Chapter 1

SEQS & MCQS BOOK ACCORDING TO UHS

MODULAR CURRICULUM

AUTHORS
DR. ABDUL MANAN
DR. AAYBAAD AHMAD
DR. GHULAM DASTGEER

3rd
 Copyright 2025
© All rights reserved TO THE PUBLISHERS. This book is protected by Copyright Act. No part of this
publication can be reproduced, stored in retrieval system, or transmitted in any form or by any means,
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ISBN 969__

FIRST EDITION 2023

SECOND EDITION 2024
THIRD EDITION 2025

Title:
CHAPTER 1

Authors:

DR. ABDUL MANAN

DR. AAYBAAD AHMAD
DR. GHULAM DASTGEER

Printed at:
Ishtiaq Mushtaq Printers, Lhr.
 ‫ٱلر ْح ه َم ِن ا‬
‫ٱلر ِح ِيم‬ ِ ‫ِب ْس ِم ه ا‬
‫ٱَّلل ا‬
"In the name of Allah the Most Gracious, the Most Merciful"

َ ‫ان ِإ اَّل َما‬

‫سعَى‬ ِ ‫س‬َ ‫ْل ْن‬ َ ‫( َوأ َ ْن لَي‬53:39)
ِ ْ ‫ْس ِل‬
And that man shall have nothing but what he strives for.

Contributed by Ahmad Raza (N68)

 Preface

Assalam-o-Alaikum!

We are glad to present you this book of Second Year MBBS which will be very helpful in
UHS exam. Its major aims are to provide topic-wise past SEQ’s and MCQ’s with authentic answers
according to UHS Modular syllabus. This book also contains Notes of Minor Subjects & Minor
topics of Major subjects, Practice MCQs of all subjects from authentic international sources.

Ideally one should practice SEQ’s and MCQ’s from this book. Adopting this routine, it will sharpen
the conceptual understanding of the subject, and will prove a beneficial tool for subsequent
examination preparation

We tried our best to make this book helpful. Please let us inform your feedback at:
mananansari3424@[Link]

aaybaadahmad@[Link]

g.dastgeer001@[Link]

Wishing you all the success!

 D E D I C A T E D TO
Our Parents & Teachers
and
Our Whole Family N-68
(Please Remember our late fellow Dr. Maryam Khan in your prayers)

For Details, Please Contact at:

Abdul Manan: 0308-8054273
Ghulam Dastgeer: 0308-1364301
Aaybaad Ahmad: 0309 0666200
Authors
Appreciation Letter by
Principal of Nishtar
Medical College

As the Principal of Nishtar Medical College,

“I am pleased to express my sincere appreciation to our Nishter graduates, from N68, who
have taken the initiative to write a past paper book series “Medical Mind Series” for their fellow
peers. This book is a valuable resource that will aid students in their preparation for upcoming exams
and provide them with an opportunity to practice and improve their knowledge and skills. The
dedication and hard work that our students have put into this project is commendable and reflects
their commitment to academic excellence. It is a testament to their passion for learning and their
desire to help their fellow students succeed. I am confident that this past paper book will prove to be
an invaluable tool for our students and will contribute to their success as they progress through their
academic journey. Once again, I would like to extend my heartfelt appreciation to the students who
have worked tirelessly to make this initiative a reality.

Best Regards,

Dr. Muhammad Rashad Qamar Rao

 DETAILED CONTENTS

BLOCK-1
Module 1: FOUNDATION MODULE
Sr. No. Subject Page No.
01 GENERAL ANATOMY 3
02 EMBRYOLOGY 22
03 HISTOLOGY 52
04 PHYSIOLOGY 64
05 BIOCHEMISTRY 91
06 PATHOLOGY 138
07 PHARMACOLOGY 160
08 COMMUNITY MEDICINE 167
09 BEHAVIORAL SCIENCES 177
10 AGING 187
11 UHS KEY OF MODULAR SYSTEM 188

Module 2: HEMATOPOIETIC & LYMPHATIC MODULE

Sr. No. Subject Page No.
01 GENERAL ANATOMY 195
02 EMBRYOLOGY 199
03 HISTOLOGY 200
04 PHYSIOLOGY 203
05 BIOCHEMISTRY 221
06 PATHOLOGY 239
07 PHARMACOLOGY 256
08 COMMUNITY MEDICINE 259
09 BEHAVIORAL SCIENCES 262
10 AGING 265
11 UHS KEY OF MODULAR SYSTEM 266

BLOCK-2
MODULE 3 ( MUSCULOSKELETAL & LOCOMOTION-1 )
Sr. No. Subject Page No.
01 GENERAL ANATOMY 271
02 EMBRYOLOGY 361
03 HISTOLOGY 366
04 PHYSIOLOGY 374
05 BIOCHEMISTRY 398
06 PATHOLOGY 438
07 PHARMACOLOGY 445
08 COMMUNITY MEDICINE 452
09 BEHAVIORAL SCIENCES 457
10 AGING 460
11 UHS KEY OF MODULAR SYSTEM 461
 BLOCK-3
MODULE 4 ( CARDIOVASCULAR-1 )
Sr. No. Subject Page No.
01 GENERAL ANATOMY 468
02 EMBRYOLOGY 483
03 HISTOLOGY 492
04 PHYSIOLOGY 496
05 BIOCHEMISTRY 549
06 PATHOLOGY 582
07 PHARMACOLOGY 602
08 COMMUNITY MEDICINE 611
09 BEHAVIORAL SCIENCES 613
10 AGING 618
11 UHS KEY OF MODULAR SYSTEM 619

BLOCK-4
MODULE 5 ( RESPIRATORY-1 )
Sr. No. Subject Page No.
01 GENERAL ANATOMY 623
02 EMBRYOLOGY 646
03 HISTOLOGY 652
04 PHYSIOLOGY 657
05 BIOCHEMISTRY 683
06 PATHOLOGY 691
07 PHARMACOLOGY 700
08 COMMUNITY MEDICINE 706
09 BEHAVIORAL SCIENCES 711
10 AGING 712
11 UHS KEY OF MODULAR SYSTEM 713
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BLOCK-1
TOS
SUBJECT SEQ MCQ MARKS
ANATOMY 4 20 40

PHYSIOLOGY 3 22 37

BIOCHEMISTRY 2 24 34

PATHOLOGY 1 8 13

PHARMACOLOGY 0 5 5

COMMUNITY MEDICINE 0 6 6

BEHAVIORAL SCIENCES 0 5 5

10x5 = 50 90 140

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FOUNDATION
MODULE

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A001 – F009
FOUNDATION GROSS ANATOMY
A-001 ֍Introduction to General Anatomy֍

1. [Annual 2011]
a) What is meant by Anatomical positions of Human body?
Answer: When a person is standing straight with eyes looking forwards, both arms by the side of body, palms facing forwards, both
feet together, the position is anatomical position
b) Briefly mention four fundamental anatomical planes used to
study human body.

Plane Description
Median Plane A plane passing through the center of the body
dividing it into two equal right and left halves
Sagittal/ Plane parallel to median or midsagittal plane is
Parasagittal the sagittal plane
Coronal A plane at right angles to sagittal or median plane
which divides the body into anterior and posterior
halves is called a coronal plane
Transverse/ A plane at right angles to both sagittal and
Horizontal coronal planes which divides the body into upper
and lower parts is called a transverse plane

A-002 ֍BONES֍

1. [2019 Annual 2019]

a) Name different parts of a growing long bone.
b) Why osteomyelitis is more common in bones of children?
Osteomyelitis is more common in bones of children because of
 Increased blood supply.
 Weak immune system
Thay make it easier for the bacteria to get into the bone.

2. [Annual 2023]
a) Describe the Arterial blood supply of the immature long bone. (03)
Artery Supply
Nutrient Artery  Bone marrow (via Central branches)
(Diaphyseal Artery)  Inner 2/3rd of Compact Bone (via Cortical branches)
Metaphyseal Arteries  Trabeculae of Spongy Bone

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Epiphyseal Arteries  Spongy Bone

 Red Bone marrow
 Deep parts of Articular cartilage
Periosteal Arteries  Outer 1/3rd of Compact Bone
 Periosteum

b) How healing of a bone occurs at the fracture site? (02)

2. (2015 Annual)
a) Classify long bones according to their shape quoting one example each.

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b) In a road accident, middle aged man got a fracture of femur neck. Clarify given terms:
Avascular necrosis A condition in which there is a loss of blood flow to bone tissue, which causes the bone to die. It is
most common in the hips, knees, shoulders, and ankles.
Osteochondrosis A term used to describe a group of disorders that affect the ossification centre in growing skeleton. It
begins as necrosis followed by regeneration

3. Explain the development of Long bone, their growth, and remodeling after birth. [Supple 2023 held in 2024]
Developement

Growth of long bones

 Growth plates are responsible for longitudinal growth during childhood & early adult age

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 Gorwth in diameter occurs by appositional growth (osteoblasts in the inner layer of the periosteum form bone, so that the
bone grows in diameter as well. As the bone diameter increases, bone tissue is removed from inside the medullary cavity by
the activity of the bone-resorbing cell called osteoclasts)
Remodeling of long bones
 The bones undergo continuous remodeling by deposition of osseous tissue at certain sites & resorption at other sites.
 This process allows bones to maintain its shape. This process is very faster in growing children & slower in adult

4. (2021 Supple)
b) What is growing end hypothesis?
The epiphysis that develops from the first appearing secondary center of ossification is the last to join diaphysis. One of the two bone
ends grows longer than other end which is termed as growing end of bone.
c) Explain Osteoporosis.
Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones
become weak and may break.

5. State the "Rule of ossification", What is the relationship of growing end of bone with direction of nutrient foramen. Which long
bone violates the rule of ossification, give its Justification. Define intramembranous & intracartilaginous ossifications. (ANNUAL
2024)
Rule of Ossification
The end of long bone which develops from first appearing secondary ossification center fuses later with diaphysis than other
epiphysis
Relationship
Direction of nutrient foramen is always AWAY from growing end of long bone for example;
 Upper end of humerus (Growing end) Direction of Nutrient foramen (DOWNWARD)
 Lower end of Radius & Ulna (Growing end) Direction of Nutrient foramen (UPWARD)
Bone violating this rule FIBULA

Intramembranous Bone formation without previous cartilage formation. Osteoblasts lay down unmineralized bone matrix called
Classification osteoid which quickly becomes mineralized
 Flat bones of the skull, Bones of the face and clavicle develop by this method
Intracartilagenous In this type of ossification a miniature cartilaginous framework is formed and bone fossification starts at the
Classification center of that framework.
(Endochondral)  Long bones such as femur develop by this method

A-003 ֍CARTILAGE֍

Note: Prepare this table for mcqs especially location

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A-004 ֍JOINTS֍

01. Synarthrosis (Fibrous & Cartilaginous Joints)

1. Define Fibrous joint & classify it with examples. (2005 Annual) (2006 Annual)
In fibrous joints the bones are joined by fibrous tissue. These joints are either immovable or permit a slight degree of movement.
Type Example
1. Sutures (i) Plane, e.g., internasal suture
(ii) Serrate, e.g., interparietal suture
(iii) Squamous, e.g., temporo-parietal suture
(iv) Denticulate, e.g., lambdoid suture
(v) Schindylesis type e.g., between rostrum of sphenoid and upper border of vomer.
2. Syndesmosis Inferior tibiofibular joint
Vertebral ligaments (supraspinous & interspinous ligamentum, ligamentum flavum, transverse ligament)
Interosseous membrane between radius & ulna, between tibia & fibula
3. Gomphosis Root of the tooth in its bony socket

Types of Cartilaginous Joints

Type Description
Synchondroses In these joints, uniting medium is hyaline cartilage
(Pri cartilaginous type) Non movement at these joints
Example  Growth plate or epiphyseal cartilage
Symphyses In these joints, uniting medium is fibrocartilage
(Sec cartilaginous type) Limited movement at these joints
Example  Pubic symphysis, Intervertevral disc, Manubirosternal joint
Note: Prepare this table as it is imp for mcqs

02. Diarthrosis (Synovial Joints)

1. (2022 Annual)
a) What is the major factor which controls the joint stability.
Answer: Muscle tone surrounding and acting on the joint is most important factor contributing to the stability of joint.
b) Explain the mechanism of factor with one example from upper & lower limb.
Muscle tone stabilizes joints through mechanisms such as muscle tension, co-contraction of agonist and antagonist muscles, joint
compression, and proprioceptive feedback. These mechanisms work together to maintain joint stability, prevent excessive movement,
and ensure proper alignment during various activities.
In upper limb
 Muscles surrounding the shoulder joint, such as the rotator cuff muscles help to maintain stability by exerting muscle tension
on the joint capsule and ligaments, preventing excessive movement and maintaining proper alignment.
In lower limb
 In the lower limb, the knee joint stability is maintained by the co-contraction of the quadriceps muscles (agonists) and the
hamstrings muscles (antagonists). The quadriceps muscles extend the knee joint, while the hamstrings muscles flex the knee
joint. The balanced activation of these muscle groups during muscle tone helps stabilize the knee joint and prevent excessive
movement.

2. (2021 Annual held in 2022)

a) What does degree of freedom of movements in synovial joint means.
The degree of freedom of movement in a synovial joint refers to the number and types of movements that can occur at that joint.

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b) Classify Synovial joints according to degree of freedom of movement giving one example of each.
Type of Joint Description
Uniaxial Joint  Hinge joints (elbow joint) allow only flexion and extension
 Pivot joints (atlas and axis vertebrae) allow only rotation
Biaxial Joint  Condylar joints (metacarpophalangeal joints) allow flexion-extension and limited rotation
 Saddle joints (joint at the base of the thumb) allow flexion-extension, abduction-adduction &
circumduction movements
Multiaxial Joint  Ball-and-socket joint such as shoulder and hip joints, allowing flexion-extension, abduction-
adduction, circumduction and rotation.

3. (Annual 2018)
a) Define Bursa & Synovial sheath. What is the role of these in relation to trauma and infection.
Bursa A bursa is a small, fluid-filled sac that acts as a cushion between bones, tendons, muscles, and other
structures in the body. It helps to reduce friction and provide smooth gliding surfaces, allowing for easy
movement of these structures against each other.
In relation to trauma & Infection
 Traumatic injury, such as direct impact or excessive pressure on a bursa, can lead to bursitis, which
is the inflammation of a bursa. Bursitis causes pain, swelling, and limited range of motion in the
affected joint.
Synovial sheath A synovial sheath is a tubular structure that surrounds certain tendons, particularly those passing through
confined spaces, such as in the hands, wrists, and feet. The role of synovial sheaths is to reduce friction and
provide a smooth gliding surface for tendons as they move within the confined spaces of the body
In relation to trauma & Infection (tenosynovitis)
 Synovial sheaths can be affected by direct injury or repetitive overuse. Trauma or inflammation can
cause swelling, thickening of the synovial sheath, and the production of excess synovial fluid. These
changes can impede the smooth movement of the tendon, leading to pain, restricted range of motion,
and conditions such as tenosynovitis or trigger finger.

b) Enumerate and briefly describe with examples the key factors stabilizing the joint.
Key Factors Description Example
Shape and size of In certain joints shape, size & arrangement In Hip joint, Acetabular socket of hip bone & large
articulating surface of long of articulating bony surface play role in ball shaped head of femur make joint stable
bones. stability of joint
Tone of muscles around It is the most important factor that Rotator cuff muscle stabilize shoulder joint by
joint contributes to the stability of joint muscle tension
Ligaments of joint They prevent excessive movements & also Knee joint is stabilized by anterior & posterior
guard against injury due to sudden & cruciate ligament
accidental stress

4. [Supple 2017 held in 2018 + 2016 Supple held in 2017 + 2015 Annual]
a) Classify the synovial joints based on shape of articular surface giving one example of each
Type Examples
Plane Joints Intermetatarsal joints
Hinge Joints Elbow joint & Interphalangeal joint
Pivot joint Superior radio-ulnar joint
Bicondylar joint Knee joint, Temporomandibular joint
Ellipsoid Joint Wrist joint, Metacarpophalangeal joint
Sellar Joint Carpo-metacarpal joint of thumb, Ankle joint, Calcaneocuboid joint.
Spheroidal Joint Hip joint & Shoulder Joint

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b) Enumerate any 6 features of synovial joint.

1. Articular Cartilage 2. Joint Cavity
3. Synovial membrane 4. Joint capsule
5. Ligaments 6. Synovial fluid
5. A doctor inserted arthroscope in a synovial joint for examination. Enlist any 6 structures which can be visualized.
See Q4b
6. What is ellipsoid joint? What movements are possible at ellipsoid joints. Give an example of ellipsoid joint from upper limb.
An ellipsoid joint, also known as a condyloid joint, is a type of synovial joint where the convex oval-shaped surface of one bone fits
into the concave surface of another bone.
Possible movements
 Flexion and extension
 Abduction and adduction
 Circumduction
 Rotation around the long axis is not possible at ellipsoid joints.
Example in upper limb
 Wrist joint between the radius bone and the carpal bones of the hand. The rounded distal end of the radius articulates with the
concave surface of the scaphoid and lunate bones, forming an ellipsoid joint
7. (Annual 2009)
a) Define Complex joint; mention 3 examples from upper limb.
A joint containing an articular disc or meniscus is classified as complex joint
Examples of complex joints in the upper limb
1. Shoulder joint
2. Elbow Joint
3. Wrist Joint (Radiocarpal Joint)
b) Explain the movements of uniaxial complex joint of upper limb which has pivot structural appearance.
Radioulnar joint
Pronation Pronation refers to the movement of the forearm where the palm of the hand turns downward or backward. In
the context of the radioulnar joint, pronation involves the rotation of the radius bone over the ulna bone. During
pronation, the distal end of the radius bone moves across the ulna, causing the palm to face downwards.
Supination In the radioulnar joint, supination occurs when the radius bone rotates back to its anatomical position parallel to
the ulna bone. This movement brings the palm of the hand to face upwards.
c) Why screws, nuts & bolts are tightened with the right hand by all persons (irrespective of handedness).
Tightening of screws, nuts and bolts require movement of hand in clock-wise direction which can be easily achieved by right hand as
compare to left hand.

A-005 ֍INTEGUMENTARY SYSTEM֍

1. What are langer‘s lines & its surgical importance? [Supple 2017 Final year MBBS]
Langer‘s lines  skin tension lines which represent orientation of dermal collagen fibers
Surgical importance  Any incision parallel to these lines results in better & less scaring

A-006 ֍MUSCLE TISSUE֍

1. Classify Skeletal Muscles on basis of group Action with examples. (2021 Supple held in 2022) & (2017 Annual)

Type Description & Example

Agonist Brings about the desired movement.
For extension of elbow, triceps is agonist.
Antagonist Oppose the prime movers. They help the prime movers by active controlled relaxation, so that the desired
movement is smooth and precise.
In extension of elbow, biceps is antagonist.

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Fixator Group of muscles which stabilize the proximal joints of a limb, so that the desired movement at the distal
joint may occur on a fixed base.
Muscles acting on shoulder joint fix it for better movement of fingers.
Synergist When the prime movers cross more than one joint, the undesired actions at the proximal joints are prevented
by certain muscles known as synergists.
During making a tight fist by long digital flexors, the wrist is kept fixed in extension by the synergists
(extensors of wrist).

2. Classify Muscle fibers parallel to line of pull with examples, range of their power and mobility. (2020 Annual)

Muscle Type Power Range of mobility Examples

Strap like Muscle Less More Sartorius, Rectus abdominus, Infrahyoid
(Sternohyoid & Sternothyroid)
Quadrilateral Muscle More Less Thyrohyoid muscle of larynx
Fusiform Muscle Intermediate Intermediate Biceps Brachii.

3. What are pinnate muscles. Give its types with example of each type. (Annual 2014)
―Feather like muscles in which muscle fibers are obliquely attached to the tendon‖
Type Description Example
Unipennate All muscle fibers are attached to the one side of tendon. Flexor pollicis longus, extensor
digitorum longus
Bipennate Muscle fibers are attached on both sides of centrally located Rectus femoris, Dorsal interossei of
tendon. both hands & feet
Multipennate Some muscles contain a series of intramuscular tendinous septa Subscapularis & Deltoid.
which afford attachment of many pennate masses lying side by
side.

A-007 ֍VASCULAR SYSTEM֍

01. Arterial Anastomosis

1. (2020 Supple held in 2021)

a) What are the end arteries? Give 2 examples. Mention the result of their occlusion.
Arteries which do not anastomose with their neighbors are called end arteries (Fig. 5.12).
Examples
1. Central artery of retina and labyrinthine artery of internal ear are the best examples of an absolute end arteries.
2. Central branches of cerebral arteries and vasa recta of mesenteric arteries.
3. Arteries of spleen, kidney, lungs and metaphyses of long bones.
Importance
 Occlusion of an end-artery causes serious nutritional disturbances resulting in death of the tissue supplied by it. For example,
occlusion of central artery of retina results in blindness.
b) Define Potential Arterial anastomosis. Give its significance with examples.
In potential arterial anastomoses the communication takes place between the terminal arterioles.
Significance:
 Such communications can dilate only gradually for collateral circulation. Therefore, on sudden occlusion of a main artery, the
anastomoses may fail to compensate the loss. The examples are seen in the coronary arteries and the cortical branches of
cerebral arteries, etc. Sudden block in coronary artery leads Myocardial infarction.

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02. Functional Classification of Blood Vessels

Group Type of vessel Function Example

Conducting vessels Elastic arteries Conduct blood from heart towards body Aorta & Pulmonary trunk
Distributing vessels Muscular arteries Supply individual organs & divide into branches Brachial artery, Femoral
within these organ artery
Resistance vessels Small arteries Source of peripheral resistance to blood flow Arterioles & Precapillary
sphincters
Exchange vessels Capillaries Exchange of substances between blood & Capillaries, Sinusoids &
interstitium postcapillary venules
Reservoir vessels Veins Accomudate large volume of blood due to their Vena cava & Juglar veins
(Capacitance vessels) distensibility
Note: Remaining things from this section will be covered in physiology & histology

A-008 ֍NERVOUS SYSTEM֍

1. (2012 Annual)
a) Define spinal nerves & name various spinal nerves existing in human body with the number.
Nerve fibers arising from spinal cord column, leaving vertebral canal through intervertebral foramen is termed as spinal nerve.
There are 31 pairs of spinal nerves, including 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal.
b) Write pattern of emergence of various spinal nerves from vertebral column.
The nerve emerges through the intervertebral foramen, gives off recurrent meningeal branches, and then divides immediately into a
dorsal and a ventral ramus. All spinal nerves emerge above the respected vertebra except 8 th cervical nerve which emerges below the
spinal arch of C7 vertebra.

2. Define dermatomes, give their number and extent of coverage of the body. [Supple 2023 held in 2024]
Dermatomes are areas of the skin whose sensory distribution is innervated by the afferent nerve fibres from the dorsal root of a
specific single spinal nerve root.
Number Extent of Coverage
C1 No dermatome
C2 & 3 Back of head, and Neck
C4,5,6,7,8, T1,2 Upper limbs
T3-12 Trunk (chest & abdomen)
T10 Umblicus
L1-5, S1-3 Lower limb
S4-5 Perianal region
Note: Spinal dermatomes do not extend over the face; skin of face is supplied by branches of trigeminal nerve (5th CN)

A-009 ֍IMAGING֍
Prepare difference between CT-scan & MRI from Laiq Hussain General Anatomy, it can be asked in viva. Prepare X-rays given in
end of Upper Limb/Lower Limb/Thorax section of Snell/s Clinical Anatomy, they are usually asked in OSPE.

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֍PAST MCQs֍

01. Anatomical Nomenclature & Introduction

01. In anatomical position

a) The body is lying down position with face directed upward c) The body erect, with arms onside, palms facing forward
b) The body is erect with palm directed backward. d) Hips & Knees are fully extended.
02. Which body plane divides body in equal 2 right & left halves.
a) Transverse c) Sagittal
b) Coronal d) Parasagittal
03. Principle type of tissue are except
a) Epithelium c) Muscle
b) Connective tissue d) Reticular tissue
04. Regarding different positions of the body supine position is ―------‖?
a) The person is lying on his face c) is lying on right side
b) A person standing erect d) is a person lying on his back
05. rotates the radius medially so that the palm of the hand faces posteriorly and its dorsum faces anteriorly
a) Pronation c) Protraction
b) Supination d) Retraction
06. Movement by which the pad of the 1st digit (thumb) is brought to another digit pad
a) Protraction c) Opposition
b) Retraction d) Reposition
07. Anterolateral movement of scapula is called _______
a) Protraction c) Protrusion
b) Retraction d) Retrusion

ANSWER KEY
1. c 2. c 3. d 4. d 5. a 6. c 7. a 8. 9. 10.

02. Bone & Cartilage

01. Which one of the following is long bone

a) Carpel c) Metatarsal
b) Tarsal d) Vertebra
02. The characteristic of elastic cartilage includes all of the following except
a) It does not ordinarily undergo calcification
b) Its matrix is abundant in elastic fibers
c) It is highly vascular
d) it is found in pinna, tip of nose, and in pharyngo-tympanic tube
03. Patella is a type of_____________________________
a) Sesamoid bone c) Long bone
b) Pneumatic bone d) Short bone
04. Regarding bone choose correct statement
a) Long bones have 1 epiphysis & 2 diaphysis c) Sesamoid bone has no periosteum
b) Pneumatic bone contain large fluid space d) Membranous bones ossify in cartilage
05. Primary ossification center
a) Appears after birth c) Responsible for increasing length of bone
b) forms diaphysis of long bone d) Present in epiphyses
06. Periosteal arteries are derived from _______
a) A major artery passing near the bone c)Muscular arteries of muscle attached to joint
b) Anastomosis around joint d) Metaphyseal arteries

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07. Knuckle shaped articular surface of bone is called _________________

a) Facet c) Trochlea
b) Condyle d) Notch
08. Which of the following is not a hyaline cartilage
a) Epiphyseal cartilage c) Costal cartilage
b) larynx, trachea & bronchi d) Epiglottis
09. Which of following is not a fibrocartilage
a) eustachian tube c) Intervertebral disc
b) Labrum acetabulum d) Meniscus
10. Which of the following is not an elastic cartilage
a) Auricle c) epiglottis
b) inferior part of external nose d) Eustachian tube
11. Choose the incorrect match
a) Pressure Epiphyses (head of femur & humerus) c) Atavistic Epiphyses (Posterior process of talus)
b) Traction Epiphyses (Greater trochanter of femur) d) Aberrant epiphyses ( head of 2nd metacarpal)
12. Wormian bone is found in ____________ suture
a) Sagittal suture c) Ethmoido-sphenoid
b) Lambdoid suture d) inter-maxillary
13. Sesamoid bone is not found in
a) Quadriceps femoris c) Adductor pollicis
b) Flexor pollicis brevis d) Extensor digitorum

ANSWER KEY
1. c 2. c 3. a 4. c 5. b 6. c 7. b 8. d 9. a 10. b
11. d 12. b 13. d 14. 15. 16. 17. 18. 19. 20.

03. Joints

1. Which of the following belongs to diarthrosis variety of joints

a) Gomphosis c) Synovial joint
b) Synchondrosis d) Symphysis
2. Regarding Joints all of the following statements are true except.
a) Symphyses is secondary cartilaginous joint b) Synovial joints are partially moveable joints
c) The joint between tooth and its bony socket is called gomphosis d) Schindylesis is a type of suture joint.
3. The following are ball and socket joints.
a) Knee and Ankle joint c) Wrist & Elbow joint
b) Shoulder & Hip joint d) Meta-carpophalangeal and interphalangeal joint
4. Regarding joints all of the following are true except.
a) Sutures are immobile c) Synchondrosis is P-cartilaginous joint
b) Gomphosis is fibrous joint d) Suture is secondary cartilaginous joint
5. The synovial joints ______________________________
a) have synovial membranes covering articular surface of bones
b) Have hyaline cartilage covering the articular surface of bone
c) Are capsule made up of skeletal muscle fibers
d) Contain synovial fluid secreted by fibrous capsule of joint.
6. Following are the types of synovial joint except
a) Saddle c) Ellipsoid
b) Pivot d) Joint between vertebral bodies

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7. A symphysis _____________________________________
a) is a primary cartilaginous joint c) Does not allow any movement
b) Contain a fibrocartilaginous disc d) has no ligaments around
8. A symphysis _____________________________________
a) is a P-cartilaginous joint c) always present in median plane
b) allows wide range of movement d) Joins metaphysis with epiphyses
9. Circumduction is a movement that involves ___________________
a) Ball & Socket joint c) Saddle joint
b) Pivot joint d) Hinge joint
10. Which of the following joint is ellipsoid
a) Ankle c) Knee
b) Wrist d) Sternoclavicular
11. Syndesmosis is a type of _______________ joint
a) S-Cartilaginous c) Synovial
b) Fibrous d) P-cartilaginous
12. Regarding joints all of the following statements are true except:
a) Symphysis is S-cartilaginous joint b) Synovial joint is partially mobile
c) Joint between tooth & socket is gomphosis d) In syndesmosis, interossious ligament is found b/w bones
13. Which one of the following joint is not fibrous
a) Suture c) Symphysis
b) Syndesmosis d) Gomphosis
14. Which characteristic is false regarding the knee joint.
a) Uniaxial joint c) complex joint
b) Bicondylar joint d) Hinge joint
15. Epiphyseal growth plate is _________________
a) Syndesmosis c) Gomphosis
b) Synchondrosis d) Suture
16. Chose incorrect match
a) Serrate suture (Sagittal suture) c) Squamous suture ( Temporoparietal suture)
b) Denticulate suture ( Lambdoid suture) d) Plane suture (between tooth & socket)
17. Which of following is not an interosseous ligament?
a) Stylohyoid ligament c) Ligament flava
b) Coracoclavicular ligament d) Cruciate ligament
18. Which of the following is not a synchondroses
a) Epiphyses of long bone c) between occipital & Petrus
b) between ethmoid & sphenoid d) Manubri-sternum
19. Which of the following is found in synchondrosis.
a) Hyaline cartilage c) Interosseous ligament
b) Fibrocartilage d) Synovial fluid
20. Which of the following is found in Symphyses
a) Hyaline Cartilage c) Interosseous ligament
b) Fibrocartilage d) meniscus
21. Meniscus is a wedge shaped fibrocartilage found in __________________
a) Hip joint c) Shoulder joint
b) Elbow joint d) Knee joint
22. Which of the following is not a complex joint
a) Elbow joint c) Sterno-clavicular joint
b) Knee joint d) Acromio-clavicular

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23. Which of the following is a compound joint

a) Interphalangeal joint c) Shoulder joint
b) Elbow joint d) Knee joint
24. Which of the following is not a plane joint
a) between articular process of vertebra c) between tarsals
b) between carpels d) knee joint
25. Select incorrect pair
a) Hinge joint (knee joint) c) Ellipsoid joint (wrist)
b) Pivot joint ( Atlantoaxial joint) d) Sellar joint (wrist)
26. Which of the following is not a saddle joint
a) 1st carpometacarpal joint c) Ankle joint
b) Metacarpophalangeal joint d) Calcaneocuboidal joint

ANSWER KEY
1. c 2. b 3. b 4. d 5. b 6. d 7. b 8. c 9. a 10. b
11. b 12. b 13. c 14. a 15. b 16. d 17. d 18. d 19. a 20. b
21. d 22. a 23. b 24. d 25. d 26. b 27. 28. 29. 30.

04. Muscle

1. Regarding Muscle all of the above statements are correct except ________________
a) Smooth muscles are spindle shaped c) Skeletal muscles are in voluntary control
b) Cardiac muscles are striated d) Smooth muscle of ciliary body are voluntary
2. Regarding the muscle all are true except _______________
a) Deltoid is multipennate muscle c) Sartorius has parallel muscle fibers
b) Dorsal interossei are multipennate d) Parallel muscle fibers have great range of movement
3. Epimysium Covers ________________
a) Muscle fiber c) Whole muscle
b) Bundle of muscle fibers d) Ligament
4. Following is a fan shaped muscle ______________
a) Omohyoid c) Orbicularis oris
b) Subclavius d) Temporalis
5. Which condition is false regarding condition of muscle atrophy.
a) Chronic illness c) Denervation
b) Lower motor neuron disease d) Weight lift
6. Tendon is made up of _____________________
a) Irregular collagen fibers c) fibroelastic cartilage
b) Elastic fibers d) dense regular collagen
7. Select the incorrect match
a) Hemiplegia (paralysis of one half of the body c) Quadriplegia (paralysis of all four limbs)
b) Paraplegia (paralysis of both lower limbs) d) Hemiparesis (Weakness of both shoulders)
8. Which of the following is not a spiral muscle
a) Latissimus dorsi c) Serratus anterior
b) Pectoralis major d) supinator
9. Which of the following is not a triangular muscle
a) Adductor longus c) Temporalis
b) Deltoid d) Frontalis
10. Which of the following is not a uni-pennate muscle
a) Rectus femoris c) Extensor digitorum
b) Flexor pollicis longus d) Peroneus tertius

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11. Which of the following is bipennate muscle

a) Flexor pollicis c) Deltoid
b) Extensor digitorum d) Rectus femoris
12. Which of the following is multipennate muscle
a) Rectus femoris c) Subscapularis
b) Deltoid d) Temporalis
13. Which of the following is circumpennate muscle
a) Sartorius c) Tibialis anterior
b) Orbicularis oris d) Rectus abdominus
14. Which of the following is a cruciate muscle
a) Massater & Sternocleido-mastoid c) Glossopharyngeus
b) Omohyoid d) latissimus dorsi
15. The sarcoplasmic reticulum:
a) is a part of neuromuscular junction c) is continuous with T-tubules
b) inhibits calcium production d) releases calcium which allows actin to bind with myosin
16. The neuromuscular junction is a specialized form of synaptic contact between motor neuron acon terminal and muscle. Which of
the following properties distinguish it from the CNS synapse.
a) The presence of junctional folds of the post synaptic membrane
b) The presence of synaptic vesicles with in the presynaptic axon
c) The presence of postsynaptic receptor membrane
d) The presence of synaptic cleft
ANSWER KEY
1. d 2. b 3. b 4. c 5. d 6. d 7. d 8. c 9. d 10. a
11. d 12. c 13. c 14. a 15. d 16. a 17. 18. 19. 20

05. Circulatory System

1. AV shunt is present in _________________

a) Lips c) Spleen
b) Deltoid d) Kidney
2. Regarding blood vessels all of the following statements are false except.
a) In the continuous capillaries, endothelium has small pores c) Aorta is an elastic artery
b) Sinusoids are dilated veins d) Capillaries have semipermeable valves
3. Following are the end arteries except ________________
a) Central artery of retina c) Renal artery
b) Coronary artery d) Splenic artery
4. Sinusoidal capillaries are found in _____________
a) Kidney c) Muscle
b) Liver d) Skin
5. Regarding blood vessels _____________________
a) large arteries are elastic having valves c) Capillaries have thick muscular coat
b) Veins of lower limb have no valves d) Sinusoids are large vascular irregular spaces
6. Portal system is formed by two sets of ________________
a) Arteries c) Arterioles
b) Veins d) Capillaries
7. Which of the following function as resistance vessel?
a) Elastic arteries c) Arterioles
b) Muscular arteries d) Venules

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8. Lymph capillaries are _____________

a) Blind ended c) little in dermis
b) have small caliber than capillary d) Don‘t make network
9. In Atherosclerosis, lipids deposit in ____________ of vessel
a) Tunica intima c) Tunica adventitia
b) Tunica media d) Muscularis externe
10. Lymph vessels are not present in __________
a) Skin c) Chest cavity
b) GIT d) Spinal cord
11. The lymph from abdomen enters in thoracic cavity by
a) Cisterna chyle c) Right lymphatic duct
b) thoracic duct d) subclavian vein
12. Fenestrated capillaries are found in following places except
a) Intestine c) Endocrine gland
b) Brain d) Kidneys
13. Select incorrect match of anastomosis with its example?
a) End to end anastomosis (right & Left gastro-epiploic artery)
b) Anastomosis by convergence (Right & left vertebral artery forming basilar artery)
c) Transverse anastomosis (Ulnar & radial arteries at wrist)
d) Potential anastomosis (retinal arteries)
14. Which of the following arteries are best example of potential anastomosis?
a) Cerebral arteries c) Coronary arteries
b) Arteries in liver d) Mesenteric arteries
15. Which of the following vascular shunt is responsible for formation of glomus bodies in skin?
a) AV-shunt c) Potential anastomosis
b) Venous anastomosis d) Arterial anastomosis
16. Portal System exists in except
a) Glomerular capillaries c) Emissary veins of skull
b) Hypothalmophyseal veins d) Hepatic veins
17. The thoroughfare channel ends at the
a. Arteriole c. Vein
b. Venule d. Capillary
18. Valves of heart are formed by folding of
a. Myocardium c. Endocardium
b. Pericardium d. Epicardium
19. Papillary muscles in heart are extensions of
a. Endocardium c. Myocardium
b. Pericardium d. Epicardium
20. Blood flow through capillary is controlled by
a. Precapillary sphincter c. Venules
b. Thoroughfare channel d. Plexus
21. Lymph is a transit fluid between
a. Interstitial fluid and blood c. Interstitial fluid and blood plasma
b. Blood and serum d. Interstitial fluid and serum
35. Valves are found in the
a. Lymphatic vessels only c. Lymphatic vessels and veins
b. Veins only d. Arteries only

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ANSWER KEY
1. a 2. d 3. b 4. b 5. d 6. d 7. c 8. a 9. a 10. d
11. a 12. c 13. d 14. c 15. a 16. c 17. b 18. c 19. a 20. a
21. a 22. c

06. Nervous System

1. The autonomic nervous system

a) Control Skeletal muscles c) Prepare the body for fight & flight response
b) Arise from spinal cord only d) has no connection with adrenal medulla
2. Which of the following is not a component of CNS?
a) Neuron c) Basal ganglia
b) Spinal cord d) Cranial nerve
3. Outermost Covering of nerve is called _____________________
a) Endoneurium c) Epineurium
b) Perineurium d) Epimysium
4. Spinal nerve ___________________
a) have dorsal and ventral rami with peripheral ganglion on dorsal ramus
b) Are formed in intervertebral foramen
c) Comprise 25 pairs
d) Distribution of lower limb is through dorsal rami.
5. A typical spinal nerve is _____________________________
a) Motor c) Mixed
b) Sensory d) Sympathetic
6. Regarding the sympathetic division of autonomic nervous system
a) Acetylcholine is released by some sympathetic post ganglionic fibers
b) Most sympathetic pre-ganglionic nerve fibers secrete nor-adrenaline
c) Sympathetic postganglionic fibers are found in spinal segment T1-L2
d) The sympathetic chain extends from thoracic to the sacral region of spinal cord
7. A part of neuron provides greatest surface area of synaptic reception
a) Axon c) Collateral axon
b) Cell body d) Dendritic process
8. Multiple Sclerosis is a disease characterized by preferential damage to myelin that becomes detached from axon in the CNS. Which
associated cells involve?
a) Oligodendrocytes c) Satellite cell
b) Microglia d) Schwan cell
9. Type of neuron in autonomic ganglion is ________________
a) Unipolar neuron c) Multipolar neuron
b) Bipolar neuron d) Purkinje cell
10. Which of the following statement regarding post-ganglionic fibers of parasympathetic ganglia is incorrect
a) From ciliary ganglion they supply constrictor of pupil c) From submandibular ganglion they supply sublingual gland
b) From pteropalatine ganglion they supply lacrimal gland d) From otic ganglion they supply minor salivary gland
11. Select the incorrect match of gland and the nerve supplying pre-ganglionic fibers.
a) Ciliary ganglion (Occulomotor nerve) c) Submandibular ganglion ( Trigeminal nerve)
b) Pterygopalatine ganglion (fascial nerve) d) Otic ganglion (Glossopharyngeal nerve)
12. Which of the following statement is incorrect regarding Spinal nerves.
a) Ventral ramii supply anterio-lateral body c) Thoracic spinal nerves are typical spinal nerve
b) Dorsal rami supply posterior part of body d) Ventral rami except T6-L3 form plexus
13. Nerve fibers are bound in fassicles and held together by connective tissue known as the
a) Endoneurium c) Perineurium
b) Sheath of schwann d) Epineurium

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14. Which of the following layer of brain contains blood vessels

a) Arachnoid c) Dura matter
b) Pia matter d) Subdural space
15. Each of the following is found within the cytoplasm of nerve cell body except
a) lysosomes c) Nissel granules
b) Microtubules d) Axoplasmic vessels
16. Nissel bodies are composed of
a) Synaptic vesicles c) Neurofilaments
b) polysomes d) SER
17. which of the following is non-capsulated afferent nerve ending.
a) Pacinian c) Meissner corpuscle
b) Kraus end bulb d) Markel‘s ending
18. Axon hillock contains
a) RER c) Microtubules
b) Ribosomes d) Golgi complex
19. The blood brain barrier is thought to occur because capillaries in the CNS have which of the following characteristics
a) Discontinuous basal lamina c) Fenestrae without diaphragm
b) Fenestrae with diaphragm d) A few pinocytic vesicles
20. Which of the following specialized receptors exhibit a large ovoid capsule containing of many concentric lamellae each separated
by a space containing tissue fluid.
a) Cold receptors c) Ruffini endings
b) Pacinian corpuscles d) Meissner corpuscles
21. Synapses may be classified on the basis of each of the following except:
a) Position c) Organelle content
b) Membrane specialization d) Synaptic vesicle content
22. Myeline is formed by:
a) Satellite cell c) Ependyma cell
b) Schwan cell d) Astrocytes
23. In CNS, macrophages are formed by
a) Astrocytes b) Microglia
c) Satellite cells d) Ependyma
24. Which of the following cell in CNS is homologous to schwann cell in PNS.
a) Astrocytes c) Oligodendrocytes
b) Satellite cell d) Microglia
25. The highest concentration of microtubules occur in which part of neuron
a) Nissil granules c) Initial segment of axon
b) Apical dendrite d) Node of Ranvier
26. Collateral sprouting occurs in:
a) Damaged axons c) Undamaged axons
b) Damaged cell bodies d) intact glial process
27. The cell lining the ventricle of the brain and central canal of the spinal cord are known as:
a) Astrocytes c) Ependymal cells
b) Microglia d) Oligodendrocytes
28. The node of Ranvier is a region which may be best described as:
a) An area of sensory input c) A motor endplate
b) A region where Schwan cells are in juxtaposition d) An area of synaptic contact
29. Major impediment to regeneration in CNS is:
a) Astrocytic process c) Axonal process
b) Oligodendrocyte process d) Collagen scar

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30. White matter of CNS contains _____________

a) Unmyelinated axons c) Myelinated axons
b) Dendrites d) Cell bodies
ANSWER KEY
1. c 2. d 3. c 4. b 5. c 6. a 7. d 8. a 9. c 10. d
11. c 12. d 13. c 14. b 15. d 16. b 17. c 18. c 19. d 20. b
21. c 22. b 23. b 24. c 25. c 26. c 27. c 28. b 29. a 30. c

07. Integumentary System

1. The superficial fascia is dense in all places except _________________

a) Scalp c) Toe of foot
b) Sole of foot d) Areola of breast
2. Fat of superficial fascia is absent in ________________
a) Face c) Breast
b) Nose d) Dorsum of hand
3. Regarding the deep fascia choose the correct statement
a) It is a mixture of adipose & loose areolar tissue c) It forms limb compartments by septa b/w muscles d) It
b) It is well developed over abdomen forms ligaments over joints
4. Which of the following is one of the appendages of skin
a) Stratum corneum c) Dermis
b) Epidermis d) Hair follicles
5. The cells helping in skin pigmentation _______________
a) Histocytes c) Monocytes
b) Melanocytes d) Keratocytes
6. Retinacula are thickening of ____________________
a) Dermis c) Deep fascia
b) Superficial fascia d) Capsules of joint
7. Stratum germinatum is another name of ____________
a) Stratum corneum c) Stratum granulosum
b) Stratum Basale d) Stratum lucedum
8. Part of human body, in which hair does not grow.
a) Palms & Soles c) lips
b) Glans penis, clitoris, labia minora d) Dorsum of hand
9. Areola of the breast is a modified
a) Sweat gland c) salivary gland
b) Sebaceous gland d) Nevus
10. Sebaceous glands are not found in
a) Face c) palms & sole
b) Axilla d) groin
11. The color of skin is the result of
a) Carotene c) Biliverdin
b) Melanin d) Oxyhemoglobin
12. Keratohyalin granules of skin are present in
a) Stratum corneum c) Stratum Spinosum
b) Stratum granulosum d) Stratum germinatum
13. The arrector pili muscle is
a) attached to the epidermis and adjacent sweat glands c) a type of cardiac muscle
b) in direct contact with hair shaft d) attached to connective tissue sheath of muscle

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14. The intercellular bridges of the skin are characteristic of which of the following layer of skin
a) Stratum corneum c) Stratum Spinosum
b) Stratum granulosum d) Stratum germinatum
15. Which of the following statement about hair follicle is true
a) They are associated with eccrine sweat gland
b) They are present in skin but not in thick skin
c) Their associated arrector pili muscle is composed of striated muscle
d) Their hair shaft inserts into papillary muscle
16. which of the following is an appendage of skin
a) Meissner corpuscle c) nail
b) Krause & bulb d) Langerhans cells
17. Which of the following is composed of connective tissue
a) Epidermis c) Hypodermis
b) Dermis d) Hypodermis & Dermis
18. The outermost layer of skin is composed of
a) Transitional epithelium c) stratified squamous epithelium
b) Pseudostratified columnar epithelium d) stratified columnar epithelium
19. Meissner corpuscles are present in which of the following region of skin?
a) Dermal reticular layer c) Hypodermis
b) Dermal papillary layer d) Stratum Basale
20. Which of the following statement concerning the stratum granulosum is true?
a) It contains melanosomes c) It is thickest layer of epidermis in thick skin
b) It is superficial to stratum Basale d) It contains keratohyalin granules
21. The intraepidermal antigen recognizing cells are called
a) Langerhans cells b) Mackel cell
c) Plasma cell d) Keratinocytes

ANSWER KEY
1. d 2. b 3. c 4. d 5. b 6. c 7. b 8. d 9.b 10. c
11. b 12. b 13. b 14. c 15. b 16. c 17. d 18. c 19. b 20. b
21. a

08. Imaging

1. Which structure is the most radio-opaque

a) Fat c) Muscle
b) Skin d) Bone
2. Select the incorrect statement regarding CT scan
a) CT provides excellent contrast resolution c) CT beams are not limited by fat or overlying gas
b) CT make it possible trans axial images d) Sagittal or coronal images can come by CT
3. Select the incorrect statement regarding MRI
a) Sagittal & Coronal images can be obtained c) Patient is exposed to ionizing radiations
b) Image with high degree intrinsic contrast can come d) Patient with pacemaker is contraindicated for MRI
4. Which of the following is incorrect statement
a) Bone is radio-opaque in x-ray skiagrams c) Ultrasonic waves are directed to human body by transducer
b) Radio-lucent material is used as contrast media d) Radiography of Spinal cord with I 2 is Myelography

ANSWER KEY
1. a 2. d 3. c 4. b 5. 6. 7. 8. 9. 10.

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A010 – A039
FOUNDATION EMBRYOLOGY
A-010 ֍Cell Division & Chromosomal Abnormalities֍

01. Chromosome Theory of inheritance

No past UHS SEQ. Not important. You can leave it

02. Different stages of Mitosis and Meiosis

Phase Description
G0 phase Resting phase
G1 phase Cells increase in size. This phase determines length of cell cycle
S phase Synthesis of DNA, RNA & Histone + Centrosome duplication
G2 phase Cells continue to increase in in size + Microtuble synthesis
M phase Cell division phase & it is the shortest phase. Mitosis is further divided into;
1. Prophase  chromation condenses
2. Metaphase  chromosomes are lined up at metaphase plate
3. Anaphase  centromere split & sister chromatids move to the opposite ends of the cell
4. Telophase  chromosome decondenses

1. What is cross-over. Give its results

It is a process that occurs during meiosis in which homologous chromosomes exchange genetic material
Results
 Each chromosome contains a unique combination of genetic material from both parents, increasing the genetic diversity of
the resulting gametes.
 Gametes produced by meiosis contain the correct number of chromosomes

2. Enumerate 5 stages of prophase of meiosis I. Explain the dictyotene pause in oocytes and mention its clinical implication.
1. Leptotene
2. Zygotene
3. Pachytene
4. Diplotene
5. Diakinesis
Dictyotene Pause
 It is a prolonged phase in oogenesis (prophase I) from 5th month of fetal life to puberty.
Clinical Implication
 It allows for genetic recombination and diversity
 Also makes oocytes more susceptible to chromosomal abnormalities and environmental damage

03. Mitosis vs Meiosis

Not important. Leave it

04. Numerical chromosomal anomalies

1. Name the various trisomies of autosomes and mention the usual cause for chromosomal error. Which of these trisomies are more
common?
 Trisomy 21 (Down Syndrome)

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 Trisomy 18 (Edward Syndrome)

 Trisomy 13 (Patau Syndrome)
Usual cause
 Non-disjunction during cell division
More common Trisomies
 Trisomy 21
 Trisomy 18

2. What is the karyotype & 6 phenotypical features of Down syndrome?

Karyotype  47, XY
Phenotypical Features
1. Brachycephaly 4. Protruding tongue
2. Flat nasal bridge 5. Transverse palmar flexion crease
3. Upward slant to palpebral fissures 6. Clinodactyly the fifth digit
3. A young male consulted to physician with complaints of formation of breast in him. After a thorough examination his physician
advised him chromosomal analysis which turned out to be 47 XXY. What is your diagnosis? Write its cause and other features
associated with this condition.
Diagnosis  Klinefelter syndrome
Cause  Non-disjunction during cell division
Features
 Tall stature  Small testes
 Gynecomastia  Infertility
 Less intelligence  Coarctation of aorta

4. Define Aneuploidy & give its cause. List any two teratogenic effects of Rubella virus on developing eye.
 Aneuploidy is any deviation from the diploid number of 46 chromosomes OR
 An abnormal number of chromosomes such as having a single extra chromosome or missing chromosome
Cause
 Non-disjunction during cell division
Teratogenic effects of Rubella
 Cataract
 Glaucoma

5.
a) What is the most common cause of abnormal chromosomes number?
Late maternal age
b) Give an example of clinical syndrome involving abnormal number of chromosomes. How can it be detected prenatally.
Down syndrome
Prenatal Detection
 Nuchal translucency  Unconjugated estriol
 Alpha fetaprotein  Amniocentesis
 hCG
05. Structural chromosomal abnormalities

Abnormality Features
Cri-du-chat syndrome Cat like cry, microcephaly, intellectual disability
Angelman‘s syndrome intellectual disability, prolonged periods of laughter
Prader willi syndrome intellectual disability, obesity, hypotonia, hypogonadism & undescended testes
Miller Dieker syndrome Seizure, cardiac & facial abnormalities

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06. Mosaicism
Ocassionally non-disjunction occurs during mitosis in an embryonic cell during the earliest cell division. Such condition produce
Mosaicism, with some cells having normal & some cells having abnormal number of chromosomes

07. Teratoma
Teratomas are tumors of disputed origin that often contain a variety of tissues, such as bone, hair, muscle, gut epithelia, and others.

08. Gene mutations & common diagnostic techniques

Not important. Leave it

A-011 ֍Gametogenesis Spermatogenesis֍

01. Spermatogenesis and Spermiogenesis

1. Define spermatogenesis & explain its events

Spermatogenesis is a sequence of events by which germ cells transformed into sperms
Event Explanation
Spermatocytogenesis  Primordial germ cells (46, 2N) from the wall of the yolk sac arrive in the testes at week 6 and remain
dormant until puberty. At puberty, primordial germ cells differentiate into type A spermatogonia (46,
2N).
 Type A spermatogonia undergo mitosis to provide a continuous supply of stem cells throughout the
reproductive life of the male. Some type A spermatogonia differentiate into type B spermatogonia
(46, 2N).
Meiosis  Type B spermatogonia enter meiosis I and undergo DNA replication to form primary spermatocytes
(46, 4N).
 Primary spermatocytes complete meiosis I to form secondary spermatocytes (23, 2N).
 Secondary spermatocytes complete meiosis II to form four spermatids (23, 1N).
Spermiogenesis  Spermatids undergo a post-meiotic series of morphological changes to form sperm (23, 1N). These
changes include:
(a) Formation of the acrosome
(b) Condensation of the nucleus
(c) Formation of head, neck, and tail
(d) Shedding of cytoplasm

02. Embryological basis for Abnormal gametes

 In rare cases, one primary oocyte contains two or even three nuclei. Such binucleated or trinucleated oocytes die before reaching
maturity.
 In contrast to atypical oocytes, abnormal sper- matozos are seen frequently, and up to 10% of all spermatozoa have observable
defects. The head or the tail may be abnormal, spermatozoa may be giants or dwarfs, and sometimes they are joined. Sperm with
morphologic abnormalities lack normal motility and probably do not fertilize oocytes

A-012 & A-013 ֍Gametogenesis Oogenesis֍

01. Prenatal and postnatal maturation of the oocyte

1. Describe the morphological changes in the development of female gametes before birth, at birth, before puberty and at ovulation. At
what age does the development of male gamete start?
Time Morphological changes
Before Birth Primordial germ cell  Oogonium  Oogonium with follicular cells (flat epithelial cells)  Primary oocyte
 Primordial follicle (primary oocyte together with surrounding flat epithelium)  Primary oocyte arrested in
diplotene stage of prophase I

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At Birth Primary oocyte still arrested in diplotene stage of prophase I

Before Puberty Primary oocyte still arrested in diplotene stage of prophase I
At ovulation  Mature follicle containing secondary oocyte rupture & release oocyte
 The secondary oocyte promptly begins meiosis II but is arrested in metaphase of meiosis II until
fertilization occurs.
Development of male gametes
 Spermatogenesis begins at puberty

A-014 ֍Gametogenesis֍

01. Compare and contrast oogenesis and spermatogenesis

1. Make flow chart of different stages of development of mature spermatozoa indicating amount of DNA and number of
chromosomes.

