 units (King—Armstrong)/dL
1.5-5.0 units (Bodansky)/dL 4-12 phenol units/L

SHORT NOTES

Q. 1. Pancreatic hormones. Ans.

Ans. Thromboxane is a main prostaglandin released by platelets.

Insulin and glucagon are the pancreatic hormones produced
by the beta cells of islets of Langerhans and alpha cells of
pancreas, respectively.
Q. 2. Thromboxane.
Major effects of thromboxanes are as follows:
1. Vasoconstriction
2. Promote platelet aggregation
3. Blood clotting (leading to thrombosis).
Quick Review Series: BDS 1st Year

NUTRITION
AND DIET
SHORT NOTE

Q. 1. Importance of milk in our daily diet.
Ans.
From the point of nutrition, milk is considered as complete
natural food. Generally, milk contains 80-90% of water.
Among the various nutrients, carbohydrates (lactose), fats
and proteins are the major constituents of milk.
Three types of proteins in the milk are casein, albumin
and globulin. Casein has high biological value. Lactoglobu-
lin produces immunity in children during breastfeeding.
Milk contains large amounts of calcium, phosphorus,
vitamin A and riboflavin. Major nutrients lacking in milk are
iron, copper and vitamin C.

SHORT NOTES

Q. 1. What is calorie? Mention the caloric value of are 4.1, 9.4 and 5.4 cal/g and when utilized in the body are
carbohydrates, proteins and fat. 4.0, 9.0 and 4.0 cal/g, respectively.
Ans. Q. 2. Balanced diet.

Calorie is the unit of heat. One calorie represents the Ans.

amount of heat required to raise the temperature of 1 g
water by 1°C.
CALORIC VALUE OF FOODS
The energy values of the three principal foodstuffs — carbo-
hydrate, fat and protein — measured in a bomb calorimeter
A diet which provides quantitatively and qualitatively ade-
quate amount of all principal foods for maintaining a good
health of an individual is known as balanced diet.
Ina balanced diet, carbohydrates should provide 65-75%,
lipids about 20% and proteins about 10-15% of the required
calories.

LONG ESSAYS

Q. 1. Classify vitamins. Indicate dietary sources, fats and oils, and also the fat solvents (alcohol, acetone, etc.).
daily requirements and deficiency symptoms of Fat-soluble vitamins can be stored in liver and adipose tissue.
fat-soluble vitamins. Briefly explain the role of vita-
min A in vision. Vitamin A

Ans. The fat-soluble vitamin A, as such, is present only in foods

of animal origin. However, its provitamins, carotenes, are
The vitamins are classified as follows (Fig. 3.14.1). found in plants.

FAT-SOLUBLE VITAMINS Biochemical functions

The four vitamins, namely, vitamin A, D, E and K are known 1. Retinol and retinoic acid function almost like steroid
as fat or lipid soluble. Their availability in the diet, absorp- hormones. They regulate the protein synthesis and thus
tion, and transport are associated with fat. They are soluble in are involved in the cell growth and differentiation.

[ais
Fat soluble
VitaminA
Vitamin D Non-B-complex
Vitamin E Vitamin C
Vitamin K
Fig. 3.14.1
2. Vitamin A is essential to maintain healthy epithelial
tissue.
3. Carotenoids (most important is B-carotene) function as
antioxidants and reduce the risk of cancers initiated by
free radicals and strong oxidants. B-Carotene is found to
be beneficial to prevent heart attacks. This is also attrib-
uted to the antioxidant property.
Dietary sources
Animal sources contain (preformed) vitamin A. The best
sources are liver, kidney, egg yolk, milk, cheese, butter. Fish
(cod or shark) liver oils are very rich in vitamin A.
Vegetable sources contain the provitamin A—carotenes.
Yellow and dark green vegetables and fruits are good sources
of carotenes, e.g. carrots, spinach, Amaranthus, pumpkins,
mango, papaya, etc.
Recommended dietary allowance
The recommended dietary allowance (RDA) of vitamin A
for adults is around 1000 retinol equivalents (5000 IU) for
man and 800 retinol equivalents (4000 IU) for woman. One
international unit (IU) is equivalent to 0.3 pg of retinol. The
requirement increases in growing children, pregnant women,
and lactating mothers.
Vitamin A deficiency
Deficiency manifestations of the eyes: Night blindness
(nyctalopia) is one of the earliest symptoms of vitamin A
deficiency. The individuals have difficulty to see in dim
light.
Severe deficiency of vitamin A leads to xerophthalmia.
This is characterized by dryness in conjunctiva and cornea,
and keratinization of epithelial cells. In certain areas of
conjunctiva, white triangular plaques known as Bitot’s spots
are seen.
Biochemistry
Water soluble
B-complex
Energy-releasing Haematopoietic
Thiamine (B,) Folic acid
Riboflavin (B,) Vitamin (B,,)
Niacin (B,) (cyanocobalamin)
Pyridoxine (B,)
Biotin (B,)
Pantothenic acid
Classification of vitamins.
If xerophthalmia persists for a long time, corneal ulcer-
ation and degeneration occur. This results in the destruction
of cornea, a condition referred to as keratomalacia, causing
total blindness. Vitamin A deficiency blindness is most com-
mon in children of the developing countries.
Vitamin D
Vitamin D is a fat-soluble vitamin. It resembles sterols in
structure and functions as does a hormone.
Recommended dietary allowance
The daily requirement of vitamin D is 400 IU or 10 g
of cholecalciferol. In countries with good sunlight (like
India), the RDA for vitamin D is 200 IU (or 5 pg of cho-
lecalciferol).
Dietary sources
Good sources of vitamin D include fatty fish, fish liver oils,
egg yolk, etc. Milk is not a good source of vitamin D.
Deficiency symptoms
Deficiency of vitamin D leads to demineralization of bone.
The result is rickets in children and osteomalacia in adults.
Rickets is derived from an old English word wrickken, mean-
ing to twist. Osteomalacia is derived from Greek (osteon,
bone; malakia, softness). Vitamin D is often called as antira-
chitic vitamin.
Rickets in children is characterized by bone deformities
due to incomplete mineralization, resulting in soft and pli-
able bones and delay in teeth formation. In rickets, the
plasma level of calcitriol is decreased and alkaline phospha-
tase activity is elevated.
In case of osteomalacia (adult rickets), demineralization
of the bones occurs (bones become softer), thereby increas-
ing their susceptibility to fractures.
“11'S Quick Review Series: BDS 1st Year

Renal rickets (renal osteodystrophy)
This is seen in patients with chronic renal failure. Renal
rickets is mainly due to decreased synthesis of calcitriol in
kidney. It can be treated by administration of calcitriol.
Vitamin E
Vitamin E (tocopherol) is a naturally occurring antioxidant.
It is essential for normal reproduction in many animals,
hence is known as antisterility vitamin.
Deficiency of vitamin K leads to the lack of active pro-
thrombin in the circulation. Therefore blood coagulation is
adversely affected. The individual bleeds profusely even for
minor injuries. The blood clotting time is increased.
Q. 2. Describe the sources and daily requirements
of vitamin D, and write a note on its deficiency.
Ans.
Refer to the answer of Long Essays Q. 1.

Recommended dietary allowance Q. 3. Enumerate the functions of vitamin D. Explain

A daily consumption of about 10 mg (15 IU) of a-tocopherol
for men and 8 mg (12 IU) for women is recommended; 1 mg
of a-tocopherol is equal to 1.5 IU. Vitamin E-supplemented
diet is advised for pregnant and lactating women.
its importance in calcium metabolism.
Ans.
Vitamin D is a fat-soluble vitamin. It resembles sterols in
structure and functions as does a hormone.

Deficiency symptoms
METABOLISM AND BIOCHEMICAL FUNCTIONS
The symptoms of vitamin E deficiency vary from one animal OF VITAMIN D
species to another. In many animals, the deficiency is associ-
Vitamins D, and D; as such are not biologically active. They
ated with sterility, degenerative changes in muscle, megalo-
are metabolized identically in the body and converted to ac-
blastic anaemia and changes in central nervous system.
tive forms of vitamin D. The metabolism and biochemical
VITAMIN K functions of vitamin D are depicted in Fig. 3.14.2.

Vitamin K is the only fat-soluble vitamin with a specific co-

enzyme function. It is required for the production of blood
clotting factors, essential for coagulation (in German, koagu- UV light kin
lation; hence, the name K for this vitamin). eyes

Cholecalciferol
Dietary sources
ive
Cabbage, cauliflower, tomatoes, alfalfa, spinach and other holecalciferol
green vegetables are good sources of vitamin K. It is also }25-Hydroxyla:
25-Hydroxy-
present in egg yolk, meat, liver, cheese and dairy products. cholecalciferol

Biochemical functions Kidney

The functions of vitamin K are concerned with blood clot- 25-Hydroxy-

alciferol
ting process. It brings about the post-translational (after 1-Hydroxylas
protein biosynthesis in the cell) modification of certain blood 4
clotting factors. The clotting factors II (prothrombin), VII, IX
and X are synthesized as inactive precursors (zymogens) in 1.25 DHC:
the liver. Vitamin K acts as a coenzyme for the carboxylation ( calcitriol‘cal pt
of glutamic acid residues present in the proteins, and this absorpti
reaction is catalysed by a carboxylase (microsomal).
ntestine
Calcitriol \
Recommended dietary allowance {Receptor (4
Calcitriol
Strictly speaking, there is no RDA for vitamin K, since it can receptor
complex (41)
be adequately synthesized in the gut. It is, however, recom- Calcitriol |
mended that half of the body requirement is provided in the Bone formatio roccccccoSaboccoccoc
diet, while the other half is met from the bacterial synthesis.
Accordingly, the suggested RDA for an adult is 70-140 ug/day.
Calcium binding
Deficiency symptoms protein

The deficiency of vitamin K is uncommon, since it is present

Ca?+

absorption
in the diet in sufficient quantity and/or is adequately synthe-
sized by the intestinal bacteria. Fig. 3.14.2 Metabolism and biochemical functions of vitamin D.

Synthesis of 1,25 DHCC: Cholecalciferol is first hydroxyl-
ated at 25th position to 25-hydroxycholecalciferol (25-OH
D3) by a specific hydroxylase present in liver, which is the
major storage and circulatory form of vitamin D. Kidneys
possess a specific enzyme, 25-hydroxycholecalciferol 1—hy-
droxylase, which hydroxylates 25-hydroxycholecalciferol at
position 1 to produce 1,25-dihydroxycholecalciferol (1,25
DHCC). It contains three hydroxyl groups (1, 3, and 25
carbon) and hence is referred to as calcitriol.
BIOCHEMICAL FUNCTIONS
Calcitriol (1,25 DHCC) is the biologically active form of vita-
min D. It regulates the plasma levels of calcium and phosphate.
Calcitriol acts at three different levels (intestine, kidney and
bone) to maintain plasma calcium.
SHORT ESSAYS
Q. 1. Ascorbic acid.
Or
Functions and deficiency of vitamin C.
Or
Functions and deficiency of ascorbic acid.
Ans.
VITAMIN C (ASCORBIC ACID)
Vitamin C is a water-soluble versatile vitamin. It plays an
important role in human health and disease.
Biochemical functions
Most of the functions of vitamin C are related to its property
to undergo reversible oxidation—reduction, i.e. interconver-
sion of ascorbic acid and dehydroascorbic acid.
1. Collagen formation: Vitamin C plays the role of a
coenzyme in hydroxylation of proline and lysine,
while protocollagen is converted to collagen (i.e.
post-translational modification). The hydroxylation
reaction is catalysed by lysyl hydroxylase (for lysine)
and prolyl hydroxylase (for proline). This reaction is
dependent on vitamin C.
Hydroxyproline and hydroxylysine are essential for the
collagen cross-linking and the strength of the fibre. In
this way, vitamin C is necessary for maintenance of nor-
mal connective tissue and wound healing process.
2. Bone formation: Bone tissues possess an organic ma-
trix, collagen and the inorganic calcium, phosphate, etc.
Vitamin C is required for bone formation.
3. Iron and haemoglobin metabolism: Ascorbic acid en-
hances iron absorption by keeping it in the ferrous form.
This is due to the reducing property of vitamin C.
Biochemistry
1. Action of calcitriol on the intestine: Calcitriol increases the
intestinal absorption of calcium and phosphate. In the in-
testinal cells, calcitriol binds with a cytosolic receptor to
form a calcitriol-receptor complex. This complex then ap-
proaches 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 in-
volved in minimizing the excretion of calcium and
phosphate through the kidney by decreasing their excre-
tion and enhancing reabsorption.
4. Tryptophan metabolism: Vitamin C is essential for the
hydroxylation of tryptophan (enzyme, hydroxylase) to
hydroxytryptophan in the synthesis of serotonin.
5. Tyrosine metabolism: Ascorbic acid is required for
the oxidation of p-hydroxyphenylpyruvate (enzyme,
hydroxylase) to homogentisic acid in tyrosine
metabolism.
6. Folicacid metabolism: The active form of the vitamin
folic acid is tetrahydrofolate (FH,). Vitamin C is
needed for the formation of FH, (enzyme, folic acid
reductase).
7. Synthesis of corticosteroid hormones: Adrenal gland
possesses high levels of ascorbic acid, particularly in
periods of stress. It is believed that vitamin C is neces-
sary for the hydroxylation reactions in the synthesis of
corticosteroid hormones.
8. Sparing action of other vitamins: Ascorbic acid is a
strong antioxidant. It spares vitamin A, vitamin E and
some B-complex vitamins from oxidation.
9. Immunological function: Vitamin C enhances the syn-
thesis of immunoglobulins (antibodies) and increases
the phagocytic action of leucocytes.
10. Preventive action on chronic diseases: Free radicals are
constantly produced in the normal metabolism. They
cause serious damage to proteins, lipids, DNA and the
cell membranes. The free radicals are implicated in the
development of cancer, heart diseases and also ageing.
Vitamin C is a strong biological antioxidant, besides
vitamin E and B-carotene.
Deficiency symptoms
The deficiency of ascorbic acid results in scurvy. This disease
is characterized by spongy and sore gums, loose teeth, anae-
mia, swollen joints, decreased immunocompetence, delayed
wound healing, haemorrhage, osteoporosis, etc.
Quick Review Series: BDS 1st Year

Q. 2. Vitamin D deficiency. reactions like transamination, decarboxylation, deamination,

transsulphuration, condensation, etc.
Ans.
1. Transamination: PLP is involved in the transamination
Deficiency symptoms: For deficiency symptoms, refer to the reaction (by transaminase), converting amino acids to
answer of Long Essays Q. 1. keto acids.
2. Decarboxylation: Some of the a-amino acids undergo
Q. 3. Biological functions of vitamin A.
decarboxylation to form the respective amines. This is
Or carried out by a group of enzymes called decarboxylases,
Describe the functions of vitamin A. which are dependent on PLP. Many biogenic amines
with important functions are synthesized by PLP decar-
Ans. boxylation.
Biochemical functions of vitamin A: Vitamin A is necessary Serotonin (5-hydroxytryptamine, 5-HT) produced from
for a variety of functions such as vision, proper growth and tryptophan is important in nerve impulse transmission
differentiation, reproduction and maintenance of epithelial (neurotransmitter). It regulates sleep, behaviour, blood
cells. For biochemical functions, refer to the answer of Long pressure, etc.
Essays Q. 1.
Tryptophan ——> 5-Hydroxytryptophan “a
Q. 4. Vitamin A deficiency. COz
Or 5-Hydroxytryptamine
Deficiency manifestations of vitamin A.
The synthesis of catecholamines (dopamine, norepi-
Ans. nephrine and epinephrine) from tyrosine requires PLP.
Catecholamines are involved in metabolic and nervous
Refer to the answer of Long Essays Q. 1.
regulation.
Q. 5. Coenzyme forms and deficiency of niacin.
PLP .
Ans. Tryptophan ——> DOPA -_y Dopamine ——~>

Niacin or nicotinic acid is also known as pellagra-preventive COz

(PP) factor of Goldberg. The coenzymes of niacin (NAD* Norepinephrine ——> Epinephrine
and NADP*) can be synthesized by the essential amino acid
tryptophan. 3. PLP is required for the synthesis of 8-amino levulinic
Deficiency symptoms: Niacin deficiency results in a con- acid—the precursor for heme synthesis.
dition called pellagra (Italian, rough skin). The disease pel-
lagra involves skin, gastrointestinal tract and central nervous Glycine ~_Ala synthase
> 6-Amino—— Heme
system. The symptoms of pellagra are commonly referred to Succinyl Co levulinic
as three Ds. The disease also progresses in that order derma-
acid (ALA)
titis, diarrhoea, dementia and, if not treated, may rarely lead
to death (fourth D).
4. PLP plays an important role in the metabolism of sul-
Q. 6. Biological functions of pyridoxine. phur-containing amino acids. Trans-sulphuration (trans-
fer of sulphur) from homocysteine to serine occurs in
Ans.
the synthesis of cysteine.
5. Deamination of hydroxyl-group-containing amino ac-
PYRIDOXINE (VITAMIN B,)
ids requires PLP.
Vitamin Bg is used to collectively represent the three com-
pounds, namely, pyridoxine, pyridoxal and pyridoxamine. Dehydratase
Serine —<u— Pyruvate+ NH3
PLP
Biochemical Functions Dehydratase
Threonine a-Ketobutyrate+ NH3
Pyridoxal phosphate (PLP), the coenzyme of vitamin Bg is PLP
found attached to the é-amino group of lysine in the en- 6. Serine is synthesized from glycine by a PLP-dependent
zyme. PLP is closely associated with the metabolism of enzyme hydroxymethyltransferase.
amino acids. The synthesis of certain specialized products
such as serotonin, histamine and niacin coenzymes from the Q. 7 Visual cycle.
amino acids is dependent on pyridoxine. PLP participates in Ans.
 Biochemistry

Wald’s visual cycle: Rhodopsin is a conjugated protein Rhodopsin

: Light
present in rods. It contains 11-cis retinal and the protein (11-cis-retinal (photon)
opsin. -opsin)

The primary event in visual cycle, on exposure to light,

is the isomerization of 11-cis retinal to all-trans retinal. Nerve
impulse
This leads to a conformational change in opsin, which is NN
responsible for the generation of nerve impulse. The all-
trans retinal is immediately isomerized by retinal isomer-
ase (of retinal epithelium) to 11-cis retinal, which com-
bines with opsin to regenerate rhodopsin and _ this
Retinal
completes the visual cycle. However, the conversion of all-
11- cis-retinal Isomerase All-trans-retinal
trans retinal to 11-cis retinal is incomplete. Therefore,
most of the all-trans retinal is transported to the liver and
NADH + H* .
converted to all-trans retinol by alcohol dehydrogenase.
Alcohol NADH +H*\1 aicohol
The all-trans retinol undergoes isomerization to 11-cis y, dehydrogenase dehydrogenase
retinol, which is then oxidized to 11-cis retinal to partici- NAD- NAD- (liver)
pate in the visual cycle (Fig. 3.14.3).
Isomerase
Q. 8. How does vitamin K take part in the coagula- 11- cis-retinal -
(liver)
All-trans-retinal
tion of blood?
Fig. 3.14.3 Visual cycle.
Ans.

Vitamin K is the only fat-soluble vitamin with a specific
coenzyme function. It is required for the production of
blood clotting factors, which are essential for coagula-
tion (in German, koagulation; hence the name K for this
vitamin).
The functions of vitamin K are concerned with blood clot-
ting process. It brings about the post-translational (after protein
biosynthesis in the cell) modification of certain blood clotting fac-
tors. The clotting factors II (prothrombin), VII, IX and X are
synthesized as inactive precursors (zymogens) in the liver.

SHORT NOTES

Q. 1. Pellagra. Vitamin D deficiency.

Ans.
Niacin deficiency results in a condition called pellagra (Ital-
ian, rough skin). The disease pellagra involves skin, gastroin-
testinal tract and central nervous system. The symptoms of
pellagra are commonly referred to as three D’s. The disease
also progresses in that order dermatitis, diarrhoea, dementia,
and, if not treated, may rarely lead to death (fourth D).
Q. 2. Vitamin C.
Or
Enumerate two biochemical functions of vitamin C.
Ans.
Vitamin C is a water-soluble versatile vitamin. It plays an
important role in human health and disease.
Biochemical Functions: Refer to the answer of Short
Essays Q. 1.
Q. 3. Vitamin D.
Or
Ans.
Vitamin D is a fat-soluble vitamin. It resembles sterols in
structure and functions as does a hormone.
Deficiency of vitamin D leads to demineralization of
bone. The result is rickets in children and osteomalacia in
adults. Vitamin D is often called as antirachitic vitamin.
Q. 4. Vitamin K.
Ans.
Vitamin K is the only fat-soluble vitamin with a specific coen-
zyme function. It is required for the production of blood clot-
ting factors, which are essential for coagulation (in German,
koagulation; hence the name K for this vitamin).
Q. 5. Fat-soluble vitamins.
Ans.
The four vitamins, namely, vitamin A, D, E and K are known
as fat or lipid soluble. Their availability in the diet, absorp-
tion and transport are associated with fat. They are soluble
 Quick Review Series: BDS 1st Year

in fats and oils, and also the fat solvents (alcohol, acetone, Thiamine (anti-beriberi or antineuritic vitamin) is water
etc.). Fat-soluble vitamins can be stored in liver and adipose soluble. It has a specific coenzyme, thiamine pyrophos-
tissue. phate (TPP), which is mostly associated with carbohy-
drate metabolism.
Q. 6. List four features of vitamin A deficiency.
TPP plays an important role in the transmission of nerve
Or impulse. It is believed that TPP is required for acetylcholine
synthesis and the ion translocation of neural tissue.
Describe the features of deficiency of vitamin A.
Q. 10. Importance of folic acid in human diet.
Or
Ans.
Deficiency diseases of vitamin A.
Folic acid or folacin (Latin, folium: meaning leaf) is
Ans.
abundantly found in green leafy vegetables. It is impor-
Refer to the answer of Long Essays Q. 1. tant for one-carbon metabolism and is required for the
synthesis of certain amino acids, purines and the py-
Q. 7. Coenzymes of riboflavin and niacin.
rimidine thymine.
Ans.
Q. 11. Source and function of vitamin Bj.
Flavin mononucleotide (FMN) and flavin adenine dinucleo-
Ans.
tide (FAD) are the coenzyme forms of riboflavin, and NAD*
and NADP* are the coenzyme forms of niacin. Vitamin B,, is also known as antipernicious anaemia vitamin.
Q. 8. What are the diseases caused by deficiency of It is a unique vitamin, synthesized by only microorganisms,
and not by animals and plants. It was the last vitamin to be
(a) niacin and (b) vitamin B,2 (cobalamin)?
discovered.
Ans.
Q. 12. Name the vitamins necessary for neurologi-
Niacin deficiency results in a condition called pellagra cal functions.
(Italian, rough skin). The disease pellagra involves skin, gas-
Ans.
trointestinal tract and central nervous system. The symptoms
of pellagra are commonly referred to as three D’s. The disease The vitamins necessary for neurological functions are as
also progresses in that order dermatitis, diarrhoea, dementia, follows:
and if not treated, may rarely lead to death (fourth D). Thiamine (vitamin B,)
The most important disease associated with vitamin Bp Pyridoxine (vitamin Be)
deficiency is pernicious anaemia. It is characterized by low
Q. 13. Coenzymes of niacin and pyridoxine.
haemoglobin levels, decreased number of erythrocytes and
neurological manifestations. Ans.
The excretion of methylmalonic acid (elevated) in urine and
Nicotinamide adenine dinucleotide (NAD*) and nicotin-
estimation of serum B,, level are used to assess B,, deficiency.
amide adenine dinucleotide phosphate (NADP*) are the
Q. 9. Explain the role of thiamine. coenzymes of niacin.
PLP is the coenzyme of vitamin pyridoxine (vitamin B,).
Ans.
BIOCHEMISTRY

VIVA QUESTIONS

. Name a sugar that is characterized by its nonreducing property; 17. Name few polyunsaturated fatty acids.
it is also called cane sugar or table sugar. Ans. Linoleic acid, linolenic acid and arachidonic acid.
Ans. Sucrose.
18. Where does fatty acid oxidation occur?
. Give the number of asymmetric carbon atoms in glucose. Ans. Cytoplasm, microsomes and mitochondria.
Ans. Four.
19. Name an omega-3 polyunsaturated fatty acid.
. Which carbohydrate has B-1,4-glycosidic bond? Ans. a-Linolenic acid.
Ans. Lactose.
20. Name a good source of polyunsaturated fatty acids.
. Name a homopolysaccharide made up of fructose. Ans. Cottonseed oil.
Ans. Inulin.
21. What is the most important role of cholesterol?
. Name a milk sugar. Ans. Cholesterol is a component of cell membrane.
Ans. Lactose.
22. Where does cerebronic acid present?
. Name aglycone portion in methyl glucoside. Ans. Galactosyl ceramide.
Ans. Methanol.
23. What is the limiting factor for fatty acid synthesis?
. Mucopolysaccharides are also known as Ans. Acetyl-CoA carboxylase.
Ans. Glycosaminoglycans.
24. Which is the base that is not found in DNA?
. Monosaccharides can be separated by which process? Ans. Uracil.
Ans. Chromatography.
25. On complete hydrolysis of DNA, what will we get?
. In fructofuranose, which is an anomeric carbon atom? Ans. Deoxy pentose sugar, phosphoric acid and purine bases.
Ans. Carbon 2.
26. DNA double helix is bound by which bond?
10. Name an amino acid having no asymmetric carbon atom. Ans. Hydrogen bond.
Ans. Glycine.
27. rRNA is mainly produced in which component of the cell?
11. Name few nonessential amino acids. Ans. Nucleolus.
Ans. Alanine, cysteine and proline.
28. In Niemann—Pick disease, which substance accumulates in CNS
12. Albumins and globulins are what type of proteins? in excess?
Ans. Simple proteins. Ans. Phosphosphingosides.

13. How are amino acids separated? 29. Mention the characteristics of the genetic code.
Ans. High voltage electrophoresis is used to separate amino acids. Ans. The genetic code is universal, nonoverlapping and it degenerates.
14, Name the process of transfer of information from the RNA to the 30. Ketone body formation takes place in which organ?
proteins. Ans. Liver.
Ans. Translation.
31. Which element is known to influence the body’s ability to handle
15. Name the precursor of melanin. oxidative stress?
Ans. Tyrosine. Ans. Selenium.

16. How does an amino acid exist at a pH below the isoelectric point? 32. Which group of proteins assists in folding of other proteins?
Ans. Cation. Ans. Chaperones.
Quick Review Series: BDS 1st Year

33. In oxidative phosphorylation, which method links the ATP 43. How many iron atoms are contained by each haemoglobin molecule?
production and respiratory chain? Ans. Four iron atoms.
Ans. Chemiosmotic methods.
44. Which substance hampers the absorption of calcium?
34. Name an element having the lowest redox potential. Ans. Phytate.
Ans. Hydrogen.
45. Name a coenzyme that takes part in hydrogen transfer
35. Name the compound having the highest redox potential. reactions.
Ans. Cytochrome c. Ans. Coenzyme Q.
36. What is the standard free energy of hydrolysis of ATP into ADP 46. Which coenzyme is required in transamination reactions?
and Pi? Ans. Pyridoxal phosphate.
Ans. —7.3 kcal/mol.
47. What is the pH of pancreatic juice?
37. Which substances poison cytochrome oxidase?
Ans. The pH of pancreatic juice varies from 7 to 8.
Ans. Carbon monoxide, hydrogen sulphide and cyanide.
48. Which is the reliable test for glomerular filtration rate?
38. Name few diseases caused by deficiencies of water-soluble vitamins.
Ans. Inulin clearance test.
Ans. Beriberi, pellagra, scurvy, etc.
49. Normal blood pH is
39. How much proportion of the total body calcium is present in
Ans. 7.38-7.4.
bones and teeth?
Ans. 99%. 50. Where does the synthesis of protein occur?
40. What is the normal range of plasma calcium? Ans. Polyribosomes.
Ans. 9-11 mg/dL. 51. What does the people consuming polished rice as their staple
41. What is the normal range of ionized calcium in plasma? food prone to develop?
Ans. 4—5 mg/dL. Ans. Beriberi.

42. Name the causes of tetany. 52. Detoxification of drugs is controlled by

Ans. Hypocalcaemia and alkalosis. Ans. Cytochrome P450.
ORAL
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Topic 4 DONtiNe 220.2... cee cece cece ceeecee ee ee eee ee eee e eee e tee aeaaeaeeeeeeeeeeeeeeeseesennsinaeeaeees 329
Topic 5 PUID Looe ce eee eee ee cece cea eeaaeeeeeeeeeeeeee ca deaaaaeaaeaeeeeeeeeeeeeseesegeeneciceeeeees 336
Topic 6 COMENTUM 0c eee eect teen eeetee entire tenet eeeeeeeetaeeeenieeeeneeeesaeeennaeenennees 342
Topic 7 Periodontal Ligament ..............cccccceeceeceeeeeeceeeeeeeeeeeeeeeeeeeeeeeenenaeeeeees 347
Topic 8 Bone (Maxilla and Mandible)...............::::ccccsesceeceececereeeeeeeseeeeessnnees 352
Topic 9 Oral MUCOUS MeEMbrane........ceccceeer center eeeeeeeeneeeteeeeetaeeentaeeennnees 355
Topic 10 = Salivary Gland... eee eect eee etter eeaeeeeeneeeeneeeetaeeenaeeneneees 364
Topic 11 TOOth Eruption .........cccccccecceceeeeeeeeeeeeeeaaeeaeeeeeeeeeeeeeesecesnccuesaeeeeeeeeeeeees 369
Topic 12 Shedding of Deciduous Teeth... eeeeeceeeeeeereeeeeeeesteeeeteeeennees 372
Topic 13 = Temporomandibular JOint...... eee eeeeneee teeter eeeeeeenaeereenneeeees 373
Topic 14 = Maxillary SINUS «0.0... eee eee cent etter ee eeneeeetaeeeeeieeeeneeeetaeeentaeenennees 374
Topic 15 Histochemistry of Oral TiSSUCS 0.0.0... eee eeeeeeeete teeter ee eneeentaeeeennees 376
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ORAL HISTOLOGY
LONG ESSAYS
Q.1. Describe the development of face. Mention the
congenital defects of orofacial region.
Ans.
1. The face is essentially derived from seven primordia:
a. Two mandibular processes
b. Two maxillary processes
c. Two lateral nasal processes
d. Median nasal process.
The mandibular and maxillary processes originate from
the first branchial arch.
The two lateral nasal processes and the median nasal
process arise from the frontonasal process, which in
turn arose as a prominence of forebrain. The lowermost
part of the median nasal process is called the globular
process.
The frontonasal process will give rise to most of the
structures of the upper and middle portions of the face.
Next, the formation and deepening of the stomodeum,
and olfactory (nasal) pits and division of the caudal
portion of the frontonasal process into the median nasal
process and two lateral processes.
The lateral nasal processes are adjacent to the maxillary
process and separated from them by shallow furrows.
Nasolacrimal grooves, which give origin to the nasolac-
rimal ducts, originate parallel and medial to the naso-
maxillary grooves.
The median nasal process is at first larger than the
lateral nasal process, but it later lags in growth.
The upper lip develops by a union of globular process
with the right and left maxillary processes.
DEVELOP
AN
10. The subsequent changes that occur are only in part to
the union of the primary separated parts and flow of
mesenchyme.
ll. The primitive oral fissure, which is wide, is reduced
by progressive fusion between the maxillary and man-
dibular processes with the formation of cheek.
12. The primitive lips and cheeks are invaded by second
branchial arch mesenchyme, which forms facial
muscles.
a. The further development of the face is mainly due to
changes in proportion and relative position.
b. The face is complete by about the 8th week.
c. In general, the derivatives of the frontonasal process
are supplied by the ophthalmic nerve, maxillary
process by maxillary nerve and the mandibular
process by mandibular nerve.
d. Clefts of the face and lips can result due to hereditary
factors and environmental factors like radiation,
drugs and nutritional deficiencies.
In summary, the development of face is as follows:
1. Formation of lower jaw and lip — By fusion of the man-
dibular processes derived from the first branchial arch.
. Formation of cheeks — By the union of maxillary and
the mandibular processes.
. Formation of external ear > From dorsal part of I ecto-
dermal cleft.
. Formation of upper part of face and middle face + By
the fusion of maxillary and the lateral nasal process.
. Formation of upper lip —> By the fusion of globular
process with the right and left maxillary process.
a0 Quick Review Series: BDS 1st Year
Q.2. Describe the development of palate.
Ans
1. As a result of differential growth, the roof of the stomo-
deum becomes progressively more highly arched. The
tongue mass, which is arising from the floor of the
primitive pharynx, is in contact with the roof.
2. The maxillary processes develop medially directed
. : . 2. III arch and
shelf-like outgrowths called palatine processes, which
impinge on the sides of developing tongue.
3. With the growth of neck and mandible in the 8th week
the tongue sinks below the level of the primitive pri-
mary palate so that the palatal processes become free to
swing in to the horizontal plane.
4, When the palatine processes assume their horizontal
position, they touch the lower border of the nasal
septum, but are still separated from each other by a
median cleft. The cleft closes gradually from the anterior
to the posterior region. . .
5. It should be emphasized that not the entire palate arises
: 3. Another unpaired swelling called tuberculum impar
from the palatine processes. Only the soft palate and the
central portion of the hard palate arise from the palatine
PTOCcesses. . .
6. The horseshoe-shaped peripheral parts originate from
maxillary process and the premaxilla (primitive palate
: two-thirds of the tongue.
or primary palate) from the globular process of the
frontonasal process.
7. In summary,
a. The palate develops from three components:
i. The two palatal processes
ii. The frontonasal process.
b. The primitive palate formed from the frontonasal
process.
c. The definitive palate is formed by the fusion of these
three parts:
i. Each palatal process fuses with the posterior
margin of the primitive palate.
ii. The two palatal processes fuse with each other in
the midlines.
iii. The medial edges of the palatal processes fuse
with the free lower edges of the nasal septum,
thus separating the two nasal cavities from each
other and from the mouth.
Clinical Consideration
1. The nonunion of the palatine processes forming the
palate can cause clefts. It may be complete or partial.
2. In cleft palate either one or both process may fail to
unite with the nasal septum. . rapidly, various types of papillae are differentiated in the
3. In a majority of patients with cleft palate there will be
associated cleft lip.
4. Both hereditary and environmental factors can be the
cause for cleft palate.
Q.3. Development of tongue.
Ans.
Tongue develops from the following:
1. Tarch,
3. TV arch
Tongue development is discussed under two headings:
1. Development of the anterior two-thirds of the tongue.
2. Development of posterior one-third of the tongue.
© Development of the Anterior Two-thirds
1. The tongue develops in the floor of the developing
mouth
2. The medialmost part of the first arch proliferates to
form a pair of lingual swellings.
: : :
develops in between the lingual swellings due to prolif-
:
eration of I arch.
4. The union of the two lingual swellings with each other
and with the tuberculum impar forms the anterior
.
Development of the Posterior One-third
1. Caudal to the median tongue buds another midline
swelling develops from the III and IV arches. This is
called the copula of His or hypobranchial eminence.
2. A transverse groove separates its lower end to form the
epiglottis. The superior part approaches the lingual
swellings spreading in the form of a ‘V to form the
posterior one-third of the tongue.
In summary, it is seen that
1. The anterior two-thirds of the tongue is formed by the
fusion of:
tuberculum impar + the two lingual swellings >
derived from I arch.
. The posterior one-third is formed by the cranial part
of the hypobranchial eminence (copula of His) >
derived from the III arch. The posteriormost portion
of posterior one-third of tongue — derived from
IV arch.
Later Stages of Tongue Development
yy ater stages of development the tongue grows very
anterior part, whereas lymphatic tissue develops in the
posterior part.

The extrinsic muscles of the tongue grow into its primi-
tive mesoderm, and the intrinsic muscles differentiate from
the mesenchyme within the tongue.
Developmental Anomalies of Tongue
1. Median rhomboid glossitis: Once thought to be due
to the persistence of tuberculum impar — the recent
concept is that it is the result of a fungal infection.
SHORT NOTES
Q.1. Meckel’s cartilage.
Ans.
1. Meckel’s cartilage is also called mandibular cartilage.
2. Meckel’s cartilage is the I arch cartilage and is closely
related to the developing middle ear.
3. It becomes ossified to form the malleus and incus of the
middle ear.
4. Meckel’s cartilage is characterized by being a model for
the mandible but not participating in the formation of
any part of the mandible except for a small area in the
symphysis region.
5. Fate of Meckel’s cartilage: Perichondral sheath of the
cartilage persists as the anterior ligament of malleus
and sphenomandibular ligament and finally undergoes
dissolution with minor contribution to ossification.
Q.2. Morula.
Ans.
1. As the cleavage of zygote proceeds, when the ovum has
16 cells, it looks like a mulberry and this stage is called
morula.
2. In a cross-section the morula shows an inner cell mass
surrounded by an outer layer of cells.
3. The inner cell mass forms the embryo proper and the
outer cell layer (trophoblasts) helps to provide nutrition
to the embryo.
4. The morula becomes blastocyst as the fluid enters into it
from uterine cavity.
Q.3. Development of tongue.
Ans.
Oral Histology
. Bifid tongue: Lack of fusion between the two lateral
lingual prominences may produce a bifid tongue.
. Thyroglossal cyst: Part of the thyroglossal duct may
persist and form cysts at the base of the tongue.
. Ankyloglossia (tongue tie): Attachment of tongue too
anteriorly to the floor of the mouth.
In summary development of tongue is as follows:
1. The anterior two-thirds of the tongue is formed by the
fusion of:
tuberculum impar + the two lateral lingual swellings >
derived from I arch.
. The posterior one-third by the cranial part of the hypo-
branchial eminence (copula of His) —> derived from the
III arch.
. The posterior most portion of posterior one-third >
derived from IV arch of tongue.
Q.4. Development of upper lip.
Ans.
1. The right and left maxillary processes — merge to form
most of the upper lip.
. Two medial nasal processes —> merge to form the
philtrum of the upper lip.
. So the upper lip develops from the fusion of globular
process with right and left maxillary process.
. Cleft lip results from failure of maxillary and medial
nasal processes to fuse; it may be unilateral or bilateral.
Q.5. Describe development of palate.
Ans.
1. The palate develops from three processes:
a. Two palatal processes
b. Frontonasal process.
2. The primary or primitive palate is formed from the
frontonasal process.
3. The secondary palate forms the hard and soft palates,
extending from the region of incisive foramen posteriorly.
This secondary palate develops from elevations of two
maxillary processes called the lateral palatine processes.
Quick Review Series: BDS 1st Year

a0) ~DEVELOPMENT AND GRO

LONG ESSAYS

Q.1. Describe in detail about the stages of tooth a. Condensation immediately subjacent to enamel or-
development. gan is dental papillae. The cells of dental papillae
form tooth pulp and dentine.
Or
b. The condensed ectomesenchyme which surrounds
Describe the process of development of tooth. tooth bud and dental papillae is called as dental sac.
The cells in dental sac will form the cementum and
Ans.
periodontal ligament.
The tooth development is a continuous process. The stages
of development of tooth are named after the shape of Cap Stage
enamel organ as follows:
1. As the tooth bud continues to proliferate, due to un-
1. Bud stage
equal growth in different parts of the tooth bud, it leads
2. Cap stage
to the cap stage.
3. Bell stage.
2. It is characterized by a shallow invagination on the deep
surface of the bud (Fig. 4A.2.2).
Bud Stage
1. Simultaneously along with the differentiation of dental
lamina, round or ovoid swellings develop from the base-
ment membrane at 10 different points corresponding to
future position of deciduous teeth. These are the pri- Oral ectoderm
mordial of enamel organs—the tooth buds.
2. In bud stage, the enamel organ consists of peripherally
Dental lamina
located low columnar cells and centrally located polygonal
cells (Fig. 4A.2.1).

Many cells of tooth bud and surrounding mesenchyme

Outer enamel
undergo mitosis. As the result of increased mitotic activity epithelium
and migration of neural crest cells into area, the ectomesen- Dental follicle
chymal cells surrounding the tooth bud condense. Stellate reticulum
Inner enamel
epithelium

Oral ectoderm
Fig. 4A.2.2 Cap stage.

3. By about 12 weeks, the odontogenic organ contains an

outer and inner layer of enamel epithelium.
Dental lamina 4. The inner layer is concave towards the mesenchyme. Its
Enamel organ cells are low columnar and show mitotic figures. This
Central polyhedral layer is called inner enamel epithelium.
cells 5. The cells of the outer layer are shorter, somewhat cuboi-
dal in shape and called outer enamel epithelium.
Condensation of
ectomesenchyme Between these two layers are star-shaped cells called the
Developing bone stellate reticulum, which is also called enamel pulp.
Peripheral low columnar 1. The inner enamel epithelium meets the outer enamel
cells epithelium at rim of the enamel organ; this region is
Fig. 4A.2.1 Bud stage. called cervical loop.
 Oral Histology

2. The underlying dental papilla shows further condensa- Advanced Bell Stage
tion and mesenchyme around the tooth germ forms the
1. During advanced bell stage, the boundary between
dental sac.
inner enamel epithelium and odontoblasts outline the
future DFJ.
Bell Stage
2. In addition, the cervical portion of enamel gives rise to
1. As invagination of epithelium deepens and its margin the epithelial root sheath of Hertwig (Fig. 4A.2.4).
continues to grow, enamel organ assumes a bell shape.
2. Following four different types of epithelial cells can be
distinguished on light microscopic examination of bell Collapsed stellate reticulum
stage of enamel organ:
a. Inner enamel epithelium
b. Stratum intermedium
c. Stellate reticulum Outer enamel

Sp
d. Outer enamel epithelium.

=
epithelium
3. The inner enamel epithelium consists of single layer of

oS

Anna a noe
Dental sac
cells which differentiates to ameloblasts (Fig. 4A.2.3).
Odontoblasts

vetast

Foes
Remnants of dental lamina Developing pulp

Fe

i!
wt
Outer enamel epithelium

fe:
Ameloblasts

Stellate reticulum
re]
34
=

Dental follicle
J

Fig. 4A.2.4 Late bell stage.

cia 0

Stratum intermedium
Panes

Odontoblasts

Dental papilla
Q.2. Describe development of roots.
Ketones

Ans.
WY

1. After the shape of the crown has been established, the

we

uy
A

dental epithelium and papilla grow downwards to form

Fig. 4A.2.3 Early bell stage.
4. A few layers of squamous cells form stratum intermedium
between inner enamel epithelium and stellate reticulum.
The layer seems to be essential for enamel formation.
5. The cells of stellate reticulum are of star-shaped, with
long processes which anastomose with those of adjacent
cells. Before enamel formation begins, stellate reticulum
disappears.
6. At the end of bell stage during formation of enamel the
smooth surface of outer enamel epithelium is laid in
folds. Between the folds, the capillary loops provide rich
nutritional supply for intense metabolic activity of avas-
cular enamel organ.
7. Before the inner enamel epithelium begins to produce
enamel the peripheral cells of dental papilla differentiate
into odontoblasts, which produces dentine.
8. The basement membrane that separates the enamel or-
gan and dental papilla just prior to dentine formation is
called membrane preformativa.
the root portion of the tooth.
2. At the junction of the outer and inner enamel epithe-
lium (cervical loop), the two epithelium proliferate
downwards to form the Hertwig’s root sheath.
3. The Hertwig’s root sheath is made of only the outer
and inner enamel epithelium, without an intermediary
stratum intermedium and stellate reticulum.
4. The sheath establishes the future dentinocemental
junction.
5. Just prior to the beginning of root formation and at the
level of the future cementoenamel junction, the Her-
twig’s sheath bends at right angles to form the epithe-
lial diaphragm, which narrows the cervical opening
of the developing tooth. The diaphragm tends to serve
as a fixed base and the proliferation occurs coronal to
the diaphragm. The space for its growth is created by
the movement of the formed crown towards the oral
cavity.
6. Hertwig’s root sheath does not maintain its integrity
throughout tooth development. Soon after the deposi-
tion of dentine at its advancing edge, it starts disinte-
grating.
Quick Review Series: BDS 1st Year

In single-rooted teeth the sheath forms a simple tube

but in multirooted teeth it becomes divided into two or Odontoblasts
three tubes corresponding to the number of roots in the
Dentine
tooth.
During formation of multirooted teeth after the estab- Cementoblasts

lishment of the crown form, tongues of epithelium grow Cementum

inward from the base of the enamel organ under and in Cell rests of Malassez
contact with the dental papilla, and fuse in the centre,
forming a perforated epithelial floor to the coronal Hertwig’s epithelial
region (Fig. 4A.2.5). root sheath

The epithelium surrounding these large perforations

then grows downwards as separate tubular root sheaths. Dental panilla
In the process it encloses the blood vessels. Hence,
Developing alveolar socket
the formation of multirooted teeth is by differential
growth.
Fig. 4A.2.5 Root formation.

SHORT ESSAYS

Q.1. Describe development, fate and functions of 2. The distal proliferation of dental lamina is responsible
dental lamina. for location of germs of permanent molars.
. The successors of deciduous teeth develop from lingual
Ans.
extension of free end of dental lamina opposite to
enamel organ of each deciduous tooth.
Development of Dental Lamina . Dental lamina provides the arising of permanent molars
When the embryo is about 6 weeks old, certain areas from its distal extension during development of jaws.
of basal cells of ectoderm proliferate more rapidly than do Q.2. Enamel knot and enamel cord.
cells of adjacent areas. This leads to development of dental
lamina. Ans.

Fate of Dental Lamina Enamel Knot

1. The total activity of dental lamina extends over the pe- 1. During the cap stage, the cells in the centre of the inner
riod of 5 years. enamel epithelium multiply and bulge into the dental
2. Any portion of dental lamina functions for much brief papilla. This is called the enamel knot.
period elapses after initiation of tooth development be- . They contribute cells to the enamel cord.
fore dental lamina begins to degenerate at that location. . Enamel knot represents a signalling centre for tooth
3. As the teeth continue to develop, they loose their con- morphogenesis.
nection with dental lamina.
4. Remnants of dental lamina persist as epithelial pearls or Enamel Septum or Enamel Cord
islands within the jaw as well as in gingiva as cell rest of
1. A vertical extension of the enamel knot is called the
Serres.
enamel cord.
. When the enamel cord extends to meet the outer enamel
Functions of Dental Lamina
epithelium, it is termed as enamel septum.
1. It serves as primordium for ectodermal portion of . The function of the enamel knot and cord is to act as a
deciduous tooth. reservoir of dividing cells for the growing enamel organ.

SHORT NOTES
Q.1. Hertwig’s root sheath.
Ans.
1. The cervical portion of enamel organ gives rise to the
epithelial root sheath of Hertwig.
2. Hertwig’s root sheath consists of outer and inner enamel
epithelia only, and it does not include stratum interme-
dium and stellate reticulum. It initiates radicular
dentine formation.
. The sheath establishes the future dentinocemental
junction.
. If Hertwig’s epithelial root sheath cells are lost prior to
cementum formation accessory canals are formed, and
if they persist, lead to formation of epithelial pearls or
enamel pearls.
Q.2. Dental lamina.
Ans.
1. During the 6th week of embryonic life, the oral ecto-
derm invades the underlying mesenchyme as an epithe-
lial thickening at the free margin of the jaws and runs
continuously like an arch. It is the future odontogenic
organ and is called dental lamina.
. Histologically, it has a surface of squamous cells and a
basal layer of columnar cells.
. Dental lamina is the band of the epithelium that has
invaded underlying ectomesenchyme along each of
horseshoe-shaped future dental arches.
. Dental lamina serves as primordium for ectodermal
portion of deciduous teeth.
Q.3. Write short note on enamel pearls.
Ans.
If cells of epithelial root sheath remain adherent to dentine
surface, they may differentiate into fully functioning amelo-
blasts 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.
Oral Histology
Q.4. Write short note on ameloblasts.
Ans.
1. The inner enamel epithelium consists of single layer of
cells that differentiate prior to amelogenesis into tall
columnar cells called as ameloblasts.
. These cells are also called as enamel-forming cells; they
form the unmineralized enamel.
. These cells are 4—5 jum in diameter and about 40 jum high.
. These elongated cells are attached to each other by
junctional complexes laterally and to cells in stratum
intermedium by desmosomes.
Q.5. Write short note on gubernacular canal.
Ans.
1. Gubernacular canal may be seen during the histological
examination of eruptive phase of tooth preparation.
. In case of those teeth with deciduous predecessors there
is an additional anatomic feature, the gubernacular
canal and its contents, the gubernacular cord which
influences eruptive tooth movement.
. The dental follicle that surrounds the tooth is con
nected to lamina propria of oral mucous membrane by
a strand of fibrous tissue called gubernacular cord,
which is believed to be a remnant of the dental lamina.
. The gubernacular canals act as pathways for successive
teeth to erupt.
. As the permanent tooth starts erupting through the guber-
nacular canal, local osteoclastic activity is seen around the
canal to widen it so that tooth passes into the oral cavity.
Q.6. Dental sac.
Ans.
1. Dental sac is formed from ectomesenchymal cells and
fibres surrounding enamel organ and dental papilla.
2. Cells of dental sac will differentiate into cementoblasts,
fibroblasts and osteoblasts to form cementum and
periodontal ligament.
Quick Review Series: BDS 1st Year

ENAMEL
LONG NOTES

Q.1. Describe in detail the structural elements of 7. The human enamel seems to contain rods surrounded
enamel. by rod sheaths and are separated by interrod substance
following a pattern called as the key hole pattern or
Ans.
paddle-shaped prism.
The fundamental organizational units or structures of
enamel are as follows: Direction of Enamel Rods
1. Enamel rods or prisms
2. Interprismatic cementing substance 1. Generally rods are oriented at the right angles to dentine
3. Rod sheath. surface.
2. In the cervical and central parts of crown of primary
Enamel Rods or Prisms tooth — the enamel rods are approximately horizontal.
Nearing the incisal edge/cusp tip — they follow oblique
1. These are long, slender, mineralized structures which direction.
run from the dentinoenamel junction to the surface of At the edge/tip of cusp — they are vertical.
enamel (Fig. 4A.3.1). Cervical area of permanent teeth — they are in apical
direction.
3. The rods are rarely straight; they follow wavy course
from dentine to enamel surface. The change in direction
of rods is responsible for appearance of Hunter—Schreger
bands. These are alternating dark and light strips of
varying width.

Interrod or Interprismatic Region

1. It is usually less than 1 micron in width.
2. The prism has a chemical composition that is identical
to that of the interprismatic region and in fact has the
same refractive index of 1.6.
3. In the inter rod region, the crystals are oriented in a
different direction from those present in the rod itself.
Fig. 44.3.1 Enamel rods (longitudinal section).
Rod Sheath

1. The region where the crystals of rod meet those of the

2. The enamel rods normally have a clear crystalline ap-
inter rod region is the region of rod sheath.
pearance permitting light to pass through them.
2. The rod sheath occurs because of the greater space that
3. In cross-sections of human enamel, many rods appear exists between the ends of crystals of rod itself and the
as fish scales.
ends of the crystals of inter rod region, as these crystals
4. The number of enamel rods has been estimated as rang-
meet at sharp angles.
ing from 5 million in mandibular lateral incisors to
12 million in maxillary first molars. Several structures present in addition to above fundamental
5. Each rod extends to the entire thickness of enamel and units of enamel are as follows:
since the thickness of enamel differs from area to area, 1. Incremental lines of Retzius
the length of enamel rods also varies in different areas. 2. Neonatal line
. The rods in the cuspal region are longer than those in the 3. Dentinoenamel junction
cervical region. The rods do not take a perfect straight 4. Enamel lamellae
course and are wavy; therefore, the length of any individ- 5. Enamel tufts
ual rod is more than the thickness of enamel in that area. 6. Enamel spindles
 Oral Histology

7. Surface structures
a. Perikymata Enamel
b. Rod ends
c. Cracks. Enamel spindle

Q.2. Mention physical and chemical properties of

enamel.
Ans. Enamel

~\\ \
lamellae
Physical Properties of Enamel Dentine

1. Colour: The colour of enamel covering the crown ranges

from yellowish white to greyish white.
Thickness: On the cusps of human molars and premo-
lars attain a maximum thickness of about 2—2.5 mm.
Hardness: The structure and hardness of enamel ren-
ders it brittle. Enamel has hardness of about 350 KHN.
Because of its high content of mineral salts and their
crystalline arrangement, enamel is highly calcified tis-
sue, in the body.
The specific gravity of enamel is 2.8.
Permeability: The enamel can act like a semipermeable
membrane, permitting complete or partial passage of
certain molecules.
Chemical Properties of Enamel
1. The enamel consists of 96% of inorganic and 4% of
organic substance and water.
The enamel matrix mineralization begins immediately
after it is secreted. The inorganic portion of enamel
is basically apatite, having calcium and phosphate in a
ratio of 2:1.
The inorganic content of enamel is crystalline calcium
phosphate, i-e. hydroxyapatite.
The chemical analysis of matrix of mature enamel
indicates amino acid composition, proteins can be
isolated in several different fractions and they contain
generally high percentage of serine, glutamic acid and
glycine.
Q.3. Describe hypocalcified areas of enamel.
Ans.
The hypocalcified areas of the enamel are as follows:
1. Enamel lamellae
2. Enamel tufts
3. Enamel spindles
4. Surface structures
a. Perikymata
b. Rod ends
c. Cracks.
Enamel Lamellae
1. They are thin, leaf-like structures extending from enamel
surface towards DEJ (Fig. 4A.3.2).
Fig. 44.3.2 Enamel tufts, lamellae and spindles.
. 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.
. There are three types of lamellae:
a. Type A— Lamellae composed of poorly calcified rod
segments.
b. Type B — Lamellae consisted of degenerating cells.
c. Type C — Lamellae arising in erupted teeth where
cracks are filled with organic matter, presumably
originating from saliva.
Lamellae of type A are restricted to enamel, and of type B
and type C are restricted to the dentine.
Enamel lamellae may be a site of weakness in tooth, and
form a road of entry for bacteria and initiate caries.
Enamel Tufts
1. They were so termed because they resemble tufts of
grass when viewed in ground section.
. They do not arise from a single, small area.
. An enamel tuft is a narrow ribbon-like structure, the
inner end of which arises at dentine.
. Enamel tuft arises at DEJ and reach into enamel to
about one-fifth to one-third of the thickness.
. Tuft consists of hypocalcified enamel rods and inter-
prismatic substance.
. They extend in long axis of crown, so that they are
abundantly seen in horizontal and longitudinal sections.
Their presence and development are consequences of an
adaptation to spatial condition in enamel.
Enamel Spindles
1. Before enamel formation occurs, some newly forming
odontoblastic processes pass between the adjoining am-
eloblasts and get trapped as enamel formation begins,
resulting in enamel spindles.
Quick Review Series: BDS 1st Year
2. Dark spindle-like structures starting from the DEJ and
extending about 100 jim into enamel are seen in ground
sections viewed in transmitted light.
3. These are best seen in longitudinal sections of cuspal
regions of enamel.
4. Enamel spindles.
5. The direction of spindles is just right angle to dentine.
Surface Structures
A structureless layer of enamel of about 30 jum thick is found
in all deciduous teeth and in about 70% of permanent teeth.
They are seen more towards the cervical areas of the tooth
than the cuspal areas.
The surface structures of the enamel are as follows:
Perikymata
1. They are transverse, wave-like grooves continuous
around the tooth, and usually lie parallel to each other
and to CEJ.
2. Ordinarily there are about 30 perikymata per millimetre
in region of CEJ.
3. Their course is regular, but in cervical region it is irregular.
4. They are believed to be the external manifestations of
striae of Retzius.
Rod ends
1. They are concave, and vary in depth and shape.
2. They are shallowest in cervical region and deepest near
cervical region.
Cracks
1. They are the outer edges of lamellae.
2. They extend from varying distance along the surface, at
right angle to DEJ from which they originate.
Q.4. Describe briefly about enamel organ.
Ans.
The epithelial enamel organ originates from the stratum
epithelium of the primitive oral cavity.
It consists of the following four layers:
1. Outer enamel epithelium
2. Stellate reticulum
3. Stratum intermedium
4. Inner enamel epithelium.
Outer Enamel Epithelium
1. The outer enamel epithelium consists of a single layer of
cuboid cells.
2. Prior to the formation of hard structures, the regular
arrangement of the outer enamel epithelium is main-
tained only in the cervical part of the enamel organ.
3. At the point of highest convexity of enamel organ, the
cells of the outer enamel epithelium are irregular in
shape and cannot be distinguished easily from the cells
of outer portion of stellate reticulum.
4. The capillaries in the connective tissue surrounding the
enamel organ proliferate and protrude towards it.
Stellate Reticulum
1. It is located between outer enamel epithelium and stra-
tum intermedium.
2. It forms the middle part of enamel organ, cells are star-
shaped with long processes.
3. The cells are separated by intercellular substance.
4. The structure of stellate reticulum renders it elastic and
resistant. It acts as buffer against physical forces.
5. The size of stellate reticulum reduces in thickness to
decrease the distance between capillaries of dental sac
and ameloblasts.
Stratum Intermedium
1. The cells of stratum intermedium are situated between
the stellate reticulum and inner enamel epithelium.
2. These cells are fat to cuboidal in shape, arranged in one
to three layers.
Inner Enamel Epithelium
1. The cells of inner enamel epithelium are derived from
the basal cell layer of oral epithelium.
2. The cells are tall, columnar and differentiate into amelo-
blasts that produce enamel matrix.
Q.5. Write in detail about life cycle of ameloblasts
and describe in detail the amelogenesis?
Ans.
Life Cycle of Ameloblasts
There are six stages in life cycle of ameloblasts as follows:
1. Morphogenic stage
. Organizing stage
wh
. Formative stage
. Maturative stage
Ue
. Protective stage
6. Desmolytic stage.
The differentiation of ameloblasts is most advanced in re-
gion of incisal edges and tips of cusps. It is least advanced in
region of cervical loop.
Morphogenic stage
1. During this stage cells are short and columnar with large
oval nuclei, which almost fills the cell body. Golgi ap-
paratus and centrioles are located in proximal end of
cell and mitochondria are dispersed in cytoplasm.

2. During differentiation of ameloblasts, terminal bars ap-
pear along with margin of mitochondria to basal region
of cell. The terminal bars are points of close contact
between cells.
3. Ameloblasts interact between adjacent mesenchymal
cells, which determine the shape of DEJ.
Organizing stage
1. In this stage of development, inner enamel epithelium
interact with adjacent connective tissue cells, which dif-
ferentiate to odontoblasts.
2. This is characterized by change in appearance of cells of
inner enamel epithelium. The cells become longer and
nucleus-free zones, and distal end of cells become as
long as proximal parts.
3. During terminal phase of organizing stage the forma-
tion of dentine by odontoblasts begins. The first appear-
ance of dentine seems to be critical phase in life cycle.
4. As long as inner enamel epithelium is in contact with
connective tissue of dental papillae, it receives nutrient
material from blood vessels of this tissue.
5. When dentine forms it cuts off ameloblasts from their
original source of nourishment, then they are supplied
by capillaries that surround and may penetrate inner
enamel epithelium.
6. 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 intermedium and
ameloblasts layers shorten.
Formative stage
1. Ameloblast enters formative stage after first layer of
dentine is formed. The presence of dentine is necessary
for beginning of enamel matrix formation.
2. During formation of enamel matrix the ameloblasts re-
tain as same length and arrangement. There are changes
in organization and number of cytoplasmic organelles
and inclusions, which are related to initiation of secre-
tion of enamel matrix.
3. The earliest apparent change is development of blunt
cell processes on ameloblasts surface.
Maturative stage
1. 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.
2. The ameloblasts are reduced in length during enamel
matrix maturation and are closely attached to enamel
matrix.
3. The cells of stratum intermedium lose their cuboidal
shape and regular arrangement, and assume spindle shape.
Oral Histology
4. During maturation, the ameloblasts display microvilli at
distal extremities.
Protective stage
1. 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.
2. These cell layers then form stratified epithelial covering
of enamel called as reduced enamel epithelium.
3. The function of reduced enamel epithelium is to protect
mature enamel by separating it from connective tissue
until tooth erupts.
Desmolytic stage
1. The reduced enamel epithelium proliferates and induces
atrophy of connective tissue separating it from oral
epithelium so that fusion of two epithelia can occur.
2. It is probable that epithelial cells release enzymes
that are able to destroy connective tissue fibres by
desmolysis.
3. If premature degeneration of reduced enamel epithe-
lium occurs, it may lead to delayed eruption.
Amelogenesis
1. Amelogenesis is the formation of enamel on teeth.
2. Amelogenesis is a two-step process:
a. The first stage is known as the secretory phase.
b. The second stage is known as the maturation stage.
Proteins and an organic matrix form a partially
mineralized enamel in the secretory stage. The matu-
ration stage completes enamel mineralization.
c. Amelogenesis is described in six phases, but is
generally subdivided into three main functional
stages:
i. The presecretory stage
ii. The secretory stage
iii. The maturation stage.
During presecretory stage
1. The differentiating ameloblasts acquire their phenotype
2. Change polarity
3. Develop an extensive protein synthetic apparatus
4. Prepare to secrete the organic matrix of enamel.
During the secretory stage
1. Ameloblasts elaborate and organize the entire enamel
thickness
2. Result in formation of highly ordered tissue.
During the maturation stage
1. Ameloblasts modulate and transport specific ions
required for mineralization.
«¥Y') Quick Review Series: BDS Ist Year
SHORT ESSAYS
Q.1. Enamel rods.
Ans.
1. These are long, slender, mineralized structures which
run from the dentinoenamel junction to the surface of
enamel.
. The enamel rods normally have a clear crystalline
appearance permitting light to pass through them.
. In cross-sections of human enamel, many rods appear
as fish scales.
. The number of enamel rods ranges from 5 million in
mandibular lateral incisors to 12 million in maxillary
first molars.
. Each rod extends to the entire thickness of enamel.
. The rods in the cuspal region are longer than those in the
cervical region. The rods do not take a perfect straight
course and are wavy; therefore the length of any individ-
ual rod is more than the thickness of enamel in that area.
. The human enamel seems to contain rods surrounded
by rod sheaths and is separated by interrod substance
following a pattern called as the keyhole pattern or
paddle-shaped prism.
. When cut longitudinally, section passes through heads
or bodies of one row of rods and tails of adjacent rows.
The bodies of rods are nearer to the occlusal and incisal
surfaces where tail points cervically.
Direction of enamel rods
1. Generally rods are oriented at the right angles to dentine
surface.
a. In the cervical and central parts of crown of primary
tooth —> the enamel rods are approximately HORI-
ZONTAL.
b. Nearing the incisal edge/cusp tip — they follow
OBLIQUE direction.
c. At the edge/tip of cusp — they are VERTICAL.
d. Cervical area of permanent teeth — they are in
APICAL DIRECTION.
. The rods are rarely straight; they follow wavy course
from dentine to enamel surface. The change in direction
of rods is responsible for appearance of Hunter—Schreger
bands. These are alternating dark and light strips of
varying width.
Q.2. Gnarled enamel.
Ans.
Gnarled enamel (Fig. 4A.3.3)
Enamel
Gnarled enamel
Dentinoenamel
junction
Dentine
Fig. 44.3.3 Gnarled enamel.
. Upon axial surfaces of teeth, the rods are usually straight
and parallel to each other.
. But on occlusal surfaces of molars and premolars
and sometimes in the incisal edges, the rods are straight
and parallel for a short distance from the surface, but as
the DEJ is approached they intertwine; this optical
appearance is called gnarled enamel.
. The gnarled enamel seems to be a functional adaptation
of enamel rods in these areas of excessive load.
. Gnarled enamel indicates that ameloblasts retreat ini-
tially in an irregular course during early amelogenesis.
Q.3. Formative phase of ameloblast.
Ans.
Formative phase is the third stage in the life cycle of ameloblasts:
1. Ameloblast enters formative stage after first layer of
dentine is formed. The presence of dentine is necessary
for beginning of enamel matrix formation.
. During formation of enamel matrix, the ameloblasts
retain same length and arrangement. There are changes
in organization and number of cytoplasmic organelles
and inclusions, which are related to initiation of secre-
tion of enamel matrix.
. The earliest apparent change is development of blunt
cell processes on ameloblasts surface.
Enamel maturation begins after most of thickness of
enamel has been formed in incisal and occlusal areas of the
teeth crown.

Q.4. Enamel lamellae and enamel tufts.
Ans.
Enamel lamellae and enamel tufts are both hypomineralized
areas of enamel.
Enamel Lamellae
1. They are thin, leaf-like structures extending from enamel
surface towards DEJ.
2. They consist of organic material, but with little mineral
content.
3. Lamellae may develop in planes of tension. Where rods
cross such a plane, a short segment of rod may not fully
calcify.
4. There are three types of lamellae:
a. Type A lamellae composed of poorly calcified rod
segments.
b. Type B lamellae consisted of degenerating cells.
c. Type C lamellae arising in erupted teeth where cracks
are filled with organic matter, presumably originating
from saliva.
Lamellae of type A are restricted to enamel and of type B
and type C are restricted to the dentine.
Enamel lamellae may be a site of weakness in tooth, and
form a road of entry for bacteria and initiate caries.
Enamel Tufts
1. They were so termed because they resemble tufts of
grass when viewed in ground section.
2. They do not arise from a single, small area.
3. An enamel tuft is a narrow ribbon-like structure, the
inner end of which arises at dentine.
4. Enamel tuft arises at DEJ and reaches into enamel to
about one-fifth to one-third of the thickness.
i. Tuft consists of hypocalcified enamel rods and inter-
prismatic substance.
ii. They extend in long axis of crown so that they are
abundantly seen in horizontal and longitudinal
sections.
Their presence and development are consequences of an
adaptation to spatial condition in enamel.
Q.5. Surface structure of the enamel.
Ans.
A structureless layer of enamel of about 30 jum thick is found
in all deciduous teeth and in about 70% of permanent teeth.
They are seen more towards the cervical areas of the tooth
than the cuspal areas.
The surface structures of the enamel are as follows:
Oral Histology
Perikymata
1. They are transverse, wave-like grooves continuous
around the tooth, and usually lie parallel to each other
and to CEJ.
2. Ordinarily there are about 30 perikymata per millimetre
in region of CEJ.
3. Their course is regular, but in cervical region it is irregular.
4. They are believed to be the external manifestations of
striae of Retzius.
Rod Ends
1. They are concave, and vary in depth and shape.
2. They are shallowest in cervical region and deepest near
cervical region.
Cracks
1. They are the outer edges of lamellae.
2. They extend from varying distance along the surface, at
right angle to DEJ from which they originate.
Q.6. Incremental lines in enamel.
Ans.
1. The incremental lines of Retzius appear as brown bands
in transmitted light in ground section of enamel.
2. Incremental lines suggest the rhythmic pattern or apposi-
tion of enamel, which is formed and mineralized in layers.
3. The incremental line of Retzius appears as concentric
circles in transverse section of the tooth.
4. In longitudinal sections they surround the tips of den-
tine and in the cervical parts they run an oblique course.
5. The incremental lines have been attributed to periodic
bending of enamel rods to variation in basic organic
structures and are hypomineralized.
6. They are believed to be the external manifestations of
perikymata.
Q.7. Describe enamel cuticle.
Ans.
1. Nasmyth’s membrane or primary enamel cuticle covers
the entire crown of newly erupted teeth.
2. Soon it is lost due to masticatory and mechanical forces.
3. It is a typical basal lamina secreted by ameloblasts after
forming enamel.
4. It is visible under light microscope because of its wavy
course.
5. The surface of enamel of an erupted tooth is covered by
a pellicle, which is a precipitate of salivary proteins.
6. It readily reappears even after a tooth is mechanically
polished. Dental plaque readily forms over the pellicles.
Quick Review Series: BDS 1st Year

SHORT NOTES

Q.1. Enamel rods. Q.4. Perikymata.

Ans. Ans.
1. These are long, slender, mineralized structures which 1. Perikymata are transverse, wave-like grooves and are
run from the dentinoenamel junction to the surface of believed to be external manifestations of the striae of
enamel. Retzius.
2. The enamel rods normally have a clear crystalline 2. Because of undisturbed development of the enamel
appearance permitting light to pass through them. prior to birth, perikymata are absent in the occlusal
3. The number of enamel rods has been ranging from parts of the deciduous teeth, but are present in the
5 million in the lower incisors to 12 million in the upper postnatal cervical parts.
first molars. Q.5. Enamel lamellae.
4. The rods measure about 5 um in breadth, 9 um in length
and 4 jum in diameter. Ans.
5. The diameter of enamel rods increases from dentinoe- Enamel lamellae are
namel junction towards the surface of the enamel at a 1. Thin leaf-like structures that extend from enamel
ratio of about 1:2. towards DEJ
Q.2. Gnarled enamel. 2. Usually develop in planes of tension
3. Enamel lamellae are of three types:
Ans. a. type A,
1. In the region of cusps or incisal ridges, the bundles of b. type B and
rods seem to intervene more irregularly. This optical ap- c. type C
pearance of enamel is called gnarled enamel. i. Type A are restricted to enamel while the type B
2. The gnarled enamel seems to be a functional adaptation and type C may extend into dentine.
of enamel rods in these areas of excessive load. ii. Type A lamellae are composed of poorly calcified
rod segments and type B consists of degenerated
Q.3. Incremental lines of Retzius.
epithelial cells (unerupted teeth).
Ans. iii. Type C lamellae are present in erupted teeth and
are filled with organic matter.
1. Seen in enamel and are attributed to periodic bending
of the enamel rods or variations in the basic organic Enamel lamellae are considered as site of weakness in a
structures (Fig. 4A.3.4). tooth and may form a road of entry for bacteria that initiate
2. Perikymata are external manifestations of striae of caries.
Retzius. Q.6. Dentinoenamel junction.
3. Neonatal line is an accentuated incremental line of
Retzius. Ans.
1. DEJ appears as scalloped line. The convexities of scallop
are directed towards the dentine.
Enamel 2. The surface of dentine at DEJ is pitted. The pitted DEJ
v TNS Incremental is preformed even before development of hard tissues,

STD
4 KT m,\"** of Retzius and is evident in arrangement of ameloblasts and base-
ment membrane of dental papillae.

\\\
3. In microradiographs of ground sections, a hypomineral-
\ (Wi H WD) Dentinoenamel
h N y/ Vy) junction ized zone of 30 jum thickness is sometimes demonstrated
a

\ NS My f
as DEJ. It is most prominent before mineralization is
LI

\y complete.
\
cs

Dentine Q.7. Enamel tufts.

Ans.

1. Enamel tufts arise at DEJ and reach into the enamel to

Fig. 4A.3.4 Incremental lines of Retzius. about one-fifth to one-third of its thickness.
 Oral Histology

2. They are usually seen in horizontal sections (Hunter—
Schreger bands are seen in longitudinal sections).
Q.8. Enamel spindles.
Ans.
1. Enamel spindles arise from odontoblastic process and
extend into enamel epithelium before substances are
formed.
The direction of enamel spindles in the enamel corre-
sponds to the original direction of ameloblasts, i-e. at
right angles to the surface of dentine.
. Since the enamel rods are formed at an angle to the axis
of ameloblasts, the direction of spindles and rods is
divergent.
Q.9. Age changes of enamel.
Ans.
Age changes of enamel are as follows:
1. Facial and lingual surfaces lose their structure much
more rapidly than proximal surfaces.
2. Enamel being a nonliving tissue is incapable of repair.
. Areas which receive maximum masticatory forces,
like cuspal regions and incisal edges, show attrition
with age.
. Teeth darken with age probably due to changes in the
organic content in the surface layers.
Q.10. Hertwig’s epithelial root sheath.
Ans.
1. The cervical portion of enamel organ gives rise to the
epithelial root sheath of Hertwig.
2. Hertwig’s root sheath consists of outer and inner enamel
epithelia only, and it does not include stratum interme-
dium and stellate reticulum initiates radicular dentine
formation.
. If Hertwig’s epithelial root sheath cells are lost prior to
cementum formation of accessory canals; and if they
persist, lead to formation of epithelial pearls (enamel
pearls).
Q.11. Nasmyth’s membrane.
Ans.
Q.12. Secondary cuticle.
Ans.
1. Primary enamel cuticle is secreted by ameloblast.
2. Secondary enamel cuticle is superficial to the primary,
and represents the portion of reduced enamel. Epithe-
lium thickness is about 10 jim.
Q.13. Enamel.
Ans.
1. Enamel is a hard, mineralized tissue that covers the
anatomical crowns of teeth.
. Enamel consists of mainly inorganic material (96%) and
only small amount of organic matrix and water (4%).
. Inorganic element present in enamel is chiefly hydroxy-
apatite.
. Organic matrix of enamel consists of some unique
proteins known as amelogenins and non-amelogenins.
Q.14. Ameloblast.
Ans.
1. The inner enamel epithelium consists of single layer of
cells that differentiate prior to amelogenesis into tall
columnar cells called as ameloblasts.
. These cells are also called as enamel-forming cells. They
form the unmineralized enamel.
. These cells are 4—5 jum in diameter and about 40 jum high.
. These elongated cells are attached to each other by
junctional complexes laterally and to cells in stratum
intermedium by desmosomes.
Q.15. Hunter-Schreger bands.
Ans.
1. Hunter-Schreger bands are alternating dark and light
bands that can be seen in longitudinal ground section
(Fig, 4A.3.5).
2. They represent regular change in the direction of rods,
which is regarded as a functional adaptation, minimizing
Enamel
Ur

1. A delicate membrane called Nasmyth’s membrane cov-

i

ers entire crown of newly erupted tooth, but is probably

=
soon removed by mastication. == Dentine

Nasmyth’s membrane is also known as primary enamel

cuticle and is secreted by ameloblast.
This membrane is a typical basal lamina found beneath \ Light bands
most epithelia. me Dark bands
. It is visible with light microscope because of its wavy
course.

. This basal lamina is secreted by ameloblasts when

enamel formation is complete. Fig. 44.3.5 Hunter-Schreger bands.
Quick Review Series: BDS 1st Year

the risk of cleavage in the axial direction under influence 1. Tomes granular layer is seen in dentine of root and is
of occlusal masticatory forces. formed by coalescing and looping of the terminal
portions of the dentinal tubules.
Q.16. Neonatal line.
2. This zone increases from CEJ to the root apex (Fig. 4A.3.7).
Ans.

1. It is an accentuated line of Retzius seen as a brown line

separating enamel formed and mineralized before birth,
and enamel mineralized after birth (Fig. 4A.3.6).

Fig. 44.3.7 Tomes granular layer.

Q.18. Pellicle.

Ans.
Fig. 4A.3.6a Neonatal line.
1. The surface of enamel of an erupted tooth is covered by
a pellicle.
2. It is a precipitate of salivary proteins.
Enamel
3. It readily reappears even after a tooth is mechanically
polished.
4. Dental plaque readily forms over the pellicles.
Prenatal
Q.19. Tomes process.
Neonatal line
Ans.
1. The projections of ameloblasts in the enamel matrix are
Postnatal known as Tomes process.
enamel
2. They show ‘Picket fence’ arrangement. Formation of
Tomes process and terminal bars is the first step in
enamel rod formation.
3. Tomes process is partly delineated by incomplete septa
Fig. 4A.3.6b Neonatal line. and also contains typical secretion granules as well as
rough endoplasmic reticulum and mitochondria.
4. The surface of developing enamel consists of depres-
2. The environment of the embryo in the intrauterine
sions resulting from the presence of Tomes processes.
life is different from the one that is encountered after
birth. This abrupt change results in a disturbance in the Q.20. Hypocalcified areas of enamel.
mineralization process resulting in this line.
Ans.
3. Deciduous teeth and permanent first molars are formed
partly before birth and partly after birth; and hence, a Following are the hypocalcified areas of the enamel:
neonatal line can be present in these teeth. 1. Enamel lamellae
4. The neonatal line will be more towards the DEJ, as . Enamel tufts
NW

enamel formation begins near the DEJ and progresses . Enamel spindle
Ww

towards surface. . Surface structures

Bm

a. Perikymata
Q.17. Granular layer of Tomes or Tomes granular layer.
b. Rod ends
Ans. c. Cracks.
 Oral Histology

LONG ESSAYS

Q.1. Describe the structure of dentine. the peripheral layers and are more closely packed near
the pulp.
Or
5. Diameter of dentinal tubules is 3-4 j1m near pulpal layer
Write in brief on structure of dentine. and 1 jum at outer ends.
6. The ratio between the number of tubules per unit area
Ans.
on the pulpal and outer surfaces of the dentine is about
Dentine is the mineralized connective tissue that surrounds 4:1.
and encloses pulp. It provides the bulk and general form of 7. Near the pulpal surface of dentine the number of tu-
the tooth. It also determines the shape of the tooth. bules per square mm varies between 50,000 and 90,000.
Structure of dentine consists of:
8. The dentinal tubules have lateral branches throughout
dentine, known as canaliculi or microtubules.
1. Dentinal tubules
Peritubular dentine
9. A few dentinal tubules extend through DEJ into enamel
for several millimetres and are called as enamel spindle.
wy

Intertubular dentine
Predentine
Peritubular dentine
ae

Odontoblast process.
1. The dentine that immediately surrounds the dentinal
The dentinal matrix of collagen fibres are arranged in the
tubules is called as peritubular dentine.
random network. The bodies of odontoblast are arranged in
2. It is more highly mineralized than intertubular dentine.
a layer on pulpal surface of dentine.
3. It constricts the dentinal tubules to a diameter of | um
near DEJ.
Dentinal Tubules
4. It is twice as thick in outer dentine than in inner den-
1. Dentinal tubules are characteristic and are found tine, but in decalcified sections, the tubule diameter
throughout normal dentine. appears similar in inner and outer dentine because of
2. The course of dentinal tubules follow the gentle curve in loss of peritubular dentine.
crown and less so in root, where they resemble a gentle
s shape (Fig. 4A.4.1). Intertubular dentine
3. These tubules end perpendicular to DEJ and DCJ. Near
1. It forms the main body of dentine.
the root tip and along incisal edges and cusps, tubules
2. It is located between dentinal tubules or between zones
are almost straight.
of peritubular dentine.
4. The ratio between the outer and inner surfaces of
. It is highly mineralized.
ies]

dentine is about 5:1, as the tubules are farther apart in

4. About one-half of its volume is organic matrix, specifi-
cally collagen fibres, which are randomly oriented
around dentinal tubules.
5. After decalcification, intertubular dentine is retained.

Enamel
Predentine
Cementum
1. It is first form of dentine and is not mineralized.
-—> Dentine
2. It is located adjacent to pulp tissue and is 2—6 jum wide.
3. As the collagen fibres undergo mineralization at preden-
¥-> S-shaped tine junction, the predentine becomes dentine and new
dentinal tubule layer of predentine forms circumpulpally.

Odonioblast process
Pulpal space 1. They are cytoplasmic extensions of odontoblasts.
2. The odontoblast cell resides in the peripheral pulp and
Fig. 44.4.1 Dentinal tubules. their processes extend into dentinal tubules.
Quick Review Series: BDS 1st Year

3. They are the largest in diameter near pulp and taper to 3. It is the outer or most peripheral part of primary
approximately 1 um further into dentine. dentine and is about 20 jm thick.
4. Some odontoblast processes traverse thickness of 4. In the crown portion of mantle dentine, larger diameter
dentine. argyrophilic collagen fibres are present called von
5. The odontoblast processes may cross DEJ and may Korff’s fibres.
extend into enamel as enamel spindles. 5. The mantle dentine of root portion is covered by the
hyaline layer of Hopewell and Smith on the cementum
Q.2. Write briefly about types of dentine.
side.
Ans. 6. Compared to circumpulpal dentine, mantle dentine is
less mineralized.
1. Dentine is a mineralized connective tissue that sur-
rounds and encloses pulp. It provides the bulk and Circumpulpal dentine
general form of the tooth. 1. It forms the remaining primary dentine or bulk of the
2. In human teeth three major types of dentine have been tooth.
recognized. These are: 2. It represents all of the dentine that is formed before root
a. Primary dentine completion.
b. Secondary dentine 3. Collagen fibrils in circumpulpal dentine are much
c. Tertiary or reparative dentine. smaller in diameter of 0.05 pm and are more closely
packed together compared to mantle dentine.
Types of Dentine
Based on time of formation Secondary dentine
1. Primary dentine (includes mantle and circumpulpal 1. Secondary dentine is the dentine which is formed after
dentine) root formation is complete.
2. Secondary dentine 2. The earlier concept that secondary dentine has formed
3. Tertiary or reparative dentine. in response to physiological forces of mastication is no
Based on structure more valid, as secondary dentine has been demonstrated
1. Peritubular even in unerupted teeth.
2. Intertubular 3. Secondary dentine has an incremental pattern, fewer
3. Predentine. tubules and these are less regular.
e At the boundary between primary and secondary
Dentine associated with age changes dentine, the tubules sometimes change their direc-
1. Dead tracts tion and show more wavy course in secondary
2. Sclerotic dentine dentine.
3. Reparative dentine. 4. With more and more of secondary dentine, the pulp
chamber gets obliterated. Secondary dentine is not
Primary dentine formed uniformly and is formed in greater amounts in
1. Primary dentine is the dentine which outlines the pulp floor and roof of the pulp chamber.
chamber and the one which is formed before comple-
tion of root takes place. Tertiary dentine
2. In primary dentine, two distinct areas are identified:
1. Itis also called reparative dentine or response or reactive
a. Mantle dentine
dentine.
b. Circumpulpal dentine.
2. It is that dentine produced by odontoblasts in response
Mantle dentine to irritation of the pulp caused by chemical, thermal or
1. Mantle dentine is the first formed dentine in the crown microbial stimuli.
and lies immediately below the DEJ. It is formed before e It is formed only in localized areas in reaction to
a tooth erupts into the oral cavity. trauma such as caries or restorative procedures.
2. Itis less calcified than rest of the dentine, and is soft and 3. When reparative dentine is formed rather rapidly, such
provides cushioning effect to the tooth. dentine contains very few irregular tubules.

SHORT ESSAYS
Q.1. Age changes in dentine.
Ans.
Age changes in dentine are as follows:
1. Obliteration of pulp chamber:
Dentine is formed throughout life, and as age advances more
and more dentine forms and obliterates the pulp chamber.
2. Formation of dead tracts:
Dead tracts are formed due to physiological processes
like attrition.
3. Sclerotic dentine:
a. This is also known as transparent dentine.
b. Formation of sclerotic dentine is a protective mecha-
nism. In case of caries, attrition, abrasion or erosion,
sufficient stimuli are generated to cause collagen
fibres, calcium salts and apatite crystals to begin
appearing in dentine tubules. This condition is preva-
lent in older individuals, especially in the roots.
4. Colour change:
The dentine becomes darker in colour with age.
5. Permeability:
As age advances the dentine becomes less permeable.
Q.2. Write a note on dentinal tubules.
Ans.
1. Dentinal tubules are characteristic and found through-
out normal dentine
2. The course of dentinal tubules follow the gentle curve in
crown and less so in root, where they resemble a gentle
‘s shape.
3. These tubules end perpendicular to DEJ and DCJ. Near
the root tip and along incisal edges and cusps, tubules
are almost straight.
4. The ratio between the outer and inner surfaces of
dentine is about 5:1, as the tubules are farther apart in
the peripheral layers and are more closely packed near
the pulp.
5. Diameter of dentinal tubules is 3—4 jum near pulpal layer
and 1 jum at outer ends.
6. The ratio between the number of tubules per unit
area on the pulpal and outer surfaces of the dentine is
about 4:1.
7. Near the pulpal surface of dentine, the number of tu-
bules per square mm varies between 50,000 and 90,000.
Oral Histology
8. The dentinal tubules have lateral branches throughout
dentine, known as canaliculi or microtubules.
9. Over their entire length they exhibit minute, relatively regu-
lar secondary curvatures, which are sinusoidal in shape.
10. A few dentinal tubules extend through DEJ into enamel
for several millimetres and are called as enamel spindle.
Q.3 Describe hypocalcified areas in dentine.
Ans.
Hypocalcified areas in dentine are as follows:
1. Contour lines of Owen
2. Neonatal line
3. Interglobular dentine
4. Predentine.
Contour Lines
Some of the incremental lines are accentuated because of
disturbances in the matrix and mineralization process. These
lines represent as hypocalcified bands.
Neonatal Line
Neonatal line separates the prenatal and postnatal dentine.
This line reflects the abrupt changes in environment that
occurs at birth. The dentine matrix formed prior to birth
is usually of better quality than formed after birth, and a
neonatal line is a zone of hypocalcification.
Interglobular Dentine
Sometimes mineralization of dentine begins in small globular
areas that fail to coalesce into a homogeneous mass. This results
in zones of hypomineralization between the globules. These
zones are known as globular dentine or interglobular space.
Predentine
The predentine is located adjacent to the pulp tissue. It is
first formed dentine and is not mineralized.
Q.4. Write briefly on incremental lines in dentine.
Ans.
1. The incremental lines of von Ebner — also called imbri-
cation lines — are fine striations or lines that run at
right angles to the tubules in longitudinal sections.
Quick Review Series: BDS 1st Year
The distance between the lines is about 4-8 um and is
fairly regular.
These lines reflect the rhythmic deposition of dentine.
The daily increment decreases after the tooth reaches
functional occlusion.
In transmitted light, the incremental lines are dark and
the increments between the lines appear light.
Accentuated incremental lines are known as contour
lines of Owen. They represent hypocalcified bands.
The general belief is that these lines are only accentuated
lines of von Ebner. But that these lines are only an opti-
cal phenomenon due to the secondary curvatures in
dentinal tubules has also been postulated.
Q.5. Briefly explain dentinal sensitivity.
Ans.
1. Dentine is sensitive to a variety of stimuli like heat, cold,
chemicals, etc.
Dentine is not uniformly sensitive. It is highly sensitive
at the DEJ and at the regions close to the pulp.
Three theories to explain the sensitivity of dentine are as
follows:
Direct Nerve Innervation Theory
1. Nerve endings are present in dentinal tubules in certain
areas of dentine. They extend to a small distance within
the tubule from the pulpal side. It is because of these
nerve endings dentine is sensitive.
2. This theory is rejected because:
a. The outer dentine, which is devoid of such nerve
fibres, is more sensitive than the inner dentine, which
posseses them.
b. A newly erupted tooth does not possess such nerve
endings and yet it is sensitive.
SHORT NOTES
Q.1. Dentinal tubules.
Ans.
1. Dentinal tubules are characteristic and are found
throughout normal dentine.
The course of dentinal tubules follows the gentle curve
in crown and less so in root, where they resemble a
gentle ‘s’ shape.
Diameter of dentinal tubules is 3—4 tm near pulpal layer
and 1 jum at outer ends.
The ratio between the number of tubules per unit
area on the pulpal and outer surfaces of the dentine is
about 4:1.
c. Application of local anaesthetics to exposed dentine
does not reduce dentine sensitivity.
Fluid or Hydrodynamic Theory
1. It is the second and most popular theory.
2. Various stimuli such as heat, cold, air blast, desiccation
or mechanical or osmotic pressure affect fluid move-
ment in the dentinal tubules.
3. When a stimulus is applied to dentine, there is displace-
ment of fluid within the tubule, and this distorts the
local pulp environment and is sensed by the free nerve
endings in the plexus of Raschkow.
4. These nerve endings act as mechanoreceptors, as they
are affected by mechanical displacement of the tubular
fluid.
This theory finds support from the facts that:
a. Pain is maximum felt at the DEJ, where there are
maximum branches of the tubules.
b. During cavity preparation when the dentine is first
exposed, small blebs of fluid can be seen on the cavity
floor. When the cavity is dried, a greater loss of fluid
is induced leading to more movement of fluid and a
further painfull experience.
c. Pain is produced by application of hypertonic fluids
on exposed dentine and by dehydration.
Transduction Theory
1. In this theory the odontoblast process is the primary
structure excited by the stimulus and that impulses
are transmitted to the nerve endings in the inner
dentine.
2. This theory is not popular since there are no neurotrans-
mitter vesicles in the odontoblast process to facilitate
synapse.
5. Near the pulpal surface of dentine the number of tu-
bules per square mm varies between 50,000 and 90,000.
6. The dentinal tubules have lateral branches throughout
dentine known as canaliculi or microtubules.
Q.2. Types of dentine.
Ans.
Refer to the answer of Long Essays Q.2.
Q.3. Predentine.
Ans.
1. Predentine is first form of dentine and is not mineralized.
 Oral Histology

2. It is located adjacent to pulp tissue and is 2-6 jum wide.
3. As the collagen fibres undergo mineralization at preden-
tine junction, the predentine becomes dentine and new
layer of predentine forms circumpulpally.
Q.4. Circumpulpal dentine.
Ans.
1. In primary dentine, two distinct areas are identified:
a. Mantle dentine
b. Circumpulpal dentine.
Mantle dentine forms the outer or most peripheral part
of primary dentine, and the circumpulpal dentine forms
the remaining primary dentine or bulk of the tooth.
It represents all of the dentine that is formed before root
completion.
Collagen fibrils in circumpulpal dentine are much
smaller in diameter of 0.05 um and are more closely
packed together compared to mantle dentine.
Circumpulpal dentine is slightly more mineralized than
mantle dentine.
Q.5. Secondary dentine.
Ans.
1. Secondary dentine is the dentine which is formed after
root formation is complete.
. Secondary dentine has an incremental pattern, fewer
tubules which are less regular.
. At the boundary between primary and secondary den-
tine, the tubules sometimes change their direction and
show more wavy course in secondary dentine.
. The pulp chamber gets obliterated as more and more of
secondary dentine gets deposited.
. Secondary dentine is not formed uniformly, and is
formed in greater amounts in floor and roof of the pulp
chamber (Fig. 4A.4.2).
. Mantle dentine is the first formed dentine in the crown
and lies immediately below the DEJ. It is formed before
a tooth erupts into the oral cavity.
. It is less calcified than rest of the dentine, and is soft
and provides cushioning effect to the tooth.
. It is the outer or most peripheral part of primary
dentine and is about 20 jm thick.
. In the crown portion of mantle dentine, larger diameter
argyrophilic collagen fibres are present called von
Korff’s fibres.
. Compared to circumpulpal dentine, mantle dentine is
less mineralized.
Q.7. Neonatal line.
Ans.
1. Neonatal line separates the prenatal and postnatal den-
tine, and is seen in all deciduous teeth and permanent
first molars.
. This line reflects the abrupt change in environment that
occurs at birth.
. A neonatal line is an accentuated contour line and is a
zone of hypocalcification.
Q.8. Interglobular dentine.
Ans.
1. Sometimes mineralization of dentine begins in small
globular areas that fail to coalesce into a homogeneous
mass. This results in zones of hypomineralization be-
tween the globules. These zones are known as globular
dentine or interglobular space (Fig. 4A.4.3).
Enamel

—> Mantle dentine

Enamel
—> Interglobular
Aor Dentine
dentine
Ce< =

\\ iss
Dead tract Dentinal tubules
at
STONY
passing through
interglobular dentine
Circumulpal dentine

Reparative dentine Fig. 44.4.3 Interglobular dentine.

oY
Pulp space

Fig. 44.4.2 Reparative or secondary dentine. . This dentine forms in the crowns of teeth in the circum-
pulpal dentine just below the mantle dentine, and it
follows the incremental pattern.
Q.6. Mantle dentine.
. The dentinal tubules pass uninterruptedly through
Ans. interglobular dentine.
«%Y') Quick Review Series: BDS Ist Year

4. In dry ground sections some of the globular dentine

may be lost and a space results that appears black in
transmitted light.
Q.9. Tomes granular layer.
aH NTE Enamel
Ans.
1. When dry ground sections of root dentine are visualized
il De ye
CG ZLe PD
rey y 7Penine

in transmitted light, a zone adjacent to cementum ap- San = aw +> Pulp space

LOX WS
ASN
pears granular and is known as Tome’s granular layer. Incremental
2. This zone increases slightly in amount from CEJ to root lines of von
apex, and is believed to be caused by coalescing and YD Ebner

looping of terminal portion of dentinal tubules.

