PRACTICAL RECORD BOOK FOR BDS STUDENTS - PHYSIOLOGY
PHYSIOLOGY
INDEX
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Expt. No. |
Name of the Experiment |
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Page No. |
Date |
Remarks |
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PRACTICAL |
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1 |
Estimation
of Haemoglobin |
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2 |
Determination
of Red cell count |
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3 |
Determination
of total white cell count |
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4 |
Determination
of Differential count of W.B.C. |
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5 |
Determination
of Blood Groups |
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6 |
Determination
of Bleeding time & Clotting time |
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7 |
Clinical
Examination of pulse |
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8 |
Determination
of Arterial blood pressure in Human |
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DEMONSTRATION |
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1 |
Determination
packed cell volume |
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2 |
Examination
of Heart and Cardio-vascular system |
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3 |
Examination
of Respiratory system |
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4 |
Effect of
stimulation of vagus & white erescent line in frog’s
heart and effect of Atropin & Adraenaline |
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5 |
Effect of
Ions Isolated perfused heart of frog |
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6 |
Effect of
Durg on isolated perfused heart of frog |
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7 |
Study of
reflexes in human beings |
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Path of Light through the Microscope
OBSERVATIONS
AND DIAGRAMS
……………………….G/100ml
of Blood
Pathological: 1) Polycythemia vera 2) Haemoconcentration e.g. Burns,
3) Congenital
Heart diseases.
Decrease
in Hb. content occurs in the blowing conditions.
1. Iron
deficiency Anaemias, 2)
Haemodilution.
Other Methods of
Determination of Haemoglobin Content
1) Tallquist’s method, common
method used at the bed side.
2) Tallquist’s method,
3) Vanslyke and stadie method,
4) Gower’s method.
5) Spectrophotometric method
6) Examination of mucos
membrane of tongue conjunctiva and nails will also give through idea about
Haemoglobin content of blood and
7) Colorimeter method.
Calculations:
- 15G of Haemoglobin
Equals 1005
…………………………………….G of Haemoglobin ………………………………
- 1G of Haemoglobin
carries 1.34ml of Oxygen at N.T.P.
………………………….G
of Haemoglobin carries ………………... Oxygen
100ml
Oxygen earned
by blood in dissolved state plazma in 0.3ml/100 ml, so total oxygen
carrying
capacity of 100ml of blood would be
1.34 mix ……………………G
if Hb + 0.3ml ……………….ml of 02/100ml
- 1 G of Haemoglobin contains 3.33 mg of Iron (Fe.)
…………………… G of Heamoglobin ………………………….mg of Iron (Fe).
Expt. No.1
Date ………….
Estimation of
Haemoglobin in Shali’sMethod
AIM: To determine the Hb content
of the blood to calculate the O2 carrying capacity of blood to find
out the iron content of the blood.
Principle: Matching the colour of the
diluting blood in which Hb is converted in to acid haematin by treatment with
N/10 Hcl a permanent standard coloured plates.
Apparatus: Sahil’s Haemometer. Haemoglobin
pipette. N/10 Hcl. Distilled water stirrer Lancet, Cotton, Spirit.
Procedure: Take N/100 Hcl in graduated
tube upto the mark 10 on the % a scale of the lowest mark. Sterlise the finger
with cotton and spirit prick the finger by lancet and draw the blood in to the
Haemoglobin pipitte up to the mark 20Cu, mm wipe away any any blood adhering
the pipette. Transfer the blood to the graduated tube immediately repeated
filling and emptying the pipette with Hcl in the graduated tube. Mix the blood
with HCL by the stirrer and wait for five minutes the clear brown colour of the
mixture is due to formation of acid haematin.
Dilute
the mixture with distilled water drop by drop stir. Care should be taken that
no froth or air bubbles result. Proceed on diluting till the colour of the
mixture exactly matches the colour of the standard plates. Take the reading of
the graduated tubes as Gms of Haemoglobin / 100ml of blood.
Normal Value:
In
male 15 to 17 Gms/100 ml of blood
In
female 13 to 15 Gms/100 ml of blood
Variations: Increase in the Hb content
occurs in the following conditions.
Physical: 1) More in new born infants about 20 to 23 G/100 ml
2)
More in the afternoon 3) Increases during and after muscular exercise.
4)
Increases in emotional state 5) Increases at hige altitude.
In
the above conditions the variation is due to alteration in the blood cell
count.
Observations
and Diagrams:
Expt.
No.2
Date
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Determination
of Total Red Cell Count
AIM: To find out the total
number of Red blood cell per Cu. mm.
Apparatus
Required:
Microscopic, Haemocytometer with counting Chamber (Neubauer ruling): Red cell
pipette, RBC Diluting Fluid, Hayem’s fluid) Cover slip, Lancet, Cotton and Spirit.
A the Counting
Chamber:
The different parts of counting chamber the middle platform AAI which bears the
ruled area, are exactly 0.1mm lower then the two wide platform C1 C2.
The
middle platform are separated from each other by the transverse groove ‘D’ and
from the two side platform by the trenches Dl and D2 when the coverslip is
placed upon the platform there is a space exactly 0.1mm. (1/10 mm) deep between
it and the ruled areas on the middle platform. Upon each ruled area there are
nine large fields each having an at of 1sqmm.
The
central field has an area of 1sq, mm and is used for R.B.C. count it is divided
into 25 big squares, each having an area of 1/25 sq. mm each big square is
further subdivided into 16 small square each having an area of 1/400 sp. mm.
and there fore there are 400 small squares in the whole central field.
Four
large fields at the corners of the above central ruled area are used for
counting the W.B.C. each field at the corner is divided into 16 big squares.
The area of one large field is 1sq mm.
B.Red Cell
Pipette: The
capillary portation in the stem of the R.B.C. pipette is divided into 10 equal parts from tip of the pipette o the
bottom of the bulb. The 5th and the 10th marks are denoted by 0.5
and 1 marks respectively. There is another mark just above the bulb and is
marked as 101 is given. To facilitate mixing a red bead is present in the bulb.
C Diluting Fluids: 1) Hayem’s Fluid: Composition given below
Sodium Chloride (acts is otonic) 1G
Sodium Sulphate Rouleax formation Hg Cl2
(Acts as antiseptic) 0.5G
Dist Water …………………………….200 e.c
2)
0 9 Persent Nacl, Solution can be also be used.
