UNIT I PATIENT MONITORING AND BIOTELEMETRY

Q. QUESTION CO CL
N LEVEL
O
PART-A
1. A model of the normal QRS complex called ______________ CO1.1 CL1
A)ECG model B)QRS model C)Template D)Detection model
2. ________material is used to improve electrical contact in electrodes with the skin. CO1.3 CL2
A)Silver tungsten B)Copper tungsten C)Electrode jelly D)Silver graphite
3. Telemetry includes data transfer over______ CO1.2 CL1
A)Wireless modes B)Optical fiber link C)computer link D)All of the above
4. Which of the following represents a telemetry? CO1.3 CL2
A)Analog device B)Digital device C)Both A&B D)None of the above
5. Radio telemetry is useful when source and receiver is at ____ CO1.4 CL1
A)Long distance B)Short distance C)Varying separation distance D)All of the above
6. Carrier frequency in radio telemetry will be ____ CO1.4 CL1
A)Low value B)high value C)Any values greater than 100Hz
D)Frequency appropriate to distance
7. Output power of transmitter will be _____ CO1.3 CL1
A)2 to10w B)2 to 50w C)2 to 100w D)above 100w
8. Frequency range of ECG is ____ CO1.4 CL1
A)0.05-150hz B)500-1500hz C)5-500khz D)0.5-150mhz
9. P wave indicates CO1.2 CL1
A)Depolarization of right ventricles
B)Depolarization of left ventricles
C)Depolarization of both atria
D)Atria to ventricular conduction time
10. Ventricular muscle depolarization is indicated by CO1.4 CL2
A)PR interval B)P wave C)U wave D)QRS complex

11. The modulation scheme used in biotelemetry is ____ CO1.1 CL1

A)FM B)AM C)FM&PWM D)PM
12. The QRS complex and RR interval was monitored in____ CO1.3 CL2
A) Cardiac monitor B)Bedside patient monitoring C)Central station D)None
13. Low pass filter amplifies signals below a certain frequency. CO1.2 CL1
a) True
b) False
14. Which of the following instrument records the electrical activity of the heart CO1.3 CL2
A) VCG(Vectorcardiograph) B)PCG (Phonocardiograph
C)ECG( Electrocardiograph) D)EEG ( Electroencephalograph)
15. Cardiac monitor is an _____ CO1.4 CL1
 A)ICU equipment B)CCU equipment C)Central monitor D)Patient monitor
16. Pulse rate measurement was carried out by_____ CO1.4 CL1
A)Electrical impedance B)Strain gauge C)Optical changes D)None
17. Central nurse station is considered in _____ CO1.3 CL1
A)ICU equipment B)Bedside patient monitoring C)Cardiac monitor D)None
18. Why Preamplifier is used? CO1.4 CL2
A) For amplification B) For stabilizing effect C) For Reducing effect D) For modifying
effects
19. _______is monitored by cardiac monitor CO1.2 CL1
A) Cardiac activity B)ECG C)Heart rate D)All the above
20. Low signals can be transmitted using cables up to____ CO1.4 CL1
A)500 km B)2km C)10km D)50km
21. Which of the following is a primary purpose of patient monitoring systems? CO1.1 CL2
A) Assessing patient vital signs
B) Administering medication
C) Performing surgical procedures
D) Assisting with patient transportation
22. Which type of patient monitoring system is commonly used for continuous monitoring in CO1.1 CL2
intensive care units (ICUs)?
a) Electrocardiography (ECG) b) Pulse oximetry
c) Capnography d) Hemodynamic monitoring
23. What is the purpose of alarm systems in patient monitoring? CO1.2 CL2
A) To alert healthcare providers of critical patient conditions
B) To control medication administration
C) To adjust room temperature
D) To manage patient billing
24. Which parameter is typically set by the healthcare provider when programming an infusion CO1.2 CL2
pump?
A) Fluid temperature B) Flow rate C) Pump weight D) Battery life
25. Which of the following is a common type of infusion pump? CO1.2 CL2
A) Electrocardiogram (ECG) pump B) Insulin pump
C) Blood pressure pump D) Oxygen pump
26. What is the primary purpose of biotelemetry? CO1.3 CL2
A) Tracking and monitoring the movement of animals in the wild
B) Investigating the behavior of plants in controlled environments
C) Analyzing the effects of pollution on aquatic ecosystems
D) Studying the interaction of pathogens with human cells
27. Which technology is commonly used in biotelemetry to collect and transmit data? CO1.3 CL1
A) Magnetic resonance imaging (MRI) B) DNA sequencing
C) Radio frequency identification (RFID) D) Polymerase chain reaction (PCR)
28. Which of the following is a limitation of biotelemetry? CO1.3 CL2
A) Limited range and coverage B) High cost and maintenance requirements
C) Ethical concerns and animal welfare issues D) All of the above
29. What is the advantage of ECG and EEG transmission? CO1.4 CL1
A) Real-time monitoring and remote access to data
B) Non-invasive and painless procedure
 C) Low cost and easy to perform
D) Suitable for all age groups
30. What is the primary purpose of EEG transmission? CO1.4 CL1
A) Diagnosing lung diseases B) Monitoring muscle activity
C) Assessing kidney function D) Evaluating brain function
PART-B
1. Explore how alarm systems are utilized in patient monitoring and their effects on patient CO1.1 CL4
safety and healthcare providers' daily routines. Discuss the significance of customizing
alarms and implementing strategies to prevent alarm fatigue.

Alarm systems play a crucial role in patient monitoring by alerting healthcare providers to
critical events or deviations from normal physiological parameters. However, the widespread
use of alarms in healthcare settings has led to a phenomenon known as alarm fatigue, where
healthcare providers become desensitized or overwhelmed by the sheer number of alarms. To
effectively analyze the role of alarm systems, it is important to consider the aspects of alarm
customization, alarm fatigue mitigation strategies, and their impact on patient safety and
healthcare providers' workflow. Alarm customization is essential for optimizing the
effectiveness of alarm systems. Healthcare settings have diverse patient populations, each with
unique physiological profiles and clinical needs. Customization allows alarm parameters to be
tailored to individual patients, ensuring that alerts are meaningful and clinically relevant.
Customization can be achieved by adjusting alarm thresholds, setting alarm delays, and
implementing individualized alarm settings based on patients' conditions. By reducing
unnecessary or false alarms, customization helps prevent alarm fatigue and ensures that
healthcare providers respond appropriately to critical situations.

IMPACTS: Early Detection of Critical Events: Alarm systems can detect early signs of
deteriorating patient conditions or abnormalities, enabling healthcare providers to intervene
quickly and prevent potential adverse outcomes.

Improved Patient Monitoring: Alarm systems allow continuous monitoring of patients' vital
signs, ensuring that any sudden changes are immediately noticed, even during periods when
direct observation may not be possible.

2. List the essential personnel and stakeholders in healthcare who heavily rely on patient CO1.3 CL1
monitoring systems to ensure patient safety and well-being.

 Healthcare Providers: This includes doctors, nurses, and other healthcare professionals
who directly care for patients. They rely on patient monitoring systems to track vital
signs, detect abnormalities, and make informed decisions about patient care and
treatment.
 Patients: Patients themselves benefit from patient monitoring systems as they provide
continuous monitoring of their vital signs, allowing for early detection of any
concerning changes in their health. It enables patients to receive timely interventions and
improves their overall safety and well-being.
 Hospitals and Healthcare Facilities: Patient monitoring systems are crucial for hospitals and
healthcare facilities to provide high-quality care. These systems help optimize resource
 allocation, facilitate efficient workflows, and enhance patient safety by ensuring continuous
monitoring of patients in various units, such as intensive care units (ICUs) and operating rooms
3.1. Classify the Patient monitoring system used in health care units CO1.2 CL1
 Vital Sign Monitors: These monitoring systems track and display essential vital signs such as
heart rate, blood pressure, respiratory rate, temperature, and oxygen saturation. They provide
real-time measurements and alarms for any abnormalities in these parameters.
 Electrocardiography (ECG) Monitors: ECG monitors focus on monitoring the electrical activity
of the heart, detecting irregularities, and displaying electrocardiogram waveforms. They are
commonly used in cardiology units, intensive care units, and during surgeries.
 Pulse Oximeters: Pulse oximeters measure oxygen saturation levels in a patient's blood, along
with pulse rate. These portable devices are often attached to a patient's finger, toe, or earlobe to
provide continuous monitoring.
 Blood Pressure Monitors: These monitors measure a patient's blood pressure, including systolic
and diastolic pressure. They can be automated or manual, and are often used in various
healthcare units for routine monitoring and assessment.
4.1. Imagine that a patient is admitted to the hospital with cardiac arrest. Provide the CO1.3 CL2
equipment suitable for continuous monitoring of the patient in order to optimize the
patient's care.
 Electrocardiogram (ECG) Monitor: An ECG monitor is crucial for monitoring the patient's heart
rhythm continuously. It provides real-time information about the electrical activity of the heart,
allowing healthcare providers to identify abnormalities, such as arrhythmias or ischemia.
 Pulse Oximeter: A pulse oximeter measures the patient's oxygen saturation levels and pulse rate.
It is essential for monitoring the patient's oxygen levels during resuscitation and post-
resuscitation care, ensuring adequate oxygenation.
 Invasive Blood Pressure Monitor: An invasive blood pressure monitor allows for continuous
monitoring of the patient's arterial blood pressure. It provides accurate and real-time
measurements, enabling healthcare providers to assess the patient's hemodynamic stability and
titrate medications or fluids accordingly.

5. In this scenario, a multispecialty hospital would be constructed that includes the medical CO1.4 CL2
units that are necessary, such as the obstetrics, cardiac care, emergency, outpatient, and
intensive care units. Analyze the existence of Critical care units and provide justifications
for placing ICU/CCU equipment in order to improve patient care.
 Enhance Patient Monitoring: The hospital aimed to provide comprehensive and real-time
monitoring of patients in the ICU. This involved tracking vital signs, oxygen saturation levels,
electrocardiogram (ECG) waveforms, and invasive hemodynamic parameters.
 Improve Data Accuracy and Accessibility: The hospital sought to ensure that accurate
patient data was readily accessible to healthcare providers. They aimed to integrate the new ICU
equipment with the hospital's electronic health record (EHR) system to facilitate seamless data
exchange and minimize manual data entry errors.
 Enable Timely Intervention: The advanced equipment was expected to provide
sophisticated alarms and alerts to notify healthcare providers of critical changes in a patient's
condition. This would help ensure prompt interventions, reducing the risk of adverse events.
 Facilitate Multidisciplinary Collaboration: The new equipment aimed to support seamless
collaboration among healthcare providers by enabling remote monitoring, secure data sharing,
and multidisciplinary team communication.
6.1. Recognize the need for precise and controlled medication delivery to enhance treatment CO1.4 CL2
outcomes and reduce the risk of medication errors and list out the objectives of
implementing infusion pumps.
2. Improved Medication Safety: The system significantly reduced the risk of medication
errors and adverse drug events. The drug library, safety alerts, and dose calculation capabilities
ensured accurate medication administration and minimized the potential for dosing errors.
3. Enhanced Workflow Efficiency: The integration with the EHR system reduced manual
documentation, streamlined medication order entry, and eliminated transcription errors. This
improved workflow efficiency, allowing healthcare providers to focus more on direct patient
care.
4. The objectives of implementing infusion pumps in healthcare settings are:
 Precise Medication Delivery
 Patient Safety
 Continuous Monitoring
 Controlled Infusion Rates
 Comfort for Patients
 Standardization of Care
7. Sketch the basic blocks of the central monitors CO1.3 CL3
8. How does biotelemetry technology aid in monitoring vital signs? CO1.4 CL2
Biotelemetry technology plays a crucial role in monitoring vital signs by enabling the
continuous and remote collection of physiological data from patients. It allows healthcare
providers to track important health indicators without the need for patients to be physically
present at a healthcare facility. Here's how biotelemetry technology aids in monitoring vital
signs:
Continuous Data Collection: Biotelemetry devices, such as wearable sensors and remote
monitoring systems, continuously collect physiological data, including heart rate, blood
pressure, respiratory rate, body temperature, and oxygen saturation. This continuous monitoring
provides a more comprehensive view of a patient's health status compared to intermittent or
spot-check measurements.
Real-time Data Transmission: Biotelemetry devices use wireless communication
technologies, such as Bluetooth, Wi-Fi, or cellular networks, to transmit the collected data in
real-time to a central monitoring system or a healthcare provider's device. This allows
healthcare professionals to access the data remotely and monitor patients' vital signs from a
 distance.
Remote Patient Monitoring: Biotelemetry technology enables remote patient monitoring,
especially for patients with chronic conditions, post-operative care, or those requiring frequent
monitoring. Patients can be monitored in their homes, reducing the need for hospitalization and
improving patient comfort.

9. Outline the working principle of landline telemetry with its applications. CO1.2 CL1

Landline telemetry, also known as wired telemetry, is a method of transmitting data over fixed
communication lines (e.g., telephone lines, fiber-optic cables) from a remote location to a
central monitoring station. The working principle involves the following steps:
Data Acquisition: At the remote location, sensors or monitoring devices collect data from
the source being monitored. This data can be various types, such as physiological parameters,
environmental measurements, industrial process variables, or any other relevant information.
Signal Conditioning: Before transmission, the acquired data may undergo signal
conditioning to convert analog signals into digital format and ensure they are within the
appropriate range for transmission and processing.
Data Transmission: The modulated and encoded data is transmitted over landline
communication channels, such as traditional telephone lines or more modern fiber-optic cables.
The data is sent in the form of electrical signals through these wired connections.
Data Reception: At the central monitoring station or receiver end, the transmitted data is
received through the landline communication channels.
Data Processing and Display: The extracted data is processed and displayed on the central
monitoring station's screen or saved for further analysis and storage. Healthcare professionals,
engineers, or relevant personnel can monitor and interpret the data in real-time or later,
depending on the application.
Applications: Healthcare monitoring, Environmental monitoring, Surveillance system.
10. Draw the basic blocks involved in single channel biotelemetry. In what way multichannel CO1.4 CL1
is different from single channel biotelemetry.
Multichannel biotelemetry systems can handle data from multiple sensors or monitoring
devices simultaneously. They are capable of monitoring and transmitting data from two or more
physiological parameters or data sources at the same time.
 Single-channel systems are simpler in terms of data acquisition, as they are designed to
handle data from one sensor or monitoring device. The data acquisition process is
straightforward and focused on a single parameter.
Single-channel systems are well-suited for applications where monitoring a single vital sign
or physiological parameter is sufficient. They are commonly used in simple and specific
monitoring tasks.

11. Consider a person with heart issues and also completed pacemaker implantation recently.
Implement a suitable postoperative monitoring tool even at remote locations to improve
the patient care.
A biotelemetry system for ECG (Electrocardiogram) transmission is a technology that
allows the continuous monitoring and remote transmission of a patient's ECG data. It enables
healthcare providers to monitor a patient's heart activity in real-time, even when the patient is
not physically present in a medical facility. The components involved in the implementation of
a biotelemetry system for ECG transmission is given below
ECG Sensors: The system includes ECG sensors or electrodes that are attached to the patient's
body to collect electrical signals produced by the heart.
Signal Conditioning Unit: The collected analog ECG signals need to be conditioned before
transmission. A signal conditioning unit converts the analog signals into digital format and
amplifies them to ensure accurate data transmission.
Transmitter: The transmitter module receives the conditioned ECG data and encodes it for
transmission. It modulates the digital ECG signals onto a carrier signal, which can be
transmitted wirelessly. Wireless communication is needed for the communication.
Central Monitoring Station: At the receiving end, a central monitoring station or a healthcare
provider's device is equipped to receive and process the transmitted ECG data.
Data Display and Analysis Software: The central monitoring station is equipped with
software that displays the received ECG data in real-time and provides tools for analysis,
visualization, and interpretation of the ECG waveform.
The person’s data is acquired by these components and properly communicated to the
 physician through the biotelemetry and the reports can be continuously monitored. Thus the
technology for continuous monitoring were implemented by considering the biotelemetry.
12. Various applications, such as ECG and EEG transmission via biotelemetry, have been CO1.4 CL2
implemented in biotelemetry. Can you guess where each application varies from the
others?
Signals Monitored:
ECG Transmission: ECG monitors the electrical activity of the heart, specifically the
depolarization and repolarization of the heart muscles. It provides information about the heart's
rhythm, rate, and overall cardiac health.
EEG Transmission: EEG monitors the electrical activity of the brain. It records brain wave
patterns, which are used to study brain functions, detect abnormalities, and diagnose
neurological disorders.
Data Complexity:
ECG Transmission: ECG data is relatively straightforward as it represents the electrical activity
of the heart over time. The data is typically a single-channel waveform with clear patterns
related to the cardiac cycle.
EEG Transmission: EEG data is more complex as it records brain wave patterns from multiple
electrodes placed on the scalp. The data consists of multiple channels and requires sophisticated
analysis to interpret brain activities and identify specific brainwave patterns.
Signal Frequency:
ECG Transmission: The frequency of ECG signals is in the range of several hertz (Hz),
reflecting the heart's electrical activity over the cardiac cycle.
EEG Transmission: EEG signals have higher frequency components, typically ranging from 0.5
Hz to 100 Hz, representing various brainwave frequencies related to different brain states.
Clinical Use and Research:
ECG Transmission: ECG is primarily used for clinical purposes, including diagnosing heart
conditions, monitoring patients with cardiovascular diseases, and guiding cardiac interventions.
EEG Transmission: EEG is widely used in both clinical and research settings. In clinical
applications, it aids in diagnosing neurological disorders, while in research, it helps study brain
function, cognition, sleep patterns, and brain responses to various stimuli.
PART-C
1. Assess the impact of a patient monitoring system on patient outcomes and healthcare CO1.1 CL4
delivery. Justify your response with evidence.
Impact of Patient monitoring system: ( 2 M)
The implementation of a patient monitoring system can have a significant impact on patient
outcomes and healthcare delivery. Such systems leverage technology to continuously track
patients' vital signs, symptoms, and other health-related data, providing healthcare providers
with real-time information and alerts
Assessment on patients outcome: ( 6M)
 Early Detection of Deterioration: Patient monitoring systems enable early detection
of deteriorating health conditions. By continuously monitoring vital signs like heart
rate, blood pressure, and respiratory rate, the system can alert healthcare providers
when there are abnormalities or signs of potential complications. Early intervention
allows for timely treatment, reducing the risk of adverse events and improving
patient outcomes.
 Improved Patient Safety: With real-time data at their fingertips, healthcare providers
 can make more informed decisions and provide personalized care. The patient
monitoring system helps identify medication errors, allergic reactions, or adverse
events promptly, reducing the likelihood of medical errors and enhancing patient
safety.
 Enhanced Chronic Disease Management: For patients with chronic conditions,
continuous monitoring can assist in managing their health more effectively. By
tracking relevant health parameters, patients and healthcare providers can work
together to adjust treatment plans, promote adherence to medication, and make
lifestyle modifications, leading to better disease management and improved
outcomes.
Evidence ( Any Case study): (4M)

2. A 65-year old male, underwent cardiac bypass surgery due to severe coronary artery CO1.2 CL3
disease. Following the procedure, he was transferred to the cardiac intensive care unit
for post operative care. Implement the suitable integrated ICU equipments and also
Explain how it is used in the patient monitoring system.
For post-operative care of a 65-year-old male who underwent cardiac bypass
surgery, an integrated ICU equipment setup is essential to monitor and manage the patient's
critical parameters. The following are some of the suitable integrated ICU equipment
commonly used in cardiac intensive care units and their role in the patient monitoring
system
Cardiac Monitor: A cardiac monitor continuously displays the patient's heart rate,
electrocardiogram (ECG) waveform, and rhythm. It helps detect any arrhythmias or
abnormal heart patterns that may require immediate attention. The cardiac monitor is
crucial for early detection of potential cardiac complications following bypass surgery.
Pulse Oximeter: A pulse oximeter measures the patient's oxygen saturation (SpO2) levels,
providing information about how well the patient's blood is being oxygenated. It is a non-
invasive way to monitor respiratory function and detect hypoxemia (low oxygen levels).
Invasive Blood Pressure Monitor: This device continuously measures the patient's arterial
blood pressure invasively through an arterial line. It provides accurate and real-time
information on blood pressure fluctuations, which is crucial for managing blood pressure
levels and ensuring adequate tissue perfusion.
Central Venous Catheter (CVC) and Pressure Monitoring System: For patients
requiring intensive hemodynamic monitoring, a central venous catheter (CVC) is inserted,
typically in the internal jugular or subclavian vein. It allows direct measurement of central
venous pressure (CVP) and provides valuable information about the patient's fluid status
and cardiac function. (10M)
Implementation: All the above equipment are integrated into a patient monitoring system,
which collects and displays the data from these devices in a centralized location. This
system allows healthcare providers to have real-time access to the patient's vital signs,
cardiac function, respiratory status, fluid balance, and other critical parameters.
The data from the monitoring system can be continuously analyzed by healthcare providers,
enabling early detection of any deterioration or abnormalities in the patient's condition.
Alerts and alarms can be set up to notify the care team if any parameter goes beyond preset
thresholds, ensuring timely interventions.
Furthermore, the integration of these devices in the ICU allows for seamless
 communication and coordination among the healthcare team. It enables prompt decision-
making, facilitates immediate responses to changes in the patient's condition, and ultimately
improves the overall post-operative care and outcomes of the patient following cardiac
bypass surgery. (2M)
3. Provide examples of how bedside monitors improve patient care, such as early CO1.2 CL2
detection of deteriorating conditions, reduced response times to critical events, and
improved clinical decision-making.
Bedside monitors play a crucial role in improving patient care by providing real-time
data and facilitating early detection of deteriorating conditions, reducing response times to
critical events, and enhancing clinical decision-making. (6M)

Early Detection of Deteriorating Conditions: (6M)