A-015 ֍Female Reproductive Cycle֍

01. Female reproductive cycles

You will do this topic in detail in 2nd year embryology 7 physiology
Corpus luteum
After ovulation, granulosa cells remaining in the wall of the ruptured follicle, together with cells from the theca interna, are
vascularized by surrounding vessels. Under the influence of LH, these cells develop a yellowish pigment and change into lutein cells,
which form the corpus luteum

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Function They secrete estrogens and progesterone. Progesterone, together with some estrogen, causes the uterine mucosa to enter
the progestational or secretory stage in preparation for implantation of the embryo.
Fate Corpus Albicans (if pregnancy does not occur), Corpous luteum graviditatis (under influence of hcG if pregnancy occurs)

05. Mittelschmerz pain

The pain, women feels during ovulation at middle of menstral cycle, is called Mittelschmerz (middle) pain.

03. Menstrual Cycle (definition & Phases)

A-016 ֍Transportation of gametes֍

01. Transportation of Oocyte

No SEQ from this topic read it from CH#3 of Langmann’s Medical Embryology if u want. Not imp

A-017 ֍Fertilization֍

01. Capacitation & Acrosomal Reaction

 Capacitation is a period of conditioning of sperms in the female reproductive tract that in the human lasts approximately 7 hours.
During this time, a glycoprotein coat and seminal plasma proteins are removed from the plasma membrane that overlies the
acrosomal region of the spermatozoa. Only capacitated sperm can pass through the corona cells and undergo the acrosome
reaction.
 The acrosome reaction, which occurs after binding of sperm to the zona pellucida, is induced by zona proteins. This reaction
culminates in the release of enzymes needed to penetrate the zona pellucida, including acrosin- and trypsin-like substances

02. Fertilization

1. Define fertilization. Name the phases and results of fertilization. What do you understand by GIFT?
2 Define fertilization, explain the three phases of fertilization, write its three main outcomes? [Supple 2023 held in 2024]
Fertilization is a process by which male & female gametes fuse, occurs in ampullary region of uterine tube
Phases
 Penetration of Corona Radiata (Capacitation & Acrosome reaction)
 Penetration of Zona Pellucida (Zona reaction)
 Fusion of Oocyte & Sperm cell membrane
o Completion of 2nd meiotic division & formation of female pronucleus
o Formation of male pronucleus
o Fusion of pronuclei & formation of zygote
Results/Outcomes of Fertilization
 Restoration of diploid number of chromosomes; half from father & half from mother

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 Determination of sex of new individual; X-carrying sperm produces a female (XX) & Y-carrying sperm produces a male
(XY)
 Initiation of cleavage
GIFT
It is a technique in which oocyte and sperm introduces in the ampulla of the fallopian tube where fertilization takes place and
development proceeds in normal fashion.

A-018 ֍Contraception֍

01. Definition & Mechanism

The deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse.
Methods Examples Mode of Action
Barrier Methods Male & Female Condomns, Diaphragms, Caps Prevent sperms entry into vagina
Hormonal Methods Oral contraceptive pills (containing estrogen & Prevents Ovulation
progesterone)
Intrauterine devices Copper-T, Mirena Prevents embryo implanting in uterus
Emergency IUD, Oral method (Ulipristal acetate,
Contraception Pills Levonorgestral)
Male & Female Tubal ligation in females, Vasectomy in males Prevents sperm reaching the oocyte
Sterilization

A-019 ֍Infertility & Assisted Reproductive Techniques֍

01. Anatomical and physiological basis of male and female infertility

Male Infertility Female Infertility

Anatomical Basis Anatomical Basis
- Testes: produce sperm - Ovaries: produce eggs
- Epididymis: stores and transports sperm - Fallopian tubes: transport eggs to the uterus
- Vas deferens: transports sperm to the penis - Uterus: supports fetal development
- Penis: ejaculates sperm - Cervix: connects uterus to vagina
Physiological Basis Physiological Basis
- Spermatogenesis: process of sperm production - Oogenesis: process of egg production
- Hormonal regulation: testosterone, FSH, LH - Hormonal regulation: estrogen, progesterone, FSH, LH
- Erectile function: necessary for ejaculation - Ovulation: release of egg from ovary
- Ejaculation: delivery of sperm to the female reproductive tract - Implantation: fertilized egg attaches to uterus
Common issues leading to male infertility Common issues leading to female infertility
- Low sperm count - Ovulation disorders
- Abnormal sperm morphology - Tubal damage or blockage
- Poor sperm motility - Uterine abnormalities
- Hormonal imbalances - Endometriosis
- Obstruction or injury to reproductive tract - Hormonal imbalances
Note: It’s not an important topic for seq & mcq. Just read to understand this topic
02. Assisted Reproductive Techniques (Define, and Mechanism of IVF)

Q#1. Woman developed severe pelvic inflammation after her first delivery
 Occlusion of both Uterine Tubes prevents the
conducted at her home. Later on, she was unable to conceive. Clinical egg from reaching the sperm and prevents
examination confirmed occlusion of both uterine tubes. the fertilized egg from reaching the uterus,
a) Which clinical techniques can help her to become pregnant and why? making it difficult to conceive naturally.
 In vitro fertilization  These Techniques can help the woman to
 Tubuloplasty become Pregnant by bypassing the blocked
tubes or removing the blockage altogether.
 GIFT
b) What are the risks involved?
o High rate of congenital malformations

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o Multiple births with high rate of morbidity & mortality

o Ectopic pregnancy

03. Correlation of multiple births with assisted reproductive techniques

―There is a risk of multiple pregnancies (12%) and therefore women on clomiphene should be monitored by ultrasound scans to track
the growth of their follicles, identify the time of ovulation and reduce the risk of multiple pregnancy‖

A-020 ֍Clevage, Blastocyst formation֍

01. Cleavage & Blastocyst formation

1. Define cleavage. What is morula & how a blastocyst formed?

Cleavage is a series of mitotic divisions of the zygote where the plane of the first mitotic division passes through the area of the cell
membrane where the polar bodies were previously extruded
Morula
 Cleavage results in a cluster of blastomeres (16–32 blastomeres) known as morula
Formation of Blastocyst
Fertilization  Zygote  Cleavage  Blastula  Morula  Morula enters uterine cavity 4 days after fertilization  fluid penetrate
zona pellucida into intercellular spaces of inner cell mass  a single cavity "Blastocele" forms  At this time, the embryo is known
as Blastocyst

2. Write formation of and structure of blastocyst?

Formation
 See above Q#2
Structure
 Inner cell mass of the blastocyst is called the embryoblast (becomes the embryo)
 Outer cell mass of the blastocyst is called the trophoblast (becomes the fetal portion of the placenta).

3. Account of events occurring on a zygote as it travels in the uterine tube.

Zygote  Cleavage  Blastula  Morula  Morula enters uterine cavity & fluid penetrate zona pellucida into intercellular spaces of
inner cell mass  a single cavity "Blastocele" forms  Blastocyst  Degeneration of zona Pellucida  Implantation of blastocyst in
posterior superior wall of the uterus on 6th day of fertilization
4. Draw and label early and late Blastocyst.

Early Blastocyst Late Blastocyst

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02. Spontaneous Abortion

―Miscarriage is a pregnancy that ends spontaneously before 24 weeks‘ gestation.‖

03. Compare & Contrast Villi

1. What are the names and formation of different stages of chorionic villi?

Name of stage Formation

Primary chorionic villi Trophoblast (Syncytiotrophoblast + Cytotrophoblast)
Secondary chorionic Trophoblast (Syncytiotrophoblast + Cytotrophoblast) + Mesoderm core
villi Villi increase in size and ramify while mesoderm grows into them
Tertiary chorionic villi Trophoblast (Syncytiotrophoblast + Cytotrophoblast) + Mesoderm core + Umbilical vessels
Branches of umbilical artery & vein grow into mesoderm and chorionic will become vascularized

A-021 ֍Implantation Week 2nd of Development֍

01. Decidua Reaction

1. What is Bilaminar Germ Disc? When and how it is formed? What changes take place in Trophoblast during second week of
development?
Epiblast and hypoblast together form a flat, ovoid-shaped disc known as the bilaminar germ disc
When it is formed?
 In 2nd week of embryonic development (8 th day)
How it is formed
o Embryoblast of blastocyst differentiate into two layers which together form bilaminar germ disc
 Hypoblast layer (cuboidal cell layer)
 Epiblast layer (columnar cell layer)
Changes in Trophoblast
 It differentiates into two layers at 8th day:
(1) Cytotrophoblast (Inner mononucleated cells)
(2) Syncytiotrophoblast (outer multinucleated cells)
 Blood filled Lacunae appears in Syncytiotrophoblast on 9th day.

02. Implantation

1. Briefly explain implantation and embedding of a human blastocyst. Enlist sites of abnormal implantation.

Time Implantation & Embedding of Blastocyst

End of 1st week Blastocyst after shedding zona pellucida is implanted in uterine endometrium by the end of Ist week.
Trophoblast cells invade the epithelium & underlying endometrial stroma with the help of proteolytic
enzymes
8th day Blastocyst is partially embedded in endometrial stroma
9th day Blastocyst is more deeply embedded in endometrial stroma & the penetration defect in the surface
epithelium is closed by a fibrin coagulum
11th – 12th day Blastocyst is completely embedded in endometrial stroma & the surface epithelium almost covers the
original defect in the uterine wall
13th day Surface defect in the endometrium has usually healed

Abnormal Implantation Sites:

 Ampulla (most common)  Pouch of Douglas
 Pelvis  Abdominal cavity
 Ovary

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2. A young married lady with a history of missed periods, presented with severe pain and tenderness in her right iliac fossa.
Investigation revealed that she had an ectopic pregnancy.
a) What is the most likely site of implantation in such case? Mention complications that might result from it
 Uterine tube
Complications
 Rupture of uterine tube
 Abnormal bleeding
 Peritonitis
 Death of embryo
b) Give the most common site of blastocyst implantation in a normal pregnancy, mentioning the earliest possible time of its
detection by ultrasonography
Common site  Posterior superior wall of uterus
Earliest detection  As early as the end of 2nd week

03. Molar Pregnancy

―A molar pregnancy is a rare complication of pregnancy. It involves unusual growth of cells called trophoblasts.‖

04. The formation of amniotic cavity, embryonic disc, umbilical vesicle, and chorionic sac.

1. Briefly explain the function and fate of epiblasts.

Function  Cavitate to form amnion
Fate  Give rise to Ectoderm, Mesoderm & Endoderm

A-022 ֍Utero-Placental circulation֍

01. Establishment of Utero-Placental circulation

Read this topic in CH#5 of Langmann‘s Medical Embryology. Not imo for seq

A-023 ֍Gastrulation֍

1. List 4 embryology events that occur during 3rd week of development.

 Gastrulation
 Appearance of primitive streak
 Formation of Notochord
 Development of somites
 Development of intraembryonic coelom

2. Give the formation & fate of primitive streak. What is sacrococcygeal tumor?
Formation
 Thickened Epiblast at the caudal end  move cranially  proliferation of cells produce primitive node  Primitive streak
Fate
 Primitive streak undergoes degenerative changes & disappears by the end of 4 th week
Sacrococcygeal Tumor
 Tumor arise from remnants of Primitive Streak and it consists of several types of tissues

A-024 ֍Formation of notochord֍

01. Notochord

1. A patient was diagnosed to be suffering from "chordoma‖ at the base of his cranium. Write the formation, 4 functions and fate of
the embryonic structure from which this tumor has originated.
Formation of Notochord
 Thickened Epiblast at the caudal end  move cranially  proliferation of cells produce primitive node  mesenchymal
cells migrate from primitive node & form midline cellular cord "Notochordal process"

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Functions of Notochord
 Defines primordial longitudinal axis of the embryo
 Provides rigidity to the embryo
 Serve as basis for the development of axial skeleton & CNS
 Contribute to the development of intervertebral disc
Fate of Notochord
 Nucleus pulposus

02. The establishment of Body Axis

CH#5 from Langmann’s Medical Embryology. (Also see figure 5.6). Leave it

04. Situs inversus, Sirenomelia, holoprosencephaly

1. Ultrasound examination of a full-term pregnant female revealed that the fetus had well-developed facial and thoracic regions, but
the caudal structures were abnormal. Kidneys were absent, lumber and sacral vertebrae were missing and the Lower limbs were fused.
(Annual 2023 – MODULAR SYSTEM)
a) What process may have been disturbed to cause such defects? Describe the process highlighting the cause of disruption and
anomalies in this case? (04)
Process Disturbed  Gastrulation in Caudal Segments. [This is a case of Sirenomelia / Caudal dysgenesis OR Mermaid
syndrome].
Pathogenesis of Disruption (Cause):

b) Name any one other anomaly you would see in the fetus? (01)
 Imperforate Anus
 Agenesis of internal genital organs e.g., Testes and Ovaries.

05. Ttrophoblast and chorionic villi

1. What are the names and formation of different stages of chorionic villi?

Name of stage Formation

Primary chorionic villi Trophoblast (Syncytiotrophoblast + Cytotrophoblast)
Secondary chorionic villi Trophoblast (Syncytiotrophoblast + Cytotrophoblast) + Mesoderm core
Villi increase in size and ramify while mesoderm grows into them
Tertiary chorionic villi Trophoblast (Syncytiotrophoblast + Cytotrophoblast) + Mesoderm core + Umbilical vessels
Branches of umbilical artery & vein grow into mesoderm and chorionic will become vascularized

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A-025 ֍Derivatives of ectoderm֍

01. Formation of Neural tube & Neural tube defects

1. How neural tube is developed?

 The notochord and paraxial mesenchyme induce the overlying ectoderm to differentiate into the neural plate. It begins during
the fourth week (22–23 days) in the region of the fourth to sixth pairs of somites.
 Its lateral edges soon elevate to form the neural folds. With further development, the neural folds continue to elevate,
approach each other in the midline, and finally fuse.
 Fusion of the neural folds and formation of the neural tube begins at the fifth somite and proceeds in cranial and caudal
directions until only small areas of the tube remain open at both ends.
 The lumen of the neural tube becomes the neural canal, which communicates freely with the amniotic cavity via two
transitory openings:
o Anterior neuropore a. closes in the fourth week (~day 25) to become the lamina terminalis.
o Posterior neuropore a. closes in the fourth week (~day 27)

2. Ultrasonography of a female with 22 weeks pregnancy revealed that the baby has anencephaly. Define this term & give its
embryological basis. Write all steps involved in the process of Neurulation. (UHS ANNUAL 2024 held in 2025)
Absence of cerebral cortex but brainstem remains intact most of the time.
Embryological basis
 Failure of cephalic part of neural tube to close
Steps involved in Neurulation See in Q#1
Note: Neural tube defects are written in detail in embryology portion of block 3 module 5 Topic A015

02. Neural Crest Cells

1. Name the tumors arising from remnants of notochord and primitive streak. Enumerate six derivatives of neural crest cells.
Tumors
 Remnants of Notochord  Chordoma
 Remnants of Primitive Streak  Teratoma
Neural Crest Derivatives MOTEL PASS
 Melanocytes  Parafollicular (C) cells of thyroid
 Odontoblasts (dentin of teeth)  Pia and arachnoid
 Tracheal cartilage  All ganglia/Adrenal medulla
 Enterochromaffin cells  Schwann cells
 Laryngeal cartilage  Septum of heart

03. Molecular & Genetic Factors for Neurolation

Leave it

04. Enlist Ectodermal Derivatives

1. Enumerate derivatives of neuroectoderm?

 Neurons  Optic nerve
 Neurohypophysis  Retina
 Pineal gland  Muscles of iris

2. A medical student was shown models of embryos of various developmental ages. If he has to identify an embryo of 28 days, which
ten external features will he look for?
3. List the events of 4th week.
 Primary brain vesicles  Head & Tail fold
 Pharyngeal arches  Lens placode

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 Otic placode  Length of embryo: 4mm – 6mm

 Limb bud  Number of somites: 30 – 35
 Body shape (tubular & C shaped)  Closing of rostral & caudal Neuropore

A-026 ֍Mesodermal derivatives֍

01. Differentiation of mesoderm into its constituting components

Read CH#6 from Langmann’s Medical Embryology.

02. Somites

1. How the somites are formed during development. Enumerate their derivatives.
During the third week of embryonic development, paraxial mesoderm begins to organized into segments known as somitomeres.
These somitomeres further orgazined into somites. These somites are formed in a cranial-to-caudal sequence
Derivatives Ist pair of somities appear in occipital region at
1. Sclerotome: which give rise to ribs, vertebrae & tendons 20th day of developement
2. Dermatome: which gives rise to the dermis of back
3. Myotome: which gives rise to the muscles of the body Tongue muscles develop from occipital somities

03. Intra-embryonic coelom

1. Write the development of intraembryonic coelom and name its derivative.

Development
The primordium of the intraembryonic coelom appears as isolated coelomic spaces in the lateral intraembryonic mesoderm and
cardiogenic mesoderm. These spaces soon coalesce to form a single horseshoe-shaped cavity, the intraembryonic coelom.
Derivatives
 Pericardial cavity
 Pleural cavity
 Peritoneal cavity

2. Describe Allantois. Give its importance

Out-pocketing from caudal wall of umbilical vesicle which extends into connecting stalk in 3rd week
Importance
 Its vessels become umbilical vessels (2 arteries & 1 vein) when allantois obliterates
 Blood cell formation occur in its wall
 Urachus & Median umbilical ligament derive from it

A-027 ֍Early development of CVS֍

Read CH#6 from langman if u want. Not important; leave it

A-028 ֍Folding of Embryo֍

01. Cephalocaudal Folding, Lateral folding

Read CH#6 from Langmann’s Medical Embryology

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A-029 ֍Germ Layer Derivatives֍

A-030 ֍Control of Embryonic Developement֍

Leave this topic

A-031 ֍Embryonic Period֍

Read CH#6 from Langmann’s Medical Embryology, Read Table 6.4

A-032 ֍Fetal Period֍

Viability of Fetus
Ability of fetus to survive in extra-uterine environment. Characterized by
 Weight > 500g
 CRL > 200 mm
 Fetal length > 40 mm
 Amniotic fluid > 350 ml
Low birth weight It refers to weight of newborn <2500g regardless of gestational age.
IUGR (Intrauterine Growth Restriction) This term applied to infant who donot attain their optimal intrauterine growth due to any
pathological reason.
SGA (Small for Gestational Age) Birth weight <10th percentile of gestational age may be due to any pathological or constitutuional
cause.

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A-033 ֍Fetal Status֍

01. Fetal Age

Measurement of fetal age
 In first trimester by CRL
 In 2nd trimester by head circumference & biparietal diameter, abdominal circumference
 In 3rd trimester by femur length
Some Imp Points
 CRL doubles by 12 weeks
 Primary ossification centers appear by end of 12 week
 External genitalia of male & female distinguished by 12-14 weeks
 Fetal movements (Quickening) feel by mother at 17-20 week
 Foot length of fetuses is usually slightly larger than the femoral length at 37 weeks & is an alternative parameter for
confirmation of fetal age
 Full term fetus (38 week) have CRL of 360 mm & weight 3400 g

02. IUGR

1. Define premature baby. Mention its two types. List six causes of intrauterine growth retardation (IUGR).
Baby having weight 750g – 1500g is known as premature baby
Types
1. Full term neonates – have low weight because of IUGR
2. Preterm neonates – have low weight because of shortened gestation
Causes of IUGR
 Maternal disease
 Genetic factors
 Alcohol & illicit Drugs
 Multiple pregnancy
 Smoking
 Impaired uteroplacental & fetoplacental circulation

03. Define Pre-eclempsia

Pre-eclampsia is defined as hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours
apart and in the presence of at least 300 mg protein in a 24-hour collection of urine, arising de novo after the 20th week of pregnancy
in a previously normotensive woman and resolving completely by the sixth postpartum week. It results from abnormal trophoblast
invasion

A-034 ֍Placenta֍
01. Decidua

1. What is decidua and its fate? Mention its regional parts

Decidua is a functional layer of endometrium that separates from the remainder of the uterus after parturition
Fate  Becomes maternal part of placenta. After birth, decidua shed together with the placenta
Regional Parts
 Decidua basalis
 Decidua capsularis
 Decidua parietalis
2. What are decidual septa? List three functions of decidual cells.
During 4th and 5th months, decidua forms a number of decidual septa which project into intervillous spaces but do not reach the
chorionic plate. It divides placenta is divided into number of compartments

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Functions of decidual cells

 Together with maternal blood and uterine secretions, they provide a rich source of nutrition for the embryo/fetus.
 Protect the maternal tissue against uncontrolled invasion by syncytiotrophoblasts.
 Involved in hormone production

02. Placenta

1. Define placental membrane, mentioning its constituents at 10 weeks of development and at term.
Placental membrane is a composite structure that consists of extra-fetal tissues separating the maternal and fetal blood
At 10th week
 Syncytiotrophoblast Normal parameters of placenta after birth!
 Cytotrophoblast  Shape circular/discoidal
 Connective tissue of villus  Weight 500-600g
 Endothelium of fetal capillaries  Thickness 3 cm
At Term  Diameter 15-25 cm
o Syncytiotrophoblast
o Connective tissue of villus
o Endothelium of fetal capillaries
2. Define the placental barrier. Mention its light microscopic tissues/ layers during 3rd and 4th month of embryogenesis respectively.
Name two viruses that can cross the placental barrier.
Placental barrier is a structure that separates maternal & fetal circulation. Sometimes placental membrane is called as placental barrier
but this term is not appropriate because only a few substances are unable to pass through it
Start of 3rd month
 Yolk sac between amnion & chorion
 Chorion leave
End of 3rd month
 Amnion & Chorion fuse
 Uterine cavity obliterates by fusion of chorion leave & decidua Parietalis
4th month
 Fetal portion formed chorion frondosum
 Maternal portion formed by decidua basalis
Viruses that can cross placenta
 Rubella virus
 Cytomegalovirus
3. Developmentally, what are the components (parts) of the placenta?
 Maternal Component – Develops from decidua basalis
 Fetal component – Develops from chorionic frondosum

4. Give the development of fetal part of placenta. What are the features of the fetal surface of a full-term placenta?
Development of fetal part
Trophoblast proliferate  produce chorionic villi & sac  chorionic villi cover the sac & sac grows  villi associated with basalis
grows rapidly, profusely branch & produce chorionic frondosum  fetal part of placenta
Features
 The umbilical cord usually attaches to the fetal surface of the placenta,
 Its epithelium is continuous with the amnion adhering to the fetal surface
 Fetal surface of a freshly delivered placenta is smooth and shiny because it is covered by the amnion.
 Chorionic vessels converge towards the umbilical cord

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5. Name the condition resulting from implantation of placenta in the lower uterine segment. What are its effects
Placenta Previa
Effects Placenta Previa
 Antepartum & Postpartum hemorrhage  Low lying placenta + bleeding
 Late pregnancy bleeding Placental abruption
 Premature labor  High lying placenta + bleeding
 Fetal malformation
 Maternal & Fetal death

Do You Know!
 Normally placenta is high lying (at uterine fundus)

Q#6. (Annual 2023 – MODULAR SYSTEM)

a) List the Placental changes at the end of the pregnancy. Draw the cross-section of a chorionic villous during the 4th month of
pregnancy and label the structures the form the placental barrier? (04)
Placental Changes at the end of Pregnancy: [Indicate reduced exchange between the 2
circulations]
 Increase in Fibrous Tissue in the core of Villus
 Thickening of basement membranes in fetal capillaries
 Obliterative changes in small capillaries of Villi
 Deposition of Fibrinoid on the surface of Villi in the Junctional zone and
Chorionic Plate, (This can cause infarction of an Intervillous lake, sometimes of
an entire Cotyledon, giving it a Whitish Appearance).
Cross-Section of Chorionic Villous during 4th Month:

A-035 ֍Fetal Membranes֍

01. Umbilical Cord

 Two umbilical arteries return deoxygenated blood from fetal internal iliac arteries to placenta.
 One umbilical vein supplies oxygenated blood from placenta to fetus; drains into IVC via liver or via ductus venosus
 Single umbilical artery (2-vessel cord) is associated with congenital and chromosomal anomalies.
 Umbilical arteries and vein are derived from allantois.

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02. Amniotic Fluid

1. Describe the formation, circulation, drainage & functions of amniotic fluid.

Formation
Amniotic fluid is constantly produced during pregnancy by the following:
 direct transfer from maternal circulation in response to osmotic and hydrostatic forces into amniotic sac
 excretion of fetal urine by the kidneys into the amniotic sac.
Circulation & Drainage
Amniotic fluid is constantly resorbed during pregnancy by the following sequence of events:
o fetus swallows amniotic fluid, amniotic fluid is absorbed into fetal blood through the gastrointestinal tract, and excess
amniotic fluid is removed via the placenta and passed into maternal blood.
Function
 Permits symmetric external growth of the embryo/fetus
 Acts as a barrier to infection
 Permits normal fetal lung development
 Prevents adherence of the amnion to the embryo/fetus
 Cushions the embryo/fetus against injuries by distributing impacts the mother receives
 Helps control the embryo/fetus‘s body temperature by maintaining a relatively constant temperature

03. Amniocentesis

1. What is the amniocentesis? What are its indications? What is the safe period to perform diagnostic amniocentesis? Give reason.
Amniocentesis
It is an invasive prenatal diagnostic procedure, performed by inserting a 22-gauge needle through the mother‘s anterior abdominal and
uterine walls into the amniotic cavity by piercing the chorion and amnion to withdraw 15ml – 20ml amniotic fluid
Indications
 Advanced maternal age (≥38 years)  History of neural tube defects in the family (spina
 Previous birth of a child with trisomy 21 bifida cystica)
 Chromosome abnormality in either parent  Carriers of inborn errors of metabolism
 Women who are carriers of X-linked recessive  To diagnose fetal chromosomal anomalies
 Disorders (e.g., hemophilia)  Fetal lung maturity problems
 To rule out chorioamnionitis
Safe period with reason
 15-18 weeks of gestation because there is little amniotic fluid before 14-week of gestation
2. When and why amniocentesis is performed? Give 4 reasons
Amniocentesis is performed between 15-18 weeks of gestation because there is little amniotic fluid before 14-week of gestation. It is
performed for following reasons
1. To detect chromosomal abnormality
2. To detect neural tube defect
3. To determine if the fetus‘ lungs are mature enough for delivery
4. To diagnose inherited disorders
3. A 40 year old diabetic 20 weeks pregnant female with history of DOWN syndrome in her previous born wants to checkstatus of her
featus. Name 2 invasive prenatal diagnostic tests that are recommended in such cases, explain any of them in detail mentioning of its
procedure, limitations, advantage and risk. [Supple 2023 held in 2024]
Invasive prenatal diagnostic tests
1. Amniocentesis
2. Chorionic villous sampling
Procedure of Amniocentesis
During amniocentesis, a needle is inserted transabdominally into the amniotic cavity identified by ultrasound, and approximately 20 to
30 mL of fluid is withdrawn. Because of the amount of fluid required, The fluid itself is analyzed for biochemical factors, such as AFP

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and acetylcholinesterase. In addition, fetal cells, sloughed into the amniotic fluid, can be recovered and used for metaphase
karyotyping and other genetic analyses
Limitations
 The procedure is not usually performed before 14 weeks’ gestation, when sufficient quantities are available without
endangering the fetus.
 Unfortunately, the harvested cells are not rapidly dividing, and therefore, cell cultures containing mitogens must be
established to provide sufficient metaphase cells for analysis. Thus, results are available 1 to 2 weeks after the procedure.
Advantages See Q2
Risk Recent studies suggest that the risk of fetal loss related to the procedure is as low as 1 in 300 to 500

05. Oligohydramnios & Polyhydramnios

1. A 36 years old female presented in the antenatal clinic with excessive increase in size of her abdomen during 30th week of
gestation. Her ultrasound examination revealed large amount of amniotic fluid. Based on your knowledge of embryology:
a) Name this condition
Polyhydramnios
b) Give any 5 causes of this condition
1. Tracheoesophageal fistula
2. Anencephaly
3. Diabetes
4. Twin to Twin transfusion syndrome
5. Esophageal atresia
6. Duodenal atresia

2. What is oligohydramnios? List three causes & name two complications

Low volume of amniotic fluid (< 400 ml) is known as Oligohydramnios
Causes Amount of amniotic fluid 50 mL at week 12 to
1. Renal agenesis 1000 mL at term
2. Blockage of urinary system
3. Early rupture of amniotic sac
Complications
1. Potter syndrome
2. Club foot

06. Umbilical vesicle (yolk sac)

 The yolk sac (umbilical vesicle) forms around day 9-10 of embryonic development from the hypoblast cells.
 The yolk sac gradually shrinks and disappears around week 12 of gestation. Remnants of the yolk sac can be seen in the
umbilical cord as the vitelline duct, which usually obliterates by birth.

A-036 ֍Multiple pregnancies֍

01. Monozygotic & Dizygotic Twins

1. Write differences between Monozygotic & Dizygotic twins

Monozygotic Twins Dizygotic Twins

Identical twins Fraternal twins
Produced from a single zygote Produced from two zygotes
Result from fertilization of one oocyte by one sperm Result from fertilization of two oocytes by two sperms
Same sex, same genotype, same blood group May have same or different sex
No erythrocyte mosaicism Erythrocyte mosaicism

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2. Define monozygotic twins. Mention their 3 ways of formation. Enumerate five problems that may arise during pregnancy with
monozygotic twins.
Identical twins that result from the fertilization of one oocyte and develop from one zygote
Ways of formation
Monozygotic twins arise from 1 fertilized egg (1 egg + 1 sperm) that splits in early pregnancy. The timing of splitting determines
chorionicity (number of chorions) and amnionicity (number of amnions)
 Splitting 0–4 days: separate chorion and amnion (di-di)
 Splitting 4–8 days: shared Chorion (mo-di)
 Splitting 8–12 days: shared chorion and Amnion (mo-mo)
 Splitting 13+ days: shared chorion, amnion, and Body (mo-mo; conjoined)
Problems
1. Twin transfusion syndrome
2. Conjoined twins
3. Premature Labor
4. Birth defect
5. Fetal distress

3. Briefly describe the causes and features of monozygotic twins.

Causes
 Familial genetic tendency
 Environmental factors
Features
 Same sex, same genotype, same blood group
 No erythrocyte mosaicism

4. A mother gave birth to twin; one was large & healthy & the other was small, pale & anemic.
a) Give the diagnosis?
Twin-Twin transfusion syndrome
b) Give the cause of the condition
Shunting of arterial blood from one twin through arteriovenous anastomosis into the venous circulation of the other twin. Donor will
be small, pale & anemic whereas the recipient twin will be large & Polycythemic.
c) What are the features related to the two babies
 Donor twin: Anemic, growth retarded, Oligohydramnios
 Recipient twin: Polycythemic, grows larger, Polyhydramnios
d) What is the fate of such babies
 Donor twin: Death due to anemia
 Recipient twin: Death due to congestive heart failure

5. An ultrasound done at 24 weeks of gestation revealed twins who are united with one another. There was a single placenta and they
shared one amnion and one chorion.
a. What type of twins are they and how are they formed?
Monozygotic Twins
Monozygotic twins arise from 1 fertilized egg (1 egg + 1 sperm) that splits in early pregnancy. The timing of splitting determines
chorionicity (number of chorions) and amnionicity (number of amnions)
b. Mention the types of such twins.
 Splitting 0–4 days: separate chorion and amnion (di-di)
 Splitting 4–8 days: shared Chorion (mo-di)
 Splitting 8–12 days: shared chorion and Amnion (mo-mo)
 Splitting 13+ days: shared chorion, amnion, and Body (mo-mo; conjoined)

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Note: Understand from this diagram

02. Fetus Papyraceous

1. (Annual 2023 held in 2024]
b) What do you understand by a Vanishing Twin? (01)
 It refers to the Death of one fetus.
 It usually occurs in 1st trimester OR in early 2nd trimester, and results from either simple resorption OR via formation of a
fetus Papyraceus (Mummified).
03. Various types of conjoined monozygotic twins

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A-037 ֍Prenatal diagnosis and fetal therapy֍

01. Define Preterm Birth

Preterm birth (delivery before 37 completed weeks) of premature Infants occurs in approximately 12% of births in the United States
and is a leading cause of infant mortality and also contributes significantly to morbidity. It is caused by preterm PROM, prema- ture
onset of labor, or pregnancy complications requiring premature delivery. Risk factors include previous preterm birth, black race;
multiple gesta- tions; infections, such as periodontal disease and bacterial vaginosis; and low maternal body-mass index.

02. Parturition & three stages of Labor.

Labor itself is divided into three stages:
(1) effacement (thinning and shortening) and dilatation of the cervix (this stage ends when the cervix is fully dilated),
(2) delivery of the fetus, and
(3) delivery of the placenta and fetal membranes.

03. The Various methods of prenatal diagnosis

Q#1. A young girl who became pregnant for the first time was advised to have a regular antenatal check. Name any six clinical
techniques available in a fully equipped hospital for this patient for assessment of growth and well-being of her developing baby.
What clinical technique is done in routine and what are its advantages.
Ultrasound Oncofetal antigens
hcG Cardiocentesis
Amniocentesis Chronic villous sampling
Alfa-fetoprotein Spectrophotometric studies
Clinical technique in routine
 The clinical technique done in routine is ultrasound. Its advantages include:
 Wide availability & low cost
 Good quality of images
 Non-invasive technique so does not harm the developing baby.
 Accurate measurements

04. Maternal serum Screening

 In cases of neural tube defects and several other abnormalities, including omphalocele, gastroschisis, bladder exstrophy, amniotic
band syndrome, sacrococcygeal teratoma, and intestinal atresia, AFP levels increase in amniotic fluid and maternal serum.
 In other instances, AFP concentrations decrease, as, for example, in Down syndrome, trisomy 18, sex chromosome abnormalities,
and triploidy

05. Fetal Therapy, Stem cell transplantation and gene therapy

Leave it

A-038 ֍Molecular regulations and signaling pathways֍

Leave it

A-039 ֍Teratogenicity֍
Most susceptible during organogenesis in embryonic period (before week 8 of development). Before implantation, ―all-or-none‖
effect. After week 8 (fetal period), growth and function affected.
fect. After week 8 (fetal period), growth and function affected
Teratogen Effects
Aminoglycosides Ototoxicity
ACEi Oligohydroamnios
Anti-epileptic drugs Neural tube defects

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Isotretinoin Craniofacial, CNS, Cardiac & thymic defects

Thalidomide Limb defects – phacomelia
Tetracyclines Discoloured teeth
Warfarin Bone & cartilage deformities – nasal & limb hypoplasia (Note: Use heparin during pregnancy as
it does not cross placenta)
Tobacco smoking Premature birth, IUGR
Rubella virus Cataract, glaucoma, heart defect, hearing loss
X-rays Microcephaly, spina bifida, cleft palate & limb defects

֍PRACTICE & PAST UHS MCQs֍

01. IST week of developement

1. A normal somatic cell contains a total of 46 chromosomes. What is the normal complement of chromosomes found in sperm
a) 22 autosomes plus a sex chromosome c) 22 autosomes
b) 23 autosomes plus a sex chromosome d) 23 autosomes
2. Time taken for spermatogenesis:
a) 24 days c) 48 days
b) 74 days d) 60 days
3. Which of the following describes the number of chromosomes and amount of DNA in a gamete?
a) 46 chromosomes, 1N c) 23 chromosomes, 1N
b) 46 chromosomes, 2N d) 23 chromosomes, 2N
4. Male is infertile if sperm count is less than _____
a) 20% c) 60%
b) 10% d) 40%
5. Which of the following chromosome compositions in a sperm normally results in the production of a genetic female if fertilization
occurs?
a) 23 homologous pairs of chromosomes c) 22 autosomes plus a Y chromosome
b) 23 autosomes plus an X chromosome d) 22 autosomes plus an X chromosome
6. All primary oocytes are formed by
a) week 4 of embryonic life c) birth
b) month 5 of fetal life d) Puberty
7. When does formation of primary spermatocytes begin?
a) During week 4 of embryonic life c) At birth
b) During month 5 of fetal life d) At puberty
8. Approximately how many sperm will be ejaculated by a normal fertile male during sexual intercourse?
a) 10 million c) 35 million
b) 20 million d) 350 million
9. Fetal sex can be diagnosed by noting the presence or absence of the Barr body in cells obtained from the amniotic fluid. What is the
etiology of the Barr body?
a) Inactivation of both X chromosomes c) Inactivation of one Y chromosome
b) Inactivation of homologous chromosomes d) Inactivation of one X chromosome
10. How much DNA does a primary spermatocyte contain?
a) 1N c) 4N
b) 2N d) 8N
11. During meiosis, pairing of homologous chromosomes occurs, which permits large segments of DNA to be exchanged. What is this
process called?
a) Synapsis c) Alignment
b) Nondisjunction d) Crossing over

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12. During ovulation, the secondary oocyte resides at what specific stage of meiosis?
a) Prophase of meiosis I c) Metaphase of meiosis I
b) Prophase of meiosis II d) Metaphase of meiosis II
13. Concerning maturation of the female gamete (oogenesis), when do the oogonia enter meiosis I and undergo DNA replication to
form primary oocytes?
a) During fetal life c) At puberty
b) At birth d) Following fertilization
14. Where do primordial germ cells initially develop?
a) In the gonads at week 4 of embryonic development c) In the gonads at month 5 of embryonic development
b) In the yolk sac at week 4 of embryonic development d) In the yolk sac at month 5 of embryonic development
15. How soon after fertilization occurs within the uterine tube does the blastocyst begin implantation?
a) Within minutes c) By day 2
b) By day 1 d) By day 7
16. Where does the blastocyst normally implant?
a) Functional layer of the cervix c) Basal layer of the endometrium
b) Functional layer of the endometrium d) Myometrium
17. Which of the following events is involved in the cleavage of the zygote during week 1 of development?
a) A series of meiotic divisions forming blastomeres c) An increased cytoplasmic content of blastomeres
b) Production of highly differentiated blastomeres d) A decrease in size of blastomeres
18. Which of the following structures must degenerate for blastocyst implantation to occur?
a) Endometrium in progestational phase c) Syncytiotrophoblast & Cytotrophoblast
b) Zona pellucida d) Functional layer of the endometrium
19. When does a secondary oocyte complete its second meiotic division to become a mature ovum?
a) At ovulation c) At fertilization
b) Before ovulation d) At puberty
20. In oogenesis, which of the following events occurs immediately following the completions of meiosis II?
a) Degeneration of the zona pellucida c) Formation of a female pronucleus
b) Sperm penetration of the corona radiata d) Appearance of the blastocyst
21. A sperm is able to fertilize an oocyte only if has undergone
a) Acrosome reaction c) Acrosome reaction & Capacitation
b) Capacitation d) Fertilization
22. The seven day Blastocyst
a) has single layer of trophoblast at embryonic pole c) is surrounded by zona pellucida
b) has an amniotic cavity d) is attached to endometrial epithelium
23. A young female was advised Plain radiograph of pelvis within a period of two weeks. She refused further exposures to X-rays as
she had heard that the primary oocytes are vulnerable to X-rays as these cells are arrested in a stage of meiosis I called;
a) Diplotene c) Interphase
b) Anaphase d) Telophase
24. Acrosomal reaction is associated with
a) Release of Hyaluronidase
b) Removal of glycoprotein coat from plasma membrane of sperm
c) Removal of seminal plasma proteins from plasma membrane of sperm
d) Reducing the oocyte permeability for entry of sperms
25. Where does fertilization occurs?
a) Ampulla c) Cervix
b) Ovary d) Myometrium
26. In counseling a couple regarding X-linked genetic disorders, you inform them that genetic sex is determined at time of
a) fertilization c) Ovulation
b) implantation d) Birth

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27. First sign of pregnancy is the presence of ___ on ultrasound

a) Intrauterine gestation sac c) Embryonic fetus
b) Fetal heart movement d) Intrauterine yolk sac

ANSWER KEY
1. A 2. B 3. C 4. B 5. D 6. B 7. D 8. D 9. D 10. C
11. D 12. D 13. A 14. B 15. D 16. B 17. D 18. B 19. C 20. C
21. C 22. D 23. A 24. A 25. A 26. A 27. A

02. 2nd week of developement

1. A 20-year-old woman presents at the emergency department with severe abdominal pain on the right side with signs of internal
bleeding. She indicated that she has been sexually active without contraception and missed her last menstrual period. Based on this
information, which of the following disorders must be included as an option in the diagnosis?
a) Preeclampsia c) Normal pregnancy
b) Appendicitis d) Ectopic tubal pregnancy
2. Which of the following components plays the most active role in invading the endometrium during blastocyst implantation?
a) Epiblast c) Extraembryonic somatic mesoderm
b) Syncytiotrophoblast d) Extraembryonic visceral mesoderm
3. Between which two layers is the extraembryonic mesoderm located?
a) Epiblast and hypoblast c) Exocoelomic membrane and syncytiotrophoblast
b) Syncytiotrophoblast and cytotrophoblast d) Exocoelomic membrane and cytotrophoblast
4. Which of the following are components of the definitive chorion?
a) Extraembryonic somatic mesoderm and epiblast
b) Extraembryonic somatic mesoderm and cytotrophoblast
c) Extraembryonic somatic mesoderm and syncytiotrophoblast
d) Extraembryonic somatic mesoderm, cytotrophoblast, and syncytiotrophoblast
5. At what location does the amniotic cavity develop?
a) Between the cytotrophoblast and syncytiotrophoblast b) Between the endoderm and mesoderm
c) Within the hypoblast d) Within the epiblast
6. At the end of week 2 of development (day 14), what is the composition of the embryonic disk?
a) Epiblast only c) Ectoderm and endoderm
b) Epiblast and hypoblast d) Ectoderm, mesoderm, and endoderm
7. Which germ layers are present at the end of week 3 of development (day 21)?
a) Epiblast only c) Ectoderm and endoderm
b) Epiblast and hypoblast d) Ectoderm, mesoderm, and endoderm
8. Content(s) of primary chorionic villi:
a) Trophoblast only c) Trophoblast, Mesoderm & Blood vessels
b) Trophoblast & Mesoderm d) Only yolk sac
9. Most common site for abnormal Implantation?
a) Posterior superior wall of uterus c) Intestine
b) Ampulla d) Pelvis
10. The epiblast is capable of forming which of the following germ layers?
a) Ectoderm only c) Ectoderm and endoderm only
b) Ectoderm and mesoderm only d) Ectoderm, mesoderm, endoderm
11. Villi first appear on
a) 7th day c) 13th day
th
b) 9 day d) 15th day

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12. Which part of blastocyst give rise to embryo?

a) Inner cell mass c) Outer cell mass
b) Cytotrophoblast d) Mesoderm
13. Cytotrophoblast is covered by
a) Syncytiotrophoblasts c) Mesoderm
b) Villi d) Chorion
14. hcG is produced by
a) Cytotrophoblast c) Amnion
b) Syncytiotrophoblasts d) Chorion
15. What is the most common condition associated with Spontaneous abortion?
a) Paternal imprinting c) Chromosomal anomalies
b) Maternal imprinting d) Ectopic pregnancy

ANSWER KEY
1. D 2. B 3. D 4. D 5. D 6. B 7. D 8. A 9. B 10. D
11. C 12. A 13. A 14. B 15. C

03. 3rd week of development

1. What major organ system undergo early development during the third week?
a) Cardiovascular system c) Musculoskeletal system
b) Respiratory system d) CNS
2. What is the probable embryologic origin of Sacrococcygeal tumor?
a) Notocord c) Notochordal process
b) Primitive streak d) Primitive pit
3. The first indication of gastrulation in the embryo is
a) formation of the primitive streak c) formation of the neural tube
b) formation of the notochord d) formation of tertiary chorionic villi
4. The prochordal plate marks the site of the future
a) umbilical cord c) mouth
b) heart d) anus
5. Somites may differentiate into which of the following?
a) Urogenital ridge c) Notochord
b) Kidneys d) Epimeric and hypomeric muscles
6. Intermediate mesoderm will give rise to the
a) neural tube c) kidneys and gonads
b) heart d) somites
7. The lateral mesoderm is divided into two distinct layers by the formation of the
a) extraembryonic coelom c) notochord
b) intraembryonic coelom d) yolk sac
8. Which structure is not included in derivatives of somities?
a) Dermis of skin c) Bone
b) Epidermis of skin d) Cartilage
9. Notochordal process lengthens by migration of cells from
a) Notochord c) Primitive streak
b) Primitive node d) Notochord plate
10. Connection between amniotic cavity & primitive duct is obliterated in
a) 3rd week c) 4th week
b) 2nd week d) 8th week

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11. Occipital myotome forms muscle of

a) Tongue c) Pharynx
b) Iris d) Jaw opening
12. When chorionic villi are vascularized, they are known as ___ villi
a) Primary c) Tertiary
b) Secondary d) Stem
13. During third week of development of embryo, the following structures are developed except:
a) Somities c) Primitive streak
b) Primitive yolk sac d) Primitive heart
ANSWER KEY
1. a&d 2. B 3. A 4. C 5. D 6. C 7. B 8. B 9. B 10. A
11. A 12. C 13. A

04. 4th to 8th Week

1. When does Neurulation completes?

a) By the end of 3rd week c) By the end of 5th week
b) By the end of 4th week d) By the end of 6th week
2. The developing embryo has a distinct human appearance by the end of
a) week 5 c) week 7
b) week 6 d) week 8
3. Which structure is derived from the same embryonic primordium as the dorsal root ganglia?
a) Gonads c) Liver
b) Kidney d) Adrenal medulla
4. Which structure is derived from the same embryonic primordium as the kidney?
a) Gonads c) Liver
b) Pineal gland d) Adrenal medulla
5. Melanocytes are derived from:
a) Neural crest cells c) Mesoderm
b) Endoderm d) Ectoderm
ANSWER KEY
1. B 2. D 3. D 4. A 5. A

05. Fetal Period

1. A mother delivers a baby having weight less than 200g & cleft lip & cleft palate. What is the most probable factor associated with
mother during antenatal period responsible for it?
a) Cigarette smoking c) Maternal diabetes
b) Alcohol d) Multiple pregnancy
2. Concentration of alpha fetoprotein less than normal in the amniotic fluid may indicates:
a) Down syndrome c) CNS defect
b) Liver cancer d) Colorectal cancer
3. Viable fetus is characterized by all of the following except:
a) Weight > 500g c) Foot length > 40 mm
b) CRL > 200 mm d) Amniotic fluid > 200 ml
4. Best indicator for assessment of fetal age in first trimester:
a) CRL c) Head circumference
b) Biparietal diameter d) Amniotic fluid amount

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5. Lanugo & Vernix caseosa are present at which embryonic age?

a) 20th week c) 17th week
b) 22th week d) 25th week
6. When does surfactant production starts?
a) 21th week c) 28th week
b) 24th week d) 36th week
th
7. Average weight of a fetus at age of 9 month of gestation;
a) 3 kg c) 2 kg
b) 1.5 kg d) 5 kg
8. Quickening is first observed by the mother in which gestation age?
a) week 17-20 c) week 21-24
b) week 13-16 d) week 22-28
9. Fetal period extends from
a) 9th week to term c) Fertilization to term
b) 12th week to term d) 7th week to term
10. When does amniocentesis is recommended?
a) 9th week c) 13th week
b) 11th week d) 15th week
11. Concentration of alpha fetoprotein higher than normal in the amniotic fluid may indicates
a) Neural tube defect c) Colorectal cancer
b) Down syndrome d) Poland syndrome
12. Chorionic villus sampling is done at which week?
a) 10-12 week c) 14-16 week
b) 12-14 week d) 16-20 week
13. Head gains half of the CRL in which week of development?
a) 9th week c) 10th week
b) 8th week d) 11th week
14. Foot length of fetus is slightly larger than the femoral length at;
a) 24th week c) 37th week
th
b) 29 week d) 39th week
15. The ultrasound marker measured before 12 weeks of gestation to assess fetal gestational age is
a) Crown rump length c) Abdominal circumference
b) Femur length d) Biparietal diameter
16. When someone is "6 weeks" pregnant, this means that she has conceived ___ weeks previously
a) 6 c) 4
b) 5 d) 3
17. A common clinical finding in Post-term infant is:
a) Absence of lanugo c) Anemia
b) Extensive vernix caseosa d) Short stature

ANSWER KEY
1. A 2. A 3. D 4. A 5. A 6. B 7. A 8. A 9. A 10. D
11. A 12. A 13. A 14. C 15. A 16. C 17. A

06. Placenta & Fetal Membranes

1. Individual blastomeres were isolated from a blastula at the 4-cell stage. Each blastomere was cultured in vitro to the blastocyst stage
and individually implanted into four pseudopregnant foster mothers. Which of the following would you expect to observe 9 months
later?
a) Birth of one baby c) Birth of four genetically identical babies
b) Birth of four genetically different babies d) Birth of four grotesquely deformed babies
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2. A 42-year-old woman presents with complaints of severe headaches, blurred vision, slurred speech, and loss of muscle
coordination. Her last pregnancy 5 years ago resulted in a hydatidiform mole. Laboratory results show a high hCG level. Which of the
following conditions is a probable diagnosis?
a) Vasa previa c) Choriocarcinoma
b) Placenta previa d) Membranous placenta
3. During the later stages of pregnancy, maternal blood is separated from fetal blood by the
a) syncytiotrophoblast only c) syncytiotrophoblast and fetal endothelium
b) cytotrophoblast only d) cytotrophoblast and fetal endothelium
4. The maternal and fetal components of the placenta are
a) decidua basalis and secondary chorionic villi c) decidua parietalis and tertiary chorionic villi
b) decidua capsularis and secondary chorionic villi d) decidua basalis and villous chorion
5. The intervillous space of the placenta contains
a) maternal blood c) maternal and fetal blood
b) fetal blood d) amniotic fluid
6. What is a normal amount of amniotic fluid at term?
a) 50 mL c) 1000 mL
b) 500 mL d) 1500 mL
7. Which of the following does not pass through the primitive umbilical ring?
a) Allantois c) Yolk sac
b) Amnion d) Connecting stalk
8. Which of the following best describes the placental components of dizygotic twins?
a) One placenta, two amniotic sacs, one chorion c) Two placentas, two amniotic sacs, one chorion
b) One placenta, two amniotic sacs, two chorions d) Two placentas, two amniotic sacs, two chorions
9. A 26-year-old pregnant woman experiences repeated episodes of bright red vaginal bleeding at week 28, week 32, and week 34 of
pregnancy. The bleeding spontaneously subsided each time. Use of ultrasound shows that the placenta is located in the lower right
portion of the uterus over the internal os. What is the diagnosis?
a) Hydatidiform mole c) Placenta previa
b) Vasa previa d) Placental abruption
10. A 19-year-old woman in week 32 of a complication-free pregnancy is rushed to the emergency department because of profuse
vaginal bleeding. The bleeding subsides, but afterward no fetal heart sounds can be heard, indicating intrauterine fetal death. The
woman goes into labor and delivers a stillborn infant. On examination of the afterbirth, a velamentous placenta is detected. Although
not much can be done at this point, what is the diagnosis?
a) Placenta previa c) Hydatidiform mole
b) Vasa previa d) Amniotic band syndrome
11. A 32-year-old pregnant woman at 30 weeks of gestation comes to her physician because of excess weight gain in a 2-week period.
Ultrasonography reveals polyhydramnios. Which fetal abnormality is most likely responsible for the polyhydramnios?
a) Bilateral kidney agenesis c) Hypoplastic lungs
b) Velamentous placenta d) Esophageal atresia
12. An ultrasound examination of a pregnant woman during the second trimester revealed multiple amniotic bands associated with the
fetus. What produces these bands?
a) Oligohydramnios c) Omphaloenteric duct
b) Amnion tear & delamination d) Polyhydramnios
13. A condition in which one twin is larger & the other has been compressed & mummified?
a) Fetus papyraceus c) Pygopagus
b) Twin-Twin syndrome d) Conjoined twins
14. Monozygotic twins mostly occurs at which stage?
a) Blastocyst stage c) Implantation stage
b) Fertilization stage d) Gastrulation stage
15. Where does the blastocyst implant in placenta Previa?
a) Internal os of uterus c) Fallopian tube
b) Posterior superior wall of endometrium d) Pelvis

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16. What is the cause of polyhydroamnios?

a) Anencephaly c) Blockage of urinary system
b) Renal agensis d) Early rupture of amniotic membrane
17. If placenta is penetrated to full thickness of endometrium, this condition is known as
a) Placenta percreta c) Placenta acreta
b) Placenta previa d) Placenta increta
18. A woman gave birth to twin baby boys. One of them was larger in size than the other. Blood groups were different. Examination
of placenta showed extensive vascular anastomosis. Clinically this condition is called:
a) Twin transfusion syndrome c) Fetus papyraceous
b) Conjoined twins d) Fraternal twins
19. Thoracopagus twins also known as
a) Monozygotic Twins c) Dizygotic twins
b) Conjoined twins d) Chimaeras
20. High level of hCH is found in
a) Placenta previa c) Sacrococcygeal tumor
b) Ectopic pregnancy d) Hydatidiform mole
21. A new born baby had intrauterine amputation of his right leg distal to middle third. The causative agent for amputation of his limb
is:
a) Chromosomal aberration c) Amniotic band
b) An extremely long cord d) Connecting stalk
22. Which substance can't pass through the placenta?
a) Heparin c) IgG
b) Warfarin d) Iron
23. Decidual septa is produced in
a) 4th month c) 5th month
b) 3rd month d) 6th month
24. Conjoined twins are produced from
a) 1 placenta + 1 chorion c) 1 placenta + 2 chorion
b) 2 placenta + 2 chorion d) 2 placenta+ 1 chorion
24. A very short cord causes
a) premature seperation of placenta c) nuchal cord
b) very late seperation of placenta d) Polyhydroamnios
ANSWER KEY
1. C 2. C 3. C 4. D 5. A 6. C 7. B 8. D 9. C 10. B
11. D 12. B 13. A 14. A 15. A 16. A 17. A 18. A 19. B 20. D
21. C 22. A 23. A 24. A

07. Human Birth Defects

1. Webbed neck & gondal dysgenesis are the characteristic findings of

a) Turner syndrome c) Klinefilter syndrome
b) Down syndrome d) Edward syndrome
2. Mental deficiency, retarded growth, scantling eyes, small ears, neural tube defects & cardiac defects are the characteristic findings
in
a) Trisomy 13 c) Trisomy 21
b) Trisomy 18 d) Turner syndrome
3. Deletion of short arm of chromosome 5 is known as;
a) Angelman syndrome c) Miller-Dieker syndrome
b) Cri-du-chat syndrome d) Prader-Willi syndrome

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4. A short stature obese girl presented with complain of seizure and ataxic movement of limbs. What is the most probable diagnosis?
a) Angelman syndrome c) Miller-Dieker syndrome
b) Cri-du-chat syndrome d) Prader-Willi syndrome
5. The main deformity of alcohol fetal syndrome is
a) Mental retardation c) Cataract & Glucoma
b) Cleft lip d) Thymic aplasia
6. Warfarin is contraindicated in pregnancy. Which of the following abnormalities are commonly associated with warfarin use in first
trimester?
a) Dextrocardia c) Renal agenesis
b) Nasal hypoplasia d) Claw hand

ANSWER KEY
1. A 2. C 3. B 4. A 5. A 6. B

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A040 – A045
FOUNDATION HISTOLOGY
A-040 ֍MICROSCOPY & STANING TECHNIQUES֍
Give a read for MCQs.

