VALLIAMMAI ENGINEERING COLLEGE

SRM Nagar, Kattankulathur – 603 203.

DEPARTMENT OF ELECTRONICS AND INSTRUMENTATION ENGINEERING

QUESTION BANK ANSWER

SUBJECT : EI6704 BIOMEDICAL INSTRUMENTATION
SEM / YEAR: VII / IV

UNIT I - FUNDAMENTALS OF BIOMEDICAL ENGINEERING

SYLLABUS
Cell and its structure – Resting and Action Potential – Nervous system and its fundamentals – Basic
components of a biomedical system- Cardiovascular systems- Respiratory systems -Kidney and
blood flow - Biomechanics of bone - Biomechanics of soft tissues - Basic mechanics of spinal
column and limbs -Physiological signals and transducers - Transducers – selection criteria – Piezo
electric, ultrasonic transducers - Temperature measurements - Fibre optic temperature sensors.
PART - A
Q.N
Questions
o
1. Differentiate action potential and resting potential.
Action potential :
When a stimulus is applied to a cell at the resting stage, there will be a high
concentration of the positive ions inside the cell. So there will be slightly high potential on
the inside of the cell due to imbalance of potassium ions. This is called action
potential.Range:20mV.
Resting potential :
The membrane potential measured when a equilibrium is reached with a potential
difference across the cell membrane negative on the inside and positive on the outside is
called resting potential.

2. At resting potential of a cell, why the inside of a cell is negatively charged.

Because there is a higher concentration of potassium ions inside the cells, their
random molecular motion is more likely to encounter the permeability pore (ion channel)
than is the case for the potassium ions that are outside and at a lower concentration.
3. Define viscoelastic.
Viscoelastic is the property of materials that exhibit
both viscous and elastic characteristics when undergoing deformation. Viscous materials,
like water, resist shear flow and strain linearly with time when a stress is applied. Elastic
materials strain when stretched and immediately return to their original state once the stress
is removed.
Viscoelastic materials have elements of both of these properties and, as such, exhibit
time-dependent strain. Whereas elasticity is usually the result of bond stretching
along crystallographic planes in an ordered solid, viscosity is the result of the diffusion of
atoms or molecules inside an amorphous material.
4. Sketch the action potential waveform.

5. Give the Nernst equation for electrode potential.

where, K – Boltzman constant

T – Absolute temperature in Kelvin
Q – charge of an electron [1.602×10-19 coulombs]
i – inside the cell
o – outside cell

6. What is bioelectric potential?

The electric potentials that are generated due to chemical activity in the cell are bio
electric potentials. Bio-electric potentials are generated at a cellular level. Each cell is a minute
voltage generator.

7. Describe propagation of action potential?

The action potential generated at the axon hillock propagates as a wave along the
axon. The currents flowing inwards at a point on the axon during an action potential spread
out along the axon, and depolarize the adjacent sections of its membrane. If sufficiently
strong, this depolarization provokes a similar action potential at the neighbouring
membrane patches.

8. What are the analogy between engineering systems and human systems?

9. Classify the two major divisions of nervous system?

The nervous system is divided into two major divisions. They are
(i) Central Nervous System (CNS)
(ii) Peripheral Nervous System (PNS)

10. Explain central nervous system?

The central nervous system is one of nervous systems which is enclosed in the skull
and vertebral column brain and spinalcord.
11. What is soft tissue injury?
The most common soft tissues injured are muscles, tendons, and ligaments.
These injuries often occur during sports and exercise activities, but sometimes simple
everyday activities can cause an injury. Sprains, strains, and contusions, as well as
tendinitis and bursitis, are common soft-tissue injuries.

12. What are the components of a biomedical system?

1. Measurand
2. Sensor / Transducer
3. Signal Conditioning
4. Output display
5. Auxiliary components

13. Discuss the use of transducers in Biomedical Engineering?

Transducer is used to detects or senses the bio-signal and converts it into an
electrical signal for biosignal processing in biomedical engineering.

14. Summarize active and passive transducers?

A transducer which gives its output without the use of an excitation voltage or
modulation of a carrier signal is called an active transducer.
A transducer which gives its output using an excitation voltage or modulation of a
carrier signal is called a passive transducer.

15. Generalize the property of piezo electric transducer.

 It is self-generating transducer.
 It does not require electric voltage source for operation.
 The electric voltage produced by piezoelectric transducer is linearly varies to
applied stress or force.
 Piezoelectric transducer has high sensitivity.

16. What is meant by depolarization and repolarisation of cell?

In normal resting state of cell, its interior is negative with respect to the outside.
When the cell ‘fires’ however, the outside of the cell becomes momentarily negative with
respect to the interior. A short time later, the cell regains the normal state in which the
inside is again negative with respect to outside. This “discharging” and “recharging” of the
cell is known as depolarisation and repolarisation.

17. Generalize “ohm’s law” for blood flow.

Blood flow rate in a blood vessel is described by two factors.
(i) The pressure difference along the vessel
(ii) The resistance offered by the vessel
R=P/F, Ohm’s law for blood flow
Where
P is the pressure difference in millimetres of mercury (mm Hg)
F is the flow rate
R is the resistance of the vessel in PRU (Peripheral Resistance Unit)
18. Sketch the stress strain curve of the Bone.

19. Explain somatic sensory nervous system?

The system of afferent nerves that carry sensory information from sensors on the
skin to the brain is called the somatic sensory nervous sytem.

20. Point out the spinal cord location in the brain.

The spinal cord is a long, fragile tubelike structure that begins at the end of the brain
stem and continues down almost to the bottom of the spine (spinal column). The spinal cord
consists of nerves that carry incoming and outgoing messages between the brain and the
rest of the body.

PART - B
1. i) Discuss the different ways of transport of ions through the cell membrane.(7)
 The living organisms can be resolved into organs, glands, tissues, cells and
organelles. It is very interesting in biology to know how solutes and water get into and
out of cells and organelles. Most attention is to be paid to erythrocytes and mitochon-
drion. The cell membrane is a complex lipoprotein structure. Some channels are
continuously open, whereas others are gated i.e. they have gates that open or close. Some
are gated by alterations in membrane potential (voltage gated) whereas others are opened
or closed when they bind a ligand (ligand gated). The ligand is often external
(neurotransmitter or hormone) or internal (intracellular Ca++, cAMP). Other transport
proteins are carriers that bind ions and other molecules and then change their
configuration, moving the bound molecule from one side of the cell membrane to the
other.
Molecules move from areas of high concentration to areas of low concentration (down
their chemical gradient). Cations move to negatively charged areas whereas anions move
to positively charged areas (down their electrical gradient), ligand gated channel. Some
of the carrier proteins are called uniports because they transport only one substance.
Others are called symports because transport requires the binding of more than one
substance to the transport protein and the substances are transported across the membrane
together.
ii) Discuss the different parts of central nervous system and their activity.(6)
Central Nervous System:
(CNS)- made up of the
spinal cord and brain.

Brain:
The brain stem continues
directly in to the spinal cord. It
consists of 1010 neurons.
Weight : 1300 - 1400 gms. It is
about 2% of your body
weight and uses 20% of the
body’s oxygen. Made up of about
100 billion neurons. “The most
complex living structure on the
universe” -Society for
Neuroscience.
The brain consists of
cerebrum, cerebellum and the brain
stem. The cerebrum consists of
two hemispheres and the
hemispheres are divided into
frontal lobe, parietal lobe,
occipital lope and temporal lope. The frontal lobes are responsible for intelligence,
constructive imagination and abstract
thought. The outer layer of the brain is
called cerebral cortex. The areas in
the cerebral cortex is responsible for
sight, hearing, touch and control of the
voluntary muscles of the body. The
upper side of the temporal lobe
contains hearing center. The temporal
lobes are also of importance for the
storage process in the long term
memory. The visual centre is situated
in the occipital lobe which is in the
back side of the brain.

Functions of Cerebrum:
The cerebrum consists of two
hemispheres and the hemispheres are
divided into frontal lobe, parietal lobe,
occipital lope and temporal lope.
The frontal lobes are responsible for
intelligence, constructive imagination and
abstract thought. The outer layer of the brain
is called cerebral cortex. The areas in the
cerebral cortex is responsible for sight,
hearing, touch and control of the voluntary
muscles of the body. The upper side of the
temporal lobe contains hearing center. The temporal lobes are also of importance for the
 storage process in the long term memory. The visual centre is situated in the occipital
lobe which is in the back side of the brain. Motor center in the cerebral cortex
corresponds to a certain body movement which can be elicited by electrically stimulating
the brain surface. In the anterior part of the parietal lobe contains the sensory center
where the sensory nerves are terminated.
Cerebellum :
Cerebellum consists of two hemispheres. They regulate the coordination of muscular
movements elicited by the cerebrum. It is also a balance center. In the brain stem, we
have diencephalon, which consists of thalamus and hypothalamus and medulla oblongata.
Thalamus is a relay station for sensory pathways to the cortical sensory center of the
cerebrum. Hypothalamus consists of centers for temperature regulation, metabolism,
fluid regulation, appetite, thirst, sleep, feelings and emotions. The medulla oblongata
contains centers for regulating the working of the heart and lungs. The brain consists of a
system of cavities called ventricles. The ventricles contain cerebrospinal fluid which
helps to resist the stresses due to acceleration.
Spinal cord :
Spinal cord is the download continuation of the medulla oblongata and is protected
by the spinal canal. It runs through the vertebral column or through the back bone. The
working of entire body is linked with it. It is connected to a large number of nerves. The
spinal cord makes the work of the brain easy by receiving messages from it and then
sending them to different organs and vice-versa. The spinal cord is meant to take
decisions where no thinking is required. If we feel thirsty, we drink water. This type of
automatic or quick reaction is called reflex or reflexaction.

2. i) Describe the action of piezoelectric transducer as arterial pressure sensor. (7)

ii) Describe the working of a fibre optic temperature sensor.(6)

Fig. Details of the fiber-sensor arrangement for the GaAs semiconductor

temperature probe

Figure shows the details of a GaAs semiconductor temperature probe. A small

prism-shaped sample of single-crystal undoped GaAs is epoxied at the ends of two side-
by-side optical fibers. The sensors and fibers can be quite small, compatible with
biological implantation after being sheathed. One fiber transmits light from a light-
emitting diode source to the sensor, where it is passed through the GaAs and collected by
the other fiber for detection in the readout instrument. Some of the optical power traveling
through the semiconductor is absorbed, by the process of raising valence-band electrons, across
the forbidden energy gap into the conduction band. Because the forbidden energy gap is a
sensitive function of the material’s temperature, the amount of power absorbed increases
with temperature. This nonmetallic probe is particularly suited for temperature
measurement in the strong electromagnetic heating fields used in heating tissue for
cancer therapy or in patient rewarming.
3. i) Sketch the block diagram of biomedical instrumentation system and explain the
functions of each block. (7)

Fig. Block diagram of a generalized bio-medical instrument system

In the above figure, each switch position connects an instrument for measurement,
for monitoring, for diagnosis, for therapy or for surgery with the signal processor. A
transducer is a device capable of converting one form of energy or signal to another
such that its output is always an electrical signal and it can act as an impedance matching
device between the biological system and the signal processor. Thus a transducer
transforms the physiological signal like temperature, pressure or biopotential into a form
that can be read by the signal processor. Signal processor is an important part of the
instrument system which amplifies, modifies, or changes the electrical output of the
transducer in a suitable manner to run the recording or display devices. The signal
processor is also called signal conditioning equipment. The type of signal processing
depends upon the function of the instrument system. In the case of therapy, it must
feedback the signal to the biological system through the feedback transform. In the case
of surgery, a surgical tool, like electrosurgical knife and laser, is in contact with the
biological system.

ii) Sketch the diagram and equivalent circuit of a differential capacitance pressure
transducer and briefly explain its operation. (6)
4. i) With the action potential waveform summarize depolarization, repolarisation and
absolute and relative refractory periods. (8)

Fig. the waveform of the action potential

 The diffusion and drift processes give rise to membrane potential. The various ions
seek a balance between the inside and outside of the cell by diffusion and drift. But the
membrane of excitable cells, such as nerve and muscle cells, readily permits the entry of
potassium and chloride ions while it effectively blocks the entry of sodium ions. For
example the permeability of sodium ions is about 2×10-8 cm/s and for potassium and
chloride ions, that are 2×10-6 cm/s and 4×10-6 cm/s respectively.
Due to difference in the permeability of different ions, the concentration of
sodium ions inside the cell becomes much lower than the outside the cell. Since the
sodium ions are positive, the outside of the cell is more positive than the inside. Similarly
the concentration of potassium and chloride ions is more inside than the outside. Thus the
charge balance is not achieved. However an equilibrium is reached with a potential
difference across the membrane such that negative on the inside and positive on the
outside. This membrane potential caused by the different concentration of ions is called
the Resting potential of the cell.
In a tissue the depolarisation disturbance of one cell is propagated to the next until
the entire tissue depolarizes. In muscle, where cells are situated in an orderly manner, a
time delay of 10 milliseconds between the action potential depolarisation and the
subsequent muscle twitch as shown in figure is observed. Regardless of the method of
excitation of cells or the intensity of the stimulus, which is assumed to be greater than the
threshold of stimulus, the action potential is always the same for any given cell. This is
known as the all-or-nothing law.
A stimulus voltage generally does not affect a cell while it is changing its
polarisation. Following the generation of an action potential, there is a brief period of time
during which the cell cannot respond to any new stimulus. Thus the absolute refractory
period is the time duration of cell nonresponse to further stimuli. It is about 1
millisecond in nerve cells. Following the absolute refractory period, there occurs a
relative refractory period during which another action potential can be triggered but a
higher stimulus is required to reinitiate an action potential and the subsequent contraction
of muscle. In nerve cells, the relative refractory period is several milliseconds. The rate at
which an action potential moves down a fiber of a nerve cell or is propagated from cell to
cell is called the propagation rate or conduction velocity. The conduction velocity varies
in nerves depending on the type and diameter of the nerve fiber and is from 20 to 140
m/s. But in heart muscle, it is very slower ranging from 0.2 to 0.4 m/s.

ii) How do you record the action potential? (5)

Requirements of instrument used:
 It should be capable of responding extremely rapidly.
 The potential changes which are in millivolts has to be amplified before
being recorded.
The instruments used are:
 Microelectrodes
 Electronic amplifiers
 Cathode ray Oscilloscope (CRO)
 Microelectrodes:
 Micropipetter-tip size less than 1 mm diameter
 Filled with strong electrolyte solution-KCl
 Resistance – 1 billion ohm
 The tip of the microphone is passed through the cell membrane of the nerve fibre
 In different electrode – in extracellular fluid.
 Connected to CRO through amplifier.
5. i) Describe the generation and features of action potential. (7)
Important features of the action potential
Different phases of the neuronal action potential are emphasized in this figure.
1. 0 - resting state
2. 1 - depolarization to threshold and beyond
3. 2 – overshoot
4. 3 - peak of the action potential
5. 4 - repolarization and
6. 5 - hyperpolarization.

