PHYSIOLOGY LAB PRACTICALS REVIEW

CRITERIA
I.

SKILLS ( 50% )
A.
B.
C.
D.

II.

Able to perform the procedure correctly

Able to perform the procedure completely
Able to choose or identify the material appropriate for the test
Communicates ideas clearly when performing the procedure

15%
15%
10%
10%

ATTITUDE ( 25% )
A.
B.

Respect for subject & facilitator / teacher

Arrives on time

15%
10%

III. KNOWLEDGE ( 25% )

A.
B.

Accuracy of info
Ability to explain (side questions, principles, mechanisms & results)

EXPERIMENT NO. V
Differentiating Isotonic from Isometric Contraction

2. Tension
3. External work

15%
10%
No change in tension
occurs
Work done

A. ISOTONIC CONTRACTION
MATERIAL
Dumbbell
PROCEDURE
a. Place the subjects extended elbow in between the thigh at midthigh level. This is the starting point (Pe).
b. Start with 2.5 lbs. weight. From Pe, the subject fully flexes his
elbow (Pf).
c. Rest for 30 seconds. Continue adding weights at 2.5 lb
increments and fully flex elbow each time.
d. Determine the subjects RM. Record the heaviest weight in
which full flexion & extension was done.
*RM = repetition maximum which the weight or resistance which
a person can move throughout a joint movement only once,
after which one can no longer repeat the movement
e. Add another weight and take note of the weight when the
subject is unable to complete the range of motion and angle eat
which motion ceased.
DISCUSSION
Explain why one can no longer flex elbow to the whole ROM
beyond the 1 RM?
- Because the maximum strength of contraction has already been
reached.
B. ISOMETRIC CONTRACTION
MATERIAL
Hand grip
PROCEDURE
a. Using the dominant hand, grasp the hand grip.
b. Squeeze the handle.
c. Grip the handle for 10 minutes or as long as you can.
DISCUSSION
Why are you not able to sustain your grip on the handle for 10
minutes?
- Because of muscle fatigue
ISOTONIC vs. ISOMETRIC CONTRACTION
1. Length of the
muscle
BACKROW Notes

ISOTONIC
Clear shortening of
the muscle length
during contraction

ISOMETRIC
Remains the same
during contraction

Tension increases
during contraction
No external work
done

EXPERIMENT NO. VI
Hematology Experiment
A. RBC & WBC COUNT DETERMINATION
MATERIALS
Hemocytometer
For RBC:
- Pipette with RED BEAD
- Bulb marked 0.5, 1 & 101 (has a volume of 200 x the capacity of
the capillary lumen from the tip to the 0.5mL mark)
For WBC:
- Pipette with WHITE BEAD
- Bulb marked 0.5, 1 & 11 (bulb has a volume 20x the capacity of
the capillary lumen from the tip to the 0.5 mark)
Diluting fluid:
For RBC: Isotonic saline solution (to preserve RBC)
For WBC: 1% acetic acid (to lyse RBC)
Microscope
Filter paper / cotton
PROCEDURE
a. Swab fingertip with alcohol
b. Prick finger with lancet
c. Suck blood up to 0.5 mark & wipe off excess blood with filter
paper
Dilution & Mixing:
For RBC:
- Suck isotonic (0.9%) saline solution up to the 101 mark
For WBC:
- Suck 1% acetic acid into the pipette up to the 11 mark
d. Shake the pipette doing figure of 8 motions with your wrists for
3 minutes
Charging the Counting Chamber
e. Place the cover slip over the counting chamber
f. Shake pipette from side to side about 5 times
g. Discard the first few drops. Allow a drop of the solution to form
at the tip of the pipette
h. Place drop at the edge of cover slip. Fluid will flow under the
cover slip by capillarity
i. There should be NO excess fluid in the gutter which may push
up the cover slip
Page 1 of 16

Counting the cells

For RBC:
- Count the red cells in 5 MEDIUM SQUARES: those on the corners
& one in the middle. Each medium square contains 16 small
squares
For WBC:
- Count the WBC in the 4 CORNER BIG SQUARES and get the
average
*TO AVOID DOUBLE-COUNTING: Just count the cells touching the
UPPER & LEFT BORDERS of a given square, ignoring the ones on the
lower & right borders
COMPUTATION:
#RBC = E/80 X 400 X 200 X 10
Where:
E = no. of RBC counted in the 5 medium (80 small) squares
400 = total number of small red squares
200 = dilution factor of the pipette with the red bead
10 = factor of depth
#WBC/cu mm = L x 20 x 10
Where:
L = average no. of WBC in 1 big square (#WBC / 4)
20 = diluting factor of the pipette with the white bead
10 = factor of depth
DISCUSSION
1. Normal range of RBC count:
3
Male: 4.5 5.5 million/mm
3
Female: 4 4.5 million/mm
2. Possible sources of error from the procedure & its effect on RBC
count
SOURCES OF ERROR
EFFECT ON RBC COUNT
Improper sample mixing
False or
Too diluted
False
Error in charging
False
Error in counting
False or
Old sample (hemolyzed RBC)
False
3. Physiologic & pathologic conditions that will lead to HIGH RBC
count
PHYSIOLOGIC
PATHOLOGIC
High altitude
Polycythemia
Strenuous exercise
Severe burns
Cigarette smoking
Hemochromatosis
Dehydration
Heart disease
4. Physiologic & pathologic conditions that will lead to LOW RBC
count
PHYSIOLOGIC
PATHOLOGIC
st
Pregnant women (1
Anemia
trimester)
Shock / Hemorrhage
Menstrual period
Kidney Failure
Over hydration
Thalassemia
5. Components of the results of CBC determination
RBC count & morphology
RBC indices (MCV, MCH, MCHC
WBC & differential count
Hemoglobin
Hematocrit
6. Normal range of WBC count and its differentials
3
5,000 10,000 / mm
BACKROW Notes

Differential WBC Count:

Neutrophils = 40 75%
Lymphocytes = 20 45%
Monocytes = 2 4%
Eosinophils = 1 -4%
Basophils = 0 1%
Stabs = 3 5%
7. Indications of increased WBC:
Neutrophils acute bacterial infections
Lymphocytes usually viral infections
Monocytes chronic bacterial infections
Eosinophils parasitic infections
Basophils allergic reactions
B. HEMOGLOBIN DETERMINATION
MATERIALS
Sahli Hellige hemometer
Diluting fluid: 10 N HCl
Lancet, cotton ball with alcohol
Distilled water
*Principle: Conversion of hemoglobin into acid hematin with dilute
HCl and then matching the brownish yellow color of this solution with
a standard.
PROCEDURE
a. Obtain blood sample. Suck into the hemometer pipette up to
3
the 20mm mark, wipe off excess blood
b. Place 5 drops 10 N HCl into the tube
c. Immerse the tip of the pipette in acid and blow the blood into
the tube. Rinse the pipette 2-3x with HCl solution. Shake the
tube until solution is well mixed
d. Add water drop by drop, mixing with the stirring rod until the
color of the solution matches that of the standards. Read the
scale of the tube
DISCUSSION
1. Normal range of Hemoglobin
Male: 14 16 g/dL
Female: 12 14 g/dL
2. Possible sources of error in the determination of hemoglobin
Procedural errors (addition of too much blood or solution,
wrong diluent, insufficient mixing)
Faded Sahli Hellige comparator
Presence of other pigments in the blood
Color blindness of observer
C. BLEEDING TIME & CLOTTING TIME
MATERIALS
Lancet, cotton ball with alcohol
Slide for clotting time
Pin or matchstick
Absorbent paper for bleeding time
Timer
PROCEDURE
Prick subjects finger to obtain blood sample.
BLEEDING TIME
- Note the time when prick was done & mark this as time zero
- Blot a drop of blood from the puncture site with absorbent
paper without touching the skin
- Repeat every 3o seconds until no more blood stain forms on the
paper
- Note the time & subtract time zero. This is the bleeding time
Page 2 of 16

(the time it took for the bleeding to stop).