A-041 ֍CELL MEMBRANE֍

Prepare this topic in Physiology Syllabus. See in P001 in CHAPTER#1 Past Papers BOOK.

A-042 ֍CELL ORGANALLES֍

01. Enlist Membranous & Non-membranous Cell Organelles

1. What are organelles? Name FIVE of them and give the difference between cytoplasmic organelles and inclusions.
Definition
 Organalles are organized structures having distinctive morphology and function which are found in the cytoplasm of all
eukaryotic cells
Five organalles
 Mitochondria  Golgi apparatus  Peroxisomes
 Ribosomes  Lysosomes  Centrioles

Cytoplasmic Organalles Cytoplasmic Inclusion

Have specific structure and shape Have no specific structure and shape
Perform functions Don't perform functions

02. Structure & Function of Organelles

It will be covered in physiology section P001

03. Cytoskeletan, (Immotile Cilia Syndrome)

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Note: The presence of a specific type of intermediate filament in tumors can often reveal the cellular origin of the tumor. Identification of
intermediate filament proteins by means of immunocytochemical methods is a routine procedure. One example is the use of GFAP to identify
astrocytomas, the most common type of brain tumor.

Immotile Cilia Syndrome (Kartagener syndrome)

Several mutations have been described in the proteins of the cilia and flagella. They are responsible for the immotile cilia syndrome
(Kartagener syndrome), whose symptoms are chronic respiratory infections caused by the lack of the cleansing action of cilia in the
respiratory tract and immotile spermatozoa, causing male infertility.

A-043 ֍CELL NUCLEUS֍

01. Structure of Chromatin, Chromosome, and Nucleolus

It will be covered in physiology & biochemistry

02. Structure & Types of DNA & RNA

It will be covered in physiology & biochemistry

03. Apoptosis & Necrosis

It will be covered in physiology & pathology

04. Cell Junctions

1. [UHS ANNUAL 2024 held in 2025]

a) Classify the intercellular junctions according to their functions.

Note: Cram whole table as it is very imp for mcqs

b) Which variety of intercellular junctions allows cellular communication? Write its ultrastructure and mention any three
sites in the body where such junctions are present.
Answer: Gap Junction Alternative names Nexus

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Ultrastructure The transmembrane gap junction proteins, connexins, form hexameric complexes called connexons, each of which
has a central hydrophilic pore about 1.5 nm in diameter. When two cells attach, connexins in the adjacent cell membranes move
laterally and align to produce connexons between the two cells.
Sites in Body
1. Heart (cardiac muscles)
2. Intestine (visceral smooth muscle)
3. Nerves
4. Placenta
Note: No Gap junction is found between skeletal muscle cells.

05. Cell Cycle & Cell Division

Features of normal cell cycle Description

Tightly controlled sequence Cell proliferation is a tightly controlled process that involves a large number of molecules and
of events interrelated pathways. To achieve DNA replication and replication, the cell goes through a tightly
controlled sequence of events called as cell cycle which consists of G1, S, G2 and M phases.
o G1 phase: It is the presynthetic phase.
o S phase: It‘s the synthetic phase.
o G2 phase: It is the premiototic phase.
o M phase: In this phase, cell divides into two.
o Note: Quiscent cells that have not entered the cell cycle are in the Go phase.
Each cell cycle is dependent on the proper activation and completion of previous ones and the
cycle stops at the place where an essential gene function is deficient
Requirement of growth The replication of cells is stimulated by growth factors and signaling from ECM components
signals
Control of cell cycle It is brought about by these mechanisms;
Check points: Embedded in cell cycle are surveillance mechanisms that are geared to sensing
damage to DNA and chromosomes. These quality control checks are called check points. The cell
cycle has multiple check points particularly:
o during emergence from Go into G1
o and the transition from G1 to S phase called Restriction point
Cyclins and cyclin dependent kinases: Progression through the cell cycle, particularly at the G1-
S transition, is regulated by proteins called cyclins and associated enzymes, CDKs, which are
activated by binding to cyclins. Their combination binds crucial target proteins that drive the cell
through the cell cycle.
Cyclin dependent kinase inhibitors: The activity of CDK-cyclin is regulated by CDK inhibitors,
which enforce cell cycle checkpoints.
DNA damage control: If cell senses DNA damage checkpoint activation delays cell cycle. DNA
damage, if too severe, results in apoptosis or senescence.
Tumor Suppression genes: several tumor suppressor genes are involved in inhibiting the
progression of neoplasm e.g.,
 RB gene: The first tumor suppressor gene to be discovered. It functions to bind the
transcription factor E2F in its active hypo phosphorylated state so that Cyclin E/CDK2
dependent progression in cell cycle does not occur.
 p-53 gene: It is also called the guardian of the genome. It thwarts neoplastic
transformation by three independent mechanisms:
o Temporary cell cycle arrest (quiescence)
o Induction of permanent cell cycle arrest (senescence)
o Triggering of programmed cell death (Apoptosis)

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06. Define Clinicopathologic terms

1. Atresia: The congenital absence or abnormal closure of a normal body opening or tubular structure, such as the esophagus or bile
ducts.
2. Anaplasia: The loss of differentiation and cellular organization in a tissue, often seen in malignant tumors, where cells appear
primitive and abnormal.
3. Neoplasia: The uncontrolled, abnormal growth of cells or tissues in the body, which can be benign (non-cancerous) or malignant
(cancerous).
4. Inflammation: The body's protective response to injury, infection, or irritation, characterized by redness, heat, swelling, pain, and
loss of function.
5. Metastasis: The spread of cancer cells from the primary site to other parts of the body, forming secondary tumors.
6. Hyperplasia, Hypertrophy, Metaplasia & Atrophy will be coved in detail in pathology section

A-044 ֍EPITHELIUM֍

01. Epithelium

1. Name various types of specialization of the apical cell surface of epithelium

 Microvilli
 Cilia
 Sterocilia
2. Draw and label the diagram of pseudostratified epithelium. Classify it on basis of surface modification of superficial cells given one
example.
Diagram: Do diagrams of histology from your Histology Practical Notebook
Surface Modification
 Pseudostratified epithelium has cilia as a surface modification of superficial cells
 Example: Epithelial lining of trachea

3. Name different types of stratified epithelia. What are the chief structural features of urothelium (transitional epithelium).
Types of Stratified epithelium
 Stratified squamous keratinized epi
 Stratified squamous non keratinized
 Stratified cuboidal epithelium
 Stratified columnar epithelium
 Transitional epithelium/Urothelium

Structural features of Urothelium

Undistended State Distended State
Consist of ≥ 6 layers of cells Consist of 2-3 layers of cells
Basal layer of cuboidal cell Basal layer of cuboidal cells
Layers of Polygonal cells over basal layer Layer(s) of flattened cells over basal layer
Most superficial layer appears to consist of very large Most superficial layer contains Plaques (rigid areas)
dome-shaped cells called umberalla cells

4. Draw and label light microscopic picture of transitional epithelium. What is its other name and why? Mention its functions.
Diagram: Do diagrams of histology from your Histology Practical Notebook
Other Name
 Urothelium
Why called so?
 Because it lines urinary system especially urinary bladder, ureter, renal pelvis and calyces
Functions
o Stretching: Transitional epithelium is able to stretch and change shape in response to changes in the volume of the bladder or
ureters. This allows the urinary system to accommodate large volumes of urine without tearing.

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o Barrier Function: Transitional epithelium is a barrier between the urine and the underlying tissues. This helps to prevent the
diffusion of harmful substances from the urine into the body.
o Secretion: Transitional epithelium is involved in the secretion of mucus, which helps to protect the urinary system from
damage by acidic urine.

Types Subtypes Examples

Simple epithelium Simple squamous epithelium  Endothelium
 Mesothelium
 Type 1 alveolar cells
Simple cuboidal epithelium  Follicular thyroid epithelium
 Epithelial lining of DCT
Simple columnar epithelium  Stomach
 Intestine
 Gallbladder
 Uterus
Stratified epithelium Stratified squamous keratinized epi  Epidermis of skin
Stratified squamous non keratinized  Oral cavity
 Oropharynx
 Esophagus
Stratified cuboidal epithelium  Ducts of sweat glands
 Ducts of pancreas & salivary glands
Stratified columnar epithelium  Eye conjunctiva
 Male urethra
Transitional epithelium/Urothelium  Urinary bladder, ureters
 Renal calyces, renal pelvis
Pseudostratified  Conducting parts of respiratory passage
epithelium  Epididymus & Ductus deferens
Note: Prepare this table very well. It is very important for seqs & mcqs

02. Exocrine Glands

1. a) Define and classify compound exocrine glands quoting one example of each. Draw diaphragmatic outline of these glands to
support your answer.
Defination
o Glands which release their products onto epithelial surface either directly or through duct

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b) Name three viscera in the body which are both endocrine and exocrine glands.
1. Pancreas
2. Ovaries
3. Testes

Do You Know!
Three basic types of secretion are used by cells of exocrine glands, depending on what substance is being
secreted.
1. Merocrine secretion releases products, usually containing proteins, by means of exocytosis at the apical end
of the secretory cells. Most exocrine glands are merocrine.
2. Holocrine secretion is produced by the disintegration of the secretory cells themselves as they complete their
terminal differentiation, which involves becoming filled with product. Sebaceous glands of hair follicles are the
best examples of holocrine glands.
3. Apocrine secretion involves loss of membrane-enclosed apical cytoplasm, usually containing one or more
lipid droplets. Apocrine secretion, along with merocrine secretion, is seen in mammary glands.

06. Mechanism of Transport across Epithelium

It will be covered in physiology

A-045 ֍CONNECTIVE TISSUE֍

01. Connective Tissue

1. Name the cells found in loose areolar connective tissue.

 Fibroblasts & Macrophages are two main types of cells
 Other cells include mast cells & adipocytes

Note: Do it for mcqs & viva

02. Glycosaminoglycans
It will be covered in biochemistry

05. Macrophage-Mononuclear-Phagocytic System

It will be covered in physiology

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06. Structure & Function of Macrophage, Mast Cell, and Plasma Cell

Cell Structure Function

Macrophage Size and shape vary considerably, corresponding to their state of Phagocytosis of ECM components
functional activity. A typical macrophage measures between 10 and 30 and debris; antigen processing and
μm in diameter and has an eccentrically located, oval or kidney- presentation to immune cells;
shaped nucleus secretion of growth factors, cytokines,
and other agents
Mast Cell oval or irregularly shaped cells of connective tissue, between 7 and 20 Release heparin, histamine, serine
μm in diameter, filled with basophilic ecretory granules which often proteases & chemotactic factors
obscure the central nucleus. Because of the high content of acidic
radicals in their sulfated GAGs, mast cell granules display
metachromasia, which means that they can change the color of some
basic dyes
Plasma cell Large, ovoid cells have basophilic cytoplasm rich in RER and a large Antibodies production
Golgi apparatus near the spherical eccentrically placed nucleus (clock-
face appearance)

07. Types of Adipose Tissue

White adipose tissue
 Found in many organs throughout the body, typically forming about 20% of the body weight in adults.
 Adipocytes of white fat are typically very large cells, ranging in diameter from 50 to 150 μm.
 These cells each contain primarily one large lipid droplet (they are unilocular), causing the nucleus and remaining
cytoplasm to be pushed against the plasmalemma.
 Fatty acids are released from white adipocytes by lipase activity when nutrients are needed and carried throughout the body
on
 plasma proteins such as albumin.
 Leptin is a polypeptide hormone with target cells in the hypothalamus that is released from white adipocytes and helps
regulate eating behavior.
Brown Adipose Tissue
 Brown fat comprises up to 5% of the newborn body weight but smaller amounts in adults.
 Adipocytes of this tissue are typically smaller than those of white fat and contain primarily many small lipid droplets (they
are multilocular) in cytoplasm containing many mitochondria and a central nucleus.
 Fatty acids released in adipocytes of brown fat are metabolized in mitochondria of these cells for thermogenesis rather than
ATP synthesis, using uncoupling protein-1.

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֍PAST MCQs֍

01. Cell

1. Which of the following cell components is not surrounded by a membrane?

a) Lysosomes c) Nucleus
b) Mitochondria d) Nucleolus
2. Golgi apparatus is concerned with:
a) Energy production. c) Synthesis of proteins.
b) Concentration & packing of secretory products d) Synthesis of secretory products.
3. The following cell organelles are subjected to the enzyme histochemistry for the detection of acid phosphatase. Which organelle
will show highest concentration of this enzyme?
a) Plasma membrane c) Ribosome
b) Lysosomes d) SER
4. Autophagy is the process by which cells ___
a) kill themselves c) neutralizes toxins
b) kill their organalles d) produce inflammation
5. Where is the glycocalyx particularly thick in the body?
a) Brain c) muscles
b) liver d) intestine
6. Which type of cell junctions present in Placenta?
a) Tight junction c) Adhering junction
b) Gap junction d) Anchoring junction
7. Which organalle is the only double layered organalle in eukaryotic cell?
a) Lysosomes c) Mitochondria
b) Microbodies d) Nucleus
8. Which part of mitochondria shows cristae?
a) External surface of outer membrane c) Intermembranous space
b) Inner surface of outer membrane d) Inner membrane
9. Which of the following organalle is basophilic?
a) RER c) Golgi apparatus
b) SER d) Mitochondria
10. Ciliated cells contain abdundant:
a) Lysosomes c) Golgi apparatus
b) SER d) Mitochondria
11. The transmembrane proteins in tight junctions
a) Occludin & claudin c) Cadherins
b) Integrins d) Vinculin
12. Cell junction connecting basal lamina with epithelium:
a) Hemidesmosome c) Junctional complex
b) Gap junction d) Desmosome
13. Which intermediate filament js found in Skin?
a) Actin c) Keratin
b) Desmin d) Vimentin
14. Using immunohistochemistry a population of cells is shown to be positive for the protein connexin. From this we can infer that the
cells are connected by what type of junction?
a. Tight (occluding) junctions c. Gap junctions
b. Zonula adherens d. Desmosomes (macula adherens)

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15. An intermediate filament protein found in cytoplasm of most epithelial cells is which of the following?
a. Actin c. Laminin
b. Vimentin d. Keratin
16. With a 5-year history of chronic respiratory infections, a 23-yearold, non-smoking man is referred to an otolaryngologist. A
bronchial biopsy indicates altered structures in the epithelial cells. Which of the following, if altered to reduce function, is most likely
involved in this patient‘s condition?
a. Hemidesmosomes c. Basolateral cell membrane folds
b. Cilia d. Microvilli
17. A medical student is observing cell division under a specialized microscope. He can visualize the chromatids being pulled apart at
the centromere and moving toward the poles. These cells are exhibiting:
a. Anaphase c. Karyokinesis
b. Cytokinesis d. Metaphase

ANSWER KEY
1. D 2. B 3. B 4. B 5. D 6. B 7. B 8. D 9. A 10. D
11. A 12. A 13. C 14. C 15. D 16. B 17. A

02. Epithelium

1. The oesophagus is lined by:

a) Simple columnar epithelium. c) Stratified squamous keratinized epithelium
b) Simple cuboidal epithelium. d) Stratified squamous non-keratinized epithelium
2. An example of the stratified squamous non-keratinized epithelium is constituted by the lining epithelium of:
a) Trachea. c) Oesophagus
b) Urinary bladder d) Stomach
3. Which example is false regarding the transitional epithelium?
a) Renal pelvis c) Urinary bladder
b) Ureter d) Collecting ducts
4. Dome cells area characteristic of which type of epithelium?
a) Simple columnar epithelium. c) Simple squamous epithelium
b) Transitional epithelium d) Stratified squamous keratinized epithelium
5. One type of epithelium may change into another by a process called
a) Regeneration c) Metaplasia
c) Meiosis b) Amitosis
6. Epithelial lining of palatine tonsil?
a) Simple cuboidal c) Stratified squamous non keratinized
b) Pseudostratified columnar d) Stratified squamous keratinized
7. The superficial cells in transitional epithelium of a contracted bladder are
a) Umberalla shape c) Polygonal
b) Fusiform d) Cuboidal
8. Pseudostratified ciliated columnar epithelium doesn't line:
a) Larynx c) Bronchi
b) Trachea d) Respiratory bronchiole
9. The effect of smoking on respiratory epithelium is described by a phenomenon known as:
a) Metaplasia c) Hypertrophy
b) Hyperplasia d) Atrophy
10. Epithelial basement membrane contain which type of collagen fibrils ?
a) Collagen type I c) Collagen type III
b) Collagen type II d) Collagen type IV
11. Which of the following is true about the structure of cilia?
a) Cilia are composed of microtubules arranged in a 9+2 pattern
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b) Cilia are composed of microfilaments arranged in a 9+2 pattern.

c) Cilia are composed of intermediate filaments arranged in a 9+2 pattern.
d) Cilia are composed of microtubules arranged in a 8+2 pattern.
12. Kinicilia are made up of:
a) Microtubules c) Microfilaments
b) Microbodies d) Ribosomes
13. Celiac disease is one of the malabsorptive disorder that leads to diarrhea in children. Keeping in view the functions of the
following structures, which one is affected in Celiac disease?
a) Cilia c) Microvilli
b) Kinicilia d) Villi
14. An 11-month-old girl is referred to a pediatric gastroenterology clinic due to a history of generalized weakness, slow growth, and
refractory diarrhea. For the past month she has been hospitalized regularly to receive parenteral nutrition. Examination of the
epithelium lining her small intestine confirms that the failure to absorb nutrients is most likely due to a significant decrease in which
of the following?
a. Microvilli c. Cilia
b. Gap junctions d. Cell layers

ANSWER KEY
1. D 2. C 3. D 4. B 5. C 6. C 7. A 8. D 9. A 10. D
11. A 12. A 13. C 14. A

03. Glands

1. Type of gland in which the apical portion of cell becomes the secretary product ?
a. Merocrine glands c. Apocrine glands
b. Holocrine glands d. Endocrine glands
2. What is an example of compound Tubular glands ?
a. Brunner's glands of duodenum c. Submandibular salivary glands
b. Axocrine portion of pancreas d. Sublingual salivary glands
3. A 25 years girl complains about excessive sweating even in normal condition. What is the type of sweat gland?
a) Colloid simple tubular c) Holocrine
b) Compound tubular d) Straight simple tubular
4. The release of lipid droplets from cells is which type of secretion?
a. Merocrine c. Endocrine
b. Apocrine d. Holocrine
ANSWER KEY
1. C 2. A 3. A 4. b

04. Connective Tissue

1. A macrophage has all of the following features except:

a) An irregularly shaped nucleus c) Many surface projections
b) Many lysosomes d) Few microfilaments
2. Plasma cells:
a) Contain few ribosomes c) Are specialized for production of humoral antibodies
b) Have a centrally placed nucleus d) Are found mostly in lymphatic tissue
3. The distinguishing feature of plasma cell is its:
a) Cartwheel nucleus c) Shape
b) Site of presence d) Membrane structure

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4. Production of antibodies is the function of:

a) Fibroblasts. c) Histiocytes.
b) Plasma cells d) Mast cells
5. Which one of the following cells located in the connective tissue arises from myeloid stem cells?
a) Pericytes c) Fibroblasts
b) Eosinophils d) Osteoblasts
6. Which cells are not resident cells of Connective tissue?
a) Adipocytes c) Macrophages
b) Fibroblasts d) Myofibroblasts
[Link] (wandering cells) of CT are:
a) Adipocytes c) Macrophages
b) Fibroblasts d) Myofibroblasts
8. Sharpey fibers are composed of:
a) Collagen type I c) Collagen type III
b) Collagen type II d) Collagen type IV
9. The most generalized type of connective tissue (in the sense of possessing the greatest variety of connective tissue components) is:
a) Adipose c) Loose
b) Reticular d) Mesenchyme
10. The precursor of the heparin is contained in:
a) The mast cells c) The fibroblasts
b) The histiocytes d) The plasma cell
11. Which one of the following statements concerning loose connective tissue is true?
a) It is less abundant than dense connective tissue
b) It has a lower proportion of cells to fibers than does dense connective tissue
c) It acts as a medium for exchange of nutrients and wastes between the blood and tissues
d) It provides structural support for organs
12. Dense regular connective tissue is present in:
a) Capsules of organs c) Tendons
b) Basement membrane d) Skin
13. Fascia lata is an example of
a) Loose CT c) Dense irregular CT
b) Dense regular CT d) Aponeurosis
14. The fibrous component of loose connective tissue is composed of:
a) Collagenous, reticular and elastic fibers c) Elastin, collagen, and glycoproteins
b) Type I collagen in loose bundles d) Type I collagen in fine fibers
15. Loose connective tissue, in comparison with tendon, contains relatively:
a) More fibers and more ground substance c) Fewer cells and more fibers
b) Fewer cells and fewer fibers d) More fibers and more cells
16. White adipocytes are derived developmentally from what precursor cells?
a. Monocytes c. Mesenchymal cells
b. Fibroblasts d. Brown adipocytes
17. Important target cells of leptin are found in which organ?
a. Small intestine c. Large intestine
b. White adipose tissue d. Hypothalamus
18. Ten days after birth a full-term newborn boy develops firm, erythematous nodules and plaques over his trunk, arms, buttocks,
thighs, and cheeks. His mother’s pregnancy was complicated by placenta previa and his airway was cleared of aspirated meconium
immediately after birth. A biopsy of subcutaneous tissue shows necrosis within the brown adipose tissue. What metabolic activity is
liable to be affected in this patient?
a. Export of fatty acids from fat c. Oxidation of fatty acids for thermogenesis
b. Thermal insulation d. Initiation of shivering

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19. What cells numerous in loose connective tissue are filled with secretory granules and stain with metachromasia?
a. Macrophages c. Fibrocytes
b. Mast cells d. Active fibroblasts
20. Which of the following connective tissue components is located in the ECM but not in the ground substance?
a. Collagen bundles c. GAGs
b. Fibronectin d. Proteoglycans

ANSWER KEY
1. D 2. C 3. A 4. B 5. B 6. C 7. C 8. A 9. D 10. A
11. B 12. C 13. C 14. A 15. B 16. C 17. D 18. C 9. B 20. A

20. Ground substance = GAGs, proteoglycans, and multiadhesive glycoproteins & CT = ground substance + collagen

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P001 – P007
FOUNDATION PHYSIOLOGY
P-001 ֍CELL BIOLOGY֍

01. Homeostasis

1. Define homeostasis. Enlist the mechanism by which homeostasis is achieved. (Annual 2021)
‗Homeostasis‘ refers to the maintenance of constant internal environment of the body (homeo = same; stasis = standing).
Mechanisms
1. Positive feedback mechanism
2. Negative feedback mechanism

DO YOU KNOW
Some movements of the body occur so rapidly that there is not enough time for nerve
signals to travel from the peripheral parts of the body all the way to the brain and then
back to the periphery again to control the movement. Therefore, the brain uses a
mechanism called feed-forward control to cause required muscle contractions. Sensory
nerve signals from the moving parts apprise the brain about whether the movement is
performed correctly. If not, the brain corrects the feed-forward signals that it sends to
the muscles the next time the movement is required. Then, if still further correction is
necessary, this process will be performed again for subsequent movements. This process
is called adaptive control. Adaptive control, in a sense, is delayed negative feedback.

02. Extracellular vs Intracellular Fluids

Not imp

03. Positive and Negative feedback mechanisms

1. What are the characteristics of positive feedback control system of body, explain with examples. (Annual 2019)
2. Briefly explain two instances where positive feedback mechanism can be useful. (Annual 2016)

Characteristics Examples
Amplification Blood clotting is an example of a positive feedback system. When a blood vessel is injured, platelets adhere
to the site and release chemicals that attract more platelets. This activates more platelets to aggregate,
leading to the formation of a blood clot. The clotting process continues and amplifies until the bleeding is
stopped.
Self-perpetuating Uterine contractions during childbirth demonstrate positive feedback. The initial contractions stimulate the
cycle release of oxytocin, a hormone that further intensifies the contractions. As contractions become stronger,
more oxytocin is released, resulting in a self-perpetuating cycle until the baby is delivered.
Destabilizing effect Fever is a positive feedback response of the body's immune system to infection. When the body detects an
infection, it releases chemicals called pyrogens, which raise the body temperature. The increased body
temperature stimulates the immune response and inhibits the growth of bacteria or viruses. As the immune
response continues, the body temperature further rises, creating a positive feedback loop until the infection
is under control.

3. (2014 Annual)
a) What is negative feedback control mechanism? Give two examples to elaborate your answer.
Negative feedback is the one to which the system reacts in such a way as to arrest the change or reverse the direction of change.

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1. Water balance by ADH

2. Control of thyroxine secretion by TSH

04. Cell Membrane and Cell Organelles

1. (Annual 2022)
a) What are the different types of cell membrane proteins and
their function?
1. Integral proteins
 are anchored to, and imbedded in, the cell membrane through
hydrophobic interactions.
 may span the cell membrane.
 include ion channels, transport proteins, receptors, and
guanosine 5′-triphosphate (GTP)–binding proteins (G
proteins).
2. Peripheral proteins
 are not imbedded in the cell membrane.
 are not covalently bound to membrane components.
 are loosely attached to the cell membrane by electrostatic interactions.

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2. Write a short note on structure & functions of a) Endoplasmic reticulum b) Golgi apparatus. (Supple 2022)

Organelle Endoplasmic reticulum Golgi Apparatus

Structure Rough Endoplasmic Reticulum: It is the Each Golgi apparatus consists of 5 to 8 flattened
endoplasmic reticulum with rough, bumpy or membranous sacs called the cisternae. Golgi apparatus
bead-like appearance. Rough appearance is due to is situated near the nucleus.
the attachment of granular ribosomes to its outer It has two ends or faces;
surface. Hence, it is also called the granular Cis face is positioned near the endoplasmic reticulum.
endoplasmic reticulum. Rough endoplasmic Reticular vesicles from endoplasmic reticulum enter
reticulum is vesicular or tubular in structure.
the Golgi apparatus through cis face.
Smooth Endoplasmic Reticulum: It is the
Trans face is situated near the cell membrane. The
endoplasmic reticulum with smooth appearance. It
processed substances make their exit from Golgi
is also called agranular reticulum. It is formed by
apparatus through trans face
many interconnected tubules. So, it is also called
tubular endoplasmic reticulum.
Function 1. Synthesis of proteins Processing, packaging, labeling and delivery of
2. Degradation of worn-out organelles proteins and lipids
3. Synthesis of lipids and steroids
4. Role in cellular metabolism
5. Storage and metabolism of calcium
6. Catabolism and detoxification of toxic
substances

3. Give comparison between the functions of lysosomes & peroxisomes (Annual 2020) (Annual 2015) (Annual 2008) (Annual 2007)
4. Briefly explain four differences between lysosomes and peroxisomes. (Annual 2023 – MODULAR SYSTEM)

Feature Lysosome Peroxisomes

Derived from Golgi appartus ER
Size large Small
Consist of Hydrolase enzyme Oxidase enzymes
Function Degradtion of macromolecules Detoxification; Fatty acid oxidation
Disorder Tay such disease Zellweger syndrome

5. Enlist various functions performed by a) Cell membrane protein b) ATP. (Supple 2018) (Annual 2006)
a) Functions of Proteins in Cell Membrane
 Integral proteins provide the structural integrity of the cell membrane
 Channel proteins help in the diffusion of water-soluble substances like glucose and electrolytes
 Carrier or transport proteins help in the transport of substances across the cell membrane by means of active or passive
transport
 Pump: Some carrier proteins act as pumps, by which ions are transported actively across the cell membrane
 Receptor proteins serve as the receptor sites for hormones and neurotransmitters
 Enzymes: Some of the protein molecules form the enzymes and control chemical (metabolic) reactions within the cell
membrane
 Antigens: Some proteins act as antigens and induce the process of antibody formation
 Cell adhesion molecules or the integral proteins are responsible for attachment of cells to their neighbors or to basal lamina
b) Functions of ATP
 Energy Storage and Transfer
 Cellular Work
 Metabolic Reactions
 Active Transport
 Enzyme Activation
 Signaling and Cell Communication

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6. Enlist the function of plasma membrane protein & carbohydrates (2016 Supple)
Functions of cell membrane proteins See in Q#3.
Functions of Cell membrane Carbohydrates
1. Carbohydrate molecules are negatively charged and do not permit the negatively charged substances to move in and out of
the cell.
2. Glycocalyx from the neighboring cells helps in the tight fixation of cells with one another
3. Some carbohydrate molecules function as the receptors for some hormones.

7. Enumerate types of endoplasmic reticulum with their corresponding functions (Annual 2014)

Organelle Functions
Rough Endoplasmic reticulum 1. Synthesis of proteins
2. Degradation of worn-out organelles
Smooth Endoplasmic Reticulum 1. Synthesis of lips & steroids
2. Role in cellular metabolism
3. Storage of metabolism & Calcium
4. Catabolism & detoxification of toxic substances

8. Which organelle can increase their number by self-replication? Give function of these organelles. (Supple 2010 + Annual 2013]
Answer: Mitochondria can increase in number by self-replication because it has its own genetic material and ribosomes.
1. Production of energy: Mitochondrion is called the ‗power house‘ or ‗power plant‘ of the cell because it produces the energy
required for cellular functions. The energy is produced during the oxidation of digested food particles like proteins, carbohydrates and
lipids by the oxidative enzymes in cristae. During the oxidative process, water and carbon dioxide are produced with release of
energy. The released energy is stored in mitochondria and used later for synthesis of ATP.
2. Synthesis of ATP: The components of respiratory chain in mitochondrion are responsible for the synthesis of ATP by utilizing the
energy by oxidative phosphorylation. ATP molecules diffuse throughout the cell from mitochondrion. Whenever energy is needed for
cellular activity, the ATP molecules are broken down.
3. Apoptosis: Cytochrome C and second mitochondria-derived activator of caspases secreted in mitochondria are involved in
apoptosis.
4. Other functions: other functions of mitochondria include storage of calcium and detoxification of ammonia in liver.
9. What is Tay-Sachs disease? (Supple 2012)
Tay-Sachs disease is a rare genetic disorder that primarily affects the nervous system. It is an autosomal recessive disorder, meaning it
occurs when an individual inherits two copies of the mutated gene, one from each parent.
Cause:
 Caused by a deficiency of an enzyme called hexosaminidase A (Hex-A), Tay-Sachs disease results in the accumulation of a
fatty substance called GM2 ganglioside in the nerve cells of the brain and spinal cord. This build-up of GM2 ganglioside
interferes with the normal functioning of the cells, leading to progressive damage and deterioration of the nervous system.
Signs & Symptoms:
 Developmental Delays, Loss of Motor Skills, Hypotonia, Vision and Hearing Problems., Seizures & Cognitive Decline
10. (Annual 2012)
a) Enumerate 4 functions of Golgi apparatus.
1. Processing of materials Vesicles containing glycoproteins and lipids are transported into Golgi apparatus. Here, the glycoproteins
and lipids are modified and processed.
2. Packaging of materials All the processed materials are packed in the form of secretory granules, secretory vesicles and lysosomes,
which are transported either out of the cell or to another part of the cell. Because of this, Golgi apparatus is called the ‗post office of
the cell‘.
3. Labeling and delivery of materials Finally, the Golgi apparatus sorts out the processed and packed materials and labels them (such
as phosphate group), depending upon the chemical content for delivery (distribution) to their proper destinations. Hence, the Golgi
apparatus is called ‗shipping department of the cell‘.

b) Which cell organelle contains oxidases & hydrolases? Give the function of oxidases.

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The cell organelle that contains oxidases and hydrolases is the peroxisome. Hydrolases are also present in lysosomes.
Oxidases are enzymes that catalyze oxidation reactions. They play a crucial role in cellular metabolism and various biochemical
processes. The function of oxidases within the peroxisome is primarily related to the breakdown of fatty acids and the detoxification
of harmful substances.

11. Draw structure of cell membrane & give its functions. (Annual 2004)

Reference:(Guyton & Hall Textbook of Physiology)

12. Compare & contrast the phenomena of necrosis with apoptosis (Annual 2019)

Features Apoptosis Necrosis

Cause Programmed Trauma
Physiological or Pathological Both Only pathological
Number of cells Individual cell Many cells
Plasma membrane Intact Disrupted
Cell contents Packed into apoptotic bodies & consumed Spill out into tissue
by phagocytes
Adjacent inflammation No Yes
Cell size Shrink Enlarged (swelling)
Nucleus DNA laddering (Fragmentation into Pyknosis→Karyorrhexis→Karyolysis
nucleosome size fragments)
Cytoplasmic appearance Dense eosinophilic Varry with different types

05. Cytoskeletan (Structure & Function)

1. Name the human body cells exhibiting the amoeboid movement. What is initiator factor for this type of movement? (2021 Supple
held in 2022)
Cells That Exhibit Ameboid Locomotion
 White blood cells
 Fibroblasts
 Germinal cells of the skin
Initiating Factor:

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 Chemotaxis which results from release of chemicals

07. Endocytosis & Pinocytosis

1. How does the digestion of phagocytic vesicle occur inside the cell? (2020 Supple)
Almost immediately after a pinocytotic or phagocytic vesicle appears inside a cell,
one or more lysosomes become attached to the vesicle and empty their acid
hydrolases to the inside of the vesicle, as shown in Figure. Thus, a digestive
vesicle is formed inside the cell cytoplasm in which the vesicular hydrolases begin
hydrolyzing the proteins, carbohydrates, lipids, and other substances in the vesicle.
The products of digestion are small molecules of amino acids, glucose,
phosphates, and so forth that can diffuse through the membrane of the vesicle into
the cytoplasm. What is left of the digestive vesicle, called the residual body,
represents indigestible substances. In most instances, this is finally excreted
through the cell membrane by a process called exocytosis, which is essentially the
opposite of endocytosis. Thus, the pinocytotic and phagocytic vesicles containing
lysosomes can be called the digestive organs of the cells.

2. Briefly explain the process of autolysis. Also mention other functions of the organelle involved in this process. [Supple 2023 held in
2024]
Damage to the cell—caused by heat, cold, trauma, chemicals, or any other factor  induces lysosomes to rupture  They release
hydrolases immediately & begin to digest the surrounding organic substances. If the damage is slight, only a portion of the cell is
removed and the cell is then repaired. If the damage is severe, the entire cell is digested, a process called autolysis.
Other Functions:
 Lysosmes involve in digestion of substances by pinocytosis and phagocytosis.
 The lysosomes also contain bactericidal agents that can kill phagocytized bacteria. These agents include (1) lysozyme, which
dissolves the bacterial cell membrane; (2) lysoferrin, which binds iron and other substances before they can promote bacterial
growth; and (3) acid at a pH of about 5.0, which activates the hydrolases and inactivates bacterial metabolic systems.

08. Cell Transport

1. Explain the mechanism of counter transport of substances across a cell membrane with help of examples. (Annual 2018 & 2017]
Sodium counter transport is the process by which the substances are transported across the
cell membrane in exchange for sodium ions by carrier protein called antiport. Various
counter transport systems are:
i. Sodium-calcium counter transport: In this, sodium and calcium ions move in opposite
directions with the help of a carrier protein. This type of transport of sodium and calcium ions
is present in all the cells.
ii. Sodium-hydrogen counter transport: In this system, the hydrogen ions are exchanged for
sodium ions and this occurs in the renal tubular cells. The sodium ions move from tubular
lumen into the tubular cells and the hydrogen ions move from tubular cell into the lumen
iii. Other counter transport systems: Other counter transport systems are sodium-magnesium
counter transport, sodium potassium counter transport, calcium-magnesium counter transport, calcium-potassium counter transport,
chloride bicarbonate counter transport and chloride sulfate counter transport.

2. Classify & describe the mechanism of active transport of substances through the plasma membrane. (Supple 2017)
1. Primary Active Transport
 It occurs against an electrochemical gradient (―uphill‖). requires direct input of metabolic energy in the form of adenosine
triphosphate (ATP) and therefore is active.
 It is carrier mediated and therefore exhibits stereospecificity, saturation, and competition.
Example

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 Na+/K+ ATPase (or Na+/K+ pump) in cell membranes transports Na+ from intracellular to extracellular fluid and K+ from
extracellular to intracellular fluid; it maintains low intracellular [Na+] and high intracellular [K+]. Both Na+ and K+ are
transported against their electrochemical gradients & energy is provided from the terminal phosphate bond of ATP. The usual
stoichiometry is 3 Na+ /2 K+.
2. Secondary Active Transport
 The transport of two or more solutes is coupled. One of the solutes (usually Na+) is transported ―downhill‖ and provides
energy for the ―uphill‖ transport of the other solute(s).
 Metabolic energy is not provided directly but indirectly from the Na+ gradient that is maintained across cell membranes.
Thus, inhibition of Na+, K+ -ATPase will decrease transport of Na+ out of the cell, decrease the transmembrane Na+
gradient, and eventually inhibit secondary active transport. d. If the solutes move in the same direction across the cell
membrane, it is called cotransport or symport.
Example
 Na+-glucose cotransport in the small intestine and renal early proximal tubule and Na+ –K+ –2Cl– cotransport in the renal
thick ascending limb. e. If the solutes move in opposite directions across the cell membranes, it is called counter transport,
exchange, or antiport.

3. Which transport mechanism through the cell membrane shows Vmax? Compare properties of this transport with those of simple
diffusion. (Annual 2016) (Annual 2010)
Answer: Facilitated transport shows Vmax.

4. Describe the functions of sodium-potassium ATPase, give other examples of primary active transport. (Supple2021)

Functions of Na+/K+ ATPase pump Examples of Primary active transport

1. Maintain membrane potential 1. Ca+ pupmp2. H+/K+ pump
2. Generate electrochemical gradient/Resting membrane potential 3. Proton pump
3. Regulate cell volume
4. Support secondary active transport.

5. Explain the relationship of Na-K ATPase activity & intracellular Na concentration with the help of an example. (Supple 2020)
When a neuron is at rest, the Na-K ATPase maintains a low intracellular concentration of sodium ions. However, during the initiation
of an action potential, there is a temporary increase in sodium ion permeability of the cell membrane, allowing sodium ions to rapidly
enter the cell. This causes a localized depolarization, known as the "upstroke" of the action potential.
After the depolarization phase, the Na-K ATPase is activated to restore the ionic balance and reset the resting membrane potential. It
actively pumps out the excess sodium ions that entered the cell during the depolarization phase. This restores the low intracellular
sodium concentration and helps establish the negative resting membrane potential, enabling the neuron to return to a state ready for
another action potential.

6. Explain the transport mechanism involved in uptake of glucose when Insulin injection is given to a Type 1 diabetic patient with the
help of a diagram. (UHS ANNUAL 2024 held in 2025)
Insulin increases cellular glucose uptake by increasing production of GLUT-4 transporters via activating JAK-STAT system. Insulin
increases facilitated diffusion of glucose.

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09. Cell Genetics

1. What is importance of genetic code in DNA. (Annual 2022)

The importance of DNA lies in its ability to control the formation of proteins in the cell. It does this by means of a genetic code. That
is, when the two strands of a DNA molecule are split apart, this exposes the purine and pyrimidine bases projecting to the side of each
DNA strand. It is these projecting bases that form the genetic code.
The genetic code consists of successive “triplets” of bases—that is, each three successive bases is a code word. The successive triplets
eventually control the sequence of amino acids in a protein molecule that is to be synthesized in the cell.

2. Enlist the reasons why only a minute fractions of cells that mutate in the body ever lead the cancer. Name the factors that can
increase the probability of mutation of cells (2021 Supple held in 2022)

Only a small fraction of cells that undergo mutations in Factors that can increase the probability of cell mutations
the body develop into cancer for several reasons: and potentially contribute to cancer development include:
 DNA Repair Mechanisms  Inherited Genetic Mutations
 Immune System Surveillance  Age
 Apoptosis (Programmed Cell Death)  Weakened Immune System
 Natural Selection  Chronic Inflammation
.

3. Briefly enlist the types of RNA‘s & their functions (Annual 2020) (Annual 2018- part a) (Annual 2017- part a)
(Supple 2016- part b)

Types of RNA Functions

Messenger RNA It carries the genetic code to the cytoplasm for controlling the type of protein formed.
Ribosomal RNA It, along with about 75 different proteins, forms ribosomes, the physical and chemical structures on
which protein molecules are actually assembled.
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Transfer RNA It transports activated amino acids to the ribosomes to be used in assembling the protein molecule.
MicroRNA They are single-stranded RNA molecules of 21 to 23 nucleotides that can regulate gene transcription
and translation.

P-002 ֍BLOOD֍

01. Blood (Composition & Functions)

Not imp

02. Plasma Proteins

1. Enumerate 6 functions of plasma proteins. From where are these synthesized?

 Transport hormones, lipids, and other substances throughout the body
 Maintenance of oncotic pressure
 pH buffering
 Humoral immunity
 Blood clotting
 Source of energy for the body during times of fasting or prolonged exercise.
Synthesis  All plasma proteins are synthesized by the liver except gamma globulin which is synthesized in plasma cells

03. Pathophysiology of Edema

Read this topic from PATHOLOGY.
Not imp. Leave it here. It will be covered in 3 rd block

P-003 ֍RBCs֍

01. Characteristics of RBCs, Different types of Bone Marrow

Leave it. Not imp

02. Erythropoiesis

1. What are the various sites of erythrocyte formation before birth & after birth? What is the normal life span of red blood cells?
Before birth  Yolk sac (1st trimester), Liver (2nd trimester) & Bone marrow (last month)
After birth  Bone marrow
Normal life span  120 days

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2. Draw and label different stages of differentiation of red blood cells.

Note: Synthesis of Hb begins in polychromatophil erythroblast

03. Erythropoietin

1. Mr. Ali goes to an altitude of 10,000 feet. What will be effect on erythropoises? Explain the mechanism of this effect.
2. A man of 30 years stays for 15 days in a village at the height of 7000 ft. What changes are likely to occur in his RBC count and
how?
3. Explain the control of RBC production in a person who has arrived at the base camp of Mount Everest?
Renal tissue hypoxia  increased tissue level of hypoxia inducible factor-1  HIF-1 increased transcription & translation of
erythropoietin (EPP)  EPO stimulates the production of red blood cells in the bone marrow.

04. Significance of vitamin B12 and folic acid in RBCs maturation

1. In a 45 year old patient chronic gastritis with anemia, the doctor did gastroscopy and reported atrophy of gastric mucosa. Further
investigations revealed: Hemoglobin = 7.5g/dl, and MCV = 105 fl.
a) What is the condition is he suffering from?
Pernicious anemia
b) What is the role of vitamin B-12 in erythropoiesis?
Vitamin B-12 requires for the synthesis of thymidine, a component of DNA. So, Vitamin B-12 is required for nuclear maturation &
cell division of erythroblastic cells of bone marrow
c) What is the normal MCV value and how it is affected in iron deficiency anemia?
The normal MCV (mean corpuscular volume) value is between 80-100 fl. In iron deficiency anemia, the MCV is typically low

2. A patient has undergone partial gastrectomy 3 years back. Now he presented to a physician with generalized weakness, pale
complexion and easy fatiguability. His clinical examination showed anemia. Lab investigations revealed Hb = 8g/dl, RBCs count =
3.5 million/µl, and MCV = 110 fl.
(a) Name the type of anemia present in this patient?
Megaloblastic anemia
(b) What is its pathophysiology?
Gastrectomy  deficiency of intrinsic factor  Vit B12 doesn't absorb  Vitamin B-12 deficiency  No synthesis of thymidine, a
component of DNA  arrest of DNA replication of rbcs and the erythroblastic cells of the bone marrow produce immature
macrocytes  macrocytes after entering the circulation have short life  anemia.

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3 Supple 2023 held in 2024

a) Enlist & Explain the role of maturation factors required for erytheropoiesis. Name the disease that results due to deficiency
of these factors.

Maturation factors Role Disease due to Deficiency

Vitamin B12 They are required for the synthesis of thymidine, a component of DNA. So, Macrocytic Anemia
Folic Acid required for nuclear maturation & cell division of erythroblastic cells of
bone marrow

b) Mention any 2 conditions in which these maturation factors are deficient.

1. Vitamin B12 (Atrophic gastritis, Gastrectomy Pernicious anemia due to deficiency or absence of intrinsic factor)
2. B9/Folic Acid (Sprue Folic acid is not absorbed through intestine in this condition.)

P-004 ֍HEMOGLOBIN֍

01. The types of normal hemoglobin in different ages of life

13. What are physiological types of hemoglobin? Enumerate functions of hemoglobin.

Adult hemoglobin
 97% HbA with 2α & 2β chains
 3% HbA2 with 2α & 2δ chains
Fetal hemoglobin
 HbF with 2α & 2γ chains
Embryonic hemoglobin
 Hb Gower-1 with 2 zeta & 2 epsilon chains
 Hb Gower-2 with 2α & 2δ chains
Functions of Hemoglobin
 Responsible for carrying oxygen from the lungs to the tissues of the body
 Transport carbon dioxide from the tissues to the lungs where it can be exhaled
 Helps to regulate the pH of the blood by binding to hydrogen ions
 Helps to maintain blood pressure by binding to nitric oxide, a vasodilator that helps to relax blood vessels

2. Write down the five steps for synthesis of one molecule of hemoglobin

02. Role of Iron in Hemoglobin formation.

1. A female of 25 year with complains of weakness and breathlessness on exertion consulted her family doctor. She was having pallor
of the skin. Her blood reports showed Hb: 8mg/dl, RBC count: 3.8 million/µl, MCV: 75fl and MCH: 24pg.
a) From which disorder the woman was suffering?
Anemia

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b) What was the type of disorder on the basis of blood reports?

Microcytic hypochromic
c) Give causes of this disorder
 Iron deficiency
 Blood loss due to hemorrhage, menstruation
 Chronic disease.

2. Explain with the help of diagram, the metabolism, storage and the transport of iron.

3. Explain why people who do not have adequate quantities of transferrin in their blood tend to develop severe hypochromic anemia in
relation to iron metabolism?
Transferrin is a protein that binds to iron in the blood and transports it to the bone marrow where it is used for the production of red
blood cells. Without adequate quantities of transferrin, the body is unable to transport iron to the bone marrow, leading to a decrease
in the production of red blood cells. This leads to hypochromic anemia.

03. Blood Indices

1. A young woman is having iron deficiency anemia. What changes occur in her hemoglobin concentration, RBCs count, MCV,
MCH, MCHC?

Parameter Change
[Hemoglobin] Decreases due to a decrease in the amount of iron available for the production of
hemoglobin
RBC count Decreases due to a decrease in the amount of iron available for the production of
new RBCs
MCV Decreases due to a decrease in the size of RBCs
MCH Decreases due to a decrease in the amount of hemoglobin in each RBC
MCHC Decreases due to a decrease in the amount of hemoglobin in each RBC, which
leads to a decrease in the concentration of hemoglobin in the blood.

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04. Abnormal types of Hemoglobin

P-005 ֍WBCs֍

01. Types of white blood cells & their functions

Not imp for seq. But can be asked in mcq & ospe

02. Explain the process of defense against invading agents by neutrophils and macrophages

1. What is the chemotaxis?

Many different chemical substances in the tissues cause both neutrophils and macrophages to move toward the source of the chemical.
This phenomenon is known as chemotaxis

2. Summarize four lines of body defense system during inflammation

Ist line of defense Within minutes after inflammation begins, the macrophages already present in the tissues
Tissue macrophages immediately begin their phagocytic actions.

2nd line of defense With in the first hour or so after the inflammation begins, large number of neutrophils begin to
Neutrophils invade the inflammed area from blood by following steps:
 Margination
 Diapedesis
 Chemotaxis
3rd line of defense Along with invasion of neutrophils, monocytes from blood enter inflammed tissue. These
Macrophage invasion into monocytes take 8 hours to become mature macrophages which then start phagocytosis
inflammed tissue
4th line of defense Stimulus from inflammed tissue stimulates granulocytic & monocytic progenitor cells of bone
↑ production of granulocytes & marrow
monocytes by bone marrow Takes 3-4 days to form mature granulocytes & monocytes

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3. Summarize the macrophage and neutrophils responses in chronological order in inflammation

Step Description Mediators

Margination & Migration of wbcs towards periphery (towards endothelium) during blood Selectins
rolling flow is known as margination. WBCs bind and detach (loose attachement)
and thus begin to tumble on the endothelial surface, a process called
rolling.
Stable Adhesion Firm adhesion of wbcs on endothelial surface mediated by integrins Integrins (ICAM-1)
Transmigration Wbcs travel between endothelial cells & exit blood vessel PECAM-1
(Diapedesis)
Migration Wbcs travel through interstitium to the site of injury or infection guided by Bacterial & Viral toxins
(Chemotaxis) chemotactic signals C5a, IL-8, LTB4
Phagocytosis Phagocytosis of a particle (e.g., a bacterium) involves binding to receptors Lysosomal enzymes
on the leukocyte membrane, engulfment, and fusion of the phagocytic ROS, NO
vacuoles with lysosomes. This is followed by destruction of ingested H2O2-MPO-halide system
particles within the phagolysosomes by lysosomal enzymes and by reactive
oxygen and nitrogen species.
ROS produced by phagocyte oxidase (also known as NADPH oxidase)
which catalyzes the conversion of oxygen into superoxide (O2−) and H2O2.
In neutrophils, this reaction is known as Respiratory burst.
Myeloperoxidase, present in the granules of neutrophils, converts H2O2 to
hypochlorite. H2O2 is also converted to hydroxyl radical (OH•), another
powerful destructive agent

04. Walling off effect

1. What is walling-off effect of inflammation?

It is a mechanism by which the body tries to contain and isolate an infectious agent or foreign substance that has entered a tissue or
organ. It involves the formation of a physical barrier or wall (fibrinogen clot) around the affected area to prevent the spread of
infection or damage to nearby tissues.

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05. Define leukocytosis and leukopenia, Explain the effects of leukemia on the body

1. Compare the effects of leukopenia & Leukemia on body

Leukopenia Leukemia
 Ulcer appear in mouth, colon & respiratory tract o Metastatic growth of leukemic cells so they may invade
within 2 days after the bone marrow stops bone causing bone pain
producing wbcs o Infection & Fever
 Infection o Anemia
 Fever o Thrombocytopenia
o Debilitation of body tissues due to excessive utilization of
carbohydrates & amino acids
o Weight loss

06. Reticuloendothelial System

1. What is reticuloendothelial system and its important sites in the body? How does it effect the Rbcs?
The total combination of monocytes, mobile macrophages, fixed tissue macrophages, and a few specialized endothelial cells is called
the reticuloendothelial system
Important sites
 Liver
 Spleen
 Bone marrow
 Lymph nodes
 Lungs
 Skin & subcutaneous tissues
The RES plays an important role in the removal of old and damaged RBCs from circulation. Macrophages engulf the old & damaged
RBCs and break them down, releasing the iron and other components for reuse in the body. This process helps to maintain the balance
of RBCs in the circulation and prevent the accumulation of old or damaged RBCs.

P-006 ֍BLOOD TYPES֍

01. Enumerate different blood group types, Explain the basis of ABO and Rh blood system

1. a) Blood of which group does not contain A, B and Rh agglutinogens?

