e e good morning everyone I hope I'm audible can you please confirm whether my audio and video is fine good morning sir yes sir you AUD thank you okay all right so um I hope you people have started reading right but I I'm very very sure that a lot of you are unable to do that so this is absolutely okay um first of all there are lot of rumors which are going on about the exam happening in September there is no confirmed news on this so please unnecessarily do not go into the Panic that this is going to happen um we are expecting that uh we going to get the confirmed news about the exam date in this particular week let us hope uh what day is today I think uh today is wedness day so let us hope that wednessday Thursday Friday in these three days we should get the date for the exam as I am thinking we have already discussed it so many time that uh consider that we will get an at least 15-day notice uh um between the exam date and the notification and this is a minimum notification that I feel that we should get we already started um a way to do the paper um uh daily one paper till the time the notification is not coming um but I have got lot of lot of messages on this which says sir we are unable to maintain a schedule I believe that the single most important thing in your preparation is discipline and we have already spoken about it the today onwards we're going to follow two strategies because I got some messages from the student that they are very happy with this paperwise schedule so if you are able to maintain it and if you are following this paperwise schedule I will still give you the paper right so uh for the students who are joining new just to tell them that um every day you will do one paper that will be told to you today and you have to do that paper and you are not supposed to read explanation from the app you're supposed to read that particular topic from your notes this will give you a revision of all 200 topics from your notes and it will give you a sense of completion that you have revised all 19 subjects right so that is how this is going to be the first so today we going to be doing neat PG 2018 paper neat PG 2018 paper we will be doing all right however if you are among those who could not follow this in the last two days we already have done two papers 22 and 20 if you are among those who have messaged me that sir I could do only 60 topics or I could do only 70 topic that mean this discipline is not for you that means you need a subject-wise discipline and in order to do that from today we are starting the revision of one shot on dbmci YouTube channel there were some um challenges that the student were facing in doing it on urup so now we have as it is already complimentary to all the students so we are now from today onwards doing the onot program on YouTube all right now what is an idea why we are doing it that you need to understand um students have an access they can go to the app also and they can watch it whenever they want the problem is whenever you want Never Comes This is the biggest challenge the moment you think that you have it and you will do it you will not do it so ultimately you have to do it in an in a structured time based Manner and that is the biggest concept of what we call as coaching so we want so that you are not wasting your time and you are completing one short program in a town time bound manner if I'm going to show you the schedule of that just give me a sec uh I I think you have the schedule but just give me a sec if I have to show you the schedule the schedule I have to take it e I'm sorry sir but you're not audible sorry for this yeah so uh I have divided them into medicine and surgery so first we're going to start today with physiology 26th of June today then pathology microbiology pharmacology and it will be very very easy for us to do the medicine after that and then Psychiatry biochemistry PSM forensic medicine and dermatology and then we're going to move to the surgical subject which include anotomy Orthopedic Radiology it will be easy for us to do the surgery after that and then anesthesia OBG pediatric Opthalmology and ENT right so these are the subject that is how it is to be done now the point is what you have to do every day in the morning you have to attend this session 8:45 to 9 if you are a dbmc student you have a privilege to join the zoom session if you are not a dbmci student then you can attend it on YouTube and know that is the only difference there is nothing else but after this session you will immediately start the physiology session all right so it will be on dbmci YouTube channel it has already been started right now this session live streaming is going on for that that moment the session will finish your physiology onot revision my request to everyone is if you even if you have done your physiology well there is no harm in doing it again because that will be a quick recap or a quick revision of your entire subject all right the PDF of this will be available to you on a dbmci telegram group on dbmci telegram group it will be given after this will end at the end I'm going to come back again and I'm going to give you a code and you can use that code to solve 100 customized questions of physiology on urul app those questions have been thoroughly verified and you will not face any challenge in them right so that is how it has been done now before we go forward I have some quick questions for you and I want an answer from all of you now let us see how you want to Mark the the answer there are some quick physiology questions that I have prepared for you okay let's see how you answer them okay these are simple questions non um integrated questions that I have prepared for you okay number one which part of the Nephron is primarily involved in countercurrent multiplication system which part of the Nephron is primarily involved in counter current multiplication system oh very good you don't need choices for this yes answer is loop of En Loop of La very good number what determines the movement of fluid across capillary membrane according to Starling Force what determines the movement of fluid across capillary membrane according to Starling forces you have four choices let me give you the four choices hydrostatic pressure and anotic pressure hydrostatic pressure and osmotic pressure oncotic pressure and osmotic pressure and hydrostatic pressure and colloid osmotic pressure and those who are writing op don't be smart op the answer is hydrostatic pressure and anotic pressure and hydrostatic pressure and quatic pressure I'm asking you very very straightforward question so that you can assess yourself that what is your basic knowledge of physiology right okay number three the chloride shift or hamburger effect in a red blood cell is crucial for the hamburger effect or a chloride shift in a red blood cell is crucial for option number one maintaining pH balance option number two maintaining electrochemical equilibrium during CO2 transport option number three oxygen binding to hemoglobin or facilitating oxygen release in tissue yeah so answer is simple it's option two maintaining electrochemical equilibrium during CO2 transport okay all right uh next helan effect primarily describes what carbon dioxide influences oxygen binding to hemoglobin oxygen influences carbon dioxide binding to hemoglobin pH influences oxygen binding to hemoglobin and pH influences carbon dioxide binding to hemoglobin repeat carbon dioxide influences oxygen binding to hemoglobin oxygen influences carbon dioxide binding to hemoglobin pH influences oxygen binding to hemoglobin or pH influences carbon dioxide binding to hemoglobin answer is option b oxygen influences carbon dioxide binding to hemoglobin okay I'm going to share these questions along with their explanation also with the with you soon okay all right last question before we move to the physiology revision a pushing reflex is characterized by all of the following except pushing reflex is characterized by all of the following except hypertension bre cardia teia irregular respiration a Cushing reflex is characterized by all of the following except hypertension bradicardia teia irregular respiration answer is teia okay it is teia all right so the point is that I have I have asked you the very very straightforward question initially I made lot of tricky questions but then I thought it's a first day let's not make too much of tricky question let me make very very simple questions but just ask yourself that are you able to do all correct okay the idea here is all correct now if you have done it wrong that means there is a scope of improve Improvement you can improve it to till the time till the time our exam is not happening we are not stopping and we are not stopping if I was scoring 160 170 correct in the GT if I was scoring Less in both the conditions you do not have an option that you are stopping all right so that's all for this particular session if you are attending it on Zoom open up dbmci YouTube channel and start with the physiology my request to everyone is please do it and it will be very very useful for you you will thank me in the exam that your preparation has come back onto the track if you're going to do this and after that we will also be solving the question paper we will be solving question paper it's not like because knowledge enhancement and knowledge testing should go together so every day morning we're going to make sure that we have a reason that why we are studying today in this 15 minutes we'll do some brainstorming session some rapid fire round sometime mcqs something till the time your exam is not happening I am not leaving you I'm going to make sure that I will try my level best that you remain disciplined But ultimately it lies with you that whether you are able to remain that at least for that particular day because next morning I will come back again all right so take care and please make sure that you are going back and watching and you are not waiting without a second thought all right CH take care and we will meet tomorrow so am I audible visible yeah okay so let me ask when they will give you the link I'm just waiting for everyone to join in okay so as they have informed the link is already there I think now is audible please check now it must be Audible The Sound is on okay okay so get ready for this physiology one short okay and the idea is to cover this 27 pages in the next 5 hours that is five page per hour is the speed velocity so 5 page per hour and we'll be covering each and everything that is need to clear the exam and whatever graph I'll tell you the secret cheat code of solving the graph like when you see a l SLA comes in the mouth that is what the same thing you see the graph answer comes to your mind that is what we are going to discuss andar link no link still link is not available so yeah it's like the batsman is ready to hit a ball but there is some you know like delay because of maybe screen issue or maybe something so I'm still waiting no link increase the volume okay I can increase that okay so I increased the volume okay am I now same or more not it's just like relationship okay in a relationship problem might not be always from both side one side but again the other side will also have to cooperate maybe suffer also otherwise breakup can occur so that is why my advice is we wait for the other side to also come and join otherwise it like a marriage in a marriage if the some party members don't join then it's going to create big fight later on so better wait otherwise it'll be a very big issue so I'm waiting for that okay yeah see got it yeah people are getting it okay so yeah so that's why I don't want anyone to have negative repercussions okay because anyhow people are very you know like sensitive nowadays they can't take any kind of what do you say humor also okay even smallest of the humor they become very violent so now this is difficult to even joke in the classes yeah so let's continue should I start now everyone yeah it feel more like not a train but like a bus why bus a bus doesn't run on time it run only when the passengers are full so that's why the conductor the driver keep on waiting let's say the bus is 6:00 no like Delhi jaur or you're going some other place so he say let other passengers come then only the bus will start so passengers can join at their own so that's what the feeling of the yes class is we are waiting not for time 600 p.m. it is when everyone get the link so I think it is done screen screen is already full screen yeah yeah okay okay just keep wearing headphones and don't open it in the house maybe some jokes are not appropriate for family audiences yeah I see my jokes are in English but do sometime the kick word a difficult to come in uh English Okay clear now in English I say ta what is TA now I can't explain what is TA in English so that's why you cannot convert it to English properly okay like saying someone Dash got T so you will say what's T maybe shirt t-shirt that's why sometime is difficult to translate all the jokes so please let's learn and let's start okay so we are going to start with the first general and cell physiology okay I'm starting all the passengers on the B very good okay very good enjoy okay yeah don't spill the Shake while laughing okay yeah it can cause aspiration and aspiration is most common to the right lung left lower lobe because the right broncus is wider again clinical correlation okay tell let's continue first is the general cell physiology what the unit of cell everything is Life Cell is the unit of life every living thing is made up of cell covered by a layer col cell membrane and cytoplasm which contain every Mal Masala everything nucleus cytoplasm contain mitochondria Etc now let's come to the cell membrane so first question is the best model okay for cell membrane was singer Nicholson fluid mosaic model I'll highlight this what I add I will add so fluid mosaic model it contain lipids and protein and remember what is more proteins are more so not lipid but proteins are more and the main lipids are phospho lipids so phospholipids are our main lipids and these phospho lipids which are our main lipid what is the speciality they are having first is they have a polar head which is charged so remember anything which is charge is polar and they are hydrophilic so remember charges salt ions anything which have charge they are water loving and the non-polar tails are made by what they are made by our lip bit chains that's why they're hydrophobic so the two part water loving and water hating and that's why they are arranged as byar with proteins in between so this is our cell membrane heads are on the outer ends okay I think now it's okay yeah sorry there was some glitch yeah now it's clear yeah so actually there was an internet glitch so I had to turn on the other connection okay sometime when your main connection is not working immediately start your backup connection okay clear so always keep backup okay in your car there should be a stepne in your life also always keep a backup okay but there's no backup of ambus profession you're either a doctor or you are nobody okay so that's why backup field okay so some things there's no backup relationship also don't keep backup otherwise this relationship will not survive okay so now we discuss the functions of the lipids so functions are number one they give Integrity so lipids are having a stickiness chipu chipu so lipids stick to each other and create the membrane so integrity means yes combination okay clear then come flexibility what is flexibility they're very flexible so the membranes can easily split into two can stretch that's why osmosis or there is a water coming water going phagocytosis all are possible because the membranes are very flexible but the main property is our property of what it is the property of solubility now what do you mean by solubility it means anything which is lipid soluble can cross the membrane without any hindrance example gases or fat soluble hormone like thyroid steroid so they are hardly yes water soluble in this case clear so they are highly yes what soluble yes lipid soluble and also vitamin A d e k whereas water soluble cannot cross why remember water soluble things are blocked by fat that is why they need proteins to help them so summary summary what do water soluble needs water soluble need proteins and what do the proteins act as number one for charge particle we use Channel charge channel so channels are used for which particle ion channels or pumps okay pumps use ATP so don't forget this pump use ATP how I'll discuss later then water use Aqua porin which is a water Channel then solutes like sugar amino acid UA or all this they use carriers example glute which is for glucose transport then water soluble hormone neurotransmitter they cannot enter the cell so they use cell surface receptors for their action again they all are water soluble substance and finally proteins can act as antigen enzyme cell marker example MHC or H antigens enzymes are so many adile cyes Gile Cycles phospholes so they are all proteins okay now we'll discuss our body water so body water how much of the water is there in the body so 60 to 70% of the body weight is made up of water so if you put someone in a machine which can extract all the water like not that Ghana juice machine you put the speed is good I check the speed see speed okay now what I did was I went back to the older land connection okay so when the first connection switch off I immediately removed the landan cable and started the Wi-Fi now the Wi-Fi was having problem so I switch back the land connection but you went from first to second even second ditch again you go back to the first one so something like that happened recently okay clear okay yeah that's why never leave the first original plan okay CH let's come back okay okay audio video sync is gone it's okay audio is lagging okay let me just check it I'm taking class since morning and there was no issue okay everything was fine yeah okay let me just I think now I'll be okay yeah now it's fine yeah I can check myself it's coming fine I can do a test one 2 3 yeah now it's fine see it's fine yeah good good okay so that's why life is just like this also okay in exam if you get two three tough question in the initial phase don't think entire paper is going to be tough clear why because we get a mindset oh first question T second T all will be tough no the next might be easy so be positive always okay CH let's continue okay yeah fine so 2/3 of the body water is inside the cell it is called as our I CF it is ICF and 1/3 is called as the ECF so 1/3 is ECF and 2/3 is our ICF now the ECF is divided into two part 25% is plasma inside the vessel this is the plasma the yellow part and the liquid which is between the cells and vessels is called as intertial fluid which is also called as tissue fluid and this tissue fluid help form lymph so lymph is formed from what it is formed from the tissue fluid where is tissue fluid present it present outside the cell and outside the vessel so the space between the two is called as our yes intertial space intertial space don't know what the issue today is speed is good it's not having any issues here yeah my end is going fine it's perfectly fine see I'm checking my own end at my end there's no problem it's coming fine audio video sing so please you yes check your end make your app restart maybe because of that it will come so restart the app that's the only advice restart the app not mine okay okay yeah yes yes so that's why sometime you don't understand the problem okay like a guy comes home and the wife put a note on on the fridge sticky node and it is not working I can't take it anymore I am leing Forever by now the person he wife is not there all her stuff is also not there now he's very tense he open the fridge and see the fridge is working now he's wondering why she said she's it is not working the fridge is working why she left is she mad left just because the fridge is not working maybe when she was there so again sometimes very confusing okay CH let's continue yeah so yes if there's a tumor which will spread first it will go to indium and then go to lymph node so first site of Matas is the lymph node because all the cell drop into indium then go to lymph and lymph node okay let's continue all exchange between cells and vessels occur where it occur in the interium so which area in the interium that's why it form the internal environment of the body and the internal environment is always maintained a constant state this is called called as our homeostasis homeostasis and homeostasis best regulation is negative feedback what do it bring value back to the normal so what bring the value back to the normal it is called as negative feedback and first question gain is given as correction by error correction by error and if correction if correction given before error before error can before change before change calls feed forward regulation feed forward okay example okay saying sorry to your partner before any mistake it's feed forward okay say sorry after mistake is feedback so feed forward is basically correcting example hypothalamus shivering occur even before the core body temperature can change so shivering before core body temperature fall otherwise the core will fall and correcting after the error is very difficult so that's why we correct it even before that okay clear even before that now how do you estimate the body flu remember we use D dilution method we put a d let the D distribute check the concentration and what is the volume amount upon concentration amount upon concentration what is the D use so there are three main Chambers yes I will share don't worry no need to write I will share this file if you can't read my handwriting then you write yourself if you can read this much then no need my file will be sufficient if you have difficulty reading my handwriting like I do then you have to take I myself use other students PDF for next session but again anyway there's a case okay yeah motor planning again so remember brain can do feed forward brain can do why because brain know what problem can be like you go to America and you buy a jacket after there or before before going that is a feed forward clear but Li doesn't know how much person will drink one bottle two bottle so liver cannot induce the enzyme before bar receptor cannot correct the BP before the exercise or shock is there so other system don't know what the error will be the only organ which can do brain so that's why feet forward is mainly brain you can write one word brain is the main organ so if there say feed forward the hint is brain is capable of feed forward brain can do feed are you clear brain next question what the D use so first for total body water so body water heavy water body water heavy see positive feedback is the value is increased same direction like if there's a one change the second change will cause increase value so when there's a same direction it is called as positive feedback so it is positive feedback so same direction same direction is positive feedback extra point I will take in the end let me finish this PDF so ifle time I can add extra otherwise I experience positive feedback because time is the problem now we cannot discuss all entire mbbs uh summary like one year mbbs syllabus of Phio cannot be summarized in just one session is like can we have a deliver of baby in 7 month maybe few months 5 6 months maybe but one day as conception tomorrow delivery not possible so we cannot do it very fast okay so total body water is heavy water like dyum oxide and titium oxide d2o and T2 d2o and t2o okay now ECF is inulin e e ECF inulin so ECF we measure with inulin heavy water is for body water plasma what is there in the plasma albumin for plasma we will go for albumin because albumin is present in the plasma so we can use radio labelled albumin so let me give a summary on other paper so I'm taking a extra paper also I'll add them later on to the main file so this is our main extra page file okay so let me give a summary so total body water what the division ICF ECF ECF two divisions it is if and plasma how much 2/3 1/3 this is 75% 25% then it is separated by blood vessel now what the formula for volume volume is amount upon concentration so the volume is amount upon concentration amount upon concentration is your volume now comes the question what is the yes D for this we use d2o for this we use inulin for plasma we use albumin which is Radio Lael some Radioactive radio label is our albumin albumin okay this the summary chart let's go back now transport across the cell membrane here n is missing so it is transport active and passive active uses ATP obviously why it is against the gradient that is going from low to high concentration okay and passive no ATP a gradient it is high to low concentration very simple like example studying versus forgetting what is active study because you are at zero knowledge level and you want to become an expert so that's why you're going against gradient forgetting it so easy don't study gone done done D done K Tata bye-bye so forgetting is passive and learning is active process very good very good good summary next question is types of the active there are two types primary active remember a very simple nemonic Papa Pump is primary Papa pumps are always primary any transporter coupled to a pump especially sodium sort they are secondary sa sa sa so sodium sorts are always secondary so remember the rule pumps are primary sodium sorts are secondary because they are coupled with sodium pottassium pump example sglt sodium amino acid transport sodium glucose all these are examples of the transport that we will see or we will have are you clear so these are the concept now remember sglt1 and sgt2 they are two type remember a very simple pneumonic git we have one git from which end from oral to the anal end so oral anal that is one git kidney have two until unless someone sold one kidney for some Noble purpose that is something like saving someone life or buying iPhone that is something then remember normally we have two kidney sgt2 git is one one gut one sgt1 passive in passive it always go from higher to a lower side it follow which law fixed law fixed law say the rate depend on the gradient so it say the rate depend on concentration depend on concentration and membrane area thickness which I'll discuss later now simple diffusion no carrier no carrier is used yeah okay yeah PDC kidney very good okay very good okay and take nephology in the DM then you can get one kidney extra implant it h best plan okay simple diffusion no carrier example oxygen CO2 if you use a carrier you use the help facilitate so carrier is facilitated carrier is facilitated example is glute so remember simple summary again I'm writing a summary copy the summary and follow it with me so I'm writing a summary please copy with me summary pump is primary pump is primary active sort is secondary active then carry carrier carrier is our facilitated diffusion and if none mention none none none then it is simple simple diffusion see I'm giving summaries also side by side pump primary Don't Close Your Eye Open the eye and click the pump okay if you see sort secondary active if they see carrier any carrier amino acid transporter Ura transport amino acid but not a pump or not not a simp facilitated nothing mentioned then it is simple diffusion now we'll discuss cell Junction so what are the cell Junction they are between the cell first is Gap Junction they made by connection and they allow current to flow so remember connection current so what allow current to go from one cell to other that is called as our Gap Junction or the protein connection protein what they act as synapsis current go through synapsis and they are present in which muscle they present in the smooth muscle and also present in our heart so smooth muscle and heart like uterus bladder git esophagus now what happens all the fibers contract together because of current spread through Gap Junction that is why they become ANP is also secondary active antiport is also secondary Port antiport sort they all are linked with sodium potassium pump are you clear so they are all secondary active antio secondary active now so what they are doing making single unit or cesium so how do you make multiple muscle fiber like so these are five fiber are they all beating together why because they connected by Gap Junction whereas if there were no Gap Junction it is pressing all fiber together Gap Junction tight Junction tight Junction are Zona udents what they do made by Udin protein and claudin what they do tight they are barrier so barriers are preventing any mixing and what are they made by tip Junction Udin Udin protein what they do prevent mixing of blood