Action potential generation

 ii) Explain the function of human respiratory system.(6)
The respiratory
system is concerned with
breathing and respiration. Its
main organs are the lungs. The
respiratory system starts
from the nose and ends in the
lungs. We breathe through our
nose. The nose has a cavity
which leads to the wind-
pipe. This is known as the
nasal cavity.
The nasal cavity
contains some hair at the
opening. These hairs filter dirt
particles as the air passes through the nose. The nasal cavity is also wet at the back. So
when we breathe in through the nose we inhale air that is free from dirt. Breathing in is
called inspiration and breathing out is called expiration. The air passes from the nose to
the wind pipe and from the wind pipe to the two bronchi where it is distributed to the left
and right lungs. In the lungs, the air stream is distributed throughout the bronchial tree via
the finer airtubes to the alveoli where gas exchange takes place.

6. i) What are the different types of muscles? Generalize the importance of motor unit in
the muscular contraction. (7)
There are only three types of muscle: smooth, cardiac and skeletal.
Smooth Muscle
Smooth muscles are also known as involuntary muscles, meaning a person cannot
physically will them to move. Instead, smooth muscles are controlled by involuntary
responses in the brain and body. One example of smooth muscle is the digestive system,
where muscles in the esophagus contract to move food down to the stomach and tighten
when you have an illness that causes you to vomit. Other examples of smooth muscle
include the uterus, the bladder and the muscle behind the eyes that keeps your eyes
focused. In terms of appearance, smooth muscles are long, thin-shaped cells attached to
bones in the body. Smooth muscles are also found in the blood vessels, helping blood to
move around the body.

Cardiac Muscle
Cardiac muscle is also known as myocardium. Similar to smooth muscle, cardiac
muscle is an involuntary muscle. These muscles are thickened because they must contract
frequently to move blood in and out of the heart. Cardiac muscle cells are quadrangular
in terms of shape, and the muscles have striations resembling stripes or lines running
through them.

Skeletal Muscle
Skeletal muscles are the voluntary muscles that allow you to control the movements
of your body. Skeletal muscles also are striated and comprise the musculoskeletal system.
These muscles are attached to your bones via tendons, which are cords of tissue. In order
to move, your skeletal muscles, tendons and bones all must work together. Skeletal
 muscles come in different shapes and sizes, as evidenced by a weightlifter's large
muscles. Other skeletal muscles in the body you may not be as aware of include those in
the neck or face. Even your tongue contains skeletal muscles. Major skeletal muscles in
the body include the deltoids (shoulders); pectorals (chest); abdominals (stomach);
quadriceps (thighs); and gluteal muscles (buttocks). Skeletal muscles often work in pairs,
such as the biceps, which bend the arms, which work with the triceps, which straighten
the arms.

Importance of motor unit

Motor unit consists of a motor neuron and the group of skeletal muscle fibers which it
innervates. Three types of motor units are found in skeletal muscle. The largest of these
are the type A motor units, which are characterized by high contractile speed and power.
The term largely refers to the relative number of muscle fibers in the motor unit. Type B
motor units are the smallest and are characterized by slow contractile speed and relatively
little power, but a high resistance to fatigue. Type C motor units seem to represent a
compromise between the other two. They are intermediate in size, contractile speed and
power, and susceptibility to fatigue.

The specific contraction requirements of a particular muscle determine the type of

motor units found in that muscle. Muscles which must produce great tension but are only
called on periodically will likely incorporate a high percentage of type A motor units in
their organization. Such muscles trade off resistance to fatigue in favor of contractile
speed and power. On the other hand, muscles which must support the body against
gravity in maintaining the upright posture must be continually active and demonstrate a
high resistance to fatigue. Such muscles would be expected to incorporate a high
percentage of type B units in their design. Still other muscles need to incorporate the best
features of both and include a percentage of type C units along with the others.

ii) How does the piezoelectric transducer produce ultrasonic waves? Create its electric
equivalent near resonance? (6)
Piezoelectric ultrasonic transducers are used to produce high frequency ultrasonic
waves and are manufactured from natural and synthetic piezoelectric materials. Quartz is
the important natural material which is widely used because it vibrates in single mode
with single frequency. Further its frequency of vibration is not affected by temperature
and moisture. Quartz is generally used to produce ultrasonic waves from 1 MHz to 10
MHz. The synthetic ultrasonic transducers designed from ceramics and these are used to
produce any desired shape. Further their cost is also very cheap.
The crystal which produces ultrasonic waves can be cut into x-cut crystal so that it
can produce longitudinal mode of vibration and y-cut crystal to produce transverse mode
of vibration. Ultrasonic waves are produced in Quartz by inverse piezoelectric
effect.When a high frequency R.F. input is given to electrical axis of the crystal, then
along the mechanical axis of the crystal, the crystal expands and contracts periodically.
Particularly when the natural frequency of the crystal is equal to R.F. input frequency,
ultrasonic resonant vibrations are obtained. The frequency of the crystal is determined by
the dimensions, Young’s modulus and density of the crystal.
The mechanical system of a quartz crystal may be represented by the equivalent
electrical circuit shown in figure (a).
 Fig. (a). equivalent electrical circuit of piezo electric transducer alone

The mechanical resonance is equivalent to a series turned LCR circuit shunted by

the capacitance C1 of the electrodes. For example, if we take x-cut quartz (longthwise
vibration) in the form of a rectangular bar having the following dimensions. X=1.4 mm,
y=30.7 mm, z=4.1mm, Then R=15000 ohms, C = 0.0228 picofarads, L=137 henries and
C1=3.54 picofarads, fo = 1/2π√LC = 90 kHz.
The production of ultrasonic waves at resonance in the transducer can be
represented as an electro mechanical (or) voltage – force transformer with electrical input
and mechanical output (fig.(b))

Fig.(b) Equivalent circuit of Piezo electric transducer near resonance for

longitudinal elastic waves along thickness (LET) mode

Let, h= stress developed / applied charge density, volt/m and Co is the static electrical
capacitance of the transducer. Further L represents mechanical inductance, C the
mechanical capacitance and R is the mechanical resistance such that
L = alρc/8
C= 8l/(ρcaπ2C2)
R=(Z1+Z2)/4
Here l the thickness of the transducer, a the single surface area, ρc the density of the
transducer material and c the acoustic wave velocity through the transducer material Z1
and Z2 are the impedances of the media in contact with the two plane surfaces of the
transducer. L, C and R form a series resonant circuit. At resonance, the frequency ‘f0’ of
the R.F. input signal is equal to fo = (1/2π√LC) which is also the fundamental mode of
 vibration frequency of the transducer. The ‘Q’ value of the transducer during mechanical
resonance is given by
Qmech = ωoL/R = π/2(Zc/Z1+Z2) and ωo2LC=1.
Therefore the value of ‘L” at resonance is given by
L=Zc/16fo
where fo represents the resonant frequency and Zc = ρca c = acoustic impedance of the
transducer material.

7. i) With a relevant graph describe the relationship between the action potential and
muscle contraction.(7)
ii) Describe in detail how pulsatile blood volume changes can be measured using
photoelectric type resistive transducer. (6)
8. i) Explain in detail about Peripheral nervous system.(7)

Peripheral Nervous System: (PNS)

- consists of all the nerves and groups of neurons outside the brain and
spinal cord.
PNS is further divided into the Somatic Nervous System (connects to skeletal
muscle) and Autonomic Nervous System (connects to smooth (involuntary) muscles).
The Autonomic Nervous System is further divided into the Sympathetic Nervous
System (usually causes effects associated with emergency situations) and the
Parasympathetic Nervous System (promotes activities associated with a normal state).
Structure of Neuron

Nerve Cells are called “Neurons” All neurons have three parts:
i) DENDRITE(s)
ii) CELL BODY and
iii) AXON
Dendrites conduct nerve impulses towards the cell body. Axon conducts nerve
impulses away from the cell body. Dendrites and axons are sometimes called FIBERS.
Most long fibers are covered by a MYELIN SHEATH. The sheath has spaces in it
exposing the axon called NODES OF RANVIER. The sheath is secreted by
SCHWANN CELLS, each of which has a nucleus.
There are three types of neurons:
1. SENSORY NEURON:
(= afferent neuron) - takes a message from a sense organ to CNS. has long
dendrite and short axon
2. MOTOR NEURON:
(= efferent neuron) - takes message away from CNS to a muscle fiber or gland.
 Short dendrites, long axon.
3. INTER NEURON:
(= association neuron or connector neuron): completely contained within
CNS. Conveys messages between parts of the system. Dendrites, axons, may be long or
short.

The PNS consists of motor and sensory nerves. The motor pathway conduct
outwards (efferent) and sensory pathways conduct inwards (offerent). The autonomic
nervous system consists of two motor systems working in opposition. They are
sympathetic and parasympathetic systems. If the nerve impulses are conducted through
sympathetic motor system in an organ, they stimulate muscular activity in one direction
and those conducted through parasympathetic system evoke the opposite effect. For
example he pupil of our eye is dilated the sympathetic and contracted by the
parasympathetic.

ii) Illustrate the working of ultrasonic transducers and discuss its application. (6)
Ultrasonic transducers are transducers that convert ultrasound waves to electrical
signals or vice versa. Those that both transmit and receive may also be called ultrasound
transceivers; many ultrasound sensors besides being sensors are indeed transceivers
because they can both sense and transmit. These devices work on a principle similar to
that of transducers used in radar and sonar systems, which evaluate attributes of a target
by interpreting the echoes from radio or sound waves, respectively. Active ultrasonic
sensors generate high-frequency sound waves and evaluate the echo which is received
back by the sensor, measuring the time interval between sending the signal and receiving
the echo to determine the distance to an object. Passive ultrasonic sensors are basically
microphones that detect ultrasonic noise that is present under certain conditions, convert
it to an electrical signal, and report it to a computer. Ultrasonic probes and ultrasonic
baths are used to apply sound energy to agitate particles in a wide range of laboratory
applications; An ultrasonic transducer is a device that converts AC into ultrasound, as
well as the reverse, sound into AC.
In ultrasonics, the term typically refers to piezoelectric transducers or capacitive
transducers. Piezoelectric crystals change size and shape when a voltage is applied; AC
voltage makes them oscillate at the same frequency and produce ultrasonic sound.
Capacitive transducers use electrostatic fields between a conductive diaphragm and a
backing plate. The beam pattern of a transducer can be determined by the active
transducer area and shape, the ultrasound wavelength, and the sound velocity of the
propagation medium. The diagrams show the sound fields of an unfocused and a focusing
ultrasonic transducer in water, plainly at differing energy levels. Since piezoelectric
materials generate a voltage when force is applied to them, they can also work as
ultrasonic detectors. Some systems use separate transmitters and receivers, while others
combine both functions into a single piezoelectric transceiver.
Ultrasound transmitters can also use non-piezoelectric principles. such as
magnetostriction. Materials with this property change size slightly when exposed to a
magnetic field, and make practical transducers. A capacitor ("condenser") microphone
has a thin diaphragm that responds to ultrasound waves. Changes in the electric field
between the diaphragm and a closely spaced backing plate convert sound signals to
 electric currents, which can be amplified. The diaphragm (or membrane) principle is also
used in the relatively new micro-machined ultrasonic transducers (MUTs). These
devices are fabricated using silicon micro-machining technology (MEMS technology),
which is particularly useful for the fabrication of transducer arrays. The vibration of the
diaphragm may be measured or induced electronically using the capacitance between the
diaphragm and a closely spaced backing plate (CMUT), or by adding a thin layer of
piezo-electric material on diaphragm (PMUT). Alternatively, recent research showed
that the vibration of the diaphragm may be measured by a tiny optical ring
resonator integrated inside the diaphragm (OMUS).

