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Certificate in Nursing · 2019
UGANDA NURSES AND MIDWIVES EXAMINATIONS BOARD
Certificate in Nursing – Anatomy and Physiology II
SECTION A: OBJECTIVE QUESTIONS 20 Marks
1. Which of the following structures prevents the trachea from collapsing?
The trachea is supported by 16 to 20 C-shaped rings of hyaline cartilage. These rigid rings ensure the airway remains patent (open) and does not collapse during the negative pressure of inhalation.
2. The organ in the respiratory system which plays an important role in sound production is the
The larynx, commonly known as the voice box, houses the vocal cords (vocal folds). As air passes through the vocal cords from the lungs, they vibrate to produce sound.
3. Which of the following does NOT happen upon inspiration?
During inspiration, the diaphragm contracts and moves downwards (flattens), which increases the thoracic volume. It does not elevate; elevation of the diaphragm occurs during expiration when the muscle relaxes.
4. Which of the following structures covers the larynx during swallowing?
The epiglottis is a leaf-shaped flap of elastic cartilage. During swallowing, the larynx elevates, and the epiglottis folds backwards to cover the glottis, preventing food and liquid from entering the respiratory tract.
5. The most important role of Bartholin’s gland is to
The Bartholin’s glands (greater vestibular glands) are located on either side of the vaginal opening. Their primary physiological role is to secrete mucus to keep the vulva moist and provide lubrication during sexual arousal.
6. The primary function of the scrotum is to
The scrotum is a sac of skin holding the testes outside the abdominal cavity. This positioning, along with the dartos and cremaster muscles, maintains the testes at roughly 2-3°C below core body temperature, which is essential for viable spermatogenesis.
7. Which of the following is NOT an internal organ of the female reproductive system?
The female internal reproductive organs consist of the vagina, uterus, cervix, fallopian tubes, and ovaries. The labia (majora and minora) form part of the external genitalia (vulva).
8. Which of the following is NOT part of the brain structure?
The brain stem, thalamus, and pons are central nervous system structures made of neural tissue. The pituitary is an endocrine gland that hangs from the hypothalamus; it is not classified as a structural part of the brain itself.
9. The part of the neuron that conveys information from one neurone to another is the
Dendrites receive incoming signals, while the axon is the elongated projection that conducts electrical impulses (action potentials) away from the cell body towards the axon terminals, passing information to the next neuron or effector organ.
10. Which of the following is considered a master gland?
The pituitary gland is historically termed the “master gland” because it produces tropic hormones (like TSH, ACTH, FSH, LH) that control and regulate the activity of many other endocrine glands in the body.
11. Which of the following glands produces the luteinizing hormone?
Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) are gonadotropins synthesized and secreted by the gonadotropic cells of the anterior pituitary gland.
12. Which of the following hormones is secreted by adrenal medulla?
The adrenal medulla produces catecholamines: epinephrine (adrenaline) and norepinephrine (noradrenaline), which are responsible for the body’s acute “fight or flight” response. Aldosterone and hydrocortisone (cortisol) are from the adrenal cortex.
13. Which of the following consists of three functions of the skin?
The skin (integumentary system) protects underlying tissues from trauma and pathogens, contains receptors for sensory perception (touch, pain, heat), and regulates core body temperature through sweat and vasodilation/constriction.
14. Which of the following is NOT an essential organ of the visual apparatus?
The visual apparatus requires the eyeballs (to capture light), retina (photoreception), and optic nerves (neural transmission). Eyebrows are accessory structures providing physical protection from sweat and debris, but are not essential for the mechanism of sight.
15. Which of the following layer of tissue is adherent to the lungs?
The pleura is a double-layered serous membrane. The visceral pleura intimately adheres to the surface of the lungs, dipping into the fissures, while the parietal pleura lines the inner chest wall.
16. The type of epithelium which lines the inner layer of the bladder is
Transitional epithelium (urothelium) is uniquely structured to accommodate fluctuations in volume. As the bladder fills with urine, the cells stretch and transition from a plump, cuboidal shape to a flattened, squamous appearance.
17. Which of the following structures does NOT enter the kidneys at the hilum?
The renal hilum is the medial depression where the renal artery, renal vein, ureter, lymphatics, and nerves enter and exit the kidney. The adrenal glands sit superiorly on top of the kidneys and do not enter the hilum.
18. Which of the following structures acts as a passage for urine from the kidneys to the urinary bladder?
The ureters are muscular tubes that utilize peristaltic contractions to propel urine from the renal pelvis of each kidney down into the urinary bladder. The urethra carries urine from the bladder to the outside.
19. Which of the following describes the normal colour of urine?
Clinically, normal urine color is described as pale yellow to deep amber. “Amber” is the standard textbook terminology denoting the pigment urochrome (urobilin) concentration depending on hydration levels.
