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HAP PRACTICAL - FINAL EXAMINATION MAY 2026
Course: Human Anatomy & Physiology (ER20-14P) | D. Pharm 1st Year
PART I - SYNOPSIS (10 Marks)
Q. 1a) Name the instrument used for measuring blood pressure by auscultatory method. (2 Marks)
The instrument used for measuring blood pressure by auscultatory method is:
Sphygmomanometer (along with a Stethoscope)
- The sphygmomanometer consists of an inflatable cuff, a manometer (mercury or aneroid), and a bulb with valve.
- The stethoscope is used to listen to Korotkoff sounds over the brachial artery.
Q. 1b) What is tissue? Write its types. (2 Marks)
Tissue is defined as a group of similar cells that are organised together to perform a specific function in the body.
Types of Tissues (4 basic types):
- Epithelial tissue - covers body surfaces, lines cavities
- Connective tissue - supports and connects structures (bone, blood, cartilage)
- Muscular tissue - responsible for movement (skeletal, smooth, cardiac)
- Nervous tissue - transmits nerve impulses (neurons and neuroglia)
Q. 1c) What is the function of skeletal muscle? (2 Marks)
Skeletal muscle (also called striated or voluntary muscle) performs the following functions:
- Body movement - produces movements of limbs, trunk, and head by acting on bones through tendons
- Maintenance of posture - maintains body posture and position against gravity
- Respiration - muscles of respiration (diaphragm, intercostals) assist in breathing
- Heat production - generates body heat through muscle contractions (thermogenesis)
Q. 1d) What is the nervous system? (2 Marks)
The nervous system is the organ system that controls and coordinates all activities of the body by transmitting electrical signals (nerve impulses) between different parts.
Divisions:
- Central Nervous System (CNS) - Brain and Spinal cord
- Peripheral Nervous System (PNS) - Cranial nerves and Spinal nerves
- Somatic nervous system (voluntary)
- Autonomic nervous system (involuntary) - Sympathetic and Parasympathetic
Q. 1e) Define Systolic Blood Pressure and Diastolic Blood Pressure. (2 Marks)
Systolic Blood Pressure (SBP):
The maximum pressure exerted on the arterial walls during ventricular contraction (systole).
Diastolic Blood Pressure (DBP):
The minimum pressure exerted on the arterial walls during ventricular relaxation (diastole).
Normal blood pressure = 120/80 mmHg
PART II - MAJOR EXPERIMENT (35 Marks)
Q. 2a) Determination of Systolic and Diastolic Blood Pressure by Palpatory and Auscultatory Method
Aim
To determine the systolic and diastolic blood pressure of a subject using palpatory method and auscultatory method.
Definition
Blood Pressure is the lateral pressure exerted by the blood on the walls of the blood vessels. It is measured in mmHg.
- Normal BP = 120/80 mmHg
- Systolic BP = Pressure during ventricular contraction
- Diastolic BP = Pressure during ventricular relaxation
- Pulse Pressure = SBP - DBP = 40 mmHg
- Mean Arterial Pressure = DBP + 1/3 Pulse Pressure = 93 mmHg
Apparatus Required
| S.No. | Instrument |
|---|
| 1. | Mercury sphygmomanometer |
| 2. | Stethoscope |
| 3. | Chair / couch for subject |
Subject
- Healthy adult volunteer
- Subject should rest for 5-10 minutes before recording
- No smoking or exercise 30 minutes before the test
METHOD 1 - PALPATORY METHOD
Principle
The cuff is inflated until the radial pulse disappears. Cuff pressure is then slowly released. The pressure at which radial pulse first reappears is the systolic BP. Diastolic BP cannot be accurately measured by this method.
Procedure
Step 1: Subject sits comfortably with right arm resting on a table at heart level. Palm facing upward.
Step 2: Wrap the cuff snugly around the upper arm, 2-3 cm above the elbow crease.
Step 3: Palpate the radial pulse at the wrist with 2-3 fingers.
Step 4: Inflate the cuff rapidly by squeezing the bulb while watching the manometer. Inflate 20-30 mmHg above the point where radial pulse disappears.
Step 5: Release the air slowly by opening the valve (2-3 mmHg per second).