with the CSF blood with the urine blood with the Amo FL barrier and desmosome desmosome are cement they connect the stuff they are made by cadin protein or desmog in the skin they keep cells together so what they are desmosome keep cells together so I'm writing a summary copy this summary and it will help you remember so okay so I'm writing the summary I'll write here itself so remember the summary okay first is desmo protein is what cadherin and function is it is yes addition desmo cin then tight tight is Udin barrier tight is Udin barrier and then last is Gap Gap is connection and function is current so please revise it with me first question very simple summary okay desmosome cering addition of the cell tight Udin barrier function and what about about the Gap Gap are for current connection where present muscles so muscle Gap connection current desmo between epithelial and other tissue keep cells together and what are the barriers barrier are tight are you clear so let's revise desmosome which protein desmosome desmosome cadherin desmosome kaderin desmosome cadin TI Junction Udin TI Junction Udin TI Junction o ludin what are the Gap Junction connection Gap Junction connection primary active pump second reactive sort facilitated carrier nothing mentioned none ECF given by inulin body water heavy water d2o plasma albumin radio label and that is the summary of the topic how much time it took 1 minute 1 minute one system done now we start with the git I hope the speed is fine because I'm trying my level best okay yeah they are all part of Cam cell addition molecule C cell addition molecule they are a group of the family of protein which help in connecting the cell cell addition molecules is integr selectin that doesn't mean I don't want but I'm just wanting to keep it sweet and simple okay too much talking will lead to telling too much which you should not be telling that's why always talk brief and precise don't tell extra point okay CH next question is our digestive system four layers are there the innermost layer is our mucosa so mucosa is what ler innermost ler contain v and micro for absorption and there's a increase area due to our what due to our mucosa in this case Okay sub mucosa it contain vessel nerve lymphatic glands for secretion so what is for secretion lymphatics which are present in our submucosa and they are having the glands muscularis external contain the smooth muscle for mortality mortality motion contraction CA is the outermost leer is outermost so outermost is CA and it is for attachment absent in esophagus so they are absent in esophagus very good okay very good perfect perfect yes Sak Dr Sak is doing very good job so now we'll discuss anric nervous system so git has its own nervous system it is called as our yes anic nervous system it is two part misner and the orbec plexus misner plexus is also called submucus me secretion me s is for secretion and location is where where are the glands present sub mucosa so sub mucosa sub mucous plexus remember me secre I am in which area I am in sub muosa whereas or back or back Mayo mayo means muscle muscle is for movement so where is the muscle mic plexus also called as or back so or back is what it is for the movement or back don't forget now ANS autonomic nervous system remember sympathetic is for fight or flight when you are doing fighting flighting and running git functions are very bad why git functions are what eating defecation and that means you need to be stationary now to eat or do party you have to sit and what the sympathetic want to sit or run suddenly tiger appear so what should the rabbit do hey wait two minute can't you say I'm busy no is the time not to do suu poy but to run so that is why the sympathetic shut down the party it shut down the git and say don't do it now we'll do it later much better all life don't do it now even this is not the time to make babies H when you are alive you can make babies later so that's why inhibit erection also why this is not the time to have intercourse and make Next Generation make it next time okay and parasympathetic is rest and digest now is the time to do all pleasure giving activi remember parasympathetic is param anandam system aha ha all the things which give you pleasure pleasurep when you eat ah so much flavor that is what git then when you do urination aha bladder relief then erection interpose oh so all the pleasure activities sleep rest is given by parasympathetic so para is for yes relaxation and relief now git contain its own pacemaker who is the pacemaker kahal cell it's not kaj it is kahal ejaculation sympath why because during intercourse there's a increase in what sympathetic activity heart rate inter when the person is humping and inserting the penis again again it's like a exercise increase in BP and then sympathetic cause the contraction of V difference ejaculation so that is why ejaculation I'm doing it in very fast fast manner okay just like rapid rapid rapid okay CH so let's continue okay who is the pacemaker is the kahal cells in the orbec plexus remember all contraction done by cells in the orbec plexus that is the case okay what do they make they make slow activity yes very good very very good keep writing the summary so they cause slow wave also called as b r what is B basil electrical Rhythm it's a very slow activity in the membrane electrical activity which when coupled with stimulus like food distension calcium AC git hormone like mlin they causes increase in the spike these spikes are like action potential increase the calcium calcium bind car modelin activate mlc which is myosin light chain kyes myosin light chain kyes and it will break the ATP cause contraction and these contraction cause git movement who's having the highest BR deod num because deod num has to empty the the stomach into the other parts so dium is the fastest who's the slowest seeum seeum is the slowest that's why most of the obstruction or intestinal TV Ur here near the seeum that is ilocal Val so revise tell me who is the pacemaker of G pacemaker kahal cell or the location location B the location it is which area it is our orbac plexus very good what current it make b e r v r plus tumulus what does stimulus make what does stimulus make by Trick simple highest is diam lowest is seeum that's it no trick needed that is more than sufficient values don't fall for values values are not important rarely they ask exact values what they ask is the concepts I'm telling you okay it create what spikes Spike increase calcium then call modelin mlck and contraction so that is a story BR stimulus spikes calcium car modelin ml CK and remember what does do contraction and movement what the minimum BR where is minimum BR anyone minimum BR minimum minimum minimum minimum b r tell me minimum yes it is our seeum is slow C see slow slowest so slow slow so she come and work she she come very slow so made come very slow she come she come very slow okay and Max BR who is the maximum BR Max BR it is our de some books have given Elum no no no no no it is seeum it is diam both are the answer B are is there okay so I hope you are yes not feeling stress because we will cover everything we have the time we are on page number three and we are on track okay so what are the git M remember peristalsis so first is peralis per when you eat Pani Puri or when you eat Perry Perry chicken you have food that is causing food movement now what the mechanism when you eat food the food cause distension so who's causing distension food cause distension release the the neurotransmitter now remember who sit in the front row of any award function celebration front VIP people and nobody else so remember who sit in the front of any award function VIP and what VIP do relax enjoy so relax so who's in the front VIP relax VIP relax Ordinary People arm J Ordinary People where are they sitting at the backside and what they do all do cont contration remember all contraction all cause it except ANP so who caus the relaxation ANP what is causing the contraction all so AC 5ht substance P even histamine dopamine all cause contraction and what the result if there's a contraction from the behind and relaxing in the front this will cause the forward movement of the food so remember this and if NP are defective it cause accasia cardia so VIP ano defect causes acalasia cardia clear birds beak appearance clear spinter doesn't open now reverse peristalsis is nothing but vomiting same thing opposite direction okay now MMC what is MMC migratory mot complexes also called as hunger pants like what you are feeling right now is MMC why dinner's time is not there dinner is 8:00 so that means you are feeling some boom boom boom boom boom boom boom this boom boom in the stomach is called as the MMC hunger pants okay so they are produced by empty stomach that's why call as what hunger panks food food food hunger PS and why they called as broomstick they clear the old content of the git and make space for new like hostlers what happens after your internship is over hosters remember the new guest are coming so what clear the git of old content and prepare for new food it is our MMC so just like the yes waiter clean the table before next guest can come and eat that is what MMC is MMC duration is around Century 100 and food when you eat it decrease the MMC start peristalsis so when do you see peristalsis when you eat the food peristalsis before the food MMC now mlin what do Morlin will do Morlin mlin okay so Morlin from the m o cells of stomach deod num increase all movement and this is our beloved Pharma answer it causes Pharma vaa answer example oral drugs they release Morin and cause n v d nausea vomiting diarrhea so PHA teacher what the side effect of sosia tell me side effect of matol sosia Sir nausea then examiner say which drug doesn't cause nauseating sir antiemetics see and you become champion of the exam so that is the story here okay fine now mass movements they are for which function they are for defecation and they produced by ganglionic cell let me make it easy for you remember as SS s ass is a slang word for gluteal region and you use your ass your gluteal region to sit and do the party so ass movements are defecation ass and what is the slang word for ass in Hindi language it is our gang leic cell never ever forget permanent lifetime memory okay so that is the case Okay so is it clear enough so remember mass movement is for defecation and the cell are ganglionic cells okay frequency 1 2 3 times a day so we can do party one to three if there's a absence of the ganglionic cell the person cannot do party he cannot do yes defecation is called as hrun disease or a ganglionic mega colon easy so that is the case and please don't say Sir what about this vulgarity ass Etc they people are shaking their ass on kacha badam becoming C abilities can't we use this term as to learn and become at least good doctors vulgarity with a purpose is fine vulgarity without purpose just for titilation provocation is not good so I'm using it for educational purposes okay CH so as is for gluteal region okay so now comes the question it is also we need what we need very good bulk of the feces for proper bowel movement what do we need very good yes bulk of pieces for proper Bell movement and what increase the mass is dietary fiber okay so that is why it causes cellulose lignin pactin kittin inin they all are dietary fiber okay so I'm giving a summary I'll write the summary here so first is food I'll use blue color pen food causes fairy stalis pces causes Mass fasting you see MMC and vomit you see what you see the anti peristalsis so this is a summary okay let's move next there are three phases of digestion first is seic Phase what is seic Phase when you smell or see the food your brain especially the ainger wasall nucleus it increase parasympathetic which cause increase in the SLA okay it's an example of feed forward regulation feed I'll write here so it which regulation feed forward response feed forward okay and second question some people is so strong they don't even need the food just the thought today marriage invitation food will be there and they start salivating so that's why saliva can come even before the food gastric is when the food enter the stomach vas M1 and gastrin from G cell it cause maximum SC secretion and also cause increase in the gastric empty now remember one rule when the food and SC enter deum it causes intestinal phase who are the mediator remember all except gastan so the rule is remember intestinal what the rule all except gastrin are involved in what in our intestinal phase what are these all they are secretin cck GP Gip anog gastron VIP Amin and what they all do they all inhibit SC secretions right all inhibit SC secretions so what they do they inhibit HCL secretion and inhibit gastric emping so what they are doing inhibiting the sccl secretion so that is a rule so the rule is they all decrease and decrease gastric empting and what they increase alkaline secretion what they increase alkaline secretion like pancreatic bile also increase insulin this is by glp and Gip they are called as intin hormones what they are called as I'll write here intin hormones in okay now what are colics they are substances which cause bile secretion like cck exra example cck and most poent example cck pz now bile is the most potent and other substances are gastrin ctin cck all are our coltic ctin but most important are bile salts and bile acids and who make them liver make them from the cholesterol now comes the question saliva saliva Maxum come from where it come from the submandibular gland so it come from submandibular gland 70% at rest the pH is acidic around 6.8 but the moment you start eating the food the pH of the SLA become alkaline McQ because of what because of the secretion of sodium potassium by so remember first question what is the saliva of the uh this is pH is acidic after eating it become alkaline so it become alkaline now functions number one saliva can have physiological and non-physiological function like saliva can be used for insulting people to spit on you that is insult but insult is not physiological it's a social function I will not Rite or counting the money say but again it's not physiological or stamp nowadays stamp is not there but still people use SLA for other purposes also that you already can understand so physiological function number one is lubrication lubrication of food then taste is not making basically dissolve the food dissolve and break food bya enzyme so dissolve and break food okay so don't mind my sense of humor okay I am myself very stressed because of excessive work daily I work 10 12 15 hour record app also take daytime class also so I get so frustrated I want some Outlet humor is a mature ego defense mechanism Psychiatry for you so I use humor as one of the best method to yes take my frustration out and keep my ego intact okay yes it's not very dark don't worry okay so mastication swallowing antibacterial IG g a zinc defensin lizine they all are antibacterial in this case so they all are antibacterial okay yeah sometime people are very serious maybe bit on the depressive side maybe low mood tendency they don't like this humor they find I'm just wasting time or I'm just making fun of their sad emotional state but again there's nothing in the life except yes living day by day so better be happy and die rather than be sad and die next question is digestive role is by the enzyme or the enzyme amas or Tylin it is going to break the starch that is why it cause the flavor to come when you eat the starch bread rice saliva enzyme break it make into sugar and sugar causes sweet flavor so it is activated by chloride okay defensin is again antibacterial they cause non oxidative killing of the pathogens okay defenses okay they make pore in the membrane okay then optimum pH is 6.7 okay clear so it is our 6.7 is the pH okay next is lipase and this but lipase act in acidic pH act in acidic pH of stomach so I'm covering everything don't worry and my promise these notes will solve 80% of any question so that is the case clear so that is our yeah you are right because that is what I'm telling you be happy don't take stress and that is the case Okay so let's start now gastric phase so what are the gastric phase so first is the main cells in the stomach are oxyc or parial cell they are Maxim the fundas and they do acid secretion what they do acid secretion what do you need for acid secretion one is our proton pump which is hydrogen potassium atps and then where the chloride come from it come through bicarbonate exchange bicarbonate chloride exchange so SC is secreted out and bicarb is brought to the blood that's why it causes alkaline pH what it causes alkaline pH so let's say once again pump through the H+ in the Lumen bab exchange with chloride so bab goes to blood chloride goes to cell that create the and bab cause what post perial alkaline tyde that's why gastric vomiting will cause what it will cause what yes it cause a hypochloric hypmic metabolic alkalosis this second it release intrinsic factor what is this intrinsic factor do first is it bind vitamin B12 diod num please remember I've seen lots of people make a mistake examiner as binding occur terminal binding occur in deod binding occur in deod but absorption occur in terminal alium so remember binding is dium absorption is terminal alium and defect cause magalo blastic anemia yeah I C again you do pyqs pyqs plus nodes will cover 80% okay pyq the must okay maglo blastic anemia now the hormone grin grin is for growth and growth hormone so grin galin growth hormone now Chief cells in the body they release pepsinogen which is inactive so who make it active who make it active the answer is SC make it into active form that is Pepsi active now SC is increased by vus vas so vus is the one what receptor M1 receptor ecl cell what is ecl anro chromin like cell they are in the stomach and they release histamine serotonin histamine via H1 increase sorry H2 increase SC H2 increase HCL so what is the receptor H2 so that's why we give tidine sein fine to drop the SC secretion and G cells in entrum release gastrin gastrin also do what it also increase git movements so Gast is double Ro one increase git movement example mass movement so that is why if there's a increased gastrin there'll be ulcer with diarrhea because of increase mass m and one more thing the brunal gland in the upper deorum protect from from acid burn of the stomach by making alkaline mucus with ph 10 to 11 so who's the highest pH most alkaline this is most alkaline most alkaline so most alkaline is the Bruner gland most alkaline is the Bruner gland or so we are at our Target page number five in our one hour we are on track so gastrinoma it is a part of pet we all know what is pet pancreatic neuroendocrine tumor okay and if you people know I revise all 19 subject in my way with fun interactive and very simple summaries of all the disease this is my summary of the gastrinoma it is Zinger Alison syndrome what will excessive gastrin do so I'll just write the summary so increase gastrin will cause fire fire is what ulcers increase SC ulcers are there dyspepsia is there and water is because of diarrhea why because of increase mass movement so that's why if a person come with ulcer and diarrhea suspect what gastrinoma it look just like a hookah what is hookai they're mainly at the yes Chief cell is mainly at the body okay Dr Vina body now remember the person has what syndrome what has fire on the top remember n to diarrhea at the bottom so diarrhea at the bottom it should be what the question they're asking C see again in this case deum should be again I don't know why they're giving judum should not affect much okay deum binding occur helium absorption stomach release so answer should be here you right the answer should be yes the answer should be in this case IAM sorry Jam so I don't know why they giving the explanation no no binding occur in B12 so again this kind of questions are not correct okay so I hope it's clear now CH let's move next digestion and absorption so proteins are broken down to amino acids and amino acids are absorbed by sodium Amino import primary secondary active secondary active secondary active in this case okay see never trust explanation given on a qbank question blindly reason I'll tell you the truth they are not made by faculties any question Bank none of them is made by faculties what we do is screen the question like we get question we go through them that's why even not all faculties are capable of going through all the question so that's why lots of question might be escaping tnd revision we take we know the question but the question Bank not humanly possible for faculties to always plus there's always controversial question overlapping question where fight will be occurring always and always like example who causes this uh okay leave the controversy let's focus here first question okay okay again if they are saying folic acid I agree but folic acid is absorbed in dium also now clear maximum is in jum but again folic acid can be absorbed okay but binding occur in deum of the both folic acid and this so again I think it's again a controversial question okay tell I will ask the faculty also but I'm telling you jum is absorbing folic acid but it is mainly absorbing deum also folic acid okay so that is the case okay so I'll just show you folic acid is absorbing deod also not just in the this area okay so I think we'll take the discussion later on it has the FID transporter so that's it's not the answer okay let's focus stomach is helping in Iron absorption bya SC diod absorb both iron and the fet also Jam also absorb fet so again stomach release intrinsic factor so again it's becoming a bit controversial question yeah so now fats okay proteins pancreatic enzyme tail is the exocrine part okay let me do the question okay I will be discussing yeah iron is in dium okay so I think we'll discuss the question part later otherwise my flow will break okay can I do that later can I discuss the question part later later okay if you all agree because if I go look at the answers discuss the explanation then it will just create let me yes continue and let me just follow through okay so first question where are the enzyme they're mainly in the tail of the pancreas that is exocrine part now trogen androy is there what is there androy it converted into Trin which is active form in the Bodum it come from pancreas it come from the pancreas next question fats what are fats converted to they converted longchain fatty acids and then these are broken by lipase ppase cpase then gastric lipase and remember the fats cannot be absorbed in git so they are converted to water soluble form by emulsification bile salt and then they get absorbed so what do the fat absorb as by emulsification now carbohydrates that is polysaccharide are convert to disaccharide die to monosaccharide and then they get absorbed what the enzyme SL Ames which we have discussed already dexas break the dextin sugars pancreatic Alpha Ames also alpha glucosides alpha glucosides which is broken blocked by what blocked by drugs which drug the AGI Alpha glucosides inhibitor like migol V carbos AC carbos which are used in diabetes treatment now disaccharide like maltose sucrose lactose the enzyme is the easiest enzyme maltes sucrase lactose what is created two glucose glucose plus fructose glucose Plus galactose so that is how we are able to get them absorbed in this particular case now monosaccharides are absorbed by what sglt1 which is secondary reactive it absorb both glucose sodium whereas sgt1 and two is for glucose and glose glute 5 is for fructose fastest absorption is for galactose so who's the fastest absorbing galactose is the fastest absorbing sugar in the gut now maximum absorption of everything occur in jum occur in the jum after that ium and cologne comes example water Etc now exception colog is for short chain fatty acids terminal Alum is for B12 and bile salts deod is iron absorption is maximum now remember as you were saying he is also Max here he is also maximum so who's also maximum he is also maximum in this case okay regarding folate it is jum more than deod but both are responsible but main thing is deum is the Lesser important for this okay let's move on okay now how do you absorb the iron first the dietary iron faric is converted to fe2+ which is called ruas of cytochrome B now the fe2 plus enter the de ordinal cells through the ayal Border dmt1 Dent metal transporter once it it come inside it can be stored as fertin or leave the cell to enter the interium through the basil border fero potin so this is how the iron come he also come in the dium see he also come in dium fet also get absorbed in deum both then this fe3+ convert to fe2+ by cytochrome B which is also called ruas then it enter through dmt1 on which border AAL border and then it can be stored as fertin or or it leave the cell through basil border ferroin basil bord the ferroin is blocked by hapin produced from the liver it act as negative feedback if your body has too much iron you don't want more iron absorption block the ferroin so it block the ferroin when there is high iron level if you are iron deficit then you don't release the hpin iron get absorbed from the git into the blood in the blood before it come fe2+ is again converted to fe3+ by half and this fe3+ enter our what enter our blood and it bind to what plasma transfering and taken to marrow for our what formation for RBC and hemoglobin production okay next question is our liver liver is for metabolism and get the blood through portal vein called as anr hepatic circulation what are the three type of cells in the liver first is cuffer cell they are the macrophases of the liver Ito cell which are our fat storing and also vitamin A so store the fat vitamin A V sell Ito or stellard cell they are called stet cell okay and lastly we have hepy what they are doing they are for metabolism metabolism break drugs break drugs okay then make fats plasma proteins plasma proteins also yes glycogen also conjugation of fat soluble to water soluble so fat soluble to water soluble form so fat soluble to water soluble form is there so fat soluble to water soluble is there and finally also Ura cycle now very important vitamin K ask in last year need PG vitamin k What does it cause gamma carox of gamma carox of what glutamic acid gamma carboxy acid or what of which factors anyone which clotting Factor very very important question two 7 9 10 it is a very important topic ask multiple time so ask multiple time very good 27 Dr Arin JM Sam kuki very good KL 27 so nowadays they are asking not just clotting Factor but they're asking which clotting factor and which process gamma carox so gamma carox very good very very good CH so we have done two systems in one hour and now we are starting with the third system page number 7 congratulation we are on track so first we discuss the Vel Airway classification so he divided Airway into 23 Generation based on the division so who's the father of everyone B tracha tracha generation zero it divide into two broni that is generation first then come 1 2 3 primary secondary loer all then come termin bronchol terminal is generation 16 which contain highest smooth muscle and then respiratory bronchol start from 17 18 19 they are also called as transitional also called as transitional bronchos okay then Alva ducts a 20 21 22 alv Generation 23 that's why 17 to 23 is called as what our exchange zone or transitional Zone conducting zone is 0 to 16 so let let's say so what is the exchange respiratory zone 17 to 23 so this is also called as asinine also call as asinus so asinus is what single respiratory bronchol and all alvite Supply that is same as the respiratory zone call as asiner Zone and what is conduction Zone it is no exchange anotomical Dead Space it is tracha to terminal Bron 0 to 16 so 0 to 16 is our terminal bronchol is the conducting Zone second maximum smooth muscle is present here is present in our terminal bronchol as per wall thickness as per wall thickness okay now what is the story next question there is Bronco constriction who cause Bronco constriction parasympathetic and histamine H1 that's why asthma H1 is involved anaphalis H1 involved and Dil is by sympathetic laas Saba we use for Bronco delici now boil FL say pressure is inverse to the volume so if I take a balloon and squeeze it the size decreases but molecule come closer pressure increase so inverse relation between pressure volume is called as what boils law it is called as the boils law now respiratory movement we'll discuss first inspiration is a active process okay and it's very very important why because if you don't inspire you will expire inspiration is life so that's why it's a active process okay again that is at the level