20. Which of the following blood vessels supplies the nephron?
The afferent arteriole is a tiny branch of the renal vascular system that directly feeds blood into the glomerulus (the capillary tuft within the nephron) for filtration. Blood exits the glomerulus via the efferent arteriole.
SECTION A: FILL IN THE BLANK SPACES 10 Marks
→ GLOMERULUS (OR RENAL CORPUSCLE)
→ PHRENIC NERVE
→ OLIGURIA
→ TRIGONE
→ OLFACTORY NERVE
→ INSULIN
→ EUSTACHIAN TUBE (PHARYNGOTYMPANIC TUBE)
→ MICTURITION (OR URINATION)
→ TESTOSTERONE
→ FALLOPIAN TUBE (AMPULLA)
SECTION B: SHORT ESSAY QUESTIONS 20 Marks
Question 31: Functions of the Kidney (10 Marks)
Outline five (5) functions of the kidney:
The kidneys are vital retroperitoneal organs responsible for maintaining homeostasis. Their primary functions include:
- Excretion of Metabolic Wastes: The kidneys filter the blood to remove toxic nitrogenous waste products generated by cellular metabolism, such as urea, uric acid, and creatinine, excreting them in urine.
- Osmoregulation (Water Balance): By adjusting the volume and concentration of urine under the influence of Antidiuretic Hormone (ADH), the kidneys strictly maintain the body’s total water volume and blood osmolarity.
- Electrolyte Regulation: The kidneys actively secrete and reabsorb essential ions (such as Sodium, Potassium, Calcium, and Phosphate), keeping plasma electrolyte concentrations within narrow, life-sustaining limits.
- Acid-Base Balance Regulation: The kidneys maintain blood pH (around 7.35 – 7.45) by excreting excess hydrogen ions (H+) and reabsorbing or generating bicarbonate ions (HCO3-).
- Endocrine Functions: The kidneys secrete crucial hormones: Erythropoietin (stimulates red blood cell production in bone marrow), Renin (regulates blood pressure via the RAAS pathway), and they activate Vitamin D to its active form (Calcitriol) for calcium absorption.
Question 32: Parts of the Air Passage (10 Marks)
Outline five (5) parts that make up the air passage:
The conducting zone of the respiratory system channels air from the external environment down into the lungs. The continuous air passage includes:
- Nasal Cavity: The primary entrance for air. It warms, humidifies, and filters incoming air using its rich blood supply, mucus, and ciliated epithelium.
- Pharynx (Throat): A muscular funnel extending from the posterior nasal cavity down to the larynx, serving as a shared passageway for both air and food.
- Larynx (Voice Box): A cartilaginous structure connecting the pharynx to the trachea. It prevents food from entering the lower airways (via the epiglottis) and houses the vocal cords.
- Trachea (Windpipe): A flexible tube supported by C-shaped cartilaginous rings that travels down the neck and into the mediastinum, carrying air into the thoracic cavity.
- Bronchi (Primary, Secondary, Tertiary): The trachea bifurcates into the right and left primary bronchi, which enter the lungs and branch extensively into smaller secondary and tertiary bronchi, distributing air to all lung segments.
SECTION C: LONG ESSAY QUESTIONS 50 Marks
Question 33: Endocrine System and Urine Formation (25 Marks)
(a) State five (5) hormones produced by the anterior lobe of the Pituitary gland (5 marks):
- Growth Hormone (GH): Stimulates cellular growth, muscle mass, and bone elongation.
- Thyroid-Stimulating Hormone (TSH): Stimulates the thyroid gland to release thyroid hormones (T3 and T4).
- Adrenocorticotropic Hormone (ACTH): Stimulates the adrenal cortex to release glucocorticoids like cortisol.
- Follicle-Stimulating Hormone (FSH): Stimulates ovarian follicle development in females and spermatogenesis in males.
- Luteinizing Hormone (LH): Triggers ovulation in females and stimulates testosterone production in males.
- Note: Prolactin (PRL) is also produced here, stimulating milk production.
(b) Outline ten (10) effects of adrenaline on various body organs (10 marks):
Adrenaline (Epinephrine) acts on the sympathetic nervous system to prepare the body for “fight or flight”:
- Heart: Increases heart rate (tachycardia) and the force of myocardial contractions, increasing cardiac output.
- Blood Vessels: Causes vasoconstriction in the skin and visceral organs, shunting blood to vital areas and increasing overall blood pressure.
- Lungs (Bronchioles): Relaxes bronchial smooth muscle, causing bronchodilation and allowing increased airflow and oxygenation.
- Liver: Stimulates glycogenolysis (breakdown of glycogen into glucose), rapidly increasing blood glucose levels for immediate energy.
- Eyes (Pupils): Contracts the radial muscles of the iris, causing mydriasis (pupil dilation) to improve visual acuity in low light.
