Solve of BPSC syllabus:

Epithelial tissue:
Functions of epithelium: Protection, Absorption, secretion, and ion transport, Filtration, Forms slippery
surfaces
Classification & Naming of Epithelial tissue
 Squamous – cells wider than tall (plate or “scale” like)
 Cuboidal – cells are as wide as tall, as in cubes
 Columnar – cells are taller than they are wide, like columns
The name may also include any accessory structures :Goblet cells,Cilia,Keratin
Simple Squamous Simple Cuboidal Epithelium: Simple Columnar Epithelium
Epithelium: Function : secretion and Function :
Functions : absorption  Absorption; secretion of
 Passage of materials by Location : mucus, enzymes,
passive diffusion and  kidney tubules,  Ciliated type propels mucus
filtration  secretory , portions of or reproductive cells
 Secretes lubricating small glands, Location :
substances in serosa  ovary & thyroid follicles  Non-ciliated form :Lines
Location: Renal corpuscles, digestive tract, gallbladder,
Alveoli of lungs , Lining of ducts of some glands
heart, blood and lymphatic  Ciliated form : Lines small
vessels,Lining of ventral body bronchi, uterine tubes,
cavity (serosae) uterus

Pseudostratified Columnar Stratified Squamous Epithelium Transitional Epithelium

Epithelium Function:Protects underlying Basal cells usually cuboidal or
Locations: tissues in areas subject to columnar, Superficial cells
Non-ciliated type :Ducts of male abrasion dome-shaped or squamous
reproductive tubes , Ducts of Location : Function: stretches and permits
large glands  Keratinized – forms epidermis distension of urinary bladder
Ciliated variety: Lines trachea  Non-keratinized – forms Location : Lines ureters, urinary
and most of upper respiratory lining of esophagus, mouth, bladder and part of urethra
tract. and vagina