O blood group
b) What is the significance of this group?
It is universal donor group. Person with O blood group can donate his blood to the person with any blood group. However, person
with O blood group can receive blood only from person with blood group O
c) Which blood group incompatibility is common in new born babies?
Rh blood group incompatibility

02. The Landsteiner law

Read this topic in CH#35 from Guyton & Hall Textbook of Physiology. Not imp

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P-007 ֍ANS֍

1. Enumerate 12 effects of sympathetic stimulation in the body. Which neurotransmitters are released preganglionic & postganglionic
sympathetic nerve fibers.
Preganglionic fibers  Acetylcholine
Postganglionic fibers  Epinephrine & Norepinephrine

Referemce: Katzung Pharmacology

2. Enumerate the effects of parasympathetic stimulation in the body.

See Q1

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3. A 36 years old male patient comes to emergency with history of severe neck trauma. He complains of variety of symptoms
including hoarseness, tachycardia / irregular heartbeat, problems with digestion and constipation. (UHS Mock test – MODULAR
SYSTEM)
a) What division of nervous system, in this patient, has been damaged? (01)
Parasympathetic Division of Autonomic Nervous system [Actually, vagus (10th cranial) nerve has been damaged in this patient, this
carries Parasympathetic fibers].
(b) What are the major effects produced on different organs by the division of nervous system damaged in this patient? (04)
See Q1

֍PAST UHS MCQs֍

01. Introduction to Physiology

1. Cell membrane is _____

A) Thick & fibrous C) Composed of proteins & lipids
B) Thin & non-elastic D) Made up of Carbohydrates only
2. Mitochondria ___________
A) are self-replicative C) Work along with SER for protein synthesis
B) Contains RNA only D) Do not have a membrane
3. Ribosomes ______
A) Have two different types of proteins C) Have 60% RNA in their structure
B) Controls biochemical activity of cell D) are entirely synthesized in cell cytoplasm
4. In primary active transport energy is derived from ________
A) ATP breakdown C) Counter transport of Ca+2 & H+
B) Ionic concentration difference D)Co-transport of glucose & Amino acids
5. Na+/K+ pump continuously pumps ____________
A) Only sodium ions to inside the cell C) Both Na+/K= ions outside
B) Chloride ions along with Na+/K= ions D) Na+ ions outside & K+ ions inside
6. Formation of peroxisomes occur from
A) Golgi apparatus C) SER
B) Mitochondria D) RER
7. Nucleolus
A) contains ATP C) has oxidative enzymes
B) has thick membranes D) is site of rRNA synthesis
8. The intercellular connections having high permeability for various ions are
A) Hemidesmosomes C) Gap junctions
B) Desmosomes D) Focal adhesions
9. The structure not involve in protein synthesis is
A) Nucleolus C) RER
B) Ribosomes D) SER
10. Facilitated diffusion
A) utilizes energy C) Involve carrier protein
B) occurs through semipermeable membrane D) involves Na+/K+ pump
11. Exocytosis is a process which play role of
A) is always employed by cells for secretion
B) is used to deliver material into extracellular space
C) Take up large molecules from the extracellular space
D) is responsible for engulfing large size particles from extracellular space
12. Which of the following is the principle intracellular cation?
A) Na+ C) K+
B) Ca+2 D) Mg+2

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13. Gasses cross the cell membrane by following mechanism

A) Secondary Active transport C) Passive diffusion
B) Primary Active Transport D) Facilitated transport
14. Which cellular organelle modifies, packages, and sorts proteins for secretions or use within cell
A) Golgi Apparatus C) ER
B) lysosomes D) Mitochondria
nd
15. NO works by which of the following 2 messenger system
A) cAMP C) JAK-STAT
B) cGMP D) IP3
16. Function of Golgi apparatus
A) Lipid synthesis C) Nucleic acid synthesis
B) Protein synthesis D) Hyaluronic acid synthesis
17. Thickness of membrane affects
A) Primary active transport C) Facilitated diffusion
B) Secondary active transport D) Simple diffusion
18. Tay Sach disease is _______ storage disease
A) Mitochondrial C) Peroxisomal
B) Lysosomal D) Golgi apparatus
19. Which nucleotide base is absent in DNA?
A) Adenosine C) Guanosine
B) thiamine D) Uracil
20. Which organelle contains hydrolytic enzymes.
A) Ribosomes C) SER
B) Lysosome D) Golgi apparatus
21. Chromatin material is also found in
A) ER C) Lysosomes
B) Golgi apparatus D) Mitochondria
22. Double membrane bounded organalle containing linear DNA:
A. Nucleus C. Mitochondria
B. Nucleolus D. Ribosome
23. Nissil bodies are present in
A. RER C. Axon hillock
B. Golgi apparatus D. Nucleus
24. Which organelle is continuous with nucleus?
A. RER C. Golgi apparatus
B. SER D. Peroxisome
25. Process that occurs in lysosome:
A. Phagocytosis C. Exocytosis
B. Pinocytosis D. All

ANSWER KEY
1. C 2. A 3. C 4. A 5. D 6. C 7. D 8. C 9. D 10. C
11. B 12. C 13. C 14. A 15. B 16. D 17. D 18. B 19. D 20. B
21. D 22. C 23. A 24. A 25. A 26. 27. 28. 29. 30.

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02. Blood

1. Excess iron in blood mainly deposit in

a) Hepatocytes c) Leukocytes
b) Astrocytes d) Reticuloendothelial cells
2. Aged RBCs mainly destroyed in
a) Liver c) Bone marrow
b) Spleen d) Lungs
3. Red blood cells :
a) are nucleated c) Hemolyse in hypertonic saline
b) contain blood group antigens on their surface d) are biconvex disc shaped
4. Receptors for IgE antibodies are present on surface of
a) Basophils c) Lymphocytes
b) Eosinophils d) Neutrophils
5. Stored blood plasma has greater concentration of
a) Sodium c) Calcium
b) Potassium d) Chloride
6. The plasma protein not synthesized in the liver
a) Albumin c) Immunoglobulins
b) Fibrinogen d) Alpha globulin
7. During intrauterine life, RBCs production first start in
a) Yolk sac c) Bone marrow
b) Spleen d) Liver
8. Erythropoietin is formed mainly by
a) Bone marrow cells c) Perivenous hepatocytes
b) Juxtaglomerular cells d) Reticuloendothelial cells
9. In Rh negative blood, Rh antibodies are present
a) Normally in the plasma b) Normally on the RBC membrane
c) Only in persons who have been sensitized by Rh positive blood d) and these can't cross placenta
10. In case of Rh blood group system:
a) Agglutinins are present since birth c) Landsteiner's law is not applicable
b) Agglutinins are generally hemolysins d) Landsteiner's law is applicable
11. Heparin is released by
a) Eosinophils c) Lymphocytes
b) Mast cells d) Neutrophils
12. Allergen & Pollen cause
a) Neutrophilia c) Neutropenia
b) Eosinophilia d) Eosinopenia
13. Smallest non-nucleated blood cells are
a) rbcs c) eosinophils
b) neutrophils d) lymphocytes
14. Which type of blood cells are characterized by 1-5 lobed nuclei?
a) Neutrophils c) Basophils
b) Eosinophils d) Lymphocytes
15. RBC enters the blood as
a) Reticulocyte c) Orthochromatic erythroblast
b) Erythrocytes d) Proerythroblast

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16. Universal donor blood group:

a) Blood group O– c) Blood group A
b) Blood group O+ d) Blood group B
17. The first cell that can be identified as belongings to RBC series
a) Basophil erythroblast c) Reticulocyte
b) Proerythroblast d) CFU-S
18. Mast cells and basophils play important role in some types of:
a) Allergic reactions. c) Acute infections.
b) Parasitic infections. d) Chronic inflammatory diseases
19. Cancerous mutation of myelogenous or Lymphogenous cells is called:
a) Leucopenia c) Leukemia
b) Anemia d) Leukocytosis
20. Two antigens – type A and type B are present:
a) On surface of RBC‘s. c) Along with plasma albumin.
b) In plasma. d) As a part of agglutinins
21. Iron for hemoglobin synthesis in rbcs is transported by
a) Transferin c) Haptoglobin
b) Ferritin d) Apoferritin
22. Number of molecules of iron carried by one hemoglobin molecule:
a) 1 c) 4
b) 2 d) 8
23. Which of the following is not released in inflammation?
a) Histamine c) Interleukin
b) Bradykinin d) Acetylcholine
24. About 65% of the total body iron is in the form of
a) Ferritin c) Myoglobin
b) Hemoglobin d) Various heme compounds
25. Infusion of a chemical agent which can cause atrophy of gastric mucosa would result in
a) Iron deficiency anemia c) Megaloblastic anemia
b) Pernicious anemia d) Hemolytic anemia
26. The term hematocrit means
a) percentage volume of blood that is rbcs b) ratio of blood volume to extracellular space
b) percentage volume of blood that is plasma d) percentage of newly formed rbcs every 120 days
27. Which cells found in bone marrow & normally don't participate in peripheral blood
A. Plasma cells C. B cells
B. Platelets D. NK cells

ANSWER KEY
1. A 2. B 3. B 4. A 5. B 6. C 7. A 8. B 9. C 10. B
11. B 12. B 13. A 14. A 15. A 16. A 17. B 18. A 19. C 20. A
21. A 22. C 23. D 24. B 25. B 26. A 27. A 28. 29. 30.

27. Plasma cells produce antibodies locally (within bone-marrow), not requiring circulation

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03. ANS

1. Adrenal medullary cells are stimulated by:

a) Dopamine c) Acetylcholine
b) Adrenaline d) Nor-adrenaline
2. Sympathetic stimulation causes:
a) Dilation of all blood vessels of the body c) Decreased cardiac activity
b) Activates gastric motility d) Pupillary dilation
3. Sympathetic fibers to which glands are cholinergic?
a) Sweat glands c) Lacrimal glands
b) Gastrointestinal glands d) Apocrine glands
4. A boy visited a circus and got scared upon seeing a lion. As a consequence of this fear, he will have reduced
a) blood flow in git c) heart rate
b) blood glucose d) mental activity
5. A factory worker encountered an accident that led to an extensive damage to his lumbar spinal cord segments. The autonomic nerve
fibers damaged;
a) Preganglionic sympathetic c) Postganglionic sympathetic
b) Preganglionic parasympathetic d) Postganglionic parasympathetic

ANSWER KEY
1. C 2. D 3. A 4. A 5. A 6. 7. 8. 9. 10.

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֍PRACTICE MCQs֍

01. Intoduction to physiology

1. The term ―glycocalyx‖ refers to

A) the negatively charged carbohydrate chains that protrude into the cytosol from glycolipids and integral glycoproteins
B) the negatively charged carbohydrate layer on the outer cell surface
C) the layer of anions aligned on the cytosolic surface of the plasma membrane
D) the large glycogen stores found in ―fast‖ muscles
2. Messenger RNA (mRNA)
A) carries the genetic code to the cytoplasm
B) carries activated amino acids to the ribosomes
C) is single-stranded RNA molecules of 21 to 23 nucleotides that can regulate gene transcription
D) forms ribosomes
3. Which of the following statements is true for both pinocytosis and phagocytosis?
A) Involves the recruitment of actin filaments
B) Occurs spontaneously and non-selectively
C) Endocytotic vesicles fuse with ribosomes that release hydrolases into the vesicles
D) Is only observed in macrophages and neutrophil
4. In comparing two types of cells from the same person, the variation in the proteins expressed by each cell type reflects
A) differences in the DNA contained in the nucleus of each cell
B) differences in the numbers of specific genes in their genomes
C) cell-specific expression and repression of specific genes
D) differences in the number of chromosomes in each cell
5. Micro RNAs (miRNAs)
A) are formed in the cytoplasm and repress translation or promote degradation of mRNA before it can be translated
B) are formed in the nucleus and then processed in the cytoplasm by the dicer enzyme
C) are short (21 to 23 nucleotides) double-stranded RNA fragments that regulate gene expression
D) repress gene transcription
6. ―Redundancy‖ or ―degeneration‖ of the genetic code occurs during which of the following steps of protein synthesis?
A) DNA replication C) Post-transcriptional modification
B) Transcription D) Translation
7. Which of the following does not play a direct role in the process of transcription?
A) Helicase C) Chain-terminating sequence
B) RNA polymerase D) ―Activated‖ RNA molecules
8. Which of the following proteins is most likely to be the product of a protooncogene?
A) Growth factor receptor C) Na + channel
B) Cytoskeletal protein D) Ca ++ ATPase
9. Which of the following events does not occur during the process of mitosis?
A) Condensation of the chromosomes C) Fragmentation of the nuclear envelope
B) Replication of the genome D) Alignment of the chromatids along the equatorial plate
10. Which of the following characteristics of a biological membrane is most influenced by its cholesterol content?
A) Thickness C) Fluidity
B) Ion permeability D) Glycosylation
11. The appearance of which of the following distinguishes eukaryotic cells from lower units of life?
A) DNA C) Membranes
B) RNA D) Nucleus

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12. A 75 year old man presented with blister formation after minimal trauma to the skin, he was diagnosed as a case of epidermolysis
bullosa. Which of the cytoskeleton is most likely to be involved.
A) Microtubules C) Keratin filaments
B) Microfilaments D) Glial filaments
13. Which of the following characteristics is shared by simple and facilitated diffusion of glucose?
A) Occurs down an electrochemical gradient C) Requires metabolic energy
B) Is saturable D) Is inhibited by the presence of galactose
14. During the upstroke of the nerve action potential
A) there is net outward current and the cell interior becomes more negative
B) there is net outward current and the cell interior becomes less negative
C) there is net inward current and the cell interior becomes more negative
D) there is net inward current and the cell interior becomes less negative
15. Which cell organelle is responsible for detoxification of harmful substances?
A) Lysosomes C)Golgi Apparatus
B) Peroxisomes D) Endoplasmic Reticulum
16. Passive transport is a transport which does not require energy for movement of substances across cell membrane. Which one is an
example of Passive transport
A) Ca+2 efflux by Ca+2 pump C) Ca+2 sequestration in sarcoplasmic reticulum
B) Na+/Ca+2 counter-transport D) K+ efflux through leaky channel
17. Which organelle is primarily responsible for synthesis of ATP through oxidative phosphorylation.
A) Mitochondria C) Nucleus
B) Endoplasmic Reticulum D) Lysosomes
18. Solutions A and B are separated by a membrane that is permeable to urea. Solution A is 10 mM urea, and solution B is 5 mM urea.
If the concentration of urea in solution A is doubled, the flux of urea across the membrane will
A) double C) be unchanged
B) triple D) decrease to one-half
19. A human cell continuously engulfing and excreting substances, the process of engulfing is called
A) Phagocytosis C) Exocytosis
B) Pinocytosis D) Active transport
20. Which of the following transport mechanisms is not rate limited by an intrinsic Vmax?
A) Facilitated diffusion via carrier proteins C) Secondary co-transport
B) Primary active transport via carrier proteins D) Simple diffusion through protein channels
21. Transport of d- and l-glucose proceeds at the same rate down an electrochemical gradient by which of the following processes?
A) Simple diffusion C) Primary active transport
B) Facilitated diffusion D) Cotransport
22. Which of the following will double the permeability of a solute in a lipid bilayer?
A) Doubling the molecular radius of the solute
B) Doubling the oil/water partition coefficient of the solute
C) Doubling the thickness of the bilayer
D) Doubling the concentration difference of the solute across the bilayer
23. Which of the following would occur as a result of the inhibition of Na+ , K+ -ATPase?
A) Decreased intracellular Na+ concentration C) Increased intracellular Ca2+ concentration
B) Increased intracellular K+ concentration D) Increased Na+ –glucose cotransport
24. Which of the following transport processes is involved if transport of glucose from the intestinal lumen into a small intestinal cell
is inhibited by abolishing the usual Na+ gradient across the cell membrane?
A) Simple diffusion C) Primary active transport
B) Facilitated diffusion D) Cotransport
25. Simple diffusion and facilitated diffusion share which of the following characteristics?
A) Can be blocked by specific inhibitors C) Require transport protein
B) Do not require adenosine triphosphate (ATP) D) Saturation kinetics

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26. A new drug is developed that blocks the transporter for H+ secretion in gastric parietal cells. Which of the following transport
processes is being inhibited?
A) Simple diffusion C) Primary active transport
B) Facilitated diffusion D) Cotransport
27. A full term pregnant patient gave birth to a healthy baby in the labor Rome, after delivery the size of uterus decreased to its pre-
pregnancy state in 6 weeks. Which of the following organelle involve in this process.
A) Golgi Apparatus C) Peroxisomes
B) Lysosomes D) Mitochondria
28. Mitochondria are rod shaped organelles found in all cells except
A) Epithelial cells C) Muscle cell
B) Germ cells D) RBC

ANSWER KEY
1. B 2. A 3. A 4. C 5. A 6. D 7. A 8. A 9. B 10. C
11. D 12. C 13. A 14. D 15. B 16. D 17. A 18. B 19. A 20. D
21. A 22. B 23. C 24. D 25. B 26. C 27. B 28. D

8. Proto-oncogenes are genes that have the potential to become oncogenes, which are genes that can cause cancer. Proto-oncogenes
normally encode proteins involved in cell growth, differentiation, and survival. When mutated or overexpressed, they can become
oncogenic, leading to uncontrolled cell growth and cancer. Growth factor receptors (A) are a type of protein that can be encoded by
proto-oncogenes. They receive signals from growth factors, which stimulate cell growth and proliferation. Examples of proto-
oncogenic growth factor receptors include HER2 (human epidermal growth factor receptor 2) and EGFR (epidermal growth factor
receptor)

02. Blood, Inflammation, Basis of Blood groups

1. During the second trimester of pregnancy, where is the predominant site of red blood cell production?
a) Yolk sac b) Bone marrow
c) Lymph nodes d) Liver
2. Normal value of hematocrit:
a) 40-45% c) 60-65%
b) 20-25% d) 80-85%
3. Which of the following substances is absent in plasma?
a) Glucose c) Antibodies
b) Hemoglobin d) Hormones
4. Gamma globulin is synthesized by :
a) T cells c) Liver
b) B cells d) Kidney
5. After the age of 20 years, main site of RBCs production is:
a) Spleen c) Bones
b) Liver d) Yolk sac
6. A committed stem cell that produces erythrocytes is called a:
a) CFU-B c) CFU-S
b) CFU-E d) MHSC
7. A 24-year-old man came into the ER with a broken leg. A blood test was ordered and his WBC count was 22 × 103/μl. Five hours
later, a second blood test resulted in values of 7 × 103/μl. What is the cause of the increased WBC count with the first test?
a) Increased production of WBC by the bone marrow b) Shift of WBCs from marginated pool to circulating pool
c) Decreased destruction of WBCs d) Increased production of selectins

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8. In a normal healthy person, which of the following blood components has the shortest life span?
a) Macrophages c) Erythrocytes
b) Memory T cells d) B lymphocytes
9. A 45-year-old man presents to the emergency room with a 2-week history of diarrhea that has gotten progressively worse over the
last several days. He has minimal urine output and is admitted to the hospital for dehydration. His stool specimen is positive for
parasitic eggs. Which type of WBCs would have an elevated number?
a) Eosinophils c) T lymphocytes
b) Neutrophils d) Monocytes
10. Where does the transmigration of WBCs occur in response to infectious agents?
a) Arterioles c) Venules
b) Lymphatic ducts d) Inflamed arteries
11. Granulocytes & Monocytes are formed in:
a) Bone marrow only c) Thymus
b) Peyer's patches d) Spleen
12. First line of defense of body against inflammation:
a) Neutrophils c) Tissue macrophages
b) Circulating monocytes d) Eosinophils
13. In which of the following condition eosinophilia is most commonly seen?
a) Parasitic infection c) Viral infection
b) Bacterial infection d) Fungal infection
14. Most common type of blood group:
a) O c) A
b) AB d) B
15. Asim, a 5 years old boy falls from his bicycle and receives a cut over the knee. His tissue macrophages & fibroblasts will move to
the site of injury for repair by:
a) Ciliary movement c) Chemotaxis
b) Ameboid movement d) Margination
16. Long term hypoxia may serve as a growth inducer of the following blood cells:
a) Basophils c) Macrophages
b) Monocytes d) Red blood cells
17. Red blood cells can pass from bone marrow to blood capillaries by diapedesis during:
a) Orthochromatic erythroblast stage c) Reticulocyte stage
b) Mature erythrocyte stage d) Proerythroblast stage
18. What occurs following activation of basophils?
a) Decreased diapedesis of neutrophils c) Contraction of blood vessels
b) Decreased ameboid motion d) Increased capillary permeability
19. Fluid exudation into the tissue in the acute inflammatory reaction is due to
a) decreased blood pressure c) obstruction of the lymph vessels
b) decreased protein in the interstitium d) increased vascular permeability
20. The protein responsible for iron transport in plasma is
a) a 1-antitrypsin c) Apo-transferrin
b) Ferritin d) Apo-ferritin
21. The mechanism of action of the following substance involves chemotaxis:
a) Bacterial & viral toxins c) Regenerative products of inflamed tissues
b) Fungal & parasitic toxins d) Reaction Products caused by inflammation
22. Ahmad was diagnosed as a severe case of sprue. His blood picture revealed macrocytic anemia of the following type:
a) Sickle cell anemia c) Blood loss anemia
b) Hereditary spherocytosis d) Pernicious anemia
23. A 30 years old male is brought to the hospital with history of gastrectomy. His skin appears lemon-yellow. Investigations reveal
hemoglobin 10 g/dl, odd shaped RBCs and Serum Vitamin B is low. He is likely to be suffering from:
a) Blood Loss Anemia c) Megaloblastic Anemia
b) Pernicious Anemia d) Hemolytic Anemia

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24. After a person is placed in an atmosphere with low oxygen, how long does it take before there are increased numbers of
reticulocytes?
a) 6 hours c) 3 days
b) 12 hours d) 5 days
25. The total life span of tissue macrophages is
a) 4-8 hours c) Several months
b) 4-5 days d) 10-20 hours
26. In the second line of defense the process of MARGINATION involves all of the following EXCEPT.
a) Interleukin-2 c) ICAM-1
b) Selectin d) Capillary & Venule endothelial cells
27. Schistosomiasis is a common parasitic infection found in as many as one third of the population of Asia. Which one of the
following can most likely kill these organisms?
a) Basophils c) Major basic protein
b) Mast cells d) Neutrophils
ANSWER KEY
1. D 2. A 3. B 4. B 5. C 6. B 7. B 8. C 9. A 10. C
11. A 12. C 13. A 14. A 15. B 16. D 17. C 18. D 19. D 20. C
21. A 22. D 23. C 24. D 25. C 26. A 27. C
7. The majority of WBCs are stored in the bone marrow, waiting for an increased level of cytokines to stimulate the release from the
bone marrow. However, trauma to bone can result in a release of WBCs into the circulation. This increase in WBC count is not due to
any inflammatory response, but instead to mechanical trauma
10. Capillaries & Venules
18. Basophils release heparin, histamine, and a series of activating factors. The histamine acts to increase capillary permeability while
the heparin prevents clotting.

03. Autonomic Nervous System

1. Adrenal medullary hormones are released in response to

a) Sympathetic preganglionic neurons c) Parasympathetic preganglionic neurons
b) Sympathetic postganglionic neurons d) Parasympathetic postganglionic neurons
2. Part of brain mainly involved in control of ANS?
a) Basal ganglia c) Cerebral cortex
b) Medulla oblongata d) Hypothalamus
3. Cutting the sympathetic nerve to bladder may cause
a) Difficulty in emptying the bladder c) Loss of pain sensation in bladder
b) Loss of tone in external sphincter d) Increased tone in external sphincter
4. Beta-1 adrenergic receptor stimulation causes:
a) Coronary vasodilation c) Bronchodilation
b) Cardiac acceleration d) Constriction of anal sphincter
5. Which of these is not a feature of postganglionic neurons in the sympathetic nervous system?
a) Originating distal to the effector organ c) Short
b) Unmyelinated d) Noradrenergic
6. Activation of the sympathetic nervous system leads to the 'fight and flight' response. Which of these is not part of that process
a) Vasodilatation in skeletal muscle c) Bladder relaxation
b) Sweating d) Increased gut motility
7. The vagus nerve regulates major elements of which part of the nervous system?
a) Parasympathetic nervous system c) Sympathetic nervous system
b) Enteric nervous system d) Central nervous system
8. Stimulation of which one of the following receptors causes vasoconstriction?
a) β1-adrenoceptors c) α-adrenoceptors
b) β2-adrenoceptors d) Nicotinic receptors

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9. Sympathetic innervation of the liver regulates which function?

a) Formation of glucose from glycogen c) Iron storage
b) Bile synthesis and production d) Endocrine function
10. Why is the adrenal gland unique in its autonomic innervation?
a) It is innervated by parasympathetic cholinergic preganglionic neurons.
b) The postganglionic neurons are cholinergic rather than noradrenergic despite being part of the sympathetic nervous system.
c) The post-synaptic response is mediated via muscarinic acetylcholine receptors.
d) It is directly innervated by the spinal cord without passing through ganglia
11. The following actions of noradrenaline are mediated by stimulation of alpha- adrenergic receptors:
a) Constriction of cutaneous blood vessels c) Dilation of arterioles to the viscera
b) Increase of myocardial contractility d) Relaxation of urinary bladder
12. Nor-adrenaline is released by sympathetic nervous system at all the following except:
a) Cutaneous blood vessels c) Sweat glands
b) SA Node d) Cardiac muscles
13. Adrenal medulla secretes
a) Epinephrine only c) Less Epinephrine & More norepinephrine
b) Norepinephrine only d) More Epinephrine & less Norepinephrine
ANSWER KEY
1. A 2. D 3. B 4. B 5. C 6. D 7. A 8. C 9. A 10. D
11. A 12. C 13. D

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B001 – B014
FOUNDATION BIOCHEMISTRY
B-001 ֍Structure of Cell֍
Only Cell Membrane is asked in UHS Past Papers, prepare rest of Cell structure & Organelles in Physiology.

B-002 ֍Cell Membrane֍

1. Why cell membrane is called fluid mosaic model? (Supple 2022)

The fluid mosaic model of membrane structure proposed by Singer and Nicholson in 1972 is now accepted widely. The membrane
proteins, intrinsic proteins (integral) deeply embedded and peripheral proteins loosely attached, float in an environment of fluid
phospholipid bilayers. It can be compared like icebergs floating in sea water.
2. Give brief account of major lipids present in fluid mosaic model of cell membrane. (Annual 2020)
Major Lipids Description
Phospholipids Phospho-glycerides
 are the more common and consist of a glycerol-phosphate backbone to which are attached two fatty
acids in ester linkages and an alcohol. The fatty acid constituents are usually even-numbered
carbon molecules, most commonly containing 16 or 18 carbons. They are unbranched and can be
saturated or unsaturated with one or more double bonds. In most phosphoglycerides present in
membranes, the 3-phosphate is esterified to an alcohol such as choline, ethanolamine, glycerol,
inositol, or serine.
Sphingomyelin
 a phospholipid that contains a sphingosine rather than a glycerol backbone. A fatty acid is attached
by an amide linkage to the amino group of sphingosine, forming ceramide. When the primary
hydroxyl group of sphingosine is esterified to phosphorylcholine, sphingomyelin is formed. As the
name suggests, sphingomyelin is prominent in myelin sheaths.
Glycosphingolipids (GSLs)
 are sugar-containing lipids built on a backbone of ceramide. GSLs include galactosyland glucosyl-
ceramides (cerebrosides) and the ganglioside, and are mainly located in the plasma membranes of
cells, displaying their sugar components to the exterior of the cell.
Sterols The most common sterol in the membranes of animal cells is cholesterol. The majority of cholesterol resides
within plasma membranes, but smaller amounts are found within mitochondrial, Golgi complex, and nuclear
membranes. Cholesterol intercalates among the phospholipids of the membrane, with its hydrophilic
hydroxyl group at the aqueous interface and the remainder of the molecule buried within the lipid bilayer
leaflet.

3. Enumerate major lipids in plasma cell membrane. Write down asymmetrical distribution of phospholipids in lipid bilayer
membrane. (Supple 2017)
Major lipids in plasma membrane  See in Q#2.
Asymmetrical distribution
 The choline-containing phospholipids (phosphatidylcholine and sphingomyelin) are located mainly in the outer leaflet; the
aminophospholipids (phosphatidylserine and phosphatidylethanolamine) are preferentially located in the inner leaflet.

4. Give an outline of membrane structure. What is fluid mosaic model? (Annual 2015)
Membrane Structure
 Membranes are composed of lipids, proteins and carbohydrates. The relative content of these components varies widely from
one type of membrane to another, but typically it contains, 40 per cent of the dry weight is lipids, about 60 per cent proteins
and 1 to 10 per cent carbohydrates. All membrane carbohydrate is covalently attached to proteins or lipids.

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The fluid mosaic model of membrane structure:

 The membrane consists of a bimolecular lipid layer with proteins inserted in it or bound to either surface. Integral membrane
proteins are firmly embedded in the lipid layers. Some of these proteins completely span the bilayer and are called
transmembrane proteins, while others are embedded in either the outer or inner leaflet of the lipid bilayer. Loosely bound to
the outer or inner surface of the membrane are the peripheral proteins. Many of the proteins and all the glycolipids have
externally exposed oligosaccharide carbohydrate chains.

5. Lipid rafts are specialized areas on cell membranes, which are involved in signal transduction. These lipid rafts are rich in which
lipids & proteins, enumerate? (Annual 2013)
They are dynamic areas of the exoplasmic leaflet of the lipid bilayers enriched in
 Cholesterol, Sphingolipids
 Signal transduction proteins

B-003 ֍Signal Transduction֍

1. How phospholipase C is activated and also mention the release of Ca+2 from endoplasmic reticulum due to signal transduction.
(Annual 2022)
2. What is the role of phosphatidyl inositol & Diacylglycerol in signal transduction across the cell membrane. (Supple 2016)
(1) Stimulus comes and activate G-protein coupled receptor;
Activated G proteins (G) stimulate the enzyme phospholipase
C (PLC).
(2) PLC splits PIP2 into diacylglycerol (DAG) and inositol
1,4,5-trisphosphate (IP3).
(3) DAG stimulates the downstream enzyme protein kinase C
(PKC).
(4) IP3 stimulates the release of Ca2+ from intracellular
stores. The Ca2+ can go on to stimulate various downstream
enzymes.

3. Give the structure of Gs protein and elaborate their role in signal transduction. (Annual 2021)
4. What would be the sequence of events once a ligand binds to Gs protein receptor. (Annual 2019)
5. Illustrate signal transduction cascade from activation of Gs protein to produce biological effects inside the cell. (Supple 2018)
6. Give an outline the steps (cascade of events) in the signal transduction pathway including Gs protein. (Annual 2018)
Structure of Gs:
 Gs proteins are guanosine triphosphate (GTP)-binding proteins that
couple hormone receptors to adjacent effector molecules. For
example, in the cyclic adenosine monophosphate (cAMP) second
messenger system, G proteins couple the hormone receptor to
adenylate cyclase.
 They have intrinsic GTPase activity.
 They have three subunits: αs, β, and γ. The αs subunit can bind either
guanosine diphosphate (GDP) or GTP. When GDP is bound to the α
subunit, the G protein is inactive. When GTP is bound, the G protein
is active.
Role in transduction:

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7. What is G protein coupled receptors? Illustrate the pathway showing activation of G protein. (Supple 2020)
G protein-coupled receptors (GPCRs), also known as seven-transmembrane domain receptors, are a large family of cell surface
receptors involved in signal transduction. They are a diverse group of proteins that play crucial roles in various physiological
processes and are the target of many drugs.
Pathway
In its inactive state, the a-subunit of the G protein binds guanosine diphosphate (GDP). When receptor binds with ligand, it causes a
conformational change in receptor that allows it to bind a-subunit of G protein. This binding causes the G protein to exchange GDP
for GTP which activates G protein

8. Plasma membrane contains various types of G proteins associated with GTP/GDP playing a key role in signal transduction. How is
an activated G protein is inactivated. (Supple 2016)
Answer: The α subunit has intrinsic phosphatase activity, slowly it removes phosphate (PO4) from its bound GTP, converting GTP to
GDP and terminating its own activity.

Reference: Textbook of Biochemistry by MN Chatterjee

9. What are G-proteins & How they are activated from inactivated form? (Annual 2012) (Supple 2008)
Answer: See in Q#2 & Q#8.

B-004 ֍Subcellular organelles֍

01. Biochemical markers and importance of subcellular organelles and their inherited disorders

Organelle Marker
ER Neutral alpha glucosidase
Golgi apparatus Galactosyl transferase
Lyosomes N-acetyl beta glucosaminidase
Mitochondria Malate dehydrogenase
Peroxisome Catalase
Nucleus Lamin A & B
Cytosol Lactate dehydrogenase
Note: These are not imp for seqs & mcqs. Can be asked in viva

Disease Organelle Defect Clinical features Treatment

involved
Refsum Peroxisome Enzyme involved in  Night blindness (Retinitis  Limit intake of
disease breakdown of phytanic acid pigmentosa) phytols (fish, beef,
(phytanoyl-CoA  Neuropathy (Weakness of dairy products)
hydroxylase) hand, feet & numbness)  Plasmapheresis
 Hearing loss
 Cerebellar ataxia
Progeria Nucleus LMNA gene mutation  Hair loss, slow growth, heart  Growth hormone
(Hutchinson (Laminin A protein) problem.
Gilford  Wrinkled skin
syndrome)  Kidney failure
 Loss of eyes sight
 Atherosclerosis

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I-cell disease Lysosome N-acetylglucosamine-1-  Skeletal abnormalities  Supportive

phosphotransferase  Mental retardation treatment
(Inclusion bodies)  Physiotherapy,
 Genetic counseling
Parkinson's Mitochondria Deficiency of dopamine &  Slowed movement  Dopamine agonists
disease formation of Lewy bodies  Tremors

B-005 ֍Chemistry of purine and pyrimidines֍

01. Chemistry of Nucleotides

1. What is Xanthine? Enumerate the 1,3,7-trimethyl xanthine & 1,3,dimethyl xanthine derived from plant source. (Annual 2021)
 Xanthine is a naturally occurring compound that belongs to a group of alkaloids known as purines. It is an intermediate in
catabolism of Adenine & Guanine.
 1,3,7-trimethyl xanthine is also known as caffeine. It is a well-known stimulant found in plants such as coffee beans, tea leaves,
and cacao beans.
 1,3-dimethyl xanthine is theophylline. It is found in higher concentrations in cocoa beans and chocolate products. Theobromine
has mild stimulant effects and is known for its vasodilatory properties.

2. Enumerate the nucleoside & nucleotide derived from adenine & thymine. Write down two synthetic analogues of uracil. (Supple
2020)
Synthetic Analogues of uracil:
1. 5-iodo-2-deoxyuridine Nitrogenous Base Nucleoside Nucleotide
2. 5-Flourouracil Adenine Adenosine AMP, ADP, ATP
Thymine Thymidine TMP, TDP, TTP

3. Nucleotides are important metabolites that participate in many cellular functions. Mention the various biochemical roles of purine
and pyrimidine nucleotides.
1. In addition to serving as precursors of nucleic acids, purine and pyrimidine nucleotides participate in metabolic functions as
diverse as energy metabolism, protein synthesis, regulation of enzyme activity, and signal transduction.
2. When linked to vitamins or vitamin derivatives, nucleotides form a portion of many coenzymes.
3. As the principal donors and acceptors of phosphoryl groups in metabolism, nucleoside tri- and diphosphates such as ATP and
ADP are the principal players in the energy transductions that accompany metabolic interconversions and oxidative
phosphorylation.
4. Linked to sugars or lipids, nucleosides constitute key biosynthetic intermediates. The sugar derivatives UDP-glucose and UDP-
galactose participate in sugar interconversions and in the biosynthesis of starch and glycogen. Similarly, nucleoside-lipid
derivatives such as CDP-acylglycerol are intermediates in lipid biosynthesis.
5. Roles that nucleotides perform in metabolic regulation include ATP-dependent phosphorylation of key metabolic enzymes,
allosteric regulation of enzymes by ATP, ADP, AMP, and CTP, and control by ADP of the rate of oxidative phosphorylation.
6. The cyclic nucleotides cAMP and cGMP serve as the second messengers in hormonally regulated events, and GTP and GDP play
key roles in the cascade of events that characterize signal transduction pathways.
7. In addition to the central roles that nucleotides play in metabolism, their medical applications include the use of synthetic purine
and pyrimidine analogs that contain halogens, thiols, or additional nitrogen atoms in the chemotherapy of cancer and AIDS, and
as suppressors of the immune response during organ transplantation

4. (Annual 2019)
a) Give at least 1 important function of UDP & cAMP.
 cAMP is used as second messenger in signal transduction.
 The sugar derivatives UDP-glucose and UDP-galactose participate in sugar interconversions and in the biosynthesis of starch
and glycogen.

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b) Name purine & pyrimidine bases of DNA & RNA.

 Purines Adenine & Guanine
 Pyrimidines DNA (Thymine & Cytosine), RNA (Uracil & Cytosine)
c) What is advantage of presence of unusual base in a nucleotide sequence?
 Expanded genetic code
 Enhanced stability
 Regulatory functions in gene expression and epigenetic processes.
 Molecular probes and markers for specific applications.
 Therapeutic applications

5. What are nucleotide & nucleosomes? Give role of synthetic nucleotide analogs in chemotherapy. (Supple 2018)
Nucleoside:
The nucleosides are composed of purine or pyrimidine base linked to either D-ribose (in RNA) or D-2-deoxy-ribose (in DNA)
Nucleotide:
A nucleotide is a nucleoside to which a phosphoric acid group has been attached to the sugar molecule by ‗esterification‘ at a definite
– OH group and thus has the general composition base – sugar – PO4.
Role of synthetic Analogues in Chemotherapy:
Their toxic effects reflect either inhibition of enzymes essential for nucleic acid synthesis or their incorporation into nucleic acids with
resulting disruption of base pairing.
Oncologists employ 5-fluoro- or 5-iodouracil, 3-deoxyuridine, 6-thioguanine and 6-mercaptopurine, 5- or 6-azauridine, 5- or 6-
azacytidine, and 8-azaguanine, which are incorporated into DNA prior to cell division.
Cytarabine is used in chemotherapy of cancer.

6. What do you know about purines, pyrimidines, nucleotides & nucleosides? (Annual 2014)
7. How will you differentiate among purines, pyrimidines, nucleosides, nucleotides, and nucleic acid. [Supple 2023 held in 2024]

Purine & Purines and pyrimidines are nitrogen-containing heterocycles, cyclic structures that contain, in addition to carbon,
Pyrimidine other (hetero) atoms such as nitrogen. Purines have 2 rings while pyrimidines have 1 ring
Nucleosides Nucleosides Are N-Glycosides; Nucleosides are derivatives of purines and pyrimidines that have a sugar linked to
a ring nitrogen of a purine or pyrimidine.
Nucleotides Mononucleotides are nucleosides with a phosphoryl group esterified to a hydroxyl group of the sugar.
Nucleic acid Long chain of nucleotides
Note: Also draw basic structures of all these terms

8. Enumerate purine & pyrimidine nucleotides resulting in formation of DNA & tRNA in man. (Annual 2013)
Human DNA and tRNA are composed
of the following purine and pyrimidine
nucleotides:
Purines:
 Adenine (A)
 Guanine (G)
Pyrimidines:
 Cytosine (C)
 Thymine (T) (found in DNA)
 Uracil (U) (found in tRNA)

Note: Prepare this diagram for mcqs

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9. What are the basic structural characteristics of nucleotides & nucleosides, along with examples of mononucleotides of cytosine &
uracil. What is the function of cAMP. (Annual 2012)

 Nucleoside  Nucleotide
 The nucleosides are composed of purine or pyrimidine  A nucleotide is a nucleoside to which a phosphoric acid
base linked to either D-ribose (in RNA) or D-2- group has been attached to the sugar molecule by
deoxyribose (in DNA). ‗esterification‘ at a definite – OH group and thus has the
 In cytidine and uridine, ribose is attached to N1 – Position general composition base – sugar – PO4.
of cytosine and uracil respectively.

Functions of cAMP
 Mediator of hormone action-acts as "Second messenger" in the cell.
 Regulates glycogen metabolism-increased cyclic AMP produces breakdown of glycogen (glycogenolysis).
 Regulates TG metabolism-increased cyclic AMP produces lipolysis (breakdown of TG).
 Cholesterol biosynthesis is inhibited by cyclic AMP.
 Cyclic AMP stimulates protein kinases so that inactive protein kinase is converted to active protein kinase.
 Cyclic AMP modulates both transcription and translation in protein biosynthesis.
 Cyclic AMP activates different steps of steroid biosynthesis.
 Cyclic AMP also regulates permeability of cell membranes to water, sodium, potassium and calcium.
 Plays an important role in regulation of insulin secretion, catecholamine biosynthesis, and melatonin synthesis.
 Histamine increases cyclic AMP production in parietal cells which in turn increases gastric secretion.
 Decrease in cyclic AMP level is involved in the excitation of bitter taste receptors in tongue.
Reference: Textbook of Medical Biochemistry by MN Chatterjee
10. What are nucleotides and nucleosomes? Describe functions of cyclic nucleotides. (Supple 2011)
Nucleotides:
Nucleotides are the building blocks of nucleic acids, which include DNA (deoxyribonucleic acid) and RNA (ribonucleic acid). Each
nucleotide consists of three main components: a nitrogenous base, a sugar molecule (ribose in the case of RNA and deoxyribose in the
case of DNA), and a phosphate group.
Nucleosomes:
Nucleosomes are structural units of chromatin, the complex of DNA and proteins that make up the chromosomes within a cell nucleus.
Each nucleosome consists of DNA wrapped around a core of histone proteins. The core histones include H2A, H2B, H3, and H4,
which form an octamer.
Functions of cyclic Nucleotides: See in Q#9.

11. Describe the important functions of UDP, ATP & cAMP. (Annual 2010)

UDP UDP-sugar derivatives participate in sugar epimerization and in biosynthesis of glycogen , glucosyl disaccharides, and
the oligosaccharides of glycoproteins and proteoglycans. UDP-glucuronic acid forms the urinary glucuronide
conjugates of bilirubin and of many drugs, including aspirin.
ATP ATP is used as energy storage, Enzyme regulation, signal transduction & phosphorylation.
cAMP See in Q#9.

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B-006 ֍DNA֍

1. Give structure of DNA. (Annual 2022)

1. Chemical components of DNA
 Each polynucleotide chain of DNA contains nucleotides, which consist of a
nitrogenous base (A, G, C, or T), deoxyribose, and phosphate.
 The bases are the purines adenine (A) and guanine (G) and the pyrimidines cytosine
(C) and thymine (T).
 c. Phosphodiester bonds join the 3‘-carbon of one sugar to the 5‘-carbon of the next
sugar.
2. DNA double helix
a. Each DNA molecule is composed of two polynucleotide chains joined by hydrogen bonds
between the bases.
 Adenine on one chain forms a base pair with thymine on the other chain.
 Guanine base pairs with cytosine.
 The base sequences of the two strands are complementary. Adenine on one strand is
matched by thymine on the other, and guanine is matched by cytosine.
b. The chains are antiparallel. One chain runs in a 5‘ to 3‘ direction; the other chain runs 3‘
to 5‘.
c. The double-stranded molecule is twisted to form a helix with major and minor grooves.

2. (Annual 2021)
b) What is complementary DNA & how does it differs from genomic DNA.
Complementary DNA (cDNA) is a form of DNA that is synthesized from a messenger RNA (mRNA) template through a process
called reverse transcription. It is a single-stranded DNA molecule that is complementary to the mRNA sequence from which it was
derived.
Here are the main differences between cDNA and genomic DNA:
 Source and structure: cDNA is synthesized from mRNA, which represents the transcribed and processed form of the gene.
cDNA is single-stranded and lacks intronic sequences, as it is derived from the mRNA after the removal of introns during mRNA
processing.
 Coding sequence representation: cDNA only represents the coding regions (exons) of genes.
 Gene expression analysis: cDNA is commonly used in molecular biology research to study gene expression. Genomic DNA, on
the other hand, provides information about the complete genomic sequence but does not provide specific information about gene
expression.
 Cloning and amplification: cDNA is often used in cloning experiments and gene amplification techniques such as polymerase
chain reaction (PCR). Due to its single-stranded nature and lack of introns, cDNA can be easily amplified, cloned into expression
vectors, or used for specific gene amplification studies.

3. What do you know about different structural forms of DNA? Give importance of each. How separation of two DNA strands can
occur. Define melting temperature of DNA. [ANNUAL 2017]
B-DNA (B-form DNA): This is the most common and well-known form of DNA. It is a right-handed helical structure and is the
biologically active form of DNA under normal physiological conditions. B-DNA is characterized by base pairs held together by
hydrogen bonds, forming a double helix. It is important for DNA replication, transcription, and most DNA-protein interactions.
A-DNA (A-form DNA): A-DNA is a right-handed helix similar to B-DNA but with a shorter and wider helical structure. It occurs
under specific conditions, such as dehydration or in the presence of certain salts. A-DNA is important in some biological processes,
including DNA repair and recombination.
Z-DNA (Z-form DNA): Z-DNA is a left-handed helical structure that forms when DNA is subjected to high torsional stress or
contains alternating purine-pyrimidine sequences with high GC content. Z-DNA is important for gene regulation and chromatin
remodeling.

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Seperation of strands
 The separation of two DNA strands, known as denaturation or melting, can occur under certain conditions. Elevated
temperature, changes in pH, or exposure to chemicals such as urea or formamide can disrupt the hydrogen bonds between the
base pairs, leading to the separation of the double helix into single strands.
Melting temperature
 The strands of a given molecule of DNA separate over a temperature range. The midpoint is called the melting temperature,
or Tm. The Tm is influenced by the base composition of the DNA and by the salt concentration (or other solutes, see below)
of the solution. DNA rich in G–C pairs, which have three hydrogen bonds, melts at a higher temperature than DNA rich in
A–T pairs, which have two hydrogen bonds.

B-007 ֍RNA֍

1. (Annual 2022)
a) Draw and label structure of tRNA.

Reference: Textbook of Medical Biochemistry by MN Chatterjee

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2. Enumerate various types of ribosomal RNA in eukaryotes and give the function of each. (Supple 2021)
18S rRNA complexes with proteins and forms the 40S ribosomal subunit. The 28S, 5.8S, and 5S rRNAs complex with proteins and
form the 60S ribosomal subunit.
 28S rRNA: The 28S rRNA is a large subunit rRNA, forming part of the 60S ribosomal subunit. It is involved in the catalytic
activity of the ribosome, specifically in peptide bond formation during protein synthesis. The 28S rRNA also contributes to the
stability and structural integrity of the ribosome.
 18S rRNA: The 18S rRNA is a small subunit rRNA, making up part of the 40S ribosomal subunit. It plays a crucial role in the
initiation of protein synthesis and the assembly of the ribosome on mRNA. The 18S rRNA also helps in the decoding of mRNA
by interacting with transfer RNA (tRNA) during translation.
 5.8S rRNA: The 5.8S rRNA is an intermediate-sized rRNA that is found in the internal transcribed spacer (ITS) region between
the 18S and 28S rRNA in the primary transcript. It plays a role in stabilizing the structure of the ribosome and contributes to the
accuracy and efficiency of protein synthesis.

3. Give structure & function of mRNA. (Annual 2018)

 mRNA comprises only about 5% of the RNA in the cell, yet is by far the most heterogeneous type of RNA in size and base
sequence. The mRNA carries genetic information from the nuclear DNA to the cytosol, where it is used as the template for
protein synthesis.
 If the mRNA carries information from more than one gene, it is said to be polycistronic. Polycistronic mRNA is characteristic of
prokaryotes. If the mRNA carries information from just one gene, it is said to be monocistronic and is characteristic of
eukaryotes.
 In addition to the protein coding regions that can be translated, mRNA contains untranslated regions at its 5'- and 3'-ends. Special
structural characteristics of eukaryotic (but not prokaryotic) mRNA include a long sequence of adenine nucleotides (a ―poly-A
tail‖) on the 3'-end of the RNA chain, plus a ―cap‖ on the 5'-end consisting of a molecule of 7-methylguanosine attached
―backward‖ (5'→5') through a triphosphate linkage.

4. There are various types of RNA molecules found in our body. Enumerate various types of RNA‘s molecules present in human
body. Describe structure of tRNA. (Supple 2016)
Types of RNA
1. mRNA
2. tRNA
3. rRNA
4. sRNA (SnRNA, miRNA, SiRNA)
Structure of tRNA See in Q#1.

5. What are the characteristic structural features & functions of mRNA & tRNA? (Supple 2008)
Answer: See in Q#1 & Q#3.

6. a) Write four differences between DNA and RNA. Draw and label structure of tRNA. (UHS ANNUAL 2024 held in 2025)

DNA RNA
Number of strands 2 antiparallel strands Only one strand
Sugar D-deocyribose D-Ribose
Nitrogenous bases Adenine, Guanine, Cytocine, Thiamine Adenine, Guanine, Cytocine, Uracil
Synthesis It is synthesized by replication of DNA It is synthesized by DNA Transcription
Structure of tRNA See in Q#1.

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B-008 ֍Nucleotides֍

1. A 55 year old diabetic male patient developed liver cancer. He was administered a synthetic nucleoside analogue Cytarabine a
chemotherapeutic agent. Outline the mode of actions of synthetic analogue. Mention two other synthetic analogues of
nucleosides/nucleotides used as chemotherapeutic agents? (Supple 2022)
Mode of action
 Cytarabine is converted to its active form, cytarabine triphosphate (Ara-CTP), through a series of enzymatic reactions inside
the cell. Ara-CT is structurally similar to the nucleoside deoxycytidine triphosphate (dCTP), a normal building block of
DNA. During DNA replication, Ara-CTP can be mistakenly incorporated into the growing DNA chain by DNA polymerase,
instead of dCTP. Once incorporated into the DNA chain, Ara-CTP cannot be easily removed by the proofreading activity of
DNA polymerase. As a result, DNA synthesis becomes inhibited because Ara-CTP lacks the necessary functional groups for
the formation of subsequent phosphodiester bonds.
Other synthetic analogues
 5-fluoro- or 5-iodouracil
 6-thioguanine
 6-mercaptopurine
 5- or 6-azauridine
2. (Annual 2022)
a) Give the mode of action of 5-fluroyracil & methotrexate in inhibiting DNA synthesis in the target cell.
5-Fluorouracil (5-FU):
 5-FU is a pyrimidine analogue that interferes with DNA synthesis primarily during the S phase of the cell cycle. It undergoes
intracellular conversion into its active metabolites. The main mode of action of 5-FU involves inhibition of thymidylate
synthase, an enzyme involved in the synthesis of thymidine, a nucleotide required for DNA synthesis. 5-FU is converted to
fluorodeoxyuridine monophosphate (FdUMP), which inhibits thymidylate synthase by binding irreversibly to its active site.
Methotrexate:
 Methotrexate is a folic acid analogue that acts as an antimetabolite, interfering with the synthesis of DNA precursors. It
inhibits the enzyme dihydrofolate reductase (DHFR), which plays a crucial role in the synthesis of tetrahydrofolate (THF), a
coenzyme required for the production of nucleotides.

3. What are the uses and applications of synthetic nucleotide analogues in clinical medicine? (Annual 2016)

Chemotherapy Oncologists employ 5-fluoro- or 5-iodouracil, 3-deoxyuridine, 6-thioguanine and 6-

mercaptopurine, 5- or 6-azauridine, 5- or 6-azacytidine, and 8-azaguanine, which are
incorporated into DNA prior to cell division. Cytarabine is used in chemotherapy of cancer.
Organ Azathioprine, which is catabolized to 6-mercaptopurine, is employed during organ
transplantation transplantation to suppress immunologic rejection.
Treatment of Gout The purine analog allopurinol, used in treatment of hyperuricemia and gout, inhibits purine
biosynthesis and xanthine oxidase activity.

B-009 ֍CHROMOSOME֍

01. The higher organization of DNA. Difference between DNA, chromatid and chromosome
See Q#3 in B-006 Foundation Module CHAPTER-1 Past papers Book.

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B-010 ֍ENZYMES֍

01. Characteristics of Enzymes

1. Active Site Enzyme molecules contain a special pocket or cleft called the active site. The active site
contains amino acid side chains that participate in substrate binding and catalysis
2. Specificity Enzymes are highly specific, interacting with one or a few substrates and catalyzing only one
type of chemical reaction.
3. Catalytic Efficience Enzyme-catalyzed reactions are highly efficient, proceeding from 103–108 times faster than
uncatalyzed reactions. The number of molecules of substrate converted to product per
enzyme molecule per second is called the turnover number, or kcat and typically is 10 2 –104
s-1.
4. Cofactor If the non-protein moiety (in Holoenzyme) is a metal ion such as Zn2+ or Fe2+, it is called a
cofactor.
5. Coenzymes If non-protein moiety (in Holoenzyme) is a small organic molecule, it is termed a coenzyme.
Coenzymes frequently are derived from vitamins. For example, NAD+ contains niacin and
FAD contains riboflavin.
6. Holoenzymes Some enzymes require molecules other than proteins for enzymic activity. The term
holoenzyme refers to the active enzyme with its nonprotein component. The enzyme
without its nonprotein moiety is termed an apoenzyme and is inactive.
7. Apoenzymes The enzyme without its nonprotein moiety is termed an apoenzyme and is inactive.
8. Prosthetic groups If the coenzyme is permanently associated with the enzyme and returned to its original
form, it is called a prosthetic group (FAD is an example).
9. Zymogens Zymogens are inactive precursors of secreted enzymes (including the proteases required for
digestion). They become activated through cleavage when they reach their proper sites of
action. For example, the pancreatic zymogen, trypsinogen, becomes activated to trypsin in
the small intestine. The synthesis of proteases as zymogens protects the cell from being
digested by its own products.

