Physiology Practical – I

Clinical Examination

1. Perform Tuning Fork Tests for Hearing and Report

(10 Mark)
2. Test for Vibration and Stereognosis and Report (05 Mark)

Clinical Case History (05 Mark)

A 3-year-old male child was brought to a doctor with complaints of

bleeding from the nose, mouth, urinary tract, and skin after trivial
injury. Sometimes swelling of joints with pain and fever was also
noticed. The bleeding was not profuse, but it was persistent. A
careful history revealed a similar bleeding tendency in male relatives.
Investigations revealed that the coagulation time was prolonged. The
bleeding time, prothrombin time and platelet count were normal.

1. What is the most likely diagnosis?

2. Why are females usually not affected by this disorder?
3. What are chances of the boy’s sister being a carrier?
4. What is the physiological basis for the treatment of this
disorder?
 Physiology Practical – I
Clinical Examination

1. Elicit Deep Tendon Reflexes of Upper Limb and Report

(10 Mark)
2. Test for Colour Vision and Report (05 Mark)

Clinical Case History (05 Mark)

A woman aged 30 years complains of general fatigue, breathlessness

on exertion, giddiness, headache, palpitation, anorexia, and
dysphagia. On examination the patient shows pallor, tachycardia,
glossitis, spooning of the nails. Sometimes tingling in the fingers and
toes is also present with edema of the dependent parts.

Investigations revealed

• Hemoglobin: 6 g%
• RBC count: 3 million/mm3 of blood
• MCHC: 28 pg
• MCV: 60 μ3
• WBC: Eosinophilia
• Stool examination: Hook worm ova abundant

1. What type of anemia does this patient have?

2. What is the cause of anemia?
3. Mention the principle involved in treatment of this patient.
 Physiology Practical – I
Clinical Examination

1. Test for Fine Touch, Tactile Localization and Discrimination and

Report (10 Mark)
2. Elicit Deep Tendon Reflexes of Lower Limb and Report
(05 Mark)

Clinical Case History (05 Mark)

A young female exhibits abnormal fatigue of muscles. Muscular

movements though initially strong, rapidly tire as the day advances
or after a vigorous exercise. Other symptoms noticed were ptosis,
weakness of chewing, swallowing, and speaking. The symptoms
showed a remitting course and often were precipitated by emotions
and infections. On examination, nervous system was found to be
normal. Remarkable recovery was seen after injection of
neostigmine intramuscularly.

1. What is your diagnosis?

2. What is the cause for this condition?
3. How does neostigmine improve the condition?
 Physiology Practical – I
Clinical Examination
1. Examine the Power and Tone of Muscles in the Upper Limb and Report
(10 Mark)
2. Test for Sensory Functions of the Facial Nerve and Report
(05 Mark)
Clinical Chart (05 Mark)

a. Name the clinical condition.

b. What are characteristic features of this clinical condition indicated by
the lines?
c. What are the causes of this clinical condition?
d. Mention two laboratory tests you would recommend for confirming
your diagnosis.
 Physiology Practical – I
Clinical Examination
1. Examine the Visual Acuity for Far and Near Vision and Report
(10 Mark)
2. Elicit Plantar Reflex and Report
(05 Mark)
Clinical Chart (05 Mark)

a. Name the waves depicted in the graph A, B, C, and D.

b. In what location these waves are recorded well?
c. Mention few features of these waves.
d. Name a few clinical conditions where this recording is a vital tool.
 Physiology Practical – I
Clinical Examination

1. Elicit Light and Accommodation Reflex and Report

(10 Mark)
2. Test for Sense of Joint Position and Report
(05 Mark)
Clinical Chart (05 Mark)

a. Name the lung volumes and capacities indicated by the numbers 1 to 9

in the above chart.
b. What are the normal values of 1 to 9?
c. Explain term Timed Vital Capacity and mention its clinical significance.
 Physiology Practical – I
Clinical Examination
1. Examine the Motor Functions of the Facial Nerve and Report
(10 Mark)
2. Test for Vibration and Stereognosis and Report
Clinical Chart (05 Mark)

a. What is Cystometrogram?
b. What are the parameters employed to plot a Cystometrogram?
c. What are the features of this graph?
d. What are Micturition contractions?
e. What is the optimum capacity of the bladder up to which inhibition of
the bladder can be exerted by voluntary effort?
 Physiology Practical – I

Clinical Examination
1. Examine the Sensory and Motor Functions of the Trigeminal
Nerve and Report (10 Mark)
2. Elicit Deep Tendon Reflexes of Lower Limb and Report
(05 Mark)

Clinical Case History (05 Mark)

A female aged 28 years came with a history of nervousness,
restlessness, tiredness, excessive sweating, palpitation, increased
appetite, and amenorrhea. On examination there was tachycardia,
dyspnea on exertion, fine tremors of outstretched hands, the eyelids
were retracted.
Investigation revealed
• BMR: increased by 40%
• Basal Pulse Rate: 120 per minute.