9. i) Explain the structure of human cell and its constituents with the help of neat
diagram.(7)
The basic living unit of the body is the cell. To understand the function of organs and
other structures of the body, it is essential to know about the basic organisation of the cell
and the functions of its component parts. Each organ of our body is an aggregate of many
different cells held together by intercellular supporting structures. Each type of cell is
meant for performing one particular function. The entire body contains about 100 trillion
cells. Among these, there are 25 trillion red blood cells which transport oxygen from the
lungs to the tissues. Generally all cells have the ability to reproduce new cells whenever
the cells of a particular type are destroyed, until the appropriate number is replenished.
Further in all cells, oxygen combines with carbohydrate, fat or protein to release the
energy required for cell function.

Figure shows the structure of the cell as seen with the biological microscope. Each
cell consists of a centrally located nucleus (cell core) surrounded by the cytoplasm (cell
body). The nucleus is separated from the cytoplasm by a nuclear membrane and the
cytoplasm is separated from the surrounding fluids by a cell membrane. The different
substances that make up the cell are collectively called protoplasm which is mainly
composed of water, electrolytes, proteins, lipids and carbohydrates.
Water is the principal fluid medium of the cell and its concentration is in between
70 and 85 percent. Water serves as a solvent for various chemicals to produce chemical
 reactions. The electrolytes present in the cell are potassium, magnesium, phosphate,
sulphate, bicarbonate and small quantities of sodium, calcium and chloride. The
electrolytes provide inorganic chemicals for cellular reactions. Further electrolytes at the
cell membrane allow transmission of electrochemical impulses in nerve and muscle fibers
and the intracellular electrolytes determine the activity of different enzymatically
catalyzed reactions that are necessary for cellular metabolism. Proteins which constitute
10 to 20 percent of the cell mass, are divided into structural proteins and globular
proteins (enzymes). Structural proteins are in the form of long thin filaments which are
composed of polymers of many protein molecules. These are used to provide the
contractile mechanism of all muscles. The globular proteins are in globular form. These
are mainly the enzymes which catalyze the chemical reactions which provide energy for
cellular function. Lipids are composed of different types of substances. They are soluble
in fat solvents and insoluble in water. Important lipids are phospholipids and cholesterol
which are used to form membranous barriers that separate the different intracellular
compartments.
Carbohydrates play a major role in nutrition of the cell. They are stored in the
cells in the form of glycogen which are used to supply the cell’s energy needs rapidly and
are present in the extracellular fluid in the form of glucose. The cell also contains highly
organised physical structures, called organelles consisting of cell’s chemical
constituents. The cytoplasm is filled with cytosol (the clear fluid portion of the
cytoplasm), in which the minute and large particles and organelles are dispersed.
Ribosomes are minute granular particles in the cytosol and are composed of a mixture of
ribonucleic acid (RNA) and proteins and they function in the synthesis of protein in the
cells. Lysosomes are vesicular organelles and provide an intracellular digestive system
that allows the cell to digest and thereby remove unwanted substances and damaged or
foreign structures such as bacteria. The mitochondria organelles are called ‘power
houses’ of the cell. The cells extract significant amounts of energy from the nutrients and
oxygen by means of the mitochondria. The mitochondria contain deoxyribonucleic acid
(DNA) similar to that found in the nucleus. DNA is the basic substance of the nucleus
that controls replication of the cell. That is why, the nucleus is called as control center of
the cell. Nucleus contains large quantities of DNA which are called genes. The genes
first reproduce themselves and after this, the cell splits by a special process called mitosis
to form two daughter cells.
The nucleus is surrounded by nuclear inner and outer membranes. Inside the
nucleus, there is a structure called nucleolus which contains a large amount of RNA and
proteins of the type found in ribosomes. The cell size is determined almost entirely by the
amount of functioning DNA in the nucleus. The size of the cells is in the range 5-10 μm.
When there is enormous quantities of DNA than normally, the cell size is larger. DNA
grows more due to the increased production of RNA and cell proteins.

ii) What are the characteristic features to be considered while selecting a transducer?
(6)
Transducers are the instruments which converts non-electric signals into an electric
signal. So while selecting any type of transducers for any special purpose, we should
think about its specifications or characteristics. Any transducer is based on a simple
concept that physical property of a sensor must be altered by an external stimulus to
cause that property either to produce an electric signal or to modulate an external electric
signal. Selection criteria of a transducer is based on different factors, such as availability,
cost, power consumption, environmental conditions, etc. After considering all these
factors we can select a best one for our use.
Selection of the transducer among the many available mainly depends upon:
• Input characteristics
• Transfer characteristics
• Output characteristics
The following points must be considered, while selecting a transducer for any
application or a particular application.
Input Characteristics :
This is one of the most important characteristic, while selecting a transducer. By
considering input characteristics we can determine,
– what type of input is needed for that transducer?
– What is the operating range for that transducer?
– What is the loading effect on that transducer?
• Type of input
• Operating range
• Loading effect

Transfer characteristics
Transfer characteristics also plays very important role in selection of transducer.
Transfer characteristics means, the effects on the signal when it is being processed.
Errors and hysteresis also occurs when the signal is being processed. Following are some
major transfer characteristics which we should keep in mind while selecting a transducer
for any special purpose:
– Transfer function ( input output relation)
– Error and hysteresis
– Accuracy and precision
– Response of transducer to the environment influences
– Calibration
Output Characteristics :
As we all know, while we are doing some work, we always set some goal or aimed
for output. Similarly for our use we should first think about what type of output we
required? So here output characteristics plays a vital role while selecting a special type of
transducer. Some of the output characteristics are summarized below:
– Type of output
– Output impedance
– Useful range
Life span: It determines how long the selected transducer will work.
Availability: While selecting a transducer we should think about its availability.
Cost
Stability and reliability
Purpose: indication, recording or control
 A number of factors decide the choice of a particular transducer to be used for the study
of a specific phenomenon. These factors include:
• The magnitude of quantity to be measured
• The order of accuracy required
• The static or dynamic character of the process to be studied.
• The site of application on the patient’s body, both for short-term and long-term
monitoring.
• Economic considerations.
•
10. i) Classify the names of the different sub systems in our body. Explain them with
respect to their function and constituents.(7)
The human body is composed of following systems:
 Skeletal System
 Circulatory System
 Respiratory System
 Digestive System
 Excretory system
 Regulatory system
 Reproductive System
 Muscular system
Skeletal system
The skeletal system includes all of
the bones and joints in the body.
Each bone is a complex living organ
that is made up of many cells,
protein fibers, and minerals. The
skeleton acts as a scaffold by
providing support and protection for
the soft tissues that make up the rest of the body. The skeletal system also provides
attachment points for muscles to allow movements at the joints. New blood cells are
produced by the red bone marrow inside of our bones. Bones act as the body’s warehouse
for calcium, iron, and energy in the form of fat. Finally, the skeleton grows throughout
childhood and provides a framework for the rest of the body to grow along with it.
The skeletal system in an adult body is made up of 206 individual bones. These bones are
arranged into two major divisions: the axial skeleton and the appendicular skeleton. The
axial skeleton runs along the body’s midline axis and is made up of 80 bones in the
following regions:
 Skull
 Hyoid
 Auditory ossicles
 Ribs
 Sternum
 Vertebral column
The appendicular skeleton is made up of 126 bones in the folowing regions:
 Upper limbs
 Lower limbs
 Pelvic girdle
 Circulatory System
The main organ of the circulatory system is the Human Heart. The other main parts
of the circulatory system include the Arteries, Arterioles, Capillaries,
Venules, Veins and Blood. The lungs also play a major part in the pulmonary circulation
system.

Respiratory System
The respiratory system is concerned with breathing and respiration. Its main organs
are the lungs. The respiratory system starts from the nose and ends in the lungs. We
breathe through our nose. The nose has a cavity which leads to the wind-pipe. This is
known as the nasal cavity.

Digestive System
The digestive system is a group of organs working together to convert food into
energy and basic nutrients to feed the entire body. Food passes through a long tube inside
the body known as the alimentary canal or the gastrointestinal tract (GI tract). The
alimentary canal is made up of the oral cavity, pharynx, esophagus, stomach, small
intestines, and large intestines. In addition to the alimentary canal, there are several
important accessory organs that help your body to digest food but do not have food pass
through them. Accessory organs of the digestive system include the teeth, tongue,
salivary glands, liver, gallbladder, and pancreas. To achieve the goal of providing energy
and nutrients to the body, six major functions take place in the digestive system:
 Ingestion
 Secretion
 Mixing and movement
 Digestion
 Absorption
 Excretion

Excretory systems
The excretory system is the system of an organism's body that performs the
function of excretion, the bodily process of discharging wastes. The Excretory system is
responsible for the elimination of wastes produced by homeostasis. There are several
parts of the body that are involved in this process, such as sweat glands, the liver, the
lungs and the kidney system. Every human has two kidneys. Each kidney is made up of
three sections: the renal cortex, the renal medulla and the renal pelvis. The blood arrives
at the kidney via the renal artery, which splits into many afferent arterioles. These
arterioles go to the Bowman's Capsules of nephrons, where the wastes are taken out of
the blood by pressure filtration. Peritubular capillaries also surround the nephron so
substances can be taken in and out of the blood. The renal cortex is the outer layer of the
kidney and the medulla is the inner layer of the kidney. The renal pelvis takes urine away
from the kidney via the ureter. Both of the ureters lead the urine into the body's only
urinary bladder, which expands and sends nerve impulses when full. From there, urine is
expelled through the urethra and out of the body.

ii) Explain the characteristics of resting potential with reference to Nernst equation.(6)
1. The value of resting potential is maintained as a constant until some kind of
disturbance upsets the equilibrium.
2. It is strongly depending on temperature.
 3. Since the permeabilities of different cell types vary, the corresponding resting
potentials vary as well. Thus it varies from -60 to -100 mV.
4. By Goldman’s equation, the resting potential ‘Vr’ of a cell can be written as

Where k = Boltzmann’s constant = 1.38×10-23 J/K

T = Absolute temperature of the cell in Kelvin
q = Charge of electron =1.602 ×10-19 C
PK = Permeability of potassium ion
PNa = Permeability of sodium ion
PCl = Permeability of chlorine ion
[K ], [Na+] & [Cl-] = Concentration of potassium, sodium and chlorine ions and the
+

subscripts I and o indicate inside the cell and outside the cell respectively.

5. If PNa ≈ 0 and PCl ≈ 0, then Goldman’s equation is reduced into Nernst equation such
that

The resting potential of a cell at 37°C (310K) can be calculated as

In the case of blood serum (plasma), if the concentration of sodium ion is at the
elevated condition then it indicates the renal damage and dehydration; when it is
decreased, then indicates the renal failure and adrenocortical hypofunction. When
concentration of potassium ion is increased, it creates shock and acidosis. When the
concentration of bicarbonates is increased, metabolic alkalosis is produced and it is
decreased, metabolic Acidosis is produced. Further an increase of chloride ions produces
respiratory alkalosis and hyperparathyrodism and decrease of chloride ions produces
diabetic acidosis, lactic acid acidosis and persistent vomiting. In acidosis, the patient has
a reduced consciousness, tachycardia develops, the blood pressure falls and signs of
cyanosis develop. Alkalosis can also be a threat to life since it can create cancer.
11. i) With an action potential waveform explain the action of the sinoatrial node.(6)

ii) Explain biomechanics of bones and soft tissues.(7)

Biomechanics of Tissues
Tissue is one of the building blocks of an organism it intermediate between cells
and a complete organ. Organs are then formed by the functional grouping
12. i) Describe the function of human Excretory system.(7)
The excretory system is the system of an organism's body that performs the
function of excretion, the bodily process of discharging wastes. The Excretory system is
responsible for the elimination of wastes produced by homeostasis. There are several
parts of the body that are involved in this process, such as sweat glands, the liver, the
lungs and the kidney system. Every human has two kidneys. Each kidney is made up of
three sections: the renal cortex, the renal medulla and the renal pelvis. The blood arrives
at the kidney via the renal artery, which splits into many afferent arterioles. These
arterioles go to the Bowman's Capsules of nephrons, where the wastes are taken out of
the blood by pressure filtration. Peritubular capillaries also surround the nephron so
substances can be taken in and out of the blood. The renal cortex is the outer layer of the
kidney and the medulla is the inner layer of the kidney. The renal pelvis takes urine away
from the kidney via the ureter. Both of the ureters lead the urine into the body's only
urinary bladder, which expands and sends nerve impulses when full. From there, urine is
expelled through the urethra and out of the body.
Kidney and flood flow
The kidneys are bean shaped organs. In fresh state the kidneys are reddish brown in
colour. They lie on the posterior abdominal wall. In the abdomen, the right kidney is
slightly lower than the left. It is because of the presence of liver superior to it. The
kidneys are surrounded by adipose tissue. Each kidney is about 11 cm in length, 6cm in
breadth and 3cm in antero posterior dimensions. In adult males the average weight of
kidney is about 150g (in adult female 135g). The inner margin of each kidney has a
small depression called the hilum. The renal artery and nerves enter and the renal vein
and the ureter exit at this region. The hilum opens into a cavity called the renal sinus.
Each kidney is enclosed by a fibrous connective tissue layer, called the renal capsule.
Internally the kidney is divided into an outer cortex and an inner medulla. The medulla
consists of several cone-shaped renal pyramids. Extensions of the pyramids called the
medullary rays, project from the pyramids into the cortex. Extension of the cortex called
renal columns, project between the pyramids. The tips of the pyramids are called the
renal papillae. They are pointed toward the renal sinus.