Skeletal Muscle Tissue Smooth Muscle Tissue Cardiac Muscle Tissue

Characteristics: Long, Characteristics: Spindle-  Characteristics: Branching
cylindrical cells, Multinucleate ,shaped cells with central cells, Uni-nucleate,
Obvious striations present. nucleus,Arranged closely to Intercalated discs must
Functions: form present
 Voluntary movement sheets, No striations  Function: Contracts to
 Manipulation of Functions: propel blood into circulatory
environment  Propels substances along system
 Facial expression internal passageways  Location : Occurs in walls of
Location: Skeletal muscles  Involuntary control heart
attached to bones (occasionally Location: Mostly walls of
to skin) hollow organs
Connective Tissue
Main classification: Connective tissue proper, Blood – Fluid connective tissue, Cartilage, Bone tissue
Components of connective tissue: Cells (varies according to tissue), Matrix
Cells found in connective tissue properFibroblasts, Macrophages, lymphocytes (antibody producing
cells), Adipocytes (fat cells), Mast cells, Plasma cells , Stem cells
Fibers:
 Collagen – very strong & abundant, long & straight
 Elastic – branching fibers with a wavy appearance (when relaxed)
 Reticular – form a network of fibers that form a supportive framwork in soft organs (i.e. Spleen & liver)
Hyaline Cartilage Elastic Cartilage Fibrocartilage
Function Function Function
Supports and reinforces Maintains shape of structure Tensile strength and ability
Resilient cushion Allows great flexibility absorb compressive shock
Resists repetitive stress Location Location
Location: Auricle,auditory tube Intervertebral discs
Ends of long bones Epiglottis Pubic symphysis
Costal cartilage of ribs Meniscus
Cartilages of nose, Acetabular labrum
trachea, and larynx
Nervous Tissue
 Function: Transmit electrical signals from sensory receptors to effectors
 Location : Brain, spinal cord, and nerves
 .Contains two types of cells: Neurons – excitatory cells, Supporting cells (neuroglial cells)
Events of hemostasis are:
a) Vascular constriction
b) Formation of platelet plug
c) Formation of blood clot as a result of blood coagulation
d) Eventual growths of fibrous tissue
Essential / primary clotting factors:
 Factor I – Fibrinogen
 Factor II – Prothrombin
 Factor III – Tissue factor
++
 Factor IV – Calcium ion (Ca )
Vitamin-K dependant blood clotting factors:
 Factor II – Prothrombin
 Factor VII – Stable factor
 Factor IX – Christmas factor
 Factor X – Stuart-Prower factor
Differences between extrinsic and intrinsic pathway
Traits Extrinsic pathway Intrinsic pathway
1) Initiation Begins with the trauma to blood Begins with trauma to blood
vessel or exposure of blood to itself or exposure of blood to
extravascular tissue sub-endothelial matrix
2) Clotting factors involved Factor III, IV, V, VII, X Factor IV, V, VIII,IX, X, XI, XII
in prothrombin activation
3) Duration Rapid process Slower process
Events of cardiac cycle:
a) Atrial events:
Atrial systole
Atrial diastole .
 b) Ventricular events:
Ventricular systole Ventricular diastole
 Isometric contraction  Protodiastole
 Minimum ejection  Isometric relaxation
 Maximum ejection  First rapid filling
 Reduced ejection  Slow filling
 Last rapid filling
Products of cardiac cycle:
1) Changes in pressure:
- Intra-atrial pressure change
- Intra-ventricular pressure change
- Pressure changes in aorta
- Pressure changes within pulmonary artery
2) Changes in volume:
- Atrial volume change
- Ventricular volume change
3) Production of heart sounds.
4) Production of apex beat.
5) Production of pulse.
6) Electrical changes (studied by ECG).
Waves & segments of a normal ECG:
 P wave: Represents atrial depolarization.
 P-R interval: Represents the time taken for the cardiac impulse to spread over the atrium and
through AV node and His’ Purkinje system.
 QRS: Represents ventricular depolarization.
 T wave: Represents ventricular repolarization.
Types of blood pressure:
1) Systolic blood pressure: Is the maximum pressure during systole. Normal adult value is 100 –
140 mm Hg (average 120 mm Hg).
2) Diastolic blood pressure: Is the minimum pressure during diastole. Normal adult value is 60 – 90
mm Hg (average 80 mm Hg).
3) Pulse pressure: Is the difference between systolic and diastolic pressure. Normal adult value is 40
mm Hg.
4) Mean pressure:
 Diastolic pressure + 1/3rd of pulse pressure or
 2/3rd of diastolic pressure + 1/3rd of systolic pressure
 Calculation: 2/3rd of 80 + 1/3rd of 120 = 93.3 mm of Hg
Factors regulate / influence / control arterial blood pressure:
1) Pumping action of heart
2) Cardiac output: BP = Cardiac output  Total peripheral resistance.
3) Peripheral resistance
4) Elasticity of arterial walls
5) Blood volume
6) Viscosity of blood
Cardiac output (CO):The volume of blood ejected by each ventricles per minute is called cardiac output.
It is also known as minute volume.
Cardiac output (CO) = Stroke volume (SV)  Heart rate (HR)
Factors influence cardiac output:
 1) Physiological factors:
i. Age: With the increase of age, cardiac output increases.
ii. Sex: Because the surface area is less in female, the CO will be 5% less.
iii. Surface area: Large surface area means large CO.
iv. Emotion: Excitement and anger increases CO, while grief and shock decrease it.
v. Digestion: Depends on the quantity of food taken, the CO will vary.
vi. Temperature: Increase temperature causes increased CO.
vii. Pregnancy: CO increases during pregnancy.
viii. Exercise: During exercise, CO increases.
2) Pathological factors:
CO increased in:Hyperthyroidism, Anemia, Fever, Arterio-venous fistula, Paget’s disease
CO decreased in: Hypothyroidism, Hemorrhage, CCF, Shock, Oligaemia
Shock:
Types / classification of shock with causes:
1) Hypovolemic shock (decreased blood volume): Hemorrhage, Trauma, Surgery, BurnsFluid
loss due to vomiting or diarrhea
2) Distributive shock (marked vasodilation; also called vasogenic or low-resistance shock) :
Fainting (neurogenic shock), Anaphylaxis, Sepsis (also causes hypovolemia due to increased
capillary permeability with loss of fluid into tissues)
3) Cardiogenic shock (inadequate output by a diseased heart) : Myocardial infarction.
Congestive heart failure, Arrhythmias
4) Obstructive shock (obstruction of blood flow) : Tension pneumothorax,Pulmonary
embolism, Cardiac tumor, Cardiac tamponade
5) Endocrine shock
Clinical features of shock:
1) Hypotension
2) Rapid, thready pulse
3) Cold, pale, clammy skin
4) Intense thirst
5) Rapid respiration
6) Restlessness or, alternatively, torpor.
Regional blood flow
Local tissue blood flow:
 Highest blood flow in
 Kidney: 400 ml/min/100 gm
 Adrenal gland: 300 ml/min/100 gm
 Thyroid: 160 ml/min/100 gm
 Low blood flow in skeletal muscle: 4 ml/min/100 gm
 Angiogenesis and blood flow regulated by
- Vascular endothelial growth factor (VEGF)
- Fibroblast growth factor
- Angiogen
+ ++ + + ++
 K , Mg , Na , H ,CO2 causes vasodilatation and Ca causes vasoconstriction.
Percent of cardiac output in different organs:
 Cerebral circulation (Brain): 14%
 Coronary circulation (Heart): 4%
 Bronchi: 2%
 Renal circulation (Kidney): 22%
  Hepatic circulation (Liver): 27%
 Muscle: 15%
 Bone: 5%
 Skin: 6%
 Thyroid gland: 1%
 Adrenal glands: 0.5%
 Other tissues: 3.5%
Pulmonary volumes: Pulmonary capacities:
 Tidal volume: 500 ml  Inspiratory capacities: 3500 ml
 Inspiratory reserve volume: 3000 ml  Functional residual capacity: 2300 ml
 Expiratory reserve volume: 1100 ml  Vital capacity: 4600 ml
 Residual volume: 1200 ml  Total lung capacity: 5800 ml
Transport of O2 in the blood: O2 is transported in the blood in two ways –
 In the from of O2-Hb: About 97% of O2 is carried in the form of O 2-Hb. O2 combines with Hb
by the process of oxygenation.
 As dissolved state: Remaining 3% of O2 is transported as the dissolved state in the water of
the plasma & cells.
Factors influence shifting the curve:
1
. Factors shifting the curve to the 2. Factors shifting to the left:
right:  Increased pH (decrease H+
+
 Decreased pH (increased H concentration)
concentration)  Decreased temperature.
 Increased CO2 concentration  Decreased PCO2.
 Increased temperature.  Fetal hemoglobin.
 Increased 2,3-  Decreased 2,3-
biphosphoglycerate (BPG) biphosphoglycerate (BPG)