3. The cause of development of this zone is similar to
branching and bevelling of tubules at DEJ.
Fig. 4A.4.4 Incremental lines of von Ebner.
Q.10. Sclerotic dentine.

Ans.

1. Sclerotic dentine is also known as transparent dentine. Contour Lines

2. Formation of sclerotic dentine is a protective mechanism. Some of the incremental lines are accentuated because of
3. Incase of caries, attrition, abrasion or erosion, sufficient disturbances in the matrix and mineralization process, and
stimuli are generated to cause collagen fibres, calcium are known as contour lines of Owen (Fig. 4A.4.5).
salts and apatite crystals to begin appearing in dentine
tubules. This condition is prevalent in older individuals,
especially in the roots.
Q.11. Denticles.

Ans. AUT { | wn Enamel

ki Ly HY OM LULUD Dentine
1. Denticles are also known as pulp stones.
2. These are nodular, calcified masses appearing in either NEN
pa of Owen
or both the coronal and root portions of the pulp organ.
3. They often develop in normal teeth, and are usually ey RX Pulp space
asymptomatic unless they impinge on nerves or blood SR RY RAS
vessels. RX

4. According to their structure, two types of denticles are

found:
a. True denticles
b. False denticles. Fig. 44.4.5 Contour lines of Owen.
True denticles are similar in structure to dentine in that they have
dental tubules and contain the processes of the odontoblasts.
Neonatal Lines
They are very rare and located close to the apical foramen.
False denticles do not exhibit dentinal tubules, but appear The prenatal and postnatal dentins are separated by an
instead as concentric layers of calcified tissue. accentuated contour line termed as the neonatal line.
Q.12. Structural lines in dentine. Q.13. Dead tracts.

Ans. Ans.

1. The incremental lines of von Ebner or imbrication lines
appear as fine lines or striations in dentine (Fig. 4A.4.4).
2. They run at right angles to the dentinal tubules and
correspond to the incremental lines in enamel or bone.
3. These lines reflect the daily rhythmic, recurrent deposition
of dentine matrix.
1. Dentinal areas are characterized by the degenerated
odontoblasts processes, which give rise to dead tracts.
2. In dried ground sections of normal dentine, the odon-
toblast processes degenerate and empty tubules are filled
with air. They appear black in transmitted and white in
reflected light.
 Oral Histology

3. The dead tracts demonstrate decreased sensitivity and
appear to a greater extent in older teeth.
Q.14. Odontoblasts.
Ans.
1. Odontoblasts are columnar in shape, and their nuclei
become basally oriented at early stage of development.
2. One or several processes arise from apical end of the cell
in contact with basal lamina.
3. The length of odontoblast then increases approximately
to 40 jum and width is 7 pm.
4. The odontoblasts secrete both collagen and other com-
ponents of extracellular matrix.
Q.15. Enumerate functions of dentine.
Ans.
Functions of dentine are as follows:
1. Dentine provides the bulk and general form of tooth.
2. It determines the shape of the crown, including the
cusps and ridges, and the number and size of the roots.
3. The dentine is necessary for formation of enamel
matrix.
4. The reparative dentine prevents entry of bacteria.
Q.16. Intertubular dentine.
Ans.
1. Intertubular dentine forms the main body of dentine.
2. Itis located between dentinal tubules.
3. After decalcification, intertubular dentine is retained,
whereas peritubular dentine is not.
Q.17. Reparative dentine.
Ans.
1. It is also called reparative dentine, or response or reac-
tive dentine.
2. It is that dentine produced by odontoblasts in response
to irritation of the pulp caused by chemical, thermal or
microbial stimuli.
3. Itis formed only in localized areas in reaction to trauma,
such as caries or restorative procedures.
4. When reparative dentine is formed rather rapidly, such
dentine contains very few tubules, irregular tubules.
Q.18. Hydrodynamic theory.
Ans.
Fluid or hydrodynamic theory:
1. It is the second and most popular theory.
2. Various stimuli such as heat, cold, air blast, desiccation,
or mechanical or osmotic pressure affect fluid move-
ment in the dentinal tubules.
3. When a stimulus is applied to dentine, there is displace-
ment of fluid within the tubule and this distorts the
local pulp environment and is sensed by the free nerve
endings in the plexus of Raschkow.
4. These nerve endings act as mechanoreceptors as they are
affected by mechanical displacement of the tubular fluid.
Q.19. Osteodentine.
Ans.
Osteodentine is an atypical dentine that develops due to
deficiency of vitamin A. The ameloblast is not differenti-
ated properly; as a result the proliferation of mesenchymal
cells is disturbed and atypical dentine is formed known as
osteodentine.
Q.20. Tertiary dentine.
Ans.
1. Tertiary dentine is also called reparative dentine or re-
sponse or reactive dentine.
2. It is that dentine produced by odontoblasts in response
to irritation of the pulp caused by chemical, thermal or
microbial stimuli.
3. It is formed only in localized areas in reaction to trauma
such as caries or restorative procedures.
4. As the reparative dentine is formed rather rapidly, such
dentine contains very few irregular tubules.
Q.21. Dentinoenamel junction.
Ans.
1. Dentinoenamel junction is best seen in cross-section
(Fig. 4A.4.6).
Enamel
Enamel rods
Dentinoenamel
junction
Dentine
Fig. 44.4.6 Dentinoenamel junction.
2. DEJ appears as a scalloped line with its concavity facing
enamel into these concavities rounded projections of
enamel rods ft.
3. The scalloping is evident even before the formation of
dentine and enamel.
Quick Review Series: BDS 1st Year

4. These scallopings at the DEJ increase the surface area 1. Enamel contains 96% inorganic and 4% organic
and probably enhance adhesion between enamel and substances and water, while dentine contains 65%
dentine. inorganic and 35% organic substances.
5. Several structures like enamel tufts and enamel spindles 2. Inorganic substance: Both contain hydroxyapatite
arise at the DEJ, and extend into enamel. crystals; but these crystals are small in dentine. Dentine
6. On the dentine side, areas of interglobular dentine can also contains phosphate, carbonate and sulphates.
be seen below the DEJ. 3. Organic substances: Enamel contains proteins like,
glutamic acid, glycine and serine. Enamel and dentine
Q.22. Difference between composition of enamel
both contain the ground substance of mucopolysaccha-
and dentine.
ride. The organic substances of dentine also contain
Ans. collagen fibres.

LONG ESSAYS

Q.1. Define pulp and describe its functions. Defensive or Reparative

Ans.
Dental pulp is defined as the connective tissue with special
functions occupying the centre of dentine and arising from
the mesenchyme of the dental papilla.
The functions of pulp are as follows:
Inductive
1. The primary role of pulp analogue is to interact with
oral epithelium cells and cause differentiation of dental
lamina, and result in enamel organ formation.
2. The pulp analogue also interacts with developing enamel
organ, as it determines particular type of tooth.
Formative
1. Pulp is the formative organ of dentine—both under
physiological and pathological conditions.
2. The pulp organ cells produce dentine, which surrounds
and protects the pulp.
Nutritional
1. Pulp has a rich blood supply with a vascular network
around the odontoblasts.
2. It supplies nutrition to the odontoblasts and their cyto-
plasmic extensions within dentinal tubules. This keeps
dentine vital.
Sensory or Protective
The nerves of the pulp react to stimulation, regardless of the
type of stimulation, by a sensation of pain.
1. Like any other connective tissue, pulp reacts by an in-
flammatory process to injury.
2. It responds to irritations whether mechanical, thermal,
chemical or bacterial by producing reparative dentine
and mineralizing affected tubules.
3. The pulp has macrophages, lymphocytes, neutrophils,
monocytes, plasma and mast cells; all of which aid in the
process of repair of pulp.
Q.2. Describe briefly the structural details of pulp.
Or
Enumerate structures in the pulp, and write in
detail on odontoblastic layer and its functions.
Ans.
Dental pulp is defined as the connective tissue with special
functions occupying the centre of dentine and arising from
the mesenchyme of the dental papilla.
The central region of both the coronal and radicular pulp
contains large nerve trunks and blood vessels.
Peripherally, the pulp is circumscribed by the specialized
odontogenic region composed of:
1. The odontoblasts (the dentine-forming cells),
2. The cell-free zone (Weil’s zone)
3. The cell-rich zone.
The structure of pulp consists of:
1. Intercellular substance
2. Fibroblasts
3. Fibres
4. Undifferentiated mesenchymal cells

Odontoblasts
Aw
Defence cells
Blood vessels
WN
Lymph vessels
Nerves and
So
1 . Nerve endings.
Intercellular Substance
1. It is dense and gel-like in nature, and varies in appear-
ance from finely granular to fibrillar.
2. It is composed of both glycosaminoglycans and pro-
teoglycans. During early development, the chondroi-
tin 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 sub-
stance. The ground substance lends support to cells of
pulp and also serves as means for transport of nutrients
from blood vessels to cells and vice versa.
Fibroblasts
1. They are most numerous cell type in the pulp.
2. They have stellate shape and extensive processes that
contact and are joined by intercellular junction to the
processes of other fibroblasts.
3. In young pulp the cells divide and are active in protein
synthesis.
4. In older pulp they appear rounded or spindle shape
with short processes and, exhibit fewer intracellular
organelles and are called as fibrocytes.
5. The fibroblasts of pulp, in addition to forming the pulp
matrix, also have capability of ingesting and degrading
this same matrix.
6. These cells have a dual function with pathways for both
synthesis and degradation in the same cell.
Fibres
1. Typical cross striations at 64 nm are exhibited by the
collagen fibres of pulp.
2. The fibres appear scattered throughout the coronal or
radicular pulp, or they may appear in bundles.
3. These are termed as diffuse or bundle collagen, depending
on their appearance.
4. Their presence may relate to environmental trauma.
Undifferentiated Mesenchymal Cells
1. They are the primary cells in very young pulp; but few
are seen in pulps after root completion.
2. 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, etc.
Oral Histology
Odontoblasts
1. Odontoblasts are second most prominent cells in the
pulp located adjacent to predentine in ‘odontogenic
zone of pulp, with cell bodies in pulp and cell processes
in the dentinal tubules.
. The form and arrangement of bodies of odontoblasts
are not uniform throughout pulp. They are most cylin-
drical and tall columnar in crown, more cuboidal in
middle of root, close to apex odontoblasts are ovoid and
spindle shaped.
. Odontoblasts function primarily as secretory cells. They
synthesize and secrete collagen of dentine, and also the
ground substance.
Defence Cells
1. The cells which are important for defence of pulp are:
a. histiocytes or macrophages,
b. mast cells and
c. plasma cells.
. In addition, there are blood vascular elements such as:
a. neutrophil,
b. basophil,
c. lymphocytes and
d. monocytes.
. The histiocyte or macrophage is an irregular-shaped cell
with short, blunt processes usually associated with small
blood vessels and capillaries.
. Mast cells are also seen along vessels in inflamed
pulp. Their number increases during inflammation
of pulp.
. The plasma cells are seen during inflammation of pulp.
The plasma cell performs the function of production of
antibodies.
. Both lymphocytes and eosinophils are found extravas-
cularly in the normal pulp; during inflammation they
increase in number.
Blood Vessels
. The pulp organ is extremely vascularized.
. The pulp organ is supplied by superior alveolar and
inferior alveolar arteries, and drains by same veins in
maxilla and mandible.
Lymph Vessels
1. The larger lymph vessels have an irregular-shaped
lumen composed of endothelial cells surrounded by an
incomplete layer of pericytes.
. They are characterized by absence of RBC and presence
of lymphocytes.
. Those draining anterior teeth pass to submental lymph
nodes, and of posterior teeth pass to submandibular and
deep cervical lymph nodes.
Quick Review Series: BDS 1st Year
Nerves
1. The majority of nerves that enter pulp are non-myelinated.
2. The non-myelinated nerves are found in close association
with blood vessels of pulp and many are sympathetic in
nature.
3. The large myelinated fibres mediate the sensation of
pain caused by external stimuli.
4. The peripheral axons form a network of nerves located
adjacent to cell-rich zone called as parietal layer of
nerves or plexus of Raschkow.
SHORT ESSAYS
Q.1. Odontogenic region of pulp.
Ans.
Histologically, four distinct zones are recognized in the pulp.
They are:
1. The zone of odontoblasts
2. Cell-free zone or zone of Weil
3. Cell-rich zone
4. Pulp core.
The zone of odontoblasts exhibits the following features:
1. A single layer of odontoblasts line the periphery of pulp
with their long axis at right angles to the pulp surface.
2. The cytoplasmic process of the odontoblasts called
odontoblastic process extends into the dentinal tubules.
3. Each tubule has one such odontoblastic process, and the
number of odontoblasts corresponds to the number of
dentinal tubules.
4. In coronal dentine there are about 45,000 odontoblasts
per square millimetre and a lesser number in root dentine.
5. In the crown, the cell bodies of odontoblasts are colum-
nar and have a length of about 40 jum and a diameter
of 5-7 um. In the mid-portion of the pulp, they are
cuboidal; and in the apical part they are flattened .
6. The nucleus of the odontoblast is situated basally
towards the pulpal side and is oval in shape.
Just above the nucleus are present the endoplasmic
reticulum and Golgi apparatus.
7. The odontoblastic process does not have any endoplasmic
reticulum.
8. The cell body of an actively secreting odontoblast shows
a prominent Golgi apparatus, abundant mitochondria
and is rich in alkaline phosphatase.
9. The plasma membrane of adjacent odontoblasts exhibit
junctional complexes connecting the odontoblasts.
Nerve Endings
1. Substances like substance P, 5HT, vasoactive intestinal
peptide, somatostatin and prostaglandin as well as ACh
and norepinephrine throughout the pulp.
2. The majority of transmitters have been shown to
affect vascular tone and modify excitability of nerve
endings.
10. Being end cells, the odontoblasts are incapable of mitosis.
The new odontoblast can only be formed from undiffer-
entiated mesenchymal cells.
11. Odontoblasts function primarily as secretory cells. They
synthesize and secrete collagen of dentine and also the
ground substance.
Q.2. Age changes and clinical consideration of
pulp.
Ans.
Age changes in dental pulp are as follows:
1. With age, the number of cells in pulp decreases and there
is a corresponding increase in the collagen content.
a. The cells are characterized by decrease in size and
number of cytoplasmic organelles.
b. The fibroblasts in aging pulp exhibit less perinu-
clear cytoplasm and posses long, thin cytoplasmic
processes.
2. With reduction in cells, the pulp shows a lowered resis-
tance to infection.
3. With successive layers of secondary dentine formation,
the pulp becomes smaller in size.
4. The reduction in the size of the apical foramen reduces
flow of blood to pulp.
5. Pulp stones or denticles are calcified masses occurring in
coronal as well as root portions of the pulp.
6. Areas of dystrophic calcification, especially in central
pulp, are seen in older pulp.
7. There is an age-related reduction in sensitivity of pulp
due to degeneration of myelinated and unmyelinated
axons.
Q.3. Pulp calcifications.
Ans.
 Oral Histology

1. Pulp stones or denticles are nodular calcified masses oc- Free Denticles
curring in coronal as well as root portions of the pulp.
a. They are entirely surrounded by pulp tissue (Fig. 4A.5.1).
2. They are not pathological, as they are seen with sufficient
frequency in normal teeth including unerupted teeth. They
are usually not painful unless they impinge on nerves.
They are classified. as: . Dentine
1. a. True denticles (with tubules)
b. False denticles (devoid of tubules) Pulp
2. a. Free (not in contact with dentine)
b. Attached (in contact with dentine wall)
3. a. Discrete (single denticles) Free pulp stone
b . Diffuse (many denticles).

True Pulp Stones

a. They occur most commonly in pulp tissue close to the
apex of the root.
b. They contain irregular tubules. Fig. 44.5.1 Free pulp stones.
c. They may arise because of inclusion of cells of Hertwig’s
root sheath within the pulp, which may induce the cells of
the pulp to differentiate into odontoblasts, which form
Attached Denticles
true denticles and surround them. True denticles are rare.
b. They are partly fused with dentine.
False Pulp Stones c. Embedded denticles are entirely surrounded by dentine
a. They do not have tubules and appear as concentric lay- (Fig. 44.5.2).
ers of calcified tissue. All above denticles form free in pulp and later they
b. They are formed around dead or degenerated cells of | become attached or embedded as dentine formation
collagen. progresses.
c. They are common in coronal pulp. The size of pulp stone increases as the age advances.
d. Pulp stones are calcified as free, attached and embedded, The presence of pulp stones is significant in that they act
depending on their relation to dentine of the tooth. as impediment during endodontic treatment.

Dentine

Pul
up Dentine

Pulp

Embedded
pulp stone

Attached
pulp stone

Fig. 4A.5.2 (A) Attached pulp stones. (B) Embedded pulp stones.
er Quick Review Series: BDS 1st Year

SHORT NOTES

Q.1. Cellular elements of pulp. Q.4. Odontoblasts.

Or Ans.

Define cells of pulp. 1. Odontoblasts are second most prominent cells in the
pulp located adjacent to predentine in ‘odontogenic
Ans. zone of pulp’ with cell bodies in pulp and cell processes
The cellular elements of pulp are as follows: in the dentinal tubules.
1. Fibroblasts 2. The form and arrangement of bodies of odontoblasts
2. Undifferentiated mesenchymal cells are not uniform throughout pulp. They are most cylin-
3. Defensive cells like: drical and tall columnar in crown, more cuboidal in
i. macrophages, middle of root, close to apex odontoblasts are ovoid and
ii. histiocytes and spindle shaped.
iii. lymphocytes. 3. Odontoblasts function primarily as secretory cells. They
4. Mast cells and plasma cells: Present in the inflammed synthesize and secrete collagen of dentine, and also the
pulp. ground substance.
5. Pericytes are somewhat elongated, contractile cells seen Q.5. Zones of pulp.
along the capillaries in pulp and have no special signifi-
cance attached to them. Ans.

Q.2. Pulp stones. Histologically, pulp consists of four distinct zones:

1. The zone of odontoblasts
Ans. 2. Cell-free zone or zone of Weil
1. Pulp stones or denticles are nodular calcified masses 3. Cell-rich zone
occurring in coronal as well as root portions of the pulp. 4. Pulp core.
2. They are not pathological, and are seen in normal teeth Q.6. Functions of pulp.
including unerupted teeth.
3. They are classified as follows: Ans.
. True denticles (with tubules) Functions of pulp are as follows:
>
p

b. False denticles (devoid of tubules) 1. Inductive: It induces the differentiation of dental lamina
B. a. Free (not in contact with dentine) and result in enamel organ formation.
b. Attached (in contact with dentine wall) 2. Formative: The cells of pulp organ produce dentine.
C. a. Discrete (single denticle) 3. Nutritional: It nourishes the dentine.
b. Diffuse (many denticles). 4. Sensory: It reacts to all stimuli by a sensation of pain.
5. Defensive: It reacts by inflammatory process to injury
Q.3. Pulp. : wl,
and also forms reparative dentine in response to
Ans. irritations.
1. Dental pulp is defined as the connective tissue with @.7% Age changes in pulp.
special functions occupying the centre of dentine and
Ans.
arising from the mesenchyme of the dental papilla.
2. Histologically, it consists of four distinct zones: 1. With age, the number of cells in pulp decreases.
a. The zone of odontoblasts 2. There is a corresponding increase in the collagen
b. Cell-free zone or zone of Weil content.
c. Cell-rich zone 3. The pulp becomes smaller in size.
d. Pulp core 4. The reduction in the size of the apical foramen reduces
3. Functions of pulp are: flow of blood to pulp.
a. Inductive 5. Pulp stones or denticles appear in coronal as well as root
b. Formative portions of the pulp.
c. Nutritional Q.8. Undifferentiated mesenchymal cells of pulp.
d. Sensory
e. Defensive. Ans.
 Oral Histology

1. Undifferentiated mesenchymal cells are the primary 2. In addition, there are blood vascular elements such as:
cells in very young pulp, but few are seen in pulps after a. Neutrophil
root completion. b. Basophil
2. They are found along the pulp vessels in cell-rich zone c. Lymphocytes
and are scattered throughout the central pulp. d. Monocytes.
3. They are the totipotent cells and when need arises they 3. The histiocyte or macrophage is an irregular-shaped cell
become odontoblasts, fibroblasts or macrophages. with short blunt processes usually associated with small
blood vessels and capillaries.
Q.9. Cell-free zone (zone of Weil) and cell-rich 4. Mast cells are also seen along vessels in inflamed pulp.
zones of pulp. Their number increases during inflammation of pulp.
5. The plasma cells are seen during inflammation of pulp.
Ans.
The chromatin of nucleus in these cells give cartwheel
Cell-free Zone arrangement. The plasma cell performs the function of
production of antibodies.
1. It is also known as zone of Weil. 6. Both lymphocytes and eosinophils are found extravas-
2. It is a space in which the odontoblast may move pulp- cularly in the normal pulp; during inflammation they
ward during tooth development and later to the limited increase in number.
extent in functional teeth.
3. It is less conspicuous during early stages of rapid Q.11. Subodontoblastic plexus of Raschkow.
dentinogenesis (Fig. 4A.5.3). Ans.
1. The cell-free zone present beneath the odontoblastic
layer is composed of reticular fibres and a plexus of
nerves called the plexus of Raschkow.
2. This plexus can be demonstrated in silver-stained
sections under light microscope.
3. This plexus can be demonstrated by immune cytochem-
Predentine ical techniques to identify various proteins associated
Odontoblastic
with nerves.
> Cell-free zone
Q.12. Odontoblastic zone or odontogenic region of
Cell-rich zone
pulp.
Pulp core
Ans.
Histologically, four distinct zones are recognized in the pulp.
Fig. 4A.5.3 Zones of pulp. They are:
1. The zone of odontoblasts
2. Cell-free zone or zone of Weil
3. Cell-rich zone
Cell-rich Zone 4. Pulp core.
1. This layer is composed principally of fibroblasts and The zone of odontoblasts exhibits the following features:
undifferentiated mesenchymal cells. 1. A single layer of odontoblasts lines the periphery of
2. During early dentinogenesis, there are many young pulp; the cytoplasmic process of the odontoblasts called
collagenous fibres in this zone. odontoblastic process extends into the dentinal tubules.
3. The pulp also consists of intercellular substance, fibres, 2. Each tubule has one such odontoblastic process, and the
defence cells, blood vessels, lymph vessels, nerves and number of odontoblasts corresponds to the number of
nerve endings. dentinal tubules.
3. In coronal dentine there are about 45,000 odontoblasts
Q.10. Defence cells of pulp. per square millimetre and a lesser number in root dentine.
4. In the crown, the cell bodies of odontoblasts are colum-
Ans.
nar, in the mid portion of the pulp they are cuboidal and
1. The cells which are important for defence of pulp are: in the apical part they are flattened .
a. Histiocytes or macrophages 5. Odontoblasts function primarily as secretory cells. They
b. Mast cells synthesize and secrete collagen of dentine, and also the
c. Plasma cells. ground substance.
Rr 74 Quick Review Series: BDS 1st Year

LONG ESSAYS

Q.1. Describe the microscopic and macroscopic 3. Extrinsic fibres are about 7 jum in thickness and are
appearance of cementum. perpendicular to the surface.
Ans.
Cementobiasts (cells lining cementum)
Cementum is a mineralized connective tissue covering the
anatomical roots of teeth. 1. Cementoblasts form the cementum, are seen lining the
root surface and are interposed between bundles of the
Structure periodontal ligament.
2. When they are active, cementoblasts are plumpy, round
The structure of cementum consists of following components: and have a basophilic cytoplasm, which indicates
1. Fibres
presence of a rough endoplasmic reticulum.
Cementoblasts (cells forming cementum)
3. In electron microscopy these cells show collagen
Wd

Cementocytes (cells within cementum)

containing, phagolysosomes.
Acellular and cellular cementum
VR

Incremental lines An active cementoblast has an open nucleus. Resting

Cementodentinal junction (CDJ) cementoblasts have a closed nucleus and scanty cytoplasm.
ND

Cementoenamel junction (CEJ).

Cells within cementum
Fibres in cementum 1. When cellular cementum is being formed, some
The collagen fibres in cementum cementoblasts become trapped within their own matrix
\ and are called cementocytes.
2. Cementocytes have very little cytoplasm and posses
numerous processes occupying canaliculi in the miner-
1. Internal fibres (Intrinsic) 2. External fibres (Extrinsic) alized matrix.
3. As cementocytes depend on the periodontal ligament
Collagen fibres of the cementum are of two types: for their nutrition, a great majority of these processes
1. Intrinsic fibres are towards the periodontal ligament side.
2. Extrinsic fibres. 4. During ground sections, the organic cementocytes and
their processes are lost, and only spaces once occupied
Intrinsic fibres by them are seen in transmitted light as dark areas
1. Collagen fibres produced by cementoblasts are called representing the lacunae and canaliculi.
intrinsic fibres.
2. These fibres belong to cementum and form organic matrix Acellular and cellular cementum
of cementum.
1. There are two kinds of cementum based on presence or
3. They are 1-2 jum in thickness and are parallel to the surface.
absence of cells within cementum:
a. Acellular cementum
Extrinsic (Sharpey’s) fibres
b. Cellular cementum.
1. Collagen fibres produced by fibroblasts of periodontal 2. Coronal two-thirds of the root consists of only acellular
ligament are incorporated into the cementum as cementum.
Sharpey’s fibres, which are known as extrinsic fibres. 3. Apical two-thirds of the root consists of both acellular
2. Sharpey’s fibres are regarded as extrinsic fibres because and cellular cementum.
they are not products of cementoblasts. 4. Both acellular and cellular are lamellated (Fig. 4A.6.1).
 Oral Histology

+> Incremental
lines of Salter

Hyaline
layer
of Hopewell
Cementocyte Tomes granular
layer
= Incremental
:
lines of
A Salter
Fig. 4A.6.1 Acellular and cellular cementum.

Acellular cementum 4. Histochemical studies reveal that the incremental lines

are highly mineralized with less collagen and more
. Also called primary cementum.
ground substance.
op

. First formed cementum.

5. They are also known as resting lines.
. Does not contain cementocytes.
aa

. It is the cementum that is formed before the tooth

Cementodentinal junction (CDJ)
reaches the occlusal plane.
It covers the cervical third or half of root. 1. The cementodentinal junction is:
oO

Sharpey’s fibres make up most of the structure of Smooth — in permanent teeth

acellular cementum, which has a principal role in Scalloped — in deciduous teeth.
supporting tooth. 2. Between the cementum and dentine a thin hyaline layer
g- More calcified than cellular cementum. is seen. It is thought to be a product of cells of Hertwig’s
root sheath and probably functions as a cementing
Cellular cementum medium between dentine and cementum.
Cellular cementum is also called secondary cementum.
Cementoenamel junction (CEJ)
TS

Formed after the tooth reaches the occlusal plane.

It is more irregular and contains cementocytes in lacunae. 1. The relation between cementum and enamel at cervical
Cellular cementum is more frequent on the apical half. region of teeth is called as cementoenamel junction.
moon

It is always thickest around the apex. 2. Types of cementoenamel junction are as follows:
Cementum that contributes to the lengthening of root is a. In about 60% of cases cementum overlaps the
cellular cementum. enamel.
b. In about 30% of cases, cementum meets the cervical
Incremental lines in cementum end of the enamel in a relatively sharp line (i.e. edge-
to-edge joint).
1. Due to the continuous but phasic deposition of cemen-
c. In 10% of cases, the cementum and enamel do not
tum, incremental lines can be seen in cementum.
meet (Fig. 4A.6.2).
2. They are best seen in decalcified sections stained
with H&E. In longitudinal sections, they are more or Q.2. Enumerate the differences between cellular
less parallel to the long axis of the tooth and in cross- and acellular cementum.
sections they appear as concentric rings.
Ans.
. They are spaced closer in acellular cementum and
farther apart in cellular cementum. They are more The differences between cellular and acellular cementum are
regular in cellular cementum. listed in Table 4A. 6.1.
67) Quick Review Series: BDS 1st Year

Cementum

Dentine

Acellular afibrillar

Butt-type
CEJ
Enamel

Cementum

Dentine

Gap-type CEJ

Enamel

Fig. 44.6.2 Types of cementoenamel junction: (A) overlap type, (B) butt type and (C) gap type.

Table 4A.6.1 Differences between cellular and acellular cementum

Acellular cementum Cellular cementum

1. Itis also known as primary cementum 1. It is also known as secondary cementum
2. Contains no cells 2. Contains cementocytes
3. Covers cervical and middle one-third of root 3. Found in apical one-third of root and in furcation areas
4. Has no collagenous matrix. Sharpey’s fibres are the only 4. Has a collagenous matrix
collagen fibres
5. Thinner 5. Thicker
6. Incremental lines are closer, less regular and more in number 6. Wider separation of incremental lines and irregular and less in number
7. Sharpey’s fibres more mineralized 7. Sharpey’s fibres are mineralized only at periphery (less mineralized)
8. First formed cementum, which develops before the tooth 8. Formed after the tooth reaches the occlusal plane
reaches the occlusal plane
9. More calcified 9. Less calcified

SHORT ESSAYS

Q.1. Intermediate cementum. 1. Intermediate cementum layer is a zone which separates

dentine from cementum. It is also known as hyaline
Ans. layer of Hopewell-Smith.

2. It does not exhibit characteristic features of either
dentine or cementum.
3. This layer is predominately seen in the apical two-thirds
of roots of molars and premolars. Rarely on incisors and
primary teeth.
4. It is found only in isolated areas; sometimes it is a
continuous layer.
5. This layer represents areas where cells of Hertwig’s
epithelial sheath become trapped in a rapidly deposited
dentine or cementum matrix.
Q.2. Cementogenesis.
Ans.
1. Cementum is formed by cementoblasts. Collagen fibres in
cementum are produced by fibroblasts and cementoblasts.
2. It is preceded by dentine deposition along the inner as-
pect of Hertwig’s root sheath, which then breaks and CT
contact dentine; so undifferentiated mesenchymal cells
from CT form cementocytes to form cementum.
3. The uncalcified matrix of cementum is called cementoid.
4. Fenestration of Hertwig’s epithelium root sheath is very
necessary for cementum to be deposited during root
development.
5. Embedded part of PDL fibres in cementum are known
as Sharpey’s fibres. Sharpey’s fibres run at right angle to
the collagen fibres.
Q.3. Enumerate types of cementoenamel junction
and write its development.
Ans.
Refer to the Cementoenamel Junction in Long Essays Q.1 of
this topic.
Q.4. Cellular cementum (secondary cementum).
Ans.
1. Cellular cementum is formed after the tooth reaches the
occlusal plane.
It is more irregular and contains cementocytes in lacunae.
YN
It is more frequent on the apical-half of the root.
It is always thickest around the apex.
ae
Cellular cementum contributes to the lengthening of
root; it is also known as secondary cementum.
SHORT NOTES
Q.1. Sharpey’s fibres.
Ans.
1. Sharpey’s fibres are the extrinsic fibres of cementum
seen as discrete bundles of collagen fibres in tangential
sections (Fig. 4A.6.3).
Oral Histology
Q.5. Acellular cementum (primary cementum).
Ans.
. It is also known as primary cementum.
ee
. First formed cementum.
Bw
N
. Does not contain cementocytes.
. It is the cementum that is formed before the tooth
reaches the occlusal plane.
. It covers the cervical-third or half of root.
nD UI
. Sharpey’s fibres make up most of the structure of acellular
cementum, which has a principal role in supporting tooth.
7. More calcified than cellular cementum.
Q.6. Write a short note on cementum.
Ans.
1. Cementum is the hard, mineralized dental tissue covering
the anatomical roots.
. Human cementum is avascular and is light yellow in
colour.
. Cementum contains 45-50% of inorganic material,
50-55% of organic material and water.
. The organic portion of cementum has type-I collagen.
. Cementum has the highest fluoride content of all
mineralized tissues and is without nerve supply.
. It begins at cervical portion of tooth to CEJ and continues
to apex.
. Cementum furnishes a medium for attachment of col-
lagen fibres that bind the tooth to surrounding structure.
. In general, the cementum is of two types:
a. Acellular
b. Cellular
© Coronal two-thirds of the root consists of only
acellular cementum.
e Apical two-thirds of the root consists of both
acellular and cellular cementum.
e Both acellular and cellular are lamellated.
The various functions of cementum are as follows:
1. It furnishes a medium for attachment of collagen fibres
that bind tooth to alveolar bone.
. It serves as major reparative tissue for root surface.
. It may also be viewed as tissue that makes functional
adaptation of teeth possible.
2. Collagen fibres produced by fibroblasts of periodontal liga-
ment are incorporated in to the cementum as Sharpey’s
fibres.
3. Sharpey’s fibres are regarded as extrinsic fibres as they
are not products of cementoblasts.
Quick Review Series: BDS 1st Year

Dentinal tubule
Cellular
cementum Incremental
ay’
— a aa

Cementocytes lines of Salter

hs
a

Alveolar bone
FA

4\.8\.
nt
—7

\e \2 \ % Incremental
nae v lines
Pseuodontal
J of Salter ligament

Fig. 44.6.4 Hypercementosis.

Fig. 44.6.3 Sharpey’s fibres.

4. They are of about 7 mm thickness and are perpendicular 2. The cementocytes are spider-like cells; they lie in lacunae.
to the surface. 3. A typical cementocyte has numerous cell processes or
5. Cemental surfaces with actively mineralizing fronts canaliculi radiating from its cell body towards the peri-
have numerous small openings that correspond to sites odontal surface of cementum. These processes may
where individual Sharpey’s fibres enter the tooth. The branch and anastomose with those of neighbouring cells.
openings represent unmineralized core of fibres. 4. The cytoplasm of cementocytes in deeper layer of cemen-
6. The deeper fibres which are away from the cementum tum contains few organelles indicating that cementocytes
surface are older ones and are mineralized. are either degenerating or marginally active cells.
5. In more deeper layer of cementum lacunae appear empty,
Q.2. Cellular cementum.
suggesting complete degeneration of cementocytes.
Ans.
Q.6. Types of cementum.
. Cellular cementum is also known as secondary cementum.
Ans.
whe

. Itis formed after the tooth reaches the occlusal plane.

. Itis more frequent on the apical-half of the root. Cementum is classified into different types on the following
. Itis more irregular and contains cementocytes in lacunae. basis:
Be

Q.3. Cementoenamel junction.

A. Based on Location
Ans.
1. Radicular cementum: This is cementum that covers
Refer to the Cementoenamel Junction in Long Essays Q.1 anatomical roots of teeth—the main bulk.
of this topic. 2. Coronal cementum: Cementum that covers enamel at
the CEJ. It is thin, afibrillar and poorly developed.
Q.4. Hypercementosis.
Ans. B. Based on the Presence or Absence of Fibrils
in The Matrix
1. Hypercementosis is an abnormal thickening of cemen-
tum. It may be diffuse or circumscribed (Fig. 4A.6.4). 1. Fibrillar Cementum
2. It may affect all teeth of dentition or single tooth or even a. The most common form and the main bulk of
a part of one tooth. cementum.
3. If overgrowth improves the functional qualities of b. Contains well-defined and densely packed collagen
cementum, it is termed as cementum hypertrophy. in the matrix.
4. If overgrowth occurs in nonfunctional teeth or if it is 2. Afibrillar cementum
not correlated with increase function it is termed as a. Lacks fibres and rare.
hyperplasia. b. Cementum covering enamel is usually afibrillar.
Q.5. Cementocytes.
C. Based on Presence or Absence of Cells
Ans. Within Cementum

1. Cementocytes are the cells that are incorporated into 1. Acellular cementum
cellular cementum. a. Also called primary cementum.

b. First-formed cementum and covers the cervical
one-third and middle one-third of the root.
c. It does not contain any cells.
2. Cellular cementum
a. It is also known as secondary cementum.
b. It is formed after the tooth reaches the occlusal plane,
and is more irregular and contains cementocytes in
lacunae.
c. It is more frequent on the apical-half of the root and
is always thickest around the apex.
Q.7. Functions of cementum.
Ans.
The various functions of cementum are as follows:
1. It furnishes a medium for attachment of collagen fibres
that bind tooth to alveolar bone.
2. It serves as major reparative tissue for root surface.
3. It makes functional adaptation of teeth possible.
Q.8. Cementoblasts and cementocytes.
Ans.
1. Cementoblasts (cells lining cementum)
a. Cementoblasts form the cementum, are seen lining
the root surface and are interposed between bundles
of the periodontal ligament.
b. When they are active, cementoblasts are plumpy,
round and have a basophilic cytoplasm.
2. Cementocytes (cells within cementum)
a. When cellular cementum is being formed, some
cementoblasts become trapped within their own
matrix and are called cementocytes.
b. Cementocytes have very little cytoplasm and possess
numerous processes occupying canaliculi in the
mineralized matrix.
Q.9. Intermediate cementum.
Ans.
LONG ESSAYS
Q.1. Describe in detail the structure of periodontal
ligament.
Or
Discuss the cells and fibres of periodontal ligament.
Ans.
Oral Histology
1. Intermediate cementum layer is a zone which separates
dentine from cementum. It is also known as Hyaline
layer of Hopewell-Smith.
2. This layer represents areas where cells of Hertwig’s
epithelial sheath become trapped in a rapidly deposited
dentine or cementum matrix.
Q.10. Histology of primary cementum.
Ans.
1. The cementum consists of cementoblasts, which synthe-
size collagen and protein polysaccharide, which make
up organic matrix of cementum.
2. The uncalcified matrix of cementum is called cementoid.
3. The embedded portions of connective tissue fibres in
cementum that serve to attach the tooth to surrounding
bone are known as Sharpey’s fibres.
4. The cementum also consists of cementocyte, which
contain few ER and mitochondria.
5. Beside this cementum consists of incremental lines, which
consist of less collagen fibres and more ground matrix.
These lines separate acellular and cellular cementum.
Q.11. Describe clinical consideration of cementum.
Ans.
1. Cementum is more resistant to resorption than bone,
and for this reason orthodontic tooth movement is
made possible.
2. Cementum resorption can occur after trauma or
excessive occlusal forces.
3. After resorption, damage is usually repaired by forma-
tion of cellular or acellular or both cementums. In most
cases of repair the outline of root is re-established. This
is called as anatomic repair.
4. In some cases of repair the outline of alveolar bone fol-
lows that of root surface so that a functional relationship
will result. This change is called as functional repair.
5. Transverse fracture of the root may occur after trauma,
and these may heal by formation of new cementum.
PERIODONTAL
The structure of periodontal ligament (PDL) is discussed
under the following headings:
1. Cellular elements
2. Extracellular substance
3. The fibre groups in PDL.
 Quick Review Series: BDS 1st Year

1. Cells of PDL 3. Many of them show cell-to-cell contact with gap junctions.
a. Synthetic cells 4. Fibroblasts synthesize procollagen, produce proteoglycan,
i. Osteoblasts and are involved in the formation and maintenance of
ii. Fibroblasts collagen fibres.
iii. Cementoblasts. 5. They help in the eruption of tooth by their contractile
b. Resorptive cells property (collagen traction theory).
i. Osteoclasts
ii. Fibroblasts Cementoblasts
iii. Cementoclasts.
1. Cementoblasts are the cells that form cementum.
c. Progenitor cells
2. They cover the surface of cementum and are found in
i. Epithelial rests of Malassez.
between fibres. These are flattened cells with an irregular
d. Defence cells
outline.
i. Mast cell
3. These cells aid in the reattachment of PDL fibres to root
ii. Macrophages
by forming fresh cementum whenever required.
iii. Eosinophils.
2. Extracellular substance
Resorptive cells
a. Ground substance
b. Interstitial tissue. Osteoclasts
Structures present in connective tissue are as follows: 1. Osteoclasts are the large multinucleated cells that resorb
. Blood vessels the bone.
Te

Veins 2. In light microscope, osteoclasts sometimes appear to

. Lymphatics occupy bays in the bone known as Howship’s Lacunae.
weooin

. Nerves The plasma membrane of this cell lying adjacent to the

. Cementicles. bone being resorbed has foldings and is called ruffled
. Fibres or striated border. There is a clear zone of cytoplasm
. Collagen fibres immediately next to the ruffled border.
sp

. Sharpey’s fibres
. Elastic fibres Fibroblasts
. Reticular fibres
moan

1. Mononuclear fibroblast resorbs the collagen fibres of

. Oxytalan fibres
. Indifferent fibre plexus.
Cells of PDL
Synthetic cells
These cells are rich in ribosomes, rough endoplasmic reticu-
lum and Golgi apparatus. In light microscope, all these cells,
exhibit a large, open-faced or vesicular nucleus with prominent
nucleoli and an abundant cytoplasm.
Osteoblasts
1. They are found covering the periodontal surface of
alveolar bone between embedded fibres.
They are plump and irregularly cuboid with a large
nucleus. A resting osteoblast is almost fat.
The number of osteoblasts decreases with age.
Osteoblasts are required for constant apposition of bone
following resorption in the functional remodelling of bone.
Fibroblasts
1. Fibroblasts are the principal cells of the PDL.
2. Found in between the fibres of the PDL. These are large
stellate-shaped cells with extensive cytoplasm. They
have a well-developed cytoskeleton.
PDL under normal physiologic condition.
2. These cells exhibit lysosomes that contain fragments of
collagen.
3. Fibroblasts have dual function of both synthesis and
resorption of same cells.
Cementoclasts
1. Cementoclasts resemble the osteoclasts and are found in
normal functioning PDL.
2. Resorption of cementum occurs in certain conditions,
and cementoclasts cause it.
3. Both osteoclasts and cementoclasts originate from
haematopoietic cells.
Progenitor cells (undifferentiated
mesenchymal cells)
1. These cells have a perivascular location within 5 microns
from blood vessels.
2. They divide to form two cells. One of the daughter cells dif
ferentiates into a functional cell (like fibroblast, osteoblast or
cementoblast) and the other remains as a progenitor cell.
3. Progenitor cells have a close-faced nucleus, which is
small and has very little cytoplasm. They replace differ-
entiated cells at the end of their lifespan.

Epithelial rests of Malassez
1. Soon after Hertwig’s epithelial root sheath breaks up,
some sheath cells that migrate towards the dental sac
become the epithelial rests of Malassez found in PDL.
2. They persist as strands, islands or tube-like structures,
close to cementum.
Blood cells
Mast cells
1. Mast cells are small, round or oval cells having a granu-
lar cytoplasm.
2. Mast cells are believed to play a role in regulating endo-
thelial and fibroblast cell population.
Macrophages
1. Located usually adjacent to blood vessels, it has horse-
shoe- or kidney-shaped nucleus with a dense uneven
layer of chromatin peripherally.
2. They may contain phagocytosed material in their
cytoplasm.
3. In the PDL, they have a dual role to play:
a. Phagocytosing dead cells
b. Secreting a growth factor that regulates the proliferation
of adjacent fibroblasts.
Extracellular Substance of PDL
Ground substance
1. It consists of glycoproteins and proteoglycans.
2. The space between cells, fibres, blood vessels and nerves
in the periodontal space is occupied by ground
substance.
3. The ground substance helps in the transportation of
materials from and to the cells.
4. The ground substance of PDL is made up mainly of
water (70%), proteoglycans and glycoproteins.
5. Proteoglycans can be demonstrated by histochemical
methods using Alcian blue and toluidine blue in light
microscopy, and using ruthenium red in electron
microscopy.
6. Glycoproteins can be demonstrated in light microscopy
by periodic acid—Schiff staining (PAS) and in electron
microscopy by periodic acid-silver methenamine
technique.
7. A special glycoprotein called fibronectin is seen in PDL,
and attaches to fibroblasts and collagen.
Interstitial tissue
1. It is composed of blood vessels, nerves and lymphatics.
2. PDL has its main blood supply from branches of supe-
rior and inferior alveolar arteries. Many arteriovenous
anastamoses occur within the PDL.
Oral Histology
3. Nerve fibres enter from apical region and run towards
gingival margin. These nerve fibres are joined by the
nerve fibres entering from lateral walls of the socket.
Four types of nerve endings are recognized in the PDL.
. Free nerve endings
op
. Ruffini corpuscles
. Coiled type (function not clear)
. Spindle type
Pon
. A network of lymphatics following the path of blood
vessels provides lymphatic drainage from the PDL
towards alveolar bone.
Fibres
Collagen fibres
1. The collagen fibres in PDL are found in bundles having
clear orientation relative to the periodontal space.
2. These fibres are also known as the ‘principal fibres’ of
the PDL.
The principal fibres of PDL are of five types:
1. Alveolar crest group: The fibre bundles radiate from the
crest of alveolar process and attach themselves to the
cervical part of cementum.
2. Horizontal fibres: The horizontal fibres run at right
angles to the long axis of the tooth from the cementum
to the bone.
3. Oblique group: They run in oblique direction and are
attached somewhat coronal to the bone. These fibres are
most numerous and constitute the main attachment of
the tooth.
4. Apical group: The bundles are irregularly arranged and
radiate from apical region of the root to the surround-
ing bone.
5. Interradicular group: The fibres of bundle are seen
to arise from the crest of interradicular septum, and
they extend to the function area of multirooted teeth
(Fig, 4A.7.1).
Oxytalan fibres
These fibres are restricted to the walls of blood vessels. They
run in an axial direction and are attached to blood vessels.
One end is either attached to cementum or bone and other
end to the walls of blood vessels.
Q.2. Describe the functions of PDL.
Ans.
PDL is the specialized connective tissue that surrounds, sup-
ports and protects teeth by its attachments to roots and sur-
rounding alveolar bone.
PDL performs the following functions:
1. Formative/resorptive
2. Nutritive
Quick Review Series: BDS 1st Year

Alveolar crest Nutritive

group of fibres
Gingival epithelium The PDL has got blood vessels that supply nutrition to
cementocytes within cementum and the other cells in
Dentine PDL space.
Lamina propria
of gingiva with Supportive
gingival group of
fibres 1. Maintains the relationship of its supporting and
Horizontal group neighbouring structures.
of fibres 2. The numerous collagen fibres that occur in PDL act as
Oblique fibres
cushion to withstand forces of mastication.
Cementum
Epithelial rests of Malassez
Protective

1. It is resilient to masticatory forces, and acts as a ‘shock

absorber and restricts movement of teeth to mastica-
tory forces.
2. This is accomplished by the syndesmosis or gamphosis
type of attachment to alveolar bone.

Sensory
1. In addition to pain sensation, it carries tactile sensation
from teeth and hence helps in localization of pain.
2. The PDL is richly innervated and has an excellent
proprioceptive mechanism.

Apical fibres of Homeostatic

periodontal ligament
1. The cells of PDL have the capacity to resorb and synthe-
B Cell rests of Malassez
size the extracellular substance of the connective tissue
Fig. 4A.7.1 Principal fibres: (A) alveolar crest and horizontal of the ligament, alveolar bone and cementum.
fibres and (B) oblique and apical fibres. 2. If the balance between synthesis and resorption is
disturbed, the quality of the tissue will be changed.
3. This will result in progressive destruction and loss of
Supportive extracellular substance of PDL.
YH

Protective 4. This loss is more prominent on bony side than on the ce-
DR

Sensory mentum side. This will lead to loss of attachment between

Homeostatic. teeth, as seen in scurvy when vitamin C is deficient in diet.

Formative/resorptive Eruptive
1. Cementoblasts and osteoblasts found in the PDL space The cells, vascular elements and extracellular matrix
form cementum and bone, respectively. proteins of the PDL function collectively to enable the teeth
2. Osteoclasts and cementoclasts resorb bone and of limited eruption to adjust their position while firmly
cementum. attached to bony socket.

SHORT ESSAYS

Q.1. Rests of Malassez. 2. Soon after Hertwig’s epithelial root sheath breaks up,
some sheath cells that migrate towards the dental sac
Ans.
become the epithelial rests of Malassez found in PDL.
1. These cells were described by Malassez in 1889 and are 3. They persist as strands, islands or tube-like structures
the remnants of Hertwig’s epithelial root sheath. close to cementum.
 Oral Histology

4. On electron microscope examination, the epithelial rest Q.2. Cells of periodontal ligament.
cells exhibit tonofilaments. They attach to each other by
desmosomes. Ans.
5. The epithelial rest cells are separated from other Refer to the answer of Long Essays Q.1.
connective tissue cells by a basal lamina.
6. Their physiological role in the functioning PDL is Q.3. Name the principal fibres of periodontal
unknown. ligament.
7. When certain pathological conditions are present,
Ans.
the cells of the epithelial rests can undergo rapid prolif-
eration, and produce a variety of cysts and tumours that See ‘Collagen fibres’ and the ‘five principal fibres of PDL
are unique in the jaws. from the answer of Long Essays Q.1.

SHORT NOTES

Q.1. Periodontium. 4. Fibroblasts synthesize procollagen, produce proteoglycan,

and are involved in the formation and maintenance of
Ans.
collagen fibres.
1. Periodontium is the connective tissue organ that 5. They help in the eruption of tooth by their contractile
attaches the teeth to the bones of the jaws and supports property (collagen traction theory).
the teeth.
Q.5. Cells of periodontal ligament.
2. Periodontium is an investing and supportive organ to
the tooth. It consists of the following: Ans.
a. Alveolar bone Cells of PDL include the following:
b. PDL 1. Synthetic cells
c. Cementum a. Osteoblasts
d. Gingiva. b. Fibroblasts
c. Cementoblasts
Q.2. Cell rests of Malassez.
2. Resorptive cells
Ans. a. Osteoclasts
b. Fibroblasts
1. Soon after Hertwig’s epithelial root sheath breaks up,
c. Cementoclasts
some sheath cells that migrate towards the dental sac
3. Progenitor cells
become the epithelial rests of Malassez found in PDL.
a. Epithelial rests of Malassez
2. They persist as strands, islands or tube-like structures
4. Defence cells
close to cementum.
a. Mast cell
Q.3. Oxytalan fibres. b. Macrophages
c. Eosinophils.
Ans.
Q.6. Sharpey’s fibres.
1. The oxytalan fibres are restricted to the walls of blood
vessels. They run in an axial direction and are attached Ans.
to blood vessels. 1. Collagen fibres produced by fibroblasts of PDL are
incorporated into the cementum as Sharpey’s fibres.
One end is either attached to cementum or bone and the
2. Sharpey’s fibres are regarded as extrinsic fibres, since
other end to the walls of blood vessels.
they are not products of cementoblasts.
Q.4. Fibroblasts of periodontal ligament. 3. They are about 7 jum in thickness and are perpendicular
to the surface.
Ans.
4. Cemental surfaces with actively mineralizing fronts
1. Fibroblasts are the principal cells of the PDL. have numerous small openings that correspond to sites
2. Found in between the fibres of the PDL, these are large where individual Sharpey’s fibres enter the tooth. The
stellate-shaped cells with extensive cytoplasm. They openings represent unmineralized core of fibres.
have a well-developed cytoskeleton. 5. The deeper fibres that are away from the cementum
3. Many of them show cell-to-cell contact with gap junctions. surface are older ones and are mineralized.
Quick Review Series: BDS 1st Year

Q.7. Alveolar crest group of fibres. Cementoblasts

Ans. 1. Cementoblasts are the cells which form cementum.
2. These cells aid in the reattachment of PDL fibres to root
Alveolar crest group by forming fresh cementum whenever required.
1. The fibre bundles radiate from the crest of alveolar Q.9. Oblique and apical group of periodontal
process and attach themselves to the cervical part of ligament fibres.
cementum. Ans.
2. These fibres resist tilting and intrusive, extrusive and
rotational forces. Oblique Group
Q.8. Synthetic cells of PDL. 1. They extend from cementum to bone in an oblique
Ans. direction, and the attachment on the bone side is at
a higher level than the attachment of the cementum.
Synthetic cells of PDL are as follows: 2. It is the main bulk of the PDL fibre group occupying
1. Osteoblasts two-thirds of the ligament.
2. Fibroblasts 3. They principally resist vertical and intrusive forces, but
3. Cementoblasts. also resist rotational forces.

Osteoblasts Apical Group

1. They are found covering the periodontal surface of
alveolar bone between embedded fibres.
2. Osteoblasts are required for constant apposition of
bone following resorption in the functional remodelling
of bone.
Fibroblasts
1. Fibroblasts are the principal cells of the PDL found in
between the fibres of the PDL.
2. Fibroblasts synthesize procollagen and are involved in
the formation and maintenance of collagen fibres.
1. They radiate from the apical region of the root to
alveolar bone.
2. Provide a cushion-like action to tooth to withstand
vertical forces.
3. Not seen in incompletely formed roots.
Q.10. Cell rests of Serres.
Ans.
The remnants of the dental lamina persist as epithelial pearls
or islands within the jaw as well as gingiva. These are referred
to as cell rests of Serres.

BONE (MAXILLA AND MANDIBLE)

SHORT ESSAYS

Q.1. Describe the structure of alveolar bone. Asa result of its functional adaptation, alveolar
Ans.
process contains two parts:

1. The alveolar process or bone may be defined as the part

of the maxilla and the mandible that forms and
supports the sockets of the teeth. A. Alveolar B. Supporting
2. The structures of alveolar process are as follows: bone proper alveolar bone
3. Alveolar bone proper
a. This part consists of a thin lamella of bone that { {
surrounds the root of the tooth and gives attachment
to principal fibres of the periodontal ligament. Lamellated Bundle Cortical Spongy
b. It consists partly of lamellated and partly of bundle bone. bone bone plates bone

4. Supporting alveolar bone: The bone that surrounds the
alveolar bone proper and gives support to the socket is
called supporting alveolar bone.
5. The supporting alveolar process or bone consists of two
parts:
a. Cortical plates: This part consists of compact bone,
and forms the outer and inner plates of the alveolar
processes.
b. Spongy bone: This part fills the area between the
cortical plates and the alveolar bone proper.
6. Cortical plates are continuous with the compact layers
of the maxillary and mandibular body.
7. The cortical plates are much thinner in maxilla than
in the mandible. They are thickest in the molar and
premolar regions in mandible.
8. In the maxilla the outer cortical plate is perforated
by many small openings for blood and lymph vessels
passage. Whereas in the lower jaw the cortical bone of
the alveolar process is dense.
9. Cribriform plate: The alveolar bone proper, which forms
the inner wall of the socket, is perforated by numerous
openings carrying the branches of inferior alveolar
nerves and blood vessels into the periodontal ligament
and is therefore known as the cribriform plate.
10. The interdental and interradicular septa contain
the perforating canals of Zuckerkandl and Hirschfield
(nutrient canals), which house the interdental and inter-
radicular arteries, veins, lymph vessels and nerves.
11. Lamellated bone: Some lamellae of lamellated bone are
arranged roughly parallel to the surface, whereas others
form Haversian system.
12. Bundle bone:
a. The bundle bone is nothing but alveolar bone proper.
b. Bundle bone is the bone in which the principal fibres
of the periodontal ligament are anchored.
c. The term bundle bone was chosen because the bun-
dles of the principal fibres continue into the bone as
Sharpey’s fibres.
d. The bundle bone contains fewer fibrils than does
lamellated bone. These fibres are arranged at right
angles to Sharpey’s fibres.
e. Bundle bone appears dark in routine haematoxylin-
and eosin-stained sections.
f. The bundle bone contains more calcium salt per unit
area than other types of bone tissues.
Q.2. Describe histology and functions of alveolar
bone.
Ans.
Oral Histology
1. The alveolar bone may be defined as the part of maxilla
and mandible that forms and supports the socket of tooth.
2. The alveolar bone consists of about 85% inorganic and
35% organic material.
3. The inorganic material almost consists of calcium and
inorganic orthophosphate in the form of hydroxyapatite
crystals. The organic material is collagen, ground
substance of glycoprotein and proteoglycans.
4. The alveolar bone consists of some cells, as discussed
below:
a. Osteoblasts
i. Osteoblasts are mononucleated cells responsible
for synthesis and secretion of matrix of bone.
ii. As the osteoblasts secrete the organic matrix of
bone, it is at first devoid of minerals salts. It is
called osteoid tissue.
b. Osteocytes: As osteoid tissue is formed, some of
the osteoblasts become embedded in it and form the
osteocytes.
c. Osteoclasts
i. Osteoclasts are large, multinucleated, giant cells.
The number of nuclei in one cell may give rise
to a dozen or more. Occasionally, uninucleated
osteoclasts are found.
ii. Osteoclasts are cells that reabsorb bone.
iii. Osteoclasts are usually found in bay-like depres-
sions in bone called as Howship’s lacunae.
iv. Ruffled border of the cell in contact with the
bone is the site of great activity. Here the pieces
of bone are broken off and released into the
extracellular spaces.
v. Osteoclasts are probably derived from the circu-
lating blood cells (monocytes).
Functions of Alveolar Bone
1. It supports the roots of teeth.
2. The alveolar bone in the form of alveolar bone proper
surrounds the root of the tooth and gives attachment to
principal fibres of periodontal ligament.
. It allows the movement of teeth to achieve better
occlusion.
. Alveolar bone gives support to lips and cheeks, thus
enhancing aesthetics.
. Supplies nutrition to periodontal ligament through
blood vessels passing through them.
6. It supports the primary teeth and protects developing
permanent teeth.
7. Helps in organized eruption of primary and permanent
teeth.
Quick Review Series: BDS 1st Year

SHORT NOTES

Q.1. Write short note on osteoclast. Q.7. Alveolar bone proper.

Ans.
Refer to the answer of Short Essays Q.1.
Q.2. Alveolar bone.
Ans.
Refer to the answer of Short Essays Q.1.
Q.3. Bundle bone.
Ans.
Refer to the answer of Short Essays Q.1.
Q.4. Howship’s lacunae.
Ans.
1. In general, osteoclasts are found in bay-like depression
in bone, called Howship’s lacunae.
2. Under electron microscope the bone-reabsorbing sur-
faces show shallow troughs with an irregular shape
known as Howship’s lacunae.
3. The irregular shape of Howship’s lacunae reflects the
activity and the mobility of osteoclasts during active
resorption.
Q.5. Write a note on resting and reversal lines of bone.
Ans.
1. The resting and reversal lines appear during reconstruc-
tion of alveolar bone.
2. The reconstruction is correlated to the functional and
nutritional demands of the bone.
3. The resorbed bone is replaced by proliferating loose
connective tissue.
4. After a time resorption ceases and new bone is apposed
onto the old.
5. The scalloped outline of Howship’s lacunae that turns
their convexity towards the old bone remains visible on
a darkly stained cementing line called reversal line.
6. The cementing lines that corresponded to a rest period
in an otherwise continuous process of bone apposition
are called resting lines.
7. The resting and reversal lines are found between layers
of bone of varying age.
Q.6. Lamina dura.
Ans.
1. In the radiograph, the alveolar bone proper is seen as a
thin radiopaque white line called lamina dura.
2. It consists partly of lamellated bone and partly of
bundle bone.
Ans.
1. This part of the alveolar bone is the innermost portion
of alveolar process and lines it, which is pierced by many
small openings and hence the name lamina cribrosa or
cribriform plate.
2. Blood vessels, lymphatics and nerves pass through the
small openings in the lamina cribrosa.
3. This part consists of a thin lamella of bone that
surrounds the root of the tooth and gives attachment to
principal fibres of the periodontal ligament.
4. It consists partly of lamellated bone and partly of
bundle bone.
5. In the radiograph, the alveolar bone proper is seen as a
thin radiopaque white line, and hence called lamina dura.
Q.8. Spongy bone.
Ans.
The supporting alveolar process or bone consists of two parts:
1. Cortical plates
2. Spongy bone.
Spongy bone
This part fills the area between the cortical plates and the
alveolar bone proper. Radiographically, the spongy bone is
classified into two main types:
1. Type I: The interdental and interradicular trabeculae are
regular and horizontal in a ladder-like arrangement.
2. Type I: Shows irregularly arranged, numerous, delicate
interdental and interradicular trabeculae.
Q.9. Haversian system.
Ans.
1. Deep to circumferential lamellae, the lamellae of bone
are arranged as small concentric layers around a central
vascular canal (Fig. 4A.8.1).
Periosteum
Outer cirumference
lamella
Osteocyte
Concentric lamella
Interstitial lamella
Haversian canal
Fig. 4A.8.1 Haversian system.
 Oral Histology

2. The Haversian (vascular) canal and concentric lamellae Ans.

together are known as the osteon or Haversian system.
3. Osteon or Haversian system is the basic metabolic unit
of the bone.
Q.10. Volkmann’s canals.
1. The Volkmann’s canals interconnect the adjacent
Haversian canals.
2. The Volkmann’s canals are the channels that contain blood
vessels and create a rich vascular network throughout the
compact bone.

ORAL MUCOUS MEMBRANE

LONG ESSAYS

Q.1. Write about the specialized mucosa of the oral

cavity.
Filiform papilla
Ans. lined by
keratinized
1. The mucous membrane covering the dorsum of the epithelium
tongue is called a specialized mucosa because it performs
the function of a receptor for the sensation of taste. Connective
2. Itis unique in that, though it is covered by what is func- tissue
tionally a masticatory mucosa, it is highly extensible. core of papilla

3. The dorsum of the tongue is rough and irregular. A Submucosa

V-shaped line called sulcus terminalis divides the tongue containing
into an anterior two-thirds and a posterior one-third. muscle

The anterior two-thirds is supplied by the lingual nerve Fig. 44.9.1 Filiform papillae.
and the posterior one-third by the glossopharyngeal for
general sensations.
4. The anterior two-thirds is called the body or papillary
portion of the tongue, and the posterior one-third is
called the base or lymphatic portion.
5. The tongue is a muscular organ composed of cross- Taste
striated muscle fibres, running in three different planes— bud
Filiform
longitudinal, transverse and vertical. papillae
6. The dorsum of the tongue is covered by stratified squa- Fungiform
mous keratinized epithelium. papillae

Connective
Filiform Papillae tissue core

On the anterior part are found numerous fine, pointed, Submucosa

cone-shaped papillae that give it a velvety appearance containing
muscle
(Fig. 4A.9.1). These are epithelial structures containing a
core of connective tissue and are called filiform papillae. Fig. 44.9.2 Fungiform papillae.
They are hair-like and do not contain taste buds.

Fungiform Papillae Foliate Papillae

Interspersed between filiform papillae are the isolated mush-
room-shaped (fungiform) papillae having a rich capillary
network and a relatively thin epithelium, and appearing as
reddish prominences. They contain one to three taste buds
in the papillae on the dorsal surface (Fig 4A.9.2).
They are sometimes present on the lateral surface of
posterior part of the tongue. They are not well-developed in
humans.
Foliate (leaf like) papillae consist of 4-11 parallel ridges
separated by deep grooves. They contain taste buds.
Quick Review Series: BDS 1st Year
Circumvallate Papillae
1. Immediately anterior to the sulcus terminalis are 8-12
circumvallate papillae.
2. These papillae are surrounded by a deep circular groove
into which open the ducts of salivary glands — the von
Ebner’s glands.
. Superiorly, these papillae are covered by keratinized epithe-
lium and on the sides, where taste buds are present, they are
covered by a non-keratinized epithelium (Fig. 4A.9.3).
These papillae do not protrude above the surface
of tongue. The maximum number of taste buds are
contained in these papillae.
——————> Keratinized stratified
squamous epitnelium
Non-keratinized epithelium
Taste buds
Connective tissue core
V-shaped trough around papilla
von Ebner'’s salivary gland
Fig. 4A.9.3 Circumvallate papillae.
Taste Buds
1. These are small, barrel-shaped organs within the epithe-
lium of tongue. They are 80 jum high and 40 jm thick.
. They extend from basal lamina to the surface of the
epithelium having a taste pore.
. Taste buds have an outer supporting cells arranged like
staves of a barrel. The inner cells that are short and
spindle shaped are called gustatory or taste cells.
. They have hair-like processes at their free end, and these
processes end below the taste pores. These are the recep-
tors of taste.
. Arich nerve plexus is found below the taste buds.
. The primary taste sensations like sweet, salt, bitter and
sour are supposed to be appreciated best in different
regions:
Sweet — at the tip of the tongue
Salt — at the lateral borders
Bitter and sour — on the palate and posterior parts of
the tongue
. The papillae mainly concerned with the different taste
sensations are as follows:
Vallate — Bitter fungiform —> Sweet and salt foliate >
Sour
Posterior One-Third of the Tongue
1. The posterior one-third of the tongue is studded with
round or oval prominences called lingual follicles.
2. They contain one or two lymph nodes.
3. They have a small pit in the centre called the lingual
crypt into which the ducts of small mucous glands open.
4. The lingual follicles put together are called lingual tonsil.
Q.2. Classify oral mucous membrane and describe
in detail about masticatory mucosa.
Or
Write in brief the basic structure of oral mucous
membrane.
Ans.
The oral mucosa can be classified as follows:
1. Based on functional criteria
a. Masticatory mucosa
Bound to bone and does not stretch, and bears mas-
ticatory forces. Examples: Gingiva and hard palate.
b. Lining or reflecting mucosa
Not exposed so much to masticatory forces. It is
stretchable. Examples: Lip, cheek, vestibule, alveolar
mucosa, floor of the mouth and the soft palate.
c. Specialized mucosa
d. Performs function of sensation of taste in addition to
general sensory functions. Example: Dorsum of the
tongue.
2. Based on the structure of surface layers
a. Keratinized mucosa. Examples: Hard palate and gingiva.
b. Non-keratinized mucosa. Examples: Cheek, soft
palate, vestibule and floor of mouth.
Light Microscopic Features
1. Oral mucous membrane has two tissue components:
a. a stratified squamous epithelium and
b. an underlying lamina propria.
2. The dividing line between the two is an about 2-ym
thick structureless layer called the basement membrane.
The basement membrane is not a straight line, but is
usually irregular. This results in projections of lamina
propria, called connective tissue papillae, which inter-
digitate with downward projections of epithelium into
the lamina propria called rete pegs or epithelial ridges.
3. Below the lamina propria of mucous membrane and
above the muscle or bone lies the submucosa with loose
fatty or glandular tissue, and blood vessels and nerves.
This is the submucosa that may be present or absent in
the different regions of the oral mucous membrane.
Different Layers of Oral Epithelium
The oral epithelium is stratified squamous and exhibits the
following layers in a keratinized mucosa:
1. Stratum basale
2. Stratum spinosum
3. Stratum granulosum
4. Stratum corneum.

Stratum Basale
1. The first layer resting on the basement membrane is the
stratum basale (basal layer).
2. The cells in this layer are cuboidal or columnar with a
large, deeply staining nuclei. They are arranged in a uni-
form row of cells. As cells in this layer can divide and
migrate above to form cells of other layers; this layer is
also called stratum germinativum.
Siratum spinosum
1. Next to basal layer are found several rows of polyhedral
cells with large nuclei, called stratum spinosum.
2. The nuclei stain less intensely than those of the basal layer.
3. The individual cells of the stratum spinosum are clearly
outlined by cell walls and appear to be joined by inter-
cellular bridges.
4. These spike-like intercellular bridges give the name
stratum spinosum or prickle cell layer to this layer.
Siratum granulosum
1. Next to stratum spinosum are rows of flattened or
round cells that contain deeply staining granules in the
cytoplasm. This row is called stratum granulosum.
2. These granules, which are basophilic, staining intensely
with acid dyes such as haematoxylin, are keratohyalin
granules.
3. Stratum granulosum is seen clearly only in keratinized
epithelium where the last layers of cells have lost their
nuclei (orthokeratosis).
4. In para-keratinization (keratinized epithelium showing
nucleated cells in the topmost layers), the stratum
granulosum is indistinct.
5. In non-keratinized epithelium, the stratum granulosum
is absent.
Stratum corneum
1. The surface layer is composed of cells that are fat and
stain bright pink with eosin. This is the keratinized layer
or stratum corneum.
2. They do not contain any nuclei, and this pattern is called
ortho-keratinization.
Non-keratinized Epithelium
1. It has the following three layers:
a. Stratum basale
b. Stratum intermedium
c. Stratum superficial.
2. Stratum basale appears the same as in keratinized
epithelium.
3. The next layer, stratum intermedium has cells larger in
size than the cells of stratum spinosum of a keratinized
epithelium. The cells do not have a spinous appearance.
Oral Histology
4. The third layer, stratum superficiale does not show any
sudden change from the cells in the layer below (stratum
intermedium).
5. The division between the two layers is arbitrary.
6. The cells in the stratum superficiale retain their nuclei,
and the cells do not stain intensely with eosin.
There is no stratum granulosum or stratum corneum in
non-keratinized epithelium.
Lamina Propria
1. It is a connective tissue of variable thickness and sup-
ports the epithelium.
2. It has a papillary portion containing connective tissue
papillae and a reticular portion having reticular fibres,
found just beneath the basement membrane.
3. This reticular zone presents a lattice-like pattern in silver
staining. These are immature collagen fibres.
4. The reticular zone is always present, but the papillary
zone may be absent in certain areas like the alveolar
mucosa where papillae are absent.
5. The lamina propria provides nutritional supply to the
epithelium.
Submucosa
1. A submucosal layer attaches the lamina propria to under-
lying structures. The submucosa may be loose or firm.
2. All lining mucosa have a submucosa.
Q.3. Write in detail about the gingiva and its functions.
Ans.
Gingiva is defined as the tissue that covers the alveolus and
encircles the necks of teeth.
Functions of Gingiva
1. Surrounds and supports teeth
2. Prevents invasion of bacteria to the periodontal space.
Gross Appearance
Colour
It is generally coral pink in colour. The colour depends on
the following:
1. The amount of circulation
2. Thickness of gingiva
3. Degree of keratinization
4. Degree of pigmentation.
It is generally darker in dark-complexioned persons.
Consistency
Gingiva is firm and resilient. Attached gingiva has greatest
firmness.
Quick Review Series: BDS 1st Year
Contour
In teeth with minimum convexity, e.g. lower incisors, the
marginal gingiva, is more or less straight or horizontal.
In teeth with greater convexities, e.g. upper anterior teeth,
it is scalloped.
Surface
1. The surface of gingiva shows an ‘orange peel’ appear-
ance. This is called stippling. It is a sign of healthy
gingiva.
2. Even in a healthy gingiva, stippling is absent in infants;
it is absent in a part of the free gingiva and in borders of
the interdental papilla. (But it is present in the central
parts of interdental papilla.)
Parts of Gingiva
The three major parts of gingiva on clinical examination are
as follows:
1. Free (marginal or unattached) gingiva
2. Attached gingiva
3. Interdental papilla.
Free Gingiva (marginal gingiva or unattached
gingiva)
It is a knife-edge part of gingiva that embraces the necks of
the teeth. Even the margins and tip of interdental papilla
have free gingiva.
In normal health, the width of the free gingiva is about
1 mm. Free gingiva ends in the free gingival groove. In free
gingiva, the gingiva is not attached to the tooth by junctional
epithelium.
When the knife edge of free gingiva is thickened and be-
comes rounded, it will act like a shelf, encouraging food
lodgement.
The width of the free gingiva can increase due to two
pathologies:
1. Chronic marginal gingivitis
2. Chronic periodontitis.
Gingival sulcus (gingival crevice)
It is the space between the marginal gingiva and the tooth
surface. It has a“V’ shape. The base is formed by the superior
end of the junctional epithelium, and is bound on one side
by the tooth surface and on the other side by the sulcular
epithelium.
The normal sulcus depth is about 0 to 2 mm. The sulcus
is normally filled with gingival fluid.
Attached gingiva
It is that part of the gingiva which is firmly bound to the
periosteum. Superiorly, it is bound by the free gingival
groove, and inferiorly, it extends up to the mucogingival line.
It is firm and resilient. The width of the attached gingiva
varies in different areas. It has a greater width in maxilla
compared to mandible.
The width is measured by finding out the distance be-
tween the base of the gingival sulcus and mucogingival line.
A decrease in width of attached gingiva is pathological,
and is due to true pocket formation and gingival recession.
Interdenital papilla
It is that part of the gingiva which extends in between two
teeth up to the contact point.
There is a facial-side interdental papilla and a lingual-side
interdental papilla. Interdental papilla has a summit (tip)
and margins that are concave.
The tip and margins are unattached, and the central
portion is attached. In inflammations, the interdental papilla
loses its concavity.
Col
Connecting the facial side and lingual side of the interdental
papilla on the proximal side is an epithelial structure called
Col. Col is covered by non-keratinized, stratified mucosa.
The term col means a valley.
Col has a concave shape in healthy gingiva; but it becomes
dome shaped in gingival recession and inflammation.
Q.4. Write a note on histology of gingiva.
Or
Describe the microscopic picture of gingiva.
Ans.
1. Gingiva is a part of masticatory mucosa. The gingiva
extends from the dentogingival junction to the alveolar
mucosa.
2. It shows
a. 75% para-keratinization (attached gingiva),
b. 15% ortho-keratinization (marginal gingiva) and
c. 5% non-keratinized (sulcular epithelium, col region
and junctional epithelium).
3. The gingiva can be divided into the following:
a. Free gingiva
b. Attached gingiva
c. Interdental papilla.
4. Free gingiva is divided from attached gingiva by free
gingival groove, which is a shallow V-shaped notch.
5. The interdental papilla is the part of gingiva that fills the
space between two adjacent teeth. It is triangular.
6. The mucous membrane of gingiva is a masticatory mucosa.
7. The gingiva is immovably and firmly attached to the
periosteum of the alveolar bone.
8. The lamina propria of gingiva consists of dense connec-
tive tissue, contains dense collagen fibres and is referred
to as gingival ligament.
 Oral Histology

Epithelial Surface Dentoperiosieal

1. Gingiva has plenty of deep rete pegs that are closely These fibres run from the cementum into the periosteum of
spaced. This increases the surface area of absorption of alveolar bone.
nutrition from lamina propria.
2. The epithelium consists of the following layers: Interdental ligament
a. Stratum germinatum (basal cell layer)
These are extended interproximally between adjacent teeth.
b. Stratum spinosum
Gingiva also contains some cells in epithelium. Other
c. Stratum granulosum
than keratinocytes, the gingiva contains the following
d. Keratinized layer.
cells:
Lamina Propria
Melanocytes
It has a papillary layer and a reticular layer. It also has
They are found in basal layer and give the pigmentation of
numerous high connective tissue papillae. The connective
tissue in gingiva is made up of bundles of collagen, capillar- gingiva either pink, brown or black.
ies, lymphatics and nerve tissue, and cells like fibroblasts,
Langerhans cells
histiocytes, monocytes, mast cells and lymphocytes.
These are involved in the immune system.
Submucosa

A definite submucosa is absent in gingiva, and the lamina Merkel cell

propria directly attaches on the periosteum. These are specialized neural pressure-sensitive receptor
cells.
Fibre Groups in Gingiva
The major groups of fibres in gingival ligaments are listed below: Lymphocytes
These are also found in gingiva.
Dentogingival
Extends from the cervical cementum into the lamina propria Vascular Supply of Gingiva
of the gingiva. These groups are most numerous.
Blood and lymphatic supply
Alveologingival Branches of alveolar arteries. The numerous lymph vessels
The fibres arise from the alveolar crest and extend into the of gingiva lead to submental and submandibular.
lamina propria.
Nerve supply
Circular
Gingiva is well-innervated: different types of nerve endings
A small group of fibres that circle the tooth and interlace such as Meissner or Krause corpuscles, end bulbs, loop or
with the other fibres. fine fibres can be observed in this layer.

SHORT NOTES

Q.1. Non-keratinocytes.
Ans.
1. Certain cells within the oral epithelium differ from
keratinocytes in their appearance. These cells are called
non-keratinocytes.
2. They have a clear halo around their nuclei, e.g. melano-
cytes, Langerhans cells, Meckel’s cells, and lymphocytes
and other inflammatory cells. They represent about
10% of the cells present in the epithelium.
3. In all these cells listed above, cytoplasm shrinks during
histologic processing, which creates a halo around their
nuclei.
4. These cells do not contain much of tonofilaments and,
hence, do not participate in the maturation (keratiniza-
tion) process of oral epithelium.
Q.2. Keratinocytes.
Ans.
Quick Review Series: BDS 1st Year
. Epithelial cells that ultimately keratinize are called
keratinocytes.
A keratinocyte is a single cell that forms a part of each
layer of keratinizing oral epithelium at different times.
. After mitosis, it may remain in the basal layer and divide
again, or it may become determined and migrate upwards.
. During its migration as a keratinocyte it becomes
committed to biochemical and morphological changes
(differentiation), which results in the formation of kera-
tinized squama — a dead cell filled with densely packed
protein and a toughened cell membrane.
. They show cell division, undergo maturation and finally
desquamate.
Q.3. Alveolar mucosa.
Ans.
1. The alveolar mucosa is the mucous membrane that
covers the outer surface of the alveolar process.
. Itis lining mucosa that is a type of non-keratinized mucosa.
The alveolar mucosa is thin and loosely attached to the
periosteum by a well-defined submucous layer.
The epithelial ridges and papillae are low and often
entirely missing.
Many sebaceous glands are found in connection with
hair follicles. Sweat gland also occurs between them.
Q.4. Gingiva col or ‘COL.
Ans.
1. Connecting the facial and lingual side of the interdental
papilla on the proximal side is an epithelial structure
called col.
The term col means a valley.
. Colhas a concave shape in healthy gingiva; but it becomes
dome shaped in gingival recession and inflammation.
4. Col is covered by non-keratinized, stratified mucosa.
Q.5. Melanocytes.
Ans.
1. Melanocytes are derived from the embryologic neural
crest and migrate into the epithelium.
2. Each melanocyte establishes contact with about
30-40 keratinocytes through their dendritic processes.
. Melanin produced by melanocytes is transferred through
their dendritic processes to the adjacent basal cell keratino-
cytes, which store the pigment in the form of melanosomes.
Melanocytes appear as clear cells in haematoxylin
sections and spider-like or dendritic with silver stains;
hence they are known as clear cells or dendritic cells.
Q.6. Papillae of tongue.
Or
Filiform papillae and fungiform papillae.
Ans.
Filiform Papillae
1. On the anterior part of the tongue are found numerous
fine, pointed and cone-shaped papillae that give it a velvet-
like appearance. These papillae are called ‘filiform papillae’
2. These papillae are epithelial structures containing a
core of connective tissue, and the covering epithelium is
keratinized.
3. The filiform papillae do not contain taste buds.
Fungiform Papillae
1. The fungiform papillae are found between the filiform
papillae.
. These are mushroom-shaped, round, reddish promi-
nences.
. Their colour is derived from a rich capillary network
visible through the relatively thin epithelium.
. Fungiform papillae contain a few taste buds.
Vallate (Walled) Papillae
1. They are present in front of the dividing V-shaped ter-
minal sulcus and are 8-10 in number.
2. They do not protrude above the tongue, but are bounded
by a deep cervical furrow. Their free surface shows
numerous secondary papillae that are covered by their
smooth epithelium. On the lateral surface of vallate
papillae, the epithelium contains numerous taste buds.
. The ducts of small serous glands called von Ebner’s
glands open into the tongue.
Q.7. Circumvallate papillae.
Ans.
1. Immediately anterior to the sulcus terminalis are
8-12 circumvallate (meaning walled) papillae.
. These papillae are surrounded by a deep circular groove
into which open the ducts of salivary glands — the
glands of von Ebner.
. Superiorly, these papillae are covered by keratinized
epithelium and on the sides, where taste buds are pres-
ent, they are covered by a non-keratinized epithelium.
. These papillae do not protrude above the surface of
tongue. The maximum number of taste buds are
contained in these papillae.
 Oral Histology

Q.8. Dentogingival junction. Mode of Attachment of Junctional

Ans. Epithelium to Tooth Surface

1. The junction of gingiva and tooth is known as dentogin-
gival junction, and is of great physiologic and clinical
importance.
This union in many ways may be a point of lessened
resistance to mechanical forces and bacterial attack.
Both epithelium and connective tissue are attached to
the tooth and, in health, each contributes to the integrity
of dentogingival junction.
The firmness of this junction is maintained by the
gingival portion of the periodontal ligament.
The adherence of epithelium to the tooth is the function
of attachment epithelium. The position of gingiva on
the surface of the tooth changes with time.
Q.9. Langerhans cell.
1. It was once thought that a difference in electrical po-
tential between the cells of the junctional epithelium
and the tooth surface brought about the attachment.
This concept is no more accepted.
Attachment by Hemidesmosomes: Junctional epithelium
is, on one side, continuous with the connective tissue of
gingiva attached to it by hemidesmosomes. On the other
side, it attaches to the lamina lucida of the basal lamina
through hemidesmosomes. The lamina lucida is continu-
ous with lamina densa of the basal lamina. Organic strands
from enamel and cementum get attached to the lamina
densa.
Q.11. Taste buds.
Ans.

Ans. 1. These are small, barrel-shaped organs within the

epithelium of tongue. They are 80 jum high and 40 pm
1. Langerhans cell is a dendritic cell with a convoluted thick.
nucleus seen in suprabasal layers of oral epithelium and . They extend from basal lamina to the surface of the
epidermis of skin. epithelium having a taste pore.
. They appear clear in histologic sections as they lack . Taste buds have outer supporting cells arranged like
desmosomal attachments. staves of a barrel. The inner cells that are short and
. As it is usually found in the upper part of epithelium, it spindle shaped are called gustatory or taste cells.
is also called high-level clear cell. . They have hair-like processes at their free end, and
. Ultrastructurally, it has a rod- or flask-shaped granule these processes end below the taste pores. These are the
called Birbeck granule. receptors of taste.
. The source of Langerhans cells is bone marrow, and they . Arich nerve plexus is found below the taste buds.
move in and out of the epithelium. . The primary taste sensations like sweet, salt, bitter and
. They have an immunologic function of recognizing, sour are supposed to be appreciated best in different
processing and presenting to helper T-lymphocytes — regions:
the antigenic material that enters epithelium. Sweet — at the tip of the tongue
Salt — at the lateral borders
Q.10. Junctional epithelium. Bitter and sour — on the palate and posterior parts of
the tongue.
Ans.
. The papillae mainly concerned with the different taste
sensations are as follows:
1. The only mode of attachment between attached
gingiva and the tooth surface is known as junctional Vallate papillae — bitter
epithelium. Fungiform — sweet and salt
Foliate — sour.
It is non-keratinized and has four to five layers of cells.
It is devoid of rete pegs. Q.12. Vermillion border.
The parts or areas of junctional epithelium are as
Ans.
follows:
a. Coronal Part — Thickest and has more layer of cells 1. The transitional zone between the skin of the lip and
and has maximum permeability. the mucous membrane of the lip is called vermilion
b. Middle Part — Has maximum adhesion. border of lip.
c. Apical part — Has maximum mitotic activity. 2. It isa red zone.
Quick Review Series: BDS 1st Year

3. Itis found only in humans.
4. The skin on the outer surface of the lip is covered by a
moderately thick, keratinized epithelium with thick
stratum corneum.
5. The transitional region is characterized by thicker
mildly keratinized epithelium with numerous densely
arranged long papillae of the lamina propria carrying
large capillary loops close to surface, giving red colour to
the lips.
Q.13. Types of gingiva.
Ans.
1. The gingiva can be divided into the following:
a. The free gingiva
b. The attached gingiva
c. The interdental papilla.
2. The free gingiva is about 0.5-1.5 mm wide.
3. The attached gingiva is about 4-6 mm wide, and the
6. Various regions in hard palate appear, depending on the
various structures of submucous layer:
a. Gingival region: Adjacent to the teeth.
b. Palatine raphe: Also known as median area,
extending from incisive papilla or palatine papilla
posteriorly.
c. Anterolateral area: It is also known as fatty zone
between the raphe and gingival (Fig. 4A.9.4).
d. Posterolateral area: It is also known as glandular
zone between the raphe and gingiva.
Ortho-keratinized
stratified
squamous
epitaelium
Lamina propria

mucogingival junction which separates gingiva from

alveolar mucosa is 3-4 mm below the level of the crest Submucosa
of the alveolar bone. containing
fat cells
Q.14. Epithelial attachment. Vertical band of
connective tissue
Ans.
Palatal bone
1. The ultrastructural attachment of ameloblasts to the with periosteum
tooth was shown to be a basal lamina to which hemides-
Fig. 44.9.4 Palate — anterolateral zone.
mosomes are attached. This mode of attachment is
referred to as the epithelial attachment.
2. Itis submicroscopic and is approximately 40 nm (400 A)
wide and is formed by attachment epithelium.
Q.16. Stratum granulosum and stratum basale.
3. The adhesive forces in this zone are molecular in
nature. Ans.
Q.15. Clinical and microscopic features of palatal Stratum granulosum and stratum basale are explained in
mucosa. Table 4A.9.1.
Or
Palatal mucosa (macroscopic and microscopic Table 4A.9.1 Differences between stratum granulosum and stratum
features). basale
Ans. Stratum granulosum Stratum basale

1. The palate forms the roof of oral cavity. It has round cells with a Basal cell layer (stratum germinatum) is
2. It consists of two parts: granular cytoplasm. the first layer. Cells in the basement
membrane are cuboidal in shape.
a. Hard palate and
b. Soft palate. The cells here have Basal cells multiply, and older cells leave
started synthesis of the area and travel towards surface.
3. The hard palate is covered by masticatory mucosa,
keratohyalin granules. During their migration, they change
which is keratinized. The granular cytoplasm their shape and get ready to produce
4. The mucous membrane of hard palate is pink in colour is not distinctly seen keratohyalin granules, which will be
and is tightly attached to the underlying periosteum and in areas of para- ultimately seen in the cells of the stratum
is, therefore, immovable. keratinization corneum. In between the cells of the
5. The cells of stratum corneum exhibit stacking. stratum basalis are found specialized
The lamina propria is thick in anterior region than in cells called melanocytes and cells for
touch sensation called Meckel cells.
posterior region of palate.
 Oral Histology

Q.17. Classify oral mucosa. 2. Stratum granulosum has round cells with a granular
cytoplasm. The cells here have started synthesis of kera-
Ans.
tohyalin granules. These granules are basophilic and
The oral mucosa can be classified as follows: stain intensely with acid dyes such as haematoxylin.
3. Stratum granulosum is seen clearly only in keratinized
1. Based on Functional Criteria epithelium, where the last layers of cells have lost their
nuclei (orthokeratosis, see Fig. 4A.9.5).
a. Masticatory mucosa
Bound to bone and does not stretch, and bears masticatory 4. In para-keratinization (keratinized epithelium showing
forces. nucleated cells in the topmost layers), the stratum
Examples: Gingiva and hard palate. granulosum is indistinct (Fig. 4A.9.6).
b. Lining or reflecting mucosa 5. In non-keratinized epithelium, the stratum granulosum
Not exposed so much to masticatory forces. It is stretchable. is absent.
Examples: Lip, cheek, vestibule, alveolar mucosa, floor of
the mouth and the soft palate. Ortho-keratinized stratified
squamous epithelium
c. Specialized mucosa
Stratum granulosum
Performs function of sensation of taste in addition to
Stratum spinosum
general sensory functions. > Stratum basale
Example: Dorsum of the tongue. > Long regular rete ridge
Lamina propria
2. Based on the Structure of Surface Layers
Vertical band of
a. Keratinized mucosa connective tissue
Examples: Hard palate and gingival. Submucosa containing fat cells
b. Non-keratinized mucosa Palatal bone with
periosteum
Examples: Cheek, soft palate, vestibule and floor of the
mouth. Fig. 44.9.5 Ortho-keratinized epithelium.