The renal papillae are surrounded by funnel shaped structures called the minor
calyces. The minor calyces of several pyramids join together to form larger funnels
called major calyces. There are 8-20 minor calyces and 2 or 3 major calyces per kidney.
The major calyces converge to form an enlarged channel called the renal pelvis. The
renal pelvis then narrows to form the ureter. The ureter leaves the kidney and gets
connected to the urinary bladder.

Nephron
The basic functional unit of each kidney is the nephron. There are approximately
1.3 million nephrons in each kidney. Atleast 450,000 of them must remain functional to
ensure survival. Each nephron consists of an enlarged terminal end called the renal
corpuscle, a proximal tubule, a loop of Henle and a distal tubule. The distal tubule opens
into a collecting duct. The renal corpuscle, proximal tubule and distal tubules are in the
renal cortex. The collecting tubules and parts of the loops of Henle enter the renal
medulla. Most nephrons measure 50-55 mm in length. 15% of the nephrons are larger
and they remain near the medulla. These are called the juxtamedullary nephrons. They
have larger loops of Henle. The renal corpuscle of the nephron consists of a Bowman’s
capsule and a bunch of capillaries called the glomerulus. In the Bowman’s capsule the
outer and inner layers are called parietal and visceral layers respectively. The outer
parietal layer is composed of simple squamous epithelium. The inner visceral layer
surrounds the glomerulus. It consists of specialized cells called podocytes. The walls of
the glomerular capillaries are lined with endothelial cells. There is a basement membrane
between the endothelial cells of the glomerular capillaries and the podocytes of
Bowman’s capsule. The capillary endothelium, the basement membrane and the
podocytes of Bowman’s capsule make up the filtration membrane.
The glomerulus is supplied with blood by an afferent arteriole. It is drained by an
efferent arteriole. The cavity of Bowman’s capsule opens into the proximal tubule. The
proximal tubule is also called the proximal convoluted tubule. It is approximately 14mm
long and 60 μm in diameter. Posteriorly the proximal tubule continues as the loop of
Henle. Each loop has a descending limb and an ascending limb. The first part of the
descending limb is similar in structure to the proximal tubule. The loops of Henle that
extend into the medulla become very thin near the end of the loop. The first part of the
ascending limb is also very thin and it consists of simple squamous epithelium, but it
soon becoms thick. The distal tubules, also called the distal convoluted tubules are not as
long as the proximal tubules.

Ureters and Urinary bladder

The ureters extend inferiorly from the renal pelvis. They arise medially at the renal
hilum to reach the urinary bladder. The bladder is meant for temporarily storing the urine.
The urinary bladder is a hollow muscular bag. It lies in the pelvic cavity. The size of the
bladder depends on the presence or absence of urine. The bladder capacity varies from
120-320ml. Filling upto 500 ml is tolerated. Micturition will occur at 280ml. The
ureters enter the bladder inferiorly on its posterolateral surface. The urethra exits the bladder
inferiorly and anteriorly. At the junction of the urethra with the urinary bladder smooth
muscles of the bladder form the internal urinary sphincter. Around the urethra there is
another external urinary sphincter. The sphincters control the flow of urine through the
urethra. In the male the urethra extends to the end of the penis where it opens to the
outside. In male the urethra is 18-20cm long. In the female the urethra is shorter. It is
about 4 cm long and 6 mm in diameter.
ii) Describe the function of human Cardiovascular systems.(6)

Cardiovascular system is also called as circulatory system. The circulatory system is a

type of transport system. It helps in supplying oxygen and digested food to different parts
of our body and removing carbon dioxide from the blood. The heart is the centre of the
circulatory system. The heart is made up of muscles. It acts as a pump. The heart pumps
blood by a movement called heart-beating. The heart pumps the blood through the
pulmonary circulation to the lungs and through the systematic circulation to other organs
of the body. In the pulmonary circulation the venous (impure or non-oxygenated) blood
flows from the right ventricle of the heart through the pulmonary artery to the lungs
where it is oxygenated and gives off carbondioxide.
The arterial (pure or oxygenated) blood flows through pulmonary veins to
the left atrium of the heart. Then the pure blood flows into left ventricle where it is
pressurised and is pumped through the aorta and its branches called arteries to the
different parts of the body. Through small arteries called arterioles, the blood is
distributed to the capillaries in the tissues where it gives up its oxygen and other
chemicals and takes up carbon dioxide and products of combustion. The blood returns to
the heart through different routes. Blood vessels which carry pure blood from the heart to
various organs are known as the arteries. Blood vessels through which improve blood
returns to the heart are known as veins. The impure blood from the upper half of the body
returns to right atrium through superior vena cava and from the lower half of the body
through inferior vena cava. The blood vessels which carry pure blood from the lungs to
heart are called pulmonary veins and the blood vessel which carries impure blood from
the heart to lungs is called pulmonary artery.
13. i) Explain about the sensors and transducer types frequently used in biomedical
application. (8)

Classification of Transducers:
ii) What are the characteristics considered for designing medical equipment?
(5)
A mechanism is a system of parts working together to create motion or transmit
force. Mechanisms can be the defining feature of a successful medical device, but
deserve careful consideration as the wrong choices can lead to safety and efficacy
problems, which means added effort to fix problems in the best case or patient harm in
the worst. Though typical engineering practices should always be considered in parallel
(parts costs, availability, working envelope, off-the-shelf options, cost, tolerances, etc.),
these seven design considerations are specifically tailored to medical devices, and are
best reviewed not only during development, but before design even starts.
1.Precision
The number one requirement of a mechanism is usually precision and accuracy,
regardless of whether it is related to the safety or efficacy of the device. However, when
precision is safety or efficacy related, it must be considered extremely carefully. How
precise does it need to be and what will happen if it is less precise than the requirements
state? How will precision in verification be measured? What happens to precision after a
number of uses or if it is dropped, and how can the confirmation be made that it
continues to be precise over its lifetime?
2.Lifetime
Lifetime is important for both precision and longevity. In a well-designed device, the
mechanisms are often the first point of failure, which means they often determine a
device’s expected lifetime or maintenance schedule. Make sure to consider the
implications of service calls or field replacements when choosing a mechanism with low
reliability. Plan who will maintain the device accordingly, when and how quickly they
can fix it in case of failure, and what that means to patient health.
3.Travel Limits
An upfront understanding of the desired travel range, accuracy of end detection, and the
consequences of over-travel will enable a holistic design from day one. Assuming the
mechanism isn’t actuated by the user (i.e., the user doesn’t move the mechanism
manually), limit switches, light gates, encoders, and a myriad of other detectors are
available to feed information back with a certain degree of accuracy.
4.Mechanical Safety
If a mechanism is exposed to (or used by) an operator or patient, there will almost
certainly be pinching or crushing hazards. These hazards should be protected or mitigated
to be as safe as possible. Follow a general standard such as IEC 60601-1 (Clause 9)
which defines safe distances, gaps, usability, and protective guard design, as well as
recommendations regarding the use of emergency stops.
5.Debris
Most mechanisms are likely to give off some debris from rubbing surfaces. This can be
large chips or fine dust that may interfere with biological samples, optics, other gears or
mechanisms, electronics, etc. Oil is often present on mechanisms and may have the same
effect. Both oil and debris can create particulate small enough to circulate with even
weak air currents and travel internally over the device or externally to other devices and
surfaces. This could lead to contamination, loss of biocompatibility, interference with
electronics or optics, or a host of other problems. Make sure the debris environment is
understood, the mechanism works with the device’s expected lifetime, and it doesn’t pose
a risk to other devices in the vicinity.
6.Fringe Cases
It is very important to consider the fringe cases of a medical device’s intended use
environment. What happens if the device is bumped? What will it do when powered off
or interrupted during motion? What happens in 35-degree heat? These are potential
causes of safety or efficacy issues in the worst case and must be considered in the risk
management procedure. From a business perspective, they can cause costly field failures,
lack of user adoption, or the need for more service calls. Although predicting these fringe
cases is usually not difficult, it is time consuming. (It will still be less time consuming
than fixing a problem in production, however.)
7.Usability
Last, but never least, mechanism usability can make or break a device’s success. It is not
just market adoption on the line. The device will fail usability testing or validation if it is
 not well designed. Here are some things to consider: if the mechanism requires input
from a person, how much effort is required to use it? Will it feel weak or break easily? Is
it going to be loud? Is it obvious to use in the way one thinks it will be used? This is an
area worth investing a lot of time in to give users a satisfied, effortless feel and to enable
successful usability testing and validation.

14. Draw the equivalent circuit of a magnetostrictive transducer at its resonance and
explain its working.(13)
Magnetostriction
Magnetostriction can be explained as the corresponding change in length per unit
length produced as a result of magnetization. The material should be magnetostrictive in
nature. This phenomenon is known as Magnetostrictive Effect. The same effect can be
reversed in the sense that, if an external force is applied on a magnetostrictive material, there
will be a proportional change in the magnetic state of the material. This property was first
discovered by James Prescott Joule by noticing the change in length of the material according
to the change in magnetization. He called the phenomenon as Joule effect. The reverse
process is called Villari Effect or Magnetostrictive effect. This effect explains the change in
magnetization of a material due to the force applied. Joule effect is commonly applied in
magnetostrictive actuators and Villari effect is applied in magnetostrictive sensors. This
process is highly applicable as a transducer as the magnetostriction property of a material does
not degrade with time.

Magnetostriction Transducers
A magnetostriction transducer is a device that is used to convert mechanical energy
into magnetic energy and vice versa. Such a device can be used as a sensor and also for
actuation as the transducer characteristics is very high due to the bi-directional coupling
between mechanical and magnetic states of the material.
This device can also be called as an electro-magneto mechanical device as the electrical
conversion to its appropriate mechanical energy is done by the device itself. In other devices,
this operation is carried out by passing a current into a wire conductor so as to produce a
magnetic field or measuring current induced by a magnetic field to sense the magnetic field
strength.

Working
The figure below describes the exact working of a magnetostrictive transducer. The different
figures explain the amount of strain produced from null magnetization to full magnetization.
The device is divided into discrete mechanical and magnetic attributes that are coupled in
their effect on the magnetostrictive core strain and magnetic induction.
 First, considering the case where no magnetic field is applied to the material. This is
shown in fig.c. Thus, the change in length will also be null along with the magnetic induction
produced. The amount of the magnetic field (H) is increased to its saturation limits (±Hsat).
This causes an increase in the axial strain to “esat”. Also, there will be an increase in the value
of the magnetization to the value +Bsat (fig.e) or decreases to –Bsat (fig.a). The maximum
strain saturation and magnetic induction is obtained at the point when the value of Hs is at its
maximum. At this point, even if we try to increase the value of field, it will not bring any
change in the value of magnetization or field to the device. Thus, when the field value hits
saturation, the values of strain and magnetic induction will increase moving from the center
figure outward.
Let us consider another instance, where the value of Hs is kept fixed. At the same
time, if we increase the amount of force on the magnetostrictive material, the compressive
stress in the material will increase on to the opposite side along with a reduction in the values
of axial strain and axial magnetization. In fig.c, there are no flux lines present due to null
magnetization. Fig.b and fig.d has magnetic flux lines in a much lesser magnitude, but
according to the alignment of the magnetic domains in the magnetostrictive driver. Fig.a also
has flux lines in the same design, but its flow will be in the opposite direction. Fig.f shows the
flux lines according to the applied field Hs and the placing of the magnetic domains. These
flux fields produced are measured using the principle of Hall Effect or by calculating the
voltage produced in a conductor kept in right angle to the flux produced. This value will be
proportional to the input strain or force.

Applications
The applications of this device can be divided into two modes. That is, one implying
Joule Effect and the other are Villari Effect. In the case where magnetic energy is converted to
mechanical energy it can be used for producing force in the case of actuators and can be used
for detecting magnetic field in the case of sensors. If mechanical energy is converted to
magnetic energy it can be used for detecting force or motion.In early days, this device was
used in applications like torque meters, sonar scanning devices, hydrophones, telephone
receivers, and so on. Nowadays, with the invent of “giant” magnetostrictive alloys, it is being
used in making devices like high force linear motors, positioners for adaptive optics, active
vibration or noise control systems, medical and industrial ultrasonic, pumps, and so on.
Ultrasonic magnetostrictive transducers have also been developed for making surgical tools,
underwater sonar, and chemical and material processing.
 PART - C
1. With neat diagrams illustrating the process of respiration and circulation, states the
purpose served by these two systems and explain the process involved in the operation of
these systems. (15)
Human Respiratory System and it’s Mechanism
The human respiratory system consists of a pair of lungs and a series of air passages
leading to the lungs.
The entire respiratory tract (passage) consists of the nose, pharynx, larynx, trachea,
bronchi, and bronchioles.