Transport of CO2 in the blood:

1. Transport as HCO3
2. Transport as carbamino compounds
3. Transport as dissolved CO2
The respiratory centers with their locations:
 Dorsal respiratory group: Dorsal portion of the medulla (nucleus tractus solitarius)
 Ventral respiratory group: Ventrolateral part of the medulla
 The pneumotaxic centre: Dorsally in the superior portion the pons.
 Apneustic centre: Lower part of the pons
Stimuli affecting respiratory centers:
1. Nervous factor or direct stimulation of respiratory centre from motor cortex.
2. Indirect stimulation from proprioceptors.
3. Chemical factors: Low O2, high CO2 and low pH.
The lung function tests:
1. Test for ventilatory efficiency:
a) Spirometry:
 Vital capacity: Male 3.2 to 4.6 liter, Female : 2.9 to 4.2 liter.
 FEV1 or timed vital capacity: 80% in first second.
 Peak expiratory flow rate (PEFR): About 6 to 15 liters/second.
b) Residual volume (RV):
 c) Flow volume loop.
d) Pressure volume loop.
2. Tests for measuring gas exchange or diffusing capacity: Carbon monooxide diffusion
measurement (TLCO).
3. Test to evaluate the alveolar ventilation: Determination of dead space volume (In a young
adult man anatomical dead space is about 150 ml). Uniform distribution of air measured by
nitrometer.
4. Test evaluating alveloar ventilation & perfusion ratio: About 0.84 depending on continuous
analysis of-the carbon dioxide percentage of the expired air by carbondioxide analyser.)
5. Measurement of maximum oxygen uptake: 250 ml/minute.
6. Blood gas analysis:PaCO2, PaO2, Blood pH

FEV1 change in restrictive airway disease:

FEV1 is not decreased (decreased but less).
FEV1/FVC ratio remains normal (as both are decreased proportionately).
FEV1 change in obstructive airway disease:
FEV1 is decreased.
FEV1/FVC ratio also decreased.

Cyanosis Types:
1) Central cyanosis: Due to heart and lung causes (e.g. congenital cyanotic heart disease like
Fallot’s tetralogy, ventricular septal defect; lung causes like severe asthma, emphysema, chronic
bronchitis etc.).
2) Peripheral cyanosis: Due to vascular cause (e.g. vasoconstriction, venous occlusion etc.).

Hypoxia:It is a clinical condition in which there is O 2 deficiency at the tissue level.

Types of hypoxia: Four types of hypoxia-
1) Hypoxic hypoxia (anoxic hypoxia)
2) Anemic hypoxia
3) Stagnant hypoxia (ischemic hypoxia)
4) Histotoxic hypoxia
Type-1 respiratory failure:
In this type of respiratory failure, there is only low PaO 2 , Here PaCO2 is normal (40 mmHg
Causes:
Acute: Lobar pneumonia, Pulmonary edema
Chronic: Emphysema, Lung fibrosis
Type-2 respiratory failure: low PaO2 (hypoxia) and high PaCO2 (hypercapnia)
Causes:
 Severe COPD
 Severe asthma
 Narcotics(heroin) poisoning
 Sleep apnea
 Tracheal / bronchial obstruction.
Movements of GIT:
a) Movements of stomach:
 Mixing movement – Mixing.
 Propulsive movement – Peristalsis.
b) Movements of small intestine:
  Mixing movement - Segmentation.
 Propulsive movement - Peristalsis.
 Antiperistalsis
 Pendular movement.