of brona the cartilage start to become deficit okay so that is the case okay now it is active process what is the funa about our active process okay it uses muscle which muscle diaphragm 75% external is our how much external is causing 25% remember a pneumonic external X expand X expand X is exp X is exp x x x is expand expand X knowledge expand so X always respect because X give you experience so remember respect your ex because they gave you experience and number two speared your life they might be spoiling someone else's life but they spared your life so always respect the X never make fun of the X okay so next question now normal expiration so what happens as the thorax expand the pressure decrease boil slow and as the pressure decrease it pull air inside the lungs so one line summary inspiration pressure is falling air is sucked in okay then comes our normal expiration normal expiration is passive normal expiration is passive again some people are very happy sir we don't have any X okay okay I'm not saying about exgirlfriend boyfriend X School X boss X house X bicycle okay I learned lot from my bicycle okay never trust a old bicycle can quit anytime okay and that's the case okay yeah so that is the story okay so every X give you experience okay x x experience now what is expiration normally caused by it is called cus by our recoil so lungs stretches in inspiration and recoil in expiration they recoil in expiration okay so yes very very good Dr bubbles keep giving good summary very good okay fire fire okay now next question forceful expiration forceful means what you are cuffing so now you need energy so it's a active process one question not related to physiology in general okay I'm asking you a question please don't take it is it related to physiology no it's not related to physiology I'm just asking you question is something like this okay maximum maximum shouting is seen in which clinical Department maximum not physio related as say maximum shouting is seen in which department surgery Pediatrics Ortho ENT Opa see see everyone give the answer as OB yes you are right OBG has the highest amount of shouting done okay yes see everyone give the answer OBG doctors are the ones who are the most energetic they are giving maximum effort toward the patient care rather than the patient in the labor shouting and applying exertion the PG the Jr of shorty mode Ron push so push so that's why they are full energy full effort so that's why OBG doctor salute to them for their maximum effort and this okay clear so yes okay okay second question and I don't know why people make fun of OBG doctor please don't make fun okay they are one of the greatest doctors available on the planet okay when we were in mbbs all Department as intern you learn which department not to join you don't learn which department to join as intern you learn which department should not join okay and that is what we learn okay so when we were uh internship we used to hear medicine people they are the most knowledgeable people they know everything but they do nothing they know everything but they do nothing they're always in confusion always in what dilemma always making DD DD question mark medicine question mark yeah maybe maybe might not be always like this this is medicine okay medicine whereas surgery they might know nothing but they do everything if a patient is there has to be operated if needed number two they might be wrong but they never in doubt clear and they don't wait like medicine people they're waiting waiting waiting surgery people don't wait they directly go for the kill and their body language is also most relaxed so what doesn't take tension the surgeon they are stress free relax body and what is OBG and other department they're always their body language like this constipated look what is looking relaxed there is surgery people button is open all cool dude okay that is the case number two and they don't even use proper language also like example we use sir prosis diagnosis this directly I think obstruction open open and now they do leoty very easily why because they are full of confidence and then they ask anything addition banding zip it zip so they are the best people okay then come OBG doctor it's not my words I heard from my senior I'm just passing it on please don't tell to any other faculty so they said about OBG they know nothing they do nothing what is happening naturally they complicate that also clear and then they call other department people to solve the complication it's not my word I heard from somebody okay so please don't take it negative okay so so let's continue okay and we have faculties who have done double MD you know Dr Niha our opam she is a double MD know double MD double MD clear so she did MD first in OBG you know this and then she did in opta you know this even I was not a double MD dou MD now I don't know what the reason she did dou MD maybe she was not happy looking at one fundas so now she get a chance to to look at two funai so fund do fundas double boss double work please don't tell her I was roasting her else she will beat me very bad so censor this joke remove this joke okay CH okay now we discuss the forceful okay so yeah no ma'am is very good yeah I'm not saying anything bad but I'm just saying ma'am double progression okay so let's see abdominal I've seen surgeon do other things also while in OT so that's the case okay double funders okay so let's so abdominal and internal intercostal they are basically forceful expiration okay so oh ma'am no CH okay it's okay I will say sorry to her and get her good chocolate okay next time so abdominal and internal Cal they compress thorax and increase the pressure and push air out maximally now we discuss okay now we discuss our respiratory pressures okay first first is intra pulmonary or intra alv pressure it is inside the lung okay I think I'm going to be removed from all Bia groups very soon because I can't change my behavior okay I'm like that one person who's always playing Joker of the class in faculties I'm that one okay the Joker of the class CH okay let's continue so what are the pressure inside the lung call it's called intra pulmonary or intra alv pressure okay first it is same as the atmosphere why because our lungs are connected to the atmosphere this is I AP this is atmosphere so obviously the pressure inside our lung is equal to atmospheric pressure what the pressure 760 since it is equal we write zero why zero no difference okay so it is our zero okay yes next question why zero it is because of that okay so yeah I do revise not teach but revise other 19 subject also like I was taking Cardiology class today before this session for a group of students and I just started your revision class so it is our basically no difference so zero is not zero it means no difference so the pressure of lung and the atmosphere same because lungs are connected as a open cavity so please remember zero means open cavity during inspiration as the thorax expand remember pressure fall boils law so there's a pull air inside so pressure fall become minus one minus one is yeah I will take it from may end so it's done may end I will start the revision session once this all is over may end okay around 20 around okay yes so that's why I used to do I will make other faculties laugh I'll tell them all the stories okay so that is our minus one and that pull air inside okay in expiration the lungs will recoil as the lung recoil pressure increase and push air out so let me give a summary so the value is it is like this I'll write you here at rest zero inspiration minus one so I don't at rest zero at rest zero inspiration negative expiration positive yeah I will take session don't worry let me finish the cabus then I will help you revise other subject also otherwise I will start getting lots of calls from head office sir please be serious they have exam on their head okay and they are very stressed trying to decrease their stress by not letting them think about the repercussions of not doing well study hard give your best but don't take stress we can't do anything is not in our hand what will happen tomorrow exam result pass fail good rank bad rank we can't control this we can control what is right now in our hand that is labers course McQ that's it so intrathoracic pressure is also called as plural pressure it is a closed cavity which is having a negative pressure so remember open cavity zero pressure Clos cavity is what it is negative pressure what the value Min -2 mmhg or -4 CM what the benefit lungs try to collapse because of Inver recoil so that's why prevent collapse due to Inver recoil so let me explain lungs try to recoil Inward and collapse but negative pressure keep pulling the lung outward and prevent the collapse so in Nemo thorx the IDP becomes zero because it's a open cavity ear enter the thorax and the lung will collapse so the purpose of negative ITP prevent collapse of the lung let me revise what is I AP so I AP is zero at rest why is it zero yes open cavity what is it in Inspiration it become minus one and ear come inside expiration + one push here so it pull here it push here poar Pusher then what about the ITP ITP is negative why close cavity and what it does yes prevent collapse of lung prevent collapse so if it become open cavity if it become open cavity then the pressure will be non zero or zero it become zero zero ITP now if it BEC zero ITP collapse of lung occur and this is called as Nemo so collapse is called as neemo thoric are you clear so collapse is nemox so I hope it's clear yes so that is the case Okay so let's say next okay come liance what is compliance is stretchability of the lungs so lungs are elastic like like rubber band they can stretch recoil stretch recoil stretch recoil so that is called as our lungs they have good compliance compliance means stretching and recoil means return back so lungs can do both okay now in all lung diseases fibrosis inflammation infiltration silicosis asbestosis neocis sarcosis the lung can't stretch there's a poor compliance what the result of poor compliance so because of the poor compliance there is poor lung movement so all the movements are decreased call as restrictive lung disease McQ so there is reduce lung movement whereas the only disease with high compliance is MMA what are the reason there's a loss of elastin protein there is low recoil but very high compliance what high compliance cause it causes hyper inflated lungs hyperinflated lungs and also what barrel chest barrel chest next if Airway are narrow there's going to be poor turbulent air flow and that is called as obstructive lung disease example COPD asema so summary there are two kind of diseases obstructive I'll make the graph don't worry obstructive and restrictive are the two type of cve obstructive and the restrictive okay so compliance is given as Delta V by Delta P where Delta V is the volume and Delta p is the pressure so Delta V and Delta P now remember first this is the compliance curve this is the compliance curve so this is the volume this is the pressure this is the value so let's say this is our curve I'll write 200 for 1 400 for 2 so what is the compliance you can calculate 400 by 2 that is 200 mL per CM this is let's say normal compliance so this is what I'll discuss this is our let's say normal compliance now let's make disease come what do you see you see now the value is 200 for 2 that is 100 ml per CM what is the case the graph has shifted to what side it is shifted to the right side so right side is reduceed compliance so I'm writing it here so right shift is reduced compliance example rld okay and remember a rule right shift in any curve is reduced Val okay like right shift of drug response curve means reduce potency right shift of Frank styling curve is reduce contract there negative inotropic effect left shift is positive inotropic effect I'll do it later don't worry okay then oxygen hemoglobin C for Affinity right means reduce Affinity left means increase Affinity so remember a very simple rule the rule is right is reduced right is reduced please remember I will write it somewhere right means reduce value so please highlight right shift reduce right means reduce value any curve shifted to right side is reduced let's see now the reverse curve C here the value is let's say the blue one it is 400 at 1 so the compliance 400 by 1 that is 400 ml per CM that is high compliance so left shift is high compliance so please remember right shift means reduce value left means increase value any curve any graph the moment they give you I'll give a example let's see I am comparing two hemoglobins for the Affinity so I write here saturation or I write here the P2 look at the two curve A and B which one has more affinity for oxygen tell me where is more Affinity A or B more Affinity A or B Tell Me A or B A is having low Affinity Baba right right shift left so left shift more Affinity drug response C DRC again so A or B which is more poent more potent which drug looks more potent A or B Tell Me A or B which drug is more important A or B A or B a because a is on the left it is more poent so please remember that is how you solve the question always remember left means more potent left L is for potency if you go to left it is more poent right is less poent so please remember right is less left is more is reduced is poor say so L is more and left is poor right so this trick will always help you solve the question now lungs have a tendency to collapse inward due to the fluid and the air the stickiness of the liquid like example water water has a stickiness what the stickiness called surface tension and it can cause collapse of the Alvi and also it can decrease the compliance as the lung become collapsed and very difficult to Breathe It causes respiratory distress syndrome plus it will pull the fluid because it love the water surface tension as it pull yes help is the pneumonic yes I agree but remember left means potent and height give you efficacy fly height okay now it pull fluid inside and cause edema and the Adema fluid plus fibrine create the highin membrane this make the lung very stiff decrease the compliance diff ult breathing and that's why call respiratory distress syndrome now who decreases the surface tension so it is decreased by surfa tent and that's why prevent RDS pulm edema and collapse so what is the collapsing force in the lung is it is our surface tension what we want the alv to collapse what prevented our surfactant now where is surfactant coming from surfactant is coming from where type two Nemo sites this spelling is wrong so type two nemoy type two nemoy is looking like so type two Nyes release what it release our what they release our Nyes Nemo sites okay second and clarel but Clara cells are not the main why because they are basically for is the main Clara cells are for bronchial secretions which cover the airway and and protect them so they are making protective bronchial secretions okay now what is the surfacant contain again phospholipids they contain phospholipid the main is dppc D pet oil fos fadil cholin this last year need PG question so this is our also called As Lain minor is fingo so what ratio we take for lung maturity l s ratio more than two indicate lung maturity so what do we use for lung maturity ratio more than two is for lung maturity so more than two is lung maturity and suant protein is also there 30% main is spb so who's the main protein spb is the main spb is the main spb is the main now surfacant production start at what age 18 to 20 weeks but secretion and action in the Alva is 28 what the meaning if a baby is born on before 28 surfactant will work or not work what do you say before 28 is not secreted so it's not going to work that's five the baby will not survive but after 28 the baby can survive baby can survive that's why the age of what viability in India for an sake so what the age of viability 28 why surfactant is in the cell or come out into the Ali come in the Alva that's why when a baby is born after 28 and take a breath what is there surfactant is there can the baby survive yes but still the lung are not fully mature what is the age for maturity it is 34 35 week by the steroid so what the full maturity 34 35 secretion 28 production 18 to 20 week one more question when do you see in our amniotic FL again 28 weeks so detected in amniotic fluid which age 28 weeks okay now one question not related to physiology it was someone was discussing what is the best life some say childhood some said adulthood some say old retired life I said no the best life is fetal life well right here why best life is fetal life anyone the reason number one no tension of need preon postponement result joining rank or next next year no problem rural posting no tension no tension of job Emi salary tax TDS no problem GST no problem no tension of adding people blocking people or people blocking you can't see the DP no problem then no tension about alarm snooze wake up sleep you can sleep whole day no one is going to disturb you number next you don't have to worry about eating today what to eat Mass food this food Dosa Pizza gastritis no you don't even have to eat direct glucose Supply direct glucose amino acid oxygen all don't even have to breathe lungs are collapse direct oxygen from the mother then temperature s AC on S AC off this very cold summer this 24/7 automatic climate control then accommodation hostel PG rent own house Emi no you have your own personal apartment when in built swimming pool swimming pooling plus you can play sports all the time more you play sport more the movement the mother is Happy wow Ronaldo is kicking inside and that's when the baby's born the baby start to cry why multiple reason but one is what kind of shitty world is this plus that's why baby start to cry so thank you to mother for this best 9 months of Life all mothers we should be thankful and thank you to Papa also Papa also played role in birth maybe small role but Papa also had a role in birth and upbringing okay so father also okay sh okay let's continue so palmary function test are by spirometry okay see maybe I was not well in that class now I'm recovering so I'm now to my full mature potential so I was like a immature teacher that time okay so let's continue okay now P function test we do by spirometry spirometry remember only record inspiratory expiratory value so it only record yes you just give them life is better yes you can kick as much as you want and after birth you are kicked by everyone so very good very very good this is too good I'll use it in my standup comedy okay CH okay so let's continue okay so I hope you people are not feeling bored at all we have almost closed to one a half hour okay and we are on target CL page number 10 that will be our halfway mark okay so pulm function tests are done by spirometry what is normal inspiration expiration call is it is called as the tidal volume so it is called as our tidal volume so startle volume normal inspiration and expiration okay now what is maximum inspiration called is so max inspiration Max inspiration is called as IV around 3 lit same way Max ACC expiration it is called as what it is called as a EB so expiratory Reserve volume is 1.3 lit is the E RV so that is almost half of the Irv half because so remember theic is easy to bring someone to your life 3 lit but difficult to remove them once they come to your life like some people who don't go from your life clear so that is the case okay next question air left in lung even after maximum forceful expiration is called as RV is called as RV and RV is not coming out because ear way and right it won't come out as small Airways get compressed yeah I will do that don't worry as small Airway as what as small Airways get compressed that is my backup plan if my teaching doesn't work I will become a yes standup comedian and when people will ask me sir you are a doctor why you doing comedy I say because my patient and then my students were not happy with me so now I'll make you people unhappy so so small Airway get compressed okay they get compressed and RV can't come out what this phenomena call is this phenomena is called as DCA DCA what is DCA damic compression of Airways okay yes fine very true laughter is best medicine but too much laughter can be Mania then you might need antic psychotics that is also a problem okay so since RV will not come out it can't be measured by spirometer and also prevent collapse during forceful expiration during forceful expiration so that is the story now comes the next question what is capacity sum of two or more volume is called as a Capac capacity first is ICC which is inspiratory capacity it is basically yes tidal volume normal inspiration plus Max inspiration Irv values 3.5 to4 EC is what expiratory capacity TV plus Erv normal 1.8 to2 just remember half F FRC it is our functional resol capacity it is Erv plus RV normal is 2.5 L okay now it is what here is the air left in lung after normal expiration or at rest so remember after Norm normal expiration Erv doesn't come out Erv comes out after forceful so they ask you air left after Force full it is your RV ear after normal Erv will not come out so remember Erv won't come out so that is why it is sum of the two why because in forceful Erv comes out in normal Erv won't come out so remember normal expiration Erv won't come out so now you are having two volumes what are the two volume the two volumes are Erv and RV very very easy so Erv and RV is the concept so Erv and the RV okay so that is why Spyro cannot measure the RV or also CV and CV also so that is why what do we use we use the helium dilution method formula is same volume is amount upon concentration amount upon concentration so that is the case yes closing capacity CV plus RV very good if you want I can write down CC closing capacity okay so what is CV sec I'll just discuss the first Airway closer is called as closing volume I write here what is CV closing volume it is first Airway closer so what is that is it is our first Airway closer in forceful expiration remember Airway close in forceful expiration that is called a CV so CV is during the dynamic compression of Airway the airway compress so first Airway closer is called as closing volume now what the formula for estimation number one it is amount of helium or nitrogen divide by concentration give you the volume of FRC or we can use single breath nitrogen wash out poers method we ask the patient to breathe out the nitrogen is there in the lung it comes out from the nitrogen concentration we can measure the dead space Also we can measure the closing volume also and RV also F FRC also FRC so what method give Dead Space closing volume FRC all three the answer is helium method okay okay if in Old the air they are narrow they will close sooner so CV will increase so I'll write it later don't worry so CV increase in Old CV increase in Old due to early closure of Airway early closure of narrow Airways so as the Airways get closed they will cause trapping of the air and yes yes that's true it closes early closer the right answer is yes yes Dr it is early okay it's not the minimal volume it is the volume where first Airway Clos okay so first Airway closer point is called as the closing volume I told now when do forceful the airway start closing and the air stop coming when the air doesn't come that is RV and the air which came is Erv so point where first air we closed during the force full is called as closing volume closing volume is given by what single breath nitrogen wash out method all also called as the fowers method okay plethysmography can be done in obstructive disease why in obstructive disease there's a problem in the what gas diffusing everywhere Airway are narrow so helium can't move freely what's the reason helium can't reach obstructed area so that's why it will give you wrong values okay so that is why what we can measure yes we can measure our yes plethysmography for old now what is vital capacity is maximum inspiration followed by maximum expiration so you ask the person to do maximum inspiration then do maximum expiration like this see Max inspiration Max expiration so this a is called as vital capacity can you see this vital capacity so does VC made by Irv TV Erv so it's made by three value Irv TV Erv normal VC male is 4.8 female is 3.2 lit now what is the total lung capacity it is the sum of all four volume Irv Erv TV RV normal 6 liter and Spyro failed to give RV F FRC and TLC why because RV cannot come out that is why use which method so again f method so we can use fowers nitrogen method so I'm giving a summary look at this summary and we will learn it okay so summary so summary is make this graph so I'll make it again so this is the curve so let's learn it what is this value is this is TV this is Irv these two combine is IC this here is Erv what is top to bottom these callers top to bottom this is our VC so top to bottom is VC and what is this year not coming out it is RV these two it was last year n PG so 20203 need PG what is this value anyone what is this value here yes it is f FRC it is f FRC it is f FRC and this is our closing volume so this part is closing volume so closing volume is first Airway closer it occurs somewhere near arv end okay closing volume CV and if you take all four it become T LC so this is a graph for all the volume it is our TLC now interesting question look at this curve and tell me what is VC plus RV give you T LC it is VC plus RV same question I plus F FRC give you what again TLC okay so that means if you remember this curve we can solve the question very easily problem in the exam you cannot recall the curve easily so when the exam this curve come and you can't recall it easily what we can do so I'll give you a very simple hint so understand do a rapid graph like this and let's solve it what this thing TV IV ER RV RV these two F FRC this is IC top three VC all four TLC done so you can make a graph and solve problem in the exam they don't give pen and paper they don't give pen and paper if they don't give pen and paper use what you have with you that is your hand so use your hand and yes please remember don't show it to the examiner if you show it to the examiner examiner might be offended okay so this okay so this is your very famous finger method to calculate all the volume so it is not copyrighted by me yes IV TV ER RV RV so easy see finger method so we can use the finger method to count all the volume okay so again again no vulgarity okay is not vulgarity it's just a method to remember the values okay I told you for me nothing is vulgar if it can get you a good rank okay and I don't know why we doctors can have sens ity we are the one doing paral examination in Hindi is a saying putting someone finger in the ass we are doing it for as a professional so other people vulgarity for us is profession clear bus so that is why yes so I will write it down so that I can use it for my standup comedy yes CH yeah I make my scripts so now I've got one more good script okay I do teach paraphilia and it is you know even YouTube Once banned my lecture I was taking fenic medicine sexual offenses YouTube banned it said it is under 18 allow so they banned my video it was very vulgar let's start okay next question what is the PFT in the diseases so PFT in the okay someone has already posted photo this photo I will save it myself okay I never realize yeah I will pin it so other faculties can also see okay I can't pin CH anyway okay so now PF diseases first is rld it is low vital capacity due to our yes poor compliance okay it is called as the rld all volumes are less what is less all volumes in old there is normal VC or can be low VC because of air trapping why the lungs are affected but Airway are okay so VC can be almost normal so VC can be also normal okay don't worry I will take paraphilia one day don't worry about that okay CH let's focus otherwise I'm going to get negative reviews and feedback class BC BC is too much class is very less okay now second is we div divide the vital capacity into part call as timed vital capacity what that call us TVC it is our VC and time taken example 5 l in 3 second so how much time a person took to complete it is called as our TVC now what the benefit we divide the TVC into part what are the parts F V1 Fe V2 and Fe V3 are the different parts now Fe V1 is what it is force expiratory volume in first second simple language how much of the vital capity you can expire in first second let's say it is let's say I make a graph also so this is let's say our VC 5 L how much come 0 1 2 3 this is our F V1 let's say it is 4 lit so this 4 lit will be 80% so 80% here came in first second second some 95 in second second and third second almost all the air came out this is seconds this is called as our fv1 if there's a obstruction air will come slow if air