SEMESTER IV VIVA EXAM PAPER (

REGARDS : ABDUL RAUF)

GIT BIOCHEMISTRY
Q#1: What is the Activators of Glycogen Synthase?

Ans: Glycogen synthase is allosterically activated by Glucose 6-phosphate

Q#2: What are the Activators of Glycogen Phosphorylase in Muscle?

Ans: The binding of epinephrine to its plasma G-protein coupled receptors results in activation of
adenylate Cyclase which form cAMP. Then, cAMP converts the phosphorylase kinase into its active
form. The active form of phosphorylase kinase phosphorylates the Glycogen phosphorylase into its
active form.

Q#3: Name the enzymes which require Thymine?

Ans: The enzymes which requires Thiamine as coenzyme are transketolase, pyruvate
dehydrogenase and α-ketoglutarate dehydrogenase

Q#4: Name the Rate limiting enzyme of Cholesterol Synthesis?

Ans: The rate limiting enzyme of cholesterol synthesis is HMG CoA reductase which catalyze the
conversion of HMG CoA into mevalonate.

Q#5: What are the Functions of Cholesterol?

Ans: Cholesterol performs the following functions:

1. It is the precursor of all the steroid hormones

2. It is the precursor of bile salt
3. It is the precursor of vitamin D
4. It is the main constituent of plasma membrane

Q#6: Name the Organs of body where cholesterol synthesis occur?

Ans: Cholesterol is synthesize mainly in liver, adrenal cortex , intestine and reproductive tissues
which includes ovaries, testes and placenta.

Q#7: Glycogen stores last for about how many hours?

Ans: Glycogen stores last for almost 6 to 8 hours in starvation state.

Q#8: Which organ plays a role in Glucose maintenance?

Ans: Liver plays a major role in glucose maintenance by maintaining a balance between the uptake
and storage of glucose via glycogenolysis and gluconeogenesis.

Q#9: Name the enzyme deficient in Niemenn pick disease?

Ans: Niemann-Pick disease is due to the deficiency of sphingomyelinase enzyme.

Q#10: Name the Enzyme deficient in acute intermittent porphyria?

Ans: Acute intermittent porphyria is due to the deficiency of Porphobilinogen deaminase which
result in the accumulation of ALA and porphobilinogen in urine.

Q#11: Name the Active form of vitamin b1.

Ans: Thiamine pyrophosphate is the active form of vitamin b1.

Q#12: Thiamine is a co-enzyme for which enzymes?

Ans: Thiamine act as coenzyme for transketolase, pyruvate dehydrogenase and α-ketoglutarate
dehydrogenase.

Q13: Comment about the role of carbohydrate in starvation?

Ans: The liver first uses glycogen degradation and then gluconeogenesis to maintain blood glucose
levels to sustain energy metabolism of the brain and other glucose-requiring tissues in the fasted (
postabsorptive) state. During fasting state , liver maintain blood glucose level as follows:

INCREASED GLYCOGEN DEGRADATION: During starvation state, blood glucose levels have
declined sufficiently to cause increased secretion of glucagon and decreased release of insulin. The
increased glucagon to insulin ratio causes a rapid mobilization of liver glycogen stores due to
phosphorylation (activation) of glycogen phosphorylase. This ultimately helps in maintaining blood
glucose level.

INCREASED GLUCONEOGENESIS : When the glycogen stores deplete, the liver use the non-
carbohydrate source for the synthesis of glucose by thee process of gluconeogenesis.

Q#14: Name the Enzyme deficiency in infant with jaundice, cataracts and hepatomegaly?

Ans: Galactose-1-phosphate uridylyltransferase deficiency causes Classic galactosemia which is

manifested by jaundice, hepatomegaly, and cataracts.

Q#15: Name the Activator of acetyl CoA carboxylase?

Ans: Citrate acts as an activator for acetyl CoA activator.

Q#16: Name the rate limiting enzyme of gluconeogenesis.

Ans: Fructose-1,6-bisphosphate is the rate limiting enzyme of gluconeogenesis.

Q#18: Name the Rate limiting step of glycogenesis.

Ans: Glycogen synthase is the rate limiting enzyme of glycogenesis.

Q#19: What is the normal value of Conjugated bilirubin?

Ans: The normal value of conjugated bilirubin is < 0.3mg/dl.

Q#20: Give the Irreversible steps of gluconeogenesis?

Ans: The irreversible steps of Gluconeogenesis are as follows:

1. Conversion of pyruvate into Phosphoenol pyruvate.

2. Dephosphorylation of Fructose-1,6-bisphosphate into fructose-6-phosphate.
3. Dephosphorylation of glucose-6-phosphate into glucose.

Q#21: Give the rate limiting step of Fatty acid synthesis?

Ans: The carboxylation of acetyl CoA to malonyl CoA is the rate limiting step of fatty acid synthesis
which is catalyze by acetyl CoA carboxylase.

Q#22: Give the rate limiting step of cholesterol synthesis?

Ans: The reduction of HMG CoA into mevalonate is the rate limiting step of cholesterol synthesis
which is catalyze by HMG CoA reductase.

Q#22: Name the enzyme deficient in Cori disease?

Ans: Cori disease is due to the deficiency of amylo-1,6-glucosidase.

Q#23: Name the Rate limiting steps of gluconeogenesis, glycogen synthesis, cholesterol synthesis.

Ans: GUCONEOGENESIS: The conversion of fructose -1,6-bisphosphate into fructose -6 –phosphate

with the help of an fructose-1,6-bisphosphatase.

GLYCOGEN SYNTHESIS: The transfer of glucose from UDP-glucose into amylose chain with the help
of an enzyme glycogen synthase.

CHOLESTEROL SYNTHESIS:

The reduction of HMG CoA into mevalonate is the rate limiting step of cholesterol synthesis which is
catalyze by HMG CoA reductase

Q#24: What hormones inhibit gluconeogenesis?

Ans: Insulin is a hormone that inhibits gluconeogenesis

Q#25: Give the function of apo cII, good cholesterol?

Ans: Apolipoprotein C-II activates the lipoprotein lipase which causes hydrolysis of TAG into fatty
acids and glycerol.