Digestive juice Water Solid Organic Inorganic

+ + +
1. Saliva 99.5% 0.5%  Enzymes: ptyalin (Salivary -  Cation: Na , K , Ca2
-
amylase), Lingual lipase,  Anion: CI-, HCO3
Lysozyme.
 Mucin , Secretory IgA
 Cells: Yeast cell, bacteria,
protozoa.
+ + 2+
2. Gastric juice 99.5% 0.5%  Enzymes: Pepsin, Gastric lipase,  Cation: Na , K , Mg ,
+
Rennin. H
3-
 Intrinsic factor of Castle, Mucus.  Anion : CI-, PO4 ,
2-
 HCl SO4
+ + 2+
3. Pancreatic juice 98.5% 1.5%  Carbohydrate splitting enzymes :  Cation : Na , K , Ca ,
2+
Pancreatic amylase Mg
- -
 Proteolytic enzymes: Trypsin,  Anion: HCO3 , Cl ,
2- 2-
Chymotrypsin, SO4 , HPO4
Carboxypolypeptidase, Elastase.
 Lipolytic enzymes :
 Pancreatic lipase, Cholesterol
esterase, PhospholipaseA2,
colipase.
 Nuclease:
4. Succus entericus 98.5% 1.5%  Carbohydrate splitting enzymes:  Cation : Na+, K+,
Sucrase, Maltase, Lactase, Ca2+, Mg2+
3- -
Isomaltase, - Dextrinase,  Anion: HCO , CI ,
2- 2-
Trehalase. HPO4 , SO4 .
 Proteolytic enzymes:
Enteropeptidase,
Aminopeptidase,
Carboxypeptidase,
Endopeptidase, Dipeptidases.
 Lipolytic enzymes: Intestinal
lipase
 Nuclease: RNAase, DNAase.
 Activator enzyme: Enterokinase.
Difference between liver bile & gall bladder bile:
Traits Liver bile Gall bladder bile
1. Concentration It is diluted. It is concentrated.
2. Mucin 0.4% 3%
3. pH 7.8 – 8.6 7.0 – 7.4
4. Specific gravity 1.01 1.04
 5. Concentration of bile salt, bilirubin, Less More
+
cholesterol, fatty acid, lecithin, Na ,
+ ++
K , Ca
– –
6. Concentration of Cl & HCO3 More Less.
End products of digestion of carbohydrate: Monosaccharides (Glucose, fructose & galactose).
End products of digestion of protein: Amino acids & peptides.
End product of digestion of fat: Fatty acids, glycerol, monoacyl glycerol and diacyl glycerol.
Site of absorption of nutrients:
Site Nutrient
Jejunum  Glucose
 Monoacylglycerols, fatty acids, glycerol, cholesterol.
 Amino acids, peptides.
 Electrolytes, iron, calcium, water.
Ileum  Bile acids
 Vitamin B12
 Electrolytes
 Water.
Mechanism of formation of urine: Urine formation takes place by the following three mechanisms-
A) Formation of glomerular filtrate
B) Tubular reabsorption
C) Tubular secretion
Factors affecting GFR:
1. Changing in renal blood flow: renal blood flow  GFR.
2. Glomerular hydrostatic pressure: It is normally 60mm Hg. It increases GFR.
3. Glomerular capillary colloidal osmotic pressure: It is 32 mm Hg. It decreases GFR.
4. Bowman’s capsule hydrostatic pressure: It is 18 mm Hg. It decreases GFR.
5. Arterial pressure: Increase or decrease in arterial pressure  autoregulation of renal blood
flow  GFR remains relatively constant.
6. Size of the capillary bed: size of capillary bed  glomerular filtration co-efficient  GFR.
7. Permeability of glomerular capillary: permeability  GFR
8. Glomerular filtration co-efficient (Kf): Kf = Permeability  surface area of glomerular
capillary. Kf  GFR.
9. Sympathetic stimulation: GFR
Renal function tests:
1. Routine examination of urine:
2. Blood analysis:
 Blood urea level (15 – 40 mg /dl)
 BUN (Blood urea nitrogen) level.
 Plasma uric acid level. (2 – 7 mg /dl)
 Plasma creatinine level (0.6 – 1.5 mg /dl)
 Plasma electrolytes.
3. Clearance tests:
 Creatinine clearance test (Usually used: 70 – 140 ml/min)
 Urea clearance test (60 – 70ml/min)
 Inulin clearance test
4. Special test:
 Water loading test
  Water deprivation test
 Acidification test.
 Renal biopsy.
6. Imaging tests:
 Plain X-ray KUB region
 Intravenous urography (IVU)
 Ultrasonogram
 CT scan
 Pyelograph
 Renal biopsy
Juxtaglomerular apparatus:
The juxtaglomerular cells (JG cells), the macula densa and the lacis cells are collectively known as
the juxtaglomerular apparatus.
Types of cells:
Types of cells Location
1. JG cells Afferent arteriole (in tunica media) &
efferent arteriole.
2. Macula densa (specialized epithelial cell) Distal tubule
3. Lacis cells / cell of Polkinsion Junction of outer layers of afferent and
efferent arterioles.
Peculiarities of renal blood flow (RBF) with their importance:
1. It is a portal system containing-
 Glomerular capillary – It is designed for filtration of plasma.
 Peritubular capillary – It is designed for the reabsorption of desirable substances from the
filtrate.
2. Rate of blood flow is very high (3.5 – 4 ml/gm/min). 22% of cardiac output flows to kidney.
Importance: This helps to clear the waste products very rapidly.
3. Kidney has a high pressure capillary bed. Hydrostatic pressure in glomerular capillary is very
high (60 mm of Hg).
Importance: Hydrostatic pressure facilitates the filtration of blood.
4. Blood flow is selective, not uniform. It is 98 – 99% in cortex and 1 – 2% in medulla. Maximum,
about 100% glomerular capillary lies in cortex. So blood flow in cortex is very high.
Importance:
 High blood flow in cortex ensures the filtration.
 Less blood flow in medulla ensures the concentrated urine formation.
5. Auto-regulation of RBF by kidney itself.
Regulation of water balance:
1. Role of Kidney:
a) Renal-body fluid feedback mechanism:
b) Renin-angiotensin mechanism:
2. Thirst mechanism
3. Sympathetic nervous system:
4. Role of atrial natriuretic peptide (ANP)
Classification of hormones:

1. According to their chemical structure:

A) Proteins and polypeptides: Including hormones of anterior and posterior pituitary gland, the
pancreas (insulin, glucagon), the parathyroid hormone, and many other hormones.
 B) Steroids: The adrenal cortex hormones (aldosterone, cortisol, androgens) the ovarian hormones
(estrogen and progesterone), the hormones of testes (testosterone) and the hormones of
placenta (estrogen and progesterone).
C) Derivatives of the amino acid tyrosine: The thyroid hormones (thyroxine, triiodothyronine),
the hormones of adrenal medullae (epinephrine and norepinephrine).
2. According to their distribution of receptors:
A) In or on the surface of the cell membrane: The protein, polypeptide and catecholamine
hormones.
B) In the cytoplasm: Steroid hormones.
C) In the cell nucleus: Thyroid hormones.
Hormones of pituitary gland:
 Anterior pituitary hormones:
- Growth hormone
- Thyrotropin / thyroid stimulating hormone (TSH)
- Adrenoorticotropic hormone (ACTH)
- Gonadotropin (FSH & LH)
 Posterior pituitary hormones:
- Antidiuretic hormone (ADH)
- Oxytocin.
5 factors that stimulate the secretion of growth hormone:
1) Exercise
2) Starvation
3) Stressful stimuli
4) Deep sleep
5) Hypoglycemia
6) Excitement
5 factors that inhibits the secretion of growth hormone:
1) Increase Glucose
2) Increase Cortisol
3) Increase Free fatty acids
4) Growth hormone ( by negative feedback mechanism)
5) Aging
Disorders of pituitary gland:
Parts involved Hyper-activity Hypo-activity
Anterior pituitary  Gigantism  Dwarfism
 Acromegaly  Acromicria
 Acromegalic gigantism  Simmond’s disease
 Cushing’s disease
Posterior pituitary  SIADH (Syndrome of  Diabetes insipidus
inappropriate hypersecretion
of ADH)
Anterior and posterior  Dytrophia adiposogenitalis
pituitary (Both)
Acromegaly:
Clinical features:
Skeletal changes:
1. Enlargement of hands and feet
2. Protrusion of lower jaw (progmathism)
 3. Prominet supraorbital ridges
4. Kyphosis
Soft tissue changes:
1. Skin thickening
2. Enlargement of lips nose tongue
3. Enlargement of thyroid gland, heart, liver
4.  heel pad thickness
Metabolic effects:
1. Glucose intolerance (25%)
2. Diabetes mellitus (10%)
3. Hypertension (25%)
ADH: It is a posterior pituitary hormone. also called ,vasopressin and pitresin.
Functions/physiological effects:
1. It causes reabsorption of water in DCT, CT & CD of the nephrons of the kidney, thus regulates
water balance.
2. It causes vasoconstriction, thus elevates blood pressure.
3. It causes contraction of smooth muscle like ureter, urinary bladder, intestine etc.