Example: A patient is admitted to the intensive care unit (ICU) after cardiac surgery. The
bedside monitor continuously displays the patient's vital signs, including heart rate, blood
pressure, and oxygen saturation. If the patient's blood pressure starts dropping or heart rate
becomes irregular, the bedside monitor can alert the healthcare team immediately. Early
detection allows prompt intervention, such as fluid resuscitation or medication adjustments,
preventing further deterioration.
Reduced Response Times to Critical Events: A patient on the medical-surgical floor starts
experiencing difficulty breathing. The bedside monitor detects a sudden drop in oxygen
saturation and triggers an alarm. The nursing staff responds immediately, initiating
appropriate interventions, such as increasing supplemental oxygen or calling for rapid
assistance from a respiratory therapist. This rapid response can prevent respiratory failure or
the need for emergent transfer to the ICU.
Improved Clinical Decision-Making : A patient with sepsis is being closely monitored in
the ICU. The bedside monitor displays trends in vital signs and laboratory values. The
patient's blood pressure, heart rate, and respiratory rate are persistently elevated. The
healthcare team, using this data, recognizes the severity of the sepsis and promptly
 administers antibiotics and fluids, leading to early stabilization and improved patient
outcomes.
4. How have advanced monitoring systems in ICUs improved patient outcomes by CO1.2 CL2
providing real-time data on vital signs and trends?
Advancements in ICU equipment have significantly optimized patient care, reduced
complications, and enhanced overall outcomes in critical care settings. These advancements
are driven by cutting-edge technologies, improved monitoring capabilities, and integration
with electronic health records (EHR). (6M)
 Ambulatory monitoring is not only an invaluable aid to the physician in the differential
diagnosis of many unexplained symptoms like dizziness, syncope and palpitation but it also
provides accurate data for the evaluation of drug therapy, stress testing, artificial
pacemakers, status of myocardial infarction and several other problems in research
programmes. The technique is so well established now that, ambulatory monitoring
departments have become a common feature in the hospital service, accepted as a matter of
course just like the X-ray or pathology department.
 Holter Monitors: Tape-based or solid-state systems that provide continuous recording of
All of the data is available to the system and screening expert for retrieval, review and editing..The
current state of Holter technology uses small recorders with flashcard technology to record and
store data from 2 to 3 ECG leads attached to the patient’s chest and collected conreturned, the data
are analyzed in digital format. Newer Holter monitors are now available with upto 2 weeks of
recording capability.
 Implantable Cardiac Monitors-Implantable cardiac monitors (ICMs) continuously monitor
the patient’s electrocardiogram and perform real-time analysis of the heart rhythm, for up to
36 months. The current clinical use of ICMs involves the evaluation of transitory symptoms
of possible arrhythmic origin. In particular, ICMs may have an emerging role in the
management of patients with atrial fibrillation and in those at risk of ventricular arrhythmias
Improved Monitoring and Data Accessibility: (6M)
 Modern ICU equipment allows for continuous monitoring of multiple vital signs, such as
heart rate, blood pressure, respiratory rate, oxygen saturation, and more. This continuous
monitoring provides a comprehensive view of the patient's condition, enabling healthcare
providers to detect subtle changes and intervene promptly.
 The integration of ICU equipment with EHR systems allows seamless data sharing and
accessibility among the care team, ensuring that all providers have real-time access to the
patient's critical data and treatment history.
Early Detection of Complications:
 Advanced ICU equipment is equipped with sophisticated algorithms and smart alerts that
can detect early signs of deterioration or complications. For example, the equipment can
alert the care team if a patient's heart rate or blood pressure deviates from the expected
range, facilitating timely interventions before a critical event occurs.
 Early detection of complications leads to faster response times, reducing the severity of
adverse events and improving patient outcomes.
Enhanced Patient Safety:
 Safety features integrated into ICU equipment, such as drug libraries in infusion pumps and
barcode medication administration systems, help prevent medication errors and adverse
drug events.
 Automated checks and alerts reduce the likelihood of human errors, enhancing patient
safety in the critical care environment.
Overall, advancements in ICU equipment have revolutionized critical care delivery, allowing for
more precise monitoring, early detection of complications, and tailored treatment plans. These
 improvements have contributed to reduced complications, enhanced patient safety, and improved
overall outcomes in the critical care setting.
5. Elaborate on the role and impact of infusion pumps in patient care and medication CO1.2 CL2
delivery within clinical settings.
Infusion pumps play a critical role in patient care and medication delivery within clinical
settings. These devices are used to deliver fluids, medications, and nutrients to patients in a
controlled and precise manner. They provide several benefits that have a significant impact on
patient safety, treatment efficacy, and healthcare efficiency.
1.Precise medication delivery: (12 M)
Infusion pumps allow for the precise and accurate delivery of medications and fluids, ensuring that
the prescribed dosage is administered at a controlled rate. This level of precision is crucial,
especially for medications with narrow therapeutic ranges or critical intravenous therapies
2. Reduction of medication error
Infusion pumps have built-in safety features, such as drug libraries and dose-checking
functionalities. These features help prevent medication errors by alerting healthcare providers if the
programmed dose exceeds safe limits or if there is a potential drug interaction.
3.Continuous infusion management
Infusion pumps are commonly used in critical care settings, such as intensive care units (ICUs), to
deliver continuous infusions of medications, such as sedatives, pain management drugs, or
vasoactive agents. Continuous infusions provide a consistent and stable drug concentration,
contributing to optimal patient care and comfort.
4.Multichannel infusion capability
Advanced infusion pumps can handle multiple channels, allowing for concurrent administration of
multiple medications or fluids. This capability streamlines patient care, especially for patients
requiring complex treatments or multiple therapies simultaneously.
5.Programmable dosing
Infusion pumps can be programmed to deliver medications based on specific dosing regimens,
including bolus doses, intermittent infusions, and tapering schedules. This flexibility allows
healthcare providers to tailor treatments to individual patient needs.
6.Enhanced mobility and patient care
Portable and ambulatory infusion pumps allow patients to move freely while receiving necessary
therapies. This mobility enhances patient comfort and facilitates more flexible treatment options,
such as outpatient care or home infusion services.
Infusion pumps play a crucial role in patient care by providing precise medication delivery, reducing
medication errors, and enabling continuous infusion management. They contribute to enhanced
patient safety, treatment efficacy, and healthcare efficiency in clinical settings. The use of infusion
pumps has revolutionized medication administration, especially in critical care, where accurate
dosing and continuous therapies are vital for optimal patient outcomes.
6. Implement a system to improve patient monitoring capabilities by employing a system CO1.3 CL3
that can simultaneously track multiple physiological parameters in real-time. Also
highlight its outcomes, benefits and challenges.
To improve patient monitoring capabilities and simultaneously track multiple physiological
parameters in real-time, a comprehensive system with multichannel telemetry can be implemented
The configuration of a multi telemetry system can vary depending on the specific needs and
requirements of the healthcare facility and the patient's condition (4M)
1. Telemetry Devices
2. Central Monitoring Station
3.Alarms and notifications
4.mobile telemetry solutions
5.Telemedicine and remote monitoring
 With appropriate electrodes/transducers and preamplifiers, the multi-channel systems permit
the transmission of the following parameters simultaneously depending upon the number of
channels required: ECG and heart rate, respiration rate, temperature, intravascular and intra-cardiac
blood pressure.
In multi-channel telemetry, the number of sub-carriers used is same as the number of signals to be
transmitted. Each channel therefore has its own modulator. The RF unit—the same for all channels
—converts the mixed frequencies into the transmission band. Similarly, the receiver unit contains
the RF unit and one demodulator for each channel. (4M)
For multi-channel radiotelemetry, various channels of information are combined into a single
signal. This technique is called multiplexing. There are two basic methods of multiplexing.
These are: FDM and TDM
Outcomes and Benefits of the System (2M)
Enhanced Patient Safety: Real-time monitoring of multiple physiological parameters allows for
early detection of complications and timely intervention, leading to improved patient safety.
Remote Monitoring Capabilities: The system's cloud-based functionality enables remote monitoring
of patients, supporting telemedicine and extending monitoring capabilities beyond the clinical
setting.
Challenges (2M)
Integration Complexity: Integrating multiple monitoring devices and ensuring seamless data
transmission can be complex and require careful planning
Equipment Reliability: The reliability of monitoring devices is crucial for continuous and accurate
data collection. Regular maintenance and calibration are necessary to ensure device accuracy.
7. Assume remote patient monitoring system in healthcare setting, which leverage CO1.3 CL2
landline communication technology to monitor patients' vital signs and transmit data
securely to healthcare providers. Give a brief description about the landline telemetry
unit with block diagram?
A landline telemetry unit, also known as a telemonitoring system, is a medical device that
allows remote monitoring of patients' vital signs and physiological parameters using a landline
(wired) connection. This system facilitates continuous data transmission from the patient's location
to a central monitoring station, where healthcare providers can review the real-time data and make
informed decisions about the patient's care. Here are the key components and functionalities of a
landline telemetry unit.
Components of a Landline Telemetry Unit (10 M)
Transducer: Used for the data acquisition
Signal processing unit: The acquired data can be processed and modulated before transmission
Receiver unit: Same way in receiver unit, demodulation and decoding process to be done and can be
used along with the display unit.
Monitoring Device: The monitoring device is the main component placed at the patient's location.
It can be a standalone unit or a set of devices that measure and record vital signs, such as heart rate,
blood pressure, oxygen saturation, respiratory rate, and temperature.
Landline Connection: A landline connection, typically using traditional phone lines or Ethernet
cables, is used to transmit the patient's data from the monitoring device to the central monitoring
station.
Central Monitoring Station: The central monitoring station is located at a healthcare facility,
where healthcare providers can access and review the patient's real-time data. It may be a dedicated
workstation or a cloud-based platform accessible through authorized devices.
 Benefits of a Landline Telemetry Unit (2M)
Improved Patient Outcomes: Continuous monitoring and timely intervention based on real-time
data lead to improved patient outcomes and reduced hospital readmissions.
Enhanced Patient Safety: Early detection of critical events and abnormalities allows for timely
response and improved patient safety.
Remote Patient Monitoring: Landline telemetry units enable the monitoring of patients in
remote locations, extending healthcare services to underserved areas.
Efficient Care Management: Healthcare providers can manage multiple patients simultaneously
through remote monitoring, leading to more efficient care management and resource allocation.
Cost-Effectiveness: Remote monitoring can potentially reduce hospitalization costs and the
need for frequent in-person visits.
8. Identify the technology that enables doctors to monitor patients without having to sit CO1.4 CL4
with them. Consider the following scenario: a person has coronary heart disease, and
Examine the deployment and use of biotelemetry in a hospital setting for the
transmission of electrocardiogram (ECG) data, which assists doctors in understanding
general, heart health by measuring specific components of your heart activity.
The deployment and use of biotelemetry in a hospital setting for the transmission of
electrocardiogram (ECG) data have become increasingly prevalent and valuable in modern
healthcare. Biotelemetry, also known as wireless telemetry or remote monitoring, involves the
continuous and real-time transmission of physiological data from a patient to a centralized
monitoring system. In the context of ECG data, this technology plays a crucial role in assisting
doctors in understanding a patient's heart health by monitoring specific components of their heart
activity. (3M)
  The subject should be able to carry on with his normal activities whilst carrying the
instruments without the slightest discomfort. He should be able to forget their presence
after some minutes of application.
 Motion artifacts and muscle potential interference should be kept minimum.
The battery life should be long enough so that a complete experimental procedure may
be carried out. While monitoring paced patients for ECG through telemetry, it is necessary to reduce
pacemaker pulses. The amplitude of pacemaker pulses can be as large as 80 mV compared to 1–2
mV, which is typical of the ECG. The ECG amplifiers in the transmitter are slew rate (rate of
change of output) limited so that the relatively narrow pacemaker pulses are reduced in amplitude
substantially. (9M)
9 Consider a person with brain disorders with the case history of internal bleeding and CO1.4 CL2
also he underwent a surgery to overcome from the disorder. Explain about the
postoperative system to be needed in patient monitoring system. Provide rationale for
your answer.
A biotelemetry unit for EEG transmission, also known as wireless EEG monitoring, is a system that
allows for the remote and continuous monitoring of a patient's brain activity through
electroencephalogram (EEG) data. This technology enables healthcare providers to capture and
analyze brainwave patterns in real-time without the constraints of wired connections, providing
valuable insights into a patient's neurological status.
Components of a Biotelemetry Unit for EEG Transmission (8 M)
EEG Electrodes and Amplifiers: The biotelemetry unit includes EEG electrodes that are placed on
the patient's scalp to measure electrical signals from the brain. Amplifiers are used to amplify and
process these signals.
Wireless Transmitter: The biotelemetry unit is equipped with a wireless transmitter that sends the
amplified EEG signals to a remote receiver or central monitoring station.
Receiver or Central Monitoring Station: The receiver or central monitoring station is typically
located within the hospital or healthcare facility. It receives and displays real-time EEG data from
multiple patients.
 Working:
Patient Preparation: EEG electrodes are placed on the patient's scalp using a special conductive
gel or adhesive. These electrodes pick up electrical signals generated by the brain.
Amplification and Signal Processing: The electrical signals collected by the EEG electrodes are
amplified and processed by the biotelemetry unit's amplifiers. This enhances the signal quality and
reduces interference or noise.
Wireless Transmission: The amplified EEG signals are wirelessly transmitted from the
biotelemetry unit to the receiver or central monitoring station. The wireless transmission technology
used may be Bluetooth, Wi-Fi, or other radiofrequency-based communication methods.
Central Monitoring and Data Analysis: At the receiver or central monitoring station, EEG data
from multiple patients is displayed in real-time. Healthcare providers, such as neurologists or EEG
technologists, can analyze the brainwave patterns and interpret the data for diagnostic purposes.
Reasons for using biotelemetry as a postoperative tool: (4M)
Intraoperative Monitoring: Biotelemetry for EEG transmission is valuable during surgical
procedures involving the brain. It helps monitor the patient's neurological status and detect any
changes in brain activity during surgery, enabling prompt intervention if necessary.
Epilepsy Monitoring: For patients with epilepsy or suspected seizure disorders, biotelemetry EEG
monitoring allows for extended monitoring outside the hospital setting. This helps capture and
analyze seizure activity in various environments to aid in diagnosis and treatment planning.
Sleep Studies: Biotelemetry EEG monitoring is used in sleep studies (polysomnography) to assess
sleep patterns, brain activity during different sleep stages, and identify sleep disorders like sleep
apnea or narcolepsy.
Neurological Assessments: In neurological assessments, biotelemetry EEG transmission helps
monitor brain activity in patients with traumatic brain injuries, strokes, or other neurological
conditions, providing crucial information for diagnosis and treatment decisions.

UNIT II DIATHERMY
Q. QUESTION CO CL
NO LEV
EL
PART-A
1. _____used to produce microwaves in microwave diathermy CO2.2 CL1
A)Klystron B)Megnetron C)TWT D)Multivibrator
2. The main application of IR lamp is _____ CO2.1 CL2
A)Wound healing B)Surgery C)Therapy D)Cancer treatment
3. ______is the source of ultrasonic diathermy CO2.2 CL1
A)Oscillator B)Crystal C)Vibrator D)vaccum tube
4. What is the frequency range of the sound used for ultrasound diathermy? CO2.2 CL1
A)0.1-0.7Mhz B)0.7-3.3 Mhz C)3.3-5 Mhz D)5-15 Mhz

5. What surgical functions are performed by the diathermy machine ? CO2.2 CL1
A)Cutting, coagulation, fulguration B)Cutting,fulguration
C)Cutting,coagulation D) Coagulation, fulguration
6. Which among the wave is electromagnetic wave? CO2.1 CL1
A)Alpha rays B) Ultrasound C)Gamma D)Beta
7. Which electromagnetic wave has maximum wavelength? CO2.1 CL1
A)X-ray B) Gamma ray C) Radio Wave D) Infra red wave
8. Which of the following rays has maximum frequency? CO2.1 CL1
 A)UV rays B)Microwave C)Infrared wave D)X-ray
9. For what purpose is diathermy principal is used? CO2.2 CL1
A)Surgical and Therapeutic B)Therapeutic and Diagnostic
C) Diagnostic and surgical D)Diagnostic and Rehabilitation
10. What are the types of therapeutic diathermy machines that exist are…………… CO2.2 CL1
A) Short wave, Micro wave and ultrasound B)Short wave, ultrasound and cold compress
C) Cold compress, microwave and electrical impulse
D)Electrical Impulse, Microwave and ultrasound
12. Monopolar electrosurgery requires the use of a grounding pad CO2.3 CL2
A)true B)false
13. Electro surgery most commonly used are____ CO2.3 CL1
A)high frequency B)high current C)low frequency D)high amplitude
14. Prior to placement of grounding pad on the patient ,you check with the, CO2.3 CL2
A)scrub B)anesthetist C)patient D)circulator
15. Select the duty performed by the circulator during the use of the ESU. CO2.4 CL1
A)clean bovie tip B)remove grounding pad C)disconnect all cords
D)check both bovie and grounding pad cables
16. Which of the diathermy machine is good for deep tissue healing? CO2.2 CL1
A) Ultrasound B) Electrosurgery unit C) Short wave D) Microwave
17. In Ultrasonic Machining, Magnetostrictor is energized at ultrasonic frequency. CO2.2 CL1
A)True B)False
18. The probe used for imaging the heart is ________ CO2.4 CL1
A) Linear Probe B)Curvilinear Probe
C) Phase Array Probe
19. Which mode is used for cardiac imaging? CO2.2 CL1
A) A – Mode B) B – Mode C) M – Mode D)3D – Mode
20. Continuous Wave (CW), Pulsed Wave (PW) and Color Flow (CF) are terms used for which CO2.2 CL1
kind of ultrasound?
A)3D ultrasound B) Dynamic Ultrasound C)Doppler Ultrasound
D) Advanced Ultrasound
21. An approximate voltage to produce voltage arc is _________ CO2.3 CL1
A) 250v B) 200v C) 220v D) 210v
22. The steady flow of current is called as __________ CO2.3 CL1
A) Surge current B) Galvanic current
C) Faradic current D) Exponential current
23. In which type,electric arcs are deliberately produced between the spray electrode and CO2.3 CL1
tissue.________
A) Spray coagulation B)Forced coagulation
C)Soft coagulation D) coagulation
24. The two electrodes are used to perform electric surgery is called_____ CO2.3 CL1
A) Monopolar technique B) Bipolar technique
C) Haemostasis technique D) None
25. The concurrent use of continuous wave for cutting and burst wave for coagulation is CO2.4 CL1
____________
A) Fulguration B) Dessication
C) Haemostasis D) None
26. ____________is performed by electrosurgical unit. CO2.4 CL1
A) Cutting B) Coagulation C) Blended D) All the above
PART-B
1. Evaluate the use of IR lamps as a non-invasive treatment modality for various medical CO2.1 CL4
conditions. Support your answers with evidence available in health care.
Infrared (IR) lamps have been used as a non-invasive treatment modality in healthcare for
various medical conditions. The therapeutic use of IR lamps, also known as infrared radiation
therapy or infrared heat therapy, involves exposing the body to infrared radiation to produce
beneficial physiological effects. Here's an evaluation of the use of IR lamps for specific medical
conditions, supported by evidence available in healthcare
Pain Relief and Musculoskeletal Conditions
Infrared heat therapy has been studied for its analgesic (pain-relieving) effects. Research has
shown that IR therapy can help reduce pain and improve function in conditions like
osteoarthritis, rheumatoid arthritis, fibromyalgia, and lower back pain. The deep heat generated
by IR lamps can help relax muscles, improve blood circulation, and alleviate pain.
Wound Healing
Infrared radiation has been shown to enhance wound healing in certain cases. Studies suggest
that IR therapy can stimulate collagen production, increase blood flow, and promote tissue
repair. It has been used in wound care settings for diabetic foot ulcers, pressure ulcers, and
other chronic wounds.
While there is evidence supporting the therapeutic use of IR lamps for certain medical
conditions, it's essential to note that research in this field is ongoing, and the clinical
applicability may vary depending on individual patient characteristics and the specific condition
being treated. As with any medical treatment, it is important for healthcare providers to
carefully assess each patient's needs, consider the available evidence, and tailor the treatment
accordingly. Moreover, IR therapy should always be administered by qualified healthcare
professionals to ensure safety and effectiveness.
2. Are UV lamps suitable for use in healthcare settings? Provide reasons for the same with CO2.1 CL2
practical applications.
UV lamps, specifically ultraviolet-C (UV-C) lamps, can be suitable for use in certain healthcare
settings for specific purposes. UV-C lamps emit ultraviolet light with a wavelength of around
254 nanometers, which has germicidal properties capable of inactivating bacteria, viruses, and
other microorganisms
Reasons with applications:
Instrument and Equipment Sterilization:
UV-C lamps can be integrated into sterilization processes for medical instruments and
equipment. These lamps are used in specialized devices that emit UV light to sterilize surgical
instruments, endoscopes, and other medical devices, complementing traditional methods like
steam sterilization.
Prevention of Hospital-Acquired Infections (HAIs)
Hospital-acquired infections (HAIs) are a significant concern in healthcare settings. UV-C
lamps can be a valuable tool in the overall infection prevention strategy, helping to reduce HAIs
and improve patient safety.
It is essential to recognize that UV-C lamps should be used with caution, as direct
exposure to UV-C light can be harmful to the skin and eyes. Therefore, proper safety protocols
and guidelines must be followed during the operation and maintenance of UV-C lamps.
 Additionally, UV-C light has limited penetration, so surfaces and areas must be exposed
adequately to ensure effective disinfection.
3. A 35 year old woman was suffered from acute back pain and after the examination, CO2.2 CL2
Doctor advised to take the physiotherapy, after the regular therapy she feels somewhat
relief from the back pain. Can you explain how the biological tissues responded to the
diathermy and how the pain relief occurs after diathermy?
Diathermy is a therapeutic technique that uses high-frequency electrical currents to
generate heat in biological tissues for various medical purposes. When applied to the body,
diathermy can have several effects on biological tissues, leading to pain relief and other
therapeutic benefits. Physical stimulus commonly employed in the practice of physiotherapy is
in the form of heat, either by simple heat radiation or by the application of high frequency
energy obtained from
special generators. The use of high frequency energy in thermotherapy has the advantage of
considerable penetration as compared with ‘simple’ heat application. Thus, with high frequency
energy, deeper lying tissues, e.g. muscles, bones, internal organs, etc. can be provided heat.
High frequency energy for heating is obtained by various ways. It may be from the shortwave
therapy unit making use of either the condenser field or the inductor field method. Microwaves
and ultrasonic waves are also used for heating purposes in special cases. Let's explore how
tissues respond to diathermy and how it contributes to pain relief:
Vasodilation and Increased Blood Flow
Nerve Modulation
Muscle Relaxation
Increased Tissue Elasticity
Accelerated Tissue Repair
Diathermy produces several physiological responses in biological tissues, including
increased blood flow, nerve modulation, muscle relaxation, and tissue repair. These effects
contribute to pain relief and improved tissue function, making diathermy a valuable therapeutic
modality in various medical and rehabilitation settings.
4. Provide background information on short wave diathermy and its potential therapeutic CO2.2 CL2
effects.
The heating of the tissues is carried out by high frequency alternating current which
generally has a frequency of 27.12 MHz and a wavelength of 11 m. Currents of such high
frequencies do not stimulate motor or sensory nerves, nor do they produce any muscle
contraction. Thus, when such a current is passed through the body, no discomfort is caused to
the subject. The current being alternating, it is possible to pass through the tissues currents of a
much greater intensity to produce direct heating in the tissues similar to any other electrical
conductor. The method consists in applying the output of a radio frequency (RF) oscillator to a
pair of electrodes which are positioned on the body over the region to be treated. The RF energy
heats the tissues and promotes healing of injured tissues and inflammations.
Therapeutic effects
 Diathermy induces vasodilation, which is the widening of blood vessels in the treated
area. Increased blood flow improves oxygen and nutrient supply to the tissues and aids
in the removal of metabolic waste products. This enhanced circulation promotes tissue
healing and reduces inflammation, which can contribute to pain relief.
 Diathermy's heat can cause muscle relaxation by reducing muscle spasm and tension.
This relaxation helps in improving muscle flexibility, range of motion, and reducing
 muscle pain and discomfort. Diathermy's ability to improve blood circulation and
promote tissue healing helps in the repair of damaged tissues. This can be beneficial for
various conditions, such as soft tissue injuries, wound healing, and musculoskeletal
disorders.
5. Compare ultrasound, microwave and short wave diathermy in terms of working principle CO2.2 CL2
and the applications in health care.

ULTRASOUND MICROWAVE SHORTWAVE

Ultrasound diathermy
utilizes high-frequency
sound waves (ultrasound) to
generate heat in tissues
through absorption of the
sound energy. The
ultrasound waves penetrate
the skin and are absorbed
by deeper tissues, where the
energy is converted into
heat. This heat can increase
blood flow, relax muscles,
and promote tissue repair.
Microwave diathermy
utilizes electromagnetic
waves with microwave
frequencies to generate heat
in tissues. The microwaves
penetrate deep into the
tissues, where they are
absorbed by water
molecules, causing friction
and heat generation
Short wave diathermy uses
high-frequency
electromagnetic waves to
produce heat within the
tissues. The waves
penetrate deep into the
tissues, and the heat
generated helps increase
blood flow, relax muscles,
and promote healing.

Physical Therapy: Deep Tissue Heating: Muscle Spasms: SWD is

Ultrasound diathermy is
commonly used in physical
therapy to treat
musculoskeletal conditions
like muscle strains, sprains,
and tendonitis. The heat
generated helps in pain
relief, reducing
inflammation, and
improving tissue healing.
Sports Injuries: Ultrasound
diathermy is employed to
manage sports-related
injuries, such as ligament or
tendon injuries. The
localized heating promotes
healing and restores tissue
function.
Microwave diathermy is effective in reducing
effective for providing deep muscle spasms and tension,
tissue heating, making it making it valuable for
useful in conditions that muscular conditions and
require deep penetration, injuries.
such as deep muscle
injuries or joint pain.
Pain Relief: The heat
generated by microwave
diathermy can help relieve
pain and muscle spasms in
various conditions.

6. As microwave diathermy improves pain management effectiveness, use it for a variety of CO2.3 CL3
musculoskeletal conditions and implement it using appropriate equipment, treatment
parameters, and safety considerations.
Microwave diathermy consists in irradiating the tissues of the patient’s body with very
 short wireless waves having frequency in the microwave region. Microwaves are a form of
electromagnetic radiation with a frequency range of 300-30,000 MHz and wavelengths varying
from 10 mm to 1 m. In the electromagnetic spectrum, microwaves lie between short waves
and infrared waves. The most commonly used microwave frequency for therapeutic heating
is 2450 MHz corresponding to a wavelength of 12.25 cm. The heating effect is produced by the
absorption of the microwaves in the region of the body under treatment.