comes slow it will take more time this is old so in Old there is decrease Fe V1 because of increase time taken and that's why decrease Fe V1 percentage also so in obstruction the time taken is increased that's why F V1 percentage will be less than 80% in case of see people still remember okay okay yes I taught cerasis it is yes excessive sexual desire in male okay so next question is Fe V1 percentage is normal in rld why because in rld all volumes are normal H sorry low and the volumes are less both are low so they cancel each other out that's why value remain Norm so in rld I write what happens there is decrease F1 there is decrease TVC so that is why the result is normal F V1 percentage so Fe V1 percentage yes remember the same so it remember the same okay so actually I was teaching sexual offenses and they made a pneumonic sir is teaching sexual offenses so they made sasis sexual offense ASI so there's a pneumonic okay so now let's revise for the best investigation to differentiate rld from old it is our Fe V1 percentage if it is decrease it is old if it is normal or increase it is in rld but rld has poor VC so poor VC but normal F V1 is rld decrease in the Fe V1 percentage is o l then what is the maximum flow rate in the starting call is it is called as Peak expiratory flate value is 250 to 500 where is the mid expiratory 150 to 300 and remember it the gold standard MFR because the middle ear come from smaller Airway is gold standard for small Airway obstruction small Airway obstruction so what is the yes small Airway obstruction it is our MFR MEF okay now we discuss the concept of ventilation what is ventilation is first it is basically volume per minute so remember ventilation is volume per minute till now we are discussing is what volume in per breath now we're discussing per minute so first is PV what is PV pulmonary your minute ventilation it's simply ear coming and going per minute in the lung how do you calculate tidal volume into RR tidal volume is 12 to 16 breath per minut sorry T volume is 5 ml and RR is 12 breath per minut so how much it give 6,000 ml or 6 lit per minute so every minute how much ear comes our lungs 6 lit out of that how much get exchanged for that we need to calculate the Dead Space also so dead space is the air which is not getting exchanged in the airway let me show a diagram look at this diagram 150 ml air stays there so50 ml air stay in the airway 350 ml is exchange and 150 is not exchange okay so that is the case so now what is the Dead Space it is not exchange a so a which is not exchange it is around 150 ml call as anatomical Dead Space Alvine there is no Dead Space reason all is exchange so Al Dead Space is zero all exchange can be exchange so that is the case now what is physiological Dead Space it is basically anotomical plus Al dead space and remember since Al is zero physiological become equal to anotomical because what is zero Al is zero that is what they teach in anatomy also that both are equal the reason is because Al is equal to zero so let's calculate the a 500 is TV how much Dead Space 150 so 350 is available for exchange 350 to 12 give you our alv ventilation 4.2 L per minut now we calculate something called as VQ ratio what is VQ ratio ventilation perfusion ratio what it indicate it indicate the gas exchange in the lung okay so remember Dead Space is your physiological why because it's not getting exchange 150 is normal if it become 200 250 it is pathological okay it's pathological okay now comes the question what indicate the gas exchange VQ ratio V is a coming per minute and what is the Q is Q is perfusion blood coming per minute or the ideal ratio one one means it is best section like example in a marriage in a marriage what the most important thing it is food and for for food what the ratio plate is to guest ratio plate is to guest so let's say we invite 500 guests so how many plate we must arrange 500 don't say we'll get more than 500 extra might come if extra come they will get to eat something else J chap slabs but not food so what the ratio 1 is to one so every person got one plate so how many plates are shot zero how many plates are extra zero are the host who are arranging the marriage food happy yes all their food is consumed is their food wasted no is the guest happy never Indian marriage guest they always unhappy make such mean comment like what kind of food they serve not good food we are not enjoying you go and enjoy your marriage okay let them enjoy they waited so many years for getting married to enjoy number two they make such mean commment this decoration not good not good this not good here someone life is getting spoiled and you thinking about your rasula selfish people huh so let's come to the ratio one is the ideal ratio so one is the 600 experience so one so now if it is not equal to one it is called as mismatch and mismatch so mismatch cause poor exchange so it causes the poor exchange and if VQ is more than one that means it is high mismatch it is called as high mismatch right High VQ mismatch and what does high mismatch do it causes air more than the blood and if the air is more than the blood it not going to be exchange at all in this particular case okay fine so air is more than the Blood air is more than the blood clear next question so air is not fully exchange so increases physiological and alv Dead Space okay example pulm emsm MMA air is not exchanged properly okay so air will be left unexchanged in this case okay now comes hypoxic hypoxia so remember hypoxic hypoxia is caused due to VQ mismatch it's the most common cause so what are the most common cause of hypoxic hypoxia all lung disease but mainly our it is VQ mismatch so what is happening tissue is not getting oxygen that is hypoxia so what is hypoxia tissue not getting oxygen to use that is hypoxia but what is the cause of this hypoxia lungs so that's why it is called as hypoxic hypoxia okay hypoxic hypoxia true true true hypoxic hypox okay lungs so if lungs fail it is called as hypoxic hypoxia what the Hallmark decrease P2 decrease SP2 and Central sinosis right on Central sinosis Central sinosis okay clear yes that's true okay okay okay so let's see okay now anemic hypoxia less hemoglobin but remember all other are normal remember only hypoxia with a decrease po2 is hypoxic because lungs are not giving oxygen all other h HP oxas have normal po2 less hemoglobin but normal SP2 normal po2 and there is par no sinosis so there is par no sinosis okay now stagnant less blood flow to the tissue shock burger again there is going to be less blood supply peripheral sinosis is seen here peripheral sinosis so Central sinosis hypoxic hypoxia peripheral is stagnant hypoxia histotoxic here the tissue themselves fail to use oxygen despite normal blood oxygen SP2 P2 all are normal here everything is normal so normal P2 normal S2 everything example cyanide cyanide block which complex complex 4 it is 2 22 need PG pyq it is complex 4 now the normal VQ for the whole lung is8 but it's maximum at the fex 1.3 due to poor perfusion and that's why the ratio is more than one so what the VQ it is more than one and I told you if the VQ is more than one yes again no sinosis I told sinosis is in two again no sinosis no sinosis okay next question what is the VQ ratio at the epex it is 1.3 it is maximum due to what it is maximum due to very less blood supply at the Apex so the blood supply at the Apex very poor that's why the VQ is more than one and therefore there is VQ mismatch so there's a VQ mismatch a is more than the blood so that is why there's a dead space why because ear is more than the blood and that is why aerophilic bacteria who love oxygen they will prefer to go to aex so that's why most common site of TB is which area is AAL L Junction with the middle lobe at Apex I'll write full Junction with middle l called as cones Focus so where is TB most common aex Junction with middle L here here TB occur so TB occur at The Junction now at the base VQ is minimum why because it get maximum perfusion because of gravity too much blood is there and also it has maximum meditation because of too much space and compliance so maximum space and compliance so that is why base has what Max perfusion and Max ventilation okay yeah when you lie down the ayal VQ decrease so in suine in suine decrease VQ at Apex due to increase perfusion McQ so that is the story okay yes you are right now we'll discuss the partial pressure so let's remember what is the part partial pressure of the oxy the alv it is p a O2 around 100 to 110 what is p a CO2 it's 40 40 mm HG 40 mm HG then what the value in the Venus blood so Venus blood is pvo2 40 to 50 PV CO2 is 46 and P a O2 95 to 98 and Pa CO2 is 40 mmhg so these are the partial pressure value okay yeah whole lung remain unchanged why because the total blood flow and the oxygen blood supply Air Supply remain unchanged so total VQ remain point8 huh variation occur in aex and base okay chak chak ah that means you are not into that next question gas exchange occur by which process it occur yeah minimum VQ at the base yeah I said now minimum VQ minimum at the base 6 due to very high perfusion you right Dr R minimum VQ at the base but when you lie down the VQ of fex decreases because of increase in the perfusion it is maximum in the Apex it will decrease like 1.2 1.1 maybe one but it is going to decrease okay so we are at our 11th page time is 10 811 so we are perfectly on track to finish our 27 pages so be happy so what is the fixed law say fixed law say the diffusion depends on three factors that is membrane pressure and gas membrane pressure gas membrane pressure gas let's see that first is gas so in gas we see the size of the gas there molecular weight of size and the liquid solubility so smaller the size faster the diffusion and more liquid solubility faster diffusion so what is more faster CO2 is faster why because CO2 is more lipid soluble so CO2 is more lipid soluble so that is the story so more lipid soluble okay all the extra point like type one type two failure type three type four all this aa gradient I will do in the end as a special request this is what physiology important topics are let me finish them then I will take them up don't worry okay I here all night with you okay clear after yes finishing the class then only I will yes rest okay CH now comes the question second factor is partial pressure when you give more partial pressure like oxen therapy example when you give a oxygen therapy even if the membrane lungs are damaged more oxygen will cause more diffusion and correct the hypoxia so what the treatment of choice in case of hypoxic hypoxia oxygen therapy third factor is our respiratory membrane so respirat is made by what type one alytes basement membrane and Pulmonary capillaries endothelial cells so pulmonary capillary endothelial cells now what is the area is so remember Normal area is 70 M square is the normal area thickness is .5 Micron meter so if there's a decrease area let's the collapse of the L this a normal area now it is collapse so decrease area like in any kind of lung disease or increase thickness so as the thickness increase gases can't diffuse it cause poor oxygen diffusion call as diffusion Disorder so what is diffusion disorder membrane is defective either area decrease or thickness increase example I ards pneumonia MMA occupation lung disease also best investigation is dlco that is diffusion capacity in lung for which gas carbon monoxide now why carbon monoxide why not any other gas remember Co used as it has 210 times more affinity for hemoglobin than oxygen that is why we use dlco we use the dlco very good Dr Danish it's true normal is pointed aex more than one base sorry aex more than one base is less than one and it is yes increase in embolism because of less blood flow very good so and that is the case and it is called as diffusion limited exchange so the only Factor deciding the diffusion it is the availability of carbon monoxide in the lung call it diffusion limited or 100% diffusion so if it is less than 100% means membrane is defective membrane is defective now next question CO2 transport just remember the main form is bicarbonate that's it so the main form of Transport is our yes it is our bicarbonate now oxygen transport is 250 ml or 5 ml% the main form is hemoglobin which carry 99 hemoglobin is like a taxi in one taxi how many passengers can sit four passengers can sit remember I'm not talking about Auto auto Ana the answer how many passengers Auto can carry answer answer answer is infinity any number if three people backside fourth person he say adjust adjust fifth adjust this side sixth he says sit on my left side seventh sit on my right side if n sit in my lap so he will adjust anywhere he adjust so that's why remember taxi hemoglobin is a taxi so pneumonic is taxi yeah so it's like a taxi taxi four passengers you'll never forget four passengers okay next question 1 G can carry 1.33 ml oxygen so if a person has normal hemoglobin 12 to 16 into 1.33 will carry 18 to 19 ml oxygen so the oxygen carrying capacity of the blood it is 18 to 19 ml% okay now dissolve oxygen dissolve oxygen is just 1% or3 now pa2 depend only on dissolved oxygen this is called as Henry's law that is when anemia pa2 is normal now come our most important the greatest the most useful is our oxygen hemoglobin dissociation cve it is s shaped why it is s shaped because of relative Affinity or cooperative binding now what is that let me write you what do that mean it means that initially Affinity is low it since okay once first oxygen bind hemoglobin it increase affinity for next oxygen okay okay so it causes a increase affinity for what next oxygen so increase affinity for next oxygen okay and this is and so on this is called as coopertive binding so graph become steep so it causes steep curve till saturation till saturation so that's why graph will go like this so it become steep in the end so this is s shaped cve this is s shape yes very good so anything which start with s very good so in fact all biological curves are s shaped okay almost all biological cures are s shaped now remember a pneumonic right shift means reduce Affinity right means reduce and now it will release oxygen to the tissue and it is called as bohar effect so it has what letter R so remember the pneumonic so right release B Boh and whereas the reverse what is Boh due to high CO2 in the tissue bind to the hemoglobin so it causes loading of the CO2 and unloading of oxygen that is called as the boher effect this is the boher effect now let's see la la so left shift is increase Affinity so it is what increase Affinity increase Affinity love love occur in lungs and it is held in la la la so la la la R so la la la ra okay so what is the story first WR release Boh right release B left is what left is our very simple it is lung H in and it is yes hemoglobin bind the oxygen and double Boh and hen see mother has matal circulation fetus is fetal both meet where in the placenta so placenta is double double placenta double double double Boh now I will write the right shift left shift in a simple manner not like this I'll make a simple summary in my way so remember right shift you know the pneumonic cadit I'll make it easy decrease P2 and increase others d d Tata bye-bye bye-bye so remember decrease po2 but increase in all other is Right shift what the story decrease in the O2 and increase other let me show you how number one carbon dioxide is increased increase pco2 oxygen is decreased yeah is more than sufficient by okay trust me just revise them very well multiple time most people think that exam is cleared by reading more exam is cleared by having command over what you are reading clear most people want to read as in depth as possible but problem is how much are you able to retain if you are able to retain more is going to be useful if you can't retain it's not going to be useful so that is why it is going to be decrease in the P2 so decrease in the P2 that is hypoxia hypoxia urva after exercise or anemia or lung diseases so my only advice is rather than going for 100 200 300 Pages go for 20 pages but do them so well that each and every word from that that page is there with you so that's why it is the case lung diseases okay so what will they do if there is yes hypoxia it increases anerobic yes increases and aerobic glycolysis even if I don't know any subject when I'm revising it I will always go for the most important topic command I might not know Psychiatry very well but I know the important things in the Psychiatry so I can revise in anesthesia I can revise because I know the most important stuff and that is very very yes required for any subject okay number next what that create increase lactic acid and increase 2 three BPG then lactic acid will create what acidosis along with carbon dioxide increase H+ so H+ will increase yes very good true next question number six also that temperature increased because of chemical reaction so and BPG is there now look at this and tell me what is the only thing which is low it is oxygen rest all is high see CO2 High anerobic glycolysis High lactic acid High H+ High BPG high temperature high and remember all these factors which are written here this yellow ones these all yellow colored factors they all cause glycolysis increase BPG one more Factor who increase BPG it is hypoxia exercise anemia lung disease high altitude is missing I'll add high altitude done let's come back so discuss it already huh remember one more thing okay 23 BPG bind beta chain and cause oxygen release right shift so that's why it causes the right shift now left shift is reverse of the right shift so that's why what is left shift is the opposite of this so fall in CO2 fall in temperature fall in this fall everything in fall and rise in O2 and rise in po2 now let discuss this hemoglobin meth carboxy or fetal they all cause left shift why that's what I'm telling you so let's come back okay so they cause the left shift which one the meth carboxy fetal so first understand fetal 23 BPG cause oxygen release whereas hbf hbf that is fetal hemoglobin it has no beta chain it has no beta chain if it has no beta chain No 2 three BPG binding if it doesn't have BPG binding what the result it has higher oxin Affinity remember who bind BPG yes our adult hemoglobin so release the oxygen so that is why hbf due to higher oxy Affinity extract O2 from maternal HB that cause the left shift of fetal hemoglobin then come our carboxy hemoglobin that is the second Factor I'm giving the blue color so carboxy hemoglobin so carboxy has 210 time more affinity and it make carboxy hemoglobin which is giving cherry red blood color and it is seen in fire in a closed room so fire in which St fire in a closed room now it's a abnormal hemoglobin it won't release oxygen so it won't be releasing the oxygen and death will occur so what will occur death can occur and why death occur won't release the oxygen now if it won't release the oxygen remember if it won't release the oxygen that's for death and it is what anemic hypoxia why it's abnormal hemoglobin and W release is what shift left shift right so it's what shift left shift so why Co poisoning cause left shift because once Co bind it make the hemoglobin unable to bind or release oxygen not leasing oxygen is left shift that's why it causes the left shift it causes the left shift it can also inhibit cytochrome p450 that means it is hiso also but hiso is not not main mechan right Co also can be hsto toxic anemia why inhibit complex for electron transport chain so it inhibit complex for but problem but but at 50 time but at 50 times lethal dose lethal dose so best is best so mainly which hypoxia mainly anemic hypoxia so are you clear so it is yes so are you clear so it is your mainly which hypoxia anemic hypoxia so prevent the release of the gases in this particular case now finally the last page of our respiration so last page is who is the pacemaker of our respiration so write down what is the pace maker of respiration yes it is our prebotzinger complex clear yeah yes it is true yes Dr AI it is true it will cause the yes necrosis of this true co poisoning okay carbon oxide will cause a decrease saturation I'll make the curve it is this curve this is normal hemoglobin it will cause less saturation and also a less sh this is Coop poisoning so it will cause a left shift so this is CB so it is less saturation and left shift left shift and because it contain less oxygen more Co slightly saturation is also low so in this cve c will be the answer c c c c is the right answer okay C okay so I'm giving all the answers also now lastly who is the pacemaker of our respiration it is our preb Zinger complex it stimulate our respiratory muscle and produce automatic involuntary breathing now what is the area for our breathing it is drg it is in Meda they all are in Meda so they are in Meda so there and it act on spir muscle and produce inspiratory Ram signal but it itself is under the drg is under the PRC PVC control vrg is forceful breathing in exercise Etc it is in exercise and all other changes okay right shift will be yes our this yes you right ri right shift will be inen in anemia hypoxia Etc vrg it causes forceful breathing that is extra breathing pre-botzinger is for not Ram it just give yes regulatory signal to drg which make the ramp and finally austic Center activate the drg increase the depth of breathing but can cause ausis depth and can cause ausis what is eposis it is respiration stop in Inspiration that's why NE xic Center and Vegas so and Vegas inhibit it so inhibit Vegas inhibit AC so two people inhibit the AC Vegas and neotex Center in the upper pawns where is the location upper pawns I'll write here upper pawns it is in lower PS so in Meda Legion respiration stop it is is called as apnea in pawns Legion the respiration become irregular why because without the acpc the breathing becom shallow so irregular shallow types so shallow is the breathing and if there's a midp potin legion and bilateral votomy fusus will occur will occur uis will occur okay so uis will occur so uis will occur so are you clear see it's an abnormal hemoglobin it doesn't release the oxygen because it's bound to co so tightly oxygen cannot come out for oxygen to come out Co should be released Co cannot be released it is very highly bound it's a useless hemoglobin who can't carry oxygen can't release oxygen that's why call as anemic I start at 8:50 class is still 11: okay sorry for long but I can't help it so 8:50 I start the class yeah after respiration we'll do CVS Etc and CNS and the kidney okay so 8:50 will restart break I'll cover okay okay I'll write it later don't worry I don't know okay I thought 8: okay so let me complete the respiration okay doubts I'll take in the break okay let me just finish it now since I've started so regulation of the respiration is by chorpus now what they do they sense and correct the respiration how basically they sense the hypoxia hyperia and stimulate the respiratory Center especially vrg drg and cause increase in the RR and TV increase RR increase TV call as hyperventilation now this is the story they are doing so what the result the hyper ventilation will increase the P2 but decrease the P2 so that will cause a increase P2 and decrease P2 back to the normal so what does the chemo receptor do they sense and correct hypoxia and hypercapnia by checking the level of this and they cause hyper ventilation example exercise or lung diseases lagal mikeal okay very good feedback system I having and it's a negative feedback what I do they reverse it like I was not having mic so they said said put the mic so I was not mic now with mic this call is negative feedback okay so Central chemo receptors and peripheral chemoreceptor central are present in the vendal Meda and they are only stimulated by increase H+ in the CSF peripheral are in koted bodies iotic bodies in the artery koted artery and the Iota and the nerve supplies ninth and 10th nerve ninth and 10th nerve now PC are stimulated by Blood changes Central by CSF changes like increase carbon dioxide decrease oxygen and increase H+ in the blood so they all cause what changes they are responsible for what our blood changes so increase CO2 decrease po2 and increase H+ that is acidosis okay yeah I will remember very good now you are talking in my language that is acidosis now PC contain oxygen sensitive potassium channel in the glomus cell type one so they will basically close so they close and depolarize this I'll discuss close and depolarize this I'll discuss in ION channel topic how the current is depolarizing current okay PC are not stimulated by anemic hypoxia why because they are not sensing the yes hemoglobin bound oxygen only the dissolv oxygen so that is the story all other hypoxia can stimulate the PC now CO2 can cross bloodb barrier and stimulate both CC PC how CC not by CO2 but by making H+ by carbonic acid so that's why the main stimulus for respiration is carbon dioxide which act on both P CC and PC now normal breathing is eia slow breathing occur in sleep drugs that is your opioids alcohol benzo daa Pines they can all slow the respiration also decrease in metabolic alkalosis as a compensation so metabolic alkalosis causes slow breathing then teia occuring exercise shock increase sympathetic and metabolic acidosis metabolic acidosis now biot is a axic breathing there is spells of apnea so if there are spells of apnea attack attack attack so it is attacki so if you are going in a taxi you go smooth but if you don't have a taxi you are walking you walk you tired you stop then you walk so it's irregular so it's a irregular breathing seen in brain stem head or brain stem injury or even ureia drug toxity ureia so this is called as our biot breathing okay now the chain Strokes or kind stroke here basically the height increases decreases then apnea increase decrease apnea it is basically seen in brain tumor congestive heart failure so congestive hard failure and high altitude high altitude so remember it look like a mountain so what look like a mountain so Mountain like breathing is seen in high altitude okay so Mountain like breathing yes sufficient for all exam just need to revise them multile time okay so sufficient okay so are you clear so that is our main Funda or the story is okay done so in high altitude there is increase ventilation why there's increase ventilation then decrease ventilation due to CO2 wash out so that causes decrease in the ventilation so as a person hyperventilate CO2 wash out occur which decrease the respiration that's why keep on fluctuating this is called as chain stroke whereas in kol there is no CO2 wash out there is continuous so this is what it's a continuous no apnea no apnea so H+ continue stimulating the respiration continue stimulating Cho receptors and the result is what continuous increase Rel rapid breathing that is called as what kol and if there is a central sleep apnea there is a suggestion of the respiration for a long period and then it will so it's a sustain or prolong apnea then rapid breathing occur then rapid so apnea then rapid apnea then rapid is called as a central sleep apnea now let me revise in my style then I'll take the break so we'll start at 9:00 p.m. so see the breathing if a person is having this breathing what do this breathing call us s I'll discuss okay don't worry aniet okay sing is seen in anxiety or stressful condition okay what is this called is what is this called is tell me this one this one this is brakes so multiple brakes this is our break biops biot break break because of damage to the brain stem the pattern is irregular biots break so break is biod very good very good what injury brain stem injury very good what is this pattern this pattern this one this one this one this is our C small so in kol there is a continuous hyperventilation so in which condition in kol there is e e e e e e e e e e e e e e e e e e e e e e e I don't like anything interrupting that is why I always wait milk is one of the best food yeah yeah the kid inside me is still alive would love to drink milk let's start now we are discussing yeah okay okay now the J reflex I will discuss soon don't worry CVS so first question yes I don't have lactose intolerance I have abundant lactase enzyme okay abundant don't worry okay so first the pace maker of heart is as Noe why due to maximum frequency more than any other tissue second it make automatic action potential due to what due to phase 4 pacemaker activity this is our phase four so phase 4 make the membrane reach firing level so what the pacemaker do so face zero is due to calcium L Channel calcium L Channel phase three is potassium Channel and phase 4 make the membrane trigger new AP so phase 4 trigger new AP and it is caused by early closure of potassium Channel funny or leaky sodium Channel and also