Quick review of loksewa by Gajendra and Rahul.

1st day rash disease, Varicella, Dew drop rash disease

QUICKChicken pox
Japanese encephalitis Brain fever
Syphilis VIP disease
Lymphatic filariasis Elephantitis
Scabies Family infectious disease
Kala-azar Camel hump fever, Black fever, Dum-dum fever , Leishmaniasis
Swin flu Hog flu or fig flu, H1N1
Plague Black death, Mahamari, The great death.
Pellagra 4 D’s disease ( Diarrhoea, Dimentia, Dermatitis and death)
Diabetes 3 P’s disease ( polyuria, polydipsis and polyphagia)
Trachoma Rough eye, Quiet disease
Brucellosis Undulent fever, Malta fever, Mediterranean fever
Giardiasis Beaver fever, Hostel diarrhoea.
Hepatitis A Epidemic Jaundice, Traveller's hepatitis, Infectious hepatitis
Stroke Apoplexy
Kysanur forest disease Monkey disease.
Trench fever Five day fever
Scarlet fever Second disease
Rubella German measles, Third disease
Ducke's disease Fourth disease
Erythema infectiosum Fifth disease
Exanthema subitum Baby measles, Sixth disease, 3 day fever
Onchocerciasis River blindness.
Ophthalom neonatrum 28th day disease
Alzhiemer's dsz Silent modern epidemics
Mumps Hande, Rubula
Yaws Bubas, Pian, Framboesia.
Scurvy Sailor's disease
Anthrax Woodhandler's disease
Tinea cruris Dhobi itch
Gingo-stomatitis Kissing disease
Endemic typhus Flea borne tyohus, Murine typhus.
Emphysema Pink puffer
Bronchitis Blue bloater
Meningococcal meningitis Cerebro spinal fever
Otitis Externa Swimmer's ear.

 Some worm and their common names.

Worms Common Names

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Ascaris lumbricoids Round worm

Ancylostoma duodenale Hook worm
Enterobius Vermicularis Pin worm/ Seat worm/ Thread worm
Trichuris trichura Whip worm
Dracunculiasis Guinea worm/ Medina/ Fiery serpent/ Dragon worm
Taenia solium Pork tape worm
Taenia Saginata Beef tape worm
Schistosoma mansoni Snail worm/ Blood fluke
Echinococcus species Dog tape worm
Diphylobothrium latum Fish taoe worm
Hymenolepis nana Dwarf tape worm
Fasicola hepatica Liver fluke
Loa-loa Eye worm
Wuchereria bancrofti Bancroftian worm
Paragonimus Oriental lungs fluke

 Period of communicability of some disease.

 Chickenpox: 1-2 days before to 4-5 days after appearance of rash.

 Measles: 4 days before to 5 days after appearance of rash.
 Rubella: 7 days before to 7 days after apparence of rash.
 Mumps: 4-6 days before symptom to 7 days there after.
 Influenza: 1-2 days before to 1-2 days after onset of symptoms.
 Diptheria: 14-28 dys from disease onset.
 Pertusis: 7 days after exposure to 3 weeks after paroxysmal stage.
 Meningococcus: Until absent from nasal and throat discharge.
 Tuberculosis: As long as not treated.
 Poliomyelitis: 7-10 dys before and after onset of symptoms.
 Hepatitis A: 2 weeks before to 1 week after onset of jaundice.
 Heptitis B: Till disappearnc of HBsAg and appearance of HBeAg.
 Tetanus: none

 Isolation period of some disease.

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 Chickenpox: 6 days after onset of rashes.

 Measles: 0nset of catarrhal to 3rd day of rash.
 German measles: None (except first trimester of pregnancy).
 Cholera and Diptheria: 3 days after Tetracycline started till 48 hour of treatment.
 Hepatitis A: 3 weeks.
 Influenza: 3 days after onset.
 Polio: 2 weeks adult and 6 weeks paediatric
 Tuberculosis: Untill 3 weeks of effective chemotherapy.
 Herpes zoster: 6 days after onset of rash.
 Mumps: Untill swelling subsides.
 Meningococcal meningitis: 4 weeks or until paroxysms case.
 Streptococcus pharyngitis: Untill 6 hours of complicated antibiotics.
 Diptheria: Upto 2 throat sample negative taken apart of 24 hours.
 Pertusis: 3 weeks after onset of symptoms.
NO ISOLATION IS REQUIRED IN DISEASE WHICH CANNOT TRANSMIT FROM MAN-MAN.
Eg: Tetanus.

 Disease and their choice of diagnosis.

Disease Choice of diagnosis

HIV/ AIDs Western blot test
TB Sputum microscopy for AFB.
Hepatitis C RIBA test
Kala-azar Rk-39 test
Typhoid Blood culture in 1st week
Giardiasis ELISA
Malaria Thin and Thick smear examination
Filariasis Thick smear examinatio
JE CSF Examination
Leprosy Slit and Scrub method of skin
Pertusis Throat swab culture
Chicken pox DNA by PCR
Mumps Clinical diagnosis
Measles Ig M test
Tetanus Clinical diagnosis
Diptheria Throat swab culture
Rabies Clinical diagnosis ( Hydrophobia)
Syphilis TPHA ( Treponema Pallidum Hemagglutination)

Sites Macrophages
Liver Kupffer cell.
CNS/ Brain Microglia.
Bone Osteoclast.
Lungs Alveolar cell/ Dust cell.
Connective tissue Histocytes.
Placenta Hoffbauer cell.
3
Spleen Littoral cell.
Kidney Mesangial cell.
Synovium Type A lining cell.
Skin Langerhans cell
Quick review of loksewa by Gajendra and Rahul.

 Macrophages of different organs

Motives :

( Belive in Your Self , You are the One who is born to Win)

( Always be ready to Sacrific, The word will be beautiful)

( I will be a Man with No enemy, But I can't gurantee : Yours)
( Love is not easy , It's Complicated: The best and Worst feeling ever )
( Friendship: Love where I always hide mY feeling: Starts with R for me )
( I m born poor it's not my Fault, But if I died being poor It wil be only my Fault)
( You will Never Know who I m, It tooks me whole life to understand: Who I am )
( 1 day I will not be here; I m a Time traveller (Start to travel on 2000 AD~ Few
year)

 Facts on FCHV Program.

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History :-
 In FY 2045/46 ( 1988 AD) FCHV program was initiated by government of Nepal in 27
district among which 19 in central development region and 8 in western
development region.
 Intially FCHV was selected as ward basis in 47 district.
 In 1993 AD: Population based approach for FCHV selection in 28 district.
 In 1994 AD: FCHV program was espanded through out the country.
 In 1988 AD : First FCHV strategy was introduced and revised 4 times ( 4 th revised in :
2010 AD).
 In 2006 AD: First National FCHV survey.
 In 2007 AD: FCHV fund establishment in first interim plan (2007-2010 AD).
 In 2014 AD: Second National FCHV survey.
Findings of FCHV survey 2006 AD:
 Median age : 38 Years
 Literacy: 62 %
 Work load: 5.1 hour / week.
Finding of FCHV survey 2014 AD.
 Rural FCHV : 94 % and Urban FCHV: 6 % .
 Median age: 41.3 years.
 Literacy: 83 %.
 Work load: 7.2 hour/week.
 Having basic training: 96 %.
 Average work experience : 14 years.
 FCHV Supervised by Health worker: 77 % .
 FCHV reported by themselves: 72 %.
 Availability of commodity: Maximum availability of ORS (75 %).
 Having FCHV fund : 97 %.
 Use of FCHV fund: 60 %.
FCHV ratio according to :-FCHV strategy 2002FCHV strategy 2010
 Mountain 150 person/FCHV 200 person/FCHV
 Hill 250 person/FCHV 350 person/ FCHV
 Terai 400 person/FCHV 1000 person/ FCHV
Members of Mother group for Health: They are in each ward.
 Mountain: 11
 Hill: 15
 Terai: 21
Logo of FCHV : Contains 4 Circle .
 1st circle (inner): Represent role of FCHV in community or ward level.
 2ndcircle: Represent role of FCHV in VDC level.
 3rd circle : Represent role of FCHV in District level.
 4th circle: Represent role of FCHV in National level.
Facts:-

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 Basic training for FCHV: 18 days.

 Refresher training for FCHV: 5 days in each 5 years.
 FCHV review meeting: Bi-annual ( 4 days in year).
 Integrated review mweting : 4 monthly ( For 5 days).
 FCHV day: 5th December.
 FCHV day was first celebrated on 1st October 2004 AD.
 FCHV reporting should be done to : Local health worker or suoervisor with in 1 st day
of next months.
 FCHV can work as FCHV up to : Age of 60 years.
 Retirement of FCHV : Ath the age of 60 years.
 In retirement FCHV will provided: 10,000-/
 BPP ( Jibansurakshya program) training is provided to FCHV by: FY 2068/69.
 Dress allowance for FCHV: 7500-/
 FCHV board: Tin plate 24 gauze thick board.
 Colour of FCHV dress: Sky blue in colour while margine is dark blue.
 Meaning of FCHV logo : Wave generated by FCHV in Health care system.
 Each community level health worker should visit the FCHV in Health care system.
 VDC level fund committee: 5 members.
 In FY 2064/65 (2007 AD) MOHP established FCHV fund by providing support of Rs.
50,000-/
 FCHV fund : 75 % fund usable and 25 % are reserved.
 FCHV are selected by : Members of mother group for Health.
Criteria for FCHV Selection:- 8 Criteria.
 Permanent resident of same ward.
 Married having at least 2-3 children.
 Age between 25-45 Years.
 Intrested to work for at least 10 years.
 Intrested to work voluntarily.
 Should not be involved in any pay full job.
 Priority should be given to literate and women of dsadvantage group.
 Application should be sumitted to mother's group.

 Some Occupational Disease.

Occupational disease Causes

Asbestosis Inhalation of asbestos particle in worker engaged in mining,

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( MC cancer: pipes, brakes, insulation and boilers.

Bronchogenic cancer) Complication: Mesothelioma
Silicosis Inhalation of silica in worker engahed in sand blasting, hard rock
mining, glass and pottery.
MC chronic occupational disease in world.
Bartosis Inhalation of Barium sulfate. ( Miners)
Stannosis Inhalation of Tin oxide ( Miners).
Siderosis Inhalation of Iron oxide ( Common in: Welders).
Byssinosis Inhalation of cotton dust/ fiber ( Common in textile worker).
Caplon syndrome Co-existance of rheumatoid arthritis with pneumoconicosis.
Farmer's lungs Inhalation of moldy hay.
Asthma Inhalation of red cidar dust.
Bagogsis Inhalation of Bagase.
Bird breeder lungs Inhlation of bird drooping.
TB Common in carpet factory.

 Efficacy of some Vaccine.

Vaccine Efficacy
Rubella 95 %. ( Highest efficacy)
Polio 90 %
Measles 85 %.
DPT 80 %.
BCG 65 %. ( Lowest efficacy)

 Some Test and related disease.

Test Disease and condition.

Shake test Vaccine.
Torniquet test Dengue Hemorrhagic Fever.
Dick test Scarlet fever.
Coomb test Hemolytic anemia.
Three test tube test Hematuria.
Rubber Catheter test Cholera.
Pin prick test Burn.
Patch test Urticaria.
Cluster sampling Immunization.
Cluster test STDs.
Kahn test Syphilis.
Washerman's test Syphilis.
Cosonic test Hydatid disease.
Chopra's antibody Kala-azar.
Albert stain Diptheria.
Ames test Carcinogenecity.

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Rose waaler test Rheumatoid fever.

Montengero / Leshmanin Kala-azar.
Tuberculin test TB
Lepromin test Leprosy
Shick test Diptheria.
Wayson test Plague.
Glimsa stain Chicken pox.
Singer's test Bleeding of fetal origin.
Aldehyde test Kala-azar.
Chandler's index Hook worm infestation.
Soiling index Air pollution.
Widal test Typhoid.
Bed side clotting test Post partum hemorrhage.
Water deprivation test Diabetic insipidus.
Urea breathe test Peptic ulcer to detect [Link].
ECG Heart activity.
EEG Brain activity.
EMG Muscle activity.

 Parasite, residing organs and their infective forms.

Parasites Residing organs Infective forms

E. histolytica Colon Quadrinucleate cyst
Leishmania donovani Macrophages Promastigote form
[Link] Liver/ RBCs Sporozoite
Round worm Intestine Embroyonated egg/ Rhabditiform
larva
Hook worm Jejunum Filariform larva/ 3rd stage.
Tinea solium Small intestine, Brain, Eye Cysticercus cellulose
Giardia lamblia Jejunum Cyst stage
Wuchereria bancrofti Lymphatics vessels Microfilaria form
Pin worm Large intestine Embroyonated egg
Whip worm Large intestine Embroyonated egg
Schistosomiasis Mesentricvenules Cercariae
Dog taoe worm Liver, Lungs, Brain Egg
Liver fluke Liver Metacercaria
Toxoplasma gondii Mesentricvenules Cyst

 Common Gestational Period for vertical transmission.