Microwave penetrates more deeply than infrared rays but not deeply as shortwave diathermy, so
microwave is not suitable for deeply placed structures (Cameron, 2009). The effective depth of
microwave penetration is about 3 cm so the depth of heating is intermediate between that of
infrared radiation and short wave diathermy. As the microwaves are strongly absorbed by
water, tissues with high fluid content are heated most, while less heat is produced for tissues
with low fluid content as fat.
7. Draw the current waveform normally employed in electro diagnosis. CO2.3 CL1
The typical specifications of an electro-diagnostic therapy unit are as follows:
 Galvanic current up to 80 mA, ripple less than 0.5% as constant current or surging
current
with adjustable surge frequency from 6 to 30 surges per minute
 Exponentially progressive current pulse sequences with continuously variable pulse
duration from 0.01 to 1000 ms and independently adjustable interval duration of 1 to
10,000 ms. The pulse form can be set continuously between triangular and rectangular
forms;
 Faradic surging current with 25 surges per minute, up to 80 mA. Precision and
constancy
of the values set better than ±10%; peak current measurement facility. Constant current
circuit, both poles earth-free.
8. Due to advancements in healthcare, doctors are now performing surgery without blood CO2.3 CL2
and sutures on patients to reduce bleeding and pain. Recognize the surgical unit and
provide a description of the unit's working principle as well as its benefits.
The use of high frequency current offers a number of important advantages. The
separation
of tissues by electric current always takes place immediately in front of the cutting edge and is
not caused by it. Electric cutting, therefore, does not require any application of force. Instead it
facilitates elegant and effortless surgery. The electrode virtually melts through the tissue
instantaneously and seals capillary and other vessels, thus preventing contamination by bacteria.
A simplified method of coagulation saves valuable time since bleeding can be arrested
immediately by touching the spot briefly with the coagulating electrode. A high frequency
apparatus is regarded as standard equipment in the operating theatre and it is kept ready for all
surgical interventions even if high frequency surgery is not intended so that use can be made of
its superior method of electro-coagulation.
Biological tissue can only be cut when the voltage between the cutting electrode and the
tissue to be cut is high enough to produce electric arcs between the cutting electrode and the
tissue. The temperatures produced at the points at which the electric arcs contact the tissue like
microscopic flashes of lightning are so high that the tissue is immediately evaporated or burned
away.Biological tissues are coagulated by thermal means if the requisite temperature is
maintained at around 70°C.
BENEFITS: Precise Tissue Cutting: Surgical diathermy provides precise cutting of tissues,
allowing surgeons to make controlled incisions with minimal damage to surrounding healthy
tissues. This precision is especially valuable in delicate surgeries where precision is critical,
 such as neurosurgery and ophthalmic surgery.
Reduced Blood Loss: The ability to coagulate blood vessels as tissue is cut significantly
reduces intraoperative blood loss, making it particularly valuable in surgeries involving highly
vascularized areas.
9. List the different current levels used in diathermy. Explain briefly CO2.4 CL1
The typical specifications of an electro-diagnostic therapy unit are as follows:
 Galvanic current up to 80 mA, ripple less than 0.5% as constant current or surging
current
with adjustable surge frequency from 6 to 30 surges per minute
 Exponentially progressive current pulse sequences with continuously variable pulse
duration from 0.01 to 1000 ms and independently adjustable interval duration of 1 to
10,000 ms. The pulse form can be set continuously between triangular and rectangular
forms;
 Faradic surging current with 25 surges per minute, up to 80 mA. Precision and
constancy
of the values set better than ±10%; peak current measurement facility. Constant current
circuit, both poles earth-free.
10. Outline the potential hazards associated with diathermy procedures also suggest the CO2.4 CL1
suitable safety procedures for each hazards.
Burns and Tissue Damage:
Hazard: Diathermy generates heat to coagulate tissues, but excessive heat or improper
technique can lead to burns and tissue damage in the treated area or surrounding tissues.
Safety Procedure:
Use the lowest effective power settings to minimize heat generation.
Avoid prolonged contact with the diathermy instrument on one spot.
Monitor the tissue temperature regularly during the procedure to prevent overheating.
Electrical Shock
Hazard: Improper grounding or insulation failure can lead to electrical shock to the patient or
healthcare personnel handling the equipment.
Safety Procedure:
Ensure proper grounding of the diathermy equipment.
Regularly inspect the equipment for any signs of wear, damage, or insulation failure.
Use a ground fault circuit interrupter (GFCI) to protect against electrical shock
Explosive Environments
Hazard: Diathermy equipment can generate sparks or electrical discharges, posing a risk in
potentially explosive environments where flammable gases or liquids are present.
Safety Procedure:
Avoid using diathermy in areas with flammable gases or liquids unless specifically designed
equipment is used for such environments.
Follow local safety guidelines and regulations in explosive environments.
11. Is the ultrasound concept the same for both ultrasound imaging and ultrasonic CO2.2 CL2
diathermy? Explain the situation.
While both ultrasound imaging and ultrasonic diathermy utilize ultrasound waves, the concepts
and applications are different due to their distinct purposes and techniques
Ultrasound Imaging
Ultrasound imaging, also known as medical sonography, is a non-invasive diagnostic
 technique used to visualize internal body structures in real-time. It uses high-frequency sound
waves (ultrasound) to create images of organs, tissues, and blood flow. The ultrasound waves
are transmitted into the body, and the reflections from different tissues are captured and
processed to create detailed images on a monitor.
The concept of ultrasound imaging involves the transmission of ultrasound waves into the
body, and the interaction of these waves with tissues leads to reflections and echoes. These
reflections are received by the ultrasound transducer and converted into images using
specialized imaging software. The intensity of the reflected ultrasound waves depends on the
density and composition of the tissues, allowing visualization of organs and structures within
the body.
Ultrasonic Diathermy
In ultrasonic diathermy, low-frequency ultrasound waves are applied directly to the
patient's skin using a specialized handheld applicator. The waves penetrate deep into the tissues,
causing molecular vibrations and friction. This friction generates heat, which helps in pain
relief, muscle relaxation, and promoting tissue healing.
12. SWD is now recommended by the majority of doctors for pain reduction therapy. Is it a CO2.2 CL2
suitable pain management therapy? If so, please provide information on the effects of
short wave diathermy.
Refer Q.NO 4
PART-C
1. Examine the existing evidence on the effectiveness of IR and UV lamps in wound healing. CO2.1 CL4
Discuss clinical studies, research findings, and practical applications in wound care
management.
It is important to note that medical research is continuously evolving, and new
evidence may have emerged since then. Always consult the most recent and reliable sources for
the latest information.
Infrared (IR) Lamps in Wound Healing: IR lamps emit non-visible light in the infrared
spectrum, which can penetrate deeper into tissues compared to visible light. There is some
evidence to suggest that IR therapy may have beneficial effects on wound healing.
Practical Applications in Wound Care Management: In clinical practice, IR therapy is often
used as part of photobiomodulation therapy (PBMT) or low-level laser therapy (LLLT) for
wound healing. The treatment involves applying IR light directly to the wound site using IR
lamps, lasers, or LEDs. The potential benefits of IR therapy in wound care management
include:
Increased blood flow and microcirculation to the wound area.
Enhanced collagen production, which aids in tissue repair and wound closure.
Reduced inflammation and pain in the treated area.(4 M) + case study (2M)
Ultraviolet (UV) Lamps in Wound Healing: UV lamps emit ultraviolet light, which is not
typically used directly for wound healing due to its potential harmful effects on tissues.
However, certain subsets of UV light (e.g., UVA and UVB) have been studied in wound
healing applications, particularly in the context of ultraviolet blood irradiation (UBI).
Practical Applications in Wound Care Management: The direct use of UV lamps for wound
healing is not common due to the potential risks of UV exposure on the skin, including sunburn
and increased risk of skin cancer. However, UBI has been investigated in some clinical settings
as a complementary or alternative therapy for certain medical conditions, although it remains a
controversial and less commonly used approach.
 Overall, while there is some evidence supporting the use of IR therapy with IR lamps for
wound healing, the direct use of UV lamps for wound healing is not recommended due to safety
concerns. It is crucial to consult with healthcare professionals and adhere to evidence-based
wound care protocols for the best possible patient outcomes. As research evolves, new evidence
may emerge, influencing clinical practices in wound care management.(4 M) + case study
(2M)
2. Explore the potential cost-effectiveness and efficiency of implementing ultrasonic CO2.2 CL3
diathermy in healthcare facilities. Analyze their impact on resource utilization and patient
outcomes.

Implementation of ultrasonic diathermy:

Ultrasonic generators are constructed on the piezo-electric effect. A high-frequency
alternating
current (e.g., 0.75-3.0 MHz) is applied to a crystal whose acoustic vibration causes the
mechanical
vibration of a transducer head, which itself is located directly in front of the crystal. These
mechanical vibrations then pass through a metal cap and into the body tissue through a coupling
medium. The therapeutic ultrasonic intensity varies from 0.5 to 3.0 W/cm2. Applicators range
from 70 to 130 mm in diameter. The larger the diameter of the applicator, the smaller would be
the angle of divergence of the beam and the less the degree of penetration.(6M)

Cost of Equipment: Initial investment in ultrasonic diathermy equipment can be a significant

factor in cost-effectiveness. The cost may vary depending on the brand, features, and
specifications of the device. However, once the equipment is acquired, it can be used for
multiple patients and over an extended period, potentially leading to a positive return on
investment.
Reducing Hospitalization Costs: By providing effective pain relief, muscle relaxation, and
tissue healing, ultrasonic diathermy may reduce the need for prolonged hospitalization or
additional treatment sessions. This can result in cost savings for both patients and healthcare
providers.
Avoiding Surgical Interventions: In some cases, ultrasonic diathermy may be used as an
alternative or adjunct to surgical interventions, especially for musculoskeletal conditions. By
avoiding surgery or assisting in post-operative recovery, it can potentially save on surgical costs
and associated hospitalization expenses.
Efficiency in Treatment: Ultrasonic diathermy is a non-invasive and relatively quick procedure.
It can be easily integrated into outpatient clinics, hospitals, and rehabilitation centers, reducing
the time required for treatment sessions. Efficient treatment times can result in increased patient
 throughput and better utilization of healthcare facilities. (6M)
3. A 55-year-old man has lower-limb and low-back joint pain. Following the examination CO2.2 CL2
and medication, the doctor recommended counseling for pain management. Suggest a
suitable diathermy for the aforementioned instance and describe how it works, as well as
its advantages over the other diathermy.
A short wave diathermy unit is the recommended unit for the above mentioned patient case.
Working of shortwave diathermy (10 M)
The short wave diathermy machine consists of two main circuits: an
oscillating circuit, which produces a high frequency current and a patient circuit, which is
connected to the oscillating circuit and through which the electrical energy is transferred to the
patient. Earlier models of diathermy machines employed single-ended or push-pull power
oscillators operating from unfiltered or partially filtered power supplies. They usually made use
of a valve circuit, a typical example of which is shown in Fig. 29.1. Transformer Tl, the primary
of
which can be energized from the mains supply, is a step-up transformer for providing EHT for
the anode of the triode valve. A second winding can provide heating current for the cathode of
the triode valve. The tank (resonance) circuit is formed by the coil AB in parallel with the
condenser Cl. The positive feedback is generated by coil CD. There is another coil EF and a
variable condenser C2 which form the patient’s resonator circuit due to its coupling with the
oscillator coil AB.The anode supply of such a circuit is around 4000 V. The conduction in the
triode takes place
during the positive half-cycle and the high frequency is generated only during this period. More
usually, the supply voltage is rectified before supplying to the anode of the oscillator valve. In
such a case, the oscillations produced are continuous and more power thus becomes available.
In order to ensure that the oscillator circuit and the patient’s resonator circuit are tuned with
each other, an ammeter is placed in series with the circuit. The variable condenser C2 is
adjusted to achieve a maximum reading on the meter, the needle swinging back on either side of
the tuned position. The maximum power delivered by these machines is 500 W. A thermal
delay is normally incorporated in the anode supply which prevents the passage of current
through this circuit until the filament of the valve attains adequate temperature. The patient
circuit is then switched on followed by a steady increase of current through the patient. A mains
filter is incorporated in the primary circuit to suppress interference produced by the diathermy
unit itself.

There are several ways of regulating the intensity of current supplied to the patient
from a
Short-wave diathermy machine. This can be done by either (i) controlling the anode voltage, or
 (ii) controlling the filament heating current, or (iii) adjusting the grid bias by change of grid
leak
resistanceR1, or (iv) adjusting the position of the resonator coil with respect to the oscillator
coil.
However, the best way of finely regulating the current is by adjusting the grid bias, by putting
a variable resistance as the grid leak resistance.
Advantages(2M)
Deep tissue penetration
Pain relief
Improved blood supply
Faster healing
Muscle relaxation
4. Consider the use of microwave diathermy in sports medicine and athletic injury CO2.2 CL2
rehabilitation. Give a description on microwave diathermy and explain its potential
applications in the management of acute sports injuries and recovery optimization for
athletes.
Microwave diathermy consists in irradiating the tissues of the patient’s body with very
short wireless waves having frequency in the microwave region. Microwaves are a form of
electromagnetic radiation with a frequency range of 300-30,000 MHz and wavelengths varying
from 10 mm to 1 m. In the electromagnetic spectrum, microwaves lie between short waves
and infrared waves. The most commonly used microwave frequency for therapeutic heating
is 2450 MHz corresponding to a wavelength of 12.25 cm. The heating effect is produced by the
absorption of the microwaves in the region of the body under treatment.

Microwave penetrates more deeply than infrared rays but not deeply as shortwave diathermy, so
microwave is not suitable for deeply placed structures (Cameron, 2009). The effective depth of
microwave penetration is about 3 cm so the depth of heating is intermediate between that of
infrared radiation and short wave diathermy. As the microwaves are strongly absorbed by
water, tissues with high fluid content are heated most, while less heat is produced for tissues
 with low fluid content as fat.(6M)
Muscle and Tendon Injuries: Microwave diathermy can be used to provide deep heating to
injured muscles and tendons. This can help reduce pain, muscle spasms, and inflammation,
promoting faster healing and recovery in acute injuries such as strains and sprains.
Ligament Injuries: Ligament injuries, such as ligament sprains, are common in sports.
Microwave diathermy can assist in the management of these injuries by increasing blood flow
to the affected ligaments, aiding in the healing process and improving stability.
Joint Injuries: Microwave diathermy can be applied to joints affected by acute injuries, such as
joint sprains. The deep heating can help alleviate pain, reduce joint stiffness, and improve range
of motion.
Pre-Exercise Warm-Up: Using microwave diathermy as part of a pre-exercise warm-up routine
can help increase blood flow to targeted muscle groups. This can improve muscle flexibility,
enhance performance, and reduce the risk of injury during physical activities.
Post-Exercise Recovery: After intense physical activity or competition, athletes can benefit
from microwave diathermy to promote muscle relaxation and reduce post-exercise muscle
soreness. The deep heating effect aids in flushing out metabolic waste products from muscles,
supporting the recovery process.
Contusion and Hematoma Management: Microwave diathermy can assist in the management of
contusions and hematomas by increasing blood flow to the affected areas, helping to reabsorb
the accumulated blood and reduce swelling.
Delayed-Onset Muscle Soreness (DOMS): Microwave diathermy can be used to manage
DOMS, which occurs after strenuous exercise. The deep heating effect can alleviate muscle
soreness and discomfort associated with DOMS. (6M)
5. Analyze the existing evidence on the long-term effects of diathermy in maintaining pain CO2.2 CL4
relief and functional improvement. Discuss the durability of treatment outcomes and
potential strategies for sustained benefits.

Any case study of diathermy (6M)

Potential Strategies for Sustained Benefits: (6M)
Comprehensive Treatment Plans: Integrating diathermy into comprehensive treatment plans
that include other evidence-based modalities, such as physical therapy, exercises, and lifestyle
modifications, may enhance the overall effectiveness and sustainability of treatment outcomes.
Regular Follow-up and Reassessment: Periodic follow-up assessments can help monitor the
patient's progress and identify any changes or deterioration in pain relief and functional
improvements. Adjustments to the treatment plan can be made based on these assessments.
Patient Education and Self-Management: Educating patients about their condition, the role of
diathermy in their treatment plan, and self-management techniques can empower them to take
an active role in their recovery. Encouraging patients to practice self-care and follow prescribed
exercises at home can contribute to sustained benefits.
Maintenance Treatments: For some individuals and conditions, maintenance diathermy
treatments at appropriate intervals may be necessary to sustain the benefits achieved during the
initial phase of therapy. This approach may be particularly relevant for chronic or degenerative
conditions.
Lifestyle Modifications: Addressing lifestyle factors that could contribute to the recurrence of
pain or functional limitations can be beneficial. Encouraging patients to adopt healthy habits,
such as regular physical activity, proper posture, and stress management, can complement the
 effects of diathermy and improve long-term outcomes.
Ongoing Rehabilitation Support: Continued involvement with rehabilitation professionals, such
as physical therapists or occupational therapists, can provide ongoing support and guidance in
managing the condition and optimizing functional improvement over time.
It is essential to emphasize that individualized treatment plans and the collaboration
between patients and healthcare providers are key to achieving and sustaining long-term
benefits with diathermy treatment. As with any medical intervention, the approach to
maintaining pain relief and functional improvement should be based on a thorough assessment
of the patient's condition and their response to treatment.
6. Investigate the role Electrosurgical unit enhancing patient well-being and quality of life. CO2.3 CL4
Discuss the mechanism of interaction with the biological tissues with its psychological and
physiological benefits
The use of high frequency current offers a number of important advantages. The
separation
of tissues by electric current always takes place immediately in front of the cutting edge and is
not caused by it. Electric cutting, therefore, does not require any application of force. Instead it
facilitates elegant and effortless surgery. The electrode virtually melts through the tissue
instantaneously and seals capillary and other vessels, thus preventing contamination by bacteria.
A simplified method of coagulation saves valuable time since bleeding can be arrested
immediately by touching the spot briefly with the coagulating electrode. A high frequency
apparatus is regarded as standard equipment in the operating theatre and it is kept ready for all
surgical interventions even if high frequency surgery is not intended so that use can be made of
its superior method of electro-coagulation.

Biological tissue can only be cut when the voltage between the cutting electrode and the
tissue to be cut is high enough to produce electric arcs between the cutting electrode and the
tissue. The temperatures produced at the points at which the electric arcs contact the tissue like
microscopic flashes of lightning are so high that the tissue is immediately evaporated or burned
away.Biological tissues are coagulated by thermal means if the requisite temperature is
 maintained at around 70°C. (8M)
Electrosurgical units (ESUs) play a crucial role in various surgical procedures by providing
controlled electrical energy for cutting, coagulation, and tissue ablation. While the primary
purpose of ESUs is to assist surgeons in performing precise and efficient surgical interventions,
their use can indirectly contribute to enhancing patient well-being and quality of life in several
ways:
Minimally Invasive Surgery: ESUs are often used in minimally invasive surgical techniques,
such as laparoscopy and endoscopy. These procedures involve smaller incisions and less tissue
disruption, leading to reduced post-operative pain, shorter hospital stays, and quicker recovery
times. Patients benefit from less pain and a faster return to their daily activities and normal
quality of life.
Reduced Blood Loss: Electrosurgical coagulation capabilities in ESUs can help control
bleeding during surgery. By reducing blood loss, patients may have a lower risk of post-
operative anemia and the need for blood transfusions, leading to better outcomes and faster
recovery.
Precision and Tissue Preservation: ESUs allow surgeons to make precise cuts and coagulate
tissues selectively. This ability helps preserve healthy tissues and vital structures, minimizing
damage to surrounding areas. As a result, patients may experience fewer complications and a
smoother recovery. (4M)
7. Categorize the various current waveforms associated with the electrosurgical unit and CO2.3 CL2
provide an explanation of how to use the various current forms in the surgical unit with
their benefits.

The typical specifications of an electro-diagnostic therapy unit are as follows:

 Galvanic current up to 80 mA, ripple less than 0.5% as constant current or surging
current
with adjustable surge frequency from 6 to 30 surges per minute
 Exponentially progressive current pulse sequences with continuously variable pulse
duration from 0.01 to 1000 ms and independently adjustable interval duration of 1 to
10,000 ms. The pulse form can be set continuously between triangular and rectangular
forms;
 Faradic surging current with 25 surges per minute, up to 80 mA. Precision and
constancy
of the values set better than ±10%; peak current measurement facility. Constant current
circuit, both poles earth-free. (6M)
 Monopolar Electrosurgery: Monopolar electrosurgery involves the use of an active electrode at
the surgical site and a return electrode elsewhere on the patient's body. The current flows from
the active electrode through the tissue to the return electrode.surgeon uses a handpiece with the
active electrode to cut or coagulate tissues. The current is applied in short bursts or
continuously as needed.
Benefits:
Precise Cutting: Monopolar electrosurgery allows for precise cutting of tissues, making it useful
in various surgical procedures.
Hemostasis: The coagulation effect helps control bleeding, reducing the need for manual
ligature or sutures.
Tissue Ablation: It can be used for tissue ablation, such as removing small lesions or tumors.
Bipolar Electrosurgery: Bipolar electrosurgery uses two electrodes within the surgical
instrument, eliminating the need for a separate return electrode. The current flows directly
between the two electrodes, which are usually close together.
The surgeon grasps the tissue between the two electrodes.
The current flows through the tissue, causing coagulation and sealing of blood vessels.
Benefits:
Reduced Tissue Damage: Bipolar electrosurgery is ideal for delicate tissues and areas with
limited space, as it minimizes the current spread to surrounding tissues.
Precision: The bipolar technique allows for controlled and localized coagulation, making it
suitable for procedures requiring meticulous tissue handling. (6M)
8. Elaborate the safety considerations and precautions associated with the use of ESU unit in CO2.4 CL2
healthcare settings. Highlight potential risks and mitigation strategies to ensure patient
and staff well-being.
The use of Electrosurgical Units (ESUs) in healthcare settings requires strict adherence to
safety considerations and precautions to ensure the well-being of both patients and staff. ESUs
generate electrical currents for cutting and coagulating tissues during surgical procedures, and
improper use can lead to potential risks (12M)
Staff Training and Competency
Proper training and competency assessment of healthcare personnel using ESUs are essential to
ensure safe operation and minimize risks.
Training should cover ESU operation, safety features, appropriate power settings, and safe
application techniques.
Equipment Inspection and Maintenance
Regular inspection and maintenance of ESUs are necessary to ensure their proper functioning
and safety.
Electrical safety checks and calibration should be performed periodically by qualified
technicians.
Grounding and Electrical Safety
Proper grounding of ESU equipment is critical to prevent electrical shocks and burns.
Ensuring electrical safety in the operating room, including using grounded outlets and
equipment, is essential to protect both patients and staff.
Tissue Proliferation and Ignition
Incorrect or prolonged application of electrical current can lead to tissue charring, proliferation,
or ignition, posing risks to patients.
Appropriate power settings, application duration, and proper tissue contact are essential to
minimize these risks.
Patient-Specific Considerations
Patients with implanted electronic devices, such as pacemakers or defibrillators, require careful
consideration and consultation with the patient's cardiologist before ESU use.
Pregnant patients and those with metal implants in the treatment area may also require special
precautions.
Fire Safety
ESUs can pose a fire hazard in the presence of flammable substances, such as alcohol-based
skin preparations or surgical drapes.
Strict adherence to fire safety protocols and the use of non-flammable materials are crucial.
 UNIT III ULTRASONIC EQUIPMENTS