calcium te Channel transient what they do make membrane reach firing level and Trigger new AP I'll discuss the rmp AP later just basic stuff reach firing level and start new AP so new AP will be starting in this particular case so new AP start in this particular case are you clear see even Dr R shetti know is my class must be lots of yeah okay so let's continue what is the cardiac AP cardiac AP has five parts that is muscle AP this is node AP this is cardiac muscle AP it has phase zero due to sodium Channel Phase 1 due to potassium channnel then phase two is because of calcium channel calcium L channels yes it is calcium L channels actually drinking anything else is not possible now in the class if you drink something else and then you say something else like never use mobile phone while you are drinking that's the advice okay alcohol impair your judgment and also increase your emotion and mobile phone you get interacted with other people so that's why simple advice do not do not keep your mobile phone while you are in in abated State that's the advice okay okay then phase three is due to potassium Channel again and finally phase four is the rmp so rmp is Phase number four so rmp is Phase number four okay so let's start now okay this is our noal pathway ass node send to AV node AV node to bundle off this AV node so as node is Pacemaker and AV node is the yes AV delay why slowest speed that's why it causes the conduction yes block okay okay okay then come bundle of fish it give two branches right and left left give anterior posterior phcle which Supply then the pering fiber and the ventricles okay now what are the main ECG waves we know a is the slowest slowest pin are the fastest speed why maximum Gap Junction so perin maximum Gap Junction that's why speed is maximum okay so that is the simple concept okay now who the slowest AV node is the slowest it caus the AV delay okay now what are the ECG waves I'm just discussing the physiology if you want to learn medicine revision chanting of ECG you can attend the live YouTube session of my uh medicine I'll be taking I can just show you the PDF if you want to see I'm just showing you my uh ECG file I'm doing it so this is my ECG file for the revision okay yeah okay so these kind of questions these are answered in yes okay DM me okay so don't ask in public okay it's not a public platform okay so this is my ECG notes okay all the findings are there p metral p ponale qwave r-wave swave t wve then camel hum sign it's Osborne Wave It's a pyq okay then it is uwave it is a small positive wave okay so that is our ECG file okay so you can just attend it I'll be taking it free on the uh May 15th or 20 onward so this is the findings or the changes okay so everything this is toets which look very similar to kind stroke see so tosset cardio version we give ECG leads all all are covered here okay so this is my ECG this is what I made okay okay so that is the important thing okay so I'll just leave it so I will share this file also if you want it cover everything in ECG in just 18 pages every finding mob bits all in just 18 Pages entire ECG is covered over here so let's continue back to our physiology so p wve is due to the yes depolarization of Atria QRS is ventricular depol T wve is due to Repros of the ventricles back to the normal state so that is a concept okay now cardic Cy is8 second and is the events occurring in one heartbeat so remember S1 to S2 is systo S2 S1 is diol there are two part of systo what are the yeah I'll share don't worry so what are the parts of cyol and diol are let me explain see when the mital Val close it is ISO volumetric contraction it start with the closer of the what closer of the AV Val so AV close and what start ISO volumetric contraction occur ISO volumetric contraction pressure increase this open the semilunar ejection occur so ejection occur due to the opening of the semi lunar well then the closure of the semilunar that cause the S2 sound this this was the S1 sound this is S2 and this is called a syone now first period in diol would be ISO volumetric relaxation so it is ISO volumetric relaxation okay and now what happens there is relaxation and MV TV open so mvtv the compliments thank you very much so let's continue okay so let me write the phases now yeah it's back it's back it's back back it was aall okay so a syall now back is back is back don't worry it's nothing just a small asol okay so small asol and it's normal okay so just small a normal okay okay so it is normal now okay don't worry okay so it happens okay it happens don't worry okay clear not okay okay now it's okay so I am on backup now don't worry okay be positive okay I am here with you people and I will take class yeah I took the mic so don't worry we'll find some solution okay if not I'll use my phone 5G so I'll use my phone 5G it has lots of data pending to finish the class don't worry okay if you tell you the story you'll say okay there are two internet provider in this area okay right now I'm in a studio in Gotham nagar there are two inter provider some excite tail some haway so whenever other companies start getting less sale the employee of that company start cutting the wires of the other company cables so their net doesn't work and then they say and they start installing there and as their number increase the other companies start cutting their wire that's why they're always cutting each other connection so okay let's continue so S1 is what is MV close mvtv close what the status all valves are closed all valves are closed that's why it is called as ISO so all valves close Okay this is ISO volumetric contraction now pressure will increase this will open the avpv iotic and pulmonary valve open yeah thank you bubbles I remember this thank you now there is ejection stroke volume 80 ml so that what you will eject then after the ejection the iotic pulmonary Val close AV PV close once they close again the volumes are same all Wells are close that is why it is called as ISO volumetric relaxation and now what happens yes I discuss murmur also if possible I will revise them now also okay yeah so I can do them if possible now again what happens the MV TV close MV TV close as they close there is now filling sorry open so as they open filling occur filling has two part yes filling has two part early and late early cause S3 yeah it happens S3 late S4 and between the two filling there is a period where there's no filling call as diastasis Dia stasis so diastasis and at S1 again mvtv close so this is our cardiac cycle so this is what this is our cardiac cycle okay and last time I revised the murmur also and I gave a very simple pneumonic which subject you study about mortality rate Mr IMR MMR PMR so all the mortality rate we study in what PSM now so that's why Mr causes PSM pan yeah S3 can be increased in any hyper Dynamic circulation uh pregnancy middle age exercise S3 is because of increased feeling so remember PSM so Mr is pan systolic murmur very easy so Mr is pan systolic murmur IMR MMR PSM PSM so PSM is Mr PSM is Mr why are you studying now need PG why will you give the need PG because you want to get Rank and rank to get what to get our MS or MD so Ms is MD so mital soses give you mid diastolic murmur mid diastolic murmur so easy so these are my pneumonics for medicine I'm not doing it now because now we'll do the physiology of the yes one shot we'll do it later so now we come back we done done that already now what the pressure changes so left Atria is around 5 to 10 mmhg it is also equal to pulmonary capillary veg pressure because the blood from the lungs flows to the right Atria left Atria left Atria so left Atria represent pulmonary capillary wedge pressure right Atria represents jvp and Central Venus pressure which pressure Central Venus pressure it is around 0 to 5 or 0 to8 CM H2O very good yes bubbles you are right it is perfectly fine perfect perfect then left ventricle right ventricle they are zero in diol because they relaxing and the pressure become almost zero to allow the filling is zero allow filling otherwise if the pressure is high filling will not occur so that's why pressure is zero iotic pressure is 120 by 80 80 is caused by elastic recoil so what the elastic recoil cause 80 mmhg so 120 is by left ventricle 80 is by elastic recoil same way pulm artery 25 is contraction of the right ventricle 10 is by elastic recoil of pulmonary artery now now we'll see jvp jvp show right Atria changes because there's no Val between the right Atria and the this so remember the pneumonic a a a a a is Atria contract a wave then ventricle contract C wve so a for Atria C for ventricular contraction so tricuspid well bulges into right Atria causing c-wave then when the Atria relax relax is X so when problems in your life become your X problem you should relax so relax X is gone so remember relax X so pneumonic is relax is X relax is X okay then one more pneumonic you want okay Xenon Zenon has the letter X so Zenon run very fast like your X run away very fast and remember X is expensive so much you lost your time your emotion your money so ax is expensive it's a expensive gas run very fast and it is only yes used in selective cases okay so relax X then when the Atria get filled by the blood coming from the yes pulmonary vein Etc it give v v is Vina Cava wave so V is Vina Cava so V is Vina Cava and mty why Why by by so when the TV open the blood goes to the ventricle it's a by by Atria so by by y y so remember m T is y so let revise with me so a c x v y so a c x v y x is relax Y is empty t y y y byy relax is X and V is filling a is contraction of Atria C is contraction of ventricle so a Atria contract C ventrical contract X relax V filling y empty cam done D done done now volume changes first what is edv edv is the volume filled in The ventricle during the diol so during the diol and normally it is 120 130 ml what does it depend on it depend on the Venus return if there is more return more edv the load on The ventricle increase now it has to pump extra blood even before you have started the contraction okay and that's why it is called ASE preload why preload because it is before contraction so call is preload after load is after contraction which I'll discuss later preload is edv then come SV what is SV stroke volume what is stroke volume blood pump by The ventricle per beit is called as a stroke volume normally 70 to 80 ML and ejection fraction is percentage of the blood ejected per beat it is 2/3 or 65% given as SV by edv into 100 so what is SV by edv it is ejection fraction what is ESV it is blood left in The ventricle after the ejection normal is 40 to 50 ml normal is 40 to 50 ml formula is edv minus stro now we'll discuss cardiac output cardiac output simply blood pump by ventricle is per minute formula is stroke volume into heart rate or we can use Eco cardiography di dilution or Thermo dilution these are based on Which principle we that cardiac output is amount of D divide by concentration into time so this is the formula for calculation so it is amount of D divide by concentration into time this give you our cardiac output cardiac output now next question during exercise the cardiac output increase how much 2025 it's a normal or extra output it is our extra output call is what cardiac reserve so that's why cardiac reserve is the case yeah it will increase increase so inspiration exercise increase the Venus return yes it will increase so if you want I can write down so increase Reserve increase by yes by Cal muscles inspiration suine posture and also sympathetic alpha 1 Veno constriction they all increase the Venus return so remember this yes they can increase the Venus return how calf muscle compress the leg vein shift the blood to the heart inspiration sucking the air into the heart suine when you lie down the blood see when you lie down the things will shift from base to the epex so again blood supply will increase to the heart and the lung and also sympathetic alpha 1 V constriction so I was telling during the exercise our cardiac output increase what does it call as cardiac reserve now the mechanism two mechanism so there are two mechanisms two mechanism one is Frank Starling law more the edv more the stroke colum as there's a increase in the edv so as edv increase let me show you let's say the graph this is edv this is stroke volume this is edv let's say edv is 120 and stroke volume is 80 if you increase it to 130 the stroke volume will become more 90 what do you see as the edv increase stroke volume also increase this is called as Frank Starling law that's why exercise IV fluids increase the edv which increase stroke volume cardiac upward what do it called as it is called as Frank Starling C so this is Frank Starling curve so what happen more the more the edv more the stroke colum now if you shift the curve to which side to our left side now there is increased stroke volume at same edv so now there is a increase in the stroke volume at same edv we don't need to increase the edv so increase edv causing more stroke volume is called as Frank stalling if there is same edv but increase in the yes stroke volume it is mainly because of calcium more calcium create more contraction and more contraction cause more pumping more stroke volume left shift is there so left shift is basically our inotropic effect and in Failure there'll be like so so this is right shift in systolic failure negative ionotropic effect negative inotropic effect very good now what are the example of our inotropic agents so example is epinephrine norepinephrine damine so dobutamine via beta 1 increase the calcium and cause increase pumping where dis oxin block the sodium potum pump increase the calcium via increase sodium calcium exchanger that is PHA for you ultimately they all increase what the increases our yes activity so let me summarize so summary if you want to increase stroke volume there are two method increase edv or increase calcium same Ed what is increased DV call as Frank Starling what is same call as it is call as inotropic effect or left shift example IV fluids in hypmic shock or exercise increase Vena here example is dis oxin or sympathetic catac Coline they all increase our calcium that is our inotropic effect so this is what effect inotropic effect let's go back first which are the factor which increase our yes sympathetic activity effects first increase heart rate is called as chronotropic effect then increase stro volume is what inotropic effect increase conduction is dromotropic effect increase excitability is called as bmot Tropic effect what is it called as bmot Tropic effect now which factor increase Venus so first I told you suine posture more return is there calf muscle compress and increase that's why it increases this and when does the return decrease yes prolong sending so prolong sending cause what increase decrease so it cause decrease return prongs sending cause decrease edv decrease VR decrease tro volume decrease card what can occur painting can occur snope can occur McQ so they ask you what changes first on sanding or suine posture the first change is Venus return Venus okay what the example of prolong sending anyone okay 26 January 15th August remember your school day we are all asked to stand in assembly standing for ours that's why very common for children to faint in the assembly reason standing for ours even soldiers can Fain and there is some politician who's coming as Chief guest he is giving the you know big lecture asks children you are the future of the country and there the future is shaking and he said future should be and the future fall down so as someone fall down everyone look back who's Fallen who's Fallen sometime even you fall down okay as someone fall down who reaches the site of this falling first PT teacher physical training teacher is same in all school every school I've seen they are same first they always wear track suit always wear tracksuit they have white shoes sports shoe with a whistle in the pocket big mustach and they have big tummy they are the most unfit person in the school most unfit but he's the PT teacher second question this teacher is doing nothing useful all the time he is just roaming here and there making fun flirting with the teacher especially with the English teacher okay now he is going to go there and start making fun today's kid they have no stamina can't even stand for 2 minutes sir we are standing since morning 5 Hour 2 minutes then he say low glucose low glucose eat no eating no proper no glucose glucose oh Ser it's not glucose it's Venus written in school time there's only one disease and that disease is our Venus return or glucose less less glucose and the treatment take to Medical room give glucose and technically everyone get cured by glucose why because when you lie down it's not glucose it's the return when you lie down the blood from the leg start going to the heart and the brain and problem is solved so problem is not going to be what corrected by glucose is actually suine posture now question is okay question is okay yeah see see see question is why PT teacher doesn't faint he's so unfit why he doesn't faint reason reason why he's not fainting reason reason reason why he's not fainting the reason he keep on walking here and there that's why his return is maintain and that's the secret of maintaining Venus return okay yeah broken English yes yes that's why keep talking to her to improve the English and other knowledges okay so you want to improve his English and maybe other subject knowledge okay that's why go there again I see some dip in the Activity one second think PT teacher I think it's fine now sorry I think my PT teacher or maybe some PT teacher has taken job of now internet connection so he listened to my you know pathetic jokes and he cut the Net Connection again again so yeah I myself check the lag and corrected so he got angry I'm making fun that's why yeah he corrected okay really sorry okay please Don't Judge Me on the base of internet connection okay and give me poor marks teacher so sorry for that okay now next is Venus valve so vals are basically for preventing the back flow for back flow okay clear second inspiration pull the air into the lung because of negative intorc pressure sympathetic I told you already and also deep facial is very thick in the leg keep the muscle and the veins compress in this particular case Okay so let's continue I think I should better take a standup comedy job it'll be much more beneficial yeah then I have to take just one video a day one hour and I will get billions of view and cores of income rather than working so much CH okay types of blood vessels so first is wind Castle vessel they are large elastic artery wind Castle vessel they stretch in the systo and recoil in diol as they recoil in diol they compress the blood to produce diastolic blood pressure of at and that's why blood flow continue in systo also and diol also so blood flow is in both cyol and diol okay okay so not too sound mean but in this country to be successful you don't need big degree big you know like educational qualification big brain you need very big gluteal region bigger the gluteal region you show on social media more number of followers you will get and you will become very successful so yeah so that the truth okay okay now next is capacitance vessel so the F of capacitance vessel it is our yes systemic veins they have high compliance so they stretch and store the blood and they contain 50 to 60% of the blood inside so what they contain 50 to 60% of the blood and that's why if there's a loss of blood they compensate and can maintain BP so they compensate and maintain BP till 30% blood loss that's the problem now if I become successful as a comedian it will be really a very regressive message ke doctors are not as successful financially as even the Tik tocker YouTubers Etc which TI and let's continue okay so next is exchange vessels exchange vessels are capillary now see the property first they are very permeable they're highly permeable okay and they have simple squamous endothelial lining they have minimum blood volume low pressure low resistance now why are they low resistance because of parallel circulation right why low resistance due to parallel Arrangement so due to the parallel arrangements okay so next question is what is the speed slowest it is in capillary so so that's why they have very good exchange and laminar Silent flow turbulent is in artery because of high speed higher the speed more the turbulence noisy flow so it is noisy flow taking place in this particular scenario okay clear so I will request no one to talk about the status of doctor right now right now we should focus only on study okay if you start looking at our condition you will feel very sad so that's why I focus on positive thing the positive thing is one subject will be over today you can focus on second subject tomorrow okay so cross-sectional area is highest in capillary because there are billions of capillary in parallel that is why their area is maximum so let me revise and summarize just remember remember all property all low minimum in capillaries what low speed d diameter blood volume what is maximum maximum is CSA what is CSA crosssectional area so what are the highest thing which is present in this case so this is our which value it is our which value it is our CSA it is our CSA crosssectional area okay now come our resistance vessel what are resistance vessel they are our basically muscular arteries and arterial they have smooth muscle they can contract or relax example they will change the diameter and control the blood flow example arterials are our main resistance vessel why because again they are just like the terminal bronchol maximum smooth muscle and have a good sympathetic Supply what does sympathetic Supply do alpha 1 cause what alpha 1 so alpha 1 is going to cause what Vaso constriction decrease the flow increase the resistance beta 2 Vaso dilation increase the flow because of yes decrease in the resistance so Alpha and beta are the two receptors next question where is Alpha 1 almost every place but beta 2 is selected side like some muscle sweat gland uterus Etc so who's everywhere Alpha 1 now if arterial are offering resistance which level not heart heart is aota they're offering it arterial which is tissue level far away from the heart that is why they are the main site of peripheral resistance and if PR increase ventricle will have to apply extra pressure to push blood against this High Resistance that is why they are called as after load so who after load PR who preload e DV so once again after load who after load it is our peripheral resistance whose preload edv is our preload now we'll discuss our blood flow regulation remember flow is given by pressure upon resistance so that means if you can change the resistance flow will also change so organs can alter control their own Flow by changing the resistance like example if the organ like brain want more blood flow it just decrease the resistance by dilating The Vessel more blood can come this is called as our Auto regulation so what is auto regulation Auto means own Auto means own and control what the word for control regulation so say control that is called as Auto regulation example how do they increase the flow of the muscle in exercise in exercise in exercise increase flow to the muscle how basically when we exercise sympathetic will increase our pressure BP second as we exercise metabolite like lactic acid carbon dioxide hypoxia k+ H+ adenosine temperature they all accumulate cause Vaso dilation and they will decrease the resistance increase the flow this is called as metabolic Auto regulation so when I'm writing where is blood going more in my hand muscle why is it going more the answer is as I write my muscle have more metabolism more lactic acid more carbon dioxide more hypoxia k+ and they cause Vaso dilation and increase the blood supply where is the best auto regulation brain and the heart and brain is by C2 and heart is by adenosine so who's the best regulator in the brain it is carbon dioxide and in the heart it is adenosine it is in the heart adenosine is in the heart now what the formula for our resistance it is 8 EA L by pi R4 now what is the EA is a symbol for viscosity more the viscosity more the resistance L is the vessel length longer The Vessel more than I'll write it better R is 8 th L by pi R4 L is length of the vessel so L is length of the vessel longer The Vessel more the resistance and finally R is radius so radius is the most important why fourth power effect that's why if you double the radius if you double the radius two times okay kidney also have Auto regulation okay and again they use mainly their own etc for blood flow regulation so resistance will fall by 16 times so which power fourth power effect done okay now we see the blood pressure blood pressure is given as cardiac output times peripheral resistance now systolic pressure is 120 produced by the ventricular contraction and depends on cardiac output that is why in shock right don't in shock what decreases cardiac output decrease so SVP or BP will decrease so that is why all shock there is what decreases decrease cardiac output and decrease BP what the reason as heart pump less blood artery receive less blood if they receive less blood obviously cardiac output BP both will decrease both will decrease DBP is 80 it is not due to The ventricle but due to elastic recoil of iorta and it depend on peripheral resistance mainly on the peripheral resistance now pulse pressure is basically SBP minus DBP it indicate how much systolic cardiac output is coming diastolic give the pr that is resistance and I told you what the formula of flow it is pressure by resistance so what pressure gives you systolic BP resistance is given by peripheral resistance or DVP so the ratio between the two or difference give you the blood flow received so that's why blood flow is given by pulse pressure and also arterial compliance how stretch in systo stretch in SVP and recoil in DVP so if the arter is not stretchable stiff hard non-c compant it can't sit in systo can't recoil in diol that's why it will affect both the pressure both will dip and that will lead to a poor compliance poor pulse pressure so that's why what is the compliance indicate stretching power also recoil power also now MVP is mean blood pressure it is is given as 95 to 100 is the range now what the formula 2/3 DBP plus 1/3 SBP or it is basically DBP plus 1/3 of pulse pressure so DBP plus 1/3 of pulse pressure give you what give you our MVP two formula either 2/3 1/3 2/3 DBP 1/3 SVP or take DBP plus 1/3 of pulse pressure now the cardiovascular regulatory centers are present in Meda there are two centers vmc which is in rostro ventrolateral Meda function is increase sympathetic increase everything increase everything so who increase everything vmc CVC is cardiovagal Center it is veal nuclear nucleus tractor solitarius and nucleus ambiguous they increase parasympathetic activity by vas and we know vas M2 receptor decrease heart rate output BP conduction all so one line summary who increase BP everything vmc who decrease everything CVC and CVC give Vegas now now who tell them increase increase decrease don't decrease that's bar receptor so baroceptor control the BP they are stretch receptors in the artery number one number two they sense and regulate MVP so sense and regulate MVP but most sensitive to pulse pressure changes so most sensitive to pulse pressure changes latest gong give this change so some of the guide Bank even our own uh oule question Mar contain MVP is a old answer please correct it to pulse pressure so if someone say it should be MVP because that question Bank the gold standard is giving there's no gold standard even gold is not 100% pure because 100% gold will be so soft so Mele will not be able to take any shape so they always mix something they can mix metals to Gold 100% gold same way even the gold standard has some weakness so that's why remember this okay so therefore most sensitive to pulse pressure okay range is 60 to 180 what the range is 60 to 180 and they act by negative feedback always decrease the BP and heart rate what they do always decrease the BP heart rate by stimulating Cardiovascular Center that is ants and inhibiting the vmc now you'll say sir but then I'm not able to understand how they work so first question location same as peripheral chemoreceptor AR of aota and koted yes arota and bifurcation of common koted artery the nerve Supply nerve Supply is what is 10th nerve and koted is ninth now koted is ninth now okay now let me explain first question understand who want the BP to increase vmc increases sympathetic increases BP okay so increases the VP always always but J BP who will sense it Barrow receptors so Barrow receptors will sense so now they send