Q#26: Name the activator of Pyruvate Carboxylase.

Ans: Acetyl CoA is the activator of Pyruvate Carboxylase.

Q#27: Name the Inhibitor of glycogen phosphorylase.

Ans: ATP and glucose-6-phosphate inhibit the glycogen phosphorylase.

Q#28: What are the importance of NADP and NAD?

Ans: NAD is a co-enzyme which acts as reducing agent in glycolysis, Kreb’s cycle and fatty acid
synthesis.

While NADP is a co-enzyme which act as a reducing agent in HMP shunt pathway, cholesterol
synthesis and fatty acid chain elongation.

GIT ANATOMY:
Q#1: Name the tributaries of Inferior vena cava.

Ans: The tributaries of inferior vena cava include:

1. Common iliac vein.

2. Lumbar vein
3. Median sacral vein
4. Renal vein
5. Right gonadal vein
6. Right supra renal vein
7. Hepatic vein
8. Inferior phrenic vein

Q#2: Give the Anatomical division of liver?

Ans: Anatomically the liver is divided into four lobes, which are:

1. Right lobe
2. Left lobe
3. Caudate lobe
4. Quadrate lobe

Q#4: Name the most vulnerable organ of GIT.

Ans: Liver is the vulnerable to a wide variety of metabolic, toxic, microbial, circulatory and
neoplastic insults.
Q#5: Give the relations of Spleen.

Ans: The relations of the spleen are:

• Anteriorly: the stomach

• Posteriorly: the left part of the diaphragm, which separates it from the pleura, lung, and ribs 9–11

• Inferiorly: the left colic flexure

• Medially: the left kidney.

Q#6: Name the Congenital Anomalies of Gut.

Ans: Some of the congenital anomalies of GIT are:

1. Cleft palate and lip

2. Esophageal atresia
3. Esophageal stenosis
4. Pyloric stenosis
5. Volvulus
6. Duodenal stenosis
7. Annular pancreas
8. Pancreatic divisum
9. Meconium ileus
10. Meckel diverticulum
11. Imperforate anus

Q#7: Name the Anterior branches of Abdominal Aorta.

Ans: The names of the anterior branches of aorta are:

1. Celiac trunk
2. Superior mesenteric artery
3. Inferior mesenteric artery.

Q#8: Name the Lateral branches of Aorta.

Ans: The names of lateral branches of aorta are:

1. Suprarenal artery
2. Renal artery
3. Gonadal artery

Q#9: Gonadal arteries arise at which level?

Ans: Gonadal arteries arise from the abdominal aorta at the level of L2 vertebra.
Q#10: What is Meckel Diverticulum?

Ans: Meckel diverticulum is a congenital finger like remnant of vitelline duct.

Q#11: Give some histological features of small intestine.

Ans: Histologically, the small intestine has four layers. From internal to external, they are mucosa,
submucosa, muscularis externa, and serosa. There are several unique features in the small intestine
, which are:

 Circular folds (valves of Kerckring, plicae circulares) are the transverse folds of mucosa
found predominantly in the distal duodenum and proximal jejunum
 Intestinal villi are fingerlike extensions of intestinal mucosa which project into the lumen
of the small intestine. Between the villi are intestinal glands (crypts of Lieberkuhn) which
secrete intestinal juice rich in digestive enzymes.
 Microvilli are projections found on the apical surface of each intestinal cell (enterocyte)

There are also features of the small intestine which are segment-specific:

 Peyer's patches are part of gastrointestinal associated lymphoid tissue (GALT). They are
found in ileum.
 Brunner glands are found in the submucosa of the duodenum.

Q#12: Para aortic lymph nodes drain into?

Ans: The right paraaortic nodes, along with the left paracaval nodes, form the right lumbar chain of
nodes, which may be found around the IVC. The left paraaortic lymph nodes communicate with the
common iliac nodes and drain into the thoracic duct.

Q#13: Name the branches of celiac trunk.

Ans: The branches of Celiac trunk includes:

1. Left gastric artery.

2. Splenic artery
3. Common hepatic arteries.

Q#14: Name the Ligaments of spleen.

Ans: The ligaments of spleen include:

1. Gastrosplenic ligament
2. Pancreaticosplenic ligament
3. Splenophrenic ligament
4. Splenocolic ligament
5. Splenorenal ligament
Q#15: Name the Foregut derivatives.

Ans: The derivatives of foregut are:

1. Primordial pharynx and its derivatives

2. The lower respiratory system
3. The esophagus and stomach
4. The duodenum, distal to the opening of bile duct
5. The liver, biliary apparatus (hepatic duct, gallbladder and bile duct) and pancreas.

Q#16: Name the embryological origin of liver.

Ans: The liver primordium appears as an outgrowth of endodermal epithelium at the distal end of
the foregut during 3rd week.

Q#17: What do you know about the function of spleen before and after birth, its nerve supply and
lymphatic drainage?

Ans: Function of spleen before birth:

Before birth the spleen perform the function of hemopoiesis.

Function of Spleen after birth :

After birth spleen perform the following functions:

 Act as reservoir of blood at time of shock or hemorrhage.

 Spleen is the main organ for destruction of old and abnormal RBCs.
 Produces lymphocytes that aid in our immune system
 Recycling of iron.

Innervation of spleen:

The nerve supply of spleen is from the Celiac plexus.

Lymphatic drainage of spleen:

The lymphatic vessels of spleen drains into Pancreaticosplenic lymph node and which ultimately
drain into celiac lymph node.

Q#17: What do you know about Hartmann’s pouch? It's importance .

Ans: Hartmann’s pouch is an abnormal sacculation at the junction of gallbladder and cystic duct. It
is clinically important because gallstone commonly collect in this pouch.

If a peptic duodenal ulcer ruptures, a false passage may form between the pouch and the superior
part of the duodenum, allowing gallstones to enter the duodenum.

Q#18: Name the components of pancreatic juice.

Ans: The pancreatic juice consists of 99.5% water and 0.5% solid components which include
organic and inorganic substances.

The inorganic components of pancreatic juice include sodium bicarbonate(110 to 150 mEq/L), Na
, Ca, Mg, Cl , phosphate and sulfate

The organic substances include Proteolytic enzyme , lipolytic enzyme and Amylolytic enzymes.