Q. QUESTION CO CL
N LEVE
O L
PART-A
1. Basically sound waves are ______________ CO3.1 CL1
A) Voltage signals B) Pressure waves C) Current D) Radiation
2. Sound waves are similar to light waves in all aspects. CO3.1 CL2
A) True
B) False
3. What is typically the frequency is used in ultrasonic inspection? CO3.2 CL1
A)0.1mhz to 15mhz B) 0.5mhz to 13mhz C)1mhz to 5mhz D)1.8mhz to 18hz
4. Which of the following medical imaging modality other than ultrasound does not use any form CO3.2 CL2
of radiation?
A) PET Scan B) SPECT Scan C)CT scan D)MRI
5. Ultrasound 'is a reflection of__________ CO3.2 CL1
A) soft tissues only B) hard tissues only C)both hard and soft D)hard muscles only
6. The wave used in the sonography is________ CO3.3 CL1
A) Infrared waves B) Microwaves C) Sound waves D) Ultrasonic waves
7. What is the wavelength of ultrasound in water ? CO3.3 CL1
A)1.5mm B)3mm C)4mm D)6.0mm
8. Ultrasound normal frequency range ___ CO3.3 CL1
A)below 20hz B) above 20hz C)below 20khz D)above 20khz
9. What property of sound waves acts like the principle of ultrasound? CO3.2 CL1
A) Reflection and Refraction B) Reflection only
C Refraction only D) Propagation
10. Fetal heart rate is calculated in USG using__________. CO3.4 CL2
A)A-mode B)B-mode C)C-mode D) M-mode
11. Which of the following/are not applications of ultrasonic waves CO3.2 CL1
A) For measuring the depth of Sea B) In sterilizing of a liquid
C) In Ultrasonography D) In sterilizing a needle.
12. Echocardiography is essentially ________ CO3.3 CL2
A) ultrasound of the heart
B) echoing sound of the heart
C) another name for a treadmill test
D) recording of heart sounds
13. Which mode is used for cardiac imaging? CO3.2 CL1
A)A-Mode B)B -Mode C)M –Mode D) 3d mode

14. Which kind of echocardiography may be recommended to diagnose coronary heart disease? CO3.3 CL2
A) Thoracic Echocardiography
B) Stress Echocardiography
C) Transesophageal Echocardiography
D) 3D Echocardiography
15. When an abdominal ultrasound is done, why is it advised to have a full bladder? CO3.4 CL1
A) To have a good acoustic window
B) To increase the water content
C) To lower impedance
D) To allow for better propagation of waves
16. Ultrasound is also useful for __________ CO3.4 CL1
i. detecting fault in metal sheets
ii. imaging marine depths
iii. looking for metals beneath the earth’s surface
iv. detecting distances v. detecting earthquakes
A) ii, iii, v
B) i, iv, v
C) i, ii, iv
D) ii, iii
17. The human body consists of various tissues, each with a different composition and density, that CO3.3 CL1
result in a sound-related property called?
A) acoustic impedance B) input impedance
C) output impedance D) z- impedance
18. What are the types of echoes? CO3.4 CL2
A) Transthoracic echocardiogram (TTE)
B) Transesophageal echocardiogram (TEE)
C) Intracardiac echocardiogram (ICE)
D) All the above
19. The most important parameters describing the wave are CO3.2 CL1
A) Wavelength
B) Parameters
C) Frequency
D) Both A and C are correct
20. Ultrasonic waves are sound in the range above what normally can be heard by the human ear, CO3.4 CL1
anything above
A) 12000 Hertz
B) 10000 Hertz
C) 20000 Hertz
D) 160000 Hertz
21. Which transducer is commonly used for performing transthoracic echocardiography? CO3.1 CL2
A) Phased array transducer b) Linear array transducer
c) Convex array transducer d) Mechanical sector transducer
22. Which echocardiography technique allows for the assessment of blood flow velocity and CO3.1 CL2
direction?
a) M-mode echocardiography b) B-mode echocardiography
C) Doppler echocardiography d) 3D echocardiography
23. Which type of echocardiography is performed using a transducer inserted into the esophagus? CO3.2 CL2
a) Transthoracic echocardiography b) Transabdominal echocardiography
c) Transesophageal echocardiography d) Transcranial echocardiography
24. Which display technique provides a three-dimensional visualization of the internal structures CO3.3 CL2
and organs?
 a) A-mode b) B-mode c) M-mode d) 3D mode
25. Which display technique in ultrasound imaging is used to assess tissue elasticity and stiffness? CO3.4 CL2
a) A-mode b) B-mode c) M-mode d) Elastography
26. Which display technique in ultrasound imaging allows visualization of blood flow and CO3.4 CL1
velocity?
a) A-mode b) B-mode c) M-mode d) Doppler mode
27. Which imaging parameter is commonly measured in echoencephalography to assess blood flow CO3.4 CL1
velocity?
a) Echo intensity b) Echo delay C) Doppler shift d) Attenuation
PART-B
1. A 48-year-old woman was admitted acutely with a 5-day history of non-specific chest and CO3.1 CL4
abdominal pain radiating through to the back. She also reported general lethargy,
breathlessness and an intermittent fever together with occasional palpitations. . She had
no cardiac risk factors and denied any preceding coryzal symptoms. On admission she
was hypotensive with a BP of 91/66 and no variation between arms and no radio femoral
delay. There were no added sounds on auscultation of the heart and the chest was clear
on ultrasound examination. Doctors recommended for the echocardiography to examine
the valvular functions. Does echo technique improve view of cardiac structures and detect
abnormalities in perfusion, while using contrast agents? Provide rationale for your
answer.
The echo technique typically refers to echocardiography, a non-invasive imaging
modality that uses ultrasound waves to visualize the heart's structures and assess its function.
Contrast agents can be used during echocardiography to improve the visualization of certain
cardiac structures and detect abnormalities in perfusion.
Improved endocardial border delineation: In some patients, especially those with
suboptimal acoustic windows, it can be difficult to obtain clear images of the endocardium
(inner lining of the heart). Contrast agents containing microbubbles can significantly enhance
the echo signals from the blood, leading to improved endocardial border definition. This
enhancement allows for better assessment of wall motion abnormalities and improves the
accuracy of cardiac function evaluations.
Detection of perfusion abnormalities: Contrast agents can help evaluate myocardial
perfusion, which refers to the blood flow into the heart muscle. By assessing how the contrast
agent travels through the myocardium, areas with reduced blood flow (e.g., due to ischemia or
infarction) can be identified more effectively. This is particularly useful in assessing coronary
artery disease and identifying regions of the heart with compromised blood supply.
Assessing cardiac viability: Following a heart attack (myocardial infarction), it is essential
to evaluate the viability of the affected myocardium. Contrast-enhanced echocardiography can
help differentiate between scarred or non-functional tissue and viable tissue that may recover
with proper treatment. This information guides clinicians in making decisions about
revascularization procedures or other interventions.
Identifying intracardiac shunts and anomalies: Contrast agents can aid in detecting
intracardiac shunts, such as patent foramen ovale (PFO) or atrial septal defects (ASDs). By
observing the passage of the contrast through these shunts, cardiologists can confirm their
presence and determine their significance in the overall cardiac function.
2. Assume an ultrasound diagnostic in Obstetrics; what is the tissue reaction to the CO3.1 CL2
ultrasound if the ultrasonic waves pass through biological tissues?
 When ultrasonic waves pass through biological tissues, the tissues undergo several
different interactions and reactions. These interactions are based on the physical properties of
the tissues, such as density, elasticity, and acoustic impedance, which determine how the
waves propagate and interact with the tissue structures. The most important interactions
include:
Absorption: Some of the ultrasound energy is absorbed by the tissues as the waves pass
through. This absorption leads to a conversion of acoustic energy into heat. Tissues with
higher attenuation coefficients, such as bone and dense structures, tend to absorb more
ultrasound energy than others.
Reflection: When ultrasound encounters an interface between tissues with different acoustic
impedances (the product of tissue density and the speed of sound in the tissue), some of the
sound waves are reflected back towards the transducer. This reflection contributes to the
creation of the ultrasound image and is essential for visualizing tissue boundaries.
Scattering: Scattering occurs when the ultrasound waves interact with small structures or
inhomogeneities within the tissues. These interactions cause the sound waves to change
direction and spread out in various directions. Scattering contributes to the speckle pattern
often observed in ultrasound images.
Transmission: The remaining portion of the ultrasound waves that is not absorbed, reflected,
or scattered continues to propagate through the tissue.
Refraction: Refraction happens when ultrasound waves pass through tissues with varying
acoustic velocities, causing the waves to change direction. This effect can distort the
appearance of structures in the ultrasound image.
3. State the basic principle of echo technique CO3.1 CL1
The basic principle of the echo technique, specifically referring to echocardiography, is
to use ultrasound waves to create real-time images of the heart's structures and assess its
function. Echocardiography is a non-invasive imaging modality that utilizes the principles of
sound waves to visualize the heart's anatomy and blood flow.
Echocardiography employs high-frequency sound waves (ultrasound) generated by a
transducer. The transducer emits and receives these sound waves, which can penetrate through
the chest wall and other tissues to reach the heart.
When the ultrasound waves encounter tissue interfaces with different acoustic impedances
(variations in density and speed of sound), some of the sound waves are reflected back to the
transducer as echoes. The transducer converts the returning echoes into electrical signals, and a
computer processes these signals to create real-time images of the heart's structures, including
the chambers, valves, walls, and blood flow patterns.
The generated ultrasound images are displayed on a monitor, allowing cardiologists and
healthcare professionals to visualize the heart in motion and assess its function. The images can
reveal various cardiac abnormalities, such as structural defects, valve disorders, and wall
motion abnormalities.
4. Compare A mode, B mode and M mode. CO3.2 CL2

A MODE B MODE M MODE

A-mode is the simplest of B-mode is the most M-mode displays motion
the three modes and commonly used mode in over time of specific
represents the amplitude of clinical ultrasound and structures along a single
the returning provides a real-time two- scan line.
 ultrasound echoes on a one- dimensional grayscale
dimensional scale. image of the scanned area.

It displays the depth of the
reflecting interface (tissue
boundary) along the X-axis
and the amplitude of the
echo on the Y-axis.
A-mode is primarily used
for biometric
measurements, such as
determining the size of
organs, measuring the
thickness of tissues, and
calculating distances
between structures.
It uses brightness or shades
of gray to represent the
varying echo intensities
received from different
tissue interfaces.
The transducer scans the
area in a raster pattern,
generating a cross-sectional
image of the structures
within the field of view.
It is particularly useful for
evaluating the movement of
cardiac structures, such as
heart valves, ventricular
walls, and the
interventricular septum,
over the cardiac cycle.

It is commonly used in B-mode allows for M-mode is represented as a

ophthalmology for
measuring the length of the
eye and in obstetrics for
measuring fetal crown-
rump length.
visualization of anatomical
structures, such as organs,
blood vessels, and tumors,
in real-time, making it
useful for diagnosis and
guiding interventions.
graph with time on the X-
axis and depth on the Y-
axis. The moving structures
appear as repetitive
patterns, allowing for
detailed assessment of their
motion and function.

5. By Implementing the M mode display, Analyze how ultrasound imaging assists in CO3.2 CL4
evaluating dynamic movement of cardiac structures?
Ultrasound imaging, particularly echocardiography, plays a crucial role in evaluating the
dynamic movement of cardiac structures. By using real-time imaging and specialized
techniques, ultrasound enables clinicians to assess the movement and function of various
cardiac components. Here's how ultrasound assists in evaluating dynamic movement of cardiac
structures:
Real-time imaging: Ultrasound provides real-time images of the heart, allowing clinicians to
visualize cardiac structures as they move and function throughout the cardiac cycle. This real-
time capability enables the assessment of both systolic (contraction) and diastolic (relaxation)
phases of the heart.
M-mode imaging: M-mode (Motion Mode) is a specialized ultrasound technique that displays
the motion of specific structures over time along a single scan line. In echocardiography, M-
mode is commonly used to assess the movement of various cardiac structures, such as heart
valves, ventricular walls, and the interventricular septum. The continuous tracing of these
structures over time provides valuable information about their motion and function.
Doppler imaging: Doppler ultrasound is used to assess blood flow in and around the heart. By
analyzing the Doppler shift of sound waves reflected from moving blood cells, clinicians can
measure blood flow velocities and assess the direction and timing of blood flow during each
phase of the cardiac cycle. Doppler imaging is essential for evaluating cardiac valve function,
 detecting valvular regurgitation or stenosis, and assessing intracardiac shunts.
Tissue Doppler imaging: Tissue Doppler imaging (TDI) is a specialized technique that
measures the velocity of cardiac structures, such as myocardial walls, during contraction and
relaxation. TDI provides quantitative information about the regional function of the heart and
aids in identifying areas of impaired myocardial function.
Strain imaging: Speckle tracking echocardiography is a strain imaging technique that evaluates
the deformation of myocardial tissue during the cardiac cycle. Strain imaging can assess
myocardial contractility and detect subtle changes in myocardial function, even before
traditional measures of cardiac function are affected.
6. How does the B-mode display technique in ultrasound imaging provide detailed CO3.2 CL2
anatomical information?
The B-mode (Brightness Mode) display technique in ultrasound imaging provides detailed
anatomical information by producing real-time two-dimensional grayscale images of the
scanned area. It utilizes the reflection and echo of ultrasound waves from different tissues and
structures within the body to create an image with varying brightness levels, representing the
different tissue interfaces and boundaries.
Cross-sectional imaging: B-mode ultrasound generates cross-sectional images of the scanned
area, showing the structures in a plane perpendicular to the ultrasound beam. This cross-
sectional view allows for a detailed assessment of the anatomical structures within the field of
view.
Gray scale representation: The B-mode image is composed of a grayscale range, where
different shades of gray represent the varying intensity of the echoes received from tissues.
Brighter areas on the image correspond to strong echoes, indicating denser tissues or interfaces,
while darker areas represent weaker echoes, indicating less dense or fluid-filled structures.
Tissue differentiation: The B-mode display allows for excellent tissue differentiation, as tissues
with different acoustic properties, such as density or stiffness, create distinct echo patterns.
This differentiation helps identify and delineate various anatomical structures, including
organs, blood vessels, muscles, and tumors.
Real-time imaging: B-mode ultrasound provides real-time imaging, meaning that the images
are continuously updated as the transducer scans the area. This real-time capability allows
clinicians to observe the dynamic movement of structures, such as heart valves opening and
closing or blood flow patterns.
Doppler overlay: Some advanced B-mode ultrasound machines offer Doppler overlays,
combining B-mode images with color-coded Doppler information. This enhancement allows
for the simultaneous visualization of blood flow and anatomical structures, providing
additional information about vascular structures and flow dynamics.
Size and dimension measurements: B-mode imaging allows for accurate measurements of
anatomical structures' size, dimensions, and distances. This feature is especially valuable in
obstetrics for measuring fetal biometry or in diagnosing organ enlargement or tumors.
7. Highlight the use of echocardiography for monitoring treatment response, tracking CO3.3 CL1
disease progression, and guiding therapeutic interventions.

Monitoring Treatment Response:

Cardiac function assessment: Echocardiography allows clinicians to monitor changes in cardiac
function over time. For example, in heart failure patients, echocardiography can evaluate
changes in left ventricular ejection fraction (EF) and assess the response to medication or other
 treatments aimed at improving cardiac function.
Valve function: Echocardiography is used to assess the function of heart valves, such as
measuring regurgitant volumes or gradients, which helps determine the effectiveness of
medical therapy or the need for surgical intervention.
Assessing myocardial viability: After a heart attack, echocardiography can help identify viable
versus non-viable myocardium. Monitoring changes in viable tissue can inform treatment
decisions and guide revascularization procedures.
Tracking Disease Progression:
Structural changes: Echocardiography can track structural changes in the heart over time, such
as ventricular remodeling or chamber dilation. These changes can be indicative of disease
progression and may influence treatment decisions.
Valve degeneration: Echocardiography is useful in tracking the progression of valve diseases,
such as aortic stenosis or mitral regurgitation, by assessing changes in valve morphology and
function.
8. A 19 year old boy met an accident and got haemorrhage in brain, Recommend the CO3.3 CL2
modality which will visualize the size, location, and characteristics of the abnormalities
and also explain the working principle.
Echoencephalogram can be recommended to study the anatomical structure of the human
brain.
Working:
In the normal brain, the mid-line surfaces are parallel to the flat areas of
the bone near the ear. When there is a head injury, the brain gets tilted to one side or the other
due to bleeding, but it still retains its normal shape. In such cases, the echoes can be easily
obtained but they are placed at different distances from the probe, when the probe is placed
first on one side and then on the other side of the skull
Even when a tumour grows in the brain, the anatomy of the brain is gently altered and there
is usually considerable tilting and displacement of the brain ventricles. Ultrasonic mid-line
echo, in such cases, immediately establishes the abnormality of the brain due to its shift to one
side from the centre. The instrument for diagnosis and detection of the mid-line of the brain is
called ‘echoencephaloscope’. It usually incorporates a measuring range of 0–18 cm of tissue
depth. The normally used frequency range is 1–3 MHz. The probe for 2 MHz with the diameter
of 15–20 mm is the most common and gives a good resolution. The probe for a 1 MHz allows
for deep penetration and may preferably be employed for elderly patients whose skulls are
strongly calcified.
9. Suggest the diagnosing modality for the diagnosis of retinal detachments, intra-ocular CO3.4 CL2
tumours, vitreous opacities, orbital tumors, and lens dislocation and present the working
with neat sketch
To study the eye structure, echooptholmoscope can be used .
A-mode ultrasonic technique was found to be useful in ophthalmology for the diagnosis of
retinal detachments, intra-ocular tumours, vitreous opacities, orbital tumours, and lens
dislocation. It helps in the measurement of axial length in patients with progressive myopia,
localization of intra-ocular foreign bodies and extraction of non-magnetic foreign bodies.
Echo-ophthalmoscopy employs a 7.5–15 MHz pencil type transducer. The transmitted pulse
should be of very small width (in nanosec) and range.
 In the normal eye,echoes can be obtained from the following structures when performing an
anterior-posterior examination along the optical axis: the surface of the lid (corresponding with
the zero marker that appears constantly on the trace); the surface.of the cornea; the anterior lens
capsule, the posterior lens capsule, the posterior wall of the globe
(usually appearing as a complex of echoes originating from the retina, choroid and sclera as a
unit) and retro-bulbar fat. represented in the display can be read directly from the screen or the
resulting photograph.
10. In the department of obstetrics and gynaecology, most doctors prefer ultrasound imaging CO3.4 CL4
for screening, and ultrasound is also the most recommended modality in other abdomen-
related examinations. Despite the fact that there are various imaging modalities available,
analyse and provide the rationale for utilising ultrasonography in diagnosing and its
advantages over other imaging modalities.
Ultrasonography, also known as ultrasound imaging, is a widely used imaging modality in
medicine due to its versatility, safety, and diagnostic capabilities. It offers numerous
advantages over other imaging modalities, making it a preferred choice in various clinical
scenarios.
1.Non-invasive and safe: Ultrasonography is a non-invasive imaging technique that does not
involve exposure to ionizing radiation, as is the case with X-rays and CT scans. This makes it
safe for repeated examinations, particularly during pregnancy and in pediatric patients, without
the risk of harmful radiation exposure.
2. Real-time imaging: One of the key advantages of ultrasonography is its ability to provide
real-time images, allowing for the observation of dynamic processes, such as cardiac motion,
blood flow, and fetal movements. This real-time feature enables immediate visualization of
structures and helps in guiding procedures and interventions.
3. Lack of contrast agents: Unlike other imaging modalities like CT and MRI, ultrasonography
does not require the use of contrast agents for routine scans. This reduces the risk of allergic
reactions or contrast-induced nephropathy, making it a safer option, especially for patients with
kidney dysfunction.
4.Portability: Ultrasound machines are typically compact and portable, allowing for easy
bedside examinations, point-of-care imaging, and assessments in remote or critical care settings
where access to other imaging modalities may be limited.
5.Cost-effective:Ultrasonography is generally more cost-effective than other imaging
 techniques, such as MRI or CT scans. This makes it an accessible and affordable option,
particularly in resource-limited healthcare settings.
11 Sort the various transducers available in ultrasonic imaging and give explanation on each CO3.2 CL1
type.
In ultrasonic imaging, various types of transducers are used to generate and receive ultrasound
waves for different applications and imaging purposes. These transducers differ in their design,
frequency, and applications
Linear Array Transducer: A linear array transducer consists of multiple piezoelectric
elements arranged in a straight line, perpendicular to the scanning direction.
Curvilinear Array Transducer: A curvilinear array transducer has piezoelectric elements
arranged in a curved or convex shape.
Phased Array Transducer: A phased array transducer utilizes multiple small elements
arranged in a rectangular or trapezoidal pattern. These elements can be electronically focused
and steered to create images.
Microconvex Transducer: A microconvex transducer is a small-sized convex transducer with
a high-frequency range, specifically designed for imaging in difficult-to-access areas.
12. The echoopthalmoscope has revolutionised ophthalmology. Give a summary of the CO3.4 CL2
modality used to diagnose retinal detachments, intraocular tumours, vitreous opacities,
orbital tumours, and lens dislocation and also include a neat sketch to illustrate their
working.
Refer Q.no 9
PART-C
1. Outline the principles of ultrasound physics utilized in the implementation of ultrasound CO3.1 CL1
as a diagnostic tool.
The implementation of ultrasound as a diagnostic tool relies on several fundamental
principles of ultrasound physics. Understanding these principles is essential for generating and
interpreting ultrasound images accurately. Here are the key principles utilized in ultrasound
imaging(6M)
Acoustic Impedance and Reflection: Acoustic impedance is a property of tissues that
determines how ultrasound waves propagate through them. When ultrasound encounters a
tissue interface with different acoustic impedances (e.g., between soft tissue and bone), some of
the sound waves are reflected back to the transducer, while others continue to propagate deeper
into the body. The reflected waves are used to create the ultrasound image, with different
shades of gray representing varying echo intensities.
 Attenuation: As ultrasound waves travel through tissues, they gradually lose energy due to
scattering, absorption, and reflection. Attenuation is the decrease in ultrasound signal strength
as it penetrates deeper into the body. Tissues with higher density and increased scattering, such
as bone or calcified structures, attenuate more ultrasound energy than soft tissues.
Understanding attenuation is crucial for optimal imaging depth and resolution.
Wavelength and frequency: Ultrasonics follow the general wavelength and frequency
relationship .This range also corresponds to radio frequencies (rf). However, there is an
important basic difference between radio frequency and ultrasonic energy. Ultrasonic waves
are transmitted as mechanical vibrations whereas rf energy would be in the form of
electromagnetic radiations. No medium is necessary for propagation of rf energy and it would,
therefore, pass even through vacuum; ultrasonic waves will, on the other hand, pass only
through a medium. (6M)
Resolution: The resolution of an ultrasound system can be defined as the system’s ability to
distinguish between closely related structures. In general, the resolution is divided into axial
and lateral resolution.
Axial Resolution: The axial resolution is the minimal axial distance parallel to the
beam axis, at which two reflecting structures are recognized as separate structures. The axial
resolution is determined by the wavelength of the transmitted pulse. This means that the
smaller the wavelength, the higher the frequency and better the axial resolution.
Lateral Resolution: The lateral resolution is the lateral distance, in a plane perpendicular
to the beam axis, at which two reflecting structures can be seen as two separate structures. The
lateral resolution is determined by the shape/divergence of the ultrasound
beam, produced by the probe.
2. Analyze the needs for relative ultrasonic imaging systems in health care to visualise CO3.1 CL4
bodily structures for abnormality diagnosis.
Ultrasonic imaging systems, commonly known as ultrasound machines, play a vital role in
healthcare for visualizing bodily structures and diagnosing abnormalities. The use of
ultrasound in medical practice is driven by several specific needs, which make it an essential
tool in various clinical settings. Here are the key needs for ultrasonic imaging systems in
healthcare for abnormality diagnosis:
Non-Invasiveness: Ultrasound imaging is non-invasive, meaning it does not require surgical
incisions or insertion of instruments into the body. This makes it a preferred choice for
diagnosing abnormalities without causing additional trauma or discomfort to the patient. Non-
 invasiveness also reduces the risk of infection and allows for quicker recovery times.
Real-Time Imaging: Ultrasound provides real-time imaging, allowing clinicians to observe
bodily structures in motion. This real-time capability is especially valuable for assessing
cardiac function, fetal development, blood flow patterns, and other dynamic processes. The
ability to visualize real-time changes in structures aids in diagnosing abnormalities that may
not be apparent in static images.
Safety: Ultrasound imaging does not involve the use of ionizing radiation, making it a safe
imaging modality for patients of all ages, including pregnant women and pediatric patients. The
absence of radiation-related risks enables repeated imaging when necessary for monitoring
disease progression or treatment response.
Accessibility and Portability: Ultrasonic imaging systems are relatively compact and portable
compared to other imaging modalities, such as CT and MRI machines. This portability allows
for point-of-care imaging, bedside examinations, and use in remote or resource-limited
healthcare settings.
Soft Tissue Contrast: Ultrasound provides excellent soft tissue contrast, allowing for clear
visualization of organs, tissues, and masses. This high contrast resolution enables the detection
of subtle abnormalities and helps in differentiating between normal and pathological structures.
Cost-Effectiveness: Ultrasound is generally more cost-effective compared to other imaging
techniques, such as MRI and CT scans. This affordability makes it an accessible diagnostic tool
in various healthcare settings and contributes to reducing healthcare costs.
Dynamic Functionality: Ultrasound is well-suited for assessing dynamic physiological
functions, such as cardiac motion, valve function, and blood flow. It allows for the assessment
of structures during different phases of the cardiac cycle and provides valuable information
about functional abnormalities.
Guided Procedures: Ultrasound is commonly used for image-guided procedures, such as
biopsies, aspirations, and injections. Its real-time visualization helps guide the placement of
needles or instruments with precision, minimizing the risk of complications and improving
procedural outcomes.
Radiation-Free Monitoring: Ultrasound is ideal for monitoring fetal development during
pregnancy without exposing the developing fetus to ionizing radiation. This ability makes it an
essential tool in obstetrics for assessing fetal growth, well-being, and detecting congenital
abnormalities.(8M)
Case study: (4M)
3. Elaborate the principles of echo technique with block diagram. CO3.2 CL2
Pulse-echo technique of using ultrasound for diagnostic purposes in medical field was first
attempted by making use of flaw detectors normally employed in industry for non-destructive
testing of metallic structures. The basic layout of the apparatus based on this principle is shown
below (12M)
 The pulse-echo technique, basically, consists in transmitting a train of short duration ultrasonic
pulses into the body and detecting the energy reflected by a surface or boundary separating
two media of different specific acoustic impedances. With this technique, the presence of a
discontinuity can be conveniently established and its position located if the velocity of travel
of ultrasound in the medium is known. Also, it is possible to determine the magnitude of the
discontinuity and to assess its physical size.
The transmitter generates a train of short duration pulses at a repetition frequency determined
by the PRF generator. These are converted into corresponding pulses of ultrasonic waves by
a piezo- electric crystal acting as the transmitting transducer. The echoes from the target or
discontinuity are picked up by the same transducer and amplified suitably for display on a
cathode ray tube. The X plates of the CRT are driven by the time base which starts at the instant
when the transmitter radiates a pulse. In this way, the position of the echo along the trace is
proportional to the time taken for a pulse to travel from the transmitter to the discontinuity and
back again. Knowing the velocity of ultrasonic waves and the speed of the horizontal movement
of trace on the CRT, the distance of the target from the transmitting end can be estimated .
Wide Band Amplifier: The echo-signals received at the receiving transducer are in the form of
modulated carrier frequency and may be as small as a few microvolts. These signals require
sufficient amplification before being fed to a detector circuit for extracting modulating signals
which carry the useful information.
Video Amplifier: The signal requires further amplification after its demodulation in the detector
circuit before it can be given to the Y-plates of the Cathode ray tube (CRT). The output of the
detector circuit is typically around 1 V, but for display on the CRT, the signal must be amplified
to about 100 to 150 V. In addition to this, the amplifier must have a good transient response
with minimum possible overshoot. The most commonly used video amplifier is the RC coupled
type, having an inductance in series with the collector load. The inductance helps in extending
the high frequency response of the amplifier.
Imaging modes: A mode, B mode and M mode
4. Exemplify the display techniques used in the ultrasound imaging. CO3.2 CL2
A-Scan (4M)
This type of scan offers only one-dimensional information. The echo signals are applied to the
Y-deflecting plates of the CRT so that they are displayed as vertical blips as the beam is swept
across the CRT. The height of the vertical blip corresponds to the strength of the echo and its
position from left to right across the CRT face corresponds to the depth of its point of origin
from the transducer.
Echoencephalogram can be recommended to study the anatomical structure of the human
brain.
Working:
In the normal brain, the mid-line surfaces are parallel to the flat areas of
the bone near the ear. When there is a head injury, the brain gets tilted to one side or the other
due to bleeding, but it still retains its normal shape. In such cases, the echoes can be easily
obtained but they are placed at different distances from the probe, when the probe is placed
first on one side and then on the other side of the skull
Even when a tumour grows in the brain, the anatomy of the brain is gently altered and there
is usually considerable tilting and displacement of the brain ventricles. Ultrasonic mid-line
echo, in such cases, immediately establishes the abnormality of the brain due to its shift to one
side from the centre. The instrument for diagnosis and detection of the mid-line of the brain is
called ‘echoencephaloscope’. It usually incorporates a measuring range of 0–18 cm of tissue
depth. The normally used frequency range is 1–3 MHz. The probe for 2 MHz with the diameter
of 15–20 mm is the most common and gives a good resolution. The probe for a 1 MHz allows
for deep penetration and may preferably be employed for elderly patients whose skulls are
strongly calcified
B mode: (4M)
To study the eye structure, echooptholmoscope can be used .
A-mode ultrasonic technique was found to be useful in ophthalmology for the diagnosis of
retinal detachments, intra-ocular tumours, vitreous opacities, orbital tumours, and lens
dislocation. It helps in the measurement of axial length in patients with progressive myopia,
localization of intra-ocular foreign bodies and extraction of non-magnetic foreign bodies.
Echo-ophthalmoscopy employs a 7.5–15 MHz pencil type transducer. The transmitted pulse
should be of very small width (in nanosec) and range.