Gestational Period Vertically transmitted disease

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First trimester Congenital Vericella, Congenital Rubella.

Second trimester Congenital Parvovirus.
Third trimester Congenital Syphilis, Congenital Toxoplasmosis, Congenital
Hepatitis B, Congenital CMV.
During Delivery Congenital HIV, Congenital Hepatitis C, Congenital Herpes.

 Case Fatality Rate (CFR) of some communicable disease.

Disease CaseFatality Rate ( CFR).

Rabies 100 %. ( Highest CFR)
Tetanua 80-90 %.
Yellow Fever 80 %.
Meningococcal meningitis 80 %. ( If early dx and treated: < 10 %).
Japanese Encephalitis 20-40 % ( May reach upto 58 %).
Chicken pox < 1 %.
Ebola virus disease 40 %. ( 20-90 %).
MERS 30 % ( Corona Virus ).
NIPAH Virus 50 %.
Avian influenza H7N9 33 %.
Diptheria 5-10 %.
Cholera 30-40 %.
Typhoid 10-20 %( If treated 1-4 % ).

 Secondar Attack Rate ( SAR) of some communicable disease.

Disease Secondar Attack Rate ( SAR).

Pertusis >90 %. ( Highest SAR)
Chicken pox 90 %.
Mumps 86 %.
Measles >80 %.
Small pox 30-45 %

 Instrument and their use in Public Health.

Instruments Use
Ice Lined Refrigerator ( ILR) Cold chain temperature maintenance.
Dial Thermometer Cold chain temoerature monitoring.
Horrock's Apparatus Estimation of chlorine demand in water.
Chlorinator / Chloronome Mixing/ regulating the dose of chlorine in water.

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Chloroscope Measuring level of residual chlorine in drinking water.

Winchester Quart bottle Assessing physical and chemical quality of drinking water.
Kata Thermometer Assess cooling power of air and air velocity.
Anemometer Assess air/wind velocity.
Hygrometer and Sling Assess air humidity ( moisture content of air).
psychrometer
Assmanpsychrometer Assess air humidity ( moisture content of air).
Mercurial Barometer Atmospheric pressure.
Anaeroid Barometer Atmospheric pressure.
Wind Vane Assess air/wind direction.
Salter's scale Field instrument for Low Birth Weight.
Infantometer Measures length of infants.
Stadiometer Measures height of adults.
Shakir's Tape Measurea Mid-Arm Circumferance ( MAC).
Sound level Meter Measures intensity of sound.
Band Frequency Analyzer Measures characteristic of sound ( Pitch).
Audiometer Measures hearing ability.

 Guideline for suture removal by area.

Body region Removal Body region Removal

Eye lid 3-4 days Chest, abdomen 8-10 days
Eye brow 3-5 days Ear 10-14 days
Nose 3-5 days Back 12-14 days
Lip 3-4 days Extremities 12-14 days
Face ( other) 3-4 days Hand 10-14 days
Scalp 6-8 days Foot and sole 12-14 days

 Antidote of some poisoning.

Poisoning Antidote
Organophosphorus Atropin/ Pralidoxin
Mushroom poisoning Atropin
Dhaturopoisonong Physiostigmine/ Neostigmine
Atropin Physiostigmine/ Neostigmine
Alcohol poisoning ( Methanol) Ethanol
Ethanol Thiamine ( Vit. B1)
Opiod/ Morphine Naloxone
Isoniazid Pyridoxin
Mercury Dimercaprol
Benzodiazepens Flumazenil

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Carbondioxid poisoning 100 % oxygen

Cooper Penicillamine
Cyanide Sodium thiosulphate
Heparin Protamin sulphate
Oral anti coagulant Vitamin K
Lead Ca Na2 EDTA
Iron Desferroxamine
Arsenic Dimercaprol
Corrosive poisoning Dilut toxin ( If acid dilut by antaacid and if Alkali dilut by
lemon juice).
Zinc phosphide / Rodenticide Dilut by milk and water
Scorpion stings Prazosin

 Some Discoveries and invention.

Discoveries Discover/ Inventor

First Vaccine Edward Jenner ( small pox vaccine)
Term " Vaccination" Edward Jenner
Term " Vaccine" Louis Pasteur
Vaccine: Anthrax, Rabies, Louis pasteur
Chicken pox & Pasteurization
First Polio Vaccine Jonas Salk
First Antibiotic " Penicillin" Alexander Fleming
Growth chart David Morley
Blood grouping Karl Landsteiner
Citrus fruit in Scurvy James Lind
prevention
Transmission of Yellow fever Walter Reed
Life Cycle of Plasmodium Ronald Ross
CT-Scan Godfrey
X-ray Wilhelm Conard Roentgen
ECG Einthoven
EEG Hans Berger
NMRI Purcell and Block
Pace maker Chardiack
DNA Waston and Crick
Sphygomanometer Riva Rocci
Stethoscope Laennaec
Bacteria Anton Van Leewenhook
Circulation William Harvey
Blood Bank Charles Richard Drew
Insulin Fredric/ Banting
BCG Vaccine Calmette and Guerine

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Compound Microscope Robert Hook

Chloramphenicol Paul Ehlrich
Streptomycin Selman
Malaria Parasite Charles Louis AlphonesLaueran
Electron Microscope Knoll and Rusk
Nucleus Robert Brown
Thermometer Galileo Galilei
Heart Transplantation Christian Bernard

 Some Honours in Public Health.

Honours Person
Father of Modern Medicine Hippocrates( First True Epidemiologist)
Father of Indian Medicine Charaka
Hindu God of Medicine Dhanvantari
Father of Modern Surgery Ambroise Pare
Father of Indian Surgery Sushruta
Father of Modern Human Anatomy Andreas Vesalius
Father of Epidemiology/ Modern John Snow
Epidemiology
Father of Bacteriology Louis Pasteur
Father of Biology Aristotle
Father of Virology WM Stanley
Father of Public Health Cholera
Father of Cytology Robert Hook
Father of Genetics G.J Mendel
Father of Modern Genetics T.H Morger
Father of Mutation Huge de Vries
Father of Taxonomy Carlous Linnaeus
Father of Endocrinology Thomas Addition
Father of Genetic Engineering Paul Berg
Father of Embryology Aristotle
Father of Antiseptic Joseph Lister
Father of Anesthesia Crawford
Father of Microbiology Robert Koch
Father of Homeopathy Samuel Hahnemann
Queen of Medicine Penicillin
Founder of Modern Nurshing Florence Nightingale

 Slogans for World Health Day.

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World Health Day Slogans

2004 AD Road Saftey.
2005 AD Make every Mother and Child count.
2006 AD Working together for Health.
2007 AD International Health Security.
2008 AD Protecting Health from the adverse effects of climate
change.
2009 AD Saves Lives, Make Hospital safe in emergencies.
2010 AD Urbanization and Health: Make cities Healthier.
2011 AD Antimicrobial resistance: No action today, No cure
tomorrow.
2012 AD Good Health adds life to years.
2013 AD Healthy Heart beat, Healthy blood pressure.
2014 AD Vector-borne disease: Small bite, big threats.
2015 AD Food Saftey.
2016 AD Halt the rise: beat diabetes.
2017 AD Depression: Let's talk.
2018 AD Universal Health Coverage: Every one, Every where.
2019 AD Universal Health Coverage: Every one, Every where.
2020 AD Support Nurses and Midwives.
2021 AD

 Profounder of theories in Public Health.

Theories Profounder
Germ Theory of Disease Louis pasteur
Multi-Factorial Causation of disease Patten koffer
Web of Causation of disease Mac Mohan and Puge
Spontaneous generation theory Aristotle
Darwinism Theory Charles Darwin
Lamarckism Theory Baptiste de lamarck

 Some " Bodies" and their appearance condition.

Bodies Appearing condition

Aschoff bodies Rheumatic fever
Negri bodies Rabies
Warthin-Finkedely bodies Measles
Nissel bodies Neuron of brain
Ross's bodies Syphilis
Winkler bodies Syphilis

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Quick review of loksewa by Gajendra and Rahul.

Council mann bodies Hepaitis

Leishman donvan bodies Kala-azar
Lewisbodies Parkinson's disease
Creola bodies Asthma
Owl Eye Inclusion Cytomegalo and Herpes virus
Hirano bodies Alzheimer's disease
Mosser bodies Endemic typhus
Torre bodies Yellow fever
Sandstrombodies Parathyroid gland

 Screening Test for some disease.

Disease Screening test

Anemia Hb level test
Hypertension Blood pressure
Syphilis VDRL
Diabetes Blood sugar
Genetic defects Aminocentesis
HIV/ HBV/ HCV ELISA
Obesity Lipid profile
TB Mantoux test
Breast cancer Mammogram
Cervical cancer Pap Smear
Prostate cancer PSA level
Colon cancer Colonscopy
Typhoid Widal test

 Drugs of choice for some disease.

Disease Drug of choice

Pneumonia Cotrimoxazole
Severe pneumonia Benzyl penicillin
Very Severe pneumonia Chloramphenicol
Pertusis Erythromycin
Typhoid Ciprofloxacin ( For carrier: Ampicillin + Probencid)
Cholera Adult: Doxycyclin
Child: Azithromycin ( old: Cotrimoxazole)
Pregnancy : Azithromycin ( Old: Furazolidine)
Kala-azar Inj. Liposomal amphotericin B
Meningococcal meningitis Penicillin ( For carrirr: Rifampicin)
Bird Flu ( H5N1) Oseltamivir ( 75 mg BD for 5 days)
Syphilis/ Endemic syphilis Benzathine penicillin

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Plague Streptomycin ( 30 mg/kg X im for 7-10 days).

Mycoplasma pneumonia Azithromycin
Q-fever Doxycycline
Diptheria Diptheriaanti-toxin ( For carrier: Erythromycin)
Endemic/ Epidemic typhus Tetracyclin
Trachoma Azithromycin
Yaws Benzathine penicillin
Malaria Chloroquine ( 25 mg/kg in divided dose for 3 days)
Redical treatment Primaquine
Falciparum malaria ACT ( Artemesininbased combination therapy)
Presumtive/ Clinical Chloroquine
Pregnancy Chloroquine
Complicated malaria Quinine
Brucellosis Tetracycline ( 500 mg QID for 3 days).
Botulism food poisoning Guanidine hydrochloride
UTI Nitrofurentoin
Scabies 5% Permethrine
PID Doxycycline
Tetanus Metronidazole ( Old: Benzathne penicillin)
Measles Ribavirin
Chicken pox Acyclovir
Rhinosinusitis Doxycycline
Trichomoniasis Metronidazole
Chagas disease Benzinidazole
Chronic Hepatitis B virus Entecavir
Acute/ Chronic Hepatits C Peg-IFN-@ + Ribavirin
Leprosy Dapsone
Amoebic dysentry Metronidazole
Bacillary dysentry Ciprofloxacin
Giardiasis Metronidazole
Round worm Albendazole
Hook worm Albendazole
Enterobiasis Albendazole
Trichuriasis Albendazole
Dracunculiasis Metronidazole
Pork tape worm Praziquantel
Beef tape worm Praziquantel
Hydatid disease Albendazole
Schistosomiasis Praziquantel
Hymenolepis nana Praziquantel
Candidiasis/ Cryptococcus Fluconazole
Coccidodomycosis Fluconazole
Herpes simplex Acyclovir
Onchocerciasis Ivermectin
Cytomegalo virus Ganciclovir

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Quick review of loksewa by Gajendra and Rahul.

Bell's palsy ( Herpes simplex) Prednisolone

Congo crimean fever Ribavirin
Relapsing fever ( Borrelia) Doxycycline
Hantaan Virus Ribavirin
[Link] in pregnancy Spiramycin
Pneumocystosis Cotrimoxazole
Surgical prophylaxis Cefazolin
Morning sickness in pregnancy Doxylamine + Pyridoxine
Post operative vomiting Ondesetrone
Crohn's disease Corticosteroid
Hepatic encephalopathy Lactulose
Zollinger Ellison syndrome Proton pump inhibitor
ATT in pregnancy Rifampicin ( Least toxic drugs in ATT)
Iron deficiency Anemia Ferrous sulphate
Pernicious anemia Vitamin B 12
Hypothyrodism Levo-thyroxin
Grave's ophthalmopathy Methyldopa
Thyroid strom Propranolol ( Life saving drugs) + Iodides
Addison's disease Corticosteroid
Type 1 DM ( NIDM) Insulin
Type 2 DM ( IDDM) Metformin
DM in pregnancy Insulin
Uncontrolled DM Insulin
Diabetic ketoacidosis Regular insulin
Acute hyperkalemia Calcium gluconate
Erectile dysfunction Sildenafil
Anovulatory infertility Clomiphene
Bartter syndrome Indomethacin
Tetany Calcium
Narcolepsy Modafinil or armodadinil
Performance anxiety Propranolol
Anti-hypertensive in pregnant @ Methyldopa
Induction of labour Oxytocin
Post partum hemorrhage Oxytocin
Acromegaly Cabergoline
Ectopic pregnancy Methotrexate
DUB/ Light bleeding Medroxy progesterone acetate
Heavy bleeding Combined Oral contraceptive
Endometriosis Combined oral pills
Wilson's disease Zinc
Seizure eclmpsia Magnesium sulphate
Nocturnal enuresis Desmopressin

 Some diseae their causative agent and Incubation period.