Method:
With
a dry R.B.C. pipette stick the blood upto mark 0.5. The blood column in the
capillary stem should not be permitted to go beyond that mark. In case this
happens gently touch the tip of the pipette to the filter paper Dip the tip of
the pipette in the diluting fluid and suck to be exact 0-5 mark blood to be
sucked mV the pipette. Stop sticking when the mark 101 is reached knot, to the
top by using the extra rubber tube. Now rotate the pipette in between the palms
of your hands to facilitate through mixing of blood with the diluting fluid.
The dilution of blood in this case is 1 in 200.
Charging the Counting
Chamber:
Counting
chamber and coverslip are cleaned and made dry put the coverslip over the counting
chamber so that it covers the ruled areas fully, discard a few drops from the
pipette and place the one drop or less than that over the counting chamber just
near by margin of the overslip the drop will instantly flow under the coverslip
by capillary action. The fluid should not flow into side chamber and should be
just sufficient to fill up the ruled, area on the chamber.
Counting of
the cells:
Focus
ruled area under low power and see whether the red cells are evenly placed or not
if the distribution of the cells in whole field is uniform then see it under
the high power count the total member of red cells present in five big squares
(4 squares at the corners and one in the centre).
NB: The entire counting of R.B.C. completed only
under high power.
Calculation:
Let
‘X’ be the total number of cells present in 80 smallest squares.
No.
of cells present in smallest squares = x /80 cells.
Area
of the each smallest = L x B
=
l/20mm x l/20mm
=
1/400sq.mm
Volume of one of smallest square L X B X H
=
1/20mm x l/20mm x 1/l0mm
=
1/4000cu. mm
i.e one smallest square having a volume of 1/4000 cu
mm. contains
= X /80 cells 1 cu. mm. contains x/80 x 4/000 = X x
50 cells.
Dilution 1:200/cu. mm. of undiluted blood contains A
X x 50 x 200 cells.
x
10.000 cells
=
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millions/cu.mm
Normal Value: Total R.B.C. Count in male
5.5 to 6.5 millions / cu mm in female - 4.5 to 5.5
millions/cu. mm.
Precaution: While counting the red
cells those cells lying on the upper and left hand boundary of square must be
considered to insi4e that square and those cells lying on the right and lower boundary
of square must be considered out side.
A
increase in number of red cells is called as polycythemia and occurs under the following
condition.
Physiological
Conditions:
1) New Born Infants. 2) During the working hours. 3) During muscular exercise.
4) Emotional states. 5) High turned environmental temperature. 6) High altitude
A) Immediate Due to mobilisation from blood store house. B) Permanent Due to
overreaction of red bone marrow 7) Injection of Aderenaline 8) Raised CO2
tension. 9. Cells more in males then in females.
Expt. No.4.
Date ……………
Determination
of Differential Count of W.B.C
Apparatus
Required:
Microscope, Glass Slides Spirit and pricking Needle Leishman’s stain, Distilled
water, staining Rack, Cotton, Lancet.
Leishman’s
Stain: It
contains both basic (Methylene Blue) and acidic (eosin) stain dissolved in
Acetone free methyl Alcohol. The methyl Alcohol fixes the smear to the slide.
It is prepared by adding 1.5 g of dry stain to 1000 ml. of acetone free methyl
alcohol. The stain improves on exposing to sunlight.
Method: Prepare an ideal peripheral
blood smear which is thin, smooth & homogenous.
No-windows
& serration it is usually tongue shaped these are the characters of a good
and ideal smear. 2-3 or the glass slide PBS- Dry the smear.
Staining: I put the slide on the
staining rack & pour sufficiently the leishman’s stain & wait for 2-3
mts (fixition stage). Note the number of drops used. NB: The stain should not
be dry on the slide.
II. Add double the amount of distilled water over
the slide & below the contents gently so that it mixes properly & wait
for 8-10mm. (staining takes at the end of 8-10 min.)
III. Discard the diluted stain & Rinse gently
with tap water to remove excess stain (ideal pinkish blue).
IV) Dry the smear thoroughly & then put a drop
of cedar wood oil or liquid paraffin & focus under immersion lens.
OBSERVATION
AND DIAGRAMS:
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Neutrophil =
_______________________________%
Esoniophil =
_______________________________%
Monocytes =
_______________________________%
Lymphocytes
=
_______________________________%
Basophil = _______________________________%
OBSERVATION
AND DIAGRAMS:
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‘A’ GROUP |
O O |
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‘B’ GROUP |
O O |
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‘AB’
GROUP |
O O |
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‘O’ GROUP |
O O |
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MY BLOOD
GROUP |
O O |
Name:
Address:
Blood
Group:
Checked by:
Expt. No. 6
Date ………………
CLOTTING TIME
Apparatus
Required: 1. Pricking Needle.
2.
Fine Capillary tube nearly 6 inches long.
3.
Stop watch.
Technique: Clean the finger and
puncture sharply the tip of the finger with pricking needle so that blood flow
freely. Discard the first 2 drops and then till the capillary tube up to 3/4 of
its total length with blood capillary tube will be filled by capillary action
when the tube is held against a drop of blood Note the time by the stop watch
when the puncture is made. Proceed to gently break a small portion of the tube
from one end and every 15 seconds until a thin film or unbroken coagulam is
seen stretching between the 2 broken ends and note the time when it happens.
The
difference between the two timings by the stop watch is the Coagulation time.
Normal -3 to 10 minutes CT > | Haemopbilta
BT-Normal
Question: Why bleeding time is less
then clotting time?
BLEEDING TIME
Apparatus
required: 1. Pricking Needle
2.
Filter Paper
3.
Stop watch
Method: Duke’s Method
Clean
the ear lobe tip of the finger with alcohol. Prick the selected site fairly
deep so that blood flows freely. Soak up the blood with filter paper without
touching the skin. Not the time by stop watch. Continue to soak the blood with
filter paper without squeezing or pressing the finger every 1/2 minute until
the filter paper is no longer stained with blood i.e. bleeding has stopped. The
time from the first appearance of the blood until the cessation bleeding is the
bleeding time.
Normal Limit: 1 to 3 minutes.
BT
> in jaundice Survey Vit. K. deficiency purpura in Thrombo cytopenic purpura
Bleeding tim 5 > but CT -5 normal.