Q.18. Rugae.
Ans.
Stratum corneum
1. Palatine rugae, which are also called transverse palatine para-keratinized epithelium layer

ridges, are irregular and often asymmetric ridges of Stratum granulosum

mucous membrane extending from incisive papilla.
2. Itis made up of dense connective tissue.
3. In the region of incisive papilla and in the midline,
the lamina propria may show concentrically arranged
epithelial cells that are keratinized. They are called
epithelial pearls and are remnants of epithelium at
the line of fusion between palatine processes.
Q.19. Incisive papilla.
Ans.
1. The pear-shaped or oval incisive papilla is formed by
dense connective tissue covering the oral side of the
vestigial nasopalatine ducts.
2. These blind ducts are lined by simple or pseudostrati-
fied columnar epithelium, rich in goblet cells.
Q.20. Stratum granulosum.
Ans.
1. Next to stratum spinosum are rows of flattened or
round cells that contain deeply staining granules in the
cytoplasm called stratum granulosum.
Stratum spinosum
Stratum basale
Long rete ridges
Lamina propria
Fig. 44.9.6 Para-keratinized epithelium.
Q.21. Free gingival groove.
Ans.
1. The gingival sulcus (gingival crevice) is the space
between the marginal gingiva and the tooth surface.
2. It has a ‘V’-shape. The base is formed by the superior end of
the junctional epithelium, and is bound on one side by the
tooth surface and on the other side by the sulcular epithelium.
3. Normally, the free gingiva is in close approximation to
the tooth surface, and the gingival sulcus opens up when
a jet of air is blown on the sulcus area.
4. The normal sulcus depth is about 0-2 mm. The sulcus is
normally filled with gingival fluid.
Quick Review Series: BDS 1st Year

SALIVARY GLANDS.
LONG ESSAYS

Q.1. Classify salivary glands, and write about 3. Lingual lipase initiates the digestion of dietary lipids,
functions of saliva. hydrolyzing triglycerides.
Ans.
Taste Perception
Salivary glands are exocrine glands. They are classified as follows: Due to the presence of water and lipocalins in saliva, it
1. Based on the size dissolves the food and helps in perception of taste.

Speech

a. Major salivary glands __b.

Minor salivary glands Saliva facilitates the speech and deglutition by keeping the
i. Parotid gland i.
Glossopalatine oral tissues moist and well-lubricated.
ii. Submandibular gland ii.
Palatine
iii, Sublingual gland iii.
Labial and buccal Tissue Repair
glands Due to the presence of variety of growth factors and trefoil
iv. Posterior lingual proteins in saliva, it promotes tissue growth, differentiation
glands and wound healing.
v. von Ebner’s glands
2. Based on the nature of secretions Excretion

1. Many substances from the blood reach saliva; hence, it is

considered as a route of excretion.
a. Serous b. Mucous c. Mixed 2. Saliva excretes urea, nitrates and heavy metals, etc.
i. Parotid gland i. All minor i. Submandibular
salivary glands, Antimicrobials
except von Ebner’s Several substances found in saliva, inhibiting the growth of
glands microorganisms and possibly preventing infection, are as
ii. von Ebner’s ii. Sublingual follows:
glands 1. The presence of peroxidase acts as bactericidal.
2. Lysosome in saliva also has antibacterial action.
The various functions of saliva are as follows: 3. The important group of defensive substances like
immunoglobulins (IgA, IgM, IgG) are present in
Mechanical saliva.
Saliva has several protective functions: 4. Another antibacterial substance found in saliva is
1. It keeps the oral tissues moist and facilitates swallowing. lactoferrin.
2. Saliva helps protect the teeth from dental caries by
means of both cleansing and buffering action of saliva. Buffering Action
3. Saliva controls the calcium and phosphate concentration Mucous is an excellent buffer for both alkaline and acidic
around the teeth. substances.

Q.2. Differences between serous and mucous

Digestive
acini.
Saliva participates in digestion
Ans.
1. By providing a fluid environment for solubilization of food.
2. Through the action of its digestive enzymes. Amylase of The major differences between serous and mucous acini are
saliva digests carbohydrates to produce glucose. listed in Table 4A.10.1.
 Oral Histology

Table 4A.10.1 Differences between serous and mucous acini 4. Interstitial connective tissue
Serous acini Mucous acini 5. Blood vessels, lymphatics and nerves.
Usually acini are spherical in Tubular in shape
Ductal System
shape
Contain pyramidal cells Contain pyramidal cells 1. The ductal system of salivary glands consists of hollow tubes
Spherical nucleus situated in the Flat nucleus resting on cell
connected initially with acinus and then with other ducts.
basal-third of cell membrane 2. The ductal system is not just a passage way for saliva,
Well-stained cytoplasm Lightly stained cytoplasm
but it actively participates in the production and modi-
fication of saliva.
Central lumen small Central lumen larger
3. The ductal system is sometimes named according to its
Cytoplasm contains zymogen Cytoplasm contains mucigen location as
granules
a. intralobular ducts (located within the lobule) and
Rough endoplasmic reticulum Golgi complex prominent b. interlobular ducts (located in the connective tissue
prominent
between lobules of the gland).
Not associated with demilunes Maybe covered by crescents 4. There are two types of intralobular ducts:
or demilunes
a. Intercalated ducts
b. Striated ducts.
Q.3. Classify salivary glands with its structural 5. Interlobular ducts are excretory ducts.
element, and write in detail on the ductal system.
intercalated ducts
Ans.
1. Intercalated ducts are the smallest ducts connecting
Salivary glands are exocrine glands. These are classified as secretory units to the next large duct, ie. striated duct.
follows: 2. They are intralobular ducts lined by a single layer of low
1. Based on the size cuboidal cells.
3. The intercalated ducts do not simply allow the passage
of saliva, but modify it through secretory and resorptive
process.
a. Major salivary glands b.Minor salivary glands 4. They contribute macromolecular components like
i. Parotid gland i.
Glossopalatine lysozymes, lactoferrin and some unknown components
ii. Submandibular gland ii.Palatine to saliva.
iii, Sublingual gland iii.Labial and buccal 5. These ducts also house undifferentiated cells that can
glands undergo differentiation to replace damaged or dying
iv. Posterior lingual cells in the end piece or striated ducts.
glands
v. von Ebner’s glands Striated ducts
2. Based on the nature of secretions
1. Striated ducts receive saliva from intercalated ducts.
2. They form largest portion of ductal system constituting
the intralobular component of ductal system.
a. Serous b. Mucous c. Mixed 3. They are lined by a layer of tall columnar epithelial cells.
i. Parotid gland i. All minor i. Submandibular
4. The combination of infoldings and mitochondria
salivary glands account for the striations seen in the light microscope.
except von Ebner’s 5. These ducts are site of electrolyte reabsorption, especially
glands of sodium and chloride, and secretion of potassium and
bicarbonate.
ii. von Ebner’s ii. Sublingual 6. Their cells are involved in active reabsorption.
glands
Excretory ducts
Basic Structure of Salivary Glands 1. The striated ducts join each other to form large intra-
The basic structure of salivary glands consists of the following: lobular ducts, which gradually increase in size and are
1. Ductal system surrounded by increasing layers of connective tissue,
2. Secretory cells which progressively becomes non-striated and is termed
3. Myoepithelial cells as excretory interlobular duct.
Quick Review Series: BDS 1st Year
2. The excretory duct contains two layers:
a. Mucosa
b. Outer connective tissue adventitia.
3. The mucosal epithelium of the duct consists of pseu-
dostratified columnar epithelium, which slowly under-
goes a transition to stratified, cuboidal and finally into
stratified squamous epithelium when it merges with the
epithelium of oral cavity.
4. It stretches passively, and allows and accommodates
varying volumes of saliva.
Salivary glands are composed of number of acini. Each
acinus is composed of a group of either saccular or tubular
alveoli that drain through canaliculi into intercalated ducts.
These ducts in turn join striated ducts and join the main
excretory ducts.
The various cell types found in the acini or secretory end
piece are as follows:
1. Serous cells
2. Mucous cells
3. Myoepithelial cells.
Serous cells
The serous cells are specialized for synthesis, storage and
secretion of proteins. The structural feature of serous cells is
typical of a protein-secreting cell.
1. In light microscope, a typical serous cell appears pyrami-
dal in shape, with its apex directed towards central lumen
and broad base resting on a thin basement membrane.
2. Its nucleus is spherical and located in the basal region of
the cell.
3. They contain eosinophilic staining secretory granules
called zymogen granules located in the apical cytoplasm.
4. The basal portion of the cytoplasm is packed with paral-
lelly stacked, ribosome-studded rough endoplasmic
reticulum (RER).
5. A closed system of membranous sacs or cisternae
constitutes RER, and is placed basal and lateral to the
nucleus of the cell.
6. The Golgi apparatus is a membranous cisterna of
several stacks of 4 + 6 smooth surfaced saccules located
apically and laterally to the cell nucleus.
SHORT ESSAYS
Q.1. Serous cells.
Ans.
Refer to the answer of Long Essays Q.3.
Q.2. Functions of saliva.
7. The serous cells also contain a good number of mito-
chondria, which are powerhouses of numerous syn-
thetic and transportation process in relation with RER
and Golgi apparatus.
8. Lysosomes are seen with hydrolytic enzymes, which
help to destroy foreign material and worn out cell
organelles.
9. Bundles of tonofilaments, associated with desmosomes
and microfilaments, may be seen in the cytoplasm.
Mucous cells
1. They are pyramidal cells with fat nucleus located basally
against cell membrane and lightly stained cytoplasm.
2. The apex of the cell appears empty, except for their
strands of cytoplasm forming a tubercular network.
3. The nucleus is oval or flattened in shape located just
above the basal plasma membrane and a thin rim of
cytoplasm is compressed against the base of the cell.
4. The nucleus of the mucous cell and the RER, mitochon-
dria and other organelles are also limited to a narrow
band of cytoplasm.
Myoepithelial cells
1. Myoepithelial cells are stellate in shape and are also
known as ‘basket cells’
2. They lie between the basement membrane and the glan-
dular or ductal epithelium.
3. Each cell consists of a central body from which four to
eight processes radiate and embrace the secretory unit.
4. Myoepithelial cells have contractile function. They
help in expelling of secretions from the lumen of
secretory units and facilitate the movement of saliva in
the ducts.
Interstitial Connective Tissue, Blood Vessels,
Lymphatics and Nerves
The connective tissue forms a fibrous capsule around the
gland and further extends into the gland dividing into lobes
and lobules.
The salivary glands have a rich blood supply, venous and
lymphatic drainage and nerves.
Ans.
The various functions of saliva are as follows: Saliva partici-
pates in digestion by
1. Providing a fluid environment for solubilization of
food.

2. Through the action of its digestive enzymes. Amylase of
saliva digests carbohydrates to produce glucose.
3. Lingual lipase initiates the digestion of dietary lipids,
hydrolyzing triglycerides.
4. Saliva has several protective functions:
a. It keeps the oral tissues moist, and facilitates
swallowing and speaking.
b. Saliva helps protect the teeth from dental caries by
means of both cleansing and buffering action of saliva.
c. Saliva controls the calcium and phosphate concen-
tration around the teeth.
SHORT NOTES
Q.1. Serous cells.
Ans.
1. The serous cells are specialized for synthesis, storage and
secretion of proteins.
In light microscope, a typical serous cell appears
pyramidal in shape.
Its nucleus is spherical and located in the basal region of
the cell.
They contain zymogen granules in the apical cytoplasm.
The basal portion of the cytoplasm is packed RER,
the Golgi apparatus, lysosomes, etc.
Q.2. Serous acini.
Ans.
1. The basic functional unit of a salivary gland is the
terminal secretory unit called acini.
2. The secretory terminal unit in serous acini is generally
made of 8-12 serous cells arranged in a roughly spheri-
cal shape surrounding a central lumen along with
myoepithelial cells located on the surface of acini.
Junctional complexes hold the cells together in an
acinus and regulate the permeability.
The serous acini have a smaller lumen compared to
mucous acini.
Q.3. Mucous acini.
Ans.
1. The mucous acini have a larger central lumen compared
to serous acini.
They are tubular in configuration.
. They have pyramidal cells with fat nucleus located basally
against cell membrane and lightly stained cytoplasm.
Q.4. Differences between serous and mucous acini.
Ans.
Refer to the answer of Long Essays Q.2.
Oral Histology
. Several substances found in saliva inhibiting the growth
of microorganisms and possibly preventing infection
are as follows:
a. The presence of peroxidase acts as bactericidal.
b. Lysosome in saliva also has antibacterial action.
c. The important groups of defensive substances
like immunoglobulins (IgA, IgM, IgG) are present in
saliva.
d. Another antibacterial substance found in saliva is
lactoferrin.
Q.5. Myoepithelial cells.
Ans.
1. Myoepithelial cells are stellate in shape and are also
known as ‘basket cells’
2. They lie between the basement membrane and the
glandular or ductal epithelium.
. Each cell consists of a central body from which 4-8 processes
radiate and embrace the secretory unit.
. Myoepithelial cells have contractile function. They help
in expelling of secretions from the lumen of secretory
units and facilitate the movement of saliva in the ducts.
Q.6. Functions of saliva.
Ans.
The functions of saliva are as follows:
1. The major function of saliva is the protection of oral
cavity and oral environment.
2. It participates in digestion through the action of diges-
tive enzymes, especially amylase.
. Saliva helps in mastication of the food and facilitates the
deglutition through lubricating properties.
. Saliva helps in taste perception.
. Saliva facilitates speech by keeping the oral cavity moist.
. Saliva promotes tissue repair due to presence of growth
factors and trefoil proteins in it.
. Excretory function: Saliva excretes urea, nitrates and
heavy metals, etc.
Q.7. Composition of saliva.
Ans.
Composition of saliva is as follows:
1. Saliva contains 99% water, and 1% organic and
inorganic substances.
. The inorganic substances of saliva are as follows:
a. Main electrolytes of saliva are Na, K, Ca, Cl, HCO;
and HPQ,.
Quick Review Series: BDS 1st Year

b. Other electrolytes present in the small concentration 2. The posterior lingual serous glands (von Ebner’s glands)
are Mg, SQ., F, SCN and I. are purely serous gland located between the muscle
3. The main organic portion of saliva contains the following: fibres of tongue below the vallate papillae.
3. Glossopalatine and palatine glands are purely mucous
Secretary proteins in nature.
a. Secretory proteins include various enzymes like amy- 4. The labial and buccal glands are mixed in nature.
lase, ribonuclease, kallikrein, lysozymes, lactoferrin and Pure mucous:
acid phosphatase. Glossopalatine
b. Large carbohydrate-rich glycoproteins or mucin, Palatine
antibacterial substance and a group of proteins.
Purely serous:
c. Certain serum constituents such as albumin, blood
von Ebner’s glands
clotting factors and immunoglobulins.
d. Other organic molecules present in saliva include amino Mixed:
acids, urea, uric acid, various lipids and hormones. Labial and buccal glands
Posterior lingual glands
Q.8. Salivary enzymes.
Q.11. Intercalated ducts.
Ans.
The principal enzymes of saliva constitute the following: Ans.
1. Amylase 1. Intercalated ducts are the smallest ducts connecting
2. Lingual lipase secretory units to the next large duct, ie. striated duct.
3. Other hydrolytic enzymes. 2. They are intralobular ducts lined by a single layer of low
Amylase enzyme acts on carbohydrates to produce glu- cuboidal cells.
cose and maltose. Its action continues for up to 30 minutes 3. The intercalated ducts do not simply allow the passage
in the stomach, before it is inactivated by the acid pH and of saliva, but modify it through secretory and resorptive
proteolysis. process.
Lingual lipase is produced by lingual serous glands. It 4. They contribute macromolecular components like lyso-
initiates the digestion of dietary lipids and hydrolyzes tri- zymes, lactoferrin and some unknown components to saliva.
glycerides into monoglycerides, diglycerides and fatty acids. 5. These ducts also house undifferentiated cells that can
The significance of other hydrolytic enzymes detected in undergo differentiation to replace damaged or dying
saliva is not yet established. cells in the end piece or striated ducts.

Q.9. Wharton’s duct. Q.12. Name ducts of major salivary glands.

Ans. Ans.

1. The main excretory duct of submandibular gland is The ducts of major salivary glands and their openings are as
Wharton’s duct. follows:
2. Wharton’s duct runs forward above the mylohyoid 1. Duct of parotid gland — Stenson’s duct — Opens near
muscle lying just below the mucosa of the floor of the maxillary second molar in the buccal mucosa
mouth in its terminal portion. 2. Duct of submandibular gland (Wharton’s duct >
3. It opens at the sublingual papillae, also known as Opens at the side of lingual Frenum known as caruncula
caruncula sublingualis, lateral to the lingual frenum. sublingualis)
Q.10. Minor salivary glands. 3. Duct of sublingual gland (a) Bartholin’s duct or (b)
several minor ducts open near submandibular duct
Ans. along the sublingual fold independently.
1. The minor salivary glands are located beneath the epi-
Q.13. Salivary lipase.
thelium in almost all parts of the oral cavity.
2. They lack a distinct capsule. The secretory units open Ans.
via short ducts directly into the mouth.
Lingual lipase is produced by lingual serous glands. It initiates
Various minor salivary glands are as follows: the digestion of dietary lipids and hydrolyzes triglycerides
1. Glands of Blandin and Nuhn are anterior lingual glands into monoglycerides, diglycerides and fatty acids.
located near the apex of the tongue. They are chiefly
Q.14. Major salivary glands.
mucous in nature. The ducts open on the ventral surface
of the tongue near the lingual frenum. Ans.
 Oral Histology

The three major salivary glands are as follows: Saliva has several protective functions as follows:
1 . Parotid Purely serous 1. It keeps the oral tissues moist, and facilitates swallowing
and speaking.
2 . Submandibular Mixed, with serous units predomi-
2. Saliva helps protect the teeth from dental caries by
nating
means of both cleansing and buffering action of saliva.
. Sublingual Mixed, with mucous units predomi- . Saliva controls the calcium and phosphate concentra-
nating tion around the teeth.
The parotid gland is the largest salivary gland and is . It protects mucosa from chemical and thermal insults by
purely serous gland. reducing the concentration, and lowering and buffering
The parotid duct called as Stenson’s duct opens into the temperature, respectively.
oral cavity on the buccal mucosa opposite the maxillary . Saliva causes dilution of detritus and oral acid neutral-
second molar. ization, thus protects oroesophageal mucosa.
Submandibular and sublingual salivary glands are
major mixed salivary glands (Fig. 4A.10.1). Q.16. von Ebner’s gland.
Ans.

1. The von Ebner’s gland is a purely serous minor salivary

gland located on the posterior region of the tongue.
Mucous accni . The posterior lingual serous glands are called von
Ebner’s glands.
. They are located between muscle fibres of the tongue,
Intralobular duct
below the vallate papillae.
Interlobular duct
Serous acini
. Their ducts open into the trough of the vallate papillae
and at the rudimentary foliate papilla on the sides of the
tongue.
. These glands have a significant protective and digestive
functions.

Q.17. Stenson’s duct.

Ans.
. Submandibular salivary gland is located in submandibular
triangle. 1. The Stenson’s duct is the main excretory duct of parotid
Submandibular salivary duct (Wharton’s duct) opens at gland.
the caruncula sublingualis. 2. It measures about 4-6 cm in length and 5 mm in
Sublingual salivary gland lies between the floor of the diameter.
mouth and mylohyoid muscle. . The Stenson’s duct crosses the Masseter muscle and
Sublingual salivary gland duct (duct of Rivinus) opens turns medially, penetrating the buccinator muscle to
near the opening of submandibular duct. open at a papilla on buccal mucosa opposite maxillary
second molar.
Q. 15. Protective functions of saliva.
. The Stenson’s duct carries the secretion of parotid gland
Ans. into the oral cavity.

TOOTH ERUPTION
LONG ESSAYS

Q. 1. Describe in detail about pre-eruptive, eruptive Describe tooth eruption.

and posteruptive tooth movements.
Ans.
Or
t¥/)) Quick Review Series: BDS 1st Year
Eruption is the process of an axial or occlusal movement of
tooth from its developmental position within the jaw to its func-
tional position in the occlusal plane. This active movement of
the tooth is the physiological eruption or active tooth eruption.
e The exposure of more and more of clinical crown due to
the apical migration of junctional epithelium is called
passive tooth eruption.
The eruption is a continuous process, which begins with
the formation of a tooth germ and ends only when the tooth
is lost or becomes ankylosed.
Active tooth eruption is arbitrarily divided into three
different phases, namely:
1. Pre-eruptive phase
2. Eruptive phase (prefunctional phase)
3. Functional phase
Pre-eruptive Phase
1. Made by the deciduous and permanent tooth within the
jaws to position the crypts of the growing teeth within
the jaws correctly.
2. When the deciduous tooth germs first differentiate, they are
extremely small and are accommodated within the jaws.
3. Butas the tooth germs grow rapidly, they become crowded.
But with increase in the size of the jaws, the tooth buds
make bodily movement to increase the distance between
them and to keep pace with growth of the jaws.
4. With increase in the height of the jaws, the tooth buds
move superiorly in mandible and inferiorly in maxilla.
5. The tooth buds of permanent teeth, which have decidu-
ous predecessors, undergo a complicated movement
during this phase. The permanent tooth buds, which
arise lingual to the deciduous predecessors, migrate in a
buccal direction.
Eruptive Phase (Prefunctional Phase)
1. The movement of a tooth from its position within the
jaw to its functional position of occlusion is called erup-
tive phase.
2. The eruptive phase extends from the time the root
formation begins till the tooth reaches its occlusal plane.
3. At the beginning of this period the teeth are still
crowded and in unfavourable axial orientation for
proper eruption to occur. For example, the permanent
upper molars are placed in such a manner that their
occlusal planes are directed downwards and backwards.
The occlusal surface of lower molars is directed up-
wards and forwards.
4. During this phase of tooth movement, the teeth make axial
movement, tilting and rotation to correct their positions.
5. The axial movement is rapid enough for the tooth to
overtake the growth of the alveolar process and come
out of the jaw.
6. This phase of tooth eruption is marked by the lengthen-
ing of the root and development of periodontal liga-
ment. The bone of the crypt or the socket shows areas of
rapid bone formation.
Functional Phase
1. Maintaining the position of the erupted tooth occlusion
while the jaws continue to grow and compensate for
occlusal and proximal tooth wear.
2. Once a tooth reaches its occlusal plane, its rapid axial or
occlusal movement ceases. But eruption slowly contin-
ues throughout life.
3. This eruption is to compensate for the occlusal wear
by axial movement and loss of tooth substance at the
contact areas by a mesial migration.
Q.2. Describe briefly the theories of eruption of teeth.
Ans.
1. The mechanism that brings about tooth movement is
still debatable and attributed to number of factors.
2. There are conflicting theories to explain the eruptive
tooth movement. The theories are conflicting because
eruption is a complicated multifactorial process in which
a cause and effect are difficult to segregate.
3. The theories which are considered seriously are as
follows:
. The bone remodelling theory
op
. The root growth theory
. The vascular pressure theory
aa
. The ligament traction theory.
Bone Remodelling Theory
1. In brief, this theory states that selective deposition and
resorption of the bone brings about eruption.
2. Various experiments conducted on this theory establish
the absolute requirement for dental follicle to achieve
bony remodeling and tooth eruption.
3. According to this theory, it is the follicle that provides
the source for new bone-forming cells and the conduit
for osteoclasts through its vascular supply.
4. This theory is rejected as the tooth continues to erupt
even after the selective removal of pulp tissue from an
erupting tooth.
Root Growth Theory
1. According to this theory tooth erupts because of the
increase in length of the root.
2. It was presumed that the elongating root apex exerts
pressure on the bone below, and which in turn produces
a counter force to push the tooth towards the oral cavity.
3. This theory is rejected because:
a. It is the crown that moves away from the root causing
an increase in root length.

b. Elongation of root actually causes resorption of bone
below the apex and does not allow generation of a
counter force.
c. If the crown of a developing tooth is pinned down to
its socket, the root continues to elongate without the
process of eruption occurring.
d. Even rootless, teeth erupt.
Vascular Pressure Theory
1. This theory supposes that a local increase in tissue fluid
pressure in the periapical region is sufficient to move
the tooth.
2. Teeth move in synchrony with the arterial pulse; it
shows that local volume changes can produce limited
tooth movement.
3. Ground substance can swell by 50% with the addition of
water, and a differential pressure sufficient to cause
tooth movement between the tissues below and above
an erupting tooth has been reported in an experiment.
4. Though vascular pressure can play an important role by
generating an eruptive force, different opinions have
been put forward as to whether these pressures are
primarily responsible for eruption.
SHORT NOTES
Q.1. Theories of eruption.
Or
Enumerate the theories of tooth eruption and write
in short the most accepted one.
Or
PDL traction theory.
Ans.
The theories of eruption which are considered seriously are
as follows:
1. The bone remodelling theory
2. The root growth theory
3. The vascular pressure theory
4. The ligament traction theory.
As on today, this theory is the most accepted theory for
tooth eruption.
The ligament traction theory
Refer to the answer of Short Essays Q.2.
Q.2. Hydrodynamic theory.
Oral Histology
Ligament Traction Theory
1. This theory proposes that the cells and fibres of the
ligament pull the tooth into occlusion.
2. According to collagen traction theory, there is a strong
evidence to suggest that the force for eruptive tooth
movement resides in the periodontal ligament.
3. During conversion of procollagen to collagen in the
periodontal ligament, a contraction of about 10%
occurs, and this causes a tractional force, resulting in
the eruptive forces.
4. The fibroblasts which are intimately in contact with the
collagen have a contractile property, and they transmit this
contractile force to the collagen to cause tooth eruption.
5. When the formation of collagen is inhibited with drugs
and fibroblastic activity is stopped in the periodontal
ligament area, eruption stops.
As on today, this theory is the most accepted theory for
tooth eruption.
In conclusion, the eruptive tooth movement is multifac-
torial, like vascular pressure at the apex along with the
contractile force generated by the dental follicle playing
an important role, and bone formation and resorption
facilitating the process of eruption.
Ans.
1. This theory contemplates that an increase in the hydro-
static pressure in the area around the developing roots
creates the eruptive force.
2. Various events like increased collection of ground
substance, new vasculature, etc. no doubt cause an
increase in hydrostatic pressure in the periapical region;
but this may not be the reason for tooth eruption
because reducing the local vascular and resultant tissue
fluid pressure does not stop eruptive process.
Q.3. Mechanisms of tooth eruption.
Ans.
The mechanisms or theories of tooth eruption are as follows:
1. The bone remodelling theory
2. The root growth theory
3. The vascular pressure theory
4. The ligament traction theory
a. In brief, the bone remodelling theory states that
selective deposition and resorption of the bone
brings about eruption.
b. According to the root growth theory, tooth erupts
because of the increase in length of the root.
Quick Review Series: BDS 1st Year
c. The vascular pressure theory supposes that a local
increase in tissue fluid pressure in the periapical
region is sufficient to move the tooth.
d. The ligament traction theory proposes that the cells
and fibres of the periodontal ligament pull the tooth
into occlusion.
Q.4. Passive eruption.
Ans.
1. Eruption is the process of an axial or occlusal movement
of tooth from its developmental position within the jaw
to its functional position in the occlusal plane.
2. The exposure of more and more of clinical crown due to
the apical migration of junctional epithelium is called
passive tooth eruption.
SHEDDING OF DECIDUOUS TEETH
SHORT ESSAY
Q.1. Write briefly about shedding of deciduous
teeth.
Ans.
1. The deciduous teeth are lost at or prior to the emergence
of permanent teeth; this physiological process has been
referred to as shedding.
It consists of a progressive resorption first of the socket
and then of roots of deciduous teeth.
The resorption of sockets and roots of primary teeth
occurs during the prefunctional phase of tooth eruption
of permanent teeth.
Due to this eruptive force osteoclasts appear in the
connective tissue that separates the permanent tooth
crown from the sockets of deciduous teeth.
The osteoclasts resorb the bone of the deciduous tooth
socket.
SHORT NOTES
Q.1. Osteoclasts.
Ans.
1. Osteoclasts are large, multinucleated, giant cells probably
derived from the circulating blood cells (monocytes).
3. The eruption is a continuous process that begins with
the formation of a tooth germ, and ends only when the
tooth is lost or becomes ankylosed.
Q.5. Active eruption of tooth.
Ans.
1. Eruption is the process of an axial or occlusal movement
of tooth from its developmental position within the jaw
to its functional position in the occlusal plane.
. This active movement of the tooth is the physiological
eruption or active tooth eruption.
. Active tooth eruption is arbitrarily divided into three
different phases, namely:
a. Pre-eruptive phase
b. Eruptive phase (prefunctional phase)
c. Functional phase.
6. Now multi-nucleated giant cells called odontoclasts ap-
pear around the roots of deciduous teeth and cause the
resorption of dentine, cementum and even enamel.
. The resorption of deciduous roots takes a definite sequence
and pattern, and this depends on the movement of the per-
manent tooth. It starts first on the lingual aspect, as the
movement of the permanent tooth is from lingual to buccal.
. During resorption, the pulp tissue of the deciduous tooth
remains vital and in fact participates in the resorptive
process.
. Odontoclasts appear within the pulp and cause resorption
of dentine from within.
10. The resorption of deciduous teeth is not a continuous
process but occurs in waves of resorptive activity
followed by attempted repair.
11. When the resorptive process has advanced so far that the
roots cannot any more support the tooth, the tooth is shed.
. Osteoclasts are cells that reabsorb bone.
. The number of nuclei in one cell may rise to a dozen or
more. Occasionally, uninucleated osteoclasts are found.
4. Osteoclasts are usually found in bay-like depressions in
the bone called Howship’s lacunae.
 Oral Histology

5 . Ruffled border of the cell in contact with the bone is the
site of great activity; here the pieces of bone are broken
off and released into the extracellular spaces.
Q.2. Odontoclasts.
Ans.
1 . Multinucleated giant cells resembling osteoclasts appear
around the roots of deciduous teeth. They are known as
odontoclasts.
They can cause resorption of dentine, cementum and
even enamel.
During resorption of deciduous teeth the odontoclasts
appear within the pulp and cause resorption of dentine
from within.
Q.3. Shedding of deciduous teeth.
Ans.
1. The resorption of deciduous roots takes a definite sequence
and pattern, and this depends on the movement of the per-
manent tooth. It starts first on the lingual aspect as the
movement of the permanent tooth is from lingual to buccal.
. During resorption of deciduous teeth the odontoclasts
appear within the pulp and cause resorption of dentine
from within.
. The resorption of deciduous teeth is not a continuous
process but occurs in waves of resorptive activity
followed by attempted repair.
4. When the resorptive process has advanced so far that the
roots cannot any more support the tooth, the tooth is shed.

TEMPOROMANDIBULAR
JOINT
SHORT ESSAYS

Q.1. Enumerate the ligaments of temporomandibular Sphenomandibular Ligament

jo int and their functions.
1. It is an accessory ligament.
Ans. 2. It is attached superiorly to the spine of the sphenoid and
inferiorly to the lingula of the mandibular foramen.
The ligaments of TMJ are as follows: 3. It is a remnant of the dorsal part of Meckel’s cartilage.
1. The fibrous capsule
. The lateral ligament Stylomandibular Ligament
hd

. The sphenomandibular ligament

WwW

. The stylomandibular ligament. 1. It is another accessory ligament of the joint.

Bm

2. It is attached above to the lateral surface of the styloid

Fibrous Capsule process and below to the angle and posterior border of
the ramus of the mandible.
1 . Itis attached above to the articular tubercle, the circum- . It represents a thickened part of the deep cervical fascia,
ference of the mandibular fossa and the squamotym- which separates the parotid and submandibular salivary
panic fissure, and below to the neck of the mandible. glands.
The capsule is loose above the intra-articular disc and
tight below it. Q.2. Write briefly about temporomandibular joint.
The synovial membrane lines the fibrous capsule and Ans.
the neck of the mandible.
1. Temporomandibular joint (TMJ) is a synovial joint of
the condylar variety (Fig. 4A.13.1).
Lateral or Temporomandibular Ligament
. Articular surfaces of temporomandibular joint are as follows:
1 . It reinforces and strengthens the lateral part of the a. The upper articular surface is formed by
capsular ligament. i. the articular eminence and
2. Its fibres are directed downwards and backwards. ii. anterior part of the mandibular fossa.
It is attached above to the articular tubercle, and b. The inferior articular surface is formed by
below to the posterolateral aspect of the neck of the i. The head of the mandible.
mandible. . The articular surfaces are covered with fibrocartilage.
Quick Review Series: BDS 1st Year

Compact bone 4. The joint cavity is divided into upper and lower parts
by an intra-articular disc.
Chondracyte
5. The ligaments of TMJ are as follows:
Superior joint
space
a. The fibrous capsule
b. The lateral ligament
Articular disc c. The sphenomandibular ligament
d. The stylomandibular ligament.
6. Blood supply
Inferior joint space Branches from superficial temporal and maxillary arteries.
Veins follow the arteries.
7. Nerve supply
Fig. 4A.13.1 Temporomandibular joint. Auriculotemporal nerve and masseteric nerve.

SHORT NOTES

Q.1. Articular capsule.
Ans.
1. Articular capsule is a joint capsule that covers the TMJ.
It is a fibroelastic sac.
2. Attachments of articular capsule are as follows:
e Anteriorly: Attaches to the ascending slope of articular
eminence.
e Posteriorly: To the lips of the squamotympanic
fissure.
e Superiorly: To the margins of the glenoid fossa.
e Inferiorly: To the neck of condyle of mandible.
3. The lateral aspect of the capsule is strengthened by
temporomandibular ligament.
4. The anterior surface is ill-defined. The inner surface of
capsule is smooth and glistening because of pressure of
a synovial membrane lining.
Q.2. Histology of temporomandibular joint.
Ans.
1. The capsule is made of fibrous tissue.
2. The synovial membrane consists of two layers, namely:
a. Cellular intima
b. Vascular subintima
3. Disc is made up of type I collagen.
4. The TMJ articulation is covered by a layer of fibrous tissue.
With age, the surface fibrous layer may become fibrocartilage.
Q.3. Articular disk of TMJ.
Ans.
1. The articular disc is an oval fibrous plate that divides the
joint into an upper and a lower compartment.
2. The upper compartment permits gliding movements,
and the lower, rotatory as well as gliding movements.
3. The disc has a concavoconvex superior surface, and a
concave inferior surface. The periphery of the disc is
attached to the fibrous capsule.
4. The disc is composed of an anterior extension, anterior
thick band, intermediate zone, posterior thick band and
bilamellar region.
5. The disc represents the degenerated primitive insertion
of lateral pterygoid.

MAXILLARY SINUS
SHORT ESSAY

Q.1. Maxillary sinus. 2. It is also known as antrum of Highmore.

Ans. Anatomical Features of Maxillary Sinus

1. The maxillary sinus is the largest of the air sinuses situ- It resembles a four-sided pyramid with
ated in the body of the maxilla and communicates with 1. the base of pyramid facing medially towards the nasal
the environment by way of the middle nasal meatus. cavity,
 Oral Histology

2. the apex pointed laterally towards the body of zygomatic 6. Subendothelial glands: These are located in the subepi-
bone, thelial layers of the sinus and reach the sinus lumen by
3. the anterior wall is formed by — facial surface of way of excretory duct.
maxilla, a. The subendothelial gland contain both serous and
4. the posterior wall — separates the sinus from pterygo- mucus cells.
palatine fossa, 7. Myoepithelial cells: Surround the acini.
5. the medial wall is on — the lateral wall of nose, 8. The subepithelial layer consists of collagen bundles,
6. the roof is formed by — the orbital plate of maxilla, and fibroblasts, vessels and nerves.
7. the floor is formed by —> the alveolar process of maxilla
carrying molar teeth. Functions of Maxillary Sinus
8. Ostium 1. Maxillary sinus helps in both the functions — olfactory
a. The antrum opens into the nasal cavity through a as well as respiratory.
small opening known as ostium in middle meatus. It 2. It causes humidification and warming of inspired air.
is 3-4 mm in diameter. 3. The air is arrested in the sinus for a certain time; it quickly
b. It communicates with other paranasal sinuses reaches the body temperature thus protecting the internal
through lateral wall of the nose. structures, particularly the brain against exposure of cold air.
c. It is lined by ciliated epithelium and is also known as 4. Other contribution in:
Schneiderian epithelium. a. the resonance of voice,
b. lightening of skull weight,
Microscopic/Histologic Features c. enhancement of the faciocranial resistance to
1. Microscopically, three distinct layers lining the space of mechanical shock and
the maxillary sinus are as follows: d. the production of bacteriocidal lysozyme to nasal cavity.
a. the epithelial layer, 5. Maxillary sinus is related to the following:
b. basal layer and a. Posterior superior alveolar nerve is situated at pos-
c. subepithelial layer. terior wall.
2. The epithelium is pseudostratified columnar ciliated b. Infraorbital nerve at roof.
and is derived from the olfactory epithelium of middle c. Roots of maxillary posterior teeth at floor.
nasal meatus.
3. In addition, there are: Nerve Supply
a. basal cells, 1. Superior dental nerve
b. columnar non-ciliated cells and 2. Infraorbital nerve
c. mucous-producing secretory goblet cells. 3. Greater palatine nerve.
4. Ciliated cells: The ciliated cells enclose the nucleus and
electron-lucent cytoplasm with numerous mitochon- Blood Supply
dria and enzyme-containing organelles. Internal maxillary artery via
a. The basal bodies, which serve as the attachment of
1. Infraorbital artery
ciliary microtubules. 2. Posterior superior dental artery
b. The cilia are typically composed of 9 + 1 pair of 3. Anterior superior dental artery.
microtubules.
c. Cilia provide the motile apparatus. Venous Drainage
5. Goblet cells: They contain all the characteristic features
of secretory cells. 1. Inferior ophthalmic vein
a. Basal segment contains nucleus. 2. Anterior facial vein.
b. Cytoplasm also contains RER and SER, and the Golgi
Lymphatic Drainage
apparatus, all of which are involved in the synthesis
of the secretory mucus substance. 1. Submandibular lymph nodes.

SHORT NOTES

Q.1. Maxillary sinus. 1. The maxillary sinus is the largest of the air sinuses situ-
ated in the body of the maxilla and communicates with
Ans. the environment by way of the middle nasal meatus.
376 Quick Review Series: BDS 1st Year

2. It is also known as antrum of Highmore. Q.3. Functions of maxillary sinus.

3. The epithelium is pseudostratified columnar ciliated.
Or
Functions
Functions of maxillary antrum.
1. Maxillary sinus helps in both the functions — olfactory
as well as respiratory. Ans.
2. It causes humidification and warming of inspired air. Functions of maxillary sinus are as follows:
Q.2. Lining of maxillary sinus. 1. Maxillary sinus helps in both the functions — olfactory
as well as respiratory.
Ans.
. It causes humidification and warming of inspired air.
1. Microscopically, three distinct layers lining the space of . It protects the internal structures, particularly the brain
the maxillary sinus are as follows: against exposure to cold air.
a. the epithelial layer, . Other contribution in:
b. basal layer and a. the resonance of voice,
c. subepithelial layer. b. lightening of skull weight and
The epithelium is pseudostratified columnar ciliated, c. the production of bactericidal lysozyme to nasal
and is derived from the olfactory epithelium of middle cavity.
nasal meatus.
In addition, there are: Q.4. Goblet cells.
a. basal cells,
Ans.
b. columnar non-ciliated cells and
c. mucous-producing secretory goblet cells. The goblet cells are mucous-producing secretory cells
The subepithelial layer consists of collagen bundles, present in the epithelium of maxillary sinus.
fibroblasts, vessels and nerves (Fig. 4A.14.1).

Features of Goblet Cells

1. They contain all the characteristic features of secretory

Cilia cells.
Goblet cells . Basal segment contains nucleus.
Pseudostratified . Cytoplasm also contains RER (rough endoplasmic
ciliated columnar reticulum), SER (smooth endoplasmic reticulum) and
epithelium
Basal lamina the Golgi apparatus, all of which are involved in the
synthesis of the secretory mucous substance.
Mixed salivary glands
. Zymogenic granules transport the mucopolysaccharides
Periosteum
produced by Golgi apparatus towards cellular apex
and finally release it onto epithelial surface of the sinus
Fig. 4A.14.1 Lining of maxillary sinus. by exocytosis.

HISTOCHEMISTRY OF ORAL TISSUES,

SHORT ESSAYS

Q.1. Enumerate the stages of tissue processing It is generally necessary to reduce the thickness of tissues
and write about fixation. before they can be microscopically examined. This may be
done in any of the following ways:
Ans. 1. By smearing the tissue

2. By disassociating the tissue elements by mechanical
means or by chemical agents
3. By cutting tissue organ or tissue into very thin slices (8 jum).
The stages of tissue processing are as follows:
1. Fixing
One of the most commonly used fixatives for dental tissues
is 10% formalin. The purposes of fixation are to coagulate
the protein and reduce alteration during subsequent treat-
ment. The fixation time varies from several days to several
hours. Fixation prevents autolysis of cells.
2. Dehydration of the Specimen
It is necessary that the embedding medium completely infil-
trate the specimen. In routine procedures as the tissues are
washed in running water after fixing the tissue, the tissue is
infiltrated with water. Water cannot mix with paraffin.
Hence, this water content is to be removed. For this, the
specimen is passed through a series of increasing percent-
ages of alcohol 40, 60, 80 and 95%, and last absolute alcohol.
The specimen remains in each dish for several hours. Alco-
hol is also not miscible with paraffin. So, the specimen is
now passed from alcohol to xylene, which is miscible with
both alcohol and paraffin.
3. Infiltration of the Specimen with Paraffin
When xylene has completely replaced alcohol in the tissue, the
specimen is now only to be infiltrated with paraffin. For this
purpose, it is placed in wax baths at 60°C for several hours.
4, Embedding the Specimen
Next step in the procedure is to embed the specimen in a
block of wax with the proper orientation of the specimen so
that it is cut in the desired plane later.
5, Cutting the Sections
The paraffin block is attached to a wooden cube, and this is
clamped on to the microtome, which is adjusted to cut the
specimen to the desired thickness.
6. Mounting
Suitable lengths of the paraffin ribbon with the tissue are
then mounted on prepared microscope slides.
7. Staining
Mounted slides are stained with the desired staining method.
Q.2. Fixation procedures and ideal fixatives.
Ans.
1. Fixation procedures used in histochemical study enable
tissue blocks to be preserved in such a way that it causes
Oral Histology
minimal changes in the reactivity of cytoplasmic and
extracellular macromolecules.
2. This is accomplished by using the following:
a. Optimum osmotic conditions
b. Cold temperatures: freeze-drying, freeze-fracture
and freeze-etching procedures
c. Controlled pH of the fixing solutions
d. Minimum possible exposure to the fixative.
3. The ideal fixatives are as follows:
a. Formaldehyde: Ideal for enzymes and other proteins.
b. Acrolein and gutaraldehyde: Frequently used aldehydes
for electron microscopy.
c. Rossman’s fluid: Used for visualization of glycogen,
glycoproteins and proteoglycans.
d. Imidazole-buffered osmium tetrachloride: Allows
localization of lipids rich in unsaturated fatty acids.
e. Nakan’s periodate-lysine—paraformaldehyde and
periodate—lysine—glutaraldehyde: Superior fixatives
for cerium-—lead-based techniques of enzyme dem-
onstration.
Q.3. Preparation of ground section of tooth.
Ans.
Steps for preparation of ground section of teeth are as
follows:
1. The labial surface of the tooth is ground down nearly to
the level of desired section using a coarse abrasive lathe
wheel attached to the lathe and water directed onto the
wheel.
2. The coarse wheel is now exchanged for a fine abrasive
lathe wheel, and the cut surface of the tooth is ground
again until the level of desired section is reached.
At this point a piece of adhesive tape is wrapped around
the wooden block in such a way that the sticky side
of the tape is directed outward.
3. The ground section of the tooth is whipped dry and
then is pressed onto the adhesive tape on one side of the
wooden block. It will stick fast.
4. With the block held securely in the fingers, the same
procedure is carried out on the lingual surface of the
tooth.
5. The finished ground section is soaked off of the adhe-
sive tape with ether and then is dried off for several
minutes.
6. Drying for too long will result in cracking. It is then
mounted on a microscopic slide.
7. To do this, a drop of mounting medium is placed on the
slide, the 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.
378 Quick Review Series: BDS 1st Year
SHORT NOTES
Q.1. Alkaline phosphatase.
Ans.
1. Alkaline phosphatase is associated with osteogenesis
and odontogenesis. Hence the osteoblasts and odonto-
blasts give an intense-staining reaction for the enzyme.
. The osteoblasts and preosteoblasts exhibit alkaline phos-
phatase activity, which is often used as cytochemical
marker to differentiate fibroblasts from preosteoblasts.
. Alkaline phosphatase activity in human gingiva is spe-
cifically demonstrated in the capillary endothelium of
the lamina propria.
. Basement membranes associated with salivary gland
acini and taste buds exhibit high alkaline phosphatase
activity.
Q.2. Preparation of ground section of tooth.
Ans.
Steps for preparation of ground section of teeth are as fol-
lows:
1. The tooth is ground down nearly to the level of desired
section on both labial and lingual sides using a coarse
and a fine abrasive lathe wheels.
. The finished ground section is soaked off of the adhe-
sive tape with ether and then is dried off for several
minutes.
. It is then mounted on a microscopic slide using a drop
of mounting medium.
4. A cover glass is affixed on the mounted specimen for
microscopic study.
Q.3. Stages in soft tissue processing.
Ans.
The stages in soft tissue processing are as follows:
1. Obtaining the specimen Without crushing.
2. Fixation of the specimen Commonly in 10% neutral
formalin.
. Dehydration of the specimen
By passing through increasing percentages of alcohol
(40, 60, 80, 95% and absolute alcohol).
. Clearing of the specimen
By passing through clearing agents, e.g. xylene.
. Infiltration of specimen with paraffin.
. Embedding the specimen in the centre of a paraffin block.
. Cutting the sections of the specimen On a precision rotary
microtome.
. Mounting the cut sections on slides.
. Staining the sections
Common combination of stains used for routine micro-
scopic study is haematoxylin and eosin (H & E).
Q.4. Decalcification.
Ans.
1. After fixation is complete, the specimen is decalcified.
This is achieved using 5% nitric acid.
2. It takes about 7-10 days for complete decalcification by
changing the specimen toa series of jars of 5% nitric acid.
Test for Decalcification
1. After decalcification, the tissue can be easily pierced
with a sharp instrument.
2. When 1 mL of concentrated ammonium hydroxide and
a few drops of saturated solution of ammonium oxalate
are added to 5 cc of the 5% nitric acid in which the tooth
to be decalcified was immersed, there should not be a
precipitate.
Q.5. Xylene.
Ans.
1. The xylene is a clearing agent.
2. After dehydration of specimen clearing of specimen is
performed so as to remove alcohol from the tissue using
xylene.
DENTAL
ANATOMY
Topic 1 Introduction to Dental Anatomy .............:::::ccccceeceeeeeeeeeeeeeeeeensaeenees 381
Topic 2 Development and Eruption of Teeth.............:::cccceeceeeeeeeeseeeeeeesseees 387
Topic 3 Primary (Deciduous) Teeth ............cccccssccceeeeesceeeeececeeeeeeeessueeeeessenees 392
Topic 4 General Consideration in the Physiology
of Permanent Dentition ........ cece eeee renee eeeeeeeeteeeeeeaeeeeneenennees 393
Topic 5 Orofacial Complex: Form and FUNnCtion .......0..ccceeeceeeeeeeeeeeeeeees 396
Topic 6 Permanent Maxillary and Mandibular Incisors................::00ce 397
Topic 7 Permanent Canines: Maxillary and Mandibular ...........0::eceeeee 403
Topic 8 Permanent Maxillary Premolar .............:c::::ccccececeeeeeeeeeeeeeeeeeneeees 409
Topic 9 Permanent Mandibular PremolatS.............::::ccccccceceeeeeeeeeeeeeeeeesaeeeees 414
Topic 10 Permanent Maxillary Molats.............2.:::::cccecceeceeeeeeeeeeeeeeeeeeneeaanenees 417
Topic 11 Permanent Mandibular MolarS..............2::::ccccccecceceeeeeeeeeeeeeeeeeseeeees 423
Topic 12 Dento-OSSeEOUS Structures 000... eee eee eeee eeeeee ee eiaeetenaeeeeneeeeeeeeee 427
Topic 13.
= Temporomandibular Joint, Muscles, Teeth
and Their FUNCTIONS... cece eeeeeeeeeeennneeeeeeeenaeeeeeeneeaeeeeeneeeeees 431
Topic 14 = OCCIUSION.... eect eeeeet eee e etter eeene etter eee teeeetaeeeecneeeeneeeesaeeennaeeeennees 435
Topic 15 MiSCeIANCOUS.............c:ceeeecee
cee eeeee eee eee cece eeaaeaeeeeeeeeeeeeeeeeeeseneseeaeeeeees 436
This page intentionally left blank
 DENTAL ANATOMY

INTRODUCTION TO DENTAL ANATOMY

LONG ESSAY

Q.1. Write briefly about the tooth numbering system. and the succeeding teeth in the increasing order of alpha-
bets up to E for the deciduous second molar, the last tooth
Ans.
in the quadrant.
@ It is necessary to substitute the lengthy names of the indi- e Identifying a specific tooth by this system combines
vidual teeth by some symbol. This is possible by designating the quadrant grid with the tooth number, in reference to
individual teeth by a number or an alphabetical letter. the midline.
The oldest known tooth designation system, the Zsigmondy/
Other systems of tooth numbering that are not in common
Palmer system has remained the most widely used method.
usage are as follows:
As per this system, the oral cavity is divided into four
i. Universal system
quadrants, and each permanent tooth has a specific num-
ii. Two-digit system (FDI system).
ber in designation.
For permanent dentition, the formula is as follows: Universal System
Maxilla e This clinical notation system is for both the permanent
87654321 | 12345678 and deciduous dentitions.
Right Left
87654321 | 12345678 For permanent dentition
Mandible e For permanent dentition in this system, beginning with
Numbering from the midline progressing posteriorly, the maxillary right third molar, the teeth are numbered
in both arches, the central incisor is designated as 1 and 1 to 16. Then beginning with the mandibular left third
with progressive increase in number for each succeeding molar, the teeth are numbered 17 to 32.
tooth ending up with number 8, for the third molar, the
12345678 | 910 11 1213 14 15 16
eighth tooth in the quadrant.
32 31 30 29 28 27 26 25 | 24 23 22 21 20 19 1817
For deciduous dentition the formula is as follows:
e For deciduous dentition, alphabets are used starting
Maxilla
from A up to T. Beginning with the maxillary right second
EDCBA | ABCDE molar, the teeth are named A to J. Then beginning with
Right Left the mandibular left second molar, the teeth are named
EDCBA | ABCDE K to T.
Mandible
ABCDE | FGHIJ
Lettering from the midline progressing posteriorly in
both arches, the deciduous central incisor is designated A, TSRQP JONMLK
Quick Review Series: BDS 1st Year

Two-digit System (Federation Dentaire For deciduous teeth

Internationale [FDI] System)
For permanent teeth
1817 161514131211 [21 22 23 24 25 26 27 28
48 47 46 45 44 43 42 41 | 31 32 33 34 35 36 37 38
The teeth in maxillary right quadrant are numbered,
starting from the central incisor to third molar as 11 up
to 18. Then the maxillary left quadrant teeth are num-
bered as 21, 22, up to 28 starting from left central incisor.
The mandibular left quadrant teeth are numbered 31
starting from central incisor to third molar, which is
numbered 38. The numbering is continued as 41, starting
from mandibular right central incisor to third molar,
which will be 48.
The teeth in maxillary right quadrant are numbered,
starting from the central incisor to second molar as 51 up
to 55. Then the maxillary left quadrant teeth are num-
bered as 61 up to 65, starting from left central incisor.
The mandibular left quadrant teeth are numbered 81,
starting from central incisor to second molar, which is
numbered 85. The numbering is continued as 71, starting
from mandibular right central incisor to second molar,
which will be 75.
55 54 535251 61 62 63 64 65
85 84 83 82 81 717273 7475
The main advantage of this system is that there is no need
to mention the quadrant.

SHORT ESSAY

Q.1. FDI system of dental nomenclature. from mandibular right central incisor to third molar,
which will be 48.
Ans.

For deciduous teeth

Two-digit System (Federation Dentaire
internationale [FDI] System) 55 54 535251 61 62 63 64 65

For permanent teeth 85 84 83 82 81 717273 7475

1817 161514131211 [21 22 23 24 25 26 27 28
48 47 46 45 44 43 42 41 | 31 32 33 34 35 36 37 38
The teeth in maxillary right quadrant are numbered,
starting from the central incisor to third molar as 11 up
to 18. Then the maxillary left quadrant teeth are num-
bered as 21, 22, up to 28, starting from left central incisor.
The mandibular left quadrant teeth are numbered 31
starting from central incisor to third molar, which is
numbered 38. The numbering is continued as 41, starting
The teeth in maxillary right quadrant are numbered,
starting from the central incisor to second molar as 51 up
to 55. Then the maxillary left quadrant teeth are num-
bered as 61 up to 65, starting from left central incisor.
The mandibular left quadrant teeth are numbered 81, start-
ing from central incisor to second molar, which is numbered
85. The numbering is continued as 71, starting from man-
dibular right central incisor to second molar, which will be 75.
The main advantage of this system is that there is no need
to mention the quadrant.

SHORT NOTES

Q.1. Ridges.
Ans.
A narrow, elongated elevation on the surface of a tooth is
known as ridge (Fig. 4B.1.1).
The ridges are named depending on their location like
buccal ridge, marginal ridge, incisal ridge, oblique ridge, etc.
Marginal ridges form the mesial and distal margins of the
occlusal surfaces of posterior teeth and lingual surfaces of
certain anterior teeth. Fig. 4B.1.1 Ridges.
 Dental Anatomy

Q.2. Grooves.

Ans.

e Grooves are developmental faults, clefts or fissures usually

found on the occlusal or buccal and lingual surfaces of
posterior teeth (Fig. 4B.1.2). They separate the primary
parts of the crown, namely the cusps or the roots.
Fig. 4B.1.4 Oblique ridge.

deciduous second molars) from the mesiopalatal cusp to

Groove the distobuccal cusp.
Q.5. Marginal ridge.
Ans.
Fig. 4B.1.2 Grooves. @ Marginal ridges are those rounded borders of the enamel
that form the mesial and distal margins of the occlusal
surfaces of premolars and molars, and the mesial and
e They may be either shallow and wide, or deep and distal margins of the lingual surfaces of the incisors and
narrow. They play an important role in the initiation of canines (Fig. 4B.1.5).
tooth decay (dental caries). Example: buccal groove of
molars.
Q.3. Cingulum.
Ans.
e A cingulum or girdle is the lingual lobe of an anterior
tooth and makes up the bulk of the cervical third of the Marginal
Ridge
lingual surface (Fig. 4B.1.3).

Fig. 4B.1.5 Marginal ridge.

Q.6. Tooth numbering system.

Or
Cingulum
Name systems of tooth numbering of oral cavity.
Ans.
Fig. 4B.1.3 Cingulum. e It is necessary to substitute the lengthy names of the
individual teeth by some symbols. This is possible by
designating individual teeth by a number or an alpha-
e Its convexity mesiodistally resembles a girdle encircling betical letter.
the lingual surface at the cervical-third. e Tooth numbering systems are as follows:
e Cingulum is more pronounced in the deciduous teeth i. Zsigmondy/Palmer system
than the permanent teeth. ii. Two-digit system (FDI system)
iii. The Universal system.
Q.4. Oblique ridge.
Q.7. Palmer system of notation.
Ans.
Ans.
e Oblique ridge is formed as the result of the union of two
triangular ridges (Fig. 4B.1.4). e The oldest known tooth designation system, the Zsigmondy/
e They cross obliquely the occlusal surfaces of maxillary Palmer system has remained the most widely used
molars (maxillary permanent molars and maxillary method.
Quick Review Series: BDS 1st Year

e As per this system, the oral cavity is divided into four @ Clinical crown: The part of the tooth that appears in the
quadrants, and each permanent tooth has a specific oral cavity and is exposed to saliva.
number in designation. e Anatomic crown: That portion of the tooth covered by
enamel is known as anatomical crown.
For permanent dentition, the formula is as follows:
Maxilla Q.10. Mamelons.
87654321 | 12345678 Or
Right Left
87654321 | 12345678 Elevation of surface of crown.
Mandible Ans.
For deciduous dentition, the formula is as follows: i. The small protuberances usually present on the incisal
Maxilla edge of the newly erupted incisors are known as mamelons
EDCBA | ABCDE (Fig. 4B.1.7).
Right Left
EDCBA | ABCDE
Mandible

@ Identifying a specific tooth by this system combines the quad-

rant grid with the tooth number in reference to the midline.
Q.8. FDI system of tooth notation.
Ans.

Two-digit System (Federation Dentaire Mamelons

internationale [FDI] System) Fig. 4B.1.7 Mamelons.

For permanent teeth

1817 161514131211
48 47 46 45 44 43 42 41
For deciduous teeth
ii. Each mamelon represents a lobe or primary section of the
21 22 23 24 25 26 27 28 formation in the development of crown, which it belongs to.
31 32 33 34 35 36 37 38 iii. They are worn out with usage or they may be missing by
birth, as in case of congenital syphilis where the central
lobe or mamelon will be missing congenitally.

55 54535251 | 61 62 636465 Q.11. Pits.

85 84 83 8281 | 7172737475 Ans.

e The main advantage of this system is that there is no need i. Pits are small or pin-point deep depressions in the
to mention the quadrant. enamel, sometimes in dentine of a tooth also (Fig. 4B.1.8).
Q.9. Crown.
Ans. Pit

e Each tooth consists of two parts—a crown and a root

(Fig. 4B.1.6).

Crown

Fig. 4B.1.8 Pit.

ii. They are usually located at the junction of developmen-

tal grooves or at the terminals of these grooves.
iii. In molars, where the developmental grooves in the cen-
tral fossa meet, there results a central pit. In about 50%
of the permanent molars at the termination of the buccal
groove, there lies a pit. They can act as areas for initiation
Fig. 4B.1.6 Crown. of dental caries.
 Dental Anatomy

Q.12. Fossa.

Ans.

i. A fossa is a depression or concavity found on the tooth

surface (Fig. 4B.1.9).

Fossa
Fig. 4B.1.10 Point angle.

Fig. 4B.1.9 Fossa.

c. Mesiolinguoincisal
d. Distolinguoincisal.
ii. Depending on their locations, they are named as follows: 2. The point angles in the posterior teeth are as follows:
a. Lingual fossa: On the lingual surface of the incisors. a. Mesiobucco-occlusal
b. Central fossa: Found on the occlusal surfaces of molars. b. Distobucco-occlusal
c. Triangular fossa: On the occlusal surface, either c. Mesiolinguo-occlusal
mesial or distal to the marginal ridges are found on d. Distolinguo-occlusal.
the molars and premolars of the triangular fossa. Q.14. Ridges and grooves.
Q.13. Line angles and point angles. Ans.
Ans.
Ridges
Line Angle e A ridge is any linear elevation on the surface of a tooth
e Aline angle is formed by the junction of two surfaces and and is named according to its location (e.g. buccal, incisal
is named after the two surfaces that form this angle. or marginal ridge).
Example: The line angles in the anterior teeth are as follows:
Mesiolingual and distolingual Grooves (Fig. 4B.1.11)
Mesiolabial and distolabial e A developmental groove is a shallow groove or line
Linguoincisal and labioincisal. between the primary parts of the crown or root.
The line angles of the posterior teeth are as follows:
Mesiobuccal
Distobuccal
Mesiolingual
Distolingual
Mesio-occlusal
Disto-occlusal Groove
Bucco-occlusal
Linguo-occlusal.
Fig. 4B.1.11 Groove.
Point Angle
e A point angle is formed by the junction of three surfaces
e A supplemental groove, less distinct, is also a shallow
and is named after the surfaces forming it (Fig. 4B.1.10).
linear depression on the surface of a tooth; but it is
Example: The junction of distal, lingual and the incisal supplemental to a developmental groove and does not
surfaces is termed the distolinguoincisal point angle. mark the junction of primary parts.
1. The point angles of the anterior teeth are as follows: e Buccal and lingual grooves are developmental grooves
a. Mesiolabioincisal found on the buccal and lingual surfaces of posterior
b. Distolabioincisal teeth.
 Quick Review Series: BDS 1st Year

Q.15. Embrasures. Tubercle

Ans. e A tubercle is a smaller elevation on some portion of the

crown produced by an extra formation of enamel. Devia-
i. Embrasure (spillway) is a triangular interproximal space
tions from the typical form are evident (Fig. 4B.1.14).
formed around the contact points due to the divergence
of the tooth surface from the contact point (Fig. 4B.1.12).

Embrasure
Tubercle

- 7

Fig. 4B.1.12 Embrasure.

ii. In all directions from the contact areas, the curving sur-
faces of the crown diverge away from each other forming Fig. 4B.1.14 Tubercle.
these embrasures. Therefore an embrasure is found
buccally, lingually, incisally, occlusally or cervically.
iti. The cervical embrasures are named after their location Q.18. Contact points.
like lingual embrasure, buccal embrasure, etc. Or
iv. Embrasures have two functions to perform:
a. They act as spillways for the escape of food during Proximal contact areas.
mastication. Ans.
b. They make the teeth more self-cleansing because of
their smooth rounded surfaces. e@ These are small circular or oval areas on the proximal
surfaces where two adjacent teeth contact or meet each
Q.16. Dental formulae. other (Fig. 4B.1.15).
Ans.

e The dental formula for the deciduous dentition is I 7/, Contact point
CM,M 7.
e The dental formula for the permanent dentition is I 7/
C1, PM 7/, M*/3.

Q.17. Define cusp and tubercle.

Ans.

Cusp Fig. 4B.1.15 Contact point.

e A cusp is an elevation or mound on the crown portion
of a tooth, making up a divisional part of the occlusal e There is no difference between the contact point and con-
surface (Fig. 4B.1.13). tact area. When the contact of two teeth involves a smaller
area, it is termed a contact point. In newly erupted teeth,
Cusp this sort of contact is best appreciated.
e With usage of these teeth in function, the so-called contact
points wear away, and a wider area of proximal surfaces
results. This type of contact is termed as the contact area.
e Example:
e Incase of the central incisors, there exists a contact point
between the mesial surfaces of the two teeth.
e At the incisor region, especially in the mandible, the
contact areas are situated towards the incisal edges.
e Passing backwards, along the dental arches, the contact
Fig. 4B.1.13 Cusp. areas become placed progressively at a lower level.
 Dental Anatomy

DEVELOPMENT AND

LONG ESSAYS

Q.1. What is chronology of deciduous dentition? In the plasma, calcium exists in three states.
i. Ionic calcium—5 mg%
Ans.
ii. Diffusible but unionized—1 mg%
iii. Bound to plasma proteins—4 mg%.
Chronology of Primary Dentition
e The chronology of the deciduous or primary teeth is pre- Exchangeable calcium
sented based on the data derived from tooth formation
Body contains a type of exchangeable calcium that tries to
standards.
keep the plasma calcium level at a constant. Most of this
First is in the bone.
evidence Teeth do not have any exchangeable calcium.
of calcifica- Crown Eruption Root Exchangeable calcium is very important to keep the bal-
tion (weeks completed (mean age completed ance of calcium concentration in the extracellular fluids
Tooth in utero) (months) | months) (years) in conditions like hypo-or hyper-availability of calcium.
Maxillary Teeth
Upper Sources
i 14 1% 10 1% Milk is a major source of calcium. About 30 mg is present
i2 16 2% 11 2 in 100 mL of milk. Green vegetables, eggs, dairy products
C 17 9 19 3% and nuts are other reasonable sources.
m1 15 6 16 2%
m2 19 11 29 3
Absorption
Mandibular Teeth Calcium occurs in nature both as an organic and as an
Lower inorganic salt. But only the inorganic salt is absorbed by
i 14 2% 8 1%
the intestine. Absorption is mainly in the jejunum and
ileum.
i2 16 3 13 1%
C 17 9 20 3%
Factors influencing absorption
m1 15% 5% 16 24 A calcium-deficient body absorbs more calcium.
Phosphate in diet forms insoluble calcium phosphate
m2 18 10 27 3
complexes and hence prevents absorption.
A low pH in the GI tract helps formation of soluble
Q.2. Describe the calcium and phosphorus metab-
calcium salts and hence favours calcium absorption.
olism in relation to development of teeth.
Proteins and amino acids form soluble calcium salts and
Ans. hence increase absorption.
Vitamin D3 (1,25 dihydroxycholecalciferol) increases
e Next to sodium and potassium, calcium is the most
absorption by synthesizing more calcium-uptaking
important mineral required by the body.
proteins in the intestinal mucosa.
Food substances containing large amounts of oxalic acid
Calcium Metabolism
(e.g. spinach) form insoluble calcium oxalate salts and
Distribution hence prevent calcium absorption.
e About 1-1.5 kg of calcium is present in the body. Of this about
Excretion of calcium
99% is present in the skeleton and 1% in the other tissues.
e The plasma calcium level is about 10 mg% and that of About five-sixths of the daily intake of calcium is excreted
phosphates is about 4-4.5 mg%. in the faeces, and the remaining one sixth in the urine.
Bots) Quick Review Series: BDS 1st Year

e Calcium is deposited in certain areas of the bone as trical-
cium phosphate. This calcium is not a permanent deposit
as bone is being constantly resorbed and redeposited.
This wear and tear of bone results in loss of several hun-
dred milligrams of calcium everyday in urine and faeces.
This amount must be replaced through the diet for the
body to maintain calcium equilibrium.
Daily requirement
e About 1g/day is recommended in an adult. In pregnancy
and during lactation, about 1.5g/day is advocated.
e Dietary calcium requirements increase with age, espe-
cially in postmenopausal women who tend to lose cal-
cium from their bones.
Functions
e Calcium is absolutely necessary for the formation of bone
and teeth. Calcium makes up the main inorganic content
of the hard tissues of teeth and bone.
Phosphate Metabolism
Though calcium and phosphate are to be recognized to-
gether in calcium metabolism, a few unique things about
phosphates demand due mention. They are:
e Vitamin D indirectly favours phosphate absorption by
encouraging calcium absorption and thereby preventing
formation of insoluble phosphate compounds of
calcium.
e Parathormone does not cause any reabsorption of phos-
phates in the kidneys.
e Inorganic phosphate is of enormous importance in the
formation of phosphate bonds of ATP and in the mainte-
nance of acid—base stability of blood.
@ Organic phosphate is present in the blood in the form of
phospholipid and phosphate from this compound can
donate phosphates for bone formation.
e The secretory osteoblasts produce alkaline phosphatase,
which is active at a pH of 9. This enzyme liberates inor-
ganic phosphate from organic phosphate compounds,
and it is present in the blood in increased concentrations
whenever normal or pathological bone formation is oc-
curring.
e There is no hormonal mechanism in the body to set right
the falling levels of phosphate in blood.
e Hypophosphatasia is a disease manifested by skeletal ab-
normalities, low levels of serum alkaline phosphatase and
premature loss of deciduous teeth.
e Hypophosphataemia or vitamin D resistant rickets is due
to an inborn error in the reabsorption of inorganic phos-
phates from the renal tubules. Due to phosphate loss, the
bone becomes soft. This disease is not due to vitamin D
deficiency and hence cannot be treated by vitamin D
supplementation.

SHORT ESSAYS

Q.1. Write briefly on effect of parathormone on de- The changes are as follows:
velopment of teeth. e Fading away of trabeculae.
¢ Loss of lamina dura around several teeth.
Ans.
e Cyst-like radiolucencies in mandible and maxilla. This is
Parathormone is the hormone of parathyroid glands. It called brown tumour.
serves the function of maintaining the plasma calcium at a e While the teeth themselves are not affected, their sur-
minimum of 10 mg%. rounding bone may become severely affected, resulting in
Hypoparathyroidism, i.e. decreased calcium levels leading loosening of teeth.
to tetany. The oral manifestations of tetany are as follows:
e The dental age is usually delayed compared to chrono- Q.2. Name the hormones involved in the calcium
logical age. metabolism, and write their roles in calcium
e Ifthe disease occurs while teeth are calcifying yet, enamel metabolism.
and dentine hypoplasia can result.
e Incomplete root formation and premature narrowing of Ans.
apical foramen are common.
e Irregular and malformed crowns may be encountered.
Hormones regulating calcium are as follows:
Hyperparathyroidism, i.e. increased calcium levels have fol- i. Vitamin D
lowing effects on teeth and jaws: ii. Parathormone
e No changes occur in tooth proper, but changes occur in iii. Calcitonin
the surrounding supporting bone, which are best appreci- iv. Other hormones like GH, insulin, thyroxin, oestrogen,
ated on a radiograph. testosterone and glucocorticoids.
 Dental Anatomy

i. Vitamin D Functions of vitamin D

e Vitamin D belongs to a group of compounds called ste- e Essential for absorption and utilization of calcium and
rols. Vitamin D; is considered to be a steroid hormone phosphorus from the intestinal tract.
similar to other steroid hormones in its mode of action. e@ Works with parathormone in calcium metabolism.
e It combines with a receptor in the cytoplasm and then
migrates into the nucleus where it combines with DNA, Vitamin D deficiency
affecting the synthesis of a messenger RNA that codes for
a calcium-binding protein to be synthesized on the ribo- Causes
somes of the endoplasmic reticulum; vitamin D has anti- e Inadequate intake of vitamin D.
rachitic property. Inadequate exposure to sunlight.
e Nearly six forms of vitamin D are known. Out of these, Intestinal malabsorption.
two active forms are: Renal tubular defects.
i. Irradiated ergocalciferol (vitamin D,) Renal rickets is a type of osteomalacia resulting
ii. Irradiated 7-dehydrocholesterol (vitamin D3) from prolonged kidney damage. The cause is mainly
due to the failure of damaged kidney to form 1,25-
Source and daily requirement dihydroxycholecalciferol.
e Dietary source of vitamin D is fish liver oil, egg yolk and
Effects
fortified milk.
e Dietary vitamin D requires moderate amounts of bile e Cartilage or osteoid which is not replaced by bone
salts and fat for absorption. remains in excess.
e The daily requirement is 200 IU. e Due to poor mineralization bones become soft and easily
bend.
Absorption from skin
Absorbed through blood when 7-dehydrocholesterol is acti- Clinical Features
vated to vitamin D or cholecalciferol by sun’s ultraviolet Vitamin D deficiency presents itself as rickets in children
rays. and osteomalacia in adults.

Synthesis of vitamin D3 Features of rickets

The synthesis of vitamin D; is explained in Figure 4B.2.1. e Irritability.
e@ Muscle weakness and hypotonia.
e Epiphyseal enlargement, which is most common at the
7-Dehydrocholesterol
end of long bones, specially wrist and knees.
Under the influence
of sunlight in skin
Frontal and parietal bossing.
Feedbacks to converted to Bowed legs and spinal kyphosis.
stop synthesis Hypoplastic teeth.
Cholecalciferol
Delayed eruption of teeth.
In liver converted to Lamina dura missing in the dental X-ray picture.
The serum calcium level in rickets remains normal be-
mips ia 25-Hydroxycholecalciferol
esis when cause the parathormone sets in right.
in sutficient Under the influence of
: parathormone in kidneys
quantity
converted to Features of osteomalacia
1, 25-Dihydroxycholecalciferol e Bending of bones

!
Produces calcium-binding proteins in the
Bone pain
Loss of height
Waddling gait
intestinal epithelium
Muscle weakness.

Increase in plasma calcium levels

ii. Parathormone

e Parathormone is the hormone of parathyroid glands.

Inhibits parathyroid activity e Parathormone serves the function of maintaining the
Fig. 4B.2.1 Synthesis of vitamin Dg. plasma calcium level at a minimum of 10 mg%.
Quick Review Series: BDS 1st Year

This is achieved by: root formation and premature narrowing of apical fora-
i. Increased absorption of calcium (and phosphate) men are common.
from the intestine by helping kidneys to synthesize Irregular and malformed crowns may be encountered.
more of vitamin D3, which in turn produces more of
calcium, binding proteins required for calcium ab- Hyperparathyroidism (von Recklinghausen’s
sorption in the intestine. disease)
ii. Increased reabsorption of calcium (and not phos-
At serum calcium levels above 12 mg, thirst, polyuria,
phates) in the renal tubules.
iti. Increased resorption of calcium (and phosphates) weakness, loss of appetite and constipation may be noticed.
As the concentration raises, these symptoms become
from bone (and never from teeth). That it achieves by
increasing the number of osteoclasts and by activating worse, and nausea, vomiting and dehydration occur.
the existing osteoclasts. Deposition of calcium in soft tissues and formation of
kidney stones are common.
Regulation of parathyroid glands
Effect on teeth and jaws
@ Itis the serum calcium concentration which regulates the Fading away of trabeculae.
parathyroid glands. A fall in the plasma calcium level be- Loss of lamina dura around several teeth.
low 10 mg% activates the parathyroid to release paratho- Cyst-like radiolucencies in mandible and maxilla; this is
romone and an increase of plasma calcium levels higher called brown tumour.
than 10 mg% gives a feedback to the gland, which auto- While the teeth themselves are not affected, their sur-
matically becomes silent. rounding bone may become severely affected resulting in
loosening of teeth.
Applied aspecis
Tetany iii. Calcitonin
e@ Muscle contraction cannot go on in the absence of cal- Produced definitely by the thyroid gland.
cium. Hence due to repeated and frequent contraction in It is an antihypercalcaemic hormone, which rapidly lowers
a calcium-deficient environment the muscles go into plasma calcium and phosphate levels, especially in young,
spasm. Spasm of the laryngeal muscles can cause death children in whom sensitivity to calcium is very high.
due to respiratory failure. Calcitonin inhibits osteoclastic resorption of bone and
Tetany can be diagnosed by employing two clinical signs, thus prevents loss of calcium and phosphate from bone to
i.e. Trousseau sign (carpopedal spasm) and Chvostek sign. blood.

Oral manifestations of tetany are as follows:

iv. Other Hormones
e Paresthesia of lips and tongue.
e In long-standing cases the maxilla and mandible become Other hormones like growth hormone, insulin, thyroxin,
abnormally dense despite a lowered serum calcium level. oestrogen, testosterone and glucocorticoids have an inter-
e Fully mineralized teeth are not affected. play in the calcium metabolism.
e The dental age is usually delayed compared to the chron- In essence, calcium metabolism pivots around an ade-
ological age. quate availability of calcium, efficiency to vitamin D and
e If the disease occurs while the teeth are calcifying yet, a delicate balance between the activity of parathormone
enamel and dentine hypoplasia can result. Also incomplete and calcitonin.

SHORT NOTES

Q.1. Eruption time of deciduous teeth. Chronology of Primary Dentition

Or The chronology of the deciduous or primary teeth is
presented based on data derived from tooth formation
Chronology of deciduous teeth.
standards.
Ans.
 Dental Anatomy

First The order of eruption of permanent teeth is as follows:

evidence i. First molars
of calcifica- Crown Eruption Root ii. Lower central and lateral incisors
tion (weeks completed (mean age completed iii. Upper centrals
Tooth _ in utero) (months) months) (years) iv. Upper laterals
Maxillary/Upper v. Lower canines
i 14 1% 10 1% vi. First premolars
i2 16 2% 11 2 vii. Second premolars
C 17 9 19 3%
viii. Upper canines
ix. Second molars
m1 15 6 16 2%
x. Third molars.
m2 19 11 29 3
Mandibular Lower Teeth Q.4. Define eruption and shedding.
Lower Ans.
i 14 2% 8 1%
Eruption
i2 16 3 13 1%
C 17 9 20 3% Eruption is a continuous process which begins with the for-
m1 15% 5% 16 2% mation of a tooth germ and ends only when the tooth is lost
or becomes ankylosed.
m2 18 10 27 3
Shedding
Q.2. Sequence of eruption of deciduous teeth. The teeth of vertebrates have a life span. The deciduous teeth
Ans. are lost at or prior to the emergence of permanent teeth.
This physiological process has been referred to as shedding.
Maxillary teeth It consists of a progressive resorption first of the socket and
then of the roots of deciduous teeth.
Q.5. Describe theories of eruption.
Mandibular teeth Ans.

The order of eruption of deciduous teeth is as follows:
A B
i. Lower central incisor
ii. Upper central incisor
iii. Upper lateral incisor
iv. First molars
y. Canines
vi. Second molars.
Theories of eruption are as follows:
Root elongation theory
D Cc E
Hydrostatic pressure theory
Bone apposition theory
Pulp proliferation theory
Theory of cushion—hammock ligament
Collagen traction theory.
Collagen Traction Theory

The first tooth starts erupting by 62 months and the last e There is a strong evidence to suggest that the force for
tooth by 3 years. eruptive tooth movement resides in the periodontal
ligament.
Q.3. Sequence of eruption of permanent teeth. e During conversion of procollagen to collagen in the
Or periodontal ligament, a contraction of about 10% oc-
curs and this causes a tractional force resulting in erup-
Sequence of eruption of permanent mandibular tive forces. Also, fibroblasts which are intimately in
teeth. contact with the collagen have a contractile property
Ans. and transmit this contractile force to the collagen to
cause tooth eruption.
The order of eruption of upper permanent teeth: @ When formation of collagen is inhibited with drugs and
6 1 2 4 5 3 7 8 when fibroblastic activity is selectively stopped in the
periodontal ligament area, eruption stops.
The order of eruption of lower permanent teeth:
As on today, this theory is the most accepted theory for
6 1 2 3 4 5 7 8 tooth eruption.
Quick Review Series: BDS 1st Year

PRIMARY (DECIDUOUS) TEETH

LONG ESSAY

Q.1. What are the major differences between de- Or

ciduous and permanent teeth?
Write the morphological and histological differ-
Or ences between deciduous and permanent teeth.
Enumerate the differences between deciduous and Ans.
permanent teeth.
Differences between deciduous and permanent teeth are as
Or
follows:
Describe in detail the difference between the per-
manent and deciduous dentition.

Parameter Deciduous dentition Permanent dentition

Number of teeth 20 32
Size Smaller Larger
Colour Whiter and more opaque Yellowish white and more translucent
Contour Has a more pronounced cervical bulge Has a less pronounced and tapering cervical margin
Cusps and fossa In newly erupted teeth, more pointed cusps with deeper Less pointed cusps with shallower fossae
fossae
Roots Shorter, with no definite root trunk Longer, with definite root trunk
Root—crown ratio Roots of anterior teeth are very much longer compared to Root length in permanent teeth not so long compared
crown length to their crown height (except canine)
Root divergence The roots of molars are more divergent The roots of permanent molars not so divergent
Shape of the root Flatter Rounded
Cementoenamel junction It is less sinuous. Enamel ends abruptly at the cementoe- More sinuous
namel junction producing a bell-shaped crown with a con-
stricted neck
Pulp chamber Larger than in the permanent teeth with correspondingly Smaller than in the deciduous with correspondingly
less depth of dentine more depth of dentine
Pulp horns More prominent and at higher level Less prominent and at lower level
Root canals Finer Less finer
Thickness of enamel and The thickness of enamel and dentine is approximately half Twice that of the deciduous teeth, but is not uniform
dentine that of the permanent teeth. More or less uniform thickness
throughout
Direction of enamel rods The rods in the cervical-third do not incline apically The rods in the cervical-third incline apically
Dentinoenamel junction Smooth Scalloped
Striae of Retzius Less prominent in number and colour More prominent in number and darker
 Dental Anatomy

SHORT NOTES
Q.1. Two differences between deciduous and per- Q.2 Leeway space
manent dentition.
Ans.
Ans.
The difference between the total mesiodistal width of
Differences between deciduous and permanent teeth: deciduous canine and molars, and the total mesiodistal
width of permanent canine and premolars is called as the
Deciduous dentition Permanent dentition Leeway space.
They are smaller, whiter and have _—‘ They are yellowish white and
amore pronounced cervical bulge more translucent with a less
pronounced and tapering
cervical margin
The thickness of enamel and den- _— The thickness of enamel and
tine is approximately half that of dentine is twice that of the
the permanent teeth. More orless deciduous teeth, but is not
uniform thickness throughout uniform
The rods in the cervical-third do The rods in the cervical-third
not incline apically incline apically

GENERAL CONSIDERA
PHYSIOLOGY OF PERMANENT

LONG ESSAYS

Q.1. Enumerate the stages of deglutition and de- At the same time, the lips close and prevent escape of
scribe each stage. food out.
Normally during this phase, the teeth of the lower jaw con-
Ans.
tact teeth of the upper jaw. The area of contact between the
e Deglutition in Latin means to swallow. tongue and the palate progresses swiftly in a posterior direc-
e Deglutition is the process of moving food from the tion due to the action of the intrinsic muscles of the tongue.
mouth to the stomach. It involves both voluntary and Due to the contraction of the suprahyoid muscles the
involuntary mechanisms. hyoid bone and the tongue now get raised.
e The three phases of deglutition: In the last part of the oral phase, the posterior part of the
i. Oral phase tongue gets raised due to the contraction of the styloglossi and
ii. Pharyngeal phase palatoglossi, and thus the bolus of food slides into pharynx.
iii Oesophageal phase. The tongue stays in this position during the first part of
the pharyngeal phase to seal the oropharyngeal isthmus
i. Oral Phase and prevents re-entry of food into the mouth. This is a
Raising of the tongue voluntary phase of deglutition.

e After the food has been formed in to a bolus by the _ ii. Pharyngeal Phase
tongue and palate, it is transferred to the posterior aspect
(a) Raising of soft palate
of the dorsum of the tongue, which is depressed while the
anterior portion of the tongue is elevated and is in con- | ® Food cannot enter the nasopharynx because the soft pal-
tact with the palate. ate gets tensed up and gets raised due to the contraction
BLT Quick Review Series: BDS 1st Year

of the tensor and levator palatine muscles closing the Q.2. Describe masticatory mucosa in detail and
entry to the nasopharynx. classify oral mucosa.
e The seal is completed by the contraction of the palato-
Ans.
pharyngeal sphincter.
The oral mucosa can be classified as follows:
(b) Pulling up of larynx
i. Based on Functional Criteria
e Due to the action of stylopharyngeus, palatopharyngeus
and salpingopharyngeus muscles the larynx is pulled up- a. Masticatory mucosa
wards to fit with epiglottis, which acts as a lid and will not
e Bound to bone and does not stretch, and bears mastica-
allow food to enter the larynx.
tory forces. Example: Gingiva and hard palate.
e The aryepiglottic folds are closely approximated by the
action of the aryepiglottic and oblique arytenoid muscles b. Lining or reflecting mucosa
completing the seal.
e So food enters the pharynx. This is an involuntary phase e Not exposed so much to masticatory forces. It is stretch-
of deglutition. As the respiratory passage is closed, breath- able. Example: Lip, cheek, vestibule, alveolar mucosa,
ing temporarily ceases during this stage. floor of the mouth and the soft palate.