Air enters the nose through the

nostrils. When air passes through the
nose, it is warmed, moistened and
filtered. The hairs present in the
nose filter out particles in the
incoming air. The air is moistened
by the mucus present in the nose,
and it is warmed by the blood
flowing through the capillaries in
the nose.
The respiratory tract from the nose
to the bronchioles is lined by
mucous membranes and cilia. The
mucus and cilia act as additional
filters.
Behind the nose lies the pharynx (throat). There are two passages here—one for food and
the other for air. The air passes from the pharynx to the larynx, or the voice box. The
opening leading to the larynx is called glottis. It is protected by a lid called epiglottis,
which prevents food from entering the passage to the lungs.
From the larynx the air goes to the trachea, or the windpipe. The trachea is about 11 cm
long. It is guarded by 16-20 C-shaped cartilage rings, which prevent the trachea from
collapsing. The trachea divides into two tubes called bronchi. Each bronchus divides and
branches out in the form of thinner tubes called bronchioles.
The bronchioles enter the lungs and divide further into finer branches called alveolar
ducts. These open into extremely thin-walled, grape-shaped air sacs called alveoli. Each
alveolus is covered by a web of blood capillaries.
The lungs are a pair of spongy organs lying in the chest cavity formed by the ribs. The
actual exchange of gases between the air and the body takes place in the capillary-covered
alveoli inside the lungs. Here, oxygen from the air in the alveoli goes into the blood, and
the carbon dioxide in the blood goes
out.
The oxygen binds to the
haemoglobin molecules present in
the red blood corpuscles and is
taken to different parts of the body.

The total surface area through which

the exchange of gases can take place
increases because of the millions of
alveoli in the lungs. Their total
surface area can be about a hundred times that of the body. The large surface area allows
sufficient oxygen intake needed for releasing the large amount of energy required by us.
Mechanism of Breathing:
There are two main steps in breathing: inspiration and expiration:
Inspiration:
Inspiration (inhalation) is the process of breathing in, by which air is brought into the
lungs.
Inspiration involves the following steps:
i. The muscles attached to the ribs on their outer side contract. This causes the ribs to be
pulled out, expanding the chest cavity.
ii. The muscle wall between the chest cavity and the abdominal cavity, called diaphragm,
contracts and moves downwards to further expand the chest cavity.
iii. The abdominal muscles contract.
The expansion of the chest cavity creates a partial vacuum in the chest cavity. This sucks
in air into the lungs, and fills the expanded alveoli.
Expiration:
After the exchange of gases in the lungs, the air has to be expelled. Expulsion of the air
from the lungs is called expiration. In this process, muscles attached to the ribs on their
inner side contract, and the diaphragm and the abdominal muscles relax. This leads to a
decrease in the volume of the chest cavity, which increases the pressure on the lungs. The
air in the lungs is pushed out and it passes out through the nose.
When we breathe out, not all of the air in the lungs gets expelled. Some of it remains in
the lungs. This keeps the lungs from collapsing and allows more time for the exchange of
gases.
Transport of Gases:
In very small organisms, there is no
need to have a separate transportation
system for gases because all its cells
are involved directly in the exchange of
gases by diffusion. However, a large
multicellular organism needs a
mechanism for the transport of gases
for its different organs and tissues.
Human beings also have a system for
transportation of gases. Oxygen is
carried by haemoglobin of the red
blood cells. Haemoglobin has a great
affinity for oxygen—each haemoglobin
molecule binds to four molecules of
oxygen. The oxygen ‘picked up’ by
haemoglobin gets transported with the
blood to various tissues.
Carbon dioxide is more soluble in
water than oxygen. So, some of it is transported in the dissolved form in our blood. Some
carbon dioxide is also transported by haemoglobin. Not all of the carbon dioxide formed is
expelled from the body. Some of it reacts with water to form compounds useful for life
processes.

Human Circulatory System

Refer Q.No. Part – B 12(ii)
2. What are the requirements of a good physiological transducer and explain the
operation of any two types of physiological transducers with relevant sketches?
(15)
Refer Part-B Q.No. 9 (ii), 6 (ii) & 3 (ii)

3. Explain the basic biomechanics of bones and spinal column in detail with its
characteristics. (15)

Biomechanics of Bones
Refer Part-B Q.No. 11 (ii)

Biomechanics of Spinal column

4. What are the effects of temperature measurements and explain the types of
temperature measurements in detail. (15)
Body temperature is one of the oldest known indicators of the general well-being of
a person. Techniques and instruments for the measurement of temperature have been
common place in the home for years and throughout all kinds of industry, as well as in the
hospital. Except for the narrow range required for physiological temperature
measurements and the size and shape of the sensing element, instrumentation for
measurement of temperature in the human body differs very little from that in various
industrial applications. Two basic types of temperature measurements can be obtained
from the human body,
– Systemic and
– Skin surface measurements
Both provide valuable diagnostic information, although the systemic temperature
measurement is much more commonly used.

Systemic temperature
Systemic temperature is the temperature of the internal regions of the body. This
temperature is maintained through a carefully controlled balance between the heat
generated by the active tissues of the body, mainly the muscles and the liver, and the heat
lost by the body to the environment. Measurement of systemic temperature is
accomplished by temperature sensing devices placed in the mouth, under the armpits, or in
the rectum. The normal oral (mouth) temperature of a healthy person is about 37°C (98.6
°F). The underarm temperature is about 1 degree lower, whereas the rectal temperature is
about 1 degree higher than the oral reading. The systemic body temperature can be
measured mostly accurately at the tympanic membrane in the ear, which is believed to
approximate the temperature at the “inaccessible” temperature control center in the brain.
For some still unknown reason, the body temperature, even in a healthy person, does not
remain constant over a 24-hour period but is often 1 to 11/2 degrees lower in the early
morning than in late afternoon. Although strenuous muscular exercise may cause a
temporary rise in body temperature from about 0.5 to 2 °C (about 0.9 to 3.6 °F), the
systemic temperature is not affected by the ambient temperature, even if the latter drops to
as low as -18°C (0 °F) or rises to over 38 °C (100 °F). This balance is upset only when the
metabolism of the body cannot produce heat as rapidly as it is lost or when the body
cannot rid itself of heat fast enough. The temperature control center for the body is located
deep within the brain (in the forepart of the hypothalamus). Here the temperature of the
blood is monitored and its control functions are coordinated. In warm, ambient
temperatures, cooling of the body is aided by production of perspiration due to secretion
of the sweat glands and by increased circulation of the blood near the surface. In this
manner the body acts as a radiator. If the external temperature becomes too low, the body
conserves heat by reducing blood flow near the surface to the minimum required for
maintenance of the cells. At the same time , metabolism is increased. If these measures are
insufficient, additional heat is produced by increasing the tone of sketal muscles and
sometimes by involuntary contraction of sketal muscles (shivering) and of the arrector
muscles in the skin (gooseflesh). In addition to the central :thermostat” for the body,
temperature sensors at the surface of the skin permit some degree of local control in the
event a certain part of the body is exposed to local heat or cold. Cooling or heating is
accomplished by control of the surface blood flow in the region affected. The only
deviation from normal temperature control is a rise in temperature called “fever”
experienced with certain types of infection. The onset of fever is caused primarily by a
delicate shutdown of the mechanisms for heat elimination. The body temperature
increases as though the “thermostat” in the brain were suddenly turned “up” thus causing
additional metabolism because the increased temperature accelerates the chemical
reactions of the body. At the beginning of a fever the skin is often pale and dry and
shivering usually takes place, for the blood that normally keeps the surface areas warm is
shut off and the skin and muscles react to the coolness. At the conclusion of the fever, as
the body temperature is lowered to normal, increased sweating (“breaking of the fever”) is
often noted as the means by which the additional body heat is eliminated.

Surface or skin temperature

Surface or skin temperature is also a result of a balance, but here the balance is
between the heat supplied by blood circulation in a local area and the cooling of that area
by conduction, radiation, conviction and evaporation. Thus skin temperature is a function
of the surface circulation, environmental temperature, air circulation around the area from
which the measurement is to be taken and perspiration. To obtain a meaningful skin
temperature measurement, it is usually necessary to have the subject remain with no
clothing covering the region of measurement in a fairly cool ambient temperature
[approximately 21 °C (70 °F)]. Care must be taken, however, to avoid chilling and the
reactions relative to chilling. If a surface measurement is to include the reaction to the
cooling of a local region, it should be recognized that the cooling of the skin increases
surface circulation, which in turn causes some local warming of adjacent areas. Heat
transferred into the site of measurement from adjacent areas of the body must also be
accounted for.

Measurement of systemic body temperature

The mercury thermometer is still the standard method or measurement. These
devices are inexpensive, easy to use and sufficiently accurate. Two types of electronic
temperature sensing devices are found in biomedical applications are
– Thermocouple
– thermister

Thermocouple
A junction of two dissimilar metals that produces as output voltage nearly
proportional to the temperature at that junction with respect to a reference junction.
 Thermistor
A semiconductor element whose resistance varies with temperature. Thermistors are
used more frequently than thermocouples because of greater sensitivity. Thermistors are
variable resistance devices formed in to disks, beads, rods (or) other desired shapes.
Thermistors are manufactured from mixture of various elements such as Nickel, Copper,
Magnesium, Manganese, Cobalt, titanium and Aluminum. These mixture is compressed
into shape with high temperature into a solid mass. It’s results resistor with a large
temperature coefficient. Unfortunately, the relationship between resistance change and
temperature change is non-linear. The resistance Rt1 of thermistor at T1 determined by the
equation
Rt1 = Rt0 eβ (1/T1-1/T0)
Where
Rt1 = resistance at temperature T
Rt0 = resistance at reference temperature T0
e=base of natural algorithms
β=temperature coefficient (range of 3000-4000)
T1=temperature at which measurement is taken
T0=reference temperature (degree Kelvin)

Selection of Thermistor probe

Selection of thermister based on the following in a bio medical application.
1.Physical configuration
2. Sensitivity of the device
3.Absolute temperature range over which the (thermistor) is designed to
operate.
4.Resistance range probe.

Fibre optic temperature sensors

Refer Part-B Q.No. 2 (ii)

UNIT II - NON ELECTRICAL PARAMETERS MEASUREMENT AND DIAGNOSTIC

PROCEDURES
SYLLABUS
Measurement of blood pressure - Cardiac output - Heart rate - Heart sound - Pulmonary function
measurements – spirometer – Photo Plethysmography, Body Plethysmography – Blood Gas
analysers, pH of blood –measurement of blood pCO2, pO2, finger-tip oxymeter - ESR, GSR
measurements.
PART - A
Q.N
Questions
o
1. What is the use of blood flow meter?
Blood flow meters are used to monitor the blood flow in various blood vessels and
to measure cardiac output.

2. Define cardiac output.

Cardiac output is defined as the amount of blood delivered by heart to aorta per
minute. For adults at rest the cardiac output is 4-6 litres/minute.
3. Asses the physical principle on which the blood flow meter based on.
The blood flow meters are based on one of the following physical principle.
(i) Electromagnetic induction
(ii) Ultra sound transmission or reflection
(iii) Thermal conversion
(iv) Radiographic principles
(v) Indicator dilution
4. Give the principle of electromagnetic blood flowmeter.
Electromagnetic blood flow meter is based on the principle of magnetic induction.
A permanent magnet or electromagnet positioned around the blood vessel generates
magnetic field perpendicular to the direction of blood flow.

5. Discuss the reason for decrease in cardiac output?

The cardiac output is decreased due to
i) Low blood pressure
ii) Reduced tissue oxygenation
iii) Poor renal function
iv) Shock and acidosis
6. Generalize Fick’s principle.
" the total uptake of (or release of) a substance by the peripheral tissues is equal to
the product of the blood flow to the peripheral tissues and the arterialvenous concentration
difference (gradient) of the substance."

7. Point out the normal heart rate of human being according to age group.
According to the American Heart Association (AHA), for adults 18 and older, a
normal resting heart rate is between 60 and 100 beats per minute (bpm), depending on the
person’s physical condition and age. For children ages 6 to 15, the normal resting heart rate
is between 70 and 100 bpm.

8. Classify different types of heart block?

There are seven types of heart block. They are
1st degree AV block – due to prolonged conduction time.
2nd degree AV block – due to conduction of few pulses instead of all from atrium.
3rd degree AV block – due to synchronous action of atrium and ventricle.
Adams – strokes attack – due to sudden attack of total block.
Bundle block – due to improper conduction of the stimulus to the ventricle.
Atrial fibrillation – due to fast beating rate (300-500 beats/min) of the atrium.
Ventricular fibrillation – due to fast beating rate of the ventricles.

9. Sketch the block diagram of heart sound recording system.

10. Differentiate between heart sound and murmurs.
Heart sounds have a transient character and it is of short duration, whereas heart
murmurs have a noisy characteristics and last for a longer time.
Heart sounds are due to the closing and opening of the valves, murmurs are due to
the turbulent flow of blood in the heart and large vessels.

11. Discuss pulmonary circulation?

In the pulmonary circulation, the venous (de-oxygenated) blood flows from the
right ventricle, through the pulmonary artery, to the lungs, where it is oxygenated and gives
off carbon dioxide. The arterial (oxygenated) blood then flows through the pulmonary veins
to the left atrium.

12. What is spirometer? Identify its diagnostic applications.

The instrument used to measure lung capcity and volumes is called spirometer.
Basically, the record obtained from this device is called a spirogram. Spirometers are
calibrated container, that collect gas and make measurements of lung volume.