Thyroid hormones:
1. Thyroxine (T4)
2. Triiodothyronine (T3)
3. Calcitonin
Factors increasing the thyroid hormone secretion:
1) Low basal metabolic rate.
2) Leptin.
3) Alpha melanocyte stimulating hormone.
Factors decreasing the thyroid hormone secretion:
1) Stress.
2) Somatostatin.
3) Glucocorticoids.
4) Dopamine.
The thyroid function tests:
1) Measurement of thyroid hormones:
a) Estimation of T3 and T4 levels.
b) Estimation of TSH.
2) Tests to determine the aetiology of thyroid dysfunction:
a) Antibodies against thyroid peroxidase (TPO) and thyroglobulin (Tg).
3) Radioiodine uptake test.
4) Thyroid scanning.
5) Thyroid ultrasound.
Clinical features of Hyperthyroidism:
1. Nervousness
2. Weight loss, but increased appetite
3. Heat intolerance
4. Tremor of hands
5.  pulse pressure
6.  Sweating
7.  BMR
 8. Extreme fatigue but inability to sleep.
Hypothyroidism:
Clinical features:
General:
 Weight gain
 Cold intolerance
 Puffy face
 Fatigue, somnolence
 Hoarseness of the voice
 Constipation
Neuromuscular:
 Carpal tunnel syndrome
 Muscle stiffness
 Deafness
 Depression
 Psychosis(myxedema madness)
Dermatological:
 Dry skin
 Dry hair
 Alopecia
Reproductive:
 Menorrhagia
 Infertility
 Galactorrhoea
 Impotence
++
The forms of Ca in plasma:
Normal plasma concentration of calcium: 9.4 mg/dl
Distribution:
a. Non diffusible (plasma protein bound): 41 percent (1 mmol/L)
b. Diffusible combined with anionic substances(with citrate and phosphate): 9 percent (0.2
mmol/L)
c. Diffusible ionized: Remaining 50 percent (1.2 mmol/L)
The hormones controlling blood calcium level:
I. Parathyroid hormone.
II. Thyrocalcitonin.
III. Vitamin D (1, 25-. Dihydroxycholecalciferol)
IV. Parathyroid hormone related protein (PTHrP)
Hypocalcaemia: Decreased blood calcium level below its normal level is called hypocalcaemia.
Causes:
1. Parathyroid dysfunction
a. Hypoparathyroidism
 Surgical
 Idiopathic
 Infiltrative carcinoma
b. Pseudohypoparathyroidism
2. Vitamin-D deficiency:
a. Nutritional vit-D deficiency
b. Malabsorption
 3. Acute pancreatitis
4. Chronic renal failure.
5. Hypomagnesaemia
Clinical feature/effects:
1. Neuromuscular: Tetany, paraesthesia, myopathy, seizures.
2. Cardiovascular: Hypotension, ECG - prolonged QT interval.
3. Osteoporosis
4. Psychosis
5. Cataract
6. Rickets in children & Osteomalacia in adults
Functions of insulin:
A) Carbohydrate metabolism:
Insulin decreases blood glucose level by –
  glycogenesis
  glycolysis
  glucose uptake by cells
  fatty acid synthesis
  glycogenolysis
  gluconeogenesis
  lipolysis
B) Fat metabolism:
Insulin exerts anabolic (synthetic) role in fat metabolism. It causes –
  lipogenesis
  glycerol synthesis
  triglyceride deposition
  lipolysis by inhibition of hormone sensitive lipase
  ketogenesis
C) Protein metabolism:
Insulin exerts anabolic (synthetic) role in protein metabolism. It causes –
  amino acid uptake by cells
  protein synthesis
  protein breakdown
Effects of insulin deficiency:
1. Diabetes mellitus – because of inability to use glucose, blood glucose level rises above
normal.
2. Insulin deficiency causes fat utilization for energy and finally causes ket-acidosis.
3. Insulin deficiency causes –
 Polyuria (Increased formation of urine)
 Polydypsia (Increased thirst)
 Polyphagia (Increased appetite)
 Asthenia (Weakness)
Consequences of hyperglycaemia:
1) Microvascular:
 Diabetic retinopathy: Leading to blindness
 Diabetic nephropathy: Leading to renal failure
 Neuropathy: Peripheral neuropathy, autonomic neuropathy
2) Macrovascular:
 Atherosclerosis: Stroke, myocardial infarction
  Diabetic myopathy
 Hypertension
Hormones of adrenal gland:
1. Hormones of adrenal cortex:
Zona glomerulosa (15%): (mineralocorticoids)
 Aldosterone
 Deoxycorticosterone
 Corticosterone
 Cortisol (hydrocortisone)
Zona fasciculata(75%): (glucocorticoids)
 Cortisol (hydrocortisone)
 Corticosterone
Zona reticularis(10%): (sex hormones)
 Androgen (most important is dehydroepiandrosterone & androstenedion)
2. Hormones of adrenal medulla: (Catecholamines)
 Adrenaline / epinephrine
 Nor-adrenaline / nor-epinephrine
Addison’s disease:
Causes: Adrenocortical atrophy (due to auto immune disease) ,Tuberculous destruction of the adrenal
gland