The proteolytic enzymes include trypsin, chymotrypsin , carboxypeptidases, nucleases, elastase

and collagenase

The lipolytic enzymes include pancreatic lipase, cholesterol ester hydrolase, phospholipase A,
phospholipase B , Colipase and bile salt activated salt.

The amylolytic enzyme includes amylase enzyme.

Q#19: Name the contents of deep perineal pouch

Ans: The contents of deep perineal pouch in male are:

1. The membranous part of urethra

2. The external sphincter urethra muscle
3. Bulbourethral gland
4. Deep transversus perineal muscle
5. The internal pudendal vessel and their branches
6. The dorsal nerves of penis

The contents of deep perineal pouch in female include:

1. The proximal part of urethra

2. The external sphincter urethra muscle
3. Deep transversus perineal muscle
4. Deep artery of clitoris
5. Dorsal artery of clitoris
6. Artery to bulb of vestibule
7. Urethral artery
8. Dorsal nerve of clitoris

GIT PATHOLOGY:
Q#1: Define Acute Gastritis and its causes.

Ans: An acute mucosal inflammation of the stomach with neutrophilic infiltration, that is usually
transient.

CAUSES:
 1. Heavy use of NSAIDS(especially aspirin).
2. Heavy smoking.
3. Sever stress e.g. trauma , burn, surgery.
4. Ischemia
5. Systemic infection
6. Idiopathic.

Q#2: What is the difference between Crohn's Disease and Ulcerative Colitis?

Ans:

ULCERATIVE COLITIS CROHN’S DISEASE

Ulcerative colitis begins in the rectum and can
extends up proximally up to the cecum while
remainder of the GI tract remain unaffected
Ulcerative colitis involves the mucosal and
submucosal layer.
The symptoms include left lower quadrant pain
with bloody diarrhea.
The gross feature include appearance of
pseudopolyps and loss of haustra
Crohn’s disease can occur anywhere from mouth
to anus while terminal ileum is the most
common site and rectum is the least common
site
Crohn’s disease involve all the layers of
intestinal wall.
The symptom include right lower quadrant pain
with non-bloody diarrhea .
Gross feature include Cobblestone mucosa,
creeping fat and strictures.

Q#3: Give the Histological manifestation of Crohn's Disease?

Q#4: What are the symptoms of blockage of hepatic Vein?

Ans: The symptoms of blockage of hepatic vein are:

Nausea, Vomitinng, weight loss, hematemesis, abdominal pain, lower limb swelling.

Q#5: What are the symptoms and causes of Portal Hypertension?

Ans: SYPTOMS OF PORTAL HYPERTENSION:

1. Ascites.
2. The formation of portosystemic venous shunt
3. Congestive splenomegaly
4. Hepatic encephalopathy.

CAUSES OF PORTAL HYPERTENSION:

PRE HEPATIC CAUSES:

1. Portal vein thrombosis.

2. Congenital atresia or stenosis of portal vein.
 3. Hepatic artery occlusion
4. Extrinsic compression (tumor).

HEPATIC CAUSES:

1. Cirrhosis.
2. Nodular regenerative hyperplasia.
3. Massive fatty change
4. Amyloidosis.

POST HEPATIC CAUSES:

1. Right sided heart failure.

2. Thrombosis of inferior vena cava.
3. Budd-Chiari syndrome
4. Arterial-portal venous fistula.

Q#6: Ground glass appearance and its cause?

Ans: Ground glass hepatocytes are liver cells which have eosinophilic granular, glassy cytoplasm
and is mostly associated with hepatitis B infection.

Q#7: Define Pancreatitis and its Lab Findings?

Ans: Pancreatitis is define as the inflammation of pancreas initiated by injuries that lead to
autodigestion of the pancreas by its own enzymes.

Laboratory findings include marked elevation of serum amylase level during the first 24 hours,
followed by a rising serum lipase level by 72 to 96 hours after the beginning of the attack.
Glycosuria occurs in 10% of cases. Hypocalcemia may result from precipitation of calcium soap in
necrotic fat.

Q#8: What is the most common cause of Chronic Gastritis?

Ans: The most common cause of chronic gastritis is the infection with bacillus H.pylori.

Q#9: What is the most common area of Peptic Ulcer?

Ans; Peptic ulcer most commonly occur in the proximal duodenum. Gastric peptic ulcers are
predominantly located along the lesser curvature near the interface of the body and antrum.

Q#10: Name the drug causing gastritis.

Ans: The NSAIDs (like aspirin) can cause gastritis . Other NSAIDS includes ibuprofen and naproxen
can also cause gastritis.

Q#11: What are the manifestations of Crohn’s disease outside intestine?

Ans: The extra intestinal manifestation of Crohn’s disease include Uveitis, migratory polyarthritis,
sacroiliitis, ankylosing spondylitis, erythema nodosum and clubbing of the fingertips.

Q#12: What are the complications of acute pancreatitis?

Ans: Complications of acute chronic gastritis includes:

1. Shock
2. Pancreatic pseudocyst.
3. Pancreatic abscess
4. Disseminated intravascular coagulation
5. Acute respiratory distress syndrome.

Q#14: Lab investigations in acute pancreatitis?

Ans: Laboratory findings include marked elevation of serum amylase level during the first 24 hours,
followed by a rising serum lipase level by 72 to 96 hours after the beginning of the attack.

Q#15: Name the most common benign tumor of parotid gland?

Ans: Pleomorphic adenoma.

Q#16: Define Sialadenitis.

Ans Sialadenitis refers to the inflammation of salivary glands.

Q#17: Name the most common cause of cirrhosis.

Ans: The most common cause of Cirrhosis is hepatitis and alcoholic abuse.

Q#18: Treatment of acute pancreatitis.

Ans: The key management of acute pancreatitis is “resting” the pancreas by total restriction of oral
intake (the patient will stop eating for couple of days in hospital) and supportive therapy with
intravenous fluid and analgesia.

Q#19: Which inflammatory bowel disease has granulomas?

Ans: Crohn’s disease.

