UNIT I

TWO MARKS

Define respiration.
Respiration is defined as the exchange of gases between an organisms and its
environment.Respiration is the process by which oxygen from the lungs is carried by the
blood to the lungs & the Co2 formed in the tissues by metabolic activity is carried by the
blood to the lungs & is expired out.

Distinguish the two types of respiration.

External Respiration Internal Respiration

Includes all the physiological
processes commencing with the entry
of air into lungs, till the delivery of
O2 to the tissues & transfer of CO2 to
blood & its expulsion out of the
lungs.
The intracellular biochemical processes
by which O2 is used by the cell and Co2 is
produced is internal respiration (Cellular
respiration).

Write down the muscles involved in respiration.

Breathing is accomplished by musculature that changes the volume of the thoracic cavity
and in doing so creates positive and negative pressures that move air into and out of the
lungs.
Two set of muscles are involved
1) Those in and near the diaphragm that cause diaphragm to move up and down,
changing the size of the thoracic cavity in vertical direction.
2) Those moves rib cage up and down to change the lateral diameter of the thorax.
[External & internal intercostal muscles]

What is the function of alveoli?

Gas exchange of oxygen and carbon dioxide takes place in the alveoli. Oxygen from the
inhaled air diffuses through the walls of the alveoli and adjacent capillaries into the red
blood cells. The oxygen is then carried by the blood to the body tissues.

What are respiratory bronchioles?

The bronchioles or bronchioli are the passageways by which air passes through the nose or
mouth to the alveoli (air sacs) of the lungs, in which branches no longer contain cartilage
or glands in their submucosa. They are branches of the bronchi, and are part of the
conducting zone of the respiratory system.The main function of the bronchi andbronchioles
is to carry air from the trachea into the lungs. Smooth muscle tissue in their walls helps to
regulate airflow into the lungs.
What is spirometer?
Spirometer is an instrument for measuring air inhaled into and exhaled out of the lungs; it
provides a simple way of determining most of the lung volumes and capacities that are
measured in PULMONARY FUNCTION TESTS. For this test, you breathe into a mouthpiece
attached to a recording device (spirometer).The information collected by the spirometer is
printed out on a chart called a spirogram.

Define Vital capacity.

Vital Capacity: (VC) it is the volume of air that can be breathed out by maximal effort after
a maximum inspiration.
By definition it amounts to IRV+TV+ERV=1200+500+3000=4700lit

Draw and label the lung volume capacity diagram

Why do we require a heart lung m/c? (May/June 2012)
The heart lung machine is a medical equipment that provides cardiopulmonary bypass or
mechanical circulatory support of the heart & lungs to maintain circulation during open heart
surgery or any other surgery of great vessels from the heart.The heart is unable to maintain
circulation during surgery to either itself or the great vessel from the heart. During these types
of surgical procedures, perfusion of the body tissues with the blood is maintained by an
extracorporeal (ie., outside the body ) pump called the heart lung machine.

Why do we need a oxygenator during the cardiac surgery ?

The heart lung machine also oxygenates the blood. The lungs normally operate because of a
partial vacuum inside the thoracic cavity created when the diaphragm drops, thereby increasing
the volume of the cavity. The pressure inside the lungs is essentially atmospheric pressure, and
the pressure in the intrapleural space outside the lungs is lightly less them atmospheric. This
differential pressure is sufficient to cause the lungs to expand and fill with air

What is the advantage of coating heparin in the oxygenator?

The advantage of coating heparin in the oxygenator avoid coagulation of blood during
extracorporeal circulation.

What is the main problem faced during the design of blood pumps?
The central problem in design of blood pumps is to avoid hemolysis – that is disintegration of
the fragile red cells. The cell must therefore not be exposed to turbulence or being squeezed
between moving parts of the pumps.

What is the purpose of using heat exchangers with the oxygenator?