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Disease Causative agent Incubation period

Chicken pox Human ( alpha) herpes virus 3 10-21 days ( 14-16 days)
Measles RNA Paramyxo virus 10-14 days (7-14 days)
Rubella RNA Toga virus 14-21 days
Mumps RNA Myxovirus 14-21 days (18 days)
Influenza Orthomyxo virus 18-72 hours
Diptheria Corynebacterium diptheriae 2-6 days
Pertusis Bordetella pertisis 7-14 days ( < 3 weeks)
Meningococcal meningitis Neisseria meninigitis 3-4 days
SARS Corona virus 3-5 days
MERS Beta corona virus 12 days
COVID-19 SARS-Cov-2 ( Nobel Corona 2-14 days
virus)
Tuberculosis Mycobacterium tuberculosis 3-6 weeks ( week-Years)
Poliomyelitis Polio virus 3-35 days (7-14 days)
Hepatitis A Entero virus / Picorna virus 15-45 days (2-4 weeks)
Hepatitis B Hepadna virus ( DNA) 45-180 days (60-90 days)
Hepatitis C Hepaci virus 30-120 days
Cholera Vibrio cholerae Few hour-5 days ( 1-2 days)
Typhioid Salmonella typhi 10-14 days ( 3 day-3 weeks)
Staphylococcal FP Staphylococcus aureus 1-6 hours
Ascariasis Ascaris lumbricoids 2 Months
Ancylostomiasis Ancylostoma duodenale 5 weeks-9 months
Malaria P. Vivax 8-17 days (14 days)
P. Falciparum 9-14 days (12 days)
P. Malariae 18-40 days (28 days)
[Link] 16-18 days (17 days)
P. Knowlesi 9-12 days (12 days)
Lymphatic Filariasis Wuchereria bancrofti 8-16 Months
Rabies Lyssa virus type-1/ Rhabdo virus 3-8 weeks (1-3 months)
Yellow Fever Flavi virus fibricus 2-6 days
Japnese Encephalitis Group B arbovirus/ Flavivirus 5-15 days
KFD Arbovirus / Flavivirus 3-8 days
Chickenguniya Arbovirus 4-7 days
Leptospirosis Leptospira interogens 4-20 days
Bubonic plague Yersinia pestis 2-7 days
Pneumonic plague Yersinia pestis 1-3 days
Septicemic plague Yersinia pestis 2-7 days
Scrub typhus Rickettsia tsutsugamushi 10-12 days
Q- Fever Coxiella burnetti 14-21 days
Taeniasis T. Solium/ T. Saginata 8-14 weeks
Leishmaniasis Leishmania donovani 1-4 Months
Trachoma Chlamydia trachomatis 5-12 days
Tetanus Clostridium tetani 6-10 days ( 1 day-1 Months)
Yaws Treponema pertenue 3-5 weeks

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HIV/ AIDs HIV/ LAV virus Months-10 Years ( Months to

> 6 Years)
Swine Flu H1N1 Types A Influenza 1-4 days
Crimean Congo fever Nairo virus/ Bunya virus 1-9 days
H7N9 Influenza H7N9 Type A Influenza 1-10 days
Ebola virus disease Ebola virus 2-21 days
Anthrax Bacillus anthracis 1-7 days
Brucellosis Brucella meltinensis 5-60 days
Gonorrhoea Neisseria gonorrhoea 2-10 days
Syphilis Treponema pallidum 9-90 days (14-28 days)
Botulism Food poisoning Clostridium botulin 12-36 hours
Salmonella FP Salmonella typhorium 12-24 hours
Amoebiasis E. histolytica 2-4 weeks ( 20-90 days)
Giardiasis G. lamblia 1-4 weeks
Bacillary dysentry Shighella , Salmonella species 5-10 days ( 1-4 days)
Leprosy Mycobacterium leprae Few weeks-25 Years (3-5
Years)
Scabies Sarcoptes scabiei ( Mite) 2-6 weeks

 Some disease and their choice of chemoprophylaxis.

Disease Choice of chemoprohpylaxis

Rheumatic fever Benzathine penicillin
Tuberculosis Isoniazid alone or with Rifampicin
Meningococcal Meningitis Rifampicin/ Ciprofloxacin
Gonorrhoea/ Syphilis Procaine penicillin
Ricketsial infection Tetracycline
Malaria Chloroquine / Mefloquine
Influenza type A and B Oseltamivir
Surgical prophylaxis Cefazolin
Anthrax Ciprofloxacin/ Doxycylin
Diptheria Erythromycin/ Penicillin
Endocarditis Amoxicillin / Clindamycin
Herpes simplex Acyclovir
Group B streptococcal infect. Ampicillin
Hemophilusinfluemza type B Rifampicin
Otitis media Amoxicillin
Pertusis Erythromycin / Azithromycin
Plague Tetracyclin
Toxoplasmosis Cotrimoxazole
UTI Cotrimoxazole
Mycobacterium avium Azithromycin/ Clarithromycin
complex

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Cholera Tetracycline
Tetanus Erythromycin
Dental procedure Amoxicillin
HIV Zidovudine

 Disease with their specific signs and Feature.

Disease Specific signs and features

Acute appendicitis Mac. Burney's point tenderness, Obturator sign, ROVSING'S
sign, Psoas sign, Dunphy sign, Hamberg sign, Aaron sign, Ten
horn sign, Dieulafoy's Triad, Murphy's Triad/ Syndrome ,
Rebound tenderness
Pelvic Inflammatory disease Chandelier's sign
Acute pancreatitis Cullen's sign, Grey turner sign
Acute cholecystitis Murphy's sign, Boas sign
Kwashiorkor (KP) Moon face, Puffyness of face, Flag sign, Flaky pant
dermatitis, Sugary baby and healthy look, Enamel spot,
Syndrome of displaced child.
Marasmus (MC) Little's old man face, Monkey face, Loss of subcutaneous fat,
Baggy pant apperance
Hydrocele Transillumination test +ve, Fluctuation test +ve, Rugosity
loss, Cough impulse -ve
Hernia Cough impulse +ve, Reducibility +ve, Getting over swelling
-ve
Measles Koplik spot ( Pathognomic feature), Warthin Finkledy cell
( Microscopic pathognomic feature)
Cushing syndrome Buffalo hump, Moon face
Hyperthyrodism Exopthalmia, Buff ophthalmia, Thyrotoxicosis, Grave's diseae
Hypothyrodism Cretinism, Myxedema, Mental retardation
Tetanus Trismus, Neck rigidity, Risussardonicus, Ophisthotonus
Meningitis Neck rigidity, Kerning's sign, Brudzinski sign
Botulism food poisoning Dysphagia, Diplopia, Dysarthria
Stroke Babinski sign
Laryngitia Hoarseness of voice
COPD Barrel shape chest
Peptic ulcer Pointing sign
Pernicious anemia Beefy Tounge
Diabetes Ketoacidosis Fruity smell, Coma
Triad of ectopic pregnancy Amenorrhoea for short period, Abdominal pain, Vaginal
bleeding
Rubella Forchheimer's sign

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 Sources and Mode of transmisson of disease.

Disease Sources Mode of transmission

Chicken pox Oropharyngeal secretion, Leison Droplet infection, droplet nuclei
of skin and mucosa
Measles Secretion from nose, throat, Droplet infection, droplet nuclei,
respiratory tract through conjunctiva
Rubella Secretion from nose, throat, Droplet infection, droplet nuclei,
respiratory tract Vertical
Mumps Saliva ( Clinical and subclinical) Droplet infection, direct contact
Influenza Oropharyngeal secretion Droplet infection, droplet nuclei
Diptheria Nasopharyngeal secretion, Droplet infection, direct contact,
discharge from skin, Fomite Fomite born
Whooping cough Nasopharyngeal and bronchial Droplet infection, direct contact,
secretion Fomite
Meningococcal M. Droplet infection
TB Sputum, Saliva, Animal milk Droplet infection, droplet nuclei
Leprosy Nasal secretion, Macular leison Droplet infection, direct contact
Poliomyelitis Faeces, Oropharyngeal secretion Feco-oral, droplet infection
Hepatitis A Faeces, Saliva, Blood Feco-oral, Parenteral, sexual
Hepatitis B Blood, Semen, Saliva Perinatal, Parenteral, Sexual,
Horizontal
Hepatitis C Blood, Semen, Saliva Perinatal, Parenteral, Sexual
Hepatitis D Blood, Semen, Saliva Perintal, Parenteral, Sexual
Hepatitis E Faeces Feco-oral
Cholera Stool ( Main) & Vomit ( danger) Feco-oral, Contaminated
food/drinks, direct contact
Typhoid Faeces, Urine Feco-oral, Urine-oral
Amoebiasis Infected food and water, Stool Feco-oral
Ascariasis Faeces Feco-oral
Ancylostomiasis Soil, Faeces Direct penetration of skin, oral
Dracunculiasis Contaminated water with Fleas Consumption of water
( Dracunculiasis Medinensis) containing Cyclops
Dengue Mosquito Aedes bite
Leptospirosis Faeces, Urine Urine, Faeces, Tissues of rat
Nipha virus Special type of Fruit bat. Consumption of bat eaten fruit,
direct contact
Ebola virus Body Fluid ( Blood, Semen, Parenteral, Sexual, Direct
Urine, Faeces, Vomit, Tears, contact
Sweat, Saliva
JE Pig/ Bird/ Man Bite of infected female culex
mosquito
Tetanus Soil and dust Infected instrument, Burn,
Fracture

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AIDs Blood, Semen, CSF, Vaginal Sexual, Parenteral, Vertical,

secretion, Milk Breast feeding
Gonorrhoea Semen, Blood, Discharge Sexual, Parenteral
Syphilis Semen, Blood, Discharge, Saliva Sexual, Parenteral, Vertical, Kiss
Trachoma Ocular discharge, Fomites Direct and indirect contact, Eye
seeking flies
Filariasis Mosquito, Lymph Bite of infected culex mosquito
Kala-azar Man, Dog, Jackal Sandfly bites, Parenteral
Rabies Saliva ( Clinical and subclinical) Animal bites ( Dog,Cats, Bat),
Lick, aerosal, person-person
(rare)
Malaria Blood Bite of infected female
anopheles mosquito, Congenital
Bacillary dysentry Infected food and waters Feco-oral
Giardiasis Infected food and waters Feco-oral route
Salmonella FP Contaminated food Feco-oral
Staphylococcal FP Contaminated food Feco-oral
Botulism FP Contamimated food Feco-oral

 Contraceptive Failure rate and Efficacy.

Device/ Method Pearl index / Failure rate (HWY) Efficacy

No method 80 %
Calender/ Rhythm method 24 %
Coitous interrupt 18 %
Condom 3-15 % 98 %
Male Condom 2-14 %
Female Condom 5-21 %
Diaphragm 12 % (6-12 %)
Vaginal sponge 9-20 % in Null parity ( 20-40 % in
Parity)
Spermicidal jelly/ Kamlachaki 10-25 %
Copper-T / IUD 0.5-2 % 99.4 %
Copper T 380 A 0.5-0.8 %
Progestasert 2%
Lippes Loop 3%
Oral pills 0.1-0.5 % ( 1-3 % ) 99.7 %
Centachroman/ Saheli 1.83-2.84 %
DMPA ( Depo) 0.03 %
Vasectomy 0.15 % ( 0.5-1.2 %)
Jaddle/ Implant 0.06 % 99.95 %
LAM ( Lactation A method) 2 % If fully breastfeed 98 %
Laproscopic sterilization 0.1 %
Tubectomy ( Minilap) 0.15-0.5 %

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 Daily Requirement of Nutrients, Vitamins and Minerals.