Expt. No. 7
Date ……………
Clinical
Examination of Pulse
Pulse
is a periodic uplift felt over artery. This is produced by sudden flow of blood
into the aorta during each systole, giving to rise increase of pressure and
arterial distension transmitted from one segment of an artery to the next in
the from of wave.
The
pulse gives information regarding the conditions of the vessel wall and the
amount and variation of pressure of the contained blood, Also pulse gives
valuable information regarding state of the heart circulation and general
condition of patient.
The
pulse can be examined of different arteries-radial brachial, axellaxy femoral,
popliteal; dorsalis paedis, superficial temporal etc.
1) MEIITOD: Commonly radial eartery is
used for examination of pulse, because it is very convenient for palpation.
Radial pulse is best felt at the lower lateral border of fore-arm near the
wrist joint when the patient forearm is pronted and wrist slightly flexed Examine
the pulse for 3 minutes to get information about pulse, as below.
2) RATE: Rate means number of beats
minute Normal average pulse is 72/mt. but in children it is more rapid as 90 to
110/mm and in old age may become slow (55 to 65) per mm examine pulse rate when
patient feels comfortable and not nervous. Because nervousness will increase
the pulse rate.
3) RHYTHM: Normal pulse wave succeed
one another at regular interval, and decreases during expiration. This
physiological irregularity in pulse is called as Sinus arrhythmia.
If
pulse is irregular occasionally with definite interval then, it is called as
irregularly regular. If irregularity is all the time, then it is irregularly
irregular.
4) Volume: It is the uplift of vessel
wall during passage of pulse wave. Normal pulse is of is moderate volume.
High
volume pulse is felt in hyperdynamic circulatory state.
Low
volume pulse is felt in peripheral shock.
5) Character: It is not usually possible
to detect the wave of normal pulse or Slight variation from the normal but in certain
diseases the character of the pulse is detectable abnormal. The most important of
these are-Anacrotic pulse Collapsing (Water-hammer) pulse, bisferiens pulse,
pulseus paradoxus, pulses alterrians.
Collapsing
(Water - hammer) pulse: Feel the pulse by grasping the subjects fore arm with
the palm and then subject’s forearm is elevated above the subjects had level.
By this procedure the pulse is felt easily and it is full bounding.
6) Conditions
of Vessel Wall: Fell the radial pulse of subject with right three fingers and simultaneously
brachial artery is felt left three fingers in cubital fossa. Now exert the
pressure over brachial arterly by the left three fingers till no pulse in
radial artery is felt by right three fingers. Now role the radial artery
against underlying bone to feel walls of radial artery by rolling against the
bone if the arterial wall is thickened, then it is felt like whip cord:
7) Equality on
Both Sides:
The pulse on the other sides is also examined in respect of all the above
points and comparison is made.
Expt. No. 8
Date …………
DETERMINATION
OF ARTERIAL BLOOD PRESSURE IN MAN
Aim: To determine the arterial
blood pressure in man by indirect method before and after exerciser.
Principle: It consists of balancing
air pressure against the pressure of blood in the bronchial artery and then
estimating the former by means of a mercury manometer.
Apparatus: Sphygmo manometer and
stethoscope are the instruments which are universally accepted and used to
determine the arterial blood pressure by indirect or clinical method.
Essentially it consists of an inflatable, Cloth -covered flat rubber bag nearly
by wrapping and extension for the cloth covering over the bag and around the
arm like a bandage. It is usually referred to as cuff. On one side the cavity
of the rubber bag is connected to manometer and on the other side it is connected
to a pressure bulb pump by means of rubber tubes.
By
using the pressure bulb, the rubber bag can be inflated to any desired pressure
on the tube leading from the bulb to the bag, there is a needle valve which can
be opened gradually to allow the air to escape, there by reducing the pressure
in the bag as required.
The
manometer consists of a wide glass bulb bottom and a vertical glass tube. The
glass bulb is filled with mercury and is connected with the inflatable cuff.
The column of mercury in the bulb rises or falls in the glass tube depending
upon the inflation or deflation of the cuff. The vertical glass tube on either
side, is celebrated each division indicating 2 mm of. Pressure can be increased
upto 300 mm Hg. from 0 mm Hg.
Position of
the Patient:
Depending upon the condition of the patient, he can be kept in lying position
(supine position on). If he is able to sit, he can sit in ‘a chair what ever
may by the position of the patient, the hand must be kept at the heart level
and the manometer must be kept at the heart level upper arm of the patient must
be bare up to the shoulder.
Procedure: The uninflated cuff is
wrapped around the upper arm neither to tight nor too loosely. The cubital
fosses must be left free the subject is advised, to relax the arm muscles: after
‘setting every thing as said above the determination of Blood pressure is
stated.
Method to
determine blood pressure: There are different methods to determine the blood pressure.
- Palpatory method
- Auscultory method
- Oscillartory method
Among
these, oscillatory method is out of date due to its inaccuracy. Palpators
method is to determine only systolic blood pressure but not the diastolic,
blood pressure. But the auscitatory method is the one by which both can be
determined and also with accuracy.
Palpatory
Method:
With the cuff wrapped around, the upped arm, the pulse is palpated first by
feeling the radial pulse the cuff is inflated to increase the air pressure till
it over comes the blood pressure and obliterates the arterial lumen so that the
pulses no longer felt. The pressure must be raised another 20 mm Hg beyond this
level.
By
means of the valve, the air is allowed to escape very gradually so that the air
pressure falls inside the cuff and the mercury column in the manometer comes
down simultaneously at the same time the pulse also must be examined as the air
pressure falls a point reaches where the pulse appears suddenly, This is the
point where the air pressure and the blood pressure are equal and the pulse
appears. That is known as the systolic pressure, once pulse appears it will
remain as it is. So the diastoic pressure can not be measured by this.
Auscultatory
method:
Here to auscultate the sounds, the stethoscope is used. The branchial artery is
palpated and the place is noted in the cubital fossa to keep the chests piece
of stethoscope.
The
air pressure is raised in the Sphygmomnometer to 20 to 30 mm Hg above the
systolic pressure as determined by palpatory method. Now the air pressure must
be slowly reduced and simultaneously the chest piece of the stethoscope is kept
on the cubital fossa to hear any sounds, it appear.
As
we reduce the compression 3 sounds are heard which finally disappears. Those sounds
appears during determination of blood pressure are known so korot koff sounds.