CLOTTING TIME
- Drop globule of blood on slide (do not touch the slide directly).
- Draw from the center of the globule of blood on the slide to its
periphery using the tip of a pin/matchstick. Repeat at 10 sec
intervals until thread-like strands seen.
- Note the time & subtract time zero. This is the clotting time (the
time it takes for the blood to form a clot).
DISCUSSION
1. Normal bleeding time: 1 3 minutes
2. Factors in the performance of the procedure that affect bleeding
time:
Depth of puncture
Vasoconstriction
3. What does bleeding time measure?
Platelet function
Endothelial injury
4. Normal clotting time: 3 6 minutes
5. What triggers the coagulation cascade?
In vitro (laboratory): exposure to (-) charged surface (silica) or
any wettable or non-porous materials
In vivo: exposure to collagen & elastin
6. What does APTT (activated Partial Thromboplastin Time) measure?
Give its significance.
Screen intrinsic & common pathway. Measures all factors except
VII & XIII
APTT monitors effect of heparin therapy on coagulation system
7. Why does the circulating blood remain in fluid form?
Because of the following:
Laminar blood flow
Fast / rapid circulation time
Smoothness of endothelium
Circulating coagulation factors are in active form
Endogenous anticoagulant (heparin)
D. BLOOD TYPING
MATERIALS
2 test tubes (containing saline solution)
Slide with 2 concavities
Matchsticks
Blood typing sera
*Principle: Presence or absence of agglutinogen (Ag) on RBC
membrane
PROCEDURE
a. Obtain 0.3 ml of blood sample & place into a test tube with
saline solution.
b. On the slide with 2 concavities place 1 drop of antiserum A in
one concavity & a drop of antiserum B in the other concavity
c. Add 1-2 drops of RBC suspension to each antiserum
d. Mix with a matchstick & observe for 5-20 minutes for any
agglutination reaction
DISCUSSION
ABO BLOOD TYPE
ANTI-A
ANTI-B
A
(+) agglutination
(-) agglutination
B
(-) agglutination
(+) agglutination
O
(-) agglutination
(-) agglutination
AB
(+) agglutination
(+) agglutination
(+) agglutination indicates the presence of the antigen reacting with
the anti-sera of known specificity

BACKROW Notes

1. What are the other classifications of blood groups besides the ABO
system? What is their medical significance?
Rh blood group system possession of D antigen; may cause
hemolytic disease of the newborn
Duffy blood group system associated with resistance to
malaria, marker for African Black Race, hemolytic transfusion
reactions
Lewis System production of fucosyltransferase enzyme, may
cause in vivo & in vitro hemolysis
Kidd blood group system common cause of hemolytic
transfusion reactions, associated with infrequent & mild cases of
HDN
2. What are the clinical applications of blood typing?
Blood transfusion, paternity dispute, organ transplant
3. What are the major indications & contraindications of whole blood
transfusion?
Indication: replacement of lost blood due to hemorrhage
Contraindications: Pulmonary embolism, pulmonary edema,
congestive heart failure, autoimmune hemolysis
E. CROSS MATCHING
MATERIALS
2 test tubes (containing saline solution)
Slide (plain)
Applicator stick
PROCEDURE
a. Centrifuge the 2.5mL clotted blood sample for 10-15 minutes at
the speed of 15 rpm until the serum is expressed from the clot
b. Place one drop of your serum on a slide & add a drop of RBC
suspension from another subject
c. Mix with applicator stick & observe for 3-5minutes for any
agglutination reaction
DISCUSSION
1. Major Cross Match (PSDR)
- Patient/Recipient Serum vs. Donor erythrocyte (RBC)
- Checks for preformed antibodies in patients serum that could
hemolyse - donor RBC
2. Minor Crossmatch (PRDS)
- Patient/Recipient erythrocyte (RBC) vs. Donor Serum
- Checks for preformed antibodies that could hemolyse - recipient
RBC
- Unlikely to produce HTR due to hemodilution (dilution of
donor serum)
Cite some medical applications of cross matching
- Blood transfusion, organ donation, exchange transfusion
F. RBC FRAGILITY TEST
MATERIAL
Big rack with 12 test tubes containing different concentrations of
saline solution
0.5% stock solution
Distilled water
dropper
*Principle: Osmotic Fragility (OF) Test or Red Blood Cell Osmotic
Fragility is an indication of the ability of RBCs to take on water
without lysing. In this test, RBCs are placed in graded dilutions of
sodium chloride. Swelling of the cells occurs at lower concentrations
of NaCl as they take on water in the hypotonic solution.
PROCEDURE
a. Arrange a series of 12 test tubes in a rack & number them 25,
24, 23, 22, 21, 20, 19, 18, 17, 16, 15, and 14
Page 3 of 16

b. Place 0.5% stock solution in each test tube using a clean

dropper. The number of drops to place in each test tube
corresponds to the number of the test tube
c. Using another dropper, add distilled water to bring the volume
to a total of 25 drops in each test tube
d. Mix the solution well in each tube by inverting the tube covered
with plastic/paraffin film or clean fingers. The percentage of salt
solution in any tube may be computed by multiplying the tube
number by 0.02
e. Add one drop of blood into each test tube. Mix the cells with the
solution immediately by inverting the test tube once while
covering the top with your finger. DO NOT shake the test tubes
f. Let the test tube stand for 2 hours at room temperature. After 2
hours, examine the test tubes to determine if hemolysis of RBC
took place
DISCUSSION
*Hemolysis can be recognized by the color of the supernatant fluid:
Partial Hemolysis = faintly pink
Complete hemolysis = homogenous red color with or without
sediments
DEGREE OF
HEMOLYSIS
NONE
PARTIAL
COMPLETE

TEST TUBE NUMBER

22 25
21 (22)
17 (18)

CONCENTRATION
OF SOLUTION
0.44
0.42 (0.44)
0.34 (0.36)

Give the clinical significance of the osmotic fragility test.

Detects whether RBCs are more likely to breakdown
Evaluates hemolytic anemia
Detects hereditary spherocyctosis and thalassemia
Evaluates immune hemolytic states
CLINICAL CONDITION
FRAGILITY
Hemolytic Disease (G6PD)

Hereditary Spherocytosis

Thalassemia

Sickle cell

G. HEMATOCRIT DETERMINATION
MATERIAL
Wintrobe tube containing anticoagulant or microhematocrit
pipette, heparinized
*Principle: To determine the ratio of the total cellular elements to
fluid in the blood
PROCEDURE
Microhematocrit pipette
a. From the syringe containing 3mL of blood sample, draw blood
into the pipette by capillary motion
b. Centrifuge for 5 minutes at a speed of 15rpm
c. Compare RBC volume from the Microhematocrit Reader Chart
DISCUSSION
1. Normal Value of Hematocrit:
Male = 47 +/- 5%
Female = 42 +/- 5%
2. Correlation
DISEASE
RBC COUNT
HEMOGLOBIN HEMATOCRIT
Polycythemia