1. Give an account of isozymes and ribozymes with at least 2 examples along with their functions.
(Supple 2018)

Isozymes Ribozymes
 Multiple forms of the same enzyme will also  Ribozymes are a group of ribonucleic acids that function as
help in the regulation of enzyme activity, biological catalysts, and they are regarded as non-protein
many of the isoenzymes are tissue-specific. enzymes.
 Although isoenzymes of a given enzyme  Ribonuclease P – an enzyme till then known to cleave
catalyze the same reaction, they differ in Km, precursors of tRNAs to give tRNAs – was functional due to
Vmax or both. RNA component present in the enzyme and not the protein
e.g., Isoenzymes of LDH and CPK. part of the enzyme.
 Hammerhead ribozyme

2. What do you know about (I) Coenzyme (II) Isoenzyme. (Annual 2006) (Supple 2005-part b)
Coenzyme  Certain enzymes require a specific, thermostable, low mol. weight, non-protein organic substance called as coenzyme.
A coenzyme may bind covalently or non-covalently to the apoenzyme.
Many coenzymes are derived as the physiologically active forms from the constituents of vitamin B-complex viz, Pantothenic acid:
CoA-SH, Vitamin B12: Cob amide, Folic Acid: Tetrahydrofolate (F.H4), Niacin: NAD+, NADP, Riboflavin: FMN, FAD, Pyridoxine:
Pyridoxal phosphate, Thiamine: TPP.
Isoenzymes See in Q#1.

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02. Enzyme Classification

1. Enumerate 6 main classes of enzymes. (Annual 2020) (Supple 2016)

03. Mechanism of enzyme action

1. (Supple 2020) (Annual 2019-part a) (Annual 2018-part a) (Annual 2017) (Annual 2013-part a)
a) What are multiple mechanisms employed by the enzymes to facilitate catalysis.
1. Catalysis For molecules to interact, they must come within bond-forming distance of one another. The higher their
by Proximity concentration, the more frequently they will encounter one another, and the greater will be the rate at which they
react. When an enzyme binds substrate molecules at its active site, it creates a region of high local substrate
concentration in which the substrate molecules are oriented in a position ideal for them to chemically interact.
This results in rate enhancements of at least a thousandfold over the same non-enzyme-catalyzed reaction.
2. Acid–Base The ionizable functional groups of aminoacyl side chains and, where present, of prosthetic groups, can
Catalysis contribute to catalysis by acting as acids or bases. We distinguish two types of acid–base catalysis. Specific acid
or base catalysis refers to reactions for which the only participating acids or bases are protons or hydroxide ions.
The rate of reaction thus is sensitive to changes in the concentration of protons or hydroxide ions, but is
independent of the concentrations of other acids (proton donors) or bases (proton acceptors) present in the solution
or at the active site. Reactions whose rates are responsive to all the acids or bases present are said to be subject to
general acid catalysis or general base catalysis.
3. Catalysis For catalysis of lytic reactions, which involve breaking a covalent bond, enzymes typically bind their substrates
by Strain in a conformation that weakens the bond targeted for cleavage through physical distortion and electronic
polarization. This strained conformation mimics that of the transition state intermediate.
4. Covalent The process of covalent catalysis involves the formation of a covalent bond between the enzyme and one or
Catalysis more substrates. The modified enzyme thus becomes a reactant. Covalent catalysis provides a new reaction
pathway whose activation energy is lower—and rate of reaction therefore faster—than the pathways available in

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homogeneous solution. The chemically modified state of the enzyme is, however, transient. Completion of the
reaction returns the enzyme to its original, unmodified state. Its role thus remains catalytic. Covalent catalysis is
particularly common among enzymes that catalyze group transfer reactions. Residues on the enzyme that
participate in covalent catalysis generally are cysteine or serine, and occasionally histidine. Covalent catalysis
often follows a “ping-pong” mechanism.

2. (Annual 2014)
b) What is Michaelis-Menten equation?

(This is called the Michaelis-Menten equation, the rate equation for one substrate-enzyme catalyzed reaction)
(V0 = Initial Velocity, Vmax= Maximum velocity, (S)= substrate concentration, K m= Michaelis-Menten constant)

04. The effect of various factors on enzymatic activity

1. How does a change in pH and temperature affect the rate of an enzyme catalyzed reaction. (Supple 2022)

 Change in pH  Change in Temperature

 The enzymatic activity is maximum at a particular pH o Each enzyme is most active at a specific temperature
which is called its optimum pH. The optimum pH of which is called its optimum temperature. Temperature
most enzymes lies in the range of 4–9. increases the total energy of the chemical system with the
 Hydrogen ions in the medium may alter the ionization result the activation energy is increased.
of active site or substrates. Ionization is a requirement o The exact ratio by which the velocity changes of 10 oC
for ES complex formation and pH may influence the temperature rise is the Q10 or temperature coefficient.
separation of coenzyme from holoenzyme complex. Reactions velocity almost doubles with 10oC rise (Q10 =
 At a very low or high pH the H-bonds may be 2) in many enzymes.
inactivated in the protein structure, destroying its 3D o Activity of enzyme progressively decreases when the
structure. temperature of reaction is below or above the optimum
temperature. However, increase in temperature also causes
denaturation of enzyme.

2. How substrate concentration, enzyme concentration & inhibitors affect the activity of enzyme? (Supple 2021)

Effect of Substrate Concentration Effect of Enzyme Concentration

At known quantity of enzyme, the reaction is directly In the beginning velocity of the enzymatic reaction is directly
proportional to the substrate concentration. However, this proportional to the enzyme concentration. When the substrate
is true only up to a certain concen-tration after which the conc. is in large excess exceeding that of Vmax, because
increasing concentration of substrate does not further enzyme is the limiting factor in the enzyme-substrate reaction
increase the velocity of reaction (because all available and providing more enzyme molecules enables the conversion
active sites of enzymes are occupied). of progressively larger numbers of substrate molecules

Effect of Inhibitors on Enzyme activity:

 Inhibitors are molecules that interact with enzymes, decreasing the rate of enzymatic reactions. Inhibitors can be substrate
analogs, toxins, drugs, or metals. (Their details are given in next section)

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05. Michaelis Menten and Line weaver Burk’s equation

1. (Supple 2022)
a) Differentiate between homotropic effectors & heterotrophic effectors and elaborate their role in regulation of allosteric
enzymes.
Homotropic effectors Heterotropic effectors
 When the substrate itself serves as an effector,  The effector may be different from the substrate, in
the effect is said to be homotropic. Most often, which case the effect is said to be heterotropic.
an allosteric substrate functions as a positive
 Heterotropic effectors are commonly encountered,
effector. In such a case, the presence of a
for example, the glycolytic enzyme
substrate molecule at one site on the enzyme
phosphofructokinase-1 is allosterically inhibited by
enhances the catalytic properties of the other
citrate, which is not a substrate for the enzyme.
substrate-binding sites—that is, their binding
sites exhibit cooperativity.
 These enzymes show a sigmoidal curve when
reaction velocity (vo) is plotted against substrate
concentration ([S]).

2. What are general ways for regulation of enzyme activity? How is catalytic activity of enzyme regulated by covalent modification?
(Annual 2012) (Annual 2010-part b)
In biological system, regulation of enzyme activities occurs at different stages in one or more of the following ways to achieve cellular
economy.
1. Allosteric regulation
2. Activation of latent enzymes
3. Compartmentation of metabolic pathways
4. Control of enzyme synthesis
5. Enzyme degradation
6. Isoenzyme
Regulation of enzymes by covalent modification:
 Many enzymes may be regulated by covalent modification, most frequently by the addition or removal of phosphate groups
from specific serine, threonine, or tyrosine residues of the enzyme. Protein phosphorylation is recognized as one of the
primary ways in which cellular processes are regulated.
1. Phosphorylation and dephosphorylation: Phosphorylation reactions are catalyzed by a family of enzymes called protein kinases
that use adenosine triphosphate (ATP) as a phosphate donor. Phosphate groups are cleaved from phosphorylated enzymes by the
action of phosphoprotein phosphatases.
2. Response of enzyme to phosphorylation: Depending on the specific enzyme, the phosphorylated form may be more or less active
than the unphosphorylated enzyme. For example, phosphorylation of glycogen phosphorylase (an enzyme that degrades glycogen)
increases activity, whereas the addition of phosphate to glycogen synthase (an enzyme that synthesizes glycogen) decreases activity.

3. How enzyme activity is regulated by allosterically. (Supple 2011)

 Allosteric enzymes are regulated by molecules called effectors (also called modifiers) that bind noncovalently at a site other than
the active site. These enzymes are usually composed of multiple subunits, and the regulatory (allosteric) site that binds the
effector may be located on a subunit that is not itself catalytic.
 The presence of an allosteric effector can alter the affinity of the enzyme for its substrate, or modify the maximal catalytic activity
of the enzyme, or both. Effectors that inhibit enzyme activity are termed negative effectors, whereas those that increase enzyme
activity are called positive effectors. Allosteric enzymes frequently catalyze the committed step early in a pathway.

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06. Competitive, Non competitive, and uncompetitive inhibition

1. Draw labelled Lineweaver-Burk plots to elaborate the effects of competitive and non-competitive inhibitors on the rate of an
enzyme catalyzed reactions.
2. Draw Lineweaver burg plot showing effect of competitive and non-competitive inhibition along with example.
Competitive Inhibitors Non-Competitive inhibitors

Examples: HMG-Co A reductase inhibitors Example: Disulfiram

3. Write down two important uses of Lineweaver-Burk plot.

 It is much easier to calculate the Km from the intercept on x-axis which is –(1/Km).
 The double reciprocal plot is useful in understanding the effect of various inhibitions.

4. In the treatment of Gout oxy-purinol drug is given which is non-competitive inhibitor of xanthine oxidase. What is the effect of
non-competitive inhibition on enzyme catalyzed reaction. (Supple 2020) (Annual 2019)
 Vmax is lowered
 Km is kept constant
5. Give examples of two enzyme inhibitors used as drugs. (Supple 2016) (Supple 2011)
1) Oxypurinol
2) HMG-co A reductase inhibitors

6. Write down equation describes Lineweaver Burk plot. Draw and explain the Lineweaver Burk plot of competitive inhibition of
enzymes.

See plot on competitive inhibitor in Q#1a.

Explanation: In competitive inhibition, for Lineweaver-Burk plots, lines for the inhibited reaction intersect on the Y-axis with those
for the uninhibited reaction. Vmax remains the same, but the apparent Km (K’m) is increased.

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7. How can you differentiate competitive inhibition from non-competitive inhibition of enzyme activity? Annual 2008 + 2015) &
(Supple 2005)

(Reference: Textbook of Medical Biochemistry by MN Chatterjee)

b) Enumerate two clinically important enzyme inhibition along with enzymes inhibited by them.
Competitive inhibitors HMG-co-reductase inhibited by statins drugs
Non-competitive inhibitors Xanthine oxidase inhibited by Allopurinol
Acetylcholinesterase inhibited by Organophosphate

8. b) Define competitive inhibitors with example. What are their effect on Vmax and Km? Draw a graph showing effect of a
competitive inhibitor on the reaction velocity versus substrate concentration ([S]). (UHS ANNUAL 2024 held in 2025)
Definition A reversible inhibitor resembling to substrate, binds on active site and lowers the substrate affinity to enzyme.
 Vmax (SAME)
 Km (INCREASED)
Graph  See Q1

07. Application of enzyme in clinical diagnosis and therapeutic use

1. (Annual 2021)
a) A patient presented with acute chest pain and admitted in CCU within first 3 hours, where he was well managed and
discharged at 5th day. Give the pattern of rise and fall of plasma enzymes of diagnostic importance during his stay in the ward.
Markers Onset Peak Normalize
Myoglobin 1-3 h 8-12 24-36 h
CK-MB 2-4 h 24 h 72 h
TnT-I 2-4 h 24 – 48 h 7-10 days
LDH 24-48 h Days 7-14 days

b) Give the role of competitive inhibitors of enzymes in treatment of disease with examples.
Answer: Statins act as competitive inhibitors of HMG-co-A reductase and decrease cholesterol production in body.

2. Give the major use of the following enzyme in clinical diagnosis: (Annual 2020)
i) Alanine Aminotransferase
ii) Alpha Amylase
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iii) Creatine kinase

iv) Alkaline phosphatase
i) Alanine Aminotransferase Viral hepatitis
ii) Alpha Amylase Acute pancreatitis
iii) Creatine kinase Muscle disorders
iv) Alkaline phosphatase Various bone disorders, obstructive liver diseases

3. (Supple 2018)
b) Give role of enzyme inhibitors used as medicine in following clinical conditions. Mention name of enzymes inhibited.
Clinical condition Enzyme Inhibitors (Drugs)
i) Hypertension ACE inhibitors Captopril
ii) Myasthenia Gravis Acetylcholine-esterase Physostigmine
iii) Heart Failure Na+/K+ ATPase Digitalis

4. (Annual 2018)
b) What are isozymes? Enumerate the Creatinine Kinase Isozymes. Elaborate the role of isozymes in the diagnosis of
Myocardial infarction.
The multiple forms of an enzyme catalyzing the same reaction are isoenzymes or isozymes. They, however, differ in their physical
and chemical properties which include the structure, electrophoretic and immunological properties, Km and Vmax values, pH
optimum, relative susceptibility to inhibitors and degree of denaturation.
Note: Estimation of the enzyme CPK2 (MB) is the earliest reliable indication of myocardial infarction.

(Reference: Biochemistry by U. Satyanarayana)

5. A young male presented with high grade fever, weakness, yellow-colored eyes and pain in abdomen. The liver profile was
performed and raised levels of Alanine aminotransferase & Aspartate aminotransferase was noted. (Supple 2017)
a) Enlist 6 major classes of enzymes.
Answer: See in Q#1 of Section ―Classification & Properties of Enzymes‖.
b) To which class and subclass of enzymes above mentioned enzyme belong?
Class Transferases, Subclass Aminotransferases
c) Write down enzyme significance in clinical diagnosis.
The above-mentioned enzymes, when elevated in serum – are useful for the diagnosis of liver dysfunction due to viral hepatitis
(jaundice), toxic hepatitis, cirrhosis and hepatic necrosis.

6. (Annual 2017)
b) Give clinical significance of determination of plasma activities of;
Enzyme Significance
Aminotransferases Raise in viral hepatitis (ALT > AST)
Acid phosphatase Raise in Prostate Cancer
Alpha Amylase Raise in Acute pancreatitis
Glutamyl transpeptidase Raise in Alcoholic liver disease

7. What is clinical significance of plasma activities of enzymes in (Supple 2016)

I. MI The elevation of enzymes – namely creatine phosphokinase (CPK), aspartate transaminase (AST)
and lactate dehydrogenase (LDH)—are important for the diagnosis of myocardial infarction (MI).

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II. Bone Cancer Bone specific Alkaline phosphatase raise in serum.

III. Acute pancreatitis Amylase & Lipase raise in Acute pancreatitis.

8. Give therapeutic uses of: (Annual 2016)

Enzyme Therapeutic Uses

I. Streptokinase To remove blood clots in Acute MI
II. Hyaluronidase  Promotes diffusion of fluids given subcutaneously
 Intra-articular injection in joints to alleviate pain in osteoarthritis.
III. Asparaginase In cancer therapy for Leukemia & Lymphoma
IV. Lovastatin To treat Hypercholestremia

9. If a person takes a piece of cake made up of flour, milk and sucrose as its primary ingredient. (Annual 2016)
a) Which intestinal enzymes are responsible for its digestion?
Answer: Amylase, Lactase, Sucrase.
b) Which major carbohydrate end products enter in blood?
Answer: Glucose, Fructose, Galactose.

10. A young male presented with high grade fever, weakness, yellow-colored eyes and pain in abdomen. The liver profile was
performed and raised level of AST & ALT. (Annual 2014)

a) To which class of enzyme, the above-mentioned enzymes belong?

Answer: Class Transferase, Subclass Amino-transferase.
b) What co-enzyme is required for their activity?
Answer: Pyridoxal Phosphate (Vitamin B6)
c) What are biochemical reactions carried out by these enzymes?

11. (Annual 2013)

b) Give diagnostic importance of plasma enzymes to differentiate different types of jaundice.
Type of Jaundice Enzyme raise
Prehepatic & Hepatic Jaundice AST, ALT
Post-hepatic/Obstructive Jaundice GGT, ALP

By Serum enzyme assay, we can find the either jaundice is prehepatic/hepatic or post-hepatic.

12. A 60 years old female with history of breast carcinoma treated by mastectomy three years ago, is now complaining of general
malaise and bone pain. Lab investigations including (LFTs) suggest metastasis of liver cancer. (Annual 2010)
a) The activities of which plasma enzymes are most likely to be raised in this patient? Why are the activities of certain enzymes
raise in this disease?
In a patient with breast carcinoma and suspected liver metastasis, plasma enzymes including ALT, AST, GGT are likely to be raised.
The elevation of these plasma enzymes in liver metastasis occurs due to the destruction or infiltration of liver tissue by cancer cells.
The cancer cells disrupt the normal functioning of liver cells, leading to leakage of enzymes into the bloodstream. The extent of
enzyme elevation can serve as an indication of the severity and extent of liver involvement.

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B-011 ֍AMINO ACIDS֍

01. Classification

1. Define and enlist essential amino acid. Also name nutritionally essential amino acids with aromatic side chain.
Essential amino acids are those that the body cannot synthesize on its own and must be obtained through the diet.
o Histidine o Lysine o Threonine
o Isoleucine o Methionine o Tryptophan
o Leucine o Phenylalanine o Valine
With Aromatic Side Chain
 Phenylalanine
 Tryptophan
2. Classify 20 standard amino acids found in proteins according to the charge and polarity of their side chains.

Non-polar side chains Uncharged polar side chains Acidic side chains Basic side chains
 Alanine  Asparagine  Aspartic acid  Arginine
 Glycine  Cysteine  Glutamic acid  Histidine
 Proline  Glutamine  Lysine
 Valine  Serine
 Methionine  Threonine
 Leucine  Tyrosine
 Isoleucine
 Tryptophan
 Phenylalanine

3. Enumerate four standard amino acids with uncharged polar groups in their side chains.
 Serine  Asparagine
 Threonine  Glutamine
 Tyrosine  Cysteine

4. Classify amino acids on the basis of their nutritional value.

Essential amino acids Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine,

Threonine, Tryptophan, Valine
Semi-essential amino acids Histidine & Arginine
Non-essential amino acids Cysteine, Glycine, Glutamine, Proline, Tyrosine, Serine, Alanine, Aspartate
Conditionally essential amino acids Cysteine, Glycine, Glutamine, Proline, Tyrosine

5. A young girl consulted a nutritionist to discuss about vegetarian diet to lose weight. He advised her diet which contained sufficient
of essential amino acids along with carbohydrate, fats, proteins, vitamins and minerals. He also advised the she must take 6 glasses of
water daily, so that she can keep up good health:
i) What do you understand by nationally essential amino acids?
See Q#1
ii) Enlist essential amino acids of human?
See Q#1
iii) Which of the essential amino acids contain Sulphur in its structure?
 Methionine
iv) Which of the essential amino acids is purely ketogenic?
 Leucine

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6. Give two examples of each

a) Aromatic amino acids
 Phenylalanine & Tryptophan
b) Branched chain amino acids
 Leucine & Isoleucine
c) Sulphur containing amino acids
 Cysteine & Methionine

7. Enlist non-protein L-α-amino acids

 GABA
 Ornithine
 Citrulline
 Homocysteine
 Homoserine
 Hydroxyproline
 Glutamate gamma semialdehyde

8. Classify Amino acids according to their R group with one example each.

Class Example
Aliphatic Glycine
Aromatic Tryptophan
Polar uncharged Tyrosine
Positively charged Aspartic acid
Negatively charged Arginine
Sulfur containing Methionine

02. Amino Acids (Structure, Physical, Chemical properties and their biomedical importance)

1. Define & write any four non-standard amino acids along with their biological functions.
Non-standard amino acids are those that are not commonly found in proteins.
Examples Biological Functions
GABA Acts as a neurotransmitter and helps regulate brain activity.
Citrulline Plays a role in the urea cycle, which removes toxic ammonia from the body.
Ornithine Intermediate in urea synthesis
Hydroxyproline Found in collagen and helps provide structural support to connective tissues

2. What is selenocysteine? Write its significance.

Selenocysteine is a rare amino acid that contains selenium in its structure instead of sulfur. It is significant because:
 It is coded for by a unique codon (UGA) that normally serves as a stop codon in the genetic code.
 Play role in certain enzymes that are involved in a variety of cellular processes, including antioxidant defense, thyroid
hormone metabolism, and immune function.

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B-012 ֍PROTEINS֍

01. Protein Classification

1. Classify proteins depending upon their biological function along with examples.

Class Examples
Structural Proteins Keratin in hair, Collagen in bone
Enzymes Hexokinase, Pepsin
Transport Proteins Hemoglobin, Albumin
Hormonal Proteins Growth factors
Contractile Proteins Actin, Myosin
Storage Proteins Ovalbumin
Genetic Proteins Nucleoproteins
Defense Proteins Immunoglobulins

02. Structural levels of proteins

1. Describe various types of secondary structures of proteins

2. Enumerate the components of secondary structure of proteins mentioning force responsible of their maintenance.
3. Name different types of secondary structures present in proteins. Explain any TWO of them

Type Features Forces for Maintenance

Alpha helix  Most common type H bond
 Polypeptide chain in spiral form
 Major component of hair & skin
 Each turn of an α-helix contains 3.6 amino acids
 Proline disrupts the structure & produce kinks in chain
Beta sheet  Fully extended two or more polypeptide chains H bond
 Can be either parallel or antiparallel, depending on the
orientation of the strands.
Beta turn (Beta  Connects successive strands of antiparallel beta sheet H bond
bends)  Reverse the direction of polypeptide chain to produce compact Ionic bond
globular structure
 Composed of 4 amino acids. Proline & Glycine are often present
Non-repetitive  Structurally unstable H bond
secondary structures  Loop & Coil are examples of motif. Salt bridges
Hydrophobic interactions
Motifs or super  Intermediate structures between secondary & tertiary structures H bond
secondary  Produced by packing side chains from adjacent secondary Salt bridges
Structures structural elements close to each other Hydrophobic interactions
 Example: Helix-turn-Helix motif found in DNA binding
proteins. Similarly triplex helix, found in collagen

4. Explain tertiary structure of protein regarding covalent & non-covalent interactions among functional groups. Discuss the bonds and
their interactions which help to stabilize tertiary structure of proteins. [SUPPLE 2023 held in 2024]
5. How is the tertiary structure of protein is maintained?
6. Give forces responsible for maintaining tertiary organization of protein structure.
Non-covalent Interactions
 Hydrophobic interactions between non-polar amino acid residue  “Major contributor”.
 Salt bridges between charged amino acids

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 Hydrogen bonds between polar amino acid residue

 Ionic interactions between charged amino acids
Covalent Interactions
 Disulfide bond between two cysteine residues

7. Hemoglobin is responsible for carrying oxygen to the tissues. Explain the structure of Hemoglobin with particular reference to its
structural classification, types of bonds involved, ringed structure of Heme and binding to Fe.
Structure of Hb
o Quaternary structure, meaning that it is made up of four subunits.
o Each subunit of hemoglobin is made up of a polypeptide chain and a heme group
o Polypeptide chains are classified as either alpha or beta, and each subunit can contain either two alpha chains and two beta
chains (in adults) or two alpha chains and two gamma chains (in fetuses).
Types of Bonds
 Two polypeptide chains in each alpha-beta dimer are held together by Hydrophobic interactions
 Ionic bond & H bond between members of dimers
Ringed structure of heme & binding to Fe
 Heme group is a ringed structure that contains an iron atom at its center
 Heme group is bound to the polypeptide chain of each subunit of hemoglobin by a covalent bond between the iron atom and a
histidine amino acid residue.

8. Differentiate tertiary & quaternary structure of protein

 Tertiary structure refers to the three-dimensional arrangement of a single polypeptide chain
 Quaternary structure refers to the arrangement of multiple polypeptide chains that come together to form a larger protein
complex.

9. Elaborate the hierarchies involved in coordination of the structure of a protein.

10. What do you understand by denaturation of protein

 Disorganization of native protein structure
 It results in loss of secondary, tertiary & quaternary structure
 It doesn't alter the primary structure
 It can be caused by physical agents (x-rays, heat & UV radiations) & chemical agents (acid, base & organic solvent)

03. Fibrous Proteins

1. How collagen is degraded? Name any four diseases associated with abnormalities in collagen structure and function?
Collagen is degraded by enzymes called collagenases, which are produced by various cells in the body, including fibroblasts and
macrophages. The collagenases cleave the collagen fibers into smaller fragments, which can then be further degraded by other
enzymes.

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Four Disease
o Osteogenesis Imperfecta
o Ehlers Danlos syndrome
o Scurvy
o Menkes syndrome
o Alport syndrome
o Epidermolysis bullosa

2. Enumerate standard & derived amino acids that are commonly found in collagen & elaborate the role of each in formation of
mature collagen fibers.
3. Collagen is the main protein found in extracellular matrix. Which amino acids play important role in giving it a triple helix structure
& how?
Standard amino acid: Glycine, Proline, Lysine
Derived amino acid: Hydroxyproline
Amino acid Role
Glycine Its small size allows it to fit into the tight spaces in the triple helix structure.
Proline Its cyclic structure allows it to fit into the tight helical structure & produces kinks
Hydroxyproline Its hydroxyl group allow it to form hydrogen bonds with other residues in the chain, further
stabilizing the helix.
Lysine Involved in cross linking of collagen fibers

4. Describe structural characteristics of collagen.

 Consist of triple helix which has 3.3 residues per turn
 Every third amino acid in collagen structure is glycine. Hence it contains Gly-X-Y repeating structure
 Proline & Hydroxyproline are also present abundantly which confer rigidity
 Lysine can be present in Y position
 Quarter staggered alignment
 Triple helix structure is stabilized by intramolecular aldol crosslinks

5. A seven month old child "fell over" while crawling, and now presents with a swollen leg. At age one month, the infant had multiple
fractures in various states of healing (right clavicle, right humerus, right radius). At age seven months, the infant has a fracture of a
bowed femur, secondary to minor trauma. In X-ray film the bones are thin, have few trabeculae, and have thin cortices. A careful
family history ruled out non-accidental trauma (child abuse) as a cause of the bone fractures
a) The child is likely to have which disease?
Osteogenesis imperfecta
b) What could be the biochemical defect in this disorder?
Decreased formation of collagen type I due to defective genes that code for its polypeptide chains
6. Draw & relate structure of Elastin with its function
Structure
 Basic building block of elastin is a protein called tropoelastin
 Some of the prolines of tropoelastin are hydroxylated to hydroxyproline
 Structure is characterized by intramolecular desmosine cross-links formed by the enzyme lysyl oxidase.
 These cross-links allow it to stretch & recoil without losing its integrity
Function
 Responsible for providing elasticity to tissues such as skin, lungs, and blood vessels.

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7. Tabulate the major biochemical differences between collagen & Elastin

Collagen Elastin
Many different genetic types One genetic type
Triple helix No triple helix
Gly-X-Y repeating unit No Gly-X-Y repeating unit
Presence of hydroxylysine No hydroxylysine
Carbohydrate containing No carbohydrate
Presence of extension peptides during biosynthesis No extension peptides during biosynthesis
Intramolecular aldol cross-links Intramolecular desmosine cross-links

8. A 25 years old male, who is much taller and has exceptionally long arms & digits, is undergoing physical fitness examination for
induction in police force. Doctors found a mid-systolic murmur during auscultation. He is suspected as a ease of Marfan syndrome.
a) Which protein is defective in this syndrome?
Fibrillin
b) Give its role in extracellular matrix.
It is a major component of the extracellular matrix of connective tissues, such as
cartilage, bone, and blood vessels. It has a structural role in providing elasticity and
tensile strength to these tissues, as it forms microfibrils that act as scaffolds for the
deposition of other extracellular matrix components, such as elastin and collagen

03. Protein folding & Disorders related to protein misfolding

1. What factors affect the folding process in protein?

 Interactive forces such as hydrophobic interactions
 Environmental conditions such as temperature, pH, electric & magnetic field
 Presence or absence of co-factors
 Molecular crowding
 Post-translation modification
 Auxiliary proteins
 Protein Aggregation

2. What is the role of amino acid side chain group in protein folding? Briefly describe the relationship of protein structure to its
function. Give at least one example.
Role of amino acid side chain
o The side chain groups of amino acids play an important role in protein folding. They can form hydrogen bonds, ionic
interactions, hydrophobic interactions, and disulfide bonds that stabilize the protein structure. The interactions between side
chains determine the three-dimensional conformation of the protein and its stability.
Relationship of structure to function
 The function of a protein is determined by its three-dimensional structure. For example, enzymes are proteins that catalyze
chemical reactions in the body. The active site of an enzyme is a specific region of the protein that binds to the substrate and
catalyzes the reaction. The structure of the active site is critical for the specificity and efficiency of the enzyme. If the protein
structure is altered, the enzyme may lose its activity or become less efficient.

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3. What are chaperons

Proteins that guide proteins along the proper pathways for folding. Protein chaperones aid protein folding in two basic ways:
a) Assisted folding and assembly
b) Provide sheltered environment to prevent aggregation

4. What is the normal mechanism of protein folding?

Primary linear structure (nascent protein)  Intramolecular H-bonding  Secondary structure  Hydrophobic interactions 
spontaneous collapse of polypeptide into compact state (molten globule)  3-dimensional functionally active Tertiary structure
Factors supporting normal protein folding are:
 Chaperon proteins which assist folding & provide sheltered environment to prevent aggregation
 Disulfide Isomerase which shuffles or interchange disulfide bonds until bonds of native conformation formed
 Prolyl cis-trans Isomerase which convert trans configuration of newly synthesized peptide chain into cis configuration
\

5. Which changes occur in protein structure resulting in the.

a) prion disease
Conformational transformation from PrPc (rich in alpha helix) get converted into PrPsc (rich in Beta sheet)
b) Alzheimer’s disease
Conformational transformation of Beta-amyloid from alpha helix rich state to beta sheet rich state.

6. State mechanism that leads to Alzheimer's disease

Apoliprotein E potentiates the conformational transformation of Beta-amyloid from alpha helix rich state to beta sheet rich state. It
leads to formation of aggregation of Beta amyloid protein & this aggregation forms senile plaques that disrupt communication
between nerve cells.
Another hallmark of Alzheimer's disease is the accumulation of tau protein in the brain, which can form neurofibrillary tangles that
disrupt the normal functioning of nerve cells.

7. A 70 year old man is diagnosed with Jacob Creutzfeldt disease and died after few months. Autopsy revealed insoluble aggregates of
the fibrils in the brain tissue. What is the mechanism for development of these aggregates in the above case?
 Conformational transformation from PrPc (rich in alpha helix) get converted into PrPsc (rich in Beta sheet)
 PrPsc triggers the production of more pathologic variants in a conformational chain reaction.
 PrPsc molecules associated strongly with one another through their exposed hydrophobic regions, thus the accumulating PrPs
units coalesce to form insoluble protease-resistant aggregates.

8. A 78 years old male presented to the neurological clinic with alterations in behaviour and impairment of intellectual function. His
family history reported progressive disorientation and memory loss over the last 6 months. The patient was tentatively diagnosed with
Alzheimer's disease (AD). (Annual 2023 – MODULAR SYSTEM)
(a) What is the Biochemical abnormality of this disease? What changes occur in prions disease? (03)
Biochemical abnormality of Alzheimer's disease:
See Q#2
Changes occur in prions (Creutzfeldt-Jacob) disease:
See Q#3
(b) Discuss the forces that stabilize the tertiary structure of the proteins with the amino acids involved. (02)
See Q#4 in Topic “Structure of Proteins”!

9. b) What is mechanism of protein misfolding? Enumerate any 2 diseases that can occur due to it? [SUPPLE 2023 held in 2024]
Mechanism of Misfolding See in Q#7.
Diseases can occur:
 Alzheimer‘s Disease
 Creutzfeldt-Jacob) disease

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B-013 ֍PLASMA PROTEINS֍

01. Plasma Proteins

1. Describe the biologic functions of plasma albumin

 Maintain osmotic pressure
 Transport substances
 pH buffering
 Antioxidant
 Immunologic

2. Give principal biologic function of heptoglobin. What is the biochemical explanation for low plasma haptoglobin in patients with
Hemolytic anemia?
Biological function
 Haptoglobin bind with free hemoglobin (Hb) released from erythrocytes. Haptoglobin-Hb complex can't pass through
glomeruli. Thus it prevents the loss of iron and the potential renal damage that can be caused by free Hb.
Low Haptoglobin in Hemolytic Anemia
 Hlaf life of heptoglobin is 5 days while that of Haptoglobin-Hb complex is 90 mints. In hemolytic anemia, there is an in
increased levels of free hemoglobin that leads to increased formation of Haptoglobin-Hb complex which in turn is rapidly
cleared from plasma resulting in decreased Haptoglobin level

3. Give an account of acute phase proteins in plasma.

Acute phase proteins are a group of proteins that are synthesized by the liver in response to inflammation, infection, or tissue injury.
They are part of the innate immune system and play a role in the body's response to injury or infection.
Positive acute phase proteins
 These proteins increase in concentration during inflammation or infection
 Examples: C-reactive protein (CRP), fibrinogen, serum amyloid A (SAA), and haptoglobin.
Negative acute phase proteins
o These proteins decrease in concentration during inflammation or infection
o Examples: include albumin and transferrin.

B-014 ֍IMMUNOGLOBULINS֍

01. Production, structure and functions of B cells, plasma cells, and antibodies

1. Give an outline of structure of immunoglobulin. Classify immunoglobulin on the basis of heavy and light chain.
Structure of immunoglobulin
 Consists of four polypeptide chains which are held together by disulfide linkages
 two identical heavy chains
 two identical light chains
 Each chain contains a variable region and a constant region
 Variable regions of the heavy and light chains form the antigen-binding site
 Constant regions of the heavy and light chains determine the antibody's isotype and effector functions.
 Papain enzyme cleave immunoglobulin molecule at Hinge region into
 2 antigen binding fragments (Fab)
 1 crystallizable fragment (Fc)

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Immunoglobulin Heavy chain Light Chain

IgG Gamma kappa or lambda
IgA Alpha kappa or lambda
IgM Mu kappa or lambda
IgD Delta kappa or lambda
IgE Epsilon kappa or lambda
Generation of antibody specificity (antigen dependent); Somatic hypermutation and affinity maturation (variable region) & Isotype switching (constant
region)

2. Enumerate the types of immunoglobulins. Which one is raised first of all in response to bacterial and viral infections?
Types  IgG, IgA, IgM, IgD, IgE
Immunoglobulin first raised  IgM

3. A 25 years old female visited ENT Clinic with complaints of sneezing and Rhinitis (running nose) after routine house-hold
cleaning. Examination revealed swollen nasal mucosa. A provisional diagnosis of Allergic Rhinitis was made.
a) Plasma level of which specific class of Immunoglobulin will be raised? Name another condition in which its level is
increased.
 IgE plasma level will be raised
 Another condition is Parasitic infection such as Schistosomiasis
b) Draw the structure of IgG

Note: Fab fragment consisting of light (L) and heavy (H) chains recognizes antigens. Fc region of IgM and IgG fixes complement. Heavy
chain contributes to Fc and Fab regions. Light chain contributes only to Fab region

4. A patient developed acute infection due to Covid-19 virus & cured after 2 weeks. Which immunoglobulin is raised in plasma after 5
days & 16 days of onset of disease?
 After 5 days  IgM
 After 15 days  IgG

5. Describe the biological functions of Alpha 1 antitrypsin & Ceruloplasmin

Alpha-1 antitrypsin (ATT)
 AAT is a serine protease inhibitor, which means that it can bind to and inhibit the activity of enzymes called proteases which
are involved in a variety of biological processes, including inflammation, tissue repair, and blood clotting.
 It protect lungs' alveoli from neutrophil elastase
Ceruloplasmin
 Oxidize Fe+² to Fe+³ which then bound to transferrin in blood
 Transport copper in blood

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02. Functions of the cytokines (Interleukins, TNF, PDGF, and PAF)

Kindly Clear concept about these chemicals from Guyton & Hall Textbook of Physiology, Immunity Portion.

03. Multiple Myeloma

Monoclonal antibody: When one ―clone‖ of antibody producing cells secrete a particular type of antibody against a particular
antigenic determinant (epitope), it is called monoclonal antibody.
Example: Monoclonal antibodies are produced in multiple myeloma, a plasma cell tumour. In this paraprotein is produced, which
gives a sharp paraprotein band in β to γregion (M-band) in electrophoresis (monoclonal gammopathy).

֍Past UHS MCQs֍

01. Cell & Signal Transduction

1. Movement of molecules from an area of low concentration to the area of high concentration against the concentration gradient is
known as:
A. Osmosis C. Phagocytosis
B. Active Transport D. Diffusion
2. Phenomenon of osmosis is opposite to
A. Diffusion C. Affusion
B. Effusion D. Coagulation
3. Which is not correct about cell membrane
A. Contains two layers of phospholipids C. may contain ion channels
B. may contain receptor proteins D. is impermeable to fat soluble substances
4. Activated Gq protein in plasma membrane activates which of the following enzymes.
A. Adenyl cyclase C. Phosphodiestrase
B. Phospholipase A2 D. Phospholipase C
5. What is correct about G-protein
A. It is serpentine receptor C. its Alpha-s inhibits cAMP synthase
B. When GDP attached it gets activated D. it has 2 components
6. Which of the following is the primary energy currency of the cell?
A. ATP C. RNA
B. DNA D. NADH
7. Which organelle is responsible for protein synthesis in eukaryotic cells?
A. Mitochondria C. Endoplasmic reticulum
B. Golgi apparatus D. Lysosome
8. Which of the following molecules is considered the "central dogma" of molecular biology?
A. DNA C. Protein
B. RNA D. Lipid
9. What is the process by which a cell engulfs and internalizes substances by forming vesicles called?
A. Exocytosis C. Phagocytosis
B. Endocytosis D. Pinocytosis
10. Which of the following is NOT a component of the cell membrane?
A. Phospholipids C. Carbohydrates
B. Cholesterol D. Nucleic acids
11. Which of the following organelles is responsible for detoxifying harmful substances in the cell?
A. Lysosome C. Golgi apparatus
B. Peroxisome D. Nucleus
12. What is the process by which cells break down glucose to produce ATP in the absence of oxygen?
A. Photosynthesis C. Oxidative phosphorylation
B. Glycolysis D. Krebs cycle

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13. Which molecule is the primary electron carrier in cellular respiration?

A. NADH C. ATP
B. FADH2 D. ADP
14. Which of the following is responsible for storing and transmitting genetic information in the cell?
A. Proteins C. DNA
B. Lipids D. Carbohydrates
15. Which of the following is an example of an enzyme?
A. Hemoglobin C. Amylase
B. Insulin D. Collagen
16. Which of the following is a common second messenger in cell signal transduction pathways?
A. DNA C. cAMP
B. ATP D. RNA
17. The binding of a ligand to a cell surface receptor typically leads to:
A. Inhibition of gene expression C. Activation of downstream signaling pathways
B. Decreased cellular metabolism D. Disruption of the cell membrane
18. Protein kinases are enzymes involved in cell signal transduction that function by:
A. Adding phosphate groups to proteins C. Binding to DNA to regulate gene expression
B. Removing phosphate groups from proteins D. Transporting ions across the cell membrane
19. G protein-coupled receptors (GPCRs) are a class of cell surface receptors that:
A. Activate gene transcription directly C. Interact with ligands inside the cell
B. Catalyze phosphorylation reactions D. Transmit signals via heterotrimeric G proteins
20. Which of the following is an example of a nuclear receptor involved in cell signal transduction?
A. G protein-coupled receptor C. Integrin receptor
B. Receptor tyrosine kinase D. Steroid hormone receptor
21. What binds with G protein after interaction with GPCR leading to dissociation of alpha subunit from beta-gamma subunit?
A. ADP C. GTP
B. GDP D. cAMP
22. A 4-year-old boy presents in the OPD. He has coarse facial features, skeletal abnormalities, and mental retardation. Hematological
results show large amounts of lysosomal enzymes in blood and urine. Large inclusion bodies are also seen in the cells of these
patients. The doctor tells his parents that the child is suffering from a genetic storage disorder due to which acid hydrolases are absent
in his sub cellular organelle. What is the most likely diagnosis?
A. Progeria C. Refsum disease
B. I-cell disease D. Parkinsonism

ANSWER KEY
1. B 2. A 3. D 4. D 5. A 6. A 7. C 8. A 9. B 10. D
11. B 12. B 13. A 14. C 15. C 16. C 17. C 18. A 19. D 20. D
21. C 22. B

02. Nucleic Acid & Nucleotides

1. The end product of purine catabolism in men is

A. Inosine C. Xanthine
B. Hypoxanthine D. Uric Acid
2. Which of the following is a structural component of RNA but not DNA
A. Adenine C. Thiamine
B. Uracil D. Cytosine
3. Methotrexate inhibit synthesis of which nucleotide?
A. Adenine C. Cytosine
B. Guanine D. Thiamine

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4. Methotrexate inhibits which of the following enzyme?

A. Xanthine oxidase C. Adenosine deaminase
B. HGPRT D. Dihydrofolate reductase
5. The purine, pyrimidine ratio in DNA is
A. 1:1 C. 2:1
B. 1:2 D. 2:3

ANSWER KEY
1. D 2. B 3. D 4. D 5. A 6. 7. 8. 9. 10.

5. In DNA, the purine bases (adenine (A) and guanine (G)) pair with the pyrimidine bases (cytosine (C) and thymine (T)) in a specific
ratio. According to Chargaff's rules, the base pairing rules in DNA are:
 Adenine (A) pairs with Thymine (T)
 Guanine (G) pairs with Cytosine (C)
Since there are two purine bases (A and G) and two pyrimidine bases (C and T), the ratio of purine to pyrimidine bases in DNA is 1:1.

03. Enzymes

[Link] of the following is not included in major classes of enzymes.

A. Transferases C. Hydrolases
B. Polymerases D. Oxidoreductases
2. In human body, the optimum temperature for enzyme is:
A. 25C C. 40C
B. 37C D. 30C
3. Enzymes are
A. DNA molecule C. Proteins
B. Nucleic Acid D. Carbohydrates
4. Enzyme Amylase breakdown
A. Nucleoproteins C. Proteins
B. Fats D. Carbohydrates
5. Which of the following factor can affect enzyme activity
A. pH C. Inhibitors
B. Temperature D. All of the above
6. Enzymes increased in MI are
A. Amylases C. CK
B. Lipases D. Esterase
7. Hydrolysis of peptides is caused by
A. Esterase C. Amylases
B. Trypsin D. Lipases
8. The active site of an enzyme:
A. Is formed only after addition of specific substrate C. Resides in a few adjacent amino-acid resides in a primary
B. Is directly involve in the binding of allosteric inhibitors sequence of the polypeptide chain.
D. Binds competitive inhibitors
9. The velocity of enzyme catalyzed reaction:
A. Decreases as the substrate concentration increases C. is related to substrate concentration at ½ Vmax
B. is lowest when enzyme is saturated with substrate D. is independent of pH of solution
10. A drug that is a competitive inhibitor of enzyme
A. increase km but does not affect Vmax C. Increases Vmax but does not affect Km
B. decreases Km but does not affect Vmax D. Decreases Vmax but does not affect Km
11. In an enzyme assay in which substrate concentration is much higher than Km, the rate:
A. approaches ½ of Vmax C. is proportional to substrate concentration
B. shows zero-order kinetics D. is independent of enzyme concentration

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12. In competitive inhibition

A. The apparent concentration of active enzyme molecules is reduced
B. Vmax is increased
C. The concentration of active enzyme molecule is unchanged
D. The apparent Km is increased
13. In non-competitive inhibition
A. The apparent concentration of active enzyme molecules is reduced B. Vmax is increased
C. The concentration of active enzyme molecules unchanged D. The apparent Km is increased
14. Which one of the following characteristics best applies on allosteric effector.
A. Competes with substrate for the catalytic site
B. Binds to a site on the enzyme molecule distinct from the catalytic site
C. changes the nature of product formed
D. Covalently modifies the enzyme
15. A competitive inhibitor alters an enzyme kinetics by
A. increasing the apparent km C. Increasing the apparent Vmax
B. Decreasing the apparent Km D. Decreasing the apparent Vmax
16. Enzymes increase the rate of reaction by:
A. increasing the free energy of activation C. Changing the equilibrium constant of reaction
B. Increasing the free energy change of reaction D. Decreasing the energy of activation
17. cofactors are sometimes described as being heat stable & non-dialyzable. This means they can be heated without losing activity
but cannot be dialyzed without losing activity. Because of this we know co-factors?
A. are large protein molecules C. are neither proteins, nor large in size
B. are large non-protein molecules D. are always metallic
18. Which of the following catalyzes the exchange of -NH2 group between an amino acid and keto acid
A. ALT C. Amino-polypeptidase
B. CK D. Urease
19. Which enzyme catalyzes hydrolysis of the terminal peptide linkage in a peptide.
A. Kinases C. Exopeptidases
B. Mixed function oxidases D. Dehydrogenases
20. HMG-CoA-reductase is inhibited by which of the following class of drugs
A. Steroids C. Macrolides
B. Statins D. beta-lactams
21. Which of the following is required for functioning of Aminotransferases
A. Niacin C. PLP
B. Riboflavin D. Biotin
22. Which is true for competitive enzyme action?
a) V max is increased c) Km is decreased
b) Km is increased d) Concentration of active enzyme molecule is reduced
23. When [S] = Km, which of the following condition does not exist?
a) Half of the active sites on enzyme are occupied by substrate c) Half of the active sites of enzyme are expire
b) The V of the reaction is half of Vmax d) High Km means weak binding of substrate with the enzyme
24. Cardiac muscles contain which of the following isoenzymes?
a) CK-MM c) CK-BB
b) CK-MB d) MM-BB
25. An enzyme that catalyzes the conversion of triacylglycerol to mono-acylglycerol and fatty acid would be classified as one of the:
a) Hydrolases c) Transferases
b) Isomerases d) Oxidoreductases
26. In which of the following types of enzyme H2O may be added to C=C without breaking the bond?
a) Hydrolase c) Hydroxylase
b) Hydratase d) Oxygenase

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27. Which of the following regulatory actions involves a reversible covalent modification of an enzyme?
a) Phosphorylation of ser-OH on the enzyme c) Competitive inhibition
b) Allosteric modulation d) Non-competitive inhibition
28. Which serum enzyme activity will be useful to establish myocardial infraction if the patient is seen after 3 weeks of suspected
attack?
a) AST c) Gamma-GT
b) LDH d. CK
29. Rise of which serum enzyme activity for 4-8 hours after acute MI is Characteristically seen.
a) CK c) AST
b) Gamma-GT d)) LDH
30. Which enzymes catalyze the hydrolysis of the terminal peptide linkage in a peptide?
a) Kinases c) Reductases
b) Mixed function oxidases d) Exopeptidases
31. In acute pancreatitis the activity of the following enzyme in plasma is specifically elevated
a) Alanine aminotransferase (ALT) c) Creatine kinase
b) Alkaline phosphatase d) Amylase
32. Cofactors are sometimes described as being heat stable and non- dialyzable. This means that they can be heated without losing
activity, but cannot be dialyzed without losing activity. Because of this we know that cofactors:
a) Are large protein molecules c) Are very small protein molecules
b) Are large non-protein molecules d) Are always metallic ions
33. A 70-year-old man was admitted to hospital emergency with a history of chest pain. Which one of the following enzymes will give
you maximum information about myocardial ischemia?
a) Lactate dehydrogenase c) CK-MB
b) ALT d) ALP
34. Which of the following statement describes isozymes:
a) They are catalytically active proteolytic degradation products of certain enzymes
b) They are catalytically inert enzymes of identical function in different cells.
c) They are molecular forms of enzymes catalyzing the same reaction in different cells.
d) They are enzymes of identical function that are isolated from different species
35. A patient was diagnosed to have acute MI. Which one of the following enzyme preparations is given I/V to dissolve the clot in his
coronary artery?
a) Glucocerebrosidase c) Streptokinase
b) Heparin d) Urokinase
36. A competitive reversible inhibitor such as physostigmine is used to treat glaucoma and myasthenia gravis and to reverse
anticholinergic syndrome. Based on this, which one of the following statements is true concerning the clinical implications of using
physostigmine?
a) Use of the drug will decrease the Km of the targeted enzyme
b) Use of the drug will increase the Km of the targeted enzyme
c) Use of the drug will increase the Vmax of the targeted enzyme
d) Use of the drug will decrease the Vmax of the targeted enzyme
37. A numerical value of Km reflects which of the following?
a) Concentration of the enzyme that gives half of Vmax
b) Concentration of the substate that gives half of Vmax
c) Half of the substrate concentration required to achieve Vmax
d) Total substrate concentration required to achieve Vmax
38. A 10-year-old boy presents with vomiting, sweating, drooling, and a decreased heart rate. His friends state that he was in a corn
field when it was sprayed by a crop duster. The chemical being sprayed was an organophosphate derivative that covalently binds to a
cholinergic enzyme found at postsynaptic neuromuscular junction and inactivates it. What type of inhibition is being displayed?
a) Competitive c) Irreversible
b) Noncompetitive d) Allosteric

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39. A 45-year-old lady is being treated for coronary artery disease. For associated hypercholesterolemia, she is prescribed a group of
drugs which inhibits an enzyme required for cholesterol biosynthesis. Which of the following enzymes is inhibited by the drug?
a) Methyl Malonyl CoA mutase c) HMG COA Reductase
b) Propionyl CoA Reductase d) HMG COA Synthase
40. Following myocardial infarction, the last serum enzyme to return to normal is:
a) Creatine kinase c) SGPT
b) SGOT d) LDH
41. In viral hepatitis:
a) The rise in SGOT is greater than that in SGPT c) SGOT and SGPT are raised equally
b) The rise in SGPT is greater than that in SGOT d) SGOT remains normal
42. The highest elevation in serum alkaline phosphatase is seen in:
a) Obstructive jaundice c) Osteomalacia
b) Rickets d) Infective hepatitis

ANSWER KEY:
1. B 2. B 3. C 4. D 5. D 6. C 7. B 8. D 9. C 10. A
11. B 12. D 13. A 14. B 15. A 16. D 17. B 18. A 19. C 20. B
21. C 22. B 23. C 24. B 25. A 26. B 27. A 28. B 29. A 30. D
31. D 32. B 33. C 34. C 35. C 36. B 37. B 38. C 39. C 40. D
41. B 42. A

41. in viral hepatitis, the characteristic pattern is SGPT (ALT) > SGOT (AST)

04. Protein & Amino acids

1. Domains fold into compact form known as

a) Primary structure c) Tertiary structure
b) Secondary structure d) Motif
2. What is the role of vitamin C in elastin synthesis?
a) Hydroxylation of proline c) desmosine cross linking
b) Hydroxylation of glycine d) O-glycosidic linkages
3. Menkes disease is a collagen protein disorder which is caused by deficiency of
a) Vitamin C c) Vitamin D
b) Copper d) Calcium
4. 3-dimensional protein structure is known as:
a) Primary structure c) Motif
b) Secondary structure d) Tertiary structure
5. Which amino acid is involved in synthesis of thyroid hormone?
a) Selenocysteine c) Hydroxylysine
b) Histidine d) Hydroxyproline
6. Negatively charged amino acid:
a) Aspartate c) Cysteine
b) Glutamine d) Asparagine
7. Defective structure in amyloid disease:
a) alpha helix c) beta bends
b) beta pleated sheet d) triple helix
8. Amino acid that is the substrate in first step of heme synthesis?
a) Glycine c) Serine
b) Histidine d) Glutamine

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9. Tendon contains which type of collagen?

a) type I c) type III
b) type II d) type IV
10. Most abundant protein in ECM:
a) Collagen c) Fibronectin
b) Elastin d) Integrin
11. An important protein involved in Cell adhesion & Migration:
a) Collagen c) Actin
b) Fibronectin d) Percalan
12. Prion disease is caused by change in _____ of protein
a) Primary structure c) Tertiary structure
b) Secondary structure d) Quaternary structure
13. The highest concentration of cysteine can be found in
a) Melanin c) Myosin
b) Chondroitin sulfate d) Keratin
14. Which of the following is not a nutritionally essential amino acid for humans?
a) Leucine c) Tyrosine
b) Tryptophan d) Methionine
15. Which of the following amino acids has two carboxyl groups?
a) Glycine c) Aspartate
b) Histidine d) Methionine
16. Enzyme raised in muscular dystrophy?
a) Creatine kinase c) Carboxyglutamase
b) Alkaline phosphatase d) CK-MB
17. Secondary structure is stabilized mainly by
a) Peptide bond c) Hydrophobic interactions
b) H bond d) Disulfide linkages
18. What is the role of collagen in metalloproteinases?
a) It inhibits the activity of metalloproteinases c) It is a substrate for the activity of metalloproteinases.
b) It activates the activity of metalloproteinases d) It has no role in metalloproteinases.
19. A variant of Prion disease that afflicts younger patients & associated with early onset psychiatric & behavioral disorders?
a) Creutzfeldt Jacob disease c) Alzheimer disease
b) Mad cow disease d) Scrapie
20. Which bonds are present in primary structure of protein?
a) H bond c) Ionic bond
b) Peptide bond d) Covalent bond
21. Branched chain amino acids
a) Valine, Leucine & isoleucine c) Cysteine, Methionine & Cystine
b) Glycine, Serine & Tyrosine d) Phenylalanine, Tyrosine & Tryptopha

ANSWER KEYS
1. c 2. a 3. b 4. d 5. a 6. a 7. b 8. a 9. a 10. a
11. b 12. c 13. d 14. c 15. c 16. a 17. b 18. c 19. a 20. b
21. a

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֍PRACTICE MCQs֍

01. Structure of Cell & Cell Membrane, Signal Transduction

Questions 1 and 2 are based on the following patient.