inhibitory command to the vmc negative feedback negative feedback Okay negative feedback and which nerves we are using 9 and 10th now and that will decrease BP back to normal are you clear so that is how the BP return back to the normal so I have a question for you question is if if you destroy baroceptor or you destroy sympathetic what will happen so if you destroy sympathetic BP will decrease that is neurogenic shock if you destroy baroceptor the inhibition is gone BP will increase so that is called as neurogenic hypertension that is written in the next slide so destruction of our Barrow receptors will lead to increase in the BP called as neurogenic hypertension and destruction of of sympathetic decrease the BP that is called as neurogenic yes hypotension decrease BP call as neuro genic shock so One More Concept clear so sympathetic causes neurogenic shock very common spinal cord surgery injuries okay three reflex then CVS over and now we'll be going to the next system so CVS reflexes first is our Bane Bridge reflex so what the question about the Bane Bridge reflex Bane Bridge reflex is a compensated mechanism your compensatory mechanism what is the story about that first it is resulting in due to increased heart rate so whenever you give IV fluids it causes increase in the heart rate call as Bane Bridge reflex so increase heart rate due to IV fluid it calls bin Bridge reflex mechanism is increased sympathetic by atrial stretch receptors atrial stretch receptor then bizol jerish reflex or jerx is apnea bradicardia hypotension following IV injection of irritants they are irritants call as what our Bol jerish reflex for the injection capin Verdine or 5 HT they are irritant they cause the heart rate Etc why via vas what the mechanism via vas so vas causes bradicardia apnea and hypotension J reflex is in the lungs in this case it is due to what again pulmonary edema or hyperinflation or irritance again and response is same again apnea bradicardia hypotension same response Vegas now again Vegas decrease BP decrease heart rate apnea that's why I never mention clear so that causes our J reflex so that is our J reflex in this case okay now comes our Mar's law Mar's law is basically a reverse relationship between BP and the heart rate it say BP is reverse to heart rate in shock BP decrease but heart rate increase why because as the BP decrease bar receptor activity decrease so sympathetic vmc will increase and that causes increase in the heart rate call as reflex techic cardia so Barrow become more or less active Barrow decrease vmc increase don't ever make a mistake so Barrow become less active so vmc become more active that's why there's a increase in sympathetic Cushing is because of increase in the head injury as does the head injury it always increase the BP okay but decrease heart rate by baroceptor vus nerve that's why it is called as our yes pushing reflex High BP low heart rate so head injury damage the brain and can cause increase sympathetic by the brain causing the increase BP called as a Cushing so in Cushing what do you see in Cushing BP is high heart rate is low who's causing low heart rate heart rate is decreased by Vegas this is called as our pushing reflex okay CH so congratulation we have finished our 17 Pages VR now only 10 pages are left so we'll be finishing it in the next 1 and a half hour 11:30 I think we'll finish Okay so so unary system kidney first is what is the functional unit of kidney we took a break also so count the break time also 20 minutes otherwise you would have finished by 11 okay so what the kidney function it is nephron what the parts of the Nephron first it is bomb and capsule then PCT Loop of hlay then there is DCT and collecting duct and the collecting tibute okay now comes the question this area which I'm highlighting it is medula this area above is the cortex so who lie in the Meda one is the medary collecting duct MCD and loop of Hy also this capillary network is called as Vasa Rea Vasa Lea and the capillary which surround all the tibule afen give glomus glom capillary give GC glomar capillary they give our e arol which then give this capillary these capillaries are called as pc pc pc what is PC par tubular capillaries around tibes so par tubular capillaries around the tubules is the story in this case so they are our per tubular capillaries so which capillaries per tubular capillaries okay so clear now comes the question what what is the next Point glom capillary they filter the plasma mainly on what basis mainly on the size basis what the criteria for filtration mainly size basis so after filtration the tibule enter the the substances enter the Tibu now good things like glucose amino acid they are reabsorbed so they will enter the blood so good things are entering the blood I'll make a diagram to show see this is tubules this is bomman capsule this is GC and this capillary is PC so first question is what is filtered everything good bad so good things once they are filtered what do they undergo so let's say these are bad things like drugs or Ura and and good things are also filtered let's say our glucose amino acids so the good things are chloride sodium so these good things are reabsorb they go back to the blood so all the good things go back to our blood what about the dirty things the dirty things like UA which might Escape filtration so this UA which is unfiltered it will be secreted out s so the three steps of urine formation filtration of everything reabsorption of good thing secretion of par tubular capillary dirty substances so secretion is what it is the unfiltered substances in the blood so that's why it is of unfiltered solutes unfiltered solutes in par Tu capillary this is called as secretion okay so are the three steps of urine formation filtration secretion reabsorption filtration is a glomular function secretion reabsorption are tubular functions now glomerular filtration membrane contain three layers first is endothelial cells of glom capillary and they contain openings called as fenestration so what are the openings they are fenestration let me show you so this green one can you see these are endothelial f con ations okay then we have the basement membrane the basement membrane contain negatively charge Calo proteins and haperon sulfate what they do they rle and prevent the filtration of negatively charged plasma protein so why albumin not filtered because it is reppel by the negative charge of the basement membrane last is the epithelial cell of BC the most favorite word of vat kohle and delites he's a Delite so 2+ 2 4 so BC BC means uh big contributor or big you know like uh confusion or something BC okay so that is the case now pite and foot process they are having filtration slits which are 10 to 20 nanom so 10 to 20 nanom okay so it is 10 to 20 now what is the net Poe size it is smaller than the smallest Poe reason if I have one filtration membrane two if I put on top what the net filtration pole it becomes smaller than the smallest one and that is why the size become very very small just one second one second okay yes so sometime without kie keep saying also Ben Strokes Ben Strokes so he keep remembering Ben Strokes so B stroke why Ki always remember me so yeah he's remembering Ben Strokes okay now the question is what is the net port 4 to8 that means anything less than four is freely filtered like inulin glucose sodium they are what they are freely filtered if more than eight they are not filtered example WBC RBC platelets they are not filtered at all okay also yes macr globins myoglobin is not filtered reason because it is bound to plasma protein and hemoglobin bind haptoglobin to prevent the filtration so remember this is a very very important topic myoglobin and our yes haptoglobin myo and hapto now if something yeah nowaday yes true okay if it is between 4 to 8 nanometer okay 4 to 8 nanometer it depends on the charge on the charge okay on the charge example if something is seven let's say albumin It Is filterable by size but it is not filtered due to the negative charge so why is albumin not getting filtered the answer is negative charge is the the reason it is rled and prevented from filtration so loss of negative charge in nephrotic syndrome causes albumin UA so why we have albumin Ura because we have lost our negative charge McQ now come PCT PCT number one it has maximum ATP oxygen blood all why because maximum so who the maximum secretion absorption PCT so it is our PCT always and always now all substances maximally reabsorb in PCT sodium potassium chloride calcium B glucose amino acid even Uria except magnesium what the exception magnesium is in the ascending Loop of hel don't forget same way all substances are maximally secreted Again by PCT what drug toxin acid all except the k+ in P cell and UA in thin Loop of handle everything else is reabsorbed in the PCT now remember maximum acid secretion occur in which area it occur in the PCT so what is occurring in PCT maximum acid secretion and it also has maximum buffers maximum buffers why to maintain the pH so that is why it is maximum buffers in the PCT that's why pH is well maintained now main buffer is bicarbonate and it need the enzyme Carbonic and hydras minor buffer is ammonia and phosphate and remember kidney make ammonia itself from glutamine so ammonia is made by tubules so it is inducible buffer so it is inducible buffer okay so it is inducible buffer okay now Meda medula of the kidney has very high hity 1200 how much 1200 it is called as hypertonic okay so it's how much 12 four time more than plasma call is hypertonic let me show you so this I told you Meda it is 1200 M Oso per so that's why when the water goes through the Meda Meda can pull the water from the this area water and the loop of water and as it reabsorb the water urine will will become concentrated so what the Meda can make the urine concentrated so don't please so that is why what it does it pull water from the urine and make concentrated hypertonic low volume urine okay up to 1200 in descending Loop and CD but remember CD needs ADH so who doesn't need the ADH uh descending Loop who need the ADH our CD now remember longer the loop more it can enter the med more it can remember longer the loop more the power so longer is better so longer more power so longer has more concentration power and that is seen in jua medular nephron so they very long Loop of hand although they are just 8 15% of NE so they are not the maximum they are just 15% of the nefron and these 15% nephron perform or do which function which thing so they are responsible for which function which thing yes so they are they are causing the main value and maintenance okay so let's continue now remember the rule descending Loop is permeable to water so it water permeable absorb the water so it reabsorb the water right here reabsorb water as it reabsorb the water hypertonic urine is made whereas ascending Loop is solute permeable it is solute permeable make hypotonic urine okay and this then goes to DCT and CD in CD ADH will make it hypertonic again I'll discuss it later now counter current system help in concentration of urine how by making medula hypertonic 1200 how first multiplier is ascending Loop of handle it multiply how much 300 into 4 is 12 so it multiply the osity four times by adding the solutes into Meda so who's putting salts into Meda ascending Loop and as it put salts in Meda Meda become hypertonic 1200 vasara is a spal capillary it maintain medary osity by water absorption out of Meda so what keep pulling excess water out of the Meda vasara pull excess water from Meda as it pull access water from the Meda what is it trying to do it is able to do what it is able to take the water out as it take the water out what the benefit the benefit is it is able to yes maintain Meda osity let me give a summary so suine my style so the target is what Target is medula should be hypertonic medula 1200 to concentrate urine so how do you make it first add salts who will add the salts ascending Loop because solute permeable and what will be it call as multiplier whereas who will drain excess water that is vasara remove water vasara so what the pneumonic pneumonic is simple V Rea remove so Vasa recta remove the water so it become Vasa recta water remove Vasa Rea water remove very very important and it is called as exchanger because the capillary capillary is exchange vessel so exchange vessels are capillary I told you already so that is a summary I hope you understood so who create it is the ascending Loop and who add the salt ascending Loop call is multiplyer who remove excess water exchanger or our Vasa recta so is it clear to all of you okay let's come back now ascending Loop has two type of Transporter thin is sodium chloride transport it is passive and this thick is nkcc which is active what is nkcc sodium potassium chloride cor transport it pump one sodium one potassium two chloride into the Meda so as they enter Meda they make the Meda hypertonic so who's putting salts answer is n KCC is putting the salts into the Meda and making the Meda hypertonic who block the nkcc so nkcc blocked by Loop dtic that cause loss of solutes in the urine all solutes that's why it causes hypona hypoc hypoc Calia hypo hypo chloremia all are lost so one word summary Loop is lutter Loop loot Loop has looted every ion so every ion is looted by Loop and what the disease barter syndrome that's why bar syndrome resemble overdose of loop diuretic overdose of loop here the ADH action is seen if ad is there water is absorb and urine become concentrated without ADH the collecting that which got what urine hypo onic urine will remove hypotonic so what ads do ads take a call whether to absorb the water or not absorb the water which I'll write later okay let's see now DCT so let's see DCT early part contain NCC sodium chloride yes Loop cause loss of all including the calcium so n KCC is in the ascending Loop NCC is in early DCd it is causing again block by thide defective in gentlement again loss of all ions except calcium loss of all ions in urine except calcium so once again loss of all ions in urine except the calcium ion so the only exception calcium is our Only Exception in this case what the only exception calcium that's why this causes increase calcium Loop cause decrease calcium so that's the main difference between but and jetl Men calcium is not lost in our jetl men okay okay yes you are right now in the CD there are two type of cells one are ey cells they are intereted cells what the function they help in acid secretion and they make most acidic pH most acidic urine in which area in CD so where is most acidic urine form in collecting that what the minimum pH possible so minimum pH possible is not always possible possible minimum pH is 4.5 is called as limiting pH so can you make pH less than 4.5 no no no no no this is the limit then come our P cell what are P cells P cells are principal cell what principal sir do he take something give something out like he take the feast give you degree diploma School Passing certificate so principal cell potassium yeah see there's a calcium sodium exchanger so that's why sodium is lost but calcium is not lost okay so that is a story okay now so blood potassium will decrease but increase in the sodium so what the principal doing he's taking the sodium in the blood and kicking pot iium out what are the mechanism inac which is epithelial sodium Channel and also sodium potassium pump so who block the uh inac is blocked by amide that's why it's a potassium sparing diuretic so it is it what potassium sparing diotic it is potassium sparing why because it will prevent the potassium secretion so potassium spearing diuretic and it a drug of choice for little syndrome in little syndrome syndrome there is increase inac activity so what is little syndrome increase inac increase inak in little syndrome so that's why the drug of choice is what we give Amite so the neonic is two condition we use our amide lles and lithium so pneumonic is Lily Lee or Lee Lily is a small girl Li and small baby girls they love to ro liily aoide aoide so that is the case okay see potassium secretion occur in yes our CD ascending Loop also secrete but that's not the main main is occurring in the CD for potassium balance what the neonic Lily amide le le amide Lily is amide are you clear now who stimulate our P cells so P cells are stimulated by our alron which hormone alron that's why it causes hyperia hypoa and also metabolic alkalosis due to increased acid secretion and the reverse is Addis disease so this is called as our con syndrome so in cones increase alone I'll write here cones increase alron so there is increase serum sodium and decrease serum potassium and then there is Addison disease there is decrease alone reverse occur decrease serum sodium that cause salt craving and increase serum po so this is our what disease this is our disease called as Addison so Addison is reverse increase alaston but decrease in the yes sodium is increase potassium so the pneumonic is there's a salt craving so imagine aun dun Addis sois disease dun adase he doesn't have viml craving earlier he had viml craving always keep viml in the pocket bolo Zaba now he say bolo Zaba saf or n so now he eat Tata and he carry packet and keep eating because he has intense salt craving and what is the treatment of salt craving obviously we give hydroc cortisol so drug of choic is hydro cortisone is the drug of choice now let's see next CD CD is remember water and UA permeable with ADH how does it do ADH increase ut3 ut3 which is UA Transporter 3 make UA enter medula and increase the osity and help counter current system okay yes bolo Tata Sal bolo dat so very good very good pneumonic okay so it causes help in the yes counter current system now also it causes increase water reabsorption via Aqua pin 2 receptor is V2 and P cell so remember it both occur via V2 receptor so V2 help in Ura transport and this so let me write it somewhere so understand the story okay so remember a DH shift UA from urine in CD to medula and increases medula osity so once again it shift Ura from urine to collecting duct and as the Ura enter Meda it increase the Meda osity and there is decrease increase counter Curr system so countercurrent system becomes stronger that is why a person with high protein High UA has more power to concentrate the urine to concentrate the urine so that is why there are two situation possible one is ADH can be high or ADH can be less if ADH is less or more if ADH is more the collecting duct is more water permeable Aqua POR in two and cause more water absorption that make low volume concentrated hypertonic urine as highest 1200 whereas if ad is absent like diabetes Inus CD is water impermeable less water absorption so hypotonic urine and high urine volume polyurea poly dipsia occur so in short ADH control control urine volume and osmolarity so urine volume and our osmolarity both are controlled by our ADH next question last renal blood flow is approximately 1,00 out of which how much is plasma so it is 50 5 to 60% of RBF because blood contains cells also so it's roughly 55 to 60% and out of that how much is filtered so out of 625 around 125 ml per minute is filtered this is called as our GFR it is a 125 ml per minute or 180 L is roughly how much so GFR is 20% of RPF now see okay see normal is around 600 normal is 600 range is 50 to 1200 this is just the range not the value range 50 to 1200 is the range of urine osmolarity now let's see clearance formula is u v by P urine concentration by plasma concentration into V so u v by P I'll write again UV by P let's see if there is only filtration no secretion no reabsorption then clearance become equal to GFR y because you're only clearing plasma by filtration what the rate of filtration called GFR so your clearance become equal to GFR okay example is inulin so inin is used for GFR estimation most accurate most accurate now if secretion also occur the clearance tends to increase and now the clearance will be more than GFR so why because you are doing I'll example why understand why because now the clearance is filtration plus secretion so that's why clearance will be more than GFR why GFR is what only filtration and what is clearances it is filtration and secretion so obviously what will be a bigger value obviously clearance will be bigger because clearance is made by filtration 20% remember GFR plus secretion from the par capillary so clearance will be 125 above 125 above 125 so remember if only filtration the clearance is equal to GFR if secretion also it will be filtration plus secretion so clearance will be 125 above 125 above 125 so clearance become above GF example creat what the value of grin clearance it is 130 what is 130 means 130 means it is above 125 that means it is getting secreted but very little why very close to GFR so that's why it is close to GFR that means it is secreted in a very small quantity that's clearance is close to GFR how much 130 versus 125 that means it is mainly cleared by filtration with little secretion but can be used for GFR estimation so remember most accurate is inulin but most use is creatinin why why it is endogenous it is endogenous easy to perform so what thing is already present in our body it is creatinine so just need to check the blood level and urine level calculate the value whereas inulin you have to inject maintain the perfusion then check so what is difficult to measure inin is difficult to measure whereas creatinin is easy so that's why they ask you in the exam what is GFR given by always go for inulin because you have to select what the most accurate answer not the most used so most accurate is inulin now if full secretion occur then 100% plasma will be cleared everything is removed in the urine clearance become equal to RPF okay example pH par amino hippuric acid it is used for RPF estimation why it is used for RPF estimation because it is 100% clear reason 100% clear now next point if reabsorption occur obviously clearance will be less than 125 that is GFR example Ura so Ura is 70 to 90 ml so is it less than GFR yes so less than 125 GF so why is it less than 125 the reason simple it is filtered and then some of the Ura is reabsorbed why is it reabsorbed from the urine to help system counter current that is why UA clearance is not equal to GFR it is rather less than GFR lastly if you reabsorb something 100% it'll be 0% cleared in the urine and 100% back to the plasma so clearance will be what will be equal to zero so zero means it is 100% reabsorbed so let's see the summary summary is clearance equal to GFR means only filtration only filtration clearance more than GFR what does that mean clearance more than GFR tell me clearance more than GFR it is filtration and secretion and clearance less than GFR it is filtration and reabsorption very good so that is the rule okay tell me what is clearance 0 equal to zero which substance zero 0 0 0 0 it is glucose then what is clearance more than GFR tell me clearance more than GFR how secretion okay secretion then clearance equal to 125 very good creating something 125 what the substance give the substance inin clearance 625 example very good 625 625 example yes example pH very good very good shabash and what is clearance 150 example 150 150 150 cre perfect perfect let's come to the last page 20 only seven pages left we'll finish it by 7:15 720 then I'll take your doubts so I am perfect on my time and whatever I promise don't worry okay so glucose is 100% reabsorbed in PCT by what by our sglt2 that is on AAL border second reactive and glute two on the basil border now how much glucose we can reabsorb it is called as TMG transport maximum glucose it the max glucose that can be reabsorbed per minute in the Tibu it is 375 what are the values 375 filter load is the amount of substance filtered per minute that is GFR into plasma concentration if FL is more than TMG then then what happens the amount is too much you can't reabsorb 100% glucose UA will occur and if reverse occur if TMG is more than FL no glycos UA and if I'll write here TMG more than yes FL no glyos UA okay so no glyos UA now what are the two reasons for glycose UA first is either there's a very high load example there is diabetes vus there's so much glucose you can't reabsorb TMG decrease if decrease its tubular damage kidney can't absorb so that is less absorption that's why glucose Ura is there example fanone or acute tubular necrosis so acute tubular necros they causes our which phenomena they causes phenomena of decrease in the TMG okay and SP also occur in play the expected value for the threshold is not matching this is called a SP so expected renal threshold and actual RT is lower than that so actual RT is lower than expected RT okay so expected RT and the actual RT is lower this is called as play so place the threshold value doesn't match reason is saturation so saturation of Transporter occur at higher level so you cannot me the expected with the actual Val what is the actual RT is lower than the expected RT this phenomena is called as and let me just go through this because space is not there and the yes we have to finish the syllabus so that that will load done I've done my part I've done my cabus I've done my uh content okay otherwise so physiology is a big subject one year subject you are squeezing it in five hour so see what we are doing okay so JG apparatus there are five or three type of cells lassis cells lassis cells are mangial cell yeah mangial cells they are acting as what macrophases destroy the pathogens they destroy the pathogens then come our JG cells in the afen arterial they sense the renal blood flow and release renin if there's a poor blood flow like shock low BP sympathetic beta 1 or low sodium now what does the renin do so renin convert liver angiotensinogen into Angiotensin one ace in the lung convert to ngot tensin 2 it cause Vaso constriction to increase the BP and also increase alron to increase sodium absorption also increase ADH and what the result of Vaso constriction thirst ADH this volume BP sodium all increase call as Ras system renin ensin alone increase BP increase thirst increase sodium increase volume increase ADH Etc so this is called as our Ras system lastly is our maula densa cell maula densa are in DCT and ascending Loop early DCT and they are for what GFR regulation call as Cho glom feedback 2019 need PG exact same question was there GFR regulation is called as what tubog glom feedback why I'll tell you first they send GFR through the sodium chloride level in tubular fluid they check whether GFR is high low or normal once they check the GFR is normal or not they correct the GFR through the intl mangial cell this is what is called as tubo glom feedback so glomular tubular so it sends the GFR and then correct the GFR call is tuo glom feedback okay now remember when the mangial cell contract they decrease the gfar and when they relax they increase our gfar and relax increase area and increase GF so whenever mangial cell relax this is the glomus these are mangial cell if if they relax GFR increase if they contract GFR will decrease okay then come our eph arol e arterial is constricted by Angiotensin 2 so blood flow will decrease I'll make a simple diagram have a look this is our glomus this is AFR this is ephr this is our a this is e this is HP HP is hydrostatic pressure this is HP and this is GF part so if e is constricted the blood will accumulate in the glomus the GFR will increase but blood flow will decrease so that is called as our ephr constriction increase the GFR but decrease the blood flow FL due to constriction and if you dilate the Fint everything increase remember one rule if you dilate the F dopamine all increases all increase and if ngot tensin to RBF increase oh sorry decrease GFR increase are you clear so this is the story about our ngot tensin tool okay so last system here that is our CNS seven slides let's do it then we have ample time for other revision and extra points okay clear Ando I have covered in medicine revision if you want I'll give you because bulk is covered in medicine very well hypo hyperism diabetes then biochemistry cover the part so I've not done it separately if you want I can give you the file in which we have the endocrine then same you can see reproduction s ovulatory cycle LH F there are hematology so that's why there's so many things which will not be sufficiently covered in a revision class so that's why they are overlap like hematology is covered very well in pathology anemia arthropyosis all clotting pathway so that's why they are not done in this slide because it is a part of patho mainly all question come from path point of view what is ftin level TC rarely they will ask phology same is reproduction all covered in OBG and embryology they cover the part of the physiology also LH FSH all so