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A Textbook of Practical Physiology
CL Ghai
SECTION 1:
Hematology
1. PARTS OF THE MICROSCOPE
A. The Support System
B. The Focusing System
C. The Optical (Magnifying) System
D. The Illumination System
2. PHYSICAL BASIS OF MICROSCOPY
A. Visual Acuity
B. Resolving Power (Resolution)
C. Magnification
D. Numerical Aperture (NA)
E. Image Formation in the Compound Microscope
F. Working Distance
G. Calculation of Total Magnification
3. PROTOCOL (PROCEDURES) FOR THE USE OF MICROSCOPE
Principle
Procedures
A. Focusing Under Low Power (100 x)
B. Focusing Under High Power (450 x)
C. Focusing Under Oil-immersion (1000 x)
Important
“Racking the Microscope”
4. COMMON DIFFICULTIES ENCOUNTERED BY STUDENTS
5. PRECAUTIONS AND ROUTINE CARE
6. OTHER TYPES OF MICROSCOPES
QUESTIONS
PREPARATION OF SLIDES
1. ASEPSIS
A. Sterilization of Equipment
B. Cleaning/Sterilization of Skin
C. Prevention of Contamination
2. THE BLOOD SAMPLE
A. Sources and Amount of Blood Sample
B. Containers for Blood Sample
C. Differences Between Venous and Capillary Blood
3. COMMONLY USED ANTICOAGULANTS
A. In vitro Anticoagulants
B. In Vivo Anticoagulants and Their Clinical Use
4. COLLECTION OF VENOUS BLOOD
APPARATUS AND MATERIALS
PROCEDURES
PRECAUTIONS
5. COLLECTION OF CAPILLARY BLOOD (SKIN-PRICK METHOD)
Selection of Site for Skin Prick
APPARATUS
PROCEDURES
Ear-lobe Prick
Pricking the Heel
PRECAUTIONS
QUESTIONS
HEMOCYTOMETRY
Principle
Units for Reporting
Significance of Counting the Cells in a Chamber
Automatic Electronic Cell Counters
RBC Counting
WBC Counting
Sources of Error in Cell Counting
Steps in Hemocytometry
HEMOCYTOMETER
STUDY OF THE DILUTING PIPETTES
Parts of a Diluting Pipette
Principle Underlying the Use of Diluting Pipettes
Differences Between the Two Pipettes
Filling the Pipette
Calculation of Dilution Obtained (Dilution Factor)
PRECAUTIONS
QUESTIONS
Improved Neubauer Chamber (Counting Chamber)
The Counting Grid
For RBC Counting
For WBC (Total Leukocyte) Counting
Focusing the Counting Grid
Charging the Counting Chamber
PROCEDURES
PRECAUTIONS
QUESTIONS
A. DROP PRESENTATION
APPARATUS AND MATERIALS
PROCEDURES
OBSERVATIONS
B. PREPARATION OF A BLOOD FILM (BLOOD SMEAR)
PROCEDURES
OBSERVATIONS
Features of an Ideal Blood Film
PRECAUTIONS
Cleaning the Slides
QUESTIONS
Relevance
Hemoglobinometry
Absolute and Relative Hemoglobin Scales
PRINCIPLE
APPARATUS AND MATERIALS
PROCEDURES
Sources and Degree of Error
OBSERVATIONS AND RESULTS
Normal Values
Advantages of Sahli Method
Disadvantages of Sahli Method
OTHER METHODS OF ESTIMATING HEMOGLOBIN
PRECAUTIONS
QUESTIONS
Relevance
PRINCIPLE
APPARATUS AND MATERIALS
PROCEDURES
Rules for Counting
OBSERVATIONS AND RESULTS
Degree and Sources of Error
