(H) for MUCOM 48

3-BP response to standing -postural fall in BP=systolic BP in lying position _ systolic BP in standing position -normal value less than 10 -abnormal more than 30

2-BP response to Valsalva maneuver -systolic —>decrease -diastolic—> increase -this test is important in supraventricular tachycardia -VMI=maximum systolic BP followings release of strain _systolic BP during the strian - normal should be more than 0

Sympathetic nervous system tests 1-blood pressure response to static exercise (hand Grip test) -systolic and diastolic increase -diastolic BP during hand grip_diastolic BP before hand grip -normal increase more than 16 mm -abnormal less than 10

Cardiovascular response to exercise -three main neural control mechanism essential for cardiovascular response to exercise:—> central command :parallel with descending motor drive to exercising muscle . —> mechanoreceptors and metaboreceptors:feedback mechanisms when exercise progression . —>baroreceptors:beat to beat regulation of arterial BP and HR - when exercise is dynamic(isotonic):during running —>increase HR—>increase cardiac output—>increase systolic pressure -diastolic pressure in this exercise unchanged cause total peripheral resistance was unchanged -sympathetic vasoconstriction of less exercising tissues and vasodilation in active tissue. -when exercise is static (isometric) :during weightlifting—>increase HR—>increase CO—>increase systolic pressure -diastolic pressure in this exercise also increase cause to increase in total peripheral resistance -sympathetic vasoconstriction in less active tissues and compression of vascular bed by the exercising muscle (يعني مثل يصير ضغط على الاوعيه الدمويه ف تزداد المقاومه ويزداد الدايستولك )

Vital signs: all of vigtal increase except diastolic Maximum heart rate = 220-age in male /in female 226_age Target pulse =50—85% from maximum Name of instrument مهم =bicycle ergometer Dynamic (isotonic ) run 1—pulse rate increase :because increase of sympathetic and decreased in parasympathetic 2—blood pressure : Diasystolic =normal because no change in peripheral resistant Systolic : increase because increase heart rate and cardiac output and Baro reflex regulation beat to beat 3—respiration:1—sympathtic epinephrine and npr epinephrine stimuli respiratiory Center 2—temperature 3—any factor effects in vasomotor Center effect in respiratory Center 4-properoctivie reflex 4—temperature :becouse increase metabolism السؤال يجي اسم الجهاز والحاله isotonic تأثير بوحده من هذني مع السبب

ECG: contraction =depolarztion Relaxed =repolarztion Atria contract before ventricle ECG: measure electrical of heart Down deflection (تجي ) =movement away from positive electrode Up ward deflection =movement toward positive electrode Perpendicular to positive electrode =equiphasic يعني نفس ال lead Time need for ECG =5min Condition with ECG : 1-irrhythem of heart 2-MI 3_congenital heart disease مهمه وجايه يطلب تحديد ال lead Lead I =right arm to left arm LeadII=right arm to left leg LeadII=left arm to left leg avr=right arm ( اكو سؤال عليه ويكون down ward ) AvL=left arm S=R متساوي AVF=left leg up ward شلون نفرق بيناتهم جماعه ليد المفروض اكو شحنتين وحده سالب وحده موجب جماعه v المفروض شحنه وحده V1-v2=s large than R located in fourth intercostal V3_v4=balance between s and r V5_v6=R larger than s ECG paper : 25mm/sec حفظ 0.1mv and10mm two large square 0.2 sec large square 0.04ms small square Eithoven triangle and hexaaxial diaphragm :بس أسمائهن والصور مهمات Sinus arthymia كلش مهمه ويجيب شريط ECG = Inspiration =increase heart rate distance between R—R decrease Expiration =decrese heart rate increase distance Systemic to read ECG : 1-speed 25 2_senstive to 1mv and 10mm 3_lead reversed = avr لازم جوه ونشوف إذا مبدل ال right ب left القوانين جدا مهمه : 1—Heart rate =300/large square هذا إذا منتظم normal 60—100 إذا مو منتظم اسوي 3 خطوات احسب 15 مربع آشوف جم Rداخل المربع اضرب في 20 2— I+III=II هذا مهم شلون احسب ال lead اطرح ال depolarztion from repolarztion هنا راح يصفر lead وينطي أشكال لازم نطلع القيم ونشوف ال axis مالته حسب ما تعلمنه غالبا يتصفر لو ليد واحد لو ليد 3 ارقام مهمه : 1_pR=0.12_0.20 (3_5 square ) 2_QT=0.36-0.44(9-11) 3-QRS=0.08-0.12(2-3)

Blood disorder: 1-blood coagulation :cougulatin time to coagulate blood for (intrnsic mechanism) *Time for this process 15min Advise for using this method 1_liver disease 2_before surgery 3_when we take anticouglation 4_suspect blood disorder Clincal If prolong coagulation indicates to=decrease in couglation protein Early dissolution =enhance of fibrolysis Retract in 30_60 min Weak friable clot mean hypofibringemaemia Instrument: 1_capillary with blue ring 2_lancent 3_coton -alcohol 4-stop watch Medication application 1_liver disease 2_deficince in vitamin k 3_new born هنه سبع نقاط 2_bleeding time :the time of vessel contracted and platelets aggregation Cause of prolonged bleeding 1_decreae number of platelets 2-abnormal funcation in platelets 3-damage in vessel 4_drug like aspirin NSIFD anti cancer Test : 1_ivy (مال ايد ) Time <10min 2_ducke (مال اذن ) Time<6min Instrument:circular filter paper الباقي نفسهم 3_hess test or touringuent or Rumpel leede test or capillary fragility 3_pt time : for externsic mechansim and common intwo way 1_time between 10_13sec Below it faster clot Above it slow clot 2-INR international normalised ratio Normal value :1.1 Below it fast Above slow 4_PTT :for intrinsic and common Partial thrmboplastin time يريدون اسماء الاختصار Incease pt abnormal in extensiv rare Increased in ppt abnormal intensic Both common *time need for intrinsic pathway 25-40sec Time need for externsic pathway 10_13sec