GIT PHYSIOLOGY:
Q#1: Name the Salivary glands with their secretions.

Ans:

Name of Salivary gland Type of Secretion

Parotid gland Pure Serous
Sub mandibular gland Mixed seromucous (predominantly serous)
Sub lingual gland Mixed seromucous ( predominantly mucous)

Q#2: What are the functions of Saliva?

Ans: The functions of saliva are as follows:

1. Lubrication.
2. Digestion. ( Salivary amylase, lingual lipase).
3. Remineralization of teeth
4. Mucosal protection
5. pH maintenance.( buffering effect)
6. Anti-microbial action.
7. Taste mediation
8. Phonation

Q#3: What are the functions of Mucous in Saliva?

Ans, The mucous in saliva binds the masticated food into slippery bolus that slides easily through
esophagus and provide protection against solid food particles.

Q#4: What do you know about Enteric Nervous system?

Ans: The enteric nervous system is the autonomic plexus in the wall of intestine which contain 100
million neurons ( as many as the entire spinal cord). ENS composes of 2 plexuses:

1.Submucosal nerve plexus also known as Meissner plexus( located in submucosa )

2. Myenteric nerve plexus also known as Auerbach's plexus ( located b/w the circular and
longitudinal smooth muscle layers in muscularis externa.

Q#5: Name the cells that activate Enteric Nervous System.

Q#6: What are the Features of Enteric Nervous System?

Ans: Features of ENS are as follows:

1.ENS consist of as many neurons as spinal cord ( 100 million neurons)

2.Located close to the effector system ( such as musculature , glands, blood vessels ).

3.ENS compose of submucosal and myenteric plexus.

Q#7: Where do myenteric plexus lies?

ANS: Myenteric plexus is located b/w the circular and longitudinal muscle layers of muscularis
externa.
Q#8: What are the Phases of Gastric Secretion?

Ans: There are 3 phases of gastric acid secretion :

1.Cephalic phase: This phase is stimulated by the sight, smell or taste of food which activates the

Parasympathetic nervous system and result in salivary secretion and gastric secretion .This phase
is responsible for 30% of HCL secretion.

2.Gastric Phase: This phase is stimulated by the presence of food in the stomach which activate the

parasympathetic nervous system and secretion of gastrin result in increase gastric motility and

gastric juice secretion .

3.Intestinal Phase :This phase is stimulated by the arrival of nutrients in duodenum which
promote the secretion of CCK and secretin and inhibit gastric motility and gastric secretion

Q#9: What are the functions of Cholecystokinin?

Ans: Cholecystokinin increases the pancreatic secretion , stimulate contraction of gallbladder and
relaxation of sphincter of Oddi, stimulate growth of exocrine pancreas and gallbladder and inhibits
the gastric emptying.

The Cholecystokinin is secreted by I cells of duodenum and jejunum in response to presence of fatty
acid , small peptide and proteins in the duodenum.

Q#10: Name the Pancreatic secretions (both exocrine and endocrine).

Ans: EXOCRINE SECRETION:

The pancreatic juice consists of 99.5% water and 0.5% solid components which include organic and
inorganic substances.

The inorganic components of pancreatic juice include sodium bicarbonate(110 to 150 mEq/L), Na
, Ca, Mg, Cl , phosphate and sulfate

The organic substances include Proteolytic enzyme , lipolytic enzyme and Amylolytic enzymes.

The proteolytic enzymes include trypsin, chymotrypsin , carboxypeptidases, nucleases, elastase and
collagenase

The lipolytic enzymes include pancreatic lipase, cholesterol ester hydrolase, phospholipase A,
phospholipase B , Colipase and bile salt activated salt.

The amylolytic enzyme includes amylase enzyme.

ENDOCRINE SECRETION:
Name of cells Secretion
Alpha cells Glucagon
Beta cells Insulin
Delta cells Somatostatin
PP cells Pancreatic polypeptide

Q#11: What is the daily amount of salivary secretion?

Ans: The amount of daily secretion of saliva ranges between 0.8ml to 1.5 ml while average is 1L.

Q#12: What do you know about brunner’s glands?

Ans: The brunner’s glands are compound tubular submucosal glands found in the submucosa of
proximal duodenum and secrete urogastrone (human epidermal growth factor) as well as an
alkaline mucoid substance that neutralizes the juice.

Q#13: What is the composition of bile?

Ans:

Q#14: What is the function of bile?

Ans: FUNCTIONS OF BILE:

1. DIGESTIVE FUNCTION: The bile salt present in bile causes emulsification of fat and promotes
the digestion of fat by lipolytic enzymes.

2. ABSORPTIVE FUNCTIONS: The bile salt present in bile helps in the absorption of fat from
intestinal lumen into the blood.
 3. EXCRETORY FUNCTIONS:

4. LAXATIVE ACTION: Bile salt present in bile act as laxative by stimulating the peristaltic
movement of intestine.

(Note:laxative is an agent which promotes defecation)

5. ANTISEPTIC ACTION:

7. MAINTENANCE OF pH IN GASTROINTESTINAL TRACT:

8. PREVENTION OF GALLSTONE FORMATION: Bile salt present in bile prevents the

precipitation of cholesterol and lecithin.

9. LUBRICATION FUNCTION:

Q#16: Describe the Sympathetic and parasympathetic effect on salivary gland?

Ans: Sympathetic stimulation decreases the saliva secretion while parasympathetic stimulation
increases the saliva secretion.

Q#17: What is the Gastrin function?

Ans: The gastrin is secreted by G cells of stomach in response to the presence of small peptide and
amino acid in the stomach, distention of stomach and vagal stimulation. It perform the function to
stimulate the gastric acid secretion and stimulate the growth of gastric mucosa.

Q#18: What do you know about cholagogue ?

Ans: Cholagogue is an agent that promote the flow of bilebinnto the intestine, especially as a result
off contraction of the gallbladder.

Q#19: What do you know about hepato creatine and its function?

RENAL PHYSIOLOGY:
Q#1: What is the value of GFR per min and per day?

Ans: The normal GFR is 125ml/min or 7500ml/hr or 180ml/day.

Q#2: What is the amount of Urine produce per day?