In the normal eye,echoes can be obtained from the following structures when performing an
anterior-posterior examination along the optical axis: the surface of the lid (corresponding with
the zero marker that appears constantly on the trace); the surface.of the cornea; the anterior lens
capsule, the posterior lens capsule, the posterior wall of the globe
(usually appearing as a complex of echoes originating from the retina, choroid and sclera as a
unit) and retro-bulbar fat. represented in the display can be read directly from the screen or the
resulting photograph.
 M mode: (4M)
In A-mode display, ultrasonic echoes produce vertical displacements of a horizontal trace on

5. Consider the person with heart abnormality like valvular obstruction, Recommend the modality CO3.2 CL2
which will study the blood flow in heart valves and detail the diagnostic process involving
echocardiography, including the selection of appropriate imaging views, measurement of cardiac
parameters, and identification of abnormalities.
In A-mode display, ultrasonic echoes produce vertical displacements of a horizontal trace
on and the distance along the horizontal trace represents the time of sound travel in human tissue,
electronically rotating the A-mode echoes 90°towards the viewer, the echoes can be presented as bright
dots of light along an imaginary horizontal base line as shown in Figure.

The distance between the dots again represents time or tissue depth and the intensity of the dots
 represents the strength of the echoes. If one of the echo sources is a moving structure, then the echo dots
of light from that structure will also move back and forth. If the dots are made to move with an
electronic sweep, from bottom to the top of the screen at a pre-selected rate of speed, the moving dots
will trace out the motion pattern of the moving structure. This display is known as M-mode display. If a
photographic film is continuously exposed to one sweep cycle of this display, a composite picture will
result, providing a waveform representation of the motion pattern of the moving structure. Alternately,
thermal video printers are used for recording the M-mode information. Echo measuring instrument,
except for the addition of a slow sweep circuit and recording arrangement For echocardiography, the
transducer is placed between the third and the fourth ribs on the outer chest wall where there is no lung
between the skin and the heart. From this probe, a low intensity ultrasonic beam is directed towards the
heart area and echo signals are obtained. The probe position is manipulated to obtain echoes from areas
of interest in the heart. Echocardiograph is a widely used and valuable instrument for carrying out
cardiac examination is possible to detect intra-cardiac structures. The movement of these structures can
also be recorded with the better resolution than with angiographic diagnostic technique. The instrument
presents time-versus-motion information about heart structures on slow speeds normally used in
electrocardiogram recordings. When an ECG trace is superimposed on the ultrasonic display, the
movement of structures detected ultrasonically can be conveniently correlated with known events in the
cardiac cycle. Phonocardiogram is also often recorded simultaneously. The echocardiogram is currently
the best method for the diagnosis of mitral stenosis. Echocardiography is also often used for the study of
the aortic valve, tricuspid valve and pulmonary valve. Another very important use is in the detection of
pericardial effusion, which is the abnormal collection of fluid between the heart and the pericardial sac.
Pulsed doppler echocardiography flow velocity in contrast to M-mode echocardiography which is based
on the anatomical (dimensional) properties of the heart. The technique is used as an adjunct to
conventional M-mode echocardiography and frequently information obtained from the pulsed Doppler
examination compliments or reinforces the M-mode procedure. In many cases, pulsed Doppler findings
provide useful diagnostic information whereas M-mode findings may be nearly normal or suggestive.
The system operates on the principle of reflected ultrasound and senses flow velocity within
a small 2 . 4 mm tear-drop shaped volume, referred to as the sample volume. The sample
volume is specifically selectable within the heart and great vessels by means of a depth control
setting and is subject to a variety of components of blood flow velocity; laminar, turbulent and
motional components like wall motion and valve motion. These components are isolated by
appropriate filters in the circuitry and each has associated audio-tonal qualities and spectral
patterns (12M)
6. An 11-year-old boy admitted to the hospital with progressive headache, nausea and vomiting CO3.3 CL3
throughout a month. A Computerized Tomography (CT) showed an obstructive hydrocephaly.
Implement the Echoencephalography to visualize the blood vessels and the other contractions for
improved health care.
Echoencephalograph: In the normal brain, the mid-line surfaces are parallel to the flat areas of
the bone near the ear. When there is a head injury, the brain gets tilted to one side or the other due
to bleeding, but it still retains its normal shape. In such cases, the echoes can be easily obtained
but they are placed at different distances from the probe, when the probe is placed first on one
side and then on the other side of the skull. Even when a tumour grows in the brain, the anatomy of the
brain is gently altered and there is usually considerable tilting and displacement of the brain ventricles.
Ultrasonic mid-line echo, in such cases, immediately establishes the abnormality of the brain due to its
shift to one side from the centre.
The instrument for diagnosis and detection of the mid-line of the brain is called
‘echoencephaloscope’. It usually incorporates a measuring range of 0–18 cm of tissue depth. The
normally used frequency range is 1–3 MHz. The probe for 2 MHz with the diameter of 15–20 mm is the
most common and gives a good resolution. The probe for a 1 MHz allows for deep penetration and may
preferably be employed for elderly patients whose skulls are strongly calcified. (6M)
 Ultrasound Machine: An ultrasound machine equipped with a specialized transducer is used for this
procedure. The transducer emits high-frequency sound waves that can penetrate through the skull and
brain tissue.
Doppler Effect: The ultrasound waves bounce off red blood cells in the brain's blood vessels. When the
blood cells move, such as during blood flow or contractions, the frequency of the returning sound waves
changes. This phenomenon is known as the Doppler effect.
Data Collection: The ultrasound machine collects data on the changes in frequency of the reflected
sound waves, which allows the speed and direction of blood flow to be measured in real-time.
Visualization: The collected data is processed and displayed as a waveform on a computer monitor,
providing visual information about blood flow patterns and any abnormalities in the brain's blood
vessels.
Interpretation: A trained medical professional, such as a neurologist or a vascular specialist, interprets
the data to assess the health of the blood vessels and identify any potential issues.
Clinical Applications: Echoencephalography is used in various clinical scenarios, such as monitoring
patients with stroke risk, identifying vascular abnormalities, assessing blood flow changes during
migraine attacks, and studying cerebral vasospasms. (6M)
7. Present specific patient cases where echocardiography was instrumental in diagnosing cardiac CO3.3 CL4
abnormalities.
Case: Aortic Stenosis Patient: A 65-year-old male with progressively worsening shortness of breath
and chest pain on exertion. (4M)
Echocardiography Findings: Echocardiography revealed thickened and calcified aortic valve leaflets
with restricted movement, indicating aortic stenosis.
Diagnosis: The patient was diagnosed with severe aortic stenosis, a condition where the aortic valve
becomes narrowed, leading to reduced blood flow from the heart to the rest of the body.
Management: Based on the echocardiographic findings, the patient underwent surgical aortic valve
replacement, which significantly improved his symptoms and quality of life.

Case: Dilated Cardiomyopathy Patient: A 50-year-old female presenting with fatigue, palpitations,
and swelling in the legs. (4M)
Echocardiography Findings: Echocardiogram showed enlarged heart chambers with reduced
contractility, indicating dilated cardiomyopathy.
Diagnosis: The patient was diagnosed with dilated cardiomyopathy, a condition where the heart
becomes enlarged and weakened, leading to decreased pumping efficiency.
Management: With the aid of echocardiography, the patient was started on appropriate heart failure
 medications and lifestyle modifications, leading to a gradual improvement in symptoms and cardiac
function.

Case: Mitral Valve Prolapse Patient: A 30-year-old female with a history of atypical chest pain and
occasional palpitations. (4M)
Echocardiography Findings: Echocardiogram revealed excessive movement of the mitral valve leaflets
into the left atrium during systole, indicating mitral valve prolapse.
Diagnosis: The patient was diagnosed with mitral valve prolapse, a condition where the mitral valve
bulges backward into the left atrium, causing potential leakage of blood.
Management: Based on the echocardiographic findings and the absence of significant mitral
regurgitation, the patient was reassured and advised to monitor her symptoms regularly.
8. Enumerate the applications of ultrasound in the field of abdomen, Obstetrics, CO3.4 CL2
Gynaecology

Ultrasound is a widely used imaging modality in the field of medicine, and it has several
applications in the abdomen, obstetrics, and gynecology. Here are some of the key
applications:
Abdominal Ultrasound: (4M)
Liver Evaluation: Assessing the liver size, detecting masses, tumors, or cysts, and evaluating
liver cirrhosis and fatty liver disease.
Gallbladder Assessment: Detecting gallstones, inflammation (cholecystitis), and other
abnormalities in the gallbladder.
Pancreatic Imaging: Identifying pancreatic masses, tumors, and evaluating for pancreatitis.
Kidney and Urinary Tract: Assessing the kidneys for stones, cysts, tumors, and evaluating the
renal blood flow. Also used for bladder evaluation and detecting urinary tract abnormalities.
Spleen Examination: Detecting splenic enlargement, masses, or other pathologies.
Abdominal Aortic Aneurysm (AAA) Screening: Used to identify and monitor the enlargement
of the abdominal aorta, which can lead to aortic aneurysms.
Appendicitis Evaluation: Supporting the diagnosis of appendicitis or ruling it out in cases of
abdominal pain.
Obstetric Ultrasound: (4M)
Pregnancy Confirmation: Confirming the presence of an intrauterine pregnancy and detecting
the number of gestational sacs.
Gestational Age Determination: Measuring fetal size to estimate gestational age and expected
due date.
Fetal Viability: Confirming the heartbeat and viability of the fetus in early pregnancy.
Anomaly Screening: Evaluating fetal anatomy to detect any structural abnormalities or birth
defects.
Amniotic Fluid Assessment: Measuring the amniotic fluid volume to ensure normal fetal
development.
Multiple Pregnancy: Detecting and monitoring twins or other multiple pregnancies.
Placental Location: Determining the location of the placenta to assess the risk of placenta
previa (when the placenta covers the cervix).
Fetal Growth: Monitoring fetal growth and assessing for fetal growth restriction or macrosomia
(large fetus).
Fetal Position and Presentation: Assessing the fetus's position in the uterus, especially as the
pregnancy progresses towards delivery.
 Gynecological Ultrasound: (4M)
Pelvic Exam: Evaluating the uterus, ovaries, and surrounding structures to detect abnormalities,
such as fibroids, cysts, or tumors.
Endometrial Thickness: Measuring the thickness of the endometrial lining for menstrual cycle
assessment or evaluating abnormal bleeding.
Ovarian Cyst Assessment: Detecting and monitoring ovarian cysts for size and changes.
Infertility Evaluation: Examining the reproductive organs to identify potential causes of
infertility.
Uterine Anomalies: Diagnosing congenital abnormalities of the uterus that may affect fertility
or reproductive health.
Guidance for Gynecological Procedures: Assisting with procedures like biopsies, cyst
aspirations, and intrauterine device (IUD) placement.

UNIT IV EXTRA CORPOREAL DEVICES AND SPECIAL DIAGNOSTIC TECHNIQUES

Q. QUESTION CO CL
NO LEVEL
PART-A
1. Which of the following increases oxygen unloading in the muscle during exercise ? CO4.1 CL1
A)an increase in muscle temperature
B)an increase in muscle co2 production
C)an increase in H+ concentration
D)all of the above
2. Respiratory dead space in atypical 200lb (91kg)athlete at rest would be approximately CO4.1 CL1
A)1L B)500 mL C)200 ml D)100Ml
3. once stimulated the time course for the formation and maturation of a red blood cell is CO4.1 CL1
approximately
A)1-3days B)5-7 days C)2 weeks D)1 month
4. In normal individual at rest the venous arterial difference in co2 content is closest to CO4.1 CL1
volumes %
A)5 B)10 C)15 D)20
5. The arterial oxygen content of a normal individual at sea level would be approximately CO4.2 CL1
___volumes %
A)20 B)30 C)40 D)97
6. Which of the following mineral should be consumed in limited quantities by those CO4.2 CL2
undertaking dialysis is
A)Mo B)Fe C)Zn D)K
7. Aside from conventional use ,dialysis may also use in the scenarios of CO4.3 CL1
A)blood transfusions B)acute poisoning C)extreme fever D)none of these
8. Which of the following can be the side effect of the hemodialysis? CO4.3 CL2
A)nausea B)cramps C)weakness D)all of the above
9. Which of the following is the access for the treatment which is used in the peritoneal CO4.2 CL1
dialysis?
 A )Graft B) Catheter C)dialysis machine D)fistula
10. How many types of dialysis are there? CO4.4 CL1
A)2 B)3 C)6 D) 4
11. Which of the following is the main principle of dialysis? CO4.2 CL1
A)capillary action B)reverse –osmosis C)diffusion D)none of the above
12. The immunosuppressant drugs can be consumed with CO4.3 CL1
A)Major viruses B)kidney transplant C)peritoneal dialysis D)none of the above
13. The estimated prevalence of vesico ureteric reflux in children with urinary tract infection CO4.5 CL1
is A)3% B)5% C)10% D)30%
14. Most common intra abdominal injury associated with laparoscopic surgery is CO4.5 CL2
A)Bowel injury B)liver injury C)vascular injury D)bladder injury
15. The fetal kidney develops from CO4.5 CL1
A)Paraxial mesoderm B)Intermediate mesoderm C)lateral mesoderm D)neural tube
16. In medicine thermograph is used to CO4.6 CL2
A)identify bacteria
B)identify infected issues
C)kill infected cells
D)identify damaged parts of an organ
17. In thermograph heat is identified by CO4.6 CL1
A)different sizes of lines on a photograph
B)different shapes on a photograph
C)different colors on a photograph
D)different images on a photograph
18. Which parameter is continuously monitored during the use of a heart-lung machine? CO4.1 CL2
a) Heart rate B) Blood oxygen saturation c) Carbon dioxide levels d) Blood pH
19. What is the purpose of the venous line in a heart-lung machine circuit? CO4.2 CL1
A) Collect deoxygenated blood from the patient
b) Remove air bubbles from the blood
c) Monitor the patient's heart rhythm
d) Administer medications
20. What is the purpose of the air trap in a hemodialyzer circuit? CO4.1 CL1
A) To prevent air bubbles from entering the patient's bloodstream
b) To remove excess air from the dialysate solution
c) To measure the pressure within the dialyzer
d) To regulate the temperature of the dialysate solution
21. How is the efficiency of a hemodialyzer measured? CO4.3 CL1
a) By the rate of blood flow through the dialyzer
B) By the clearance of urea and other waste products
c) By the size of the dialysate solution used
d) By the number of dialyzer membranes
22. What is the primary function of an oxygenator in a cardiopulmonary bypass circuit? CO4.3 CL2
A) Oxygenate the blood
b) Remove carbon dioxide from the blood
c) Maintain blood pressure
d) Monitor oxygen saturation
23. What is the purpose of the membrane inside an oxygenator? CO4.3 CL1
 A) Facilitate gas exchange between blood and gas
b) Regulate blood flow rate
c) Remove air bubbles from the blood
d) Measure oxygen concentration
24. Which factor determines the choice of lithotripsy technique for a specific patient? CO4.4 CL1
a) Stone composition B) Stone size c) Patient age d) Patient gender
25. What is the term used to describe the process of breaking down kidney stones using laser CO4.4 CL2
energy delivered through a thin, flexible tube?
A) Laser lithotripsy b) Percutaneous nephrolithotomy
c) Ureteroscopy d) Stent placement
26. Which endoscopic technique involves inserting a thin tube with a light source and camera CO4.4 CL2
through the mouth to examine the esophagus, stomach, and upper small intestine?
a) Colonoscopy b) Laparoscopy C) Esophagoscopy
d) Endoscopic retrograde cholangiopancreatography (ERCP)
27. Which endoscopic procedure is used to examine the upper digestive tract, including the CO4.5 CL2
esophagus, stomach, and duodenum?
a) Colonoscopy b) Bronchoscopy C) Gastroscopy d) Cystoscopy
28. Which of the following is NOT a type of endoscopy? CO4.6 CL2
a) Colonoscopy b) Bronchoscopy c) Echocardiography d) Gastroscopy
29. What is the advantage of using thermography for medical imaging? CO4.6 CL2
a) It provides real-time images
B) It does not involve radiation exposure
c) It offers high-resolution images
d) It is widely available and inexpensive
30. Which of the following is a limitation of thermography? CO4.6 CL1
A) It cannot provide detailed anatomical information
b) It requires the use of contrast agents
c) It is invasive and uncomfortable for patients
d) It has limited availability in medical facilities
PART-B
1. Provide the main purpose of utilizing a heart-lung machine during cardiac surgery? CO4.1 CL1
The main purpose of utilizing a heart-lung machine during cardiac surgery is to
temporarily take over the function of the heart and lungs, allowing the surgical team to
perform procedures on the heart while the blood is diverted away from the heart and
oxygenated outside the body.
During cardiac surgery, the heart-lung machine, also known as a cardiopulmonary bypass
machine, is used to maintain the circulation of blood and the supply of oxygen to the
body's organs and tissues. The machine performs several vital functions:
Oxygenation: The heart-lung machine oxygenates the blood by removing carbon dioxide
and adding oxygen. It acts as an external lung, ensuring that the patient's body receives
oxygenated blood despite the heart being temporarily stopped for surgery.
Blood circulation: The machine pumps the oxygenated blood back into the patient's body,
bypassing the heart. This maintains blood circulation and supplies oxygen to organs and
tissues.
Blood temperature regulation: The heart-lung machine helps regulate the temperature of
the blood, ensuring that it remains at a safe level during the surgery.
 By utilizing the heart-lung machine, the surgical team can safely stop the heart to repair or
replace damaged heart valves, perform coronary artery bypass grafting (CABG), or
conduct other complex heart procedures. Once the surgery is completed, the heart-lung
machine is gradually weaned off, and the heart is allowed to resume its normal function.
This technology has revolutionized cardiac surgery and has significantly improved the
success rates of various heart procedures.
2. Enumerate the working of pumps in Heart lung machine. CO4.2 CL2
The heart-lung machine, also known as the cardiopulmonary bypass machine,
consists of pumps that play a crucial role in maintaining blood circulation and oxygenation
during cardiac surgery. Here's an enumeration of how the pumps work in the heart-lung
machine:
Venous Pump: The venous pump is responsible for collecting deoxygenated blood from
the patient's body. It is typically connected to a large vein, such as the superior vena cava
or the right atrium of the heart. The pump creates negative pressure, which helps draw
blood from the patient into the heart-lung machine's circuit.
Reservoir: The collected deoxygenated blood is stored in a reservoir or collection
chamber within the heart-lung machine. This reservoir ensures a steady supply of blood
for circulation through the machine.