A heat exchanger system is used first to lower the blood & body temperature during heart
surgery so as to increase the surgery time and to increase the temperature to body temperature
after resuming the normal circulation.

What is the significance of hypothermia?

 The first is to reduce body metabolism of therefore to reduce the oxygen consumption during
the operation, thereby the operation time can be increased.
 Secondly the brain damage due to O2 starvation is reduced. Between 30C & 37C, the
brain consumption of O2 is reduced approximately 7% for each 0◦C lowering of body
temperature.Without hypothermia the operation time is limited to 10 minutes.

Name some parameters that has to be monitored during the cardiac surgery.
Because respiration is being controlled, and a machine is meeting metabolic demand, it is
necessary to monitor the patient's blood chemical makeup. Chemical sensors placed in the
blood path are able to detect the amount of oxygen bound to hemoglobin. Other, more
elaborate sensors can constantly trend the blood pH, partial pressure of oxygen and carbon
dioxide, and electrolytes. This constant trending can quickly analyze the metabolic demands
of the body. Sensors that communicate system pressures are also a necessity. These
transducers are placed in areas where pressure is high, after the pump to alert high and low
pressure.
Mention some uses of Heart lung m/c .
 The heart lung machine is a medical equipment that provides cardiopulmonary bypass or
mechanical circulatory support of the heart & lungs to maintain circulation during open
heart surgery or any other surgery of great vessels from the heart.
 The heart is unable to maintain circulation during surgery to either itself or the great
vessel from the heart. During these types of surgical procedures, perfusion of the body
tissues with the blood is maintained by an extracorporeal (ie., outside the body ) pump
called the heart lung machine.
 In severe cases of hypothermia, a patient’s body temperature can be corrected by
extracorporeal circulation with the heart lung machine.

What is Hemodialysis?
The waste materials and excess of fluid is removed by extracorporeal circulation with
the help of a artificial kidney

What is peritoneal dialysis?

The abdominal organs are covered by a thin membrane called peritoneum. An empty
Space exist between the abdominal organs called peritoneal cavity. Peritoneal dialysis is
performed by introducing a dextrose and salt solution into the peritoneal cavity. Waste
material and water moves across the peritoneal membrane into this fluid which is
drained out.

What is artificial kidney/ Dialyser?

Artificial dialyzing unit which is a mechanical device capable of assuming the
functions ordinarily performed by the kidney. It receives patients blood from
the cannulated artery in the patients arm and the blood is channeled through
semipermeable membrane immersed in the dialysate solution for the exchange of waste
products takes place.

Name the four types of artificial lungs/ Oxygenators.

(April /May 2011, May/June 2012)
 Bubble Oxygenators
 Disc type or Film type Oxygenators
 Membrane type Oxygenators
 Liquid-liquid Oxygenators

What is the functional unit of kidney? Give its structure. (May/June 2013)
Nephron is the basic structural and functional unit of the kidney. Its chief function is to
regulate the concentration of water and soluble substances like sodium salts by filtering the
blood, reabsorbing what is needed and excreting the rest as urine. A nephron eliminates wastes
from the body, regulates blood volume and blood pressure, controls levels of electrolytes and
metabolites, and regulates blood pH.
Name the natural pacemaker and give the normal rate of the heart .

Sino-atrial node is the natural pace maker of the heart and the narmal heart rate is 72beats/ min
The sinoatrial node is composed of a group of specialised cells positioned in the wall of the right
atrium just lateral to the junction where the superior vena cava enters the right atrium, The
sinoatrial node (often abbreviated SA node; also commonly called the sinus node and less
commonly the sinuatrial node) is the pacemaker of the heart and is responsible for the initiation
of the heart beat. It spontaneously generates an electrical impulse, which after conducting
throughout the heart, causes the heart to contract.

Name the different types of cardiac arrhythmias.