Ans: The average urine produce in adult is 1-2L per day.

Q#3: Which segment of nephron is called diluting segment?

Ans: The ascending limb is also called the diluting segment of the nephron.

Q#4: Give the functions of Kidney.

Ans: Kidney performs the following functions:

1. Excretion of waste material

2. Electrolyte balance
3. Maintain the appropriate acid-base balance of plasma
4. Regulation of erythropoiesis by formation of erythropoietin .
5. Regulation of blood pressure
6. Vitamin D metabolism.

Q#5: Describe the Role of Renin in hypertension.

Ans: When blood volume or sodium levels in the body are low, juxtamedullary cells in the kidney
release renin.

The renin acts on angiotensinogen to form angiotensin I.

Then the ACE converts the angiotensin I into angiotensin II

The angiotensin II causes constriction of blood vessels (causes increase in blood pressure), acts on
the zona glomerulosa of adrenal cortex to release aldosterone (promotes sodium reabsorption and
water retention), acts on pituitary gland to secrete ADH (promote water reabsorption).

Q#6: What is the location for absorption of Glucose in kidney?

Ans: The reabsorption of filtered glucose occurs in proximal convoluted tubule.

Q#7:What do you mean by facultative reabsorption of water?

Ans: Facultative reabsorption refers to the reabsorption of water in collecting duct under the
influence of ADH through aquaporin 2. It amounts for 10% percent of water reabsorbed.

Q#9: Describe the Renin angiotensin system.

Ans: When blood volume or sodium levels in the body are low, juxtamedullary cells in the kidney
release renin.

The renin acts on angiotensinogen to form angiotensin I.

Then the ACE converts the angiotensin I into angiotensin II

The angiotensin II causes constriction of blood vessels (causes increase in blood pressure), acts on
the zona glomerulosa of adrenal cortex to release aldosterone (promotes sodium reabsorption and
water retention), acts on pituitary gland to secrete ADH (promote water reabsorption).

Q#10: Name the Hormones that increase and decrease urine output.

Ans: There are 3 hormones that regulate the volume of urine.

1. Antidiuretic hormone: secreted by posterior pituitary gland

 2. Aldosterone: secreted by adrenal cortex.
3. Atrial natriuretic peptide: produced by heart.

Q#11: What affects glomerular filtration?

Ans: The factors which determine the glomerular hydrostatic pressure are:

1. Glomerular hydrostatic pressure, which promote the filtration.

2. Hydrostatic pressure in Bowman’s capsule, which opposes the filtration.

3. The colloid osmotic pressure in glomerular capillaries, which opposes the filtration.

4. The colloid osmotic pressure in Bowman’s capsule, which promote the filtration (but its
magnitude is zero under normal condition).

Q#12: What do you know about Bartter syndrome?

Ans: Bartter syndrome is an autosomal recessive disorder characterized by hypokalemic metabolic

alkalosis with hypercalciura and salt wasting.

Q#13: What is metabolic acidosis and mention its causes.

Ans: The decreased in blood pH less than 7.5 due to accumulation of acid in blood or loss of
bicarbonate from blood.

Causes:

Diarrhea, Diabetic Ketoacidosis, acid ingestion,

Q#14: What is the functional unit of kidney?

Ans: Nephron is the functional unit of kidney.

Q#15: Name the parts of nephron.

Ans: The nephron consists of:

1. Bowman’s corpuscle (Bowman’s capsule and glomerulus)

2. Proximal convoluted tubule.

3. Loop of Henle.

4. Distal convoluted tubule.

(Note: Collecting duct is not the part of nephron)

Q#16: Which substance doesn't have transport maximum?

Ans: The substances that are passively reabsorb do not have transport maximum.

RENAL ANATOMY
Q#1: What do you mean by Atonic Bladder?

Ans: Atonic bladder is the diseased condition which occurs due to the loss of sensory innervation of
urinary bladder as a result, the urinary bladder becomes flaccid.

Q#2: Give the Anterior relations of kidney.

Ans:

Anterior Relation of right kidney Anterior relation of left kidney

1. Right supra renal gland 1. Left supra renal gland
2. Liver 2. Spleen
3. Duodenum 3. Stomach
4. Right colic flexure 4. Pancreas
5. Left colic flexure
6. Jejunum

Q#3: Name the components of Juxtaglomerular apparatus.

Ans: The components of juxtaglomerular apparatus are:

1. Macula densa.

2. Juxtaglomerular cells.

3. Extraglomerular mesangial cells.

Q#4: When does bladder lie in abdomen?

Ans: In children and infants the bladder lies inn abdomen even when empty. It begins to enter the
pelvis major at the age of 6 years.

Q#5: Renal corpuscle is composed of which structure?

Ans: Renal corpuscle is composed of Bowman’s capsule and glomerulus.

Q#6: What do you know about the development of kidney?

Ans: The kidneys develop in 3stages:

1. Pronephros: Appears in the 4th week of development and regresses completely by the end
of week 4.
 2. MESONEPHROS: appears in the late 4th week just caudal to pronephros . It functions as
interim kidneys for approximately 4 week and degenerate toward the end of week 12.
3. METANEPHROS: It appears around the 5th week of development and becomes functional
around 12 week.
The permanent kidneys develop from 2 sources
i) Ureteric bud (a diverticulum of from mesonephric duct)
ii) The metanephrogenic blastemal (derived from the caudal part of nephrogenic cord)

The collecting system which includes ureter, renal pelvis, major and minor calyces and collecting
tubules.

The metanephric blastemal gives rise to excretory system which includes Bowman’s capsule,
glomerulus, proximal convoluted tubule, loop of henle and distal convoluted tubule.

Q#7: What is renal pyramid?

Ans: Renal pyramid is the conical structure present in renal medulla, its base lies adjacent to renal
cortex and its apex(renal papilla) projects into minor calyx.

Q#8: What do you mean by horseshoe shaped kidney?

Ans: Horseshoe shaped kidney refers to the congenital abnormality on which the inferior pole of
both the kidneys are fuse with each other by a band of tissue.

Q#10: What are the derivatives of Urogenital sinus?