Clinical features:
1. Weight loss
2. Weakness
3. Anorexia
4. Nausea & vomiting
5. Diarrohea & constipation
6. Hypotension
7. Pigmentation of skin & mucus membrane
Treatment:
Administration of glucocorticoids & mineralocorticoids.
Cushing’s syndrome:
Clinical features:
1. Moon face (due to deposition of fat in the face)
2. Buffalo hump (due to deposition of fat in the back of neck)
3. Pendulous abdomen (due to deposition of fat in the abdomen)
4. Reddish purple abdominal striae.
5. Wasting and weakness of proximal thigh muscle
6. Osteoporosis
7. Poor wound healing
8. Hypertension
9. Hyperglycemia
Sex hormones in male (androgens) :
 Testosterone
 Dihydrotestosterone (DHT)
 Inhibin
 Andostenedione
Sex hormones in female:
  Estrogen
 Progesterone
 Relaxin
 Inhibin
The reproductive functions of the male: Three major subdivisions –
(1) Spermatogenesis, which means simply the formation of sperm;
(2) Performance of the male sexual act; and
(3) Regulation of male reproductive functions by the various hormones.
Hormonal factors that stimulate of spermatogenesis:
Several hormones play essential roles in spermatogenesis. Some of these are as follows –
 Testosterone: this hormone is essential for the growth and division of the testicular
germinal cells, which is the first stage in forming sperm.
 Luteinizing hormone: secreted from anterior pituitary gland, stimulates the Leydig cell to
secrete testosterone.
 Follicle stimulating hormone: secreted from anterior pituitary gland, stimulates the Sertoli
cells without this stimulation, the conversion of the spermatids to sperm (spermiogenesis) is
not possible.
 Estrogen: Formed form testosterone by the Sertoli cells, essential for spermiogenesis.
 Growth hormone: GH is required for controlling background metabolic functions of the
testes. It promotes the early division of the spermatogonia.
Semen:
Characters:
Color: White
Specific gravity: 1.028
pH: 7.35-7.50
Sperm count: average 100 million/ml with fewer than 20% abnormal forms.
Composition of semen:
1) Sperm
2) Other components:
A) From seminal vesicle (60% of total volume):Fructose, Phosphorylcholine, Ergothineine,
Ascorbic acid , Flavins, Prostaglandins
B) From prostate (20% of total volume): Spermine, Citric acid , Cholesterol, phospholipids,
Fibrinolysin, fibrinogenase, Zinc, Acid phosphatase
C) Hyaluronidase
Secondary sexual characteristic of female:
a. Onset of menstruation.
b. Enlargement of breast.
c. Change in voice (high pitched low frequency)
d. Maturation of female sex organs.
e. Appearance of pubic and axillary hair.
f. Enlargement of pelvis in all diameter (Gynaecoid pelvis)
g. Feminine distribution of the fat
h. Increase attraction to opposite sex
Menstruation:
It has following stages:
 Proliferation of the endometrium
 Development of the secretory changes of the endometrium
 Desquamation of the endometrium, which is known as menstruation
Clinical features of menopause:
1) “hot flushes” characterized by extreme flushing of the skin,
2) psychic sensations of Dyspnoea,
3) irritability,
4) fatigue,
5) anxiety,
6) occasionally various psychotic states, and
7) Decreased strength and calcification of bones throughout the body.
Indicators (sign-symptoms) of ovulation:
 Basal body temperature usually rises.
 Slight pain felt in the side of ovulation of the lower abdomen.
 Others direct evidence-
 LH level very high, FSH level fall
 High level of estrogen
 Urinary excretion estrogen
 Imaging of the lower abdomen-ultrasound.
Hypothalamic hormones:
 Releasing hormones:
- Growth hormone releasing hormone (GHRH)
- Thyrotropin releasing hormone (TRH)
- Corticotropin releasing hormone (CRH)
- Gonadotropin releasing hormone (GnRH)
 Inhibitory hormones:
- Growth hormone inhibitory hormone (GHIH, also called somatostatin)
- Prolactin inhibiting factor (PIF).
Another two hormones synthesized in hypothalamus but secreted from neurohypophysis:
 Antidiuretic hormone(ADH)/vasopressin (mainly
 Oxytocin.
Functions of hypothalamus:
1) Regulation of water balance: Thirst center
2) Formation of oxytocin and ADH (vasopressin): (From supra-optic and para-ventricular
nuclei).
3) Concerned with sleep, somnolence and wakefulness.
4) Regulation of body temperature.
5) Regulation of fat and carbohydrate metabolism.
6) Concerned with hunger, feeding, satiety and thirst.
7) Reflex center for emotional disturbance.
8) Concerned with sexual function.
9) Influence on autonomic activity  Control of both sympathetic and parasympathetic activity.
10) Concerned with release and regulation of releasing hormone secretion, thus control pituitary
function.
11) Regulation of cardiovascular activities.
12) Influence on different cyclic phenomena.
13) Relation to adrenalin and noradrenalin secretion.

Parts of the neuron with functions:

a) Cell body:
 Cytoplasm: Contains different organelles.
  Nucleus: Controls the cell function.
b) Cell processes:
 Axon: Conduct electrical impulse away from the cell body.
 Dendrite: Conduct electrical impulse towards the cell body.

Organization of nervous system:

Nervous system

Central nervous system Peripheral nervous system

Brain Spinal cord Somatic Autonomic

a) Forebrain - Cranial nerves - Sympathetic

- Cerebrum (12 pairs) (thoraco-lumber outflow)
- Diencephalons - Spinal nerves - Parasympathetic
b) Midbrain (31 pairs) (Cranio-sacral outflow)
c) Hindbrain
- Medulla
- Pons
- Cerebellum

Functions of glial cells:

Glial cell Functions
Microglial cells  Phagocytosis
Astrocytes 1) Provide supportive framework
2) Act as electrical insulator
3) Limit spread of neurotransmitter
4) Store glycogen
5) Take place of dead neurons
6) Produce neurotropic substances
Oligodendrocytes  Formation of myelin sheath in CNS.
Ependymal cells 1) Line the cavities of the CNS and make up the walls of the
ventricles. These cells create and secrete cerebrospinal
fluid (CSF) and beat their cilia to help circulate that CSF.
Schwann cell  Formation of myelin sheath in PNS.
Properties of nerve fiber:
1) Excitability
2) Conductivity
3) All or none law
 4) Refractory period
5) Summation
6) Adaptation
7) Accommodation
8) Indefatigability
List of neurotransmitters:
A) On the basis of mode of action:
1) Excitatory:
 Acetylcholine
 Adrenaline
 Noradrenalin
 Glutamate
2) Inhibitory
 Dopamine
 Glycine
 Alanine
 GABA
 Serotonin
3) Both excitatory and inhiobitory:
 5-HT (hydroxytryptamine)
 Histamine
 Prostaglandin
 Noradrenalin
Classification of reflxes:
A) Clinical:
a) Superficial: e.g. plantar response, abdominal reflex, cremasteric reflex, corneal reflex,
conjunctival reflex, sucking reflex etc.
b) Deep reflexes: Knee jerk, ankle jerk, biceps jerk, triceps jerk etc.
c) Visceral reflexes: Pupillary reflex, baro-receptor reflex, gastric reflexes.
d) Pathological reflexes: Babinski’s sign.
B) Anatomical:
a) Segmental
b) Intersegmental
c) Suprasegmental
C) Physiological:
a) Flexor / withdrawal reflex
b) Extensor reflex
D) Inborn or acquired:
a) Conditioned reflex: Develop after birth and their appearance depends upon previous
experiences.
b) Unconditioned reflex: All are inborn (present since birth).
Reflexes tested clinically:
a) Superficial: e.g. plantar response, abdominal reflex, cremasteric reflex, corneal reflex,
conjunctival reflex, sucking reflex etc.
b) Deep reflexes: Knee jerk, ankle jerk, biceps jerk, triceps jerk etc.
c) Visceral reflexes: Pupillary reflex (light reflex).
d) Pathological reflexes: Babinski’s sign.
Differences between the upper motor and lower motor neuron lesions:
Traits Upper motor neuron lesion Lower motor neuron lesion
1) Affected muscles Opposite site of the body affected Same side of the body affected
2) Type of paralysis Spastic type of paralysis occur Flaccid type of paralysis occur
3) Reflexes All superficial reflexes are lost and Both superficial and deep reflex
deep reflex are exaggerated. are lost.
4) Muscle wasting Muscle wasting absent. Muscle wasting present.
5) Fasciculation Fasciculation absent Fasciculation present
6) Clonus Clonus present Clonus absent
Functions of cerebellum:
a. Paleocerebellum: It facilitates a smooth, coordinated voluntary movement.
b. Neo-cerebellum:
 It plays an active role in the performance of voluntary movement.
 By maintaining muscle toile, it helps in maintenance of posture.
c. Archicerebellum: It helps in regulation of posture and equilibrium.

Cerebellar nuclei:
There are four pairs of nuclei of cerebellum –
1) Nucleus fastigii
2) Nucleus globosus
3) Nucleus emboliformis
4) Nucleus dentatus
Signs of cerebellar lesion:
1. Dysmetria and astaxia: .
2. Past pointing:
3. Failure of progression:
 Dysdiadochokinesia: Loss of rapid alternating movement is called dysdiadochokinesia.
 Dysarthria: Difficulty to form verbal words.
4. Intention Tremor:
5. Cerebellar nystagmus:
6. Hypotonia
Tests for cerebellar lesions:
 Finger nose test
 Adiadochokinesis / dysdiadochokinesia
 Gait test – ataxic gait
 Speech test – Slurred speech
 Ocular movement (for cerebellar nystagmus)
Special senses with their receptors:
Name of special sense Receptor
Vision Rods and cones
Hearing Hair cell of organ of corti
Olfaction or smell Bipolar cell of olfactory mucosa
Taste Taste bud of tongue
Equilibrium Vestibular apparatus
Names of refractory / optical media:
1. Cornea
2. Aqueous humour
3. Lens
 4. Vitreous humour.
Refractory error of the eye:
1. Myopia: Focus is formed in front of the retina.
2. Hypermetropia: Focus is formed behind the retina.
3. Astigmatism: No single point of focus is formed.
4. Presbyopia: Difficulty in both distant and near vision.
light reflex: Fall of light on cornea  refractive media  retina  received by rods and cones  optic
nerve  Opitc chiasma  Optic tract  pretectal nucleus  Edinger Westphal nucleus of same side 
Oculmotor nerve of same side  Ciliary ganglion  short ciliary nerve  sphincter pupilae of the eye of
same side  constriction of pupil of the eye of same side.
Changes occur in accommodation reflex :
1. Convergence of the eyeballs.
2. Contraction of ciliary muscles.
3. Relaxation of suspensory ligament.
4. Curvature of the lens increases.
5. Constriction of the pupil.
Components of Visual Pathway:
1. Rods & cones of retina.
2. Optic nerve.
3. Optic Chiasma
4. Optic tract
5. Lateral geniculate body
6. Optic radiation
7. Visual Cortex.
Lesion in part of visual pathway Effect

Optic nerve Total blindness of eye

Optic chiasma Bitemporal hemianopia
Optic tract Homonymous hemianopia
 Loss of nasal vision of affected side
 Loss of temporal vision of opposite side
Optic radiation Homonymous hemianopia
Pathway of hearing:
Air vibrate the tympanic membrane  impulse pass through malleus, incus and stepes  fenestra
st
vestibule  endolymph  hair cell of the organ of corti (auditory receptor)  spiral ganglion (1 order
nd
neuron)  cochlear nerve  dorsal and ventral cochlesr nucleus (2 order neuron)  auditory fiber 
rd
dorsal nucleus of trapezoid body (3 order neuron)  lateral leminiscus  inferior colliculus  medial
th
geniculate body (4 order neuron)  auditory radiation  auditory cortex (superior and inferior
transverse temporal gyrus).