Step 6: Note the manometer reading when the radial pulse first reappears - this is the Systolic BP.
Step 7: Completely deflate the cuff and allow 1-2 minutes rest.
Observation (Palpatory)
| Reading | Value (mmHg) |
|---|
| Point of pulse disappearance | _______ |
| Systolic BP (pulse reappears) | _______ mmHg |
| Diastolic BP | Not determinable |
METHOD 2 - AUSCULTATORY METHOD
Principle
Based on Korotkoff sounds heard through stethoscope over the brachial artery as cuff pressure is gradually released. Five phases of sounds are heard:
| Phase | Sound | Significance |
|---|
| Phase I | First tapping sound appears | = Systolic BP |
| Phase II | Soft swishing sounds | Turbulent flow |
| Phase III | Louder thumping sounds | More flow |
| Phase IV | Sounds become muffled | Near diastolic |
| Phase V | Sounds completely disappear | = Diastolic BP |
Procedure
Step 1: Subject sits comfortably, right arm at heart level, elbow slightly flexed, palm upward.
Step 2: Apply the cuff 2-3 cm above the antecubital fossa (elbow crease). Middle of cuff bladder over the brachial artery.
Step 3: Place the stethoscope bell/diaphragm firmly over the brachial artery in the antecubital fossa.
Step 4: Inflate the cuff rapidly to 20-30 mmHg above the previously estimated systolic pressure (from palpatory method).
Step 5: Release pressure slowly at 2-3 mmHg per second by opening the valve.
Step 6: Listen carefully:
- Note reading when first tapping sound is heard = Systolic BP
- Note reading when sounds completely disappear = Diastolic BP
Step 7: Deflate cuff completely. Record the reading as Systolic/Diastolic (e.g., 120/80 mmHg).
Step 8: Repeat 2-3 times at 1-2 minute intervals. Take the average.
Observation Table (Auscultatory Method)
| Reading No. | Systolic BP (mmHg) | Diastolic BP (mmHg) |
|---|
| 1st reading | | |
| 2nd reading | | |
| 3rd reading | | |
| Average | | |
Classification of Blood Pressure (JNC / Standard)
| Category | Systolic (mmHg) | Diastolic (mmHg) |
|---|
| Normal | < 120 | < 80 |
| Elevated | 120-129 | < 80 |
| Hypertension Stage 1 | 130-139 | 80-89 |
| Hypertension Stage 2 | ≥ 140 | ≥ 90 |
| Hypotension | < 90 | < 60 |
Result
| Method | Systolic BP | Diastolic BP |
|---|
| Palpatory | _______ mmHg | Not measured |
| Auscultatory | _______ mmHg | _______ mmHg |
The blood pressure of the subject is / mmHg, which is NORMAL / HYPERTENSIVE / HYPOTENSIVE.
Precautions
- Subject should rest for at least 5-10 minutes before measurement.
- Cuff should be applied snugly - not too tight or loose.
- The arm should be at the level of the heart.
- Release cuff pressure slowly (2-3 mmHg/sec) for accurate reading.
- Do not talk during the recording.
- Repeat the measurement 2-3 times and take average.
- Do not smoke or exercise 30 minutes before the test.
- Empty the bladder before recording (full bladder increases BP).
PART II - MINOR EXPERIMENT (25 Marks)
Q. 2b - BATCH A: Recording of Blood Pressure in Various Postures, Different Arms, Before and After Exertion
Aim
To record blood pressure in various postures, in different arms, before and after exertion, and interpret the results.
Apparatus
Sphygmomanometer, Stethoscope, Chair, Couch
Procedure
Record blood pressure by auscultatory method (as described in Q.2a) under the following conditions:
1. Blood Pressure in Various Postures
| S.No. | Posture | Procedure |
|---|
| A | Lying (Supine) | Subject lies flat on couch for 5 min, then record BP |
| B | Sitting | Subject sits comfortably, arm at heart level |
| C | Standing | Subject stands upright, arm hanging at side, then record |
Observation - Posture:
| Posture | Systolic BP (mmHg) | Diastolic BP (mmHg) |
|---|
| Lying (Supine) | | |
| Sitting | | |
| Standing | | |
Interpretation:
- BP is slightly higher in standing than lying due to increased sympathetic activity (orthostatic response).