Anemia

BACKROW Notes

EXPERIMENT NO. VII

Respiratory Experiment
A. STATIC LUNG VOLUME
MATERIAL
Spirometer
PROCEDURE
TIDAL VOLUME
a. Take a normal inspiration & exhale normally into the spirometer
b. Repeat & take the average
TIDAL PLUS EXPIRATORY RESERVE
a. Take a normal inspiration & make a maximal expiration into the
spirometer
b. Repeat & take the average
VITAL CAPACITY
a. Take the deepest possible inspiration (start at the end of a
normal expiration) and then make a maximal expiration into the
spirometer
b. Repeat & take the average
DISCUSSION
DEFINITIONS:
VITAL CAPACITY (4.6 L): the maximum amount of air that can be
expired forcefully after a maximal inspiratory effort
TOTAL LUNG CAPACITY (5.8 L): the volume of air present in the
lungs at the end of maximal inspiration
TIDAL VOLUME (500 mL) : the volume of air inspired or expired
during quiet breathing
EXPIRATORY RESERVE VOLUME (1 L): the volume of air that can
be expired with a maximum expiratory effort after passive
expiration
INSPIRATORY RESERVE VOLUME (3 L): the volume of air inspired
with a maximal inspiratory effort in excess of the tidal volume
RESIDUAL VOLUME (1.2 L): the volume of air left in the lung at
the end of a maximal expiratory effort
MINIMAL AIR: amount of air left in the lungs after collapsing
RESPIRATORY MINUTE VENTILATION (6L/min): the amount of air
that leaves & enters the lung per minute
ALVEOLAR VENTILATION (4.2L/min): the amount of air reaching
the alveoli per minute without considering the physiologic dead
space
st
FEV1: the fraction of vital capacity expired during the 1 second
of a forced expiration
FVC: the total volume expired forcefully with greatest force &
speed after a maximal inspiration
*decreased FEV1/FVC ratio obstructive lung disease
* normal or increased FEV1/FVC ratio restrictive lung disease
B. RECORDING RESPIRATORY MOVEMENTS
MATERIALS
Pneumograph, kymograph, timer
PROCEDURE
a. Adjust the pneumograph to the subjects chest & connect it to
the recording tambour. Time your records. Keep the sidearm of
the connecting T tube open while making adjustments.
b. Record the respiratory movements in 1 minute under the
following conditions
b.1. normal respiratory movements , while silently reading a
non-stimulating book
b.2.while attention is focused on breathing
b.3. Hyperventilate by breathing deeply for 30ec, followed
immediately by concentrated reading or mathematical
computation, so as to keep attention away from breathing
movements
Page 4 of 16

b.4. while reading aloud

b.5. place a paper bag filled with several breaths of expired air
over the nose & mouth and breath in & out of the bag.
c. Note the depth or amplitude of the respiratory movements,
rhythm & rate based on your tracings.
DISCUSSION
1. What do you observe with the rate, amplitude & regularity of the
respiratory movements in the different procedures?
PROCEDURE
RATE
AMPLITUDE
RHYTHM
B1
NORMAL
NORMAL
REGULAR
B2
NORMAL

REGULAR
B3

REGULAR
B4
NORMAL

IRREGULAR
B5
NORMAL

REGULAR
2. What is the mechanism involved in the control of respiration in
each of the above procedures?
B1, B2, B4 NEURAL
B3, B5 CHEMICAL
C. DURATION OF VOLUNTARY APNEA
MATERIALS
Pneumograph, kymograph, timer
PROCEDURE
a. Take records using slow drum speed
b. Determine how long you can hold your breath under the
following conditions
b.1. Hyperventilate by breathing fast & deep for 30 sec, followed
immediately with breath holding at the end of expiration
b.2. Make a maximal forced expiration and hold at its end
b.3. Take the deepest breath possible and hold at its end
b.4. Take a few breaths from a paper bag partially filled with
expired air and hold at the end of inspiration
DISCUSSION
1. In what procedure can you voluntary hold your breath the longest?
Why?
- Procedure B.1. (Hyperventilation). Because among the 4
procedures, its the only one with increased O2
- The cortex (voluntary breathing) overpower the dorsal
respiratory group (involuntary breathing) while a person holds
his breath until the PaCO2 concentration is so great that the
DRG eventually overpowers the cortex to make the person
breath again
2. What is the lung volume in each procedure?
PROCEDURE
LUNG VOLUME
QUALITY OF AIR
B1
Functional Residual
CO2, O2
Capacity (FRC)
B2
Residual Volume (RC)
CO2, O2
B3
Total Lung Capacity (TLC) No change
B4
FRC + Tidal Volume
CO2, O2

opening or prevent the sliding indicator from moving the full

length of the scale
c. Place mouthpiece in mouth & seal lips around it. BLOW AS HARD
AS POSSIBLE. One quick & sharp blast
d. The final position of the indicator is your PEFR (peak expiratory
flow rate)
e. Repeat the procedure 3x, note the highest of the 3 readings
this is your personal best
DISCUSSION
PEAK EXPIRATORY FLOW RATE
- Measures the maximal rate of exhalation & determines airway
obstruction
- It is the greatest flow rate achieved during the maneuver of
inhaling maximally & then exhaling rapidly & completely as
possible
Advantages of PEFR monitoring
Monitoring respiratory distress
Detect lung abnormalities
Differentiate obstructive from restrictive lung disease
Clinical conditions where PEFR is useful:
Asthma
Chronic bronchitis
Emphysema
E. EXAMINATION OF THE CHEST & LUNGS
MATERIALS
Stethoscope
PROCEDURE
Physical examination of the chest (subject removes his shirt)
INSPECTION
a. Observe the chest movements during inspiration & expiration.
Check for equal excursions/expansion of the chest on both sides
(right & left) and retractions
PALPATION
Feel for tactile fremitus (the palpable vibrations transmitted through
the bronchopulmonary tree to the chest wall when the subject
speaks)
a. Place the tips of your fingers at the back of the subject at the
interscapular area
b. Instruct the subject to talk (e.g. ask the subject to repeat the
words ninety-nine, one-one-one, or blue moon)
c. Note the vibration of the subjects voice on the tip of your
fingers
d. Repeat steps a to c in the different areas illustrated below
e. Compare the vibrations on the right & left lung fields

3. What are the factors that determine the duration at which one can
hold his breath voluntarily?
- Carbon dioxide & oxygen tension
D. MEASUREMENT OF PEAK EXPIRATORY FLOW RATE
MATERIALS
Peak flow meter
PROCEDURE
a. Attach the plastic mouthpiece on the input. Make sure that the
sliding indicator is at the bottom side of the scale or base of the
meter
b. Hold the meter so that your fingers do not block the outlet
BACKROW Notes

Note: Normally, fremitus is most prominent in the interscapular area

than in the lower lung fields, and is often more prominent on the
right side than on the left. It disappears below the diaphragm
because more & more tissue impedes sound transmission as you
progress down.

Page 5 of 16

PERCUSSION
a. Place your left middle finger on the interscapular area between
the ribs
b. Hit your left middle finger with your right middle finger
c. Listen and take note of the percussion note produced
d. Repeat steps a to c in the different areas (*omit the areas over
the scapulae the thickness of muscle & bone alters the
percussion notes over the lungs)
e. Compare the percussion notes on the right & left lung fields

Note: Hollow areas like the lungs with air will sound resonant. Solid
areas like bone or muscle will sound flat. Relatively dense organ like
liver or spleen sound dull.
AUSCULTATION
a. Place the diaphragm of your stethoscope over the back of your
subject at the following areas of the lungs (see illustration
above)
b. Instruct the subject to breath in through the nose & out through
the mouth
c. Listen for at least one full minute in each location.
Normal Breath Sounds:
VESICULAR
- soft & low pitched
- heard through inspiration, continue without pause through
expiration, and then fade away about one third of the way
through expiration
BRONCHOVESICULAR
- with inspiratory & expiratory sounds about equal in length, at
times separated by a silent interval
BRONCHIAL
- louder & higher in pitch, with a short silence between
inspiratory & expiratory sounds
- expiratory sounds last longer than inspiratory sounds

DISCUSSION
INSPECTION
(note the
expansion of
the chest)
Symmetric
chest
expansion
(-) retractions

PALPATION
(note the
vibration
produced)
Normal
fremitus

PERCUSSION
(note the
percussion
sound
produced)
Resonant

AUSCULTATION
(note the
characteristic
breath sounds
heard)
Vesicular
breath sounds