- Gastrointestinal Tract: Decreases peristaltic motility and inhibits digestive gland secretions, halting digestion.
- Skeletal Muscles: Increases blood flow (vasodilation to skeletal muscles) and heightens muscle tone and readiness for action.
- Adipose Tissue: Stimulates lipolysis, breaking down stored fats into free fatty acids to be used as fuel.
- Urinary Bladder: Relaxes the detrusor muscle and constricts the internal urethral sphincter, preventing urination during stress.
- Skin: Stimulates arrector pili muscles (causing “goosebumps”) and increases sweat gland secretion to cool the body.
(c) Outline the process of urine formation (10 marks):
Urine formation occurs continuously in the nephrons of the kidneys through three distinct physiological steps:
- Glomerular Filtration: Blood enters the glomerulus (a high-pressure capillary bed) via the afferent arteriole. The high hydrostatic pressure forces water, glucose, amino acids, urea, and electrolytes out of the blood and across the semi-permeable filtration membrane into Bowman’s capsule. This fluid is now called glomerular filtrate. Large molecules like red blood cells and plasma proteins are too large to pass and remain in the bloodstream.
- Tubular Reabsorption: As the filtrate travels through the renal tubule (Proximal Convoluted Tubule, Loop of Henle, and Distal Convoluted Tubule), the body reclaims essential substances to prevent loss. 100% of glucose and amino acids, and the majority of water and essential electrolytes (Na+, Cl-), are actively and passively transported out of the tubule and reabsorbed back into the surrounding peritubular capillaries.
- Tubular Secretion: This is the final tuning process. Excess ions (such as H+ and K+), metabolic wastes like creatinine, and certain drugs (like penicillin) are actively secreted from the peritubular capillaries directly into the distal convoluted tubule and collecting duct. The resulting concentrated fluid remaining in the collecting ducts is urine, which drains into the renal pelvis.
Question 34: The Eye and Physiology of Sight (25 Marks)
(a) Outline five (5) parts of the eye (5 marks):
- Cornea: The clear, dome-shaped anterior window that allows light to enter and provides major refractive power.
- Iris: The pigmented muscular ring that controls the size of the pupil and the amount of light entering the eye.
- Lens: A transparent, biconvex structure situated behind the iris that changes shape to fine-tune the focus of light onto the retina.
- Retina: The innermost sensory layer containing millions of photoreceptor cells (rods and cones) that detect light.
- Optic Nerve (Cranial Nerve II): The nerve bundle extending from the back of the eye that carries visual electrical impulses to the brain.
(b) Outline six (6) ways by which the eye is protected from injury or foreign bodies (12 marks):
- The Bony Orbit (Eye Socket): The eyeballs sit deeply inside a strong, bony cavity of the skull, surrounded by a cushion of orbital fat, which protects them from direct mechanical blows.
- Eyelids (Palpebrae): Highly mobile skin folds that reflexively snap shut (blink reflex) when an object approaches quickly or in bright light, shielding the delicate cornea.
- Eyelashes: Stiff hairs projecting from the eyelid margins that act as biological sensors and physical traps, preventing dust, insects, and debris from falling into the eye.
- Eyebrows: Thicker hair positioned above the orbits that specifically diverts sweat and rain horizontally, preventing acidic or salty fluids from dripping into the eyes.
- Lacrimal Apparatus (Tears): The lacrimal glands continuously secrete tears that flush away microscopic foreign particles. Tears also contain lysozyme, a powerful antibacterial enzyme that prevents ocular infections.
- The Conjunctiva: A thin, transparent mucous membrane lining the inner eyelids and covering the anterior sclera. It secretes lubricating mucus and acts as a physical barrier preventing microbes from migrating to the back of the eye.
(c) Outline the process by which human beings are able to see (8 marks):
- Refraction of Light: Light rays bouncing off an object enter the eye. They pass first through the cornea, then the aqueous humor, the pupil, and the lens. The curvature of the cornea and the adjustable lens bend (refract) these light rays so they converge precisely on the focal point of the retina.
- Phototransduction: When the focused light hits the retina, it strikes the photoreceptor cells (rods for black/white and dim light, cones for color and detail). The light energy triggers a chemical breakdown of visual pigments (e.g., rhodopsin), which converts the light energy into electrical nerve impulses.
- Transmission: These electrical impulses are gathered by ganglion cells and transmitted backwards along the optic nerve. The signals from both eyes partially cross over at the optic chiasm, ensuring both hemispheres of the brain receive binocular data.
- Perception in the Brain: The impulses reach the visual cortex located in the occipital lobe at the back of the brain. The brain processes these signals, inverts the upside-down image received by the retina to be right-side up, interprets colors, shapes, and depth, resulting in the conscious perception of vision.
Original examination paper