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FOPS 1 HAP - Final Examination (Practical)

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PART I - Synopsis (10 Marks) - Answer All

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Q1a. Name the instrument used for measuring blood pressure by the auscultatory method. [2 Marks]

• An inflatable arm cuff connected to a mercury or aneroid manometer (to measure cuff pressure)
• A rubber squeeze bulb with a release valve (to inflate and slowly deflate the cuff)
• A stethoscope (used in conjunction, placed over the brachial artery at the antecubital fossa to detect Korotkoff sounds)

Ganong's Review of Medical Physiology, 26e - The sphygmomanometer cuff is wrapped around the arm and a stethoscope is placed over the brachial artery to detect sounds of Korotkoff during slow cuff deflation.

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Q1b. What is tissue and write its types? [2 Marks]

Junqueira's Basic Histology, 17e - Animal cells differentiate during embryonic development into these four basic tissue types, each an assemblage of similarly specialized cells performing specific functions.

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Q1c. What is the function of skeletal muscle? [2 Marks]

1. Voluntary movement - Produces movement of bones, enabling locomotion (walking, running) and work production.
2. Posture and body position - Maintains static posture by continuous low-level contraction.
3. Respiration - The diaphragm and intercostal muscles (skeletal muscles) drive breathing.
4. Heat production (thermogenesis) - Muscle contraction generates ~85% of body heat; shivering increases heat when body temperature falls.
5. Protection - Muscles of the abdominal wall protect internal organs.
6. Facial expressions and communication - Facial and laryngeal muscles.

Medical Physiology (Boron & Boulpaep) - "Skeletal muscle is responsible for the voluntary movement of bones that underlies locomotion and work production."

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Q1d. What is the nervous system? [2 Marks]

• Consists of the brain and spinal cord
• Encased in bone (skull and vertebral column)
• Integrates and processes all sensory input and generates responses

• Consists of all nerves outside the CNS (cranial nerves, spinal nerves, ganglia)
• Subdivided into:
  • Efferent (motor) division - carries signals from CNS to muscles and glands
  • Afferent (sensory) division - carries signals from receptors to CNS

Lippincott Illustrated Reviews: Pharmacology - "The nervous system is divided into two anatomical divisions: the CNS (brain and spinal cord) and the PNS (nerves connecting the CNS with peripheral structures)." Histology: A Text and Atlas - "The nervous system enables the body to respond to changes in its external environment and controls the functions of internal organs."

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Q1e. Define systolic blood pressure and diastolic blood pressure. [2 Marks]

Ganong's Review of Medical Physiology, 26e - "The cuff pressure at which the sounds are first heard is the systolic pressure... the diastolic pressure in resting adults correlates best with the pressure at which the sound disappears."

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PART II - Major Experiment (Compulsory) [35 Marks]

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Q2a. To determine the systolic and diastolic blood pressure by using palpatory and auscultatory method. [35 Marks]

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AIM

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APPARATUS / INSTRUMENTS REQUIRED

• Sphygmomanometer (mercury or aneroid) with arm cuff
• Stethoscope
• Recording chart / observation table

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PRINCIPLE

• Systolic BP: pressure during ventricular contraction (normal ~120 mmHg)
• Diastolic BP: pressure during ventricular relaxation (normal ~80 mmHg)
• Pulse pressure = SBP - DBP (normally ~40 mmHg)
• Mean arterial pressure (MAP) = DBP + 1/3 Pulse Pressure

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PROCEDURE

(i) PALPATORY METHOD

1. Seat the subject comfortably with the arm at heart level. Ensure 5 minutes of rest beforehand.
2. Expose and support the right arm. Apply the sphygmomanometer cuff snugly around the upper arm (~2.5 cm above the antecubital fossa). The cuff bladder should cover ~80% of the arm circumference.
3. Locate the radial pulse at the wrist (or brachial pulse at the antecubital fossa).
4. Inflate the cuff rapidly while palpating the radial pulse. Continue inflating until the pulse disappears, then inflate a further 20-30 mmHg beyond.
5. Slowly deflate the cuff at ~2-3 mmHg per second.
6. Note the pressure at which the radial pulse first reappears - this is the systolic blood pressure by palpation.
7. Continue deflating until pulsation becomes full - this gives an approximate diastolic reading (less reliable by palpation).
8. Record the reading.

Note: The palpatory method only reliably determines systolic BP. It tends to slightly underestimate systolic pressure.