1. Vibration, Percussion note & Breath sounds on the following

conditions:
PERCUSSION
BREATH
VIBRATION
NOTE
SOUNDS
Air in the
Decreased
Hyperresonant
Decreased
pleural cavity
Fluid in the
Decreased
Dull
Decreased
pleural cavity
Solidification
of lung
Increased
Dull
Increased
segment
2. When do you hear the following adventitious sounds?
Wheezes: in obstructive lung diseases such as asthma or
emphysema
Crackles or Rales: in patients with pneumonia, pulmonary
fibrosis, pulmonary edema, early bronchitis
3. Egophony is an increased resonance of voice sounds heard when
auscultating the lungs, often caused by lung consolidation &
fibrosis.
EXPERIMENT NO. IX
Examination of the Heart & Pulses
MATERIALS
Stethoscope, Watch with second hand
PROCEDURE
EXAMINATION OF HEART SOUNDS
a. Place the ear pieces of the
stethoscope in the ear canal
opening. Be sure that the
curves from the ear pieces are
facing backward
b. Listen to the heart sounds on
the following physiologic clinical
areas of auscultation on the
chest:
nd
Aortic Area
2 ICS RPSB
nd
Pulmonic Area
2 ICS LPSB
th
Tricuspid Area
4 ICS LPSB
th
Mitral Area
5 ICS LMCL
c. Determine the heart rate on one area for a full minute
EXAMINATION OF THE ARTERIAL PULSES
a. Place the tip of the first 2 fingers of your left hand over the
subjects right radial artery
b. While palpating for the radial pulse, locate the left carotid artery
using your right hand and feel the pulse
c. Count and compare the pulses of the 2 areas simultaneously for
1 full minute

BACKROW Notes

Page 6 of 16

TIMING OF PULSE & HEART RATE

a. With a stethoscope held by right hand, listen to your partners
heart sounds at the aortic area
b. With your left hand palpate the radial artery of the right wrist of
subject
DISCUSSION
st
1. Physiologic or anatomic causes of S1 (1 heart sound): Closure of
the mitral valve / systole / isovolumetric contraction
nd
2. Physiologic or anatomic causes of S2 (2 heart sound): Closure of
the aortic valve / diastole / isovolumetric relaxation
3. Are S3 & S4 heart sounds normal?
- S3 is normal in children but not in adults. It arises from rapid
deceleration of the column of blood against the ventricular wall
early in diastole.
- S3 can be heard in patients with volume overload (e.g. mitral or
tricuspid regurgitation, CHF)
- S4 is pathologic. It marks atrial contraction. It immediately
precedes S1 of the next beat, and reflects a pathologic change in
ventricular compliance (stiff valves).
- S4 can be heard in patients with conditions like hypertensive
heart disease, coronary heart disease, aortic stenosis,
cardiomyopathy, pulmonic stenosis
4. The radial pulse coincides with what heart sound? S2
5. Is there an observable difference between the heart rate & pulse
rate of a normal subject when taken simultaneously? NONE
6. What is the range of normal heart rate? 60 100 bpm
7. What anatomic structure of the heart determines the heart rate?
Why?
- SA Node. Because it is the pacemaker of the heart. It has the
highest firing rate / highest rate of discharge of impulse (7080/min) among the other pacemakers, thereby overpowering
the rest.
EXPERIMENT NO. X
Arterial Blood Pressure Determination
MATERIALS
Sphygmomanometer
Stethoscope
3 Essential Parts of Sphygmomanometer:
1. Cuff or armlet a flat rubber bag covered by an undistensible
envelope made of cotton or synthetic with Velcro or hooks
2. Manometer either mercurial or aneroid which measure the
pressure
3. Rubber bulb & needle exhaust valve used to introduce or remove
pressure into the system
Parts of stethoscope:
1. Ear piece (angled towards the nose when inserted in the ear)
2. Metal tubing/ear tubes/binaural tubes
3. Rubber tubing
4. Stem
5. Chest piece
- Diaphragm detects high-pitched sounds
- Bell detects low-pitched sounds

BACKROW Notes

PROCEDURE
PALPATORY METHOD
a. With the subject seated, wrap the cuff snugly around the arm,
about 2cm above the cubital fossa
b. Connect the manometer to the cuff & place the manometer in
such a way that the readings can be seen only by the observer<
NOT the subject
nd
rd
c. Palpate the subjects radial pulse using your 2 & 3 fingertips
over the artery. NEVER use the thumb for you may feel your
own pulse
d. Inflate the cuff up to a point when the pulse can no longer be
felt
e. Slowly release the pressure by deflating the bag and note the
manometer reading at which the pulse first reappears. This is
the systolic pressure reading
f. Continue releasing pressure until bag is completely deflated
AUSCULTATORY METHOD
a. Let the subject rest for at least 5 minutes and then wrap the cuff
snugly & smoothly around the arm 2cm above the cubital fossa
b. Connect the manometer to the cuff & portion it so that you can
see it but the subject cannot
c. Put the stethoscope on the cubital fossa approximately over the
brachial artery. Avoid undue pressure on the artery
d. Inflate the bag with the rubber bulb at a pressure higher than
the palpatory reading (about 30mmHg higher). Sounds from the
environment should not be audible through the stethoscope
e. Deflate the bag at about 2-4mmHg per pulse
f. Note the manometric reading at the appearance of first sound,
which has a clear faint tapping quality. This is the SYSTOLIC
PRESSURE
g. Continue releasing the pressure at that rate & note the changes
in the quality of the sounds (Korotkov sounds) until such time it
disappears. Note the manometer reading before the sound
disappeared (last sound). This is the DIASTOLIC PRESSURE
h. The needle valve may now be opened completely to release all
the pressure in the system
Note: Remember to completely deflate the cuff & allow the subject
to rest before repeating the process of taking his blood pressure
DISCUSSION
1. What are the physiologic determinants of blood pressure?
Cardiac Output
- Heart rate, systolic volume
Total Peripheral Resistance
2. Why do you record systolic reading only in palpatory method?
- Palpatory method only records the systolic reading because the
gush of blood from the systolic pressure which is much stronger
than diastolic pressure can be palpated, unlike diastolic pressure
which is too weak.
3. Why is it important to take the palpatory BP prior to taking the
auscultatory BP? What is an auscultatory gap?
- To prevent obtaining inaccurate readings by not measuring the
auscultatory gap.
- AUSCULTATORY GAP the interval of pressure where Korotkoff
sounds indicating the systolic pressure fade away & reappear at
a lower pressure point during the manual measurement of
blood pressure
- Auscultatory gap is usually seen in patients who are
hypertensive or present with arterial stiffness and
atherosclerotic disease
4. Enumerate the precautionary measures to be considered when
taking the blood pressure
The subject should be mentally & physically relaxed
The size of the cuff should be proportionate to the
circumference of the arm of the subject
Page 7 of 16

 The zero reading of the manometer should be kept at the level

of the heart
Blood pressure should be detected first by palpatory method
before recording by auscultatory method
Pressure must be raised 30mmHg above the palpatory level
The cuff pressure should be decreased to zero level between
successive trials
5. Is gender a factor to consider in determining BP & HR? -YES
- Females have lower blood pressure due to lower blood volume
because of menstrual periods. Also, due to the effect of
estrogen that relaxes the smooth muscles of the blood vessels.
- Females have faster heart rate
- Males have higher BP because they have greater muscle mass,
hence, higher blood volume.
EFFECT OF POSTURE ON BLOOD PRESSURE
A. Standing to lying
Immediate response:
Decreased resistance to gravity increased venous return
increased cardiac output increased arterial pressure
increase in BP
Compensatory response:
Increased arterial pressure in the heart & upper body
increase in pressure sensed by baroreceptors in the carotid
sinus sends impulse to the vagus nerve increase stimulation
to the cardiac inhibitory center decrease in HR & BP
B. Lying to standing
Immediate response
Gravity increases pooling of blood in the lower extremities
decreased venous return decreased cardiac output
decreased arterial pressure decrease in BP
Compensatory response
Decreased arterial pressure in the heart & upper body
Decreased stimulation of baroreceptors in the carotid sinus
increased stimulation of sympathetic nervous system
increase in HR & BP
EFFECTS OF EXERCISE ON BLOOD PRESSURE & HEART RATE
Isotonic Exercise: Treadmill (15mins), Stationary Bike (15mins)
Isometric Exercise: Hand grip (5mins)
Before the start of exercise: HR (in anticipation)
During exercise: HR & BP
After exercise: HR & BP
Isotonic Exercise vs. Isometric Exercise
ISOTONIC EXERCISE
ISOMETRIC EXERCISE
Heart rate (HR)
HR at the start of exercise
proportionately with the
(mainly due to decreased vagal
severity of exercise
tone)
Cardiac output (CO)
SV changes relatively little
markedly due to in HR &
stroke volume (SV)
Systolic pressure
Sharp in systolic & diastolic
Diastolic pressure increases in
pressure
MILD exercise, and does not
change or decreases slightly in
MODERATE exercise and always
decreases in SEVERE EXERCISE
Blood flow to exercising
Blood flow to exercising
muscle
muscle
Note: In isometric exercise, the exercising muscles are tonically
contracted. Peripheral resistance increases, which increases the
diastolic pressure.
BACKROW Notes