Cardiac arrhythmia, also known as cardiac dysrhythmia or irregular heartbeat, is a group of

conditions in which the heartbeat is irregular, too fast, or too slow. A heartbeat that is too fast ie,
above 100 beats per minute in adults is called tachycardia and a heartbeat that is too slow ie,
below 60 beats per minute - is called bradycardia. Examples: Atrial fibrillation, Ventricular
fibrillation, atrial flutter, Myocardial infarction, coronary insufficiency.

What is ventricular fibrillation?

Ventricular fibrillation (V-fib or VF) is a condition in which there is uncoordinated contraction

of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract
properly. Ventricular fibrillation is the most commonly identified arrhythmia in cardiac arrest
patients. Such an arrhythmia is only confirmed by electrocardiography. Ventricular fibrillation is
a medical emergency that requires prompt Advanced Life Support interventions If the patient is
not revived after a sufficient period (within roughly 5 minutes at room temperature), the patient
could sustain irreversible brain damage and possibly become brain-dead, due to the effects of
cerebral hypoxia.

What is a cardiac pacemaker?

Cardiac pacemaker is an electronic instrument to produce external electrical stimulation impulses
to the heart muscles to regulate the heart rate when the natural pacemaker SA node) fails to
generate pulses. The cardiac pacemaker is an electrical stimulator that produces periodic electric
pulses that are conducted to the electrodes located on the a.surface of the heart(the epicardium)
or b. within the heart muscle(the myocardium) or c.within the cavity of heart or the lining of the
heart(the endocardium)

Mention the radioactive isotopes used in nuclear powered pacemaker batteries.

(May/June 2012) Nuclear batteries work due to a nonstop radioactive decay of certain elements.
They can last for incredibly long times. Agreed these batteries were costly and weighed a lot, but
that was not the problem. The big problem was that they contained hazardous material which had
to be recovered once a patient died. Example: Plutonium238 with an half life of 87 years.

Differentiate external pacemaker and internal pacemakers.

External pacemaker Internal pacemakers

External pace makers are used when the heart
block presents as an emergency and when it is
expected to be present for a short time.
Transcutaneous external cardiac pacing (TEP)
employs an external pacemaker, which
cardiologists might use temporarily to adjust
bradycardia, sinus bradycardia, or
atrioventricular node blocks. They might also
be used to regulate tachycardia.
Inte Internal pacemakers are used in cases
requiring long-term pacing because of
permanent damage that prevents normal self-
triggering of the heart. Cardiac
resynchronization therapy (CRT) requires an
internal pacemaker, which generally consists of
a pulse generator about the size of a matchbox
that contains a battery and a microcomputer.
The programmable circuitry within the device
senses and times the heart rhythm. It can also
emit electrical impulses to initiate a muscle
contraction.

Define cardiac fibrillation.

The cardiac fibrillation is a condition wherein the individual myocardial cells contract
asynchronously (continuously stimulated by the adjacent cells) with only very local pattern
relating the contraction of one cell and that of the other. During defibrillation the normal
rhythmic contraction of either the atria or the ventricles are replaced by rapid irregular twitching
of the muscular wall. Fibrillation of atrial muscles is called atrial fibrillation. Fibrillation of
ventricles is known as ventricular fibrillation.

Differentiate atrial fibrillation and ventricular fibrillation.

Atrial fibrillation Ventricular fibrillation.

Atrial fibrillation occurs when the upper
chambers of the heart, or atria, fibrillate. This
means that they beat very rapidly and
irregularly. Blood is not pumped efficiently to
the rest of the body which may cause you to
feel weak or tired, or to experience
uncomfortable heart sensations like a racing or
irregular heartbeat. This may cause symptoms
like heart palpitations, fatigue and shortness of
breath.traeting atrial fibrillation is important
because it may cause a stroke.
Ventricular fibrillation (V-fib or VF) is a
condition in which there is uncoordinated
contraction of the cardiac muscle of the
ventricles in the heart, making them quiver
rather than contract properly. Ventricular
fibrillation is the most commonly identified
arrhythmia in cardiac arrest patients. Such an a
r r h y t h m i a i s o n l y c o n f i r m e d by
electrocardiography. Ventricular fibrillation is
a medical emergency that requires prompt
advanced life support interventions. If the
patient is not revived after a sufficient period
(within roughly 5 minutes at room
temperature), the patient could sustain
irreversible brain damage and possibly become
brain-dead, due to the effects of cerebral
hypoxia.