Arterial Pump: The arterial pump is responsible for pumping oxygenated blood back into
the patient's body. After the blood is oxygenated and carbon dioxide is removed in the
oxygenator (a component of the heart-lung machine), the arterial pump generates positive
pressure to propel the oxygenated blood back into the patient's arterial system. This pump
ensures that oxygenated blood reaches the organs and tissues throughout the body.
3. Sort the different types of oxygenators used in the heart lung machine. CO4.2 CL1
Oxygenators used in the heart-lung machine are categorized into two main
types based on their design and function:
Bubble Oxygenators: Bubble oxygenators are the older and simpler type of oxygenators.
In these oxygenators, deoxygenated blood is exposed to streams of oxygen, creating
bubbles. These bubbles facilitate the exchange of oxygen and carbon dioxide between the
blood and the gas phase. The oxygenated blood is then returned to the patient's circulation.
Membrane Oxygenators: Membrane oxygenators, also known as microporous membrane
oxygenators, are the more modern and widely used type of oxygenators in cardiac surgery.
These oxygenators use a semipermeable membrane that separates the blood from the
 oxygenating gas, typically a mixture of oxygen and other gases. Oxygen and carbon
dioxide diffuse across the membrane, allowing for efficient gas exchange. The oxygenated
blood is then returned to the patient's circulation.
4. Consider patients who require heart transplantation. Is it possible to monitor CO4.2 CL4
functional parameters during surgery? If so, describe the electronic monitoring of
functional parameters.
Yes, it is possible to monitor the functional parameters.Electronic monitoring of
functional parameters refers to the use of electronic devices and sensors to continuously
measure and track various physiological and functional parameters in a patient. These
monitoring systems play a crucial role in modern healthcare settings, providing real-time
data that helps healthcare professionals assess the patient's condition, detect changes, and
make informed clinical decisions. Some common functional parameters that are
electronically monitored include:
Heart Rate (HR): The number of heartbeats per minute, measured using
electrocardiography (ECG) or other heart rate monitoring devices.
Blood Pressure (BP): The force of blood against the walls of the arteries, measured using
automated blood pressure cuffs or invasive arterial lines.
Respiratory Rate (RR): The number of breaths taken per minute, measured by
monitoring chest movements or using respiratory belts.
Oxygen Saturation (SpO2): The percentage of oxygen saturation in the blood, typically
measured non-invasively using pulse oximetry.
Temperature: The patient's body temperature, measured using electronic thermometers or
invasive temperature probes
Neuromuscular Monitoring: Monitoring the neuromuscular response during anesthesia
to assess the patient's neuromuscular blockade level.
5. Emphasize the significance of haemodialyzer to optimize treatment outcomes and CO4.3 CL2
improve patient well-being.
Blood Purification: The primary function of the hemodialyzer is to remove waste
products, toxins, and excess fluids from the patient's blood. It acts as an artificial kidney,
replicating the function of the patient's damaged or non-functioning kidneys and helping
maintain a proper balance of electrolytes and fluid levels in the body.
Improved Quality of Life: Hemodialysis with the hemodialyzer allows individuals with
kidney failure to manage their condition and maintain a reasonable quality of life. By
effectively removing waste and excess fluids, the patient's symptoms can be relieved,
reducing complications associated with kidney failure such as fatigue, shortness of breath,
and edema.
Long-term Survival: For patients with ESRD, hemodialysis with the hemodialyzer is a
life-sustaining treatment option. It provides them with the opportunity for long-term
survival while they await a kidney transplant or explore other treatment options.
Stabilization of Electrolyte and Acid-Base Balance: The hemodialyzer helps regulate
the levels of essential electrolytes like sodium, potassium, calcium, and bicarbonate in the
blood, preventing potentially life-threatening imbalances.
6. List and explain the basic blocks involved in the operation of a hemodialyzer. CO4.3 CL1
Blood Circuit:
The blood circuit is a closed loop that connects the patient's vascular access (usually a
surgically placed arteriovenous fistula or graft) to the hemodialyzer.
 Blood is withdrawn from the patient's bloodstream through the access and directed into the
hemodialyzer's blood compartment.
Dialysate Circuit:
The dialysate circuit is another closed loop that circulates the dialysate solution, which is a
special fluid used to facilitate the exchange of solutes and waste products with the patient's
blood. The dialysate solution typically contains specific concentrations of electrolytes and
is adjusted based on the patient's individual needs.
Semipermeable Membrane (Dialyzer Membrane):
The semipermeable membrane is the heart of the hemodialyzer. It separates the blood
compartment from the dialysate compartment. The membrane allows the exchange of
solutes and fluids between the patient's blood and the dialysate, facilitating the removal of
waste products and excess fluids.
Blood Pump:
The blood pump is responsible for drawing blood from the patient's vascular access and
propelling it through the blood circuit into the dialyzer.The pump ensures a constant and
controlled flow of blood through the dialyzer, allowing sufficient time for effective waste
removal and dialysis.
7. Name a non-invasive technique used for kidney stone fragmentation and describe the CO4.4 CL2
are the factors that influence the selection of the technique as a treatment option for
kidney stones?
Lithotripsy was used for the kidney stone fragmentation.
Stone Size: Lithotripsy is generally effective for treating smaller kidney stones, typically
those less than 2 centimeters in diameter. Larger stones may require alternative treatment
methods, such as percutaneous nephrolithotomy (PCNL) or ureteroscopy.
Stone Location: The location of the kidney stone is crucial in determining the feasibility
of lithotripsy. Extracorporeal shock wave lithotripsy (ESWL), the most common type of
lithotripsy, is well-suited for stones located in the kidney or upper ureter. If the stone is
located in the lower ureter, other treatment options like ureteroscopy might be more
effective.
Stone Composition: The composition of the kidney stone can influence the success of
lithotripsy. ESWL is most effective for stones made of certain materials, such as calcium
oxalate or calcium phosphate. Some stones, like uric acid stones, may be less responsive to
shock wave treatment.
Patient's Health Status: The overall health and medical history of the patient are critical
factors. Lithotripsy is generally considered safe for patients without significant medical
complications. However, patients with certain medical conditions or who are pregnant may
not be suitable candidates for lithotripsy.
8. Outline the principles of cryogenic technologies and their potential benefits for CO4.4 CL2
patients.
Principles of Cryogenic Technologies
a) Cryopreservation: Cryopreservation is the process of preserving biological materials,
such as cells, tissues, or organs, at very low temperatures to maintain their viability for
long periods. Cryopreservation relies on the principle that freezing biological materials to
ultra-low temperatures (-80°C to -196°C) can significantly slow down metabolic processes
and prevent cellular damage.
b) Cryosurgery: Cryosurgery, also known as cryoablation or cryotherapy, involves the
 use of extreme cold to destroy abnormal or diseased tissues, such as tumors or
precancerous lesions. Liquid nitrogen or argon gas is applied to the targeted tissues,
causing cell death through ice crystal formation and tissue destruction.
Potential Benefits for Patients
a) Organ Transplantation: Cryogenic preservation allows for the long-term storage of
organs, such as kidneys, hearts, and livers, making it possible to build an "organ bank" for
transplantation. This could significantly increase the availability of organs for patients in
need of life-saving transplants.
b) Fertility Preservation: Cryopreservation of eggs, sperm, and embryos enables
individuals facing medical treatments that may impair fertility (e.g., chemotherapy) to
preserve their reproductive potential for future use.
c) Cancer Treatment: Cryosurgery is used as a minimally invasive treatment option for
certain cancers, offering benefits such as reduced damage to healthy tissues, shorter
recovery times, and fewer complications compared to traditional surgery.
9. Assume a person is suffering from ear ache and suspects that wax has become CO4.5 CL2
clogged. Suggest a suitable mode of examination and explain the operating concept
using a nice diagram.
Otoscope was used for the ear examination.

The white LED light, which is normally used for imaging, can also be used as a
light source for measurements of the diffuse reflectance spectrum. When the now added
flip-in mirror is turned to a horizontal position, the eardrum, which is illuminated by the
LED light, is imaged onto the complementary metal oxide semiconductor (CMOS)
camera, installed in the commercial unit. Measurements of a reflectance spectrum can be
performed when the flip-in mirror is turned to an inclination angle of 45 degrees. A
speculum (tube with a free channel with a smallest diameter of 5 mm) is normally used at
the head of an otoscope and is inserted into the ear canal to approach the eardrum. In all
our present work, we used the constrictions given by this confined channel, through which
all the experiments had to be pursued to be realistic for our final clinical application. In
preparation for GASMAS measurements, the CMOS camera can be used to monitor the
 position of the speculum in real-time until it reaches an optimum position for the
measurements. When performing the GASMAS measurements, laser light is transmitted
through an optical fiber, laterally passing along the wall of the small speculum channel to
approach the eardrum, and the optical path for detection is then the same as that for the
measurements of the reflectance spectrum. The light sources were switched, that is, the
LED is turned off and the narrow-band diode laser is turned on for GASMAS monitoring.
The small channel in the speculum can in principle be flushed with nitrogen during the
whole measurement procedure to remove the oxygen present in the ear canal and the
interior of the otoscope. Twelve bare fibers with a core diameter of 400 μm were arranged
as light collecting fibers in the spectroscopic measurements. The light received was
directed to a spectrometer (Ocean Optics USB4000) for reflectance measurements, or a
photodiode (PD) for GASMAS measurements
10. Think of patients with a variety of conditions, such as gastrointestinal bleeding, polyp CO4.5 CL4
removal, and gastrointestinal tumor resection. Endoscopy and laparoscopy are both
minimally invasive diagnostic and therapeutic procedures. By investigating and
contrasting their various benefits, drawbacks, and consequences, Provide valuable
insights for healthcare professionals in determining the best approach for various
instances.
Endoscopy and laparoscopy are both minimally invasive procedures used for
diagnostic and therapeutic purposes in the gastrointestinal tract. Each procedure has its
unique benefits, drawbacks, and consequences, and the choice between them depends on
the specific condition and the patient's individual circumstances. Let's investigate and
contrast their various aspects.
For gastrointestinal bleeding or polyp removal in the upper or lower GI tract,
endoscopy is often the first choice due to its non-surgical nature, direct visualization, and
minimal invasiveness.
For gastrointestinal tumor resection or more extensive interventions involving
multiple abdominal organs, laparoscopy may be preferred for its comprehensive view,
precision, and suitability for complex surgeries.
Healthcare professionals should consider factors such as the patient's medical
history, condition severity, procedural expertise, and available resources when determining
the best approach for each instance. A multidisciplinary team discussion and patient
consultation are essential to make informed decisions that optimize patient outcomes and
safety.
11. In a recorded thermogram, how is temperature data obtained and represented? CO4.5 CL1
Infrared Detection: The infrared camera contains a sensor known as a microbolometer or
a similar device capable of detecting infrared radiation. When the camera is directed
towards an object or a person, it measures the intensity of infrared radiation emitted by the
surface.
Temperature Measurement: The infrared camera translates the intensity of the detected
infrared radiation into temperature values using a process called radiometry. Each pixel in
the camera's sensor corresponds to a specific temperature reading, and these readings are
captured and stored as a digital image.
Thermal Image Generation: The collected temperature data is combined to create a
thermal image, also known as a thermogram. In a thermogram, different colors or shades
are used to represent different temperature levels. Typically, warmer areas are represented
 by colors like red, orange, or yellow, while cooler areas are represented by colors like blue
or green. The range of colors or shades used in the thermogram corresponds to the
temperature scale being used by the camera.
Visualization: The thermal image is displayed on the camera's screen or stored as a digital
file. This image shows the temperature distribution across the object or person being
observed. The variations in temperature are represented by the different colors or shades in
the thermogram.
Analysis and Interpretation: The recorded thermogram is then analyzed and interpreted
by trained professionals. In medical or industrial applications, thermograms can be used to
identify areas of abnormal temperature, detect heat patterns, assess equipment
performance, and diagnose various conditions.
12. Indicate some medical applications where thermography is commonly used. CO4.6 CL1
Breast Health and Breast Cancer Detection: Thermography is used as an adjunctive
tool for breast cancer screening. It can detect areas of abnormal heat patterns in breast
tissue, which may be indicative of underlying conditions, including breast cancer or breast
inflammation. It is particularly useful for women with dense breast tissue or those who
cannot undergo mammography.
Vascular Assessment: Thermography is used to assess blood flow and vascular
abnormalities. It can identify areas of poor circulation, detect venous insufficiency, and
help in the evaluation of peripheral vascular diseases.
Musculoskeletal Injuries and Inflammation: In sports medicine and orthopedics,
thermography is used to assess musculoskeletal injuries, monitor inflammation, and
evaluate conditions such as tendonitis, bursitis, and arthritis.
Pain Management: Thermography is employed in pain management to visualize areas of
increased heat associated with pain and inflammation. It can be helpful in monitoring the
effectiveness of treatments and interventions.
Dermatology and Skin Conditions: In dermatology, thermography is used to identify
skin conditions, monitor wound healing, and detect areas of inflammation or infection.
PART-C
1. Justify the importance and its working principle of heart lung machine with neat diagram CO4.1 CL4
The heart-lung machine, also known as the cardiopulmonary bypass machine, is a
vital tool in cardiac surgery. Its importance lies in its ability to temporarily take over the
functions of the heart and lungs, allowing surgeons to perform complex procedures on the
heart while the blood is diverted away from the heart and oxygenated outside the body.
This machine has revolutionized cardiac surgery and has significantly improved patient
outcomes in various heart procedures. Its key importance includes:
Safe and Controlled Blood Flow: The heart-lung machine ensures a continuous flow of
oxygenated blood to vital organs, providing them with oxygen and nutrients during the
period when the heart is stopped for surgery.
Facilitating Complex Surgeries: The machine enables surgeons to work on a motionless
and bloodless heart, allowing them to perform delicate and intricate procedures with
improved precision and reduced risk of bleeding.
Safeguarding Patient's Life: By temporarily taking over heart and lung functions, the
heart-lung machine provides a lifeline to patients with severe heart conditions, enabling
them to undergo critical surgeries that would otherwise not be possible.
Management of Blood Chemistry: The machine helps control the composition of the
 patient's blood, including levels of oxygen, carbon dioxide, and pH, ensuring stable and
optimal conditions for the patient during surgery.
Wider Timeframe for Surgery: The heart-lung machine extends the time available for
complex surgeries, giving the surgical team more time to carry out procedures that can
save or improve the patient's life. (6M)

Working Principle of Heart-Lung Machine: (6M)

The heart-lung machine operates on the principle of extracorporeal circulation,
meaning blood is temporarily diverted outside the patient's body for oxygenation and
filtration. Here's how the heart-lung machine works:
Blood Collection: Deoxygenated blood is withdrawn from the patient's body through a
cannula inserted into a large vein, usually the right atrium or the superior vena cava. Blood
is then collected in a venous reservoir.
Oxygenation: The collected blood is pumped from the venous reservoir into the
oxygenator, a component of the heart-lung machine that facilitates gas exchange. The
oxygenator contains a semipermeable membrane that allows for the diffusion of oxygen
into the blood and the removal of carbon dioxide.

Pumping and Circulation: After oxygenation, the oxygenated blood is pumped back into
the patient's body by an arterial pump. This pump generates positive pressure to propel the
blood through the arterial system, bypassing the heart.
Temperature Regulation: The heart-lung machine also includes a heat exchanger to
regulate the temperature of the blood, ensuring it remains at an appropriate level during
surgery.
2. Give a detailed explanation of the different types of oxygenators used in the heart CO4.2 CL2
lung machine.
In the heart-lung machine, oxygenators are crucial components responsible for the
exchange of oxygen and carbon dioxide between the patient's blood and the oxygenating
gas mixture. There are two main types of oxygenators used in the heart-lung machine:
bubble oxygenators and membrane oxygenators. (6M)
1. Bubble Oxygenators: Bubble oxygenators are the older and simpler type of
oxygenators, though they are less commonly used today due to advancements in medical
technology. The working principle of bubble oxygenators involves the following steps:
a. Blood Chamber: The deoxygenated blood from the patient's body is collected in a
blood chamber or reservoir. This chamber provides a space for the blood to accumulate
before entering the oxygenator.
b. Oxygenation Process: The collected blood is allowed to flow slowly through a thin
tube or conduit. At the bottom of this tube, a mixture of oxygen and other gases is
introduced, creating small bubbles in the blood.
c. Gas Exchange: As the blood flows upward through the tube, the bubbles facilitate the
exchange of oxygen and carbon dioxide between the blood and the gas phase. Oxygen is
absorbed into the blood, and carbon dioxide is released from the blood into the gas phase.
d. De-Bubbling and Defoaming: After passing through the oxygenation process, the
blood may contain small air bubbles. Before returning the oxygenated blood to the patient,
the blood is passed through de-bubbling and defoaming chambers to remove excess air
from the blood.

2. Membrane Oxygenators: Membrane oxygenators, also known as microporous

membrane oxygenators, are the more modern and widely used type of oxygenators in
cardiac surgery. These oxygenators work on a different principle and offer several
advantages over bubble oxygenators. The working principle of membrane oxygenators
involves the following steps:
a. Hollow Fiber Membrane: Membrane oxygenators contain numerous hollow fibers,
typically made of biocompatible materials like polypropylene or polyurethane. These
fibers have microporous walls, allowing gas exchange to occur across their membranes.
b. Blood Flow and Gas Flow: Blood flows through the hollow fibers inside the
 oxygenator, while the oxygenating gas mixture is circulated on the outer side of the fibers.
The gas flow maintains a concentration gradient, allowing efficient gas exchange
c. Gas Exchange: As the blood and gas flow in opposite directions across the membrane,
oxygen and carbon dioxide diffuse through the micropores. Oxygen from the gas phase
enters the blood, and carbon dioxide from the blood enters the gas phase.
d. Membrane Efficiency: The membrane's microporous structure provides a large surface
area for gas exchange, making membrane oxygenators more efficient in gas transfer
compared to bubble oxygenators.
e. Reduced Blood Trauma: Membrane oxygenators cause less mechanical trauma to
blood cells compared to bubble oxygenators, resulting in less hemolysis and a lower risk
of clot formation. (6M)
3. Mr. John Smith has a history of chronic kidney disease (CKD) that has progressed to CO4.3 CL2
end-stage renal disease, Explain how the haemodialyzer is utilized for his therapy.
The hemodialyzer, also known as the dialyzer, is a critical component of the hemodialysis
machine, which is used to perform hemodialysis on patients with kidney failure or end-stage renal
disease (ESRD). Hemodialysis is a life-saving treatment that involves the removal of waste
products, excess fluids, and electrolytes from the patient's blood when their kidneys are unable to
perform these functions adequately. Here's how the hemodialyzer is utilized in the hemodialysis
process:
1. Blood Access: Before starting hemodialysis, a vascular access point is established in the
patient's bloodstream. There are different types of vascular access, such as arteriovenous fistulas,
arteriovenous grafts, and central venous catheters. The access point allows blood to be withdrawn
from the patient and returned after filtration through the hemodialyzer.
2. Blood Withdrawal and Pumping:
The hemodialysis machine is equipped with a blood pump that draws the patient's blood from the
vascular access point into the machine. The blood pump maintains a continuous and controlled
flow of blood through the dialyzer.
3. Hemodialyzer Set-up:
The hemodialyzer consists of a bundle of hollow fibers made of a semipermeable membrane.
These fibers act as a filter, allowing the exchange of waste products and excess fluids between the
patient's blood and the dialysate solution.
The dialyzer has two compartments, one for blood (blood compartment) and another for dialysate
(dialysate compartment). The blood and dialysate flow in opposite directions across the
semipermeable membrane, facilitating the exchange of substances.
4. Dialysate Preparation and Circulation:
The dialysis machine prepares a dialysate solution, which is a specialized fluid with a specific
composition of electrolytes. The dialysate helps remove waste products and excess substances
from the patient's blood during the filtration process.
The dialysate is circulated through the dialysate compartment of the hemodialyzer using a separate
pump. It flows countercurrent to the blood flow to enhance the efficiency of solute removal.
5. Blood Filtration:
As the patient's blood flows through the blood compartment of the hemodialyzer, waste products,
excess fluids, and electrolytes pass through the semipermeable membrane and into the dialysate
compartment.
Beneficial substances, such as essential electrolytes, are kept in the blood and not removed by the
dialyzer.
6. Dialysate Disposal:
After passing through the dialysate compartment, the used dialysate is discarded, carrying away the
filtered waste products and excess fluids from the patient's blood.
 7. Blood Return and Circulation:
The filtered and cleaned blood exits the hemodialyzer and is returned to the patient's bloodstream
through the vascular access point.
8. Duration of Hemodialysis:
Hemodialysis sessions typically last several hours, and the frequency of dialysis depends on the
patient's condition and prescription from their healthcare provider.
9. Monitoring and Adjustments:
During the hemodialysis process, the machine continuously monitors various parameters, including
blood pressure, blood flow rate, and dialysate composition. The healthcare team makes necessary
adjustments to ensure the patient's safety and optimal dialysis efficacy. (12M)
4. Elaborate in detail about the principle of cryogenic technique and its applications. CO4.4 CL1

Principle of Cryogenic Technique: The principle of cryogenic technique is based on the use of
extremely low temperatures, typically below -150°C (-238°F), to achieve specific effects on
various materials and substances. At such ultra-low temperatures, the thermal energy of the
molecules is significantly reduced, leading to unique physical and chemical behaviors. The
primary principle underlying cryogenic techniques is the manipulation of material properties and
processes at these extremely cold temperatures. The application of cryogenic techniques requires
specialized equipment and a deep understanding of the effects of low temperatures on different
materials (3M).
Applications of Cryogenic Technique: Cryogenic techniques find diverse applications across
various scientific, industrial, and medical fields. Some of the key applications include:
Cryopreservation: Cryogenic techniques are extensively used for cryopreserving biological
materials, such as cells, tissues, and organs. Preservation at ultra-low temperatures can extend the
shelf life of biological samples and enable long-term storage for research, transplantation, and
fertility preservation.
Superconductivity: Certain materials exhibit superconductivity at extremely low temperatures.
Cryogenic techniques are essential in creating and maintaining the conditions necessary to achieve
superconductivity, which has applications in electronics, power transmission, and magnetic
levitation.
Liquefaction of Gases: Cryogenic techniques are used to liquefy gases, such as nitrogen, oxygen,
and helium. Liquid forms of these gases have numerous industrial applications, including in rocket
propulsion, medical imaging, and cryotherapy.
Gas Separation: Cryogenic distillation is employed in the separation of air into its component
gases, such as nitrogen, oxygen, and argon. This process is essential in producing high-purity gases
for industrial and medical use.
Cryogenic Cooling: Cryogenic techniques are used for cooling purposes, such as in refrigeration
systems for food preservation, cryogenic cooling of electronic components, and cooling of infrared
detectors and telescopes.
Cryogenic Grinding: In the food and pharmaceutical industries, cryogenic techniques are used for
grinding and milling heat-sensitive materials to prevent degradation and preserve product quality.
Medical Applications: In medicine, cryogenic techniques are applied in cryosurgery for the
treatment of various medical conditions, such as cancerous tumors and abnormal tissue growth.
Cryotherapy is also used to treat skin lesions, warts, and certain eye conditions.
Cryogenic Fuels: Cryogenic fuels, such as liquid hydrogen and liquid oxygen, are used in rocket
engines for space exploration.
Materials Research: Cryogenic techniques are employed in materials research and development,
including studying the behavior of materials at extremely low temperatures and exploring their
potential applications.
Quantum Computing: Cryogenic temperatures are essential in quantum computing experiments,
as they help create conditions for stable quantum states and reduced quantum decoherence.(9M)
5. Mrs. Emily Johnson has a history of recurrent kidney stone formation. She has previously CO4.4 CL3
undergone conservative management for smaller stones. However, the current case involves a
larger stone in the left kidney causing severe pain, urinary symptoms, and recurrent urinary
tract infections. Implement the principle of Lithotripsy to give the treatment plan for the
patient well being.

Principle of Lithotripsy: (3M)

The principle of lithotripsy is based on using shock waves or mechanical means to break
down kidney stones or other urinary tract stones into smaller fragments, which can be more easily
passed out of the body through the urinary system. The goal of lithotripsy is to treat kidney stones
non-invasively, avoiding the need for surgery and reducing patient discomfort. There are different
types of lithotripsy techniques, but the most common one is Extracorporeal Shock Wave
Lithotripsy (ESWL).

