PRACTICAL RECORD BOOK FOR BDS STUDENTS - PHYSIOLOGY

 

PHYSIOLOGY

INDEX

Expt. No.	Name of the Experiment		Page No.	Date	Remarks
	PRACTICAL
1	Estimation of Haemoglobin	---
2	Determination of Red cell count	---
3	Determination of total white cell count	---
4	Determination of Differential count of W.B.C.	---
5	Determination of Blood Groups	---
6	Determination of Bleeding time & Clotting time	---
7	Clinical Examination of pulse	---
8	Determination of Arterial blood pressure in Human	---
	DEMONSTRATION
1	Determination packed cell volume	---
2	Examination of Heart and Cardio-vascular system	---
3	Examination of Respiratory system	---
4	Effect of stimulation of vagus & white erescent line in frog’s heart and effect of Atropin & Adraenaline	---
5	Effect of Ions Isolated perfused heart of frog	---
6	Effect of Durg on isolated perfused heart of frog	---
7	Study of reflexes in human beings	---

 

 

 

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:

 

1. 15G of Haemoglobin Equals 1005

…………………………………….G of Haemoglobin ………………………………

 

2. 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

 

3. 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 …………..

 

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 10^th 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

                =              ---------------

                            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:

 

 

 

Neutrophil             =  _______________________________%

Esoniophil             =  _______________________________%

Monocytes            =  _______________________________%

Lymphocytes       =  _______________________________%

Basophil                                =  _______________________________%

OBSERVATION AND DIAGRAMS:

 

 

‘A’ GROUP	O                     O
‘B’ GROUP	O                     O
‘AB’ GROUP	O                     O
‘O’ GROUP	O                     O
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.

1. Palpatory method
2. Auscultory method
3. 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

 

Pressure	Before Exercise in mm. Hg.	After Exercise in mm. Hg.
Systolic Pressure
Diastolic Pressure
Pulse Pressure
Mean Pressure

 

 

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:

1. Scoliosis (Lateral bending)
2. Kyphosis (Forward bending)
3. Pigeon - chest (Ricket)
4. Flattening of one apex (Apical fibrosis due to tuberculosis)
5. 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 5^th  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

1. Commonest cause is thoracic diformities e.g. Scoliosis
2. 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

1. Shape Of the chest
2. Neck veins
3. Veins over the chest wall
4. Cardiac impulse
5. Other pulsations in the neck, suprasternal notch over the chest and, in the epigastric region.
6. 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 5^th I.C.S. afterwards one should go to mid axilary line & start pecussing in left 5^th  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 4^th, 3^rd and 2^nd 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 5^th 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 5^th I.C.S. repeat the same procedure for R.t 4^th, 3^rd, 2^nd 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:

1. Pleural cavity containing air S lung is more or less collapsed towards the hilum.
2. Hyper-resonant sound or tympanic sound is regularly found in pneurnothorax.
3. Emphysema

 

Resonance is diminished:

1. When the pleura is thickened
2. Pleural effusion
3. Pul. Febrosis
4. Collapse of lungs

 

Auscultation: Three observations must be made at this point.

1. Character or the breath sounds.
2. Character of the vocal resonance.
3. 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,

 

1. Exhaustion of acetylcholine in the nerve and also the destruction of acetyicholine by the enzyme cholinestrase.
2. The liberation of acetyicholine by the simultaneous stimulation of sympathetic fibres which also run along with vagal nerve fibres.
3. 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.

1. Bain - Bridge reflex and
2. 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:

1. 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.
2. Effect of potassium chloride the potassium ions relax the heart and the heart stops in diastole immediately.
3. 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: 5^th Lumber and 1^st 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              : 7^th to 9^th Thoracic.

                                Abdominal            : 11^th Thoracic to 1^st 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: 5^th Cranical (sensory) and 7^th 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 3^rd 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 7^th 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: 5^th and 6^th

 

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: 6^th and 7^th

 

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

1. By crossing one knee over the hanging.
2. By freely hanging knee the joint when the patient is sitting near the edge of the table.
3. The lying down or recumbent posture (in sick patients only).

 

Thus knee jerk should be tested in all the three positions as mentioned above.