- A drop of >20 mmHg systolic on standing = Postural/Orthostatic Hypotension.
2. Blood Pressure in Different Arms
| S.No. | Arm | Observation |
|---|
| A | Right Arm | |
| B | Left Arm | |
Interpretation:
- Normally a difference of 5-10 mmHg between both arms is acceptable.
- A difference of >10-15 mmHg may indicate arterial stenosis on the side with lower BP.
3. Blood Pressure Before and After Exertion
Procedure:
- Record resting BP first (after 5 min rest).
- Ask the subject to perform step test / brisk walking / 20 squats for 2 minutes.
- Immediately record BP after exertion.
- Record again after 5 minutes of rest (recovery).
| Condition | Systolic BP (mmHg) | Diastolic BP (mmHg) | Heart Rate (per min) |
|---|
| Before exertion (Rest) | | | |
| Immediately after exertion | | | |
| After 5 min recovery | | | |
Interpretation:
- During exercise, Systolic BP rises significantly (due to increased cardiac output).
- Diastolic BP may slightly decrease, remain same, or mildly increase.
- Recovery: In healthy individuals, BP returns to normal within 3-5 minutes.
- Slow recovery may indicate cardiovascular inefficiency.
Overall Result
The BP of the subject was recorded under different conditions. The variations observed are consistent with the normal physiological responses to posture change and physical exertion.
Q. 2b - BATCH B: Measurement of Height, Weight, and BMI
Aim
To measure the height, weight, and Body Mass Index (BMI) of the subject and interpret the results.
Apparatus Required
| S.No. | Equipment |
|---|
| 1. | Stadiometer / measuring tape (for height) |
| 2. | Weighing scale (calibrated) |
| 3. | Calculator |
MEASUREMENT 1 - HEIGHT
Procedure:
- Ask the subject to remove footwear and stand upright on a flat surface.
- The subject should stand with heels together, back straight, head in Frankfurt plane (eyes and ears in the same horizontal plane).
- Heels, buttocks, shoulder blades, and back of head should touch the wall/stadiometer.
- Place the headboard horizontally on top of the head.
- Read the height in centimetres.
Observation: Height = _______ cm (_______ feet _______ inches)
MEASUREMENT 2 - WEIGHT
Procedure:
- Ensure weighing scale is calibrated (reads zero before use).
- Ask the subject to remove heavy clothing and footwear.
- Subject stands still in the centre of the weighing scale.
- Read the weight in kilograms.
Observation: Weight = _______ kg
MEASUREMENT 3 - BMI (Body Mass Index)
Formula:
$$BMI = \frac{Weight\ (kg)}{Height\ (m)^2}$$
Calculation:
- Height = _______ cm = _______ m
- Weight = _______ kg
$$BMI = \frac{_____}{(_____)^2} = _____ \ kg/m^2$$
BMI Classification (WHO Standard)
| BMI (kg/m²) | Category |
|---|
| Less than 18.5 | Underweight |
| 18.5 - 24.9 | Normal weight |
| 25.0 - 29.9 | Overweight |
| 30.0 - 34.9 | Obese (Class I) |
| 35.0 - 39.9 | Obese (Class II) |
| 40 and above | Morbidly Obese (Class III) |
(For Asian/Indian population: Normal BMI = 18.5 - 22.9 kg/m²)
Observation Summary Table
| Parameter | Measurement | Normal Range |
|---|
| Height | _______ cm | - |
| Weight | _______ kg | - |
| BMI | _______ kg/m² | 18.5 - 24.9 kg/m² |
| Category | _______ | Normal weight |
Result
- Height of the subject = _______ cm
- Weight of the subject = _______ kg
- BMI of the subject = _______ kg/m²
The subject falls in the _______ category as per WHO BMI classification.
Precautions
- Height should be measured without footwear.
- Weight should be measured without heavy clothing, preferably in the morning on an empty stomach.
- The weighing scale should be calibrated before use.
- For BMI, height must be converted from cm to metres.
- Measurements should be taken at least twice and average recorded.
All answers are written in standard D.Pharm HAP Practical examination format with Aim, Principle/Definition, Apparatus, Procedure, Observation Table, Classification, Result, and Precautions.