First
sound- sudden appearance of a clear, tapping sound which corresponds with the systole
of the heart and corresponds with systolic pressure, Second sound with further failing
the air pressure. The sound attains harsh murmurish quality.
Third
sound with still further reduction in the air pressure, the sound become
clearer, louder and gonging type.
Then
finally, with still further reduction in. the air pressure, the sound become
muffled and finally disappears. The appearance of the first sound .is systolic
pressure and the disappearance of the sound is the diastolic pressure.
Normal average
values:
Systolic
B. P. 120. 120+20 nim. Hg
Diastolic
B. P. 75 + 15 mm. Hg.
N.B: The systolic and diastolic pressure are
conventionally written as 120/80 or 130/90 etc.
Precaution: 1) Observe the arterial
pressure only after the subject has been assured and when he is quietly resting
free from excitement and with the arm relaxed. This is relevant, for the
arterial pressure show temporary variations with change of posture after meals,
in excitement etc.
2) Reject the first reading in nervous subject, for
it is often too high. A second reading will more closely represent the true
pressure.
3) When successive estimation to be made the air
pressure in the armlet should be allowed to fall to zero as soon as each reading
has been taken. The work should be quiet and quick.
4) Repeated compression and decompression of the armlet
just before making actual V determination of arterial blood pressure will
remove any spasm of the arterial wall and eliminate the source of in accuracy.
The
subject is asked to perform moderate and strenuous exercise in strenuous
exercise of the systolic pressure is found to rise very much. Where as in
moderate exercise there is slight rise of systolic pressure hardly change
during moderate exercise - In strenuous muscle exercise the diastolic pressure
falls.
RESULT
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Pressure |
Before Exercise in mm. Hg. |
After Exercise in mm. Hg. |
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Systolic
Pressure |
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Diastolic
Pressure |
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Pulse
Pressure |
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Mean
Pressure |
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Pulse Pressure = Systolic Pressure – Diastolic
Pressure
Mean Arterial Pressure = Diastolic 1/3 Pulse
Pressure.
Expt. No. 8
Date…………..
TO DETERMINE
THE PACKED CELL VOLUME AND
CALCULATE TUE
ABSOLUTE VALUES OF BLOOD INICES
Determine of
Packed Cell Volume:
After
taking the E.S.R. reading in the wintrobe’s tube centrifuge the tube at 3000
revolutions per minute for half an hour, the packed cell volume can be read directly
from the marking on the tube, Normal value -40 to 45 percent.
Calculation of
the Absolute Values of Blood Indices:
Data
required R.B.C. conut/ in millions /cu. nm. Haemoglobin content 15gms/l00cc.
P.C.V. 45 percent
a) Mean corpuscular volume in cubic microns:
P.C.V per 1000 c.c. of blood
M.C.V=
R.B.C. in millions per c.mm
= 90 Cu Microns (Range 78-91 cu Microns)
b) Mean corpuscular haemoglobin:
Hb.
in grams per l000c.c.
MCH
=
R.B.C.
in millions/c m.m.
= 30 micro - micro grams or picograms
Normal range ………..= 29-32 micro micro gms or pico
grams
c) Mean corpuscular haemoglobin concentration in
percent.
M.C.H.C
= Hb. content in gms/100
c.c. X 100
=
Packed cell volume
=
=
33 percent
Normal range :
31-35 percent
d) Colour Index (C.L)
Percentage of Rb
Percentage of RBC
100
percent (15 gms of Hb is equivalent
to 100% &
100
percent 5 millions of RBC is
100%
Normal range :
0.85 to 1.0
CALCULATION:
THE ABSOLUTE
VALUES OF BLOOD FROM THE FOLLOWING DATA:
and
find out type of anaemia, show your calculations to the teacher In charge and
confirm the results.
R.B.C.
count ………………………………………2 millions/c.mm.
Hb
content ………………………………………4Gms/l00c.c.
P.C.V.
………………………………………15 percent
Significance
of Absolute Values
Of these values the most important are
M.C.V.M.C.H.C.
If M.C.V. is above 94cub. Micron the anaemia is
macrocytic in type, if it is between 78 to 94 the anaemia is normocytic and if
it is below 78 cub Micron the anaemia is microcytic.
The
M.C.H.C. expresses the amount of haemoglobin for 100 ml. of cells rather than
amount per 100 ml. of blood and is therefore the true measure of the degree of
saturation of cells with haemoglobin. It cannot be increased because the red
calls cannot hold a greater concentration of haemoglobin than normal. When it
is reduced below 32% it is an indication that the patient should be treated
with iron, the anemia being hypochromlc when M.C.H.C. is within normal limits
is called as normochromic.
Demonstration No.1
Date ……………………….
DETERMINATION
OF PACKED CELL VOLUME
Apparatus
Required: Wintrobe
haematocrit tube, Centrifuge, Fine Capillary droper, Oxalate bulb. Oxalated
bulb (containing Potassium Oxal ate and ammonium Oxalate).
Method: Blood is drawn from a vein
taking. all the precautions and is transferred to the oxalate bulb. Oxalate
bulb is thoroughly mixed and wintrobe a filled with fine capillary dropper upto
mark ‘O” (Zero), Tube is placed in a centrifuge and is revolved at speed 3000
rotation per minute (R.P.M.) for half an hour. After half an hour the packed
cell volume is read directly from the markings on the tube.
Note: Normal Value 40-45%
Expt. No. 2
Date ………..
Clinical
Examination Cardio - Vascular System
Inspection: Chest and pericardium. 2)
Neck veins. 3) Veins on the chest wall.
4) Cardiac impulse or Apex beat. 5) Other pulsations.
1) CHEST AND PERICARDIUM: Shape Normally the chest
is bilaterally symmetrical and Elliptical in shape of the chest-varies with the
build of the individual i.e. often being, broad and deep in the thick and long,
flat and narrow in tall.
Chest Depor
Mites:
- Scoliosis (Lateral bending)
- Kyphosis (Forward bending)
- Pigeon - chest (Ricket)
- Flattening of one apex (Apical fibrosis due to tuberculosis)
- Barrel shaped chest [obstructive disease)
NECK VEINS: Neck veins should be
examined with the patient in a good light and reclining at an angle of about 450
veins normally show slight pulsation and 3 small waves can be distinguished in
each cardiac cycle. There is mean level and the perpendicular height of this
level in health is the same as that of mauu-brium sterni-i.e. in healthy person
recycling at angle 450 the mean level (definite upper level) will be
invisible because it is below the clavicle but some slight pulsation may appear
above the clavicle Arterial pulsation may also be visible in the neck. Neck
should be supported so that the neck muscles are relaxed.