13. Define plethysmography?

Instruments measuring the volume changes in any part of the body that result
from the pulsations of blood occurring with each heart beat (or) providing outputs that can
be related to them are called plethysmographs. The measurement of these volume, changes
or phenomena related there to is called plethysmography.

14. Generalize the basic principle of blood gas analyzer.

Blood gas analysis is performed to assess the acid-base balance and
evaluate the respiratory oxygenation status of the patient.
15. Illustrate the requirements of a blood pump?
The blood pump used in dialysis machines is usually of the peristaltic type. It is
designed to give blood flow at a rate of 50 to 350 ml/min.

16. What is meant by ESR and GSR?

The Galvanic Skin Response (GSR) is defined as a change in the electrical
properties of the skin. The signal can be used for capturing the autonomic nerve response as
a parameter of the sweat gland function.

17. How does the pH value determine the acidity of alkalinity in blood fluid.
The normal human arterial pH is 7.4
(i) If the pH lies in the range of 7.35 to 7.45 then the fluid is slightly alkaline.
(ii) If the pH exceeds 7.45 human body is considered to be in state of alkalosis.
(iii)If the pH is below 7.35 it indicates the body is in the state of acidosis are
(acid).
18. Give the normal value of pH, pCO2, pO2 in human blood.
Parameters Arterial blood Venous blood

pH 7.37 – 7.44 7.35 -7.45

pCO2 Men 34 – 35 mmHg 36 – 50 mmHg

Women 31 – 42 mmHg 34 – 50 mmHg

pO2 75 – 90 mmHg 25 – 40 mmHg

19. What is the use of oxymeters? Classify the types of oxymeters.
The oxymeters are used to determine the percentage of oxygen saturation of
the circulating arterial blood. The two types of oximetry are
(i) Vitro oximetry
(ii) Vivo oximetry

20. Define systole and diastole.

Systole is the period of contraction of the ventricular muscles during that time blood
is pumped into the pulmonary artery and the aorta. Diastole is the period of dilation of the
heart chambers as the blood fills the heart. For normal adult the systolic pressure is around
140 mm of Hg and diastolic pressure is around 80 mm of Hg. It is measured using
noninvasive blood pressure measuring device called as Sphygmomanometer.

PART - B
1. i) What are the methods for measuring blood pressure? Sketch a typical setup
and explain.(7)
Measurement Methods
• Direct Blood Pressure Measurement
• Indirect Blood Pressure Measurement
Preparation for measurement
Before the blood pressure measurement begins the following conditions should
be met:
1. Subjects should abstain from eating, drinking (anything else than water),
smoking and taking drugs that affect the blood pressure one hour before
measurement.
2. Because a full bladder affects the blood pressure it should have been emptied.
3.Painful procedures and exercise should not have occurred within one hour.
4.Subject should have been sitting quietly for about 5 minutes.
5.Subject should have removed outer garments and all other tight clothes. The
sleeve of shirts, blouses, etc. should have been rolled up so that the upper right arm
is bare. The remaining garments should not be constrictive and the blood pressure
cuff should not be placed over the garment.
6.Blood pressure should be measured in a quiet room with comfortable temperature.
The room temperature should have been recorded.
7. The time of day should have been recorded.
8.The blood pressure measure should be identified on the blood pressure data
 recording form.
Position of the subject
Measurements should be taken in sitting position so that the arm and back are
supported. Subject's feet should be resting firmly on the floor, not dangling. If the
subject's feet do not reach the floor, a platform should be used to support them.
Position of the arm
The measurements should be
made on the right arm whenever
possible. The subject's arm should be
resting on the desk so that the
antecubital fossa (a triangular cavity
of the elbow joint that contains a
tendon of the biceps, the median
nerve, and the brachial artery) is at
the level of the heart and palm is
facing up. To achieve this position,
either the chair should be adjusted or
the arm on the desk should be raised,
e.g. by using a pillow (see Picture ).
The subject must always feel comfortable.

Selection of the cuff

The greatest circumference of the upper arm is measured, with the arm relaxed
and in the normal blood pressure measurement position (antecubital fossa at the
level of the heart), using a non-elastic tape (see Picture ). The measurement should
be read to the nearest centimeter. This reading should be recorded in the data form.
Select the correct cuff for the arm circumference and record the size of the selected
cuff in the blood pressure recording data form. The cuff should be placed on the
right arm so that its bottom edge is 2-3 cm above the antecubital fossa, allowing
sufficient room for the bell of the stethoscope. The top edge of the cuff should not
be restricted by clothing.

Number of measurements
• Three measurements should be taken one minute apart.
If three measurements are not feasible, two will suffice with a certain loss in data
stability.

i) Describe the working principle of ultrasonic blood pressure measurement. (7)

3. Automatic blood pressure monitors have also been designed based on the
ultrasonic detection of arterial wall motion. The control logic incorporated in the
instrument analyzes the wall motion signals to detect the systolic and diastolic
pressures and displays the corresponding values. In principle, the instrument
consists of four major subsystems (Fig.).
The power supply block converts incoming ac line voltage to several filtered and
regulated dc voltages required for the pneumatic subsystem in order to inflate the
occlusive cuff around the patient’s arm. At the same time, control subsystem
signals gate-on the transmitter in the RF and audio subsystem, thereby generating a
2 MHz carrier, which is given to the transducer located in the cuff. The transducer
converts the RF energy into ultrasonic vibrations, which pass into the patient’s arm.
The cuff pressure is monitored by the control subsystem and when the pressure
reaches the preset level, further cuff inflation stops. At this time, audio circuits in
the RF and audio subsystems are enabled by control subsystem signals and the
audio signals representative of any Doppler frequency shift are thus able to enter
the control subsystem logic. The control subsystem signals the pneumatic
subsystem to bleed off the cuff pressure at a rate determined by the preset bleed
 rate. As air bleeds from the cuff the frequency of the returned RF is not appreciably
different from the transmitted frequency as long as the brachial artery remains
occluded. Till then, there are no audio signals entering the control subsystem.

ii) What is PCG? Give the characteristics of different heart sounds. (6)
Phonocardiography (PCG)
The graphic record of the heart sounds is called “phonogram”. Because the
sound is from heart, it is called phonocardiogram. The instrument used to measure
the heart sounds is called phonocardiograph. This instrument uses a
phonocatheter, a device similar to a conventional catheter, with a microphone at
the tip. The basic aim of phonocardiograph is to pick up the different heart sounds,
filter out the heart sounds and to display them (or) record them.
characteristics of different heart sounds
There are four basic separate heart sounds that occur during the sequence of
one complete cardiac cycle.
(a) First heart sound
(b) Second heart sound
(c) Third heart sound
(d) Fourth heart sound
First heart sound
The first heart sound is produced by a sudden closure of the mitral and
tricuspid valves associated with myocardial contraction.
(a) Timings:
• The low frequency vibrations occur approximately 0.05 second after the
onset of the ‘QRS’ complex of the ECG.
(b) Duration:
• The first heart sound lasts for 0.1 to 0.12 second.
(c) Frequency:
• The first heart sound ranges from 30-50 Hz.
(d) Asculatory Area:
• The first heart sound is best heard at the apex of the mid pericardium

Second heart sound

The second heart sound is due to the vibration set up by the closure of
semilunar valves (i.e.) the closure of aortic and pulmonary valves.
(a) Timings:
• The second heart sound starts approximately 0.03-0.05 second after the end
of ‘T’ wave of the ECG.
(b) Duration:
• This lasts for 0.08 to 0.14 second.
(c) Frequency:
• The frequency is upto 250 Hz.
(d) Asculatory Area:
• The second sound is best heard in the aortic and pulmonary areas.
 Third heart sound
The third heart sound arises as the ventricles relax and the internal pressure
drops well below the pressure in atrium. Mean while the atrio-ventricular valves
open and the blood has a rapid movement into the relaxed ventricular chambers.
(a) Timings:
• The third heart sound starts at 0.12-0.18 second after the onset of the second
heart sound.
(b) Duration:
• This lasts for 0.04 to 0.08 second.
(c) Frequency:
• The frequency is approximately 10-100 Hz.
(d) Asculatory Area:
• The third sound is usually best heard at the apex and left lateral position
after lifting the legs.

Fourth heart sound

The fourth heart sound also called an atrial sound is caused by an accelerated
flow of blood into the ventricles (or) due to atrial contraction. This occurs
immediately before the first heart sound.
(a) Timings:
• The fourth heart sound starts approximately 0.12-0.18 second after the onset
of the P-wave.
(b) Duration:
• The sound lasts for 0.03 to 0.06 second.
(c) Frequency:
• The frequency is 10-50 Hz.
(d) Asculatory Area:
• Because of its extremely low frequency it is usually inaudible.

4. ii) Explain the measurement of heart sound with suitable diagram. (6)
Heart sounds are classified into four group on the basis of their mechanism of
orgin; they are
1) Valve closure sounds
2) Ventricular filling sounds
3) Valve opening sounds and
4) Extra cardiac sounds
Valve closure sounds
These sounds occur at the beginning of systole (first heart sound) and the
beginning of a diastole (second heart sound). The first heart sound is due to the
closure of mitral and tricuspid valves. The second heart sound is due to closure of
the aortic and pulmonary valves. The two sounds are normally present in an
individual.
Ventricular filling sounds
These sounds occur either at the period of rapid filling of the ventricles (third
 hear sound) (or) during the terminal phase of ventricular filling (i.e.) artrial
contraction and are believed to be caused by sudden distention of the ventricular
wall. These sounds are normally inaudible.
Valve opening sounds:
These sounds occur at the time of opening of the atrio-ventricular valves and
semilunar valves.
Extra cardiac sounds:
These sounds occur in mid (or) late systole (or) early diastole and are believed
to be caused by thickened pericardium which limits ventricular distensibility.
Recording Setup
A block diagram for the recording setup is shown in fig.

The heart sounds are converted into electrical signals by means of a heart
microphone fastened to the chest wall by an adhesive strip. the electrical signals
from microphone are amplified by a phonocardiographic preamplifier followed by
suitable filters and recorder. Further the electrodes are placed on the limbs to
pickup the electrical activity of the heart and these signals are amplified and
recorded. This recorded ECG is used as a reference for PCG.

5. Sketch the block diagram of automated electro sphygmomanometer for blood pressure
measurement and explain its operation. (13)

There are three types of sphygmomanometersused to measure blood pressure:

mercury, aneroid, and digital. Reading blood pressure by auscultation is considered the gold
standard by the Heart, Lung and Blood Institute of the NIH.

Subject

 Position: supine, seated, standing.

 In seated position, the subject's arm should be flexed.
 The flexed elbow should be at the level of the heart.
 If the subject is anxious, wait a few minutes before taking the pressure.

Procedures

 To begin blood pressure measurement, use a properly sized blood pressure cuff. The
length of the cuff's bladder should be at least equal to 80% of the circumference of
the upper arm.
 Wrap the cuff around the upper arm with the cuff's lower edge one inch above the
antecubital fossa.
  Lightly press the stethoscope's bell over the brachial artery just below the cuff's
edge. Some health care workers have difficulty using the bell in the antecubital
fossa, so we suggest using the bell or the diaphragm to measure the blood pressure.
 Rapidly inflate the cuff to 180mmHg. Release air from the cuff at a moderate rate
(3mm/sec).
 Listen with the stethoscope and simultaneously observe the sphygmomanometer.
The first knocking sound (Korotkoff) is the subject's systolic pressure. When the
knocking sound disappears, that is the diastolic pressure (such as 120/80).

 Record the pressure in both arms and note the difference; also record the subject's
position (supine), which arm was used, and the cuff size (small, standard or large
adult cuff).
 If the subject's pressure is elevated, measure blood pressure two additional times,
waiting a few minutes between measurements.
 A BLOOD PRESSURE OF 180/120mmHg OR MORE REQUIRES IMMEDIATE
ATTENTION!

Precautions

 Aneroid and digital manometers may require periodic calibration.

 Use a larger cuff on obese or heavily muscled subjects.
 Use a smaller cuff for pediatric patients.
 For pediatric patients a lower blood pressure may indicate the presence of
hypertension.
 Don't place the cuff over clothing.
 Flex and support the subject's arm.
 In some patients the Korotkoff sounds disappear as the systolic pressure is bled
down. After an interval, the Korotkoff sounds reappear. This interval is referred to
as the "auscultatory gap." This pathophysiologic occurrence can lead to a marked
under-estimation of systolic pressure if the cuff pressure is not elevated enough. It is
 for this reason that the rapid inflation of the blood pressure cuff to 180mmHg was
recommended above. The "auscultatory gap" is felt to be associated with carotid
atherosclerosis and a decrease in arterial compliance in patients with increased blood
pressure.

Practice

 Use our aneroid and mercury sphygmomanometers simulators to practice your blood
pressure measurement skills.
 Then take one of our courses that feature blood pressure, auscultation, and other
physical examination skills.
 For pediatric patients, the NIH provides tables which use age, sex and height to
interpret blood pressure findings. View our pediatric blood pressure drills for more
information.

Explain with the help of functional diagram the working of spirometer. (13)
7. The instrument used to measure lung capcity and volumes is called spirometer.
Basically, the record obtained from this device is called a spirogram.
Basic Spirometer
Most of the respiratory measurements can be adequately carried out by the classic
water-sealed spirometer (Fig.).