Ans: The urogenital sinus is divided into 3 parts:

1. A vesical part that develops into urinary bladder and is continuous with allantois.

2. A pelvic part that develops into urethra in the neck of bladder, the prostatic part of urethra in
male and the entire urethra in female.

3. A phallic part that develops into primordium of penis or clitoris.

Q#11: Which structures maintain kidney position?

Ans: The structures responsible for maintaining the position of kidney are:

1. Renal fascia.

2. Peri-renal fat.

3. Renal capsule.

4. Peranephric fat.

Q#12: Define trigone of bladder.

Ans: Trigone of bladder refers to the triangular smooth area at the base of bladder between the two
openings of the ureters and internal urethral orifice

Q#13: Name the layers of glomerular basement membrane.

Ans: The glomerular basement membrane consists of 3 layers:

1. Lamina rara externa

2. Lamina densa.

3. Lamina rara interna.

Q#14: Describe the route of ureter?

Ans: The Renal pelvis continues into ureter and then the ureters leave the kidneys posterior to the
renal vessels. Both ureters pass inferiorly over the abdominal surface of the psoas major, with the
genitofemoral nerve behind it and the vessels of the gonads in front. As the right ureter travels
towards the bladder, it travels posterior to the duodenum and further down it is crossed by
branches of the superior mesenteric vessels.

The left ureter, however, travels laterally to the inferior mesenteric vessels and is subsequently
crossed by its branches. Eventually, the vessels leave the psoas major as the common iliac arteries
bifurcate to enter the true pelvis. The ureter pierces through the wall of the urinary bladder from
lateral to medial and posterior to anterior.

Q#15: Define hydronephrosis.

Ans: Hydronephrosis refers to the dilation of the renal pelvis and calyces which may result from the
obstruction of low of urine.

RENAL BIOCHEMISTRY:
Q#1: Name the enzyme deficient in Lesh-Nyhan syndrome.

Ans: Lesch-Nyhan syndrome is due to the deficiency of Hypoxanthine-guanine

phosphoribosyltransferase.

Q#2:A patient has COPD so pH of his urine will be?

Q#4: Mention the rate limiting step of Purine Synthesis.

Ans:The conversion of phosphoribosyl pyrophosphate into 5-phosphoribosylamine is the rate

limiting step in purine synthesis. Amido phospho-ribosyltransferase is the rate limiting enzyme of
purine synthesis

Q#5: Give the steps of Urea Cycle occuring in cytoplasm.

Ans: Steps of urea cycle occurring in cytoplasm:

1. Synthesis of arginosuccinate:

The citruline condenses with aspartate to form arginosuccinate in the presence of

arginosuccinate synthase enzyme.

2. Synthesis of arginine:

The arginosuccinate is broken down into arginine and fumarate by arginnosuccinase.

3. Synthesis of Urea:

The arginine is broken down into urea and ornithine by enzyme arginase.

Q#6: Name the Conditions associated with normal Anionic gap.

Ans: Diarrhea, Renal tubular necrosis, Addison’s disease and Carbonic anhydrase inhibitor.

Q#8: What do you mean by alkaptonuria?

Ans: Alkaptonuria is an autosomal recessive disorder caused by a defect in the enzyme

homogentisate oxidase which leads to the lack of ability to breakdown homogentisic acid into 4-
maleylacetoacetic acid.

Q#9: What do you mean by phenylketonuria?

Ans: Phenylketonuria is an autosomal recessive disorder caused by the deficiency of phenylalanine

hydroxylase and leads to the accumulation of phenylalanine and its metabolites in tissue and body
fluid.

Q#10: Name the enzymes of urea cycle present in cytoplasm.

Ans: The enzymes of urea cycle present in cytoplasm are:

1. Arginosuccinate synthase 2.Arginosuccinase 3.Arginase

Q#11: Why does diabetes cause polyuria?

Ans: In diabetes the glucose concentration remains high in blood which leads to excessive amount
of filtration of glucose. The kidney reaches to threshold of reabsorption and cannot reabsorb the
glucose completely which leads to glycosuria. This increases the osmotic pressure of urine and
retention of fluid in urine and ultimately results in polyuria.

Q#12: Define tonicity.

Ans: Tonicity is a measure of the effective osmotic pressure gradient of a solution. In other words,
tonicity is the relative concentration of solute dissolved in a solution which determine the extent
and direction of diffusion.
Q#13: Mention the kidney function tests other than urea and creatinine clearance tests.

Ans: RENAL FUNCTIONN TESTS ARE:

I. Tests based on Glomerular filtration:

• Urea clearance test. • Endogenous creatinine clearance test.

• Inulin clearance test. • Cr51-EDTA clearance test.

II. Tests to measure Renal Plasma Flow (RPF):

• Para-amino hippurate test (PAH). • Filtration fraction

III. Tests based on tubular function:

• Concentration and Dilution tests. • 15 minute-PSP excretion test.

• Measurement of tubular secretory mass.

Q#14: Why does chronic renal failure lead to anemia?

Ans: About 90% of total erythropoietin is produced of kidney. So a patient with chronic renal
failure leads to anemia due to deficiency of erythropoietin.

REPRO ANATOMY:
Q#1: How would you define Sertoli cells and its functions?

Ans: Sertoli cell are large tall columnar cells in the seminiferous tubule that extends from the
basement membrane to the lumen of seminiferous tubule.

FUNCTIONS:

1. Protection of germ cells (Blood testes barrier)

2. Support and nutrition of the spermatogenic cells
3. Phagocytic function.
4. Secretory function: The sertoli cells secrete testicular fluid, androgen binding protein and
inhibin. During fetal life , it secretes Mullerian-inhibiting substance.

Q#2: What do know about Ampulla of Male genital duct (ductus deferens)?

Ans: The ampulla of ductus deferens is the dilation of ductus deferens at the base of the bladder just
before it join the duct of seminal gland to form ejaculatory duct.

Q#3: What do you know about MIF?

ANS: Mullerian inhibiting factor is the hormone secreted by sertoli cells to suppress the growth of
Paramesonephric duct in male fetus.

Q#4: Mention the functions of Uterine tubes.