Implementation Steps: (9M)

Shock Wave Generation: During ESWL, shock waves are generated externally outside the body
using a specialized medical device called a lithotripter. The lithotripter consists of an
electromagnetic or electrohydraulic system that creates focused shock waves.
Focus on Stone: The generated shock waves are precisely focused on the location of the kidney
stone or urinary tract stone. The lithotripter's imaging system, such as ultrasound or X-ray, helps
target the stone accurately.
Shock Wave Delivery: The focused shock waves are directed towards the stone through the
patient's skin, muscles, and tissues without the need for any incisions or invasive procedures.
Stone Fragmentation: When the shock waves reach the kidney stone, they create rapid and
intense pressure changes, causing the stone to break into smaller fragments. The shock waves act
like a hammer, breaking the stone into tiny pieces.
Stone Passage: The fragmented stone pieces become small enough to be passed out of the body
naturally through the urinary system. These smaller stone fragments are more easily flushed out
during urination.
Post-Lithotripsy Care: After the lithotripsy procedure, patients are typically advised to drink
plenty of fluids to help flush out the stone fragments. Pain medications may be prescribed to
manage any discomfort during the stone passage.
6. Consider a person is suffering from abdomen pain and suspects that possibilities of CO4.5 CL2
ulcer. Recommend him a proper diagnosing modality for examination and explain
the operating concept using a neat sketch.
Endoscopy was recommended to diagnose the abdominal issues. (2M)

Working principle of Endoscopy: (10M)

The working principle of endoscopy involves the use of a specialized medical instrument
called an endoscope to visualize and perform diagnostic and therapeutic procedures inside
the body. Endoscopy is a minimally invasive technique that allows healthcare
professionals to examine and treat internal organs, tissues, and cavities without the need
for large incisions. Here's how endoscopy works:
Endoscope Design: An endoscope is a flexible or rigid tube equipped with a light source
and a high-definition camera at its tip. It may also have channels for the insertion of
additional instruments, such as biopsy forceps or surgical tools.
Insertion into the Body: Depending on the specific area to be examined, the endoscope is
inserted into the body through natural openings, such as the mouth, anus, urethra, or small
incisions in the skin. The type of endoscope used and the entry point depend on the target
organ or area of interest.
Light and Visualization: The endoscope's light source illuminates the internal structures,
while the camera at the tip captures real-time images and videos. These images are
transmitted to a video monitor, allowing the healthcare professional to view the internal
organs and tissues in detail.
Control and Navigation: The healthcare professional can control the movement of the
endoscope using knobs or controls located outside the body. This allows them to navigate
the instrument to different areas of interest and obtain a comprehensive view of the
internal structures.
Diagnosis and Visualization: During the endoscopy procedure, the healthcare
professional can visualize and assess the condition of the organs, tissues, or cavities being
examined. Abnormalities, such as inflammation, ulcers, tumors, or polyps, can be
identified and evaluated for further diagnosis.
Biopsy and Therapeutic Interventions: If needed, the endoscope can be equipped with
biopsy forceps to take small tissue samples for laboratory analysis. Additionally,
endoscopes with channels can be used to introduce small surgical instruments for
therapeutic interventions, such as polyp removal or cauterization of bleeding vessels.
 Minimal Invasiveness: Endoscopy is considered minimally invasive because it avoids the
need for large surgical incisions. Instead, it relies on small entry points or natural body
openings, which results in reduced post-operative pain, faster recovery, and improved
cosmetic outcomes.
Endoscope Removal: Once the endoscopic examination or procedure is completed, the
endoscope is carefully withdrawn from the body. If biopsies or therapeutic interventions
were performed, the entry points may be closed with sutures or allowed to heal naturally.
7. Is laproscopy is suitable for diagnosing ulcers in abdomen? And also discuss how CO4.5 CL4
endoscopy and laproscopy differ from one another. Justify your answer with
appropriate evidence.
Laparoscopy is generally not the primary method for diagnosing ulcers in the
abdomen. Ulcers are typically diagnosed using endoscopy, specifically a procedure called
esophagogastroduodenoscopy (EGD) or upper gastrointestinal endoscopy. During EGD, a
flexible endoscope is inserted through the mouth into the esophagus, stomach, and
duodenum (the first part of the small intestine) to directly visualize the lining of these
organs. This allows the healthcare professional to identify and biopsy any ulcers or
suspicious lesions for further evaluation.
Endoscopy vs. Laparoscopy: (8M)
Purpose and Scope of Examination:
Endoscopy: Endoscopy is a diagnostic procedure used to directly visualize the interior of
organs, such as the esophagus, stomach, small intestine, colon, and airways. It is primarily
used to diagnose conditions like ulcers, gastritis, polyps, and tumors in these organs.
Laparoscopy: Laparoscopy is a surgical procedure that involves the examination and
treatment of the organs and structures within the abdominal and pelvic cavities. It is used
for diagnostic purposes when the cause of abdominal pain or other symptoms is not clear.
It can also be used for therapeutic interventions, such as removing gallbladders,
performing hernia repairs, and treating endometriosis.
Access and Entry Points:
Endoscopy: Endoscopy is typically performed through natural body openings, such as the
mouth for upper gastrointestinal endoscopy and the anus for colonoscopy. In some cases,
endoscopic procedures may require minimal incisions to assist with certain interventions.
Laparoscopy: Laparoscopy requires the insertion of a laparoscope through small incisions
in the abdominal wall to gain access to the abdominal cavity. Additional instruments may
be introduced through separate incisions.
Level of Invasiveness:
Endoscopy: Endoscopy is considered minimally invasive as it does not require large
incisions and is generally well-tolerated by patients. The recovery time is relatively quick.
Laparoscopy: Laparoscopy is also minimally invasive compared to traditional open
surgery. However, it involves a slightly higher level of invasiveness compared to
endoscopy due to the small incisions in the abdominal wall.
Organ Visualization:
Endoscopy: Endoscopy provides a direct and close-up view of the mucosal lining of the
organs being examined, allowing for precise assessment and targeted biopsies.
Laparoscopy: Laparoscopy provides a more panoramic view of the abdominal cavity and
its organs but does not offer the same level of detailed visualization of the mucosal
surfaces as endoscopy.
 Case study: (4M)
8. Ms. Sarah Thompson underwent a routine mammogram screening that revealed CO4.6 CL2
dense breast tissue, making it challenging to detect potential abnormalities. As a
supplementary assessment, recommend a technique to provide additional
information about her breast health. Detail the working principle along with benefits
and its potential applications.
The working principle of a thermograph is based on the detection and
measurement of infrared radiation emitted by objects or surfaces, which corresponds to
their temperature. A thermograph is a device equipped with an infrared camera or thermal
imaging sensor that captures and converts the infrared radiation into visible images or
videos, known as thermograms. The process of how a thermograph works can be broken
down into the following steps:
Infrared Detection: When an object or surface is at a temperature above absolute zero (-
273.15°C or 0 Kelvin), it emits infrared radiation as a form of electromagnetic radiation.
The amount and wavelength of this radiation depend on the object's temperature.
Infrared Sensor or Camera: The thermograph is equipped with a specialized infrared
sensor or camera known as a microbolometer or thermopile. These sensors are capable of
detecting the intensity of the infrared radiation emitted by the objects being observed.
Thermal Imaging Processing: The infrared sensor captures the intensity of the infrared
radiation across the entire field of view. This data is then processed using thermal imaging
techniques.
Temperature Measurement: Each pixel in the thermograph's sensor corresponds to a
specific temperature reading. The thermograph's software calculates the temperature value
for each pixel based on the intensity of the infrared radiation detected.
Color Mapping or Grayscale: The thermograph's software assigns different colors or
shades to represent the range of temperatures detected. For example, warmer temperatures
might be represented by colors like red, orange, or yellow, while cooler temperatures
might be represented by colors like blue or green. Alternatively, in grayscale thermograms,
different shades of gray are used to indicate temperature variations.
Thermogram Display: The temperature data is then displayed as a thermogram on the
thermograph's screen or saved as a digital image or video file.
Visualization and Analysis: The thermogram allows the user to visualize and analyze the
temperature distribution across the objects or surfaces being observed. Hotspots,
temperature gradients, or abnormalities can be identified in the thermogram. (8M)
Benefita:
Benefits of Thermography: (4M)
Non-Invasive and Non-Contact: Thermography is a non-invasive and non-contact
method of temperature measurement. It does not require physical contact with the object or
subject being observed, making it suitable for sensitive or delicate surfaces and living
organisms.
Real-Time Imaging: Thermography provides real-time imaging, allowing immediate
visualization and analysis of temperature variations. This real-time feedback is valuable in
applications where timely responses are necessary.
Wide Temperature Range: Thermography can measure temperatures over a wide range,
from very low temperatures (cryogenic) to extremely high temperatures (e.g., in industrial
processes or combustion engines).
 Applications :
Medical Imaging: In medicine, thermography is used for various diagnostic purposes,
such as detecting breast abnormalities, identifying inflammation, monitoring blood flow,
and assessing skin conditions.

UNIT V PATIENT SAFETY

CO Topics
CO5.1 Physiological effects of electricity – important susceptibility parameters
CO5.2 Macro shock – Micro shock hazards
CO5.3 Patient‘s electrical environment – Isolated Power system – Conductive surfaces
CO5.4 Electrical safety codes and standards – IEC 60601-1 2005 standard
CO5.5 Basic Approaches to Protection against shock, Protection equipment design
CO5.6 Electrical safety analyzer – Testing the Electric system

Q. QUESTION CO CL
NO LEVEL
PART-A
1. There are ____types of effects of electric current CO5.1 CL1
A)5 B)3 C) 4 D)2
2. When electric current passes through a conducting solution it causes CO5.1 CL1
A)chemical reactions B)light effect C)magnetic effect D)nucleus reaction
3. Tick the chemical effect of electric current? CO5.1 CL1
A)boiling B)motion C)electro shock D)electroplating
4. Who discovered heating effect of electric current? CO5.1 CL1
A)jams watt B)joules lenz C)Michael faraday D)Thomas Edison
5. When an electric current pass through by the conductors the conductor CO5.2 CL1
A) to begin crash B)going to freeze C)heats up D)going to melt
6. One advantage for physiological effects of electric current CO5.2 CL2
A)respiratory paralysys B) rgan starts to burn C) tissue start to burn D) galvano therapy
7. One of the main function of personal protective grounds is to provide a CO5.3 CL1
______impendence path for a short circuit
A)high B)low C)smooth D)adequate
8. ____use caution when working near electricity CO5.3 CL2
A)always B)never C)rarely D)sometimes
9. ____is the flow of electrons around a circuit CO5.2 CL1
A)current B)electricity C)power D)voltage
10. ____all electrical equipments before use CO5.4 CL1
A)clean B)inspect C)label D)organize
11. Gloves used for electrical production must be electrically tested every ___ CO5.2 CL1
A)3months B)6months C)12 months D)never
12. Electrical ________ is the connection of two or more metal parts to establish electrical CO5.3 CL1
continuity and conductivity.
A) grounding B) both a&b C) bonding D)none of the above
13. The best or safest form of electrical shock is _________ CO5.5 CL1
A)freezing B)safety C)awareness D) no shock at all
14. The ________ within an electrical circuit is commonly referred to as the circuit voltage. CO5.5 CL2
A) potential difference
B) Either potential or potential difference
C) potential
D) potential summation
15. Safety related work practices involve CO5.6 CL1
A)the use of ground fault circuit interrupters
B)verifying power is off before doing repairs
C)keeping proper distance from overload power lines
D)all of the above
16. Which body tissue is most vulnerable to thermal damage caused by electric shock? CO5.6 CL2
A) Skin b) Liver c) Kidneys d) Lungs
17. What is the primary cause of physiological effects observed in electric shock victims? CO5.6 CL1
A) Disruption of normal electrical activity in the body
b) Direct tissue damage caused by electric current
c) Activation of the sympathetic nervous system
d) Release of endorphins and pain-relieving chemicals
18. What are the potential effects of electric shock on respiratory function? CO5.1 CL2
A) Decreased oxygen uptake b) Increased respiratory rate
c) Bronchodilation d) Enhanced cough reflex
19. Which of the following is a characteristic of an isolated power system? CO5.2 CL1
a) It is connected to the ground
B) It eliminates the risk of electrical shock
c) It operates at high voltage
d) It requires frequent maintenance
20. Which of the following is a typical example of a conductive surface in an isolated power system? CO5.3 CL1
a) Plastic enclosure b) Wooden panel c) Insulated wire D) Metal conduit
21. Which safety measure is crucial when working with conductive surfaces in an isolated power CO5.3 CL1
system?
A) Wearing insulating gloves b) Using grounded tools
c) Using non-conductive materials d) Performing regular electrical inspections
22. What is the primary purpose of grounding in electrical systems? a) To reduce electrical resistance CO5.3 CL2
B) To provide a return path for fault current c) To increase electrical capacitance d) To
eliminate electrical noise
23. What does the term "double insulation" refer to? CO5.3 CL1
A) The use of two layers of electrical insulation material
b) The presence of both grounded and ungrounded components in a circuit
c) The use of backup power sources in case of electrical failure
d) The use of surge protectors in electrical systems
24. Which safety measure is recommended when working with electrical systems? CO5.4 CL1
a) Using non-conductive tools
b) Using surge protectors with high voltage ratings
c) Using ungrounded outlets
d) Using grounded outlets without electrical insulation
25. Which safety standard is commonly used as a reference for electrical safety testing with an CO5.4 CL2
Electrical Safety Analyser?
a) IEEE 802.11 b) ISO 9001 C) IEC 60601 d) ASTM D4236
26. Which of the following devices can be tested using an Electrical Safety Analyser? CO5.4 CL2
a) Power generators b) Circuit breakers c) Transformers D) Medical equipment
27. Which of the following tests can be performed to assess electrical leakage in medical devices? CO5.5 CL2
a) Dielectric strength test b) Ground continuity test c) Insulation resistance test
D) Patient auxiliary leakage test
PART-B
1. Is electricity affects the metabolism of human body? Justify your answer by considering the CO5.1 CL4
physiological effects of electricity.
Electricity can indeed affect the metabolism of the human body, and this can be justified
by considering the physiological effects of electricity on the body. When a person comes into
contact with an electric current, it can have various effects on different physiological processes.
Physiological effects of electricity:
Muscle Contraction: Electric currents can cause involuntary muscle contractions, known as
tetany. These contractions can lead to increased energy expenditure as the muscles contract and
relax repeatedly, affecting the body's overall metabolism.
Nervous System Response: Electric shocks can stimulate the nervous system, leading to an
increase in heart rate, respiratory rate, and other physiological responses. These responses can
result in an increase in metabolic rate as the body's systems work to handle the stress induced by
the electrical shock.
Tissue Damage: High levels of electrical current can cause tissue damage, leading to inflammation
and repair processes. The body's immune response and repair mechanisms may lead to increased
metabolic activity in the affected tissues.
It's important to note that the impact of electricity on metabolism depends on various
factors, such as the intensity and duration of the electrical exposure, the pathway the current takes
through the body, and the individual's overall health. Low-level exposures or brief contact with
electricity may not have significant effects on metabolism, while higher levels of exposure can lead
to more pronounced physiological responses. While these effects on metabolism are possible, it's
essential to remember that electricity can be extremely dangerous, and any contact with live
electrical sources should be avoided. Electrical accidents can cause severe injuries, including
burns, cardiac arrest, and even death. Always prioritize electrical safety and take necessary
precautions when working with electrical systems or handling electrical equipment. If an electrical
accident occurs, seek immediate medical attention.
2. How does electric shock affect the cardiovascular system? CO5.1 CL2
Cardiac Arrhythmias: Electric shock can disrupt the normal electrical impulses that
coordinate the heart's contractions. This interference can lead to abnormal heart rhythms, known as
arrhythmias. Ventricular fibrillation, where the heart quivers instead of pumping blood effectively,
is a severe arrhythmia that can be life-threatening if not treated immediately.
Cardiac Arrest: In some cases, particularly with high-voltage electric shocks, the disruption
of the heart's electrical signals can lead to cardiac arrest. Cardiac arrest is a condition where the
heart stops beating altogether, and immediate cardiopulmonary resuscitation (CPR) and
defibrillation are necessary to restore the heart's rhythm.
Blood Pressure Fluctuations: Electric shock can cause rapid fluctuations in blood pressure.
Initially, blood pressure may increase due to the body's stress response, but prolonged exposure or
a severe electric shock can lead to a sudden drop in blood pressure, which can result in dizziness,
fainting, or shock.
Damage to Blood Vessels: High-voltage electric shocks can cause damage to blood vessels
and surrounding tissues, leading to internal bleeding and inflammation. This can affect blood flow
 and put additional strain on the cardiovascular system.
3. When exposed to electrical currents, the human body reacts in a variety of ways, posing CO5.2 CL1
numerous health hazards. Classify the critical susceptibility parameters in order to evaluate
the safety and potential effects of electromagnetic stimulation on human physiology.
Current Pathway: The pathway the electric current takes through the body plays a crucial role
in determining the severity of the injury. The current's path can affect which organs and tissues are
affected, and whether vital organs like the heart or respiratory muscles are impacted.
Current Magnitude: The magnitude of the electric current is a critical factor in determining
the severity of the injury. Higher current levels can cause more significant damage to tissues and
organs and increase the risk of cardiac arrest.
Duration of Exposure: The length of time the current flows through the body also influences
the extent of injury. Prolonged exposure to electric current can lead to more severe damage
compared to a brief contact.
Electrical Grounding: The presence or absence of grounding can significantly affect the
outcome of an electrical accident. Proper grounding can help dissipate current safely, reducing the
risk of injury.
Type of Current: Different types of electric currents, such as direct current (DC) and
alternating current (AC), can have varying effects on the body.
4. Examine real-life incidents of microshock and macroshock in medical facilities, analyzing CO5.2 CL2
their causes and consequences to identify areas for improvement.

Microschock
Characteristics: Microshock refers to a small
electric current that typically enters the body at
a specific point, such as through a catheter or
medical device that comes into direct contact
with internal tissues. These currents are
usually in the range of microamperes (μA) to
milliamperes (mA).
Macroschock
Characteristics: Macroshock refers to a larger
electric current that can enter the body through
external contact with live electrical sources,
such as power outlets, power lines, or faulty
electrical equipment. Macroshock currents are
typically in the range of milliamperes (mA) to
amperes (A).

Potential Effects: Microshocks are especially
dangerous during medical procedures, such as
when medical equipment malfunctions or
becomes improperly grounded. The small
current magnitudes may not cause immediate
pain or obvious signs of injury, but they can
interfere with the heart's electrical signals.
This interference may lead to dangerous
arrhythmias and can be life-threatening,
particularly for patients with compromised
heart function.
Potential Effects: Macroshocks can cause
immediate pain, muscle contractions, burns,
and other visible injuries. They can lead to
cardiac arrest, respiratory paralysis, and severe
tissue damage. The severity of injury depends
on factors such as the current magnitude,
pathway through the body, and the duration of
exposure. Macroshocks can be life-threatening
even for healthy individuals.

Preventive Actions: Preventing microshocks Preventive Actions: Preventing macroshocks

involves proper design, maintenance, and
safety protocols for medical equipment.
Ensuring electrical equipment is grounded,
using isolation transformers to separate the
power source from the patient, and adhering to
safety guidelines are essential preventive
measures.
involves general electrical safety practices. It
includes proper grounding and insulation of
electrical equipment, using circuit breakers or
residual current devices (RCDs) to detect and
interrupt electrical faults, and implementing
safety training and protocols to minimize the
risk of accidental contact with live electrical
 sources.
5. Why is it important to ensure a safe electrical environment for patients in healthcare CO5.3 CL2
settings?
Patient Safety: The primary reason for ensuring a safe electrical environment is to protect
the safety and well-being of patients. Patients in healthcare facilities are often vulnerable and may
have compromised health conditions. Electrocution or electric shock can lead to severe injuries or
even fatalities, especially in individuals with pre-existing health issues.
Medical Equipment Dependence: Healthcare settings rely heavily on various medical
equipment and devices that use electricity. These devices are essential for patient care, diagnosis,
and treatment. A safe electrical environment ensures the proper functioning and reliability of
medical equipment, reducing the risk of equipment malfunctions or failures that could jeopardize
patient care.
Electrical Medical Procedures: Some medical procedures involve the use of electrical
currents for diagnostics and treatment, such as electrocardiograms (ECGs) or defibrillation.
Maintaining a safe electrical environment ensures that these procedures are conducted with
precision and without undue risks to patients.
Preventing Fires and Accidents: Electrical malfunctions or hazards can lead to fires and
other accidents within healthcare facilities. Such incidents can disrupt patient care, cause injuries,
and result in the evacuation of patients. A safe electrical environment reduces the likelihood of
electrical fires and accidents, promoting a secure healthcare setting.
Compliance and Legal Requirements: Healthcare facilities are subject to strict regulations
and safety standards, including those related to electrical safety. Ensuring a safe electrical
environment helps healthcare organizations comply with these requirements and avoids potential
legal liabilities in case of accidents.
6. While designing the electric circuit for an intensive care unit, what is the most important CO5.3 CL2
thing we should keep in mind and list out the objectives of the implementation in healthcare
settings?
Grounding and Insulation: Proper grounding and electrical insulation are essential to
prevent electrical leakage and ensure that electrical currents flow safely through the intended paths.
Proper Load Balancing: Ensure that the electrical load is appropriately distributed across
circuits to prevent overloading and tripping of breakers.
Isolation and Separation: Isolate sensitive medical equipment, such as ventilators and
monitors, from other electrical devices to prevent interference and noise.
Electromagnetic Compatibility (EMC): Design the electrical circuit to minimize
electromagnetic interference, which can affect medical equipment accuracy and functionality.
7. Highlight the role of conductive surfaces in electrical systems? CO5.4 CL2
Electrical Conductivity: Conductive surfaces are specifically chosen for their ability to
conduct electricity. They have low electrical resistance, allowing electrical current to flow through
them with minimal impedance.
Grounding and Earthing: Conductive surfaces, like metal rods or plates buried in the
ground, are used for grounding and earthing purposes. They serve to protect against electrical
faults, dissipate excess current safely, and maintain electrical equipment at a safe potential with
respect to the ground.
Electrically Isolated Surfaces: In contrast to their role as conductive pathways, conductive
surfaces can also be used for electrical isolation. For example, conductive coatings are applied to
insulating materials to create conductive paths on the surface.
Electrostatic Discharge (ESD) Protection: Conductive surfaces can be designed to provide
ESD protection, preventing damage to sensitive electronic components due to electrostatic
discharge events.
8. Assume a Hospital construction area, to prevent the electrical accidents brief out some CO5.4 CL2
 common electrical safety codes and standards followed in residential and commercial settings
NFPA 70 - National Electrical Code (NEC): The NEC, published by the National Fire
Protection Association (NFPA), is one of the most widely used electrical codes in the United
States. It provides requirements for the safe installation and use of electrical systems in all types of
buildings, including healthcare facilities. NEC covers electrical wiring, grounding, electrical
equipment, and fire protection.
NFPA 99 - Health Care Facilities Code: NFPA 99 specifically addresses electrical safety
requirements in healthcare facilities. It covers essential aspects such as electrical system
maintenance, emergency electrical systems, grounding, equipment installation, and the protection
of patients and medical personnel from electrical hazards.
IEC 60601-1 - Medical Electrical Equipment Safety Standards: This standard is specific to
medical electrical equipment and provides requirements for the safety and essential performance of
medical devices. It covers aspects such as electrical insulation, leakage currents, grounding, and
protection against electrical hazards.
EN 60601-1 - European Standard for Medical Electrical Equipment: Similar to IEC 60601-
1, EN 60601-1 is the European version of the standard for medical electrical equipment safety. It is
applicable to medical devices used in healthcare facilities within the European Union.
Joint Commission Standards: The Joint Commission, an independent organization that
accredits healthcare facilities in the United States, sets standards for quality and safety in
healthcare. These standards include provisions related to electrical safety and equipment
management.
9. Identify a common safety measure to prevent electrical shock related to wet environments. CO5.5 CL2
One common safety measure to prevent electrical shock related to wet environments is the
use of Ground Fault Circuit Interrupters (GFCIs). GFCIs are electrical devices designed to quickly
shut off power to a circuit if they detect a difference in the amount of current flowing into the
circuit compared to the amount of current flowing out. This difference in current could be caused
by a ground fault, such as electricity leaking into water or a person coming into contact with an
energized conductor in a wet environment.
When GFCIs detect such a fault, they react quickly to interrupt the flow of electricity, preventing
the risk of electric shock. GFCIs are commonly used in areas where there is a high risk of electrical
hazards in wet conditions, such as bathrooms, kitchens, outdoor outlets, and near swimming pools
or hot tubs.
It's essential to regularly test GFCIs to ensure they are functioning correctly and providing
the necessary protection against electrical shock. These devices have a "test" button that should be
pressed regularly to check their operation. If a GFCI is not working correctly, it should be replaced
promptly to maintain a safe electrical environment in wet areas.
10. The design of protective equipment played a critical role in preventing occupational hazards CO5.5 CL4
and injuries. Justify the statement
The statement can be justified by considering the following points:
Personal Safety: Protective equipment is designed to safeguard workers from various
occupational hazards and injuries. Depending on the work environment, different types of
protective gear are used, such as safety helmets, goggles, gloves, earplugs, safety shoes, and
respiratory protection. These items create a physical barrier between the worker and potential
hazards, reducing the risk of injuries and accidents.
Hazard Mitigation: Different work settings expose employees to diverse hazards, such as falling
objects, chemical spills, noise, and airborne particles. Properly designed protective equipment is
tailored to address specific risks. For instance, construction workers wear hard hats to protect their
heads from falling debris, while lab technicians wear goggles and lab coats to shield themselves
from chemicals.
Legal Compliance: Many countries have strict regulations mandating the use of appropriate
 protective equipment in hazardous workplaces. Employers are legally bound to provide their
workers with the necessary protective gear and ensure its correct usage. Compliance with these
regulations helps prevent injuries, promotes a safe work environment, and avoids potential legal
consequences.
Injury Reduction: The use of protective equipment significantly reduces the severity and
frequency of workplace injuries. This not only improves the overall health and safety of the
workforce but also reduces the economic burden on employers and society caused by medical
expenses, lost productivity, and workers' compensation claims.
11. Implement an Intensive care unit with 4 bed system by considering the isolated CO5.3 CL3
power system and ensure the safety considerations of the patient care.
Below is a detailed outline of the essential elements to achieve this:
Physical Layout and Isolated Power System:
Design the ICU layout to accommodate four individual patient bays with sufficient space around
each bed for medical equipment and staff access.
Install an isolated power system (IPS) for each patient bed. An IPS provides an extra layer of
electrical safety, reducing the risk of electrical shocks and ensuring the availability of clean and
stable power for critical medical equipment.
Bed and Equipment Considerations:
Select ICU beds that allow easy adjustment and patient monitoring. Ensure they are comfortable
for patients and easily accessible for medical staff.
Install bedside monitors, infusion pumps, and other essential medical equipment near each bed to
facilitate prompt patient care and monitoring.
Monitoring and Communication Systems:
Implement a central monitoring system that allows medical staff to monitor patients' vital signs
from a centralized location.Install a reliable communication system (e.g., intercom or nurse call
system) to facilitate quick communication between patients and medical staff.