This consists of an upright, water filled cylinder containing an inverted counter

weighted bell. Breathing into the bell changes the volume of gases trapped inside, and the
change in volume is translated into vertical motion, which is recorded on the moving drum
of a Kymograph. The excursion of the bell will be proportional to the tidal volume. For
most purposes, the bell has a capacity of the order of 6-8 l. Unless a special light weight bell
is provided, the normal spirometer is only capable of responding fully to slow respiratory
rates and not to rapid breathing, sometimes encountered after anaesthesia. Also, the
frequency response of a spirometer must be adequate for the measurement of the forced
expiratory volume. The instrument should have no hysteresis, i.e. the same volume should
be reached whether the spirometer is being filled or being emptied to that volume.
The spirometer is a mechanical integrator, since the input is air flow an dthe output
is volume displacement. An electrical signal proportional to volume displacement can be
obtained by using a linear potentiometer connected to the pulley portion of the spirometer.
The spirometer is a heavily damped device so that small changes in inspired and expired air
volumes are not recorded. The spirometers can be fitted with a linear motion potentiometer,
which directly converts spirometer volume changes into an electrical signal. The signal may
be used to feed a flow-volume differentiator for the evaluation and recording of data. The
response usually is ±1% to 2 Hz and ±10% to 10 Hz.

Wedge Spirometer

A wedge spirometer consists of two square pans, parallel to each other and hinged
along one edge. The first pan is permanently attached to the wedge casting stand and
contains a pair of 5 cm inlet tubes. The other pan swings freely along its hinge with respect
to the fixed pan. A space existing between the two pans is sealed airtight with vinyl bellows.
The bellows is extremely flexible in the direction of pan motion but it offers high resistance
to ‘ballooning’ or inward and outward expansion from the spirometer. As a result, when a
pressure gradient exists between the interior of the wedge and the atmosphere, there will
only be a negligible distortion of the bellows. A gas enters or leaves the wedge, the moving
pan will change in compensation for this change in volume. The construction of the wedge
is such that the moving pan will respond to very slight changes in volume. Volume and flow
signals for the wedge are obtained independently from two linear transducers. The
transducers are attached to the fixed frame and are coupled to the edge of the moving pan.
One transducer produces a dc signal proportional to displacement (volume), while the other
has a dc output proportional to velocity (flow). The transducer outputs are connected to an
electronics unit, which contains the power supply, an amplifier and the built-in calibration
networks. A pointer attached to the moving pan and a scale affixed to the frame, combine to
provide a mechanical read out for determining the approximate volume position of the
spirometer.
Ultrasonic Spirometer
Ultrasonic spirometers depend for their action on transmitting ultrasound between a
pair of transducers and measuring changes in transit time caused by the velocity of the
intervening fluid medium. They employ piezo-electric transducers and are operated at their
characteristic resonant frequency for their highest efficiency. Ultrasonic spirometers utilize
a pair of ultrasonic transducers mounted on opposite sides of a flow tube.(Fig.)

The transducers are capable of both transmitting and receiving ultrasonic pulses.
 The velocity of sound, C, does not appear in the final equation. Thus, the output
accuracy is unaffected by fluid density, temperature, or viscosity. In gas flow
measurements, pulmonary function tubes larger than 3 cm in diameter must be used; the
single frequency systems that measure time delay directly must be able to resolve
nanoseconds since the total transit delay, t, is usually measured in microseconds. This
technique is not easily implemented because of the difficulty in measuring these small
differences.

8. i) Explain the any one method of measuring cardiac output. (7)

Cardiac output is the amount of blood delivered by the heart to the aorta per
minute. During each beat, in the case of adults, the amount of blood pumped ranges
from 70 to 100 ml and hence for normal adults the cardiac output is about 4-6
litres/minute. The measurement of cardiac output is necessary to study the various
cardiac disorders. A decrease in cardiac output may be due to low blood pressure,
reduced tissue oxygeneration, poor renal function, shock and acidosis. Using
implanted electromagnetic flow probe on the aorta, we can find the cardiac output
per minute directly by multiplying the stroke volume with the heart beat rate per
minute. Since this direct method involves surgery, it is not adopted practically.
Only the indirect methods are adopted in routine applications and are given below.
– Fick’s method
– Indicator dilution method
– Measurement of cardiac output by impedance change
Fick’s Method
 The fick’s method is based on the determination of cardiac output by the
analysis of the gas-keeping of the organism. Thus the cardiac output can be
calculated by continuously infusing oxygen into the blood or removing it from the
blood and measuring the amount of the oxygen in the blood before and after its
passage.
Let I be the amount of infused or removed oxygen per unit time and is equal
to the difference between the amounts in the blood arriving at and departing from
the site of measurement.
Thus, I = CA Q – CV Q

(or)

Where
• Q is the cardiac output in terms of litres/minute.
• CA and CV are the concentration of oxygen in terms of millilitres of oxygen
per litre of blood in the arterial blood (outgoing blood) and mixed venous
blood (incoming blood) respectively.
• I is the volume of oxygen uptake by ventilation which is expressed in terms
of millilitres of oxygen per litre of blood.
The oxygen consumption is determined by analyzing the exhaled air collected in a
bag during 10 minutes. The oxygen concentration of mixed venous blood is
measured by taking samples from a central vein through a cardiac catheter. For
analysis of arterial blood, samples are taken from an artery in the force arm.
Eventhough this method is somewhat complicated, difficult to repeat, necessitates
catheterisation, it is practised at some places.

ii) Conclude the part of electrocardiogram which is most useful for determining
heart rate? Explain. (6)
There are two different rates that can be determined on an ECG. The atrial
rate is indicated by the frequency of the P waves. The ventricular rate is indicated
by the frequency of the QRS complexes.
In the absence of disease, the atrial rate should be the same as the ventricular
rate. However, certain conditions including third-degree atrioventricular nodal
block or ventricular tachycardia can alter this normal relationship, causing “AV
dissociation.” In this setting, the atrial rate (P waves) and ventricular rate (QRS
complexes) are at different heart rates.
One quick and easy way to measure the ventricular rate is to examine the RR
interval — that is, the distance between two consecutive R waves — and use a
standard scale to find the rate. If two consecutive R waves are separated by only
one large box, then the rate is 300 beats per minute. If the R waves are separated by
two large blocks, then the ventricular rate is 150 bpm. Continuing down the scale, if
two consecutive R waves are separated by eight large boxes, then the rate is 37
bpm. The pictorial explanation of this method is shown here.
Another quick way to calculate the rate is based on the entire ECG being 10
seconds. By counting the number of QRS complexes and multiplying by six, the
number per minute can be calculated — because 10 seconds times six equals 60
seconds, or 1 minute. This is a better method when the QRS complexes are
irregular, as during atrial fibrillation, in which case the RR intervals may vary from
beat to beat. Below are examples using each method.
Example 1
Note that the QRS complexes are about 5 1/2 large boxes apart. Referencing the
above image, it can be determined that the ventricular heart rate is between 50 and
60 bpm. This is a full 10-second rhythm strip, and there are nine QRS complexes
total. Multiply the number of QRS complexes by six, and the exact heart rate is 54
bpm. There is one P wave for each QRS complex, thus the atrial rate is the same.

Example 2
These QRS complexes are exactly three large boxes apart; therefore, the ventricular
heart rate is 100 bpm. Now, multiply the number of QRS complexes on this strip by
six. This would be 17 x 6 = 102. There is one P wave for each QRS complex, thus
the atrial rate is the same.

Example 3
These QRS complexes are less than two large boxes apart, thus the heart rate is
between 150 and 300 bpm. Multiply the number of QRS complexes by six for the
ventricular rate — that is, 29 x 6 = 174 bpm. There is likely one P wave for each
QRS complex (difficult to see on this strip), thus the atrial rate is likely the same.

Example 4
The below ECG strip shows the irregularly irregular QRS complexes present during
atrial fibrillation. Using the first method to determine heart rate would not be
accurate because the RR intervals vary significantly. The best way to determine the
ventricular heart rate would be to simply count the QRS complexes and multiply by
6, which would be 15 x 6 = 90 bpm. The P waves are not able to be identified in
atrial fibrillation, and it is assumed that the atrial rate is between 400 and 600 bpm.

Example 5
This ECG strip shows AV dissociation, meaning the P waves (indicating atrial
activity) are at a different rate than the QRS complexes (indicating ventricular
activity), as explained earlier. This rhythm is actually an accelerated idioventricular
rhythm, or slow ventricular tachycardia. The atrial rate is indicated by the P waves.
There are almost exactly five large boxes between P waves, indicating an atrial rate
of 60 bpm. There are a total of ten P waves on this strip (difficult to see some of
them, as they are intermittently buried in the QRS complexes) and 10 x 6 = 60. This
confirms the first method. There are just more than four big boxes between each
QRS complexes, thus the ventricular rate is between 60 and 75. Because there is a
total of eleven QRS complexes in this full 10-second strip, the calculation for the
actual ventricular rate is 11 x 6 = 66 bpm.
10. i) Explain the Rheographic method of blood pressure measurement. (7)
A fully automatic apparatus for measuring systolic and diastolic blood
pressures has been developed using the ordinary Riva-Rocci cuff and the principle
of rheographic detection of an arterial pulse. Here, the change in impedance at two
points under the occluding cuff forms the basis of detection of the diastolic
pressure. In this method, a set of three electrodes (Fig.), which are attached to the
cuff are placed in contact with the skin. A good contact is essential to reduce the
skin electrode contact impedance. Electrode B which acts as a common electrode is
positioned slightly distal from the mid-line of the cuff. Electrodes A and C are
placed at a certain distance from the electrode B, one distally and the other
proximity. A high frequency current source operating at 100 kHz is connected to
the electrodes A and C. When we measure the impedance between any two
electrodes before pressurizing the cuffs, it shows modulation in accordance with the
blood flow pulsations in the artery. Therefore, arterial pulse can be detected by the
demodulation and amplification of this modulation.

When the cuff is inflated above the systolic value, no pulse is developed by
the electrode A. The pulse appears when the cuff pressure is just below the systolic
level. The appearance of the first distal arterial pulse results in an electrical signal,
which operates a valve to fix a manometer pointer on the systolic value. As long as
the pressure in the cuff is between the systolic and diastolic values, differential
signal exists between the electrodes A and C. This is because the blood flow is
impeded underneath the occluding cuff and the pulse appearing at the electrode A is
time delayed from the pulse appearing at C. when the cuff pressure reaches
diastolic pressure, the arterial blood flow is no longer impeded and the differential
signal disappears. A command signal is then initiated and the diastolic pressure is
indicated on the manometer. In the rheographic method of measuring blood
pressure, the cuff need not be precisely positioned as in the case with the Korotkoff
microphone, which is to be fixed exactly above an artery. Also the readings are not
affected by ambient sounds.
11. i) Explain the automatic and semiautomatic methods of measuring blood
pressure. (7)
Automatic method - Rheographic method (Refer Part-B Q.No. 10 (i) )
Semiautomatic method - Oscillometric method (Refer Part-B Q.No. 13 (ii) )

ii) For what measurements can the spirometer be used? Explain why basic lung
volumes and capacities cannot be measured with a spirometer? (6)
Measurement of lung volumes and capacities with the use of a spirometer. IT
measures the following lung capacity and lung volumes,
1. Tidal Volume (Vt)
2. Inspiratory Reserve Volume (IRV)
3. Expiratory Reserve Volume (ERV)
4. Residual Volume (RV)
5. Total Lung Capacity (TLC)
6. Vital Capacity (VC)
7. Functional Residual Capacity (FRC)
8. Inspiratory Capacity (IC)

Spirometers can measure three of four lung volumes, inspiratory reserve

volume, tidal volume, expiratory reserve volume, but cannot measure residual
volume. Four lung capacities are also defined: inspiratory capacity, vital capacity,
functional residual capacity, and the total lung capacity.

TLC = tidal volume + inspiratory reserve volume + expiratory reserve volume +

residual volume
TLC CANNOT be measured with a spirometer because residual volume is
part of its equation. Residual volume CANNOT be measured by a spirometer.
FRC = expiratory reserve capacity + residual volume
FRC CANNOT be measured with a spirometer because residual volume is
part of its equation. Residual volume CANNOT be measured by a spirometer.

12. i) Define the important lung capacities and explain them. (7)
 Respiratory Capacities
1. Functional Residual Capacity (FRC):
The volume of gas remaining in the lungs after normal expiration.
2. Total Lung Capacity (TLC):
The volume of gaas in the lungs at the point of maximal inspiration.
TLC = VC + RV
3. Vital Capacity (VC):
The greatest volume of gas that can be inspired by voluntary effort after
maximum expiration, irrespective of time.
4. Inspiratory Capacity (IC):
The maximum volume that can be inspired from the resting end expiratory
position.
5. Forced Vital Capacity (FVC):
This is the total amount of air that can be forcibly expired as quickly as
possible after taking the deepest possible breath.

ii) Describe in detail with neat diagram, differential ausculatory technique of

blood pressure measurement. (6)
The relaxed subject sits on a chair with the lower arm supported as before. The
blood pressure cuff is placed on the subject's right arm, allowing 1 inch between
the bottom of the cuff and the crease of the elbow. The brachial pulse is palpated
just above the angle of the elbow (the "antecubital fossa").

One group member puts on a

stethoscope, with the earpieces on
the headpiece angled forward. The
recording end of the stethoscope is
twisted, so that the diaphragm and
not the bell is activated. This can be
tested by tapping lightly on the
diaphragm.