Vanous Pulse Arterial
Pulse
1. It is more sinous & less sharp 1. It is
more sharp& thirsting in nature
2. Mean level falls during inspiration 2. No. change
3. It is impalpable 3.
Easily palpable
4. Firm pressure (Gentle) on the 4. No.
change
abdomen (rt) will rise level
Raised
venous pressure is usually indicative of Rt. heart failure. Slight rise in
venous pressure also occurs with an increase in the circulation blood volume
e.g. pregnancy and acutencphritis.
Veins on the
Chest Wall: Veins
will .be seen a) Normally seen when the patients skin is unusually transfarent
when intra-thoacic growth or aneurysm obstructs the of blood to the heart.
c) When portal obstruation or inf. vena.cava
obstruation is present.
Cardiac
impulse: It
is lowest and outer most impulse seen per felt, usually seen in the left 5th
I C S about 9cm [3 ½] away from midline or [1 ½] medial to the
midclavicular line. It may be seen or felt in the ant, exillary line if the
person is laying on his left side.
Displacement
of apex beat
- Commonest cause is thoracic diformities e.g. Scoliosis
- Real displacement may be due to disease of the surrounding viscera
which push or pull it from its usual site.
Pushing: Found in pleural effusion
and pneumothorax.
Pulling: Found in pulmonary
fibrosis, collapse of the lung diseases of the heart (left ventricular
(hypertropy)
Left
ventricle normally produces the apex beat, one should also remember that it is
left on the Rt side in congential dextrocardia.
Other
Pulsations:
Should be looked
i. In the nect
a) Normally pulsations can be
seen visibly on exertion and from mental excitent.
b) Thyrotoxicosis
c) Aortic incompetence
d) Hypertension.
e) Aneurusm of Aorta
ii. In the
supre-sternal notch: seen in
a) Hyper-tension
b) Coarctation of the aorta
c) Aneurysm of the arch of the
aorta
iii. In the
thorax :
pulsation seen in
a) Aneurysm of aorta - Ascending
- Descending
- Transverse
b) Coarotation of aorta.
iv. In the
epigastrium :
a) Pulsation is most commonly
due to nervousness of excitement in a thin person.
b) Less commonly seen due to
transmission of aortic pulsation by a tumour such as carcinoma of the stomach.
c) Occasionally due to
distensible pulsation of the liver in heart failure with tricuspid
regurgitation.
d) Very rarely seen due to
aneurysm of abdominal aorta.
Palpation: All the inspectory findings
should be confirmed by palpation
- Shape Of the chest
- Neck veins
- Veins over the chest wall
- Cardiac impulse
- Other pulsations in the neck, suprasternal notch over the chest
and, in the epigastric region.
- One should palpate the praecordium for the presence of thrill.
Thrill is palpable murmur
and on palpation it will give a sensation of a purring of a cat. It is due to
abnormal load heart sounds.
Percussion: This Examination is done to
know the limits of the heart i.e. to make out the borders of the heart
especially left & right border.
Left Border: To precuss for the lef tborder
of the heart one should localise the apical impulse i.e. left 5th I.C.S.
afterwards one should go to mid axilary line & start pecussing in left 5th
I.C.S. and come towards heart. The
moment you approach the heart there will be change in the note i.e. from
resonant to dull note and mark a point by the skin surface marking pencil. Then
you repeat the same procedure in the 4th, 3rd and 2nd
left I.C.S spaces and mark another three points. Now one should join these four
points this is the. Limit of the heart on the left side.
To
percuss for the Rt. border: First percuss for the liver dullines on must go to
one space above this i.e. Rt 5th I.C.S. in the midaxilary line and
start percussing and approach the sternum note down: the change of the percussion
note from resonant to dull. Continue the precussion and approach the heart till
one must get the more dull note that limits the Rt border of the heart in the Rt
5th I.C.S. repeat the same procedure for R.t 4th, 3rd,
2nd I.C spaces and mark the four points and join the. This is the Rt
border of the heart.
Auscultation: It is done by using the
stethoscope.
a) The following areas to be auscultated
1) Mitral area. 2) Tricuspid. 3) Aortic area. 4)
Pulmonary area
I & II heart sounds are usually heard in all the
four areas but I Heart sound is best heard in the Mitral and tricuspid areas
and II Heart sound is best heard in the Aortic and pulmonary areas. One must
differentiate between I & II heart sounds.
|
I.H.S |
I.H.S |
|
1) It is dull, prolonged and low pitched |
1) Short, sharp & high pitched |
|
2) Duration 0.l to 0.l7sec |
2) Duration 0.14 sec |
|
3) Best heard in Mitral tricuspid areas |
3) Best heard in aortic and pulmonary areas |
|
4) It coincides with apex best and coincides with
carotid pulse |
4) If comes after the commencement of the apex
best and after carotid pulse |
|
5) It coincides with R wave of ECG |
5) It comes after T wave of ECG |
|
6) It coincides with the C wave of the JVP |
6) It coincides with the notch of the ascending
limb of V wave |
b) One must auscultate for the presence of any
abnormal loud heart sounds i.e. murmus.
Expt. No. 3
Date………….
Clinical
Examination of Respiratory System
Inspection: Trachea, shape of the
chest, movement of the chest movement of the chest, cardiac impulse.
Trachea: Note down whether the
trachea appears to be central or deviated slight deviation of the trachea’ to
the right may be found in healthy people.
Significant
displacement of trachea suggests that the position of mediastinum has been
alterated by disease of lungs or pleurae.
a) Conditions while push the mediastinum away from
the affected side i) Pleural effusion ii) Pneumothorax b) Conditions which draw
it towards the affected side are: i) Fibrosis of the lung in tuberculosis or
after bronch opneumonia ii) Collapse of one or more lobes of lung.
Shape of the
Chest:
Shape varies with the build of the individual normal shape Bilaterally
symmetrical & ellipercalin shape, Pigeon chest in Rickets, Lateral Bending
kyphosis; Forward bending, Barrel shaped, severe obstructive airway diseases
are all seen in diseases affecting .the vertebrae, and in chronic bronchitis
there is severe obstruction to airway.