Blood pressure 🩸: Systolic pressure/diasystolic pressure normal 120/80mmHg Systolic pressure: highest blood pressure in cardiac rhythm.represent muscle contraction normal value 100_140 Diasystolic :lowest blood pressure in cardia rhythm.represent relaxation Normally 60_90 Pulse :different between systolic and diasystolic Normally 30_60 Arterial pressure:cardiac output(systolic)*periphral resistance (diastolic) Mean arterial pressure:avarge of arterial blood in time Diasystolic +1/3pulse rate Name of instrument:sphymomanometer +stethscope Method : palpabtory : 1-measuring just systolic 2- By redial artery 3_don’t need stethoscope auscutatory method: used stethoscope By brachial artery Measure both systolic and diastolic Procedure: عساس يجيبون صوره ويريد الخطأ علعموم هاي ملاحظات تفيد 1-check air bag in cuff 2-remove of clothes 3-make the level of sphymomenometer and arm in same level of heart 4_patients relax and sit or lying 5_white coat hypertension:increase blood pressures due antoxity 6_pressure in left arm high in right because aorta 7- stethoscope not underneath cuff Sound : first indication to systolic Two and three softer Fourth :muffeled Fifth :diasystolic Exercise and pregrent and child don’t have fifth phase and muffeled conseder diasystolic Physiological: In sleep systolic lower In eat systolic increase In exercise:increase systolic Male have high blood pressure than female Heavy blind have higher blood pressure because Large of muscle mass and need o2 Diasystolic high in standing position and lower in sit and lowest in lying يجيبون سؤال ادوات ويريد اسمها وشفت انو مال procedure جايبين برنسبل 3 جوابه هاي النقاط السبعه

ESR: is the rate of RBC sediment by rouleaux formation - factors that effect of ESR(rouleaux formation) 1-composition of plasma proteins —>fibrinogen or globulin or acute phase proteins —>increase ESR(rouleaux formation) -ESR increase in pregnancy due to increase in fibrinogen and globulin -albumin —>inhibitory effect on erythrocyte aggregation (decrease ESR) 2-viscosity of blood:increase RBC—>increase viscosity—>decrease ESR -reduction of RBC—>decrease the viscosity—>increase in ESR 3-shape of RBC—>decrease ESR -ESR—>used for follow up and prognosis of the condition -ESR and CRP —>markers of inflammation CRP have rapid response and less affect -instruments of ESR —>westergren pipette and westergren rack (0-200mm ) -normal range in men0-10mm in hour -noraml range in women0-15 -increase in ESR (physiological)—>in pregnancy ,menstruation,parturition (Pathological)—>in anemia,infections,inflammation -decrease in ESR—>polycythemia,spherocytosis,sickle cell anemia -Technical errors in elevation of ESR—> tilted ESR,increase temperature,sample dilution,time more than an 1 hour -technical errors of slow ESR—>inadequate anticoagulation,short ESR tube,vibration,low temperature,delay in test performance, bubbles in tube الاسئله : اسم الاداه Techincal error Factor effect ESR Phenomenon Normal value

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Temperature: المناطق الي على السطوح مثل ال axilla و groin اقل درجه حراره من ال oral والي صايره جوه مثل ال rectum وال tympanic اعلى حراره الفرق بين المناطق الجوه على البره درجه سيليزية وحده F=(c*9/5)+32 الثاني ميحتاج حفظ نكبله Normal 36.6 _37.2 Sub normal <36.6 Ferbil>37.2 Hypothermia <35 Hyperprexia>41 Oxygen يأثر ب oral +techipynea Mercury:oral -groin ( شفتها بالصوره ) electrical: axilla -oral-rectum infrared : tympanic –temporal Band:fever Tympanic : tymanic بس أتوقع قصده انو تدز infrared كلهن مناسبات عده ال rectum وال band Conscious =oral Un conscious/child=axilla Unconscious/infant =rectal Groin =children إذا حسيت مقاومه ب rectum كبل اسحبه Heat gain : basal metabolism Heat loss :evaporation نوع السؤال صوره التيست او الاداه ويطلب نوع التيست وجم سؤال مال شوكت ما نستخدمه Contaidication : Oral :1—unconscious 2—fever 3—after oral surgery Axilla infection in Axilla and trauma in upper limb the groin infection in groin trauma in lower limb Rectum :new born Anus imperfoted Diarhea Bleeding Physiological : Diurnal variation (circadian fluctuation 0.5˚ – 0.7˚ C) body temperature is lowest at about (6 a.m.) and highest in the evening.  Monthly cycle in women: during menstruation the average body temperature is at minimum, but during ovulation there is a rise in temperature.  Age: in young children body temperature is 0.5˚ C higher than adults.  Exercise: increase body temperature.  Emotional stress: increases body temperature

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