The diaphragm is placed over the

brachial artery in the space between the
bottom of the cuff and the crease of the
elbow. At this point no sounds should
be heard.
 The cuff pressure is inflated quickly to
a pressure about 30 mm Hg higher
than the systolic pressure determined
by the method of palpation. Then the
air is let out of the cuff at a rate such
that cuff pressure falls at a rate of
about 5 mm Hg/sec.

At some point the person listening

with the stethoscope will begin to hear
sounds with each heartbeat. This point
marks the systolic pressure.

The sounds are called Korotkoff

sounds.

As the pressure is lowered further, the

character of the Korotkoff sounds
should change. At some point, the
sounds will disappear.

The pressure reading at this point

gives the diastolic pressure.

The subject should now lie on his or her back for five minutes. The systolic
pressure and diastolic pressure are recorded. Then the subject stands up, and
the pressures are immediately recorded once more.

The laminar flow that normally occurs in arteries produces little vibration of the
arterial wall and therefore no sounds. However, when an artery is partially
constricted, blood flow becomes turbulent, causing the artery to vibrate and
produce sounds.
 When measuring blood pressure using the auscultation method, turbulent blood
flow will occur when the cuff pressure is greater than the diastolic pressure and
less than the systolic pressure. The "tapping" sounds associated with the
turbulent flow are known as Korotkoff sounds. Remember that these sounds are
not to be confused with the heart sounds produced by the opening and closing of
the heart valves.

Summary of the auscultatory method:

Initially the cuff is inflated to a level

higher than the systolic pressure.
Thus the artery is completely
compressed, there is no blood flow,
and no sounds are heard. The cuff
pressure is slowly decreased. At the
point where the systolic pressure
exceeds the cuff pressure, the
Korotkoff sounds are first heard and
blood passes in turbulent flow
through the partially constricted
artery. Korotkoff sounds will
continue to be heard as the cuff
pressure is further lowered.
However, when the cuff pressure
reaches diastolic pressure, the sounds
disappear. Now at all points in time
during the cardiac cycle, the blood
pressure is greater than the cuff
pressure, and the artery remains
open.
13. ii) Discuss the Oscillometric blood pressure measurement method. (6)
The oscillometric technique operates on the principle that as an occluding cuff
deflates from a level above the systolic pressure, the artery walls begin to vibrate or
oscillate as the blood flows turbulently through the partially occluded artery and
these vibrations will be sensed in the transducer system monitoring cuff pressure.
As the pressure in the cuff further decreases, the oscillations increase to a maximum
amplitude and then decreases until the cuff fully deflates and blood flow returns to
normal. The cuff pressure at the point of maximum oscillations usually corresponds
to the mean arterial pressure. The point above the mean pressure at which the
oscillations begin to rapidly increase in amplitude correlates with the diastolic
pressure (fig.)
 The oscillometric method is based on oscillometric pulses (pressure pulses)
generated in the cuff during inflation of deflation. Blood pressure values are usually
determined by the application of mathematical criteria to the locus or envelope
formed by plotting a certain characteristic called the oscillometric pulse index of
the oscillometric pulses against the baseline cuff pressure (Fig.). The baseline-to-
peak amplitude, peak-to-peak amplitude, or a quantity based on the partial or full
time-integral of the oscillometric pulse can be used as the oscillometric pulse index.
The baseline cuff pressure at which the envelope peaks (maximum height) is
generally regarded as the MAP (Mean Arterial Pressure). Height-based and slope-
based criteria have been used to determine systolic and diastolic pressures.
PART -C
1. What are known as “Korotokoff sound”? How will you measure them with an indirect
method of measurement? (15)
Refer Part –B Q.No. 12 (ii)
3. Discuss a detailed study about diagnosis and treatment of High blood pressure
(hypertension). (15)

Diagnosis

Blood pressure measurement

To measure your blood pressure, your doctor or a specialist will usually place an inflatable
arm cuff around your arm and measure your blood pressure using a pressure-measuring
gauge.
A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The
first, or upper, number measures the pressure in your arteries when your heart beats
(systolic pressure). The second, or lower, number measures the pressure in your arteries
between beats (diastolic pressure).
Blood pressure measurements fall into four general categories:
 Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg.
 Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from
120 to 129 mm Hg and a diastolic pressure below 80 mm Hg. Elevated blood
pressure tends to get worse over time unless steps are taken to control blood pressure.
 Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130
to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
 Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic
pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.
Both numbers in a blood pressure reading are important. But after age 50, the systolic
reading is even more significant. Isolated systolic hypertension is a condition in which the
diastolic pressure is normal (less than 80 mm Hg) but systolic pressure is high (greater than
or equal to 130 mm Hg). This is a common type of high blood pressure among people older
than 65.
Your doctor will likely take two to three blood pressure readings each at three or more
separate appointments before diagnosing you with high blood pressure. This is because
blood pressure normally varies throughout the day, and it may be elevated during visits to
the doctor (white coat hypertension).
Your blood pressure generally should be measured in both arms to determine if there is a
difference. It's important to use an appropriate-sized arm cuff.
Your doctor may ask you to record your blood pressure at home to provide additional
information and confirm if you have high blood pressure.
Your doctor may recommend a 24-hour blood pressure monitoring test called ambulatory
blood pressure monitoring to confirm if you have high blood pressure. The device used for
this test measures your blood pressure at regular intervals over a 24-hour period and
provides a more accurate picture of blood pressure changes over an average day and night.
However, these devices aren't available in all medical centers, and they may not be
reimbursed.
If you have any type of high blood pressure, your doctor will review your medical history
and conduct a physical examination.
Your doctor may also recommend routine tests, such as a urine test (urinalysis), blood tests,
a cholesterol test and an electrocardiogram — a test that measures your heart's electrical
activity. Your doctor may also recommend additional tests, such as an echocardiogram, to
check for more signs of heart disease.

Taking your blood pressure at home

An important way to check if your blood pressure treatment is working, to confirm if you
have high blood pressure, or to diagnose worsening high blood pressure, is to monitor your
blood pressure at home.
Home blood pressure monitors are widely available and inexpensive, and you don't need a
prescription to buy one. Home blood pressure monitoring isn't a substitute for visits to your
doctor, and home blood pressure monitors may have some limitations.
Make sure to use a validated device, and check that the cuff fits. Bring the monitor with you
to your doctor's office to check its accuracy once a year. Talk to your doctor about how to
get started with checking your blood pressure at home.
Devices that measure your blood pressure at your wrist or finger aren't recommended by the
American Heart Association.

Treatment
Changing your lifestyle can go a long way toward controlling high blood pressure. Your
doctor may recommend you make lifestyle changes including:
 Eating a heart-healthy diet with less salt
 Getting regular physical activity
 Maintaining a healthy weight or losing weight if you're overweight or obese
 Limiting the amount of alcohol you drink
But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor
may recommend medication to lower your blood pressure.
Your blood pressure treatment goal depends on how healthy you are.
Your blood pressure treatment goal should be less than 130/80 mm Hg if:
 You're a healthy adult age 65 or older
 You're a healthy adult younger than age 65 with a 10 percent or higher risk of
developing cardiovascular disease in the next 10 years
 You have chronic kidney disease, diabetes or coronary artery disease
Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you
need treatment (medications) to reach that level.
If you're age 65 or older, and use of medications produces lower systolic blood pressure
(such as less than 130 mm Hg), your medications won't need to be changed unless they
cause negative effects to your health or quality of life.
The category of medication your doctor prescribes depends on your blood pressure
measurements and your other medical problems. It's helpful if you work together with a
team of medical professionals experienced in providing treatment for high blood pressure to
develop an individualized treatment plan.
Medications to treat high blood pressure
 Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act
on your kidneys to help your body eliminate sodium and water, reducing blood
volume.
Thiazide diuretics are often the first, but not the only, choice in high blood pressure
medications. Thiazide diuretics include chlorthalidone, hydrochlorothiazide
(Microzide) and others.
If you're not taking a diuretic and your blood pressure remains high, talk to your
doctor about adding one or replacing a drug you currently take with a diuretic.
Diuretics or calcium channel blockers may work better for people of African heritage
and older people than do angiotensin-converting enzyme (ACE) inhibitors alone. A
common side effect of diuretics is increased urination.
 Angiotensin-converting enzyme (ACE) inhibitors. These medications — such as
lisinopril (Zestril), benazepril (Lotensin), captopril (Capoten) and others — help relax
blood vessels by blocking the formation of a natural chemical that narrows blood
vessels. People with chronic kidney disease may benefit from having an ACE
inhibitor as one of their medications.
 Angiotensin II receptor blockers (ARBs). These medications help relax blood
vessels by blocking the action, not the formation, of a natural chemical that narrows
blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others.
People with chronic kidney disease may benefit from having an ARB as one of their
medications.
 Calcium channel blockers. These medications — including amlodipine (Norvasc),
diltiazem (Cardizem, Tiazac, others) and others — help relax the muscles of your
blood vessels. Some slow your heart rate. Calcium channel blockers may work better
for older people and people of African heritage than do ACE inhibitors alone.
Grapefruit juice interacts with some calcium channel blockers, increasing blood
levels of the medication and putting you at higher risk of side effects. Talk to your
doctor or pharmacist if you're concerned about interactions.
Additional medications sometimes used to treat high blood pressure
If you're having trouble reaching your blood pressure goal with combinations of the above
medications, your doctor may prescribe:
 Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing
the effects of natural chemicals that narrow blood vessels. Alpha blockers include
doxazosin (Cardura), prazosin (Minipress) and others.
 Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-
beta blockers slow the heartbeat to reduce the amount of blood that must be pumped
through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol
(Trandate).
 Beta blockers. These medications reduce the workload on your heart and open your
blood vessels, causing your heart to beat slower and with less force. Beta blockers
include acebutolol (Sectral), atenolol (Tenormin) and others.
Beta blockers aren't usually recommended as the only medication you're prescribed,
but they may be effective when combined with other blood pressure medications.
 Aldosterone antagonists. Examples are spironolactone (Aldactone) and eplerenone
(Inspra). These drugs block the effect of a natural chemical that can lead to salt and
fluid retention, which can contribute to high blood pressure.
 Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an
enzyme produced by your kidneys that starts a chain of chemical steps that increases
blood pressure.
Aliskiren works by reducing the ability of renin to begin this process. Due to a risk of
serious complications, including stroke, you shouldn't take aliskiren with ACE
inhibitors or ARBs.
 Vasodilators. These medications, including hydralazine and minoxidil, work directly
on the muscles in the walls of your arteries, preventing the muscles from tightening
and your arteries from narrowing.
 Central-acting agents. These medications prevent your brain from signaling your
nervous system to increase your heart rate and narrow your blood vessels. Examples
include clonidine (Catapres, Kapvay), guanfacine (Intuniv, Tenex) and methyldopa.
To reduce the number of daily medication doses you need, your doctor may prescribe a
combination of low-dose medications rather than larger doses of one single drug. In fact,
two or more blood pressure drugs often are more effective than one. Sometimes finding the
most effective medication or combination of drugs is a matter of trial and error.

Resistant hypertension: When your blood pressure is difficult to control

If your blood pressure remains stubbornly high despite taking at least three different types
of high blood pressure drugs, one of which usually should be a diuretic, you may have
resistant hypertension.
People who have controlled high blood pressure but are taking four different types of
medications at the same time to achieve that control also are considered to have resistant
hypertension. The possibility of a secondary cause of the high blood pressure generally
should be reconsidered.
Having resistant hypertension doesn't mean your blood pressure will never get lower. In
 fact, if you and your doctor can identify what's behind your persistently high blood pressure,
there's a good chance you can meet your goal with the help of treatment that's more
effective.

Your doctor or hypertension specialist may:

 Evaluate potential causes of your condition and determine if those can be treated
 Review medications you're taking for other conditions and recommend you not take
any that worsen your blood pressure
 Recommend that you monitor your blood pressure at home to see if you may have
higher blood pressure in the doctor's office (white coat hypertension)
 Suggest healthy lifestyle changes, such as eating a healthy diet with less salt,
maintaining a healthy weight and limiting how much alcohol you drink
 Make changes to your high blood pressure medications to come up with the most
effective combination and doses
 Consider adding an aldosterone antagonist such as spironolactone (Aldactone), which
may lead to control of resistant hypertension
Some experimental therapies such as catheter-based radiofrequency ablation of renal
sympathetic nerves (renal denervation) and electrical stimulation of carotid sinus
baroreceptors are being studied.
If you don't take your high blood pressure medications exactly as directed, your blood
pressure can pay the price. If you skip doses because you can't afford the medications,
because you have side effects or because you simply forget to take your medications, talk to
your doctor about solutions. Don't change your treatment without your doctor's guidance.

4. i) In case of indicator dilution method for the cardiac output measurement, 10

mg of indicator dye is injected. The area under the dilution curve is found to
be 150 mgs/litre. Calculate the cardiac output per minute.
(5)

ii) In the body plethysmograoh, the volume of the chamber is 0.20 m3. The
maximum thorax pressure is 2×105 pascals and its minimum is 0.35×105
pascals when the patient goes through breathing motions after the mouthpiece
valve is closed. Meanwhile the chamber pressure goes from 0.97×105 pascals to
1.03×105 pascals. Calculate the total lung capacity.
(10)