Ans: FUNCTONS OF UTERINNE TUBE:

 The uterine tube picks up the ova ovulated from the ovary, provide necessary environment
required for fertilization and, if fertilization takes place , initial development of zygote also
occurs in the uterine tube.
 The epithelium lining the uterine tube contain peg cells ,which produce tubal fluid that
contain glucose , proteins and other substances that provide nourishment to the ovum,
spermatozoa and the zygote.

Q#5: Name the parts of male urethra and its blood supply.

Ans:

Parts of Male Urethra Arterial Supply

Prostatic urethra Inferior vesicle artery(branch of internal iliac
artery)
Membranous urethra Bulbourethral artery(branch of internal
pudendal artery)
Penile urethra Internal pudendal artery
Q#6: Gives the features of mucosa of uterine tubes.

Ans: The mucosa of uterine tube consists of epithelium and lamina propria.

The epithelium of uterine tube is of simple columnar variety and consist of 2 types of cells i.e;
secretory peg cells and ciliated cells. The secretory peg cells produce tubal fluid for nourishment of
ovum, spermatozoa and zygote. The ciliated cells bears kinocilia which beats towards the cavity of
of the uterus.

The lamina propria consist of loose connective tissue.

Q#7: Mention the names of external genitalia of female.

Ans: The vulva is the collective term use for external genitalia of female. The components of
external genitalia of female are:

1. Mons pubis 2.clitoris 3.Labia majora 4.Labia minora

5. Vestibule of vagina (which consist of):

 External urethral orifice

 Vestibule gland (Bartholin’s gland, Skene’s gland)
 Vaginal opening
 Hymen
Q#8: What is gonadal ridge?

Ans: Gonadal ride is the precursor of gonads which develops on the medial side of mesonephros.

Q#9: Describe the development of male genital tract.

ANS: The male genital ducts are derived from Mesonepheric duct. Under the influence of
testosterone( secreted by leydig cells during 8th week) , the proximal part of each mesonephric duct
becomes epididymis while distal to epididymis , the mesonephric duct becomes the ductus deferens
. The mesonephric tubules form efferent ductules which open into epididymis.

The part of mesonephric duct between the seminal gland and the urethra becomes the ejaculatory
duct.

Q#10: Name the layers of endometrium.

Ans: The endometrium consist of :

1. Stratum compactum
2. Stratum spongiosum
3. Stratum basale

(Note: Stratum compactum and stratum spongiosum collectively form stratum functionalis)

Q#11: Describe the histology of vagina.

Ans: Histologically the wall of vagina consists of 3 layers:

1.Mucusa 2.Muscularis 3.Adventitia

The mucosa pf vagina consist of epithelium and lamina propria .

The epithelium vaginal mucusa is stratified squamous non-keratinized variety. The lamina propria
consists of layers of loose connective tissue (rich in elastic fibers), plexus of small veins, a large
number of neutrophils and lymphocytes.

The muscularis of vagina consist of smooth muscle fibers.

The adventitia of vagina consist of an inner layer of dense connective tissue.

Q#12: Which duct form male repro system?

Ans: The male genital ducts are develop from Mesonephric duct(Wolffian duct).

Q#13: Uterovaginal primordium is formed by?

Ans: Uterovaginal primordium is form by the fusion of caudal part of paramesonepheric duct.

Q#14: Describe the route of ovarian artery.

Ans: The ovarian arteries arise from the anterolateral aspects of the abdominal aorta, inferior to the
origin of the renal arteries and superior to the inferior mesenteric artery, around the level of
vertebra L2/L3. They run inferolaterally in the retroperitoneum; the right artery crosses anterior
to the inferior vena cava, while the left one lies posterior to the inferior mesenteric artery.

Both arteries run anterior to the psoas major and the middle portion of the ureter which they
usually supply. Upon crossing the pelvic brim, they continue their course between the two layers of
the suspensory ligament of ovary, towards the ovary. On their course, the arteries are accompanied
by the ovarian veins.

REPRO PHYSIOLOGY:
Q#1: Testosterone is secreted by which type of cells and give its functions.

Ans: In males the testosterone is secreted by leydig cells of testes and in addition to it , testosterone
is secreted by adrenal cortex.

In females, some amount of testosterone is also secreted by ovary and placenta.

FUNCTIONS OF TESTOSTERONE:

1. It increases the protein anabolism.

2. It increases storage of creatinine in the muscles.
3. It increases the fructose production by seminal vesicles.
4. Promote the growth of male sex organs like prostate gland, seminal vesicle, Cowper’s gland
and penis.
5. Develop male secondary sexual characteristics like distribution of hairs , influences voice
etc.

Q#2: What is puberty?

Ans: Puberty is the process of physical changes through which a child's body matures into an adult
body capable of sexual reproduction.

Q#3: Name the hormones which play role in PCOS.

Ans: The hormones which play role in PCOS are:

1. Excess androgens: disturbs ovulation

2. Excess Insulin:triggers the ovary to make more androgens
3. Low levels of progesterone.

Q#4: Name the steroid producing organs.

Ans: The steroid producing organs are:

1. Testes
 2. Adrenal cortex
3. Ovary
4. Placenta

Q#5: Name the progesterone producing cells in the body.

Ans: The granulosa lutein cells of corpus luteum produce progesterone.

In addition to corpus luteum, progesterone is also synthesized by placenta, testes and adrenal
cortex.

Q#6: Name the hormones released by ovary.

Ans: The ovary mainly release progesterone and estrogen.

Q#7: Where is progestrone made in ovary?

Ans: In ovaries, the granulosa lutein cells of corpus luteum produce progesterone.

-after pregnancy progesterone is made from

Q#8: Name the main hormone secreted by placenta?

Ans: The hormones secreted by placenta are:

1. HCG 2.Chorionic somatomammotropin 3.Progesterone 4.Estrogen

5. Relaxin

Q#9: Mention the names of main androgens.

Ans: The main androgen produces by the body are:

1. Testosterone 2. Dehydroepiandrosterone 3.Epiandrosterone

4. Androsterone

Q#10:Define menstrual cycle.