not covered so don't mind sir why there is no endocrine here so don't worry I'm starting so that is a story okay I'll take on YouTube okay YouTube free of cost so I take I'm a I believe I earn enough money from coaching that you people pay the fees for so I can do revisions for free so I'm alone so I don't charge anything yeah so I'll send all the yeah see nve muscle physio is here this is rmp AP so I will do the nerve physiology here and muscle also don't worry that's done in CNS okay okay just give me a minute I'll take my steps my throat is getting bit irritated yeah yeah one is there I got it yeah I'll discuss don't worry okay so now we have emple time for CNS okay so I'll give you all the links of my notes I'll show you if you want to see so these are my notes these are my race notes can you see so PDF so the are PDF of all the subject patho medicine anesthesia let me open anesthesia for you look at my anesthesia not see starting with TG Mor demon ether so Mortin make mosquito unconscious Mortin made human unconscious so that is Mortin for you then or the feature lignocaine amide contain two eyes Easter contain single eye so benzocaine cocaine procane single eye and that is there most commonly used then pneumonic for the structure Spears it is Sasa three Liga dab Sasa is what skin subcutaneous three Liga what is three Liga three Liga subcutaneous suas spinus enter this first remember the ligamenta in flavor Bahari under flavor bah so Supra inter Flav so suari in suari in inter ligament flavor B and dap is dura aroid this okay all are there okay P index system so in 27 Pages all the anesthesia is covered 27 Pages all anesthesia is there so I will share this PDF to you people you can revise it no problem at all okay okay I'll share it in the end I'll write in the group links everything is there funny funny pneumonics okay okay now neurons CNS there are two type of cells one are the neurons other are the okay phys have already shared with you okay so neurons and the gal cells so neurons are 100 billion and no new neurons are formed after birth that's why neurons are precious If lost lost so hippocampus and also all factory system okay okay I am doing chanting for past 14 years I used to do for fmg students in Gotham nagar free of course so it's not like I am someone new and I have copied I'm doing it for past 14 years only thing is I don't do it for any commercial basis because something is very close to me is like helping people when they need it's not something like you don't charge for the mouth fresher okay that is given for free or for water given for free it's just like that helping is not full classes which can be charge I feel revision Etc which I can do I can take it for free of cost okay yeah hopefully I will do CH let's continue first is G cells are more in number and they can form new cell like gliosis or Goma so they are occurring all the time I will discuss everything don't worry okay so this is our main main main fun okay fine so now comes the question what are the types of gal cell first is microa they are CNS macrophases and they do phagocytosis oligo dendrite they make the milin in the CNS whereas in the peripheral nervous system Shan cell make the milin endal cell they cover the ventricle so they are the covering cells of the ventricle whereas astroides are the supporting cells to neuron they help in formation of bloodb brain barrier made by tight junctions now CSF is around 150 ml daily production is 500 ml per day or 20 ml per hour now secretion choid plexus CC C secretion choroid CC absorption aoid secretion C absorption R normal pressure 50 to 130 mm water or 5 to 10 Mercury please don't make mistake it is Mercury 5 to 10 water is 50 to 130 mm of H2 now CSF function obviously it give nutrition like what glucose amino acid okay ions ions all the ions then waste removal then maintain temperature pH osity Etc and also shock absorb that's why when you bang your hand in Anger let's say someone someone not replying to your call or someone block you you see no DP and you bang your head why your head is not traumatized answer is our yes CSF absorb the pressure next question CSF is similar to plasma but lower concentration example glucose is 60 proteins are less cells are less only thing more is CO2 B magnesium and chloride they are four higher in CSF comp to any other area now let's see neuron Anatomy first is this is our cell body Soma or cell body these dots are called as nissle granules NGS so these are NG nissle grenes which I'll tell very soon so nissle grenes these are dendrite where synapses are formed this is our milein sheet these are nodes of Ren maximum sodium Channel maximum sodium channels are present here so what is present here okay it is our here and this is our then wres neurotransmitters are released and that is the case now first remember where is AP Genesis occur it occur at the Exon Hilo so nle granules are free ribosomes what they do protein synthesis and a neuronal injury called as Valerian degeneration the first change is breakdown of nissle granules it is called as chromatolysis AP Genesis at Exon hillo after sumission and AP propagation start from is that is initial segment so it is initial segment propagation start so what start propagation start from initial segment now we see rmp and AP so understand cell membrane at rest is selectively permeable okay it is permeable to which ions potassium and chloride call as diffusible ions but not permeable to sodium calcium these are inde diffusible ions so that is why there's a uneven distribution of ions which is called as Gibs Donan equilibrium and it is mainly due to intracellular proteins this was the question a question intracellular proteins now what is the result result is sodium calcium are more outside the cell protein and phosphate are more inside the cell and to balance them pottassium is more inside and chloride is more outside now as a result there's a gradient created for ions to come inside or go outside this is called as equilibrium potential so where does sodium want to go so sodium want to come inside chloride want to come inside but pot ium want to go outside so it want to go outside so that is why ions want to move and this is because they are not equal so that is why when they move it create electrical current this is called as equ Librium potential and is given by Nur equation no need to remember Nur equation just remember it is - 60 mol log of concentration outside by just write plus minus concentration inside okay now sodium is a cation which is more outside so when it come inside it create positive EP plus 100 same way calcium is also positive coming inside create EP so what two create 100 value so both create 100 value why 100 because plus value because they're coming inside chloride is an anion these were cations coming inside so create negativity minus EP whereas potassium minus 0 it is a cation plus charge but it's more inside so it'll go outside so cause a loss of plus create negative EP so Which ion create negative value chloride and potassium let me summarize it sorry let's say the cell is like your bank account and me sir ECF if I give you money let's say sodium 60 rupees so your account will read plus 60 rupees mine will be minus 60 are they both right statement yes so when I give you 60 I am minus 60 you are plus 60 both both are right but what value we should take we will take ICF because that is unit of life so that's why we write plus 60 got the idea plus 60 the change produced by sodium entry now I say can you give me some money say yes now I'm not asking money just example you can give money an example so you say sir how much I say nothing just 90 90 lakhs you said 90 lakh okay so I will be + 90 you are - 90 now which value to take minus 90 y because it is the flow of the plus outside that create minus inside are you clear so that is why what the value created by the potassium minus 90 is the value so what potassium create minus 90 value clear okay come back at rest membrane is permeable to Which ion it is permeable to potassium and chloride but not permeable to the sodium so sodium has role or no role in rmp so remember sodium no role in rmp why because is not permeable at rest so Which ion is permeable at rest potassium and Chlor right so they cause the rmp who cannot cause the rmp answer is potassium can cause sodium can't cause and they both have negative EPS remember - 70 minus that's why rmp is always negative and most permeable is our Which ion most permeable is our potassium that's why main cause of rmp is potassium so let me ask you if membrane was permeable to sodium but not to potassium rmp would be how much negative positive positive so that's why what happens is at rest membrane is permeable to potassium so create a negative value rmp but when you give a proper stimulus the sodium Channel open sodium come inside and create a positive value this is action potential so now I'll write the summary remember membrane at rest potassium permeable negative rmp on excitation on stimulation sodium permeable sodium chel open now there is a positive action potential so summary so what is membrane permeable at to potassium what cause the negative rmp it is potassium causing negative rmp but on appropriate stimulation what channel open sodium Channel open sodium come inside and create what create a positive action potential in this case okay done so that is the story here now let's see the rmp values what the rmp of our neuron is it is 70 of the cardia and thyroid this muscle is 90 smooth muscle thyroid is minus 50 they are so Shameless people even ask RBC ones RBC so RBC is what -2 then sodium is not causing rmp remember that okay now rods and con is- 30 and cocka hair cell is minus 40 if they ask next remember if you give a stimulus and the membrane become less negative it is called as as our depolarization I'll write it here so remember first right here if membrane becomes more negative called as hyperpolarization and if membrane becomes less negative or positive it is called as depolarization so remember if you give a stimulus and the membrane become more negative like - 80 - 90 - 100 it is called as more negative hyper so the word more is hyper is more negative and less negative is decrease polarity decrease decrease so decrease is our this so that is why it become less negative is D let me show you in a diagram look at this this is membrane at rmp it is negatively polarized at rmp minus 70 if you give us tumulus if you give us tumulus this is tumulus okay tumulus minus 5 will make it 65 - 10 will make it - 60 less negative call is depolarization depolarization if you give - 5 - 10 it'll make it - 7 - 80 more negative more negative is called as hyperpolarization now remember very interesting thing if you depolarize up to a value called as firing level minus 55 it open sodium Channel and action potential can occur what can occur action potential can occur AP so what can trigger AP so AP can be produced if you reach firing level so what create the AP yeah it is firing level create the AP so it create the AP that is why depolarization is excitatory Okay whereas hyper take the membrane away from firing level can you see that so it's going away from firing that's why hyperpolarization is inhibitory in nature so who inhibitory hyperpolarization is inhibitory d is excitatory clear so D trigger the AP hyper inhibit the AP are you clear now remember one more thing as I told you if there is a hyperemia less potassium can come out so it'll create less negative value and if hypoa more can come out I'll write it later at the bottom so I'll write here so let me just first do the topic then I'll write the changes because just disturb okay so when a neurotransmitter is released the neurotransmitter B the receptor and create electrical currents which can either be depolarizing current or hyperpolarizing current so if there's a depolarization at synapse it is causes excitatory why because depolarization can trigger the AP so who excitatory depolarization call as EP PSP so remember remember this term depolarization is excitatory EP PSP whereas hyperpolarization is our inhibitory IP so it is inhibitory ipsp okay inhibitory ipsp now how do you create apsp or ipsp neurotransmitters when they are released at the synapse they bind the receptor open ION channel and produce epsp or ipsp so what they produce either epsp or our ipsp so what they produce epsp or ipsp how let's see if you open sodium Channel sodium will come inside sodium cause depolarization that is EP SP example glutamate by nmda receptor so glutamate is doing excitation through what glutamate receptor and they are the main excitatory neurotransmitter in the CNS who our glutamate whereas calcium channel opening cause calcium entry it again depolarize and excite so sodium calcium are excitatory that's why sodium calcium blocking drugs like CCB are inhibitory they're anti-m class one class 4 sodium is class one calcium is class 4 Verapamil delam and they also can inhibit the brain antiepileptic like phenin valpro lamotrin ethos sumis calcium Locker or our fomate they all block the sodium channels okay next question what is the example of this example is substance P which causes peristalsis also it stimulate SG cell anotomy question which is substantia gelosa cell is the first neuron of pain path f it causes pain sensation so that's why how does injury causes pain injury release substance P substance P stimulate SG cell by opening calcium channel it causes the pain to be perceived in the brain call algia algesia or dollar now pottassium channel opening if you open potassium Channel obviously potassium is more inside it'll go outside as it go outside membrane become more negative so that's why it is inhibitory example Morphine Morphine inhibit the SG cell via mu opioid receptor inhibit the pain analgesia will occur so that's why morphine decrease the pain and finally if you open chloride Channel chloride will enter the cell and cause a hyperpolarization called as ipsp example glycine is the main inhibitory in spinal cord Gaba is main inhibitory in our brain in our brain one more question I'll write here if there is hypoa more potassium can come out more potassium can come out and more negative EP created more negative more negative uh rmp call is what hyper and vice versa if there is hypoc cemia sorry hyperemia there will be less negative what is less negative callus D polarization so please highlight it cover it so depolarization by hyperemia and yes hyperpolarization by hypo CIA by the hypoc calmia so these are the changes that we can see or we will see okay next question when you open chloride Channel again chloride will come inside the cell and cause what hyperpolarization and that causes inhibition example GBA and glycine that's why benzoa Pines barbiturates so what they do they inhibit the brain remember andb they B the brain so they or ban the brain and banine also ban so they are CNS depressants used for anti-epileptic effect muscle relaxation also general anesthetic effect anti-epileptic effect and also they can be used for anti anxiety clear so they ban the brain then come our action potential when you give a threshold stimulus of plus 15 molt AP will occur if you give less than 15 no AP occur so there's either yes or no 100% or 0% called as all or none law what is it called as all or none law so either AP occur or it won't occur in this case so either AP or there is no AP p in this case now when you give a threshold stimulus + 15 it changes the rmp from -70 to - 55 M - 55 is our firing level so it is our firing level at firing level voltage gated sodium Channel open mgate the moment they open the sodium start coming cause a big big deep up to plus 35 this is called as Spike potential so this is Spike potential or overshoot then sodium Channel close as sodium Channel close the membrane will yes stop depolarizing and the D is over end of D with a closure of H gate now pottassium channel open potassium goes out so this is caused by sodium so this phase is due to sodium and this period is due to potassium so sodium caused D potassium caused the repolarization okay and sodium potassium pump by pumping sodium out and bringing potassium in restore the ionic equilibrium always keep sodium high in the ECF potassium high in the ICF and that's why help in rmp and AP so what they help in they help in rmp and AP both next question where is memory stored answer is synapsis so they are store in the synapsis here so with synapsis no not spinal cord not in the brain stem but neocortex neuron now what is it called as I'll explain when you repeat a stimulus again again again there's a increase neurotransmitter and receptor and now in the future you are able to recall like example what the difference between OTP OTP versus phone number so do you remember OTP no why because it's one time if something come once you will not remember it but your phone number you remember how you remember your phone number how do you remember your phone number reason the reason is very simple because of a very simple fact why the reason is what the reason the reason is yes yeah we can share OT okay so phone number can be yes remember because it's repeated and as you repeat the memory is form so phone number you repeat OTP no one remember that is why it is difficult to recall you can't remember now what is this example is long-term potentiation there's a area in the brain called as hippocampus C1 neurons what they do they increase nmda receptors and we all know nmda is the receptor of glutamate more glutamate more excitation more you know response so that is why the long-term potentiation help in increasing the synaptic activity and cause a longterm memory so where is this long-term memory stored it is stored in neotic so when you repeat something multiple time there's a increase in what synapsis in that neurons and now in future they fire better as they fire the output come easily you don't have to even look at the thing example mother's face can you recall your mother's face can you people recall your mother face or you have to look at her face as phone family member ahma no you don't have to look at the phone want to see your mother's face you can recall in your brain how the answer is simple when you activate the visual cortex neuron they are able to fire in the same pattern they fire when you see her face that's why you able to recall her face that is called a synaptic plasticity so that is the simple story okay so like some things you never forget some you forget very easily okay now see understand li is neurotransmitter voltage gated is AP voltage G Li G so these are Li G these are Li gated so they need this this Li gated and the voltage gated they open with minus 55 so this is voltage G clear up voltage G is for AP and Lian G is for apsp and other phenomena okay Dr A done okay now any sensory system that we read so we are on the page 23rd very soon will'll be over then you will be free from my side I know some of you must be harassed by constant yes classes Etc one second okay so let's study okay so see stored in hippocampus no hippocampus is just remember hippocampus like Google it is for conversion and retrieval conversion and retrieval that is recall storage is neocortex okay so storage occur in the neotex okay Dr John okay so let's come back so that is the story so storage occur here so storage occur only and only in the neocortex okay now any sensory system has three part receptor pathway cortical area receptor make the AP from the stimulus pathway take AB cortex and cortical Center of for memory neocortex and perception perception is conscious under understanding of sensation so first rule for perception you should understand what is the stimulus is okay now properties of the threshold number one threshold is minimum stimulus needed to give a response like example can we hear sound below 20 HZ no so minimum stimulus is threshold 20 htz number two spicity what is that it is receptor respond mainly to their type of stimulus they don't respond to every stimulus they respond mainly to their type of stimulus example light is sensed only by rods and cones so if you flash a torch over the nose you cannot smell the torch ah smell or put in the air you can't hear the torch so you can only see the light with Retina not any other receptor are you clear then adaptation if you give a stimulus constantly you feel less this is called as adaptation example slow adapting okay so rapidly is touch smell that's why when you go to a garden you can smell and your smell is there after few minutes the smell disappear not because Rose is not there Rose is there but your nose become adapted and what the benefit of this benefit help working in government hospital or most Hospital possible there's so much bad smell coming in the hospital but how are you able to survive and smell is no longer perceived and that made yes possible okay so yes it is possible okay then come our slow adapting proprioception so you feel for longer time pain never adapt so pain is felt all the time it doesn't stop so it's nonadapting so pain is nonadapting finally Weber fasher law or Steven power law it says that intensity we feel is proportional to power of stimulus not to stimulus so that's a exponential exponential rise in sensation so I is K S A where K is a constant so I is KSA so I is KSA now we see spatial senses first is our vision so Vision were the receptors remember rods and cones are The receptors then pathway is optic pathway area is 17 18 19 and it is color vision is area V4 and which pathway for color vision parvo cellular pathway write in braet parvo cellular pathway so which pathway parvo cellular pathway par cellular pathway then come dark in dark the ropin vitamin A show 11 CIS retinal deide plus opsin chain when the light form it transform so light transform into all transretinal deide okay and now there's a closure of sodium Channel as sodium Channel Clos by transducing G protein it lead to hyperpolarization remember all other receptors produce depolarization only rods and cones cause hyper it's a 100% exam question for the only receptor causing hyper the answer is rods and cones all other cause depolarization so the only one causing hyper yes hyper is caused only by rods and cones all other cause depolarization okay what the protein transducing what channel closes sodium what the form in the dark dark is 11 CIS and light causes all transretinal deid what the light causes all transretinal deide is the form that we will see when the light is going to fall if light is not falling it will not become all transformed so that is a funa in this case are you clear yes let's start now we discuss the auditory system what is the story or F about our auditory system it is the inner hair cell at the organ of C in the ca potassium is very high in the Endo of Scala media and it create a plus 85 mol Ando lymphatic potential so plus 85 endolymphatic potential are you clear next question when the potassium Channel open what open pottassium Channel open this causes our currents call as clear micronic potential which are then converted to action potentials by spiral ganglia so who make the aps spiral ganglia convert or make our action potential so who make the aps spiral ganglia create the aps okay then the pathways Cola that is taught in ENT also and not also C for colear nucleus o for olivy Superior olivy then L for lateral liscus I for inferior culus M for medial geniculate body a for auditory cortex so what a is a is our auditory cortex so what is a is auditory cortex Area 41 42 okay now Superior temporal Gus area 22 is our one case area it is for language comprehension understanding whereas angular gyus area 39 is for word memory so it is for what thing it is for our word memory so what is for word memory it is area 39 so leion causes anomic Aphasia or word blindness word blindness word blindness okay now next is our taste so taste is by Papa or The Taste birds in the tongue fungi form is in the tip remember where is fun loving people so fun is in the front fun is in the front fun is in the front then foliate is leate laterally so they are side and circumvent late C sit at the back so remember late CER sit at the back and remember what is the mechanism of the flavor so first question salty flavor is due to sodium potassium SAR is because of H+ or acid sweet is G protein couple receptor it bind sugars whereas bitter is again gpcr it's gpcr it is again gpcr but what does it bind I'll write gpcr here so bitter is is also gpcr but bind poison like cyanide alkaloids then quinine Etc so all of these are bitter taste sensation now recently we have discovered new flavor Umami Umami is due to mono sodium glutamate which is present in agomo salt or meat egg all now remember the story The Sweet is at the tip and bitter is at the back so remember in the school where are the sweet kids sitting in the front they are sitting in the front and what they keep saying good morning teacher teacher teacher teacher teacher they are always always licking the dash of the teacher the boots of teacher so they are teacher boot licker teacher teacher teacher teacher check the homework when they say teacher check the homework the back benches get angry what are you so they are very bitter so that's dash dash so that is the story so they are always angry salty people sit on the sides salty so this is salty flavor and on the middle ma is in the middle ma who's in the middle ma is in the middle ma oh Mami ma is in the middle Ma and the yes slightly back is SAR so SAR is here so that is on the back side but lateral margin okay so back side lateral margin now chili is not a taste chili is not a taste but pain chili is pain that is why a person who say I love chili flavor is wrong no no you don't love chili the flavor you love chili the pain that means you love pain and pain lovers are called as masochist and you are giving the pain Yourself by eating chili you are a sadow moch sadow moch plus chili is pain sensation and pain can occur any body part so where can chili be felt nose mouth or any part of body so chili burning can be felt any part of body eat too much chili in the night next day morning also you can feel the chili sensation around your rectum because pain sensors are in the rectum also that is why it's a torture method called as bellari where they insert chilies in the rectum and the person has burning pain call is bellari bellari okay now what chili contain irritant call is capin remember capsicum capin it bind viloid receptor it bind what villoid or trpv4 and causes hot burning painful sensation hot burning painful sensation painful Sensation that day I was teaching and I said let me make you remember if someone eat chili by mistake what do you ask him to eat chili ice cream which is the most common ice cream flavor I say some someone said strawberry I strawberry cor what are you thinking I'm asking about ice cream flavor I don't know what they are thinking which flavor so it is vanilla so vanilla ice cream so remember neonic vanilla chili if someone eat chili eat vanilla ice cream you'll never forget okay so yes not strawberry okay strawberry something else okay like cuff syrup okay okay now SSS what is SSS somato sensory system sensory system okay again even I couldn't understand why people are laughing when I said strawberry but again anyway so first question is somato sensory system is bringing Sensations from various parts of body like touch temperature pain they are not located to some specific area but almost each and every part of the body okay now comes our merkal disc merkal disc is an epidermis and it is for sustained touch pressure and also twoo discrimination remember twoo discrimination or discriminative touch Merkel is the best again some gold standards are saying it is misner and I will show you references I will take any book it is Merkel not our misner for two point discrimination don't write Merl misner sorry misner merkl is the answer don't go by just reputation reputation RCB very big reputation very big team understandance okay for the best is it is at fingertips and the lips fingertips and the lips and it is basically help blind read what scrip it has the blind read Braille script why because they use the touch so that is the story in this case Okay okay so don't take any names the reason is or the reason the reason is now you know already okay so don't take any names taking name is not allowed okay so now comes the question misners and pinan remember one thing first all the Corpus Sals corpuses they are rapidly adapting number one rule they are caps ated and also they are for vibration and they are in dermis Yow so remember copper cells are rapidly capsulated vibration dermis so they are dermis dermis dermis okay now comes the question what the location of misner corus so they are