3. Movements
of the Chest:
a) Rate of resp: 14/mm. Tachypnoea important sign of pulmonary disease. . .
Increased rate may result from;
i. Exertion
ii. Nervous excitement
iii.Fever.
iv. Hypoxia
v. Pleurisy with pain
vi. Peritonitis
b) Ratio between respiration and pulse: In health is
about 1 to 4 where as in pnenmonia Respiratory rate may occur as frequently as
the pulse.
c) Type of Respiration
- Abdomino Thoracic .type (Males)
- Thoraco -
Abdominal type (Female)
Note down whether inspiration is prolonged or
expiration is prolonged.
-Prolonged inspiration is commonly associated with.
i)
Laryngal disease ii)
Tracheal disease
d) Movement: All the quadrants of chest
move equally and bilaterally with the respiration. Chest Expansion: Normally it
is 5.8cm (2-3) on deep inspiration in emphysema chest expansion may be 1 cm or
less.
Resonance is
increased:
- Pleural cavity containing air S lung is more or less collapsed
towards the hilum.
- Hyper-resonant sound or tympanic sound is regularly found in
pneurnothorax.
- Emphysema
Resonance is
diminished:
- When the pleura is thickened
- Pleural effusion
- Pul. Febrosis
- Collapse of lungs
Auscultation: Three observations must be
made at this point.
- Character or the breath sounds.
- Character of the vocal resonance.
- Presence or a absence of added sounds.
Breath Sounds: i) Vesicular breathing. ii)
Bronchial breathing.
i. Vesicular breath sounds are
produced by the passage of air in and out of normal lung tissue and, heard all
over the chest. Bronchil breath sounds are produced by the passage of air
though trachea and large bronchi. Normally they can be heard by listening over
the traches but they are not heard over the normal lungs tissue. i) Vesicular
breathing is heard typically ‘in the axillary and infrascapallar regions. Inspiratory
sounds is fairly intense pitch is low & rustling in quality. The expiratory
sound follows that of inspiration without district pause.
ii. Bronchial breathing:
Students should listen over ‘the trachea. The inpirtory sound is moderately
intense & becomes inaudible shortly before the end of respiration.
Expiratory sound is generally harsh and aspirate. There is definite gap between
inspiration and expiration. Breath sounds must be auscultated in the various
regions, their character in each noted and similar regions on the two sides of
the chest compared vesicular Breath sound maybe present but reduced in
intensity in bronchia in General Breath sounds ‘may be diminished or absent in.
- Thickened pleura
- Pleural effusion
- Pneumothorx
Collapse or fibrosis
Bronchial breath sounds are heard in:
- Consolideration of lungs due to pneumonia.
Bronchial sounds maybe heard whenever patient btonchei are connected to the
Chest wall by a sufficiently uniform sound conducting medium.
Vocal
Resonance:
Patient should be told to arpere the word” One One, One”, “Nine, Nine, Nine”
and ausculatate all over the chest and compare with the corresponding points on
the other side.
Vocal
Resonance is increased
- Consolideratin
- Cavity
Vocal
Resonance is Decreased: Either entirely abolished or much diminished where a layer of fluid
separates the lung from the chest wall and in pneurnothorax thickned pleura and
emphysema.
Added Sounds: i) Ronchi ii) Crepitations
Bonchi: Are prolonged uninterruted
roises arise in the bronchi and are due to partial obstruction to their lumen,
by swelling of the mucosa. They may be high pitched or low pitched, high pitched
ronchi are called sibilan, low pitched ronchi are present in 1) Bronchitis 2)
Asthama.
Crepitations: Are continuous crackling or
bubbing sounds which may be produced in the alveoli bronchi or the cavities.
They sound like the bursting or air bubbles and indicate the presence of fluid
secretion.
1)
Fine 2) Coarse
Fine crepitations are probably the opening up of
collapsed alveoli.
They are heard in i)
In the first stage of Pneumonia
ii)
Tuberculosis (Apices)
iii)
Heart failure (at the bases)
Coarse crepitations are bubbling or clicking noise
heard is
i) Bronchitis
ii) Bronchiectasis
iii) Fibrosing alveolitis
Expt. No. 4
Date ………….
EFFECT OF
STIMULATION OF VAGUS AND WHITE CRESCENTIC
LINE IN FROG’S
HEART
Aim: To demonstrate the effect
of stimulation of vagus nerve and the white cresentic line in frogs heart.
Requires: All mechanical and
electrical appliances
Electrical
Connections:
Connection are made for Foradic shock.
Speed of the
Drum: Slow
speed with pulleys-S4 D1 and gear slow.
Procedure: 1) Dissection: The heart of
pitched frog is exposed and pericardium is removed on one side the bronchial
plexus is identified the Muscles and other tissues below this plexus are
cleaned the brachial nerve is then cut this expose a shiny tendon of muscle
over this is the pterygoid muscle lying transversely. By everting this muscle
gently, the vagus nerve can be seen underlying it. It can be identified by the
fact that it crosses the shining tendon transversely and is underneath the
pterygoid muscle accompanied by n artery and is crossed by the hypoglossal
nerve, which hooks round the pterygoid muscle. The vagus nerve can also be separated
from the pterygoid muscle carefully.
2) Recording: After the identification of
the vagus nerve. It is stimulated by .Faradic shock with minimum strength and
the stoppage of the heart is observed after this confirmatory test, the frog is
kept on the myograph board and electrode is kept beneath the nerve during
stimulation, the heart does not stop if the nerve is cut while doing
dissection. In that Case the nerve of side must be identified.
First,
normal cardiogram is recorded. Then the vagus nerve is stimulated, the
stimulation is continued even during the stoppage of the heart. Inspite of the continuous
stimulation. The heart starts beating again which is called the vagal escape.
Then the stimulus is stopped and cardiogram is recorded.
Then
the white crescentic line is stimulated and the effects are recorded.
Observation: When the vagus nerve is
stimulated the heart stops immediately in diastole. When the stimulation is
continued the heart escapes from the vagal inhibition and starts beating, and
when the stimulation is stopped there is increase in force of contraction (Stair
- case) which is followed by the normal cardiogram.
The
stimulation of white crescentic line also gives the same effect.