An Isolation power system

An isolation power system provides an ungrounded electrical service for various applications
within a hospital or a medical office building. These isolation power systems remain in operation
in the event of a single line-to-ground fault situation. These systems also eliminate the danger of an
electric shock to patients who may be more susceptible to leakage current and unable to move in
their beds.
If there is a fault, the system alarm in the isolation panel activates. When the alarm is
activated, the critical medical equipment remains operational, because no ground fault protection
or overcurrent protective device trips. The triggering of an alarm from a single ground fault must
be rectified as soon as possible at a “safe” time, as a second ground fault could trigger the short
circuit protection and take an entire operating room offline.

12. Does the testing of electrical system is very much needed in health care? Provide CO5.6 CL2
reasons for your answer and also explain any method of testing of electric system
 Yes, testing of electrical systems is crucial in healthcare settings for several reasons:
Patient Safety: In healthcare, patients are often vulnerable and rely on life-saving medical
equipment. Properly functioning electrical systems are essential to ensure the safe operation of
medical devices and equipment. Testing helps identify any potential electrical hazards that could
jeopardize patient safety.
Continuous Operations: Hospitals and healthcare facilities operate 24/7, and interruptions in
electrical supply can have severe consequences. Testing helps identify weak points in the electrical
system, enabling proactive maintenance and reducing the risk of unexpected power outages.
Medical Equipment Reliability: Testing the electrical system ensures the reliability of medical
equipment. Faulty electrical systems can damage or render medical devices inoperable, leading to
delays in patient care and potential harm to patients.
Compliance with Regulations: Healthcare facilities must adhere to strict safety and regulatory
standards to maintain their operations. Regular testing of electrical systems is often a legal
requirement to comply with safety regulations and meet accreditation standards.
PART-C
1. Analyze the factors that contribute to the severity of electrical injuries and their CO5.1 CL4
impact on the physiological response to electric shock.
Electricity can have various physiological effects on the human body, depending on the magnitude,
duration, and pathway of the electric current. The susceptibility of an individual to electric shock is
influenced by several parameters, including the following: (6M)
Electric Current Pathway:
The path of electric current through the body plays a significant role in determining the severity of
physiological effects. Current passing through vital organs, such as the heart or brain, can be life-
threatening, while current passing through extremities may cause localized injuries.
Current Magnitude (Amperage):
The magnitude of electric current flowing through the body is a critical factor in determining its
physiological effects. Even small currents can cause discomfort, while higher currents can lead to
muscle contractions, tissue damage, and potentially life-threatening effects.
Current Duration:
The duration of exposure to the electric current is also crucial. Brief exposures may cause minor
effects, such as muscle spasms, while prolonged exposures can lead to more severe injuries and
long-term complications.
Current Frequency:
Alternating current (AC) and direct current (DC) have different physiological effects. AC is more
likely to cause muscular tetanus, making it more dangerous in some situations compared to DC.
Path of Least Resistance:
The human body is a conductor of electricity, and the electric current will follow the path of least
resistance. Factors like skin moisture and the presence of conductive objects in contact with the
body can affect the current pathway.
The physiological effects of electricity on the human body include: (6M)
Electric Shock:Electric shocks can cause muscle contractions, which can lead to falls and
secondary injuries. Severe electric shocks can result in cardiac arrhythmias, respiratory distress,
and loss of consciousness.
Burns:High-current electricity can cause thermal burns at the entry and exit points of the current in
the body, leading to deep tissue damage.
Cardiac Effects:Electric currents passing through the heart can disrupt its normal electrical
activity, potentially leading to cardiac arrest and ventricular fibrillation.
Neurological Effects:Electric shocks can affect the nervous system, causing sensations like
tingling, numbness, or temporary paralysis.
Respiratory Effects:Severe electric shocks may lead to respiratory muscle paralysis, making
 breathing difficult or impossible.
Psychological Effects:Electric shocks can lead to psychological trauma, anxiety, and fear of
electricity or electrical devices.
2. A 72-year-old female with a pre-existing heart condition, was admitted to the hospital CO5.2 CL3
for a routine surgical procedure. She had a pacemaker implant that required close
monitoring and adherence to electrical safety measures due to the potential risk of
microshock hazards. Implement electrical safety precautions, including proper
grounding, insulation, and monitoring
Ensuring electrical safety for a 72-year-old female with a pre-existing heart
condition and a pacemaker implant is of utmost importance to prevent any potential risks
associated with microshock hazards. Here are some key electrical safety precautions that
should be implemented: (12M)
Proper Grounding:
All electrical equipment and devices in the patient's room, including medical equipment,
should be properly grounded. Grounding helps to divert any leakage currents away from
the patient, reducing the risk of electrical shocks.
Isolated Power System (IPS):
Use an isolated power system for the patient's bed and the surgical equipment used during
the procedure. An IPS provides an extra layer of protection against electrical hazards and
is particularly crucial for patients with sensitive medical devices like pacemakers.
Insulation Testing:
Regularly perform insulation testing on all electrical equipment to ensure the integrity of
their insulation. This test helps identify any potential leaks or faults in the equipment that
could lead to electrical hazards.
Monitoring and Alarms:
Utilize monitoring equipment to continuously monitor the patient's vital signs and the
functioning of the pacemaker. Alarms should be set up to alert medical staff promptly in
case of any abnormalities or changes in the patient's condition.
Clear Labeling:
Clearly label all electrical outlets, switches, and medical equipment with their respective
functions to avoid confusion and ensure proper usage.
Adherence to Manufacturer's Instructions:
Strictly follow the manufacturer's guidelines for the pacemaker and any other medical
devices to ensure safe operation and minimize the risk of interference or malfunction.
Regular Maintenance:
Schedule regular maintenance and inspection of all electrical systems, including medical
equipment, to identify and address any potential safety issues promptly.
Emergency Procedures:
Have clear and well-practiced emergency procedures in place in case of electrical
accidents or power failures. Medical staff should know how to respond quickly and
effectively to minimize harm.
Limited Electrical Devices Near the Patient:
Minimize the use of personal electronic devices near the patient, as they could potentially
interfere with the pacemaker's functioning.
Patient Education:
Educate the patient and their family about potential electrical safety risks and provide
guidelines on how to avoid them both in the hospital and at home.
 By implementing these electrical safety precautions, the hospital can significantly
reduce the risk of microshock hazards for the 72-year-old female with a pacemaker
implant, ensuring a safe and successful surgical procedure and recovery process.
3. Can the macroshock hazard have an effect on the human neurological system? CO5.2 CL2
Explain the safety factors as well as the occurrence of the macroshock danger.

Macroshock hazards can indeed have effects on the human neurological system,
particularly if the electrical current magnitude is high enough. Macroshock refers to an
electric shock that occurs when a significant amount of current flows through the body. It
is generally more dangerous than microshock, which involves lower current levels but may
still pose risks for individuals with certain medical conditions or medical devices.
Occurrence of Macroshock Danger: (4M)
Macroshock hazards can occur in various settings, including homes, workplaces, and
healthcare facilities.
In healthcare settings, macroshock hazards may arise when medical equipment
malfunctions, electrical systems are improperly maintained, or when there are errors in the
application of medical devices.
In non-medical settings, macroshock dangers can result from faulty electrical appliances,
exposed wiring, or unsafe electrical practices.
Safety Factors: (4M)
Proper grounding: Ensuring all electrical equipment and systems are properly grounded
helps prevent macroshock hazards. Grounding diverts electrical currents away from the
body, reducing the risk of electric shock.
Equipment insulation: Regular testing and maintenance of electrical equipment help ensure
that insulation is intact, preventing current leakage and reducing the risk of macroshock.
Safe electrical practices: Adhering to safe electrical practices, such as proper handling of
electrical equipment and following safety guidelines, can significantly reduce the risk of
macroshock hazards.
Emergency procedures: Having well-established emergency procedures in place helps
medical staff respond promptly and appropriately in the event of an electrical accident,
minimizing potential harm.
Preventive Measures: (4M)
Implementing proper grounding and isolation systems to protect patients with medical
conditions or devices sensitive to electrical currents, such as pacemakers.
Regularly testing and inspecting electrical equipment and systems to identify potential
hazards and ensure safety compliance.
Educating medical staff, patients, and the public about electrical safety measures and
potential risks associated with macroshock hazards.
Training healthcare personnel to respond to electrical emergencies effectively and
providing adequate resources for emergency situations.
4. Explore the process of updating and revising electrical safety codes and standards to CO5.4 CL2
adapt to evolving technologies and safety practices.
Electrical safety codes and standards are a set of guidelines, regulations, and best practices
established by national and international organizations to ensure the safe design,
installation, operation, and maintenance of electrical systems. These codes and standards
are continuously updated to keep up with advancements in technology and to enhance
 electrical safety. They cover various aspects of electrical systems, including wiring,
equipment, devices, and installations, with the primary goal of preventing electrical
hazards and protecting human life.
Some of the most widely recognized electrical safety codes and standards include:
National Electrical Code (NEC) / National Fire Protection Association (NFPA 70):
The NEC, published by the NFPA, is one of the most widely adopted electrical codes in
the United States. It provides comprehensive requirements for electrical installations,
covering everything from conductors and overcurrent protection to grounding, wiring
methods, and the use of electrical equipment. The NEC is updated every three years to
reflect new safety practices and technological advancements.
International Electrotechnical Commission (IEC) Standards:
The IEC is an international organization that develops and publishes global standards for
electrical and electronic technologies. IEC standards cover a wide range of electrical
components, devices, and systems, ensuring international uniformity and interoperability
of electrical equipment.
International Building Code (IBC) / International Fire Code (IFC):
These codes provide requirements for electrical safety in buildings, including guidelines
for electrical installations, fire protection, and emergency systems. The IBC and IFC are
often adopted at the state or local level in the United States and play a crucial role in
ensuring electrical safety in construction projects.
Occupational Safety and Health Administration (OSHA) Standards:
OSHA is a U.S. federal agency responsible for enforcing workplace safety regulations.
OSHA's electrical standards address electrical hazards in workplaces and outline safety
requirements for employees and employers working with electrical equipment.
Institute of Electrical and Electronics Engineers (IEEE) Standards:
The IEEE develops standards for various electrical engineering areas, including power
generation, distribution, and utilization. IEEE standards ensure the safe and efficient
operation of electrical systems in industrial and commercial settings.
International Organization for Standardization (ISO) Standards:
ISO develops standards for various industries, including electrical safety. ISO standards
aim to promote international standardization, efficiency, and quality in electrical products
and systems.
Canadian Electrical Code (CEC):
The CEC is the Canadian equivalent of the NEC and provides safety requirements for
electrical installations across Canada.
European Norm (EN) Standards:
EN standards are adopted throughout Europe and ensure conformity of electrical products
and systems to common safety requirements. (12M)
5. Analyse how an isolated power supply differs from a standard power supply in terms CO5.3 CL2
of electrical safety? Exemplify your response
An isolated power supply (IPS) differs from a standard power supply in terms of
electrical safety by providing an additional layer of protection against electrical hazards,
particularly for critical applications and sensitive equipment. The key difference between
the two lies in the design of the power supply and the level of electrical isolation they
offer.
Standard Power Supply: A standard power supply typically consists of a transformer that
 steps down the voltage from the main power source to a lower voltage suitable for the
equipment's operation. The output of the transformer is then rectified and filtered to
provide a DC (direct current) output. While standard power supplies are generally safe and
widely used in various applications, they do not provide electrical isolation between the
input and output sides of the power supply.
Isolated Power Supply (IPS): An isolated power supply, on the other hand, is designed
with enhanced safety features to isolate the output circuit from the input circuit. The
isolation is achieved using an isolation transformer, which electrically separates the input
and output sides of the power supply. As a result, there is no direct electrical connection
between the input and output terminals of the IPS. (6M)
Electrical Safety Differences:
Protection against Ground Faults: IPS is specifically designed to minimize the risk of
ground faults. In an IPS, if a ground fault occurs on the output side (e.g., equipment
malfunction or leakage), it does not pose an immediate danger to the input side. The
isolation provided by the transformer prevents the ground fault current from reaching the
main power source.
Microshock Prevention: For applications where sensitive medical equipment is used,
such as in hospitals or surgical theaters, an IPS is essential. Medical-grade IPS is
employed to ensure that even tiny leakage currents (microshocks) that may arise due to
contact with the patient do not pose a risk to their safety, especially for patients with
implanted medical devices like pacemakers.
Safety in High-Risk Environments: In certain environments where electrical hazards are
more prevalent, such as industrial settings or laboratories handling hazardous materials, an
IPS can provide an extra level of safety by reducing the potential for electrical accidents or
fires. (6M)
Example: A common example of the use of an isolated power supply is in operating
rooms within hospitals. Medical-grade IPS is employed to power surgical equipment and
support life-saving medical devices. The isolation provided by the IPS ensures that
electrical faults or microshocks occurring within the surgical equipment do not affect the
patient or pose risks to the medical staff.
6. Evaluate the patient safety by using safety approaches and basic electrical standards CO5.5 CL4
Ensuring patient safety in healthcare settings requires the implementation of safety
approaches and adherence to basic electrical standards. The combination of safety
approaches and electrical standards helps minimize electrical hazards, reduces the risk of
patient harm, and promotes a safe healthcare environment. Here's an evaluation of patient
safety using safety approaches and basic electrical standards: (12M)
Isolated Power Systems (IPS):
Implementing IPS in areas where patients with medical conditions or sensitive medical
devices (e.g., pacemakers) are present ensures additional protection against electrical
hazards. IPS minimizes the risk of microshocks and ground faults, which could otherwise
pose serious threats to patients' health.
Grounding and Insulation:
Proper grounding of electrical equipment and systems, along with regular insulation
testing, helps prevent electrical leakage and reduces the risk of macroshock hazards.
Ensuring that electrical outlets and equipment are properly insulated prevents accidental
contact with live electrical components, protecting patients and healthcare staff from
 potential electrical shocks.
Regular Maintenance and Testing:
Implementing routine maintenance and testing protocols for electrical equipment and
systems ensures their proper functioning and identifies potential hazards promptly.
Regular inspections help prevent electrical failures, reducing the likelihood of disruptions
to patient care due to electrical issues.
Clear Labeling and Signage:
Clearly labeling electrical outlets, switches, and medical equipment ensures that healthcare
staff can easily identify and use them correctly, minimizing the risk of accidental errors
and electrical accidents.
Training and Education:
Providing comprehensive training to healthcare personnel on electrical safety protocols
and safe electrical practices enhances their awareness of potential hazards and equips them
to handle electrical equipment safely.
Educating patients about electrical safety measures and guidelines helps them understand
potential risks and contributes to a safe patient environment.
Emergency Preparedness:
Having well-established emergency procedures for electrical accidents and power failures
ensures a prompt and efficient response to minimize harm to patients and healthcare staff.
Compliance with Electrical Codes and Standards:
Adhering to electrical codes and standards, such as the National Electrical Code (NEC)
and relevant healthcare-specific standards, ensures that electrical systems and equipment
are designed, installed, and maintained according to the highest safety standards.
Compliance with standards promotes a culture of safety and continuous improvement in
healthcare facilities.
Integration of Technology and Alarms:
Utilizing advanced technology, such as central monitoring systems and alarms, helps
continuously monitor patients' vital signs and the functioning of medical devices, enabling
swift responses to any abnormalities.
Incorporating safety approaches and adhering to basic electrical standards is
essential to safeguarding patients and creating a secure healthcare environment. By
consistently implementing these measures, healthcare facilities can significantly reduce the
likelihood of electrical accidents and ensure optimal patient safety throughout the care
journey.
7. Present the challenges encountered during the design and implementation of the CO5.5 CL4
protection equipment.
Designing and implementing protection equipment can be a complex and challenging
process, as it involves considering various factors to ensure effective and reliable
protection. Some of the key challenges encountered during the design and implementation
of protection equipment include:
Safety and Reliability: The foremost challenge is to ensure that the protection equipment
provides a high level of safety and reliability. It must accurately detect faults, abnormal
conditions, or hazards and promptly initiate the appropriate protective measures.
Coordination and Selectivity: In complex power systems with multiple protection
devices, ensuring proper coordination and selectivity is essential. The protection
equipment should be coordinated such that the device closest to the fault operates first,
 minimizing the impact on unaffected parts of the system.
Time Grading and Speed of Operation: Different protection devices in a power system
are set to operate at different time delays to ensure proper coordination. Achieving the
right balance between speed of operation and time grading is crucial to avoid unnecessary
tripping and ensure efficient fault clearance.
Sensitivity and Stability: Protection equipment must be sensitive enough to detect faults
accurately, but it should also be stable and not trip unnecessarily due to transient
disturbances or system fluctuations.
Integration with Control Systems: Integrating protection equipment with control
systems and automation can be challenging to ensure seamless operation and
communication between different components.
Compatibility and Interoperability: Protection equipment from different manufacturers
should be compatible and interoperable, allowing for seamless integration and operation
within the power system.
Cybersecurity Concerns: As protection equipment becomes increasingly digitized and
connected, ensuring cybersecurity is vital to prevent unauthorized access or cyber-attacks
that could compromise the integrity of the protection system.
Testing and Validation: Rigorous testing and validation of the protection equipment are
essential to ensure its proper functioning under different operating conditions, fault
scenarios, and disturbances.
Cost and Budget Constraints: Designing and implementing protection equipment can be
expensive, and budget constraints may limit the availability of the latest technology or
comprehensive redundancy measures.
Maintenance and Monitoring: Regular maintenance and monitoring of protection
equipment are critical to ensure its continued reliability. Adequate resources and
monitoring systems must be in place to detect and address any potential issues promptly.
Environmental Factors: In certain settings, protection equipment may be exposed to
harsh environmental conditions, such as extreme temperatures, humidity, or corrosive
atmospheres. Ensuring the equipment's resilience to these factors can be a challenge.
Compliance with Standards: Protection equipment must comply with relevant industry
standards, safety codes, and regulations, adding complexity to the design and
implementation process. (12M)
Despite these challenges, the design and implementation of protection equipment
are essential for maintaining the stability, safety, and efficiency of power systems.
Collaborative efforts among engineers, manufacturers, and industry experts are crucial to
address these challenges and develop effective protection solutions for modern power
systems.
8. Mr. James Anderson was admitted to the hospital for a surgical procedure that CO5.6 CL3
required the use of medical equipment powered by electricity. Due to his pre-existing
medical conditions, including heart disease and diabetes, ensuring electrical safety
during the procedure was critical to minimize any potential risks. Implement the
integrated Electrical Safety Analyser for Patient Safety to enhance the patient care.
To enhance patient care and ensure electrical safety for Mr. James Anderson during
the surgical procedure, an Integrated Electrical Safety Analyzer (ESA) can be employed.
An ESA is a specialized device that allows healthcare professionals to conduct
comprehensive electrical safety testing of medical equipment and systems, ensuring they
comply with safety standards and regulations. Below are the key steps to implement the
Integrated Electrical Safety Analyzer for patient safety:
1. Pre-Procedure Equipment Check:
Before the surgical procedure, the medical equipment to be used, such as anesthesia
machines, electrocardiographs, and electrosurgical units, should be thoroughly checked
using the ESA.
The ESA can verify that the equipment is correctly grounded, has proper insulation, and
complies with safety standards.
2. Insulation Testing:
The ESA performs insulation testing to ensure there are no electrical leaks in the
equipment that could lead to potential shocks or harm to the patient.
By conducting insulation resistance measurements, the ESA can identify any faults or
deteriorations in the equipment's insulation.
3. Ground Continuity Testing:
The ESA checks the continuity of the grounding system for medical equipment.
Proper grounding is essential to divert any leakage currents away from the patient,
reducing the risk of electric shock.
4. Leakage Current Testing:
The ESA measures the leakage current from medical equipment to detect any abnormal
current flow that might be hazardous to the patient.
For a patient with pre-existing medical conditions, monitoring leakage currents becomes
crucial to ensure their safety.
5. Functional Testing:
The ESA can perform functional testing of medical equipment to ensure it operates
correctly and safely.
Functional testing includes verifying the proper operation of safety mechanisms and
alarms in the equipment.
6. Safety Compliance Verification:
The ESA can cross-check the electrical safety performance of medical equipment against
relevant safety standards and regulations, such as IEC 60601 series, ensuring compliance.
7. Real-time Monitoring during the Procedure:
During the surgical procedure, the ESA can continuously monitor electrical parameters of
the medical equipment, providing real-time feedback to healthcare professionals.
This constant monitoring allows immediate detection of any electrical safety issues that
may arise, enabling prompt corrective actions.
8. Post-Procedure Inspection:
After the surgical procedure, a post-inspection using the ESA can be performed to ensure
that the medical equipment remains safe and functional for future use.
9. Staff Training:
Healthcare professionals involved in the procedure should receive training on using the
Integrated Electrical Safety Analyzer effectively.
Proper training ensures accurate testing and interpretation of results, enhancing overall
patient safety.
By implementing the Integrated Electrical Safety Analyzer as part of the patient care
process, healthcare facilities can significantly enhance electrical safety during surgical
procedures, especially for patients with pre-existing medical conditions. The ESA provides
comprehensive electrical safety testing, real-time monitoring, and compliance verification,
enabling healthcare professionals to deliver safe and reliable patient care. (12M)