1. A patient has severe weakness of a muscle group after repeatedly contracting that muscle group. After rest, the muscle appears to
function normally unless repeatedly contracted again. The antibody causing this disease process would directly affect which one of the
following?
A. The number of ACh vesicles C. Na + and K+ gradients
B. Voltage-gated Ca 2+ channels D. ACh receptors in skeletal muscle
2. In the patient described in the previous question, ACh and other similar neurotransmitters use which one of the following modes of
action to transmit their signal?
A. Endocrine C. Autocrine
B. Paracrine D. Neuropeptide
3. Which of the following is an example of an intracellular signaling molecule?
A. Hormones C. Cytokines
B. Neurotransmitters D. Second messengers
4. Which of the following is the energy currency of the cell?
A. ATP C. RNA
B. DNA D. NADH
5. Which type of RNA carries the genetic information from DNA to the ribosomes during protein synthesis?
A. Messenger RNA (mRNA) C. Ribosomal RNA (rRNA)
B. Transfer RNA (tRNA) D. Small nuclear RNA (snRNA)
6. What is the function of ribosomes in the cell?
A. DNA replication C. Lipid synthesis
B. Protein synthesis D. Cellular respiration
7. What happens to protein kinase A (PKA) following the binding of cAMP?
A. The regulatory subunits of PKA dissociate, thereby activating the catalytic subunits.
B. PKA catalytic subunits then bind to two regulatory subunits, thereby activating the catalytic subunits.
C. The inhibitory regulatory subunits dissociate from the catalytic subunits, completely inactivating the enzyme.
D. The stimulatory regulatory subunits dissociate from the catalytic subunits, inhibiting the enzyme.
8. Which of the following is not a major macromolecule found in cells?
A. Proteins C. Lipids
B. Nucleic acids D. Sugars
9. Which organelle is responsible for the synthesis of ATP through cellular respiration?
A. Golgi apparatus C. Mitochondria
B. Endoplasmic reticulum D. Lysosomes
10. Enzymes are:
A. Carbohydrates that provide energy to cells C. Proteins that catalyze biochemical reactions
B. Lipids that store genetic information D. Nucleic acids that form the structural framework of cells
11. Regarding membrane lipids, select the one FALSE answer.
A. The major phospholipid by mass in human membranes is generally phosphatidylcholine.
B. Glycolipids are located on the inner and outer leaflets of the plasma membrane.
C. Phosphatidic acid is a precursor of phosphatidylserine, but not of sphingomyelin.
D. Phosphatidylcholine and phosphatidylethanolamine are located primarily on the outer leaflet of the plasma membrane.
12. Regarding membrane proteins, select the one FALSE answer.
A. Because of steric considerations, α-helices cannot exist in membranes.
B. A hydropathy plot helps one to estimate whether a segment of a protein is predominantly hydrophobic or hydrophilic.
C. Certain proteins are anchored to the outer leaflet of plasma membranes via glycophosphatidylinositol (GPI) structures. D. Adenylyl
cyclase is a marker enzyme for the plasma membrane.

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13. Regarding membrane transport, select the one FALSE statement.

A. Potassium has a lower charge density than sodium and tends to move more quickly through membranes than does sodium.
B. The flow of ions through ion channels is an example of passive transport.
C. Facilitated diffusion requires a protein transporter.
D. Insulin, by recruiting glucose transporters to the plasma membrane, increases uptake of glucose in fat cells but not in muscle.
14. Regarding the Na+-K+-ATPase, select the one FALSE statement.
A. Its action maintains the high intracellular concentration of sodium compared with potassium.
B. It can use as much as 30% of the total ATP expenditure of a cell.
C. It is inhibited by digitalis, a drug that is useful in certain cardiac conditions.
D. It is located in the plasma membrane of cells
15. What molecules enable cells to respond to a specific extracellular signaling molecule?
A. Specific receptor carbohydrates localized to the inner C. Ion channels
plasma membrane surface D. Receptors that specifically recognize and bind that
B. Plasma lipid bilayer particular messenger molecule
16. Indicate the term generally applied to the extracellular messenger molecules that bind to transmembrane receptor proteins.
A. Competitive inhibitor C. Scatchard curve
B. Ligand D. Substrate
17. In autocrine signaling:
A. Messenger molecules reach their target cells via passage through bloodstream.
B. Messenger molecules travel only short distances through the extracellular space to cells that are in close proximity to the cell that is
generating the message.
C. The cell producing the messenger expresses receptors on its surface that can respond to that messenger.
D. The messenger molecules are usually rapidly degraded and hence can only work over short distances.
18. Regardless of how a signal is initiated, the ligand-binding event is propagated via second messengers or protein recruitment. What
is the ultimate, or final biochemical outcome of these binding events?
A. A protein in the middle of an intracellular signaling pathway is activated.
B. A protein at the bottom of an intracellular signaling pathway is activated.
C. A protein at the top of an extracellular signaling pathway is activated.
D. A protein at the top of an intracellular signaling pathway is deactivated.
19. What features of the nuclear receptor superfamily suggest that these proteins have evolved from a common ancestor?
A. They all bind the same ligand with high affinity. D. They all contain regions of high amino acid sequence
B. They all function within the nucleus. similarity/identity.
C. They are all subject to regulatory phosphorylation.
20. What effect does degradation of receptor-ligand complexes after internalization have upon the ability of a cell to respond if
immediately reexposed to the same hormone?
A. The cellular response is attenuated due to a decrease in cellular receptor number.
B. Cellular response is enhanced due to reduced receptor ligand competition.
C. The cellular response is unchanged to subsequent stimuli.
D. Cell hormone response is now bimodal; enhanced for a short time and thereafter inactivated.
21. Typically, what is the first reaction after most receptor protein tyrosine kinases (RTKs) bind their ligand?
A. Receptor trimerization C. Receptor denaturation
B. Receptor degradation D. Receptor dimerization
22. Where is the kinase catalytic domain of the receptor protein tyrosine kinases found?
A. On the extracellular surface of the receptor, immediately adjacent to the ligand-binding domain.
B. On the cytoplasmic domain of the receptor.
C. On an independent protein that rapidly binds the receptor upon ligand binding.
D. Within the transmembrane spanning portion of the receptor.
23. The subunits of the heterotrimeric G-proteins are called the __, __, and__ subunits.
A. α, β, and χ C. α, γ, and δ
B. α, β, and δ D. α, β, and γ

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24. Of the receptors listed below, which can directly conduct a flow of ions across the plasma membrane when bound to their cognate
ligand?
A. Receptor tyrosine kinases (RTKs) C. G-protein gamma α subunit.
B. G-protein–coupled receptors (GPCRs) D. Ligand-gated channels
25. Which of the following is not a natural ligand that binds to G-protein–coupled receptors?
A. Hormones C. Chemoattractants
B. Steroid hormones D. Opium derivatives
26. Place the events of signaling listed below in the correct order. 1. G-protein binds to activated receptor forming a receptor–G
protein complex. 2. Release of GDP by the G-protein. 3. Change in conformation of the cytoplasmic loops of the receptor. 4. Binding
of GTP by the G-protein. 5. Increase in the affinity of the receptor for a G-protein on the cytoplasmic surface of the membrane. 6.
Binding of a hormone or neurotransmitter to a G-protein– coupled receptor. 7. Conformational shift in the α subunit of the G-protein.
A. 6 – 3 – 5 – 1 – 2 – 4 – 7 C. 6 – 3 – 5 – 1 – 7 – 2 – 4
B. 6 – 5 – 4 – 1 – 7 – 2 – 3 D. 6 – 7 – 3 – 5 – 1 – 2 – 4
27. Which heterotrimeric G-proteins couple receptors to adenylyl cyclase via the activation of GTP-bound Gα subunits?
A. Gs family C. Gi family
B. Gq family D. G12/13 family
28. What must happen in order to prevent overstimulation by a hormone?
A. Hormones must be degraded.
B. G-proteins must be recycled and then degraded.
C. Receptors must be blocked from continuing to activate G-proteins.
D. Receptors must dimerize
29. Which of the following hormones termed the ―flight-or-fight‖ hormone is secreted by the adrenal medulla?
A. Epinephrine C. Insulin
B. Oxytocin D. Glucagon
ANSWER KEY
1. D 2. B 3. D 4. A 5. A 6. B 7. A 8. D 9. C 10. C
11. B 12. A 13. D 14. A 15. D 16. B 17. C 18. B 19. D 20.A
21. D 22. B 23. D 24. D 25. B 26. C 27. A 28. C 29. A

1. The patient's symptoms suggest a diagnosis of Myasthenia Gravis, an autoimmune disease where antibodies target nicotinic
acetylcholine receptors (AChR) at the neuromuscular junction. This leads to a decrease in the number of functional AChRs, causing
muscle weakness and fatigue. The antibodies directly affect the AChRs, impairing their ability to bind with acetylcholine (ACh), the
neurotransmitter released by motor neurons.
2. ACh and other neurotransmitters use paracrine signaling to transmit their signal. Paracrine signaling involves the release of a
signaling molecule (in this case, ACh) from one cell (the motor neuron) that acts on nearby cells (skeletal muscle fibers) to produce a
response

02. Structure of Nucleic Acid, Nucleotides

1. Fluorouracil is an anti-tumor agent that binds and irreversibly inhibits which of the following enzyme?
A. ribonucleotide reductase C. dihydrofolate reductase
B. thymidylate synthase D. PRPP amido transferase
2. Which of the following is the degradation product of pyrimidines?
A. beta-alanine C. Allantoin
B. Uric acid D. Glycine
3. Gout is caused by the deposition of urate crystals in the joints and kidney. Purines are metabolized to uric acid, whereas
pyrimidines, when metabolized, do not generate uric acid. Which one of the following should be restricted in the diet of a patient with
gout?
A. Cytosine C. Thymine
B. Guanine D. Uracil

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4. Two Nitrogen of the pyrimidine ring are obtained from:

A. Glutamine and carbamoly-P C. Glutamate and ammonia
B. Aspartate and carbamoly-P D. Glutamine and ammonia
5. Targeting certain structural features of eukaryotic mRNA can result in an inhibition of protein synthesis. Which one of the
following describes a unique aspect of eukaryotic mRNA?
A. A polyguanosine tail is found at the 3′-end.
B. The 5′-end begins with a leader sequence that contains an adenine cap.
C. The cap and tail of the mRNA are added post-transcriptionally.
D. The poly(A) tail is found at the 3′-end of the mRNA.
6. The Nitrogen of a purine molecule are derived from all of the following amino acids, except?
A. Aspartic Acid and Glutamine C. Glutamate and Alanine
B. Asparagine and Glutamine D. Glycine and Alanine
7. Methotrexate inhibits which of the following enzyme?
A. ribonucleotide reductase C. dihydrofolate reductase
B. thymidylate synthase D. PRPP amido transferase
8. Understanding the structure of DNA, and the process of replication, enabled various drugs to be developed that interfered with
DNA replication. In DNA, the bond between the deoxyribose sugar and the phosphate is best described by which one of the
following?
A. A polar bond C. A hydrogen bond
B. An ionic bond D. A covalent bond
9. Certain drugs can intercalate between DNA bases and alter the backbone of the DNA. The backbone of a DNA strand is composed
of which of the following? Choose the one best answer.
A. Phosphates and sugars C. Nucleotides and sugars
B. Bases and phosphates D. Phosphates and nucleosides
10. Analysis of one strand of a double-stranded piece of DNA displayed 20 mol % A, 25 mol % T, 30 mol % G, and 25 mol % C.
Which one of the following accurately represents the composition of the complementary strand?
A. A is 25 mol %, T is 20 mol %, G is 25 mol %, and C is 30 mol %.
B. [A] is 30 mol %, [T] is 25 mol %, [G] is 20 mol %, and [C] is 25 mol %.
C. [U] is 25 mol %, [T] is 20 mol %, [G] is 25 mol %, and [C] is 30 mol %.
D. [A] is 25 mol %, [T] is 25 mol %, [G] is 25 mol %, and [C] is 25 mol %.
11. In humans, the principal catabolic product of pyrimidines is:
A. Uric acid C. Hypoxanthine
B. Allantoin D. β-Alanine
12. Followings are the example of nucleosides, EXCEPT
A. Adenosine C. Cytosine
B. Cytidine D. Uridine
13. Which of the following is not the precursor for the de novo purine biosynthesis?
A. Aspartic Acid C. Glutamine
B. Glycine D. Arginine
14. Purines and Pyrimidines are the nitrogen bases present on the nucleotides. Which of the following is a purine base?
A. Adenosine C. Thymine
B. Cytosine D. Uracil
15. Nucleotides are:
A. Purine bases C. Nitrogen bases + Pentose sugar + Phosphate
B. Nitrogen bases+ Pentose Sugar D. None of the above
16. Cyclic AMP is a cyclic nucleotide formed from:
A. ADP C. CMP
B. Adenylic acid D. ATP
17. The four nitrogen atoms of purines are derived from:
A. Urea and ammonia C. Ammonia, aspartate and glutamate
B. Ammonia, glycine and glutamate D. Aspartate, glutamine and glycine

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18. Glycine contributes to the following C and N of purine nucleus:

A. C-1, C-2, and N-7 C. C-4, C-5 and N-7
B. C-8, C-6 and N-9 D. C-3, C-4 and N-1
19. In formation of cyclic AMP the stimulation of adenyl cyclase by the hormone-receptor complex requires the presence of:
A. CTP C. UTP
B. GTP D. CDP
20. Cyclic GMP is a cyclic nucleotide formed form:
A. ATP C. GTP
B CTP D. UTP

ANSWER KEY
1. B 2. A 3. B 4. B 5. D 6. A 7. B 8. D 9. A 10. A
11. D 12. C 13. D 14. A 15. C 16. D 17. D 18. C 19. B 20. C

03. ENZYME

1. Competitive inhibitors stop an enzyme from working by

A. Changing the shape of the enzyme C. blocking the active site of the enzyme
B. merging with the substrate instead D. combining with the product of the reaction
2. In recent years, a non-protein compound has been identified to bring about catalysis in biological system. The name of the
compound
A. DNA C. Lipids
B. RNA D. Carbohydrates.
3. Gamma-Glutamyl transpeptidase activity in serum is elevated in
A. Pancreatitis C. Myocardial infarction
B. Muscular dystrophy D. Alcoholism.
4. A patient has accidentally ingested the insecticide malathion, leading to symptoms of an overstimulated autonomic nervous system.
Which one of the following best describes malathion in this context?
A. Enzyme C. Inhibitor
B. Coenzyme D. Cofactor
5. Penicillin is an antibiotic used to treat certain infections. It is a transition state analog and suicide inhibitor. The use of penicillin
affects which one of the following in susceptible targets?
A. Viral cell wall C. Viral nucleus
B. Bacterial cell wall D. Bacterial nucleus
6. Vitamins can act as coenzymes that participate in catalysis by providing functional groups. Therefore, vitamin deficiencies reflect
the loss of specific enzyme activities that depend on those coenzymes. Coenzymes are best described by which one of the following?
A. In humans, they are always synthesized from vitamins. C. They participate in only one reaction, like enzymes.
B. They are proteins. D. They are complex, nonprotein organic molecules.
7. In the feedback regulation, the end product binds at
A. Active site C. E-S complex
B. Allosteric site D. None of these.
8. Pepsin is an example for the class of enzymes namely
A. Oxidoreductases C. Hydrolases
B. Transferases D. Ligases.
9. Salivary amylase is an enzyme that digests dietary starch. Assume that salivary amylase follows Michaelis-Menten kinetics. Which
one of the following best describes a characteristic feature of salivary amylase?
A. The enzyme velocity is at one-half the maximal rate when 100% of the enzyme molecules contain bound substrate.
B. The enzyme velocity is at one-half the maximal rate when 50% of the enzyme molecules contain bound substrate.
C. The enzyme velocity is at its maximal rate when 50% of the enzyme molecules contain bound substrate.
D. The enzyme velocity is at its maximal rate when all of the substrate molecules in solution are bound by the enzyme.

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10. A 64-year-old man complains of an acute onset of unilateral eye pain and reduction in visual acuity. On physical examination, you
notice conjunctival injection (eye redness) and a mid-dilated and nonreactive pupil. Funduscopic examination reveals cupping of the
optic disc. Recognizing the signs and symptoms as glaucoma, you administer the medication acetazolamide to decrease the production
of aqueous fluid and lower the intraocular pressure. Acetazolamide is a noncompetitive inhibitor of carbonic anhydrase and, therefore,
will lead to which of the following concerning the kinetic constants of carbonic anhydrase?
A. An increase in the apparent Km C. An increase in Vmax
B. A decrease in the apparent Km D. A decrease in Vmax
11. A 10-year-old boy presents with vomiting, sweating, drooling, and a decreased heart rate. His friends state that he was in a corn
field when it was sprayed by a crop duster. The chemical being sprayed was an organophosphate derivative that covalently binds to
acetylcholinesterase and inactivates the enzyme. What type of inhibition is being displayed?
A. Competitive C. Irreversible
B. Noncompetitive D. Feedback
12. A competitive reversible inhibitor such as physostigmine is used to treat glaucoma and myasthenia gravis and to reverse
anticholinergic syndrome. Based on this, which one of the following statements is true concerning the clinical implications of using
physostigmine?
A. Use of the drug will decrease the Km of targeted enzyme. C. Physostigmine will increase Vmax of targeted enzyme.
B. An overdose of physostigmine can typically be reversed. D. Physostigmine will decrease Vmax of targeted enzyme.
43. ADH requires NAD+ for catalytic activity. In the reaction catalyzed by ADH, an alcohol is oxidized to an aldehyde as NAD+ is
reduced to NADH and dissociates from the enzyme. The NAD+ is functioning as a (an):
A. apoenzyme. C. coenzyme-prosthetic group.
B. coenzyme-co-substrate. D. cofactor.
14. In thyroid hormone production, thyrotropin-releasing hormone (TRH) from the hypothalamus stimulates thyroid-stimulating
hormone (TSH) release from the anterior pituitary, which stimulates the thyroid to produce thyroid hormones (triiodothyronine [T3]
and thyroxine [T4]). Normal or high levels of thyroid hormone then suppress release of TRH. The regulation of this pathway is best
described by which one of the following?
A. Complementary regulation C. Compartmentation
B. Feedback regulation D. Feed-forward regulation
15. In cases of ethylene glycol poisoning and its characteristic metabolic acidosis, treatment involves correction of the acidosis,
removal of any remaining ethylene glycol, and administration of an inhibitor of alcohol dehydrogenase (ADH, alcohol: NAD+
oxidoreductase), the enzyme that oxidizes ethylene glycol to the organic acids that cause the acidosis. Ethanol (grain alcohol)
frequently is the inhibitor given to treat ethylene glycol poisoning; it works by competitively inhibiting ADH. As a competitive
inhibitor, ethanol:
A. increases apparent Km without affecting Vmax. C. increases apparent Vmax without affecting Km.
B. decreases apparent Km without affecting Vmax. D. decreases apparent Vmax without affecting Km.
16. Pathway regulation can occur via the expression of tissue-specific isozymes. Glucose metabolism differs in red blood cells and
liver in that red blood cells need to metabolize glucose, whereas the liver prefers to store glucose. The first step of glucose metabolism
requires either glucokinase (liver) or hexokinase I (red blood cells), which are isozymes. Which one of the following best describes
these different isozymes and their Km for glucose?
A. The Km of hexokinase I is higher than the Km of C. The Km of hexokinase I is the same as the Km of
glucokinase. glucokinase.
B. The Km of hexokinase I is lower than the Km of D. Hexokinase I is found in liver.
glucokinase.
17. An antibiotic is developed that is a close structural analog of a substrate of an enzyme that participates in cell wall synthesis in
bacteria. This binding of the antibiotic reduces overall enzyme activity, but such activity can be restored if more substrate is added.
The binding of the antibiotic to the enzyme is not via a covalent bond, nor does the enzyme alter the structure of the antibiotic. Which
one of the following would best describe this antibiotic?
A. It is a suicide inhibitor. C. It is a competitive inhibitor.
B. It is an irreversible inhibitor. D. It is a noncompetitive inhibitor.
18. Which one of the following is true for the inhibitor described in the previous question?
A. It increases the apparent Km of the enzyme. C. It has no effect on the apparent Km of the enzyme.
B. It decreases the apparent Km of the enzyme. D. It increases the Vmax of the enzyme.
19. A hypochromic microcytic anemia with increased Fe stores in the bone marrow may be:
A. Folic acid responsive C. Pyridoxine responsive
B. Vitamin B12 responsive D. Vitamin C responsive

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20. A deficiency of copper affects the formation of normal collagen by reducing the activity of which of the following enzyme?
A. Prolyl hydroxylase C. Lysyl hydroxylase
B. Lysyl oxidase D. Glucosyl transferase
21. Molecular iron (Fe), is:
A. Stored primarily in spleen C. Absorbed in the ferric, Fe3+ form
B. Absorbed in the intestine by transferrin D. Stored in the body in combination with ferritin
22. All the following statements regarding calcium are correct except:
A. It diffuses as a divalent cation C. It can exist in the blood as ionic form and also protein
B. It freely diffuses across the endoplasmic reticulum of bound
muscle cells D. It is found in high concentration in bones
23. Iron is absorbed from:
A. Stomach C. IIeum
B. Duodenum and jejunum D. Caecum
24. The normal route of calcium excretion is:
A. Kidney C. Kidney and intestine
B. Kidney and liver D. Kidney, intestine and pancreas
25. Hypocalcemia affects:
A. Skeletal muscles C. Cardiac muscles
B. Smooth muscles D. Skeletal muscles + smooth muscles + cardiac muscles
26. Transferrin is a type of:
A. Albumin C. β1-globulin
B. α-globulin D. γ-globulin
27. In case of Wilson‘s disease (hepatolenticular degeneration), the features include all of the following, except:
A. Progressive hepatic cirrhosis C. Aminoaciduria
B. Kayser-Fleischer ring D. Urinary excretion of Cu is decreased
28. In vitamin D poisoning (hypervitaminosis):
A. Both serum and urinary Ca are high C. The serum Ca is increased and urinary Ca is normal
B. The serum Ca is low and urinary calcium high D. Both serum and urinary Ca are low
29. The % of K in extracellular fluid is about:
A. 1% C. 10%
B. 2 to 3% D. 15%
30. The Fe containing pigments are:
A. Haematoidin C. Hemosiderin
B. Bilirubin D. Urobilinogen
31. All of the following are true of Wilson‘s disease, except:
A. Low total plasma Cu C. Arthritis
B. Elevated urinary copper D. Aminoaciduria
32. An increased serum iron and decreased Fe-binding capacity are found in:
A. Fe-deficiency anemia C. Thalassemia
B. Sideroblastic anemia D. Anemia of chronic disorders
33. Iron therapy is ineffective in which of the following conditions:
A. Chronic blood loss C. Hypochromic anemia of pregnancy
B. Inadequate Fe-intake in diet D. Thalassemia minor (α-chain thalassemia)
34. In haemochromatosis, the liver is infiltrated with:
A. Copper C. Manganese
B. Iron D. Chromium
35. All of the following are true of hypochromic anemias not due to iron deficiency, except:
A. Serum Fe is high C. Stainable iron in bone marrow
B. Normal or low transferrin D. Iron therapy is effective

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36. Cytosolic superoxide dismutase contains:

A. Zn only C. Zn and Cu both
B. Copper only D. Manganese
37. A rise in blood Ca may indicate:
A. Paget‘s disease C. Cushing disease
B. Vitamin D deficiency D. Hypervitaminosis D
38. The essential trace element which catalyzes the formation of Hb in the body is:
A. Mn C. Mg
B. Se D. Cu
39. Zinc is a constituent of the enzyme:
A. Succinate dehydrogenase C. Mitochondrial superoxide dismutase
B. Carbonic anhydrase D. Aldolase
40. The active transport of Ca is regulated by ________, which is synthesized in kidneys:
A. Cholecalciferol C. 25-OH cholecalciferol
B. Ergosterol D. 1,25-diOH-cholecalciferol
41. Caeruloplasmin shows the activity of:
A. As ferroxidase C. As ligase
B. As reductase D. As transferase

ANSWER KEY:
1. C 2. B 3. D 4. C 5. B 6. D 7. B 8. C 9. B 10. D
11. B 12. B 13. B 14. B 15. A 16. B 17. C 18. A 19. C 20. B
21. D 22. B 23. B 24. C 25. D 26. B 27. D 28. A 29. B 30. C
31. C 32. B 33. D 34. B 35. D 36. C 37. D 38. D 39. B 40. D
41. A

9. This is a characteristic feature of Michaelis-Menten kinetics, where the enzyme velocity (V) is half of the maximal velocity (Vmax)
when the substrate concentration ([S]) is equal to the Michaelis constant (Km). At this point, 50% of the enzyme molecules have
bound substrate.
10. Acetazolamide is a noncompetitive inhibitor of carbonic anhydrase, meaning it binds to an allosteric site on the enzyme, changing
its conformation and reducing its activity. This type of inhibition decreases the Vmax (maximum velocity) of the enzyme, as the
inhibitor reduces the enzyme's ability to convert substrate to product. Noncompetitive inhibition does not affect the Km (Michaelis
constant), which is a measure of the enzyme's affinity for the substrate
12. Physostigmine is a competitive, reversible inhibitor of acetylcholinesterase, the enzyme responsible for breaking down
acetylcholine. Since it is a reversible inhibitor, its effects can be overcome by increasing the concentration of the substrate
(acetylcholine) or by administering an anticholinergic agent to counteract the effects of the inhibitor. Therefore, an overdose of
physostigmine can typically be reversed.

05. Amino Acids

1. All of the following are sulfur containing amino acids found in proteins except:
a) Cysteine c) Cystine
b) Threonine d) Methionine
2. With the exception of glycine, all amino acids found in proteins are:
a) Optically inactive c) Of L-configuration
b) Dextrorotatory d) Of D-configuration
3. An essential amino acid in man is:
a) Proline c) Aspartate
b) Threonine d) Tyrosine

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4. An amino acid that does not form an α-helix is:

a) Asparagine c) Tryptophan
b) Tyrosine d) Proline
5. Some amino acids are termed non-essential as they:
a) Are not component of tissue proteins
b) Have no role in metabolism
c) May be synthesized in the body from ‗essential‘ amino acids
d) May be synthesized in body in prolonged fasting
6. Derived amino acid present in collagen:
a) Hydroxyproline c) Homocysteine
b) Pyro lysine d) Glycine
7. Which amino acid is exclusively ketogenic?
a) Leucine c) Alanine
b) Glycine d) Tyrosine
8. Amino acids with the aliphatic ‗R‘ group are
a) Glycine, alanine, leucine c) Lysine, arginine, histidine
b) Serine, threonine, cysteine d) Phenylalanine, tyrosine and tryptophan
9. Which of the following amino acids is not necessary to be taken in the diet?
a) histidine c) serine
b) threonine d) lysine
10. The first amino acid of any polypeptide chain in eukaryotes is
a) Valine c) glycine
b) methionine d) alanine
11. Which one of the following amino acids is most responsible for this patient‘s recurrent kidney stones?
a) Cysteine c) Arginine
b) Methionine d) Lysine
12. Amino acids share a common structure. The part of the amino acid responsible for the functionality of the protein is the
a) Alpha Carbon c) Side chain (R group)
b) Carboxyl Group d) Amino group

ANSWER KEY
1. b 2. c 3. b 4. d 5. c 6. a 7. a 8. a 9. c 10. b
11. a 12. c

06. Protein

1. Major contributor to the formation of molten globule during protein folding:

a) Low temperature c) Cis-Trans Isomerase
b) Hydrophobic interactions d) Chaperones
2. In protein structure, the α-helix and β-pleated sheet are examples of:
a) Primary structure c) Tertiary structure
b) Secondary structure d) Quaternary structure
3. Glutathione is a:
a) Dipeptide c) Oligopeptide
b) Polypeptide d) Tripeptide
4. Denaturation of proteins involves breakdown of:
a) Secondary structure c) Quaternary structure
b) Tertiary structure d) All of the above
5. In denaturation of proteins, the bond which is not broken:
a) Disulfide bond c) Hydrogen bond
b) Peptide bond d) Ionic bond

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6. The protein present in hair is:

a) Elastin c) Keratin
b) Prolamine d) Gliadin
7. What are the following is not a factor responsible for the denaturation of proteins?
a) pH change c) Heat
b) Organic solvents d) Charge
8. Triple helix of collagen is an example of:
a) Primary structure c) Tertiary structure
b) Secondary structure d) Quaternary structure
9. Myoglobin is a ______
a) Alpha helix rich structure c) Bends rich structure
b) Beta sheet rich structure d) Loops rich structure
10. Each turn of beta turn consist of how many amino acids?
a) 3 c) 2
b) 4 d) 6
11. Related to protein structure, "Domain" is a part of
a) Primary structure c) Tertiary structure
b) Secondary structure d) Quaternary structure
12. The number of helices present in a collagen molecule is:
a) 1 c) 3
b) 2 d) 4
13. Which one of the following best describes the Alzheimer disease?
a) It is associated with β-amyloid —an abnormal protein with an altered amino acid sequence.
b) It results from accumulation of denatured proteins that have random conformations.
c) It is associated with the accumulation of amyloid precursor protein.
d) It is associated with the deposition of neurotoxic amyloid peptide aggregates.
14. Quaternary structure is differ from tertiary structure regarding:
a) Sequence of amino acids c) Number of polypeptide chains
b) Forces stabilizing the structure d) denaturation process
15. What is the name of the protein that is responsible for the normal function of nerve cells, but is misfolded in prion diseases?
a) Tau protein c) Prion protein
b) Amyloid beta peptide d) Alpha-synuclein
16. What is the name of the protein that is misfolded in Alzheimer's disease?
a) Tau protein c) Prion protein
b) Amyloid beta peptide d) Alpha-synuclein
17. What is the name of the protein that accumulates in the brains of Alzheimer's patients and forms neurofibrillary tangles?
a) Tau protein c) Prion protein
b) Amyloid beta peptide d) Alpha-synuclein
18. Which of the following statements is correct concerning prion disease?
a) It is a disease process in which proteins appear to be the sole pathophysiologic entity
b) It is a disease process in which a mRNA secondary structure appears to be the sole pathophysiologic entity
c) The disease is only found in humans
d) Effective treatments are available for the disease
19. The mutation associated with Marfan syndrome is with the fibrillary protein fibrillin. What aspect of protein structure is affected in
this disorder?
a) β-turn b) β-sheet
c) Primary structure d) Tertiary structure
20. Sequence of 51 amino acids into 2 chains of insulin is an example of _____ structure of protein
a) Primary c) Tertiary
b) Secondary d) Quaternary

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21. Which of the following is an example of regulatory ptotein?

a) Adrenaline c) Collagen
b) Keratin d) Myosin
22. Which of the following disorder is characterized by hyperextensibility of skin & hypermobility of joint?
a) Alport syndrome c) Ehler Danlos syndrome
b) Epidermolysis bullosa d) Menkes disease
23. Alport syndrome is a genetic disorder that mainly affects ______
a) type I collagen c) type VII collagen
b) type IV collagen d) type III collagen
24. Autopsies of patients with Alzheimer disease show protein aggregates called neurofibrillary tangles and neuritic plaques in various
regions of the brain. These plaques exhibit the characteristic staining of amyloid. Which of the following structural features is the most
likely characteristic of at least one protein in these plaques?
a) A high content of β-pleated sheet structure c) A high content of random coils
b) A high content of α-helical structure d) Disulfide bond cross-links between polypeptide chain
25. Keratins are rich in arginine but hair keratin is rich in
a) Gly c) Met
b) Cys d) Asp
26. Collagens are deficient in amino acid
a) Trp c) Val
b) Ala d) Gly
27. In order for lipid-based hormones such as testosterone or estrogen to be transported in the bloodstream, they are bound to and
transported by water soluble proteins. In order to be water-soluble, the transporting protein contains which one of the following amino
acids on its surface in contact with aqueous blood?
a) Valine c) Leucine
b) Arginine d) Phenylalanine
28. One theory of amyloid fibril formation is that sections of α-helical structure are converted to β-sheets. Such regions of the amyloid
proteins would most likely lack which one of the following amino acids?
a) Cysteine c) Proline
b) Methionine d) Leucine
29. Sickle cell anemia is caused by a single nucleotide change in DNA that leads to the substitution of one amino acid (E6V) in the β-
chain. This one change in the primary sequence leads to the ability of the deoxygenated form of HbS to form polymers. As the
polymers grow in size, the shape of the red blood cell is altered to accommodate the chains of hemoglobin. Which one of the
following primarily dictates the polymerization of deoxygenated HbS?
a) Peptide bonds c) Hydrophobic interactions
b) Ionic interactions d) Hydrogen bonds

ANSWER KEY
1. b 2. b 3. d 4. d 5. b 6. c 7. d 8. d 9. a 10. b
11. c 12. c 13. d 14. c 15. c 16. b 17. a 18. a 19. c 20. a
21. a 22. c 23. b 24. a 25. b 26. a 27. b 28. c 29. c 30.

19. C The fibrillin mutation found in Marfan syndrome results in a defective a-helix due to an alteration in the sequence of amino
acids in the protein, an altered primary structure.
27. B Arginine is a charged polar amino acid and is water-soluble, whereas the others listed are nonpolar and hydrophobic and are not
expected to be on the surface of a protein exposed to an aqueous environment
29. In the sickle version of hemoglobin, a valine has replaced a glutamate in the sixth position of the β-chain. In the deoxygenated
state, the valine forms hydrophobic interactions with a hydrophobic patch on another sickle hemoglobin molecule, leading to
polymerization of the hemoglobin molecules. The primary interaction is not the result of ionic interactions or hydrogen bonding; it is
the hydrophobic interactions between molecules that initiate the polymerization. The peptide backbone, along with peptide bonds, can
participate in hydrogen bonding but does not play a role in polymerization.

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07. Plasma Proteins & Immunoglobulins

1. Transferrin is a type of:

a) Albumin c) β1-globulin
b) α-globulin d) γ-globulin
2. In case of Wilson‘s disease (hepatolenticular degeneration), the features include all of the following, except:
a) Progressive hepatic cirrhosis c) Urinary excretion of Cu is decreased
b) Kayser-Fleischer ring d) Low levels of caeruloplasmin
3. Which of the following immunoglobulin is a pentamer?
a) IgG c) IgA
b) IgM d) IgE
4. Immunoglobulin classes are differentiated from each other on the basis of their:
a) Electrophoretic mobility c) By their light chains
b) Molecular weight d) By their heavy chains
5. The serum antibody responsible for fighting gram +ve pyogenic bacteria is:
a) IgD c) IgG
b) IgE d) IgA
6. Which of the following immunoglobulins can cross the placenta?
a) IgM c) IgA
b) IgG d) IgE
7. Which immunoglobulin is directly involved in Opsonization?
a) IgG c) IgA
b) IgM d) IgD
8. β-globulin fraction contains:
a) Haptoglobin c) Ceruloplasmin
b) α-fetoprotein d) Transferrin
9. Half life of Haptoglobin in normal healthy adults:
a) 20 days c) 5 days
b) 10 days d) 25 days
10. Electrophoretic pattern of densitometric scanning of various serum protein fractions shows highest % of
a) alpha globulin c) Beta globulin
b) Albumin d) Gamma globulin
11. Which of the following plasma protein is not synthesized in liver?
a) Transferrin c) Gamma globulin
b) Ceruloplasmin d) Alpha globulin
12. In which of the following case, half life of plasma albumin is reduced?
a) Crohn disease (ileitis) c) Hepatitis
b) Skin burn d) Diarrhea
13. Normal Albumin/Globulin ratio :
a) 1:2 c) 1.2
b) 2:1 d) 2.1
14. Low Albumin/Globulin ratio may indicate
a) Bone marrow depression c) Polycythemia
b) Kwashiorkor d) Fever
15. Elevated level of which plasma protein is an important indicator of acute inflammation?
a) CRP c) Albumin
b) Transferrin d) Haphaestin
16. Which plasma protein binds free heme?
a) Haptoglobin c) Hephaestin
b) Hemopexin d) Ceruloplasmin

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17. Plasma protein containing greater than 4% of hexosaminae are called

a) Mucoproteins c) C reactive proteins
b) Orsomucoids d) Glycoproteins
18. Hepcidin causes hypoferremia by
a) Increasing Heme synthesis c) Inhibition of Ferroportin
b) Reducing rbcs degradation d) Inhibition of ceruloplasmin
19. Deficiency of which plasma protein may lead to Liver cirrhosis & Emphysema?
a) Ceruloplasmin c) Hepcidin
b) Alpha-1 antitrypsin d) Orsomucoid
20. The normal reference range for total plasma proteins is.......................
a) 2.5-4.5 gm/dl c) 6.0-8.3 gm/dl
b) 4.5-6.0 gm/dl d) >8.3gm/dl
21. Based on the electrophoretic mobility, the globulin fraction may be further classified into alpha-1 globulin, alpha-2 globulin, beta-
globulin, and gamma-globulin. Which of the following protein is present in the gamma-globulin fraction?
a) Transthyretin c) Haptoglobin
b) Ceruloplasmin d) Immunoglobulin
22. Albumin is the major plasma protein constituting 60% of total plasma proteins. Which of the following is not the function of
albumin?
a) Maintenance of osmotic pressure c) Transport of iron
b) Binding and transport of fatty acids and bilirubin d) Transport of drugs

ANSWER KEY
1. C 2. C 3. B 4. D 5. C 6. B 7. A 8. D 9. C 10. B
11. C 12. A 13. C 14. B 15. A 16. B 17. A 18. C 19. B 20. C
21. D 22. C

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Pa001 – Pa003
FOUNDATION PATHOLOGY
Pa-001 ֍CELL INJURY֍

01. Cellular adoptive responses to stress

Adoptive Response Physiological Pathological

Hypertrophy  Skeletal muscle hypertrophy due to ↑  Cardiac hypertrophy in hypertension
↑ in size of cell workload/weight lifting
 Breast enlargement in lactating lady
 Breast enlargement in pregnant lady
 Uterus enlargement in pregnant lady
Hyperplasia  Breast enlargement at puberty  Endometrial hyperplasia (↑ gland : stroma)
↑ in number of cells  Breast enlargement in pregnant lady  Benign prostate hyperplasia
 Liver regeneration after partial resection  Skin warts by papilloma virus
Metaplasia  Squamous metaplasia of endocervix at  Gastric acid → esophageal squamous
change in type of cell that puberty metaplasia (Barrett's esophagus)
can better tolerate stress  Smoking →respiratory squamous metaplasia
Atrophy  Uterus & ovarian atrophy after menopause  Loss of skeletal mass due ↓ workload
↓ in size of cell/organ (↓ gland : stroma in endometrial atrophy)  Muscle denervation
 Brain atrophy with ageing  Starvation (Kwashiorkor)

Dysplasia
 Means change in cell structure.
 Characterized by loss of uniformity of cell size and shape (pleomorphism); loss of tissue orientation; nuclear changes (eg,
↑nuclear:cytoplasmic ratio and clumped chromatin)
 It predisposes to cancer
 For example: Barrett esophagus → Esophageal carcinoma

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1. A 33 years old man sustains a left femoral fracture in an accident. His leg placed in a plaster cast, is immobilized for six weeks. The
diameter of the left calf decreased in size after immobilization. What alteration in his calf muscle has resulted in this change in size?
Enlist four causes leading to this condition. (Annual 2021)
Alteration in calf muscle  Atrophy
4 causes
1. Disuse
2. Denervation
3. Diminshed blood supply (ischemia)
4. Ageing
5. Starvation (malnutrition)
2. A 55 years old female with history of gastroesophageal reflux presents with acute epigastric pain in emergency. Endoscopic
findings include replacement of esophageal squamous cells by intestinal columnar cells. (Annual 2018)
a) Name the cellular adaptation. Give two other examples of this adaptation.
Metaplasia
Other 2 examples  See above in table
b) What are different types of adaptation in response to stress?
See above in table
3. A 65-year-old habitual cigarette smoker for past 20 years has chronic cough. Now he presents with fever and history of weight loss.
What is the change in phenotype of differentiated cells in respiratory tract of such a patient and what is likely complication? (Supple
2017 held in 2018)
Squamous Metaplasia. It can lead to dysplasia and carcinoma
4. A 32 years old habitual cigarette smoker complains of persistent chronic cough and frequent severe respiratory infections for the
last 15 months. (Annual 2017)
a) Which type of adaptive changes is most likely to occur in the respiratory epithelium? Is this change reversible? (1)
Adoptive change  Squamous metaplasia
Yes, it is reversible
b) Give the mechanisms of this cellular adaptation. (2.5)
Metaplasia does not result from a change in the phenotype of an already differentiated cell type; instead the result of a reprogramming
of stem cells that are known to exist in normal tissues, or of undifferentiated mesenchymal cells present in connective tissue. In a
metaplastic change, these precursor cells differentiate along a new pathway. The differentiation of stem cells to a particular lineage is
brought about by signals generated by cytokines, growth factors, and extracellular matrix components in the cells‘ environment. These
external stimuli promote the expression of genes that drive cells toward a specific differentiation pathway. A direct link between
transcription factor dysregulation and metaplasia is seen with vitamin A (retinoic acid) deficiency or excess, both of which may cause
metaplasia
c) Enlist three other types of cellular adaptations with one example for each. (1.5)
See above in table

5. A 12-year-old girl notices enlargement of her breasts while taking a bath. [Supple 2016 held in 2017]
a) What is the main physiological cause of this enlargement of breast? (1.5)
Hyperplasia
b) What are its morphological features and types? (2)
Morphological features
 Proliferation of the glandular epithelium of the female breast
Types
 Compensatory hyperplasia
 Hormonal hyperplasia
c) what is the mechanism of this adaptation? (1.5)
Hyperplasia is the result of growth factor-driven proliferation of mature cells and, in some cases, by increased output of new cells
from tissue stem cells

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6. Gross examination of brain on autopsy of a 90-year-old man with a long history of atherosclerotic disease reveals shrunken brain
with loss of brain substance, narrowed gyri and widened sulci. (Annual 2015)
a) Which type of cellular adaptation has occurred? Give the underlying mechanism.
Atrophy
A gradual decrease in blood supply (ischemia) to a tissue as a result of slowly developing arterial occlusive disease results in atrophy
of the tissue. In late adult life, the brain may undergo progressive atrophy, mainly because of reduced blood supply as a result of
atherosclerosis
b) Give any two other causes of this cellular adaptation with examples.
See above in table

7. A 21-year-old female gives birth to her 1st baby. She started to give breast feed right after birth and continued till 1 year with no
difficulties and complications. (Supple 2015)
a) Name and define the cellular processes that started in breast during pregnancy that allowed her to nurse the baby during
this period of time.
Hyperplasia occurs in pregnant lady breast and it is usually accompanied by hypertrophy
b) Give three pathological examples of this process and describe its pathogenicity/mechanism.
Pathological examples of hyperplasia
1. Endometrial hyperplasia (↑ gland : stroma)
2. Benign prostate hyperplasia
3. Skin warts by papilloma virus
Pathogenesis
 Hyperplasia is the result of growth factor-driven proliferation of mature cells and, in some cases, by increased output of new
cells from tissue stem cells

8. The endocervix of the uterus is lined by mucus secreting columnar epithelium in healthy adult females. A biopsy was taken in a 35-
year-old female and the endocervix was found to be lined by benign stratified squamous epithelium. (Annual 2012)
a) What is this phenomenon called?
Metaplasia
b) Describe mechanism of this change and enumerate more examples.
See in Q4b

9. (Annual 2010)
a) A 45-year-old woman was investigated for hypertension and was found to have enlargement of the left kidney and the right
kidney was smaller than normal. Contrast studies revealed stenosis of right renal artery. The size change in the right kidney is
an example of which of the adaptive changes?
Atrophy
b) Give the underlying mechanism of such change.
Renal artery stenosis  Reduced renal blood flow  Ischemia  Atrophy of right kidney

10. (Annual 2014)

a) A body builder develops his muscle arms by doing exercise. What type of adaptation is this?
Hypertrophy

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b) What is the mechanism of this adaptation?

02. CAUSES OF CELL INJURY

1. Enumerate any six causes of cell injury. [Supple 2013]

2. The causes of cell injury range from gross physical trauma of a motor vehicle accident to the single gene defect that result in a
defective enzyme underlying a specific metabolic disease. (Annual 2008)
a) Mention six categories in which they are found.
b) List 4 potentially toxic agents encountered daily in our polluted environment.
1. Oxygen deprivation (Hypoxia)
2. Physical agents  mechanical trauma, pressure, electric shock, radiation, burn & deep cold)
3. Chemical agents & drugs  arsenic, cyanide, mercuric salt, potentially injurious substances are our daily companions:
environmental and air pollutants, insecticides, and herbicides; industrial and occupational hazards, such as carbon
monoxide and asbestos; recreational drugs such as alcohol
4. Infectious agents
5. Immunological reactions
6. Genetic derangements
7. Nutritional imbalance

03. TYPES OF CELL INJURY

Reversible cell  ↓ATP  ↓ activity of Ca2+ and Na+/K+ pumps  cellular swelling (cytosol, mitochondria,
injury ER/Golgi), which is the earliest morphologic manifestation
 Ribosomal/polysomal detachment  decreased protein synthesis
 Plasma membrane changes (eg, blebbing)
 Nuclear changes (eg, chromatin clumping)
 Myelin figures (aggregation of peroxidized lipids)
Irreversible  Breakdown of plasma membrane  cytosolic enzymes (eg, troponin) leak outside of cell, influx of
Ca2+  activation of degradative enzymes such as phospholipases, ATPases, endonucleases

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 Rupture of lysosomes  autolysis

 Nuclear degradation: pyknosis (nuclear condensation)  karyorrhexis (nuclear fragmentation
caused by endonuclease-mediated cleavage)  karyolysis (nuclear dissolution)

1. Cell membrane permeability defect is an essential component of cell injury. What are the various biochemical mechanisms that can
damage the cell membrane during cell injury? (Supple 2012)
Biochemical Processes
 Activation of phospholipase
 Activation of Protease
 Lipid Peroxidation

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2. What are the two main morphological correlates/features of reversible cell injury. Briefly give the microscopic appearance of these
changes. (Supple 2013)
See in above table

04. Necrosis vs Apoptosis

Features Apoptosis Necrosis

Cause Programmed Trauma
Physiological or Pathological Both Only pathological
Number of cells Individual cell Many cells
Plasma membrane Intact Disrupted
Cell contents Packed into apoptotic bodies & consumed Spill out into tissue
by phagocytes
Adjacent inflammation No Yes
Cell size Shrink Enlarged (swelling)
Nucleus DNA laddering (Fragmentation into Pyknosis→Karyorrhexis→Karyolysis
nucleosome size fragments)
Cytoplasmic appearance Dense eosinophilic Varry with different types

Examples of Physiological Apoptosis

 Embryogenesis e.g removal of webbing between fingers & toes during embryonic development
 Shedding of uterine lining in menstrual cycle
 Elimination of immune cells that are no longer needed after an Infection has been cleared
 Removal of cells in thymus gland that are not able to recognize the body's own tissue

1. Enlist FIVE differences between apoptosis and necrosis. [Supple 2022]

See above in table

2. What are histologic signs of necrosis? [Supple 2018 held in 2019]

 Increased eosinophilia
 More glassy homogeneous appearance than do normal cells, mainly as a result of the loss of glycogen particles
 Myelin figures
 Disrupted plasma membrane
 Marked dilation of mitochondria with the appearance of large amorphous densities
 Nuclear changes (Pyknosis→Karyorrhexis→Karyolysis)

3. [Annual 2016]
a) What is apoptosis? Give two pathological conditions showing apoptosis. (2)
Apoptosis is a pathway of cell death that is induced by a tightly regulated suicide program in which cells destined to die activate
intrinsic enzymes that degrade the cells‘ own nuclear DNA and nuclear and cytoplasmic proteins
Pathological Conditions
1. Pathologic atrophy in parenchymal organs after duct obstruction, such as occurs in the pancreas, parotid gland, and kidney
2. Chemotherapy for breast cancer
3. Hepatitis
b) Briefly describe the morphological features that characterize cells undergoing apoptosis. (3)
 Cell shrinkage
 Chromatin condensation
 Formation of cytoplasmic blebs and apoptotic bodies
 Intensely eosinophilic cytoplasm with fragments of dense nuclear chromatin
 Intact cell membrane
 No signs of inflammation like necrosis

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05. Morphological Types of Necrosis

1. What are the types of necrosis? Describe the morphology of any two types. (Annual 2011)
2. Give two examples of coagulative necrosis.
3. A 45 years old male presented in the outpatient department with blackening of right foot with a foul smelling discharge. He has a
history of uncontrolled diabetes mellitus for the last 10 years. After examination the physician came out with the diagnosis of
gangrene and plan of debridement was made. Gangrene is one of the examples of necrosis. What are other types of necrosis? Explain
with an example. [Supple 2023]

Morphological Type Cause Morphology Examples

Coagulative Ischemia/Infarction in most  Loss of nucleus Myocardial infarction
necrosis tissues except brain  Preservation of cellular shape Kidney infarction
 Eosinophilic appearance
 Necrotic cells are removed firstly by
action of neutrophils & then by
macrophages
Liquefaction Ischemic injury to brain  Pus (cellular debris + macrophages or Brain abscess
necrosis neutrophils)
Caseous necrosis Chronic granulomatous  Soft, friable & cheese like Tuberculosis
Infection  Granuloma
Fat necrosis Action of lipases on  Chalky white appearance Acute pancreatitis
adipocytes
Fibrinoid necrosis Immunologic injury &  Eosinophilic homogeneous appearance Polyarteritis nodosa
vascular hypertensive damage of vessel wall (vasculitis)
Gangrenous Chronic ischemia  Dry gangrene has coagulative necrosis Dry foot gangrene in
necrosis pattern long standing
 Wet gangrene has liquefactive necrosis diabetes
pattern

06. Pathways of Apoptosis

1. A 24-year-old male is admitted to the hospital with jaundice for past one month. His LFTs show a rise in ALT and AST. Serology
confirms the diagnosis of Hepatitis C infection. A liver biopsy is taken. Histological examination findings are presence of dead
hepatocytes in the form of pink bodies with mild inflammatory infiltrate. [Supple 2015 held in 2016]
a) Which pathological process results in the formation of these bodies?
Apoptotic bodies
b) Describe briefly the different pathways of apoptosis. (4)
1. Intrinsic (mitochondrial) pathway
Regulated by
 Pro-apoptotic factors are BAX & BAK →form pores in mitochondrial membrane →release of cytochrome c into cytoplasm
→activation of caspases
 Anti-apoptotic factors are Bcl2 & Bcl-xL → decrease permeability (Bcl2) & inactivates caspases (Bcl-xL)
2. Extrinsic (death receptor) pathway)
Regulated by
 FasL binding to Fas (CD95) receptor
 TNFα binding to TNF receptor
3. Perforin/granzyme B pathway
Regulated by cytotoxic T cells & Natural killer cells that
 Release of Perforin→form pore for graznzyme to enter target cells
 Release of Granzyme B

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2. A 55 year old woman is on chemotherapy for breast carcinoma. The chemotherapy reduced the size of the tumour. [Annual 2023]
a) Define the process by which tumour size decreases.
Apoptosis
b) Make a flowchart to show two pathways of this process.
See above

07. Types of calcification

Features Dystrophic Calcification Metastatic Calcification

Site In abnormal (diseased tissue) In normal tissue such as kidney, lung and blood vessel
Extend Localized Widespread
Causes Secondary to injury or necrosis Secondary to
 hyperphosphatemia (chronic kidney disease)
 hypercalcemia
 Vit D toxicity
Examples o Fat necrosis (sponification) o Paget disease
o Psammoma bodies
o Aortic calcific stenosis
o Atherosclerotic plaques
o Tuberculosis lesion
Note: Psammoma bodies are Concentrically laminated calcified spherules

08. Intracellular accumulation

1. An 83-year-old man dies and undergoes autopsy. His heart muscle on H&E staining shows light brown skin. What is it called and
how it develops? (Supple 2011)
Lipofusin
It is derived through lipid peroxidation of polyunsaturated lipids of subcellular membrane

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Accumulation Characteristics
Hyaline  Homogeneous glassy pink appearance
Examples
o Mallory bodies in alcoholic liver
o Russel bodies in multiple myeloma
Melanin  Endogenous brown black pigment
 Normally present in skin & hair
 Formed when the enzyme tyrosinase catalyzes the oxidation of tyrosine to
dihydroxyphenylalanine in melanocytes
Hemosiderin  Endogenous hemoglobin derived golden brown pigment
 Prussian blue stain can identify iron in hemosiderin
Lipufusin  Golden brown pigment
 Wear & tear pigment in old age
 Important indicator of free radical injury
 Derived through lipid peroxidation of polyunsaturated lipids of subcellular membrane
Bilirubin  Accumulates in newborn' brain causing Kernicterus
Coal  Exogenous black pigment
 Causes anthracosis (black lung disease)
Note: This topic is also the part of histology

Pa-002 ֍Introduction to Microorganisms֍

01. Compare the structure of bacterial cell and virus

Give differences between virus & bacteria. [Annual 2007]

02. Microbes Causing Infectious Diseases

1. Bacteria
2. Viruses
3. Protozoa
4. Fungi

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03. Structure of Bacteria

04. Comparison of Gram positive & Gram-Negative Bacteria

1. Compare the cell walls of gram positive and gram-negative bacteria.

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Note: Only gram-negative bacteria have a periplasmic space where β-lactamases are found

05. Bacterial Growth Curve

1. Explain diagrammatically the four phases of bacterial growth curve. (2.5) [Supply 2016 held in 2017]
2. What are different phases of bacterial growth curve? Give the different cellular events that take place in each phase. [Annual 2015]

Phases Description
Lag phase During it, vigorous metabolic activity occurs but cells do not divide. This can last for a few minutes up to
many hours
Log Phase When rapid cell division occurs. Many antibiotics, such as penicillin, are most efficacious during this phase
because they act by disrupting biosynthetic processes carried out by the bacterial cell during active growth
(i.e., when they are dividing). The log phase is also known as the exponential phase
Stationary phase It occurs when nutrient depletion or toxic products cause growth to slow until the number of new cells
produced balances the number of cells that die, resulting in a steady state. Cells grown in a special apparatus
called a ―chemostat,‖ into which fresh nutrients are added and from which waste products are removed
continuously, can remain in the log phase and do not enter the stationary phase.
Death phase The final phase is the death phase, which is marked by a decline in the number of viable bacteria.