(c) Propelling movement in pharynx c. Specialized mucosa

e Once food has entered the pharynx, the sequential contrac-
tion of the pharyngeal constrictor muscles from above to
downwards propels the bolus of food into the oesophagus.
iii, Oesophageal Phase
e The oesophagus is a 10 inch long muscular tube that be-
gins at the end of the laryngopharynx and terminates in
the superior portion of the stomach. It does not produce
any digestive enzymes, but only transports food to the
stomach.
e There are two sphincters in oesophagus:
a. Superior oesophageal sphincter at the entrance of the
oesophagus, which opens when food contacts it to al-
low entry of food into the oesophagus. Food passes
down the oesophagus due to peristaltic waves.
b. Inferior oesophageal sphincter, which opens to allow
food into the stomach.
e Both the sphincters open to allow food in only one direc-
tion from above to downwards and not in the reverse di-
rection.
@ The oesophageal phase is also involuntary.
e The passage of a solid food from the mouth to stomach
takes about 4-8 seconds. Liquids pass through in above
1 second.
Nervous Regulation of Deglutition
e The oral phase of swallowing is voluntary, while the
other two phases namely pharyngeal and oesophageal are
involuntary.
e Deglutition centre to control involuntary swallowing
movements is in the medulla.
e The afferent impulses travel from oropharynx through
glossopharyngeal nerve.
e The motor impulses travel down the motor nerves sup-
plying the various muscles involved in swallowing.
Performs function of sensation of taste in addition to gen-
eral sensory functions. Example: Dorsum of the tongue.
ii. Based on the Structure of Surface Layers
a. Keratinized mucosa
e Example: Hard palate and gingiva.
b. Non-keratinized mucosa
Example: Cheek, soft palate, vestibule and floor of mouth.
Light Microscopic Features
i.
Oral mucous membrane has two tissue components:
I.
Stratified squamous epithelium and
II.
An underlying lamina propria.
ii.
The dividing line between the two is about a 2-u1m thick
structure less layer called the basement membrane. The
basement membrane is not a straight line, but is usually
irregular. This results in projections of lamina propria
called connective tissue papillae, which interdigitate
with downward projections of epithelium into the lam-
ina propria called rete pegs or epithelial ridges.
iii. Below the lamina propria of mucous membrane and
above the muscle or bone lies the submucosa with loose
fatty or glandular tissue and blood vessels and nerves.
This is the submucosa that may be present or absent in
the different regions of the oral mucous membrane.
Different layers of oral mucous membrane are:
IA. Stratified squamous epithelium
The oral epithelium is stratified squamous and exhibits the
following layers in a keratinized mucosa:
a. Stratum basale
b. Stratum spinosum

c. Stratum granulosum
d. Stratum corneum.
a. Stratum basale
The first layer, resting on the basement membrane is the
stratum basale (basal layer).
The cells in this layer are cuboidal or columnar with a
large deeply staining nuclei.
They are arranged in a uniform row of cells.
As cells in this layer can divide and migrate above to form
cells of other layers, this layer is also called stratum germi-
nativum.
b. Stratum spinosum
Next to basal layer are found several rows of polyhedral
cells with large nuclei called stratum spinosum.
The nuclei stain less intensely than those of the basal layer.
The individual cells of the stratum spinosum are clearly
outlined by cell walls and appear to be joined by intercel-
lular bridges.
These spike-like intercellular bridges give the name stra-
tum spinosum or prickle cell layer to this layer.
Stratum granulosum
n
Next to stratum spinosum are rows of flattened or round
cells that contain deeply staining granules in the cyto-
plasm. This row is called stratum granulosum.
These granules, which are basophilic, staining intensely with
acid dyes such as haematoxylin, are keratohyalin granules.
Stratum granulosum is seen clearly only in keratinized
epithelium where the last layers of cells have lost their
nuclei (orthokeratosis).
In para-keratinization (keratinized epithelium showing
nucleated cells in the topmost layers), the stratum granu-
losum is indistinct.
In non-keratinized epithelium, the stratum granulosum
is absent.
d. Stratum corneum
The surface layer is composed of cells that are flat and
stain bright pink with eosin. This is the keratinized layer
or stratum corneum.
SHORT NOTES
Q.1. Deglutition.
Ans.
Deglutition in Latin means ‘to swallow. Deglutition is the
process of moving food from the mouth to the stomach.
It involves both voluntary and involuntary mechanisms.
Dental Anatomy
They do not contain any nuclei, and this pattern is called
ortho-keratinization.
Non-keratinized epithelium:
It has the following three layers:
a. Stratum basale
b. Stratum intermedium
c. Stratum superficial.
Stratum basale appears the same as in keratinized epithe-
lium.
The next layer, stratum intermedium has cells larger
in size than the cells of stratum spinosum of a keratin-
ized epithelium. The cells do not have a spinous
appearance.
The third layer, stratum superficiale does not show any
sudden change from the cells in the layer below, i-e. stra-
tum intermedium.
The division between the two layers is arbitrary.
The cells in the stratum superficiale retain their nuclei,
and the cells do not stain intensely with eosin.
There is no stratum granulosum or stratum corneum in
non-keratinized epithelium.
I. Lamina propria
It is a connective tissue of variable thickness and supports
the epithelium.
It has a papillary portion containing connective tissue
papillae and a reticular portion having reticular fibres
found just beneath the basement membrane.
This reticular zone presents a lattice-like pattern in silver
staining. These are immature collagen fibres.
The reticular zone is always present, but the papillary
zone may be absent in certain areas like the alveolar mu-
cosa, where papillae are absent.
The lamina propria provides nutritional supply to the
epithelium.
Submucosa
A submucosal layer attaches the lamina propria to under-
lying structures. The submucosa may be loose or firm.
All lining mucosa have a submucosa.
Q.2. Stages of deglutition.
Or
Process of mastication.
Ans.
 Quick Review Series: BDS 1st Year

The three phases of deglutition are: e Deglutition centre to control involuntary swallowing
i. Oral phase movements is in the medulla.
ii. Pharyngeal phase e The afferent impulses travel from oropharynx through
iti. Oesophageal phase. glossopharyngeal nerve.
e The motor impulses travel down the motor nerves sup-
Q.3. Neural control of deglutition.
plying the various muscles involved in swallowing.
Ans.
e The oral phase of deglutition is voluntary while the other
two phases namely pharyngeal phase and the oesophageal
phase are involuntary.

OROFACI
FORM AN

SHORT NOTES

Q.1. Embrasures. e These are small, circular or oval areas on the proximal
surfaces where two adjacent teeth contact or meet each
Ans.
other (Fig. 4B.5.2).
i. Embrasure (spill way) is a triangular interproximal space
formed around the contact points due to the divergence
of the tooth surface from the contact point (Fig. 4B.5.1).
Contact point

Embrasure

Fig. 4B.5.2 Contact point.

Fig. 4B.5.1 Embrasure.

ii. In all directions from the contact areas the curving sur-
faces of the crown diverge away from each other forming
e There is no difference between the contact point and
these embrasures. Therefore an embrasure is found buc-
contact area. When the contact of two teeth involves
cally, lingually, incisally, occlusally or cervically.
a smaller area, it is termed a contact point. In newly
iti. The cervical embrasures are named after their location
erupted teeth, this sort of contact is best-appreciated.
like lingual embrasure, buccal embrasure, etc.
e With usage of these teeth in function, the so-called
iv. Embrasures have two functions to perform:
contact points wear away, and a wider area of proximal
a. They act as spillways for the escape of food during
surfaces results. This type of contact is termed as the
mastication.
contact area.
b. They make the teeth more self-cleansing because of
their smooth rounded surfaces. Example:
@ Incase of the central incisors, there exists a contact point
Q.2. Contact point
between the mesial surfaces of the two teeth.
Or e At the incisor region, especially in the mandible, the
contact areas are situated towards the incisal edges.
Proximal contact areas.
e Passing backwards, along the dental arches, the contact
Ans. areas become placed progressively at a lower level.
 Dental Anatomy

Q.3. Crown.
Crown
Ans.

e Each tooth consists two parts—a crown (Fig. 4B.5.3) and

a root.
e Clinical crown: The part of the tooth that appears in the
oral cavity and which is exposed to saliva.
e Anatomic crown: That portion of the tooth covered by
enamel is known as anatomical crown.

Fig. 4B.5.3 Crown.

Topic 6

LONG ESSAYS

Q.1. Measurement and chronology
maxillary central incisor.
Ans.
of permanent = e¢ The permanent dentition is completed from 18 to
25 years of age if the third molar is included.
e The central incisor is the second permanent tooth to
emerge into the oral cavity, tooth emergence occurs
between 6 and 7 years.

Measurement of Maxillary Central Incisors

Dimensions sug- 10.5mm

gested for carv-
ing technique

Chronology of Permanent Maxillary Central Incisor — Labial surface (Fig. 4B.6.1)

e It is convex both mesiodistally and cervicoincisally and
also in the cervical-and middle-thirds.
Incisal-third is flattened and the labial surface has two
faint developmental grooves, prominent at the incisal
cl 3-4 4-5 7-8 10 edge dividing it into three mamelons.

Maxillary Permanent Central Incisor

General features
Largest of all the incisors in the mouth.
Two in number—one on either side of the midline.
Most prominently seen in the oral cavity.
Occludes with the lower central and lateral incisors. Fig. 4B.6.1 Labial surface of maxillary central incisor.
 Quick Review Series: BDS 1st Year

e The mesial and distal borders taper cervically. There is a Labial

definite concavity in the cervical third of the distal border

and the mesial border is straight.
e The distoincisal angle is rounded and the mesioincisal
angle is sharper. The cervical line is convex rootwards.
e The maximum mesiodistal width is at the middle-third of
the crown.
Palatal

Palatal surface (Fig. 4B.6.2) Fig. 4B.6.4 Incisal edge of maxillary central incisor.

e When the tooth is held straight and viewed from this

aspect, the crown obscures the root. The labial side looks
relatively broad and flat in the incisal third.

Root (Fig.4B. 6.5)

e The root is conical, straight and round on cross-section.
e Single root, with labial, mesiolingual and distolingual
surfaces. It gradually tapers towards the apex, with the
apex inclined distally.
Fig. 4B.6.2 Palatal surface of maxillary central incisor.

e The palatal surface is concave with a pronounced convex

cingulum, and prominent mesial and distal marginal ridges,
which run up to the incisal edge and enclose the lingual fossa.
@ Overall surface area is less than that of the labial surface
due to the lingual convergence of the proximal surfaces.
e The cervical line is convex rootwards.

Mesial and distal surfaces (Fig. 4B.6.3)

Fig.4B.6.5 Root and pulp chamber of maxillary central incisor.

Pulp (Fig.4B. 6.5)

@ Spoon-shaped pulp chamber, with two cornua directed
towards the mesial and distal incisal angles
Mesial Distal
e Single root canal.

Fig. 4B.6.3 Mesial and distal surfaces of maxillary central incisor. Q.2. Measurement and chronology of permanent
maxillary lateral incisor.
e Triangular in outline.
Ans.
e The mesial contour is straight with the height, of contour
at the incisal edge.
Permanent Maxillary Lateral Incisors
e The distal is more rounded with the height of contour at
the junction of the middle, and incisal-third. General features
e The mesioincisal angle is shaper than the distoincisal angle.
e They are two in number, situated in between the central
e The cervical line is concave rootwards and on the mesial
incisor and the canine in the maxilla.
surface. The contact area on the mesial aspect lies at a
e It is second tooth from the midline.
lower level than that of the distal aspect.
e Occludes with the lower lateral incisor and canine.
Incisal edge (Fig. 4B.6.4) e Though resembling the crown form of the maxillary per-
manent central incisor, this tooth is both shorter and
e The incisal edge is straight with three mamelons and narrower than the maxillary central incisor.
placed on the labiolingual midpoint.
 Dental Anatomy

Labial surface (Fig.4B.6.6)

Mesial Distal
Fig. 4B.6.8 Mesial and distal sides of maxillary lateral incisor.
D M

Fig. 4B.6.6 Labial surface of maxillary lateral incisor (right side). is more convex, with height of contour in the middle one
third of the crown.
e The cervical line is concave rootwards, more so on the
e The labial surface may be lobulated and slightly convex. mesial aspect. The incisal edge is thin.
© The distoincisal angle is more rounded than the mesioin- | © The mesial surface area is more than that of the distal
cisal angle. surface area.

@
e The incisal edge slopes mesiodistally. | edge ( ,
Incisal edge (Fig. 4B.6.9
Lingual surface (Fig. 4B.6.7)

Fig. 4B.6.9 Incisal edge of maxillary lateral incisor.

e Incisal edge may have mamelons, is placed in the labiolin-

gual midpoint and has a thin incisal edge with a more
M D rounded distal edge.
Fig. 4B.6.7 Lingual surface of maxillary lateral incisor.
g g y Root (Fig. 4B.6.10)
e Lingual surface is concave with less-prominent cingulum.
e In the lingual fossa, in a majority of teeth, there is a pit
found undermining the cingulum called the foramen
caecum incissivum.
e Lingual surface has very distinct lingual anatomy, mesial
and distal marginal ridges, cingulum, lingual fossa and
central pit.

Mesial and distal surfaces (Fig. 4B.6.8)

e Wider mesiodistally than labiolingually.
© Wedge-shaped crown.
e The mesial contour is convex, with height of contour at
the junction of the middle- and incisal-thirds. The distal Fig. 4B.6.10 Root and pulp chamber of maxillary lateral incisor.
 Quick Review Series: BDS 1st Year

e The root is slightly longer in proportion to the crown,

when compared with the dimensions of the central
incisor. The apex is distally inclined.
e Developmental depressions present on the mesial and
distal surfaces of the root.
e Root is more ovoid than central incisor.

Pulp (Fig. 4B.6.10)

@ Small pulp chamber with two cornua and a single root canal.
Q.3. Measurement and chronology of permanent
mandibular central incisor. D M

Ans. Fig. 4B.6.12 Lingual surface of mandibular central incisor.

Mandibular Permanent Central Incisor

Mesial and distal surfaces (Fig. 4B.6.13)
General features
e Two in number, situated on either side of the midline.
e The smallest of all the permanent teeth. It is long but narrow.
e Occludes only with the maxillary central incisor. Crown
height is more than the width.
e Bilaterally symmetric and forming almost 90° angle with
the incisal edge.

Labial surface (Fig. 4B.6.11)

Mesial Distal

Fig. 4B.6.13 Mesial and distal surfaces of mandibular central

incisor.

@ Mesial and distal profiles mirror one another being

straight, height of contour at incisal edge.
M D e These surfaces of the crown are wedge-shaped. Both
surfaces form a right angle with the incisal edge.
Fig. 4B.6.11 Labial surface of mandibular central incisor.
e The crown appears to incline more lingually than in the
e It is convex but generally flat in the incisal half. There is maxillary incisors.
an even tapering incisocervically on both the borders— e Cervical line concave rootwards, and more so on the
mesial and distal. mesial aspect.
e The incisal border is straight, showing sharp mesial and
distal incisal angles. Incisal edge (Fig. 4B.6.14)
e The cervical line is convex rootwards.

Lingual surface (Fig. 4B.6.12)

e The lingual surface has very indistinct lingual anatomy.
© Overall surface area is less than that of the labial surface.
e Itis concave except at the cervical-third, where it is con-
vex due to presence of a not so well-developed cingulum.
e The marginal ridges are also not well-developed with a
shallow lingual fossa.
Cervical line is convex rootwards. Fig. 4B.6.14 Incisal edge of mandibular central incisor.
 Dental Anatomy

e@ When viewed from this aspect, the labiolingual diameter

is strikingly more than the mesiodistal diameter.
e The incisal edge is straight, showing three mamelons in
newly erupted teeth.
e The incisal edge is lingual to the labiolingual midpoint
and the edge is perpendicular to a line dividing the tooth
labiolingually.
Root (Fig. 4B.6.15)

Fig. 4B.6.16 Labial surface of mandibular lateral incisor.

e The distal contour is more convex with a more rounded

distofacial angle.
e The distal height of contour at the incisal one-third.

Lingual surface (Fig. 4B.6.17)

Fig. 4B.6.15 Root and pulp chamber of mandibular central incisor.

e The tooth is single rooted and the root is flattened mesio-

distally.
e The distal groove is more marked than the mesial groove,
with the blunt root apex distally inclined.
e Root is ovoid in cross-section and wider labiolingually
than mesiodistally.
Pulp (Fig. 4B.6.15) Fig. 4B.6.17 Lingual surface of mandibular lateral incisor.
@ Spoon-shaped pulp chamber with two cornua directed
e The incisive edge is wider.
towards the mesial and distal angles of the incisal edge.
e Lingual anatomy again is indistinct.
e It has a narrow root canal. Rarely there may be two root
canals—a buccal and a lingual. Mesial and distal surfaces (Fig. 4B.6.18)
Q.4. Measurement and chronology of permanent
mandibular lateral incisor.
Ans.

Permanent Mandibular Lateral Incisor

General features
e Two in number, second tooth from the midline situated
in between the central incisor and canine. Occludes with
the maxillary central and lateral incisor.
e It resembles the mandibular permanent central incisor,
but for the following differences.

Labial surface (Fig. 4B.6.16) Mesial Distal

e It is slightly larger than the central incisor. Fig. 4B.6.18 Mesial and distal surface of mandibular lateral incisor.
e The mesial contour is straight with a height of contour at
the incisal edge. e The marginal ridges are much better developed.
Incisal edge (Fig. 4B.6.19) e The distoincisal angle is more rounded than the sharp
mesioincisal angle.
e The incisal edge is lingual to the labiolingual midpoint of
Labial surface
the crown, but the edge itself is not at right angle to a line
bisecting the crown. However. it follows the arch curva-
ture, making the distal end more lingually placed.
@ The incisal edge is rather curved distally and not straight.

Root
Lingual surface e Root length is more compared to the central incisor.
Fig. 4B.6.19 Incisal edge of mandibular lateral incisor.

SHORT ESSAYS

Q.1. Measurement and chronology of permanent =e The central incisor is the second permanent tooth
maxillary central incisor. to emerge into the oral cavity (i.e. tooth emergence
Ans occurs between 6 and 7 years) and the first molar at
. 6 years.
e The permanent dentition is completed from 18 to 25 years
of age, if the third molar is included.

Measurement Details of Maxillary Central Incisors (in mm)

Dimensions sug-
gested for carv-
ing technique

Chronology of Permanent Maxillary Central Incisor

Central incisor

SHORT NOTES

Q.1. Line angles and point angles in maxillary cen- =e - Distolabial

tral incisor. e Linguoincisal
e Labioincisal.
Ans.
. The point angles of the maxillary central incisor are:
The line angles in the maxillary central incisor are: @ Mesiolabioincisal
e Mesiolingual e Distolabioincisal
e Distolingual @ Mesiolinguoincisal
e Mesiolabial e Distolinguoincisal.
 Dental Anatomy

Q.2. Line angles of labial surface of central incisor. Q.3. Measurement of permanent maxillary central
incisor.
Ans.
. . : . Ans.
The line angles in the labial surface of central incisor:
e@ Mesiolabial
e Distolabial
e Labioincisal.

Measurement Table
Mesiodis- _Labio- or Labio- or
Cervico- Mesiodis- taldiame- buccolin- buccolin- Curvature
incisal tal diam- ter of gualdiam- gualdiam- ofcervical Curvature of
length of | Length eter of crown at eter of eter at line— cervical
crown of root crown cervix crown cervix mesial line—distal
Dimensions sug- 10.5 mm 13.0 8.5 7.0 7.0 6.0 3.5 2.5
gested for carving
technique

PERMANENT CANINES: MAX

AND MANDI

LONG ESSAYS

Q.1. Enumerate the anatomical difference between Deciduous maxillary

deciduous maxillary canine and permanent maxil-
lary canines.
Ans.
The anatomical differences between deciduous and perma-
nent maxillary canines are as follows:
Deciduous maxillary
canine
e The crown-root ratio is
smaller
¢ Diamond-shaped crown
from facial aspect.
Crowns appear shorter
and fatter
¢ Labial surface is
smoother
e Prominent cingulum-
cusped appearance
e Mesial and distal con-
tacts at same level
Permanent maxillary canine
e Longest tooth in the mouth known
as the corner stone of the arch
e Bell-shaped crown. It is convex
both mesiodistally and cervicoin-
cisally
¢ Central ridge running vertically
from the tip of the cusp towards
the cervical margin dividing the
labial aspect into the mesial and
distal surface slopes
e The palatal anatomy is very dis-
tinct with prominent distal and
mesial marginal ridges with a
bulky cingulum
e The mesial contact point is at a
lower level compared to the distal
contact point
canine Permanent maxillary canine
e Longer mesial incisal ¢ The overall surface area of the
slope than distal incisal mesial slope is less than that of
slope the distal slope
¢ Height of crown less than * The greater diameter is at the junc-
mesiodistal diameter tion of middle and incisal one-third
e In this aspect, both the mesiodis-
tal and labiolingual measure-
ments are almost equal, with an
irregular circular outline
¢ Single root. Root length ° Long single root
is more than double the
crown length
Q.2. Describe in detail the chronology, morphology
of maxillary permanent canine.
Ans.
Maxillary Permanent Canine
General features
e Longest tooth in the mouth known as the corner stone of
the arch.
e It is called canine because of its resemblance to the pre-
hensile teeth of carnivore. It is also called cuspid because
it carries a single cusp.
Z0Y) Quick Review Series: BDS 1st Year

e Two in number. Third tooth from midline. Situated in be- The palatal anatomy is very distinct with prominent distal
tween the lateral incisor and the first premolar in the maxilla. and mesial marginal ridges with a bulky cingulum.
Occludes with the mandibular canine and first premolar. The lingual height of contour is low in the cingulum near
the cervical line.
Labial surface (Fig. 4B.7.1) A central ridge runs from the cingulum towards the cusp
tip, dividing the lingual fossa into a mesiolingual fossa
and a distolingual fossa.
Cervical line convex rootwards.

Mesial and distal surfaces (Fig. 4B.7.3)

Mesial Distal

M D

Fig. 4B.7.1 Labial surface of permanent maxillary canine.

e Bell-shaped crown. It is convex both mesiodistally and

cervicoincisally.
e The incisal edge carries a pointed cusp.
e Central ridge running vertically from the tip of the
towards the cervical margin dividing the labial aspect
the mesial and distal surface slopes.
e The overall surface area of the mesial slope is less
that of the distal slope.
e The single cusp divides the incisal edge into a mesial
and a distal arm, of which the mesial arm is shorter.
e The mesial contact point is at a lower level compared to
the distal contact point.
e The mesial and distal borders taper cervically. The cervi-
cal line is convex rootwards. The greater diameter is at the
junction of middle and incisal one-third.
Palatal aspect (Fig. 4B.7.2)
cusp
into Fig. 4B.73 Mesial and distal surface of permanent maxillary
canine.
than
Cervicoincisal convexity of the labial surface is best ap-
arm
preciated from these aspects.
The mesial surface area is larger than the distal surface
area. Both these surfaces incline lingually.
The mesial contour is only slightly convex and may be flat
in the cervical one-third, with a height of contour almost
at incisal edge at the junction of the middle and incisal
one-third.
The distal contour is very bulbous or convex with height
of contour in the middle of the crown.
Cervical line is concave rootwards.

Incisal edge (Fig. 4B.7.4)

Labial

D M
Palatal
Fig. 4B.7.2: Lingual surface of permanent maxillary canine. Fig. 4B. 7.4 Incisal edge of permanent maxillary canine.
 Dental Anatomy

e In this aspect, both the mesiodistal and labiolingual mea- Labial surface (Fig. 4B.7.6)
surements are almost equal with an irregular circular
outline.
e The distal half of the labial profile is round and the mesial
half is flattened or even a little concave.

Root
e Long single root, triangular in cross-section with rounded
angles.
e Both mesiolingual and distolingual surfaces of the root
carry developmental depressions.
e Root tip usually inclined distally.

Pulp (Fig. 4B.7.5)

Fig. 4B.76 Labial surface of permanent mandibular canine.

e From this aspect, the mandibular canines appear to have

a longer crown than the maxillary canines.
e The mesial outline of the crown makes almost a straight
line with the mesial outline of the root. The distal outline
is convex in the incisal-third and tapering cervically.
e The mesioincisal angle is again sharper than the distoin-
cisal angle.
e The tooth is narrower in a mesiodistal diameter than the
maxillary canine.
e The mesial height of contour is at the incisal one-third of
the tooth. The distal height of contour is at the junction
of the middle and incisal one-third.
e On the incisal border, it carries a single cusp with a
shorter mesial arm.
e The cervical line is convex rootwards.
Fig. 4B.7.5 Root and pulp chamber of permanent maxillary
canine.
Lingual surface (Fig. 4B.7.7)

e The pulp cavity is large and oval in cross-section.

e There are no cornua, as the pulp chamber simply tapers
towards the tip of the crown.
Q.3. Describe in detail the chronology and mor-
phology of mandibular permanent canine.
Ans.

Mandibular Permanent Canine

General features
e Long pointed tooth, total length is less than the maxillary Fig. 4B.7.7 Lingual surface of permanent mandibular canine.
canine but crown is longer.
e Two in number. Third tooth from the midline, situated in
between the mandibular lateral incisor and the first pre- e This surface is almost flat, with a smooth and small
molar. cingulum.
e Occludes with the maxillary lateral incisor and canine. @ Poorly developed marginal ridges are present.
e It is less well-developed as compared to the maxillary e The lingual fossa is not very distinct.
canine. e The cervical lines convex rootwards.
406 Quick Review Series: BDS 1st Year

Mesial and distal surfaces (Fig. 4B.7.8) The mesiodistal diameter is less than the labiolingual di-
ameter. The cusp tip is not sharp.
The incisal edge is lingual to the labiolingual midpoint.

Root
Single rooted, oval in cross-section.
Flattened mesially and distally with the apex inclined
distally.
The root has both a mesial and distal depression or
concavity.

Pulp (Fig. 4B.7.10)

Mesial Distal
Fig. 4B.78 Mesial and distal surface of permanent mandibular
canine.

The labial and lingual curvatures are less marked than

that of the upper canine with thin incisal edge.
The cervical line dips more apically on the mesial aspect
than the distal aspect.
The mesial contact area, is at a higher level than the distal
contact area which is more cervically placed. Both sur-
faces have a wedge-shaped outline.
Fig. 4B.7.10 Incisal edge of permanent mandibular canine.
Incisal aspect (Fig. 4B.7.9)

Pulp chamber tapering towards the cusp.

Single root canal.

Fig. 4B.7.9 Incisal edge of permanent mandibular canine.

SHORT NOTES

Q.1. Maxillary permanent canine. Two in number. Third tooth from midline. Situated in be-
tween the lateral incisor and the first premolar in the maxilla.
Ans.
Occludes with the mandibular canine and first premolar.
Maxillary Permanent Canine
Labial surface (Fig. 4B.7.11)
General features e Bell-shaped crown. It is convex both mesiodistally and
Longest tooth in the mouth known as the corner stone of cervicoincisally.
the arch. e The incisal edge carries a pointed cusp.
It is called canine because of its resemblance to the pre- e Central ridge running vertically from the tip of the cusp
hensile teeth of carnivore. It is also called cuspid because towards the cervical margin dividing the labial aspect into
it carries a single cusp. the mesial and distal surface slopes.
 Dental Anatomy

CrM D

Fig. 4B.7.11 Labial surface of maxillary permanent canine.

Mesial Distal

Fig. 4B.7.13 Mesial and distal surface of maxillary permanent

e The overall surface area of the mesial slope is less than canine.
that of the distal slope.
e The single cusp divides the incisal edge into a mesial arm
and a distal arm, of which the mesial arm is shorter. e The mesial contour is only slightly convex and may be flat
e The mesial contact point is at a lower level compared to in the cervical one-third, with a height of contour almost
the distal contact point. at incisal edge at the junction of the middle and incisal
e The mesial and distal borders taper cervically. The cervi- one-third.
cal line is convex rootwards. The greater diameter is at the e The distal contour is very bulbous or convex with height
junction of middle and incisal one-third. of contour in the middle of the crown.
e Cervical line is concave rootwards.
Palatal aspect (Fig. 4B.7.12)
Incisal edge (Fig. 4B.7.14)

Labial
CI

Palatal
Fig. 4B.7.12 Lingual surface of maxillary permanent canine. Fig. 4B.7.14 Incisal edge of maxillary permanent canine.

e The palatal anatomy is very distinct with prominent distal

and mesial marginal ridges with a bulky cingulum.
e The lingual height of contour is low in the cingulum near
the cervical line.
e A central ridge runs from the cingulum towards the cusp
tip dividing the lingual fossa into a mesiolingual fossa and
a distolingual fossa.
© Cervical line is convex rootwards.
Mesial and distal surfaces (Fig. 4B.7.13)
© Cervicoincisal convexity of the labial surface is best-
appreciated from these aspects.
e The mesial surface area is larger than the distal surface
area. Both these surfaces incline lingually.
e In this aspect, both the mesiodistal and labiolingual mea-
surements are almost equal with an irregular circular
outline.
e The distal half of the labial profile is round and the mesial
half is flattened or even a little concave.
Root
e Long single root, triangular in cross-section with rounded
angles.
e Both mesiolingual and distolingual surfaces of the root
carry developmental depressions. Root tip usually in-
clined distally.
ZEN Quick Review Series: BDS 1st Year
Pulp (Fig. 4B.7.15)
Fig. 4B.7.15 Pulp cavity of maxillary permanent canine.
e The pulp cavity is large and oval in cross-section. There
are no cornua as the pulp chamber simply tapers towards
the tip of the crown.
Q.2. Labial aspect of mandibular permanent canine.
Ans.
e Mandibular permanent canine is a long pointed tooth
and is third tooth from the midline, situated in between
the mandibular lateral incisor and the first premolar.
e It is less well-developed as compared to the maxillary
canine.
Labial aspect of mandibular permanent canine
(Fig. 4B.7.16)
Fig. 4B.716 Labial surface of mandibular permanent canine.
. . . nent canine.
e From this aspect, the mandibular canines appear to have
a longer crown than the maxillary canines.
e The mesial outline of the crown makes almost a straight line
with the mesial outline of the root. The distal outline is
convex in the incisal third and tapers cervically. (This gives
the impression that the crown is tilted distally over its root).
@ The mesioincisal angle is again sharper than the distoincisal
angle. The tooth is narrower in a mesiodistal diameter than
the maxillary canine. The mesial height of contour is at the
incisal one-third of the tooth. The distal height of contour
is at the junction of the middle and incisal one-third.
e On the incisal border, it carries a single cusp with a
shorter mesial arm. The cervical line is convex rootwards.
Lingual surface (Fig. 4B.7.17)
Fig. 4B.7.17 Lingual surface of mandibular permanent canine.
e This surface is almost flat, with a smooth and small cin-
gulum.
e Poorly developed marginal ridges are present.
e The lingual fossa is not very distinct. The cervical liners
convex rootwards.
Mesial and distal surfaces (Fig. 4B.7.18)
Mesial Distal
Fig. 4B.718 Mesial and distal surfaces of mandibular perma-
© e The labial and lingual curvatures are less marked than
that of the upper canine with thin incisal edge.
 Dental Anatomy

e The cervical line dips more apically on the mesial aspect Root
than the distal aspect. e Single rooted, oval in cross-section. Flattened mesially
e The mesial contact area is at a higher level than the distal and distally, with the apex inclined distally.
contact area, which is more cervically placed. Both sur- @ The root has both a mesial and distal depression or concavity.
faces have a wedge-shaped outline.
Pulp (Fig. 4B.7.20)
Incisal aspect (Fig. 4B.7.19)
e Pulp chamber tapering towards the cusp. Single root canal.
e The mesiodistal diameter is less than the labiolingual di-
ameter. The cusp tip is not sharp.
e The incisal edge is lingual to the labiolingual midpoint.

Fig. 4B.7.19 Incisal edge of mandibular permanent canine. Fig. 4B.720 Pulp cavity of mandibular permanent canine.

PERMANENT MAXILLARY PREMOLARS.

LONG ESSAYS

Q.1. Write the chronology and morphology of max- Maxillary Permanent First Premolar
illary first premolar and difference between maxil-
General features
lary first premolar and maxillary second premolar.
Premolar is also called bicuspid, for having two cusps.
Or
They are two in number.
Describe in detail morphology of maxillary first It is fourth tooth from the midline.
premolar. Situated in between the canine and the second premolar
in maxilla. Occludes with the mandibular first and second
Or premolars.
Describe the morphology of maxillary first premo- Buccal surface (Fig. 4B.8.1)
lar. Add a note on its chronology.

Or

Describe morphological characteristics of maxil-

lary first premolars, and write the differences
between maxillary first premolar and maxillary
second premolar.

Or

Compare morphology of maxillary first premolar

and maxillary second premolar. M D
Ans. Fig. 4B.8.1 Buccal surface of maxillary permanent first premolar.
‘STi Quick Review Series: BDS Ist Year
Resembles very much the canine from this aspect, except
that the mesial arm of the buccal cusp is longer and
straighter than the distal arm.
Buccal surface has a prominent ridge running axially,
bordered by depressions, giving the buccal surface a
three-lobed appearance.
e Buccal surface is wider than lingual surface.
e The mesial and distal borders converge incisocervically.
The cervical line is convex rootwards.
Lingual surface (Fig.4B.8.2)
D M
Fig. 4B.8.2 Lingual surface of maxillary permanent first premolar.
e The crown tapers labiolingually.
e The lingual cusp is narrower mesiodistally than the buc-
cal cusp and is more pointed.
The occlusocervical convergence is more prominent on
the lingual aspect. Both the cusps are seen from this aspect.
Cervical line is convex rootwards.
Mesial and distal surfaces (Fig. 4B.8.3)
Mesial Distal
Fig. 4B.8.3 Mesial and distal surfaces of maxillary permanent
first premolar.
From both these aspects the buccal and the lingual sur-
faces show their convexity.
On the mesial aspect, there is a distinct depression ex-
tending from the cervical-half of the crown to the root
bifurcation called the canine fossa.
Also on the mesial aspect, there is a well-defined develop-
mental groove in the enamel of the mesial marginal ridge,
which is continuous with the central groove of the occlu-
sal surface called the canine groove.
Marked mesial concavity in an axial direction, which pro-
gresses onto root as the mesial intraradicular groove giv-
ing correct impression of two roots (only premolar which
normally has two roots).
Buccal cusp is slightly larger than the lingual cusp, and is
distally placed.
Mesial cusp ridge is slightly longer than distal cusp ridge,
and lingual cusp is slightly mesial to the midpoint.
The cervical line is concave rootwards on the mesial as-
pect, and is almost straight on the distal aspect.
Occlusal surface (Fig. 4B.8.4)
Fig. 4B.8.4 Occlusal surface of maxillary permanent first
premolar.
Hexagonal crown profile from the occlusal view, mesial
and distal surfaces converge towards the lingual and have
a trapezoidal occlusal table.
The crown is roughly ovoid in outlin, being broader buc-
cally than lingually.
The buccolingual dimension is more than the mesiodistal
dimension.
The two cusps are separated by a distinct central groove.
There is a mesial and distal marginal ridge.
Two supplemental grooves— the mesiobuccal and the
distobuccal— join the central groove, and in their point
of meeting there results a mesial and a distal developmen-
tal pit.
Immediately inside the marginal ridge are found—mesial
and distal triangular fossa, upper-first premolar has then
two pits and two fossae.
Root
Usually there are two roots—a longer buccal and a
shorter palatal.
e It is not uncommon to see single rooted upper premolar.
e The depression on the mesial surface of the root is more
distinct.
 Dental Anatomy

Pulp (Fig.4B.8.5) Q.2. Crown morphology of maxillary second premolar.

Ans.

Maxillary Second Premolar

General features
e Two in number. Fifth tooth from the midline. Situated in
between the first premolar and the first molar in the max-
illa. Occludes with the mandibular second premolar and
the first premolar.

b
Buccal surface (Fig. 4B.8.6)

Fig. 4B.8.5 Root and pulp cavity of maxillary permanent first

premolar.

e Pulp chamber, oval in shape, with the long axis buccolin-

gually. Two cornua directed towards the respective cusps.
e Root canals, always two in number in single-rooted first
premolars, join to form a single canal, which is seen just
near the apex of the root.
The differences between the maxillary first premolar and sec-
ond premolar are as follows:

Fig. 4B.8.6 Buccal surface of maxillary permanent second

Parameter Maxillary | premolar Maxillary Il premolar
premolar
Cusps Two sharply defined Two shallower cusps—
cusps buccal and palatal more
Buccal cusp larger than equal in size
the palatal Mesial slope shorter than e Two cusps are more or less equal in size, and hence only
Mesial slope of buccal distal in the buccal cusp one cusp is seen when viewed either from the labial aspect
cusp longer than distal or from the lingual aspect.
slope e Buccal surface has relatively indistinct lobes.
Mesiodistal 7” mm 6.75 mm (i.e. smaller)
crown Lingual surface (Fig. 4B.8.7)
diameter
e The canine fossa found in the first premolar is absent.

d
Roots Two roots, buccal and Single root, fattened
lingual, and two root Mesiodistally longer than |
canals premolar roots
One or two root canals
Root groove Mesial intraradicular Distal root groove more
groove prominent
Canine Concave canine fossa on No canine fossa, mesial
fossa mesial surface of crown surface is convex
extending to pronounced
longitudinal groove on
mesial surface of root
Marginal Central developmental Occlusal mesiodistal
ridge groove interrupts mesial fissure does not interrupt
marginal ridge mesial marginal ridge
Tendency for additional
fissures and grooves Palatal
Occlusal More angular, hexagonal OQvoid to diamond occlusal Fig. 4B.8.7 Lingual surface of maxillary permanent second
outline outline premolar.
‘S39 Quick Review Series: BDS Ist Year

Mesial and distal surfaces (Fig. 4B.8.8)
@ The occlusal surface is slightly smaller, and is of ovoid or
diamond profile and rectangular. Occlusal table with little
lingual convergence.
e Cusps are more equal in height and width, and the tips
are centred on the tooth in a mesiodistal direction.
e The central groove between the two cusps is less deeper
and it does not cross the mesial marginal ridge.

Root
e The root is longer compared with the first premolar and
is single-rooted.

Q.3. Crown morphology of maxillary second pre-

Mesial Distal molar and mandibular second premolar.
Fig. 4B.8.8 Mesial and distal surface of maxillary permanent
second premolar. Ans.

e Aslight concavity or even convexity may be seen on the oninulaneeeonel

mesial surface. The mesial marginal ridge is not inter- Maxillary second premolar
rupted by a groove. ° Narrow shouldered
. ¢ Less prominent buccal lobes
Occlusal surface (Fig. 4B.8.9) ¢ Buccal and lingual cusps
centred mesiodistally
¢ Buccal and lingual cusp equal
e Less prominent mesial axial
concavity
e Little lingual convergence
e Rectangular occlusal table
¢ Qvoid to diamond occlusal
profile
¢ One root
Fig. 4B.8.9 Occlusal surface of maxillary permanent second
premolar
premolar
¢ Equal buccal and lingual
surfaces
¢ Buccal cusp almost equal to
lingual
* May have 2 or 3 cusps (in
3 cusp type lingually, with
ML bigger than DL, and has
lingual groove)
e Little lingual convergence
¢ Square occlusal outline
¢ Central pit
¢ Occlusal pattern for 3 cusps
¢ Occlusal pattern for 2 cusps
¢ Rounder root on cross-
section

SHORT ESSAYS

Q.1. Enumerate differences between maxillary first and second premolars.

Maxillary first premolar Maxillary second premolar

Broad shouldered Narrow shouldered
Prominent buccal lobes Less prominent buccal lobes
Buccal cusp-distal and lingual cusp-mesial Buccal and lingual cusps centred mesiodistally
Slightly larger buccal than lingual cusp Buccal and lingual cusps are equal
Prominent mesial axial concavity Less prominent mesial axial concavity
Lingual convergence Little lingual convergence
Hexagonal occlusal profile Ovoid to diamond occlusal profile
Trapezoidal occlusal table Rectangular occlusal table
Two roots One root
Mesial marginal developmental groove and mesial intraradicular groove
 Dental Anatomy

SHORT NOTES

Q.1. Premolars. Two supplemental grooves, the mesiobuccal and the disto-
buccal, join the central groove, and in their point of meet-
Ans.
ing there results a mesial and a distal developmental pit.
Immediately inside the marginal ridge are found mesial
General features
and distal triangular fossa, upper-first premolar has then
Premolars are also called bicuspids, for having two two pits and two fossae.
cusps.
Q.3.Mesial surface of maxillary first premolar.
e Four in number.
e The first and second premolars are fourth and fifth tooth Ans.
from the midline, respectively.
Situated in between the canine and the first molar in Mesial Surface of Maxillary First Premolar
maxilla. (Fig. 4B.8.11)
Occludes with the mandibular first and second premolars.
From the mesial aspect, the buccal and the lingual
Q.2. Occlusal surface of maxillary permanent first surfaces show their convexity.
premolar. On the mesial aspect there is a distinct depression extend-
ing from the cervical-half of the crown to the root bifur-
Ans.
cation called the canine fossa.
Also on the mesial aspect, there is a well-defined develop-
Occlusal Surface of Maxillary Permanent First
mental groove in the enamel of the mesial marginal ridge,
Premolar (Fig. 4B.8.10)
which is continuous with the central groove of the occlu-
Hexagonal crown profile from the occlusal view, mesial sal surface called the canine groove.
and distal surfaces converge towards the lingual and has a Marked mesial concavity in an axial direction, which
trapezoidal occlusal table. progresses onto root as the mesial intraradicular groove,
The crown is roughly ovoid in outline, being broader buc- giving correct impression of two roots.
cally than lingually. Buccal cusp is slightly larger than the lingual cusp and is
The buccolingual dimension is more than the mesiodistal distally placed.
dimension. Mesial cusp ridge is slightly longer than distal cusp ridge.
The two cusps are separated by a distinct central groove. The cervical line is concave rootwards on the mesial aspect.
There is a mesial and distal marginal ridge.

Fig. 4B.8.10 Occlusal surface of maxillary permanent first Fig. 4B.8.11 Mesial surface of maxillary permanent first premolar.
premolar.
Ca Quick Review Series: BDS 1st Year

PERMANENT MANDIBULAR PREMOLARS:

LONG ESSAYS

Q.1. Enumerate the differences between permanent

mandibular first bicuspid and permanent mandibu-
lar second bicuspid.
Ans.

The differences between first and second mandibular biscus-

pids are as follows:

Mandibular first premolar Mandibular second premolar

Wider buccal than lingual
surfaces
Buccal cusp much greater than
lingual
Lingual convergence
Diamond occlusal profile
Round root on cross-section
Resembles canine
Unique characteristics
Mesiolingual developmental
groove
Transverse ridge
Lingually inclined occlusal
table
Lingual cusp-like cingulum
Equal buccal and lingual surfaces
Buccal cusp almost equal to
lingual Fig. 4B.9.1 Buccal surface of mandibular first premolar.
Little lingual convergence
Square occlusal outline
Rounder root on cross-section e The mesial arm of the buccal cusp is shorter than the
Resembles premolar distal arm.
e The tip of the buccal cusp is centred over the long axis of
May have 2 or 3 cusps (if 3 cusps, the root.
2 are lingual with ML bigger than © Cervical lines convex rootwards.
DL, and has lingual groove)
Central pit Lingual surface (Fig. 4B.9.2)
Y occlusal pattern for 3 cusps
H occlusal pattern for 2 cusps

Q.2. Describe morphology of mandibular first pre-

molar and discuss the possible variations.
Or
Describe the morphology of mandibular right first
premolar.
Ans.

Mandibular Permanent First Premolar

General features Fig. 4B.9.2 Lingual surface of mandibular first premolar.

@ Itis the smallest premolar in the permanent dentition.

e Two in number, fourth tooth from the midline, placed in
between the canine and the second premolar. Occludes
with the maxillary canine and the first premolar.
Buccal surface (Fig. 4B.9.1)
e From the buccal aspect, it looks like a canine, the buccal
cusp obscuring the lingual cusp.
© Overall surface area is less than that of the buccal surface.
There is a labiolingual taper.
e A smaller lingual cusp and a larger buccal cusp are seen
from this aspect.
e A mesiolingual developmental groove is characteristically
seen from this aspect.
 Dental Anatomy

Mesial and distal surfaces (Fig. 4B.9.3) e There is a smaller mesial triangular fossa and a larger
distal triangular fossa.
e The mesial marginal ridge is much less distinct than the
distal marginal ridge.

Root
e Single root, which is flattened mesiodistally, with devel-
opmental depression on both sides.

Pulp (Fig. 4B.9.5)

M D
Fig. 4B.9.3 Mesial and distal surfaces of mandibular first premolar.

e From both these aspects, the crown is rhomboidal in

outline.
e The uneven heights of the buccal and lingual cusps are
well made out. Fig 4B.9.5 Root and pulp of mandibular first premolar.
e The mesial outline is pronounced convex, and tip of the
buccal cusp situated on the long axis of the root, while the e Pulp chamber with a prominent buccal cornua. Single
lingual cusp is tilted lingually. root canal.
e The crown as a whole tilted lingually.
e The mesial marginal ridge is at a lower level, with an ex- Q.3. Describe in detail morphology of mandibular
treme slope unlike the distal marginal ridge. permanent second premolar.
Ans.
Occlusal surface (Fig. 4B.9.4)
Mandibular Second Premolar

General features
e Two in number.
e Fifth tooth from the midline, situated in between the first
premolar and the first molar in mandible. Occludes with
the maxillary first and second premolars.
e It resembles the lower first premolar, but is larger than it.

Buccal surface (Fig. 4B. 9.6)

Fig. 4B.9.4 Occlusal surface of mandibular first premolar.

e Roughly diamond-shaped outline with convergence to

the lingual.
e Lingually inclined occlusal table.
e A larger buccal cusp and a smaller lingual cusp make up
the bulk of the occlusal area.
@ Mesiolingual groove produces a slight concavity at about
the mesiolingual line angle of the tooth.
e Tooth is very asymmetric in the mesial and distal profiles,
with a prominent mesial bulge.
e A transverse ridge joins the buccal cusp tip to the lingual
cusp. Fig. 4B.9.6 Buccal surface of mandibular second premolar.
‘ST Quick Review Series: BDS Ist Year

e Broader than the first premolar. Occlusal surface (Fig. 4B.9.9)

e Has a shorter and blunter buccal cusp.

Lingual surface (Fig. 4B 9.7)

D M Fig. 4B.9.9 Occlusal surface of mandibular second premolar.

e Tooth is square in outline and may have different occlusal

Fig. 4B 9.7 Lingual surface of mandibular second premolar.
e Has a slightly larger lingual cusp than that of the first
premolar, hence less of the occlusal surface is seen from
this aspect.
e On many occasions, a lingual groove divides the lingual
cusp into two.
Mesial and distal surface (Fig. 4B.9.8)
e The crown is wider buccolingually than the first premolar.
e The buccal cusp is not centred over the root trunk. Both
the marginal ridges are at right angles to the long axis of
the tooth.
patterns Y for three-cusped tooth or H for two-cusped
tooth.
e Buccal width and lingual width of nearly equal size may
have one or two lingual cusps.
e If two lingual cusps are present, then the mesiolingual is
larger than the distolingual, which are separated by lin-
gual groove extending from the central pit.
e Frequently, the transverse ridge is absent and a deep de-
velopmental groove runs mesiodistally, connecting the
mesial and the distal fossa.
Root
e Single root. Flattened mesiodistally with distal inclination.
Pulp (Fig. 4B.9.10)
e Pulp chamber with cornua corresponding to the cusps
present. Single root canal.

Mesial Distal

Fig. 4B.9.8 Mesial and distal surfaces of mandibular second _ Fig. 4B.9.10 Occlusal surface of mandibular second premolar.
premolar.

SHORT NOTES

Q.1. Premolars. e Premolars are also called bicuspids.

e Mandibular first premolar is the smallest premolar in the
Ans. permanent dentition.
 Dental Anatomy

e Mandibular premolars are four in number, fourth and
fifth tooth from the midline and placed in between the
canine and the first molar.
e Occludes with the maxillary canine, first premolar, and
the second premolars.
Q.2. Occlusal surface of permanent first premolar.
Ans.
Occlusal surface of mandibular first premolar
(Fig. 4B.9.11)
e A larger buccal cusp and a smaller lingual cusp make up
the bulk of the occlusal area.
© Mesiolingual groove produces a slight concavity at about,
the mesiolingual line angle of the tooth.
e A transverse ridge joins the buccal cusp tip to the lingual
cusp.
e There is a smaller mesial triangular fossa and a larger
distal triangular fossa.
e The mesial marginal ridge is much less distinct than the
distal marginal ridge.
Q.3. Differences between maxillary and mandibular
first premolar.
Ans.

Maxillary first premolar Mandibular first premolar

e Broad shouldered
¢ Prominent buccal lobes
¢ Slightly larger buccal than
lingual cusp
e Prominent mesial axial
Fig. 4B.9.11 Occlusal surface of mandibular first premolar. concavity
¢ Hexagonal occlusal profile
e Trapezoidal occlusal table
e Roughly diamond-shaped outline, with convergence to e Two roots
the lingual. e Mesial intraradicular
e Lingually inclined occlusal table. groove
e Wider buccal than lingual
surfaces
Lingual cusp-like cingulum
e Transverse ridge
e Buccal cusp much greater than
lingual
* Diamond occlusal profile
¢ Lingually inclined occlusal table
¢ Round root on cross-section
e Mesiolingual developmental
groove

PERMANENT MAXILLARY MOLARS.

LONG ESSAYS

Q.1. Discuss morphology of maxillary permanent Or

first molar.
Describe in detail the morphology of permanent
Or maxillary first molar crown.
Describe in detail the morphology of maxillary Or
right permanent first molar.
Describe the morphology of permanent maxillary
Or first molar and add a note on its chronology.
Describe the occlusal surface of maxillary perma- Or
nent first left molar.
Describe the morphological differences between
Or the permanent maxillary and mandibular first
Describe in detail the morphology of maxillary molars.
permanent first molar. Or
Or Describe the morphology of crown of maxillary
Describe the occlusal surface of maxillary perma- first molar. Differentiate between maxillary and
nent first right molar. mandibular first molar.
 Quick Review Series: BDS 1st Year

Or Lingual surface (Fig. 4B.10.2)

Describe the occlusal surface of permanent max-
illary first molar. Write the difference between
permanent maxillary first molar and permanent
mandibular first molar.
Or
Differences between maxillary and mandibular
molars.
Ans.

Chronology of Permanent Maxillary First Molar M D

Emer- Fig. 4B.10.2 Lingual surface of maxillary first molar.

First Crown gence Root
evidence of completed (eruption) completed
Tooth calcification (years) (years) (years)
M1 At birth 2%-3 6-7 9-10 e The lingual surface is also convex. It presents two lingual
cusps and a cusplet.
e They are two in number. e The mesiolingual cusp is the largest.
e Each of them is sixth tooth from the midline, situated in e The cusplet is known as ‘the cusp of Carabelli. It is pres-
between second premolar and second molar in maxilla. ent only in about 70% of the maxillary permanent first
e These are the largest teeth in the human dentition and molars.
have four well-developed cusps and a cusplet. e The fifth cusp is found on the mesiolingual surface of the
mesiolingual cusp and is outlined by an irregular devel-
Buccal surface (Fig. 4B.10.1) opmental groove.
e A lingual developmental groove separates the two major
lingual cusps. From this aspect, only the lingual cusps are
seen.
e The cervical line is almost straight.

Mesial and distal surfaces (Fig. 4B.10.3)

D M
Fig. 4B.10.1 Buccal surface of maxillary first molar.

e From the buccal aspect, it is roughly trapezoidal, with the

cervical and occlusal sides being uneven, the shortest side
being the cervical side.
e The buccal surface is convex, presenting two cusps — the
broader mesiobuccal cusp and a narrower distobuccal
cusp.
e A buccal developmental groove divides the two buccal
cusps. At the end of this groove, in the middle-third of the
buccal surface, a buccal pit is often present.
e The mesial outline of the buccal surface is straighter than
the distal outline, with a constriction at the cervical-third.
All the four major cusps are seen from this aspect.
e The cervical line is almost straight.
Mesial Distal
Fig. 4B.10.3 Mesial and distal surfaces of maxillary first molar.
e While the distal surface is convex, the mesial surface is
almost fat.
e A shallow concavity is usually found above the contact
area (ie. cervically) on the mesial aspect.
e@ Cervical line on the mesial surface is concave rootwards,
and, on distal surface, it is almost straight.
 Dental Anatomy

Occlusal surface (Fig. 4B.10.4)

Fig. 4B.10.4 Occlusal surface of maxillary first molar.

Fig. 4B.10.5 Roots and pulp chamber of maxillary first molar.

It is rhomboidal in outline. Differences between maxillary and mandibular

The buccolingual dimension is more than the mesiodistal first molars
dimension.
A peculiarity of the maxillary first molar is that it is Upper molars Lower molars
the only tooth where the proximal surfaces converge Crown is broader buccolingually Crown is broader mesiodistally
buccally. There are three large cusps and There are four large cusps. A fifth
It presents four major cusps—mesiolingual, mesiobuccal, a small cusp small cusp may be present
distobuccal and distolingual—and a fifth cusp, the cusp Two buccal cusps are unequal. Two major buccal cusps—
of Carabelli on the largest mesiolingual cusp. Mesiobuccal cusp is larger than mesiobuccal and distobuccal—
The buccal cusps are more pointed than the lingual distobuccal cusp. Two lingual are of equal size. Two major
cusps. cusps are unequal. Distolingual lingual cusps are of equal size
The mesial and distal marginal ridges connect the buccal cusp is rudimentary

and the lingual cusps. An oblique ridge joins the mesio- Distobuccal cusp is joined to All the cusps are separated from
lingual and the distobuccal cusps, thereby dividing the mesiolingual cusp by an oblique each other by fissures
ridge
occlusal surfaces into a larger mesial triangular area, the
“Trigor’ comprising of three cusps and a smaller distal They have three roots—two They have two roots—one mesial
buccal and one lingual and one distal
triangular area, and the “Talor’ comprising only the disto-
lingual cusp.
An H-shaped groove pattern separates the four major Q.2 Describe the occlusal surface of permanent
cusps, and the horizontal bar of this H crosses the oblique maxillary first molar. Write the difference between
ridge, i-e. crista obliqua. permanent maxillary first molar and permanent
There is a central fossa, bound by mesiobuccal cusp, maxillary second molar.
distobuccal cusp and the oblique ridge. Also present
Ans.
are the mesial and distal pits and mesial and distal
triangular fossae, bound by the marginal ridges prox-
Occlusal Surface of Maxillary First Molar
imally.
(Fig. 4B.10.6)
Roots e It is rhomboidal in outline.
There are three roots—a mesiobuccal, a distobuccal and a @ The buccolingual dimension is more than the mesiodistal
palatal. dimension.
e All the three roots have a common straight root trunk.
e The palatal root is the longest and the distobuccal root the
shortest.
Both the buccal roots are fattened mesiodistally, whereas
the palatal root is conical.

Pulp (Fig. 4B.10.5)

It has a box-shaped pulp chamber, with cornua di-
rected towards the major cusps. Three root canals are
present. Fig: 4B.10.6 Occlusal surface of maxillary first molar.
 B
420 Quick Review Series: BDS 1st Year

e A peculiarity of the maxillary first molar is that it is the

only tooth where the proximal surfaces converge buccally.
e It presents four major cusps—mesiolingual, mesiobuccal,
distobuccal and distolingual— and a fifth cusp, the cusp
of Carabelli on the largest mesiolingual cusp.
e The buccal cusps are more pointed than the lingual
cusps.
e The mesial and distal marginal ridges connect the buccal
and the lingual cusps. An oblique ridge joins the mesio-
lingual and the distobuccal cusps, thereby dividing the
occlusal surfaces into a larger mesial triangular area, the
“Trigor’ comprising of three cusps and a smaller distal
triangular area, and the ‘Talon’ comprising only the disto- Fig. 4B.10.7 Buccal surface of maxillary second molar.
lingual cusp.
e An H-shaped groove pattern separates the four major
@ The distobuccal cusp is smaller and allows part of the
cusps, and the horizontal bar of this H crosses the oblique
distal marginal ridge and part of the distolingual cusp to
ridge, i-e. crista obliqua.
be seen.
e There is a central fossa bound by mesiobuccal cusp, dis-

:
tobuccal cusp and the oblique ridge. Also present are the
Palatal surface (Fig. 4B.10.8)
mesial and distal pits—- and mesial and distal triangular
fossae, bound by the marginal ridges proximally.
The differences between maxillary permanent first and second
molar are as follows:

Permanent maxillary first | Permanent maxillary second

molar
¢ 4cusps (MB, ML,DB,DL)
¢ Carabelli cusp
e Mesiolingual and mesiobuc-
cal cusps very large
e Distobuccal cusp large
e Distolingual
cusp smaller
¢ Rhomboidal from occlusal
(MB and DL angles acute
ML and DB angles obtuse)
e Buccal roots plier-handled,
lingual root straight
Q.3. Describe in detail the morphology of maxillary
molar
° 4 cusps (MB, ML, DB, DL)
¢ No Carabelli cusp
« ML and mesiobuccal cusps
smaller than first molar
. DB cusp smaller
Fig. 4B.10.8 Palatal surface of maxillary second molar.
. DL cusp smaller or may be
missing
=» Rhomboidal (MB and DL an- e Its general form very much resembles the maxillary per-
gles more acute ML and DB manent first molar, except for the following differences:
more obtuse)
i. The distolingual cusp of the crown is smaller in size.
All roots distally inclined ii. The distobuccal cusp may be seen through the sulcus
between the mesiolingual and distolingual cusp.
iii. No fifth cusp is evident.

_
permanent second molar. Mesial surface (Fig. 4B.10.9)
Ans.

e Maxillary permanent second molars are two in number.

e Each of them is the seventh tooth from the midline and
situated in between the maxillary first molar and third
molar.
e Each of these occludes with the mandibular second molar
and third molar.

Buccal surface (Fig. 4B.10.7)

e The crown is a little shorter cervico-occlusally and nar-
rower mesiodistally than the maxillary first molar. Fig. 4B.10.9 Mesial surface of maxillary second molar.
 Dental Anatomy

e The buccolingual diameter is equal to that of the maxil- | Maxillary Permanent Third Molar
lary permanent first molar, whereas the mesiodistal diam-
: General features
eter is very much lesser.
e Two in number.
Distal surface (Fig. 4B. 10.10) e Last tooth in the maxillary arch. Occludes only with man-
dibular last molar (third molar).
e Almost similar in form to the maxillary permanent
second molar, but smaller in size.

Buccal surface (Fig. 4B.10.12)

Distal
Fig. 4B.10.10 Distal surface of maxillary second molar.

e Because the distobuccal cusp is smaller than in the maxil-

lary first molar, more of the mesiobuccal cusp may be
seen from this angle.
e The mesiolingual cusp cannot be seen.
Occlusal surface (Fig.
. 4B.10.11) Fig.ig 48.10.12
0. B uccal | surface
surf oftf maxillary
ill permanent t third
third molar.
molar.

e The distobuccal cusp is much smaller and may be

missing.

Palatal surface (Fig. 4B.10.13)

Fig. 4B.10.11 Occlusal surface of maxillary second molar.

e The rhomboidal outline of the occlusal surface is more

marked.
e Although in comparison with the first molar, the acute
angles of the rhomboid are less and the obtuse angles are
greater.
e The buccolingual diameter of the crown is about equal,
but the mesiodistal diameter is approximately 1 mm less. _ Fig, 48.10.13 Palatal surface of maxillary permanent third molar.

Roots

e The roots are less divergent and sometimes fused.

Distolingual i lly missing.
Q.4. Describe in detail the morphology of maxillary © feastolingua’ Cusp 18 Usually MISSINg
permanent third molar. Mesial and distal surfaces (Fig. 4B.10.14)
Ans. e It has only the mesial contact area.
Loy) Quick Review Series: BDS 1st Year

Fig. 4B.10.15 Occlusal surface of maxillary permanent third

molar.

Fig. 4B.10.14 Mesial and distal surfaces of maxillary perma-

nent third molar.
e The oblique ridge may be small or missing, and the distal
fossa being absent.
Occlusal surface (Fig. 4B.10.15)
e Most frequently the occlusal surface is triangular or Root
heart-shaped in outline, with only three cusps due to the e Roots are shorter and curved distally.
loss of the distolingual cusp. e The lingual root is usually fused to the buccal roots.

SHORT NOTES

Q.1. Cusp of Carabelli. e The buccal surface is convex, presenting two cusps—the
broader mesiobuccal cusp and a narrower distobuccal
Or cusp.
Tubercle of Carabelli. e A buccal developmental groove divides the two buccal
cusps. At the end of this groove, in the middle-third of the
Ans. buccal surface, a buccal pit is often present.
e The mesial outline of the buccal surface is straighter than
e Cusp of Carabelli is a rounded projection on the sur-
the distal outline, with a constriction at the cervical-third.
face of a crown, and represents a deviation from the
All the four major cusps are seen from this aspect.
normal.
e The cervical line is almost straight.
e The paramolar cusp occasionally seen on the buccal
aspect of the permanent lower molars can be considered
as a tubercle.

Q.2. Crown of upper permanent first molar.

Or

Buccal surface of permanent maxillary first molar.

Ans.

Buccal Surface of Maxillary First Molar

(Fig. 4B.10.16)
e From the buccal aspect, it is roughly trapezoidal with the M
cervical and occlusal sides being uneven, the shortest side
being the cervical side. Fig. 4B.10.16 Buccal surface of maxillary first molar.
 Dental Anatomy

oie =©PERMANENT MANDIBULAR MOLARS)

LONG ESSAYS

Q.1. Describe the morphological characteristics of | ¢ From the buccal aspect, the crown looks trapezoidal in
permanent mandibular first molar, and write the outline.
differences between permanent mandibular first © The convex buccal surface presents three cusps—
molar and permanent mandibular second molar. mesiobuccal, distobuccal and distal cusps. Separating
Or these cusps are a more prominent mesiobuccal groove
, . . and a less-prominent distobuccal groove.
Describe in detail the morphology of mandibular = «The buccal pit is present at the end of the mesiobuccal
right first molar. groove. From this aspect, all the five cusps are seen.
Or © Cervical line is almost straight.
Describe in detail the morphology of permanent Jingyal surface (Fig. 4B.11.2)
mandibular first molar tooth.
Or
Describe morphology of mandibular permanent
first molar.
Ans.

Permanent Mandibular First Molars

General features
e The permanent mandibular first molars are two in number.
e A mandibular permanent first molar is the sixth tooth
from the midline, and is situated in between the second
premolar and the second molar.
@ It occludes with the maxillary second premolar and the
first molar. It is the largest tooth in the mandibular arch. Fig. 4B.11.2 Lingual surface of permanent mandibular first molar.
It has five major cusps.

Buccal surface (Fig. 4B.11.1)

e From this aspect, only three cusps are seen—the two lin-
gual and the lingual portion of the distal cusp.
e There is a faint lingual developmental groove separating
the mesiolingual and the distolingual cusps.
© Overall surface area of the lingual aspect is less than that
of the buccal surface.
e Cervical line is almost straight.

Mesial and distal surfaces (Fig. 4B.11.3)

e Buccolingual measurement is more on the mesial aspect
than on the distal aspect.
e From the mesial aspect, only the mesiobuccal and the
mesiolingual cusps are seen, whereas from the distal as-
Fig. 4B.11.1 Buccal surface of permanent mandibular first molar. pect, all the five cusps are seen.
 y
/¥Y) Quick Review Series: BDS 1st Year

Mesial Distal Fig. 4B.11.5 Roots and pulp of permanent mandibular first molar.
Fig. 4B.11.3 Mesial and distal surface of permanent mandibular
first molar.
Roots (Fig. 4B.11.5)
Occlusal surface (Fig. 4B.11.4) e Roots are two in number—a larger mesial and a small
distal, starting from the common root trunk.
e The mesial root is flat mesiodistally, with the longitudinal
Occlusal groove groove on the mesial surface. The distal root is compara-
tively rounder.
e Both the roots show distal inclination.
Pulp
e The mandibular permanent first molar has a box-shaped
pulp chamber with the long axis mesiodistally, with five
cornua directed towards five cusps.
e Three root canals—two in the mesial root, i.e. the mesio-
buccal and mesiolingual, and one in the distal root.
The differences between permanent mandibular first molar
and permanent mandibular second molar are as follows:
Fig. 4B.11.4 Occlusal surface of permanent mandibular first
molar.
Permanent mandibular first Permanent mandibular
molar second molar
. . . . 4 ° 5 cusps ¢ 4Acusps
° It is roughly rectangular in outline, with the mesiodistal * 2 buccal grooves (MB and DB) * Single buccal groove
dimension being longer than the buccolingual dimen- * Pentagonal shape (occlusal ¢ Rectangular shape
sion. Also, the buccal outline is longer than the lingual surface) (occlusal surface)
outline. ¢ Bi-planar buccal surface ¢ Single plane buccal surface
e Ithas five cusps: the mesiobuccal, mesiolingual, the disto- ¢ Buccal surface wider than lin- ¢ Buccal and lingual surfaces
buccal, distolingual and the distal cusps. gual surface ; equal ;
e The mesiolingual cusp is the largest and the distal is the ° Mesial surface wider than distal * Mesial and distal surfaces
smallest e Mesial and distal marginal equal
. . . grooves ¢ No marginal grooves
e A mesial marginal ridge connects the mesial cusps, and ¢ Mesial and distal root concavi: © No root concavities
the distal marginal ridge connects the distolingual and ties * More distinctly distally
the distal cusps. * Distally inclined roots inclined roots
e From the central fossa, a cruciform-fissure pattern radi- ¢ Rounded apex of root ¢ Pointed apex
ates mesially, distally and lingually.
e The distal extension of this fissure separates the distal
Q.2. Describe in detail the morphology of perma-
cusp from the distobuccal and the distolingual cusps. In
nent mandibular second molar.
addition, it separates the distobuccal and distolingual
cusps. Or
 Dental Anatomy

Write briefly on occlusal aspect of permanent i. The distobuccal cusp is relatively larger and is placed
mandibular second molar tooth. more distally than in the first molars.
. The distal marginal ridge connects the distobuccal and
Ans.
the distolingual cusps.

v
Permanent Mandibular Second Molars
iii. The occlusal outline is more or less square.

e The permanent mandibular second molars are two in —_Mesial and distal surfaces (Fig. 4B.11.8)
number. Each of these is the seventh tooth from the mid-
line, and is situated in between the first permanent molar
and the third molar in mandible.
e It occludes with the maxillary first and second molars. It
resembles permanent mandibular first molar in general
form with the following variations.

General features
Buccal surface (Fig. 4B.11.6)

Mesial Distal

Fig. 4B.11.8 Mesial and distal surfaces of permanent mandibu-

lar second molar.

i. Roots are less divergent or may be fused.

ii. No developmental grooves can be seen interrupting the
marginal ridges.

Occlusal surface (Fig. 4B.11.9)

Fig. 4B.11.6 Buccal surface of permanent mandibular second

molar.

i. It is smaller in overall size.

ii. The buccal surface presents only one developmental
groove.
iii. It has only four cusps, which are almost equal in size.
(The distal cusp is absent.) The mesial cusps are slightly
larger than the distal cusps.

Lingual surface (Fig. 4B.11.7) Fig. 4B.11.9 Occlusal surface of permanent mandibular second
molar.

Occlusal aspect of mandibular permanent second molar

is more or less square in outline; central fossa with a
central pit, central groove, buccal and lingual grooves
radiating from the central pit.
e Mesial triangular fossa with mesial pit.
e Distal triangular fossa with distal pit.
No developmental grooves can be seen interrupting the
marginal ridges.
M e On the occlusal surface, the buccal and lingual develop-
mental grooves meet the central developmental groove
Fig. 4B.11.7 Lingual surface of permanent mandibular second forming a cross, which divides the occlusal portion into
molar. four equal parts.
426 Quick Review Series: BDS 1st Year

Q.3. Describe in detail morphology of mandibular e The mandibular third molar, when well-developed, cor-
third molar. responds closely to the form of the second molar except
for size.
Ans.
Mesial and distal surface (Fig. 4B.11.12)
Mandibular Permanent Third Molar

General features
e Permanent mandibular third molars are two in number.
e It is the last tooth in the quadrant. Occludes with the
maxillary second and third molar. Has only mesial con-
tact area.
e This tooth shows maximum morphological variations,
may resemble first or second molar. Usually much shorter
and more bulbous.
Mesial Distal
Buccal surface (Fig. 4B.11.10) Fig. 4B.11.12 Mesial and distal surfaces of permanent man-
dibular second molar.

e The roots are shorter with the mesial root tapering more
from cervix to apex. The apex of the mesial root is usually
more pointed.
e The buccolingual measurement is least at the distal end.
e Teeth with oversized crown portions are much more
spheroidal above the cervical line.
Fig. 4B.11.10 Buccal surface of permanent mandibular third e The distal root appears small, both in length and in buc-
molar. colingual measurement, when compared with the large
crown portion.

e Ithas a markedly convex buccal surface inclined lingually. Occlusal surface (Fig. 4B.11.13)
e The crown is wider at contact areas mesiodistally than at
the cervix.
e The buccal cusps are short and rounded.
e The crest of contour is mesially and distally located a little
more than half the distance from cervical line to tips of
cusps.
e Two buccal cusps are seen only from this aspect.

Lingual surface (Fig. 4B.11.11)

Fig. 4B.11.13 Occlusal surface of permanent mandibular
second molar.

e Ovoid occlusal table and crown outline.

e Many supplemental grooves radiate from the central
groove.

Root
e Roots are two or three in number.
Fig. 4B.11.11 Lingual surface of permanent mandibular second e Roots are short, sometimes fused and very distally
molar. inclined.
 Dental Anatomy

SHORT NOTES

Q.1. General features of mandibular first molar e Occlusal surface of permanent mandibular first mo-
tooth. lar is roughly rectangular in outline, with the mesio-
distal dimension being longer than the buccolingual
Ans.
dimension.
e The buccal outline is longer than the lingual outline.
Mandibular First Molar
e It has five cusps; the mesiolingual cusp is the largest
e Buccal surface wider than lingual surface with five cusps and the distal the smallest.
and two buccal grooves (MB and DB). e A mesial marginal ridge connects the mesial cusps, and
Pentagonal shape (occlusal surface). the distal marginal ridge connects the distolingual and
Mesial surface wider than distal. the distal cusps.
Mesial and distal marginal grooves. e From the central fossa, a cruciform fissure pattern radi-
Mesial and distal roots exhibit root concavities. ates mesially, distally and lingually.
e Distally inclined roots with rounded apex of root.
Q.2. Occlusal surfaces of permanent mandibular
first molar.
Ans.

DENTO-OSSEOUS STRUCTURES
LONG ESSAYS

Q.1. Describe the blood and nerve supply of maxil-
lary teeth.
Or
Describe the innervations of upper permanent
teeth.
Ans.
Blood Supply
i. The maxillary and mandibular teeth are supplied by the
maxillary artery—a branch of the external carotid artery.
ii. The maxillary artery by its posterior superior alveolar,
middle superior alveolar and the anterior superior alveo-
lar branches forms a plexus, supplies the pulp and
supporting structures of the maxillary teeth.
iii, On the palatal aspect, the nasopalatine artery supplies
anteriorly, and the greater palatine artery supplies poste-
riorly. They are both branches of the maxillary artery.
iv. The mandibular teeth are supplied by the inferior dental
artery, a branch of the maxillary artery, on the lingual
aspects by the lingual artery, also a branch of the external
carotid artery.
Nerve Supply
Maxillary teeth are supplied by the maxillary branch of the
trigeminal nerve.
Maxilla
i. The incisors
Pulp is supplied by the anterior superior dental nerve. The
labial-supporting tissues are supplied by the labial branch of
the infraorbital nerve, and the palatal supporting tissues by
the nasopalatine nerves.
i. Canine
Pulp is supplied by the anterior superior dental nerve. Labial
supporting tissues are supplied by labial branch of infraor-
bital nerve and the palatal supporting tissues by greater
palatine nerves.
iii. Premolars
Pulp is supplied by the middle superior dental nerve. Palatal
supporting tissues are supplied by the greater palatine nerve,
in addition.
428 Quick Review Series: BDS 1st Year

iv. Molars Q.2. Write briefly about lingual nerve.

Pulp is supplied by the posterior superior dental nerve. The
buccal supporting tissues are supplied by the long buccal nerve
and palatal supporting tissues by the greater palatine nerve.
Mandible
i. Incisors and canines
These are supplied by incisive branch of the inferior dental
nerve. Labial supporting tissues are supplied by the mental
branch of the inferior dental nerve, and the lingual support-
ing tissues by the lingual nerve.
ii. Premolars
Pulp tissue is supplied by the inferior dental nerve, buccal
supporting tissues by mental branch of inferior dental nerve
and lingual supporting tissues by the lingual nerve.
iti. Molars
Pulp is supplied by the inferior dental nerve, buccal support-
ing tissues by the long buccal nerve and the lingual support-
ing tissues by the lingual nerve.
Drainage
Except the maxillary and mandibular incisors that drain into
the submental group of lymph nodes, remaining teeth drain
into the submandibular group of lymph nodes.
Ans.
The lingual nerve arises within the infratemporal fossa from
the posterior division of the mandibular nerve.
Course
@ It is joined by the chorda tympani branch of the facial
nerve within the infratemporal fossa and emerges along
the lower border of the lateral pterygoid muscle.
e It lies in front of the inferior alveolar nerve and vessels.
e The nerve is superficially situated medial to the mandibu-
lar third molar covered only by the oral mucous mem-
brane.
It then crosses the hyoglossus muscle and loops around
the submandibular duct, terminates by supplying the mu-
cous membrane of the anterior two-thirds of the tongue.
Branches of lingual nerve are as follows:
e Branches to supply the mucous membrane of the floor of
the mouth and the anterior two-thirds of tongues, gums
of the mandible.
e It communicates with the following:
a. Chorda tympani nerve within the infratemporal fossa,
b. Submandibular ganglion and hypoglossal nerve, when
it lies on the hyoglossus,
c. The inferior alveolar nerve rarely.

SHORT ESSAYS

Q.1. Ramus of mandible. e All the muscles of mastication are attached to the ramus.
e The four arteries related to ramus of the mandible are as
Ans.
follows:
e Ramus is a quadrangular-shaped posterior part of the i. Mental vessels
mandible. ii. Inferior alveolar vessels
e It has four borders and two surfaces. iti. Mylohyoid vessels
e The borders of the ramus are: iv. Masseteric vessels.
i. Anterior border
ii. Posterior border Q.2. Inferior alveolar nerve.
iti. Superior border (mandibular notch) Or
iv. Inferior border.
e The surfaces of the ramus are: Inferior dental nerve.
i. Lateral surface
Ans.
ii. Medial surface.
e From the upper border of the ramus two processes are e The mandibular nerve leaves the skull through the fora-
projecting upwards. men ovale and almost immediately breaks up into its
i. Coronoid process several branches.
ii. Condyloid process. e The chief branch to the lower jaw is the inferior alveolar
e The junction between the posterior border and inferior nerve, which at first runs directly downward across the
border forms the angle of the mandible. The lateral sur- medial surface of the lateral pterygoid, at the lower border
face is rough in nature. of which it is directed laterally and downwards across the

outer surface of the medial pterygoid muscle to reach the
mandibular foramen.
e Just before entering the foramen, it releases the mylohy-
oid branch, which is a motor branch to the mylohyoid
muscle and anterior belly of the digastric muscle.
e The inferior alveolar nerve continues forward through
the mandibular canal beneath the roots of the molar teeth
to the level of the mental foramen.
SHORT NOTES
Q.1. Tuberosity.
Ans.
e The lower border of the zygomatic process are somewhat
distal to the roots of the third molar.
e The inferior portion of this surface is more prominent,
where it overhangs the root of the third molar and is
called the maxillary tuberosity.
e Medially, this tuberosity is limited by a sharp, irregular
margin that articulates with the pyramidal process of the
palatine bone, and in some cases, the lateral pterygoid
plate of the sphenoid bone.
e The maxillary tuberosity is the origin for some fibres of
the medial pterygoid muscle.
A portion of the infratemporal surface superior to maxil-
lary tuberosity is the anterior boundary to the pterygomaxil-
lary fissure.
Q.2. Genial tubercle.
Ans.
e Mandible, when observed from the rear, shows that the
median line is marked by a slight vertical depression, rep-
resenting the line of union of the right and left halves of
the mandible, and immediately below this, at the lower
third, that the bone is roughened by eminences called the
superior and inferior mental spines or genial tubercles.
e These genial tubercles provide attachment to geniohyoid
and genioglossus muscles.
Q.3. Mental foramen.
Ans.
e The mental foramen is an important landmark on the
lateral aspect of the mandible.
e It is the opening of the anterior end of the mandibular
canal, and is directed upward, backward and laterally.
e The foramen is usually located midway between the supe-
rior and inferior border of the body of the mandible
when the teeth are in position, and most often, it is below
the second premolar tooth, a little below the apex of the
root.
Dental Anatomy
e During this part of its course, it gives off branches to the
molar and premolar teeth, and their supporting bone and
soft tissues.
e The nerve to the teeth does not arise as individual
branches but as two or three larger branches that form a
plexus from which inferior dental branches enter indi-
vidual tooth roots, and interdental branches supply alveo-
lar bone, periodontal membrane and gingiva.
e The position of this foramen is not constant, and it may
be between the first premolar and the second premolar
tooth. After the teeth are lost and resorption of alveolar
bone has taken place, the mental foramen may appear
near the crest of the alveolar border.
e In childhood, before the first permanent molar has come
into position, this foramen is usually immediately below
the first primary molar and nearer the lower border.
Q.4. Inferior alveolar canal or mandibular canal.
Ans.
e This passage is found within the mandible.
e Jt extends between the mandibular foramen to the mental
foramen.
e Terminally, it divides into mental and incisive canals.
e The inferior alveolar vessels and nerves pass through this
canal.
Q.5. Greater palatine foramen.
Ans.
e Greater palatine foramen is situated between the hori-
zontal plate of palatine bone and alveolar process of the
maxilla.
e The posterior edge of the palatine process becomes rela-
tively thin, where it joins the palatine bone at the point of
the greater palatine foramen.
e This foramen lies in between first and second molars 1 cm
from the gingival margin.
Q.6. Inferior alveolar nerve.
Or
Inferior dental nerve.
Ans.
e The mandibular nerve leaves the skull through the fora-
men ovale and almost immediately breaks up into its
several branches.
e The chief branch to the lower jaw is the inferior alveolar
nerve, which at first runs directly downward across the
430 Quick Review Series: BDS 1st Year
medial surface of the lateral pterygoid, at the lower border
of which it is directed laterally and downwards across the
outer surface of the medial pterygoid muscle to reach the
mandibular foramen.
e Just before entering the foramen, it releases the mylohy-
oid branch, which is a motor branch to the mylohyoid
muscle and anterior belly of the digastric muscle.
e The inferior alveolar nerve continues forward through
the mandibular canal beneath the roots of the molar teeth
to the level of the mental foramen. During this part of its
course, it gives off branches to the molar and premolar
teeth, and their supporting bone and soft tissues.
e The nerve to the teeth does not arise as individual
branches, but as two or three larger branches that form a
plexus from which inferior dental branches enter indi-
vidual tooth roots, and interdental branches supply alveo-
lar bone, periodontal membrane and gingiva.
Q.7. Nerve supply of maxillary teeth.
Ans.
Nerve Supply of Maxillary Teeth
Maxillary teeth are supplied by the maxillary branch of the
trigeminal nerve:
incisors
e Pulp is supplied by the anterior superior dental nerve.
e The labial supporting tissues are supplied by the labial
branch of the infraorbital nerve, and the palatal support-
ing tissues by the nasopalatine nerves.
Canine
e Pulp is supplied by the anterior superior dental nerve.
e Labial supporting tissues are supplied by labial branch of
infraorbital nerve and the palatal supporting tissues by
greater palatine nerves.
Premolars
e Pulp is supplied by the middle superior dental nerve, and
palatal supporting tissues are supplied by the greater
palatine nerve.
Molars
e Pulp is supplied by the posterior superior dental nerve.
e The buccal supporting tissues are supplied by the long
buccal nerve, and palatal supporting tissues by the greater
palatine nerve.
Q.8. Arterial supply of maxillary teeth.
Or
Blood supply of mandibular teeth.
Ans.
e@ The maxillary and mandibular teeth are supplied by
the maxillary artery— a branch of the external carotid
artery.
e The maxillary artery by its posterior superior alveolar,
middle superior alveolar and the anterior superior alveo-
lar branches forms a plexus, and supplies the pulp and
supporting structures of the maxillary teeth.
@ On the palatal aspect, the nasopalatine artery supplies
anteriorly, and the greater palatine artery supplies
posteriorly. They are both branches of the maxillary
artery.
e The mandibular teeth are supplied by the inferior dental
artery—a branch of the maxillary artery; on the lingual
aspects by the lingual artery, also a branch of the external
carotid.
Q.9. Ramus of mandible.
Ans.
e Ramus is a quadrangular-shaped posterior part of the
mandible.
e All the muscles of mastication are attached to the ramus.
e It has four borders and two surfaces.
The borders of the ramus are:
i. Anterior border
ii. Posterior border
iii. Superior border
iv. Inferior border.
The surfaces of the ramus are:
i. Lateral surface
ii. Medial surface.
e From the upper border of the ramus, two processes are
projecting upwards, i.e. coronoid process and condyloid
process.
e The junction between the posterior border and inferior
border forms the angle of the mandible.
e The four arteries related to ramus of the mandible are as
follows:
Inferior alveolar vessels, mylohyoid vessels, masseteric
vessels and mental vessels.
Q.10. Lymphatic drainage of maxillary teeth.
Ans.
Lymphatic drainage of maxillary teeth:
e Except the maxillary and mandibular incisors that drain
into the submental group of lymph nodes, remaining all
teeth drain into the submandibular group of lymph
nodes.
Q.11. Canine fossa.
Ans.
e A deeper concavity present posterior to the canine emi-
nence on a higher level is called the canine fossa.
 Dental Anatomy

Q.12. Mylohyoid ridge.
Ans.
e The mylohyoid ridge lies on the internal surface of the
body of the mandible.
e Itstarts at or near the lowest part of the mental spines and
passes backward and upward, increasing in prominence
until the anterior portion of the ramus is reached and
gradually disappears.
e This ridge is the point of origin of the mylohyoid muscle,
which forms the central portion of the floor of the
mouth. Above the anterior part of the mylohyoid ridge a
smooth depression, the sublingual fossa, may be seen. The
sublingual gland lies in this area.
e Asmall, roughened oval depression, the digastric fossa, is
found on each side of the symphysis immediately below
the mylohyoid line and extending onto the lower border.
e Towards the centre of the body of the mandible, between
the mylohyoid line and the lower border of the mandible,
a smooth oblong depression is located called the subman-
dibular fossa. The submandibular gland lies within this
fossa.

TEMPOROMANDIBULAR JOI
Topic 13
TEETH AND THEI

LONG ESSAYS

Q.1. Describe the structure and functions of mus- Origin

cles of mastication. It has three layers:
Ans. e Superficial layer arises from anterior two-thirds of lower
border of zygomatic arch and adjoining zygomatic pro-
The muscles of mastication are as follows: cess of maxilla.
e The masseter e Middle layer arises from anterior two-thirds of deep sur-
The temporalis face and posterior one-third of lower border of zygomatic
The lateral pterygoid arch.
The medial pterygoid. e Deep layer arises from deep surface of zygomatic arch.
Superficial fibres pass downwards and backwards at 45°
Masseter muscle middle and deep fibres pass vertically downwards.
e The masseter muscle is quadrilateral in shape and covers
the lateral surface of ramus of mandible (Fig. 4B.13.1). Insertion
e Superficial layer is inserted into lower part of lateral sur-
face of ramus of mandible.
@ Middle layer is inserted into middle part of ramus.
e Deep layer is inserted into upper part of ramus and coro-
noid process of the mandible.

Nerve supply
e The masseteric nerve—branch of anterior division of
mandibular nerve— supplies the masseter muscle.

Action
Masseter
muscle e It elevates mandible to close the mouth.

Temporalis muscle
e Temporalis muscle is a fan-shaped muscle, filling the tem-
Fig. 4B.13.1 The masseter muscle. poral fossa (Fig. 4B.13.2).
‘%¥yy Quick Review Series: BDS 1st Year

Origin
© Upper head (small): Arises from infratemporal surface
and crest of greater wing of sphenoid bone.
© Lower head (larger): Arises from lateral surface of lateral
pterygoid plate, and the fibres run backwards and later-
ally and converge for insertion.

Insertion
e Pterygoid fovea on the anterior surface of neck of man-
dible.
e Anterior margin of articular surface of temporomandib-
ular joint.
e Insertion is posterolateral at a slightly higher level than
Fig. 4B.13.2 The temporalis muscle. origin.

Nerve supply
e A branch from anterior division of mandibular nerve
Origin supplies the lateral pterygoid muscle.
e The temporalis muscle arises from temporal fossa and
temporal fascia. The fibres converge and pass through gap Action
deep to zygomatic arch. e Along with suprahyoid muscles, it helps in depressing the
mandible to open the mouth.
Insertion e Lateral and medial pterygoids protrude the mandible.
e Temporalis muscle inserts into margins and deep surface e Left lateral pterygoid and right medial pterygoid turn the
of coronoid process and anterior border of ramus of chin to left side.
mandible.
Medial pterygoid muscle (Fig. 4B.13.3)
Nerve supply
e The medial pterygoid muscle is quadrilateral in shape and
e Two deep temporal branches from anterior division of has a small superficial and a large deep head.
mandibular nerve.
Origin
Action
© Superficial head (small slip): From tuberosity of maxilla
e Elevates mandible. and adjoining bone.
e Posterior fibres retract the protruded mandible. © Deep head (quite large): From medial surface of lateral
e Helps in side-to-side grinding movements. pterygoid plate and adjoining process of palatine bone.
The fibres run downwards, backwards and laterally.
Lateral pterygoid muscle (Fig. 4B.13.3)
e The lateral pterygoid muscle is a short, conical muscle, Insertion
and has upper and lower heads. e Roughened area on the medial surface of angle and ad-
joining ramus of mandible, below and behind the man-
dibular foramen and mylohyoid groove.

Nerve supply
Nerve to medial pterygoid, branch of main trunk of man-
dibular nerve.