What is defibrillation?

Electric shock to the heart can be used to re-establish a more normal cardiac rhythm. Ventricular
fibrillation can be converted into a more efficient rhythm by applying high energy shock to the
heart.By applying sudden surge across the heart which causes all the heart muscle fibres to
contract simultaneously there by cardiac fibrillation can be converted to normal rhythm

What is a cardiac Defibrillator?

Mention the difference between external and internal defibrillators. (Nov/Dec 2014) A cardiac
defibrillator is a device that delivers high energy shock to the heart muscle undergoing a fatal
arrhythmia, so as to convert them into normal rhythm. This high energy shock depolarizes a
critical mass of the heart muscle, terminates the dysrhythmia and allows normal sinus rhythm to
be reestablished by the body's natural pacemaker, in the sinoatrial node of the heart. In external
defrillation the shock is delivered to the heart by means of electrodes placed on the chest of the
patient. In internal defibrillation, the electrodes may be held directly against the heart when the
chest is open. Higher voltages are required for external defrillation than the internal
defibrillation.

What are the drawbacks of AC defibrillator? (May/June 2012)

A defibrillator is a device that delivers high energy shock to the heart muscle undergoing a fatal
arrhythmia, so as to convert them into normal rhythm. The success rate for a.c.defibrillators is
rather low, as it was useful for correcting atrial fibrillation. In attempting to correct atrial
fibrillation using a.c defibrillator often resulted in producing ventricular fibrillation, a much more
serious arrthythmia.
Differentiate synchronized and unsynchronized defibrillators.

Synchronized defibrillators Unsynchronized defibrillators

In unsynchronized defibrillator, defibrillation
is a nonsynchronized delivery of energy during
any phase of the cardiac cycle which is used to
restore synchronised working of the heart with
the pacemaker of the body
Whereas in synchronized defibrillators (
cardioversion), is the delivery of energy that is
synchronized to the large R waves or QRS
complex. For the termination of ventricular
tachycardia, atrial fibrillation and other
arrhythmias it is essential to use a defibrillator
with synchroniser circuit.

Classify the types of pacemakers.

What is a cardioverter?

The conversion of atrial fibrillation to a normal rhythm by defibrillation is usually called as

Cardioversion and defibrillator with a synchronizer is called a cardioverter which delivers a
shock only after detecting a R wave threshold. 30.Mention the energy requirements of
pacemaker? • Heart can be stimulated with electric shock • Min Energy required – 10µJ •
Typically a pulse of 5V, 10mA, 2ms is used • More than 400µJ causes ventricular fibrillation

What is bone condction?

Bone conduction is the conduction of sound to the inner ear through the bones of the skull. Bone
conduction transmission can be used with individuals with normal or impaired hearing.

What is pure tone adiometry?

Pure tone audiometry (PTA) is the key hearing test used to identify hearing
threshold levels of an individual, enabling determination of the degree, type and
configuration of a hearing loss. Thus, providing the basis for diagnosis and management.
PTA is a subjective, behavioural measurement of hearing threshold, as it relies on patient
response to pure tone stimuli.

How is hearing loss categorised?

 Hearing loss can be categorized by which part of the auditory system is damaged.
There are three basic types of hearing loss: conductive hearing loss, sensorineural
hearing loss, and mixed hearing loss.

What are the different degrees of hearing loss?

Degree of hearing loss refers to the severity of the loss. The table below shows
one of the more commonly used classification systems. The numbers are representative
of the patient's hearing loss range in decibels (dB HL).