FIGURE Growth curve of bacteria:

a, lag phase;
b, log phase;
c, stationary phase;
d, death phase.

06. Stages of Bacterial Pathogenesis

Most bacterial infections are acquired from an external source. However, some bacterial infections are caused by members of the
normal flora and, as such, are not transmitted directly prior to the onset of infection. A generalized sequence of the stages of infection
is as follows:
(1) Transmission from an external source into the portal of entry.
(2) Evasion of primary host defenses such as skin or stomach acid.
(3) Adherence to mucous membranes, usually by bacterial pili.
(4) Colonization by growth of the bacteria at the site of adherence.
(5) Disease symptoms caused by toxin production or invasion accompanied by inflammation
(6) Host responses, both nonspecific and specific (immunity), during steps 3, 4, and 5.
(7) Progression or resolution of the disease.

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1. Enlist a generalized sequence of different stages of bacterial pathogenesis. (Annual 2021)

07. Determinants of Bacterial Pathogenesis

Transmission The modes of transmission of microbes include

 Human-to-human transmission can occur either by direct contact or indirectly via a vector
such as an insect, notably ticks or mosquitoes.
 Animal-to-human transmission can also occur either by direct contact with the animal or
indirectly via a vector.
 Nonhuman to human transmission include animals, soil, water, and food.
Adherence to Cell  Pili are the main mechanism by which bacteria adhere to human cells. They are fibers that
Surfaces extend from the surface of bacteria that mediate attachment to specific receptors on cells.
 Glycocalyx is a polysaccharide ―slime layer‖ secreted by some strains of bacteria that
mediates strong adherence to certain structures such as heart valves, prosthetic implants, and
catheters.
Invasion, Inflammation, Invasion of tissue is enhanced by enzymes secreted by bacteria. For example,
& Intracellular Survival  hyaluronidase produced by S. pyogenes degrades hyaluronic acid in the subcutaneous tissue,
allowing the organism to spread rapidly.
 IgA protease degrades secretory IgA, allowing bacteria to attach to mucous membranes.
 Leukocidins destroy both neutrophilic leukocytes and macrophages.
Inflammation is an important host defense induced by the presence of bacteria in the body. There are
two types of inflammation
 Pyogenic inflammation, the host defense against pyogenic (pus-producing) bacteria such as
S. pyogenes, consists of neutrophils (and antibody and complement)
 Granulomatous inflammation, the host defense against intracellular, granuloma-producing
bacteria, such as M. tuberculosis, consists of macrophages and CD4-positive T cells.
Bacteria can evade our host defenses by a process called intracellular survival (i.e., bacteria that can
live within cells are protected from attack by macrophages and neutrophils). Note that many of these
bacteria (e.g., M. tuberculosis) are not obligate intracellular parasites (which can grow only within
cells), but rather have the ability to enter and survive inside cells.
Toxin Production

1. Enlist six major differences between exotoxins and endotoxins. (3) [Supply 2018 held in 2019]
2. Enumerate four major differences between exotoxins and endotoxins. (2) [Annual 2016]

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Note: Last year, mcq related to cholera toxin came in exam

Note: Mechanism of diphtheria toxin is imp as it is also a part of biochemistry

08. Viral Replication

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Pa-003 ֍STERILIZATION & DISINFECTION֍

01. Sterilization vs Disinfection

Sterilization The killing or removal of all microorganisms, including bacterial spores, which are highly resistant.
Sterilization is usually carried out by autoclaving, which consists of exposure to steam at 121°C under a
pressure of 15 lb/in2 for 15 minutes. Surgical instruments that can be damaged by moist heat are usually
sterilized by exposure to ethylene oxide gas, and most intravenous solutions are sterilized by filtration.
Disinfection the killing of many, but not all, microorganisms. For adequate disinfection, pathogens must be killed, but
some organisms and bacterial spores may survive. Disinfectants vary in their tissue-damaging properties from
the corrosive phenol-containing compounds, which should be used only on inanimate objects, to fewer toxic
materials such as ethanol and iodine, which can be used on skin surfaces.

02. Agents/Methods for Sterilization & Disinfection

Chemical Agent Agents that disrupt Cell membrane

 Alcohol (Ethanol)
 Detergents (Benzalkonium chloride)
 Phenols (Chlorhexidine)
Agents that modify proteins
 Chlorine (hypochlorite)
 Iodine
 Heavy Metals (Thimerosal, Silver nitrate & Silver sulfadiazine)
 Hydrogen peroxide
 Formaldehyde & Glutaraldehyde
 Ethylene Oxide
 Acids & Alkali
Agents that modify Nucleic acids
 Dyes (Crystal violet dye, Malachite green dye)
Physical Agent Heat
 Moist heat sterilization, usually autoclaving, is the most frequently used method of sterilization.
Dry heat requires temperatures in the range of 180°C for 2 hours. This process is used primarily for
glassware and is used less frequently than autoclaving.
 Pasteurization, which is used primarily for milk, consists of heating the milk to 62°C for 30 minutes
followed by rapid cooling. (“Flash” pasteurization at 72°C for 15 seconds is often used.) This is
sufficient to kill the vegetative cells of the milk-borne pathogens (e.g., Mycobacterium bovis,
Salmonella, Streptococcus, Listeria, and Brucella), but not to sterilize the milk.
Radiations
 UV light (The greatest antimicrobial activity of UV light occurs at 250 to 260 nm, which is the
wavelength region of maximum absorption by the purine and pyrimidine bases of DNA. The most
significant lesion caused by UV irradiation is the formation of thymine dimers, but addition of
hydroxyl groups to the bases also occurs. As a result, DNA replication is inhibited and the organism
cannot grow)
 X-rays (X-rays have higher energy and penetrating power than UV radiation and kill mainly by the
production of free radicals (e.g., production of hydroxyl radicals by the hydrolysis of water). These
highly reactive radicals can break covalent bonds in DNA, thereby killing the organism).

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Filtration
 The most commonly used filter is composed of nitrocellulose and has a pore size of 0.22 mm. This
size will retain all bacteria and spores. Filters work by physically trapping particles larger than the
pore size and by retaining somewhat smaller particles via electrostatic attraction of the particles to the
filters.

1. Enumerate the different physical methods of sterilization with one example each. (1.5) [Annual 2018]

2. A laboratory technician is asked to sterilize instruments used in Operation Theatre to prevent sepsis and Hepatitis B and C infection
in patients undergoing delivery. Define sterilization and enlist its physical methods with examples. (2.5) [Supply 2016 held in 2017]

3. Give any two mechanisms by which chemical agents kill microorganisms. Give two examples of chemical agents from each
category. [Supply 2013]

Note: Prepare this table very well. It’s very important for mcqs

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֍PAST & PRACTICE MCQs֍

01. Cell Injury

1. Process of apoptosis is most likely triggered by release of which of the following substances into the cytosol?
a) BCL2 c) Cytochrome c
b) Catalase d) Phospholipase
2. In a study of viral hepatitis infection, it is observed that cytotoxic T lymphocytes (CTLs) induce death in virally infected
hepatocytes. The CTLs release perforin to allow entry of their granules. Which of the following substances is found in those granules
that directly activates programmed cell death?
a) BCL2 c) Granzyme B
b) Endonuclease d) Nitric oxide
3. A 71-year-old man diagnosed with pancreatic cancer is noted to have decreasing body mass index. His normal connective tissues
undergo atrophy by sequestering organelles and cytosol in a vacuole, which then fuses with a lysosome. However, the cancer
continues to increase in size. Which of the following processes is most likely occurring in the normal cells but is inhibited in the
cancer cells of this man?
a) Aging c) Autophagy
b) Apoptosis d) Karyorrhexis
4. At autopsy, the heart of a 63-year-old man weighs only 250 g (normal 330 g) and has small right and left ventricles. The
myocardium is firm, with a dark chocolate-brown color throughout. An excessive amount of which of the following substances would
most likely be found in the myocardial fibers of this heart?
a) Bilirubin c) Lipofuscin
b) Hemosiderin d) Melanin
5. An impending myocardial infarction was successfully averted by thrombolytic (clot-dissolving) therapy in a 55-year-old man.
Which of the following biochemical events most likely occurred during the period of hypoxia?
a) Decreased hydrogen ion concentration c) Loss of intracellular Na+ and water
b) Increase in oxidative phosphorylation d) Stimulation of anaerobic glycolysis and glycogenolysis
6. In acute pancreatitis, which of the following types of necrosis is most characteristic?
a) Caseous c) Enzymatic
b) Coagulative d) Fibrinoid
7. Which type of necrosis is found in the granulomatous lesions ?
a) Caseous c) Enzymatic
b) Coagulative d) Fibrinoid
8. A 45-year-old woman is investigated for hypertension and is found to have enlargement of the left kidney. The right kidney is
smaller than normal. Contrast studies reveal stenosis of the right renal artery. The size change in the right kidney is an example of
which of the following adaptive changes?
a) Aplasia c) Hyperplasia
b) Atrophy d) Hypertrophy
9. A 56-year-old man recovered from a myocardial infarction after his myocardium was entirely ―saved‖ by immediate thrombolytic
therapy. If it had been possible to examine microscopic sections of his heart during his ischemic episode, which of the following
would be the most likely cellular change to be found ?
a) Karyolysis c) Pyknosis
b) Karyorrhexis d) Swelling of the endoplasmic reticulum
10. Which of the following types of necrosis is most characteristic of brain abscess formation?
a) Caseous c) Enzymatic
b) Coagulative d) Liquefactive
11. A 20-year-old man presents with yellowing of the sclerae, skin, and oral mucosa. Which of the following accumulations underlies
these findings?
a) Bilirubin c) Lead
b) Hemosiderin d) Melanin

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12. A 60-year-old woman with breast cancer and widespread bony metastases is found to have calcification of multiple organs. The
calcifications are best described as
a) dystrophic with decreased serum calcium b) dystrophic with increased serum calcium
c) metastatic with decreased serum calcium d) metastatic with increased serum calcium
13. A 56-year-old man dies 24 hours after the onset of substernal chest pain radiating down his left arm to the ulnar aspect of his
fingertips. Which of the following morphologic myocardial findings is an indicator of irreversible injury?
a) Cell blebs c) Myelin figures
b) Mitochondrial swelling d) Pyknotic nuclei
14. A 53-year-old woman with no prior illnesses has a routine checkup by her physician. On examination she has a blood pressure of
150/95 mm Hg. If her hypertension remains untreated for years, which of the following cellular alterations would most likely be seen
in her myocardium?
a) Apoptosis c) Hyperplasia
b) Dysplasia d) Hypertrophy
15. A 22-year-old woman becomes pregnant. At delivery of an infant, her uterus was found very enlarge. Which of the following
cellular processes has contributed most to the increase in her uterine size?
a) Endometrial glandular hyperplasia c) Endometrial stromal hypertrophy
b) Myometrial fibroblast proliferation d) Myometrial smooth muscle hypertrophy
16. A 16-year-old boy sustained blunt trauma to his abdomen when he struck a bridge abutment at high speed while driving a motor
vehicle. Peritoneal lavage shows a hemoperitoneum, and at laparotomy, a small portion of the left lobe of the injured liver is removed.
Two months later, a CT scan of the abdomen shows that the liver has nearly regained its size before the injury. Which of the following
processes best explains this CT scan finding?
a) Dysplasia c) Hydropic change
b) Hyperplasia d) Steatosis
17. A 71-year-old man has had difficulty with urination, including hesitancy and increased frequency, for the past 5 years. A digital
rectal examination reveals that his prostate gland is palpably enlarged to twice normal size. Which of the following pathologic
processes has most likely occurred in his prostate?
a) Metaplasia c) Hyperplasia
b) Dysplasia d) Hypertrophy
18. A 29-year-old man sustains a left femoral fracture in a motorcycle accident. His leg is placed in a plaster cast. After his left leg has
been immobilized for 6 weeks, the diameter of the left calf has decreased in size. This change in size is most likely to result from
which of the following alterations in his calf muscles?
a) Aplasia c) Dystrophy
b) Atrophy d) Hypoplasia
19. An experimental drug administered to a tissue preparation is found to inhibit cellular oxidative phosphorylation when given in
high doses, and ATP production drops to 5% of normal. Cell membrane function is diminished. Which of the following substances is
most likely to be present at increased concentration in culture fluid bathing the tissue?
a) Calcium c) Potassium
b) Glucose d) Sodium
20. A tissue preparation is experimentally subjected to a hypoxic environment. The cells in this tissue begin to swell, and chromatin
begins to clump in cell nuclei. ATPases are activated, and ATP production decreases. Which of the following ions accumulating in
mitochondria and the cytosol contributes most to these findings and to eventual cell death?
a) Ca+2 b) Cl-
+
c) K d) Na+
21. A 45 year old lady with ovarian cancer presented with psamoma bodies (laminated calcified bodies) in ovary. This is an example
of
a) Dystrophic calcification c) Metaplasia
b) Metastatic calcification d) Hypertrophy
22. On day 28 of her menstrual cycle, a 23-year-old woman experiences onset of menstrual bleeding that lasts for 6 days. She has had
regular cycles since menarche. Which of the following processes most likely occurs in her endometrial cells to initiate the onset of
menstrual bleeding?
a) Apoptosis c) Caseous necrosis
b) Atrophy d) Heterophagocytosis

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23. Early clumping of nuclear chromatin is most closely associated with

a) Reduced intracellular pH c) Release of lysosomal enzymes
b) Increased intracellular pH d) Decreased DNA synthesis
24. Calcium may play role in cell injury by
a) activating phospholipases c) inducing autophagocytosis
b) causing ATP depletion d) reducing intracellular pH
25. Barrett esophagus is a predisposing factor of
a) Carcinoma c) Metaplasia
b) Esophagus reflex disease d) Aplasia
26. Reduction in size of tumor after chemotherapy or radiotherapy is an example of
a) Apoptosis c) Atrophy
b) Necrosis d) Calcification
27. Important natural defence mechanism againt neoplasia (development of cancer)?
a) Apoptosis c) Atrophy
b) Necrosis d) Calcification
28. The boundary between reversible and irreversible cell injury is blurred. Which of the following morphological features would be
strongly suggestive of irreversible injury?
a) Marked swelling of mitochondria with amorphous densities
b) Loss of microvilli
c) Cytoplasmic blebs on plasma memorane
d) Dilatation of endoplasmic reticulum
ANSWER KEY
1. C 2. C 3. C 4. C 5. D 6. C 7. A 8. B 9. D 10. D
11. A 12. D 13. D 14. D 15. D 16. B 17. C 18. B 19. C 20. A
21. A 22. A 23. 24. A 25. A 26. A 27. A 28. A

3. Autophagy is a form of cellular downsizing in response to stress, as the cell consumes itself. Cell death may eventually be triggered
by autophagy, but by a different mechanism than apoptosis, a form of single cell necrosis in which cell fragmentation occurs. Cancer
cells acquire the ability to prevent autophagy, and maintain a survival advantage even as the patient is dying. There is slow autophagy
with aging, but autophagy is accelerated with stressors such as malnutrition and chronic disease.
4. Lipofuscin (golden brown) is a ―wear-and-tear‖ pigment that increases with aging, particularly in liver and myocardium.
9. If infarction is averted by immediate thrombolytic therapy, indicators of necrosis, such as karyorrhexis, pyknosis, and karyolysis,
which represent irreversible changes, would not be expected. Swelling of the endoplasmic reticulum from increased cell water, one of
the earliest ultrastructural changes observed in injured cells, is reversible and would be expected.
12. Metastatic calcification, or deposition of calcium in previously normal tissue, is caused by hypercalcemia. In this patient, tumor
metastases to the bone with increased osteolytic activity caused mobilization of calcium and phosphate, resulting in hypercalcemia.
Metastatic calcification should be contrasted with dystrophic calcification, in which the serum calcium concentration is normal and
previously damaged tissues are the sites of deposition
19. Reduction in oxidative phosphorylation leads to reduction in synthesis of ATP and diminished activity of the plasma membrane
sodium pump, which maintains high intracellular potassium concentration. Loss of ATP leads to efflux of intracellular potassium,
while net influx of sodium and water promote cell swelling. A marked rise in plasma potassium can indicate significant cell damage or
death (such as skeletal muscle crush injury or hemolysis). When cells are not consuming glucose via oxidative metabolism, the
glucose is metabolized via other pathways, and glucose is maintained within normal ranges. Though cell membranes are composed of
lipid, dysfunction or disruption of those membranes does not significantly alter plasma lipid concentration
20. Irreversible cellular injury is likely to occur when cytoplasmic calcium increases. Calcium can enter cells and also accumulate in
mitochondria and endoplasmic reticulum. The excess calcium activates ATPases, phospholipases, proteases, and endonucleases,
which injure cell components. Mitochondrial permeability is increased to release cytochrome c, which activates caspases leading to
apoptosis. Of the other ions listed, sodium enters the cell, while potassium diffuses out when the sodium pump fails as ATP levels fall;
but this is potentially reversible.

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02. Microbiology

1. You‘re watching a television program that is discussing viruses called bacteriophages that can kill bacteria. Your roommate says,
―Wow, maybe viruses can be used to kill the bacteria that infect people! You‘re taking the Microbiology course now; what‘s the
difference between viruses and bacteria?‖ Which one of the following would be the most accurate statement to make?
(A) Viruses do not have mitochondria, whereas bacteria do. (B) Viruses do not have a nucleolus, whereas bacteria do.
(C) Viruses do not have ribosomes, whereas bacteria do.
(D) Viruses replicate by binary fission, whereas bacteria replicate by mitosis.
2. Bacteria, fungi (yeasts and molds), viruses, and protozoa are important causes of human disease. Which one of the following
microbes contains either DNA or RNA but not both?
(A) Bacteria (C) Protozoa
(B) Molds (D) Viruses
3. Which one of the following contains DNA that is not surrounded by a nuclear membrane?
(A) Bacteria (C) Protozoa
(B) Molds (D) Yeasts
4. The initial step in the process of many bacterial infections is adherence of the organism to mucous membranes. The bacterial
component that mediates adherence is the:
(A) lipid A (C) peptidoglycan
(B) nucleoid (D) pilus
5. Chemical agent to sterilize endoscope?
a) Formaldehyde c) Chlorhexidine
b) Glutaraldehyde d) Iodine
60. Which of the following microbial control methods does not actually kill microbes or inhibit their growth but instead removes them
physically from samples?
a) filtration c) Non-ionizing radiation
b) Dry heat d) Disinfection
61. Beta lactamases are an important cause of antibiotic resistance. Which one is the most common site of beta lactamases?
a) Attached to DNA in nucleoid c) Within periplasmic space
b) Free in cytoplasm d) Within capsule
8. Of the following bacterial components, which one exhibits the most antigenic variation?
(A) Capsule (C) Peptidoglycan
(B) Lipid A of endotoxin (D) Ribosome
9. β-Lactamases are an important cause of antibiotic resistance. Which one of the following is the most common site where β-
lactamases are located?
(A) Attached to DNA in the nucleoid (C) Free in the cytoplasm
(B) Attached to pili on the bacterial surface (D) Within the periplasmic space
10. Which one of the following is the most accurate description of the structural differences between gram-positive bacteria and gram-
negative bacteria?
(A) Gram-positive bacteria have a thick peptidoglycan layer, whereas gram-negative bacteria have a thin layer.
(B) Gram-positive bacteria have an outer lipid-rich membrane, whereas gram-negative bacteria do not.
(C) Gram-positive bacteria form a sex pilus that mediates conjugation, whereas gram-negative bacteria do not.
(D) Gram-positive bacteria have plasmids, whereas gram-negative bacteria do not.
11. Bacteria that cause nosocomial (hospital-acquired) infections often produce extracellular substances that allow them to stick firmly
to medical devices, such as intravenous catheters. Which one of the following is the name of this extracellular substance?
(A) Axial filament (C) Flagella
(B) Endotoxin (D) Glycocalyx
12. Lysozyme in tears is an effective mechanism for preventing bacterial conjunctivitis. Which one of the following bacterial
structures does lysozyme degrade?
(A) Endotoxin (C) Peptidoglycan
(B) Nucleoid DNA (D) Pilus
13. Several bacteria that form spores are important human pathogens. Which one of the following is the most accurate statement about
bacterial spores?
(A) They are killed by boiling for 15 minutes.
(B) They are produced primarily by gram-negative cocci.

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(C) They are formed primarily when the bacterium is exposed to antibiotics.
(D) They are metabolically inactive yet can survive for years in that inactive state.
14. Figure bacterial growth curve depicts a bacterial growth curve divided into phases a, b, c, and d. In which one of the phases are
antibiotics such as penicillin most likely to kill bacteria?
(A) Phase a (C) Phase c
(B) Phase b (D) Phase d
15. Some bacteria are obligate anaerobes. Which of the following statements best explains this phenomenon?
(A) They can produce energy both by fermentation (i.e., glycolysis) and by respiration using the Krebs cycle and cytochromes.
(B) They cannot produce their own ATP.
(C) They do not form spores.
(D) They lack superoxide dismutase and catalase
16. Regarding endotoxin, which of the following is the MOST accurate?
(A) Endotoxin is a polypeptide, the toxic portion of which consists of two d-alanines.
(B) Endotoxin is produced by both gram-positive cocci and gram-negative cocci.
(C) Endotoxin acts by binding to class II MHC proteins and the variable portion of the beta chain of the T-cell receptor.
(D) Endotoxin causes fever and hypotension by inducing the release of interleukins such as interleukin-1 and tumor necrosis factor.
17. Regarding sterilization and disinfection, which one of the following is the most accurate statement?
(A) Seventy percent alcohol is a better antiseptic than iodine, so 70% alcohol should be used to disinfect the skin prior to drawing a
blood culture rather than iodine.
(B) Disinfectants kill both bacterial cells and bacterial spores.
(C) During sterilization by autoclaving, the temperature must be raised above boiling in order to kill bacterial spores.
(D) Transmission of milk-borne diseases can be prevented by pasteurization, which kills both bacterial cells and spores.
18. Which one of the following chemicals is used to sterilize heat sensitive materials, such as surgical instruments, in the hospital?
(A) Benzalkonium chloride (C) Ethylene oxide
(B) Phenol (D) Thimerosal
19. Which of the following methods of sterilization utilizes heat to kill microorganisms?
A) Filtration C) Ethylene oxide gas
B) Radiation D) Autoclaving
20. What is the recommended temperature and time for autoclaving to achieve sterilization?
A) 100°C for 15 minutes C) 160°C for 30 minutes
B) 121°C for 15 minutes D) 200°C for 1 hour
21. Which of the following sterilization methods is suitable for heat-sensitive materials?
A) Dry heat sterilization C) Pasteurization
B) Incineration D) Ethylene oxide gas sterilization
22. Which chemical agent is commonly used for disinfection rather than sterilization?
A) Glutaraldehyde C) Hydrogen peroxide
B) Sodium hypochlorite D) Formaldehyde
23. Which of the following organisms have thick peptidoglycan in their cell wall?
a) Gram -ve bacteria c) Yeast
b) Gram +ve bacteria d) Mold
24. What is the primary target of ionizing radiation during sterilization?
A) Nucleic acids C) Enzymes
B) Cell membrane D) Cell wall
25. Which of the following methods of sterilization is used for delicate instruments and electrical devices?
A) Dry heat sterilization C) Ethylene oxide gas sterilization
B) Steam sterilization D) Filtration
26. Which of the following sterilization indicators is used to monitor the effectiveness of autoclaving?
A) Biological indicator C) Temperature indicator
B) Chemical indicator D) Pressure indicator
27. What is the minimum exposure time required for UV radiation to achieve sterilization?
A) 5 minutes C) 30 minutes
B) 15 minutes D) 60 minutes

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28. Which of the following methods of sterilization is commonly used for preserving food?
A) Boiling C) Dry heat sterilization
B) Irradiation D) Ethylene oxide gas sterilization
29. Which stage of bacterial pathogenesis involves the attachment of bacteria to host cells?
A) Invasion C) Adherence
B) Colonization D) Toxigenesis
30. Which of the following is NOT a determinant of bacterial pathogenesis?
A) Virulence factors C) Antibiotic resistance
B) Host immune response D) Bacterial growth rate
31. Which stage of bacterial pathogenesis involves the multiplication and spread of bacteria within the host?
A) Colonization C) Adherence
B) Invasion D) Toxigenesis
32. Which of the following is an example of an exotoxin produced by bacteria?
A) Lipopolysaccharide (LPS) C) Streptolysin
B) Endotoxin D) Capsule
33. Which determinant of bacterial pathogenesis helps bacteria evade phagocytosis by host immune cells?
A) Capsule C) Endotoxin
B) Lipopolysaccharide (LPS) D) Streptolysin
34. Which stage of bacterial pathogenesis involves the spread of bacteria from the initial site of infection to other tissues or organs?
A) Colonization C) Adherence
B) Invasion D) Toxigenesis
35. Which determinant of bacterial pathogenesis allows bacteria to acquire nutrients from the host and establish a niche for growth?
A) Capsule C) Iron acquisition systems
B) Exotoxins D) Adhesins
36. Any process that destroys the non-spore-forming contaminants on inanimate objects like towel is
a) Disinfection c) Disinfestation
b) Antisepsis d) Sterilization
37. Which stage of bacterial pathogenesis involves the production and release of toxins by bacteria?
A) Colonization C) Adherence
B) Invasion D) Toxigenesis
38. Which determinant of bacterial pathogenesis enhances bacterial survival and replication within host cells?
A) Iron acquisition systems C) Virulence factors
B) Antibiotic resistance D) Phagocytosis
39. Which of the following is NOT a step in the viral replication cycle?
A) Attachment C) Transcription
B) Uncoating D) Phagocytosis
40. During viral replication, the release of newly formed viral particles from the host cell is known as:
A) Attachment C) Maturation
B) Uncoating D) Budding
41. Steps of viral replication includes: Virus attachment to host cell, Penetration , Uncoating .......................? Viral assembly &
Release
a) Budding c) Addition
b) Degradation d) Synthesis
42. Name the most possible bacteria associated with the opportunistic infections that occur in patients who have cystic fibrosis
a) Staphylococcus aureus c) Chlamydia trachomatis
b) Pseudomonas aeruginosa d) Candida albicans
43. Some bacteria and fungi need an iron receptors molecule for their growth which is an important virulence factor of bacterial
pathogenesis, what is it called?
a) Siderophores c) Siderocytes
b) Ionophores d) None of the above
44. An antibiotic can target all except:
a) Cell membrane c) DNA
b) Cell wall d) Spore

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45. Which statement is true about iodine?

a) It kills microbe by inactivating DNA and RNA c) It is an antiseptic
b) It is used in water filtration d) It is effective against bacterial but not viruses
46. What is the major difference between an antiseptic and disinfectant?
a) One destroys prions other doesn't c) the cost
b) surface on which they are used d) one is effective against spores‘ other doesn't
47. Dry heat to substance ―............‖?
a) Sterlize it c) Doesn't kill bacteria
b) Disinfect it d) Doesn't kill fungi
48. Which of the following is primarily used for its bacteriostatic properties?
a) Heat c) Filtration
b) Antibiotics d) Ionizing radiations
49. Hormones and sera are sterilized by:
a) Radiations c) Drying
b) Membrane filter d) Antiseptics
50. Bacterial genome or nucleoid is made of?
a) a single double stranded DNA c) histones and non-histones
b) a single stranded DNA d) RNA and histones
51. Bacteria are classified on the basis of
a) Method of reproduction c) Nucleus
b) Cell wall d) Pigments
52. Process of killing of all microbes including bacterial spores is known as
a) Sterilization c) Disinfection
b) Disinfection d) Antisepsis
53. Bacterial endospore function is?
a) Protein synthesis c) Survival
b) Reproduction d) Storage
54. Main difference in Gram +ve and Gram -ve bacteria resides in their?
a) Cell membrane c) Flagella
b) Cell wall d) Nucleoid
55. Which of the following structure is not found in all bacteria?
a) Flagella c) Cell membrane
b) Chromatin bodies d) Cytoplasm
56. A microbicidal agent has what effect?
a) destroys microorganism c) is toxic to human cells
b) inhibits microorganism d) Sterlizes
57. Which of the following actions are not affected by antimicrobial agents?
a) Capsule formation c) Protein synthesis
b) Cell wall synthesis d) Nucleic acid synthesis

ANSWER KEY
1. C 2. D 3. A 4. D 5. B 6. A 7. C 8. A 9. D 10. A
11. D 12. C 13. D 14. B 15. D 16. D 17. C 18. C 19. D 20. B
21. D 22. B 23. B 24. A 25. C 26. B 27. B 28. B 29. C 30. D
31. B 32. C 33. A 34. B 35. C 36. A 37. D 38. A 39. D 40. D
41. D 42. B 43. A 44. D 45. A 46. B 47. A 48. B 49. B 50. A
51. B 52. B 53. C 54. B 55. A 56. A 57. A

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Ph001 – Ph003
FOUNDATION PHARMACOLOGY
Ph-001 ֍ABSORPTION, DISTRIBUTION, METABOLISM & EXCRETION֍

01. Basic Definitions

Pharmacology Pharmacology is the body of knowledge concerned with the action of chemicals on biologic systems
 Pharmacokinetics describes the effects of the body on drugs such as absorption, distribution,
metabolism & elimination
 Pharmacodynamics describes the effects of the drug on the body such as mechanism of action and
therapeutic and toxic effects

Drug Substances that act on biologic systems at the chemical (molecular) level and alter their functions
Pro-drug Drugs which are inactive when administered
Placebo An inactive ―dummy‖ medication made up to resemble the active investigational formulation as much as
possible but lacking therapeutic effect
Orphan drug Drug used for rare diseases

02. Active Principles

Constituent of a drug, upon the presence of which the characteristic therapeutic action of the substance largely depends
 Alkaloid
 Glycoside
 Protein, Lipids & Carbohydrates

03. Sources of Drugs

 Plants such as Morphine (opium poppy plant), Digitalis (fox glove) and Atropine (Atropa belladonna)
 Animals such as Insulin is derived from pigs or cows
 Microbes
 Synthetic e.g., Sodium Bicarbonate
 Biotechnology
 Minerals: as Iron, Iodine and Zinc

04. Pharmacodynamics

Absorption Mechanisms of absorption of drug from GIT

 Passive diffusion & Facilitated diffusion
 Active transport
 Endocytosis & Exocytosis

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Absorption of drug depends upon

 Routes of administration (amount of drug absorbed into systemic circulation divided by amount of
drug administered constitutes its BIOAVAILIBILITY by that route)
o Enteral – oral & sublingual
o Parenteral – Intravenous, Intramuscular, Subcutaneous & Intradermal
o Others – Inhalation, Topical & Rectal
o For example: More & rapid absorption if drug is given intravenously. IV route has 100%
bioavailability.
 Surface area available for absorption  absorption
 Blood flow to absorption site  absorption
 Contact time at absorption surface  absorption
 Drug concentration at the site of administration
 Expression of P-glycoprotein ¹/ absorption
Site of absorption
 Basic drugs are better absorbed in intestine (jejunum) – alakaline media
 Acidic drugs are better absorbed in stomach – acidic media
Distribution Distribution of drug depends upon
 Size of organ
 Blood flow to organ
 Chemical nature (lipophilicity)
 Drug binding to plasma proteins & to tissue proteins
o As [free drug] decreases due to elimination, bound drug dissociates from albumin to
maintain free drug concentration in plasma
 Volume of distribution = [drug] in body/[drug] in plasma
o Drug that binds strongly with albumin will have low volume of distribution
Disposition Metabolism + Elimination, OR
Distribution + Metabolism + Elimination
Metabolism It is a mechanism of activation or termination of drug
 Drugs converted from active form into inactive form
 Prodrugs are inactivated when administered & metabolized into active form
Mainly metabolism occurs in liver
Elimination Elimination may occur with or without metabolism
 Some drugs are excreted from body after the drug is metabolized into inactive metabolite
 Some drugs are modified by the body; continue to act until excreted from the body
Drug elimination is not the same as drug excretion

Ph-002 ֍BASIC TERMINOLOGIES֍

01. Definitions of ………..

Receptor Receptors are the specific molecules in a biologic system with which drugs interact to produce
changes in the function of the system
 Receptors have active & inactive conformation
 Receptors must be selective in their ligand binding & also must be modifiable
Constitutive activity Activity of a receptor in the absence of an agonist
Partial agonist A drug that binds to its receptor but produces a smaller effect at full dosage than a full agonist b/c
partial agonist bind with both active & inactive conformation of receptors
In the presence of a full agonist, a partial agonist acts as an inhibitor
Inverse agonist A drug that binds to the inactive state of receptor molecules and decreases / abolishes the constitutive

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activity of receptor
Pharmacological A drug that binds without activating its receptor and thereby prevents activation by an agonist
anatgonist
Competitive antagonist A pharmacologic antagonist that can be overcome by increasing the concentration of agonist
concentration
Irreversible antagonist A pharmacologic antagonist that cannot be overcome by increasing agonist concentration
Chemical antagonist A drug that counters the effects of another by binding the agonist drug (not the receptor)
Note: Only basic definitions are included in syllabus. You will do these topics in detail in 3 rd year

02. Signaling Mechanism

Intracellular, steroid Membrane JAK-STAT Ligand activated Ion GPCRs & second messengers
receptor like spanning receptors receptors channels (cAMP, IP3 & DAG)
Steroids (cortisol) Insulin Cytokines Na /K+ channel
+
Adrenergic drugs
Vitamin D Epidermal growth Cl– channel Muscarinic drugs
NO factor

Ph003 ֍AUTONOMIC SYSTEM֍

01. Cholinocepters

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02. Adrenocepters

03. Dopamine receptors

04. Effects of ANS

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Note: This table is also the part of physiology

֍PAST & PRACTICE MCQs֍

01. Basic Principles

1. Which of the following is not a mechanism of absorption of drugs from GI tract?

a) Passive diffusion c) Active transport
b) Facilitated diffusion d) Pinocytosis
2. All of the following factors directly affect drug absorption except
a) pH c) Contact time at absorption site
b) Blood flow d) Molecular weight of drug
3. Which factor doesn't affect the distribution of drug?
a) Blood flow c) Volume of distribution
b) Chemical nature of drug d) Molecular weight
4. Which statement is incorrect about drug metabolism?
a) All drugs are modified before their removel from body c) It is a mechanism of activation & termination of drug action
b) Action of drugs is terminated before their elimination d) Conversion of drug to inactive form
5. Route of drug excretion from the body:
a) Liver & Kidney c) Lungs
b) Intestines d) All of these
6. An 18 year old female patient is brought to the emergency department due to drug overdose. Which of the following routes of
administration is the most desirable for administering antidote for drug overdose?
a) Intramuscular c) Oral
b) Intravenous d) Transdermal
7. A molecule that interacts as an activator or inhibitor and brings about a change in the biological function through its chemical
actions is known as …………………………
a) Hormone c) Protein
b) Neurotransmitter d) Drug
8. The action of the drug on the body is known as
a) Pharmacokinetic c) Pharmacology
b) Pharmacodynamic d) Pharmacotherapeutics

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9. Which of the following statement about receptor is not true?

a) It determines the quantitative relations between dose or concentration of drug and pharmacologic effects.
b) Responsible for the selectivity of drug action.
c) Mediates the actions of pharmacological agonists and antagonists
d) None of the above
10. The IV administration of drugs are
a) 100% bioavailable c) Undergoes the first-pass metabolism
b) Rapidly absorbed d) Rapidly excreted by renal
11. For a drug given orally, the principal site of drug absorption is ……………………
a) Stomach c) Oesophagus
b) Small intestine d) Large intestine
12. A drug that binds to inactive state of receptor & decreases constitutive activity is known as
a) Partial agonist c) Antagonist
b) Inverse agonist d) Allosteric agonist
13. What is mean by constitutive activity of a receptor?
a) Activity in absence of ligand c) Activaty in presence of inverse agonist
b) Activity in presence of partial agonist d) Activity in presence of antagonist
14. Partial agonist produces less than full effect because
a) it binds to activated & nonativated states of receptor c) it exhibit only constitutive activate
b) it has low affinity for receptor d) It binds to only activated state of receptor
15. Type of agonist which decrease or abolish constitutive activity of receptor?
a) Partial agonist c) Full agonist
b) Inverse agonist d) Allosteric agonist
16. Type of agonist which act as antagonist in presence of full agonist is known as
a) Partial agonist c) Allosteric agonist
b) Inverse agonist d) None
17. Which type of transmembrane signaling receptors are used by Vitamin D?
a) Intracellular c) Membrane spaning
b) JAK-STAT d) G-protein coupled
18. A study was carried out in isolated skeletal muscle preparations to determine the action of a new drug ―succinylcholine,‖ which in
separate studies bound to the same receptors as acetylcholine. In the absence of succinylcholine, acetylcholine caused contraction of
the muscle & in presence of Succinylcholine, acetylcholine did not cause contraction of muscle. But when concentration of
acetylcholine was increased, muscle contraction occured. Which of the following expressions best describes succinylcholine?
a) A chemical antagonist c) Competitive antagonist
b) An irreversible antagonist d) A physiologic antagonist
19. Sugammadex is a new drug that reverses the action of rocuronium and certain other skeletal muscle-relaxing agents (non-
depolarizing neuromuscular blocking agents). It appears to interact directly with the rocuronium molecule and not at all with the
rocuronium receptor. Which of the following terms best describes sugammadex?
a) Chemical antagonist c) Partial agonist
b) Noncompetitive antagonist d) Pharmacologic antagonist
20. Which drug act by phosphorylating STAT molecules & lead to regulate transcription?
a) Cytokine c) Vit D
b) Steroid d) Acetylcholine
21. Which route of administration is commonly used for vaccines?
a) Intramuscular c) Intradermal
b) Subcutaneous d) Oral
22. Which route of administration is commonly used for insulin?
a) Intravenous c) Subcutaneous
b) Intramuscular d) Oral
23. Which route of administration is used for drugs that require a steady, prolonged release, such as nitroglycerin?
a) Transdermal c) Inhalation
b) Topical d) Oral
24. Which route of administration is commonly used for drugs having bitter taste?
a) Intravenous c) Rectal
b) Intramuscular d) Oral

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ANSWER KEY
1. D 2. D 3. D 4. A 5. D 6. B 7. D 8. B 9. D 10. A
11. B 12. B 13. A 14. A 15. B 16. A 17. A 18. C 19. A 20. A
21. A 22. C 23. A 24. C
Note: Mcqs 21 – 24 are very basic and can be asked in proff. That’s why I added these.

02. ANS

1. Which physiological change is expected when the sympathetic system is inhibited using a pharmacological agent?
a) Reduction in heart rate c) Decrease in fluid secretions
b) Increase in blood pressure d) Constriction of blood vessels
2. An elderly man is brought to the emergency room after ingesting large quantity of prazosin tablet (alpha 1 antagonist), which
mediate effects of epinephrine & nor-epinephrine on blood vessels & urinary bladder. Which symptom is most likely to be seen in this
patient?
a) Bradycardia c) Increased blood pressure
b) Dilation of vessels d) Reduced in urinary frequency
3. M2 receptors are located :
a) Heart c) Autonomic ganglia
b) Blood vessels d) Neuromuscular end plate
4. Which receptors are present at neuromuscular end plate?
a) Muscarinic c) Adrenergic
b) Nicotinic d) No receptor
5. Which receptor don't act through G-protein signaling pathway?
a) Nicotinic receptor c) Adrenergic receptors
b) Muscarinic receptors d) Dopamine receptors
6. Nicotinic receptors mimic the action of
a) Adrenaline c) Acetylcholine
b) Nor adrenaline d) Histamine
7. Which of the following is a sign of alpha receptor activation?
a) Bronchodilation c) Pupillary ilation (mydriasis)
b) Bronchoconstriction d) Increased intestinal motility
8. Full activation of Parasympathetic nervous system produces :
a) Bronchodilation c) Pupillary constriction (miosis)
b) Decreased intestinal motility d) Increased heart rate (Tachycardia)
9. Botulinum toxins impair all types of cholinergic transmission so if a child presents with ingestion of botulinum toxin, what
sign/symptoms will confirm the diagnosis of botulinum poisoning?
a) Bronchospasm c) Cycloplegia (loss of accommodating power of eye
b) Diarrhea d) Skeletal muscle spasm
10. Which of the following neurotransmitter is released normally in SA node of heart in response to increased heart rate?
a) Adrenaline c) Acetylcholine
b) Nor-adrenaline d) Dopamine
11. Stimulation of which subtype of the muscarinic cholinergic receptor causes miosis?
a) M1 c) M4
b) M2 d) M3
12. Beta 2 receptors are present on
a) Cardiac muscle c) Smooth muscle, liver & heart
b) Juxtaglomerular apparatus d) Effector tissues

ANSWER KEY
1. A 2. B 3. A 4. B 5. A 6. C 7. C 8. C 9. C 10. C
11. D 12. C 13. 14. 15. 16. 17. 18. 19. 20.

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CM001 – CM005
FOUNDATION COMMUNITY MEDICINE
CM-001 ֍CONCEPT OF HEALTH֍

01. Changing concept

Biomedical Concept Health means ―absence of disease‖. It is inadequate

Etiological Concept Dynamic equilibrium between man & his environment
Psychological Health is not only a medical phenomenon. It is influenced by social, psychological, cultural, economic &
Concept political factors of people concerned. Thus, health is a both medical & social phenomenon
Holistic Concept Biomedical + Ecological + Psychosocial concept

02. Bio-Psycho-Social model

Note: This topic is actually the part of Behavioural Sciences but it’s better to do here

Application of Health Belief Model in Managing GIT presentation

The HBM suggests that an individual's belief in a personal threat of a health problem, combined with their belief in the effectiveness
of a particular action, will influence their likelihood of taking that action to prevent or treat the health problem
Lets take an example of peptic ulcer
Perceived Susceptibility Patients with a family history of peptic ulcer disease may perceive themselves as susceptible to
developing peptic ulcer.
Perceived Severity Understanding the potential consequences of untreated peptic ulcer can help patients recognize the
severity of the condition
Perceived Benefits Patients may be more likely to adhere to lifestyle modifications (e.g., dietary changes) and
medications (e.g., proton pump inhibitors) if they believe these interventions will effectively manage
their symptoms and prevent complications.
Perceived Barriers Identifying barriers to adherence, such as the cost or side effects of medications, can help healthcare
providers address these concerns and provide alternative strategies
Note: Although this topic is not as such mentioned in UHS syllabus, but mcq came in final exam 2024 so do it. You will do in 2nd year also

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03. New Philosophy

 Health is a fundamental right
 Health is the essence of productive life
 Health is intersectorial
 Health is the integral part of development
 Health is central to quality of life
 Health involves individuals, families, communities, local, national & international responsibilities
 Health & its maintenance is a social investment
 Health is a worldwide social goal

04. Responsibility for health

Responsibility for health is shared among:
 Individuals: Making informed choices, adopting healthy behaviors, and seeking care when needed.
 Communities: Creating supportive environments, promoting social connections, and advocating for health resources.
 Healthcare providers: Delivering patient-centered care, providing education, and coordinating services.
 Governments and policymakers: Ensuring access to healthcare, addressing social determinants, and promoting health
policies.
 Organizations and workplaces: Fostering healthy environments, promoting work-life balance, and supporting employee well-
being.

CM-002 ֍POSITIVE HEALTH, DIMENSIONS, HEALTH DETERMINANTS֍

01. Positive health Dimensions

Physical Health Refers to the overall condition of the body and its ability to function optimally. It includes aspects such as
physical fitness, absence of illness or disease, and the maintenance of a healthy body weight.
Mental Health Focuses on emotional and psychological well-being. It encompasses aspects such as emotional resilience,
coping skills, self-esteem, and the ability to manage stress. Mental health is vital for overall well-being and
impacts our thoughts, feelings, and behaviors.
Social Health Relates to the quality of our relationships and interactions with others. It involves having a supportive
social network, maintaining healthy relationships, and participating in meaningful social activities. Social
health contributes to a sense of belonging, connectedness, and overall life satisfaction.
Emotional Health Refers to the ability to recognize, understand, and manage our emotions in a healthy way. It involves
developing emotional intelligence, self-awareness, and effective coping strategies. Emotional health plays a
significant role in our overall well-being and can impact our relationships, decision-making, and mental
well-being.

02. Determinants of Health

Individual Personal choices and behaviors, such as diet, exercise, substance use, and adherence to medical advice,
Behavior significantly impact health outcomes. Individual behavior plays a crucial role in disease prevention and
overall well-being.
Social and Socioeconomic status, education, employment, and social support networks are important determinants of
Economic Factors health. These factors can influence access to healthcare, opportunities for healthy lifestyles, and the ability
to cope with stressors. Socioeconomic inequalities can result in health disparities.
Physical The physical environment, including access to clean air and water, safe housing, and availability of parks
Environment and recreational facilities, can impact health outcomes. Environmental factors play a role in the
development and prevention of diseases and can influence overall well-being.

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Healthcare System The quality and accessibility of healthcare services, including preventive care, diagnosis, treatment, and
ongoing management of health conditions, are critical determinants of health. A well-functioning healthcare
system can contribute to positive health outcomes and improve overall population health.

03. Physical quality of life index & Human developement index

PQLI HDI
Components Mnemonic ILL Mnemonic KIL
 Infant mortality rate  Knowledge (Mean years + Expected years of schooling)
 Life expectancy at 1 year of age  Income
 Litracy rate  Life expectancy at birth
Range  0-100  0-1

CM-003 ֍HEALTH INDICATORS֍

01. Health Indicators

Classification Examples
1. Mortality indicators Crude death rate, Life expectancy, Infant mortality rate, under 5 Child mortality rate, Maternal
mortality rate
2. Morbidity indicators Incidence, prevalence, Case fatality ratio, Admission & Discharge rates, Notification rate
3. Disability rates Suvillian‘s index, HALE, DALY, Disability free life expectancy
4. Nutrition status indicators Anthropometric measures, Prevalence of Low birth babies
5. Health care delivery Doctor-patient ratio, Doctor-Nurse ratio, Population bed ratio, Patient-trained birth attendant
indicators ratio
6. Utilization rates Infants immunized under EPI schedule, % population using family planning services, Bed
occupancy rate
7. Indicators of social & Suicide, Homicide, Road traffic accidents, Smoking, Juvenile delinquency
mental health
8. Environmental indicators Air pollution, radiation, noise, solid waste
9. Health policy indicators Allocation of adequate resources, proportion of GDP for health resources
10. Socioeconomic indicators Per capita GNP, Unemployment, Dependency ratio, Literacy rates, family size
11. Indicators of quality of life Infant mortality, Life expectancy at 1 year of age, Literacy

Crude death rate (CDR=

Life expectancy (Average no. of years that will be lived by those borne alive in the population if current age-specific mortality rates
persist. Example In Pakistan, according to 2021 data, life expectancy of men & women are 67 & 69 respectively)

Infant mortality rate =

Under-5 child mortality rate =

Maternal mortality rate =

Incidence =

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Prevalence =

Case fatality ratio represents killing power of a disease; CFR=

Suvilian’s index: It is calculated by subtracting probable duration of disability from life expectancy

HALE: Health adjusted life expectancy is based on life expectancy at birth, it is no. of years a new born is expected to live in full
health

DALY: Daily adjusted life year measures overall disease burden, it represents no. of years lost due to ill health

Bed occupancy rate =

02. Compare Indicators Among Countries

 Infant mortality rate – it is universally accepted mortality indicator
 Life expectancy at age 1 year
 Literacy

CM-004 ֍DISEASE CAUSATION֍

01. Disease Causation

Disease causation refers to the factors and mechanisms that contribute to the development of a disease. It involves understanding the
causes and risk factors that lead to the onset and progression of a particular illness.

02. Natural History of disease

It describes the course of a disease from its initial development to its resolution or chronicity if left untreated.

03. Germ Theory of Disease

 According to the germ theory, specific microorganisms, known as pathogens, invade the body and cause infectious diseases.
These pathogens can be transmitted from person to person through various means such as direct contact, airborne droplets,
contaminated food or water, or vectors like mosquitoes.
 This theory was first proposed by Louis Pasteur and later expanded upon by Robert Koch.

04. Multifactorial Causation

Multifactorial causation suggests that the development of most diseases is influenced by multiple factors acting together. These
factors can include genetic predisposition, environmental exposures, lifestyle choices, socio-economic factors, and individual
behaviors. Rather than being caused by a single factor, multifactorial diseases result from complex interactions between various
genetic and environmental factors. Examples of multifactorial diseases include heart disease, diabetes, cancer, and certain mental
health disorders. Identifying and understanding the various contributing factors is crucial in preventing and managing these diseases.
Web of Disease Causation
It recognizes that disease causation is influenced by a complex interplay of multiple factors at various levels, including individual,
interpersonal, community, and societal levels. This model acknowledges the multifactorial nature of diseases and highlights the
intricate relationships and interactions among various determinants.

05. Epidemiological Triad

The epidemiological triad is a conceptual model used in epidemiology to understand and explain the occurrence of infectious diseases.
It consists of three components: the host, the agent, and the environment. These three factors interact with each other to determine
the likelihood of disease transmission and the development of illness

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06. Gradient of Infection

 The gradient of infection, also known as the dose-response relationship, describes the relationship between the intensity of
exposure to an infectious agent and the probability or severity of infection. It suggests that as the level of exposure or dose of
the infectious agent increases, the risk of infection or the severity of the disease also increases.
 For example, in the case of an airborne infection, individuals who are exposed to a higher concentration of infectious particles or
spend more time in close proximity to an infected person are more likely to acquire the infection compared to those with minimal
exposure.
 Understanding the gradient of infection is essential for assessing the risk of disease transmission, implementing appropriate
preventive measures, and estimating the impact of interventions. It helps inform public health strategies, such as setting exposure
limits, implementing infection control measures, and determining the effectiveness of vaccines and treatments.

CM-005 ֍DISEASE PREVENTION֍

01. Principles of Prevention and Control on Prevalent Diseases

 Risk Assessment: Conducting thorough risk assessments to identify the factors contributing to the prevalence of a disease. This
includes understanding the epidemiology, determinants, and risk factors associated with the disease.
 Health Promotion: Promoting healthy behaviors and lifestyles to prevent the onset of diseases. This involves educating
individuals and communities about risk factors, providing information on preventive measures, and encouraging the adoption of
healthy behaviors such as regular exercise, balanced diet, and avoidance of tobacco and alcohol.
 Early Detection and Diagnosis: Implementing strategies for early detection and diagnosis of diseases. This includes regular
screening programs, diagnostic tests, and prompt identification of symptoms to enable early intervention and treatment.
 Specific protection (Vaccination): Utilizing vaccination programs to prevent the occurrence and transmission of vaccine-
preventable diseases. Vaccination helps build immunity in individuals and reduces the risk of infection and transmission within
the population.
 Environmental Control: Implementing measures to control environmental factors that contribute to disease transmission. This
includes ensuring access to clean water and sanitation, proper waste management, vector control (e.g., mosquito control for
diseases like malaria and dengue), and reducing exposure to environmental pollutants.
 Treatment and Management: Ensuring timely and appropriate treatment and management of prevalent diseases. This involves
providing access to healthcare services, promoting adherence to treatment regimens, and facilitating disease management and
rehabilitation.

02. Difference between Elimination and Eradication

Elimination is complete interruption of transmission of disease in a defined geographical area (country or region) but the causative
organism or disease may be persisting somewhere
o The elimination of polio in many countries means that there have been no indigenous cases of polio for a certain
period of time within those countries. However, polio is still present in some regions of the world. Other examples are
Measles and Cyclop
Eradication refers to the complete and permanent worldwide eradication of a disease. It means the total extermination of the
infectious agent, making it impossible for the disease to re-emerge anywhere in the world without intervention.
o Smallpox is the only disease to date that has been eradicated from the world.

03. Disease Surveillance

Disease surveillance is the systematic collection, analysis, interpretation, and dissemination of data regarding the occurrence and
spread of diseases within a population. It plays a crucial role in monitoring disease trends, detecting outbreaks, and guiding public
health interventions. There are different types of disease surveillance:
1. Active Surveillance: In active surveillance, public health officials actively collect data by reaching out to healthcare
providers, laboratories, and other sources to gather information on disease cases. This proactive approach ensures
comprehensive and timely data collection.
2. Passive Surveillance: Passive surveillance relies on the voluntary reporting of cases by healthcare providers and laboratories.
It involves the passive collection of data without active involvement from public health officials. Passive surveillance is less
resource-intensive but may lead to underreporting or delayed reporting of cases.

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3. Sentinel Surveillance: Type of surveillance in which information is collected on disease trends rather than Individual cases. It
is used to find out missing cases.