Ans: Menstrual cycle is defined as cyclic events that take place in a rhythmic fashion in which an
ovum matures, is ovulated, and enters the uterine lumen through the fallopian tubes. This cycle last
an average of 28 days, with day 1 of the cycle designated as that day on which menstrual flow
begins.

Q#11: Describe the effect of GnRH.

Ans: GnRH acts on the pituitary gland to secrete follicle stimulating hormone and lutenizing
hormone.

Q#12: Mention the functions of estrogens and their sites of production.

Ans: SITES OF PRODDUCTION OF ESTEROGEN: Ovary(mature graffian follicle and corpus luteum),
Placenta , adrenal cortex and testes.

FUNCTIONS OF ESTROGEN:

 Appearance of secondary sexual characteristics in female.

 Proliferation of endometrium lining the uterus.
 Growth of uterine muscles
 Increase the vascularity of uterus
 Estrogen stimulates the closure of epiphysis.
 It increases the rate of glycolysis with accumulation of lactic acid , which ultimately
increases the acidity of vaginal secretion. In short, under the influence of estrogen the
uterus is less susceptible to infection.
 β-estradiol prevents the osteoporosis.
 Estrogen have cholesterol lowering effect and reduces plasma cholesterol level and a fall in
the level of β-lipoprotein.

Q#13: Mention the functions of progesterone and their sites of production.

Ans: SITES OF SECRETION OF PROGESTERONE: Corpus luteum, placenta, adrenal cortex and testes.

FUNCTIONS OF PROGESTERONE:

 Extensive development of endometrium

 It causes increase in glycogen, mucin and fat in the lining epithelial cells of uterus
 Progesterone is responsible for the rise in basal temperature.
 Stimulates the mammary gland.
 Inhibits LH and FSH secretion.

Q#14: Discus the function LH in female and male.

Ans: In female, LH stimulate ovulation, production of estrogen by follicles and after ovulation, it
stimulates the production of progesterone by corpus luteum.

In Males, LH stimulates the production of testosterone by Leydig cells.

Q#15: Discuss the anabolic functions of testosterone.

Ans: It stimulates the protein synthesis and increases the muscle mass of the body.

It stimulates the growth of bones before the closure of epiphyseal plate.

Q#16: Define androgens and sites of production in male and female.

Ans: DEFINITION OF ANDROGEN: The hormones which stimulates the activity of male accessory
male sex organs and promotes the development of male sex characteristics.
SITES OF PRODUCTIONN IN MALE: Testes, Adrenal cortex

SITES OF PRODUCTION IN FEMALE: Ovary, placenta and adrenal corex.

Q#17: Define infertility.

Ans: Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical
pregnancy after 12 months or more of regular unprotected sexual intercourse.”

REPRO PATHOLOGY:
Q#1: Define PCOS and mention the Clinical features of PCOS.

Ans: DEFINITION: PCOS refers to the presence of multiple ovarian follicular cyst due to hormonal
imbalance.

The clinical features of PCOS are:

1. Hirsutism 2.Infertility

3. Irregular menses 4.Obesity

5. Insulin resistance 6.Acne

6. Metabolic syndrome and cardiovascular disease.

Q#2:Treatment of PCOS

Q#3: Define Cryptorchidism.

Ans: Cryptorchidism refers to the failure of one or both testes to descend into scrotum.

Q#4: Define prostatitis .Give the signs and symptoms of acute bacterial prostatitis and its causes.

Ans: DEFINITION: Prostatitis refers to the inflammation of testes.

SIGN AND SYMPTOMS:

The patient presents as dysuria with fever and chills.

On digital rectal examination, the prostate is tender and boggy.

CAUSES:

Chlamydia trachomatis and Neisseria gonorrhea are common causes in young adults.

Escherichia Coli and Pseudomonas are common causes in older adults.

Q#5: Mention both the grame positive and grame negative bacteria related to Prostitis.
Ans:

Grame Negative bacteria Grame Positive bacteria

E.Coli Streptococcus
Pseudomonas Staphylococcus
Chlamydia trachomatis
Neisseria Gonorrhea

Q#6: Define miscarriage.

Ans: A miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy.

Q#7: Define hydrocele.

Ans: Hydrocele is a collection of fluid around one or both testicle and cause swelling of scrotum.

Q#8: Define adenomysosis.

Ans: Adenomyosis is a benign disorder of uterus, characterized by ectopic occurrence of

endometrial gland and stroma within myometrium.

Q#9: What is the cause of infertility in PCOS.

Ans: The main cause of infertility in PCOS women is chronic anovulation.

Q#10: Mention the name of common non neoplastic cysts of ovaries.

Ans: The most common non neoplastic cyst of ovary are:

1. Follicular cyst 2.Corpus luteum cyst

3. Endometriotic cyst (Chocolate cyst) 4.Theca lutein cyst.

Q#11: Define Preeclampsia

Ans: Development of hypertension with proteinuria and edema due to pregnancy, usually arising
inn 3rd trimester of gestation

Q#12: Define Eclampsia.

Ans: Development of hypertension , proteinuria, edema and seizures due to pregnancy, usually
arising inn 3rd trimester of pregnancy.

Q#13: Define Endometriosis.

Ans: Endometriosis refers to the ectopic occurrence of endometrial glands and stroma.

Q#14: Define ectopic pregnancy.

Ans: The implantation and development of blastocyst outside the cavity of uterus.

Q#15: How would you define endometrial hyperplasia and give its classification on the basis of
histology?

Ans: Endometrial hyperplasia is defined as “hyperplasia of endometrial gland relative to stroma”.

CLASSIFICATION:

On the basis of histology, endometrial hyperplasia can be divided into 2 types:

1. Non atypical hyperplasia 2.Atypical hyperplasia

Q#14: Define benign prostate hyperplasia and which hormone is responsible for causing it.

Ans: BPH is the enlargement of prostate due to hyperplasia of both glandular and stromal
commponents.

Dihydrotesterone is responisble for BPH.

Q#15: Define placenta accreta and mention the complications cause by it.

Ans: Placenta accrete is defined as “ the implantation of placenta into the myometrium with little or
no intervening decidua”.

The complications cause by placenta accreta includes difficult delivery of placenta and postpartum
bleeding.

REGARDS: ABDUL RAUF D24.