EFFECT OF HYPERVENTILATION
Determine the BP & HR of the subject after 5min rest
Ask subject to hyperventilate for 30sec & record BP in the last 5 sec
Determine BP & HR 5min after hyperventilation
1. Which determinant of BP is affected most by hyperventilation?
- Cardiac Output
- During hyperventilation, the thoracic pressure is decreased,
decreasing also the right atrial pressure, thus increasing the
pressure gradient & will allow the venous return to increase, as
well as the stroke volume & blood pressure
2. Enumerate the factors that affect venous return
Valve competence
Blood volume
Right atrial pressure
Gravity, posture
Degree of filling of systemic circulation
COLD PRESSOR TEST
MATERIALS
Pain perception scale
o
Bucket of ice cold water (0-5 C)
Sphygmomanometer
Stethoscope
Principle: BP is modified by emotional disturbance or pain. The cold
pressor test is a method of determining the lability of blood pressure
with a standard sensory stimulus
PROCEDURE
a. Let the subject lie down on the table & rest for 5 minutes
b. Record the pain perception of the subject based on the scale
c. Take the BP readings at 1min intervals for 5min or longer if
satisfactory stable pressure is not obtained. This is the control
BP
d. Immerse the subjects hand in the bucket of ice cold water (0o
3 C)
e. Record the exact time of onset of subjects discomfort
f. While hand is immersed in the bucket, take the blood pressure
30sec later & determine the intensity of pain according to the
pain perception scale. Repeat BP reading 30sec later (after 1min
of immersion)
g. Remove hand from the bucket & continue taking BP readings at
1 min intervals until BP returns to the control
DISCUSSION
1. Both systolic and diastolic BP will change.
Increase SBP is related to pain sensation of the patient causing a
fight/flight response or SNS stimulation
Increased DPB is due to the vasoconstriction brought by the cold
temperature. This increases the TPR thereby increasing diastolic
BP
2. Classifications of reactions (difference between control BP to
response BP)
a. Hyporeactor: 0-10 mmHg
b. Normoreactor: 11-20 mmHg
c. Hyperreactor:>20 mmHg (suggest a risk of developing future
high blood pressure)
3. After removing hand from the bucket, hyperemia will be expected.
This is a compensatory response after vasoconstriction or
occlusion of the blood vessel wall. Decrease in oxygen will be
sensed by chemoreceptors thus there would be parasympathetic
stimulation causing vasodilation. (Reactive hyperemia)

Page 8 of 16

EXPERIMENT NO. XI
Kidney Function Test
MATERIALS
Clean small bottles for urine collection
Graduated cylinder
Dip stick
Urinometer
PROCEDURE
24 HOUR INPUT-OUTPUT DETERMINATION
st
a. Empty bladder & discard 1 voided urine. HOUR ZERO
b. Measure 24hr fluid intake & record type & amount of the fluid
taken
c. Measure the volume of each urine void in the 24hr period. Note
the time of each void, volume, color & transparency of each
sample. Take 3oml aliquot sample from every voided urine &
th
refrigerate. The last sample should coincide with 24 hr of
collection
d. Determine the specific gravity of each sample using the
urinometer
e. Note the activities for the day of the experiment as well as the
ambient temperature
DILUTION TEST
a. Eat, but do not drink any other liquid aside from 150cc of water
(1.5hr before the actual experiment)
b. Empty bladder & discard urine
c. Drink 1,500mL of plain water within 30min
d. Collect urine every 30min & determine the volume, color,
transparency & specific gravity of 8 samples
CONCENTRATION TEST
a. Eat supper (not later than 9PM), do not drink extra fluids, only 1
glass (270mL) of water
b. Empty bladder before sleep & discard the urine
c. Collect 30mL sample upon waking up (6AM), one hour after
(7AM)
d. Eat breakfast but do not drink any fluid. Collect sample one hour
after breakfast (8AM)
e. Note volume, color, transparency of the samples. Label &
refrigerate
f. Determine the specific gravity of the 3 samples using
urinometer
EFFECTS OF THE INTAKE OF DIFFERENT FLUIDS ON URINE VOLUME &
SPECIFIC GRAVITY
a. Eat, but do not drink any other liquid aside from 150cc of water
(1.5hr before the actual experiment)
b. Empty bladder & discard urine
c. Drink 500mL of assigned fluid in 3mins or less
d. Collect urine every 30min for a total of 3 urine samples and
determine the volume, color, transparency & specific gravity of
all urine samples from the different subjects assigned to drink
different kinds of fluid
*Types of fluid used: Buko, black coffee plain tea, mt. dew, regular
cola, unsweetened choco, very sweet juice
DISCUSSION
24 HOUR INPUT-OUTPUT DETERMINATION
1. Total volume of INTAKE > OUTPUT
2. urine volume = specific gravity = darker color
3. urine volume = specific gravity = lighter color
4. activity sympathetic stimulation afferent arteriole
constriction GFR urine volume
5. BMR (Body temp) vasodilation of cutaneous vessels
(shunting) renal blood flow & GFR urine volume

BACKROW Notes

DILUTION TEST
Events that bring about dilute urine:
water intake plasma osmolarity inhibits osmoreceptors
in the anterior hypothalamus secretion of ADH from posterior
pituitary water permeability in distal convoluted tubule &
collecting duct water reabsorption urine osmolarity
urine volume
CONCENTRATION TEST
1. specific gravity = less transparent = darker color = urine vol.
2. specific gravity = more transparent = lighter color = urine vol.
3. How does kidney form concentrated urine?
plasma osmolarity stimulates osmoreceptors in anterior
hypothalamus secretion of ADH from posterior pituitary
water permeability of late distal tubule & collecting duct
water reabsorption urine osmolarity & urine volume
EFFECTS OF THE INTAKE OF DIFFERENT FLUIDS ON URINE VOLUME &
SPECIFIC GRAVITY
Black coffee, tea, cola, Mountain Dew, unsweetened choco
- Contains caffeine, a xanthine derivative, which increases
glomerular filtration and inhibits reabsorption of Na+ within
nephrons
- Diuretic/natriuretic effect: ADH excretion of Na+ and
water OR Na+ and water reabsorption
- Caffeine dilates the afferent and the efferent arterioles, thus
increasing blood flow to the glomerulus GFR
- Caffeine also causes the HR to increase: HR BP
hydrostatic pressure filtration urine output
- Can be affected by tolerance of an individual to caffeine.
Buko juice
- Causes pressure diuresis
- Can be used as ORS replacement
- plasma volume hydrostatic pressure in filtration
rate urine volume
- Works as a plasma expander
Very sweet juice
- Has an osmotic diuretic effect
- High glucose level causes an in the filtration, as glucose
takes/attracts water with it, therefore urine volume
EXPERIMENT NO. XII
General Senses
I. CUTANEOUS SENSES
A. PUNCTIFORM DISTRIBUTION OF SENSORY RECEPTORS
MATERIALS
Large handkerchief for blindfolding the subject
Graphing paper with 10x10 mm square hole
Fine bristle or horse hair
Pin head
Container with ice cold water
4 colored pens / pencils
PROCEDURE
a. Cut out a 10x10mm square hole from a piece of graphing paper
b. Blindfold the subject
c. Lay this piece of paper on the volar surface of the forearm.
Divide this square hole into 4 smaller squares & label them A, B,
C, D
d. Test squares A, B, C & D with the following:
1. Fine bristle or horse hair - touch
2. Heated pin head (dip in hot water container) warmth spots
3. Cold pin head (dip in iced cold water container) cold spots
Page 9 of 16