Action
e Elevates mandible.
© Helps protrude the mandible.
Lateral
Lateral/ Superior head pterygoid e Right medial pterygoid with left lateral pterygoid turns
pterygoidL Inferior head i plate the chin to left side.
Medial pterygoid
Q.2. Enumerate the ligaments and functions of TMJ.
Fig. 4B.13.3 The lateral and medial pterygoid muscles. Ans.

e Temporomandibular joint (TMJ) is a synovial joint of the
condylar variety. The articular surfaces are covered with
fibrocartilage.
s
Articular capsule
e Articular capsule is a joint capsule that covers the TMJ. It
is a fibroelastic sac.
e Attachments of articular capsule are as follows:
e Anteriorly: Attaches to the ascending slope of articular
eminence.
e Posteriorly: To the lips of the squamotympanic fissure.
e Superiorly: To the margins of the glenoid fossa.
e Inferiorly: To the neck of condyle of mandible.
e The lateral aspect of the capsule is strengthened by tem-
poromandibular ligament.
e The anterior surface is ill-defined.
e The inner surface of capsule is smooth and glistening
because of pressure of a synovial membrane lining.
n
Articular disc
The joint cavity is divided into upper and lower parts by an
intra-articular disc.
e The articular disc is an oval fibrous plate that divides the
joint into an upper and lower compartments.
ee
e The upper compartment permits gliding movements, and
the lower permits rotatory as well as gliding movements.
e The disc has a concavo-convex superior surface, and a
concave inferior surface. The periphery of the disc is at-
tached to the fibrous capsule.
e The disc is composed of an anterior extension, anterior
thick band, intermediate zone, posterior thick band and
bilamellar region.
e The disc represents the degenerated primitive insertion of
lateral pterygoid muscle.
Ligaments of TMJ
a. The fibrous capsule
b. The lateral ligament
SHORT NOTES
Q.1. Masseter muscle—origin and insertion.
Ans.
e The masseter muscle is quadrilateral in shape and covers
lateral surface of ramus of mandible.
Origin
It has three layers:
e Superficial layer arises from anterior two-thirds of lower
border of zygomatic arch and adjoining zygomatic pro-
cess of maxilla.
Dental Anatomy
c. The sphenomandibular ligament
d. The stylomandibular ligament.
. Fibrous capsule
e It is attached above to the articular tubercle, the circum-
ference of the mandibular fossa and the squaamotympanic
fissure, and below to the neck of the mandible.
e The capsule is loose above the intra-articular disc and
tight below it.
e The synovial membrane lines the fibrous capsule and the
neck of the mandible.
b. Lateral or temporomandibular ligament
e It reinforces and strengthens the lateral part of the capsu-
lar ligament.
@ Its fibres are directed downwards and backwards. It is at-
tached above to the articular tubercle and below to the
posterolateral aspect of the neck of the mandible.
Sphenomandibular ligament
e Itis an accessory ligament.
It is attached superiorly to the spine of the sphenoid and
inferiorly to the lingula of the mandibular foramen.
It is a remnant of the dorsal part of Meckel’s cartilage.
xn @
. Stylomandibular ligament
It is another accessory ligament of the joint.
It is attached above to the lateral surface of the styloid
process and below to the angle and posterior border of
the ramus of the mandible.
e It represents a thickened part of the deep cervical fascia,
which separates the parotid and submandibular salivary
glands.
Blood supply
e Branches from superficial temporal and maxillary arteries.
e Veins follow the arteries.
Nerve supply
e Auriculotemporal nerve and masseteric nerve.
e Middle layer arises from anterior two-thirds of deep sur-
face and posterior one-third of lower border of zygo-
matic arch.
e Deep layer arises from deep surface of zygomatic
arch. Superficial fibres pass downwards and back-
wards at 45° middle and deep fibres pass vertically
downwards.
Ce Quick Review Series: BDS 1st Year

Insertion
e Superficial layer is inserted into lower part of lateral sur-
face of ramus of mandible.
@ Middle layer is inserted into middle part of ramus.
e Deep layer is inserted into upper part of ramus and coro-
noid process of the mandible.
Q.2. Action of lateral pterygoid muscle.
Ans.
The lateral pterygoid muscle is one of the muscles of masti-
cation. It is a short, conical muscle, and has upper and lower
heads.
Action
e Along with suprahyoid muscles, it helps in depressing the
mandible to open the mouth.
e Lateral and medial pterygoids protrude the mandible.
@ Left lateral pterygoid and right medial pterygoid turn the
chin to left side while right lateral pterygoid and left me-
dial pterygoid turn the chin to right side.
Q.3. Name muscles of mastication.
Ans.
The muscles of mastication are as follows:
The masseter
The temporalis
The lateral pterygoid
The medial pterygoid.
Q.4. Synovial fluid.
Ans.
Synovial fluid is secreted by synovial cells.
It is a viscid muco-albuminous fluid, rich in hyaluronic acid.
It is yellow in colour.
Its electrolyte content is similar to blood plasma and there
is a constant exchange between it and blood plasma.
e It contains free cells, mostly macrophages, which remove
tissue debris from the articular cavity caused by normal
wear of the articulating surfaces.
e The synovial fluid serves as a lubricative and nutritive
agent for the avascular tissues of the articulation.
Q.5. Articular capsule.
Ans.
e Articular capsule surrounds the joint and its upper half,
ie. above the articular disc and forms a loose envelope
that is attached to the squamotympanic fissure behind the
articular eminence, in front and the margins of the gle-
noid fossa all around.
@ It is also attached to the articular disc at its medial and
lateral margins.
Q.6. Ligaments of temporomandibular joint.
Ans.
The ligaments of temporomandibular joint are as follows:
i. Lateral temporomandibular ligament
ii. Accessory ligaments
iii. Sphenomandibular ligament
iv. Stylomandibular ligament.
Q.7. Bony components of TMJ.
Ans.
e The bony components of TMJ are made up of the glenoid
fossa on the under surface of the squamous part of tem-
poral bone and the condyle of the mandible.
e The glenoid fossa is concavo-convex from behind for-
wards and extends from squamotympanic fissure to the
anterior border of articular eminence.
e The condyle of mandible makes up lower component.
The transverse measurement of the condyle is greater
than the anteroposterior measurement.
@ It is convex from side-to-side as well as anteroposteriorly.
The transverse axes of the condyles of the two sides are
not ina line.
Q.8. Articular disc.
Ans.
e Articular disc is a fibrous disc, which divides the joint
cavity into a superior and inferior joint cavities.
e Its upper surface is concavo-convex from before to back-
wards to fit with the articular eminence and fossa of the
temporal bone. The lower surface is concave to fit with
the convex head of the condyle. The centre of the disc is
avascular while its periphery is highly vascular.
e Anteriorly, the disc joins the capsule and is also at-
tached to front of the neck of the condyle. Posteriorly
it is attached to the capsule and the squamotympanic
fissure.

SHORT ESSAY
Q.1. Describe in detail about the occlusal relation-
ship of maxillary and mandibular teeth.
Ans.
e The buccal cusps of the upper posterior teeth and the
incisive edges of the upper anterior teeth occlude outside
the buccal or labial surfaces of lower teeth.
e Lower canines always close in front of the upper
canines.
e The mesiolingual cusps of the upper molars occlude with
the central fossa of the corresponding lower teeth.
SHORT NOTES
Q.1. Mesial drift.
Or
Physiologic mesial migration.
Ans.
e The teeth have a tendency to move marginally mesially
throughout their life. This is because of the wear and tear
occurring on the proximal surfaces of the teeth. Mesial
migration in essence tries to maintain the contact be-
tween the approximating teeth.
e The belief that the deciduous teeth do not migrate mesi-
ally is unfortunately a misconception. No doubt they also
have mesial migration; but because of the relative excess
of growth of the jaws in the deciduous dentition period,
there results an apparent spacing between the deciduous
teeth. Hence, the physiological migration of teeth in de-
ciduous dentition is not well-appreciated.
Q.2. Occlusion.
Ans.
e Occlusion is the relationship of the upper and the lower
teeth when the jaws are closed.
© Occlusion then is a sum of the contact made by the cusps,
fossae and incisive edges of opposing teeth.
Q.3. Centric relation and centric occlusion.
Or
Centric occlusion.
Dental Anatomy
OCCLUSION
e The apices of the mesiobuccal cusp of the upper teeth oc-
clude outside, and opposite the buccal groove between
the two buccal cusps of the lower teeth.
e Each tooth in the upper dental arch is opposed not only by
the arch but also by the tooth immediately distal. This is
because of the greater mesiodistal width of the upper cen-
tral incisor compared with that of the lower central incisor.
e The exceptions to this are the upper third molar, which
occludes with only the lower third molar and the man-
dibular central incisor, which occludes only with the op-
posing upper central incisor.
Ans.
e Centric occlusion or intercuspal position is defined as
maximum intercuspation of the teeth.
e Centric relation is a position (or path of opening and
closing without translation of the condyles) of the man-
dible in which the condyles are in their uppermost posi-
tion in the mandibular fossae and related anteriorly to the
distal slope of the articular eminence.
Q.4. Occlusal curvature.
Ans.
e Graf von Spee described this curvature of natural teeth
originally in the German literature in 1890, and, for that
reason, it is called the curve of Spee.
e Spherical occlusal curvature suggested by the lingual in-
clination of the mandibular molars is the basis for the
curve of Wilson (i.e. the curvature of the mandibular
teeth is concave and that of the maxillary teeth as convex).
e The template for these curvatures cannot be used to
set teeth in complete dentures or for full mouth oral
rehabilitation.
e The degree of anteroposterior curvature is related to the
amount of anterior guidance that is needed to obtain
posterior disclusion of the teeth in lateral and protrusive
mandibular movements.
Q.5. Compensatory curves.
Or
Curve of Spee.
436 Quick Review Series: BDS 1st Year

Ans.

The compensatory curves are as follows:

Curve of Spee
e The curve of Spee is an anteroposterior curve that follows an
imaginary line touching the buccal cusps of all lower teeth Fig. 4B.14.2 Curve of Wilson.
from the lower canine backwardly and approximates the arc
of a circle (Fig. 4B.14.1). A continuation of this curve back-
wards will nearly always pass through the head of the condyle. The arc of the curve, which is concave for mandibular
teeth and convex for maxillary teeth are defined by a line
drawn from left mandibular first molar to right mandibu-
lar first molar. The artificial counterparts of these two
curves incorporated in a denture are called compensatory
curves.
Q.6. Curve of Monson.
Ans.

The curve of Monson is a lateral curve with its concavity

facing upwards and increases in steepness from before back-
Fig. 4B.14.1 Curve of Spee. wards, the occlusal surfaces of the upper molars facing out-
wards and downwards.
Curve of Monson
Q.7. Overjet.
e The curve of Monson isa lateral curve with its concavity Ans.
facing upwards and increases in steepness from before
backwards, the occlusal surfaces of the upper molars fac- © Overjet is the horizontal distance between the most ante-
ing outwards and downwards. rior part of the labial surface of anterior teeth and the
closest point on the lingual surface of the maxillary ante-
Curve of Wilson rior teeth in intercuspal position.
e The greater the overjet the more will be the freedom in
The curve of Wilson is the across arch curvature or posterior moving the mandible forward and laterally, and less in-
occlusal plane (Fig. 4B.14.2). jury to the anterior teeth during those movements.

MISCELLANEOUS
LONG ESSAYS

Q.1. Discuss the influence of fat-soluble vitamins e Fat-soluble vitamins can be stored in liver and adipose
on oral tissues. tissue.
Ans.
Vitamin A
The vitamins are classified as follows:
@ The fat-soluble vitamin A as such is present only in foods
of animal origin. However, its provitamins, carotenes are
Fat-soluble vitamins
found in plants.
e The four vitamins, namely, vitamin A, D, E and K are
known as fat— or lipid— soluble. Biochemical functions
e Their availability in the diet, absorption and transport are i. Retinol and retinoic acid function almost like steroid
associated with fat. They are soluble in fats and oils, and hormones. They regulate the protein synthesis and thus
also the fat solvents (alcohol, acetone, etc). are involved in the cell growth and differentiation.
 Dental Anatomy

ii. Vitamin A is essential to maintain healthy epithelial tissue. e Rickets in children is characterized by bone deformities
iii. Carotenoids (most important is B-carotene) function as due to incomplete mineralization, resulting in soft and
antioxidants and reduce the risk of cancers initiated by pliable bones and delay in teeth formation. In rickets, the
free radicals and strong oxidants. B-Carotene is found to plasma level of calcitriol is decreased and alkaline phos-
be beneficial to prevent heart attacks. This is also attrib- phatase activity is elevated.
uted to the antioxidant property. e In case of osteomalacia (adult rickets), demineralization
of the bones occurs (bones become softer), thereby in-
Dietary sources creasing their susceptibility to fractures and renal rickets
e Animal sources contain (preformed) vitamin A. The best (renal osteodystrophy). This is seen in patients with
sources are liver, kidney, egg yolk, milk, cheese, butter. chronic renal failure.
Fish (cod or shark) liver oils are very rich in vitamin A. e Renal rickets is mainly due to decreased synthesis of
e Vegetable sources contain the provitamin A—carotenes. calcitriol in kidney. It can be treated by administration
Yellow and dark green vegetables and fruits are good of calcitriol.
sources of carotenes, e.g. carrots, spinach, Amaranthus,
pumpkins, mango, papaya, etc. Vitamin E

Recommended dietary allowance e Vitamin E (tocopherol) is a naturally occurring antioxi-

e The recommended dietary allowance (RDA) of vitamin A
dant. It is essential for normal reproduction in many ani-
mals; hence is known as antisterility vitamin.
for adults is around 1000 retinol equivalents (5000 IU)
for man and 800 retinol equivalents (4000 IU) for woman.
Recommended dietary allowance
e One international unit (IU) is equivalent to 0.3 pg of
retinol. The requirement increases in growing children, e A daily consumption of about 10 mg (15 IU) of
pregnant women and lactating mothers. a-tocopherol for men and 8 mg (12 IU) for women is
recommended; 1 mg of a-tocopherol is equal to 1.5 IU.
Vitamin A deficiency
Deficiency symptoms
e Deficiency manifestations of the eyes: Night blindness
(nyctalopia) is one of the earliest symptoms of vitamin A e The symptoms of vitamin E deficiency vary from one
deficiency. animal species to another. In many animals, the defi-
e Severe deficiency of vitamin A ciency is associated with sterility, degenerative changes in
It leads to xerophthalmia. This is characterized by dryness muscle, megaloblastic anaemia and changes in central
in conjunctiva and cornea, and keratinization of epithe- nervous system.
lial cells.
e In certain areas of conjunctiva, white triangular plaques Vitamin K
known as Bitot’s spots are seen. e Vitamin K is the only fat-soluble vitamin with a specific
coenzyme function.
Vitamin D
e Itis required for the production of blood clotting factors,
e Vitamin D is a fat-soluble vitamin. It resembles sterols in essential for coagulation (in German—koagulation;
structure and functions as does a hormone. hence, the name K for this vitamin).

Recommended dietary allowance Dietary sources

e The daily requirement of vitamin D is 400 IU or 10 g of
cholecalciferol.
e In countries with good sunlight (like India), the RDA for
vitamin D is 200 IU (or 5 yg of cholecalciferol).
Dietary sources
Good sources of vitamin D include fatty fish, fish liver oils,
egg yolk, etc. Milk is not a good source of vitamin D.
Deficiency symptoms
e Vitamin D is often called as antirachitic vitamin.
@ Deficiency of vitamin D leads to demineralization
bone. The result is rickets in children and osteomalacia in
adults.
e Cabbage, cauliflower, tomatoes, alfalfa, spinach and other
green vegetables are good sources of vitamin K. It is also
present in egg yolk, meat, liver, cheese and dairy products.
Biochemical functions
e The functions of vitamin K are concerned with blood
clotting process.
e It brings about the post-translational modification of
certain blood clotting factors.
e The clotting factors I] (prothrombin), VII, IX and X are
synthesized as inactive precursors (zymogens) in the liver.
of Vitamin K acts as a coenzyme for the carboxylation of
glutamic acid residues present in the proteins, and this
reaction is catalysed by a carboxylase (microsomal).
438 Quick Review Series: BDS 1st Year

Recommended dietary allowance In hypoactivity of anterior pituitary during early life the oral
© Strictly speaking, there is no RDA for vitamin K, since it changes occurring are:
can be adequately synthesized in the gut. i. Slow development of face.
e The suggested RDA for an adult is 70-140 j1g/day. ii. Late shedding of deciduous teeth and delayed eruption
of permanent teeth.
Deficiency symptoms iii. Root formation incomplete, wide pulp chamber and api-
e The deficiency of vitamin K is uncommon, since it is cal foramen.
present in the diet in sufficient quantity and/or is ade- iv. Under development of mandible and crowding of teeth.
quately synthesized by the intestinal bacteria. v. Hypoplasia of enamel possible.
@ Deficiency of vitamin K leads to the lack of active pro-
thrombin in the circulation. Therefore, blood coagulation Thyroxin
is adversely affected. e The hormone of thyroid gland, thyroxin is essential for
e The individual bleeds profusely even for minor injuries. growth, maturation and differentiation of oral tissues.
e The blood clotting time is increased. e Children with hyperthyroidism exhibit rapid growth of
Q.2. Discuss the effects of various hormones on the entire skeletal system— including the jaws and teeth.
oral tissues. There will be premature loss of deciduous teeth and ad-
vanced eruption of permanent teeth.
Ans. ¢ Inhypothyroidism occurring in infants there will be delay
e Many hormones have a definite influence on the growth, in closure of cranial sutures resulting in a large head.
development and health of oral tissues. There will be delayed eruption of both deciduous and
e Growth hormone, thyroxin, parathormone, oestrogen permanent teeth. Individual teeth may be stunted and
and testosterone probably have the greatest influence on hypocalcified.
the oral tissues.
Oestrogens
Growth hormone © Oéestrogens stimulate cell division in deeper layers of skin,
e Growth hormone of the anterior pituitary is essential for gingiva and oral mucous membrane.
stimulation of growth of tissue and for deposition of pro- e Bone metabolism is significantly affected by it with a
teins into tissues. positive calcium and phosphorus balance.
e Due to oestrogen deficiency occurring in menopause, the
In gigantism, which is due to hyperactivity of anterior pituitary oral epithelium becomes atrophic, dry and there will be
in early life, there will be: burning sensation.
i. Early shedding of deciduous teeth and premature erup- e There will be delayed eruption of permanent teeth.
tion of permanent teeth.
ii. Macrodontia in 50% cases. Parathormone
In hyperactivity of anterior pituitary occurring after puberty, e The hormone of parathyroid gland regulates the serum
(acromegaly), there will be: calcium level.
i. Prominent frontal bones. e In hyperparathyroidism, there will be demineralization of
ii. Enlarged tongue and lips. bone and loss of lamina dura.
iti. Enlarged mandible and spacing between teeth. e In hypoparathyroidism, the dental age is delayed com-
iv. Hypercementosis. pared to the chronological age.

SHORT ESSAYS

Q.1. Describe the muscles of tongue. Intrinsic muscles

Ans. Superior longitudinal

Inferior longitudinal
e The tongue is a muscular organ. A middle fibrous septum
Transverse
divides the tongue into right and left halves.
Vertical.
e Each half contains four intrinsic and four extrinsic muscles:

Extrinsic muscles
© Genioglossus
e Hyoglossus
© Styloglossus
e Palatoglossus.
Intrinsic muscles of the tongue
e The intrinsic muscles occupy the upper part of the
tongue, and are attached to the submucous fibrous layer
and to the median fibrous septum. They alter the shape of
the tongue.
i. The superior longitudinal muscle lies beneath the
mucous membrane. It shortens the tongue and makes
its dorsum concave.
ii. The inferior longitudinal muscle is a narrow band ly-
ing close to the inferior surface of the tongue between
the genioglossus and the hyoglossus. It shortens the
tongue and makes its dorsum convex.
iti. The transverse muscle extends from the median sep-
tum to the margins. It makes the tongue narrow and
elongated.
iv. The vertical muscle is found at the borders of the an-
terior part of the tongue. It makes the tongue broad
and fattened.
Extrinsic muscles of the tongue
e The extrinsic muscles connect the tongue to the following:
i. Mandible via genioglossus
ii. Hyoid bone through hyoglossus
iii. Styloid process via styloglossus
iii. The palate via palatoglossus.
e Genioglossus is a fan-shaped muscle, which forms the
main bulk of the tongue. It arises from the upper genial
tubercle of the mandible. From here the fibres fan out and
run backwards. The upper fibres are inserted into the tip,
the middle fibres into the dorsum and the lower fibres
into the hyoid bone. The upper fibres retract the tip, the
middle fibres depress the tongue, and the lower fibres pull
the posterior part of the tongue forward and thus pro-
trude the tongue from the mouth.
e This muscle if paralysed will fall back on the oropharynx
and block the air passage.
SHORT NOTES
Q.1. Scurvy.
Ans.
e A deficiency of vitamin C can result in scurvy.
e Scurvy leads to defective formation of collagen, im-
pairs healing of the wounds and causes capillary
Dental Anatomy
Q.2. Describe the blood supply, nerve supply and
lymphatic drainage of tongue.
Ans.
The tongue is a muscular organ. The blood supply, nerve sup-
ply and lymphatic drainage of the tongue is described below.
Blood supply
e Arterial supply of tongue is chiefly derived from the lin-
gual artery— a branch of the external carotid artery.
e The root of the tongue is also supplied by the tonsillar
and ascending pharyngeal arteries.
Nerve supply
Nerve supply of the tongue is as follows:
Motor nerves
e All the intrinsic and extrinsic muscles except the palato-
glossus are supplied by the hypoglossal nerve.
e The palatoglossus is supplied by the cranial root of the
accessory nerve through the pharyngeal plexus.
Sensory nerves
e The lingual nerve is the nerve of general sensation and the
chorda tympani is the nerve of taste for the anterior two-
thirds of the tongue, except vallate papillae.
e The glossopharyngeal nerve is the nerve for both general
sensation and taste for the posterior one-third of the
tongue, including the circumvallate papillae.
e The posterior most part of the tongue is supplied by the
vagus nerve through the internal laryngeal branch.
Lymphatic drainage
e The tip of the tongue drains bilaterally to the submental
nodes.
e The right and left halves of the remaining part of the an-
terior two-thirds of the tongue drain unilaterally to the
submandibular nodes. A few central lymphatics drain
bilaterally to the same nodes.
e The posterior one-third of the tongue drains bilaterally to
the jugulo-omohyoid nodes; these are known as the
lymph nodes of the tongue.
haemorrhage and reduced platelet adhesiveness,
haemorrhage can occur in the muscles, joints, nail
beds and gingival tissues.
e Scurvy is associated with swelling, secondary infection,
loosening of teeth, enlarged, haemorrhagic, bluish, red
gingiva.
440 Quick Review Series: BDS 1st Year
Treatment
e A dose of 250 mg vitamin C, 8 hourly by mouth should
saturate the tissues quickly.
e Diet also should be corrected.
Q.2. Calcitonin.
Ans.
e Calcitonin is produced definitely by the thyroid gland.
@ Itis an antihypercalcemic hormone, which rapidly lowers
plasma calcium and phosphate levels especially in young
children in whom sensitivity to calcium is very high.
@ Calcitonin inhibits osteoclastic resorption of bone, and thus
prevents loss of calcium and phosphate from bone to blood.
Q.3. Effects of vitamin C deficiency on oral tissues.
Ans.
e Daily requirement of vitamin C is 60 mg.
e It controls collagen synthesis and synthesis of intercellu-
lar ground substance.
e Acts as a coenzyme in the oxidation of tyrosine.
A deficiency of vitamin C can result in:
e An enlargement and oedema of gingiva, which readily
bleeds.
e In experimental animals it has been seen that vitamin-C
deficiency causes failure of histo-differentiation of tooth
germ.
e The general resistance is lowered.
Q.4. Vitamin D.
Ans.
e Daily requirement—400 IU.
e Required for absorption of calcium for biologic activities
like formation of mineralized tissues in the body, cell
motility, etc.
e Deficiency results in soft bone and hypomineralized teeth.
e There will be loss of lamina dura.
e Vitamin D deficiency presents itself as rickets in children
and osteomalacia in adults.
Q.5. Functions of calcium.
Ans.
Functions of calcium are as follows:
e Calcium is absolutely necessary for the formation of bone
and teeth.
e Required for clotting of blood, cell motility, muscle
contraction, nerve excitability and conduction.
e Required for secretory processes.
e Required for hormonal responses.
Q.6. Decalcification of tooth structures in laboratory.
Ans.
Decalcification of tooth structures:
e After fixation is complete, the specimen is decalcified.
e This is achieved using 5% nitric acid.
e It takes about 7-10 days for complete decalcification by
changing the specimen to a series of jars of 5% nitric
acid.
Q.7. Nerve supply to tongue.
Ans.
Motor nerves
e All the intrinsic and extrinsic muscles except the palato-
glossus are supplied by the hypoglossal nerve.
e The palatoglossus is supplied by the cranial root of the
accessory nerve through the pharyngeal plexus.
Sensory nerves
e The lingual nerve is the nerve of general sensation and the
chorda tympani is the nerve of taste for the anterior two-
thirds of the tongue, except vallate papillae.
e The glossopharyngeal nerve is the nerve for both general
sensation and taste for the posterior one-third of the
tongue, including the circumvallate papillae.
e The posterior most part of the tongue is supplied by the
vagus nerve through the internal laryngeal branch.
Q.8. Infantile swallowing.
Ans.
e The first coordinated muscular activity of the infant is the
suckling reflex.
@ It is the suckling activity that occurs with the object mak-
ing contact with the infant's mouth. This reflex lasts for
approximately 12 months.
e Fluoroscopic investigations have revealed that the suck-
ling reflex is seen even before birth.
e In the newborn, the tongue is relatively large and posi-
tioned forward during normal suckling.
e The tip of the tongue protrudes through the anterior gum
pads and provides the anterior lip seal. This type of swal-
lowing is called visceral or infantile swallowing.
ORAL HISTOLOGY AND
DENTAL ANATOMY
VIVA QUESTIONS

ORAL HISTOLOGY

Who described the arrangement of the natural teeth first? 14. Which is the first permanent tooth to erupt in the oral cavity?
Ans. Graf von Spee. Ans. Mandibular first molar.

Two-digit nomenclature to separate teeth of four quadrants of 15. First evidence of initiation of primary dentition is usually around
oral cavity is given by which system? which period?
Ans. Federation Dentaire Internationale. Ans. 4 months in utero.
The calcification and eruption of both deciduous and permanent 16. Eruption date of deciduous maxillary 2nd molar is
teeth was given by Ans. 24 months.
Ans. Logam and Kronfeld.
17. Which deciduous molars bear the greatest resemblance to a premolar?
The portion of the tooth exposed in the oral cavity is known as
Ans. Maxillary first deciduous molars.
Ans. Clinical crown.
18. The largest mesiodistal diameter in primary dentition is seen in
What do you call the line of depression found between the devel-
which tooth?
opmental labial lobes of an anterior tooth?
Ans. Mandibular second molar.
Ans. Developmental groove.
What do you call the V-shaped space between proximal surfaces 19. What is the extent of primary dentition period?
of adjacent teeth? Ans. From 6 months to 6 years.
Ans. Embrasure.
20. How many cusps do the crown of the maxillary first primary
What happens to centric occlusion (CO) when all the teeth are molar have?
extracted? Ans. Four.
Ans. Centric occlusion (CO) is lost when all the teeth are extracted.
21. Which tooth has the maximum faciolingual diameter of the
Which is the last primary tooth to be replaced by a permanent tooth? crown among deciduous maxillary and mandibular molars?
Ans. Maxillary canine. Ans. Deciduous maxillary second molar.

What is the most common sequence of eruption of the permanent 22. How many roots do a primary maxillary first molar have?
maxillary teeth in children? Ans. Three.
Ans. 6-1-2-4-3-5-7-8.
23. Name the primary tooth that has outstanding morphologic
10. Calcification of permanent first molar usually begins at what age? resemblance to permanent teeth?
Ans. At birth. Ans. Mandibular first molar.
11. A radiograph of a 4-year-old child reveals no evidence of calcifi- 24. How do the roots of primary and secondary teeth are different?
cation of mandibular second premolar. What does this indicate? Ans.
Ans. The teeth may develop at a later age. © The roots of primary teeth are longer, slender, more divergent
12. The usual order of appearance of the primary teeth in the mouth is and flaring.
Ans. Central incisors, lateral incisors, first molars, canines, second @ The other difference is that the primary roots show less accessory
molars. and lateral canals.

13. Generally in majority of children, the sequence of eruption of 25. What is the shape of the occlusal surface of the permanent maxillary
permanent teeth in mandible is first molar?
Ans. 6-1-2-3-4-5-7-8. Ans. Rhomboidal.
‘V93) Quick Review Series: BDS 1st Year

26. Which tooth has the longest root? 39. Which premolars have a mesial marginal ridge more cervical than
Ans. The root of a maxillary canine is the longest. the distal marginal ridge?
Ans. Mandibular first premolar.
27. Palatogingival groove is found in which tooth?
Ans. Maxillary lateral incisor. 40. Using occlusal morphology as guide, the mandibular third molar
is most similar to
28. Greater crown bulk distal to the faciolingual bisecting plane of a
Ans. Mandibular permanent second molar.
tooth is the most typical of which of the mandibular teeth?
Ans. Canine teeth. 41. The total number of cingula in each dentition is
Ans. Twelve.
29. Which teeth have five cusps?
Ans. Maxillary and mandibular first molar teeth. 42. Name the maxillary teeth which have single antagonist teeth.
30. Which teeth have more than one occlusal form?
Ans. Third molars.
Ans. Maxillary first molar. 43. In occlusion, the anterior teeth have what type of contact?
31. What is the most common curvature of the palatal root of maxillary Ans. Surface-to-surface contact.
first molar?
44. In normal occlusion, with which grooves/surfaces of the perma-
Ans. Facial. nent mandibular first molar does the mesiobuccal cusp of the
32. Which teeth are seen with most common morphological variation? permanent maxillary first molar occlude?
A. Maxillary lateral incisors. Ans. Mesiobuccal surface.

33. A pronounced developmental groove is usually present on the 45. Group function occlusion is common in which age group?
mesial marginal ridge of which permanent teeth? Ans. Above 30 years.
Ans. Maxillary first premolar.
46. When a molar has no opposing tooth, what happens to its position?
34. In which tooth the mesiodistal measurements are greater Ans. Extruded.
lingually than facially?
47. Define overjet.
Ans. Maxillary first molar.
Ans. Horizontal overlap; overjet is the horizontal overlap of the incisal
35. Largest cusp in permanent mandibular first molar is ridges or buccal cusp ridges of the maxillary teeth to the incisal ridges
Ans. Mesiobuccal cusp. or buccal cusp ridges of the mandibular teeth in centric occlusion.
36. If a mandibular canine has bifurcated roots, how are they most 48. In centric occlusion, the cusp tip of the maxillary canine is in
commonly placed? alignment with which mandibular tooth?
Ans. Bifurcated roots and root canals are sometimes seen in man- Ans. Facial embrasure of canine and premolar.
dibular canines. If they are present, they are situated one labially
49. Normal dentition in centric occlusion, opposing contact may be
and one lingually.
expected at
37. Which teeth have five cusps? Ans. Buccal slopes of lingual cusps of maxillary posterior teeth.
Ans. Maxillary and mandibular first molar teeth.
50. In the intercuspal position, the lingual cusp of maxillary second
38. Which of the premolars are usually the smallest? premolar contacts which tooth?
Ans. Mandibular first premolar teeth. Ans. Distal fossa of mandibular second premolar.

DENTAL ANATOMY

Reversal lines which may be seen on the cribriform plate (alveolar . What is the blood supply of cementum?
bone proper) of the alveolar process indicate the cessation of Ans. Cementum is avascular.
Ans. Osteoclastic activity.
. Cementum has the highest content of which substance among all
Organ of Chievitz is seen near which surface of mandible? the mineralized tissues?
Ans. Medial surface of the mandible. Ans. Fluorides.

What do you call the fibres which continue from bone to ligament? . The microhardness of dentin as compared to enamel is
Ans. Sharpey’s fibres. Ans. The microhardness of dentin is one-fourth of that of enamel.

Osteoclasts are rich in which enzyme? 10. Physically and chemically, the dentin is closely related to which tissue?
Ans. Acid phosphatase. Ans. Bone tissue.

How is the inorganic content of cementum related to bone? 11. What is the formula of hydroxyapatite crystal?
Ans. Inorganic content of cementum is equal to that of bone. Ans. 3Ca(P0,4))*Ca(OH) 9.

Maximum fluoride content is seen in which layer of tooth? 12. Dentin consists of how much of organic and inorganic material?
Ans. Dental cementum. Ans. 35% organic + 65% inorganic.
 Oral Histology and Dental Anatomy

13. Before the first division in meiosis, how much is the DNA content? 32. What are the functions of the oral mucosa?
Ans. DNA content is tetraploid. A. Protection and secretion.

14, What do you call a fluid-filled hollow ball in which two cell types 33. What is the function of the Odland body found in cells?
can be distinguished after multiple cleavages in fertilized ovum? Ans. Formation of intercellular agglutinating material.
Ans. Blastocyst.
Or
15. Which cells are responsible for formation of bilaminar disc in an
embryo?
The Odland body is a small organelle which discharges its contents
Ans. Embryoblasts.
into intercellular space forming an intercellular agglutinating
material contributing to permeability barrier.
16. Which structures form the tongue?
Ans. First, third, fourth branchial arches. 34. What do you call the connective tissue part of the oral mucosa?
Ans. Lamina propria.
17. Give few characteristics of the buccopharyngeal (oropharyngeal)
membrane. 35. What is the width of the basement membrane?
Ans. The buccopharyngeal membrane: Ans. 1-4 mm.
© consists of ectoderm and endoderm only
36. Which cells of periodontal ligament are of epithelial origin?
© separates foregut from stomodeum
Ans. The cell rests of Malassez.
@ extends between the frontonasal elevation and the processes of
the first branchial arch. 37. Collagen biosynthesis occurs inside which cells?
Ans. Fibroblasts.
18. The oronasal membrane, located between the nasal sac and
the embryonic oral cavity, is a structure consisting of which 38. Width of the periodontal ligament is least at which region on
embryonic layer? teeth?
Ans. Ectoderm only. Ans. Fulcrum of rotation.
19. Initiation of tooth formation occurs in which embryonic age? 39. Development of supporting tissues of the tooth is initiated by
Ans. 6th week of IU life. which cells?
20. The dental tissue develops from which embryonic layer? Ans. Cells of dental follicle.
Ans. Ectoderm and mesoderm.
40. The radicular pulp is continuous with tissues of the periapical
21. The percentage of inorganic matter in fully developed enamel is area via which structure?
about Ans. Apical foramen.
Ans. 96%.
41. Which two things will decrease with age in the dental pulp?
22. The hardest calcified tissue in the human body is Ans. Number of reticulin fibres and size of pulp.
Ans. Enamel.
42. What is the number of pulp organs in a person?
23. Inorganic material in enamel is Ans. 52 pulp organs (32 in the permanent and 20 in primary
Ans. 96%. teeth).

24. Which calcified tissue has the largest hydroxyapatite crystals? 43. What is the total volume of all permanent pulp organs?
Ans. Enamel. Ans. 0.38 cc.

25. Gubernacular canal and gubernacular cord are seen in relation to 44. Salivary glands arise from which structure?
Ans. Succedaneous teeth. Ans. Ectomesenchyme.
26. Movement of tooth to close the intermaxillary gap during eruption 45. How do you describe the structure of salivary glands?
is due to which type of eruption? Ans. Compound acinar.
Ans. Active eruption.
46. Which of the salivary glands ducts show the basal cell membrane
27. How does tooth eruption occur? foldings with radically arranged mitochondria?
Ans. Tooth erupts due to eruptive forces. Ans. Striated duct.
28. What do you call if a tooth without antagonist overerupts further? 47. What are the striations observed in striated ducts of major
Ans. Supra-erupted. salivary glands?
Ans. Mitochondria that supply energy.
29. What do you call the opening of maxillary sinus into nasal cavity?
Ans. Ostium. 48. What is the normal interincisal distance?
Ans. 48 mm.
30. Which type of epithelium lines the maxillary sinus?
Ans. Pseudostratified columnar and ciliated. 49. The roof of the mandibular fossa consists of what type of bone?
Ans. Thin compact bone.
31. When does the maxillary sinus develop as compared to ethmoidal
sinus? 50. The condyle of the mandible is composed of which type of bone?
Ans. The maxillary sinus develops before ethmoidal air sinus. Ans. Cancellous bone covered by thin layer of compact bone.
This page intentionally left blank
MULTIPLE
CHOICE
QUESTIONS
Section! |General Anatomy, General Histology and Embryology
Section Il Physiology
Section Ill Biochemistry
Section IV Oral Histology and Dental Anatomy
This page intentionally left blank
MULTIPLE CHOICE
QUESTIONS
SECTION I: GENERAL ANATOMY, GENERAL HISTOLOGY AND EMBRYOLOGY

. Which of the following papillae of the tongue are the . The parotid duct pierces the buccinator muscle oppo-
largest, are the least numerous, have many taste buds site the
and are associated with the ducts of von Ebner’s glands? . mandibular first premolar
a. Foliate ap. maxillary first premolar
b. Filiform . maxillary first molar
c. Fungiform . maxillary second molar
ofa

d. Circumvallate . maxillary third molar

. Fordyce spots appearing on the mucous membrane of . In salivary glands, folds of the basal portion of the cell
the cheek result from the presence of membrane containing mitochondria are characteristic
. aberrant sweat glands of the
ap

. aberrant sebaceous glands a. cells composing demilunes

. superficial salivary glands b. cells of the striated ducts
. aberrant fatty accumulations c. cells of the intercalated ducts
ean

. none of these d. serous cells of the parotid gland

. Which of the following structures contacts the thyroid . All of the following structures can be seen in a histologic
gland? examination of the adult parotid gland except
a. Lingual nerve . striated ducts
op

b. Phrenic nerve . serous demilunes

c. Thoracic duct . intercalated ducts
onan

d. Thyroarytenoid muscle . myoepithelial cells

e. Recurrent laryngeal nerve . granular serous cells
. Cell bodies of taste fibres from the anterior two-thirds . Which of the following tissues would be least affected if
of the tongue are located in which of the following the anterior lobe of the hypophysis were destroyed?
ganglia? . Thyroid epithelium
ap

a. Otic . Medulla of the adrenal gland

b. Geniculate . Interstitial cells of the testis
conn

c. Trigeminal . Zona fasciculata of the adrenal gland

d. Pterygopalatine . Spermatogenic epithelium of the testis

l.d 2.b 3.€ 4b 5.d 6.b 7.b 8D

448 Quick Review Series: BDS 1st Year

A section of the posterior lobe of the hypophysis con- 15. The combined layers of stomodeum ectoderm and fore-
tains mainly gut endoderm comprise the
a. follicles a. buccopharyngeal membrane
b. alpha and beta cells b. first pharyngeal arch
c. chromophobes and chromophils c. mandibular process
d. unmyelinated nerve fibres d. primitive palate
10. Colloid in the usual thyroid follicle stains 16. The thinnest epithelium of the oral cavity is found
a. basophilic on the
b. acidophilic . soft palate

op
c. positive for DNA . buccal gingiva
d. positive for steroids . lingual gingiva

onan
. sublingual mucosa
11. The oral mucosa of the cheek differs from the skin cov-
. oral surface of lip
ering the outer surface of the lip by possessing
a. sweat glands in the submucosa 17. An upward extension from the thyroid gland may be
b. groups of sebaceous glands associated with hair identified as
follicles a. a remnant of the thyroglossal duct
c. dense, collagenous fibres that immovably fix it to the b. a pyramidal lobe
orbicularis oris muscle c. a muscular slip
d. a stratified, squamous, keratinized epithelium with a d. any of the above
thicker lamina propria
18. The point where the parietomastoid, occipitomastoid
e. a stratified, squamous, non-keratinized epithelium
and lambdoid sutures meet is
with a thinner lamina propria
a. pterion
12. In salivary glands, branched cells that lie between the b. obelion
basement membrane and glandular or ductal epithe- c. asterion
lium are known as d. bregma
a. demilunes
19. The submucosa of the anterolateral area of the hard pal-
b. myoepithelial cells
ate is characterized by
c. mucous cells
. serous glands only
d. serous cells
ap

. mucous glands only

13. All of the following structures are concerned with devel- . mixed serous and mucous glands
onan

opment of the tongue except . adipose tissue

. copula . dense connective tissue
wep

. macula
20. Where does the submandibular duct open into the oral
. tuberculum impar
cavity?
. second branchial arch
ona

a. At the sublingual caruncle (papilla)

. third branchial arch
b. At the mandibular second molar
14. Which of the following is correct concerning the struc- c. At the maxillary second molar
ture of the palatal submucosa? d. On the plica fimbriata
a. A network of vascular spaces acts as a hydrostatic
21. The oesophagus is subdivided into three portions on the
cushion
basis of a transition in the
b. The entire submucosa consists of loose connective
a. submucosa
tissue containing compressible ground substance
b. adventitia
c. The anterior zone contains spaces filled with fat,
c. mucosal layer
while the posterior zone contains nests of mucous
d. muscularis externa
glands
d. The anterior zone consists of a dense collagenous
network, while the posterior zone contains com-
pressible vascular spaces

9.d 10.b ll.e 12.b 13.b 14.¢ 15.a 16.d 17.d 18.c 19.d 20.a 21.d
 Multiple Choice Questions

22. Which of the following laryngeal muscles is not inner- 28. Cell bodies of primary sensory neurons of mechano-
vated by the recurrent laryngeal nerve? receptors in the periodontal ligament are found in
a. Cricothyroid which of the following brainstem nuclei?
b. Aryepiglottic a. Nucleus solitarius
c. Transverse arytenoids b. Reticular formation
d. Lateral cricoarytenoid c. Descending nucleus of V
e. Posterior cricoarytenoid d. Chief sensory nucleus of V
e. Mesencephalic nucleus of V
23. The lateral boundary of the retropharyngeal space at the
level of the oropharynx is the 29. Most of the postganglionic sympathetic nerve fibres of
a. carotid sheath the head are derived from the
b. pterygomandibular raphe a. superior cervical ganglion alone
c. medial pterygoid muscle and its fascia b. superior cervical ganglion and the vagus nerve
d. stylopharyngeus muscle and its fascia c. superior cervical ganglion and the glossopharyngeal
nerve
24, Most intrinsic muscles of the larynx receive their motor
d. inferior, middle and superior cervical ganglia
innervation from
. the laryngeal plexus 30. The thoracic splanchnic nerves to the celiac ganglion
ap

. the inferior (recurrent) laryngeal nerve consist predominantly of

. the external branch of the superior laryngeal nerve a. parasympathetic fibres
onan

. the internal branch of the superior laryngeal nerve b. preganglionic visceral efferents
. both external and internal branches of the superior c. postganglionic visceral efferents
laryngeal nerve d. sympathetic fibres
25. Which of the following has no lymph sinuses, and is sur- 31. Which of the following nerves descends anteriorly to the
rounded partly by connective tissue and partly by epi- root of the right lung and between the mediastinal
thelium, the latter forming deep infoldings? pleura and the pericardium?
. Thymus a. The right vagus nerve
op

. Peyer’s patch b. The right greater splanchnic nerve

. Lingual tonsil c. The nerve that supplies the right half of the diaphragm
. Palatine tonsil d. The nerve that supplies pain fibres to alveoli of the
enn

. Pharyngeal tonsil right lung

26. Trigeminal neuralgia (tic douloureux) is characterized by 32. The posterior cord of the brachial plexus gives rise to
a. paralysis of one side of the face which of the following nerves?
b. uncontrollable twitching of one eye . Radial
ap

c. prolonged episodes of pain in one side of the face . Long thoracic

d. dull pain when pressure is applied over the affected . Thoracoacromial
area . Medial pectoral
ofa

e. sharp excruciating pain when light pressure is applied . Lateral pectoral

to the affected area
33. The postcentral gyrus is located in the
27. Which of the following nerves innervates the capsule of insula
Te

the temporomandibular joint? . frontal lobe

. Facial . temporal lobe
wep

. Buccal . parietal lobe

eon

. Maxillary . occipital lobe

. Mylohyoid
ona

34. Cell bodies of taste fibres from the anterior two-thirds of

. Auriculotemporal
the tongue are located in which of the following ganglia?
a. Otic
b. Geniculate
c. Trigeminal
d. Pterygopalatine

22.a 23.a 24.b 25.e€ 26.e 27.¢e 28.¢ 29.a 30.b 31.c 32.a 33.d 34.b
450 Quick Review Series: BDS 1st Year

35. Proprioceptors are found in each of the following except 42. Which of the following areas of the cerebral cortex is
. gingiva concerned with the recognition of painful stimuli from
ap

. skeletal muscle the teeth?

. the pulp of a tooth a. Precentral gyrus
. the periodontal ligament b. Superior temporal gyrus
ean

. the temporomandibular joint c. Postcentral gyrus

d. Cortex along the lips of the calcarine fissure
36. The postganglionic sympathetic fibres to the vessels of
the submandibular salivary gland arise from cells in the 43. Which of the following contains the hypothalamo-
a. otic ganglion hypophyseal tract?
b. submandibular ganglion . Pars nervosa

ep
c. pterygopalatine ganglion . Pars intermedia
d. superior cervical ganglion . Infundibular stalk

onan
. Pars distalis of the hypophysis
37. The optic tracts consist of axons from which of the fol-
. None of the above
lowing cells?
Rod 44. Ependymal cells constitute the tissue that
TS

. Bipolar a. lines the ventricles of the brain

. Ganglion b. lines the ventricles of the heart
. Horizontal c. forms a part of the peripheral neuroglia
eon

. All of the above d. covers the nerve cell body in the ganglion
38. The large ascending bundle of fibres in the medulla that 45. The primary source of cranial connective tissue cells is
is composed of second-order neuron fibres conveying ectoderm
TS

proprioception and discriminatory touch sensations to . endoderm

conscious levels is the . ectomesenchyme
a. medial lemniscus . primary follicle
enn

b. reticular formation . none of the above

c. spinal trigeminal tract
46. Sensations of pain and temperature are carried by the
d. inferior cerebellar peduncle
. corticospinal tract
ap

39. Which of the following structures passes through the . corticobulbar tract
foramen rotundum? . lateral spinothalamic tract
a. Maxillary nerve . ventral reticulospinal tract
ofa

b. Zygomatic nerve . dorsal spinocerebellar tract

c. Lacrimal artery
47. The auriculotemporal nerve carries some fibres that are
d. Maxillary artery
a. secretory to the parotid gland
40. A major tract connecting right and left cerebral hemi- b. motor to the masseter muscle
spheres is the c. afferent from the carotid body
a. cingulum d. sensory to the lining of the tympanic cavity
b. corpus callosum
48. Embryologically, the spinal autonomic ganglia are de-
c. internal capsule
rived from
d. superior occipitofrontal bundle
a. the neural crest
Al. Motor fibres from the mandibular division of the trigemi- b. the neural tube
nal nerve are distributed to which of the following muscles? c. cranial placodes
a. Stylopharyngeus muscle only d. all of the above
b. Intrinsic muscles of the tongue
49. Surgical excision of the parotid gland endangers which
c. Muscles of mastication and anterior belly of digastric
of the following structures in addition to the facial nerve?
only
a. Hypoglossal nerve
d. Muscles of facial expression and posterior belly of
b. Motor nerves to the muscles of mastication
digastric
c. External carotid artery and auriculotemporal nerve
e. Muscles of mastication, anterior belly of digastric,
d. Lesser occipital nerve and spinal accessory nerve
tensor tympani, tensor veli palatini and mylohyoid

35.c 36.d 37.c 38.a 39.a 40.b 41.e 42.c 43.c 44.a 45.c 46.c 47.a 48.a 49.c
 Multiple Choice Questions

50. The primary auditory cortex of the brain is a part of 56. Which of the following arteries is not a branch of the
which lobe? maxillary artery?
a. Insular . Deep temporal

ap
b. Frontal . Middle meningeal
. Parietal . Inferior alveolar
. Occipital . Superficial temporal
oan

ofa
. Temporal . Posterior superior alveolar
51. Which of the following branches of the axillary artery 57. Which of the following arteries is not derived from the
usually supplies the latissimus dorsi muscle? celiac trunk or its branches?
a. Thoracodorsal a. Left gastric
b. Thoracoacromial b. Short gastric
c. Lateral thoracic c. Gastroduodenal
d. Circumflex scapular d. Left gastroepiploic
e. Posterior humeral circumflex e. Inferior pancreaticoduodenal
52. The presence of valves characterizes 58. Which of the following blood elements is a fragment of
. veins only megakaryocytic cytoplasm?
ap

. blood sinusoids only . Platelet

op
. lymphatic vessels only . Normoblast
onan

. veins and lymphatic vessels . Erythrocyte

onan
. blood sinusoids and blood capillaries . Promyelocyte
. Proerythroblast
53. In the circulating blood of an adult, which of the follow-
ing leucocytes normally appear in the highest numbers? 59. In the fetus, blood enters the common carotid arteries
a. Basophils by means of the
b. Monocytes . aorta
ap

. Eosinophils . pulmonary vein

. Neutrophils . pulmonary artery
oan

conn

. Lymphocytes . ductus arteriosus

. thebesian veins (venae cordis minimae)
54. The external carotid artery contributes to the blood sup-
ply of the nasal cavity by way of the 60. The most prominent functional component in the
a. facial artery, the superior labial artery and angular tunica media of small arteries is
arteries . elastic fibres
ep

b. lingual artery, the deep lingual artery and internal . smooth muscle
nasal arteries . striated muscle
onan

c. occipital artery, the ascending palatine artery and . reticular fibres

posterior nasal arteries . collagenous fibres
d. maxillary artery, the sphenopalatine artery and pos-
61. Which of the following arteries is most concerned with
terior lateral nasal arteries
the blood supply to the upper lip?
e. superficial temporal artery, the transverse facial
. Facial
artery and external nasal arteries
op

. Maxillary
55. The zona pellucida is associated with which of the fol- . External nasal
onan

lowing? . Greater palatine

. Corpus luteum . Anterior superior alveolar
op

. Corpus albicans
62. Right subclavian and right common carotid arteries
. Oocyte in a mature follicle
arise from the
aa

. Oocyte in an early primary follicle

. thoracic aorta
ap

. ascending aorta
. arch of the aorta
conn

. pulmonary artery
. brachiocephalic artery

50.e 51.a 52.d 53.d 54.d 55.c 56.d 57.d 58.a 59.a 60.b 61.a 62.e
452 Quick Review Series: BDS 1st Year

63. The upper five or six anterior intercostal arteries are 70. The normal percentage of neutrophilic leucocytes in a
branches of the differential blood count is approximately
. thoracic aorta . 0.5-1%
wep

ap
. musculophrenic arteries . 2.5%
. pericardiacophrenic arteries . 8.15 %
. internal thoracic arteries
ona

ofa
. 20-25 %
. superior epigastric arteries . 60-70 %

64. Which of the following structures is not found in the 71. Most of the antibodies in the body that act against bac-
substance of the parotid gland? terial antigens are produced by
a. Facial vein a. T-lymphocytes
b. Facial nerve b. B-lymphocytes
c. External carotid artery c. macrophages
d. Superficial temporal artery d. plasma cells
e. A branch of the great auricular nerve
72. The muscles of mastication receive their major blood
65. Which of the following connective tissue cells is most supply from branches of which part of the maxillary
concerned with defense against bacterial invasion? artery?
a. Basophil a. Mandibular (first) part
b. Eosinophil b. Pterygoid (second) part
c. Mast cell c. Pterygopalatine (third) part
d. Macrophage d. None of the above
e. Erythrocyte
73. Abdominal organs supplied by the three unpaired
66. The lingual artery passes branches of the aorta include all of the following
a. deep to the hyoglossus muscle except the
b. superficial to the mylohyoid muscle . spleen
ap

c. superficial to the digastric muscle . stomach

d. between digastric and mylohyoid muscles . pancreas
conn

. vermiform appendix
67. One important collateral circulation of the hepatic por-
. suprarenal (adrenal)
tal system is via the
a. renal veins 74. The presence of valves characterizes
b. mesenteric veins veins only
SP

c. oesophageal veins . blood sinusoids only

d. external iliac veins . lymphatic vessels only
veins and lymphatic vessels.
eon

68. Which of the following does not occur during contrac-

. blood sinusoids and blood capillaries
tion of the left ventricle of a normal heart?
. The aortic semilunar valve opens 75. Which of the following characterizes a lymph node?
wep

. Blood enters the coronary arteries a. It contains medullary cords

. The pulmonary semilunar valve opens b. It lacks afferent lymphatics
. The left atrioventricular valve closes c. It has crypts lined with stratified squamous epithelium
ona

. The right atrioventricular valve closes d. It has efferent lymphatics leaving at multiple sites
from the capsule
69. The middle cardiac vein empties into the
. left atrium 76. Which of the lymphoid tissues in the body are consid-
op

. right atrium ered subepithelial and nonencapsulated?

. coronary sinus . Thymus gland and lymph nodes
p

. great cardiac vein b. Lymph nodes and aggregated nodules

enn

. anterior cardiac vein c. Pharyngeal tonsils and thymus gland

d. Peyer’s patches and pharyngeal tonsils

63.d 64.a 65.d 66.a 67.c 68.b 69.c 70.e 71.d 72.b 73.¢ 74.d 75.a 76.d
 Multiple Choice Questions

77. Infections or neoplasms that spread by lymphatics from 83. Connective tissue proper is characterized as having
the skin of the angle of the mouth pass to the a. little tissue fluid
. parotid nodes b. poor reparative ability
wep

. cavernous sinus c. sensitivity as its main function

. pterygoid plexus d. more intercellular material than cells
. submandibular nodes
ona

84. The superficial head of the medial pterygoid muscle

. anterior auricular nodes
originates on the tuberosity of the maxilla and on the
78. The secretion of which of the following endocrine a. pterygoid fossa
glands is not essential to life? b. pyramidal process of the palatine bone
. Parathyroids c. crest of the greater wing of the sphenoid bone
ap

. Adrenal cortex d. lateral surface of the lateral pterygoid plate

. Adrenal medulla
85. Which of the following muscles serves as the forearm’s
. Anterior pituitary
ean

principal extensor?
. Pancreatic islets (Langerhans)
. Pronator teres

ap
79. The submental lymph nodes receive drainage from the . Brachioradialis
1. upper lip. . Triceps brachii
2. tip of the tongue. . Coracobrachialis

ofa
3. mandibular incisors. . Extensor carpi radialis longus
4. anterior floor of the mouth.
86. The tendon of the tensor veli palatini muscle curves
5. middle portion of the lower lip
around the
6. lateral portion of the lower lip
angular spine
. (1), (2), (3) and (4)
TS

. styloid process
p

b. (1), (2), (3) and (6)

. pterygoid hamulus
c. (1), (2), (5) and (6)
. lateral pterygoid plate
enn

d. (1), (4), (5) and (6)

. spine of the sphenoid
e. (2), (3), (4) and (5)
87. The posterior cervical triangle is bounded partly by
80. The basic framework or stroma of all lymphoid tissues
a. trapezius and subclavius muscles
except thymus consists of
b. splenius capitis and trapezius muscles
a. reticular fibres primarily and a lesser amount of col-
c. trapezius and sternocleidomastoid muscles
lagen fibres
d. the clavicle and the longus colli muscle
b. a combination of epithelioid cells and reticular fibres
c. acombination of smooth muscle and reticular fibres 88. The middle constrictor muscle of the pharynx origi-
d. some smooth muscle and trabeculae of collagen nates from the
fibres a. hyoid bone
e. collagen fibres primarily and some elastic fibres b. thyroid cartilage
c. pterygoid hamulus
81. Variation of the size of the lumen of the bronchiole dur-
d. pterygomandibular raphe
ing inspiration and expiration is caused primarily by
a. striated muscle and cartilage 89. A portion of which of the following muscles has fibres
b. smooth muscle and elastic fibres inserting into the articular disc of the temporomandib-
c. the basement membrane and collagen fibres ular joint?
d. areolar connective tissue and cartilage . Upper head of the lateral pterygoid
p

b. Lower head of the lateral pterygoid

82. The cellular organelle that binds and releases calcium dur-
c. Deep head of the medial pterygoid
ing relaxation and contraction of skeletal muscle is the
d. Superficial head of the medial pterygoid
. nucleus
ap

. lysosome
. mitochondrion
. transverse tubule
ean

. sarcoplasmic reticulum

77.d 78.c 79.¢ 80.a 81.b 82.¢ 83.d 84.b 85.c 86.c 87.c 88.a 89.a
454 [ellife k Review Series: BDS 1st Year

90. At a muscle-tendon junction, the union is made by 95. The sphenomandibular ligament is attached to the
a. myofibrils connecting with collagenous fibrils of the a. lesser wing of the sphenoid bone and the neck of the
tendon mandible
b. an abundance of reticular fibres in the area of the b. spine of the sphenoid bone and lingual of the
junction mandible
. acontinuity of connective tissue sheaths of the mus- c. spine of the sphenoid bone and the angle of the
cle with those of the tendon mandible
. a special thickening of sarcoplasm that unites with d. none of the above
collagenous fibrils of the tendon
96. The hypopharyngeal diverticulum is normally present
91. Most intrinsic muscles of the larynx receive their motor at
innervation from a. Laimer’s triangle
. the laryngeal plexus b. Rathke’s pouch
ap

. the inferior (recurrent) laryngeal nerve c. Killian’s dehiscence

. the external branch of the superior laryngeal nerve d. Denker’s triangle
. the internal branch of the superior laryngeal nerve
enn

97. Peripherally located nuclei are found in which of the

. both external and internal branches of the superior
following types of adult muscle cells?
laryngeal nerve
a. Smooth only
92. Which of the following muscles or muscle fibres are b. Cardiac only
elevators of the mandible? c. Skeletal only
. Medial pterygoid muscle d. Smooth and cardiac
WN eH

. Lateral pterygoid muscle e. Cardiac and skeletal

. Anterior fibres of the temporal muscle
98. The mylohyoid muscle functions to
. Posterior fibres of the temporal muscle
a. depress the hyoid bone
. (1) and (3) only
b. raise the floor of the mouth
Tp

. (1), (3) and (4)

¢. approximate faucial pillars
. (2), (3) and (4)
d. close the opening to the nasopharynx
ohn

. (2) and (4) only

e. prevent food from entering the larynx
. All of the above
99. Alpha cells in the islets of Langerhans are the source of
93. In skeletal muscle, a triad consists of
a. insulin
a . a‘T’ tubule and associated mitochondria
b. glucagon
b. aT? tubule and invagination of the sarcolemma
c. glycogen
¢. a zone of attachment between adjacent cells
d. secretin
d. . terminal cisternae and sarcoplasmic reticulum.
e. thiamine
e. terminal cisternae and a finger-like invagination of
the sarcolemma 100. Beta cells in the islets of Langerhans are the source of
. insulin
94. Which of the following structures crosses the masseter
ap

. glucagon
muscle and pierces the buccinator muscle?
. glycogen
. Parotid duct
. secretin
ofa

. Masseteric nerve
aap

. thiamine
. Transverse facial artery
. Zygomatic muscle branch of the facial nerve

90.c 91.b 92.b 93.b 94.a 95.b 96.c 97.c 98.b 99.b 100.a
 Multiple Choice Questions

SECTION Il: PHYSIOLOGY

. Thermoregulatory response activated by cold is . In clinical practice, GFR is estimated using the plasma
a. cutaneous vasodilatation clearance value of
b. anorexia a. inulin
c. increased voluntary activity b. PTH
d. increased respiration c. glucose
d. creatinine
. Which of these organelles function as the digestive sys-
tem of the cell? 10. The number of muscle fibres in a motor unit are least in
a. Mitochondria a. laryngeal muscles
b. Rough ER b. pharyngeal muscles
c. Golgi apparatus c. muscles of middle ear
d. Lysosomes d. extraocular muscles

. Thrombopoietin is produced by ll. Normal myeloid:erythroid ratio is

a. monocytes a. 3:1
b. liver b. 1:3
c. megakaryocytes c. 4:1
d. megakaryoblasts d. 6:1
. In determining blood pressure by the auscultatory 12. Glucose Tolerance Test is usually done to assess
method a. acute pancreatitis
a. the loudest sound is the diastolic blood pressure b. carcinoma of head of pancreas
b. systolic pressure estimation tends to be lower than c. acinar function of the pancreas
that made by the palpatory method d. endocrine dysfunction of pancreas
c. the first sound heard is the systolic blood pressure
13. All of the following hormones have cell surface recep-
d. the sounds that are heard are generated in the heart
tors except
. Which of the following is a function of the Golgi a. insulin
apparatus? b. adrenalin
a. Modification of proteins c. thyroxin
b. mRNA synthesis d. growth hormone
c. Protein storage
14. The normal brown red colour of faeces results from the
d. tRNA synthesis
presence of
. The normal pH of human blood is a. heme
a. 7.0 b. stercobilin
b. 7.2 c. biliverdin
c. 7.35-7.40 d. bilirubin diglucuronide
d. 7.6
15. The supraoptic nucleus of the hypothalamus is believed to
. Intestinal absorption of Ca** is reduced by control the secretion of which of the following hormones?
a. phytic acid a. ADH
b. lactic acid b. Oxytocin
c. proteins c. GH
d. carbohydrates d. ACTH

. The following factors increase the cardiac output except 16. Steroid hormones are believed to enter target cells by
a. preload a. facilitated diffusion
b. afterload b. carrier-mediated endocytosis
c. heart rate c. cholesterol-lined pores in the plasma membrane
d. myocardial contractility d. simple diffusion

lic 2.d 3.b 4c 5.a 6.c 7.a 8b 9.d 10.a lla 12.d 13.c 14.b 15.a 16.d
456 Quick Review Series: BDS 1st Year

17. The skeletal muscle action potential 26. Renin release in inhibited by
a. is not essential for contraction to occur a. PGL
b. has a prolonged plateau phase b. atrial natriuretic peptide (ANP)
c. spreads inward to all parts of the muscle via T-tubule c. epinephrine
system d. decreased glomerular filtration
d. begins with an inward movement of K* ions
27. Citrate is a useful anticoagulant because of its ability to
18. The substance renin is a. buffer basic groups of coagulation factors
a. a hormone b. bind factor XII
b. an enzyme c. bind vitamin K
¢. a potent vasoconstrictor d. chelate calcium
d. a vasodilator
28. Ventricular muscle receives impulses directly from the
19. What effect does hyperventilation have on the oxygen? a. Purkinje system
a. PO, and O, affinity decreases b. bundle of His
b. PO, and ©, affinity increases c. right and left bundle branches
c. PO, decreases and ©, affinity increases d. AV node
d. PO, increases and O, affinity decreases
29. After secretion of trypsinogen into the duodenum, the
20. Acromegaly is a disorder of enzyme is converted into its active form trypsin by
a. excess growth hormone secretion a. enterokinase
b. excess thyroxin secretion b. procarboxypeptidase
c. excess ACTH secretion c. pancreatic lipase
d. excess FSH secretion d. previously secreted trypsin
21. Supporting cells of taste buds are called 30. Sensory receptors for pain are
a. sustentacular cells a. Pacinian corpuscles
b. taste cells b. end organs of Ruffini
c. von Ebner cells c. end bulbs of Krause
d. basket cells d. free nerve endings
22. Partially keratinized papilla is 31. The haemoglobin—oxygen saturation of blood entering
a. fungiform the right ventricle is approximately
b. filiform a. 97%
c. circumvallate b. 85%
d. foliate c. 75%
d. 53 %
23. Physiologic programmed cell death is known as
a. apoptosis 32. Function of hepatic Kupffer cells is
b. lysis a. formation of sinusoids
c. autolysis b. vitamin A storage
d. autopsy c. increases blood perfusion
d. phagocytosis
24, Open-faced nucleus in a cell signifies
a. that the cell is resting 33. Glomerular filtrate contains all of the following except
b. that the cell is active a. urea
c. nothing b. glucose
d. that the cell is in a transition phase c. plasma proteins
d. sodium chloride
25. Which of the following is not an effect of insulin?
a. Decreased gluconeogenesis 34. The non-REM (NREM) sleep is commonly associated with
b. Increased gluconeogenesis a. frequent dreaming
c. Increased transport of glucose into cells b. frequent penile erections
d. Induction of lipoprotein lipase c. increased blood pressure
d. night terrors

17.c 18.b 19.c 20.a 21.a 22.c 23.a 24.b 25.b 26.b 27.d 28.d 29.a 30.d 31.c 32.d 33.c 34.d
 Multiple Choice Questions

35. Which of the following is a procoagulation protein? 43. Adams-—Stokes syndrome is caused due to
a. Thrombomodulin a. atrial fibrillation
b. Protein C b. atrial extrasystole
c. Protein S c. complete AV block
d. Thrombin d. ventilation fibrillation
36. HbA 1c level in blood explains 44. The blood cells responsible for humoral immunity are
a. acute rise in sugar a. T cells
b. long-term status of blood sugar b. B cells
c. hepatorenal syndrome c. no cells, only antibodies
d. chronic pancreatitis d. mostly B cells, sometimes T cells
37. Bone marrow transplantation can be used as a treat- 45. Osteoclasts are inhibited by
ment for all except a. parathyroid hormone
a. osteopetrosis b. calcitonin
b. adrenoleukodystrophy c. 1.25-dihydroxycholecalciferol
c. Hurler’s syndrome d. tumour necrosis factor
d. haemochromatosis
46. CO, is primarily transported in the arterial blood as
38. The main excitatory neurotransmitter in CNS is a. dissolved CO;
a. glycine b. carbonic acid
b. acetylcholine c. carbaminohaemoglobin
c. aspartate d. bicarbonate
d. glutamate
47. The membrane protein, clathrin, is involved in
39. The force of muscle contraction can be increased by all a. cell motility
of following except b. receptor-mediated endocytosis
a. increasing the frequency of activation of motor units c. exocytosis
b. increasing the number of motor units activated d. cell shape
c. recruiting larger motor units
48. All of the following can cause osteoporosis, except
d. increasing the amplitude of action potential in the
a. hyperparathyroidism
motor neurons
b. steroid use
40. The blood in the vessels normally does not clot because c. fluorosis
a. vitamin K antagonists are present in plasma d. thyrotoxicosis
b. thrombin has a positive feedback on plasminogen
49. Hypercalcaemia associated with malignancy is most of-
c. sodium citrate in plasma chelates calcium ions
ten mediated by
d. vascular endothelium is smooth and coated with
a. parathyroid hormone (PTH)
glycocalyx
b. parathyroid hormone-related protein (PTHrP)
41. Golgi bodies are responsible for c. interleukin-6 (IL-6)
a. synthesis of polypeptides d. calcitonin
b. formation of glycoproteins only
50. SA node acts as a pacemaker of the heart because of the
c. lipid and steroid synthesis
fact that it
d. modification and sorting of glycoproteins
a. is capable of generating impulses spontaneously
42. Lipoxins belong to which of the following family of b. has rich sympathetic innervations
chemical mediators of inflammation? c. has poor cholinergic innervations
a. Arachidonic acid metabolites d. generates impulses at the highest rate
b. Kinin system
c. Chemokines
d. Cytokines

35.d 36.b 37.d 38.d 39.c 40.b 41.d 42.a 43.c 44.d 45.b 46.d 47.b 48.c 49.b 50.d
Quick Review Series: BDS 1st Year

SECTION III: BIOCHEMISTRY

. The class of amino acids that contains only nonessential . An enzyme that functions in the beta-oxidation path-
amino acids is way is
a. acidic a. hexokinase
b. basic b. pyruvate
c. aromatic c. maltase
d. branched chain d. acyl CoA dehydrogenase
. Serum creatine kinase-3 (CK-3) is elevated in 10. Which of the following vitamins functions as a carbon
a. muscular dystrophy fragment carrier during the initial step of fatty acid bio-
b. myocardial infarction synthesis?
c. alcoholic cirrhosis a. Vitamin A
d. brain tumours b. Biotin
c. Vitamin C
. The enzyme known to cause spontaneous thrombosis as
d. Vitamin D
an adverse reaction is
a. tyrosine kinase ll. The proteins and lipids of serum lipoproteins are held
b. aromatase together by
c. asparaginase a. ionic bonds
d. collagenase b. ester bonds
c. polar and hydrophobic bonds
. Transport form of iron is
d. glucocorticoid receptors
a. transferrin
b. ferritin 12. Von Gierke’s disease is associated with deficiency of
c. apoferritin a. glucose-6-phosphate dehydrogenase
d. lactoferrin b. glucose-6-phosphatase
c. phosphorylase in liver
. The elements that have same atomic number but differ-
d. hexokinase
ent atomic weights are called
a. isomers 13. Deficiency of vitamin C causes the following except
b. isotopes a. painful swollen gums
c. isobars b. abnormal collagen
d. none of the above c. anaemia
d. diarrhoea
. Prokaryotic and eukaryotic cells differ in that
a. eukaryotic cells were probably the first cells to evolve 14. Intestinal absorption of Ca‘? is decreased by
b. most bacteria and blue green algae are examples of a. proteins
eukaryotic cells b. lactose
c. prokaryotic cells probably evolved from eukaryotic cells c. phytic acid
d. eukaryotic cells are complex cells with subcellular d. acidity
components separated by discrete membranes
15. All cells do not divide at the same rate. Events in which
. Which of the following is a monosaccharide? phase of the cell cycle determine when a cell is going to
a. Maltose replicate?
b. Galactose a. M phase
c. Sucrose b. G1 phase
d. Lactose c. S phase
d. G2 phase
. Fatty acid oxidation occurs in
a. the cytoplasm
b. the microsomes
c. the mitochondria
d. the Golgi apparatus

lla 2.a 3.c 4.a 5.b 6.d 7.b 8c 9.d 10.b 1l.c 12.b 13.d 14.c 15.B
 Multiple Choice Questions

16. Which one of the following human tissues contains the 24, A mutation that converts an amino acid to a stop codon
greatest amount of body glycogen? isa
a. Liver a. non-sense mutation
b. Kidney b. transversion
c. Skeletal muscle c. silent mutation
d. Cardiac muscle d. frame shift mutation

17. Supporting cells of taste bud are 25. Which one of the following amino acid is purely keto-
a. sustentacular cells genic?
b. taste cells a. Proline
c. von Ebner cells b. Phenylalanine
d. acini c. Isoleucine
d. Leucine
18. The monosaccharide glucose is best described by which
one of the following statements? 26. The major components of cell membranes are
a. It usually exists in the furanose form a. proteins and nucleic acids
b. It is a ketose b. lipids and proteins
c. It possesses an anomeric C-2 carbon atom c. lipids and nucleic acids
d. It forms part of the disaccharide sucrose d. polysaccharides and nucleic acids
19. Which one of the following is a precursor of both go- 27. Scurvy is the result of deficiency of
nadal and adrenocortical hormones? a. vitamin C
a. Progesterone b. vitamin A
b. Cortisol c. vitamin B
c. Testosterone d. vitamin D
d. Corticosterone
28. Mature red blood cells are distinguished from most
20. Which of the following vitamins is bound to gastric in- body cells by their
trinsic factor? a. reliance on anaerobic glycolysis
a. Vitamin K b. spherical shape
b. Folic acid c. lack of plasticity
c. Vitamin B,, d. relative impermeability to plasma anions
d. Vitamin D
29. A person on a fat-free—carbohydrate-rich diet continues
21. Which of the following enzymatic reactions is directly to grow obese. Which of the following lipoproteins is
related to vitamin K? likely to be elevated in his or her blood?
a. Activation of factor X a. Chylomicrons
b. Regulation of blood calcium level b. VLDL
c. Conversion of fibrinogen to fibrin ce. LDL
d. Synthesis of prothrombin d. HDL

22. Aspartate aminotransferase is released 30. An enzyme that makes a double-stranded DNA copy from
a. by viable cells single-stranded RNA template molecule is known as
b. after cell necrosis a. DNA polymerase
c. either of the two b. RNA polymerase
d. none of the above c. Reverse transcriptase
d. Phosphokinase
23. What is true of iron?
a. It is stored as ferritin 31. A segment of an eucaryotic gene that is not represented
b. It is absorbed by transferring in the intestine in the mature mRNA is known as
c. Spleen is the major storage organ a. intron
d. Fe** is excreted in urine b. exon
c. plasmid
d. TATA box

16.c 17.a 18.d 19.a 20.c 21.d 22.b 23.a 24.a 25.d 26.b 27.a 28.a 29.b 30.c 3l.a
itt Quick Review Series: BDS 1st Year

32. The transmembrane region of protein is likely to have 40. Iron is present in all of the following except
a. a stretch of hydrophilic amino acids a. myoglobin
b. stretch of hydrophobic amino acids b. cytochrome
c. a disulphide loop c. catalase
d. alternating hydrophilic and hydrophobic amino acids d. pyruvate kinase
33. Which of the following groups of proteins assists in 4l. The normal range of serum osmolality (in mOsm/L) is
folding of other proteins? a. 270-285
a. Proteases b. 300-320
b. Proteasomes c. 350-375
c. Templates d. 200-250
d. Chaperones
42. Vitamin B,, acts as coenzyme to which one of the fol-
34. The cell component that is genetically continuous from lowing enzymes?
one cell generation to the next is a. Isocitrate dehydrogenase
a. nuclear member b. Homocysteine methyltransferase
b. Golgi complex c. Glycogen synthase
c. central bodies d. G-6-P dehydrogenase
d. chromatin
43. The ligand-receptor complex dissociates in the endo-
35. All of the following hormones have cell surface recep- some because
tors except a. of its large size
a. adrenalin b. the vesicle loses its clathrin coat
b. growth hormone c. of the acidic pH of the vesicle
c. insulin d. of the basic pH of the vesicle
d. thyroxin
44. The human plasma lipoprotein containing the highest
36. Fluoride, used in the collection of blood samples for percentage of triacylglycerol by weight is
glucose estimation, inhibits the enzyme a. VLDL
a. glucokinase b. Chylomicrons
b. hexokinase c. HDL
c. enolase d. LDL
d. glucose-6-phosphatase
45. The sigma (co) subunit of prokaryotic RNA polymerase
37. Both vitamins K and C are involved in a. binds the antibiotic rifampicin
a. the synthesis of clotting factors b. is inhibited by a-amanitin
b. post-translational modifications c. specifically recognizes the promoter site
c. antioxidant mechanism d. is part of the core enzyme
d. microsomal hydroxylation reaction
46. Salivary amylase is specific for the hydrolysis of polysac-
38. Enzymes that move a molecular group from one mole- charides containing
cule to another are known as a. alpha 1-4 glycosidic bonds
a. ligases b. beta 1-4 glycosidic bonds
b. oxido-reductases c. alpha 1-6 glycosidic bonds
c. transferases d. either alpha or beta 1-4 glycosidic bonds
d. dipeptidases
47. The zymogen pepsinogen is produced by the chief cells of
39. Lipoprotein most strongly associated with coronary the gastric mucosa and is converted to its active form by
heart disease is . pancreozymin
op

a. apolipoproteins enterokinase
b. VLDL . trypsin
aan

c. HDL . low pH
d. total lipoproteins

32.b 33.d 34.d 35.d 36.c 37.b 38.c 39.a 40.d 41.a 42.b 43.c 44.b 45.c 46.a 47.d
 Multiple Choice Questions

48. Kwashiorkor is associated with 50. The total daily volume of gastrointestinal secretion is
a. high blood glucose approximately
b. low blood cholesterol a. 3000 cc
c. low plasma albumin b. 7000 cc
d. low plasma gamma globulin c. 5000 cc
d. 6000 cc
49. Salivary secretion is stimulated by
a. acetylcholine
b. norepinephrine
c. both A and B
d. neither A nor B

SECTION IV: ORAL HISTOLOGY AND DENTAL ANATOMY

1. Which of the following jaw positions is determined al- 6. In an acquired class III cross-bite relationship, as the
most exclusively by the behaviour of the musculature? mandible retrudes, the maxillary lateral incisor contacts
a. Postural which of the following teeth?
b. Intercuspal a. Central incisor
c. Retruded contact b. Lateral incisor
d. Protruded contact c. Central and lateral incisors
2. In an ideal intercuspal relation, the mesiolingual cusp of d. Canine and lateral incisors
the maxillary first molar contacts the mandibular first 7. In a class II occlusal relationship, the tip of the facial
molar in (on) the cusp of a mandibular first premolar lies directly below
a. central fossa the contacting area between which maxillary teeth?
b. distal fossa a. Canine and lateral incisor
c. mesial fossa b. Canine and first premolar
d. mesial marginal ridge c. First and second premolars
3. Which of the following ligaments has an outer oblique d. Second premolar and first molar
portion that limits the extent of jaw opening and initi- 8. Which extrinsic muscle of the tongue functions to re-
ates translation of the condyle down the articular tract the tongue?
eminence? a. Hyoglossus
a. Capsular b. Styloglossus
b. Collateral c. Genioglossus
c. Stylomandibular d. Palatoglossus
d. Temporomandibular 9. In an ideal intercuspal position, the distofacial cusp of a
4. When a protrusive mandibular movement (anterior teeth maxillary first molar opposes which feature on a man-
edge-to-edge) is achieved, the mandibular first molar has dibular first molar?
the potential to contact which of the following maxillary a. The distal cusp
teeth? b. The distofacial cusp
a. First and second premolars c. The distofacial developmental groove
b. Second premolar only d. The mesiofacial developmental groove
“ Second premolar and first molar 10. What condylar movement is performed as the mandible
d. First and second molars : .
moves from a pure protrusive movement from maxi-
5. Which of the following can adversely affect the self- mum intercuspal position to a maximum protruded
cleaning quality of a dentition in normal alignment? position?
a. Contact of adjacent teeth a. Translation
b. Efficient use of a toothbrush b. Rotation
c. Friction of food material during mastication c. Hinge
d. Too great a contour of the cervical enamel ridge d. Medial and forward

48.c 49.c 50.b Oral Histology and Dental Anatomy 1.a 2.a 3.d 4.c 5.d 6.d 7.c 8.b 9.c 10.a
uty Quick Review Series: BDS 1st Year

11. Protrusive movement is produced primarily because of . The embrasures surrounding the contact area of an an-
contracture of which of the following muscles? terior tooth are
. Masseter a. gingival, cervical, facial and lingual
wep

. Mylohyoid b. incisal, cervical, facial and lingual

. Temporalis c. incisal, cervical and facial only
. Medial pterygoid d. cervical, lingual and facial only
ona

. Lateral pterygoid
19. The primary teeth that present the most outstanding
12. The lingual cusp(s) on which of the following mandibu- morphologic deviations from permanent teeth are
lar posterior teeth is (are) approximately two-thirds the a. central incisors
height of the respective facial cusp(s)? b. lateral incisors
a. First premolar c. canines
b. Second premolar d. first molars
c. First molar
20. The highest and sharpest cusp on a primary mandibular
d. Second molar
first molar is the
13. In protrusive movement, the mandibular canines in a a. mesiolingual
class II occlusal relationship articulate with which of the b. distolingual
following maxillary teeth? c. mesiofacial
a. Canines only d. distofacial
b. Lateral incisors only
21. The roots of a primary mandibular second molar are
c. Canines and lateral incisors
flared to allow space for the developing tooth bud of
d. Canines and first premolars
which permanent mandibular tooth?
14. As the mouth is opened widely, the articular disc moves a. First molar
in what direction in relation to the articular eminence? b. Second molar
a. Laterally c. First premolar
b. Anteriorly d. Second premolar
c. Posteriorly
22. The primary function of the dental pulp is to
d. Medially
a. form dentine
15. The dentist instructs the patient, who has a severed left b. provide nutrition
lateral pterygoid muscle, to open his or her mouth wide. c. provide sensation
The patient’s mandible will move in which direction? d. assure root-end closure
a. To the left
23. Which of the following teeth is most likely to occasion-
b. To the right
ally exhibit a lingual groove that extends from the
c. Ina straight protrusive direction
enamel onto the cemental area of the root?
d. Ina retrusive direction
a. Maxillary canine
16. In cases of delayed resorption of primary incisors, the b. Maxillary central incisor
permanent incisors may be expected to erupt c. Maxillary lateral incisor
a. facial to the normal arch form d. Maxillary first premolar
b. lingual to the normal arch form
24, On which of the following primary molars would a
c. mesial to the normal arch position
prominent transverse ridge typically occur?
d. distal to the normal arch position
a. Maxillary first molar
17. A primary mandibular second molar differs from a per- b. Maxillary second molar
manent mandibular first molar in that a primary man- c. Mandibular first molar
dibular second molar d. Mandibular second molar
. is darker in colour
25. The distal contact area of a permanent maxillary canine
ap

. is larger in size
is usually located at the
. has a form peculiar to itself
a. middle third
. has a larger occlusal surface
enn

b. middle of the incisal third

. has roots that are more divergent
c. middle of the cervical third
d . junction of incisal and middle thirds

ll.e 12.a 13.c 14.b 15.a 16.b 17.e 18.b 19.d 20.a 21.d 22.a 23.c 24.c 25.a
 Multiple Choice Questions

26. Which axial surface of the crown of a mandibular canine 34. Calcification of the roots of the primary dentition is
is almost parallel to the long axis of the tooth? normally completed at what age?
a. Mesial a. 1-2 years
b. Distal b. 3-4 years
c. Facial c. 5-6 years
d. Lingual d. 7-8 years
27. Which of the following teeth is most likely to resist 35. In comparison with the faciolingual dimension of the
caries? crown of a permanent mandibular first molar, the me-
a. Maxillary central incisor siodistal dimension is
b. Mandibular canine . slightly less

p
c. Mandibular first premolar b. slightly greater
d. Maxillary lateral incisor c. approximately twice
d. approximately half
28. How does the greatest faciolingual measurement of the
mandibular canine compare with its greatest mesiodis- 36. On the basis of morphology, a mesio-occlusal (class II)
tal measurement? cavity preparation would be most difficult in which of
a. The faciolingual measurement is less the following teeth?
b. The measurements are equal a. Primary mandibular first molar
c. The faciolingual measurement is greater b. Primary mandibular second molar
d. There is no definite relation c. Permanent mandibular first molar
d. Permanent maxillary second molar
29. In cross section, the root of a mandibular canine is de-
scribed as 37. Which pulp horn of a permanent mandibular first mo-
a. roughly conical lar is the smallest?
b. irregularly oval a. Distal
c. flattened in a mesiodistal direction b. Mesiofacial
d. broader mesiodistally on the lingual than on the labial c. Distofacial
d. Mesiolingual
30. The percentage of dentine that is organic is
a. 3-5% 38. The ridges that together make up the oblique ridge of a
b. 10-15% permanent maxillary first molar meet near the centre of
c. 20-30% the occlusal surface on a level with the
d. 40-50% a. tips of the mesiolingual and distofacial cusps
b. depth of central and distal fossae
31. In the mandibular arch, the greatest lingual inclination c. cusp of Carabelli
of the crown from its root is seen in a permanent d. marginal ridges
a. canine
39. At what age is a primary maxillary canine usually
b. third molar
exfoliated?
c. first premolar
. 6-7 years
d. central incisor
op

. 8-9 years
32. A carious developmental pit is most likely to be found in . 10-11 years
the lingual surface of a
aa

. 12-13 years
a. mandibular central incisor
40. Which of the following types of mucosa characterizes
b. mandibular lateral incisor
attached gingiva?
c. mandibular canine
a. Free
d. maxillary lateral incisor
b. Alveolar
33. The pulp horns most likely to be exposed accidentally in c. Specialized
the preparation of a class II cavity in a maxillary first d. Masticatory
molar are
4l. Membrana performativa is seen in
a. mesiofacial and mesiolingual
a. bell stage
b. mesiolingual and distolingual
b. cap stage
c. distolingual and distofacial
c. bud stage
d. distofacial and mesiofacial
d. advanced bell stage

26.a 27.b 28.c 29.b 30.c 31.c 32.d 33.a 34.b 35.b 36.a 37.a 38.d 39.c 40.d 41.a
Cree) Quick Review Series: BDS 1st Year

42 . Which of the following permanent teeth is least likely to 50. Which of the following muscles is the prime mover in
have a divided pulp canal? effecting a left working movement?
a. Maxillary central incisor a. The left lateral pterygoid
b. Maxillary first premolar b. The left medial pterygoid
c. Mandibular central incisor c. The right lateral pterygoid
d. Mandibular lateral incisor d. The right medial pterygoid
43. Which of the following fibres are not periodontal liga- 51. Which of the following characterizes a temporoman-
ment fibres? dibular joint?
. Apical a. It has four synovial cavities
op

. Oblique b. It has one synovial cavity

. Principal c. It has two synovial cavities
. Transverse d. It has no synovial cavities
enn

. Trans-septal
52. In a posterior cross-bite relationship, which of the fol-
44, Temporary structures in enamel organ before enamel lowing may contact in a working movement?
formation are a. Outer aspects of mandibular facial cusps
a. enamel knot b. Outer aspects of maxillary lingual cusps
b. enamel cord c. Outer aspects of mandibular lingual cusps
c. both aand b d. Inner aspects of mandibular lingual cusps
d. enamel cuticle
53. The condyle on the working side generally rotates about a
45. Shape of enamel rod is a. sagittal axis only
a. key hole or paddle shaped b. horizontal axis only
b. square c. horizontal axis and translates laterally
c. round d. vertical axis and translates laterally
d. none of the above
54. In a right lateral excursion, the mesiofacial cusp of the
46. Enamel spindles are formed by maxillary right first molar passes through which of the
a. cracks following grooves of the mandibular right first molar?
b. ameloblasts a. Lingual groove
c. odontoblasts b. Central groove
d. hypocalcified rods c. Facial groove
d. Distofacial groove
47. The dentine adjacent to the dentinoenamel junction is
called the 55. The contact area on the mesial surface of a mandibular
a. mantle dentine canine is located at the
b. circumpulpal dentine a. middle-third
c. predentine b. incisal-third
d. secondary dentine c. cervical-third
d. junction of the middle- and cervical-thirds
48. When viewed from the proximal, which of the following
permanent teeth appears to be aligned in its arch with 56. The Bennett movement is best described as the
the axial inclination of its roots most nearly vertical? a. medial shift of the working condyle
a. Maxillary first molar b. lateral movement of the nonworking condyle
b. Mandibular second molar c. bodily shift of the mandible in the direction of the
c. Maxillary first premolar working condyle
d. Maxillary central incisor d. bodily shift of the mandible in the direction of the
nonworking condyle
49. In an ideal intercuspal position, the cusp tip of a perma-
nent maxillary canine should contact 57. The nonworking pathway of the maxillary cusps on the
. both mandibular canine and first premolar mandibular posterior teeth is toward the
oe

. the mandibular first premolar only a. distofacial

. the mandibular lateral incisor only b. distolingual
aa

. No other tooth c. mesiofacial

d. mesiolingual

42. .a 43.e 44.c 45.a 46.c 47.a 48.c 49.d 50.c 51.c 52.d 53.d 54.a 55.b 56.c 57.a
 Multiple Choice Questions

58. The wear facets on the incisal edges of the mandibular 65. The contraction of the lateral pterygoid muscle causes
lateral incisors are caused by occlusion with the a. the initial upward closure of the mandible
a. maxillary central incisors only b. forward movement of the condyle from the articular
b. maxillary central and lateral incisors fossa
c. maxillary lateral incisors and canines c. posterior displacement of the condyle from the ar-
d. none of the above ticular eminence
d. the final forceful closure of the molars through a
59. In an ideal permanent tooth relationship, the tip of a
bolus of food
mandibular canine in lateral excursion passes
a. distal to the tip of the maxillary canine cusp 66. Which of the following muscles is not an elevator of the
b. mesial to the tip of the maxillary canine cusp mandible?
c. directly in line with the maxillary canine cusp tip a. Temporal
d. through the embrasure between the maxillary canine b. Masseter
and first premolar c. Medial pterygoid
d. Lateral pterygoid
60. Moving the mandible from a maximum intercuspal po-
sition to a retruded contact position usually results in 67. During a protrusive excursion, the mandibular condyles
a. increased occlusal vertical dimension progress in which of the following directions?
b. decreased vertical overlap a. Forward and upward
c. increased horizontal overlap b. Forward and downward
d. all of the above c. Backward and upward
d. Backward and downward
61. When the mandible slides in a protrusive contacting
movement, which of the following mandibular teeth can 68. The primary maxillary canine is usually exfoliated be-
make contact with the maxillary lateral incisors? tween the ages of
. Central and lateral incisors a. 6 and 7 years
. Central incisors and canines b. 8 and 9 years
aap

. Lateral incisors and canines c. 10 and 11 years

. All of the above d. 12 and 13 years
62. Which of the following positions would yield the small- 69. From a proximal view, which of the following perma-
est measurement of vertical dimension? nent teeth tends to be positioned in the arch with its axis
a. Reverse overlap most nearly vertical?
b. Edge-to-edge a. Maxillary canine
c. Retruded contact b. Maxillary lateral incisor
d. Maximum intercuspation c. Maxillary central incisor
d. Mandibular lateral incisor
63. The lingual cusps of a mandibular first molar must be
restored to accommodate 70. The cemental union of two fully formed teeth that were
. centric relation originally separate entities is
TS

. working movement a. fusion

. nonworking movement b. concrescence
. protrusive position c. dilaceration
eon

maximum intercuspation d. dens in dente

64. A broad, flat facet existing on
mesiolingual cusp of a maxillary
in a mesiolingual to distofacial
caused by which of the following
a. Working
b. Nonworking
c. Protrusive
d. Lateral protrusive
the outer aspect of the 71. How soon after the eruption of a permanent tooth is the
first molar, and running apex usually fully developed?
direction, was probably a. Immediately
contacting movements? b. 3 months
c. 2 or 3 years
d. 5 or 6 years

58.b 59.b 60.d 61.c 62.d 63.b 64.a 65.b 66.d 67.b 68.c 69.a 70.b 71.c
466 Quick Review Series: BDS 1st Year