at the tip of dermal papilla and they are for fine touch and low frequency vibration what is for high frequency vibration it is passing so remember pacinian is high frequency misner is low frequency and one more thing pan Anan onion shape so pacinian is onion shape they look like this onion shape so what receptor is onion shape pan onion onion shape and also also they are for pressure so PR pressure onion pressure onion pacinian pressure onion pacinian now rufini endings are for warmth and remember they all are in dermis warmth and also for uh pressure sustained pressure by mistake it is for sustained pressure cross is for cold and cold is basically less than 25° C and less than 10° is pain so if your temperature become less than 25 you start feeling cold and if it become less than 10 it causes pain so pain is less than 10° okay next question free nve endings they are for pain temperature itching and sexual Sensations remember s Al okay now next is pain is two type V to there are multiple type of pain you know like pain of this pain of that but two main types are fast and slow fast is called as fast because it is mated fiber slow is C unmated fiber second It Is by somatic nerve fiber which fiber somatic nerve fiber whereas It Is by autonomic nerve fiber so autonomic nerve fiber done then our skin injury is fast pain and angina colic headache or any git problem liver kidney all the visceral organ that's why it's called what visceral pain deep or visceral it is called superficial somatic from skin it is sharp and well localized so you know exactly where where the cut or injury is so which case you know exactly the sight of injury it is our fast pain so skin is cut here you know exactly where the touch is you don't say I think on some part of my face no you say exactly just above my cheek Temple nose whatever it is dull and diffused so if there's an angina you don't say exactly here inferior wall and fact is there and the artery involv is right corner no now or he say there are two St 5 mm in my n so doesn't get diffused it's not localized it diffused and can radiate or refer so where can the pain go it like angina can go to left arm left shoulder or amus referred pain of what uh testicular injury so that's why it can show now what carry the pain so remember lateral lateral carry what lateral lateral lateral so if someone kick you Lar pain and you become hot with anger so lateral carry pain and temperature lateral pain and temperature and they cross to opposite side cross to opposite whereas anterior ant if a ant is crawling on your skin an ant it cause itching and cause itching Anor here itching and ant is also called a Chey Chi itching Chichi so ant cause itching itching is chy chii itching and ant is very rude animal keep running here and there so it is crude crude sensation rest all are carried by dorsal column so it carry fine touch pressure vibration proprio from which side same side that is why in brown seet syndrome you lose pain temperature on opposite side but what is loss on same side touch pressure vibration proprio stereognosis is what identity the object held in the hand so if you are given a remote and you feel with eyes closed you say it's a remote it's a pen this is called as what stereognosis so stereognosis is done by this okay now parial lobe contain our sensory cortex okay post Central gyus which gyus post Central Gus now area 312 our primary area whereas secondary is area 5 and 7 so primaries 312 secondaries 5 and 7 maximum area in the H class is face for lips can you see so lips are very big I'll make it red color lipstick lips very big and in the hand who is huge so in the hand it is a thumb so thumb is very big so Thumb in the hand has the largest area thumbil okay okay now motor cortex is located where in area 4 and six in which area in Pre Central gyus they contain bed cell which are umn andn give corticospinal or pamal tract 80 85% fiber cross at the lower end of medala pyramid that's why they're called as pyramid tra and they are for voluntary fine skilled movement okay what do they stimulate they stimulate our element in the anterior horn what element Alpha motor neuron which are present in the anterior horn they control the muscle via releasing acetal colon let me explain so umn control element via motor descending track PT and EP EP is extra pyramidal tracks extra pyramidal TR now if there's a tract Legion that is uml Legion there is paralysis because the involuntary movements are produced by element why because of increased element activity increase element activity so who produce tone and reflexes they are produced by element and if they are uncontrolled they will cause more reflexes and more tone so that is why tone and reflex increase Inn Legion causing paralysis so the reason High tone due to loss of control over element element become uncontrolled causing involuntary contraction whereas element control the muscle yes element control the muscle via what via motor nerve and they release a at neuromuscular Junction and and they cause all the contraction and cause all contractions cause all contraction so it cause all contractions voluntary and involuntary tone and reflexes and who control them under control of um under control of umn so that is why if there is a leion the effect of leion is the control is there or lost so the control is lost as the control is lost the tone and reflexes will increase and that is causing paralysis but if there's a LML Legion you lose all contraction Placid why element Legion cause loss of all loss of all voluntary and involuntary contractions so what is the loss causes flaccid paralysis so flaccid paralysis is a finding of alml Legion paralysis the finding ofl Legion because umn are unable to control the element so too much Stone too much reflexes are produced now who senses the length of the muscle it is sense by our muscle spindle so what thing muscle spindle it is two kind of fiber nuclear back fiber and nuclear chain fiber nuclear chain fiber are for sensing resting length sense resting length whereas nuclear back fibers what are they for so they are for motion they are for motion velocity even resting length that's why they are Dynamic fiber I'll give example see my hand right now who's sensing the length of bicep tricep deltoid it is my chain fiber mainly when I start to move the angle Direction velocity are now sensed by what our bag fiber so motion is bag and resting length is CH cheer CH I am sitting so sit with ch cheer sitting so cheer is rest so remember pneumonic cheer is rest Chan is so CH say chair bad jum and what is the bag bag is motion b b bag is running so it's motion so if I move the hand it is B fiber stationary is chain fiber okay next question muscle and I will give you the PDF which is detailed also 100 page PDF if you have time you can read the 100 page PDF that will have more detail information this is 27 page brief information is up to you what do you want if you want 100 page PDF also I will give you I'll give both to you okay after the class I will share 100 page also okay now what is the tension sens by tension is sensed by GGI tendon organs remember the pneumonic tendon tension T tension T and spin so length le le so corn L length L selfie l l length so length is so measuring the length length is spindle and stretch is also by spindle so stretch and length and what is tendon tendon organ tendon tendon organ now come our stretch reflex what is stretch reflex is it is our a deep tendon reflex what is stretch reflex it's a deep tend reflex like knee J bicep all the reflexes now increased length of the muscle is sensed by spindle and then spindle stimulate Alpha motor neuron via 1 a primary eent fiber which fiber 1 a primary afen nerve fiber and once they stimulate the alpha alpha cause the contraction and length return back to the normal this is called as what this is called as our deep tendon or stretch reflex what the benefit regulate the length now there is another neuron called as gamma motor neuron they are in the anterior horn in anterior horn they cause muscle tone which is a continuous muscle contraction how they stimulate the muscle spindle and cause continuous contraction now because of this continuous contraction of what anti-gravity muscles so it's a continuous anti gravity extensor muscle contraction keep the posture so posture is maintained by what back muscle like neck back hip they keep me standing or sitting so what are the benefit posture and how balance if I start falling one side they contract the other side muscle by changing the tone so by chaining the tone they are able to maintain the tone balance gas ET okay and what is under control of gamma motor neuron undern control mainly mainly mainly EP and basil ganglia BG BG is basil ganglia so who is the main controller of the yes our uh tone it is our basil ganglia through extra pyramidal track now what does basil ganglia do number one it is for planning of the moment control the tone via APD and epd act on the gamma motor neurons gamma motor neurons now what they do they cause a dopamine release from substantia it's not josa substantia and it increases the movement by stimulating the strum strum is made by cordate nucleus and pamin so that increase the mement all other structures decrease movement so the only one increasing the movement it is our basil ganglia dopamine from substantia all other decrease the movement like subthalamic nucleus Globus padus subthalamic nucleus or even our what even our yes which area lentiform nucleus so that is a story so the only one increasing movement it is dopamine from substantia see time is less to explain the circuits Etc else I would have explained in detail how there is athetosis Korea but I'm again telling you if you want I will give the PDF with all the link physiology also medicine also with all the pneumonic all the you know funny ones like Huntington disease Huntington remember Hunter Huntington Hunter Hunter do what Hunter is hunting the animal and make them dance so dance is Cora so make dance number two Hunter lock animal in cages so CAG repeat which is triple nucle and cage has how many side four side chromosome number four C repeat are there then Hunter is very dominant person autosomal dominant and make the animal Dance plus he very violent cruel so that is why there is Mania psychosis hyperkinesis and we should ban such hunter ban so Tetra bazine is the drug of choice which inhibit the dopamine release so easy so that is why the finding is Huntington make animal dance Korea lock in cage C four chromosome so chromosome number four and very violent Behavior psychosis and finally also dementias there there's also what which appearance there's corded atrophy which cause box carar ventricle so many findings are there but I'm just telling you the summaries I can give very well you can do it later okay now what is for coordination and correction of movement it is cereum leion causes Adia which is loss of coordination and this okay they all are in the PDF I will share in the end okay yeah corded nucleus atrophies there I can show but again I'm just showing you for the sake of yes psychological belief yesd notes so I'll just show you the medicine CNS see this is gber remember Hunter animal cage CAG this is puspa puspa can't look down remember puspa PSP Progressive supranuclear gauge py to P Salah that's why the person can't look down inferior gauge py and that is there and what does the pushpa pushp flower means the bird sit on flower so humming bird appearance so also give you humming bird appearance humming bir appearance PPA PPA humming bir appearance so they're all the notes of the thing I can show you I can give you and I will share in the end not now okay last part last page okay emotions are produced by lyic system in temporal Lo okay and who control the emotion it is controlled by our frontal Lo I'll explain all the question don't worry so explanation of the questions I will do in the end let me just first finish the last pages okay so emotions are produced by lyic system in temporal Lo okay right fear by amida Love by insula then the pleasure by which area pleasure pleasure is by dopamine nucleus acement hypothalamus so that is giving you pleasure and dopamine come from ventral tegmentum VTA what is VTA ventral tegmental area so I write here VTA ventral tegmentum so that is why what give you pleasure dopamine and who control the emotions it is our frontal L which control the emotion and cognition so what is for control frontal Lo that is why leion of frontal L causes antisocial Behavior anti social behavior so remember emotion come from lyic system like fear from Amidala love insula pleasure dopamine nucleus aumens hypothalamus so they and rage from again hypothalamus rage anger so rage hypothalamus this area dorsomedial so dorsomedial is for which is the area they're not showing okay so the area for rage also I'm writing it is for rage so dorsomedial is involved in the rage activity so rage activity dorso medial okay and that is why emotions are controlled by frontal L okay yes Clover busy syndrome is seen in the case of a yes am Legion CL how much I go deep in 5 hour how much we can cover that's the main thing this's endless amount of physiology left still so that is why we are doing it as a one shot one shot means trying to cover 70 80% in the given time otherwise so there's no limit even gong will not be okay see cine LaVine is different it is basically again temporal Lo Legion but there is what hyper uh what is say somnia also Sleeping Beauty syndrome the person keep on sleeping so that is the case so if this hyper somnia think of cine LaVine and if there is hyperphagia with hypersexuality common feature this is CL buy okay CL buy Buu Ys let me wrap it up okay clear so main function of hypothalamic nucleus so remember Supra optic is basically for release of ADH ADH is the main so what the main thing ADH can release the oxytocin but main is our ADH so what the main ADH is the main then come paraventricular paraventricular is for again osmo but here oxytocin is the main so main is oxytocin so main is oxytocin so if they ask you where is oxytocin mainly paraventricular supr optic is mainly for our yes ADH next question also it release TR CR so it is TR CR release TR CR TR CR TR C okay Supra asmatic is for yes Cadian Rhythm and pineal function and in dark release melatonin dark Mala arquit is the one which release all the ghr GN R then P which is Prolactin inhibiting Factor Pi P okay so that is the case also ghih GH also aperti but main regulation of atid is by ventromedial nucleus then come per ventricular it is for inhib of GH is a GH IH only then ventromedial is for our satty Center so the ctiy center ventromedial and it is cumulated by by our insulin then git hormones Alpha msh and also our leptin hormone that's why they decrease our hunger so they decrease our hunger then rage is by dorso medial lateral is the hunger Center it is stimulated by mango so we Indians love to eat mango so mango causes increase hunger remember mango cause increase hunger what is mango let's write MCH AGP neuropeptide y also our gin and orexin so these are our lateral hypothalamic Factor lateral hypothalamic factors okay preoptic is for Thermo regulation but mainly thust it is our thust Center and also male sexual behavior so that's why preoptic is The Thirst Center most thir water thir thir also sexual thir so it is water and sex thir sex so sexual thirst is preoptic sexual thirst is preoptic okay anterior is for cooling center posterior is for heating so I'll write down here so cooling and heating so what is causing the cooling of the body anterior what is causing the warming of the body it is posterior so what does first change is skin Vaso dilation and then increase sweating and it is absent in heat stroke so sweating is absent in heat stroke posterior hypothalamus it is for heat adaptation so it increase the BMR increase sympathetic increase T3 T4 so the increase and first change first change is skin Vaso constriction skin Vaso constriction I never try to hurry up I explain everything I could have just skipped the pages but I never did this because I want you to understand so first change is skin Vaso constriction then increase uh shivering is there here shivering absent in newborn so what they use that's why they use non shivering Thermo Genesis Brown fat and brown fat is absent in adults so that is the story Brown fat absent last page just easy it'll be finished in next 5 minutes so yes we have taken exact time 27 Pages we have covered 5 and a half hour half an hour break was there so 5 and a half far I took so EG and sleep so remember first question what is the Delta wave it is minimum frequency minimum frequency how much just two or three wave in 1 second that is 3 Herz but it is maximum amplitude and remember d d Delta D Delta deep deep sleep what is that n r m 3 4 just write like this 3 4 that is deep sleep 4 to7 is Theta wave Theta light ta so by light so light is Theta deep is Delta it is nrm 1 and two Theta 4 to 7 Herz then if it's 8 to 13 and this this is awake person so remember awake person and it is Alpha wave which is very synchronized very sing like this one second eight waves and person is awake but eyes closed mind is free and relaxed so mind is free and relaxed beta wave is basically awake eye opening busy mind any sensory stimulation any sensory stimulation and also R sleep RM and it is also called as Sawtooth pattern I'll discuss it so RM sleep there's a rapid eye moment recorded by EOG there's a below neck body paralysis sleep paralysis by low Co serulus then there is what wave in the EG there is beta wave s tooth pattern s to S tooth and there is memory formation so active memory formation that's why it is called as active mind sleep why because you see beta wave so active mind or paradoxical sleep par toxical sleep why active mind because you can see the be wave which is awake person wave so beta wave is seen in awake person eye open and also in RM sleep RM sleep now there's a below neck body paralysis So Below neck body paralysis that is why sleep paralysis occur body is paralyzed not the panis panis can be erect so remember body is paralyzed not the panis and the person is doing active dreaming which is very well remembered so if a person here a very fearful dream nightmare m M M for memory so M for memory and M for remember so remember the dream so he can remember Ram so remember is Ram sleep so let's say you're sleeping and you watch a horror movie if you're watching a Indian horror movie what comes to your sleep that Indian Ghost Indian Ghost always wear white Sor so what they are wearing white Sor and they have a candle in the hand so they're carrying a candle plus they are having long hair eyeliner lipstick so she first went to a beauty parlor and then she get ready s plus she will be having full makeup this much makeup she is there to frighten us or provoke us and then she come and sit on the chest and try to press the neck and the person's afraid he's shaking shivering High BP and then he wake up and he say oh nobody it is called as nightmare so nightmare is fearful dream which you can't remember now what are the Sleep phases so let me explain awake person beta wave stage one ANM Alpha and theta waves so it is drowsiness also it is beta waves and this is Alpha then stage two Theta wave is there and still it is light sleeve Theta is the hall Mark and stage two is our sleep spindle and K complex so this is spindles it's not shown much here I'll show you so these are spindles these are spindles spindle and this is our K complex this is K complex it look like this so K complex and stage two is the longest stage of sleep longest sleep and also show broism also show show brism and if Delta wave come it is stage three and four deep sleep this is deep sleep and RM we see s too Sawtooth okay deep sleep no memory that's why Knight Terror occur what is Knight Terror unknown fear so night terror is what fear unknown fear is there there is night terror and also sleep walking can occur call a somnambulism even my pen is tired and then it is nocturnal aneuris that is bad wetting and it is normal till what age it is normal till the age of 5 years okay bed wetting so if it is normal till 5 years so if after 5 year do the bed wetting what we do bed alarm method Indians don't do bed alarm method why Indians don't do bed alarm method because we have a natural bed alarm in the form of what in the form of our parents the moment our India kids sleep with the parent the moment the kids start wetting the the bed the parent feel the wetness and they yes wake the person and as the child wake up he doesn't do so India we have natural bed wetting prevention called as the parents so parents sleep with the kids in foreign country parents sleep alone kids sleep alone I don't know why why they sleep separate kids alone maybe they are frightened but India par okay we all slept I slept with my my parent till I think 10 or 11 year then I got a separate room not separate but there was Uncle so I used to stay with Uncle so it's not easyi okay Uncle used to sleep on bed there's only one bed charpai I used to sleep on the floor so again I'm telling you my childhood memories okay so I hope you all enjoyed okay the class I tried my level best to be as human num is possible without taking extra time but again I covered so anything extra you want I will share all the link so I'm sharing my uh PDF link Google Drive plus I'll share my group link where I have posted all my memes I'll show you some memes you want to see okay now the time now so let me show you my memes where is me me me so let me show you the memes okay okay so these are all the memes I am having see I'll show you so in a pregnant female what the Mother-in-law say la beta La beta so what the Mother-in-law say l is used in pregnancy preclampsia so laa law so that is again a pneumonic there all various pneumonic and the stories which are there and I will be sharing it with you so you can watch these are other disease like VIP so this is a summary of VIP Di IES ntic migratory EMA and weight loss all are there okay so I'm writing my number please copy it and I'll post the file very soon so my number is 7 77 0 0 0 5 046 so 5046 okay and my group link I'll post in this okay question I will discuss now okay so it showing this type of reflex duration after discharge okay see question is in this case they're asking see what is cross extensive reflex okay understand in withdrawal reflex when you give a stimulus the opposite group muscle contract and cause the flexion let me explain it okay okay so first okay let me just give it to all the people let me say bye-bye I'll explain it to them okay yeah very good okay already posted so I will also post okay yeah chanting I will take in May I will post in my channel when when to take so I'm posting it so this is my telegram group yes it is right this is exactly right okay yeah thank you very much yeah and I will post the uh G Drive Link also so this is my G Drive Link for all the file just give me a minute then I'll come to the doubts okay let me release the people who are waiting to take rest and sleep those who want to solve the doubt they can stay because it take time for me to solve the doubts okay even I want to go to toilet my bladder is reaching its firing is almost 400 ml plus so copy so first I'm posting the case so G Drive Link okay yeah la Play Store recording in progress okay so I'll be ending so now let me solve the queries anything you want to ask ask me then I will solve these queries because that is what I plan to do okay so so let's solve the queries thank you very much for everyone for staying uh for what do you say awake okay wakanda forever Dr AR Dr good afternoon everyone so I hope uh you have learned a decent amount of physiology all right so uh before uh we go forward and I tell you that how to um check the question paper first let us understand that why I am doing this oneshot program um I can bet on this particular part that those who are thinking that this onot program is available on the urul as a recorded version yes it is available on the urul as a recorded version also let us let us do an open Challenge and that open challenge is that the student who has attended it live versus the student who is waiting or who is thinking that I will do it in the recording on a 1x or a 1.5x or a 2X let us see that the percentage of the students who are able to finish this subject in how much time the time that you're going to take in finishing it with this mode will be much much less and the preparation is all about discipline any student who get good R versus any student who's unable to get so-called that rank the biggest difference between the two is discipline nothing else what as an Institute we are trying to inculcate in you trying to bring in your preparation is that discipline that's a biggest difference between a coaching and having a content in the form of a product in the form of a recorded lecture that's all nothing the coaching is to provide you a discipline and to provide you a right amount of content at the right time so that you can finish it in the given time now after learning this great physiology by Dr Ashish now you have to do what now you have to give the test and how you going to give the test in order to give the test download the urul app if you have not done it please remember all this is complimentary you need not to subscribe to any course this is to reduce apprehension in your mind so that you are not uh getting anxious up if you already have an eul app then that your you're already sorted but if you do not have download the urul app in the urul app go to the test section there are five uh let me just see if I can share my screen with you can we do this okay all right uh to uh in the Gul app go to the test section the moment you going to click to the test section in the test section go to the QR QR test and if you're going to go to the QR QR test in the QR test you're going to see physiology onot test it's a customized test of 100 questions for you okay and I'm going to share a QR code right now with you just give me a sec just give me a sec guys [Music] I have a do see this is the QR code I hope you can see this okay let me just try to see that if I can zoom it up yeah the test will be available later also but I would recommend again discipline B I would recommend that if you can do it right now scan this QR code just let me know that if you're able to do it but you have to go to ur app in the urul app go to the test section in the test section go to the QR test and in this QR test scan this QR code scan this QR code there is a separate video for this on the dbmci uh YouTube channel and you can go to that video also to check that how you can do it okay if you're unable to do this just just give me a sec and let me make it slightly bigger for you okay allow me a sec for this allow me a sec okay now I hope uh you can see it ah yes but you have to scan the QR code each time and that's uh that is what actually you should do that you have to scan the QR code each time I hope you are able to scan it and please let me know that if you are uh able to see the paper this is a 100 question paper and I'm sure that it will be very very useful in your preparation knowledge enhancement knowledge testing you remain disciplined no matter what these people are doing when are they come doing the exam and I am very very sure that you're going to see a significant remarkable difference in your preparation in comparison to anybody who is not reading with discipline what you are reading definitely matters but more important than that matters is that how you are reading it and with how much discipline you are reading I am a person who believes in in in a third power in God and I believe that the God is also looking at it that how much hard work how much efforts you are putting up to do this and I'm sure that together we will be able to pull through it and we will be able to pull through it um this QR code will be shared with all of you on all the dbmci groups as well as on auto mentorship group as well as onto the dbmci premier telegram group also so irrespective of the access that you have I'm sure you will be able to get it and I'm telling you that together we will pull through this anxious time this tough time we are there to take care and to support you in the best possible capacity that we have all right so that is all from my side thank you very much for supporting and for watching this one shot with such an enthusiasm I'm sure that this going to make a significant difference in your preparation take care and may God bless you all and do not forget to send the screenshot of your score to me on a message either on Insta or on telegram so how you did it all right take care