Normal Red Cell Count
PRECAUTIONS
QUESTIONS
Relevance
APPARATUS AND MATERIALS
PROCEDURES
OBSERVATIONS AND RESULTS
PRECAUTIONS
QUESTIONS
Relevance
APPARATUS AND MATERIALS
PROCEDURES
I. Mean Corpuscular Volume (MCV)
Formula
II. Mean Corpuscular Hemoglobin (MCH)
Formula
For example
III. Mean Corpuscular Hemoglobin Concentration (MCHC)
For example
IV. Mean Corpuscular Diameter (MCD)
V. Color Index (CI)
QUESTIONS
Relevance
PRINCIPLE
APPARATUS AND MATERIALS
PROCEDURES
OBSERVATIONS AND RESULTS
PRECAUTIONS
QUESTIONS
Physiological Leukocytosis
Pathological Leukocytosis
Physiological Leukopenia
Pathological Leukopenia
Relevance
PRINCIPLE
Special Importance of a Blood Smear
APPARATUS AND MATERIALS
Steps in Differential Leukocyte Counting
PROCEDURES
A. Preparing the Blood Films
B. Fixing and Staining of Blood Films
OBSERVATIONS AND RESULTS
C. Assessment of Stained Blood Smears
Features of a Well-stained Blood Smear
D. Identification of Leukocytes Under Oil-immersion
E. Differentiation Between Various Leukocytes
F. Differential Counting of Leukocytes
PRECAUTIONS
QUESTIONS
Relevance
APPARATUS AND MATERIALS
Procedures
PRECAUTIONS
QUESTIONS
Relevance
Counting Methods
PRINCIPLE
APPARATUS AND MATERIALS
PROCEDURES
OBSERVATIONS AND RESULTS
PRECAUTIONS
QUESTIONS
PROCEDURES
Relevance
PRINCIPLE
APPARATUS AND MATERIALS
Theory of Reticulocyte Staining
PROCEDURES
OBSERVATIONS AND RESULTS
Calculations
Normal Values
Absolute Reticulocyte Count
PRECAUTIONS
QUESTIONS
Relevance
PRINCIPLE
APPARATUS AND MATERIALS
PROCEDURES
APPARATUS AND MATERIALS
PROCEDURES
OBSERVATIONS AND RESULTS
PRECAUTIONS
QUESTIONS
Rouleaux Formation
Factors Affecting Rouleaux Formation
Relevance
PRINCIPLE
APPARATUS AND MATERIALS
PROCEDURES
OBSERVATIONS AND RESULTS
PRECAUTIONS
QUESTIONS
Blood Group Systems
Physiological Basis of ABO System
Genetic Basis of ABO System
Agglutinins of ABO System
Clinical Significance of Rh factor
Relevance
Hemostasis
PHYSIOLOGICAL BASIS OF BLEEDING DISORDERS
A,B. DEFECTS OF PLATELETS AND VESSEL WALLS
C. DEFECTS OF CLOTTING
TESTS FOR HEMOSTASIS
BLEEDING TIME (BT) AND CLOTTING TIME (CT)
PROCEDURES
PRECAUTIONS
Procedure
A. DIRECT METHODS
PROCEDURES
B. INDIRECT METHOD
C. AUTOMATED METHOD
[I]CAPILLARY BLOOD CLOTTING TIME (WRIGHT'S CAPILLARY GLASS TUBE METHOD)
[II] Drop Method
[III]VENOUS BLOOD CLOTTING TIME (LEE AND WHITE TEST-TUBE METHOD)
TESTS FOR OTHER CLOTTING FACTORS
QUESTIONS
Clotting Factors
Basic Theory of Coagulation
ESSENTIAL STAGES OF BLOOD CLOTTING
Relevance
PRINCIPLE
APPARATUS AND MATERIALS
PROCEDURES
OBSERVATIONS AND RESULTS
Normal Range of Fragility
Modified Experiment
Precautions
QUESTIONS
Relevance
Principle
APPARATUS AND MATERIALS
PROCEDURES
OBSERVATION AND RESULTS
QUESTIONS
PROCEDURES
Viscosity of Blood
SECTION 2:
Human Experiments
APPARATUS AND MATERIALS
PROCEDURES, OBSERVATIONS AND RESULTS
PRECAUTIONS
QUESTIONS
Relevance
PROCEDURES
OBSERVATIONS AND RESULTS
QUESTIONS
Relevance
Measurement
DEFINITIONS AND TERMINOLOGY
LUNG VOLUMES AND CAPACITIES
STATIC AND DYNAMIC LUNG VOLUMES AND CAPACITIES
PROCEDURES
OBSERVATIONS AND RESULTS
PROCEDURES
Clinical Significance of Timed Vital Capacity
I. Obstructive Pattern
II. Restrictive Pattern
A. Conditions Involving Lungs.
B. Conditions Outside the Lungs
PEAK EXPIRATORY FLOW RATE (PEFR)
QUESTIONS
PULMONARY FUNCTION TESTS
Purpose of Lung Function Tests
Classification of Pulmonary Function Tests
I. Simple Tests
II. Tests of Ventilatory Function
III. Tests of Gas Exchange Functions
IV. Tests for Perfusion Functions
V. Special Techniques
QUESTIONS
AIM OF CPR
THE ABC OF CPR
CAUSES OF CARDIOPULMONARY ARREST
SIGNS AND SYMPTOMS OF CARDIOPULMONARY ARREST
WHAT TO DO IMMEDIATELY
What Not To Do
GENERAL PLAN FOR CARDIOPULMONARY RESUSCITATION
ARTIFICIAL RESPIRATION (PULMONARY RESUSCITATION)
A. Manual Methods
Holger-Nielson Method (Back-pressure arm-lift, BPAL method)
B. Mouth-to-Mouth Respiration (Rescue breath; Exhaled-air ventilation)
PROCEDURES
C. Mechanical Respirators
EXTERNAL CARDIAC MASSAGE (CARDIAC RESUSCITATION)
PROCEDURES
Note
In Infants
Internal or Open Cardiac Massage
CPR for Oneself
Reasons for Failure of CPR
Ventricular Fibrillation (VF)
PROCEDURES
Emergency Procedure in Children
QUESTIONS
INTRODUCTION
Measurement of Blood Pressure
Direct Method
Indirect Methods
PRINCIPLE
APPARATUSES
Stethoscope (Steth = chest, scope = to inspect)
Sphygmomanometer (Commonly called the “BP apparatus”)
PROCEDURES
A. Palpatory Method (Riva Rocci 1896)
B. Oscillatory Method
PROCEDURE
C. Auscultatory Method (Korotkoff, 1905)
COMMENTS, OBSERVATIONS AND RESULTS
PRECAUTIONS
QUESTIONS
PROCEDURAL PRECAUTIONS
EFFECT OF CHANGE IN POSTURE
PROCEDURES
EFFECT OF GRAVITY
PROCEDURES
EFFECTS OF MUSCULAR EXERCISE
PROCEDURES
OBSERVATIONS AND RESULTS
QUESTIONS
Effects of Acute Isotonic Exercise
Long-term Benefits
Efficiency Index
QUESTIONS
PROCEDURES
QUESTIONS
PROCEDURES
QUESTIONS
PROCEDURES
Experiment I
Experiment II
Experiment III
QUESTIONS
White Line (White Reaction)
Triple Response
INSTRUMENTATION
I. The ECG, Machine
II. Electrodes
III. ECG Paper
IV. Pen Recording System
V. Electrocardiographic Leads
Electrode Positions
PHYSIOLOGICAL BASIS OF ECG
Cardiac Vector or Cardiac Axis
Why 12 ECG Leads are Employed?
Einthoven Triangle
THE 12-LEAD ELECTROCARDIOGRAM
PROCEDURE
Recording ECG on Student Physiograph
Systematic Analysis of ECG
Clinical Applications of ECG
Special Uses of ECG
Some Common Abnormalities of ECG.