72. The mesial surface of the crown is almost parallel to the 80. When viewed from the facial, which of the following
long axis and the root of a premolars has a mesial cusp ridge longer than its distal
a. maxillary first premolar cusp ridge?
b. mandibular second premolar a. Maxillary first
c. maxillary canine b. Maxillary second
d. mandibular canine c. Mandibular first
d. Mandibular second
73. When a fourth root canal exists in a maxillary first molar,
it is most likely located in which of the following roots? 81. When viewing a maxillary central incisor from the me-
a. Lingual sial aspect, one normally finds the incisal ridge of the
b. Distofacial crown
c. Distolingual a. facial to the centre of the root
d. Mesiofacial b. lingual to the centre of the root
74. The smallest cusp of a permanent mandibular first mo- c. on line with the centre of the root
lar is the d. in variable positions
a. distal 82. Which of the following primary teeth has the smallest
b. distofacial faciolingual dimension of its crown?
c. mesiofacial a. Maxillary lateral incisor
d. distolingual b. Maxillary canine
75. The cross-sectional outline at the cervical level is roughly c. Mandibular lateral incisor
triangular in a d. Mandibular central incisor
a. mandibular second premolar 83. In which of the following primary teeth is the mesial
b. permanent maxillary second molar portion most distinctly separated from the remainder of
c. permanent mandibular first molar the occlusal table by a transverse ridge?
d. primary mandibular second molar a. Maxillary first molar
76. Primary molars differ from permanent molars in that b. Mandibular first molar
primary molars c. Mandibular second molar
a. have heavier root trunks d. None of the above
b. tend to have less pronounced cervical ridges 84. When viewing a permanent maxillary canine from the
c. have thicker enamel compared to the total bulk of mesial aspect, one would normally expect a line bisect-
crowns ing the root longitudinally to
d. have flatter facial and lingual surfaces extending from a. pass facial to the cusp tip
the occlusal to the cervical ridge b. pass lingual to the cusp tip
77. The cervical line on adult teeth has the greatest depth of c. bisect the cusp tip also
curvature toward the incisal on the d. none of the above
a. mesial aspect
85. Viewed from the occlusal, the greatest faciolingual di-
b. distal aspect ameter of a permanent mandibular second molar is lo-
c. facial aspect
cated in which third of the crown?
d. lingual aspect a. Distal
78. In a longitudinal section of a premolar crown, the b. Mesial
enamel is thickest in the c. Middle
a. cervical-third d. None of the above
b. middle-third
86. Mesial inclination of lingual cusps is present in which
c. occlusal-third
maxillary premolars?
d. junction of the cervical- and middle-thirds
a. First premolars only
79. Which of the following permanent molars has the larg- b. Second premolars only
est mesiodistal measurement of its crown? c. Both first and second premolars
a. Maxillary first d. Neither first nor second premolars
b. Maxillary second
c. Mandibular first
d. Mandibular second

72.d 73.d 74.a 75.b 76.d 77.a 78.c 79.c 80.a 81.c 82.d 83.b 84.b 85.b 86.c
 Multiple Choice Questions

87. Which of the following teeth has its mesial contact area 94. The spacing between anterior teeth in the primary den-
located within the incisal or the occlusal one-third? tition is most frequently caused by
a. Maxillary canine a. thumb sucking
b. Maxillary first molar b. tongue thrusting
c. Mandibular second premolar c. the growth of the dental arches
d. Mandibular central incisor d. the pressure from succedaneous teeth
88. Which root of a permanent maxillary first molar is flat- 95. Which of the following groups of fibres of the peri-
tened mesiodistally and has root depressions on both its odontal ligament is most likely to be found in the
mesial and distal surfaces? middle-third of the root?
a. Lingual a. Apical
b. Distofacial b. Oblique
c. Mesiofacial c. Horizontal
d. Distolingual d. Trans-septal
89. In a molar, where do root canals usually join the pulp 96. The proximal contact of posterior teeth creates wear
chamber? patterns that eventually cause
a. At the level of the furcation a. gingival recession
b. At varying levels, dependent on age b. increased length of clinical crowns
c. Within the cervical-third of the crown c. decreased length of clinical crowns
d. Apical to the cementoenamel junction d. reduced interproximal embrasure spaces
90. A branch of which of the following cranial nerves to the 97. Which of the following premolars has a mesial mar-
tongue may be anaesthetized during administration of ginal ridge that is more cervically located than its distal
an inferior alveolar block? marginal ridge?
a. V a. Maxillary first
b. VII b. Maxillary second
c. IX c. Mandibular first
d. XII d. Mandibular second
91. Which of the following anatomic features of a maxillary 98. When compared with the incisal embrasure between
lateral incisor will most likely complicate root planing? the maxillary central and lateral incisors, the incisal
a. A root bifurcation embrasure between the maxillary central incisors is
b. A mesial concavity a. larger
c. A distolingual groove b. smaller
d. An extreme distal cervical line curvature c. the same size
92. Perikymata are the result of 99. Which of the following primary molars has an occlusal
a. enamel hyperplasia surface that most often bears the greatest resemblance
b. enamel hypoplasia to a premolar?
c. interstitial growth a. Maxillary first
d. normal enamel apposition b. Maxillary second
c. Mandibular first
93. From an occlusal view, the arrangement of permanent
d. Mandibular second
teeth of the maxillary and mandibular arches are para-
bolic in shape in one segment of the dentition, however, 100. In the mandibular arch, the contact areas (cervico-
four teeth are aligned in a straight line. In what region is incisally or cervico-occlusally) are at approximately
this segment located? equal levels mesially and distally on each tooth except
a. Maxillary anterior the mandibular
b. Maxillary posterior a. canine
c. Mandibular anterior b. first molar
d. Mandibular posterior c. first premolar
d. lateral incisor

87.d 88.c 89.d 90.a 91.c 92.d 93.d 94.c 95.b 96.d 97.¢ 98.b 99.a 100.a
This page intentionally left blank
PREVIOUS

I
YEARS’
QUESTION
BANK
Section IA: General Anatomy
Section IB: General Histology
Section IC: Embryology
Section Il: | Physiology
Section Ill: Biochemistry
Section IVA: Oral Histology
Section IVB: Dental Anatomy
This page intentionally left blank
PREVIOUS YEARS’
QUESTION BANK

Section 1A: General Anatomy

1. OSTEOLOGY OF HEAD AND NECK 10. Superior orbital fissure. [RGUHS Jun 91, Dec 93]

11. Greater horn of hyoid bone. [RGUHS Mar 01]

Long Essays 12. Surgical importance of pterion. [RGUHS Apr 00]
1. Write the origin, course and branches of facial nerve. (or)
Give the formation of pterion and structures related deep to it.
2. Write a note on dangerous area of the face. [RGUHS Apr 2004]
[RGUHS Apr 99]
13. Name four arteries related to ramus of mandible.[RGUHS Apr 99]
Short Essays
(or)
1. Enumerate any four structures passing through foramen mag- Give the four arteries related to ramus of mandible. [RGUHS
num. [RGUHS Sep 98] Mar 05]
Give the attachments, nerve supply and actions of inferior con- 14. List out four structures passing through superior orbital fissure.
strictor muscles. [RGUHS Apr 99] [RGUHS Sep 97]
a. Give the attachments of pterygomandibular raphe. [RGUHS . Name the muscles attached to greater cornua of hyoid bone.
Sep 99] [RGUHS Apr 01]
b. Foramens of middle cranial fossa. [AP Apr/May 04] 16. Structures passing through foramen ovale. [RGUHS Mar 04]
c. Pyriform recess. [AP Apr/May 04]
17. Structures passing through anterior condylar canal. [RGUHS
Hyoid bone. [RGUHS Dec 2011, 2010/Jan 2012 (RS & RS2)] Mar 00, Sep 01]
wo S

Describe the age changes in mandible. [RGUHS Dec 2010 (OS)] 18. Openings in the middle meatus of the nose. [RGUHS Apr 00]
PND

Metopic suture. [RGUHS Dec 2010 (RS & RS2)] 19. Give the attachments of pterygomandibular raphe and name the
Zygomatic bone. [RGUHS Jun/Jul 2010 (RS & RS2)] muscle attached to it. [RGUHS Sep 98]
Development of hyoid bone. [RGUHS Jun/Jul 2010 (RS & RS2)] 20. Ligaments attached to the mandibular surface. [RGUHS Sep 04]
21. Enumerate any four structures passing through foramen mag-
num. [RGUHS Mar 04]
Short Notes
22. Name the contents of pterygopalatine fossa. [RGUHS Mar 04]
. Dens. [RGUHS Mar 92, Dec 92]
=

23. A typical feature of atlas. [AP Sep 06]

. Maxilla. [RGUHS Sep 01]
NY

24. Atlantoaxial joint. [AP Aug 05]

VF

. Hyoid bone. [RGUHS Jun 91, Dec 93, Mar 05]

YW

25. Write any four structures passing through the jugular foramen.
. Mastoid groove. [RGUHS Dec 89, Oct 94, Apr 98]
[AP Oct 04]
. Auditory tube. [RGUHS Oct 94, Apr 98] 26. Pterion. [AP Oct 04]
. Cervical fascia. [RGUHS Apr 98] 27. Significance of pyriform fossa. [AP Mar/Apr 05]
NDA

. Jugular foramen. [RGUHS Jun 91, Sep 00]

28. Atlanto-occipital joint. [AP Oct 02]
(or) 29. Muscles attached to the ramus of the mandible. [AP Oct 02]
Name any four structures passing though jugular foramen.
[RGUHS Sep 02] 30. Sphenomandibular ligament. [AP Feb 02]
. Foramen lacerum. [RGUHS Dec 91] 31. Name the bones ossified in membrane. [AP Feb 02]
. Zygomatic arch. [RGUHS Mar 05] 32. Name different types of sutural joints. [Maharashtra May 03]
‘yey Quick Review Series: BDS Ist Year

33. What is pterion? Give its surgical importance. [Maharashtra . Cutaneous innervation of face. [RGUHS Sep 04]
May 03] . Mention the sensory nerve supply to the face. [RGUHS Mar 05,
34. What is metopic suture? [AP Jun 08] Apr 99]
35. Name the bones meeting at pterion. [AP Jun 08] . Give a short account of parts, relation and nerve supply of lacri-
36. Foramen ovale of skull. [AP Jun 08] mal gland. [RGUHS Sep 98]

37. Superior nuchal lines. [AP Jun 08] . Origin, course, relation and branches of facial artery. [RGUHS
Mar 04]
38. Give the structures passing through foramen ovale. [RGUHS Dec
2011/Jan 2012 (OS) . Connections, course and distribution of chorda tympani.
[RGUHS Mar 04]
39. Give the special features of first cervical vertebra. [RGUHS Dec
2010 (OS)] 9. Platysma. [AP Mar/Apr 05]

40. Zygomatic arch. [RGUHS Dec 2010 (RS & RS2)] 10. Zygomaticus major. [AP Mar/Apr 05]

41. Foramen magnum. [RGUHS Jun/Jul 2010 (RS3)] 11. Facial artery. [AP Jun 08]

42. Ligaments of mandibular bone. [RGUHS Jun/Jul 2010 (RS3)] 12. Orbicularis oculi. [AP Jun 08]

43. Structure of bone. [RGUHS Jun/Jul 2010 (RS3)] 13. Facial nerve in face. [RGUHS Dec 2010 (RS3)]

44. Mastoid process. [RGUHS Jun/Jul 2010 (RS & RS2)] 14. Sensory innervation of the face. [RGUHS Dec 2010 (RS3)]
15. Layers of the scalp. [RGUHS Dec 2010 (RS3)]
16. Veins of face. [RGUHS Dec 2010 (RS & RS2)]
2. SCALP, TEMPLE AND FACE
Short Notes
Long Essays
. Platysma. [RGUHS Dec 91, Sep 94]
1. Enumerate the layers of scalp. Give their blood supply, nerve sup-
ply and lymphatic drainage. [RGUHS Aug 95] . Buccinator. [RGUHS Aug 93, Apr 98]
Pp wn

Describe the maxillary nerve under the following headings: ori- . Bell’s palsy. [RGUHS Apr 01]
een

gin, course, branches, distribution and applied anatomy. . Facial vein. [RGUHS Sep 04]
[RGUHS Sep 02]
. Facial artery. [RGUHS Aug 93]
aw

Describe the course, branches and distribution of mandibular

Deep facial vein. [RGUHS Mar 98]
division of trigeminal nerve. [RGUHS Sep 99]
« Orbicularis oculi. [RGUHS Jul 90, Feb 96]
Describe the origin, course, relation and branches of facial artery.
[RGUHS Apr 98] . Palpebral ligament. [RGUHS Mar 88]

Secretomotor supply to lacrimal gland. [AP Aug 05] . Danger area of scalp. [RGUHS Aug 91, Mar 04]
Classify deep fascia of neck. Describe the investing layer and a . Epicranial aponeurosis. [RGUHS Sep 1994]
note on its surgical anatomy. [Goa 04] . Palatine aponeurosis. [RGUHS Mar 04]
eS
K&
ee

Describe the deep fascia of neck. Add a note on its applied anat- . Nasolacrimal apparatus. [RGUHS Mar 04]
eS
Au — WY

omy. [Goa Jul 06] . Name the structures forming lacrimal apparatus. [RGUHS Mar 04]
Se

Describe the layers of scalp. Give its nerve supply, blood supply . Levator palpebrae superioris. [RGUHS Sep 1999]
and lymphatic drainage. Add a note on its surgical anatomy.
. Name the cervical branches of facial artery. [RGUHS Sep 98]
[Goa Jul 07]
. Give the formation and termination of anterior facial vein.
SE

Describe the deep fascia of neck. Add a note on its surgical anat-
[RGUHS Apr 99, Mar 05]
omy. [Goa Jul 08]
17. Dangerous area of scalp. [AP Oct 02]
10. Describe the layers of scalp. Add a note on its applied anatomy.
[Goa Jul, 08] 18. Four components of deep cervical fascia. [AP Feb 02]

11. Describe the scalp under the following headings: [RGUHS Dec 19. Facial vein. [AP Jun 08]
2010 (RS & RS2)| 20. Mention the branches of maxillary nerve on face. [RGUHS Dec
. Extent 2011/Jan 2012 (OS)]
te

. Layers 21. Branches of facial artery. [RGUHS Dec 2011/Jan 2012/Jun/Jul

. Blood supply 2010 (RS & RS2)]
conn

. Nerve supply
22. Nasolacrimal duct. [RGUHS Dec 2010 (RS3)]
. Applied anatomy.
23. Nerve supply of scalp. [RGUHS Jun/Jul 2010 (RS3)]
Short Essays
3. SIDE OF THE NECK
Facial artery. [RGUHS Sep 99]
Origin, course, relation and branches of facial artery. [RGUHS Long Essay
Mar 04]
1. Describe the boundaries and contents of subclavian triangle.
Buccinator muscle. [RGUHS Mar 05] [RGUHS Mar 95]
 Previous Years’ Question Bank

Short Essays 4. BACK OF THE NECK

1. Carotid sheath. [RGUHS Sep 04]
2. Brief account of carotid sheath and its contents. [RGUHS Apr 97]
Long Essays
Formation, attachments, relation and contents of carotid sheath. 1. Axillary nerve. [RGUHS Oct 94]
»

[RGUHS Sep 97] . Mention boundaries of suboccipital triangle. Describe the con-
What is torticollis? [RGUHS Mar 05] tents of triangle. [RGUHS Jun 92]
woe

General investing layer of deep cervical fascia. [RGUHS Mar 04] . Describe the submandibular gland under the following headings:
Boundaries and contents of posterior triangle. [RGUHS Sep 04]
[RGUHS Jun/Jul 2010 (RS3)]
. Situation and coverings
NA

Attachments, relation, nerve supply and action of sternocleido-

op
. Surfaces and relations
mastoid. [RGUHS Sep 02] . Nerve supply

pa
Give the attachments, nerve supply and action of sternocleido- . Applied anatomy.
mastoid. [RGUHS Apr 99]
Give the formation, course and termination of external jugular Short Essays
vein. [RGUHS Apr 99]
1. Suboccipital triangle. [AP Sep 06, Jun 08]
10. Carotid sheath. [AP Aug 05, Oct 02]
2. Microscopic anatomy of palatine tonsil. [RGUHS Jun/Jul 2010
11. Subclavian triangle. [AP Feb 02]
(RS3)]
12. Suprasternal space. [AP Feb 02, Jun 08]

13. Lymphatic drainage of head and neck. [AP Apr/May 04]

Short Notes
14, Sternocleidomastoid. [AP Sep 06]
1. Vertebral artery. [RGUHS Dec 91]
15. Suprasternal space. [AP Jun 08]
2. Styloid process. [RGUHS Dec 93]
16. Sternocleidomastoid. [RGUHS Dec 2011/Jan 2012 (RS3)]
3. Contents of suboccipital triangle. [RGUHS Sep 01]
17. External jugular vein. [RGUHS Dec 2011/Jan 2012 (RS3)]
4. Boundaries and contents of posterior triangle. [RGUHS Sep 04]

Short Notes
5. CONTENTS OF THE VERTEBRAL CANAL
Occipital artery. [RGUHS Sep 99]
Cervical fascia. [RGUHS Jun 993] Short Notes
PF YP

Suprasternal space. [RGUHS Aug 94]

PNA

1. Spinal dura mater. [RGUHS Oct 87]

Pretracheal fascia. [RGUHS Jun 92]
2. Subarachnoid space. [RGUHS Mar 88]
External jugular vein. [RGUHS Sep 04]
Formation of external jugular vein. [RGUHS Sep 04]
6. CRANIAL CAVITY
Contents of carotid sheath. [RGUHS Sep 01]
Root value of brachial plexus. [RGUHS Apr 00] Long Essays
Spinal part of accessory nerve. [RGUHS Jun 92]
1. Enumerate dural venous sinus. Describe the cavernous sinus in
oP

Sternocleidomastoid muscle (nerve supply and action). [RGUHS detail. [RGUHS Mar 95]
Mar 05] . Describe cavernous sinus and its relations. [RGUHS Mar 91]
10. Name four tributaries of external jugular vein. [RGUHS . Classify dural venous sinuses. Describe in detail its position, con-
Mar 05]
tents, tributaries and applied aspect of cavernous sinus. [RGUHS
11. Pretracheal fascia. [AP Sep 06] Apr 00]
12. External jugular vein. [AP Sep 06] . Describe the relation, tributaries and connections of cavernous
13. Sternocleidomastoid muscle. [AP Aug 05] sinus. Add a note on applied anatomy. [RGUHS Apr 01, Mar 05]

14, Suprasternal space (Burn’s). [AP Oct 02] . Describe the pituitary gland in detail. Mention its blood supply,
development and relation. [RGUHS Aug 93]
15. Ansa cervicalis. [AP Oct 02]
. Describe the relations, tributaries and connections of cavernous
16. Name branches of the external carotid artery. [Maharashtra
sinus. Add a note on applied anatomy. [AP Oct 02]
Oct 03]
. Describe the cavernous venous sinus. Add a note on its surgical
17. Name the tributaries of internal jugular vein. [Maharashtra
anatomy. [Goa Aug 05]
May 02]
. Enumerate the intracranial venous sinuses. Describe in detail
18. External jugular vein. [Goa 04]
the cavernous venous sinus giving its surgical anatomy. [Goa
19. Buccopharyngeal fascia. [RGUHS Dec 2010 (RS3)] Jul 07)
20. Straight venous sinus. [RGUHS Dec 2010 (RS & RS2)] . Describe the position, relation, connections and tributaries of
21. Pharyngobasilar fascia. [RGUHS Jun/Jul 2010 (RS & RS2)] cavernous sinus. [RGUHS Dec 2011/Jan 2012 (OS)]
‘YE Quick Review Series: BDS Ist Year

10. Describe the cavernous sinus under the following headings.

7. CONTENTS OF THE ORBIT
[RGUHS Dec 2011/Jan 2012 (RS3)]
. Location
Long Essay
. Relations
anoe

. Tributaries 1. Write about origin, innervation and action of muscles of eyeball.

. Communications [RGUHS Aug 96]
e. Applied anatomy.
11. Describe the situation, relations, blood supply, nerve supply and Short Essays
histology of pituitary gland. [RGUHS Dec 2010 (OS)]
. Lateral rectus muscle of eyeball. [RGUHS Mar 04]

Short Essays . Give the positions, connections and branches of ciliary ganglion.
[RGUHS Sep 98]
1. Tentorium cerebelli. [RGUHS Mar 04]
. Boundaries and structures passing through superior orbital fis-
2. Cavernous sinus. [RGUHS Mar 05] sure. [RGUHS Sep 04]
Cavernous sinus, its relations and tributaries. [RGUHS Sep 04,
»

Sep 05, Mar 05]

Short Notes
Trigeminal ganglion in middle cranial fossa. [RGUHS Sep 04]
wo S

. Ciliary ganglion. [RGUHS Dec 91, Aug 94]

Middle meningeal artery. [AP Mar/Apr 05]
PND

. Nasociliary nerve. [RGUHS Mar 04]

Circle of Willis. [AP Jun 08]

Yr
. Extraocular muscles. [RGUHS Jun 92]
Trigeminal ganglion. [RGUHS Dec 2010 (RS & RS2)]
. Oblique muscle of eyeball. [RGUHS Oct 87, Mar 04, Sep 00]
Inferior sagittal sinus. [RGUHS Jun/Jul 2010 (RS & RS2)]
WP Name branches of nasociliary nerve. [RGUHS Mar 04]

Short Notes . Actions of oblique muscles of eyeball. [RGUHS Sep 0]

SND

. Short ciliary nerve. [RGUHS]

Falx cerebri. [RGUHS Aug 92, Mar 94]
Meckel’s cave. [RGUHS Mar 95]
. Give the connections of ciliary ganglion. [RGUHS Dec 2011/Jan
2012 (OS)]
Se FNnND

Emissary vein. [RGUHS Aug 95, Mar 00, Sep 04]

YP

. Name the artery which runs in the optic nerve. What is its impor-
Cavernous sinus. [RGUHS Aug 92, Feb 93]
tance? [RGUHS Dec 2010 (OS)]
YP

Tentorium cerebelli. [RGUHS Aug 91, 93]

Diaphragm sellae. [RGUHS Aug 96]
8. ANTERIOR TRIANGLE OF THE NECK
Hypoglossal nerve. [RGUHS Apr 98]
Superior sagittal sinus. [RGUHS Mar 05, Feb 93] Long Essays
Middle meningeal artery. [RGUHS Mar 05] 1. Describe the origin, course, relations and branches of maxillary
Name four emissary veins. [RGUHS Mar 95] artery. [RGUHS Aug 99]
eee
prs

. Confluence of dural venous sinus. [RGUHS Sep 00] 2. Describe the boundaries and contents of carotid triangle of neck.
Name any four tributaries of cavernous sinus. [RGUHS Mar 04, [RGUHS Sep 01]
Apr 99, Mar 05]
13. Structures passing through major openings in diaphragm. Short Essays
[RGUHS Sep 00]
. Lingual artery. [RGUHS Sep 01, Mar 05; AP Oct 02]
14, Name structures in the lateral wall of cavernous sinus. [RGUHS
Sep 01] . External jugular vein. [RGUHS Sep 04, Mar 04]

15. Name the folds of dura mater present in the cranial cavity. . Give the formation relations and branches of ansa cervicalis.
[RGUHS Mar 04] [RGUHS Sep 98]

16. Trigeminal ganglion in middle cranial fossa. [RGUHS Sep 04] . Location, formation and distribution of ansa cervicalis. [RGUHS
Sep 98]
17. Circle of Willis. [AP Apr/May 04]
. Name any four branches of external carotid artery given in the
18. Processes of dura mater of brain. [AP Feb 02]
carotid triangle. [RGUHS Sep 98]
19. Enumerate paired dural sinuses. [Maharashtra May 03]
. Ansa cervicalis. [AP Mar/Apr 05]
20. Superior sagittal sinus. [RGUHS Dec 2011/Jan 2012 (RS &
NH

RS2)] . Facial artery. [AP Feb 02, Oct 02]

21. Parts of pituitary gland. [RGUHS Dec 2011/Jan 2012 (RS & . External carotid artery. [AP Jun 08]
De

RS2)] . Lingual artery. [RGUHS Dec 2011/Jan 2012 (RS3); Jun/Jul 2010
22. Ciliary ganglion. [RGUHS Dec 2010 (RS & RS2)] (RS & RS2)]
 Previous Years’ Question Bank

Short Notes . Describe the parotid salivary gland under following heads. [Ma-
harashtra Jul/Aug 05]
Lingual artery. [RGUHS Aug 94, Mar 05] a. Morphology
Fe YP RP

Ansa cervicalis. [RGUHS Dec 91] b. Histology

c. Applied anatomy.
AY

Anterior jugular vein. [RGUHS Oct 94]

Contents of digastric triangle. [RGUHS Apr 00] 10. Describe the extracranial course of facial nerve. Add a note on its
surgical aspect. [Goa Jul 08]
Mention the branches of lingual artery. [RGUHS Sep 02]
11. Describe the extracranial cause of facial nerve. Give its applied
Action and insertion of posterior cricoarytenoid muscle. [RGUHS
anatomy. [Goa Aug 05]
Sep 01]
12. Describe the anatomy of parotid gland. Add a note on its surgical
Name the branches of external carotid artery. [RGUHS Sep 01]
N

anatomy. [Goa Aug 05, Jul 07]

8. Name the muscles which bring about depression of the hyoid
13. Describe the extracranial course of facial nerve and add a note on
bone. [Maharashtra May 2003]
its applied aspect. [Goa Jul 06]
Digastric triangle. [Goa Aug 05]
14. Write origin, course and branches of facial nerve. Write a note on
10. Lingual artery. [Goa Jul 06] dangerous area of the face. [AP Jun 08]
11. Facial artery. [Goa Jul 07, Jul 08] 15. Describe the course, branches and applied anatomy of the facial
12. Name the muscles forming the floor of carotid triangle. [AP Jun 08] nerve. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]
13. What are the branches of third part of maxillary artery? [AP Jun 08]
14, Submental triangle. [AP Jun 08]
Short Essays
15. Give the formation of ansa cervicalis (draw and label diagram . Extracranial course of facial nerve. [RGUHS Apr 00]
only). [RGUHS Dec 2011/Jan 2012 (OS)] . Connections, course and distribution of chorda tympani.
16. Ansa cervicalis. [RGUHS Dec 2011/Jan 2012 (RS3)] [RGUHS Aug 95]
17. Branches of facial artery. [RGUHS Dec 2011/Jan 2012 (RS & RS2)] . Beginning, course, termination and relations of parotid duct.
we

18. Carotid sheath. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]
[RGUHS Mar 04]
19. Name any four branches of external carotid artery. [RGUHS Dec
Describe structures passing through parotid gland. [RGUHS Mar 05]
ep

2010 (OS)] . Structures passing through parotid gland. [RGUHS Mar 05]
Daw

20. Name the branches of arch of aorta. [RGUHS Dec 2010 (OS)] . Intrapetrous part of facial nerve. [RGUHS Mar 04]
21. External jugular vein. [RGUHS Jun/Jul 2010 (RS & RS2)] . Bell’s palsy. [AP Oct 04]
en

. Give an account of the structures passing through the parotid

gland. [RGUHS Dec 2011/Jan 2012 (OS)]
9. PAROTID REGION
10. Intraparotid structures. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]

Long Essays
Short Notes
1. Describe the gross anatomy of parotid gland and add a note on
. Parotid duct. [RGUHS Feb 93, Sep 94]
=

nerve supply. [RGUHS Aug 92, Feb 96]

. Facial nerve. [RGUHS Apr 91]
YY

Describe the relations, blood supply, nerve supply and applied

anatomy of parotid gland. [RGUHS Sep 98] . Chorda tympani. [RGUHS Aug 95]
YW

Describe the external features, relations and nerve supply of pa- . Parotid duct opening. [RGUHS Sep 01]
fF

rotid gland. [RGUHS Sep 99] . Nerve supply to parotid gland. [RGUHS Mar 00, Sep 00,
an

Describe the course of fascial nerve. Write its applied aspects. Apr 01]
[RGUHS Feb 93] . Name the arteries seen in the substance of parotid gland. [RGUHS
Give an account of extracranial course relations and branches of Sep 97]
facial nerve. Add a note on its applied anatomy. [RGUHS Sep 97] . List the branches of facial nerve soon after its emergence through
Describe extracranial course of facial nerve under following head- the stylomastoid foramen. [RGUHS Sep 98]
ings: exit from cranial cavity, course in neck and parotid gland, . Structure pierced by the parotid duct. [AP Feb 02]
branches, distribution and applied aspects. [RGUHS Mar 04] . Anatomy of parotid gland. [AP Apr/May 04]
Describe the relations, blood supply, nerve supply and develop- 10. Parotid duct. [AP Aug 05]
ment of parotid gland. [AP Mar/Apr 05]
11. Give secretomotor nerve supply of the parotid gland. [Maharash-
Describe the facial nerve under following headings. [Maharashtra tra May 02, Oct 03]
May 03]
12. Nerve supply of parotid gland. [Goa Jul 2004]
a. Extracranial course
b. Distribution and branches 13. Parotid duct. [RGUHS Dec 2011 /Dec 2010 /Jan 2012 (RS3)]
c. Applied anatomy.
4716 Quick Review Series: BDS 1st Year

23. Name the muscles of mastication. Give the origin, insertion,

10. TEMPORAL AND INFRATEMPORAL FOSSA
nerve supply and actions of the muscles of mastication. Add a
note on its surgical anatomy. [Goa Jul 07]
Long Essays
24. Name the muscles of mastication. Describe the attachments,
1. Name muscles of mastication. Describe the origin, insertion, nerve supply and actions of any one of them. [AP Jun 08]
nerve supply actions and relations of any one of them. [RGUHS
25. Describe the temporomandibular joint under the following head-
Mar 92, Sep 94, Aug 95]
ings: [AP Jun 08]
. Describe the muscles of mastication under following headings: a. Type and subtype
name the muscle attachments, nerve supply and action. [RGUHS . Bones taking part

conn st
Sep 04] . Ligaments
. Give an account of lateral pterygoid muscle. [RGUHS Mar 88, . Movements and muscles responsible
Mar 04] . Applied anatomy.
. Describe lateral pterygoid muscle and its relations. [RGUHS Jul 90] 26. Name the muscles of mastication (major and minor). [AP Jun 08]
. Describe the origin, relations and branches of maxillary artery. 27. Describe the type, bones articulating muscles and movements of
[RGUHS Jul 90] the temporomandibular joint. [RGUHS Dec 2011/Jan 2012 (OS)]
. Describe the mandibular nerve under following headings: ori- 28. Describe the mandibular nerve under the following headings:
gin, root fibres, its contents, termination and relations. [RGUHS [RGUHS Dec 2010 (OS)]
Mar 04] . Origin

Fas
. Describe the mandibular nerve under the following headings: . Course and relations
formation, course and its relations, branches and its distribution. . Branches

onan
[RGUHS Sep 04, Mar 04] . Distribution
. Applied anatomy.
. Give an account of origin, course relations and branches of man-
dibular nerve. Add a note on its applied anatomy. [RGUHS Sep 97]
Short Essays
. Describe origin, source relation and its distribution of lingual
nerve. [RGUHS Dec 92, Oct 94, Feb 96] . Articular disc. [RGUHS Oct 94]
=

10. Describe functional components of trigeminal nerve. Write in . Buccinator muscle. [RGUHS Mar 05]
YY

detail about mandibular nerve. [RGUHS Aug 96] . Inferior alveolar nerve. [RGUHS Sep 04]
11. Mention boundaries and contents of infratemporal fossa. . Pterygopalatine ganglion. [RGUHS July 90]
VW

[RGUHS Sep 00]

. Muscles of mastication. [RGUHS Jul 90]
12. Describe the movements of temporomandibular joint and men-
. Styloid process of temporal bone. [RGUHS Sep 04]
tion the muscles producing these movements. What are the fac-
ND

tors responsible for its stability? [RGUHS Apr 99] . Attachments, relations, nerve supply and action of lateral ptery-
goid muscle. [RGUHS Mar 04]
13. Describe temporomandibular joint. [RGUHS Aug 91, Jun 92,
Mar 95] . Give the attachment, relations and nerve supply of lateral ptery-
goid muscle. [RGUHS Sep 98]
14, Describe the articulating surfaces, ligaments and movements of
temporomandibular joint. [RGUHS Sep 00] 9. Inferior alveolar nerve. [AP Mar/Apr 05]
15. Describe the temporomandibular joint under following headings: 10. Pterygoid plexus of veins. [AP Feb 02]
type of joint, articular surfaces, ligaments, nerve supply, move- 11. Maxillary artery. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]
ments and muscles producing movement. [RGUHS Sep 01]
12. Movements of temporomandibular joint. [RGUHS Dec 2011/Jan
16. Describe the temporomandibular joint under following headings: 2012 (RS & RS2)]
articulating bones and articulating surfaces, capsule, intra-articu-
13. Articular disc of temporomandibular joint. [RGUHS Dec 2010
lar disc, ligaments, movements with muscles producing it and
(RS & RS2)]
applied anatomy. [RGUHS Mar 04, Mar 05]
14. Buccinator. [RGUHS Dec 2010 (RS & RS2)]
17. Describe the course, branches and distribution of mandibular
division of trigeminal nerve. [AP Oct 02] 15. Lateral pterygoid muscle. [RGUHS Jun/Jul 2010 (RS3)]

18. Describe the attachments, actions and nerve supply of muscles of 16. Otic ganglion. [RGUHS Jun/Jul 2010 (RS & RS2)]
mastication. [AP Feb 02]
19. Give the anatomy, position and relations of TMJ. Write briefly Short Notes
about the movements of temporomandibular joint (TMJ). [AP . Lingual nerve. [RGUHS Jun 93, Sep 04]
=

Apr/May 04]
. Jugular foramen. [RGUHS Jul 90]
wW PB wn

20. Name the muscles of mastication. Describe in detail any one. Add
. Auriculotemporal nerve. [RGUHS Mar 88, Aug 92]
ND

a note on its surgical anatomy. [Goa Jul 08]

. Inferior alveolar nerve. [RGUHS Aug 96]
21. Describe the origin, course, termination, relations distribution
and applied anatomy of lingual nerve. [Goa Jul 04] . Muscles of mastication. [RGUHS Feb 96]

22. Enumerate the muscles of mastication. Describe any one in detail. . Stylomandibular ligament. [RGUHS Sep 94]
[Goa Jul 06] TMJ movements. [RGUHS Sep 94]
 Previous Years’ Question Bank

8. Articular disc of TMJ. [RGUHS Jul 90] 8. Development and nerve supply of digastric muscles. [AP Aug 05]
9. Sphenomandibular ligament. [RGUHS Aug 91] 9. Chorda tympani nerve. [AP Aug 05]
10. Pterygoid plexus of veins. [RGUHS Mar 94] 10. Digastric muscle. [RGUHS Dec 2010 (RS & RS2)]
11. Pterygomandibular raphe. [RGUHS] 11. Lingual nerve. [RGUHS Dec 2010 (RS & RS2)]
12. Name any four branches of first part of maxillary artery. [RGUHS
Sep 04] 12. DEEP STRUCTURES OF THE NECK
13. Lateral pterygoid plate. [RGUHS Mar 04]
Long Essays
14, Sphenomandibular ligament. [AP Mar/Apr 05]
15. Name the muscles of mastication (major and minor). [AP Apr/ 1. Thyroid gland. [RGUHS Mar 04]
May 04] 2. Describe thyroid gland under following headings: [RGUHS Sep 04]
16. Name the muscles of mastication. Give their nerve supply and a. Coverings
action. [Maharashtra May 02] b. Parts and relations
c. Blood supply
17. Name the muscles of mastication. Give their nerve supply.
d. Applied aspect.
[Maharashtra Jul/Aug 05]
. Describe anatomy of thyroid gland. Give its surgical importance.
18. Name the contents of the temporal fossa. [Maharashtra May 03]
[RGUHS Dec 92]
19. Lateral pterygoid muscle. [Goa Aug 05]
. Give an account of gross anatomy and histology of thyroid
20. Morphology and attachments of sphenomandibular ligament. gland. How is it developed? [RGUHS Mar 88, Sep 94, Aug 95,
[AP Jun 08] Apr 88]
21. Lateral pterygoid muscle. [RGUHS Dec 2010 (RS & RS2)] . Describe the thyroid gland. Add a note on blood supply and his-
tology. [RGUHS Apr 98]
11. SUBMANDIBULAR REGION . Describe the thyroid gland under the following: position and
parts, relations, blood supply, lymphatic drainage and develop-
Long Essays ment of gland. [RGUHS Apr 00]
. Describe the blood supply, relations and development of thyroid
1. Write about origin, insertions, relations and nerve supply of
mylohyoid muscle. [RGUHS Mar 94]
gland. [AP Aug 05]
Describe submandibular gland. Add a note on its histology and . Describe the position, relations, microscopic structure and ap-
plied anatomy of thyroid gland. [AP Oct 04]
innervation. [RGUHS Mar 95]
Describe the anatomy, histology, blood supply and nerve supply
. Describe the thyroid gland under the following heads: [Maha-
of submandibular salivary gland. [AP Oct 04, Jun 08]
rashtra Oct 03]
a. Morphology
Sh ort Essays b. Relations
1. Otic ganglion. [RGUHS Jun 92, 93, Sep 01] c. Arterial supply
Submandibular ganglion. [RGUHS Mar 05] d. Applied importance.
Give the development and nerve supply of digastric muscle. 10. Describe the anatomy of thyroid gland. Give its development and
[RGUHS Sep 98] surgical anatomy. [Goa Jul 04]
Mylohyoid muscles. [AP Mar/Apr 05] 11. Describe the thyroid gland under the following headings:
Submandibular salivary gland. [RGUHS Dec 2011/Jan 2012 (RS [RGUHS Dec 2010 (RS3)]
& RS2)] a. Situation and coverings
b. Parts and relations
Digastric muscle. [RGUHS Dee, Jun/Jul 2010 (RS3)]
c. Blood and nerve supply
Give the development of submandibular gland and its anomalies. d. Applied anatomy.
[RGUHS Dec 2010 (OS)]
Chorda tympani nerve. [RGUHS Jun/Jul 2010 (RS3)] Short Essays
1 . Scalenus anterior muscle. [RGUHS Mar 05]
Short Notes
2 . Blood supply of thyroid gland. [RGUHS Sep 00]
Otic ganglion. [RGUHS Aug 91, Feb 93]
3. Styloid process of temporal bone. [RGUHS Mar 04, Sep 04]
Digastric muscle. [RGUHS Oct 87, Aug 92, Jun 93]
4 . Give the origin, insertion and superficial relations of scalenus
YP

Mylohyoid muscle. [RGUHS Jun 92] anterior muscle. [RGUHS Sep 97]
Hyoglossus muscle. [RGUHS Mar 92] . Thyroid gland follicle. [AP Oct 04]
wn
Ve

Submandibular duct. [RGUHS Sep 04] 6. Styloid process. [RGUHS Dec 2011/Jan 2012 (RS3)]
Submandibular lymph nodes. [RGUHS Jun 92] 7. Spinal accessory nerve. [RGUHS Dec 2011/Jan 2012 (RS &
NA

Relations of hyoglossus muscle. [RGUHS Mar 05] RS2)]

4718 Quick Review Series: BDS 1st Year

8. Thyroid cartilage. [RGUHS Dec 2010 (RS3)] Short Notes

9. Styloid apparatus. [RGUHS Jun/Jul 2010 (RS & RS2)] 1. Atlanto-axial joint. [RGUHS Jun 92]
2. Vertebral artery. [RGUHS Oct 87]
Short Notes
Esophagus. [RGUHS Sep 94] 14. MOUTH AND PHARYNX
Thyroid gland. [RGUHS Aug 91, Sep 94]
Styloid process. [RGUHS Feb 96] Long Essays
Se FNM
PF YP

Accessory nerve. [RGUHS Jul 90, Aug 92] 1. Describe anatomy of palatine tonsil. Give its surgical importance.
Thyroglossal duct. [RGUHS Mar 04] [RGUHS Jun 91, Aug 94]

Stylohyoid ligament. [RGUHS Aug 82, Aug 93, Oct 87, Apr 98]
Recurrent laryngeal nerve. [RGUHS Mar 04]
Recurrent laryngeal nerve of right side. [RGUHS Sep 01]
Recurrent laryngeal nerve in the neck. [RGUHS Mar 05]
Jugulodigastric lymph node. [RGUHS Mar 04]
Pe Ps S
. Give an account of position, relations, blood supply and develop-
ment of palatine tonsil. Add a note on its applied anatomy.
[RGUHS Apr 01, Mar 05]
. Give account of position, relations, blood supply and develop-
ment of palatine tonsil. Add a note on development. [RGUHS
Aug 93]

. Isthmus of thyroid ligament. [RGUHS Mar 00] . Describe external features, muscles, nerve supply and blood sup-
meee

Blood supply of thyroid gland. [RGUHS Apr 00] ply of soft palate. [RGUHS Sep 99]

Formation of internal jugular vein. [RGUHS Apr 98] . Name the muscles of pharynx. Give the origin, insertion, nerve
supply and applied anatomy of superior constrictor muscle of
Formation and termination of internal jugular vein. [RGUHS
pharynx. [Goa Aug 05]
Apr 98]
. Describe the pharynx under the following headings: [RGUHS
15. Name any four structures related to medial surface of thyroid
Dec 2010 (RS & RS2)]
gland. [RGUHS Apr 01]
a. Extent
16. Name any four structures attached to the styloid process. [RGUHS . Relation
ono et

Sep 02] . Subdivisions

17. Styloid apparatus. [AP Oct 02] . Blood supply
18. Styloid process. [AP Mar/Apr 05] . Nerve supply.

19. Name the structures attached to the styloid process. [Maharashtra

Jul/Aug 05] Short Essays
20. Scalenus anterior muscle. [Goa Jul 04, Jul 07] « Oropharynx. [RGUHS Mar 05]
21. Name any four tributaries of internal jugular vein. [AP Jun 08] . Describe the features of lateral wall of nasopharynx. [RGUHS
nN

22. Medial relations of lobe of thyroid gland. [AP Jun 08] Mar 88, Jul 90, Feb 96]

23. Name the branches of vagus nerve in the neck. [RGUHS Dec . Development of tooth. [AP Aug 05]
Ww

2011/Jan 2012 (OS) . Deglutination. [AP Oct 04]

—

24. Ligament of Berry. [RGUHS Dec 2011/Jan 2012 (RS3)] . Functions of saliva. [AP Apr/May 04]
Aan

25. Medial relations of thyroid gland. [RGUHS Dec 2011/Jan 2012 . Give an account of inferior constrictors. [RGUHS Dec 2011/Jan
(RS & RS2)] 2012 (OS)]
26. Styloid process. [RGUHS Dec 2011/Jan 2012 (RS & RS2)] . Waldeyer’s ring. [RGUHS Dec 2011/Jan 2012 (RS3)]
“I

27. Formation and termination of internal jugular vein. [RGUHS . Nasopharynx. [RGUHS Dec 2011/Jan 2012/Jun/Jul 2010 (RS &
Dec 2011/Jan 2012 (RS & RS2)] RS2)]
28. Contents of carotid sheath. [RGUHS Dec 2010 (RS3)] . Development of tonsil. [RGUHS Dec 2010 (RS & RS2)]
29. Define pleura. [RGUHS Dec 2010 (OS)] 10. Development of palate. [RGUHS Jun/Jul 2010 (RS3)]
30. Infrahyoid muscles. [RGUHS Dec 2010 (RS & RS2)] 11. Constrictors of pharynx. [RGUHS Jun/Jul 2010 (RS & RS2)]
31. Internal jugular vein. [RGUHS Dec 2010 (RS & RS2)]
32. Muscles attached to styloid process. [RGUHS Dec 2010 (RS & Short Notes
RS2)] . Soft palate. [RGUHS Mar 91]
=

. Nasopharynx. [RGUHS Mar 88]

13. PREVERTEBRAL REGION
NY

. Palatine tonsil. [RGUHS Mar 80, Jul 90]

Ww

Short Essays . Muscles of soft palate. [RGUHS Jun 93, Dec 93, Sep 04]
fF

1. Atlanto-occipital joint. [RGUHS Apr 00] . Tensor palatine muscle. [RGUHS Dec 92]

2. Give the extent, relations, parts, branches of vertebral artery. . Pharyngobasilar fascia. [RGUHS Feb 93]
NDA

[RGUHS Dec 2010 (OS)] . Pharyngotympanic tube. [RGUHS Dec 91]

 Previous Years’ Question Bank

Lymphatic drainage of tonsil. [RGUHS Aug 96] . Give the boundaries, contents, openings of air sinuses of the lat-

Superior constrictor of pharynx. [RGUHS Aug 91] eral wall of the nasal cavity. [RGUHS Dec 2011/Jan 2012 (OS)]

10. List the lymphatic nodules in Waldeyer’s ring. [RGUHS Sep 97] 10. Septum of the nose. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]

11. Enumerate four relations of constrictor muscle of pharynx. 11. Give the boundaries, relations and applied anatomy of frontal air
[RGUHS Sep 97] sinus. [RGUHS Dec 2010 (OS)]

12. Name the lateral relations of palatine tonsil. [RGUHS Mar 04] 12. Middle meatus of nose. [RGUHS Jun/Jul 2010 (RS3)]

13. Molar teeth. [AP Mar/Apr 05]

Short Notes
14, Temporary (milk) teeth. [AP Aug 05]
15. Premaxilla. [AP Mar/Apr 05] . Frontal sinus. [RGUHS Dec 89]

=
16. Oral diaphragm. [AP Feb 02] . Nasal septum. [RGUHS Oct 94]

YM
17. Superior constrictor muscle. [Goa Jul 06] . Orbital nerve. [RGUHS Mar 88]

YW
. Maxillary sinus. [RGUHS Sep 04]

&—
18. Sinus of larynx. [RGUHS Dec 2011/Jan 2012 (RS3)]
19. Mention the bones forming hard palate. [RGUHS Dec 2010 (OS)] . Paranasal sinuses. [RGUHS Feb 93]

NV
20. Cleft palate. [RGUHS Jun/Jul 2010 (RS & RS2)] . Sphenoidal air sinus. [RGUHS Jun 91]

A
21. Nerve supply of pharynx. [RGUHS Jun/Jul 2010 (RS & RS2)] . Sphenopalatine ganglion. [RGUHS Apr 01]

nNt
. Blood supply of nasal septum. [RGUHS Sep 04]

OP
15. NOSE AND PARANASAL SINUSES . Middle meatus of nose. [RGUHS Mar 05]
. Name the paranasal sinus opening into middle meatus of the

oS
Long Essays _ nose. [RGUHS Apr 99]
1. Describe lateral wall of nasal cavity. [RGUHS Aug 93, Sep 96, 11. Mention the paranasal sinuses opening into middle meatus of the
Mar 00] nose. [RGUHS]
Describe the features of lateral wall of nose in detail. [RGUHS 12. Name any four bony constituents of nasal septum. [RGUHS Mar 05]
Apr 98] 13. Enumerate the structures opening in the middle meatus of the
Describe lateral wall of nose under following headings: bone for- lateral nasal wall. [Maharashtra Oct 03]
mation features, opening, blood supply and nerve supply. 14. Nasal septum. [Goa Aug 05, Jul 06]
[RGUHS Mar 04] 15. Maxillary sinus. [Goa Jul 07, Jul 08]
Describe maxillary air sinus and its relation. [RGUHS Jul 90]
16. Nerve supply of septum of nose. [AP Jun 08]
Describe gross anatomy of nasal septum. [RGUHS Aug 92]
17. Nasal septum. [RGUHS Dec 2010 (RS & RS2)]
Describe maxillary nerve under the following headings: origin,
18. Inferior meatus of nose. [RGUHS Jun/Jul 2010 (RS & RS2)]
termination, course and relations, branches, distribution and ap-
plied anatomy. [RGUHS Mar 05]
Describe the nasal septum. Give its blood supply, nerve supply, 16. LARYNX
lymphatic drainage and surgical anatomy. [RGUHS Goa 04]
Long Essay
Describe the lateral wall of the nose under the following headings.
[RGUHS Dec 2010 (RS3)] 1. Describe the larynx under the following headings: [RGUHS Jun/
. Parts Jul 2010 (RS3)]
. Openings a. Extent
ane

. Blood supply b. Parts

. Applied anatomy. c. Vocal folds
Describe the paranasal air sinuses. Add a note on its innervation d. Nerve supply.
and applied anatomy. [RGUHS Jun/Jul 2010 (RS & RS2)]
Short Essays
Short Essays . Vocal folds. [RGUHS Mar 04]
Nasal septum. [RGUHS Sep 04, Sep 00] . Vocal cords. [RGUHS Apr 01]
Maxillary air sinus. [RGUHS Feb 94] . Location, attachments and movements of vocal cords. [RGUHS

Give the boundaries, relations and applied anatomy of sphenoidal Sep 02]
»

air sinus. [RGUHS Apr 99, Mar 05] . Thyroid cartilage. [AP Mar/Apr 05]
Lateral wall of nasal cavity. [AP Sep 06] . Cricoid cartilage. [AP Aug 05]
YF

Paranasal air sinus. [AP Mar/Apr 05]

Maxillary air sinus. [AP Mar/Apr 05] Short Notes
PNA

Sphenoidal sinus. [AP Apr/May 04] 1. Vocal folds. [RGUHS Dee 92, Jun 93, Oct 94]
Paranasal air sinuses. [AP June 08] 2. Rima glottidis. [RGUHS Sep 04]
LEY) Quick Review Series: BDS 1st Year

. Cricoid cartilage. [RGUHS Mar 98] Short Essays

Ww

Thyroid cartilage. [RGUHS Jun 91, Sep 04]

1. Nerve supply of tongue. [RGUHS Sep 01]
aA Ve
wen

. Thyrohyoid membrane. [RGUHS Mar 92] 2. Lymphatic drainage of tongue. [RGUHS Jul 90, Aug 93, Sep 00]
. Cricothyroid muscle. [RGUHS Aug 92] . Lymph vessels and lymph nodes draining lymph from tongue.

we
. Nerve supply of larynx. [RGUHS Mar 05] [RGUHS Sep 02]
. Paired cartilage of larynx. [RGUHS Mar 00] . Hyoglossus muscle. [AP Aug 05, Sep 06]
. Give boundaries of rima glottidis. [RGUHS Apr 99] . Lymphatic drainage of tongue. [AP Sep 06]

NNW
. Name the intrinsic muscle of larynx. [RGUHS Apr 00] . Development of tongue. [AP Apr/May 04]
11. Action and insertion of posterior cricoarytenoid muscle. [RGUHS . Give an account of the lymphatic drainage of the tongue. [RGUHS
Sep 00] Dec 2011/Jan 2012 (OS)]
12. Name sensory nerve supply of larynx. [RGUHS Mar 04] . Give the attachments, relations, nerve supply and actions of hyo-
13. Give the attachments, nerve supply and actions of inferior con- glossus muscle. [RGUHS Dec 2011/Jan 2012 (OS)]
strictor muscle. [RGUHS Mar 2005] . Lymphatic drainage of tongue. [RGUHS Dec 2010 (RS & RS2)]
14, Rima vestibule. [AP Mar/Apr 05]
15. Vocal cords. [AP Apr/May 04, Mar/Apr 05] Short Notes
16. Rima glottidis. [AP Aug 05] . Lingual nerve supply. [RGUHS Sep 04]
17. Name the cartilages of larynx. [AP Oct 02] . Nerve supply of tongue. [RGUHS Dec 93]

Pp wn
18. Give origin, nerve supply and actions of the cricothyroid muscle. . Lymphatic drainage of tongue. [RGUHS Jul 90, Aug 93]
een
[Maharashtra Oct 03]
. Relations of hyoglossus muscle. [RGUHS Mar 05]
19. Enumerate the cartilages of larynx. Draw a diagram showing their
. Lymphatic drainage of tongue. [AP Aug 05]
arrangement. [Maharashtra May 02]
aw

Sensory nerve supply of tongue. [AP Oct 04]

20. Cricothyroid muscle. [Goa Jul 08]
. Development of tongue and its anomalies. [Goa Aug 05]
21. What is the nerve supply and actions of cricothyroid muscle? [AP
Jun 08] . Nerve supply and lymphatic drainage of tongue. [Goa Jul 07]

22. Movements of vocal cords. [AP Jun 08] . Name and draw the papillae in the tongue. [RGUHS Dec 2011/
Jan 2012 (OS)]

17, TONGUE 10. Nerve supply of the tongue. [RGUHS Dec 2010 (RS3)]
11. Name the papillae of the tongue. [RGUHS Dec 2010 (OS)]
Long Essays 12. Development of tongue. [RGUHS Jun/Jul 2010 (RS & RS2)]
1. Describe surface features of dorsum of tongue. How do you correct
its epithelial innervation to its development? [RGUHS Mar 87] 18. EAR
. Give an account of musculature of tongue and its development.
Write briefly about lymphatic drainage of tongue. [RGUHS Mar Short Essays
88, Aug 91, Feb 93]
1. Give the position, nerve supply and development of tympanic
. Describe in detail about tongue including its blood supply and membrane. [RGUHS Sep 97]
innervation. [RGUHS Apr 98]
. External auditory meatus. [AP Jun 08]
. Describe anatomy of tongue. Add a note on its development.
. Tympanic membrane. [RGUHS Jun/Jul 2010 (RS3)]
[RGUHS Dec 93, Apr 98]
. Describe tongue under following headings: [RGUHS Sep 04]
a. Parts and gross external features Short Notes
b. Nerve supply . Tympanic membrane. [RGUHS Dec 93, Sep 04]
c. Development including anomalies.
. External acoustic meatus. [RGUHS Sep 04]
NY

. Describe the anatomy, nerve supply and lymphatic drainage of

. Nerve supply to the auricle (pinna). [AP Mar/Apr 05]
we

tongue. [AP Feb 02]

Middle ear ossicles. [AP Mar/Apr 05]
Fe

. Describe the tongue under following heads: [Maharashtra May 02]

a. Development . Auditory tube. [Goa Jul 08, Jul 06]
au

b. Microscopic anatomy
c. Applied importance. 19. EYEBALL
. Describe the tongue and give its blood supply, nerve supply, lym-
phatic drainage and applied anatomy. [Goa Jul 06] Long essay
. Describe the external features, muscles, nerve supply and devel- 1. Describe the extrinsic muscles of the eye ball under the following
opment of the tongue. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]
headings. [RGUHS Dec 2011/Jan 2012 (RS3)]
10. Describe the innervation, lymphatic drainage and development a. Origin
of tongue. [RGUHS Jun/Jul 2010 (RS & RS2)] b. Insertion
 Previous Years’ Question Bank

c. Nerve supply Short Essay

d. Action
1. Give the parts, blood supply, relations and applied anatomy of
e. Applied anatomy.
internal capsule. [RGUHS Dec 2010 (OS)]

Short Essays
Short Notes
Give the development of retina. [RGUHS Sep 97]
1. Central sulcus. [RGUHS Dec 91]
pr

Lateral rectus muscle of eyeball. [RGUHS Mar 04]

2. Name the nuclei of cerebellum. [Maharashtra May 03]
Lacrimal apparatus. [AP Oct 02]
3. Draw and label the superolateral surface of the cerebrum showing
Fe

Extrinsic muscles of eyeball. [RGUHS Dec 2011/Jan 2012 (RS &

important functional areas. [Maharashtra Oct 03]
RS2)]
. Name the nuclei of cerebellum. [Maharashtra Jul/Aug 05]

Short Notes . Name any four tracts passing through inferior cerebellar pedun-
cle. [Maharashtra Jul/Aug 05]
Short ciliary nerve. [RGUHS Mar 05]
6. Parts of corpus callosum. [AP June 08]
Actions of oblique muscles of eyeball. [RGUHS Sep 99]
7. Give the functions of cerebellum. [RGUHS Dec 2010 (OS)]
PF YP

Fascial sheath of eyeball. [RGUHS Apr 00]

PNA

Extrinsic and intrinsic muscles of eye. [AP Oct 02] 22. MISCELLANEOUS
Central artery of retina. [AP Feb 02]
Superior oblique muscle of eyeball. [AP Jun 08] Long Essays
Chorion. [RGUHS Dec 2010 (RS & RS2)] 1. Radicular artery. [RGUHS Aug 91]
Superior rectus muscle of eyeball and its action. [RGUHS Jun/Jul 2. Blood supply of long bone. [RGUHS Sep 04]
2010 (RS & RS2)]
Short Essay
20. REGIONAL ANATOMY OF NECK
1. Medulla oblongata (only external features). [AP Sep 06]

Long Essay
Short Notes
1. Cervical sympathetic chain. [RGUHS Sep 99]
1. Inferior horn of lateral ventricle. [AP Sep 06]

21. BRAIN 2. Spinal cord. [AP Apr/May 04]

3. Draw and label section of spinal cord showing major descending
Long Essay and ascending tracts. [Maharashtra May 02]

1. Describe superolateral surface of cerebrum. [RGUHS Mar 91] . What are the functions of intra-articular discs? [Maharashtra
May 02]
2. Describe the gross features, relations, blood supply and constitu-
ent fibres of corpus callosum. [AP Sep 06] . Structure of suprarenal gland. [RGUHS Jun/Jul 2010 (RS & RS2)]

Section 1B: General Histology

Short Essays 12. Histology of hypophysis cerebri. [RGUHS Aug 96]

Histology of cartilage. [RGUHS Mar 88] 13. Histology of thyroid. [RGUHS Feb 93, 94, Aug 95]

Histology of hyaline cartilage. [RGUHS Mar 91, Mar 95]

YP

Histology of bone. [RGUHS Jul 90] Short Notes

Histology of skeletal muscle. [RGUHS Mar 92] . Histology of cartilage. [RGUHS Jun 91, Dec 92]
PF

Histology of medium-size artery. [RGUHS Aug 91] . Histology of compact bone. [RGUHS Aug 94]
Vk NHN
AY

Histology of lymph node. [RGUHS Jul 90, Sep 94] . Histology of lymph node. [RGUHS Jun 91, 92]
YW

Histology of thymus. [RGUHS Mar 96] . Histology of thymus. [RGUHS Jun 93, 94]
eS FN

Histology of parotid gland. [RGUHS Aug 93] . Histology of large-size artery. [RGUHS Jun 93, 94]

Histology of lung. [RGUHS Aug 92] . Histology of submandibular gland. [RGUHS Dec 92]
A

Histology of oesophagus. [RGUHS Aug 91] . Histology of parotid gland. [RGUHS Aug 94]
©

Pen
ee

. Histology of kidney. [RGUHS Mar 92] . Histology of kidney. [RGUHS Dec 92]
—
/E¥y Quick Review Series: BDS 1st Year

9. Histology of pituitary gland. [RGUHS Dec 92] 20. Histology of liver. [AP Apr/May 04]
10. Histology of adrenal gland. [RGUHS Dec 91] 21. Adrenal cortex zone fasciculatum. [AP Oct 04]
11. Draw a well-labelled diagram of histology of thymus. [Maharash- 22. Histology of lymph node. [AP Oct 04, Aug 05]
tra May 02] 23. Parathyroid glands. [AP Oct 02]
12. Draw and label a TS of an osteon. [Maharashtra Oct 03] 24. Microscopic anatomy and development of tonsil. [AP Feb 02]
13. What are different types of epiphysis? [Maharashtra Jul/ Aug 05] 25. Microscopic structure of hyaline cartilage. [AP Feb 02]
14. Name the four sites where hyaline cartilage is present. [Maharash- 26 . Microscopic structure of lymph node. [AP Feb 02]
tra Jul/Aug 05]
27. Haversian system. [AP Oct 03]
15. Give the mi ic struct f two: [Goa 04
ive the microscopic structure of any two: [Goa 04] 28. Microscopic structure of trachea. [AP Oct 03]
a. Developing tooth
b. Collagen fibres 29. Histology of hyaline cartilage. [AP Oct 03]
c. Golgi apparatus. 30. Histology of pituitary. [AP Sep 06]
16. Give the microscopic structure of any two: [Goa Aug 05] 31. Histology of large artery. [AP Sep 06]
a. Endochondral ossification 32. Islets of Langerhans. [AP Sep 06]
b. Thymus .
c. Tooth. 33. Histology of pancreas. [AP Mar/Apr 05]
17. Give the microscopic structure of any two: [Goa Jul 06] 34. Histology of bone. [AP Mar/Apr 05]
a. Loose areolar tissue 35. Histology of tonsil. [AP Mar/Apr 05]
b. Pituitary gland 36. Histology of kidney. [AP Aug 05]
c. Tooth.
37. Histology of elastic cartilage. [AP Aug 05]
18. Give the microscopic structure of any two: [Goa Jul 07]
a. Palatine tonsil 38. Microscopic structure of spleen. [AP Jun 08]
b. Hyaline cartilage 39. Types of epiphyses with examples. [AP Jun 08]
c. Bell stage of developing tooth. 40. Histological appearance of elastic artery. [AP Jun 08]
19. Give the microscopic structure of any two: [Goa Jul 08] 41. Microscopic picture of suprarenal gland. [AP Jun 08]
a. Palatine tonsil
b. Yellow elastic cartilage
c. Developing tooth.

Section 1C: Embryology

1. SOME PRELIMINARY CONSIDERATIONS 3. FORMATION OF GERM LAYERS

Short Notes Short Notes

1. Chromosome. [RGUHS Mar 2005] 1. Effects of fertilization. [RGUHS Mar 04]
2. Classification of chromosomes. [AP Jun 08] 2. Intraembryonic mesoderm. [AP Jun 08]
3. What is Barr body or sex chromatin? From which structure is it
derived? [Maharashtra May 03] 4. FURTHER DEVELOPMENT OF EMBRYONIC DISC

2. SPERMATOGENESIS AND OOGENESIS Short Essays

1. Formation, functions and fate of notochord. [RGUHS Mar 04]
Short Essays
1. Give parts of uterine tube. What is tubectomy? [Maharashtra Short Notes
May 02] 1. Formation and fate of notochord.
2. Enumerate the stages of normal spermatogenesis. [Maharashtra
May 03] 5. PHARYNGEAL ARCHES

Short Notes Short Essays

1. Oogenesis. [RGUHS] 1. Development of mandible. [RGUHS Mar 05]
2. Graafian follicle. [AP Oct 04] 2. Development of thyroid. [RGUHS Sep 04]
 Previous Years’ Question Bank

Development of thyroid gland and its anomalies. [RGUHS Sep 02] 3. Palatine aponeurosis. [RGUHS Sep 04]
Cartilage, arch, artery and muscular derivatives of first pharyn- 4. Development of palate. [RGUHS Mar 05; Goa Jul 08]
>

geal arch. [RGUHS Sep 02] 5. Enumerate congenital anomalies of teeth. [Maharashtra May 03]
What are derivatives of 3rd pouch? [Maharashtra Jul/ Aug 05] 6. Development of oral mucosa. [AP Oct 03]
Se FnNnn yw

Derivatives of second pharyngeal arch. [AP Oct 03] 7. Developmental anomalies of the lip. [AP Oct 03]
Meckel’s cartilage. [AP Oct 04] 8. Cleft lip. [AP Oct 02]
Bones derived from second pharyngeal arch. [AP Mar/ Apr 05] 9. Development of upper lip. [AP Oct 04]
Pharyngeal pouches. [AP Jun 08] 10. Developmental anomalies of face. [AP Jun 08]

Short Notes
7. ALIMENTARY SYSTEM
Derivatives of first pharyngeal arches. [RGUHS Mar 04]
Derivatives of mesoderm of II pharyngeal arch. [RGUHS Mar 04] Short Essay
F YN
AY

Structures developed from III pharyngeal arch. [RGUHS Sep 02] 1. Development of tongue. [RGUHS Sep 04, AP Mar/Apr 05]
Derivatives of III endodermal pouch pharynx. [RGUHS Sep 02]
Formation and fate of first pharyngeal pouch. Short Notes
Give persistent structures of fibrous envelop of Meckel’s cartilage. 1. Give a detailed account of development of milk teeth. [RGUHS
[RGUHS Mar 05] Sep 04]
Fate of endodermal pouches. [Goa Jul 04, Aug 05] 2. Structure of tooth (labelled diagram only). [RGUHS Mar 05]
N

Derivatives of first branchial arch. [Goa Jul 06]

Derivatives of second branchial arch. [Goa Jul 07] 8. ELEMENTARY GENETICS
10. Enumerate the muscles derived from second branchial arch. [Ma-
harashtra May 02]
Short Notes
11. Meckel’s cartilage. [AP Feb 02, Jun 08] 1. Karyotype and any two clinical features of Turner syndrome.
12. Derivatives of first pharyngeal arch. [AP Oct 04]
[RGUHS Mar 04]
. Down’s syndrome. [Goa Jul 04, AP Oct 03]
13. Second pharyngeal arch. [AP Jun 08]
NY

. Turner’s syndrome. [Goa Jul 06]

BW

6. FACE, NOSE AND PALATE . Karyotyping. [Goa July 07, Jul 08]
fF

. What is Down’s syndrome? Give four clinical features of Down’s

a

Short Essays syndrome. [Maharashtra May 02]

1. Development of face. 6. Give any four features of the Down’s syndrome. [Maharashtra
Oct 03]
2. Frontonasal process of embryo. [RGUHS Mar 05]
Give the development of palate and associated anomalies.
9. MISCELLANEOUS
»

[RGUHS Mar 03]

Development of palate and associated anomalies. [AP Jun 08]
Short Note
WOR

Oblique facial cleft. [AP Oct 04]

. Development of pituitary gland. [RGUHS Mar 92]
Development of face and its anomalies. [AP Aug 05]
. Development of thyroid gland. [RGUHS Sep 02]
NA

NY

Development of palate and its anomalies. [AP Mar/Apr 05]

. Development of parathyroid gland. [RGUHS Mar 91]
BY

Short Notes . Give development of thyroid gland. [Maharashtra Jul/ Aug 05]
fF

. Development of hypophysis cerebri. [AP Feb 02]

1. Hare lip or cleft lip. [RGUHS Mar 05]
a

2. Cleft palate. [RGUHS Mar 04]

Section 2: Physiology

1. CELL STRUCTURE AND FUNCTION 2. TYPES OF TISSUES

Short Notes Short Note

1. Mitochondria. [RGUHS Feb 91] 1. Epithelial tissues. [AP Oct 02]
2. Derivatives of cholesterol and their importance. [RGUHS Apr 98]
7EY SY) Quick Review Series: BDS 1st Year

3. BLOOD 23. Describe the mechanism of coagulation of blood. Name few anti-
coagulants. [AP Jun 90]
Long Essays 24. What is haemoglobin? Describe the types, functions and fate of
haemoglobin. [Mangalore University Apr 99]
1. Enumerate plasma proteins giving normal values. Explain any
five functions of plasma protein. [RGUHS Feb 96]
25. Explain intrinsic and extrinsic mechanisms of blood clotting.
[NTRUHS Jun 2010]
. Classify WBCs and describe their function with diagrams.
26. Mention the names of the clotting factors in proper order. Ex-
[RGUHS Jun 90, Aug 96]
plain the intrinsic mechanism of blood clotting. [NTRUHS Jan
. What is the basis for classification of blood groups and what are 2010 (OR)]
the uses of blood grouping? Add a note on Rh1 blood. [RGUHS
Aug 88, Jun 89, Mangalore University Dec 91]
27. Explain intrinsic and extrinsic mechanism of blood clotting.
[NTRUHS Jun 2011 (NR & OR)]
. Describe the mechanism of coagulation of blood. [RGUHS Apr
87, Jul 90, Aug 93]
. Describe intrinsic and extrinsic pathway of blood coagulation. Short Essays
[Mangalore University Jun 91, Dec 92] . Rh incompatibility. [RGUHS Apr 00]
. What is erythropoiesis and where does it occur in the adult? Give . Mention the function of plasma proteins. [RGUHS Mar 04
stages of erythropoiesis and requirement of each stage. [RGUHS Sep 04]
Mar 88, Aug 92, Feb 93, Mar 95]
. Oxygen—-haemoglobin dissociation curve. [Maharashtra May 03]
. Describe the mechanism of coagulation of blood. Mention
4. Coagulation of blood. [Maharashtra May 03]
different anticoagulants and mechanism of action. [RGUHS
Jan 89] . Define circulatory shock. Explain the various stages. [Maharash-
tra May 03]
. Describe the morphology of red blood corpuscles.
Briefly outline the stages in erythropoiesis. Mention two factors . Transport of O, in the blood and oxygen dissociation curve. [Ma-
that affect erythropoiesis. [RGUHS Sep 99] harashtra May 02]

. Define blood pressure. What is the normal blood pressure? De- . Name the three chief plasma proteins. Give the function of each.
scribe the regulation of blood pressure. [RGUHS Sep 04, Mar 05] [RGUHS Feb 07]
10. Define blood pressure. What is the normal blood pressure? De- . Name the plasma proteins and describe their functions [RGUHS
scribe the regulation of BP. [RGUHS Apr 00] Jul 08]
11. Describe the transport of oxygen in the body. [Maharashtra Jul/ . Discuss the factors regulating erythropoiesis. [RGUHS Jul 08]
Aug 05] 10. Factors required for erythropoiesis. [Goa 02]
12. Name the sites of erythropoiesis in an infant and an adult. Name 11. Plasma proteins. [Goa Jul 06]
the different stages of erythropoiesis. List the various changes oc- 12. Cyanosis. [Goa Jul 08]
curring at different stages of erythropoiesis. Name the factors
13. Platelets. [Goa Jul 08]
influencing erythropoiesis. [RGUHS Feb 07]
14, Blood groups. [AP Jun 08]
13. Why does blood not normally clot in the circulating blood? Give
three main steps in the clotting of blood. What is the role of aspi- 15. Anticoagulants. [AP Jun 08]
rin in blood coagulation? [Goa 03] 16. Composition and functions of blood. [AP Sep 06]
14, Name different blood group systems. What is the importance of 17. Rh group. [AP Sep 06]
determination of blood groups? What are the effects of mis- 18. Coagulation of blood. [AP Mar/Apr 05]
matched blood transfusion? [Goa Jul 05]
19. Rh incompatibility. [AP Apr 02]
15. Classify and describe the different types of white blood corpus-
cles. What are their functions? [AP Feb 02] 20. Reticulocyte. [AP Oct 99]

16. Give the composition of blood and explain importance of plasma. 21. Functions of plasma proteins. [AP Feb 00]
[AP Oct 02] 22. Mismatched blood transfusion reaction. [AP Oct 98]
17. Explain the steps in coagulation of blood. Add a note on antico- 23. Discuss briefly the functions of platelets. [AP Apr 95]
agulants. [AP Feb 02] 24. Discuss briefly the functions of plasma proteins. [AP Apr 96]
18. Give the composition of blood and explain the importance of 25. Discuss briefly the factors affecting heart rate. [AP Nov 94]
plasma. [AP Oct 02]
26. What are the effects of mismatched blood transfusion? [AP
19. Describe the mechanism of coagulation. Name two anticoagu- Aug 91]
lants. [AP Oct 97]
27. Mention two functions of blood platelets. [AP Aug 91]
20. Discuss briefly the functions of white blood corpuscles (WBC).
28. In what forms is CO, carried in the blood? [AP Feb 91]
[AP Apr 95]
29. Name two bleeding diseases. How are they caused? [AP]
21. Discuss the composition and functions of blood. [AP Nov 94]
30. Mention the functions of serum proteins. [AP Jun 90]
22. What is the normal blood volume? What are the methods used
for determining blood volume? Describe the various causes of 31. Give the normal concentration of fibrinogen in blood and outline
hypovolaemia (decrease) in humans. [AP] the role played by it. [RGUHS Dec 2011/Jan 2012 (OS)]
 Previous Years’ Question Bank

32. Discuss the mechanisms of blood coagulation. [RGUHS Dec 27. Mention the immediate effects of moderate haemorrhage. [AP
2011/Jan 2012 (RS3)] Feb 02]
33. What are anticoagulants? Name the anticoagulants and describe 28. Blood groups. [AP Apr/May 04 Mangalore University Jun 93]
the mechanism of action of any one of them. [RGUHS Dec 2011/ 29. Anticoagulants. [AP Apr/May 04]
Jan 2012 (RS & RS2)] 30. Anaemia. [AP Mar/Apr 05]
34. Functions of haemoglobin. [NTRUHS Jun 2010]
31. Types of lymphocytes. [AP Apr 02]
35. Erythropoietin. [NTRUHS Jun 2010]
32. Neutrophil. [Mangalore University Jun 91]
36. Erythroblastosis fetalis. [NTRUHS Jan 2010 (OR)]
33. Pernicious anaemia. [Mangalore University Dec 91, Apr 98]
37. Haemophilia. [NTRUHS Jan 2010 (NR)] 34. Megaloblastic anaemia. [Mangalore University Dec 92]
38. Give the functions of platelets. [RGUHS Dec 2010 (RS & RS2)] 35. Lymphocytes. [Mangalore University Dec 93]
39. Name the three main protein function of plasma. Give the func- 36. Purpura. [Mangalore University Dec 93]
tion of any one of them. [RGUHS Dec 2010 (RS & RS2)]
37. Rh factor. [Mangalore University Jun 92]
40. Blood transfusion and complications. [RGUHS Jun/Jul 2010 (RS
38. Hazards of blood transfusion. [Mangalore University Oct 94]
& RS2)]
39. Bleeding time. [Mangalore University Jul 91, 93]
41. Composition, circulation and functions of lymph. [RGUHS Jun/
Jul 2010 (RS & RS2)] 40. Platelets. [Mangalore University Dec 91, Oct 94]
41. Lymphocytes. [Mangalore University Apr 99]
Short Notes 42. Erythroblastosis fetalis. [Maharashtra May 03]
43. Functions of red blood cells. [NTRUHS Dec 2011/Jan 2012 (NR
1. Plasma proteins. [RGUHS Apr 97 Mangalore University Dec 92,
& OR)]
NTRUHS Jun 2010]
44. Erythropoietin. [NTRUHS Jun 2011 (NR & OR)]
Plasma. [RGUHS Mar 94]
45. Name any two factors that regulate erythropoiesis. [RGUHS Dec
PF YD

Bile pigments. [RGUHS Jan 89, Mar 94]

2010 (RS3)]
FNA

Iron. [RGUHS Sep 94, Feb 96 Mangalore University Jun 03]

46. Chelating agent. [RGUHS Dec 2010 (RS & RS2)]
Leukocytes. [RGUHS Mar 92]
YT

47. Mention any two functions of plasma proteins. [RGUHS June/Jul

Neutrophils. [RGUHS Feb 96] 2010 (RS3)]
Rh factor. [RGUHS Mar 88] 48. List the effect of anaemia. [RGUHS Jun/Jul 2010 (RS & RS2)]
Bleeding and clotting time. [RGUHS Aug 91]
Anticoagulants. [RGUHS Oct 87, Feb 96] 4. CARDIOVASCULAR SYSTEM
ewe

Haemophilia. [RGUHS Mar 95 Feb 07, Mangalore University

-
=

Jun 91, 93] Long Essays

11. Physiology of clotting. [RGUHS Mar 00] 1. What is cardiac cycle? Describe events occurring during normal
12. Mention any four types of anaemia. [RGUHS Apr 01] cardiac cycle. [RGUHS Jul 90, Aug 92]

13. Four functions of plasma proteins. [RGUHS Apr 00] . Define cardiac cycle. Explain the mechanical changes during car-
diac cycle with the help of a diagram. [RGUHS Apr 03]
14, What are the functions of lymphocytes? [RGUHS Sep 01]
. Draw and label a diagram of normal ECG. Describe the various
15. What are the structural and functional differences between adult
waves in ECG. [RGUHS Jun 89, Mar 95]
and fetal haemoglobin? [RGUHS Apr 02]
. Define electrocardiogram. Draw a neat diagram and briefly de-
16. Aplastic anaemia. [RGUHS Sep 02]
scribe different waves. What is the significance of P—R interval?
17. Erythroblastosis fetalis. [RGUHS Sep 04, Mar 05] [RGUHS Sep 99]
18. Enumerate the functions of plasma proteins. [Maharashtra Jul/ . Draw a labelled diagram to depict innervation of heart. Explain
Aug 05] how heart rate is regulated. [RGUHS Aug 96]
19. Enumerate the four important functions of plasma proteins. . What is normal heart rate? Describe variation and regulation of
[Maharashtra Oct 03] heart rate. [RGUHS Aug 88]
20. Diastasis. [Maharashtra May 02] . What is cardiac output? Mention factors affecting cardiac output.
21. Mention two tests done in persons with haemorrhagic disorder. Add a note on venous return. [RGUHS Jan 89, Aug 93]

[RGUHS Jul 08] . What is normal arterial blood pressure and physiologic varia-
22. Classify anaemia. Give examples. [RGUHS Jul 08] tions? Describe role of sinoaortic mechanism regulation of blood
pressure. [RGUHS Jan 91, Aug 91]
23. Anaphylactic shock. [Goa 02]
. Explain regulation of blood pressure brought about by barore-
24. Plasma proteins. [Goa 04] ceptor mechanism. [RGUHS Feb 96]
25. Cyanosis. [AP Jun 08, RGUHS Dec 2011/Jan 2012 (RS & RS2)] 10. What is systolic, diastolic and pulse pressure? Give an account of
26. Functions of platelets. [AP Oct 04] factors that maintain blood pressure. [RGUHS Mar 88]
LEY Quick Review Series: BDS 1st Year

11. Define the terms cardiac output and cardiac index. Describe 15. Briefly discuss the functions of lymphatics and lymph gland. [AP
briefly any one method of measuring cardiac output that can be Nov 94]
safely used in man. What are the factors that influence cardiac 16. Explain Fick’s principle. [AP Aug 91]
output? [RGUHS Apr 98]
17. List the differences between the first and second heart sounds.
12. Define blood pressure. What are the factors that influence it? Give [AP Feb 91]
in detail the factors regulating blood pressure. [RGUHS Apr 00,
18. How many heart sounds are there? Give the important factors
Sep 02]
responsible for production of I and II heart sounds. [AP]
13. Define systolic and diastolic blood pressures. Give their
19. What is the normal cardiac output? How is it determined in man?
normal values. Describe the medullary control of blood pres-
[AP Jun 90]
sure. [Goa 04]
20. Dehydration shock. [NTRUHS Jun 2010]
14, Define cardiac output and give its normal value. Enumerate dif-
ferent methods of measurement of cardiac output. Describe the 21. Second heart sound. [NTRUHS Dec 2011/Jan 2012 (NR &
factors regulating cardiac output. [Goa 05] OR)]
22. Discuss the role of vagus on the heart. [RGUHS Dec 2010 (RS &
15. What are heart sounds? How are they produced? [AP Jun 08]
RS2)]
16. Enumerate the events of cardiac cycle. Describe the pressure
23. Define cardiac cycle. Explain the mechanical change taking place
changes in the left ventricle of the heart. [AP Jun 08]
in the left ventricle during different phases of cardiac cycle.
17. What is cardiac output? Enumerate the methods of determining [RGUHS June/Jul 2010 (RS3)]
it in man. [AP Oct 99]
18. Define blood pressure. Mention the important factors controlling
Short Notes
it. [AP Apr 98]
. Pacemaker. [RGUHS Oct 87]
19. What is cardiac output? Discuss the factors regulating and affect-
ing cardiac output. [AP Apr 95] . Sinoaortic node. [RGUHS Feb 92]
NY

20. Describe the various changes occurring during one cardiac cycle . Heart sounds. [RGUHS Mar 92, AP Apr 02]
YW

with suitable diagrams. [AP Nov/Dec 91] . ECG. [RGUHS Sep 94]
VF

21. Define cardiac impulse. Trace its origin and conduction. [RGUHS Venous return. [RGUHS Jan 90]
Dec 2011/Jan 2012 (OS)] . Baroreceptors. [RGUHS Mar 94]
A

22. Describe the cardiac cycle. State the causes of heart sounds occur- . Cardiac cycle. [RGUHS Mar 00]
ring during the cycle. [RGUHS Dec 2011/Jan 2012 (RS3)]
eFenN

. SA node. [RGUHS Apr 99]

23. Define cardiac cycle. Describe the mechanical events of cardiac
. Draw a labelled diagram of ECG. [RGUHS Apr 03]
Wo

cycle. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]

. First heart sound. [Maharashtra Jul/Aug 05]
&
ee

Short Essays . Draw and label the special conduction tissues of heart. [Maharashtra
—-

May 03]
1. What are heart sounds? How are they produced? Mention their
clinical significance. [RGUHS Sep 97] 12. Draw a neat diagram of ECG and label it. What is the importance
of recording ECG? [RGUHS Feb 07]
. What are the properties of cardiac muscle? [RGUHS Sep 01]
Name the specialized conducting tissues of the heart. [RGUHS
NH

13.
. Explain origin and spread of cardiac impulse. [RGUHS Apr 02] Jul 08]
WY

. Sino aortic mechanism. [Maharashtra Oct 03] 14. Intraventricular pressure curve. [RGUHS Jul 08]
fF

. List three properties of cardiac muscle. Explain any one of them. 15. EGG in lead I. [Goa Jul 06]
an

[RGUHS Feb 07] 16. Role of sinoaortic mechanisms in control of blood pressure. [Goa
. Functional tissues of the heart. [RGUHS Feb 07] Jul 08]
Nn
won

. Regulation of cardiac output. [RGUHS Jul 08] 17. Properties of cardiac muscle. [AP Oct 02]
. Electrocardiograph. [AP Oct 04] 18. Cardiac muscle. [AP Sep 06]
. How many heart sounds are heard, and how are they positioned . Venous return. [AP Mar/Apr 05]
in a normal cardiac cycle? [AP Feb 02] 20. Muscles of inspiration. [AP Oct 02]
10. Conduction of cardiac impulse. [AP Apr/May 04] 21. Name the waves of the electrocardiogram indicating the positive
11. Mention three distinctive properties of the cardiac muscle. Ex- waves. [RGUHS Dec 2011/Jan 2012 (OS)]
plain the basis of any one. [AP Feb 00] 22. Define cardiac output. Explain any one method of measuring it.
12. Special junctional tissues of the heart. [AP Oct 98] [NTRUHS Jan 2010 (NR)]
13. Draw and label a normal electrocardiogram. What is P—R inter- 23. Name any two factors that alter the heart rate. [RGUHS Dec 2010
val? [AP Oct 98] (RS3)]
14, Define stroke volume. Mention the factors regulating cardiac 24. P_R interval. [RGUHS Dec 2010 (RS & RS2)]
output. [AP Apr 96] 25. Marey’s law. [RGUHS Dec 2010 (RS & RS2)]
 Previous Years’ Question Bank

16. Outline the chemical factors controlling respiration. [AP Apr 96]
5. RESPIRATION
17. Define respiratory dead space. [AP Aug 91]
Long Essays 18. Describe the various steps of mouth-to-mouth method of artifi-
cial respiration. [AP]
1. Describe the factors determining oxygen uptake in lung. [RGUHS
Oct 87] 19. Explain the mechanism of chemical regulation of respiration. [AP
Nov/Dec 91]
. Describe transport of oxygen in blood. [RGUHS Jan 91]
20. Classify hypoxia. Explain each type of hypoxia with examples.
. Describe mechanics of respiration. [RGUHS Aug 95]
[RGUHS Dec 2011/Jan 2012 (OS); (RS & RS2)]
. Discuss factors affecting transport and diffusing gases. [RGUHS
21. What is the shape of the oxygen dissociation curve? Give the
Aug 93]
significance and cause for such a shape. [RGUHS Dec 2011/Jan
. Describe nervous regulation of respiration. [RGUHS Sep 94] 2012 (OS)]
. Define hypoxia and enumerate the different types of hypoxia. 22. Haldane’s effect. [NTRUHS Jan 2010 (OR)]
Explain five changes taking place in the body during acclimatiza-
tion hypoxia. [Goa 03]
23. PCV. [NTRUHS Jan 2010 (NR)]
24. Landsteiner’s law. [NTRUHS Jan 2010 (NR)]
. What is surfactant? Where is it synthesized? Explain three of its
important functions. [Goa 04] 25. Is eupnoea voluntary or involuntary? How is it brought about?
- In which forms is oxygen transported in the body? Draw and label
[RGUHS Dec 2010 (RS & RS2)]
oxygen—Hb dissociation curve. State the factors causing shift of . Define ‘timed vital capacity. Give its normal value. Mention a
curve to right. [Goa 05] condition in which it is decreased. [RGUHS June/Jul 2010
(RS3)]
. With the help of a labelled diagram of oxygen—haemoglobin dis-
sociation curve, explain the transport of oxygen from the lungs to 27. Describe the mechanism of inspiration. [RGUHS Jun/Jul 2010
the tissues. Give two factors shifting this curve to the right and (RS & RS2)]
significance of such shift. [Goa Jul 06] 28. Vital capacity and timed vital capacity. [RGUHS Jun/Jul 2010 (RS
10. Draw and describe the neural regulation of respiration. [AP Feb 00] & RS2)]
11. Give an account of the nervous control of respiration. [AP Oct 98]
Short Notes
12. Name respiratory centres. Explain the neural regulation of respi-
ration. [NTRUHS Jan 2010 (NR)] . Surfactant. [RGUHS July 90, Aug 91, Apr 02]
13. Enumerate respiratory centres. How is the respiration regulated . Vital capacity. [AP Oct 04, Jun 08, RGUHS Apr 87, Jan 90, Oct 94,
by these centres? [NTRUHS Dec 2011/Jan 2012 (NR & OR)] Feb 96]
14, State the name and location of respiratory centres. Describe their . Oxygen—haemoglobin dissociation curve. [RGUHS Jan 89,
role in normal breathing. [RGUHS Dec 2010 (RS3)] Jun 94]

. Hypoxic hypoxia. [RGUHS Mar 88, 95]

Short Essays
. Hypoxia. [RGUHS Aug 92, Feb 93, Oct 94, Sep 02]
1. Draw a normal oxygen—haemoglobin dissociation curve. Explain
. Cyanosis. [RGUHS Apr 87, Aug 88, Jan 90, Dec 91, Mar 92, Jun
Boht’s effect. [RGUHS Sep 97]
94, Sep 94]
. Neural regulation of respiration. [RGUHS Apr 00]
. Apnoea. [RGUHS Mar 92]
. What are the two types of dead space? How is it determined?
. Artificial respiration. [RGUHS Mar 00]
[RGUHS Sep 01]
. Chloride shift. [RGUHS Sep 99]
. Classify hypoxia. Explain each type of hypoxia with examples.
[RGUHS Apr 03] 10. List types of hypoxia. [RGUHS Sep 02]
. Mention the different types of hypoxia and explain with suitable 11. Respiratory centres. [RGUHS Jun 92]
examples. [RGUHS Sep 04, Mar 05] 12. Chemoreceptors. [AP Oct 04, RGUHS Jun 93]
. Hypoxia. [Maharashtra Oct 03] 13. Asphyxia. [RGUHS Dec 91]
Vns o

. Bohr’s effect. [RGUHS Feb 07] 14. Dyspnoea. [RGUHS Jun 91]
. Chemoreceptors. [RGUHS Jul 08]
15. Respiratory dead space. [Maharashtra Jul/Aug 05]
. Inspiratory muscles. [Goa 02]
16. Define compliance. What is the normal value? How can it be
. Surfactant. [AP Jun 08] measured? [Maharashtra Oct 03]
11. Outline the mechanics of respiration. [AP Feb 02] 17. What is vital capacity? Enumerate factors affecting vital capacity.
12. Respiratory muscles. [AP Oct 02] [Maharashtra May 02]
13. Artificial respiration. [AP Apr 02] 18. Define vital capacity and give its normal value. [RGUHS Feb 07]
14. Vital capacity. [AP Oct 99, Oct 04, Jun 08] 19. Name the lung volumes and capacities. [RGUHS Jul 08]
15. Chemical regulation of respiration. [AP Apr 98] 20. Effect of voluntary hyperventilation. [RGUHS Jul 08]
ZEEJ) Quick Review Series: BDS 1st Year

21. Centres for respiration. [AP Apr/May 04] . Give an account of the factors influencing gastric emptying.
22. Muscles of inspiration. [AP Oct 02] [RGUHS Feb 07]
23. Muscles of respiration. [AP Sep 06] . Name the bile salts and describe their functions. [RGUHS Jul 08]

24. Baroreceptors. [AP Mar/Apr 05] . Functions of stomach. [Goa 03]

25. Properties of cardiac muscle. [AP Oct 02] . Functions of bile. [AP Jun 08]

26. Enumerate two factors that affect the shift of oxygen dissociation . Gastrin. [AP Jun 08]
curve to right. [RGUHS Dec 2011/Jan 2012 (RS3)] . Regulation of salivary secretion. [AP Oct 04]
27. Artificial respiration. [NTRUHS Jun 2010] . Enumerate the stages of digestion of starchy food in human body.
28. List the different types of hypoxia and explain any one of them. [AP Feb 02]
[NTRUHS Jan 2010 (OR)] 12. Phases of gastric secretion. [AP Apr/May 04]
13. Functions of liver. [AP Oct 02]
6. DIGESTIVE SYSTEM 14. Second stage of deglutition. [AP Feb 02]
15. Functions of gall bladder. [AP Feb 00]
Long Essays
16. Role of bile salts in digestion. [AP Oct 98]
1. Proteolytic enzymes. [RGUHS Feb 96] 17. Peristalsis. [AP Oct 98]
2. Give in detail the functions of liver. [RGUHS Jan 89] 18. Discuss briefly the functions of liver. [AP Apr 95]
3. Name phase of gastric secretion and describe in detail. [RGUHS 19. Write short notes on peristalsis. [AP Apr 95]
Oct 87]
20. Briefly give the composition and functions of pancreatic juice.
. Describe composition and functions of saliva. [RGUHS Feb 93, [AP Apr 96]
Aug 93]
21. Briefly discuss the mechanism of deglutition. [AP Nov 94]
. Enumerate any four functions of saliva. Draw a labelled diagram
22. Write briefly on mass peristalsis. [AP Oct 2004]
showing efferent nerve supply to salivary secretion. [RGUHS
Feb 96] 23. Enumerate the functions of saliva. [AP June 90]
. Describe exocrine function of pancreas. How are they regulated? 24. Describe the mechanism of formation of HCL. [RGUHS Dec
[RGUHS Feb 93, Mar 92] 2011/Jan 2012 (OS)]
. What is normal serum calcium level? Describe the hormone regu- 25. Describe the pharyngeal stage of deglutition. [RGUHS Dec 2011/
lation of serum calcium level. Add a note on tetany. [RGUHS Jan 2012 (RS & RS2)]
Jan 89] 26. Describe the functions of liver. [RGUHS Dec 2011/Jan 2012 (RS
. Describe the components and functions of saliva. Add a note on & RS2)]
the regulation of salivary secretion. [RGUHS Sep 97] 27. Gastric juice. [NTRUHS Jun 2010]
. Describe the mechanism of gastric secretion. [RGUHS Apr 98] 28. Bile salts. [NTRUHS Jan 2010 (OR)]
10. Briefly describe the phases of gastric secretion. Give a brief ac- 29. Describe the functions of large intestine. [RGUHS Dec 2010
count of the composition and functions of gastric juice. [RGUHS (RS3)]
Apr 99] 30. Describe enterohepatic circulation of bile salts. [RGUHS Dec
11. Explain how starch, sucrose and lactose are hydrolyzed in the 2010 (RS & RS2)]
gastrointestinal tract. Add a note on glucose absorption. [RGUHS 31. List the important ingredients of bile juice and give their func-
Apr 99] tions. [RGUHS June/Jul 2010 (RS3)]
12. Discuss the composition, function and regulation of gastric juice.
[RGUHS Jul 08] Short Notes
13. Describe different phases of deglutition and their regulation. [AP . Proteolytic enzyme of pancreas. [RGUHS Apr 00]
Mar/Apr 05]
. Bile. [RGUHS Mar 88, Jun 89, Sep 94]
NY

14, What are the stages in deglutition? Describe them in detail with a
went

. Peristalsis. [RGUHS Oct 87, Aug 93, Mar 00]

WwW

note on dysphagia. [AP Apr 02]

. Saliva. [RGUHS Mar 00]
What is deglutition? Describe second stage in detail. [Mangalore
aA vk

15.
Movements of small intestine. [RGUHS Sep 01]
University Apr 87]
. List four functions of liver. [RGUHS Apr 02]
Short Essays . List four functions of bile. [RGUHS Apr 03]
1. Phases of gastric juice secretion. [RGUHS Apr 00] . Bile salts. [RGUHS Sep 04, Mar 05]
2. Describe the small intestine movements. [RGUHS Sep 04, . Pharyngeal phase of deglutition. [Maharashtra July/Aug 05]
Mar 05] . Enumerate four important functions of saliva. [Maharashtra
oS
_

Composition and functions of saliva. [Maharashtra Oct 03] May 03]

Mention the functions of large intestine. Briefly describe any two . Enumerate the functions of liver. [Maharashtra Oct 03]
Se
en

of them. [RGUHS Feb 07] . Functions of liver. [RGUHS Feb 07]

 Previous Years’ Question Bank PRET)

13. Mention the enzymes of pancreatic juice. [RGUHS Jul 08] 30. Peristalsis. [NTRUHS Dec 2011/Jan 2012 (NR & OR)]
14, Name two gastrointestinal hormones acting on pancreas. 31. Gastric emptying time. [RGUHS Jun/Jul 2010 (RS & RS2)]
[RGUHS Jul 08]
15. Deglutition. [Goa 02] 7. VITAMIN AND METABOLISM
16. Functions of saliva. [Goa 04]
Long Essays
17. Regulation of salivary secretion. [Goa Jul 06]
18. Functions of stomach. [Goa Jul 08] 1. Give an account of sources, daily requirement, absorption and
function of vitamin D. [RGUHS Mar 98]
19. Peristalsis. [AP Jun 08]
2. What are the hormones that regulate the calcium metabolism?
20. Functions of bile. [AP Jun 08]
Describe regulation of one hormone in detail. [AP Oct 04]
21. Taste buds. [AP Apr/May 04]
3. Give an account of the hormonal regulation of calcium metabo-
22. Pancreatic juice. [AP Sep 06] lism. [AP Aug 91]
4. Describe in detail about vitamin D. [Mangalore University Jun 94]
Short Notes
5. Describe sources and daily requirement of vitamin C. Add a note
. Functions of saliva. [Mangalore University Jan 89] on its deficiency. [Mangalore University Dec 94]
=

. Regulation of salivary secretion. [Mangalore University Jul 90] 6. Write in detail about balanced diet. [Mangalore University Jun 92,
HF NY

. Mastication. [Mangalore University Jun 89] Dec 93]

YW

. Cephalic phase gastric secretion. [Mangalore University Aug 96]

Short Notes
. Describe process of deglutition. [Mangalore University Dec 92]
. Fat-soluble vitamins. [RGUHS Aug 88]
. Composition of pancreatic juice. [Mangalore University Aug 92] =&
DA

. Vitamin A. [RGUHS Oct 87, Aug 96]

YP

. Pancreozymin. [Mangalore University Mar 95]

. Source and function of vitamin B,.. [RGUHS Apr 87]
CN

YW

. Describe mechanism of gastric secretion and how it is controlled.