Nutrient, Vitamin & Minerals Daily requirement

Carbohydrate:-
Normal adult  1800-2400 Kcal/day
Pregnancy  + 350 Kcal Extra required
Lactation  + 600 Kcal extra in first 6 months and then +
520 Kcal
Heavy worker  3490 Kcal ( 3900 Kcal )
Protein:-
Normal adult  1 gm/kg/day ( 60 gm/day)
Pregnancy  +23 gm extra/day
Lactation  +19 gm/day extra in first 6 months and then +
13 gm extra/day
Fat:-
Normal adult  20-30 gm/day
Pregnancy  30 gm/day
Lactation  45 gm/day
Vitamin A:- ( Retinol)
Normal adult  600 mcg/day
Pregnacy 800 mcg/day
Lactation  950 mcg/day
Infants (0-12 months) 350 mcg/day
Children ( 1-6 Years and 7-12 Years) 400 mcg / day & 600 mcg/day respectively.
Adolescent ( 13-19 Years)  600 mcg/day

Vitamin B1 / Thiamine 0.5 mg per 1000 Kcal of energy intake

Vitamin B2 / Riboflavin 0.5 mg per 1000 Kcal of energy intake
Vitamin B3/ Niacin 6.6 mg per 1000 Kcal of energy intake
Vitamin B5/ Pantothenic acid 10 mg/day
Vitamin B6 / Pyridoxin 2 mg/day
Vitamin B7 / Biotin 10-20 mg/day
Vitamin B9/ Folic acid ( Pteryl Glutamic-PGA 100-120mcg /day ( Pregnancy: 400 mcg/day)
Vitamin B12 / Cyanocobalmin 1 mcg/day
Vitamin D / Cholecalciferol 100 IU/day( 2.5 mcgcalciferol) ( 400 IU/day in
pregnancy.
Vitamin E / Tocopherol 0.8 mg/gm of essential fatty acids
Vitamin K / Phylloquinone 0.03 mg/kg
Iron:-
Adult male  17 mg/day
Adult Female  Mense ( 21 mg/day), Pregnancy ( 35 mg/day)
Lactation ( 21 mg/day)

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Infant  5 mg/day

Iodine:-
Adults (> 12 Years)  150 mcg/day
Pregnancy and lactation  250 mcg/day
Pre-school child ( 0-59 months)  90 mcg/day
School children ( 6-12 Years)  120 mcg/day

Fluorine 0.5-0.8 mg/litre of water

Calcium :-
Adult  600 mg/day
Pregnant and lactation  1200 mg/day

Magnesium 340 mg/day

Phosphorus 400-500 mg/day
Sodium 5 gm/day
Zinc:-
Adult male  12 mg/day
Adult Female  10 mg/dayy
Infants  5 mg/day

 Some Food Adulteration Disease.

Disease Toxin Adulterant

Lathyrism BOAA Khesari dal ( Lathyrussativus)
Epidemic Dropsy Sanguinarine Argemone oil
Endemic Ascites Pyrrolizidine alkaloids Crotolaria seed ( Jhunjhunia)
Aflatoxicosis Aflatoxin Aspergillus flavus/ Parasiticus
Ergotism Clavine alkaloids Claviceps fusiformis

 Vitamins and Vitamin Deficiencies.

Vitamins Chemical Names Deficiency state

Vitamin A Retinol, Retinoid, Carotenoid Xerophthalmia
Vitamin B1 Thiamine Beri-beri, WernickesKorasoff

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psychosis
Vitamin B2 Riboflavin Ariboflavinosis
Vitamin B3 Niacin, Niacinamide Pellegra
Vitamin B5 Pantothenic acid Burning feet syndrome
Vitamin B6 Pyridoxin Anemia, Peripheral neuropathy
Vitamin B7 Biotin Dermatitis, Entritis
Vitamin B9 Folic acid, Folinic acid Megaloblastic anemia, Neural
tube defects
Vitamin B12 Cyanocobalamin Megaloblastic anemia
Hydroxycobalamin
Methylcobalamin
Vitamin C Ascorbicacid Scurvy
Vitamin D Ergocalciferol, Cholecalciferol Rickets and Osteomalcia
Vitamin E Tocopherols, Tocotrienol Hemolytic disease of newborn
Vitamin K Phylloquinone Hemorrhagic disease of new born
Menaquinone
Menadione

 Major Canals ( DUCTs) in our body.

Canals/ Ducts Site/ present in.

Canal of Schlemn Near the junction of cornea and Sclera (Eye)
Duct of Rvinus Sublingual duct of salivary gland
Wharton's duct Sub-Mandibular duct of salivary gland
Stenson's duct Parotid duct of salivary gland
Endolymphatic duct Internal Ear
Haversian canal Bones
Hyaloid canal Eye
Inguinal canal Reproductive organs ( Pathway between abdominal wall and
external genitalia)
Lacrimal duct Eye
Lactiferous duct Mammary gland
Leydig's duct/ Wolffian duct Internal genitalia
Neuroentericcanal Vertebrate embryo
Duct of Bellini/ Papillary duct Kidney ( Part of renal tubule)
Volkmann's canal Bones

 Important Foramen in human body.

Foramen Organ/ Part of human body

Foramen Magnum Skull

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Foramen Monro Brain

Foramen Ovale Heart
Foramen of Luschka Brain ( Two openings on the lateral side of roof of 4 th Ventricle
of brain
Foramen Mental Opening on the lateral surface of each ramus of the lower jaw
Foramen Spinosum Opening in the Sphenoid bone
Obturator foramen Pelvic bone
Foramen rotundum An openin in the Sphenoid bone

 Some body fluids, their PH and amount of secretion.

Body fluids PH Amount Nature

Blood 7.35-7.45 5-6 Litre Alkaline
Saliva 5.8-7.4 1.5 lt/day Slightly acidic
Gastric Juice 1.5-3.5 1.5-2 lt/day Acidic
Bile 6.0-8.5 500-1000 ml/day Alkaline
Urine 4.5-8 1500 ml/day Slightly acidic
CSF 7.33 0.5 ml/min or 720 Alkaline
ml/day
Pancreatic juice 8 200-800 ml/day Alkaline
Intestinal Juice 7.8-8 2.5-3 lt/day Alkaline
Vaginal Fluid 3.5-4.5 Acidic
Semen 7.35-7.5 3-5 ml/ ejaculation Alkaline
Water 6-8.5 Neutral

 Clean for Safe delivery for prevention of Neonatal Tetanus.

3 Clean 5 Clean 7 Clean

CleanHands Clean Hands Clean Hands
Cleandeliverysurface Clean delivery surface Clean delivery surface
Cleancordcare Clean cord cut/ blade Clean cord cut/ blade
Clean cord Tie Clean cord Tie
Clean cord Stump Clean cord Stump
Clean towel
Clean water

 Classification of Helminthics.

Nematods Trematodes Cestodes

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Round worm (A. lumbricoides) BloldFluke ( Schistosoma Pork tape worm (T. solium)
mansoni)
Hook worm ( A. duodenale) Lungs Fluke (Paragonimus Beef tape worm ( T.
westermani) saginata)
Pin worm ([Link]) Liver Fluke ( Fasicola hepatica) Fish tape worm
( Diphylobothrium latum)
Thread worm Dog tape worm
(Strongyloidesstercoralis) ( [Link])
Filarial worm ( W. bancrofti) Dwarf tape worm
( Hymenolepis nana)
Whip worm (Trichuris
trichuria)
Trichinea worm
( Trichinelaaspiralis)
Guinea worm ( Dracunculiasis
medinensis)

 Some vector borne disease and their vector.

Vectors Diseases transmitted

Housefly ( Muscadomestica) Diarrhoeal and dysentricaldisease, Poliomyelitis, Yaws,
Anthrax, Trachoma
Sandfly( Phlebotomusargentipus) Kala-azar ( Visceral leishmaniasis), Oriental sore
( Cutaneous leishmaniasis), Sandfly fever, Oroya fever
Tse-tsefly ( Gossinapalpalis) Sleeping sickness of Africa ( African Trypanosomiasis)
Reduvidbug Chagas disease (Sleeping sickness of America-American
Trypanosomiasis).
Blackfly Onchocerciasis ( River blindness)
Softtick Relapsing fever, Q-fever, KFD ( Outside India)
Hardtick KFD ( India), Tick paralysis, Tick typhus, Tularemia, Tick
hemorrhagic fever
Louse Epidemic Typhus, Trench fever, Relapsing fever
Mite Scrub Typhus, Rickettsial pox
Flea Plague, Murine Typhus
Anophlesmosquito Malaria, Filariasis ( Outside India)
Culexmosquito Bancroftian filariasis, Japanese Encephalitis, West Nile fver
Arthritis
Aedesmosquito Yellow fever, Dengue fever, DHF, Chicekgunya fever
Mansonoides Malayon filariasis, Chickengunya

 Composition of Oral Rehydration Salt ( ORS)

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Quick review of loksewa by Gajendra and Rahul.

Composition Standared Formula-ORS New Formula ( WHO-ORS)

Nacl 3.5 gm 2.6 gm
Kcl 1.5 gm 1.5 gm
Trisodium citrate 2.9 gm 2.9 gm
Glucose 20 gm 13.5 gm
Water 1 Litre 1 Litre
Na+ 90 mmol/l 75 mmo/l
K+ 20 mmol/l 20 mmol/l
Cl- 80 mmol/l 65 mmol/l
Citrate 10 mmol/l 10 mmol/l
Glucose 111 mmol/l 75 mmol/l
Total Osmolarity 311 Mosm/ L 245 Mosm/ L

 Outercovering of some organs.

Organs Outer coverings

Heart Pericardium
Uterus Perimetrium
Lungs Pleura
Kidney Renal Fascia
Liver Glisson's capsule
Brain Meninges
Meninges Dura Mater
Testes Tunica Vaginalis
Blood vessels Tunica adventitia
Abdomen Peritoneum

 Length and Diameter of some organs.

Organs Length Diameter

Trachea 10-11 cm ( 10 cm) 2 cm
Pharynx 12-14 cm
Esophagus 25 cm 2 cm
Ureter 25 cm 3 mm
Fallopian tube 10 cm
Urethra Male (20 cm), Female ( 4 cm)
Vasdeference 45 cm
Cystic duct 3.4 cm
Common bile duct 8 cm 6 mm
Femur 45 cm
Pancrease 15 cm

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Quick review of loksewa by Gajendra and Rahul.

Small intestine 5.25 m

Duodenum 25 cm
Jejunum 2m
Ileum 3m
Ascending colon 15 cm
Transverse colon 50 cm
Descending colon 30 cm
Sigmoid colon 40 cm
Rectum 13 cm
Anal canal 3.8 cm ( 4 cm)
Vermiform appedix 13 cm ( if not: 9 cm)
Caecum 6 cm X 7.4 cm (l X b)
Prostate gland 2 cm X 4 cm ( l X b)
Nasolacrimal duct 2 cm
Eustachian tube 4 cm
Right bronchus 2.5 cm
Left bronchus 5 cm
Thoracic duct 45 cm
Stomach 25 cm
Ascending aorta 5 cm
Superior benecava 7 cm
Nephrone 6 cm
Medulla oblongata 2.5 cm
Spinal cord 45 cm
External auditory canal 2.5 cm
Cochlea 3.5 mm
Gall bladder 75 cm X 3 cm
Epididymis (Uncoiled) 6m
Eye Volume: 6.5 CC/ ml 2.5 cm
Vaginal wall 9 cm ( 7.5-9 cm) 2.5 cm
RBCs 7 micrometer
WBCs 10 micrometer
Platelets 2-4 micrometer
Uterus 75 cm X 5 cm X 2.5 cm
Ovary 3 cm X 2 cm X 1 cm

 Weight of some organs.

Organs Weight
Brain 1500 gm ( 1/50th of body weight)
Heart Male ( 300 gm), Female ( 250 gm)
Kidney 130-150 gm

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Liver 1-2.3 kg ( 1.5 kg)

Lungs Right ( 650 gm), Left ( 600 gm)
Ovaries 4-8 gm ( 3 Ounce)
Pancrease 60-100 gm
Placenta 500-600 gm ( 1/6th of body wt of fetus)
Uterus 30-60 gm ( 50 gm))
Uterus at term of pregnancy 900-1000 gm
Testes 10-15 gm
Eye 7 gm
Spinal cord 30 gm
Prostate gland 8 gm
Spleen 200 gm
Thyroid gland 25 gm
Parathyroid gland 50 mg single
Thymus gland 15 gm
Adrenal gland 5 gm

 Some organs amd their shape.

Organs Shape of organs

Malleus Hammer shaped
Incus Anvil shaped
Stapes Stirrup shaped
Stomach J shaped
Duodenum C shaped
Diaphragm Dome shaped
Heart Cone shaped
Lungs Cone shaped
Kidney Bean shaped
Kidney medulla Conical shaped
Gall bladder Pear shaped
Auditory canal S shaped
Uterus Pear/ Hallow muscular shaped
Urinary bladder Oval/ rough shaped
Testes Oval shaped
Cochlea Snail shaped
Spleen Slightly oval shaped
Renal pelvis Funnel shaped
Cerebellum Ovoid shaped
Eye ball Spherical shaped
Cartilage of trachea C shaped
# Bowman's capsule Cup shaped
Scapula, Patella Flat triangular shaped

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 Key age group definition.