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(ii) AUSCULTATORY METHOD

1. With the same setup, re-inflate the cuff to 20-30 mmHg above the previously obtained palpatory systolic pressure.
2. Place the stethoscope bell/diaphragm lightly over the brachial artery in the antecubital fossa (do not tuck it under the cuff).
3. Deflate the cuff slowly and steadily at 2-3 mmHg per second or per heartbeat.
4. Listen for the five phases of Korotkoff sounds:

1. Note the cuff pressure at Phase I (systolic) and at Phase V (diastolic).
2. Deflate the cuff completely. Wait 1-2 minutes before repeating.
3. Record two readings and take the average.

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OBSERVATION TABLE

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NORMAL VALUES

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CLASSIFICATION OF BLOOD PRESSURE (JNC / ACC/AHA)

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PRECAUTIONS

1. Subject should rest for at least 5 minutes before measurement.
2. No smoking, caffeine, or exercise 30 minutes prior.
3. The cuff must be the appropriate size for the arm (too small overestimates; too large underestimates BP).
4. The arm should be at heart level.
5. The stethoscope should not be placed under the cuff.
6. Deflate the cuff at a slow, steady rate (2-3 mmHg/sec).
7. Allow 1-2 minutes between repeated measurements.
8. Avoid talking during measurement.

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RESULT

• Systolic BP (Auscultatory): _______ mmHg
• Diastolic BP (Auscultatory): _______ mmHg
• Systolic BP (Palpatory): _______ mmHg

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PART II - Minor Experiment (25 Marks) - Answer ONE (Based on Batch)

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Q2b (Batch A). Recording of Blood Pressure in various postures, different arms, before and after exertion, and interpreting results. [25 Marks]

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AIM

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APPARATUS

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PROCEDURE AND EXPECTED OBSERVATIONS

1. Supine (lying down) - after 5 min rest
2. Sitting - after 1 min
3. Standing - after 1 min

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• During exercise, cardiac output rises (increased heart rate and stroke volume), causing a significant rise in systolic BP.
• Diastolic BP typically remains stable or may slightly decrease because exercising muscles cause vasodilation (reduced peripheral resistance).
• Failure of BP to rise with exercise (blunted response) may indicate poor cardiac reserve.
• Slow return to baseline may indicate poor cardiovascular fitness.

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PRECAUTIONS

• Standardize cuff size and position for all readings
• Measure the same arm for pre/post-exercise comparisons
• Use the same examiner throughout

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Q2b (Batch B). Measurement of Height, Weight, and BMI. [25 Marks]

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AIM

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APPARATUS

• Stadiometer (height measuring scale) or measuring tape fixed to wall
• Calibrated weighing scale (digital or mechanical)
• Recording sheet

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DEFINITIONS

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PROCEDURE

1. Ask the subject to remove footwear and stand erect against the stadiometer/wall.
2. Ensure the subject stands with heels together, back straight, and head in the Frankfurt plane (the lower margin of the orbit and upper margin of the ear canal are horizontal).
3. Lower the headpiece until it rests firmly on top of the skull (vertex).
4. Read the measurement in centimeters/meters and record.
5. Repeat once and average.

1. Calibrate the weighing scale to zero before use.
2. Ask the subject to remove heavy clothing, shoes, and accessories.
3. Subject stands still at the center of the scale, distributing weight evenly.
4. Read the weight in kilograms and record.
5. Ideally weigh in the morning before meals.

1. Convert height to meters (if in cm, divide by 100).
2. Apply the formula:

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OBSERVATION TABLE

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INTERPRETATION OF BMI (WHO Classification)

Note: For Asian populations, overweight is defined at BMI ≥ 23.0 kg/m² and obesity at ≥ 27.5 kg/m².

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PRECAUTIONS

1. Calibrate instruments before use.
2. Measure height without footwear; weight without heavy clothing.
3. Maintain Frankfurt plane of the head during height measurement.
4. Subject should be in the center of the scale, standing still.
5. Repeat measurements for accuracy.

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CLINICAL SIGNIFICANCE OF BMI

• BMI is a simple, low-cost screening tool for nutritional and obesity-related health risks.
• Elevated BMI correlates with increased risk of: type 2 diabetes, hypertension, cardiovascular disease, joint problems, and certain cancers.
• Limitations: BMI does not distinguish between fat mass and muscle mass, and does not account for fat distribution (central vs. peripheral).

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PART III - Viva Voce [10 Marks]

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