[Mangalore University Jun 93] . Vitamin C. [RGUHS Aug 92, 93; Mangalore University Dec 92]
F&F

. Pharyngeal phase of deglutition. [Mangalore University Feb 96] . Citric acid cycle. [RGUHS Feb 96]
UV

10. Movements of small intestine. [Mangalore University Aug 91, 92] . Glycolysis. [RGUHS Apr 87]
A

11. Jaundice. [Mangalore University Aug 91] . Essential amino acids. [RGUHS Mar 95]
APen

12. Functions and use of gastric juice. [Mangalore University Jun 91, . Fat metabolism. [RGUHS Jul 90]
92, Dec 92, Oct 94] . Ketone bodies. [RGUHS Mar 88]
Oo

13. Saliva. [Mangalore University Dec 91, 93, Oct 94] . BMR. [RGUHS Jan 89, Sep 94]
&

14, Peristalsis. [Mangalore University Dec 91] . Vitamin D. [RGUHS Sep 00, Mangalore University Jun 92]
YK

15. Haemolytic jaundice. [Mangalore University Dec 92, 93, Jun 94] . Classification of enzymes. [RGUHS Apr 99]
16. Deglutition. [Mangalore University Jun 93, 94] . Classification of proteins. [RGUHS Sep 99]
Ww

17. Bile salts. [Mangalore University Apr 99] . Basal metabolic rate. [RGUHS Sep 99]
FF

18. Pancreatic juice. [Mangalore University Jun 93, 94] . Parathyroid hormone. [AP Oct 02]
un

19. Gall bladder. [Mangalore University Jun 93] . Tetany. [AP Feb 02, Mar/Apr 05; Goa 05]
A

20. What hormones are involved in calcium homeostasis? [RGUHS . Cretin. [AP Oct 98]
ePen

Dec 2011/Jan 2012 (OS)] . Briefly describe the manifestations of tetany. [AP Feb 91]
tm

21. What is the action of cholecystokinin and the stimulus for its se- . Enzyme inhibition. [Mangalore University Dec 92]
Oo

cretion? [RGUHS Dec 2011/Jan 2012 (OS)]

. Vitamin K. [Mangalore University Dec 91]
yy
oS

22. Name two hormones that help maintain calcium homeostasis.

. Citric acid cycle. [Mangalore University Jun 92]
[RGUHS Dec 2011/Jan 2012 (RS3)]
Ne
=

. GTT. [Mangalore University Jun 91]

N
N

23. Enumerate any two functions of saliva. [RGUHS Dec 2011/Jan

2012 (RS3)] . Glucose tolerance test. [Mangalore University Jun 93]
wn
ny

24. Secretin. [RGUHS Dec 2011/Jan 2012 (RS & RS2)] . Essential amino acids. [Mangalore University Dec 91, Jun 94]
te
rs

25. Functions of liver. [NTRUHS Jun 2010, 2011 (NR & OR)] . Cholesterol. [Mangalore University Jun 91]
nN
on

26. Composition and functions of saliva. [NTRUHS Jun 2010, 2011

(NR & OR)] 8. EXCRETORY SYSTEM AND BODY FLUIDS
27. Give the composition of pancreatic juice. [NTRUHS Jan 2010
Long Essays
(OR)]
28. Functions of liver. [NTRUHS Jan 2010 (NR)] 1. Briefly explain mechanism of formation. [RGUHS Sep 94]
29. Explain the mechanism of secretion of hydrochloric acid in the 2. Describe the nerve supply of urinary bladder and explain how
stomach. [NTRUHS Jan 2010 (NR)] contraction of detrusor muscle is stimulated. [RGUHS Apr 98]
ECT Quick Review Series: BDS 1st Year

. Draw and label the parts of a nephron. Explain the formation of 7. Juxtaglomerular apparatus. [RGUHS Mar 88, 92]
urine. [RGUHS Sep 01] 8. Proximal convoluted tubule. [RGUHS Feb 96]
. Write in detail the formation of urine. [AP Apr/May 04] 9. Composition of urine. [RGUHS Aug 92, Feb 93, Sep 02]
. What is micturition reflex? Describe the process of urine forma- 10. Ketone bodies. [RGUHS Sep 99]
tion. [AP Sep 06]
11. Pathological constituents of urine. [RGUHS Sep 02]
. Describe the changes undergone by the glomerular filtrate as it
12. Draw a flow chart of renin—angiotensin mechanism. [Maharash-
courses through the proximal and distal convoluted tubule. [AP
tra Jul/Aug 05]
Feb 91]
13. Reabsorption of water in kidneys. [Maharashtra May 03]
Short Essays 14. Functions of proximal tubule. [Maharashtra May 02]
15. Functions of kidney. [Goa 05]
. Juxtaglomerular apparatus. [RGUHS Apr 00]
16. Micturition reflex. [AP Jun 08]
. Draw and describe the juxtaglomerular apparatus. What are its
functions? [RGUHS Sep 01] 17. Glomerular filtration. [AP Oct 04]
. What is juxtaglomerular apparatus? Draw a neat diagram of it 18. Functions of distal convoluted tubule. [AP Mar/Apr 05]
and label its parts. What are its functions? [RGUHS Apr 02] 19. Derive the value for effective filtration pressure in the glomerulus.
. What are the physiological changes that occur in the body when [RGUHS Dec 2011/Jan 2012 (OS)]
exposed to high temperatures? [RGUHS Apr 02] 20. The chloride-shift mechanism. [NTRUHS Jun 2010]
. Explain micturition reflex. [RGUHS Sep 04, Mar 05] 21. Explain the reabsorption of water in renal tubules. [NTRUHS Jan
. Renin—angiotensin mechanism. [Maharashtra May 02] 2010 (NR)]
. What are the parts of the juxtaglomerular apparatus? Give its 22. Define GFR. State the normal value. [RGUHS Dec 2010 (RS3)]
function. [RGUHS Feb 07] 23. Name the two types of sweat glands. [RGUHS Dec 2010 (RS3)]
. Functions of juxtaglomerular apparatus with diagram. [RGUHS 24. Cystometrogram. [RGUHS Dec 2010 (RS & RS2)]
Jul 08] 25. List any two functions of distal convoluted tubule. [RGUHS June/
. Differences between cortical and juxtamedullary nephrons. Jul 2010 (RS3)]
[RGUHS Jul 08] 26. What are the factors affecting GFR? [RGUHS Jun/Jul 2010 (RS &
10. Proximal tubule. [Goa 02] RS2)]
11. JG apparatus. [AP Apr 02]
12. Juxtaglomerular apparatus. [Goa 03, Jul 08] 9. ENDOCRINE GLANDS AND REPRODUCTION
13. Proximal convoluted tubule. [Goa Jul 06]
Long Essays
14, Antidiuretic hormone. [AP Feb 00, Oct 04]
1. Describe the regulation of normal glucose level. [Mangalore Uni-
15. Nephron. [AP Apr 98]
versity Apr 87]
16. Define renal clearance value of a substance. What is its signifi-
2. Mention hormones secreted by anterior pituitary. Describe action
cance? [AP 00]
of growth hormone. How is hormone synthesis regulated? [Man-
17. Write briefly on effective filtration pressure. [AP Jul 06] galore University Jan 90, Mar 92]
18. What is the normal GFR? How is it measured? [AP Jun 90] 3. Name hormones of posterior pituitary gland. Explain their action
19. Describe the counter current mechanisms operating in the kidney and regulation of secretion. [Mangalore University Feb 96]
to produce hypertonic and hypotonic urine. [RGUHS Dec 2011/ 4. Describe synthesis and action of thyroid hormone. Add a note
Jan 2012 (RS3)] on hyperthyroidism. [Mangalore University Aug 88, Sep 94,
20. Define homeostasis. Explain with an example. [RGUHS Dec Mar 00]
2011/Jan 2012 (RS3)] 5. Synthesis and action of thyroxin. [Mangalore University Jun 89, 95]
21. Describe micturition reflex. [RGUHS Dec 2011/Jan 2012 (RS & 6. Give an account of secretion function and regulation of parathy-
RS2)] roid hormone. Add a note on tetany. [Mangalore University Oct
22. Glomerular filtration rate. [NTRUHS Jun 2010; Dec 2011/Jan 87, Jul 90, Aug 92]
2012 (NR & OR)] 7. What are the hormones of adrenal cortex? Describe the action of
glucocorticoids. [Mangalore University Feb 91, Aug 91]
Short Notes 8. Enumerate the adrenal cortical hormones. Describe briefly the
- Function of kidneys. [RGUHS Aug 93] action of glucocorticoids. [Mangalore University Apr 02]
. Nephrons. [RGUHS Mar 95] 9. Describe the function of thalamus. [Mangalore University Aug
nau NY

91, Mar 00]

. Juxtamedullary nephrons. [RGUHS Mar 94, Sep 99]
YW

10. Describe uterine and ovarian changes occurring during normal

. Glomerular filtration rate. [RGUHS Oct 87, Aug 88, Jan 90, Apr 03]
fF

menstrual cycle. Give physiological basis of these changes. [Man-

. What is GFR? What is its normal value? [RGUHS Apr 03] galore University Feb 93]
. Renal tubular function. [RGUHS Aug 98] 11. Safe period. [Mangalore University Jul 90, Feb 96]
 Previous Years’ Question Bank

12. Spermatogenesis. [Mangalore University Aug 88, Jun 89, Aug 93] 19. Functions of placenta. [AP Apr 02]
13. Family planning method for female. [Mangalore University Jan 20. Parathyroid hormone. [AP Oct 02, AP Oct 99]
90, Aug 93] 21. Pregnancy test. [AP Oct 99]
14, Name the hypoglycemic hormone of the body. Discuss its actions, 22. Oxytocin. [AP Apr 98]
regulation of its secretion and features of deficiency of the hor-
23. Describe the phases of menstrual cycle. [AP Oct 98]
mone. [RGUHS Feb 07]
24. Write short notes on physiological basic of contraceptive pills.
15. Name the hormones of anterior pituitary gland. Describe the ac-
[AP Apr 95]
tions and regulation of secretion of growth hormone. [RGUHS
Jul 08] 25. Write briefly on parathormone. [AP Apr 96]
16. Give the normal blood glucose level. Name the hormones that 26. Write short notes on pregnancy tests. [AP Nov 94]
affect blood glucose level. Give four important functions of insu- 27. What is the effect of female sex hormones in the growth of mam-
lin. [Goa 03] mary gland? [AP Aug 91]
17. Write an essay on distribution, normal level, and hormonal con- 28. What are the manifestations of cretinism? [AP Jun 90]
trol of plasma calcium and phosphorus. [Mangalore University
29. Enumerate the hormones of anterior pituitary gland, and give the
Jun 91, Jun 92, Dec 91, Dec 93]
important function of one hormone. [AP Nov/Dec 91]
18. How is normal blood sugar level maintained? [RGUHS Dec 92]
30. Name the hormones of anterior pituitary gland. Describe the
19. Enumerate the hormones of anterior pituitary. Describe the func- actions of any one of them. [RGUHS Dec 2011/Jan 2012 (RS &
tions of any one of them. [NTRUHS Jun 2010] RS2)]
20. Describe the structure of the adrenal cortex. Name the hormones 31. Describe the tests for ovulation. [RGUHS Dec 2011/Jan 2012 (RS
secreted by it. Discuss the function of any one of them. [RGUHS & RS2)]
Dec 2010 (RS & RS2)]
32. Goitre. [NTRUHS Jun 2010; Jun 2011 (NR & OR)]
21. Classify hormones. Give the list of anterior pituitary hormones.
33. Corpus luteum. [NTRUHS Jan 2010 (OR)]
Explain the action of any one of them. [RGUHS June/Jul 2010
(RS3)] 34. Dwarfism. [NTRUHS Dec 2011/Jan 2012 (NR & OR)]
22. What is the normal serum calcium level? How is the serum cal-
Short Notes
cium level regulated in our body? [RGUHS Jun/Jul 2010 (RS &
RS2)] 1. Myxedema. [Mangalore University Feb 93, Mangalore University
Jun 91]

Short Essays . Cretinism. [Mangalore University Mar 88, Jan 90, Goa 04, AP Sep 06]
LV

1. Name the posterior pituitary hormones. Explain action of any

. Functions of calcium. [Mangalore University Aug 88, 93]
Hu WwW

one of them. [Mangalore University Apr 03] . Goitre. [Mangalore University Sep 94, AP Oct 04]
—

Enumerate the actions of thyroxin. [Mangalore University Sep 02] . Parathormone. [Mangalore University Aug 91]
Describe the formation and functions of corpus luteum. [Manga- . Insulin. [Mangalore University Aug 91, Oct 94, Maharashtra
lore University Sep 97] May 03]
Explain the regulation of secretions of thyroid hormones. [Man- . Glycosuria. [Mangalore University Oct 87]
“I

galore University Sep 04, Mar 05] . Aldosterone. [Mangalore University Aug 93]
Write in brief the actions of thyroid hormones. [Maharashtra . Ovarian hormones. [Mangalore University Mar 00, AP Feb 02,
May 02] Oct 02]
Explain the role of parathormone in the regulation of blood cal-
10. Hormones regulating blood glucose. [Mangalore University Apr
cium level. [RGUHS Feb 07]
98, AP Oct 02]
Myxedema. [RGUHS Jul 08]
11. Hypothyroidism. [Mangalore University Apr 98]
Testosterone. [Mangalore University Feb 98, Aug 92]
12. Myxedema. [Mangalore University Sep 99]
Functions of testes. [RGUHS Jul 08]
13. Hormones produced by the posterior pituitary gland and one ac-
10. LH in male and female. [Goa 02] tion of any one of them. [Mangalore University Dec 93, Apr 00,
11. Ovulation. [AP Mar/Apr 05, Goa 03, NTRUHS Jun 2010; Jun AP Apr/May 04]
2011 (NR & OR); RGUHS Jun/Jul 2010 (RS & RS2)] 14. Hormones produced by the adrenal cortex. [Mangalore Univer-
12. Thyroid hormones. [Goa Jul 06] sity Apr 00]
13. Contraceptive methods in women. [Goa Jul 08] 15. Testosterone. [Mangalore University Jun 91]
14, Estrogen. [AP Jun 08] 16. Pregnancy test. [Mangalore University Apr 98]
15. Oral contraceptives. [AP Jun 08] 17. Functions of ovaries. [Mangalore University Sep 01]
16. What is the role of adrenal gland in conditions of stress? [AP Feb 02] 18. List any four methods of contraceptives in females. [Mangalore
17. Testosterone and its actions. [AP Apr/May 04] University Apr 02]
18. Insulin. [AP Mar/Apr 05] 19. List four functions of estrogen. [Mangalore University Apr 03]
ZCI) Quick Review Series: BDS 1st Year

20. Explain mechanism of action of oral contraceptive pills. [Manga- . Types of synapse. [AP Apr 02, AP Oct 98]
lore University Sep 02] . Define a reflex. Draw and label the parts of a reflex arc. [AP Feb
21. Corpus luteum. [Mangalore University Sep 04, Mar 05] 91, AP Apr 98]
22. Functions of placenta. [Maharashtra Jul/Aug 05] . Write short notes on reflex action. [AP Apr 95]
23. Ovulation. [Maharashtra Oct 03, May 03] 10. How does neuromuscular transmission of impulses take place in
24. Abnormalities of growth hormone. [Maharashtra Oct 03] producing muscle contraction? [AP Nov/ Dec 91]

25. Acromegaly. [Maharashtra May 02, Mangalore University Dec 91, 11. Draw a labelled diagram of ‘neuro-muscular junction’. [NTRUHS
Jun 94, Goa 02] Jun 2010]

26. Progesterone. [Maharashtra May 02] 12. Draw a labelled diagram of stretch reflex arc and explain the func-
tion of stretch reflex arc. [NTRUHS Jan 2010 (OR)]
27. What are the advantages of condom as a contraceptive device?
[RGUHS Feb 07]
11. MUSCLES
28. Mechanism of action of oral contraceptives. [RGUHS Feb 07]
29. Spermatogenesis. [Goa Jul 06] Long Essay
30. Functions of glucocorticoids. [Goa Jul 08]
1. Describe the neuromuscular junction (NMJ) with the help of a
31. Thyrotoxicosis. [AP Jun 08] diagram, and explain the mechanism of transmission of nerve
32. Glucagon. [Mangalore University Dec 91, Jun 94] impulse across NMJ. [RGUHS Apr 02]
33. Blood sugar regulation. [Mangalore University Dec 91]
34. Gonadotropic hormone. [Mangalore University Jun 92]
Short Essays
35. Dwarfism. [Mangalore University Jun 93] 1. Regulation of muscle tone. [AP Oct 04]
36. Gigantism. [Mangalore University Dec 93] 2. Seat of fatigue. [AP Oct 99]
37. Calcium regulation. [Mangalore University Dec 92, Jun 93] 3. Rigor mortis. [AP Apr 98]
38. Tetany. [Mangalore University Oct 94] 4. Name the important differences between voluntary and involun-
tary muscle. [AP Feb 91]
39. Addisons disease. [Mangalore University Dec 92]
. What is meant by motor unit? [AP Jun 90]
wn

40. Name the phases of menstrual cycle. [RGUHS Dec 2011/Jan 2012
(RS3)] 6. Sarcomere. [NTRUHS Jan 2010 (NR)]
41. Oestrogen. [NTRUHS Dec 2011/Jan 2012 (NR & OR)] 7. Drawa labelled diagram of ‘neuro-muscular junction’ [NTRUHS
42. Enumerate any two functions of glucocorticoids. [RGUHS Dec
Jun 2011 (NR & OR)]
2010 (RS3)]
Short Notes
43. Dwarfism versus cretinism. [RGUHS Dec 2010 (RS & RS2)]
44. List two endometrial changes occurring during ‘proliferative’ . Write short notes on sarcomere. [AP Nov 94, RGUHS Aug 88]
Be

phase of menstrual cycle. [RGUHS June/Jul 2010 (RS3)] Neuromuscular transmission. [RGUHS Jun 89]
Au Pp wd

45. Differences between cretinism and dwarfism. [RGUHS Jun/Jul . What is isometric and isotonic contraction? [RGUHS Apr 03]
ern

2010 (RS & RS2)]. . Salutatory conduction. [RGUHS Sep 04, Mar 05]
. Draw a well-labelled diagram of sarcomere. [Maharashtra May 02]
10. NERVE
. Membrane potential. [Maharashtra May 02]

Short Essays . Myasthenia gravis. [RGUHS Feb 07]

. Sarcomere. [RGUHS Dec 2011/Jan 2012/Jun/Jul 2010 (RS & RS2)]
1. Saltatory conduction. [NTRUHS Jan 2010 (OR)]
. Dead space. [NTRUHS Jun 2010]
2. Babinski’s sign. [NTRUHS Dec 2011/Jan 2012 (NR & OR)]
3. Describe with the help of a diagram the ionic basis of action po-
12. NERVOUS SYSTEM
tential. [RGUHS Dec 2010 (RS3)]

Long Essays
Short Notes
1. Draw a diagram to show different parts of reflex arc. Describe
Types of nerve fibres. [RGUHS Sep 01] properties of reflex. [RGUHS Feb 91]
PoP

Synaptic transmission. [Maharashtra May 03] . Describe pyramidal tract with the help of diagram from origin to
Neuromuscular transmission. [Maharashtra Oct 03] termination. [RGUHS Aug 88]
ee

Draw a labelled diagram of neuromuscular junction (NMJ)
skeletal muscle. List the events occurring in neuromuscular trans-
mission. [RGUHS Feb 07]
. Conduction of impulse in myelinated nerve fibres. [RGUHS Jul 08]
Neuron. [AP Apr 02]
in . Add a note on hemisection of spinal cord. [RGUHS Jun 90]
. Name any two ascending tracts of spinal cord. Describe origin,
course, termination and functions of any one. [RGUHS Feb 96]
. Trace the course of spinothalamic tract. With help of diagram, label
various parts and describe functions of the same. [RGUHS Feb 93]
 Previous Years’ Question Bank

Pathway of pain. [RGUHS Mar 92] 14. What are the functions of cerebrospinal fluid? [AP Feb 02,

Describe origin, course and function of corticospinal tracts. Sep 06]

[RGUHS Feb 96] 15. Autonomic nervous system. [AP Sep 06]
Describe function of hypothalamus. [RGUHS Jul 90] 16. What are the components of reflex arc? [RGUHS Dec 2011/Jan
Name the clinical difference between upper motor neuron and 2012 (OS)]
lower neuron lesion. [RGUHS Sep 02] 17. Name two functions of hypothalamus. [RGUHS Dec 2011/Jan
10. With the help of a diagram explain how the pain sensation is car- 2012 (RS3); NIRUHS Dec 2011/Jan 2012 (NR & OR)]
ried from the receptor to the cerebral cortex. [Goa 02] 18. Give any two features of cerebellar lesion. [RGUHS June/Jul 2010
11. Describe the origin, course and termination of pain pathway (RS3)]
from lower limbs. [Goa Jul 08]

Short Essays 13. SPECIAL SENSE

1. Pathway of pain. [RGUHS Apr 00] Long Essays

2. Formation of CSE. [RGUHS Sep 01]
1. Describe visual pathway. [RGUHS Jun 89]
3. Mention the names of ascending tracts. What are the sensations
2. What are primary tastes? Describe pathway of sensation of taste.
carried by them and where will they terminate? [RGUHS Mar 05]
[RGUHS Apr 87, 92]
4. Spinothalamic tracts. [Maharashtra May 02]
. Name the receptors for light. Give their specific functions. Draw
Name the descending tracts of the spinal cord. Trace the course of and explain the visual pathway. [Goa 04]
“

corticospinal tract. [RGUHS Jul 08]

. Explain role of skin in temperature regulation. [Goa Jul 08]
Cerebellum. [Goa Jul 06]
eFNn Ss

. Give an account of the structure and functions of skin. [AP

Cerebrospinal fluid. [AP Oct 99, NTRUHS Jun 2010]
Apr 96]
Draw and label pyramidal pathway. [AP Feb 00]
Functions of frontal lobe. [AP Oct 98]
oe

Short Essays
10. What are the functions of cerebellum? [AP Feb 91]
1. What are the contents and functions of middle ear? Explain tym-
11. Draw and label the structure of the functional unit of nervous
panic reflex. [RGUHS Apr 02]
system. [AP Nov/Dec 91]
12. Differentiate between upper and lower motor neuron type of . Trace the pathway of taste with the help of a diagram. [RGUHS
paralysis. [RGUHS Dec 2010 (RS3)] Sep 04, Mar 05, AP Feb 02, Sep 06]

13. Trace the pathway for crude touch. [RGUHS Dec 2010 (RS & . Describe the visual pathway with the help of a neat diagram.
RS2)] [RGUHS Feb 07]
14, Define reflex action and describe Babinski sign. [RGUHS Dec . Describe the properties of sensory receptors. [RGUHS Feb 07]
2010 (RS & RS2)] . Describe the refractory errors of the eye and how they are cor-
15. Defaecation reflex with diagram. [RGUHS Jun/Jul 2010 (RS & RS2)] rected. [RGUHS Jul 08]
6. Functions of middle ear. [Goa 03, AP Oct 98, Aug 91]
Short Notes
7. Myopia. [AP Oct 98, Jun 08, NTRUHS Jun 2010, Jun 2011 (NR &
Reflex arc. [RGUHS Mar 88] OR)]
Reflex action. [RGUHS Jun 89, Mar 92, Sep 94, Sep 01] . Pathway for pain. [AP Apr/May 04]
PF YP
SND

Referred pain. [RGUHS Oct 87, Mar 98, Sep 01] . Enumerate the functions of skin. [AP Oct 02]
Lower motor neuron. [RGUHS Mar 88] 10. Referred pain. [AP Feb 02]
Hypothalamus. [RGUHS Jun 89, Jun 89] 11. Taste pathway. [AP Feb 02]
Pathway of pain. [RGUHS Mar 00] 12. Temperature regulation. [AP Mar/Apr 05]
Name any four mechanoreceptors. [RGUHS Apr 02] 13. Accommodation by the eye. [AP Feb 00]
Mention the names of ascending tracts. What are the sensations 14. Taste receptors. [AP Apr 98]
carried by them and where will they terminate? [RGUHS
Sep 04] 15. Write short notes on sense of smell. [AP Nov 94]

Functions of cerebellum. [RGUHS Sep 04, Mar 05, Maharashtra 16. What are the receptors for vision? Draw and label the visual path-
Jul/Aug 05, AP Apr 02] way. [AP Nov/Dec 91]

10. Functions of pyramidal tract. [Maharashtra May 02] 17. Functions of skin. [NTRUHS Jun 2010, 2011 (NR & OR)]
11. Lumbar puncture. [RGUHS Jul 08] 18. Taste bud. [NTRUHS Jan 2010 (NR)]
12. Cerebrospinal fluid. [Goa 04 , RGUHS Dec 2011/Jan 2012 (RS & 19. Presbyopia. [NTRUHS Dec 2011/Jan 2012 (NR & OR)]
RS2)] 20. Explain the refractive errors of eye with diagram. [RGUHS Jun/
13. Brown—Sequard syndrome. [AP Jun 08] Jul 2010 (RS & RS2)]
ZCY Quick Review Series: BDS 1st Year

Short Notes 16. Draw a diagram of pathway for pain sensation from the face.
[RGUHS Feb 07]
. Accommodation of eye. [RGUHS Aug 88]
=&

17. Dark adaptation. [Goa 02]

. Rods and cones. [RGUHS Jul 90, Apr 99]
NHN

18. Errors of refraction. [Goa 05]

. Refractory error of eye. [RGUHS Apr 87, Aug 92]
YW

19. Referred pain. [Goa 05, AP Jun 08]

. Myopia. [RGUHS Jan 90, Mar 92, Sep 94, AP Jun 08]
20. Accommodation. [Goa Jul 06]
VF

. Presbyopia. [RGUHS Mar 94, Maharashtra May 03, Oct 03]

21. Visual pathway. [Goa Jul 08]
. Aqueous humour. [RGUHS Mar 95]
DA

22. Heat loss mechanism in the body. [AP Jun 08]

. Functions of aqueous humour. [RGUHS Apr 00]
APenN

23. What is myopia? How can it be corrected? [AP Feb 02]

. Colour blindness. [RGUHS Oct 94]
24. What is the normal body temperature in man? Mention the regu-
. Taste pathway. [RGUHS Jan 89, Aug 92, Mar 95, 00]
Oo

latory organs in the body. [AP Feb 02]

. Sensation of smell. [RGUHS Jul 90]
25. Receptors for vision. [AP Oct 02]
&

. Organ of Corti. [RGUHS Feb 91]

26. Functions of middle ear. [RGUHS Dec 2011/Jan 2012 (RS &
&
eit

. Primary tastes. [RGUHS Mar 94, Feb 93] RS2)]

YM

. Accommodation reflex. [RGUHS Sep 99] 27. Astigmatism. [NTRUHS Jun 2010]
YB

. Define referred pain and give two examples. [RGUHS Feb 07] 28. List the functions of middle ear. Explain any one of them.
fF

. Enumerate the heat gain mechanism occurring in the body when [INTRUHS Jan 2010 (OR)]
a

the body is exposed to cold environment. [RGUHS Feb 07] 29. Mention two function of skin. [RGUHS June/Jul 2010 (RS3)]

Section 3: Biochemistry

1. CHEMISTRY AND METABOLISM OF
CARBOHYDRATES
Long Essays
1. Give the steps of glycolysis and its energetics. [RGUHS Apr 00]
2. Describe the reactions of glycolysis. Mention its significance.
[RGUHS Mar 03]
. Define glycolysis. Enumerate the reactions of pathway. Explain
the energetics of pathway. [RGUHS Sep 02]
. Describe the aerobic glycolysis in muscle and compute energetics.
[RGUHS Sep 98, Sep 77]
. Outline the aerobic glycolytic pathway. Define substrate level
phosphorylation. Give two examples. [RGUHS Sep 99]
. Describe the citric acid cycle and its energetics. [RGUHS Mar 04
(old scheme) ]
. Describe the regulation of blood glucose and add a note on dis-
orders of blood glucose regulation. [RGUHS Mar 00]
. Explain the glycogen synthesis in liver and its hormonal regula-
tion. [RGUHS Apr 99]
. Define glycolysis. Describe anaerobic glycolysis mentioning the
bioenergetics. [AP Oct 04]
10. What is the normal fasting blood sugar level? Describe the various
processes involved in its regulation. [AP Sep 06]
11. Name the abnormal constituents of urine and the pathological
conditions where they are seen. How will you detect sugar in the
urine? [AP Apr 03]
12. Give an account of the steps of the citric acid cycle. Explain why
it is known as ‘terminal oxidative pathway” [AP Oct 99]
13. Name the hormones that increase the blood glucose level. Explain
the mechanism in any one of them. [AP Feb 00]
14. What are disaccharides? Give examples. How will you identify
them in the laboratory? What is the normal level of glucose in
blood? [AP Apr 98]
. Describe in detail the steps involved in glycolysis. Indicate the
sites at which ATPs are formed. [AP Apr 95]
16. Describe glycolysis. Add a note on its energetics. [RGUHS Feb 07]
17. What is the fasting blood glucose concentration in man? How is
it maintained within normal limits? [AP Nov/Dec 91]
18. Define carbohydrates. Classify them and add a note on biomedi-
cal importance of carbohydrates. [Goa Jul 03]
. Describe the process of glycolysis by Embden—Meyerhof pathway.
Add a note on its energetics. Enumerate the fates of pyruvate.
[Goa 05]
20. Classify carbohydrates with example of each group. Discuss the
digestion and absorption of carbohydrates in gastrointestinal
tract. [Goa 06]
21. Define and classify carbohydrates. Add a note on biological sig-
nificance of carbohydrates. [Goa 08]
22. Describe the anaerobic glycolysis of glucose. Add a note on the
bioenergetics. [TN Nov 01]
23. Describe HMP pathway. Write its clinical significance. [TN Aug 04]
24. Describe glycolytic pathway, and state its energetics under aerobic
and anaerobic conditions. [Maharashtra May 02]
. Explain TCA cycle with its energetics [RGUHS Dec 2011/Jan 2012
(0S)]
26. Write an essay on glycolysis. Add a note on the bio-energetics of
the pathway. [RGUHS Dec 2010 (RS3)]
 Previous Years’ Question Bank

27. Describe the pathway of Krebs citric acid and add a note on its . Glycolysis. [NTRUHS Dec 2011/Jan 2012 (NR & OR), RGUHS
energetics and significance. [RGUHS June/Jul 2010 (RS3)] Apr 87]
28. Describe anaerobic glycolysis and compute the energetic. . Significance of glycolysis. [RGUHS Mar 03]
[RGUHS Jun/Jul 2010 (RS & RS2)] . What is meant by substrate level phosphorylation? Give one ex-
ample. [RGUHS Sep 04, Mar 05]
Short Essays . How many ATP molecules are produced in anaerobic glycolysis
1. Oral glucose tolerance test. [RGUHS Jun 93, Apr 02; AP Oct 04] and aerobic glycolysis? [RGUHS Sep 03]

2. Classification of carbohydrates. [RGUHS Sep 01] . Citric acid cycle. [RGUHS Jun 92]

. Structure and biomedical importance of disaccharides. [RGUHS . Significance of TCA cycle. [RGUHS Sep 01]
w

Mar 03] 10. Name four mucopolysaccharides in the body. [RGUHS Apr 02]
. Polysaccharides. [AP Feb 02] 11. List four examples of mucopolysaccharides. [RGUHS Sep 03]
Pp

Hormones that regulate blood sugar. [AP Apr/May 04] 12. Name three glycosaminoglycans (mucopolysaccharides) in the
NRW

. Glycolysis. [AP Mar/Apr 05] body. Mention their significance. [RGUHS Mar 05]

. Name the non-reducing sugars. What are their components? [AP 13. Composition and functions of two homopolysaccharides.
Apr 03] [RGUHS Mar 04]
. Renal threshold for glucose. [AP Oct 99] 14. What is cane sugar? Mention its composition. [RGUHS Sep 04,
oO

Mar 05]
9. Citric acid cycle. [AP Feb 00; TN Oct 03]
15. What is milk sugar? Mention its composition. [RGUHS Sep 03]
10. Amylose and amylopectin. [AP Apr 98]
16. Name the key enzymes of gluconeogenesis. [RGUHS Sep 01]
11. Glycogen storage disorders. [AP Jun 08]
17. Mutarotation. [RGUHS Sep 99]
12. Significance of citric acid cycle. [AP Feb 91]
18. Renal glycosuria. [AP Oct 04]
13. Gluconeogenesis. [AP May 01]
19. Heparin. [AP Apr/May 04]
14, Glucose tolerance test. [AP Nov/Dec 91; TN Aug 04]
20. What are the normal levels of blood sugar, urea, cholesterol and
15. Glycosuria. [Goa 02]
total proteins? [AP Oct 02]
16. Starch and glycogen. [Goa 04]
21. Name two inhibitors or poisons interfering in glycolytic pathway.
17. Normal GTT curve. [TN Sep 02] How do they act? [AP Oct 02]
18. Galactosaemia. [TN Apr 03] 22. Mention the important functions of insulin and glucagon. [AP
19. Write any two irreversible steps of glycolysis. [Maharashtra Oct 02]
May 03] 23. Significance of HMP pathway. [AP Mar/Apr 05]
20. Schematically write four different metabolic fates of pyruvic acid. 24. Glycogen. [AP Apr 03, RGUHS Dec 2011/Jan 2012 (OS)]
[Maharashtra May 03]
25. Detection of fructose in the urine. [AP Oct 97]
21. ‘Glycerol is not a carbohydrate’—justify the statement. [Maha-
26. Name key enzymes of gluconeogenesis. [AP Jun 08]
rashtra Oct 03]
27. Define gluconeogenesis and name the key enzymes of gluconeo-
22. Write the reactions to overcome the irreversible steps of glycolysis
genesis. [AP Jun 08]
during neoglucogenesis. [Maharashtra Oct 03]
28. Structure of animal starch. [AP Jun 08]
23. Explain why sucrose is a non-reducing sugar. [Maharashtra May 02]
29. What are the hormones which increase the blood sugar level?
24. Regulation of blood glucose. [RGUHS Feb 07]
[RGUHS Jul 08]
25. What are hetero-polysaccharides? Give examples. [RGUHS Dec
29. Osazones. [AP Nov 94]
2011/Jan 2012 (OS)
30. Various glycogen storage disorders. [AP Jun 90]
26. Mucopolysaccharides. [RGUHS Dec 2011/Jan 2012 (RS3)]
31. Write the biochemical reasons for the development of caries due
27. What is normal fasting blood glucose level? Describe the hor-
to sugar eating. [AP Jun 90]
monal regulation of blood glucose. [RGUHS Dec 2011/Jan 2012
(RS & RS2)] 32. Significance of HMP. [Maharashtra Jul/Aug 05]
28. Benedicts test. [NTRUHS Jan 2010 (NR)] 33. Insulin overdose causes hypoglycemia. Explain. [RGUHS Dec

29. Blood glucose. [NTRUHS Dec 2011/Jan 2012 (NR & OR)]
2011/Jan 2012 (RS & RS2)]
34. Classify carbohydrates giving two examples for each. [RGUHS
30. Hormonal regulation of blood sugar. [RGUHS June/Jul 2010 (RS3)]
Dec 2011/Jan 2012 (RS & RS2)]
35. Digestion and absorption of carbohydrates. [NTRUHS Jan 2010
Short Notes
(OR)]
1. GTT. [RGUHS Mar 97, Jun 91] 36. Hormones that regulate blood sugar. [NTRUHS Jan 2010 (OR)]
2. Glycosuria. [RGUHS Sep 02] 37. Name one reducing and one non-reducing disaccharide. [RGUHS
3. What is glucosuria? Mention the normal renal threshold for glu- Dec 2010 (RS & RS2)]
cose. [RGUHS Aug 05] 38. Describe the Cori’s cycle. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]
496 Quick Review Series: BDS 1st Year

2. CHEMISTRY AND METABOLISM OF AMINO 17. Explain the separations of plasma proteins by electrophoresis.

ACIDS AND PROTEINS

[RGUHS Jul 08]
18. Synthesis of urea. [AP Feb 91]
Long Essays 19. Structure of proteins. [AP Dec 96]

1. Describe the urea cycle and its disorders. [RGUHS Sep 01] 20. Essential amino acids. [AP Nov/Dec 91]

2. Describe the urea cycle and list two disorders of urea cycle. 21. Digestion of proteins. [Goa 02]
[RGUHS Sep 03] 22. Urea cycle. [Goa 03]
. What is the normal blood urea level? Describe the synthesis and 23. Ribonucleic acid. [Goa 03]
fate of urea in our body. [AP Apr/May 04] 24. Conjugated proteins. [Goa 04]
. Describe the formation and excretion of urea in the body. Men- 25. Essential amino acids. [TN Nov 01]
tion the inborn errors met with during the process. [AP Oct 02]
26. Structure and functions of DNA. [TN Nov 01]
. Describe the formation and fate of ammonia. [AP Mar/Apr 05]
27. Transfer RNA structure. [TN Apr 03]
. What is urea? Enumerate the steps of urea cycle and mention its
28. Electrophoresis. [TN Oct 03]
significance. [AP Jun 08]
29. Phenylketonuria. [TN Aug 04]
. Describe urea cycle. [RGUHS Jul 08]
30. Limiting amino acids. [TN Aug 04]
. Describe urea cycle; discuss clinical significance of blood urea
level. [RGUHS Jul 08] 31. Four important functions of protein. [Maharashtra May 03]
. How are proteins digested? Indicate the specific site at which pro- 32. Importance of transamination process. [Maharashtra Oct 03]
teolytic enzymes act. Add a note on amino acid pool. [AP Apr 96] 33. Schematically represent different fates of acetyl CoA. [Maharashtra
10. Name the sulphur-containing amino acids. Describe the metabo- Oct 03]
lism of any one of them. [AP Feb 91] 34. What are conjugated proteins? Give two examples. [Maharashtra
11. Name the aromatic amino acids. Describe the metabolism of any May 02]
one of them. [AP Apr 01] 35. What is trans-methylation? Give two examples. [NTRUHS Jun 2010]
12. Describe the synthesis of urea and add a note on its regulation. 36. Difference between DNA and RNA. [NTRUHS Jun 2010]
[TN Apr 03]
37. Name the purine bases. [NTRUHS Jan 2010 (OR)]
13. Describe the different processes of catabolism of amino acids.
38. Maple syrup disease. [NTRUHS Jan 2010 (OR)]
Mention the different fates of carbon skeleton of amino acids af-
ter catabolism. [Maharashtra May 03]. 39. Structure of t-RNA. [NTRUHS Jan 2010 (NR)]

14, What is urea? Discuss the steps of urea synthesis and its signifi- 40. Metabolic alkalosis. [NTRUHS Jan 2010 (NR)]
cance. [NTRUHS Jun 2010]. 41. Ketone bodies. [NTRUHS Jan 2010 (NR)]
15. Describe the formation and fate of ammonia. Write any two in- 42. Gout. [NTRUHS Dec 2011/Jan 2012 (NR & OR)]
born errors of protein metabolism. [RGUHS Dec 2011/Jan 2012 43. Transamination. [NTRUHS Dec 2011/Jan 2012 (NR & OR)]
(RS & RS2)] 44. Blood urea. [NTRUHS Dec 2011/Jan 2012 (NR & OR)]
45. Types of RNA. [RGUHS Dec 2010 (RS3)]
Short Essays
46. What is S-adenosyl methionine (SAM)? How is it formed and
. Denaturation of proteins. [RGUHS Sep 04, Mar 05] what is its importance? [RGUHS Dec 2010 (RS & RS2)]
ene

. How is creatine-P synthesized? [RGUHS Sep 97]

47. Watson and Crick model of DNA structure. [RGUHS June/Jul
. Substance formed from tyrosine. [Apr 00] 2010 (RS3)].
What are conjugated proteins? Give three examples. [RGUHS
a

Sep 03] Short Notes

. Primary and secondary structure of proteins. [RGUHS Mar 04]
WI

1. Active methionine. [RGUHS Sep 97]

aAen

. Describe urea cycle. [RGUHS Mar 04]

Nn

2. Essential amino acids. [RGUHS Dec 91, Mar 95; Goa 02; AP Sep 06]
. Functions of plasma proteins. [AP Oct 04]
. Name essential amino acids and discuss their functions. [RGUHS
we

. Transamination. [AP Apr/May 04] Aug 05]

. Diagrammatic representation of urea cycle. [AP Sep 06]
Oo

. Denaturation of proteins. [RGUHS Sep 02]

SP

10. Biologically important peptides. [AP Mar/Apr 05] . Classification of proteins. [RGUHS Sep 99]
Den un

11. Albumin and globulin. [AP Apr 98] . Functions of lipoproteins. [RGUHS Sep 01]
A

12. DNA and RNA. [AP Apr 98] . Primary structure of proteins. [RGUHS Mar 03]
13. Transamination. [AP Apr 95, Oct 98] . Biological value of proteins. [RGUHS Apr 98]
14, Structure and function of tRNA. [AP Jun 08] . What are zwitterions? [RGUHS Aug 05]
15. Classify amino acids with example. [RGUHS Jul 08] . What are nucleosides and nucleotides? Give examples of each
16. Clinically important transaminases. [RGUHS Jul 08] one. [RGUHS Aug 05]
 Previous Years’ Question Bank

11. Name the inborn errors of metabolism in phenylalanine pathway, 51. Functions of proteins in body. [NTRUHS Jan 2010 (OR)]
and mention the enzymes which are missing in each case. 52. Structure of protein. [NTRUHS Jan 2010 (NR)]
[RGUHS Aug 05]
53. What are essential amino acids? [RGUHS Dec 2010 (RS&RS2)]
12. Name different types of RNA and their functions. [RGUHS 99]
54. Essential amino acids. [RGUHS June/Jul 2010 (RS3)]
13. Structure and functions of mRNA. [RGUHS Mar 05]
55. Transamination reaction. [RGUHS June/Jul 2010 (RS3)]
14, Significance of blood urea estimation. [RGUHS Sep 97]
15. Describe the features of genetic code. [RGUHS Mar 04]
3. CHEMISTRY AND METABOLISM OF LIPIDS
16. Where is urea synthesized? [RGUHS Sep 04, Mar 05]
17. Name three conjugated proteins and their significance. [RGUHS Long Essays
Mar 04]
1. Give an account of beta-oxidation of fatty acids and give the en-
18. Name four conjugated proteins and their significance. [RGUHS ergetics on oxidation of one molecule of palmitic acid. [RGUHS
Mar 99] Aug 05]
19. Protein energy malnutrition. [RGUHS Mar 97] . Describe beta-oxidation of fatty acids and its energetics. [RGUHS
20. Protein calorie malnutrition. [RGUHS Apr 99] Mar 03]
21. Four functions of plasma proteins. [RGUHS Mar 04] . Explain beta-oxidation of fatty acids. What is the importance of
this process? [RGUHS Apr 88]
22. Transamination. [RGUHS Mar 04]
. Name the different pathways of fatty acid oxidation. How is the
23. Semiessential amino acids. [AP Oct 04]
palmitic acid oxidized in the body? Write down the energetics.
24. Name two non-protein nitrogens present in the body. What are
[RGUHS Mar/Apr 99]
their normal serum levels? [AP Feb 02]
. Classify lipids. Give examples. Give an account of essential fatty
25. What is ‘scavenger’ lipoprotein? Why is it so called? [AP Feb 02] acids. [AP Feb 02]
26. Describe histamine fast achlorhydria. [AP Feb 02]
. What are bile salts and bile pigments? How are they identified in
27. Phenylketonuria. [AP Sep 06; AP Jun 08] the urine? Describe the biochemical tests done in a case of jaun-
28. Characteristics of genetic code. [AP Sep 06] dice. What is the normal level of serum bilirubin? [AP Oct 98]

29. Name the aromatic amino acids and inborn errors in any one of . What are ketone bodies? Describe their synthesis and utilization.
them. [AP Apr 03] [AP Jun 08]

30. What are the normal levels of blood sugar, urea, cholesterol and . Describe in detail the beta-oxidation of fatty acids. Indicate the
total proteins? [AP Oct 02] sites at which ATPs are formed. [AP Nov 94]

31. Dietary sources of essential amino acids. [RGUHS Feb 07] . Outline the beta-oxidation of fatty acids. [AP Aug 91]
32. Ascorbic acid deficiency. [RGUHS Feb 07] 10. Ketosis. [AP Nov/Dec 91]

33. Buffer systems in the blood. [RGUHS Feb 07] 11. Classify lipids giving suitable examples. Describe the oxidation of
fatty acids. Give the importance of HDL and LDL cholesterol.
34. Essential fatty acids. [RGUHS Feb 07]
[Goa 04]
35. Four functions of calcium. [RGUHS Feb 07]
12. Write in brief on B-oxidation of palmitic acid. Name other types
36. tRNA. [RGUHS Feb 07] of fatty acid oxidation. Add a note on functions of cholesterol.
37. Name the sulphur-containing amino acids. [RGUHS Jul 08] [Goa 05]
38. Explain the protein-sparing action of carbohydrates. [RGUHS Jul 08] 13. Write beta-oxidation of triglyceride in detail, such as hydrolysis,
39. Base pairing and its importance for the function and structure of Knoop’s theory, reactions and energetics. [Maharashtra Jul/

DNA. [AP Jun 90] Aug 05]

40. Genetic code. [Goa 05] 14. Name the ketone bodies. Mention the basic metabolic defect that
leads to ketosis. How ketone bodies are utilized in peripheral tis-
41. Structure of proteins. [Goa 05]
sues? [Maharashtra Oct 03]
42. Urea cycle. [Goa 06]
15. Write an essay on B-oxidation of fatty acids. Add a note on its
43. Secondary structure of proteins. [Goa 06] bioenergetics. [RGUHS Dec 2011/Jan 2012 (RS3)]
44. Factors affecting iron absorption. [Goa 08] 16. Describe B-oxidation of palmitic acids. How many ATPs are pro-
45. Structure and function of glycogen. [Maharashtra May 03] duced by the complete oxidation? [RGUHS Dec 2010 (RS &
46. What is SGPT? What is its normal range and discuss with its RS2)]
clinical significance? [RGUHS Dec 2011/Jan 2012 (OS)]
Short Essays
47. Denaturation. [RGUHS Dec 2011/Jan 2012 (RS3); (RS&RS2)]
48. Write a brief note on plasma proteins. [RGUHS Dec 2011/Jan 1. Essential fatty acids. [RGUHS Apr 00]
2012 (RS & RS2)| 2. Cholesterol degradation. [RGUHS Sep 01]
49. Synthesis and uses of glucuronic acid. [NTRUHS Jun 2010] 3. Phospholipids (structure and functions). [RGUHS Sep 04, Mar 05]
50. Structure of deoxyribonucleic acid (DNA). [NTRUHS Jun 2010, 4. Classification of lipids with two examples of each class. [RGUHS
2011 (NR & OR)] Mar 03, Mar 99]
EGY) Quick Review Series: BDS 1st Year

5. Digestion and absorption of triglycerols. [RGUHS Mar 04] 8. Beta-oxidation. [RGUHS Sep 97]
6. Explain the beta-oxidation of fatty acids. What is the importance 9. Fat metabolism. [RGUHS Jul 90]
of this process? [RGUHS Mar 04] 10. Unsaturated fatty acids. [RGUHS Aug 96,Apr 02]
7. Name the ketone bodies; how are they formed? Mention two 11. Phenylketonuria. [RGUHS Apr 00]
causes of ketosis. [RGUHS Mar 05]
12. Normal values of cholesterol. [RGUHS Apr 00]
8. Briefly give the pathway of ketogenesis. How is the presence of
13. Name any four functions of lipids. [RGUHS Sep 02]
ketone bodies in urine detected? [RGUHS Apr 02]
14. In which form fats are stored in our body? Where is fat stored?
9. Ketone bodies. [AP Oct 98; TN Nov 01; AP Oct 02]
[RGUHS Sep 04, Mar 05]
10. Cholesterol. [AP Apr 95; AP Oct 02]
15. What are lecithins? Mention their physiological importance.
11. Fatty liver. [AP Sep 06] [RGUHS Aug 05]
12. Ketosis. [AP Aug 91; AP Sep 06] 16. Give normal values for serum cholesterol. [AP Oct 04]
13. What is ‘good’ cholesterol? Why is it so called? [AP Apr 03] 17. Formation of ketone bodies. [AP Mar/Apr 05]
14. What are polyunsaturated fatty acids? Give examples and men- 18. Atherosclerosis. [AP Mar/Apr 05]
tion their clinical importance. [AP Apr 03]
19. What are the normal level of blood sugar, urea, cholesterol and
15. What is the normal serum level of bilirubin? Name the patho- total proteins? [AP Oct 02]
logical conditions where it is raised. [AP Apr 03]
20. What are bile salts? How are they tested in the laboratory? [AP
16. Bile salts. [AP Oct 99] Oct 02]
17. Absorption of fats. [AP Oct 99] 21. Fate of bilirubin in the body. [AP Oct 97]
18. Saturated and unsaturated fat. [AP Apr 98] 22. Structure and properties of cholesterol. [AP Oct 97]
19. ‘Good’ cholesterol. [AP Oct 98] 23. Bile pigment formation. [RGUHS Feb 07]
20. Lipoproteins and their functions. [AP Jun 08; RGUHS Jul 08] 24. LDL. [RGUHS Feb 07]
21. Role of carnitine in beta-oxidation. [AP Jun 08] 25. What is fatty liver? Give example of lipotropic substance. [RGUHS
22. Essential fatty acids. [TN Apr 03; RGUHS Feb 07] Jul 08]
23. Classify lipids with suitable examples. [RGUHS Jul 08] 26. Write biological importance of cholesterol. [RGUHS Jul 08]
24. Various lipoproteins circulating in human plasma and their func- 27. Essential fatty acids. [AP Nov 94]
tion. [AP Apr 96] 28. Ketosis. [AP Nov 94]
25. Beta-oxidation of saturated fatty acids. [Goa 02] 29. Beta-oxidation of palmitic acid (only pathway and energetics).
26. Lipoproteins. [Goa 03] [Goa 08]
27. What are ketone bodies? [Goa 06] 30. Four important functions of lipid. [Maharashtra Jul/Aug 05]
28. Electrophoresis. [TN Oct 03] 31. Soap formation. [Maharashtra Jul/Aug 05]
29. Phospholipids. [TN Aug 04] 32. Source, structure and functions of cholesterol. [Maharashtra May 03]
30. Draw and label the general structure of lipoprotein. [Maharashtra 33. What are essential fatty acids? Write any two important functions
Oct 03] of it. [RGUHS Dec 2011/Jan 2012 (OS); Jun/Jul 2010 (RS & RS2)]
31. State any four functions of cholesterol. [Maharashtra May 02] 34. Classification of lipids. [NTRUHS Jan 2010 (OR)]
32. Describe the biochemical functions of cholesterol. [RGUHS Dec 35. Name the essential fatty acids and their importance. [NTRUHS
2011/Jan 2012 (OS) Jan 2010 (NR)]
33. Describe the digestion and absorption of dietary lipids. [RGUHS 36. Essential fatty acids [RGUHS Dec 2010 (RS3)]
Dec 2011/Jan 2012 (RS & RS2)] 37. Lipotropic factors. [RGUHS Dec 2010 (RS3)]
34. Essential fatty acids. [NTRUHS Dec 2011/Jan 2012 (NR & OR)] 38. Classify lipids, giving one example each. [RGUHS Dec 2010 (RS
35. What are ketone bodies? Mention the causes of ketosis. [RGUHS & RS2)]
Jun/Jul 2010 (RS & RS2)] 39. Four functions of cholesterol. [RGUHS June/Jul 2010 (RS3)]

Short Notes 4. METABOLISM OF INORGANIC SUBSTANCES

. Fatty liver. [RGUHS Sep 02]
Long Essays
Ye

. Cholesterol. [RGUHS Jun 91]

. Derivatives of cholesterol and their importance. [RGUHS Apr 98] 1. What is the normal serum calcium level? How is it regulated?
Enumerate the physiological functions of calcium. [RGUHS Mar/
What are essential fatty acids? Name them. [RGUHS 94]
PF

Apr 99]
. Ketone bodies. [RGUHS Mar 88, 94; AP Oct 97; Goa 02]
nu

2. What is the normal blood calcium level? What are the factors
. Name ketone bodies and two conditions in which they are ex-
DA

which maintain this level? [RGUHS Mar 77]

creted. [RGUHS Sep 01]
3. Discuss the functions of calcium in human body. Explain the
7. What is ketosis? List two causes of ketosis? [RGUHS Sep 03] homeostasis of blood calcium. [RGUHS Sep 04]
 Previous Years’ Question Bank

. Write the dietary sources, factors influencing absorption, biochem- 18. Biochemical functions of phosphorus. [AP Sep 06]
ical functions and daily requirements of calcium. [RGUHS Apr 02] 19. Biochemical functions of selenium. [AP Mar/Apr 05]
. Biochemical functions of calcium. [RGUHS Mar 99] 20. What is the normal calcium level in blood? How is it regulated?
. Give the synthesis, sources and the daily requirement of vitamin [AP Apr 96]
D. Explain the deficiency effects of vitamin D. [Goa 03] 21. Hypercalcemia. [AP Nov 94]
22. Write the metabolism of copper and iodine. [AP Jun 90]
Short Essays
23. Parathormone. [Goa 02]
. Functions of calcium. [RGUHS Mar 04]
24. Role of hormones in regulations of serum calcium level.
. Regulation of serum calcium. [RGUHS Sep 03; RGUHS Feb 07] [NTRUHS Jun 2010]
HK

. Absorption and transport of iron. [AP Oct 04] 25. What are the normal values of: [NTRUHS Jun 2011 (NR & OR)]
wen
DAM Bw

. Synthesis and functions of 1,25-dihydroxycholecalciferol. [AP Oct 04] a. Sodium

b. Potassium
. Scurvy. [AP Feb 02]
c. Chloride
. Calcium homeostasis. [AP Mar/Apr 05, NTRUHS Jan 2010 (NR)] d. Bicarbonate in plasma.
. Rickets. [AP Apr 95]
Hypokalaemia. [AP Apr 95] 5. BIOLOGICAL OXIDATION
. Absorption and transport of iron from the GI tract. [AP Oct 04]
. Four functions of calcium. [RGUHS Feb 07] Short Essays
&

. Fluorosis. [AP Aug 91, RGUHS Dec 2010 (RS3)] 1. Write briefly about electron transport chain. [RGUHS Apr 02]
KK

. Iron absorption. [AP Feb 02] . Name two antioxidants and their functions. [AP Apr 03]
NY

. Sources and functions of calcium. [AP Nov/Dec 91] . Mention the reactions where reduced NADP is required. [AP
YW

. Deficiency and excess of fluoride. [TN Sep 02] Feb 00]

fF

. Active form of vitamin D and its functions. [TN Aug 04] . Name the components of electron transport chain, mentioning
Vv

the site of ATP generation and its inhibitors. [AP Jun 08]
. Four important functions of calcium. [Maharashtra May 03]
A

. Oxidative phosphorylation. [RGUHS Feb 07]

. Name hormones of calcium metabolism. [Maharashtra Oct 03]
nw
APenN

. Jaundice. [TN Oct 03]

. State importance of fluoride. [Maharashtra May 02]
pete

. Substrate level phosphorylation. [NTRUHS Jun 2010]

. Factors affecting calcium absorption. [NTRUHS Dec 2011/Jan
Oo

on

2012 (NR & OR)] . Give two examples of detoxification by conjugation. [NTRUHS
Jun 2010]
20. What is the normal serum calcium level? Write briefly on the role
of calcium in the body. [RGUHS Dec 2010 (RS & RS2)]
Short Notes
Short Notes 1. Synthesis of cyclic AMP. [AP Jun 08]

. Importance of iodine. [RGUHS Apr 02] 2. Oxidation of pyruvic acid. [AP Jun 08]

. Normal value of serum calcium. [RGUHS Apr 0] 3. Degradation of heme. [AP Jun 08]
wn

Four functions of calcium. [RGUHS Mar 03, Mar 04] 4. Name the various ATP sites in the respiratory chain. [RGUHS

. Functions of calcium in the body. [RGUHS Sep 02]

Jul 08]
. Components of electron transport chain and sites of ATP forma-
ve

wn

. Name the hormones which regulate serum calcium level. [RGUHS

tion. [AP Apr 96]
Sep 02]
6. Haemoglobin. [Goa 02]
. Name two trace elements and their biological role. [RGUHS Sep 02]
DN

7. Haemoglobin—structure and synthesis. [Goa 05]

. Potassium balance. [RGUHS Sep 97]
. Glycosylated from of haemoglobin-A;.. [Maharashtra Jul/
. Describe the functions and deficiency of fluorine. [RGUHS Mar
Aug 05]
04, Mar 05]
. Oxidative deamination. [RGUHS Dec 2011/Jan 2012 (RS3)]
. Functions of fluoride. [RGUHS Mar 97]
10. Role of fluoride in prevention of dental caries. [RGUHS Aug 05]
6. WATER, ELECTROLYTE AND ACID-BASE
11. Dental fluorosis. [RGUHS Mar 03, Sep 97]
BALANCE
12. Fluorosis. [RGUHS Aug 05]
13. Give the sources and functions of iodine. [AP Oct 04] Short Essays
14. Give normal value for the following: serum calcium. [AP Oct 04]
1. Explain the role of kidney in acid-base balance. [RGUHS Apr 02]
15. What is transferrin? What is its function? [AP Feb 02]
2. What is the normal pH of the blood? Explain various mecha-
16. Serum cholesterol. [AP Apr/May 04] nisms by which it is regulated. [RGUHS Aug 05]
17. Factors affecting absorption of iron. [AP Sep 06] . Name the buffer systems of the body. [NTRUHS Jan 2010 (OR)]
Quick Review Series: BDS 1st Year

Short Notes 18. Discuss about the clinical importance of enzymes with their nor-
mal values and clinical significance. [RGUHS Jul 08]
Importance of buffers in blood. [RGUHS Feb 07]
19. Enzyme inhibition. [AP Aug 91, Nov/Dec 91,RGUHS Dec 2011/
Blood buffers. [AP Apr/May 04]
Jan 2012 (OS)]
WPF YP
Srna

Standard urea clearance. [AP Oct 99]

20. Factors affecting enzyme action. [AP Feb 91]
Normal pH of blood. [AP Feb 00]
21. Name three clinically important enzymes, and write their diag-
Metabolic acidosis. [AP Jun 08] nostic significance. [AP Feb 02]
Buffer systems in the blood. [RGUHS Feb 07] 22. Mechanism of action of enzymes. [Goa 02]
Metabolic and respiratory acidosis. [TN Oct 03] 23. lsoenzymes and coenzymes. [Goa 03]
. Electron transport chain. [NTRUHS Dec 2011/Jan 2012 (NR & OR)] 24. Factors affecting enzyme activity. [Goa 04]
Blood buffer. INTRUHS Jun 2011 (NR & OR); RGUHS Dec 2010 25. Inhibitors of enzyme action. [TN Sep 02]
(RS3)] 26. Define enzyme and mention two examples of competitive inhibi-
10. Explain acidosis. [RGUHS Jun/Jul 2010 (RS & RS2)] tors. [Maharashtra May 03]
27. Allosteric regulation of enzyme activity. [Maharashtra Oct 03]
7 ENZYMES 28. Explain effect of temperature on rate of enzyme reaction. [Maha-
rashtra May 02]
Long Essays
29. Discuss the various factors affecting enzyme activity. [RGUHS
1. Define an enzyme. How are enzymes classified? Describe the fac- Dec 2011/Jan 2012 (RS & RS2)]
tors affecting enzyme-catalyzed reactions. [RGUHS Mar 97]
30. Isoenzymes. [RGUHS Dec 2010 (RS3)]
2. What are enzymes? Give an account of the effect of substrate
31. Explain rhodopsin cycle in detail. [RGUHS Jun/Jul 2010 (RS &
concentration, pH and temperature on enzyme activity.
RS2)]
[NTRUHS Jan 2010 (OR)]
How do you classify enzymes? Describe the various factors af- Short Notes
fecting enzyme activity. [NTRUHS Dec 2011/Jan 2012 (NR &
OR)] . LDH isoenzymes. [RGUHS Sep 97]
. Enzyme inhibition. [RGUHS Dec 92]
Short Essays . What are proenzymes? Give two examples. Mention their signifi-
Isoenzymes. [RGUHS Apr 00; AP Oct 02, Apr/May 04] cance. [RGUHS Mar 05]
. Give the enzyme and cofactors necessary for transamination reac-
Define isoenzymes. Name them (any three) and give their clinical
importance. [RGUHS Aug 05] tion. [RGUHS Aug 05]

Classification of enzymes. [RGUHS Apr 03] . Enzymes related to myocardial infarction. [AP Apr 03]
oAen VI

Classification of enzymes with one example of each class. . Enzyme poisons. [AP Oct 97]
Nn

[RGUHS Sep 03] . Lactic acid dehydrogenase. [AP Oct 97]

Define competitive inhibition. Give three examples. [RGUHS Sep . What are isoenzymes? Give two examples. [RGUHS Jul 08]
04, Mar 05] . What are proenzymes? Explain with examples. [RGUHS Jul 08]
Oo

Features and examples of competitive and feedback inhibition. . Draw the normal GTT curve and compare it with different dia-
[RGUHS Mar 04] betic conditions. [AP Apr 96]
Examples of the competitive inhibition of enzymes. [RGUHS 11. Factors affecting enzyme action. [Goa 05]
Sep 02]
12. Competitive inhibition of enzymes. [Goa 06]
Competitive inhibition and non-competitive inhibition. [RGUHS
13. Effect of pH and temperature on enzyme activity. [Goa 08]
Sep 97]
14. Coenzyme. [Maharashtra Jul/Aug 05]
Name five clinically important enzymes in plasma. Indicate their
normal values and clinical significance. [RGUHS Mar 05] 15. Competitive inhibition. [NTRUHS Jun 2010, 2011 (NR & OR)]

10. SGOT and SGPT. [AP Feb 02] 16. Define isoenzymes with examples. [RGUHS Jun/Jul 2010 (RS &
RS2)]
11. Describe enzyme action. [AP Feb 02]
12. Enzymes of diagnostic importance. [AP Sep 06]
8. BILE
12. TUB classification of enzymes. [AP Mar/Apr 05]
13. What is the role of gastric juice in protein digestion? [AP Oct 99] Long Essays
14, Heparin. [AP Oct 98] 1. What are the various sources for the formation of acetyl CoA in
15. Serum alkaline phosphatase. [AP Oct 98] the body, and how is it oxidized to CO, and water? [AP Jun 90]
16. Isoenzymes and their clinical significance. [AP Jun 08] 2. Blood. What are the biochemical basis of various types of jaun-
17. Different types of enzyme inhibition and their significance. dice? How will you distinguish different types of jaundice using
[RGUHS Feb 07] biochemical tests for urine? [NTRUHS Jan 2010 (NR)]
 Previous Years’ Question Bank

Short essays 4. Give normal levels of the following: [AP Jun 08]
a. Serum amylase
1. Heparin. [NTRUHS Jan 2010 (OR)]
b. Serum inorganic phosphorus.
5. Write the tests to identify the following in urine: [AP Jun 90]
Short Notes
a. Sugar
1. Normal value of bile acids. [RGUHS Apr 00] b. Ketone bodies
c. Proteins.
2. What is fatty liver? Explain briefly. [RGUHS Dec 2011/Jan 2012
(OS)] 6. Gastric function tests. [AP Feb 91]
3. Test for urinary bile salts and bile pigments. [NTRUHS Jun 2011 7. van den Bergh test and its importance. [NTRUHS Jan 2010 (NR
(NR & OR)] & OR)]
Or
van den Bergh test. [RGUHS June/Jul 2010 (RS3)]
9. HAEMOGLOBIN AND PORPHYRINS
8. Explain creatinine clearance test. [RGUHS Jun/Jul 2010 (RS &

Short essays RS2)]

1. What are immunoglobulins? [RGUHS Dec 2010 (RS & RS2)]

12. HORMONES

Short Notes Short Notes

Haemoglobin. [RGUHS Sep 99] 1. Pancreatic hormones. [RGUHS Sep 01]
Ye yr

Haemoglobin—structure and synthesis. [Maharashtra May 03] 2. Thromboxane. [AP Jun 08]
AVF

Glycosylated form of haemoglobin. [Goa 02] 3. Synthesis of thyroid hormone. [NTRUHS Jun 2010]
Degradation of heme. [AP Oct 99] 4. Isoenzymes and their clinical significance. [NTRUHS Jan 2010
Transferrin. [RGUHS Dec 2011/Jan 2012 (OS)] (NR)]
Tron-deficiency anaemia. [NTRUHS Jun 2010, 2011 (NR &
OR)] 13. NUTRITION AND DIET
7. Immunoglobulins. [NTRUHS Dec 2011/Jan 2012 (NR & OR)]
Short Essays
10. URINE 1. Gastric functions tests. [AP Feb 91]
2. Importance of milk in our daily diet. [TN Sep 02]
Short Essays 3. Regulation of blood calcium. [RGUHS Dec 2011/Jan 2012 (RS3)]
1. Detection of fructose in the urine. [AP Oct 97]
2. Write the tests to identify the following in urine: [AP Jun 90] Short Notes
a. Sugar 1. Balanced diet. [Goa 08, NTRUHS Jun 2010]
b. Ketone bodies
2. What is calorie? Mention the caloric value of carbohydrates, pro-
c. Proteins.
teins and fat. [RGUHS Mar 04]
3. Creatinine clearance test. [RGUHS Dec 2011/Jan 2012 (RS3)]
3. Protein—-calorie malnutrition. [RGUHS Dec 2011/Jan 2012
(RS3)]
Short Note
4. Basal metabolic rate (BMR). [NTRUHS Jun 2011 (NR & OR);
1. Normal value of blood urea. [RGUHS Apr 00] RGUHS Dec 2010 (RS3)]
5. What is calorific value? [RGUHS Dec 2010 (RS & RS2)]
11. ORGAN FUNCTION TESTS 6. Calorific value of carbohydrates, proteins and lipids. [RGUHS
June/Jul 2010 (RS3)]
Short Essays 7. Define BMR (basal metabolic rate). [RGUHS Jun/Jul 2010 (RS &
1. Explain van den Bergh test. [AP Feb 00] RS2)]
2. Enzyme changes in liver disease. [RGUHS Feb 07]
14. VITAMINS
3. Enzyme marker in myocardial infarction. [NTRUHS Jun 2010]

Long Essays
Short Notes
1. Classify vitamins. Indicate dietary sources, daily requirements
1. Normal value of serum alkaline phosphates. [RGUHS Apr 00] and deficiency of fat-soluble vitamins. Briefly explain the role of
2. Enzymes of diagnostic importance in liver diseases. [AP Mar/ vitamin A in vision. [RGUHS Sep 99]
Apr 05] 2. Describe the sources and daily requirements of vitamin D. Add a
3. Describe two tests done in the lab to confirm obstructive jaundice. note on its deficiency. [RGUHS Sep 99]
[AP Oct 02]
Quick Review Series: BDS 1st Year

. Enumerate the functions of vitamin D. Explain its importance in 17. Vitamin C. [Goa 04]
calcium metabolism. [RGUHS Sep 97] 18. Ascorbic acid. [TN Nov 01]
. Give an account of the source, metabolic functions, daily require- 19. Niacin. [TN Oct 03]
ment and deficiency manifestations of vitamin C. [AP Oct 97]
20. Name coenzymes of niacin, riboflavin, pantothenic acid, and
. Describe the formation of active form of vitamin D. Describe its thiamine. [Maharashtra May 02]
biochemical function, deficiency features and daily requirements.
21. Functions of vitamin C. [RGUHS Dec 2011, 2010/Jan 2012 (RS3)]
[RGUHS Feb 07]
22. Scurvy. [NTRUHS Jan 2010 (OR)]
. Give the sources, daily requirement and functions of vitamin C.
Explain the effects of deficiency states. [Goa 02] 23. Biologic functions of vitamin C. [NTRUHS Jan 2010 (NR)]
. Give the sources, daily requirement, functions and deficiency 24. Functions and deficiency symptoms of vitamin C. [NTRUHS Jun
symptoms of vitamin A. [Goa 04] 2011 (NR & OR)]
. What are the various sources for the formation of acetyl CoA in 25. Functions of vitamin A. [RGUHS June/Jul 2010 (RS3)]
the body, and how is it oxidized to CO, and water? [AP Jun 90]
. Give an account of the sources, daily requirement, biochemical Short Notes
functions and deficiency manifestations of vitamin C. [Goa 08]
1. Pellagra. [RGUHS Apr 02; AP Oct 04, Nov 94]
10. Name three important vitamins which are required for proper
functioning of nerves. Describe the sources, requirement, bio- 2. Vitamin C. [RGUHS Aug 92, Dec 92]
chemical functions and deficiency manifestations of any one of (or)
them. [TN Sep 02] Enumerate two biochemical functions of vitamin C. [RGUHS
Apr 02]
11. Write an essay on vitamin D. [TN Oct 03]
. Vitamin D. [RGUHS Jun 92]
12. Give an account of sources, functions and deficiency manifesta-
tions of retinol. [Maharashtra May 02]
(or)
Vitamin D deficiency. [RGUHS Mar 03]
13. What are the sources, requirement, biochemical functions and
4. Vitamin K. [RGUHS Dec 91]
deficiency manifestations of vitamin D? [NTRUHS Jun 2010,
2011 (NR & OR)] . Fat-soluble vitamins. [RGUHS Aug 88]
. List four features of vitamin A deficiency. [RGUHS Sep 03]
Short Essays (or)
Describe the features of deficiency of vitamin A. [RGUHS Mar 04,
1. Ascorbic acid. [RGUHS Sep 01; AP Apr 98] Sep 02]
(or) (or)
Functions and deficiency of vitamin C. [RGUHS Mar 04] Deficiency diseases of RGUHS vitamin A. [RGUHS XXxX]
(or) . Coenzymes of riboflavin and niacin. [RGUHS Sep 01, Sep 99]
Functions and deficiency of ascorbic acid. [RGUHS Mar 03]
. What are the diseases caused by deficiency of: (a) niacin and (b)
. Vitamin D deficiency. [RGUHS Mar 03]
vitamin B,, (cobalamin). [RGUHS Aug 05]
. Biological functions of vitamin A. [RGUHS Mar 03]
. Explain the role of thiamine. [RGUHS Aug 05]
(or)
Describe the functions of vitamin A. [RGUHS Mar 05] 10. Importance of folic acid in human diet. [RGUHS Sep 97]

. Vitamin A deficiency. [RGUHS Aug 96; AP Oct 02] 11. Source and function of vitamin B,, .[RGUHS Apr 87]
(or) 12. Name the vitamins necessary for neurological functions. [RGUHS
Deficiency manifestations of vitamin A. [AP Oct 98; RGUHS Mar Sep 04, Mar 05]
02] 13. Coenzymes of niacin and pyridoxine. [RGUHS Mar 04]
. Coenzyme forms and deficiency of niacin. [RGUHS Mar 05]
14. Name the coenzyme forms of vitamin B,, B,, niacin and ribofla-
. Biological functions of pyridoxine. [RGUHS Aug 05] vin. [AP Feb 02]
onNn

. Visual cycle. [RGUHS Aug 05] 15. Deficiency of vitamin D. [AP Apr/May 04]
- How does vitamin K take part in the coagulation of blood? 16. Deficiency manifestation of thiamine. [AP Apr 03]
[RGUHS Sep 97]
17. Name haemopoietic vitamins. [RGUHS Feb 07]
. Vitamin By. [AP Oct 99]
18. Functions of ascorbic acid. [RGUHS Feb 07]
10. Vitamin A deficiency symptoms. [AP Feb 00]
19. What is fatty liver? Give examples of lipotropic substances.
11. Vitamin K. [AP Apr 95; TN Apr 03] [RGUHS Jul 08]
12. Give the sources, functions and deficiency symptoms of vitamin 20. Name the sulphur-containing amino acids. [RGUHS Jul 08]
A. [AP Jun 08]
21. What are isoenzymes? Give two examples. [RGUHS Jul 08]
13. Give functions of ascorbic acid. [RGUHS Feb 07]
22. Name the various ATP sites in the respiratory chain. [RGUHS
14, Riboflavin deficiency. [AP Aug 91] Jul 08]
15. Synthesis of thyroxine. [AP Aug 91] 23. Explain phenylketonuria. [RGUHS Jul 08]
16. Functions of vitamin D. [AP Feb 91] 24. Functions of vitamin C. [AP Apr 01]
 Previous Years’ Question Bank

25. Rhodopsin cycle. [Goa 06] 28. Functions and deficiency symptoms of vitamin C. [NTRUHS Jun
26. Write a short note on scurvy. [RGUHS Jul 08] 2010]
27. Coenzyme nucleotides and vitamins. [RGUHS Dec 2011/Jan 2012 29. Beriberi. [NTRUHS Jun 2011 (NR & OR)]
(RS3)] 30. Name the vitamins which have antioxidant properties. [RGUHS
Dec 2010 (RS & RS2)]

Section 4A: Oral Histology

1. DEVELOPMENT OF FACE AND ORAL CAVITY . Write briefly about Hertwig’s root sheath. [RGUHS Aug 96,
BUHS Aug 96]
Long Essays 6. Describe development of roots. [RGUHS Mar 88, BUHS May 88]
1. Describe the development of face. Mention the congenital defects 7. Describe physiologic growth of teeth. [RGUHS Feb 92, BUHS
of orofacial region. [NTR-OR Apr 94] Feb 92]
Describe the development of palate. [RGUHS Mar 87] . Describe the cap and bell stage of tooth development. [NTR-OR
Name the branchial arches involved in the development of Apr 94]
tongue, and write in detail about the development of tongue. . Enumerate the stages of tooth development, and write about the
[RGUHS Mar 04] formation of root. [NTR-NR Oct 04]
10. Brief the stages in the development of tooth. Explain the ‘ad-
Short Essays vanced Bell stage’ with suitable diagram. [RGUHS Dec 2011/Jan
2012 (RS3)]
Development of palate. [RGUHS Sep 00]
11. Describe in detail dentinogenesis.[RGUHS Dec 2011/Jan 2012
Meckel’s cartilage. [NTRUHS Dec 2010/ Jan 2011] (RS & RS2)]
Development of upper and lower lip. [RGUHS Dec 2011/Jan
2012(RS3)] Short Essays
Enamel knot. [NTRUHS Dec 2011/ Jan 2012; (RS & RS2)] 1. Dental lamina. [RGUHS Sep 00, Dec 2010 (RS3)]
2. Bell stage of tooth development. [RGUHS Sep 04]
Short Notes
3. Name the stages of tooth development, and write in detail about
1. Development of tongue. [BUHS May 87, NTRUHS Dec 2011/ Jan the cap stage. [RGUHS Sep 02, 04]
2012, RGUHS Aug 88, Jan 90, Sep 00] . Write the layers of Hertwig’s epithelial root sheath and its role in
Development of upper lip. [NTR-OR Apr 97] tooth development. [RGUHS Apr 03]
Fe YN

Describe development of palate. [BUHS May 87] . Enamel knot and enamel cord. [RGUHS Mar 05]
nw
Ay

Meckel’s cartilage. [RGUHS Sep 02] . Dental follicle. [NTRUHS Jun 2011]
Morula. [RGUHS Mar 04] . Fate of dental lamina. [NTRUHS Jun 2010]
Aen

Development of palate. [NTRUHS Dec 2011/ Jan 2012, (RS & . Odontoblast. [NTRUHS Jan 2010]
RS2)] . Epithelial mesenchymal interactions. [RGUHS Dec 2011/Jan
oOo

2012 (OS)]
2. DEVELOPMENT AND GROWTH OF TEETH 10. Theories of calcification. [RGUHS Dec 2010 (RS3)]

Long Essays Short Notes

1. Describe in detail about stages of tooth development. [RGUHS 1. Dental lamina. [RGUHS Aug 98, Jan 90, Feb 91, BUHS Jan 90,
Mar 94, Sep 99, Apr 00, Mar 04, Sep 04, Mar 05, NIR-NR Oct 06, BUHS Feb 91]
BUHS Mar 94] . Dental sac. [RGUHS Feb 93, BUHS Feb 93]
Enumerate stages of tooth development. Describe Bell stage in . Histophysiological stages of tooth development. [RGUHS Apr 08]
detail. [RGUHS Aug 95, Sep 98, Jul 90, Aug 92, Mar 97, NTR-OR
Hertwig’s root sheath. [RGUHS Mar 98, NTR-NR Oct 04]
Apr 93, NTR-NR Sep 06]
. Vestibular lamina. [RGUHS Sep 00]
Draw a neat labelled diagram of ‘tooth gern bell stage and ex-
plain the role of each structure. [NTR-OR Apr 98] Stratum intermedium. [RGUHS Sep 00, RGUHS Sep 02]

Write briefly about cap stage of tooth development. [RGUHS . Bell stage. [NTR-OR Apr 84, Feb 90, Feb 01, Apr 00]
Mar 91] . Cap stage. [NTR-OR Aug 01, NTR-NR Oct 02, NTR-NR Oct 03]
LY) Quick Review Series: BDS 1st Year

9. Enamel organ. [NTR-OR Apr 96, Apr 97] Short Essays

10. Dental lamina. [NTR-OR Oct 97, Apr 99, Feb 01]
1. Enamel rods. [RGUHS Sep 00, Sep 04]
11. Root formation. [NTR-NR Oct 04] 2. Gnarled enamel. [RGUHS Sep 99, Apr 99]
12. Development of root. [NTR-OR Oct 97] . Formative phase of ameloblast. [RGUHS Mar 05, RGUHS Sep 04,

we
13. Composition of structure of tooth. [NTR-OR Apr 93, NTR-OR Mar 05]
Apr 96] . Enamel lamellae and enamel tufts. [RGUHS Sep 00, Mar 05]

SP
14, Dental lamina and vestibular lamina. [NTR-NR Apr 06] . Surface structure of the enamel. [RGUHS Mar 06]

DON un
15. Hertwig’s epithelial sheath. [NTR-NR Apr 03, NTR-OR Sep 84, . Incremental lines in enamel. [RGUHS Aug 06]

aA
Feb 90, NTR-OR Apr 99, Aug 01]
. Describe enamel cuticle. [RGUHS Aug 88, BUHS Aug 88]
16. Fate of dental lamina. [RGUHS Mar 06]
. Nasmyth’s membrane. [NTRUHS Dec 2011/ Jan 2012]
17. Enamel knot and enamel chord. [RGUHS Sep 04]
. Gnarled enamel. [NTRUHS Jan 2010]
18. Primary epithelial band and dental lamina. [RGUHS Aug 05]
. Tomes process. [NTRUHS Jan 2010 (OR); Dec 2011/Jan 2012 (RS
19. Name the stages of tooth development, and write in detail about
& RS2)]
the cap stage. [RGUHS Sep 02, 03, Mar 05]
11. Enamel lamellae. [RGUHS Dec 2011/Jan 2012 (OS), (RS & RS2)]
20. Write the layers of the Hertwig’s epithelial root sheath and its role
12. Hypocalcified structures of enamel. [RGUHS Jun/Jul 2010 (RS3)]
in development of tooth root. [RGUHS Apr 03]
21. Stellate reticulum. [NTR-NR Apr 06]
Short Notes
22. Stratum granulosum. [NTR-NR Oct 04]
1. Enamel rods. [RGUHS Oct 87]
23. Epithelial cell rests of Malassez. [NTR-NR Mar 05]
. Gnarled enamel. [RGUHS Sep 00, NTR-OR Feb 01, NTR-NR
24. Lamina propria. [RGUHS Aug 05]
Sep 06]
25. Cap stage of tooth development. [NTRUHS Dec 2010/ Jan 2011]
. Incremental lines of Retzius. [RGUHS Nov 86, Feb 93, BUHS Nov
26. Hertwig’s epithelial root sheath. [NTRUHS Jun 2010] 86, Feb 99]
27. Bell stage of tooth development. [NTRUHS Jan 2010] 4. Perikymata. [RGUHS Feb 96, NTR-OR Sep 85, NTR-OR Oct 92]
28. Cell rests of Malassez. [RGUHS Jun/Jul 2010 (RS3)] 5. Enamel lamellae. [RGUHS Mar 89, Mar 92, Feb 96, Aug 96, NTR-
NR Sep 06]
3. ENAMEL . Dentinoenamel junction. [RGUHS Aug 91, Apr 98, NTR-OR Apr 96]
. Enamel tufts. [RGUHS Jul 90]
Long Essays
. Enamel spindles. [RGUHS Feb 93, NTR-NR Oct 05]
1. Describe in detail structures of enamel. [RGUHS Mar 88, Sep 98, . Age changes of enamel. [RGUHS Jan 90]
BUHS Mar 02]
. Enamel organ. [RGUHS Aug 93, NTR-OR Oct 94]
. Write about hypocalcified areas of enamel. [RGUHS Jun 89, Sep 02,
. Chemical composition of enamel. [RGUHS Apr 98, Apr 03]
Sep 03, NTR-NR Apr 05, NTR-OR Jan 92, BUHS Jun 89, Mar 94]
. Hertwig’s epithelial root sheath. [RGUHS Sep 99]
. Describe briefly about enamel organ. [RGUHS Oct 87]
. Composition of enamel. [RGUHS Mar 04, Apr 03]
. Describe life cycle of ameloblasts. [RGUHS Jul 90, Mar 95]
. Nasmyth’s membrane. [RGUHS Mar 04]
. Describe in detail about amelogenesis. [RGUHS Aug 88, Sep 99,
Apr 99, Aug 06, BUHS Aug 89] . Secondary cuticle. [RGUHS Mar 04]
. Write briefly about mineralization of enamel. [RGUHS Feb 93, . Enamel. [NTR-OR Apr 97]
BUHS Eeb 91] . Ameloblast. [NTR-OR Apr 99, Feb 01]
. Describe the physical and chemical properties of enamel. De- . Hunter-Schreger bands. [NTR-OR Sep 84, Apr 98, NTR-NR Apr 06]
scribe in brief histology of enamel. [RGUHS Apr 99]
. Reduced enamel epithelium. [NTR-OR Apr 93]
. Enumerate the hypocalcified structures of enamel, and describe
. Chemical composition of enamel. [NTR-OR Apr 86, NTR-NR
each in detail. [RGUHS Sep 02]
Apr 02, 04]
. Describe the stages in life cycle of an ameloblasts. [NTR-NR Oct 02]
21. Enamel tufts, lamellae and spindles. [NTR-OR Oct 94, 98]
10. Write in detail about life cycle of ameloblasts, and describe in
22. Neonatal line. [NTR-NR Oct 05, RGUHS Dec 2011/Jan 2012 (RS
detail the amelogenesis. [NTR-OR Apr 00]
& RS2)]
11. Describe the physical and chemical properties of enamel. De-
23. Granular layer of Tomes. [NTR-NR Oct 03]
scribe histology of enamel. [RGUHS Apr 99]
24. Tomes’ granular layer. [BUHS Aug 95, RGUHS Apr 00]
12. Write the chemical composition of enamel. Describe the hypocal-
cified structures of enamel, and add a note on age changes in 25. Pellicle. [RGUHS Sep 04, RGUHS Mar 05]
enamel. [RGUHS Aug 05] 26. Tomes’ process. [RGUHS Sep 00]
13. Describe the stages in the life cycle of an ameloblast. [RGUHS 27. Hypocalcified areas of enamel. [NTRUHS Dec 2011/ Jan 2012,
Dec 2011/Jan 2012 (OS)] RGUHS Apr 00]
 Previous Years’ Question Bank