04. Levels of prevention

Levels of Prevention 5 Levels of Intervention Purpose/Aim

Primordial prevention Prevention of emergence of development of risk
factors
Primary Prevention 1. Health Promotion Avoid occurrence of disease or injury thus reduces
2. Specific Protection by incidence of a disease
 Vaccination/Immunization
 Chemoprophylaxis
Secondary Prevention 3. Early diagnosis by screening and Identify & adequately treat a disease or injury as soon
prompt treatment as possible
Tertiary Prevention 4. Disability limitation Treat a disorder when it has advanced beyond its early
5. Rehabilitation stages to limit complications
Quaternary Prevent overdiagnosis & overtreatment
Prevention

Type of Description Examples

Rehabilitation
Medical Restoration of function Physiotherapy e.g., in case of Polio
Social Restoration of family & social relationships Counselling of addicted persons
Vocational Restoration of capacity to earn livelihood Vocational guidance / Counselling
Occupational Restoration of ability to perform necessary daily activities. Provision of ergonomic equipment to office
worker having carpel tunnel syndrome
Psychological Restoration of personal dignity & self-confidence Psychotherapy

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֍PAST & PRACTICE MCQs֍

1. The science and art of preventing diseases, prolonging life and promoting physical and mental health is known as
a) Public health c) Social medicine
b) Social hygiene d) Health protection
2. Disease near to eradicate in Pakistan;
a) Polio c) Hepatitis B
b) HIV d) Small pox
3. In a country where there is no problem of environmental pollution, legislation is made to have efficient vehicle engines & to have
hydroelectricity power plants instead of coal power plants to prevent air pollution. This is an example of
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary Prevention
4. Imparting health and religious education to drug addicts is which type of intervention?
a) Primordial prevention c) Secondary prevention
b) Specific protection d) Rehabilitation
5. In an area with fluoride rich water, the defluoridation of water is which level of prevention?
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary Prevention
6. Amputation of foot in a diabetic patient exhibiting signs and symptoms is an example of
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary Prevention
7. Most acceptable indicator of health of whole population and of socioeconomic conditions ?
a) IMR c) maternal mortality rate
b) under 5 year mortality rate d) Case fatility ratio
8. Pakistan spends how much of its GDP on health ?
a) 1% c) 10%
b) 5% d) 25%
9. There is no single cause of disease. Multiple causes interact in various ways and lead to chronic disease. This concept is
a) Natural history of disease c) Epidemiological triad
b) Web of causation d) Temporal association
10. Type of Surveillance used to find out missing cases ?
a) Active surveillance c) Sentinal surveillance
b) Passive surveillance d) Focused surveillance
11. Which of the following is not a component of Human development index?
a) Mean years of schooling c) Life expectancy at birth
b) Literacy rate d) Infant mortality rate
12. In a population of 60,000, there were 250 cases of T.B. on 1st January. During 1-year period, 50 more cases were added. During
this year, 20 patients with T.B. died while 40 were cured. Prevalence rate of TB at thr end of this year:
a) 0.4% c) 0.2%
b) 0.84% d) 0.24%
13. In a population of 60,000, there were 250 cases of T.B. on 1st January. During 1-year period, 50 more cases were added. During
this year, 20 patients with T.B. died while 40 were cured. Incidence rate of TB at the end of this year:
a) 0.4% c) 0.2%
b) 0.84% d) 0.24%
14. The gradient of infection refers to:
a) The rate at which a pathogen spreads from person to person c) The concentration of a pathogen in the environment
b) The severity of symptoms caused by a pathogen d) The relationship between the pathogen and the host
15. Prevention of the emergence or development of risk factors is known as
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary prevention

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16. Objective of primary prevention is to reduce disease'

a) incidence c) complications
b) prevalence d) elimination
17. A child coming to Immunization clinic for polio Vaccine. This type of prevention is
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary prevention
18. A Urine strip for sugar detection was employed to screen diabetics in a community. This type of prevention is
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary prevention
19. A village community was given health education to prevent spread of malaria. This type of prevention is
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary prevention
20. A 20 yr old male takes chemoprophylaxis during an epidemic of Meningococcal meningitis. This is a
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary prevention
21. A class of 5 yr old children is discouraged from adopting harmful lifestyles, smoking, etc. This type of prevention is
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary prevention
22. Best level of prevention for Non-communicable diseases :
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary prevention
23. Human living standards can be compared in different countries by
a) Human Development Index (HDI) c) Human poverty index (HPI)
b) Physical quality of life index (PQLI) d) DALY
24. Which of the following is a Mortality Indicator?
a) Life Expectancy c) DALY
b) Notification Rate d) Bed turn-over ratio
25. Epidemiological triad contain all except:
a) Agent c) Host
b) Manpower d) Environment
26. Measures involved in sentinel surveillance includes all of the following except
a) Identifying missing cases in notification of diseases c) Identifying old and new cases
b) Identifying new cases of infection d) Identifying cases free of disability
27. Continuous scrutiny of factors that determine the occurrence and distribution of disease and other condition of ill health is the
definition of:
a) Monitoring c) Disease control
b) Surveillance d) System analysis
28. Decrease in the incidence of a disease to a level where it ceases to be a public health problem is:
a) Control c) Eradication
b) Elimination d) Surveillance
29. Causative agent is present but there is no transmission is known as:
a) Elimination c) Eradication
b) Control s) Holoendemic
30. Zero incidence is
a) Elimination of disease c) Elimination of infection
b) Eradication of disease d) Eradication of infection
31. Missing cases are detected by
a) Active surveillance c) Sentinel surveillance
b) Passive surveillance d) Monitoring

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32. Disease elimination means:

a) Cure of the disease c) Eradication of the vector
b) Preventing the transmission totally d) Complete termination of infective organism
33. Disease elimination refers to:
a) Extinction of disease agent c) Global removal of disease agent
b) Termination of all disease d) Regional removal of disease agent
34. In a population to prevent coronary artery disease changing harmful lifestyles by education is referred to as:
a) High risk strategy c) Secondary prevention
b) Primary prevention d) Tertiary prevention
35. Which of the following is primordial prevention?
a) Action taken prior to the onset of disease
b) Prevention of emergence of development of risk factors
c) Action taken to remove the possibility that a disease will ever occur
d) Action that halts the progress of a disease
36. Primordial prevention in coronary heart disease:
a) Exercise in high risk area c) Salt restriction
b) BP monitoring d) Statins drugs
37. Primary prevention:
a) Marriage counseling c) Self breast examination
b) Early diagnosis and treatment d) Immunization
38. Surveillance is:
a) Scrutiny of factors c) Prevention of disease
b) Treatment of contacts d) Chemoprophylaxis of disease
39. Definition of health given by WHO does not include which of the following dimensions?
a) Social c) Emotional
b) Mental d) Economic
40. The intervention for restoration of health in early pathogenic phase falls under which type of prevention?
a) Primordial prevention c) Secondary prevention
b) Primary prevention d) Tertiary prevention
41. In 4th Century BCE the scholars believe that the health was determined by the humoral factors. The disequilibrium of the humoral
factor leads to disease. This concept of disease causation falls under which of the following theory?
a. Personnel theory c. Biomedical concept
b. Naturalistic theory d. Multifactorial theory
42. 24. Mr. Riaz is 50 years old and has never undergone colorectal cancer screening. He is unaware of the potential consequences of
untreated colorectal cancer and does not perceive himself as at risk. Which component of the Health Belief Model is Mr. Riaz
LACKING?
A. Percieved severity C. Percieved susceptibility and severity
B. Percieved susceptibility D. Percieved barrier

ANSWER KEY
1. A 2. A 3. A 4. D 5. B 6. D 7. A 8. A 9. B 10. C
11. D 12. A 13. B 14. C 15. A 16. A 17. B 18. C 19. B 20. B
21. A 22. A 23. A 24. A 25. B 26. D 27. B 28. A 29. A 30. A
31. C 32. B 33. D 34. B 35. B 36. C 37. D 38. A 39. D 40. C
41. B 42. C

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12.

13.
Incidence rate

per year

42. Patient is not considering himself susceptible to colorectal cancers. It means he is lacking perceived susceptibility. He is also
unaware of yhe consequences of untreated cancer. It means he is also lacking perceived severity

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BhS 001 – 006

FOUNDATION BEHAVIORAL SCIENCES
BhS-001 ֍BIOLOGICAL BASIS OF BEHAVIOUR֍

01. Biological basis of Behavior & Social Brhavior

The biological basis of human behavior refers to the influence of biological factors, such as genetics, brain structure and function,
hormones, and neurotransmitters, on human behavior. These factors interact with environmental and social factors to shape individual
behaviors, cognitive processes, and emotional responses. Understanding the biological basis of human behavior helps us gain insights
into the underlying mechanisms that drive various aspects of human cognition, emotion, and social interactions.
Social Behavior encompasses the range of interactions and relationships between individuals within a society or social group. It
involves the ways in which individuals perceive, interact with, and influence others. Social behavior is influenced by a combination of
biological, psychological, and environmental factors. While the biological basis of social behavior is complex and multifaceted, it is
evident that certain brain regions, neural pathways, and neurotransmitters play significant roles in social cognition, empathy,
cooperation, and other social behaviors.

04. Neurobiology of ____

Memory Memory is a complex cognitive process that involves the encoding, storage, and retrieval of information.
The neurobiology of memory involves the interaction of various brain regions, including the hippocampus,
amygdala & other areas such as thalamus, mammary bodies & hypothalamus. NMDA receptor is
extremely active in long term potentiation as is the role of Ca++. & An important part of memory formation
is increased sensitivity of nerves to acetylcholine
Sensory memory  storage of sensory events such as sights, sound & tastes
Short term memory  provides a working memory where we do much of our thinking such as dialing a
phone number, doing mental arithmetic & remembering a shopping list
Long term memory  permanent storehouse of information such as remembering water boils at 100 oC
Emotions Emotions are subjective experiences accompanied by physiological and behavioral responses. The
neurobiology of emotions involves the
Prefrontal cortex  takes into account the emotions elicited & decides the most logical & rational action to
take in a situitaion. Amygdala  responsible for expression of emotions
Neurotransmitters, such as serotonin, dopamine, oxytocin and norepinephrine, are involved in regulating
emotional responses
Sleep Sleep is a vital process that plays a critical role in maintaining
physical and mental health.
Two centers which induce sleep are located in brainstem:
Role of Raphe Nucleus
o Raphe nucleus is situated in lower pons and medulla.
Activation of this nucleus results in non-REM
sleep. It is due to release of serotonin by the nerve
fibers arising from this nucleus. Serotonin induces
non-REM sleep.
Role of Locus Ceruleus of Pons
o Activation of this center produces REM sleep.
Noradrenaline released by the nerve fibers arising
from locus ceruleus induces REM sleep.
NREM 1 Theeta waves
NREM 2 Sleep spindle & K complex
NREM 3 Delta waves
REM Beta waves

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Features of REM
o active form of sleep usually associated with dreaming and active bodily muscle movements.
o Muscle tone throughout the body is exceedingly depressed
o Heart rate and respiratory rate usually become irregular
o Despite the extreme inhibition of the peripheral muscles, irregular muscle movements do occur.
These are in addition to the rapid movements of the eyes.
Learning Learning is the process of acquiring new knowledge, skills, or behaviors. The neurobiology of learning
involves synaptic plasticity, neural networks, and the release of neurotransmitters, such as dopamine and
glutamate. Brain regions like the hippocampus and prefrontal cortex are involved in different types of
learning, including declarative memory and procedural memory.
Motivation Motivation refers to the internal processes that drive behavior towards achieving goals or satisfying needs.
The neurobiology of motivation involves the reward system, which includes brain regions like the nucleus
accumbens and the release of dopamine. Other neurotransmitters, such as serotonin and norepinephrine,
also play a role in motivation.
Sex and Arousal Sexual behavior and arousal are influenced by hormonal and neural factors. Hormones, such as
testosterone and estrogen, affect sexual drive and behaviors. Brain regions like the hypothalamus and
limbic system are involved in the regulation of sexual behavior and arousal.
Reward and The neurobiology of reward and punishment involves the mesolimbic dopamine system, which includes
Punishment the nucleus accumbens and the ventral tegmental area. Dopamine release in response to rewarding stimuli
reinforces behaviors, while punishment signals inhibit or discourage behaviors.

BhS-002 ֍PSYCHOLOGICAL DISORDERS֍

01. The burden of mental illness on the person, family, and society

Person Mental illness can significantly impact an individual's quality of life, overall functioning, and well-being. It may
lead to distressing symptoms such as persistent sadness, anxiety, hallucinations, or delusions, which can impair
daily activities, relationships, and work performance. Mental illness can also contribute to feelings of isolation,
stigma, and reduced self-esteem.
Family Mental illness often places a substantial burden on families. Family members may experience emotional distress,
caregiver fatigue, and stress related to supporting and caring for a loved one with mental illness. They may face
challenges in understanding and coping with the symptoms, managing disruptions in daily routines, and navigating
the healthcare system. Family dynamics and relationships can be strained, leading to conflicts and disruptions in
family functioning.
Society Mental illness has a significant impact on society as a whole. It results in a range of direct and indirect costs,
including healthcare expenses, lost productivity, and reduced economic output. Mental health conditions can
contribute to increased healthcare utilization, including emergency room visits and hospitalizations. They also have
implications for public health, as individuals with mental illness may be at higher risk for substance abuse,
homelessness, and involvement in the criminal justice system. Stigma and discrimination associated with mental
illness can further hinder social integration and access to resources and support.

02. Intellectual Disability

Intellectual disability, also known as intellectual developmental disorder, is a neurodevelopmental disorder characterized by
limitations in intellectual functioning and adaptive skills. It typically appears during childhood or adolescence and is characterized by
an IQ below average (typically an IQ of 70 or below) and difficulties in areas such as communication, self-care, social skills, and
academic performance. Intellectual disability can vary in severity, ranging from mild to profound, and it may be associated with other
co-occurring conditions or genetic syndromes.
IQ = mental age/chronological age x 100

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03. Mental Disorders

Mental disorders encompass a wide range of conditions that affect a person's thinking, feeling, behavior, or mood. These disorders can
significantly impact an individual's emotional well-being, cognitive abilities, and functioning in various areas of life. Examples of
mental disorders include
Depression Characterized by depressive mood (feeling sad), loss of pleasure or interest in activaties, suicidal
thoughts, low self-esteem, loss of appetite, loss of weight
Anxiety disorders Characterized by excessive fear and worry, panic attacks
Schizophrenia Characterized by delusions, hallucination, disorganized thinking, extreme agitation
Bipolar disorder Characterized by alternating depressive episodes with periods of manic symptoms (increased activity,
increased self-esteem, euphoria)
Post-traumatic stress Characterized by re-experiencing the traumatic event (flashbacks or nightmares), avoidance of thoughts
disorder (PTSD) and memories of event
Delirium Poor memory, Hallucinations / Illusions and reversal of Sleep pattern / Disturbed Sleep
Delusion  fixed false belief such as believing one has superpowers
illusion  perceiving a stimulus wrong such as perceiving a rope as a snake
Hallucination  perceiving in absence of stimulus such as hearing a voice when nobody is speaking

04. Personality Disorders

Personality disorders are a group of mental health conditions characterized by enduring patterns of behavior, cognition, and inner
experiences that deviate significantly from cultural expectations and cause distress or impairment. These patterns are inflexible and
pervasive across different situations, leading to difficulties in relationships, self-identity, and functioning. Examples of personality
disorders include borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder.
Cluster A (“Mad”) Cluster B (“Bad”) Cluster C (“Sad”)
Paranoid: Distrustful Histrionic: Dramatic, Provocative Obsessive compulsive: Profectionist,
Preoccupied with rules
Schizoid: Detached, Emotionless Narcississtic: Grandiose, Self loving Anxious/Avoidant: Insecure
Schizotypal: Odd, Magical thinking Borderline: Emotionally unstable, Self Dependant: Submissive, Helpless, Needy
harm, Drug abuse

BhS-003 ֍PSYCHOLOGY & DISEASE֍

01. Psychosocial aspects of various system diseases

Psychosocial factors play a significant role in various illnesses, influencing their development, progression, and outcomes. These
factors encompass psychological, social, and behavioral aspects that interact with biological factors to impact health. Here's an
overview of the psychosocial aspects in various system diseases:
Disease Effect of Psychological factors
Cardiovascular System Coronary artery disease
Hypertension
Heart failure
Central Nervous System Depression
Anxiety disorder
Neurodegenerative diseases like Alzheimer's disease
Gastrointestinal Tract Irritable bowel syndrome (IBS)
Inflammatory bowel disease (IBD)
Respiration Asthma
Chronic obstructive pulmonary disease (COPD)
Renal System Chronic kidney disease (CKD)
End-stage renal disease (ESRD)
Endocrine System Diabetes
Thyroid disorders
Adrenal disorders

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BhS-004 ֍BEHAVIORAL FACTORS & PHARMACOLOGICAL TREATMENT֍

01. Behavioral factors associated with pharmacological treatment

Compliance The extent to which individuals follow their prescribed medication regimen is a critical behavioral factor. It
involves taking medications as prescribed, following dosage instructions, and adhering to the recommended
treatment duration. Poor treatment adherence can significantly impact treatment outcomes.
Medication Proper management of medications, including organizing and storing them appropriately, tracking refills, and
Management understanding potential drug interactions, is an important behavioral factor. This ensures that medications are
taken correctly and consistently.
Lifestyle Certain diseases, such as cardiovascular conditions or diabetes, may require individuals to make behavioral
Modifications changes in their lifestyle. This can include adopting a healthy diet, engaging in regular physical exercise, quitting
smoking, reducing alcohol consumption, and managing stress.
Self- Some diseases or conditions may require individuals to monitor their symptoms or specific health parameters.
Monitoring This can involve regular monitoring of blood pressure, blood glucose levels, or other relevant indicators.
Behavioral factors such as adherence to self-monitoring routines and accurately recording the data can aid in the
management of the disease and guide treatment decisions.

Factors That Affect Compliance

 Demographic: Female gender, very young, adolescents, elderly, non- Caucasian races, low-income groups, lower social
classes, the unemployed
 Disease: Patients with conditions that require prophylactic treatment, mild asymptomatic conditions, chronic conditions,
conditions whereby the effect of terminating treatment is delayed (e.g., epilepsy)
 Personality: Normal personality traits resulting in social stigma, paranoia or hypochondria, fear of becoming dependent upon
the treatment
 Treatment: Longer duration, higher frequency of dosing, increased number of prescribed medications, route of drug
administration (parenteral has the highest rate of compliance), tablet size, dosing regimen, appearance, color, and taste of
medication
 Social Factors: Widowed, single, individuals with language difficulties and physical disability, poor family ties, negative
attitude of others in the community, lack of local help
 Doctor-Patient Relationship: Poor quality, duration, and frequency of doctor-patient interaction

02. Health Belief Model (HBM)

The Health Belief Model is a psychological framework that explains and predicts individuals' health-related behaviors. It suggests that
people's beliefs about the perceived benefits of taking action, the perceived barriers to taking action, their perceived susceptibility to
a health condition, and the severity of the condition influence their health-related decision-making and behavior.
In the context of pharmacological treatment, the HBM can help understand how individuals' beliefs about the effectiveness of
medications, the perceived barriers to treatment (e.g., side effects, cost), and their perception of the severity of the disease influence
their adherence to medication regimens.

03. Drug Resistance

Drug resistance occurs when microorganisms, such as bacteria or viruses, develop the ability to survive and multiply despite the
presence of medications designed to kill or inhibit them.

BhS-005 ֍PALLIATIVE CARE֍

01. Rehabilitation for Patients on Dialysis and Physical Disability

For patients on dialysis, rehabilitation focuses on improving and maintaining their physical functioning, enhancing their quality of life,
and promoting independence. Some key aspects of rehabilitation for patients on dialysis and those with physical disabilities include:

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Physical Therapy Physical therapy aims to improve strength, flexibility, balance, and mobility. It may involve exercises,
stretching, gait training, and assistive devices to enhance functional abilities.
Occupational Occupational therapy focuses on helping individuals perform daily activities independently. It involves
Therapy strategies to adapt the environment, teaching adaptive techniques, and providing assistive devices to
maximize functional capacity.
Speech Therapy Speech therapy is beneficial for individuals with speech or swallowing difficulties. It includes exercises and
techniques to improve speech clarity and swallowing function.
Psychological Rehabilitation programs often include psychological support to address the emotional impact of living with
Support a chronic condition or physical disability. Counseling, support groups, and stress management techniques
may be provided.
Assistive Devices Depending on the specific needs, patients may be prescribed assistive devices such as wheelchair, walkers,
and Mobility Aids canes, or prosthetic limbs to improve mobility and independence.

02. Care Requirements in Chronic Debilitating Conditions like Diabetes

Medication Adhering to prescribed medications, including insulin or oral hypoglycemic agents, and regularly
Management monitoring blood glucose levels.
Lifestyle Implementing healthy lifestyle habits, such as following a balanced diet, engaging in regular physical
Modifications activity, maintaining a healthy weight, and avoiding tobacco and excessive alcohol consumption.
Blood Glucose Regular monitoring of blood glucose levels using glucose meters or continuous glucose monitoring systems
Monitoring to maintain optimal control.
Diabetic Patient education on diabetes management, including self-care skills, meal planning, medication
Education administration, recognizing and managing hypoglycemia/hyperglycemia, and foot care.
Regular Health Regular visits to healthcare professionals for comprehensive health assessments, including eye exams, foot
Check-ups exams, kidney function tests, cholesterol monitoring, and blood pressure checks.

03. Multi-Palliative Care

Multi-palliative care refers to the provision of comprehensive care for individuals with multiple chronic conditions and complex
healthcare needs. It aims to improve the quality of life, relieve symptoms, and provide psychosocial and spiritual support. Key aspects
of multi-palliative care include:

Symptom Addressing and managing symptoms such as pain, nausea, shortness of breath, fatigue, and depression
Management through a combination of pharmacological and non-pharmacological interventions.
Care Coordination Coordinating care among multiple healthcare providers and specialties to ensure seamless communication,
collaboration, and integration of services.
Psychosocial and Providing emotional support, counseling, and assistance with psychosocial and spiritual needs to enhance
Spiritual Support overall well-being.
Advance Care Facilitating discussions about end-of-life care preferences, including the creation of advance directives and
Planning discussions about goals of care.

BhS-006 ֍STRESS֍

01. Stress-Related Multiple Sclerosis and Autoimmune Diseases:

Stress is known to influence the development and progression of multiple sclerosis (MS) and other autoimmune diseases. While stress
itself does not cause these conditions, it can impact the immune system and contribute to disease activity. Key points include:
 Disease Exacerbation: Stress can trigger or worsen MS symptoms, leading to increased inflammation, fatigue, and disability.
 Immune System Dysregulation: Chronic stress can dysregulate the immune system, leading to increased immune activity
and inflammation. In individuals with autoimmune diseases, this can potentially exacerbate the underlying condition

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02. Behavioral Manifestations of Stress

Changes in Sleep Stress can lead to difficulty falling asleep, staying asleep, or result in restless and fragmented sleep.
Patterns
Altered Eating Habits Stress can affect appetite, leading to overeating or loss of appetite. Emotional eating or craving
unhealthy foods can also be a behavioral response to stress.
Irritability and Mood Increased stress levels can result in irritability, mood swings, anxiety, or depression.
Changes
Social Withdrawal Some individuals may withdraw from social interactions or isolate themselves as a response to stress.
Changes in Productivity Stress can impair cognitive functioning, leading to difficulties in concentration, memory, and decision-
and Concentration making.
Nervous Habits Nail-biting, teeth grinding, fidgeting, or other nervous habits may manifest as behavioral responses to
stress.

֍PAST & PRACTICE MCQs֍

1. How stress is associated with endocrinal system?

a) Testosterone c) Nor-adrenaline
b) Aldosterone d) Thyroid hormone
2. Symptoms of stress through endocrines may be?
a) Increased pupil dilatation, Perspiration and Increased heart rate and blood pressure
b) Decreased body fluids
c) Increased sexual problems
d) Arousal
3. Stress can have the following symptoms?
a) Physical symptoms
b) Emotional symptoms
c) Behavioral symptoms
d) Physical symptoms, Mental symptoms, Behavioral symptoms and Emotional symptoms
4. Behavioural symtoms of stress include
a) Nail biting c) Urination
b) Abdominal cramps d) Indigestion
5. Mental symptoms of stress may include:
a) Eating problems c) Gastritis
b) Food problems d) Memory lapses
6. Which of the following is considered a positive symptom of schizophrenia?
a) Poor hygiene c) Meaningless communication
b) Affective flattening d) Hallucinations
7. In Behavioural Sciences the Bio-Psycho-Social (BPS) model of health care is best described as:
a) The management of psychological and social issues of patients.
b) Biological aspects of disease being more important than psychosocial aspects.
c) Use of social and psychological factors alongside the biological aspects of the illness.
d) A method in which a patient should be seen by a psychologist and a social worker.
8. Biopsychosocial Model was given by:-
a) George engle (1970) c) Sigmand freud's (1901)
b) Einstein (1930) d) Robert plut chik (1909)
9. Bio psycho Social Model provides:-
a) Biological & Psychological Hypothesis c) Chinical approach to practice of allopathic medicine.
b) Biological Model of psychiatry. d) Clinical Approach to practice of holistic Medicine.

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10. An important extremely active receptors in long term potentiation in memory

a) alpha receptors c) NMDA-receeptors
b) Beta receptors d) Dopamine recepter
11. Which of the following is the most common sensation hallucination seen in schizophrenia?
a) Auditory c) Olfactory
b) Visual d) Tactile
12. Which of the following statements about stress is true?
a) Stress is caused by working too much c) Stress is cured by working more
b) Stress is cured by working less d) Stress levels are unrelated to professional status
13. Which of the following neurotransmitters is NOT associated with anxiety?
a) Gamma-aminobutyric acid (GABA) c) Nor epinephrine
b) Epinephrine. d) Serotonin (5-HT)
14. A patient in the medical ward started complaining of hearing voices, seeing pictures and images, thoughts as if being controlled by
someone and feeling low. Which of the following describes one of his/her presenting symptoms?
a) Precognition c) Illusions
b) Depression d) Hallucinations
15. Stress was defined by:-
a) Robert Plutchik c) Lazarus
b) Sigmund Freud d) Aristotle
16. In emotional manifestation of stress, guilt, grief, sadness, isolation are expressed in:
a) Sympathetic Reactions c) Parasympathetic Reactions
b) Sympathomimetic Reactions d) Parasympathomimetic Reactions
17. "Fight or flight response" is the responsibility of the following system:
a) Somatic nervous system c) Sympathetic division of autonomic nervous system
b) Central nervous system d) Parasympathetic division of autonomic nervous system
18. Which one of the following is best example of psychosocial stress:
a) Noise c) Hunger
b) Economic viability d) Disease
19. I.Q. is equal to:-
a) Mental age/ Tooth age X 1000 c) Mental age/chondrical age X 100
b) Mental age /chronological age X 1000 d) Mental age/chronological age X100
20. An elementary school boy begins to have poor school performance. After episodes of agitation and separation anxiety, the child is
brought to a clinician. History reveals the child has tried to run away on occasion. The child says sometimes he hears funny voices
when no one is around. Which of the following is most likely?
a) Depression c) Oppositional
b) Separation anxiety d) Normal child
21. Which of the following personality disorders is part of Cluster A (odd or eccentric)?
a) Antisocial personality disorder c) Histrionic personality disorder
b) Borderline personality disorder d) Schizoid personality disorder
22. In breaking the bad news the best model to be used is
a) Biopsychosocial model c) Full disclosure model
b) Individualized disclosure model d) Paternalistic disclosure model
23. A 39 year old male is brought by his family with the complaints that he has been unable to follow his daily routine and does not
take care of him-self. Sleep and appetite are also disturbed. He weeps a lot and wishes for death. Most likely diagnosis
a) Depressive disorder c) Manic episode
b) Schizophrenia d) Phobic disorder
24. Which of the following model helps in understanding the strong influence of socio-cultural factor in the treatment of disease?
a) Social Support Model c) Health belief model
b) Explanatory model of illness d) Biopsychosocial model
25. Stress may be defines as
a) Pressure
b) Anxiety

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c) "wear and tear" our minds and bodies experience as we attempt to cope with our continually changing environment
d) Uneasiness
26. Holistic Medicine is inspired from the theory of
a) Holism, which states that reality is made up of unified wholes that are greater than the sum of their parts
b) Traditional allopathic medicine
c) Homeopathic Medicine
d) APC
27. Holistic Medicine aims at:-
a) Treating of diseases
b) Restoring health and wellness to persons whole rather than focusing diseased part only
c) Health of community
d) All of above
28. A physician is a/an
a) Allopathic + Homeopathic Doctor c) Who reals only children
b) A physically fit doctor d) Who supports health
29. Practice of Holistic Medicine demands knowledge:-
a) Homeopathic Medicine c) Knowledge of Behavioural Science
b) Allopathic Medicine d) All of Above
30. Behavioural Science deals:
a) Study of human thoughts & Actions
b) Study of human behavioural by principles of psychology, Sociology, Anthropology in condition of health & Disease Study of
human behaviour by study of psychiatric books
c) Study of human behaviour of other humans & animals
d) Study of structure of human body
31. Particular importance is of what in memory:-
a) Thalamus c) Hippocampus
b) Cortex d) Mammary bodies
32. Part/Parts related to receiving & storing new information is/are
a) Hippocampus c) Cortex & Hippocampus
b) Amygdala d) A & B
33. An important extremely active receptors in long term potentiation in memory are receptors
a) alpha receptors c) NMDA-receptors
b) Beta receptors d) Dopamine receptors
34. An important part of memory formation is an increase in sensitivity of certain nerve cells to
a) Acetylcholine c) Norepinephrine
b) Acetylcholinesterase d) Dopamine
35. Whenever we ask anyone about his/her childhood, He/ She uses one of the following memories to describe it
a) Sensory memory c) Short term memory
b) Retrieval d) Long term memory
36. One of the following ions are involve in "long term memory potentiation";
a) Na+ c) Ca+²
b) K+ d) Cl-
37. A student becomes very nervous just prior to giving a graded presentation in front of class. Their heart rate increases and they feel
"butterflies" in their stomach. However, shortly after the presentation begins these feelings subside. Which of the following best
describes this situation?
a) Panic attack c) Performance anxiety disorder
b) Social anxiety disorder d) Physiologic anxiety
38. Mr. A is very hard working and competitive man but under stress he cannot control, becomes anxious, disorganized and
consistently in hurry: He fulfills the criteria one of the following:
a) Type A personality c) Extrovert Personality
b) Alexithemic Personality d) Type B personality

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39. A 75 year old gentleman with chronic renal failure, suddenly starts to become Irritable refuses to recognize his family members,
and appears to be seeing things that aren't there. His daughter reports that he does not sleep at night and sleeps throughout the day
Instead. The most likely diagnosis is:
a) Dementia c) Schizophrenia
b) Delirium d) Depression with psychotic features
40. Symptoms of stress through endocrine system include
a) Increased pupil dilation and blood pressure c) Arousal
b) Movement problem d) Decrease body fluids
41. Which of following category belongs to " Parasomnias"?
a) Narcolepsy parasomnia c) Sleep Terror Disorder & Sleep Walking.
b) Nightmare Disorder. d) B & C
42. A 39-year old man brought by his family with the complaint of loss of appetite and does not care of himself. Sleep and appetite is
also disturbed. He weep a lot and wishes for death. Most likely diagnosis is:
a) Depressive disorder c) Phobic disorder
b) Manic episode d) Schizophrenia
43. After accident, MRI and CT scan showed sever damage to the hippocampus. Which of following would be defective
a) Sensory memory c) LTM
b) STM d) Encoding
44. Sleep spindle and K complex are part of Stage
a) Stage 1 c) Stage 3
b) REM sleep d) Stage 2 non-REM
45. A 45 year old bank manger present to his doctor with symptoms of disturbed sleep, Increased sweating and constipation.
Regarding stress which system is overactive in this patient
a) Sympathetic system c) Parasympathetic system
b) GIT d) CNS
46. Dr. Mosin Alyas complaint with disturbed sleep and low mood for two weeks, his heart rate is also elevated most of the time.
Which of following is most likely your diagnosis?
a) Generalized anxiety disorder c) Mixed anxiety depression disorder
b) Panic disorder d) Major depression
47. A person is in state of rellef with his closed eyes. The following pattern of EEG would be seen in this patient
a) Alpha wave c) Theta wave
b) Beta wave d) Delta Wave
48. People with Type A personality are more vulnerable to:
a) Psychiatric disorders c) Increased incidence of eye disease
b) Have the same incidence of heart disease as general d) Increased incidence of heart disease.
population.
49. Common characteristics of Type B person are:
a) Hard driving c) Non-competitive
b) Easy going d) Jittery and irritable under stress
50. Which of the following disorders presents with individuals who are enmeshed in their own accomplishments, crave admiration,
have unrealistically inflated views of their talents, and may become angry when criticized?
a) Borderline personality disorder c) Antisocial personality disorder
b) Narcissistic personality disorder d) Histrionic personality disorder
51. Which psychiatric co morbidity is present in the majority of patients with Anxiety Disorder?
a) Depression c) Psychosis
b) Panic Disorder d) Mental Retardation
52. Difficulty in falling in sleep and maintaining that sleep is:
a) Primary insomnia c) Narcolepsy
b) Depression d) Nightmares disorders
53. Following is true about antisocial personality:
a) Self dramatization and craving for attention and excitement
b) Feeling socially inferior, timid and insecure
c) Socially detached and preoccupied in fantasy
d) Aggressive, disregard and lack of concern for others and irresponsibe

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54. Which psychiatric co morbidity is present in the majority of patients with Anxiety Disorder?
a) Depression c) Psychosis
b) Panic Disorder d) Mental Retardation
55. During REM Sleep:
a) Waves occur of comb-tooth shape. c) Saw-tooth like.
b) Tooth shape. d) All
56. Physiological processes in human are directly affected by psychological stress which includes
a) immune system c) belief system
b) personality issues d) doctor patient relationship
57. It involves being excused from various duties & obligation
a) Stigma c) Thief
b) Stigmatizations d) Sick role
58. Emotions may be defined as
a) Expression c) Degree of verbal fluency
b) Spontaneous imagination d) Psycho biological state and range of propensities to act
59. A patient from suburban area of Lahore comes to you and says he does multiple visits to different clinics for uncontrolled blood
pressure, Blood sugar and headache but does not find improvement in his problems. You have a strong suspicion that patient has not
good compliance to medications. Which of the following element can improve patients compliance.
a) ask him he is dying without medication.
b) making a specific plan to implement the regimen
c) say patient you can't treat him if he doesn't take medicine
d) charge patient more consultation fee to reduce visits of patient
60. A patient comes to opd with complaint of b.p on detailed history. She is on beta blockers and diuretics .her vitals are b.p 170/110,
pulse 110 per min she says her b.p always remain greater than 130/90. On detailed inquiry it reveals she is not taking medicines
regularly. How will you explain situation in medical terms
a) Compliance to medicines c) compliance good, poor b.p control due to senility
b) non adherence to medicines d) frustration phenomenon
61. A woman visited dermatologist. She felt that her hands were always dirty and she used to wash her hands repeatedly. She most
probably suffering from which mental disorder?
a) Obsessive compulsive disorder c) Schizophrenia
b) Paranoid disorder d) Anxiety
62. A 4th year boy was examined by a psychiatrist. His symptoms were unduly extreme suspicion. There was irrational and persistent
feeling that other people have hidden motives or out to harm him. Mental disorder ?
a) Obsessive compulsive disorder c) Schizophrenia
b) Paranoid disorder d) Anxiety
63. Symptom of stress directly related to CNS?
a) Tension headache c) Amenorrhea
b) Abdominal pain d) Asthma
64. Cultural assessment of the patient can be best done by using
a. health belief model c. bio psychosocial model
b. checking personality disorder d. checking IQ levels
65. Following are part of coping with stress, except
a) managing the stressor c) managing own behaviour
b) blaming others d) relaxation
ANSWER KEY
1. C 2. A 3. D 4. A 5. D 6. D 7. C 8. A 9. D 10. C
11. A 12. D 13. B 14. D 15. C 16. C 17. C 18. B 19. D 20. A
21. D 22. A 23. A 24. D 25. C 26. A 27. B 28. D 29. C 30. B
31. C 32. D 33. C 34. A 35. D 36. C 37. D 38. A 39. B 40. A
41. D 42. A 43. C 44. D 45. A 46. D 47. A 48. D 49. B 50. B
51. A 52. A 53. D 54. A 55. C 56. A 57. D 58. D 59. B 60. B
61. A 62. B 63. A 64. C 65. D

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Ag001
FOUNDATION AGING
Ag-001 ֍Process of Aging֍

01. Telomeres and telomerase and their clinical significance in aging.

Telomeres are the repeating sequences of DNA at end of
chromosomes that protect genetic material from damage during
cell division.
Telomerase is an enzyme that adds DNA sequences to
telomeres, thus preventing them from shortening during cell
division.
Most normal cells have a limited capacity for replication. After
about 60–70 cell divisions, all cells become arrested in a
terminally nondividing state, known as senescence.
Werner syndrome is a rare disease characterized by premature
aging, damaged DNA, and a markedly reduced capacity of cells to divide (shortening of telomere). The following mechanisms may be
responsible for progressive senescence of cells and decreased cellular replication in aging.
Telomerase has been shown to increase telomere length, and some studies suggest that telomerase activation may slow down the aging
process and reduce the risk of age-related diseases. However, telomerase activation may also increase the risk of cancer, as it can
promote the growth of cancerous cells.

֍Past & Practice MCQs֍

1. What are telomeres?

A) Proteins that repair DNA C) Repetitive nucleotide sequences at the ends of
B) Enzymes that synthesize DNA chromosomes
D) Segments of RNA involved in protein synthesis
2. What is the primary function of telomerase?
A) To degrade damaged DNA C) To remove telomeres during cell division
B) To add nucleotide sequences to the ends of telomeres D) To initiate DNA replication
3. Why are telomeres important for cellular aging?
A) They increase the cell's energy production C) They promote continuous cell division without any errors
B) They protect chromosomes from deterioration or fusion D) They facilitate protein synthesis
4. How is telomerase activity linked to cancer?
A) Increased telomerase activity can cause cells to age faster
B) Decreased telomerase activity is commonly observed in cancer cells
C) Increased telomerase activity allows cancer cells to divide indefinitely
D) Telomerase activity has no impact on cancer cell division
5. What is the clinical significance of telomere shortening in aging?
A) It leads to enhanced immune function C) It contributes to the aging process and age-related diseases
B) It results in the activation of oncogenes D) It causes cells to become more resistant to stress

ANSWER KEY
1. C 2. B 3. B 4. C 5. C 6. 7. 8. 9. 10.

UHS KEY OF MODULAR SYSTEM

FOUNDATION
2023 – 2025

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֍ANNUAL & SUPPLE 2023 HELD IN 2024֍

GROSS ANATOMY
1 What muscles control unwanted movement by stabilizing joints? Fixator
2 Interphalangeal joint is a type of joint? Hinge joint
3 In which muscle, heterotopic bone found? Quadricep muscle
4 The plane dividing the body into unequal right and left halves is called? Sagittal plane
5 The spinal cord is part of the central nervous system, and its segments are named according Vertebral level
to the
6 Duning viva the student was asked questions related to spinal nerve; which characteristic is A
true related to it?
A. Dorsal ramus supply skin of the back
B. Are 30 in number
C. Ventral nerve ramus is identified by its spinal ganglion
D. They all have only sensory innervation to skin
E. Their somatic efferent fibers are posterior horn cells
7 Primary cartilaginous joint (synchondroses)? Epiphyseal plate
8 Functionally, brachial artery is a type of A
A. Distributing vessel B. Conducting vessel C. Resistance vessel
D. Exchange vessel E. Reservoir vessel
9 Which bone violates growing end hypothesis? Fibula
10 Occlusion of which artery lead to tissue death? End artery
EMBRYOLOGY
11 A low birth weight baby has been delivered, and the doctor wants to determine whether the Round shaped placenta
baby is full term. The placenta is given to a specialist for examination. Which characteristic
of the placenta would indicate that the baby is full term?
12 Structures present in 8 month pregnant female‘s ovaries? Graffian follicle
13 When are mitotic spindles synthesized? M phase
14 Healthy placenta weights after delivery: 300g weight
15 Implantation of blastocyst is confirmed by Invasion of endometrium by
embryonic cels
16 At 28 weeks, a fetus may have Primordial follicles
17 Decreased alpha-fetoprotein (AFP) levels can indicate ........... in a developing fetus Down syndrome
18 The umbilical vesicle contains Mucoid tissue
19 Spindle proteins are synthesized during the .... phase of the cell cycle S phase
20 An infant born without limbs, this condition is termed as? Amelia
21 A G3P2 lady presented for antenatal visit. Her Symphyseofundal height is more than her Anencephaly
age of gestation. On USG she has more amniotic fluid (polyhydramnios). Which of the
following fetal condition can be responsible of it?
22 Major gross structural birth defects in a developing human are induced by teratogens 3 - 8 weeks
during week
23 Gastrulation begins with the formation of: B
A. Neural tube B. Primitive streak C. Notochord
D. Prechordal plate E. Epiblast

24 Pre-eclampsia, a condition characterized by maternal hypertension and proteinuria, is C

caused by:
A. Constriction of maternal blood vessels B. Diabetes in mother
C. Trophoblastic disorder D. Rupture of spiral arteries

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E. Incomplete formation of umbilical vessels

25 In a pregnant female who suffers from Rubella virus infection, the fetus is prone to have: A
A. Congenital Cataract B. Intellectual disability C. Limb defects
D. Cleft palate E. Microcephaly
26 Microtubule synthesis in which phase? G2
HISTOLOGY
27 Scanning electron microscope uses Electron beam
28 Gap junctions and tight junctions are types of Intercellular junctions
29 Simple columnar epithelium is present in the lining of the digestive tract, including the Stomach & intestine
30 While studying the staining properties of the tissue/structures, which of the following is the A
feature of a Basophilic substance?
A. Attracts acidic dye B. Attracts basic dye
C. is itself basiphilic in nature D. In a cell is cytoplasm
PHYSIOLOGY
31 Smooth endoplasmic reticulum is involved in the formation of? Lipids
32 Blood pressure regulation: Negative feedback
33 What type of movement is associated with a track-like motion Linear movement
34 Which organelle is not responsible for forming enzymes but are involved in energy Mitochondria
production?
35 Active transport is carried out by Protein pumps embedded in
cell membrane
36 Which of the following organelle is produced by SER? Peroxisomes
37 All cells which synthesize, segregate and secrete proteins usually: D
A. Are rich in mitochondria and SER
B. Have multiple nuclei
C. Are acidophilic on staining
D. Have abundant RER and golgi apparatus
38 Which of the following conditions will stimulats the formation of erythropoietin and C
increase the red blood cell count:
A. Atrophic gastric mucosa B. Liver diseases
C. Pulmonary diseases D. Infections in body
39 The laboratory investigations of a 28-year old woman having four children shows; B
Hemoglobin= 7.5 gm/dl, HCV 80 FL, Iron binding capacity is increased, reticulocyta
count=0.7% and a blood smear shows hypochromic, microcytic red blood cells. She is most
likely having
A. Aplastic anemia B. Megaloblastic anemia
C. Iron deficiency anemia D. Autoimmune hemolytic anemia
40 Which cell type migrates into inflammatory sites to clean up necrotic tissue and also play A
Important role in initiating development of antibodies?
A. Neutrophils B. Macrophages
C. Basophils D. Eosinophils
41 Fluid exudation into the tissue in an acute inflammatory reaction is due to which of the D
following?
A. Decreased blood pressure
B. Decreased protein in the interstitium
C. Obstruction of the lymph vessels
D. Increased vascular permeability
E. Increased clotting factors
42 Which of the following provides second line of defense?
A. Already available neutrophils

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B. Presence of tissue macrophages

C. Increased production of lymphocytes
D. Increased production of granulocytes
E. Increased production of monocytes
43 Example of negative feedback mechanism? BP regulation
44 Golgi apparatus involved in formation of? Lysosome
45 A young man has no AB antigen and Rh antigens in his blood. His blood group is: O negative
46 Postganglionic sympathetic nerve fibers to the sweat glands secrete: A
A. Acetylcholine B. Histamine
C. Adrenaline D. Noradrenaline
47 Sympathetic response mediated through beta adrenergic receptors is: A
A. Bronchodilation B. Vasoconstriction C. Intestinal relaxation
D. Bladder sphincter contraction E. Pupillary dilation
48 The neurotransmitter secreted by both preganglionic sympathetic and parasympathetic A
nerve fibers is:
A. Acetylcholine B. Epinephrine
C. Dopamine D. Nor-epinephrine
49 Which of the following cell organelle is considered rich in hydrolytic enzymes? Lysosome
50 Hb synthesis begins in Polychromatophilic stage
BIOCHEMISTRY
51 Calcium mobility from intracellular source is increased by: IP3
52 Which nucleotide is involved in glycogen synthesis? UDP
53 What type of bonds form between purines and pyrimidines in the DNA double helix H bonds
structure?
54 During DNA replication, which strand is synthesized discontinuously in short fragments? Lagging strand
55 Which of the following drugs is used to treat Gout? Allopurinol
56 During protein synthesis on ribosomes, which enzyme is responsible for catalyzing the Peptidyl transferase
formation of the polypeptide chain?
57 In DNA replication, what enzyme is responsible for filling the gaps between Okazaki DNA polymerase
fragments on the lagging strand?
58 Orotic Aciduria is treated by? Uridine
59 Enzyme deficient in I-cell, also known as mucolipidosis II, disease? N-acetylglucosamine-1-
Note: Actually Full form of deficient enzyme was asked phosphotransferase
60 Enzyme deficient in Refsum Disease... pAH (phytanoyl-CoA
hydroxylase)
61 If enzymes are heated at 47°C, what will happen? Enzyme denaturation
62 Biotin is covalently attached to the enzyme. This linkage is termed as Coenzyme Prosthetic group
63 Which of the following enzyme catalyze phosphorylation? Kinase
64 Which of the following enzyme removes phosphate group? Phosphatase
65 The major lipids present in the mammalian membrane are: B
A. Cholesterol B. Phosphoglycerides
C. Sphingomyelin D. Glycosphingolipid
66 Lesch Nyhan syndrome pathway deficient? Purine salvage
PATHOLOGY
67 Commonly used disinfectant to sterelize heat sensitive material? Ethylene oxide
68 Calcification of a tissue without disturbing calcium metabolism? Dystrophic calcification
69 Bacteria prepares itself for division in which phase? Lag phase
70 Process of white blood cells moving through blood vessel wall to reach tissues? Diapedesis
71 Gram-positive bacteria are differ from gram negative bacteria because gram positive Thicker peptidoglycan
bacteria have

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72 Programmed cell death is called? Apoptosis

73 Substance to purify swimming pool water? Chlorine
74 Penicillin against bacteria is most effective in Log phase
COMMUNITY MEDICINE
75 The components of the epidemiological triad are. Host, agent & environment
76 Disease causation is influenced by a complex interplay of multiple factors at various levels, Web of causation
including individual, interpersonal, community, and societal levels. This model is known as
77 Most acceptable indicator of health of whole population and of socioeconomic conditions ? IMR
78 The behavioural change interventions in which people are informed about choices & they A
change behavior voluntarily that is conductive to health is termed as
A. Health promotion B. Health protection
C. Secondary prevention D. Primordial prevention
BEHAVIORAL SCIENCES
79 Which structure stores the emotional association of memory. Amygdala
80 Memory is stored in which structures? Both amygdala & hippocampus
81 A diseased patient don‘t want to seek medical health. He believes he will regain his health Health belief model
by prayers. Which type of model?
82 After road traffic accident, a 32 years old patient find it very difficult to express emotions B
despite of the strong desire. Blood analysis shows some abnormality in the dopamine &
serotonin levels. At functional level, both the dopaminergic system and the serotonergic
system' neurons project into
A. Limbic And Prefrontal Cortex B. Amygdala And Hippocampus
C. Amygdala D. Pons
D. Pons and Limbic
83 A 30 years age, after the road traffic accident is very concerned about his role as, student, C
teacher, friend and sole breadwinner. The multiple role Mr. A possessing, which are
compromised because of his illness are best termed as?
A. Dynamism B. Optimization
C. Self-efficiency D. Self-efficacy
84 A 31 years old obese patient, after the diagnosis of type II diabetes, are not complying with B
the instructions regarding Insulin use. Patient is arguing by saying that once I started using
this injection (Insulin), it will never leave me until my death. This behavior of patient can
best be explained by:
A. Transference B. Resistance
C. Burn out D. Distress
85 A 35-year-old woman with severe heart failure is advised by her doctor to undergo a heart A
transplant. However, she expresses hesitation and declines the procedure for the time being.
This scenario illustrates:
A. Refusal of treatment
B. Resistance to medical advice
C. Non-compliance with treatment recommendations
D. Transference
PHARMACOLOGY
86 Two drugs acting on different receptors & producing opposite action, is termed as? Physiological antagonism
87 What term in pharmacology describes the interaction hindering the effect of another drug? Antagonism
88 Antidote for a drug overdose is given through which route? IV route
89 Alpha adrenergic system causes? Vasoconstriction
90 Preganglionic nerve fibers release which of the following? Acetylcholine
91 A drug with bitter taste is better administered Rectally
92 Bioavailability Amount of drug reached
systemic circulation
93 Drug to treat small cases Orphan drug

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֍ANNUAL & SUPPLE 2024 HELD IN 2025֍

GROSS ANATOMY
1 Which of the following is a bipinnate muscle? Rectus femoris
2 What is the term for incomplete or partial dislocation of a joint? Subluxation
3 Which plane divides the body into right and left halves? Sagittal plane (median plane)

4 Fibrocartilage is found in: Menisci of the knee

EMBRYOLOGY
5 Implantation is complete by: 12th day
6 Partial splitting of the primitive streak or node occurs in: Monochorionic diamniotic
7 The first occipital pair of somites appears on: 20th day
8 Which procedure is performed before week 14 of pregnancy? Chorionic villus sampling
9 Preeclampsia, characterized by maternal hypertension and proteinuria, is caused by: Cytotrophoblast incomplete
differentiation
10 Gastrulation, the process of organ formation, is initiated by: Primitive streak formation
11 Primary oocytes are arrested in: Prophase I of meiosis I

12 Metarterioles open into Capillary Bed

13 Implantation completes in 2nd Week
HISTOLOGY
14 Microvilli are present in: A
A. Intestine B. Bronchi C. Trachea
15 Reticular fibers contain: Type III collagen
16 Integral proteins are formed by: Ribosomes attached to the RER
17 What is used for bright light microscope? Paraffin
PHYSIOLOGY
18 Where are IgE receptors located? Basophils
19 A person under family pressure, feeling antisocial and guilty, has which system stimulated? Sympathetic system
20 A person who lost 2L of blood in an accident, heart is not pumping normal. What will Positive feedback
prevent further weekening of heart?
A. Positive feedback B. Negative feedback
C. Delayed feedback negative D. Adaptive feedback
21 The neurotransmitter involved in both sympathetic and parasympathetic systems is: Acetylcholine
22 In the sympathetic nervous system: Respiration rate increases, and
airway resistance decreases
23 Which organelles are self-replicating? Mitochondria
24 Receptors detecting environmental changes at a distance are called Extero-receptors
25 The protein that combines with antithrombin to increase its action is: Heparin
26 A drug that increases heart rate binds to which receptors? Beta adrenergic
27 Which organelle is responsible for the inflammatory response? Lysosomes
28 After entering the general circulation, invaders are phagocytosed in the: Spleen
29 The protein involved in walling off infections is: Fibrinogen
30 Tissue macrophages are derived from: Monocytes
BIOCHEMISTRY
31 The outer leaflet of the cell membrane contains: Phosphotidylcholine
32 The fibrous structure of collagen is maintained by: Covalent or hydrogen bonds
33 In sickle cell anemia, glutamic acid is replaced by: Valine

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34 Chaperones are used for: Folding proteins

35 The backbone of DNA is composed of: Phosphate and sugar
36 Alpha chain depletion in alpha thalassemia causes: Hydrops fetalis
37 Which of the following is a basic amino acid? Histidine & Lysine
38 An amino acid found in collagen is: Proline
39 Michaelis-Menten equation relates to: Enzyme kinetics
40 The marker of acute pancreatitis is: Serum Lipase
41 The number of base pairs in one nucleosome is: 146
42 The tertiary structure of proteins is stabilized by: Disulfide bonds
43 Statins are: Competitive inhibitors
44 Lead inhibits which of the following enzyme in heme synthesis: ALA dehydratase
45 The Schilling test is used to detect: Vit.B12 deficiency
46 Which act as template for protein synthesis? A
A. Mrna B. nhRNA C. tRNA
PATHOLOGY
47 A condition characterized by bluish discoloration of the skin, enlarged spleen, and platelets Thrombocytopenia
of 90,000 is called:
48 Programmed cell death is called: Apoptosis
49 The commonly used fixative in pathology is: Formalin
50 What occurs in reversible cell injury? Microvilli damage
51 A mother with a positive blood group conceiving a negative blood group child may Erythroblastosis fetalis
develop:
52 Surgical glovs are sterilized by: Autoclave
53 Vibrio cholerae infection causes: cAMP increase
54 Antibiotics kill bacteria during the: Log phase
55 Bacteria attach to one another using: Pilli
PHARMACOLOGY
56 A drug that binds to another drug instead of receptor sites is called a: Pharmacological antagonist
57 A drug that increases heart rate binds to which receptors? Beta adrenergic
58 A drug with basic pH is absorbed in the: Jejunum
59 Alpha adrenergic stimulation causes B
A. Cardioacelration B. Dilation of pupils C. Constriction of pupils
PUBLIC HEALTH
60 A patient with cardiac failure showing poor drug compliance likely has: Depression
61 Awareness about disease in schools is an example of: Primary prevention
62 A patient diagnosed with HCC starts taking alcohol; which Health Belief Model (HBM) Perceived severity
aspect applies?
63 Mortality rate calculation 96
64 A sharp medical student detecting lies has high activity in: Paracortex (dorsal cortex)
65 Which of the following is not a mortality indicator? C
A. Fetal death B. Maternal mortality C. Death due to specific disease It’s a morbidity indicator

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