Degree of hearing loss Hearing loss range (dB HL)

Normal –10 to 15
Slight 16 to 25
Mild 26 to 40
Moderate 41 to 55
Moderately severe 56 to 70
Severe 71 to 90
Profound 91+
Explain the different degree of hearing loss. (Any two can be asked for 2
marks)

Decibel
Hearing Loss
Loss
16 – 25 Slight - Problems if listening conditions are poor (i.e. a noisy party)
Mild - Difficulty hearing soft or distant speech in church or theatre; may benefit from
26 – 40
a hearing aid
Moderate - Conversation heard from 1-2 metres, but understanding speech is a strain,
41 – 55
especially with background noise; hearing aids required
Moderately severe - Conversation must be loud and nearby; hearing aids should be
56 – 70
complemented by other devised and speech reading instruction
Severe - Cannot hear loud speech or understand speech on the telephone; besides
71 – 90 hearing aids, other technology and speech reading, counseling and speech therapy may
be required
Profound - Some very loud sounds may be heard or felt through vibration. Speech
91 + reading training, speech therapy and counseling are essential (this is the level of
hearing loss for a late deafened person)

What is conductive hearing loss?

Conductive hearing loss occurs when sound is not conducted efficiently through
the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear.
Conductive hearing loss usually involves a reduction in sound level or the ability to hear
faint sounds. This type of hearing loss can often be corrected medically or surgically.

List the causes for conductive hearing loss?

  Fluid in the middle ear from colds
 Ear infection (otitis media)
 Allergies (serous otitis media)
 Poor eustachian tube function
 Perforated eardrum
 Benign tumors
 Impacted earwax (cerumen)
 Infection in the ear canal (external otitis)
 Swimmer's Ear (otitis ecxterna)
 Presence of a foreign body
 Absence or malformation of the outer ear, ear canal, or middle ear

What is sensorineural hearing loss?

Sensorineural hearing loss (SNHL) occurs when there is damage to the inner ear
(cochlea), or to the nerve pathways from the inner ear to the brain. Most of the time,
SNHL cannot be medically or surgically corrected. This is the most common type of
permanent hearing loss. SNHL reduces the ability to hear faint sounds. Even when
speech is loud enough to hear, it may still be unclear or sound muffled.

List the causes for sensorineural hearing loss?

 Illnesses
 Drugs that are toxic to hearing
 Hearing loss that runs in the family (genetic or hereditary)
 Aging
 Head trauma
 Malformation of the inner ear
 Exposure to loud noise

What is mixed hearing loss?

Sometimes a conductive hearing loss occurs in combination with a sensorineural
hearing loss (SNHL). In other words, there may be damage in the outer or middle ear and
in the inner ear (cochlea) or auditory nerve. When this occurs, the hearing loss is referred
to as a mixed hearing loss.

What is air conduction?

Air conduction is the transmission of sound to the inner ear through the external
auditory canal and the structures of the middle ear. The middle ear is a space behind the
eardrum that contains three small bones called ossicles. This chain of tiny bones is
connected to the eardrum at one end and to an opening to the inner ear at the other end.
Vibrations from the eardrum cause the ossicles to vibrate which, in turn, creates
movement of the fluid in the inner ear.

Write the advantages of bone conductions.

Bone conduction products have the following advantages over traditional
headphones:
 Does not block outside sound
  Maintains sound clarity in very noisy environments
 Can be used with hearing protection

List the disadvantages of bone conduction?

 Crosstalk between stereo channels (the effect is insignificant for spatial
localization of sound sources).
 Some implementations require more power than headphones
 Reduced frequency bandwidth

What is masking?
Masking is the use of noise of any kind to interfere with the audibility of another
sound. For any given intensity, low pitched tones have a greater masking effect than
those of a high pitch. The use of a noise applied to one ear while testing the hearing
acuity of the other ear to avoid cross hearing is masking.