Inference: The vagus nerve carries parasympathetic
fibres to the heart, and their stimulation liberates acetyicholine which
inhibits toe activity of the heart and the causes for vagal escape are,
- Exhaustion of acetylcholine in the nerve and also the destruction
of acetyicholine by the enzyme cholinestrase.
- The liberation of acetyicholine by the simultaneous stimulation of
sympathetic fibres which also run along with vagal nerve fibres.
- Initiation of indo ventricular rhythm.
The
above mentioned are causes or vagal escape in pithed frog and in unpithed frog
the following also can cause vagal escape.
- Bain - Bridge reflex and
- Mareys reflex
The
stimulation of the white crescentic line also gives the’ same effect of vagal
stimulation as the white crescentic line is the collection of post ganglionic neurones
where the pre-ganglionic fibres of vagus end.
Expt. No.5
Date ………….
EFFECT OF IONS
PERFUSET HEART OF FROG
Aim: To isolate frog’s heart and
to study the effect of variousions
Requires: Recording instructions.
Perfusion funnel, Syme’s cannula perfusion fluid. Sodium Chloride, potassium
chloride and calcium chloride solutions.
Speed of the
drum: Slow
speed with gear and pulleys S4 – D1.
Procedure: Perfusion of frog’s heart:
The .heart of the pithed frog is exposed and the pericardium is removed. A
thread is passed beneath the inferior venacave. A small opening is made on the
ventral side of the inferior vanacav and blood is completely washed out using
perfusing fluid.
The
nozzle of the cannuala is in inserted through the opening of the inferior
venacave till the tip of the cannula reaches the sinus venosus. Now the
venacave is tied to the cannula with the thread. Then .by holding the cannuala
and by keeping the index finger at the nozzle of the cannualaand by keeping the
index finger at the nozzle of the cannuala along with the inferior venacave.
The other structures are, removed from the heart.
The
cannuala with the heart is fized to the clamp attached to the myograph stand.
The horizontal limb of the cannuala is connected by means of rubber tube to the
perfusion tunnel which is also fixed to the myograph stand by clamp and the
perfasion fluid from the funnel is allowed to pass through’ the heart.
The
bent hook is passed through the tip of the ventricle, and the head of this bent
pin is tied with the thread which is also tied to the stariling’s level fized
to the myograph stand for this experiment the lever is fixed up side down.
2) Study of
effects of ions: First the normal cardiogram is recorded. Few drops of 1% sodium
chloride solution is added through cannuala and the effect is recorded. Then
the solution in the cannuala is washed out and normal cardiogram is recorded
‘similarly the effects of 1%. potassium chloride and 1% calcium solution are
recorded.
Observations:
- Effect of sodium chloride sodium ions first exit the cardiac
tissue and then the rate and force of contraction are increased later the
sodium chloride causes increase in amplitude and stoppage of heart in
diastole.
- Effect of potassium chloride the potassium ions relax the heart
and the heart stops in diastole immediately.
- Effect of the calcium chloride when calcium chloride is added the
force of contraction gradually increases and the heart stops in systole
which is called the calcium rigor the calcium rigor is irreversible one.
Inference
1) Composition
of perfusion fluid
a) Sodium chloride ………………………0.650 gm%
b) Calcium Chloride ………………………0.0 12 gm%
c) Potassium Chloride ………………………0.014 gm %
d) Sodium bicarbonte ………………………0.010 gm %
e) Sodium phosphate ………………………0.001 gm %
2) Mode of
action of ions:
The
excess of sodium ions depresses the cardiac function as the sodium ions
complete with calcium ions which are necessary for causing the action potential
and contraction of the muscle. The potassium ions also cause the heart to
become dilated but the reason is different from the action of sodium the excess
of potassium ions decreases, the resting membrane potential. As the resting
membrane potential decreases, the intensity of the action potential are
decreases, which Makes the contraction of heart to become progressively,
weaker. The calcium ions cause the exactly opposite effects of sodium and
potassium ions. The calcium makes the heart to go into spastic contraction by
exciting the cardiac contraction contractile process.
Expt. No. 6
Date…………
EFFECT OF
DRUGS ON PERFUSED HEART OF FROG
Aim: To study the effect of
Adrenaline and Acetytholinc on perfused heart of frog
Requires: Perfusion funnel, syme’s
cannula perfusion fluid, Adrenaline (1. in 10000) and Acetylcholine (in 10,000)
Speed of the
Drum: Slow
speed with slow gear and pulleys S4 - Dl
Procedure: Frog’s heart is isolated
and normal cardiogram is recorded by using perfusion- fluid. Few drops of Ademaline
is added through the cannula and the effect is recorded. Then the solution in
the cannula is washed out and normal cardiogram is recorded. Similarly the effect
of actycholine is recorded.
Observation: When addrenoline is added
there is increase in both rate and force of contraction, and Acetycholine in
small doses decreases the rate and force of contraction, and in large doses If
stops the heart in distole.
Inference: The adrenaline increases
the rate and force of contraction of heart by accelerating the enzymatic and
metabolic activities of cardiac tissue. The acetyicholine stops the heart in
diastole by causing hyperpolarization.
Expt. No. 7
Date………….
STUDY OF
REFLEXES IN MAN
When
a part of muscle or skin is stimulated, afferent impulses start from these and
reach a center in some part of central nervous system, from these afferent
impulses descend to motor nerve fibres and resulting in contraction of a muscle
of group of muscles takes place. These reflex responses depend upon the
integrity of the reflex arc and damage to any part of reflex are causes reflex
to disappear.
There
is three classes of reflexes. i) The superficial reflexes, ii) The deep or
Tendon Reflex and iii) The organic reflexes (including the action of the
sphincters)
i) The superficial
Reflexes:
In these, the simple form of reflex action is concerned. If certain part of
skin or mucous membrane is stimulated it results in contraction of certain
muscles. The path of impulse is by sensory nerve fibres to the spinal cord or
to a higher centre in the brain-stem or forebrain, thence by motor nerve fibres
to the muscle.
a) The Planter
Reflex:
flow to Elicit: The muscle of the lower limb should be relaxed and care should
be taken to see that the sole of the foot is warm. Stimulate the other edge of
the sole of the foot by gentle scratching with a pin or fingernail from behind
forwards.