Key age Definition

Ovum 0-2 weeks
Embryo 2-9 weeks
Fetus 9 weeks-Delivery
Period of Viability POG > 28 weeks
Perinatal period 28 weeks POG -7 days post delivery
Neonatal period 0-28 days after birth ( 0-4 weeks post delivery)
Early Neonate 0-7 days after birth ( 1st week of life)
Late Neonate 8-28 days after birth
Post Neonatal 29 days-365 days after birth ( 2-4 weeks )
Infancy Birth-365 days ( 1st Year of life)
Toddlers 1-3 years age
Pre-school 3-6 Years (2-4 Years)
Puberty Girls (10-12 Years), Boys ( 12-14 Years)
Adolescent 10-19 Years ( WHO definition)
Early adolescence 10-13 Years
Mid adolescence 14-16 Years
Late adolescence 17-19 Years
Youth 15-24 Years ( UN definition)
Young people 10-24 Years
Reproductive age 15-44 Years or 15-49 Years
Geriatric age Above 60
Legal age for marriage in Nepal 20 Years for both Boys and Girls ( They can marriage at age
18 Years by their parent conset).
Legal age for employment in Nepal Above 14 Years ( Prohibited below age of 14) A/c The Child
Labour Prohibition amd Regulation Act 2000.
Legal age for conset by a girl for 16 Years.
sexual intercourse in Nepal
Juvenile age For both Boys and Girls: < 18 Years
Tobacco product can't be sold in To age below 18 Years and pregnant women ( A/C Tobacco
Nepal product control and regulatory act 2068 Bs (2011 AD).
Alcohol cannot be sold in Nepal To age below 21 Years and pregnant women.

 Milestone Development in Child.

Age Milestones
1 Month Alerts to sound
2 Months Social smile
3 Months Neck holding, Recognizes mother; anticipates feeds, Coos ( musical) sound
4 Months Bidextrous reach, Laugh loud

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5 Months Rolls over

6 Months Sits in tripod fashion ( Sitting with support), Unidextrous reach, Recognizes
strangers; stranger anxiety, Monosyllables ( ba, ma, pa), ah-goo sound
8 Months Sitting without support
9 Months Stands with support, Immature pincer grasp, waves "bye-bye", Bi-syllables
( baba, mama, dada)
12 Months Creep well, walk but fall, stands with out support, Comes when called, Plays
simple ball game, 1-2 word with meanings.
15 Months Walks alone, Creeps up stair, Jargon
18 Months Runs, Explore drawers, Copes parents in task ( e.g sweeping)
2 Years Walks up and down stairs, Ask for food, drink and toilet, Pulls people to show
way, 2-3 word sentences.
3 Years Rides tricycles, recognize their own sex/gender, Shares toy, Knows full name
4 Years Hops on the foot, Copies cross bride with blocks, Goes to toilet alone, Plays
cooperatively in group
5 Years Copies triangle; gate with blocks, Helps in household task, Dresses amd
undresses, Ask meaning of words

 APGAR Scoring ( Given by Dr. Virginia Apgar)

Indicators/ Features Score ' 0 ' Score ' 1 ' Score ' 2 '
Appearance ( Colour) Blue or pale Body pink, Limb Pink all over
blue
Pulse ( Heart rate ) Nill < 100/ min >100/ mim
Grimace ( Reflex response) to Nill Grimace or feeble Cry or sneezing
nasal catheter cry
Activity ( Muscle tone) Limb ( Complete Some flexion of Active movements
flaccid) limb
Respiration Nill Slow and irregular Good and stronge

If score is 8-10  Prognosis is very good ( Normal).

If score is 4-7  Prognosis is moderate ( Mild Asphyxiated)

If Score is 0-3  Prognosis is grave ( Severe Asphyxiated)

 Normal Value of Bio-chemical of human body.

Test Normal Range

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Quick review of loksewa by Gajendra and Rahul.

Sodium 135-143 mmol/L or mEq/L

Potassium 3.5- 5 mmol/L or mEq/L
Calcium 8.5-10.5 mg/dl or 2.12-2.62 mmol/L
Cholesterol 3.6 -6.7 mmol/L or 140-260 mg/dl
H.D.L Cholesterol 40-80 mg/dl
L.D.L Cholesterol 85-125 mg/dl
Triglycerides 50-150 mg/dl
Fasting blood glucose < 110 mg//dl
Random blood glucose 100-140 mg/dl
Post prandial blood glucose < 140 mg/dl
Uric acid Male ( 2.5-7 mg/dl) , Female ( 1.5-6 mg/dl)
Urea 15-40 mg/dl or 2.5-6 mmol/L
Creatinine 0.6-1.2 mg/dl
Billirubin ( Total) 2-20 Umol/L ( Micro mol)
Hb Male ( 13-18 gm/dl), Female ( 11.5-16.5 gm/dl)
RBC Male ( 4.5-6.5 million/mm3) , Female ( 4.5-5
million/mm3)
WBC 4000-11000/mm3
Differential leucocytes count ( DLC)
Neutrophils 40-75 %
Eosinophils 1-6 %
Basophils 1.1 %
Monocytes 2-10 %
Lymphocytes 20-50 %
Platelets 200000-350000/mm3
Bleeding Time 2-7 Min ( Ivy's method)
Prothrombin Time 10-14 Sec
Coagulation time 5-11 Min
TSH ( Thyroid Stimulating Hormone) 0.5-5 mIU/L
Total T3 (Tri-iodo-thyronine) 0.7-1.5 ng/dl
Total T4 ( Thyroxin) 4.9-11.7 mg/dl
Total protein 6-8 gm/dl
Albumin 35-50 gm/L

 Facts on Human body and Health.

Largest artery is Aorta (2.5 cm)

Largest Blood cell is Monocytes ( WBC)
Smallest Blood cell is Platelets
Smallest WBC is Lymphocyte
Largest cavity is Abdominal cavity
Largest cell is Ovum (130 micrometer)
Smallest cell is Sperm

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Largest nerve is Sciatic nerve

Largest cranial nerve is Trigeminal
Longet cranial nerve is Vagus
Longest intracranial nerve is Abducens
Thinnest and smallest cranial nerve is Trochlear
Shortest cranial nerve is Optics
Largest endocrine gland is Thyroid gland
Largest foramen is Obturator foramen
Largest gland is Liver
Largest organ of body is Skin
Largest internal organ is Liver
Largest joint is Knee joint
Largest and strongest bone Pelvic bone
Longest bone is Femur
Largest and bulkiest muscle is Gluteus maximus
Largest organ of digestive system is Large intestine
Longest organ of digestive tract is Small intestine
Largest part of brain is Cerebrum
Largest Salivary gland is Parotid
Largest Sinus is Maxillary sinus
Largest Tooth is Molar
Largest Vein is Inferior venecava
Longest cell is Nerve cell ( Neurone)
Longest muscle is Sartorius ( Tailor's muscle)
Longest Tooth is Canine
Smallest muscle is Stapedius
Smallest bone is Stapes
Smallest endocrine gland is Pineal gland
Calcium stored in bone 98 % of total calcium
Types of bone a/c to shape and size 5 types ( Long, Short, Flat, Irregular, Sesamoid bone)
Total number of bone in adult 206
Total number of bone in newborn 300
Axial skeleton consists of 80 bones
Appendicular skeleton consists of 126 bones
Number of bone in skull is 22 bones ( Cranium: 8 and Facial: 14)
Length of Sternum/ Breast bone 17 cm
Number of bones in Vertebra is 33 ( C7 T12 L5 S5 C4)
Number of Ribs is 12 Pairs ( True ribs: 1-7 Pair, False ribs: 8,9,10 and
Floating ribs : 11 and 12 )
Functional Foramen is Foramen magnum
Shape of Anterior fontanella is Diamond shape and large and fills in 12-18 months
Shape of posterior fontanella is Triangle shape and fills in 2-3 months ( 6-8 weeks)
Composition of bone is Water 20 %, Organic matter 30-40 %, Inorganic 40-50 %
Water % in muscle is 75 %

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Types of muscle is 3 Types ( Voluntary, Imvoluntary and Cardiac)

Voluntary muscle has Cylindrical shape, Multi nucleated
Involuntary muscle has Spindal shape and Single nucleated
Cardiac muscle has Cylindrical shape and Single nucleated
Major muscle of chest is Pectoralis major (main), Pectoralis minor
Muscle of Neck is 2 (Trapezius, Sternocleido-mastoid)
Muscle of Pelvic floor is Coccygeous, Levatorani
Strongest muscle is Masseter
Climbing muscle is Lattismusdorsi
Kicking muscle is Rectus femoris
Peripheral Heart is Soleus / Calf muscle
Dancing muscle is Hamestrings / Quadriceps femoris
Horror or surprise muscle is Palatysma
Subcutaneous muscle is Dartus, Palmaris brevis, Palatysma
Smiling / Chewing muscle is Buccinators / Trumpeter's muscle
Kissing muscles is Orbicularis oris
Honeymoon muscle is Gracilis
Muscle of Mastication is Masseter, Temporalis, Pterygoid
Micro muscles is Arrectorpillorum
Most common site for IM injection is Deltoid (2nd Gluteus maximus)
Best site for IM injection is Gluteus maximus
Most common and best site for IM Thigh
injection in child is
Best route for diagnostic purpose Intra dermal
Digestive tract is lined by Columnar epithelium
Tounge is lined by Startified squamous epithelium
Nerve supply of tounge is Cranial nerve (7,9,10 and 12)
1st teeth to erupt in temporary set Lower Central Incisors
Last teeth to erupt in temporary set 2nd Molar
1st teeth to erupt in permanent set 1st Molar
Last teeth to erupt in permanent set 3rd Molar
Hardest substance of body is Enamel
Hardest tissue of body is Dentine
Hardest connective tissue is Bone
Peritoneum that covers stomach js Greater Omentum ( Police man of abdomen)
Peritonem that covers small intestine Mysentry
Peritonem that covers large intestine Mesocolon
In Duodenum absorption of Vitamin C , Iron and Calcium
Vitamin B12 and Folic acid are Absorbed from terminal part of ileum
Food and water are maximum Jejunum
absorbed from
Capacity of gall bladder is 30-60 ml
Normal pleural fluid is 5-15 ml
Normal peritoneal fluid is 10-20 ml

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Right lungs has 3 lobes, 2 fissure and 10 bronchopulmonary segment

Left lungs has 2 lobes, 1 fissure and 8 bronchopulmonary segments
Tidal Volume is 500 ml
Inspiratory reserve volume is 3100 ml
Expiratory reserve volume is 1200 ml
Residual volume is 1200 ml
Vital capacity is 4800 ml
Total lungs capacity is 5800 ml
Anatomical dead space is 150 ml
Absorbed volumes is 250 ml
Alveolar ventillation is 5.25 L
Life Span of sperm is 48 Hours ( 36-72 hours)
Life span of ovum is 24
Universal receiver blood group is AB+
Universal Donar blood group is O-

 Health Agencies Headquarters.

Health Agencies Headquarters

WHO ( World Health Organization) Geneva,Switzerland
UNICEF ( United Nations Children Fund) New York, USA
UNDP ( United Nations Development Program) New York, USA
FAO ( Food and Agriculture Organization) Rome, Italy
ILO ( International Labour Organization) Geneva, Switzerland
IRC ( International Red croos) Geneva,Switzerland

 Ideal time for treatment of some surgical condition.

Condition Time of treatment

Undescended testes 6 months
Hypospadias 6-12 months
Cleft lip 3-6 months
Cleft palate 6-18 months
Umbilical hernia 5 Years

 Facts on Disaster and Disaster Management.

Facts
Disaster ( A/c to WHO) Is any occurrence that causes damage, ecological

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disruption, loss of human life or deterioration of health

and health service on a scale sufficient to warrant an
extra ordinary response from outside the affected
community or area.
Disaster ( A/c to Colin grant) Is a catasttrophecausing ' Injury or illness'
simultaneously to at least 30 people; who will require
hospital emergency treatment.
Most commonly reported disease in Gastroenteritis
post disaster phase
Most practical and effective strategy Supplying safe drinking water and proper disposal of
of disease prevention and control in human excreta .
post disaster phase is
Foremost step for disease prevention Chlorination of all water bodies.
and control in post disaster phase is
Level of residual chlorine to be >0.7 mg/L ( > 0.7 ppm)
maintained in water bodies in post
disaster phase is
Most common micronutrient Vitamin A deficiency ( others common deficiency are
deficiency in disaster is Vitamin C, Iron, Niacin)
Stage of disaster cycle Disaster impact and responseStage of health and
medical reliefRehabilitation  Mitigation Disaster
preparedness ( 5 phase)
Most crucial phase of disaster Health and medical relief
management is the stage of
World disaster reduction day 2nd Wednesday of October
Greater need for emergency care in First few hours
immediate post disaster occurs in
World worst man made disaster is Bhopal gas Tragedy, 3rd Dec 1984 AD
Gas leaked in Bhopal gas Tragedy was Methylisocyanate ( MIC)

 Facts on Mosquitos.