28. Theories of calcification. [NTRUHS Dec 2011/ Jan 2012] Short Notes
29. Surface structure of enamel. [NTRUHS Jun 2011] . Dentineal tubules. [RGUHS Aug 95, NTR-OR Apr 97, 98]
30. Enamel lamellae and enamel tufts. [NTRUHS Jan 2010] . Types of dentine. [RGUHS Apr 99, Sep 99]

Ye
31. Physical characteristics of enamel. [NTRUHS Jan 2010 (OR)] . Predentine. [RGUHS Aug 91, NTR-NR Oct 03]

BY
32. Physical characteristics and chemical properties of enamel. . Circumpulpal dentine. [RGUHS Mar 92, BUHS Mar 92]

fF
[RGUHS Dec 2011/Jan 2012 (RS3)] . Secondary dentine. [RGUHS Jun 89, Feb 91, Sep 94, Mar 97, Sep

a
33. Primary and secondary cuticle. [RGUHS Dec 2010 (RS3)] 97, BUHS Jun 89, Feb 91]
. Mantle dentine. [RGUHS Mar 87, Feb 91, BUHS May 87,

4. DENTINE Feb 91]

. Neonatal line. [RGUHS Mar 92]
Long Essays . Interglobular dentine. [NTR-OR Apr 98, NTR-NR Oct 02, Apr 05,
Oct 05, Sep 06, RGUHS Mar 92, Feb 93, Mar 95]
1. Write briefly about types of dentine. [RGUHS Jan 90]
. Tomes’ granular layer. [RGUHS Mar 94, Aug 95, Feb 91]
2. Discuss types of dentine. [NTR-NR Apr 06]
10. Dead tracts. [RGUHS Mar 89, Sep 94, Aug 96, RGUHS Mar 04,
3. Describe the types of dentine with their clinical significance.
NTR-OR Oct 96 NTR-OR Oct 97]
[NTR-OR Sep 84, 85]
11. Sclerotic dentine. [RGUHS Oct 87, RGUHS Jul 90, NTR-OR Oct
. Define dentine. Describe various types of dentine. [NTR-OR Feb
97, BUHS Oct 67, BUHS Jul 90]
90, NTR-OR Aug 01]
12. Denticles. [RGUHS Apr 99, Mar 06]
. Write the physical properties and chemical composition of den-
tine. Describe the various hypocalcified structures of dentine. 13. Structural lines in dentine. [RGUHS Sep 99]
[RGUHS Sep 04, Mar 05] 14. Tomes’ granular layer. [RGUHS Apr 00]
. Write physical and chemical composition of dentine. Describe the 15. Odontoblasts. [NTR-OR Apr 96]
histology of dentineal tubules. [RGUHS Aug 05] 16. Intertubular dentine. [NTR-OR Apr 00, RGUHS Apr 03]
. Describe in detail the microscopic structures of dentine. [RGUHS 17. Interglobular dentine. [NTR-OR Apr 98, NTR-NR Oct 02, Apr 05,
Sep 00] Oct 05, Sep 06, RGUHS Jun/Jul 2010 (RS3)]
. Describe the histology of various types of dentine and their func- 18. Theories of dentine sensitivity. [NTR-OR Oct 03, NTR-NR
tion. [NTR-OR Apr 03] Mar 05]
. Discuss various types of dentine. [NTRUHS Jun 2011] 19. Tonofilaments. [RGUHS Aug 05]
20. Reparative dentine. [RGUHS Sep 04, Mar 05, NTR-NR Oct 04]

Short Essays 21. Curvatures of dentine. [RGUHS Apr 03, Mar 05]
22. Hydrodynamic theory. [RGUHS Mar 05, Aug 05]
1. Age changes in dentine. [RGUHS Sep 04, Dec 2011/Jan 2012 (RS
&RS2)] 23. Osteodentine. [RGUHS Sep 03]

. Structure of dentine. [RGUHS Sep 04] 24. Tertiary dentine. [RGUHS Mar 06]

3. Curvatures in dental tubules. [RGUHS Mar 05] 25. Structural lines in dentine. [RGUHS Sep 99]

. Write briefly on incremental lines in dentine. [RGUHS 26. Dentoenamel junction. [RGUHS Apr 04]
Feb 93] 27. Write briefly on incremental lines in dentine. [BUHS Feb 93]
. Briefly explain dentineal sensitivity. [RGUHS Jul 92, Aug 93] 28. Enumerate the different types of dentine and describe them
briefly. [NTRUHS Dec 2011/ Jan 2012]
. Describe the hypocalcified structure of dentine. [NTR-OR
Jan 92] 29. Theories of pain transmission in dentine. [NTRUHS Dec 2010/
Jan 2011]
. Briefly explain sensitivity of dentine. [BUHS Jul 92, Aug 83]
30. Physical and chemical properties of dentine. [NTRUHS Jan
. Dead tracts. INTRUHS Dec 2010/ Jan 2011]
2010]
. Circumpulpal dentine. [NTRUHS Dec 2010/ Jan 2011]
31. Dentine hypersensitivity (theories of). [NTRUHS Jan 2010 (OR)]
10. Predentine. [NTRUHS Jun 2010]
11. Reparative dentine. [NTRUHS Jun 2010; RGUHS Dec 2011/Jan 5. PULP
2012 (OS)]
12. Pattern of mineralization of dentine and add note on age changes Long Essays
of dentine. [NTRUHS Jan 2010 (OR)] 1. Describe briefly about pulp. [RGUHS May 87, Mar 89, Jun 89,
13. Primary, secondary and tertiary dentine. [RGUHS Dec 2011/Jan BUHS May 87, Mar 89]
2012 (RS3)] . Define pulp and describe its functions. [RGUHS Sep 94]
14, Types of dentine in cross-section. [RGUHS Dec 2010 (RS3)] . Describe cellular elements and functions of pulp. [BUHS Sep 96,
15. Formation of root. [RGUHS Jun/Jul 2010 (RS3)] RGUHS Sep 96]
Quick Review Series: BDS 1st Year

Write briefly about age changes in pulp. [RGUHS Mar 94, BUHS 6. CEMENTUM
Mar 94]
Enumerate the structures present in the pulp, and write in detail Long Essays
on odontoblastic layer and its function. [RGUHS Apr 03]
1. Describe the microscopic and macroscopic appearance of cemen-
6. Describe cellular elements of pulp. [NTR-OR Apr 99]
tum. [NTR-OR Jul 89]
7. Describe the structure and functions of pulp. [NTR-NR
. Enumerate the differences between cellular and acellular cemen-
Apr 04]
tum. [NTR-NR Oct 04]
Describe briefly microscopic structure of pulp. [NTR-OR
Apr 97]
Enumerate functions of pulp. Discuss the histology of pulp. Short Essays
[NTR-OR Feb 01] . Intermediate cementum. [RGUHS Sep 99, Apr 99]
10. Define pulp and describe the functions of pulp. [BUHS Sep 94] . Cementogenesis. [RGUHS Apr 03]
11. Enumerate structures in the pulp. Write in detail on odontoblas- . Enumerate types of cementoenamel junction and write its devel-
tic layer and its functions. [RGUHS Apr 03] opment. [RGUHS Mar 04]
12. Describe the histological structures of pulp. [RGUHS Dec 2010 . Histology of primary cementum. [RGUHS Mar 05]
(RS3)]
. Cellular cementum. [NTR-NR Apr 04]
Short Essays . Cementoenamel junction. [NTR-OR Apr 96, Oct 98, NTR-NR
Apr 03]
Odontogenic region of pulp. [RGUHS Sep 00]
PoP

. Cementicles. [RGUHS Apr 03]

Age changes and clinical consideration of pulp. [RGUHS Sep 02]
Pulp calcifications. [RGUHS Sep 04] . Acellular cementum. [RGUHS Sep 04]
ee

Pulp stones. [NTRUHS Jun 2010; RGUHS Dec 2011/Jan 2012 . Secondary cementum. [RGUHS Aug 06, NTRUHS Jun 2010]

(OS)] 10. Hypercementosis. [RGUHS Dec 2010 (RS3)]

Zone of Weil. [NTRUHS Jan 2010] 11. Cementoenamel junction. [RGUHS Jun/Jul 2010 (RS3)]
“

Histology of pulp. [RGUHS Dec 2011/Jan 2012(RS3)]

Functions of pulp. [RGUHS Jun/Jul 2010 (RS3)] Short Notes
Short Notes 1. Sharpey’s fibres. [RGUHS Nov 86, Jun 89, Feb 91, Jul 92,
Aug 93]
1. Cellular elements of pulp. [RGUHS Aug 91, NTR-NR Oct 03,
BUHS Aug 91] . Cellular cementum. [RGUHS Aug 88, Mar 98, NTRUHS &
RGUHS (RS3) Dec 2010/ Jan 2011, NTR-OR Mar 83, 86,
2. Define cells of pulp. [RGUHS Nov 86].
Oct 95]
Pulp stones. [RGUHS Mar 88, RGUHS Sep 99, NTR-NR Oct 02,
»

. Cementoenamel junction. [NTRUHS Jun 2010, RGUHS Mar 92,

NTR-NR Oct 04]
Aug 96, NTR-OR Apr 96, Oct 98]
Pulp. [NTR-OR Oct 92]
. Hypercementosis. [RGUHS Apr 00, NTR-NR Apr 05]
woF

Odontoblasts. [NTR-OR Sep 85, NTR-OR Apr 96]

. Cementocytes. [RGUHS Sep 04]
Zones of pulp. [NTR-OR Apr 98, NTR-NR Oct 05, Sep 06]
. Cementicles. [NTR-OR Apr 00, Aug 01, RGUHS Dec 2011/Jan
NAD

Functions of pulp. [NTR-OR Apr 87, Oct 96]

2012 (OS)]
Age changes in pulp. [NTR-OR Oct 98, NTR-NR Apr 06,
. Sharpey’s fibres. [NTR-OR Sep 85, 96]
NTRUHS Dec 2010/ Jan 2011, RGUHS Sep 00, 03]
. Types of cementum. [NTR-OR Apr 99, NTR-OR Feb 01, NTR-
Subodontoblastic plexus of Raschkow. [NTR-NR Apr 05]
~

NR Oct 05, NTRUHS Jun 2011]

9. Odontoblastic zone. [RGUHS Sep 04, Mar 05]
. Functions of cementum. [NTR-OR Jan 92]
10. Odontogenic region of pulp. [RGUHS Sep 00]
10. Cementoblasts and cementocytes. [NTR-OR Apr 93]
11. Cell-free and cell-rich zones of pulp. [RGUHS Mar 04]
11. Cementogenesis. [RGUHS Apr 03]
12. Zone of Weil. [NTR-NR Apr 03]
12. Intermediate cementum. [RGUHS Apr 99, Sep 99]
13. Undifferentiated mesenchymal cells of pulp. [RGUHS Mar 04,
Aug 05] 13. Age changes in cementum. [RGUHS Apr 03]
14, Langerhans cells. [NTR-NR Apr 05] 14. Cellular and acellular cementum. [RGUHS Aug 05]

15. Defence cells of pulp. [NTR-NR Oct 03] 15. Histology of primary cementum. [RGUHS Sep 04, Mar 05]

16. Intermediate plexus. [RGUHS Mar 04] 16. Theories of dentineal sensitivity. [NTRUHS Jun 2011]
17. Functions of the pulp. [NTRUHS Jun 2011; RGUHS Dec 2011/ 17. Difference between cellular and acellular cementum. [NTRUHS
Jan 2012 (OS) (RS & RS2)] Jan 2010]
 Previous Years’ Question Bank

18. Cementocyte. [RGUHS Dec 2011/Jan 2012 (RS & RS2)] 14. Transseptal fibres. [NTR-NR Oct 05]
15. Cell rests of Serres. [NTR-NR Sep 06]
7 PERIODONTAL LIGAMENT 16. Principal fibres of periodontal ligament. [NTRUHS Jan 2010;
RGUHS Dec 2011/Jan 2012 (RS & RS2)]
Long Essays
17. Deficiency of vitamin C. [NTRUHS Jan 2010 (OR)]
1. Describe in detail the structure of periodontal ligament. [RGUHS 18. Intermediate plexus. [RGUHS Dec 2011/Jan 2012 (OS)]
Oct 87, BUHS Oct 87]
Describe fibres of periodontal ligament and functions of PDL. 8. BONE (MAXILLA AND MANDIBLE)
[RGUHS Mar 95, BUHS Mar 95]
Write briefly about principal fibres of PDL. [RGUHS Feb 96, Long Essays
BUHS Feb 96, Aug 96, RGUHS Sep 00, NTR-OR Oct 97]
1. Define bone and alveolar bone. Describe the structure of alveolar
Describe histology and functions of PDL. [RGUHS Mar 92, Sep bone. [NTR-OR July 89]
97, BUHS Mar 92]
. Write briefly about the Meckel’s cartilage. [BUHS Mar 94, RGUHS
Discuss the cells and fibres of periodontal ligament. [NTR-NR Mar 94]
Apr 05, NTR-OR Sep 85, Apr 96]
Describe the fibres of periodontal ligament. Add a note on func- Short Essays
tions of periodontal ligament. [NTRUHS Dec 2011/ Jan 2012]
1. Write age changes and clinical consideration of mandible. [RGUHS
Define periodontium. Discuss the principal fibres of periodontal
Mar 04]
ligament. [NTRUHS Jun 2010]
. Osteoclasts and osteoblasts. [RGUHS Aug 05, NTR-NR Apr 03,
Short Essays Apr 06]
. Osteocyte. [NTRUHS Jun 2011]
Rests of Malassez. [RGUHS Sep 00]
. Alveolar process. [RGUHS Jun/Jul 2010 (RS3)].
Cells of periodontal ligament. [RGUHS Sep 02]
Name the principal fibres of periodontal ligament and draw a
Short Notes
neat labelled diagram. [RGUHS Mar 04, RGUHS Sep 97]
Enumerate the functions of periodontal ligament. [RGUHS Apr 1. Meckel’s cartilage. [RGUHS Nov 86, Jul 92, Sep 99, NTR-OR Oct
99, NTR-OR Apr 89] 98, Aug 01, NTR-NR Oct 02, NTR-NR Oct 05]

Cells of periodontal ligament. [NTRUHS Jun 2011] . Alveolar bone. [RGUHS Jul 92, Aug 95, Jul 96, Sep 99, NTR-OR
Apr 93, Oct 97, NTR-NR Oct 04, NTRUHS Dec 2010/ Jan 2011]
Sharpey’s fibres. [NTRUHS Dec 2010/ Jan 2011; (RS & RS2)]
. Bundle bone. [RGUHS Feb 93, Apr 98, Sep 00, NTR-OR Sep 89,
we

Bundle bone. [NTRUHS Jan 2010; RGUHS Dec 2011/Jan 2012

Jan 92, NTR-NR Oct 03]
(OS)]
Howship lacunae. [RGUHS Aug 91, NTR-NR Oct 04, BUHS Aug 91]
Cementicles. [NTRUHS Jan 2010 (OR)]
. Reversal line. [RGUHS Mar 92, BUHS Mar 92]
Short Notes . Osteoclasts. [NTR-NR Oct 04]
. Lamina dura. [NTR-QR Apr 96]
Periodontium. [RGUHS Feb 93, BUHS Feb 93]
. Supporting alveolar bone. [NTR-NR Oct 05]
Cell rests of Malassez. [RGUHS May 87, Aug 88, Jul 92, Sep 04,
BUHS May 87, Aug 88, Jul 92] . Volkmann’s canal. [NTR-OR Apr 99]
Oxytalan fibres. [RGUHS Sep 99, Apr 99, Sep 03] . Alveolar bone proper. [NTR-NR Mar 05]
4. Fibroblasts of periodontal ligament. [RGUHS Sep 04] . Development of mandible. [NJR-OR Oct 97, NTR-NR Apr 06]

Periodontal ligament or PDL. [RGUHS Aug 91, NTR-NR Oct 04, . Development of maxillary process. [NTR-OR Oct 91, NTR-NR
“

BUHS Aug 91] Sep 06]

Cells of periodontal ligament. [NTR-OR Apr 00] 13. Spongy bone. [NTR-NR Sep 06]
. Sharpey’s fibres. [NTR-OR Oct 96, Oct 99, NTR-NR Apr 06 , Oct 04] 14. Haversian system. [NTR-NR Apr 03]
a

Alveolar group of fibres. [NTR-OR Apr 93] 15. Reversal lines. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]
wom

. Bundle fibres of periodontal membrane. [NTR-NR Apr 02, Apr 04] 16. Osteon. [RGUHS Dec 2010 (RS3)]
10. Principal fibres of periodontal ligament. [NTR-OR Jan 82, Jan 92,
NTR-NR Sep 06] 9. ORAL MUCOUS MEMBRANE
11. Synthetic cells of PDL. [RGUHS Sep 04, Mar 05]
Long Essays
12. Alveolar synthetic fibres. [ RGUHS Mar 04]
1. Classify oral mucous membrane and describe in detail about
13. Oblique and apical group of periodontal ligament fibres. [RGUHS
masticatory mucosa. [NTR -NR Sep 2006]
Aug 05]
Quick Review Series: BDS 1st Year

2. Write about the specialized mucosa of the oral cavity. [NTR-NR Short Notes
Oct 05]
1. Non-keratinocytes. [RGUHS Aug 95, Mar 04, NTR-NR Apr 06,
. Classify oral mucous membrane. Describe the gingiva. [NTR-OR NTRUHS Jun 2010; RGUHS Dec 2011/Jan 2012 (RS & RS2)]
Feb 90]
2. Keratinocytes. [RGUHS Mar 95, BUHS Mar 95]
. Classify oral mucus membrane. Describe the layers of keratinized
3. Alveolar mucosa. [RGUHS Sep 00]
mucosa and add a note on gingiva. [NTR-OR Oct 90, Oct 98,
RGUHS Sep 99] . Gingival col or “COL. [RGUHS Aug 88, Sep 99, NTR-NR Apr 04,
Apr 06, NTR-OR Oct 92, Oct 97]
. Classify oral mucous membrane. Enumerate the histological dif-
ferences between hard and soft palate. INTR-OR Mar 93] . Melanocytes. [RGUHS Sep 00, NTR-NR Apr 04]
. Describe the lining mucosa. [BUHS Feb 93, RGUHS Feb 93] . Papillae of tongue. [RGUHS Mar 89, Nov 86, NTR-OR Sep 85,
. Describe in detail specialized mucosa. [RGUHS Sep 00] Apr 99, Aug 01]

. Describe briefly keratinized oral mucosa. [BUHS May 87, RGUHS . Circumvallate papillae. [RGUHS Mar 88, Jan 90, Sep 04, Apr 98,
May 87] NTR-NR Oct 03, Oct 04]

. Classify oral mucosa and describe keratinized mucosa. [BUHS . Dentogingival junction. [RGUHS Sep 99, Mar 05, NTR-OR Oct
Aug 95, RGUHS Feb 96] 96, NTR-NR Sep 06]

10. Classify oral mucous membrane and describe in detail about 9. Changes in oral mucosa. [RGUHS Mar 89, Sep 97, BUHS Jan 90]
masticatory mucosa. [BUHS Aug 91, RGUHS Jan 90, Apr 00, 10. Langerhans cells. [RGUHS Sep 00, NTR-NR Mar 05]
Apr 02]
11. Junctional epithelium. [RGUHS Mar 04]
11. Describe microscopic and macroscopic structures on dorsal
12. Taste buds. [NTR-OR Sep 00, NTR-NR Oct 02, Oct 03]
surface of anterior 2/3rd of tongue. [BUHS Aug 93, RGUHS
Aug 93] 13. Vermillion border. [NTR-OR Apr 00]
12. Write the development, structure and different stages of dento- 14. Types of gingiva. [NTR-OR Apr 97, Apr 99, Feb 01]
gingival junction. [RGUHS Sep 03] 15. Mucogingival groove. [NTR-OR Apr 86]
13. Write in detail about the gingiva. [RGUHS Mar 97, Apr 98] 16. Epithelial attachment. [NTR-OR Apr 93, RGUHS Sep 99,
14, Define oral mucosa. Write in detail about the microscopic and Mar 92]
macroscopic features of gingiva. [RGUHS Aug 05] 17. Reduced enamel epithelium. [NTR-OR Apr 93]
15. Describe the clinical appearance and histological detail of gingiva. 18. Clinical and microscopic features of palatal mucosa. [NTR-NR
[RGUHS Apr 98] Apr 06]
16. Write briefly about epithelial attachment. [RGUHS Feb 96] 19. Palatal mucosa (macroscopic and microscopic features). [NTR-
17. Classify oral mucous membrane and describe keratinized mu- NR Sep 06]
cosa. [NTRUHS Dec 2010/ Jan 2011] 20. Filiform papillae and fungiform papillae. [RGUHS Mar 05]
18. Classify oral epithelium and discuss the histology of orthokera- 21. Stratum granulosum and stratum basale. [RGUHS Apr 04]
tinized epithelium. [NTRUHS Jan 2010]
22. Classify oral mucosa and write about specialized mucosa.
19. Classify oral mucosa. Write in detail on masticatory mucosa. [RGUHS Sep 04]
[RGUHS Jun/Jul 2010 (RS3)]
23. Uvula. [NTR-NR Oct 02]

Short Essays 24. Rugae. [NTR-NR Oct 05]

25. Incisive papilla. [NTR-NR Apr 02, Apr 03, Apr 04]
. Circumvallate papillae. [RGUHS Apr 98]
26. Stratum granulosum. [NTR-NR Oct 04]
. Write briefly the development of three stages of dentogingival
junction. [RGUHS Mar 04] 27. Macrophages. [RGUHS Mar 05]

. Filiform papillae and fungiform papillae of tongue. [RGUHS 28. Free gingival groove. [RGUHS Mar 05]
Mar 05] 29. Lining mucosa. [NTRUHS Dec 2011/ Jan 2012]
. Langerhans cells. [NTRUHS Dec 2011/ Jan 2012] 30. Muscles of tongue. [NTRUHS Dec 2010/ Jan 2011]
SP

. Circumvallate papillae. [NTRUHS Dec 2011/ Jan 2012] 31. Structure of keratinized epithelium. [NTRUHS Jan 2010 (OR);
Dan un

. Taste bud. [NTRUHS Jun 2011] RGUHS Dec 2011/Jan 2012 (OS)]
aA

. Histology of anterolateral zone of palate. [NTRUHS Jun 2011] 32. Melanocyte. [RGUHS Dec 2011/Jan 2012 (OS)]

. Stratum granulosum. [NTRUHS Jun 2010] 33. Lamina propria. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]

. Birbeck granules. [NTRUHS Jan 2010] 34. Col. [NTRUHS Dec 2011/ Jan 2012]

. Nerve supply of tongue. [RGUHS Dec 2011/Jan 2012 (RS3)]

10. SALIVARY GLANDS
11. Gingiva. [RGUHS Dec 2011/Jan 2012 (RS3)]
12. Functional and histological differences between keratinized and Long Essays
non-keratinized mucosa. [RGUHS Dec 2010 (RS3)]
1. Classify salivary glands and write about functions of saliva.
13. Structures on dorsum of tongue. [RGUHS Jun/Jul 2010 (RS3)]. [RGUHS Sep 97]
 Previous Years’ Question Bank

. Classify salivary glands, and describe histological appearance of . Composition of saliva. [NTR-OR Oct 98, NTRUHS Dec 2011/
parotid gland. [RGUHS Feb 91, Feb 00, BUHS Feb 91] Jan 2012, RGUHS Nov 86, Sep 04]

. Describe difference between serous and mucous acini. [RGUHS . Salivary enzymes. [NTR-OR Jan 92]
Jan 89]
. Wharton’s duct. [NTR-NR Oct 03]
. Describe briefly about ductal system of salivary gland. [RGUHS
10. von Ebner’s gland. [NTR-OR Apr 00, Feb 01, RGUHS Sep 00]
Mar 87, BUHS May 87]
11. Minor salivary glands. [NTR-OR Oct 97, Apr 97, Apr 06, RGUHS
. Describe briefly about functions of saliva. [RGUHS Mar 88]
Sep 00]
. Describe the composition, functions and formation of saliva.
12. Intercalated ducts. [RGUHS Mar 04]
[RGUHS Apr 03]
13. Name ducts of major salivary glands. [RGUHS Sep 99]
. Discuss composition and functions of saliva. [NTR-OR Apr 99,
Feb 01] 14. Salivary lipase. [RGUHS Sep 00]
. Classify salivary glands. Describe the parotid gland briefly. [NTR- 15. Major salivary glands. [RGUHS Sep 02]
OR Feb 90] 16. Ptyalin. [NTR-NR Oct 02]
. Classify salivary glands and enumerate the difference between the 17. Name the ducts of major salivary glands. [NTR-DR Sep 99]
serous and mucous acini. [NTR-OR Apr 94]
18. Stenson’s duct. [RGUHS Sep 99, Aug 05, BUHS May 87, BUHS
10. Write briefly about sublingual salivary glands. [BUHS Nov 86, Aug 93]
Feb 92, RGUHS Nov 86]
19. Protective functions of saliva. [RGUHS Aug 06]
11. Classify salivary glands with its structural element, and write in
detail on the ductal system. [RGUHS Sep 03]
12. Write in detail composition and functions of saliva. [NTRUHS 11. TOOTH ERUPTION
Jan 2010 (OR)]
Long Essays
Short Essays
1. Describe briefly the theories of eruption of teeth. [NTR-OR Mar
1. Functions of saliva. [NTRUHS & RGUHS Dec 2010/ Jan 2011; 83, Oct 96, NTR-NR Apr 06, RGUHS Mar 89]
RGUHS Jun/Jul 2010 (RS3), RUGHS Apr 00] . Describe tooth eruption. [BUHS Feb 96]
. Composition of saliva. [RGUHS Sep 02]
. Enumerate theories of eruption of teeth. Add a note on clinical
. Write briefly about sublingual salivary glands. [RGUHS Nov 86] considerations related to tooth eruption. [RGUHS Mar 06]
. Describe briefly about functions of saliva. [BUHS Aug 95, Feb 96, . Describe in detail about pre-eruptive, eruptive and post-eruptive
i

RGUHS Mar 97] tooth movements. [RGUHS Mar 04]

. Saliva—composition and functions. [NTR-OR Oct 96]
nan w

. Ductal system of major salivary glands. [NTR-DR Apr 99]

Short Essay
Dan

. Serous cells. [NTR-NR Oct 05]

1. Mechanism of tooth eruption. [RGUHS Sep 99]
. Myoepithelial cell. [NTRUHS & RGUHS (RS3) Dec 2011/ Jan 2012]
2. Fibronexus theory of tooth eruption. [RGUHS Jun/Jul 2010
. Minor salivary gland. [NTRUHS Dec 2011/ Jan 2012] (RS3)]
10. Basket cell. [NTRUHS Jun 2011]
11. Glands of Blandin and Nuhn. [NTRUHS Jun 2011]
Short Notes
12. von Ebner’s gland. [NTRUHS Jun 2010]
1. Theories of eruption. [NTR-NR Apr 04, Oct 03, Apr 00, RGUHS
13. Difference between serous and mucous gland. [RGUHS Dec
Mar 95]
2011/Jan 2012 (OS)
. Hydrodynamic theory. [RGUHS Mar 05]
14, Serous acini. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]
. Mechanism of tooth eruption. [RGUHS Sep 99]
15. Functions of striated duct. [RGUHS Dec 2010 (RS3)]
. Enumerate the theories of tooth eruption, and write in short the

Short Notes most accepted one. [RGUHS Sep 03]

. PDL traction theory. [RGUHS Jan 90, BUHS Jan 90]
« Serous acini. [NTR-OR Jun 92, Oct 98, NTR-NR Oct 03]
. Eruption dates of deciduous and permanent teeth. [RGUHS
. Mucous acini. [RGUHS Mar 97, Aug 88, BUHS Aug 88]
FWYN

Oct 87]
. Serous and mucous acini. [NTR-NR Sep 06]
. Sequences of maxillary teeth eruption. [RGUHS Sep 00]
. Difference between serous and mucus glands. [NTR-NR
. Passive eruption. [NTR-NR Oct 03]
Apr 04]
. Active and passive eruption of tooth. [NTR-NR Apr 05]
. Myoepithelial cells. [NTR-OR Jan 92, Apr 93, Apr 98, Apr 00,
NTR-NR Apr 05, RGUHS Jan 89, Sep 00] 10. Sequence of eruption of deciduous teeth. [RGUHS Apr 03]

. Functions of saliva. [NTR-NR Oct 02, Oct 03, Apr 04, NTR-NR 11. Theories of tooth eruption. [NTRUHS Jan 2010; RGUHS Dec
Oct 05, RGUHS May 87] 2011/Jan 2012 (RS3)]
Quick Review Series: BDS 1st Year

12. SHEDDING OF DECIDUOUS TEETH Short Notes

1. Maxillary sinus. [NTR-OR Oct 98, Aug 01, NTR-NR Apr 03]
Short Essay
2. Lining of maxillary sinus. [RGUHS Mar 06]
1. Write briefly about shedding of deciduous teeth. [BUHS Mar 88,
3. Functions of maxillary sinus. [NTRUHS Jun 2010, RGUHS Sep
RGUHS Mar 88] 02, NTR-NR Oct 05]

4. Functions of maxillary antrum. [RGUHS Mar 06]

Short Notes
5. Goblet cells. [RGUHS Mar 05]
Osteoclasts. [NTR-OR Apr 99]
6. Histology of maxillary sinus. [RGUHS Dec 2010 (RS3)]
RP

Odontoclasts. [RGUHS Sep 02, RGUHS Sep 03]

Shedding of deciduous teeth. [NTR-NR Apr 04] 15. HISTOCHEMISTRY OF ORAL TISSUES
PY

Shedding. [RGUHS Dec 2011/Jan 2012 (OS)]

Short Essays
13. TEMPOROMANDIBULAR JOINT 1. Enumerate the stages of tissue processing and write about fixa-
tion. [RGUHS Mar 04]
Short Essay
. Fixation procedures and ideal fixatives. [RGUHS Sep 04]

NY
1. Enumerate the ligaments of temporomandibular joint and their . Preparation of ground section of tooth. [RGUHS Dec 2011]

WwW
functions. [RGUHS Apr 03]
. Xylene. [NTRUHS Jun 2011]

fF
2. Ligaments of TMJ. [NTRUHS Jan 2010]
. Tests for decalcification. [RGUHS Dec 2011/Jan 2012 (RS & RS2)]

Short Notes a
Short Notes
1. Articular capsule. [NTR-OR Feb 01, RGUHS Dec 2011/Jan 2012
. Alkaline phosphate. [NTR-OR Apr 98, NTR-NR Apr 02, Apr 04]
(OS)]
eB

Ground section of tooth. [RGUHS Mar 06]

Histology of temporomandibular joint. [RGUHS Aug 06]
ween Pp wn

. Fixing in soft tissue processing. [RGUHS Aug 05]

Articular disc of TMJ. [RGUHS Sep 04]
oFYe

. Fixation of tissues. [RGUHS Sep 04 ]

Histology of TMJ. [NTRUHS Jun 2011]
Fixing of sections. [NTR-NR Apr 03, 04]
Temporalis muscle. [RGUHS Dec 2011/Jan 2012 (OS)]
au

. Xylene. [RGUHS Sep 03]

14. MAXILLARY SINUS . Stages in soft tissue processing. [RGUHS Oct 01]
. Robinson’s alkaline phosphatase. [RGUHS Apr 03]
Short Essays . Haematoxylin and eosin stains. [NTRUHS Jun 2010]
1. Maxillary sinus. [RGUHS Sep 99] . Ground section. [NTRUHS Jan 2010]
&
i

2. Write briefly about functions of maxillary sinus. [NTR-OR Feb 02] . Clearing agents. [NTRUHS Jan 2010 (OR)]
3. Histology of maxillary sinus. [NTRUHS Jan 2010 (OR)] . Decalcifying agents. [RGUHS Dec 2011/Jan 2012 (RS3)]
yn
—

Section 4B: Dental Anatomy

1. INTRODUCTION TO DENTAL ANATOMY Short Notes

1. Ridges. [NTR-OR Oct 98, NTR-NR Sep 06, NTRUHS Jun 2011,
Long Essay RGUHS Mar 94]
1. Write briefly about the tooth numbering system. [BUHS Mar 94, 2. Grooves. [NTR-OR Oct 97]
RGUHS Apr 99] . Cingulum. [NTR-OR Aug 01, NTR-NR Oct 04, Oct 02, RGUHS
we

Apr 99, [RGUHS Mar 04]

Short Essays . Oblique ridge. [NTR-NR Aug 01]

ps

. Marginal ridge. [NTR-NR Apr 03]

1. FDI system of dental nomenclature. [RGUHS Mar 05]
nwn

Tooth numbering system. [NTR-NR Sep 06, RGUHS Apr 99]

2. Tooth numbering systems. [NTRUHS Jun 2011]
. Palmer system of notation. [NTR-NR Oct 03]
Sn

3. Traits. INTRUHS Jun 2010 ]

. FDI system of tooth notation. [BUHS Aug 99, RGUHS Mar 05]
 Previous Years’ Question Bank

9. Name systems of tooth numbering of oral cavity. [RGUHS

3. PRIMARY (DECIDUOUS) TEETH
Aug 05]
10. Mamelons. [RGUHS Sep 00, Oct 87; BUHS Oct 07] Short Essays
11. Pits. [RGUHS May 96, BUHS May 87, Feb 91, RGUHS Sep 00]
1. What are the major differences between deciduous and perma-
12. Fossa. [RGUHS Sep 94, BUHS Sep 94] nent teeth? [NTR-OR Apr 96]
13. Crown. [RGUHS Sep 99] 2. Enumerate the differences between deciduous and permanent
14. Buccal cingulum. [RGUHS Apr 99] teeth. [NTR-OR Oct 89, Oct 96, Apr 03, RGUHS Apr 87]

15. Line angles and point angles. [RGUHS Sep 00, Sep 02, NTR-NR 3. Describe in detail the difference between the permanent and de-
Sep 06] ciduous dentition. [RGUHS Apr 00]
16. Ridges and grooves. [RGUHS Mar 05] 4. Write the morphological and histological differences between
deciduous and permanent teeth. [RGUHS Mar 04]
17. Embrasures and ridges. [NTR-NR Oct 04]
18. Dental formulae. [RGUHS Sep 03] Short Note
19. Define cusp and tubercle. [RGUHS Mar 03]
1. Differences between deciduous and permanent dentition? [NTR-
20. Cingulum. [NTRUHS Dec 2011/Jan 2012] OR Jan 92, Apr 93, Apr 98, NTR-NR Oct 03, Oct 06]
21. FDI tooth numbering system. [NTRUHS Dec 2010/ Jan 2011

22. Cusp of Carabelli. [INTRUHS Dec 2010/ Jan 2011] 4. GENERAL CONSIDERATION IN THE
23. Embrasures. [NTRUHS Dec 2010/ Jan 2011 PHYSIOLOGY OF THE PERMANENT DENTITION
24. Mamelon. [NTRUHS Jan 2010
25. Zsigmondy—Palmer notation. [NTRUHS Jan 2010 (OR)]
Short Essay
26. Thyroxine. [NTRUHS Jan 2010 (OR)] 1. Curve of Spee. [RGUHS Sep 99]

27. Line and point angles. [NTRUHS Jan 2010 (OR)]

Short Notes
28. Submerged teeth. [NTRUHS Jan 2010 (OR)]
1. Curve of Spee. [RGUHS Mar 94]
2. Elevation of surface of crown. [RGUHS Sep 99]
2. DEVELOPMENT AND ERUPTION OF TEETH 3. Embrasures. [RGUHS Sep 00, Sep 04]

Short Essays
5. OROFACIAL COMPLEX: FORM AND FUNCTION
1. What is chronology of deciduous dentition? [NTR-OR Apr 97,
NTR-OR Apr 00] Short Notes
2. Write briefly on the role of calcium in development of the teeth. 1. Embrasures. [NTR-OR Apr 97, Apr 98, Oct 98, Apr 99, Apr 00,
[RGUHS Aug 91] Feb 01, NTR-NR Apr 03, Apr 04, Mar 05, RGUHS Mar 88]
3. Enumerate the differences between deciduous and permanent 2. Contact points. [NTR-OR Oct 96, NTR-NR Oct 02]
dentition. [NTRUHS Dec 2010/ Jan 2011]
3. Proximal contact areas. [NTR-OR Apr 96]
4. Measurement and chronology of permanent maxillary central
Short Notes incisor. [RGUHS Apr 98]
1. Eruption time of deciduous teeth. [NTR-OR Oct 98] 5. Spill way spaces. [NTR-NR Apr 06]

2. Sequence of eruption of deciduous teeth. [NTR-NR Mar 04,

RGUHS Mar 03, NTRUHS Dec 2011/Jan 2012] 6. PERMANENT MAXILLARY CENTRAL INCISORS
3. Sequence of eruption of permanent teeth. [NTR-NR Apr 04,
Oct 04, NTRUHS Jun 2011]
Short Essay
4. Sequence of eruption of permanent mandibular teeth. [RGUHS 1. Measurement and chronology of permanent maxillary central
Sep 00, NTR-NR Apr 06] incisor. [NTR-OR Apr 98]

Define eruption and shedding. [RGUHS Mar 06]

Short Notes
Chronology of deciduous teeth. [BUHS Jun 90]
PNA

1. Line angles and point angles in maxillary central incisor. [RGUHS

Alkaline phosphatase. [NTRUHS Dec 2010/ Jan 2011] Mar 05]
Eruption dates of permanent teeth. [NTRUHS Jun 2010] 2. Line angle of labial surface of central incisor. [RGUHS Mar 06]
Quick Review Series: BDS 1st Year

7. PERMANENT CANINES: MAXILLARY AND Short Essays

MANDIBULAR 1. Enumerate the differences between permanent maxillary bicus-
pid and permanent mandibular bicuspid. [NTR-OR Apr 92]
Long Essay . Describe morphology of mandibular premolar and discuss the
1. Morphology? Discuss the morphology of permanent maxillary
possible variations. [BUHS Aug 91, RGUHS Aug 91]
canine. [NTRUHS Jun 2010] . Crown morphology of maxillary 1st premolar and mandibular
2nd premolar. [RGUHS Apr 04]
Short Essays . Describe in detail morphology of mandibular right permanent
second premolar. [RGUHS Aug 88]
1. Enumerate the anatomical difference between deciduous maxil-
lary canine and permanent maxillary canines. [RGUHS Apr 03] . Describe the morphology of mandibular right first premolar.
[RGUHS Sep 04]
Describe in detail the chronology, morphology of maxillary per-
manent canine. [RGUHS Aug 93] . Nerve supply of mandibular teeth. [NTRUHS Dec 2011/ Jan
2012]
Short Notes
Short Notes
1. Maxillary permanent canine. [RGUHS Feb 96]
1. Premolars. [NTR-OR Oct 96]
2. Mandibular permanent canine. [BUHS Feb 94, RGUHS
2. Occlusal surface of permanent first premolar. [NTR-OR Jan 92]
Feb 96]
3. Crown morphology of maxillary 1st premolar. [RGUHS Apr 03]
4 . Difference between maxillary and mandibular Ist premolar.
8. PERMANENT MAXILLARY PREMOLARS
[RGUHS Sep 03]

Short Essays . Occlusal pattern of mandibular second premolar. [RGUHS

Nov 86]
1. Enumerate the difference between permanent maxillary bicuspid
6. Mesial surface of mandibular first premolar. [RGUHS Mar 06]
and permanent mandibular bicuspid.
7. Occlusal pattern of the mandibular second premolar. [BUHS Nov
Write the chronology and morphology of maxillary first premo-
86, Mar 88]
lar, and difference between maxillary first premolar and maxillary
second premolar. [NTR-NR Sep 06]
10. PERMANENT MAXILLARY MOLARS
Describe morphological characteristic of maxillary first premo-
lars, and write the differences between maxillary first premolar
Long Essay
and maxillary second premolar. [NTR-OR Apr 98]
Crown morphology of maxillary 1st premolar and mandibular 1. Morphology of permanent maxillary first molar. [NTRUHS Jun
2nd premolar. [RGUHS Apr 04] 2011]
Describe in detail morphology of maxillary first premolar. . Discuss the morphology of permanent maxillary first molar.
[RGUHS Jan 90] [NTRUHS Jan 2010]
Describe masticatory mucosa in detail and classify oral mucosa.
Short Essay
[RGUHS Apr 99]
Describe the morphology of maxillary first premolar. Add a note 1. Discuss morphology of maxillary permanent first molar. [NTR-
on its chronology. [RGUHS Mar 05] OR Aug 01]
Compare morphology of maxillary first premolar and maxillary . Describe the morphological differences between the permanent
second premolar. [RGUHS Apr 03] maxillary and mandibular first molars. [NTR-NR Apr 01]
. Describe the occlusal surface of permanent maxillary first molar.
Short Notes Write the difference between permanent maxillary first molar and
permanent maxillary second molar. [NTR-OR Oct 98]
Premolars. [NTR-OR Oct 96]
. Describe the morphology of crown of maxillary first molar. Dif-
RP

Occlusal surface of permanent first premolar. [NTR-OR Jan 92] ferentiate between maxillary and mandibular first molar. [NTR-
Mesial surface of maxillary first premolar. [RGUHS Aug 05] OR Apr 86, Jul 89]
PY

Maxillary permanent first premolar. [RGUHS Feb 96] . Describe the morphology of permanent maxillary 1st molar and
add a note on its chronology. [RGUHS Mar 05]
. Describe in detail the morphology of maxillary right permanent
9. PERMANENT MANDIBULAR PREMOLARS
1st molar. [BUHS Mar 89, Mar 92, Mar 89, Aug 92]

Long Essay . Describe the occlusal surface of maxillary permanent Ist left mo-
lar. [BUHS Mar 95, BUHS Aug 96]
1. Describe the morphology of mandibular second premolar. Add a
. Describe in detail the morphology of maxillary permanent Ist
note on its chronology. [NTRUHS Dec 2011/ Jan 2012]
molar. [RGUHS Oct 87]
 Previous Years’ Question Bank

9. Describe the occlusal surface of maxillary permanent Ist right 12. DENTO-OSSEOUS STRUCTURES
molar. [RGUHS Mar 95]
10. Describe in detail the morphology of permanent maxillary first Long Essays
molar crown. [RGUHS Apr 98]
1. Describe the innervations of upper permanent teeth. [NTR-OR
11. Describe theories of eruption. [RGUHS Apr 99]
Jan 92]
12. Describe the occlusal surface of permanent maxillary first molar.
2. Describe the blood and nerve supply of maxillary teeth. [BUHS
Write the difference between permanent maxillary first molar and
Nov 86, RGUHS Nov 86]
permanent mandibular first molar. [RGUHS Sep 02]
3. Write briefly about lingual nerve. [RGUHS Nov 92]

Short Notes Short Essay

Cusp of Carabelli. [NTR-OR Sep 84, Apr 98, RGUHS Sep 02]
1. Ramus of mandible. [RGUHS Mar 97]
RP

Left maxillary first molar tooth. [NTR-OR Apr 96]

2. Inferior dental nerve. [RGUHS May 87]
Crown of upper permanent first molar. [NTR-OR Apr 93]
PY

Occlusal surface of permanent maxillary first molar. [NTR-OR Short Notes

Oct 96, NTR-NR Mar 05]
1. Tuberosity. [NTR-OR Feb 01, NTR-NR Apr 03]
5. Tubercle of Carabelli or cusp of Carabelli. [RGUHS Jul 92, Sep 99,
2. Genial tubercle. [NTR-OR Feb 01]
NTR-NR Mar 04, Oct 04]
3. Mental foramen. [NTR-OR Feb 01, NTR-NR Oct 02, Apr 03]

4. Inferior alveolar canal. [NTR-OR Apr 96, Aug 01, NTR-NR Oct 02]
11. PERMANENT MANDIBULAR MOLARS
5. Nerve supply of palate. [NTR-NR Oct 04]
Long Essay 6. Inferior alveolar nerve. [NTR-OR Apr 93][NTR-OR Apr 96]

1. Describe the morphology of crown of maxillary first molar. Dif- 7. Nerve supply of maxillary teeth. [NTR-OR Apr 98]
ferentiate between maxillary and mandibular first molar.[NTR- 8. Arterial supply of maxillary teeth. [NTR-OR Apr 97]
OR Apr 86, Jul 89]
9. Ramus of mandible. [RGUHS Mar 97]
2. Describe the occlusal surface of permanent maxillary first molar, 10. Inferior dental nerve. [BUHS May 87]
and write difference between permanent maxillary 1st molar and
11. Canine fossa. [NTR-NR Apr 03]
permanent maxillary 2nd molar. [NTR-OR Oct 98]
12. Mylohyoid ridge. [NTR-NR Apr 03]
3. Describe the morphological characteristics of permanent man-
dibular first molar, and write the differences between permanent 13. Greater palatine foramen. [NTR-NR Apr 03]
mandibular first molar and permanent mandibular 2nd molar. 14. Blood supply of mandibular teeth. [RGUHS Mar 05]
[NTR-OR Oct 97] 15. Lymphatic drainage of maxillary teeth. [RGUHS Sep 03]
4. Differences between maxillary and mandibular molars. [BUHS
Aug 95, RGUHS Aug 95]
13. TEMPOROMANDIBULAR JOINT, MUSCLES,
5. Write briefly on occlusal aspect of mandibular permanent 2nd TEETH AND THEIR FUNCTIONS
molar tooth. [BUHS Mar 92, RGUHS Mar 92]
6. Describe in detail morphology of mandibular right 1st molar. Long Essays
[BUHS Jul 89, Feb 93]
1. Describe the structure and functions of muscles of mastication.
7. Describe in detail morphology of permanent mandibular Ist
[NTR-OR Apr 93]
molar tooth. [BUHS Jul 92, RGUHS Sep 00]
2. Enumerate the stages of deglutition and describe each stage.
8. Describe morphology of mandibular permanent first molar.
[RGUHS Sep 03]
[RGUHS Nov 86, Sep 99]
3. Enumerate the ligaments and functions of TMJ. [RGUHS
9. Describe in detail the morphology of mandibular right first mo- Mar 01]
lar. [RGUHS Jan 89]
10. Describe the morphology of the permanent mandibular 1st mo- Short Essay
lar. Write the difference between permanent mandibular and
maxillary 1st molar. [NTRUHS Jan 2010 (OR)] 1. Muscles of mastication. [NTR -NR Jan 2010]
2. Deglutition. INTRUHS Jan 2010 ]
Short Notes
Short Notes
1. Mandibular first molar tooth. [NTR-OR Apr 97]
1. Deglutition. [NTR-OR Apr 98]
2. Occlusal surfaces of permanent mandibular first molar. [NTR-
NR Oct 05] 2. Stages of deglutition. [NTR-NR Mar 05, RGUHS Oct 04]
3. Roots and root canals in permanent mandibular first molar. 3. Process of mastication. [NTR-OR Oct 91, Jan 92]
INTRUHS Jun 2011]
“3 Quick Review Series: BDS Ist Year

. Neural control of deglutition. [NTR-NR Oct 03] . Discuss the influence of fat-soluble vitamins on oral tissues.
SP

. Masseter muscle. [NTR-OR Jan 92, Apr 96, Oct 97, Apr 99] [NTR-OR Apr 84]
Dan un

. Lateral pterygoid muscle. [NTR-OR Apr 97] . Discuss the effects of various hormones on oral tissues. [NTR-OR
aA

Feb 90]
. Muscles of mastication. [NTR-OR Feb 01, NTR-NR Sep 06]
. Describe the calcium and phosphorus metabolism in relation to
. Synovial fluid. [NTR-OR Aug 01]
development of teeth. [NTR-NR Oct 03]
. Articular capsule. [NTR-OR Feb 01]
. Write briefly on role of calcium on development of teeth. [BUHS
10. Ligaments of temporomandibular joint. [NTR-NR Apr 06] Aug 91]
11. Leeway space. [NTR-NR Oct 04, Mar 05] . Name the hormones involved in the calcium metabolism, and
12. Physiologic mesial migration. [NTR-NR Apr 06] write their roles in calcium metabolism. [BUHS Feb 91]
13. Overjet and overbite. [RGUHS Mar 03] . Discuss briefly: (a) lingual nerve and (b) physiology of degluti-
tion. [BUHS Mar 97]
14. Articular disc. [RGUHS Mar 06]
15. Bony components of TMJ. [RGUHS Mar 05]
Short Notes

14. OCCLUSION « Scurvy. [NTR-OR Oct 97]

. Vitamin A. [NTR-OR Feb 01, NTR-NR Apr 00]
Long Essay

Pp wn
. Vitamin C. [NTR-NR Oct 02]

een
1. Describe in detail about the occlusal relationship of maxillary and . Vitamin D. [NTR-OR Apr 99, Feb 01]
mandibular teeth. [RGUHS Mar 88, BUHS Mar 88]
. Calcitonin. [NTR-NR Apr 06]
aw Parathormone. [NTR-OR Aug 01, NTR-NR Oct 02, Apr 03]
Short Essay
. Functions of calcium. [NTR-OR Jan 92]
1. Curve of Monson. [NTRUHS Dec 2011/ Jan 2012]
. Calcium homeostasis. [NTR-NR Apr 04]
2. Factors affecting occlusion. [NTRUHS Jan 2010 (OR)]
. Effects of hormones on oral tissue. [NTR-NR Apr 04]
. Theories of mineralization. [NTR-NR Apr 00, Sep 06]
Short Notes
&

. Decalcification of tooth structures. [NTR-OR Apr 00]

eK

Mesial drift. [NTR-OR Apr 97]

YK

. Procedure of decalcification of the tooth. [NTR-NR Apr 05]

eK

Occlusion. [NTR-OR Feb 01]

. Lymph nodes. [NTR-NR Apr 03]
YY

YW
Ke

Centric occlusion. [NTR-NR Oct 02]

. Pathways of pain. [NTR-NR Oct 04]
BP
—

Occlusal curvature. [NTR-OR Apr 96]

PF

. Nerve supply to tongue. [NTR-OR Jan 92]

BK

Curve of Spee. [NTR-OR Sep 84, NTR-NR Oct 05, Sep 06]
Dw

. Blood supply to anterior two-third of tongue. [NTR-OR Mar 91]

BS

Curve of Monson. [NTR-OR Oct 98, NTR-NR Apr 06]

A

. Submerged teeth. [RGUHS Apr 98, NTR-NR Oct 05]

KF

Overjet and overbite. [RGUHS Sep 00]

FN

. Supernumerary teeth. [RGUHS Apr 97, Oct 98]

Se FN

BS

Compensatory curves. [RGUHS Mar 05]

. Functions of calcium. [RGUHS Aug 05]
S|
HO

Centric relation and centric occlusion. [RGUHS Sep 03]

. Tetany. [NTR-NR Mar 05]
SCS
KY

Mental foramen. [TR-NR Oct 02]

. Demilunes. [NTR-NR Oct 05]
ee

KF
e YPN PS

KY

. Nerve supply of palate. [NTR-NR Apr 03]

. Pathways of taste. [NTR-NR Oct 04]
NY
KY

Greater palatine foramen. [NTR-NR Oct 04, Apr 03]

AY

. Effects of vitamin C deficiency on oral tissues. [NTR-NR Oct 05]

YW
ee

NY

Blood supply of mandibular teeth. [RGUHS Mar 05]

. Fibro nexus. [RGUHS Mar 05]
FF
KY

Lymphatic drainage of maxillary teeth. [RGUHS Sep 03]

« Terminal bar. [RGUHS Mar 05]
VM
eee

KY

Curve of Spee. [NTRUHS Dec 2010/ Jan 2011]

. Tuberculum impar. [RGUHS Sep 03]
RY
NDA

Curve of Wilson. [NTRUHS Jun 2010

. Infantile swallowing. [RGUHS Aug 05]
17. Bennett movement of mandible. [NTRUHS Jan 2010 (OR)]
YY

. Bennett movement of mandible. [RGUHS Sep 02]

Oe

. Inferior alveolar nerve. [NTRUHS Jan 2010]

15. MISCELLANEOUS
ry

. Calcitonin. INTRUHS Dec 2010/ Jan 2011]

So
ew

Long Essay
1. Describe the muscles of tongue. [NTR-NR Oct 02]
2. Classify muscles. Describe the blood supply and lymphatic drain-
age of tongue. [NTR-OR Feb 86]
A Aqueous humour, 256 Blood urea, 301
Abnormalities in S-T-T changes, 178 Arachnoid, 27 estimation, 482
Accessory meningeal artery, 41 Arterial supply of maxillary teeth, 430 BMR, 215
Accessory nerve, 23, 71 Arteria profunda linguae, 43 Brachial plexus, 250
Accessory phrenic nerve, 18 Articular capsule, 374, 433 Branches of third part, 41
Accommodation of eye, 255 Articular disc, 57, 434 Buccal nerve, 55
Accommodation reflex, 255 of TMJ, 374 Buccinator, 15
Acellular cementum Articular surfaces, 56 Buccinator muscle, 8, 13
(primary cementum), 343, 345 Artificial respiration, 195 Buccopharyngeal fascia, 6
Acid—base balance, 499 Arytenoid cartilage, 46 Bud stage, 316
Acromegaly, 238 Ascending pharyngeal artery, 33 Buffers, 293
Action of glucocorticoids, 228 Ascending tracts, 251
Action of lateral pterygoid muscle, 434 of spinal cord, 247
Action of oral contraceptive pills, 238 Ascorbic acid, 305 Cc
Active eruption of tooth, 372 Asphyxia, 196 Calcitonin, 393, 440
Active methionine, 275 Atlantoaxial joint, 73 Calcium, 288
Addison’s disease, 239 Atlanto-occipital joint, 73 Calcium metabolism, 292
Adenohypophysis, 30 Atlanto-occipital membrane, 25 Calorie, 302
Adrenal cortex, 168, 228, 236 Atlas, 4 Cancellous bone, 107
Adult haemoglobin Atrial cycle, 175 Cane sugar, 274
structural and functional differences, 170 Atrial diastole, 175 Canine fossa, 435
Advanced Bell stage, 317 Atrial systole, 175 Cap stage, 316
Age changes, 338 Attached denticles, 339 Capsules of thyroid, 68
in dentine, 331 Attached gingiva, 358 Carbohydrates, 268
in pulp, 340 Auditory tube, 4 Cardiac cycle, 175, 188
Agglutinin, 164 Auriculotemporal nerve, 11 events occurring, 175
Agglutinogen, 164 Axilla, 17 Cardiac impulse, 186
Aldosterone, 235 Axillary nerve (circumflex nerve), 24 Cardiac index, 185
Alkaline phosphatase, 378 Axis, 3 Cardiac monitoring, 178
Alveolar bone, 353 Cardiac muscle 186
Alveolar bone proper, 354 properties of, 187
Alveolar crest group of fibres, 352 B Cardiac output, 180, 185, 184
Alveolar mucosa, 360 Balanced diet, 213, 302 Cardiovascular reflexes, 180
Alveolocapillary membrane, 190 Baroreceptor, 188 Carotid sheath, 6, 23
Ameloblast, 319, 322, 324, 327 Baroreceptor reflexes (Marey’s reflex), 183 Carotid triangle, 15
Amino acids, 276 Bell’s palsy, 15 Carpopedal spasm, 204
Anaemia, 173 Bell stage, 317 Cavernous sinus, 29, 33, 141
types 173 Beta-oxidation, 282 Cell-free zone, 346
Anaemic hypoxia, 193 Bile, 207 Cell rests
Anatomical dead space, 192 Bile acids, 299 of Malassez, 354
Annular tendon, 36 Bile pigments, 197 of Serres, 352
Anrep effect, 182 Bile salts, 207 Cells
Ansa cervicalis, 34, 43 Bleeding and clotting time, 172 of periodontal ligament, 352
Ansa hypoglossi, 43 Blood, 427 of pulp, 336
Anterior condylar canal, 7 Blood coagulation of thymus, 110
Anterior facial vein, 17 intrinsic and extrinsic pathway, 165 Cellular (secondary) cementum, 345, 346
Anterior jugular vein, 45 Blood calcium, 491 Cementoblasts, 348
Anterior pillar of fauces, 75 Blood glucose, 494 Cementoblasts and cementocytes, 347
Anterior pituitary, 222 Blood group Cementoclasts, 349
Anticoagulants, 173 importance, 165 Cementocytes, 346
Apical group, 352 uses, 164 Cementogenesis, 345
Aplastic anaemia, 174 Blood pressure, 170 Cementum, 342
Apneustic centre, 191 Blood supply, 432, 440, 520 clinical consideration, 347
Apnoea, 195 of long bone, 102 Central sulcus, 102
Aponeurosis, 16 of thyroid gland, 73 Centric occlusion, 440
 Index

Centric relation, 440 Course of spinothalamic tract, 248 Diaphragma sellae, 29, 33
Cephalic phase, 198 Cracks, 225 Diastolic BP, 184
of gastric secretion, 198 Creatine-P synthesized, 273 Diastolic pressure, 169
Cerebral hemispheres, 33 Cretinism, 234 Dicoumarol, 167
Cerebrospinal fluid, 28, 29 Cricoid cartilage, 23, 46 Differences,
Cervical fascia, 23 Cricothyroid muscle, 88 deciduous and permanent
Cervical sympathetic chain, 98 Crista galli, 34 teeth, 394
Cervical vertebra, 20 Crown, 384, 397 Different anticoagulants, 166
Chemoreceptors, 196 Curve of Different waves, 177
Chloride shift, 195 Monson, 436 Diffusing gases, 191
Cholesterol, 214, 282 Spee, 436 Digastric branch, 50
degradation, 282 Wilson, 436 Digastric muscle, 65
Chondrocytes, 105 Cushing’s reflex, 169 Digastric triangle, 45
Chorda tympani, 14, 49, 50 Cusp, 386 Digestion and absorption,
Chorda tympani nerve, 14 Cusp of Carabelli, 422 carbohydrates, 205
Chovstek’s sign, 204 Cyanosis, 194 Digestive phase, 198
Chromosome, 119 Direct nerve innervation theory, 332
Chronology of 387 D Disaccharides, 268
deciduous dentition, 387 Dead space, 193 Disjunctive movements, 37
permanent maxillary central Dead tracts, 334 Dislocation of mandible, 58
incisor, 397, 407 Decalcification, 378 Dorsum of tongue, 480
primary dentition, 390 Deciduous maxillary canine and Ductal system, 365
Chymotrypsinogen, 197 permanent maxillary canines, 403 Ducts of major salivary glands, 368
Ciliary ganglion, 37, 38 Deep cervical fascia (fascia coli), 5, 17, 19 Dural venous sinuses, 28, 32
Cingulum, 383 Deep facial vein, 16 Dura mater, 13, 27
Circulating blood volume, 184 Deep lingual artery, 44 Dwarfism, 238
Circumpulpal dentine, 333 Deep temporal nerves, 55 Dye dilution technique, 185
Circumvallate papillae, 356, 360 Defence cells of pulp, 341 Dyspnoea, 196
Citric acid cycle, 212, 263 Deglutition, 207
Classical ABO system, 164 Deltoid, 24 E
Classification Denaturation of proteins, 273 Early normoblast, 167
of blood groups, 164 Dens, 3, 4 ECG, 177, 188, 189
of enzymes, 213 Dental fluorosis, 291 clinical application, 178
Cleft lip and cleft palate, 125, 126 Dental lamina, 318, 319 Edinger—Westphal nucleus, 38
Cobalamin, 308 Dental sac, 319 Effect of
Coenzymes Denticles, 334 baroreflex and chemoreflex on
of niacin and pyridoxine, 308 Dentinal sensitivity, 332 heart rate, 179
of riboflavin and niacin, 308 Dentinal tubules, 331, 332 hypoxia, 193
Col, 358 Dentinoenamel junction, 335 Elastic and muscular arteries, 109
Collecting ducts, 216 Dentogingival junction, 361 Elastic cartilage, 106
Colloidal osmotic pressure, 162 Derivatives Elasticity of vessel wall, 184
Colour blindness, 256 of cholesterol, 163 Electrocardiogram (ECG), 177, 188
Compact bone, 115 of first pharyngeal arch, 122 Electron transport chain, 291
Compensatory curves, 435 of second pharyngeal arch, 123 Embrasures, 386, 396
Competitive inhibition, 297 of third endodermal pouch pharynx, 124 Emissary veins, 29, 34, 474
Composition of third pharyngeal arch, 125 Enamel, 316, 291, 327
of gastric juice, 204 Determination of cardiac output, Enamel and dentine,
of saliva, 367 dilution technique, 185 composition of, 336
of urine, 215, 220 Detrusor muscle, 215 Enamel cuticle, 325
Compound epithelium, 162 Development Enamel knot, 318
Conchae, 80 of face, 124,313 Enamel lamellae, 321, 325
Conditioned reflex (psychic phase), 198, 208 of mandible, 121 and enamel tufts, 325
Conduction, 220 of milk teeth, 131 Enamel organ, 322
Confluence of sinuses, 34 of palate, 77, 126 Enamel pearls, 319
Congenital defects, orofacial region, 313 of parathyroid gland, 129 Enamel rods or prisms, 320, 324
Conjugated proteins, 274 of pituitary gland, 128 Enamel septum or enamel cord, 318
Conjugate ocular movements, 37 of retina, 96 Enamel spindles, 321, 327
Constrictor muscle of pharynx, 79 of roots, 317 Enamel tufts, 321, 325
Contact point, 396, 396 of thyroid gland, 129, 315 Enzyme, 205, 295
Contraceptives in females, 237 of tongue, 126 inhibition, 214
Convection, 217 of tooth, 316 Epicranial aponeurosis, 16
Corpus luteum, 233, 238 of upper lip, 315 Epimysium, 108
 Index

Epithelial attachment, 362 Foramen caecum, 34 Glucose tolerance test (GTT), 214, 267
Epithelial rests of Malassez, 348 Foramen lacerum, 5 Glycogen synthesis, 266
Epithelial tissues, 163 Foramen magnum, 3 Glycolysis, 261, 269
Erb’s sign, 204 Foramen ovale, 7 Glycosaminoglycans, 270
Eruption and shedding, 391 Foramen spinosum, 34 Glycosuria, 235
Eruptive phase, 370 Foramen transversarium, 26 Gnarled enamel, 324
Erythroblastosis fetalis, 174 Formation and termination of Goblet cells, 376
Erythrocyte, 168 internal jugular vein, 72 Goitre, 234
Erythropoiesis, 167 Formation, functions Gonadotropic hormone, 238
Erythropoietin, 168 notochord, 120 Graafian follicles, 119
Essential amino acids, 213 Formation Greater cornua, 6
Excretory ducts, 365 of CSF, 250 Greater palatine foramen, 429
Exocrine functions of pancreas, 201 of fibrin (role of fibrin-stabilizing Greater petrosal nerve, 49
External acoustic meatus, 40, 95 factor), 166 Grooves, 385, 388
External carotid artery, 15 of urine, 215 Ground section of tooth, 377
External jugular vein, 22, 23 Fossa, 385 Growth hormone, 168, 223, 438
Extraocular muscles, 39 of Rosenmuller, 78 Gubernacular canal, 319
Extrinsic factors, 181 Frank-Starling phenomenon, 181
Extrinsic muscles, 443 Free denticles, 339 H
Extrinsic pathway, 166 Free gingiva, 358 Haemocytoblast or stem cell, 167
Free gingival groove, 363 Haemoglobin, 169, 300
F Frenulum linguae, 90 types, 170
Facial artery, 12, 13, 15, 17, 22, 44 Frontal sinus, 34, 85 Haemolytic jaundice, 211
Facial nerve, 13, 15, 43, 49, 50, 51, 52 Frontonasal process of embryo, 124 Haemophilia, 173
Facial vein, 16 Functional phase, 370 Hard palate, 16
Factors affecting Functions, 373 Hare lip, 126
cardiac output, 180 of bile, 208 Haversian system, 354
maintaining blood pressure, 184 of calcium, 203, 234 Hazards of blood transfusion, 174
transport, 191 of cementum, 242, 356 Heart rate (chronotropic effect), 182
False pulp stones, 339 of dentine, 335 Heart sounds, 186, 188
Falx cerebri, 33, 34 of fluoride, 290 clinical significance, 186
Family planning method for females, 234 of kidneys, 219 effect of baro and chemoreflex, 179
Fascial sheath of eyeball, 97 of leucocytes, 164 innervation of, 178
Fate of liver, 197 Heme, 300
of haemoglobin, 169, 170 of lymphocytes, 174 Heparin, 167
of notochord, 121 of oestrogen, 237 Hertwig’s epithelial root sheath, 318, 327
Fat metabolism, 286 of ovaries, 237 Hiatus semilunaris, 7
Fat-soluble vitamins, 307, 436 of PDL, 249 Histology
and vitamin A, 212 of plasma proteins, 162, 171, 173 of arteries, 108
Fats stored, 287 of pulp, 338 of bone, 106
Fatty acids, 280 of saliva, 200, 367 of cartilage, 105
Fatty liver, 286 of testosterone, 231 of compact bone, 115
Federation Dentaire Internationale [FDI] of vitamin B,, 212 of gingiva, 357
system, 382, 384 of vitamin D, 389 of hypophysis cerebri, 113
Feedback inhibition, 297 Fungiform papillae, 355 of kidney, 113
Fertilization, 120 of large-size artery, 115
Fetal haemoglobin G of lung, 111
structural and functional difference, 174 Gallbladder, 211 of lymph node, 115
Fibroblasts, 337 Ganglia, 98 of oesophagus, 112
of periodontal ligament, 352 Gastric juice, 210 of parotid gland, 116
Fibrocartilage, 106 Gastric phase, 198 of salivary gland, 110
Filiform papillae, 355 Gastric secration phases of, 198 of skeletal muscle, 109
First pharyngeal arch Generation of prothrombin activator, 166 of submandibular gland, 115
cartilage, arch, artery and muscular Genetic code, 279 of temporomandibular joint, 373
derivatives, 122 Genial tubercle, 429 of thymus, 110, 115
formation and fate, 124 Gigantism, 438 Histotoxic hypoxia, 193
First rapid-filling phase, 176 Gingiva, 358 Homeostasis of blood glucose level, 221
Fixation procedures, 377 Gingiva col or ‘COL, 360 Homopolysaccharides, 270
Fluid or hydrodynamic theory, 332 Gingival crevice, 358 Hormonal regulation
Fluorosis, 291 Glomerular filtration rate, 215, 219 of Ca++, 203
Foliate papilla, 356 Glucagon, 238 of heart rate, 179, 180
Folic acid, 308 Gluconeogenesis, 271 Hormones regulating blood glucose, 236
 Index
Horner’s syndrome, 17 Isovolumetric contraction phase, 176
Howship’s lacunae, 354 Isovolumetric relaxation phase, 176
Hunter—Schreger bands, 327 Isthmus of thyroid ligament, 72
Hyaline cartilage, 105
Hydrodynamic theory, 335, 372
J
Hyoglossus muscle, 66 Jaundice, 210
Hyoid bone, 4, 15, 155
Jugular foramen, 5, 25
Hypercementosis, 347 Jugular vein, 15
Hyperthyroidism, 225, 227 Junctional epithelium, 261
Hypocalcaemia, 204 Juxtaglomerular apparatus, 217
Hypocalcified areas Juxtamedullary nephrons, 219
in dentine, 331
of enamel, 328
Hypoglossal nerve, 31 K
Hypophyseal fossa, 29 Kallikrein, 199
Hypophysis cerebri, 30 Karl Landsteiner law, 164
Hypothalamo-hypophyseal tract, 31 Karyotype, 128
Hypothalamus, 31, 251 Keratinized mucosa, 394
Hypothyroidism, 236 Keratinocytes, 359
Hypoxia, 193 Ketone bodies, 213, 285
types, 195 Ketosis, 285
Hypoxic hypoxia, 193, 194 Kiesselbach’s plexus, 86
l L
Incisive papilla, 363 Lacrimal artery, 34
Incremental lines Lacrimal gland, 14, 17
in dentine, 331 Lacrimal groove, 36
in enamel, 325 Lacrimal sac, 41
of Retzius, 325, 326 Lacunae, 105
Infantile swallowing, 440 Lamellar bone, 107
Inferior alveolar artery, 41 Lamina dura, 354
Inferior alveolar canal or mandibular Lamina propria, 395
canal, 429 Langerhans cell, 361
Inferior alveolar nerve, 12, 56, 428, 429 Larynx, 24
Infrahyoid muscles, 45 Late normoblast, 167
Infraorbital foramen, 41 Latent tetany, 204
Infratemporal fossa, 14 Lateral pterygoid muscle, 11, 54, 432
Infratrochlear nerve, 38 Lateral pterygoid plate, 61
Infundibulum, 31 Lateral rectus, 39
Innervation of tongue, 93 Lateral rectus muscle of eyeball, 96
Insulin, 235 Lateral wall
Intercalated ducts, 365, 346 of nasal cavity, 80
Interdental papilla, 358 of nasopharynx, 77
Interglobular dentine, 333 Layers of scalp, 8
Intermediate cementum, 344 LDH isoenzymes, 299
Intermediate normoblast, 167 Lecithins, 287
Internal carotid artery, 30 Lesser cornua, 6
Internal jugular vein, 19, 21 Leucocytes, 172
Interprismatic region, 320 Levator palpebrae superioris, 16
Intertubular dentine, 335 Ligaments,
Intervertebral foramen, of TMJ, 374, 435, 435
Intratonsillar cleft, 26 Line angles, 385, 403
Intrinsic factors, 181 Lingual artery, 43, 44, 45
Intrinsic muscles, 91 Lingual nerve, 12, 43, 56, 428
of larynx, 89 Lining of maxillary sinus, 376
Intrinsic pathway, 166 Lining or reflecting mucosa, 394
Investing layer, 5 Lipids, 283, 284
Iodine, 290 Lipoproteins, 277
Tron, 170 Little’s area, 86
Isoenzymes, 296 Liver, 197
Isometric contraction, 243 Long-term regulation, BP, 169
Isotonic contraction, 243 Loop of Henle, 216
Lower motor neuron, lesion, 249, 251
Lumbar puncture, 27
Lymphatic drainage
of maxillary teeth, 430
of tonsil, 79
Lymph nodes, 44
of tongue, 94
M
Major salivary glands, 368
Mamelons, 384
Mandible, 15
Mandibular canal, 41
Mandibular foramen, 12
Mandibular nerve, 10, 56
Mandibular permanent canine, 410
Mandibular permanent central incisor, 405
Mandibular permanent third molar, 426
Mantle dentine, 426
Marginal ridge, 333
Masseteric nerve, 383
Masseter muscle, 52, 431
origin and insertion, 433
Mastication, 209
Mastoid foramen, 33
Mastoid groove, 4
Maxilla, 4
and mandible, 13
Maxillary air sinus, 10, 85
Maxillary artery, 35
Maxillary central measurement
details, 402
Maxillary first premolar and maxillary
second premolar, 409
Maxillary second premolar, 412
Maxillary nerve, 9, 29
Maxillary permanent canine., 406
Maxillary permanent first molar, 417
Maxillary permanent second molar, 420
Maxillary permanent third molar, 421
Maxillary second premolar, 411
Maxillary sinus, 82, 85
Maximum ejection phase, 176
Mean pressure, 169
Meatuses, 81
Mechanical changes, 175
Mechanics of respiration, 189
Mechanism of action, 166
Mechanism of coagulation
of blood, 165
Mechanisms of tooth eruption, 371
Mechanoreceptors, 251
Meckel’s cartilage, 124
Meckel’s cave, 33
Medial pterygoid muscle, 54,
Medullary centres, 195
Melanocytes, 361
Meninges, 7
Menstrual cycle, 230
Mental foramen, 41, 429
Mesial drift, 435
Micturition reflex, 218

Middle cranial fossa, 13, 38
Middle ear, 254
Middle meatus of nose, 7, 86
Middle meningeal artery, 34
Milk, 302
Milk sugar, 271
Mitochondria, 161
MNS system, 165
Morula, 315
Movements, 206
and functions of soft palate, 77
of small intestine, 208
of vocal folds, 87
M-RNA, 278
Mucopolysaccharides, 270
Mucous acini, 367
Mucous cells, 366
Muller’s muscle, 16
Muscles
of mastication, 52, 431
of pharynx, 3
of soft palate, 75, 79
of tongue, 439
Muscular branches, 41
Musculature of tongue, 92
Mutarotation, 274
Mylohyoid muscle, 61, 65
Mylohyoid ridge, 431
Myocardial contractility
(inotropic effect), 181
Myoepithelial cells, 366
Myofibrils, 108
Myopia, 255
Myxoedema, 234
N Otic ganglion, 65
Nasal septum, 15, 84, 85, 86
Nasmyth’s membrane, 327
Nasociliary nerve, 39
Nasolacrimal apparatus, 16
Nasolacrimal duct, 16
Nasopharynx, 77
Neonatal line, 328, 333
Nephrons, 215, 219
Nerve supply,427, 430, 433
of maxillary teeth, 430
of tongue, 93
to salivary glands, 199
to tongue, 440
Nervous regulation of respiration, 191
Neural regulation, 179
Neuromuscular junction, 241
Neuromuscular transmission, 242
Neutrophils, 172
Niacin, 306
Non-competitive inhibition, 298
Non-keratinized mucosa, 394
Non-keratinocytes, 359
Normal arterial blood pressure, 182
Normal concentration,
Normal ECG, 177
Normal heart rate, 179
Normal serum calcium level, 203
Nucleosides and nucleotides, 278
oO
Oblique muscles, 39
of eyeball, 99
Oblique ridge, 383
Obstetrician’s hand, 204
Occipital artery, 22, 44
Occipital triangle, 17, 22
Occlusal curvature, 435
Occlusion, 435
Oculomotor nerve, 17
Odontoblastic zone, 341
Odontoblasts, 335
Odontoclasts, 373
Odontogenic region of pulp, 338
Oesophageal phase, 394
Oesophagus, 70
Oestrogens, 438
Oogenesis, 119
Ophthalmic artery, 26, 38
Optic canal, 36
Optic foramen, 16
Oral glucose tolerance test, 267
Oral mucosa, 394
classification, 268
Oral mucous membrane, 355
Oral phase, 396
Orbicularis oculi, 15
Orbital nerve, 85
Organ of Corti, 256
Oropharynx, 78
Osteoclasts, 348, 353
Osteodentine, 335
Ovarian hormones, 235
Overjet, 436
Oxygen dissociation curve, 194
Oxygen-haemoglobin dissociation
curve, 194
Oxygen uptake in lung, 189
Oxytalan fibres, 351
Oxytocin, 31, 225
Pp
Pacemaker, 187
Paired cartilages of larynx, 89
Palatal mucosa, 362
Palatine aponeurosis, 16
Palatine tonsil, 74, 79
Palmer system of notation, 383
Pancreatic hormones, 301
Pancreatic juice, 196, 201, 209
Pancreozymin, 210
Papillae of tongue, 360
Paranasal sinuses, 85
Paranasal sinus openings into middle
169 meatus of nose, 86
Parasympathetic nerve fibres, 200
Parasympathetic nerve (vagus), 178
Index
Parasympathetic nervous supply
by vagus, 178
Parathormone, 234, 388, 389, 438
Parathyroid hormone, 227
Parotid duct, 20, 49
opening, 51
Parotid gland, 13
Pars flaccid, 94
Passive eruption, 372
Pathological constituents of urine, 220
Pathway
of fatty acid, 282
of ketogenesis, 285
of pain, 249
of taste, 253
Pellagra, 307
Pellicle, 328
Penicillin, 25
Perikymata, 322
Perimysium, 108
Periodontal ligament, 352
Periodontium, 351
Peripheral vascular resistance, 184
Peristalsis, 208
Permanent mandibular first second
bicuspid, 414
Permanent mandibular first molars, 423
Permanent mandibular lateral incisor, 401
Permanent mandibular second molar, 423
Permanent maxillary lateral incisors, 398
Permanent maxillary second molar, 419
Permanent second premolar, 415
Pernicious anaemia, 174
Petrous temporal bone, 32
Pharyngeal phase, 393
of deglutition, 209
Pharyngobasilar fascia, 5
Pharyngotympanic tube, 81
Phases of gastric secretion, 198
Phenylalanine pathway, 278
Phenylketonuria, 287
pH of the blood, 293
Phosphate metabolism, 388
Phospholipids, 283
Physiological dead space, 193
Physiological variations
of heart rate, 178, 182
Physiologic mesial migration, 435
Physiology of clotting, 173
Pia, 27
Pits, 384
Pituicytes, 31
Pituitary fossa, 29
Pituitary gland, 29
Plasma, 162
Plasma calciums, 172, 287
Plasma proteins, 162, 171
methods of isolation of, 172
Platelets, 175
Platysma, 15, 20
Plica fimbriata, 90
Plica triangularis, 75
 Index
Pluripotent cell, 167
Pneumotaxic centre, 196
Point angles, 385, 402
Posterior auricular nerve, 49
Posterior auricular vein, 24
Posterior cranial fossa, 24
Posterior cricoarytenoid muscle, 46
Posterior ethmoidal nerve, 39
Posterior one-third of tongue, 91
Posterior pillar of fauces, 76
Posterior pituitary gland, 224,
Posterior pituitary hormones, 236
Posterior superior alveolar
nerve, 232
Posterior triangle, 18
of neck, 17
Postganglionic fibres, 38
Postprandial state, 221
Potassium balance, 290
Predentine, 329
Pre-eruptive phase, 370
Pregnancy tests, 237
Presbyopia, 256
Pressure changes during
breathing, 190
Pressure gradient, 191
Pretracheal fascia, 23
Pretracheal layer, 5
Prevertebral layer, 5
Primary cementum, 347
Primary tastes, 253, 256
Process of clotting, 165
Process of deglutition, 209
Proenzymes, 299
Proerythroblast, 167
Progenitor cells, 348
Protective functions of saliva, 369
Protein—calorie malnutrition, 279
Protein—energy malnutrition, 279
Proteins, 213
primary structures, 274
Proteolytic enzymes of pancreas, 196
Protodiastole, 176
Protraction, 57
Proximal convoluted tubule, 220
Pterion, 6
Pterygoid, 41
plexus, 29
of veins, 60
Pterygomandibular raphe, 7, 61
Pterygomaxillary fissure, 41
Pterygopalatine fossa, 8, 40
Pterygopalatine ganglion, 58
Ptosis, 17
Pulp, 336, 340
calcifications, 338
Pulp stones, 338
Pulsating exophthalmos, 29
Pulse pressure, 169, 183
Purpura, 174
Pyramidal tract, 245
Pyridoxine, 306
R Sclera, 36
Radicular artery, 102 Sclerotic dentine, 334
Ramus Scurvy, 439
of mandible, 6, 428, 430 Secondary cuticle, 327
Rathke’s pouch, 30 Secondary dentine, 330
Recurrent laryngeal nerve, 74 Secondary structure of protein, 274
Reduced ejection phase, 176 Second cervical vertebra, 275
Referred pain, 251 Second rapid-filling phase, 176
Reflex action, 251 Sella turcica, 29
Reflex arc, 243, 250 Sensation of smell, 256
Refractory error of eye, 255 Sepsis, 29
Regulation Septum or Little’s area, 84
of blood pressure, 168, 183 Sequence of eruption of
of erythropoiesis, 168 deciduous teeth, 390
of heart rate, 178 permanent teeth, 391
of pancreatic secretion, 202 Serous acini, 367
of salivary secretion, 199 Serous and mucous acini, 364
Relations of hyoglossus muscle, 94 Serous cells, 366, 111
Renal threshold for glucose, 269 Serum alkaline phosphatase, 301
Renal tubular function, 219 Serum calcium level, 287
Respiratory centres, 195 Sex hormones, 168
Respiratory reflexes, 192 Sharpey’s fibres, 345
Resting and reversal lines, 358 Shedding of deciduous teeth, 372, 373
Rests of Malassez, 350 Short ciliary nerve, 97
Reticulocyte, 168 Short-term regulation, BP, 169
Retraction, 58 Sickle cell anaemia, 170
Retromandibular vein, 23 Significance of P-R interval, 177
Rh factor, 172 Simple epithelium, 161
Rh group system, 164 Sinoaortic node, 188
Rh incompatibility, 171 Skeletal muscle, 107
Rh +ve blood, 166 Skull, 28
Ridges, 382, 385 Slow filling phase, 176
Rima glottidis, 86 Small intestine, movements, 205
Rod ends, 325 Soft palate, 75, 77
Rods and cones, 255 Specialized mucosa, 394
Rod sheath, 320 of oral cavity, 355
Role of nerves, 178 Spermatogenesis, 239
Role of sinoaortic mechanism of Sphenoidal air sinus, 84
regulation of blood pressure, 182 Sphenoid bone, 16, 28
Rugae, 363 Sphenomandibular ligament, 11
Sphenopalatine ganglion, 85
Spinal accessory nerve, 19, 22
Ss Spinal cord, 17
Safe period, 239 hemisection, 245
Saliva, 208 Spinal dura mater, 27
composition and function, 199 Spinal subarachnoid space, 27
Salivary enzymes, 368 Spine of sphenoid, 14
Salivary gland Spongy bone, 354
basic structure, 365 Spread
classification, 369 of cardiac impulse, 187
major, 368 Stages
minor, 368 in soft tissue processing, 378
Salivary lipase, 368 of coagulation, 165
Salivary secretion, 209 of deglutition, 393
Salpingopharyngeal fold, 78 of erythropoiesis, 167
Saltatory conduction, 243 of tissue processing, 376
Sarcomere, 108, Stagnant hypoxia, 193
Sarcoplasm, 242 Stenson’s duct, 369
Scalene muscles, 108 Sternocleidomastoid muscle, 17, 19
Scalenus anterior muscle, 69 Stratified epithelium, 162
Scalp, 13 Stratified squamous epithelium, 394
Scapula, 18 Stratum basale, 362
 Index

Stratum granulosum, 363 Testosterone, 237 Urea synthesized, 279

Striated ducts, 365 Tetany, 204, 227 Urinary bladder, 214
Striated muscle, 107 Theories of eruption, 370, 391 Urine, 300
Stroke volume, 181 Thiamine, 308 pathological constituents, 220
Structural details of pulp, 336 Thrombosis, 29 Uses of blood grouping, 164
Structural lines in dentine, 334 Thromboxane, 301 Uvula, 75
Structure Thyrocervical trunk, 18
of alveolar bone, 352 Thyroglossal duct, 71
V
of dentine, 329 Thyrohyoid membrane, 88
Vagus nerve, 19, 35, 42
of haemoglobin, 170 Thyroid cartilage, 88
Various waves in ECG, 177
of tooth, 128 Thyroid function tests, 239
Vasopressin, 31
Stylohyoid branch, 49 Thyroid gland, 44, 66
Venous return, 180, 182, 188
Stylohyoid ligament, 50 Thyroid hormones, 168, 225, 233
Ventricular cycle, 175
Styloid apparatus, 59 Thyroxin, 232, 438
Ventricular diastole, 175
Styloid process, 27, 73 Tomes granular layer, 328
Ventricular filling, 176
of temporal bone, 70 Tomes process, 328
Ventricular systole, 175
Stylomandibular ligament, 61 Tongue, 90, 92
subphases, 176
Stylomastoid foramen, 48 development, 314
Vermillion border, 361
Subarachnoid space, 28 Tooth eruption, 369
Vertebral artery, 26
Subclavian artery, 18 Tooth numbering system, 381, 383
Vertex, 13
Subclavian triangle, 18, 22 Torticollis, 19
Vestibular fold, 86
Submandibular duct (Wharton’s Trace elements, 290
Vibrissae, 80
duct), 63, 66 Transamination,
Viscosity of blood, 184
Submandibular ganglion, 64 reaction, 280, 299
Visual cycle, 306
Submandibular gland, 15 Transduction theory, 332
Visual pathway, 252
Submandibular salivary gland, 44, 45 Transitional epithelium, 162
Vital capacity, 194
Suboccipital muscles, 25 Transport
Vitamin A, 305, 436
Suboccipital triangle, 25 of carbon dioxide, 191
Vitamin B,,, 308
Subodontoblastic plexus of of oxygen, 191
Vitamin C, 212
Raschkow, 341 of oxygen in blood, 189
Vitamin C (ascorbic acid), 305
Substrate-level phosphorylation, 263 ‘Transverse cervical artery, 18
Vitamin D, 211, 213, 304, 307,
Superior constrictor of pharynx, 79 Trapezius, 17
389, 437
Superior nuchal line, 20 Trigeminal ganglion, 29, 31
Vitamin D deficiency, 389
Superior orbital fissure, 6 ‘Trigeminal nerve, 9
Vitamin E, 437
Superior sagittal sinus, 34 Triglycerols, 285
Vitamin K, 214, 307, 437
Superolateral surface of cerebrum, 99 Trousseau’s sign, 204
Vitamins, 302
Supraclavicular space, 20, 22 True pulp stones, 339
Vocal cords, 46, 86
Suprascapular artery, 18 ‘Trypsinogen, 197
Vocal fold, 86
Suprascapular nerve, 18 Tuberosity, 429
Volkmann’s canals, 355
Suprasternal space, 20, 22 Turner syndrome, 128
von Ebner’s gland, 369
Surfactant, 194 Tympanic membrane, 14, 95
Suspensory ligament Tympanic reflex, 254
of eye, 97 Types Ww
of Lockwood, 97 of acidophil cells, 114 Waldeyer’s ring, 79
Sympathetic nerves, 178, 200 of basophil cells, 114 WBC classification, 163
Synthesis of vitamin D5, 389 of cementum, 346 Wharton’s duct, 63, 368
Synthetic cells of PDL, 352 of dead space, 192 White fibrocartilage, 105
Systolic pressure, BP, 169 of dentine, 330 Woven bone, 107
of gingiva, 362
T of nerve fibres, 240
of NM junctions, 241 X
Taste buds, 356, 361 of RNA, 278
Xylene, 378
‘Taste pathway, 253, 256 Tyrosine, 442
Temporal fascia, 53
Y
Temporalis muscle, 53, 431
Yellow fibrocartilage, 106
Temporomandibular joint, 56, 433 U
movements, 60 Unconditioned reflex, 209
Tendinous ring, 36 Undifferentiated mesenchymal cells Z
Tensor palatine muscle, 78 of pulp, 340 Zones of pulp, 340
Tentorium cerebelli, 31, 33 Unipotent cell, 167 Zsigmondy/Palmer system, 381
Tertiary dentine, 335 Universal system, 381 Zwitter ions, 277
Test for decalcification, 378 Urea cycle, 271 Zygomatic arch, 5, 16
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