4. Pin or fine needle point for pain spots

Note: Stimulate 15 random spots per test square for each type of
stimulus
e. Ask the subject each time if he/she feels the stimulus for each
spot tested. There should be a total of 60 different stimuli tested
per square. Draw the results.
f. Lay the paper on the back of the nape (avoid the hairy portions)
of the subject. Repeat procedure d & e
DISCUSSION
1. Sensation an impression produced by the stimulation of a
sensory receptor site & transmission of the nerve impulse along an
afferent fiber to the brain
Examples: touch, tickle, itch, cold, warmth, pain, taste
2. Perception the conscious recognition & interpretation of sensory
stimuli that serves as a basis for understanding a particular action
or reaction
Examples: depth perception, stereognostic perception
3. Stimuli arranged according to the number of receptors felt:
Pain > Touch > Cold > Warmth
4. Volar surface of the forearm (anterior) has more sensory receptor
sites as compared to the nape (posterior). [No. of receptors:
Anterior > Posterior]
B.1. ATTRIBUTES OF SENSATION: CONTRAST
MATERIALS
Large handkerchief for blindfolding
Beaker 1 filled with warm water
Beaker 2 filled with tap water
Beaker 3 filled with ice water
PROCEDURE
a. Blindfold the subject
b. Place the subjects left index finger in beaker 1 (warm water) &
right index finger in beaker 3 (ice water). Maintain this position
for about 30sec
c. Ask the subject what sensation he/she feels & record
d. After recording the sensation, remove both fingers from their
previous locations & place simultaneously into beaker 2 (tap
water). Ask the subject what sensation he now feels in each of
his index fingers
DISCUSSION
Sensation felt:
INDEX FINGER
BEAKER 1 or 3
BEAKER 2
LEFT
Warm (1)
Cold
RIGHT
Cold (3)
Hot
CONTRAST EFFECT exposure to a stimulus of different value
enhances or diminishes the other, relative to what would normally be
perceived without the other stimulus
2 TYPES:
1. Successive contrast when 2 opposite sensations are introduced,
the first event lowers the threshold of the successive opposite
sensation
*This was the contrast experienced by the subject
2. Simultaneous contrast 2 stimuli presented at the same time
Note: Temperature sensations are not absolute but relative to the
baseline previously established by sensory adaptation

PROCEDURE
a. Blindfold the subject
b. Gradually immerse the subjects hand into the basin, staring first
with the fingertips then slowly moving the hand downwards
until the wrist is submerged. The entire procedure should be
done within 10 seconds
c. Ask the subject to rank the degree of sensation felt according to
the extent of immersion
DISCUSSION
SENSATION
EXTENT OF IMMERSION
WARM
Fingertips
WARMER
Palm
WARMEST
Wrist
*The sensation that the subject felt is due to spatial summation
(more receptors are being stimulated to cause more intense warm
sensation)
surface area nerve fibers recruited/stimulated stimulus
strength signal strength
B.3. ATTRIBUTES OF SENSATION: ADAPTATION
MATERIALS
Basin filled with warm water
Large handkerchief for blindfolding the subject
Piece of cork
Thermometer
PROCEDURE
a. Blindfold the subject
Procedure A
b. Immerse the subjects whole hand into the water basin for
5minutes
c. Make sure that the temperature of the water remains constant
during the experiment
Procedure B
b. Place a piece of cork on the forearm of the blindfolded subject,
and leave it there for 1-2 minutes
DISCUSSION
*The sensation felt for the both procedures weakened due to
sensory receptor adaptation
ADAPTATION
- is the change in frequency of the sending of impulses with
constant stimulus, and therefore a decline in sensation
- when a continuous sensory stimulus is applied, the receptor
responds at a high impulse rate at first and then at a
progressively slower rate until finally the rate of action
potentials decreases to very few or often to none at all.
Types of Adaptation
FAST ADAPTING RECEPTORS
SLOW ADAPTING RECEPTORS
Sends information related to
Send information regarding
changing stimuli
ongoing stimuli
Shorter sensation due to fast
Longer sensation due to slow
conduction velocity
conduction velocity
Examples: stretch receptors,
Examples: pain receptors,
pacinian corpuscles, olfactory
proprioception, baroreceptors
receptors
*Both the procedures demonstrated FAST ADAPTATION
C. PRESSURE SENSE

B.2. ATTRIBUTES OF SENSATION: SUMMATION

MATERIALS
Basin filled with warm water
Large handkerchief for blindfolding the subject
BACKROW Notes

MATERIALS
Large handkerchief for blindfolding the subject
Small bucket with water & sand

Page 10 of 16

PROCEDURE
a. Blindfold the subject
b. Dip the index finger of the subject & ask him/her to determine
which art of the finger feels the greatest sensation of pressure in
each of the following positions:
1. When only the fingertip is touching the surface of the sand
2. Entire finger is immersed in the sand stationary
3. Entire finger is immersed in the sand slowly moving sideways
DISCUSSION
AREA IN THE FINGER FEELING THE GREATEST PRESSURE
POSITION
1
Fingertip
2
Lateral sides of the finger
3
Lateral sides of the finger
Touch tactile reception on the superficial skin (Meissners
corpuscle, Ruffinis endings)
Pressure sensation felt deeper in the tissue (Pacinian corpuscle);
force acting on any direction against resistance
Position 1 stimulated touch receptors, position 2 stimulated
pressure receptors. Both were stimulated by position 3
The shift from position 1 to position 2 elicited the greatest
difference in pressure.

D. ARISTOTLES EXPERIMENT
MATERIALS
Large handkerchief for blindfolding the subject
Marble or any rounded object
PROCEDURE
a. Blindfold the subject
b. Cross the subjects right middle finger over the right index
finger. Place a small round object between the ends of these
fingers. Roll the object. How many object/s does he perceives?
DISCUSSION
Number of objects perceived with:
- Crossed fingers: 2
- Uncrossed fingers: 1
Relate the concept of cortical representation to the results of the
experiment:
Cortical map
- describes the distribution of minicolumns (vertical group of
neurons through the cortical layers of the brain, each
responsible for a particular receptive field) in the brain cortex.
Cortical representation
- The marble was perceived as two objects with the crossed
fingers because ordinarily, one would not feel one object on the
lateral side of the index finger and medial side of the middle
finger at the same time. Non-adjacent neurons were stimulated,
thus 2 different cortical areas, so the marble was perceived as
two objects.
- When the fingers were uncrossed, adjacent neurons which have
the same cortical area were stimulated, leading to the
perception of one object.

E.1. SYNTHETIC SENSES: TWO-POINT DISCRIMINATION

MATERIALS
Large handkerchief for blindfolding the subject
Double pointed compass
Ruler
PROCEDURE
a. Blindfold the subject
b. Determine the threshold for two-point discrimination on the
following regions:
1. Fingertip
2. Nape
Set the 2 points of the compass together & test the above
area. Separate the 2 points 2mm apart & test the same area.
Increase the distance between the 2 points until they can be
perceived as 2 separate stimuli. Measure the distance in mm.
this is called two-point threshold. The 2 points must be
applied gently, simultaneously & with equal pressure
c. Do 2 trials each region & record
DISCUSSION
TWO-POINT DISCRIMINATION ability to perceive two distinct
stimuli as separate.
Fingertip is more sensitive than the nape.
Threshold is inversely proportional to sensitivity
Peripheral Innervation Density (PID) the number of nerves
innervating an area; the number of receptive fields in a unit area of
skin
Peripheral Receptive Field (PRF) the area by which a stimulus of
sufficient magnitude will evoke a response in the sensory unit
PRF is inversely proportional to sensitivity
AREA
SENSITIVITY
PID
PRF
Fingertip
Higher
High
Small
Nape
Lower
Low
Big