Life span of mosquitos varies from 8-34 days

Life span of mosquito is influenced by Temperature and humidity
Life span of adult mosquito is about 2 Weeks ( Have short life span than
female)
Stages in mosquito life cycle 4 ( Egg LarvaPupaAdult)
Egg stage of mosquito last for 1-2 days
Larva of mosquito passes through 4 stages of Instars ( in which moulting occurs)
growth called
Resting stage of mosquito life cycle is Pupa
Pupa stage last for 1-2 days
Life cycle of mosquito complete in 7-10 days

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Anopheles Mosquito
Disease tramsmitted by Anopheles mosquito Is Malaria
Breeding habitate of Anopheles mosquito is Clean water
Eggs of Anopheles mosquito are Boat shaped with lateral floats and are
laid singly
Larva of Anopheles mosquito Rest parallel to under surface of water
and have no Siphon tubes.
Pupae of Anophles mosquito have Broad and short siphon tubes
Adult Anopheles mosquito rest Inclined at angle to surface and have
spotted wings
Flight range of Anopheles mosquito is 3-5 Km
Anopheles mosquito is also known as Sophisticated mosquito
Culex mosquito
Disease transmitted by Culex mosquito is Bancroftian Filariasis, J.E and West Nile
fever
Breeding habitate of culex mosquito is Dirty, Polluted water
Eggs of culex mosquito are Rafts shaped and are laid in small clusters
Larvae of culex mosquito Rest perpendicular to undersurface of
water and have Siphon tubes
Pupae of culex mosquito have Long and narrow siphon tubes
Adult of culex mosquito rest Hunch back
Flight range of culex mosquito is 11 Km
Culex mosquito is also known as Nuisance mosquito
Aedes mosquito 
Disease transmitted by Aedes mosquito is Dengue, DHF, Chickengunya, Yellow
fever, Rift valley fever
Breeding habitate of Aedes mosquito is Artificial collections of water
Eggs of Aedes mosquito are Cigar shaped and are laid singly
Larva of Aedes mosquito Rest in dark bottoms corner and have
Siphon tubes
Pupa of Aedes mosquito have Long and narrow siphon tubes
Adult Aedes mosquito have Stripes on body and legs
Flight range of Aedes mosquito 100 M
Aedes mosquito is also known as Tiger mosquito
Mansonia 
Diseaese transmitted by Mansonia Malayan ( Brugian Filariasis)
Breeding habitat of Mansonia is Water bodies containing aquatic plants
Eggs of Mansonia are Star shaped and are laid in clusters
Larva of Mansonia rest Attached to rootlets of plants amd have
siphon tubes
Pupa of Mansonia have Long and narrow siphon tubes

 Facts on Vaccine.

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Facts :
Vaccine is An immuno-biological substance designed to
produce specific protection against a given
disease.
Term " Vaccine" was coined by Louis pasteur
Term " Vaccination" was coined by Edward jeener
First vaccine to be developed Small pox (1978) by Edward jeener
Types of vaccine 5 Types ( Live attenuated, Killed, Toxoids,
Cellular fraction, Combined vaccine )
In Live attenuated vaccine Pathogenecity/ Virulence is reduced but
antigenicity/ Immunogenecity are present.
In killed/ Inactivated vaccine Organism are killed by heat or chemicals
stimulate active immunity when introduced in
body.
Toxoids Toxins produced by organisms are detoxicated
and used for vaccine preparation.
Cellular fraction vaccine Prepared from extracted cellular fraction
Mixed/ Combine vaccine More than one kind of immunizing agent is
used in vaccine.
Example of Live attenuated vaccines are BCG, OPV/Sabin, Measles, Mumps, Rubella,
Varicella, Yellow fever, Typhoral, Epidemic
typhus, Live attenuated influenza vaccine
Example of killed vaccines are Pertusis, IPV/Salk, Rabies, Cholera,
Meningococcal, Hepatitis B, Typhim-Vi, Killed
plague, JE, KFD vaccine
Example of toxoids vaccine are Diptheria toxoids, Tetanus toxoid
Example of Cellular fraction vaccine PCV, Hemophillus influenza B, Meningococcal,
Hepatitis B
Example of Combined vaccine DPT, MMR DT
WHO recommended strain of BCG vaccine Danish 1331 strain
Strain of OPV/IPV vaccine P1, P2 and P3 ( Monovalent or Trivalent)
Most commonly used strain of Measles Edmonstonzagreb strain
vaccine
Strain of Rubella vaccin RA 27/3
Strain of Yellow fever vaccine 17 D strain
Strain of Varicella vaccine OKA strain
Strain of JE Vaccine used in Nepal SA-14-14-2
Strain of swine flu vaccine A7/ California/ 2009
Strain of Malaria vaccine Spf 66 strain ( Lytic coktail)
Strain of Hiv vaccine mVA ( modified vaccinia Ankara) strain
rAAV ( recombinent Adeno associated viral
vaccine)
Vaccine contraindicated in pregnancy All live vaccine EXCEPT Yellow fever vaccine
Vaccine contraindicated in HIV Asymptomatic HIV  NONE vaccine
Symptomatic HIV  All live vaccine EXCEPT

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BCG vaccine
Vaccine contraindicated in Immuno- All live vaccine
suppression
Vaccine contraindicated in steroid therapy All live vaccine
Vaccine contraindicated in Fever Typhoid vaccine ( Typhoral, Typhim-Vi, TAB)
Vaccine contraindicated in ARTI/ Diarrhoea None vaccine
Vaccine contraindicated together Yellow fever and Cholera vaccine
Vaccine contraindicated in preterm-premature Hepatitis B vaccine
baby with birth weight < 2 kg
Vaccine contraindicated in progressive Pertusis
neurlogical disease
Vaccine contraindicated in Infants (< 1 year) Yellow fever, Meningococcal, Pneumococcal
Vaccine
Pertusis vaccine is not contraindicated in Epilepsy controlled on medication and cerebral
palsy
Only absolute contraindication of killed Severe local or general reaction to previous
vaccine dose
Guillian Barre syndrome is side effect of Killed Influenza vaccine
Vaccine associated paralysis is side effect of OPV / Sabin Vaccine
Toxic shock syndrome is side effect of Measles vaccine and MMR vaccine
Shock is side effect of DPT and Pertusis vaccine
Hypersensitivity is side effect of Hepatitis-B, Meningococcal, DPT, DT Vaccine
Live attenuated vaccine are more potent than Killed vaccines
BCG stands for BacilleCalmette Guerin
BCG is a Freeze dried ( Lypholized ) vaccine
DANISH 1331 strain is derived from Mycobacterium bovis
Dilut used for BCG vaccine is Normal saline
BCG vaccine should be used with in 6 Hours after reconstitution ( A/c to NIP)
( [Link]: Should be used with in 1 hour)
Aftet BCG vaccination Mantoux test become 8-14 weeks
positive in
BCG vaccime does not protect from Pulmonary tuberculosis
Protective efficacy of BCG vaccine from Severe 0-80 % ( 50 %)
form of TB ( TB Meningitis)
Protective efficacy of BCG vaccine from 20-40 %
Leprosy
Protective duration of BCG vaccine 20 Years
Complication of BCG vaccine Suppurative lymphadenitis, Osteomyelitis,
Prolonged severe ulceration, Death
Strength of BCG vaccine 0.1 mg in 0.1 ml
Measles vaccine is a Live attenuated,Freeze dried ( Lypholized),
Tissue culture vaccine
Dilut use for Measles vaccine is Distilled/Sterile water
Incubation period of Vaccine induces Measles 7 days
Ideal gap between 2 successive dose of 6 Months

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Measles vaccine
OPV vacvines provides Both Systemic ( Humoral) and Local ( Intestinal)
Immunity
IPV vaccine only provides Humoral immunity
Dry ice is Solidified carbon dioxide
V V M is a marker of Vaccine potency
V V M indicates efficiency of Cold chain ( Temperature maintainance)
Adjuvant used in DPT vaccine is Aluminium hydroxide or Aluminium phosphate
Adjuvant increases the immunogenecity of
vaccine)
Preservative used in DPT vaccine is Thiomersal
Thermostabilizer used in OPV vaccine is Magnesium chloride
Preservative used in Measles vaccine is Neomycin and Erythromycin
Rare vaccine reaction of measles vaccine is Thrombocytopenia
Rare vaccine reaction of BCG vaccine is Suppurative lymphadenitis
Cold chain is a System of storage and transportation of
vaccines from the point of manufactures to the
point of admistration.
Cold chain temperarure of vaccine is +2-+8 ° C
Ice pack is prepared by keeping in a Deep freezer
Capacity of icepack is 320-340 ml
Dial thermometer is Instrument used to monitor the temperature of
cold chain.
Dial Thermometet is based on the principle of Thermocouple
Vaccine stored in cold compartment are DPT-HepB-HiB, PCV, TD ( All freeze sansitive
vaccine), Reconstituted BCG amd Measles
vaccine
Vaccine stored in Freeze compartment are OPV, Measles nd BCG in powder form
Multi dose vial policy vaccine are DPT-HepB-HiB, OPV, T.T
Non Multi dose vial policy vaccine are BCG, Measles and rubella, Fipv
Most heat sensitive vaccine is OPV (2nd : Measles)
Most Freeze sensitive vaccine is HepB-HiB-DPT

 Facts on Epidemiology and Concept of Health and disease.

Definition of Health (A/c to WHO) Health is a state of complete physical, mental and social
well being, and not merely an absence of disease or
infirmity ( Recently include- and an ability to lead a
socially and economically productive life.
Standared of housing include Income and Occupation
Standared of housing, sanitation and nutrition
Level of provision of health, educational, recreational and
other services.

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Standared of living depends upon Per capita GNP

HDI stands for Human Development Index
HDI Value ranges from 0-1
Rank of Nepal in HDI in world 147 Out of 189 countries (0.579 in 2018)
HDI includes Knowledge, Income and Longetivity ( Life exectancy at
birth)
PQLI stands for Physical Quality of Life index
PQLI includes Life Expectancy at 1 years, Infant Mortality rate, Literacy
rate
PQLI value ranges from 0-100
Morbidity indicators are Incidence and prevalence, Notification rate, Attendance
rate at hospital, Admission, readmission and discharge
rate, Duration of hospital stay, Spells of sickness
Mortality indicators are IMR, MMR, Child Mortality rate, U5 Proportionate
mortality rate, CDR, Life Expectancy, Proportional
Mortality rate, Disease specific mortality rate
Life Expectancy is a Positive mortality indicators
Sullivan's index is Life expectancy-Duration of disabiliy
Sullivan's index is also known as Disability Free Life Expectancy ( DFLE)
Best measures of burden of disease DALY ( Disability Adjusted Life Year)
in a defined population is
1 DALY is One year of healthy life lost
CFR ( Case Fatality Rate) represent Killing power of a disease
CFR is closely related to Virulence of organism
CFR is calculated by Total no. of deaths due to a disease/ Total no. of case due
to same disease X 100 %
CFR is a Proportion ( Always expressed in percentage)
CFR is complement of Survival rate ( 1- Survival rate)
Iceberg phenomenon is also known Biological Spectrum of a disease
as
Iceberg phenomenon of disease is Rabies, Tetanus, Measles, Rubella
not shown by
In Iceberg phenomenon, Floating Clinical case ( What physician sees in community)
Tips represent
In Iceberg phenomenon, vast Hidden mass of disease ( Latent, inapparent, pre-
submerged portion represents symptomatic and undiagnosed cases and carriers)
In Iceberg phenomenon, water Demarcation line between apparent and inapparent
surface represent infections.
Epidemiologist is concerned with Hidden portion of iceberg.
Clinician is concerned with Tip of iceberg
In Iceberg phenomenon, Screening Hidden portion of Iceberg.
is done for
Prepathogenesis phase of disease is Period before onset of disease in man at risk
In Prepathogenesis phase Primary level of prevention is possible
Epidemiological Triad is Interaction between agent, host and environment

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Pathogenesis phase of disease is Period after entry of organism in susceptible host

In pathogenesis phase of disease Secondary and Tertiary level of prevention are possible
Surveillance is Continuousscrunity of the factors that determine the
occurrence and distribution of disease and other condition
of ill-health.
Types of surveillance 3 ( Active, Passive and Sentinel surveillance)
Active surveillance is Health system seek out 'actively' the collection of data, i.e
goes out to community to collect data.
Passive surveillance is Data is itself reported to the health system
Sentinel surveillance is Monitoring of rate of occurrence of specific conditions to
assess the stabilty or change in health levels of a
populations.
Sentinel surveillance is used for Identifying missing cases and supplementing notified cases
Monitoring is Performance and analysis of routine measurments aimed
at detecting changes in environment or health status of a
population.
Disease control primarily refers to Primary and Secondary level of prevention
Sequences of disease control Disease control Disease Elimination Disease
Eradication
Disease control is Reducing the transmission of disease agent to such a low
level that it ceases to be a public health problem. It aims at
reducing Incidence of dsz, Duration of dsz, Effects of
infection, Financial burden to the community.
Disease Elimination is Complete interruption of transmission of disease in a
defined geographical area, but the causative agent may be
persisting in environment.
E.g. Nepla eliminate Trachoma on: 24 April, 2018 AD
Nepal eliminate Leprosy in National level on 19 Jan,
2010 AD.
Disease Eradication is " Complete exterimination of organism"
" Tearing out by roots" of disease
It exhibits " All or none phenomenon".
E.g. World has eradicated ONLY 1 disease till date : Small
pox on 8 May, 1980 AD.