1. Comment on the investigation report.

2. What is your diagnosis?
3. What other investigations would you suggest confirming your
diagnosis?
 Physiology Practical – I

Clinical Examination
1. Examine for Coordination of Movements in Upper and Lower
Limb and Report (10 Mark)
2. Map the Field of Vision by finger Confrontation Test and Report
(05 Mark)
Clinical Case History (05 Mark)
A middle-aged individual comes with a history of weakness,
increased thirst, urine output and appetite. He also complaints of
weight loss and poor wound healing.

Investigations Revealed

• Urine contains Sugar but no ketone bodies

• Fasting blood glucose: 160 mg/dl

1. What is your diagnosis?

2. What are the causes for the presenting symptoms?
3. What does the absence of ketone bodies suggest?
 Physiology Practical – I

Clinical Examination
1. Test for Fine Touch, Tactile Localization and Discrimination and
Report (10 Mark)
2. Examine for the Extraocular Muscles of the Eye and Report
(05 Mark)
Clinical Case History (05 Mark)
A 35-year-old business executive complains of pain on the
upper abdomen which is relieved by taking food. His basal secretion
of HCl was 6 mEq/L and the secretion during an augmented
histamine test was 35 mEq/L.

1. What is your likely diagnosis in this patient?

2. What is the normal value for augmented histamine test?
3. Mention one other agent that can be used to provoke gastric
secretion.
4. Why is the pain relieved by food intake?
 Physiology Practical – I

Clinical Examination
1. Examine the Visual Acuity for Far and Near Vision and Report
(10 Mark)
2. Elicit Plantar Reflex and Report (05 Mark)

Clinical Case History (05 Mark)

A patient comes to a doctor with the history of yellow
coloration of the sclera and skin. The stool was clay colored, bulky,
and foul smelling. He also developed itching and loss of appetite.
Examination showed bradycardia.

Investigations Revealed

• Stercobilinogen absent in the stool

• Bilirubin present in the urine
• Coagulation prolonged
• Serum albumin lowered
• Serum bilirubin: 6 mg/dl
• Liver function test: Enzyme levels elevated
• Vanden-Burgh test direct positive

1. What is your diagnosis?

2. Why the stool was pale, bulky, and foul smelling?
3. Why the Vanden-Burgh test direct positive?
 Physiology Practical – I

Clinical Examination
1. Elicit Light and Accommodation Reflex and Report
(10 Mark)
2. Examine for Functions of 12th Cranial Nerve and Report
(05 Mark)

Clinical Case History (05 Mark)

An individual brought to the hospital from the site of an
accident. He showed the following symptoms and signs: restlessness,
extreme weakness, pale cold clammy skin, rapid thready pulse,
hypotension, and oliguria.

1. What is your provisional diagnosis?

2. How do you explain the symptoms and signs?
3. What immediate treatment do you suggest?
 Physiology Practical – I

Clinical Examination
1. Examine the Power and Tone of Muscles in the Upper Limb and
Report (10 Mark)
2. Test for Colour Vision and Report (05 Mark)

Clinical Case History (05 Mark)

A patient comes to a doctor with a history of swelling of the
legs which increases towards the evening. Examination showed
dependent pitting edema, distension of neck veins, enlargement of
liver which was soft and tender. Patient also has oliguria and
nocturia. JVP is raised.

Investigations revealed

• Urine albumin: Present

• X-ray chest: Right ventricular hypertrophy
• ECG: elevated ‘p’ wave.

1. What is your diagnosis?

2. How do you explain dependent edema and enlargement of
liver?
3. Why ‘p’ wave in ECG is elevated?
 Physiology Practical – I

Clinical Examination
1. Perform Tuning Fork Tests for Hearing and Report
(10 Mark)
2. Examine for the Functions of 11th Cranial Nerve and Report
(05 Mark)

Clinical Case History (05 Mark)

A patient comes to a doctor with severe constrictive pain
behind the sternum. After questioning he reveals that the pain
radiates along the ulnar border of the left upper limb. The severity of
the pain is proportional to the degree of exertion.
Investigations revealed

• X-ray chest: Normal

• ECG: Nothing suggestive

1. What is your diagnosis?

2. Why was ECG normal?
3. What advice should be given to such patient?