E.2. SYNTHETIC SENSES: STEREOGNOSIS

MATERIALS
Large handkerchief for blindfolding the subject
3 different common objects (e.g. coin, pen, key)
PROCEDURE
a. Blindfold the subject
b. Place one object at a time in the subjects hand. Allow him/her
to feel the object for a minute
c. Instruct subject to identify the object
DISCUSSION
Stereognosis the ability to identify an object, in the absence of
vision, by using concepts of size, form, texture
Graphesthesia the ability to recognize writing on the skin in the
absence of vision
What sensations are necessary in identifying objects when
blindfolded?
- Touch, pressure, prior knowledge of the object
Synthetic senses perception of something youve known before
(for integration) for cortical analysis
Graphesthesia & Stereognosis are synthetic senses
E.3. VIBRATION SENSE (PALLESTHESIA)
MATERIALS
Tuning fork
Timer (watch with a second hand)
PROCEDURE
a. Make the tuning fork vibrate by hitting it against your palm
b. Place the base of the vibrating tuning fork on the various bony
prominences (e.g. malleolus, olecranon, patella). Record the

BACKROW Notes

Page 11 of 16

duration of vibration felt

c. Place the base of the vibrating tuning fork on various muscular
regions. Record the duration of the vibration felt
DISCUSSION
Duration of vibration: Bones > muscles
Tissue density & vibration conduction are directly proportional.
Bony prominences have higher densities, hence, more capable of
preserving vibrations
Pathway of vibration through the CNS (Dorsal Column Medial
Lemniscus Pathway):
Receptor dorsal column of medulla cross midline (internal
arcuate fibers) medial lemniscus ventral posterolateral (VPL)
area of the thalamus Postcentral gyrus (Brodmann area 3,1,2)
II. MUSCLE & JOINT SENSES (PROPRIOCEPTION)
A. STATIC POSITION SENSE
PROCEDURE
a. Ask the subject to balance himself on one leg while performing
the following:
- Eyes open
- Eyes closed
- With your eyes closed & head tilted to one side
DISCUSSION
Eyes open balanced; Eyes closed unsteady; Eyes closed & head
tilted to one side no balance
Static position sense the conscious perception or orientation of
the parts of the body in relation to each other
Balance is dependent on several modalities: visual, vestibular
(main), proprioception from muscles & joints
How do you explain what happens when you attempt to balance
yourself with eyes closed & head tilted to one side?
- In closing your eyes, you lose the ability to measure your
balance with respect to the room, the addition of tilting your
head to one side will change the orientation of your vestibular
system with regards to the position of your body. This will send
signals to your brain that do not coordinate with each other,
thus resulting to the loss of balance
B. KINESTHESIA
MATERIALS
Protractor
PROCEDURE
a. Let the subject wear only his undershirt to eliminate the
influence of cutaneous sensations. Blindfold the subject
b. Place the subjects arm at various positions, measuring each
angle formed by the arm against the trunk (use a protractor).
These will be called test angles
c. After each position, drop his arm to his side & ask him to
duplicate the previous position. Measure the angle formed by
the arm against the trunk. This is called the response angle. Note
the time it takes for the subject to duplicate the position
DISCUSSION
RECEPTORS
REACTION
PERCENT
TEST ANGLE
STIMULATED
SPEED
ERROR
Narrow angles
Less
Slower
More
Wide angles
More
Faster
Less
Kinesthesia the perception of limb movement and position, rate
of movement sense, and dynamic proprioception.
The kinesthetic system is usually based on three variables:
perception of limb position, limb movement and force.
Wider angles correspond to greater stretch of the ligaments and
deep tissues, which result in a greater number of receptors
stimulated, thus less percent error.
BACKROW Notes

EXPERIMENT NO. XV
Temperature Regulation
MATERIALS
Digital thermometer
Reading material
Watch or timer
Snacks
Cotton balls with alcohol
PROCEDURE
a. Let the subject rest for 5-10 minutes then record the subjects
baseline temperature (axillary), pulse rate, and respiratory rate.
b. Have the subject read silently for 5 minutes then record the
subjects temperature, pulse rate & respiratory rate
c. Let the subject rest for 5-10 minutes then record the subjects
temperature (axillary), pulse rate, and respiratory rate.
d. Have the subject jog around the room for 5-10 minutes then
record the subjects temperature, pulse rate & respiratory rate
e. Let the subject rest for 5-10 minutes then record the subjects
temperature (axillary), pulse rate, and respiratory rate.
f. Have the subject eat a snack for 5-10 minutes. Record the
temperature, pulse rate & respiratory rate 10-15 minutes after
the subject finished eating
DISCUSSION
Two main factors that determine body temperature:
1. Heat input/production
2. Heat output/loss
in physical activity results in body temperature & heat
production. This is due to Muscle Contraction and ATP hydrolysis.
Eating also metabolic activity, which also results in production
of body heat
EXPERIMENT NO. XVI
Reflexes in Man
MATERIALS
Cotton for corneal reflex
Penlight for pupillary light reflex
Tongue depressor for gag reflex
Neurologic/reflex hammer for jaw, knee, ankle jerk reflex &
plantar reflex
PROCEDURE
Corneal Reflex
- Touch the cornea gently with a thread of wisp of cotton(ensure
that you do NOT touch the subjects eyelashes)
Pupillary Light Reflex
- Let the subject look into the distance. Shine a flashlight
obliquely into the right eye. Repeat with the other eye. Note the
change in pupillary size before & after flashing light
Gag / Vomiting Reflex
- Touch the uvula or the posterior pharyngeal wall with an
applicator
Jaw Jerk
- With the patients jaw sagging loosely open, the examiner rests
a finger across the chin. Strike the finger a crisp blow from the
neurological hammer
Abdominal Reflex
- Stroke the external abdominal muscle medial ward (towards the
umbilicus) with a blunt probe on all 4 quadrants of the abdomen
Knee Jerk
- Let the subject sit down on a table & cross his legs. Tap the
patellar tendon just below the knee cap with a reflex hammer
Page 12 of 16

Ankle Jerk
- Let the subject stand with one knee resting on a chair. Tap the
tendon of Achilles at the ankle
Plantar Reflex
- With a blunt probe, stroke the lateral half of the sole of the foot
starting from the heel going towards the toes
DISCUSSION
TYPICAL SPINAL REFLEX ARC
CROSSED EXTENSOR REFLEX a withdrawal reflex. When the reflex
occurs, the flexors in the withdrawing limb contract & the extensors
relax, while in the other limb, the opposite occurs

ANAL REFLEX
Afferent/Efferent Nerve: Pudendal Nerve
Center: S3, S4
- Elicited by stroking the skin near the anus. Observe the contraction
of the external anal sphincter
CREMASTERIC REFLEX
Afferent/Efferent Nerve: Genitofemoral Nerve
Center: L1, L2
- Elicited by lightly stroking the superior & medial part of the thigh.
The normal response is an immediate contraction of the cremaster
muscle that pulls up the testis on the side stroked
BABINSKI SIGN - dorsiflexion of the big toe and fanning of the other
toes on stimulation of the sole, occurring in lesions of the pyramidal
tract and is a pathognomonic feature of upper motor neuron
paralysis; a normal reflex in infants & disappears by 2 years.

EXTENSOR THRUST REFLEX extension of flexed leg when the sole of

the foot is stimulated. Present in infants up to 2 months.
Examples of visceral reflexes:
Micturition reflex
Defecation reflex
Swallowing reflex
EXPERIMENT NO. XVII
Motor System Examination

CLASP KNIFE REFLEX - exists only in certain pathological conditions

(e.g. upper motor neuron disease). Under these conditions, there is
an extensor spasticity that resists any attempt to flex the limbs,
especially the arms. If the arm is gradually, forcibly flexed by
someone other than the patient, a point will be reached when the
resistance to flexion suddenly melts away, and the limb collapses
easily into full flexion.