QUESTIONS
The ‘Student Physiograph’ Consists of
A. The Main Console
B. Couplers
C. The Stimulator
D. Transducers
Steps for the Use of the Physiograph
The Visual Pathway
Perimeter
Student Perimeter
Factors Affecting Visual Field
PROCEDURES
PRECAUTIONS
QUESTIONS
I. Mariotte's Experiment
II. Plotting the Blind Spot
I. Near Point
PROCEDURES
II. Near Response
III. Range of Accommodation
QUESTIONS
PROCEDURES
PROCEDURES
PROCEDURES
PROCEDURES
Factors Affecting Visual Acuity
TEST FOR DISTANT VISION
Testing the Distant Visual Acuity
TEST FOR NEAR VISION
Range of Accommodation
Amplitude of Accommodation
COMMON ERRORS OF REFRACTION
Mechanism of Color Vision
TESTING OF COLOR VISION
Procedure
CLINICAL SIGNIFICANCE
DEFECTS OF COLOR VISION
INTRODUCTORY
I. Nature and Characteristics of Sound Waves
II. Mechanism of Hearing
III. Auditory Pathway
IV. Tests of Hearing
Tuning-Fork Tests
Air (Ossicular) Conduction (AC)
Bone Conduction (BC)
Principles of Tuning-Fork Tests
Conduction (or, Conductive) Deafness
Nerve Deafness
PROCEDURES
Important
I. Rinne's Test
II. Weber's Test
III. Schwabach's Test
QUESTIONS
OSPE
Procedures
Procedures
Receptors for Taste
Basic Taste Modalities
Taste Perception
TESTING THE TASTE SENSATION
Material Required
Procedures
TASTE PATHWAY (FIGURE 2-28A)
Olfactory Mucous Membrane
PATHWAY FOR SMELL (FIGURE 2-28B)
PROCEDURES
PRINCIPLE
FEATURES OF EEG WAVES
Cause of EEG Waves
Instrumentation
1. EEG Machine
2. Electrodes
3. Electrode or Input Board
4. Electrode Placement
5. EEG Paper
6. Pen Recording System
Protocol
Interpretation of EEG
Clinical Applications of EEG
Terminology
Equipment
Precautions
Clinical Significance
Nerves and Nerve Fibers
Nerve Fiber Type and Function
MOTOR NERVE CONDUCTION
Principle
PROCEDURE
Ulnar Nerve
PROCEDURES
OBSERVATIONS AND RESULTS
QUESTIONS
Relevance
INTRODUCTION
MOTOR UNIT POTENTIAL (MUP)
A. Characteristics of MUP
B. Factors Affecting MUP
METHODOLOGY
Principle
Instrumentation
Procedure for Surface EMG
Procedure for Needle EMG
OBSERVATIONS AND RESULTS
QUESTIONS
BRAINSTEM AUDITORY EVOKED POTENTIALS (BAEPS)
Equipment
PROCEDURES
Observations and Results
Clinical Significance
VISUAL EVOKED POTENTIALS (VEPs)
SOMATOSENSORY EVOKED POTENTIALS (SEPs)
MOTOR EVOKED POTENTIALS (MEPs)
INTRODUCTION
Equipment
PROCEDURE
EQUIPMENT
PROCEDURES
HAND-GRIP DYNAMOMETER
PROCEDURE
QUESTIONS
OSPE
INTRODUCTION
AUTONOMIC FUNCTION TESTS
A. TESTS FOR SYMPATHETIC FUNCTIONS
B. TESTS FOR PARASYMPATHETIC FUNCTIONS
Other Tests
Equipment Required
A. TESTS FOR SYMPATHETIC FUNCTIONS
Procedure
Rationale
Procedure
Rationale
Results
Results
B. TESTS FOR PARASYMPATHETIC FUNCTION
Rationale
Procedure
Rationale
Procedure
Procedure
Observations
Clinical Significance
Procedure
C. OTHER TESTS
1. TEST FOR PUPILLARY FUNCTION
Denervation Hypersensitivity
2. TEST FOR LACRIMATION (Schirmer's test)
Relevance
Characteristics of Normal Semen and Comments
Volume
Physical Characteristics
pH
Morphology
Motility
Count
Clotting and Liquefaction
Fructose
Apparatus and Materials
PROCEDURES
QUESTIONS
I. BIOLOGICAL DIAGNOSTIC TESTS
II. IMMUNOLOGICAL TESTS
Principle
Procedures
III. ULTRASONOGRAPHY
QUESTIONS
I. Methods Based on Physiological Principles
II. Barrier Methods (Condom and diaphragm)
III. Use of Spermicidal Agents
IV. Interruption of the Normal Paths of Sperms or Ovum (Surgical Sterilization)
V. Intrauterine Devices (IUDs)
VI. Oral Contraceptives (Hormonal Methods)
Other Hormonal Methods Include
QUESTIONS
SECTION 3:
Clinical Examination
CLINICAL EXAMINATION
I. HISTORY TAKING
A. General Interrogation
B. Special Interrogation
II. PHYSICAL EXAMINATION
A. General Physical Examination
B. Systemic Physical Examination (Common Non-Invasive Procedures)
Inspection
COMMONLY USED TERMS
Important Signs and Symptoms of Respiratory Disease
INSPECTION
PALPATION
PERCUSSION
Protocol
AUSCULTATION
IMPORTANT SIGNS AND SYMPTOMS OF CARDIOVASCULAR DISEASE
EXAMINATION OF THE CARDIOVASCULAR SYSTEM
QUESTIONS
EXAMINATION OF THE ARTERIAL PULSE
Examination of Radial Pulse
NORMAL PULSE WAVE
Types of Abnormal Arterial Pulse waves
EXAMINATION OF NECK VEINS
Jugular Venous Pressure (JVP)
PROCEDURE
EXAMINATION OF THE HEART
Inspection
Apex beat
PALPATION
PERCUSSION
AUSCULTATION
IMPORTANT SIGNS AND SYMPTOMS OF GIT DISEASE
INSPECTION
PALPATION
PERCUSSION
AUSCULTATION
History Taking
Common Signs and Symptoms of Neurological Disease
Diagnosis of Nervous System Diseases
Clinical Examination of Nervous System
The 1st or Olfactory Nerve (Sensory)
The 2nd or Optic Nerve (Sensory)
A. Visual Acuity
B. Color Vision
C. Field of Vision
Oculomotor and Pupillary Innervation—The 3rd (Oculomotor), 4th (Trochlear), 6th (Abducent) and Sympathetic Nerves
The 5th or Trigeminal Nerve (Sensory and Motor)
A. Sensory Functions
B. Motor Functions
The 7th or Facial Nerve (Almost Purely Motor)
The 8th or Vestibulocochlear Nerve (Composite Sensory Nerve)
The 9th or Glossopharyngeal Nerve (Mixed Nerve)
The 10th or Vagus Nerve (Mixed Nerve)
The 11th or Accessory Nerve (Motor Nerve)
The 12th or Hypoglossal Nerve (Motor Nerve)
COMPONENTS OF THE MOTOR SYSTEM
Planning and Execution of Movements
TESTING THE MOTOR FUNCTIONS
Testing the Muscles of the Trunk
A. SUPERFICIAL REFLEXES
B. DEEP REFLEXES
Stimulus
Grading of Tendon Reflexes
C. VISCERAL REFLEXES
MOTOR NEURON LESIONS
V. SENSORY FUNCTIONS
Physiological and Anatomical Considerations
Components of Sensory System
Pathways for General Sensations
Clinical Testing of General Sensations
Touch (Tactile) Sensation
Proprioception
Vibration
Pain
Visual Analog Scale of Pain
Temperature
SECTION 4:
Experimental Physiology (Amphibian and Mammalian Experiments)
APPARATUSES
Electrical Connections
Arranging The Apparatus
Trouble Shooting
Ringer's Solution
PRINCIPLE
APPARATUS
PROCEDURES
OBSERVATIONS AND RESULTS
QUESTIONS
PROCEDURES
Precautions
QUESTIONS
EXPERIMENTAL PROCEDURES
QUESTIONS
EXPERIMENTAL PROCEDURES
Calculation of Velocity
QUESTIONS
EXPERIMENTAL PROCEDURES
QUESTIONS
EXPERIMENTAL PROCEDURES
QUESTIONS
PROCEDURES
QUESTIONS
PROCEDURES
OBSERVATIONS AND RESULTS
QUESTIONS
Exposure of the Frog's Heart
OBSERVATIONS
NORMAL CARDIOGRAM
Procedures
QUESTIONS
PROCEDURES
Effect of Temperature on the Heart
PROCEDURES
QUESTIONS
EXPERIMENTAL PROCEDURES
QUESTIONS
PROCEDURES
Refractoriness in the Beating Heart: Extrasystole and Compensatory Pause
Stannius Ligatures
QUESTIONS
PROCEDURES
SPINAL FROG
DECEREBRATE FROG
QUESTIONS
INSTRUMENTATION
EXPERIMENTAL PROTOCOL
The Blood Pressure Tracing
EXPERIMENTS
SECTION 5:
Charts
OTHER QUESTIONS
SECTION 6:
Calculations
Appendix
UNITS AND MEASURES EMPLOYED IN PHYSIOLOGY
Decimal Multiples and Submultiples of the SI Units
LABORATORY VALUES OF CLINICAL IMPORTANCE
BODY FLUIDS AND OTHER MASS DATA
BLOOD—Reference intervals
Arterial gases
Arterial oxygen saturation (at rest)
CARDIOVASCULAR SYSTEM
BRAIN
BIOCHEMISTRY—Reference values (S: serum; P: plasma)
INDEX
TOC
Index
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