Types of Level of prevention are 4 ( Primordial, Primary, Secondary and Tertiary)

Primordial prevention It is the prevention of the emergence or development of
risk factors in countries or population groups in which they
have not yet appeared.
Mode of intervention in primordial Individual Education and Mass education
prevention ( Objective is Minimize hazards to health)
Best level of prevention for Non- Primordial prevention
communicalbe disease is
Primary level of prevention It is the action taken prior to onset of disease, which
removes the possibility that a disease will ever occur .

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Mode of intrvention for primary Healthpromotion: E.g. Health education, Enviromental

prevention is modification, Life style and behaviour change, Nutritional
intervention.
Specific protection: E.g. Vaccine, Contraception.
Primary level of prevention re Risk factors are present but disease has not yet taken
applied when place.
Secondary level of prevention It halts the progress of disease at it's incipient stage and
prevents complication.
Mode of intervention Early diagnosis and Treatment
Secondary level of prevention are Disease has possibly set in.
applied when
Imperfect tool in control of Secondary prevention
transmission of disease
Tertiary level of prevention It is applied when disease has advanced beyond early
stage and it aims is to reduce or limit impairements and
disabilities, minimize suffering caused by existing
departures from good health.
Mode of intrvention in Tertiary Disabilty limitation and Rehabilitation
level of prevention Eg. Physiotherapy in poliomyelitis, Crutches in
poliomyelitis.
Tertiary level of prevention signifies Intervention in late pathogenesis phase.
Any abnormal condition of an organism that impairs
Disease is function. E.g. Accident leads to disease.
Impairmentis Any loss or abnormality of psychological, Physiological or
anatomical structure or function. E.g Loss of foot leads to
impairment.
Disabilty is Any restriction or inability to perform an activity in range
considered normal for a human being ( Because of
impairment ). E.g Unable to walk.
Handicap is A disadvantage for a given individual, resulting from an
impairment/ disabilty; that limits or prevents fulfillment of
a role considered normal. E.g Unemployed because he
cannot walkso cannot fulfill his role in the society.
Time distribution of disease Short term fluctuations, Long term fluctuation and
includes periodic fluctuation.
Short term fluctuations is also Epidemic
known as
Epidemics is Occurrence of disease ' Clearly in excess of normal
expectancy.
Epidemic is when No. of cases exceed twice the standared deviation ( [Link]
cases > Mean + 2 SD )
Types of Epidemics 3 ( Common source epidemics, Propagated epidemics,
Slow modern epidemics)
In Single exposure or ' point source All cases develop with in one incubation period
' epidemics ' Sharp rise and sharp fall ' in [Link] cases

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' Clustring of cases' in a narrow interval of time .

E.g Food poisoning, Measles, Chicken pox , Bhopal Gas
tragedy.
In common source epidemics ' Sharp rise ' in no. of [Link] in prostitution.
In propagated epidemics ' Gradual rise and gradual fall ' over a long time.
Result from ' Person to person transmission' . E.g HIV,
Tuberculoss
Periodic fluctuation includes SeasonalTrends: E.g. Measles in early springs, Upper
respiratory infection in winters, Gastrointestinal infections
in summer.
Cyclictrends: E.g Measles every 2-3 years, Rubella every 6-
9 years, Influenza pandemics every 10-15 Years.
Long term fluctuations / Secular Implies changes in occurrence of a disease ( progressive or
trends decrease) over a long term period of time, generally
several years or decades. E.g NCD are incresing in past few
decades.
Seasonal trends is due to Vectors variation, enviromental factors and change in herd
immumity.
Types of epidemiological study 2 ( Observational and Experimental studies)
Observational studies include Descriptive studies and Analytical studies
Descriptive epidemiology is used Hypothesis formulation
for
Analytical studies is used for Hypothesis testing
Analytical studies include Cohort study, Case control study, Cross sectional study and
Ecological study.
Experimental studies is used for Hypothesis confirmation
Eperimental study includes Randomized controlled trial, Field trip, Commumity trial,
Clinical trial
Unit of study of Cohort study, Case Individual
control study, Cross sectional study
Unit of study of Ecological study Population
Unit of Randomized control trial is Patients
Unito of Field trial is Healthy people
Unit of community trial is Community
Unit of clinical trial is Patients
Cohort study is also known as Prospective study, Forward looking study, Cause to effect
study, Risk factor to disease study, Exposure to outcome
study, Follow up study, Incidence study.
Case control study is also known as Retrospective study, Backward looking study, Effect to
cause study, Disease to risk factor study, Outcome to
exposure study, TROHOC study.
Cross sectional study is also known Prevalence study, SNAPSHOT of population study
as
Ecological study is also known as Correlation study
Rate Numerator is a part of denominator and multiplier is 1000,

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10,000 or 100000 and so on…. [( A/A+B) X 1000]

Ratio Numerator is not a part of denominator and both
numerator and denominator are unrelated ( A/B X
100000)
Proportion Numerator is a part of denominator and multiplier is 100.
Always expressed in % [A/A+B) X 100 ]
Infant Mortality rate ( IMR) is (No. of infants deaths/ [Link] live birth ) X 1000 . It is rate.
Maternal Mortality ratio ( MMR) ([Link] maternal deaths/ No. of live birth) X 100000. It is
ratio
Sex ration is (No. of females/ No. of males ) X 1000
Incidence is rate (No. of new case/ Total population at risk ) X 1000
Prevalence is Proportion ( No. of new + old cases / Total populatio) X 100
Case Fatality rate ( CFR) is ( [Link] death/ No. of cases) X 100 . It is proportion.
Relative Risk is Incidence among exposed / Incidence among non-exposed
. It is ratio.
Crude Birth rate ( CBR) is (No. of birts in an area in a year / Total mid-year populatio)
X 1000
Crude Death rate ( CDR) is (No. of death in an area in a year / Total mid-year
population) X 1000
Simplest measures of estimating Proportional Mortality Rate ( PMR)
the burden of a disease
Standarized Mortality Ratio ( SMR) (Observed deaths / Expected deaths ) X 100
Incidence can be determined from Cohort study
Prevalence can be determined from Cross sectional study
Best measures of disease frequency Incidence
in etiological study is
Incidence includes Attack rate, Secondary attack rate
Types of prevalence Point prevalence, Period prevalence
Prevalence Incidence X Mean duration of disease ( P= I X D)
Endemic is Constant presence of a disease or infectious agent in a
defined geographical area ( It is usual or expected
frequencyof a disease in a population ).
Types of Endemic 2 ( Hyper-endemic and Holo-endemic)
Hyper-endemic is Constant presence of disease or infectious agent at high
incidence/ prevalence and affects all age groups equally.
Holo-endemic is A high level of infection beginning early life and affecting
most of the children population.
Pandemic is An epidemic usually affecting a large proportion of the
population, occuring over a large geographical area such
as part of a nation, nation, continent or world.
Sporadic is Cases which are ' Scattered about'
Irregular and Haphazardly occurrence o disease.
Strength of associatiom of Cohort Relative risk, Attributable risk, Population attributable risk
study is
Strength of association of case Odds ratio.

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control study is
Least preferable observational/ Ecological study/ correlational study
analytical study design
Randomization is also known as Heart of a trial
Infectivity is Number of infected / Number of exposed.
Pathogenecity is Number of disease / Number of infected.
Virulence is Number of serious condition/ Number of diseased.
Case fatality is Number of death/ Number of cases
Communicabilty is Ability of a disease to spread from infective to susceptible
hosts.
Zoonoses is An infection or infectious disease transmissible under
natural conditions from vertebrate animals to man.
Tyes of zoonoses 3 ( Anthropozoonoses, Zooanthroponoses, Amplixenosis)
Anthropozoonoses is Infections transmitted from animals ( zoo) to man
( anthro) E.g Rabies, Plague, Anthrax, Hydatid disease,
Trichinosia
Zooanthroponoses/ Reverse Infection transmitted from man (anthro) to animals (zoo).
zoonoses E.g Human TB in cattle.
Amplixenoses Infection transmitted in either direction between animals
and man. E.g. Trypanosomacruzi
Epizootic is Outbreak of disease in animals population. E.g Anthrax,
Brucellosis, Imfluenza, Rabies, JE, Q- fever.
Enzootic is Endemic of disease in occuring in animals. E.g Anthrax,
Rabies, Bovine TB.
Epornithic is Outbreak of a disease in bird population.
Serial Interval is The gap in onset between primary case and secondary
case.
Incubation period is The time interval between invasion by and infectious
agent and apperance of the first sign or symptoms of the
disease.
Median Incubation period is Time required for 50% of cases to occur.
Generation Time Time taken for a person from receipt of infection to
develop maximum infectivity.
Latent period is The period fror disease initiation to disease detection,
used in non-infectious disease as equivalent to incubation
period.
Period of communicability is The time during which an infectious agent may be
transferred directly/ Indirecty from an infected person to
another person, from infected animal to man or from an
infected person to animals including arthropods.
Incubation period depends upon Generation time of the pathogen, Infective dose, Portal of
entry, Individual susceptibilty.
Sources is A person, animal, objects or substances from which an
infevtious agent passes or is disseminated to the host.
Reservoir is Any person, animal, arthropods,, plant, soils or substance

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in which an infectious agent lives and mutiplies as well as

survive.
Types of reservoir 3 Types ( Human, Animal, Non-living things)
Human reservoir are of 2 types ( Cases amd Carrier)
Cases are Person having particular disease, Health disorder or
condition under investigation.
Carriers are Infected person or animals that harbours a specific agent
in the absence of discernible clinical disease, and serves as
a potential source of infection for others.
Sources for Hook worm is Soil
Reservoir for Hook worm is Man
Source and Reservoir for Tetanus Soil
Source for Typhoid Faeces/ Urine/ Food / Milk/ Water
Reservoir for Typhoid Cases and carrier
Types of cases 3 Types ( Primary case, Secondary case and Imdex case)
Primary cases First case of communicable disease introduced into the
population unit being studied.
Secondary case Cases that develop from contact with the primary case.
Index case First Case that comes to the notice of the Investigators/
First case reported to the Health system.
Types of carrier 3 ( Incubatory carriers, Convalscencecartier, Healthy
Carrier)
Incubatory carriers Shed infectious agent during incubation period of disease.
E.g. Measles, Mumps, Polio, Pertusis, Influenza, Diptheria,
Hepatitis B
Convalscence carrier Shed the disease agent during the period of convalscence.
E.g Typhoid, Bacillary dysentry, Amoebic dysentry,
Cholera, Ditheria and pertusis.
Healthy carrier Emerge from subclinical cases without suffering from overt
disease. E.g Poliomyelitis, Cholera, Meningococcal
meningitis, Diptheria, Salmoellosis
Steps for Investigation of an 10 Steps
Epidemics
First step in investigation of an Verification of diagnosis
epidemic
An area is declearedfree of No case is reported in " Twice the incubation period of the
epidemics when disease since the occurrence of last case".
Disease is Apperarance of clinical manifestation or symptoms.
Illness is Personal feeling of dysfunction
Sickness is Social dysfunction
Exotic disease is Disease which are imported into a country from outside.
Infection is Multiplication and entry of micro-organsism inside the
host body.
Infestation is Lodgement, developmentand reproduction of arthropods
on the surface of the body or in the clothings.E.g Itchy

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mite causing scabies.

Contamination is Presence of an infectious in the body surface or other
inanimate articles or substances.
Pollution is Presence of an offensive but not necessarily infectious
matter in the environment.
Most commnly seen problem in Anthropozoonosis
rural areas
Umberella Health/ One Health Related to prevention of zoonotic disease.
strategy is
Universally accepted indicators of Infant Mortality Rate
health status and socio-economuc
development in whole population
is
Most sensitive indicators of Health Infant Mortality Rate
is
Antigen is External protein having capacity to stimulate immune
system also called Immunogens.
Hepten is Low molecular protein which do not have caoacity to
stimulate immune system.
Antibody is Internal protein having capacity to kill or phagocytose the
antigen.
Resistance The degree of immunity that tbe body posses, a measure
of it’s ability to stand with disease.
Oppotunistic infection ( IOS) Infection by an organism that is not normall pathogenic
but can cause disease if resistance is lower. E.g TB
infevtion in HIV/AIDS.
Noscomial infection is Hospital acquired infection are called Noscomial infection.
E.g Infection with I 24-48 hours of hospital administration .
Most common route of Noscomial Respiratory route.
infection is
Iatrogenic infection is Health worker or physician induced infection.
Best approach to prevent Iatrogenic Hand washing ( Prevent 80 % of infection)
infection is
Screening is Identification of disease individual by the application of
certain test in an apparently healthy people or population.
It is done for early detection of disease.
E.g. ELISA in HIV/AIDs
Tyoes of screening is 3 Types ( Individual, Mass and Multstage screening)
Senisitivity indicates True positive
Specificity indicates True negative
Quarantine is Restriction of movements of human or animal population,
those who are suspected case to disease upto maximum
period of incubation. E.g In case COVID-19, suspected case
are kept in quarentine for 14 days.
Quarantine is also known as Active surveillance

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Quarentine is done to prevent Exotic disease

Isolation is Separation off disease individual or patient from other
hostupto maximum period of communicability.
Applicable for Communicable disease that can be
transmitted between Man-Man
Interferons are Protein inhibitng viral replication
Carrier have High infevtivity but low pathogenicity
Herd immunity is Provide group protection from immunization from a
particular disease
Man is secondary/ Intermediate Malaria, Hydatid disease
host for
Human is dead end host for Tetanus and Rabies
Most common Neonatal disorder to Neonatal hypothyrodism.
be screened is

 Facts on AntitubercualrDrugs .