MATERIALS
Neurologic/reflex hammer for deep tendon reflexes
PROCEDURE
MUSCLE GROUP TESTED for STRENGTH
1. FACIAL MUSCLES
- Subject wrinkles forehead, squeezes the eyes shut, and shows
the teeth
2. NECK MUSCLES
- Subject resists attempts by the examiner to flex & extend the
neck by exerting pressure on the occiput & forehead,
respectively
3. ARM ABDUCTORS
- Subject holds his arm laterally at right angles to the body
while the examiner pushes down on the elbow
4. HIP FLEXORS
- In a sitting position, the subject holds the knee up off the
chair against resistance
5. ANKLE EXTENSORS
- The subject resists attempts to bend from 90 degrees angle

WITHDRAWAL REFLEX an involuntary process that causes a part of

the body to automatically pull away from something that is causing
pain (noxious stimulation)

COORDINATION
1. FINGER TO NOSE TESTING
- The subject is asked to touch alternately his nose & then
the examiners finger with the tip of his index finger. The
examiners finger must be far enough away so that the
subject must fully extend the arm with the eyes open &
then with the eyes closed

BACKROW Notes

Page 13 of 16

- Abnormal leg movements (e.g. excessively high step)

- Instability (gait ataxia)
- Associated postural movements (e.g. pelvic swaying)
MUSCLE TONE (to passive resistance on elbows, wrists, knees)
Ensure that the patient is relaxed, and assess tone by:
1. Alternately flexing & extending the elbow and wrist
2. Alternately flexing & extending the knee joint. Note the resistance

2. HEEL TO SHIN TESTING

- The subject places the heel carefully on the opposite knee
and slides it slowly along the edge of the tibia to the ankle &
back up the knee again

3. RAPID ALTERNATING TEST

- Alternately patting the front & back of the hand on the knee
as rapidly & regularly as possible

GAIT & STATION

1. STATION
Rombergs Test: subject stands straight with the heels together
first with eyes open then with eyes closed. Note for any excessive
postural swaying of loss of balance (+ Romberg)

2. GAIT
- Observe certain aspects of the gait while patient does the
following:
a. Walk normally back & forth at a moderate rate
b. Walk on heels
c. Walk on toes
d. Tandem walk along straight line (i.e. touching heel to toe)
e. Hop on each leg
Note the following during each of the different steps listed above:
- Length of step (vertical distance between the heel of one foot &
the toe of the other foot)
- Width of base (horizontal distance between both heels)
BACKROW Notes

+ Hypotonia
++ Normal
+++ Hypertonia
++++ Hypertonia with clonus
REFLEXES
1. JAW JERK ask the patient to relax jaw. Place finger on the chin &
tap with hammer

2. TRICEPS JERK strike the patients elbow a few inches above the
olecranon process. Look for elbow extension & triceps contraction

3. BICEPS JERK ensure patients arm is relaxed & slightly flexed.

Palpate the biceps tendon with the thumb & strike with tendon
hammer. Look for elbow flexion & biceps contraction

4. KNEE JERK ensure that the patients leg is relaxed by hanging it

over the edge of the bed. Tap the patellar tendon with the
hammer & observe quadriceps contraction and plantar flexion

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DISCUSSION
STRENGTH
- Power of muscle group in performing specific action according
to: age, occupation, physical activity & muscular development
LEVELS OF STRENGTH:
NORMAL level of strength expected for that person
MILD WEAKNESS level of strength less than expected but not
sufficient to impair any daily function
SEVERE WEAKNESS strength sufficient to activate the muscle &
move it against gravity but not against any added resistance
COMPLETE PARALYSIS no detectable movement
GRADE
DESCRIPTION
0/5
No muscle movement
1/5
Visible muscle movement but no movement at joint
2/5
Movement at joint but not against gravity
Movement against gravity but not against added
3/5
resistance
Movement against added resistance but less than
4/5
normal
5/5
Normal strength

Rombergs Test
- To achieve balance, a person requires 2 out of the following 3
inputs to the cortex:
1. Visual confirmation of position
2. Non-visual confirmation of position (including proprioceptive
and vestibular input)
3. A normally functioning cerebellum.
*Therefore, if a patient loses their balance after standing still with
their eyes closed, and is able to maintain balance with their eyes
open, then there is likely to be lesion in the cerebellum. This is a
positive Romberg.
REFLEXES
REFLEXES

RESULTS

Jaw Jerk
Triceps Jerk

+
++

Biceps Jerk

++

Knee Jerk
Ankle Jerk

++
++

CRANIAL NERVE / SPINAL

ROOT INNERVATION
CN V
C6, C7 (Radial Nerve)
C5, C6 (Musculocutaneous
Nerve)
L2, L3, L4 (Femoral Nerve)
S1, S2 (Tibial Nerve)

COORDINATION
- Coordination of muscle movements requires that four areas of
the nervous system function in an integrated way:
1. The motor system for muscle strength
2. The cerebellar system (also part of the motor system) for
rhythmic movement & steady posture
3. The vestibular system for balance & for coordinating eye,
head & body movements
4. The sensory system for position sense
DYSMETRIA
- refers to a lack of coordination of movement typified by the
undershoot or overshoot of intended position with the hand,
arm, leg, or eye
- indicates lesion on the lateral zone of cerebellum; abnormal
finger-to-nose test result
DYSDIADOCHOKINESIA
- inability to perform rapidly alternating movements, such as
rhythmically tapping the fingers on the knee
- indicates lesion on the lateral zone of cerebellum
ATAXIA
- an impaired ability to coordinate movement, often
characterized by a staggering gait & postural imbalance
Can be classified into:
Sensory Ataxia: results from the loss of sensory input from the
lower extremities due to diseases of peripheral nerves, dorsal
roots, dorsal columns of the spinal cord or medial lemnisci
Cerebellar Ataxia: results from a lesion or degeneration focused
in the bodys gait and balance center: the vermis of the
cerebellum.
GAIT & STATION
Walking on heels is the most sensitive way to test for foot
dorsiflexion weakness, while walking on toes is the best way to test
early foot plantar flexion weakness.
Abnormalities in heel to toe walking (tandem gait) may be due to
ethanol intoxication, weakness, poor position sense, vertigo and
leg tremors. These causes must be excluded before the unbalance
can be attributed to a cerebellar lesion. Most elderly patients have
difficulty with tandem gait purportedly due to general neuronal
loss impairing a combination of position sense, strength and
coordination.
BACKROW Notes

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REFLEX

CORNEAL

PUPILLARY LIGHT

GAG / VOMITING

JAW JERK

ABDOMINAL

KNEE JERK

ANKLE JERK

PLANTAR

CLASSIFICATION OF
REFLEX
Polysynaptic
Superficial
Somatic
Polysynaptic
Superficial
Somatic
Polysynaptic
Superficial
Somatic
Monosynaptic
Deep Tendon Reflex
Somatic
Polysynaptic
Superficial
Somatic
Monosynaptic
Deep Tendon Reflex
Somatic
Monosynaptic
Deep Tendon Reflex
Somatic
Polysynaptic
Superficial
Somatic

AFFERENT NERVE

CENTER (CRANIAL
CENTER OR SPINAL
CORD SEGMENT)

EFFERENT NERVE

RESPONSE

Ophthalmic Division
of Trigeminal Nerve
(V1)

Spinal Trigeminal
Nucleus

Facial Nerve (CN VII)

Blinking of both eyes

Optic Nerve (CN II)

Pretectal nucleus

Oculomotor Nerve
(CN III)

Constriction of both
pupils

Glossopharyngeal
Nerve (CNIX)

Solitary nucleus

Vagus Nerve (CN X)

Elevation of soft
palate, bilateral
contraction of
pharyngeal muscles

Trigeminal Nerve
(CN V)

Trigeminal motor
nucleus

Trigeminal Nerve
(CN V)

Slight jerking of
mandible upwards

Thoracic Nerve

T8 T12

Thoracic Nerve

Contraction of
abdominal muscles

Femoral Nerve

L2 L4

Femoral Nerve

Tibial Nerve

S1, S2 (Primarily S1)

Tibial Nerve

Tibial Nerve

L5, S1

Tibial Nerve

Contraction of
quadriceps, extension
at knee joint
Contraction of calf
muscles, plantar
flexion of the foot
Inversion &
dorsiflexion of the
ankle with flexion
(curling) of all toes

*Classification of reflex:
No. of synaptic connection: monosynaptic or polysynaptic
Location or receptor: superficial or deep tendon reflex
Location of effector organ: somatic or visceral

BACKROW Notes

Page 16 of 16