Cairo University Systems & Biomedical Engineering Dept.

Faculty of Engineering Ph.D. Program

Review Sheet (1) - Solved

Physiological Monitoring and Testing

1. Intensive care may be broadly defined as a service for patients who (T/F)
a) Have potentially recoverable conditions (F)
b) Suffer from intolerable pain (F)
c) Can benefit from more detailed observation and invasive treatment than can
be provided safely in an ordinary ward or high dependency area (T)
d) Are currently experiencing severe bleeding (F)
e) Have a body temperature above 40ºC (F)

2. It is usually reserved for patients with (lung cancer/ threatened or established

organ failure/ virus C hepatitis) resulting from (acute disease/ chronic disease/
infectious disease) conditions

3. The information required during patient referral to the ICU is to be added to the
(patient progress report/ patient record/ hospital information system/ patient
discharge note).

4. Name five requirements needed to be satisfied by ICUs

 A clear operational policy
 A minimum nurse:patient ratio of 1:1
 24-hour dedicated on-site cover by medical staff
 The ability to support common organ system failures, in particular, ventilatory,
circulatory and renal failure
 A sufficient case load to maintain skills and expertise.
 Multidisciplinary care and effective communication.
 Adequate administrative, technical and secretarial support.
 Continuing education and training of medical and nursing staff

5. A minimum nurse:patient ratio of 1:1 , together with additional nurses should be

satisfied by an ICU according to four criteria. What are these criteria?
• patient needs
• training requirements
• the total number of beds
• the geographical arrangements within the unit

6. Name the three sources of information used by physicians/nurses in the ICU.

State which of them is classified as knowledge and which as data?
• Physicians' and nurses personal skilled observations (classified as knowledge)
• The laboratory (classified as data)
• An array of electronic monitoring equipment at each bedside (classified as data)
7. Name five parameters to be measured on a patient in an ICU.
a) Classify them according to their relevance as first, second, third, and fourth class
parameters.
b) State which of them are analog and which are digital data?
First class parameters:
• ECG waveform (analog)
• HR (digital)
Second class parameters:
• Arterial blood pressure (digital)
Third class parameters:
• Temperature (digital)
• Respiration rate/apnea (digital)
• Venous pressure (analog)
• Right atrial pressure (analog)
• Cardiac output (digital)
• EEG (analog)
Fourth class parameters:
• Arterial pressure waveform (analog)

8. The following is not considered a piece of information required during the referral
of a patient to the ICU:
a) Date of referral
b) Present patient’s diet
c) Past medical history
d) Recent lab investigations

9. Draw the block diagram of a digitized bedside monitor. Briefly discuss the
function of only three of its blocks.

ECG Amplifier: Provides amplification of ECG signal and patient isolation.

A/D Converter: Converts the amplified analog ECG signal into a digital form to
be used by the BSM controller and further transmitted to the central station
through the Modem Unit.
Modem Unit: The role of the Modem (Modulator/Demodulator) is to facilitate
digital data transmission from the bed side to the Central Station by minimizing
the transmission losses through the medium by means of pulse modulating the
digitized ECG signal. At the receiver (Central Station) demodulation takes place
by means of another Modem to recover the digital ECG signal.
 Alarm: This is triggered usually with the occurrence of abnormally low or
abnormally high cardiac rates.
Local Scope: Dispalys the important traces like ECG & arterial pressure, as well
as digital parameters like the heart rate and blood oxygen saturation.
BSM Controller: It is usually a microprocessor/microcontroller to control the
operation of the bedside monitor and the alarm, run self-tests, and synchronize
system operations.

10. Name three pieces of information that should appear on a central station display
for each individual patient.
• Heart rate
• Alarm limits
• Display of ECG waveforms

11. One of the main functions of a Central Station is the routing of all analog signals,
numerical data, and alarm status signals from each bedside monitor to the central
station.

12. A Central Station should provide certain items. Name at least three of them.
– an array of multichannel oscilloscopes
– an array of heart rate meters (plus occasionally blood pressure meters)
– a computer terminal
– an alarm status annunciator panel
– a communications system

13. Draw the block diagram of a typical central monitor.

14. One of the technological advances in patient monitoring is the
a) Change from analog to digital
b) Reduction of cost
c) Extensive practice of sterilization in the ICU
d) Installation of defibrillators in the central station

15. Name other four technological advances in patient monitoring.

• Integration with information systems
• Shift from wired to wireless
• Increasing the use of open architecture in design of devices
• Intensive use of telemedicine
• Miniaturization of technology
• Increasing communication between devices of different departments in a
hospital
16. Name the most important features of today’s patient monitors.
– mobility
– ease-of-use
– effortless patient data transfer

17. Mobility includes portability and what we call interoperability.

18. Name two means by which ease of use can be achieved.

a. Touch-screen displays
b. Multi-level, menu-driven profiles

19. A secure monitoring architecture is designed to provide a minimal target for

(curious individuals/ unauthorized personnel/ would-be attackers).

20. Open monitoring is a concept meaning the employment of (open source/

hypertext transfer protocol (HTTP)/ freeware/ firmware) software allowing for
basic system operation from any web browser.

21. The web-based control mentioned in Question (20)

a) Reduces development cost
b) Increases system immunity against malicious programs
c) Minimizes requirements for installing specialized software on local machines
d) Increases software maintainability

22. Intelligent monitoring is essentially (error-free/ knowledge based/ flexible/ easily

upgradable).

23. A Wilson central terminal

a. Reduces ECG circuit noise
b. Provides additional patient protection
c. Increases the input impedance to the ECG amplifier
 d. Connects the limb electrodes through equal-valued resistors to a common
node

24. In practice, the values of the Wilson network resistors should be at least 5 MΩ.
Explain why?
To minimize the loading of any particular lead.

25. A more practical approach regarding Question (24) is to use (compensators/

buffers/ integrators/ solid-state relays) between each electrode and the equal-
valued resistors. Examples include (Darlington pairs/ voltage followers/
MOSFET devices).

26. Draw a circuit diagram for the Wilson's network connection to the patient.

27. Patient monitors have become more portable than ever before thanks to:
• battery and battery management technologies
• the proliferation of wireless communications technologies like Bluetooth
and ZigBee
By portability in this sense it is meant (mobility/ interoperability).

28. A key feature in the advancement of monitoring technology is the replacement of

the complicated mix of knobs and dials with menu-driven displays and user
prompts by touch screen control and audio feedback.
29. A patient monitoring system presents the challenge to designers of
a) Accounting for the frequency response of the biophysical amplifier
b) Continuously adjusting the amplifier gain according to the patient condition
c) Measuring very small electrical signals in the presence of much larger
common-mode voltages and noise
d) Obtaining a reliable reading accuracy

30. Front-end amplifiers perform the essential conditioning that (denoises the
biophysical signal/ complements downstream digital processing/ protects the
patient from surge currents/ removes any possible interference).

31. Successfully meeting the biophysical signal acquisition challenge requires system
designers to have knowledge of the signal souce, good design practice, and ICs
with appropriate characteristics.

32. Breathing:
o Respiratory arrest
o Worsening respiratory acidosis
o Respiratory rate < 8 or > 30/min
o O2 saturation < 90% on 50% oxygen
Circulation:
o Cardiac arrest
o Pulse rate < 40 or > 140 bpm
o Systolic blood pressure < 90 mmHg
o Metabolic acidosis (pH < 7.20)
o Urine output < 0.5 mL/kg/h