With
a moderate stimulus, the response obtained is flexion of all the toes on the metartarsus
and they are drawn together. There is plantar Flexion of Big toe (The normal flexor
response)
Segments: 5th Lumber and 1st
Sacral
Note: 1.Plantar reflexes are diminished during sleep.
2
In infants, the reflex is brisk and the earliest response is drawing back of
the great toe, followed by extension and spreading out of all toes with
eversion of foot or dorsiflex on the ankle subsequently the knee and ship hip
air flexed (infa. tile response) Extension plantar response.
b. Babinski’s
Sign: (Extensor
Response) resembles the response obtained in infants but with difference of a
few points.
In
is deliberate and obtained with certainly on each stimulation, Extension of
great toe precedes all other movements. It is followed by extension and spreading
out of all toes, dorsiflexion of ankle and flexion of knee and hip.
Note: It is obtained in adults
only in cases if organic disease involving the pyramidal tracts. (U.M.N
paralysis)
c) Epigastric
and Abdominal Reflexes: These are valuable signs as they disappear hen the pyramidal tract of
the some side is affected.
How to Elicit: The person whose reflexes
are to be tested lies on his back and the abdomen is exposed.
A
pin or handle of pen is drawn firmly but lightly across the abdominal wall, on each
side in turn as shown.
This response is brisker in the upper part of
abdomen (Epigastric Reflex).
Note: in infants, it is not
present.
In
adults obesity or laxity of abdominal wall may abolish them.
Absence
or diminution suggests lesion of the pyramidal system.
Segments: Epigastric :
7th to 9th Thoracic.
Abdominal : 11th Thoracic to 1st
Lumbar.
d) Superficial
Reflex Dependent on. Cranial Nerve:
1) Conjuctival
Reflex: It
is elicited by touching the conjunetiva by a wisp of cottonwool or it results
in reflex closure of Eye due to contraction of the orbicular is palpabruxn.
Note: It is protective
phenomenon.
It
is absent in unconsicious persons.
Nerves
Concerned:
5th Cranical (sensory) and 7th Cranial (Motor).
2) Light
Reflex or Pupillary Reflex
How to Elicit: Ask the person to focus on
distant object one eye with one hard and with other hard shine a light from a
torch on the pupil from the sides only not front side.
The
pupil reflexly contracts immediately and then dilates again little and after undergoing
slight oscillations settles down to its normal size.
Note: Each eye should be tested
and do not use very bright light.
Path of Light
Relfex:
Afferent fibers involved are contained in the opti nerve intermediate station
is in corpora quardrigemina. Efferent fibres pass by 3rd nerve through the
ciliary ganglion to the pupil (SP) sphincter.
It
is a protective phenomenon.
It
is a sluggish the person may be semi-conscious.
The
reflex is absent if there is any lesion of the 3rd nerve.
3) Corneal
Reflex: If
cornea is touched by a wisp of cotton wool, it results in rapid closure of
eyelids. This reflex is abolished in coma of any type.
Nerve
concerned:
It depends on the integrity of the 1st division of cranial Afferent and the 7th
cranial (Efferent) nerve.
4) Pharyngeal
Reflex:
irritation of the pharyangeal mucous membrane by a spatula or a swabstick
produces. Constriction of the pharyngeal muscles. It results in producing vomiting
sensation or even vomiting sometimes.
Nerves
Concerned:
Afferent Glassopharyngeal.
Efferent: Vagus and spinal accessory
ii) Deep of
Tendon Reflexes: If a muscles is put on stretch and its tendon is sharply stuck the
contraction of a muscle results. It is known as deep or tendon reflex. They are
known as strength Reflexes.
a) Biceps
Jerk: The
elbow is fixed a right angle and forearm slightly, pronated. Thus, is then
placed over biceps tendon and struck by a percussion hammer, It results in
contraction of biceps causing flexion and slight supination of forearm.
Segments
Cervical: 5th
and 6th
b) Tricps Jerk: Flex the arm at right
angles and support it at the wrist strike the tricpes tendon just proximal to
the point of the elbow. ft results in contraction of the tricps causing
extension of the elbow.
Segments Cervical: 6th and 7th
c) Knee Jerk: The person whose knee jerk
to be tested is asked to sit on a chair or on the edge of the bed and cross one
knee over the other. This way the Quadriceps extensor is lightly stretched and
reflexly tone is increased.
Divert
his attention by engaging him in conversation or ask him to let the leg hand as
if it does not belong to him. Now strike a sharp blow by a percussion hammer on
the patellar Tendon mid-way between the patella its insertion Sudden
contraction of muscles cause the food to be jerked up. The briskness varies in
different individuals, therefore, always compare It with the other side in
health it is hardly ever absent. This procedure known as reinforcement.
Segments: Lumber: 2, 3 and 4
d) Ankle Jerk: Place the lower limb on the
bed everted or slight by flexed with one hand lightly dorsiflexed the foot so
as to put the tendo Achillies on the stretch and with the other hand strike the
latter on its posterior surface. A sharp contraction of the call muscle results.
Segments: Sacral 1 and 2
iii) Organic
Reflexes and Sphincters: This term includes such processes as Respiration Deglutition,
Micturition and Defaecation. They depend on complex muscular movements excited
by increased tension in the wall of the viscus concerned or in case of
respiration. partly by stimulation of a centre in the Medulla.
a) Respiration: Does not
require be tested
b) Deglutition : Does not need
to be specially tested:
c) Defaecation : Segments:
Sacral 4 and 5.
d) Micturition: This reflex act is
voluntarily controlled to a great extent by the higher centres in the brain
normally initiated by a voluntarily efforts but once started becomes a reflex
act difficult to interrupt: the stimulus being distension of bladder with urine
stimulus passes to the cord by way of nervi erigentes and rami communicates:
controlling centre being situated in the lower centre.
at various levels so that although the reflex arc is
left intact, spinal cord and cerebral lesions results in defects in the act micturition.
Nerves: The reflex path is partly
through plexuses in the bladder wall & partly in the pelvic plexuses. There
innervations of these plexuses is from the sympathetic (from lumber 3, 4 and 5
segments) and parasympathetic systems (secral 2 and nervi erigentes).
Knee jerk is tested by different methods as follows
- By crossing one knee over the hanging.
- By freely hanging knee the joint when the patient is sitting near
the edge of the table.
- The lying down or recumbent posture (in sick patients only).
Thus knee jerk should be tested in all the three
positions as mentioned above.
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