Most effective Anti-tubercualr drugs is Rifampicin

Most bactericidal anti-tubercular drugs is Rifampicin
Most toxic anti-tubercular drugs is Isoniazid
Antitubercular drugs causing rapid sputum conversion Isoniazid
Antitubercular drugs causing orange discoloration of Rifampicin
urine
Antitubercular drugs first to develop resistance Isoniazid
Antitubercular drugs contraindicated in AIDs patient on Rifampicin
protease inhibitors
Antitubercular drugs contraindicated in HIV patient Thiacetazone
Antitubercular drugs contained in all phase of all RifampicinandIsoniazid
categories of DOTS
Injectable Antitubercular drugs Streptomycin
Antitubercular drugs contraindicated in pregnancy Streptomycin
Antitubercular drugs contraindicated in children < 6 Ethambutol
Years age
Antitubercular drugs causing Optic neuritis ( Red-Green Ethambutol
color blindess)
Antitubercular drugs causing Vestibular damage Streptomycin
Antitubercular drugs recently omitted from DOTS in Streptomycin ( Now not in use)
Nepal

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 Facts for Health Loksewa.

Facts on Health Loksewa

Treatment of small hydrocele is Lord's procedure ( Plication of sac)
Treatmemt of medium hydrocele is Jaboulay's procedure ( Eversion of sac)
Treatment of large hydrocele is Excision of sac
Growth chart was first designed by David morley ( Later modified by WHO)
Growth chart is the Passport to child's health care.
Growth chart is also known as Road to Health chart
Gibbon's hernia is Hernia with hydrocele
Hypospadias is A congenital condition in males in which the opening
of the urethra is on the under side of the penis
Maximum life span of a transfused 50 days
RBCs is
RBCs are stored at 1-6 ° C
Mean life of transfused RBC is 35 days
Platelets are only one blood products 20-24 ° C for 5 days
which are stored at room temperature
1 Unit of platelets increase the platelet 5000-10000
count in blod by
Blood can be strored for 35 days ( if anti-coagulat CPDA-1 is used)
Most common blood transfusion Febrile non-hemolytic transfusion reaction
reaction is
Lead poisoning is also known as Plumbism / Saturnism / Painter's colic
Screening test for lead poisoning is Coproprophrinin urine ( CPU)
Earliest and most consistent sign of Facial pallor
lead poisoning is
Types of anemia in lead poisoning is Microcytic hypochromic
Burtonian line is Lead sulphide line on gums ( Upper Jaw)
Clinical symptoms of plumbism occurs >70 mcg/dl
when blood lead level is
Most suitable food immediately after Clostrum
birth of baby
Clostrum milks comes for 3-6 days after birth
Clostrum milk contains All five immunoglobulin ( Ig A, Ig D, IgE, Ig G, Ig M)
Clostrum milk is high in Carbohydrate, Protein and Antibodies
Clostrum milk is poor in Fat
Coal worker lungs is known as Black lungs
Silicosis is also known as Grinder's disease
Pneumoconioses occur due to Especially of the size 0.5-3.0 micron diaeter.
occupational exposure to dust
Most dangerous particle size for 0.5-3.0 micron diameter
pneumoconioses( Occuational dsz)

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First disease of Man with Known cause Scabies

Drug of choice for Scabies 5 % Permethrine
Systemic drug of choice for Scabies Ivermectin ( Single dose)
Most desirable temperature range for 5-10 ° C (40-50 ° F)
drinking watet
Level of residual chlorine to be >0.5 mg/L ( > 0.5 ppm) for a contact period of 1 hour
maintained in drinking watet
Level of residual chlorine to be >0.7 mg/L (> 0.7 ppm)
maintained in all water bodies in post
disaster phase
Level of residual chlorine to be >1 mg/L (> 1 ppm)
maintained for swimming pool
WHO recommended strategy for ' Catch up-Keep up-Follow up' strategy
Measles elimination is
WHO recommended strategy for polio ' Pulse strategy'
eradication is
WHO recommended strategy for SAFE strategy
Trachoma Elimination is
" GET 2020 " is related to Global elimination of blinding Trachoma by the year
2020.
Most common age group for Trachoma 2-5 Years
Chemical used in Long lasting Synthetic pyretheroids ( Especially Deltamethrine
insecticide treated bed nets ( LLINs) 2.5%)
Life span of LLINs 3 Years and for 20 washes.
No. of holes per square inch of LLINs >150 ( Diameter of each hole is < 0.0475 inch
Blindness is ( WHO) Visual acquity<3/60 in better eye with best possible
correction.
Legal blindness is Visual acquity< 6/60 or Visual field < 20 ° in better eye
with best possible correction.
Work vision / Economics blindness is < 6/60
visual acquity
Walk vision/ Social blindness Visual acquity<3/60
Low vision is Visual acquity< 6/18-6/60.
Normal vision is visual acquity 6/6
"Vision 2020-The right To Sight " A global initiative by WHO and International NGOs to
reduce avoidable ( preventable and curable) blindness
by 2020.
Clofazimine used in MDT is Bacteristatic drugs
About ? percentage of blindness is 80%
avoidable

 Facts on Communicable Disease.

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Epidemiological Reason for Small pox No known animal reservoir, No long term carrier,
eradication Infection provides life long immunity, Subclinical case
did not transmit, A highly effective vaccine was
available, Case detection simple due to characteristics
rash.
Leading killer disease in NIP Measles
Measles is also known as Rubeolla, दादुरा, 4th day rash disease, 3 C disease, 1st
disease, Winter disease.
Causative agent of Measles is RNA paramyxo virus
Most common age group for Measles 6 months – 3 years
Incubation period of Measles is 10-14 days
Source of infection of Measles is Cases
Carrier in Measles are Absent
Mode of transmission in Measles is Droplet infection
Period of communicabilty in Measles is 4 days before and 5 days after the appearance of rash
Rash in Measles are Retro-auricular origin ( First appears behind Ears)
Stages present in Measles 3 Stages ( Pro-dermal, Eruptive and Post measles stage)
Measles are highly infectious during Pro-dermal and eruptive stage
Secondary Attack rate of Measles is >80 %
Measles shows a Cyclical trend ( Increase every 2-3 years)
Pathognomic clinical features of Koplik spots ( Buccal mucosa opposite to upper 2 nd
Measles is molar) – Appears in prodermal stage .
Pathognomic microscopic features of Warthin Finkledy cells ( Multinucleated gaint cells)
Measles is
Most common complication of Measles Diarrhoea
is
Most common complication of Measles Otitis media
in young children is
Death causing complication of Measles Pneumonia ( common in adult)
is
Rare complication of Measles is SSPE ( SubacuteSclerosing Pan Encephalitis) develop
after 7-10 years after Measles infection.
SSPE ( SubacuteSclerosing Pan Dawson's disease / Dawson's Encephalitis
Encephalitis) is also known as
Epidemic of Measles occur if proportion >40 %
of susceptible children is
If Measles is introduced in a virgin >90% children
community it infects
Eradication of Measles required Vaccination coverage > 96 %
Isolation period of Measles is 10 days
Baby Measles ( Exanthem subitum- Sixth disease/ 3 day fever
roseolainfantum) is also known as
German Measles is Rubella
Measles is best prevented by Active immunization by Measles vaccine
Most common Vaccine strain used for Edmonstonzagreb strain

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Measles is
WHO recommended strategy for ' Catch up-Keep up- Follow up' strategy
Measles Elimination is
Chicken pox is also known as Varicella, 1st day rash disease,ठेउला, Dew drop rash
disease
Chicken pox is caused by Varicella zoster virus [ Human (alpha) Herpes virus-3].It
is DNA Virus.
Incubation period of Chicken pox is 10-21 days (14-16 days)
Most common age group for chicken < 10 Years
pox
Source of infection of Chicken pox is Case ( Person-to-Person contact)
Mode of Transmisson of Chicken pox is Droplet infection
Period of Communicability of Chicken 1-2 days before to 4-5 days after appearance of rash
pox is
Isolation in Chicken pox is done for 6 days
Secondary Attack rate of Chicken pox is 90 %
Rash in Chicken pox is Pleomorphic and Dew drop on rose petal appearance
Distribution of rash in Chicken pox is Centripetal distribution
Distribution of rash in Small pox is Centrifugal distribution
Case Fatality Rate of Chicken pox is <1%
Stages in Chicken pox is 2 Stages ( Pre-eruptive and Eruptive stages)
In Chicken pox scabs form after 4-7 days
Most common complication of Chicken Varicella hemorrhage
pox is
Death Causing complication of Chicken Pneumonia
pox is
Most common late complication of Shingles ( Caused by reactivation of the virus decades
Chicken pox is after the initial episodes of chicken pox)
Most rapid and sensitive means of Examination of vesicle fluid under electron microscope
diagnosis of Chicken pox is (Shows round particles).
Treatment of Chicken pox No specific treatment. Supportive treatment is done by
Acyclovir.
Congenital Varicella is most dangerous 1st Trimester of pregnancy ( May cause abortion and
if transmitted in congenital anamolies).
Vaccine Strain used for Chicken pox is OKA strain.
Aspirin must not be given in Chicken Reye's syndrome
pox because it may cause
Mumps is caused by Myxovirus parotiditis( RNA paramyxovirus)
Mumps is also known as Hande/ Gulfulo
Incubation period for Mumps is 14-21 days
Source of infection of Mumps is Clinical and Subclinical cases
Mode of Transmission of Mumps is Droplet infection
Period of communicability of Mumps is 4-6 days before to 7 days after onset of symptoms
Isolation in Mumps is done for Till swelling get subside
Secondary Attack Rate of Mumps is 86 %

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Most common age group for Mumps is 5-9 Years child

Most common symptom of Mumps is Earache
Most common complication of Mumps Aseptic Meningitis ( In Children especially)
is
Most common complication of Mumps Orchitis and Oopheritis
in adolescents is
Swelling in Mumps subside in 1-3 weeks
Epidemics of Mumps occur every 2-5 Years
Rubella is also known as German Measles / Third disease
Rubella is caused by Togavirus ( RNA virus)
Incubation period of Rubella is 14-21 days ( ~18 days)
Source of infection of Rubella is Cases or subclinical cases
Mode of Transmission of Rubella is Droplet infection
Period of communicabilty of Rubella is One week prior to onset of symptoms to one week
after rash appears
Most widely used test for diagnosis of Heme-agglutination test (HAI)
Rubella is
Most dangerous time of Rubella First trimester of pregnancy
infection is
If Rubella infection occur in 1st Congenital Rubella Syndrome ( CRS)
trimester of pregnancy, it may lead to
Congenital Rubella Syndrome includes Congenital deafness, Congenital Cataract, Patent
Ductus Arteriosus as congenital heart defect.
Skin Lesions seen in CRS is Blueberry muffin lesions
CRS is said to have occurred if Infants has IgM rubella antibodies shortly after birth, Or
Ig G antibodies persists for more than 6 months.
Vaccine strain used for Rubella is RA 27/3
Influenza is also known as Flu
Influenza is caused by Orthomyxovirus ( 3 types A, B, C.)
Most common cause of outbreak/ Type A
Epidemics of Influenza is
Only cause of pandemics of Influenza is Type A
Cause o f Swine flu is H1N1 ( Type A)
Cause of Birdflu/ Avian Influenza is H5N1 ( Type A)
Influenza shows Cyclical trends
Type A Influenza epidemics occurs Every 2-3 years
Type B Influenza epidemics occurs Every 4-7 years
Type A Influenza pandemics occurs Every 10-15 years
Most commonly Antigenic variation Type A
occuring Influenza is
Antigenic shift and Antigenic drift Influenza
occurs in
Incubation period of Influenza is 18-72 hours
Period of infectivity of Influenza is 1-2 days before to 1-2 days after onset of symptoms
Caustaive agent of Bird Flu/ Avian H5N1

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Influenza is
Drug of choice for Bird flu is Oseltamivir
Oseltamivir is contraindicated in Infants
Influenza pandemic/ Swine flu is H1N1 ( Type A)
caused by
WHO declaration of Influenza 11 June 2009
pandemic on
Most timely and sensitive test for RT-PCR test
Swine flu/ Influenza pandemic is
Isolation in Swine flu is done for 7 days after onset of illness oR 24 hours after resolution
of fever/ respiratory symptoms.
Drug of choice for Influenza is Oseltamivir
Most common complication of Sinusitis and Otitis Media
influenza is
Death Causing complication of Pneumonia
Influenza is
Severe/ Rare complication of Influenza Reye's syndrome
is
Diptheria is also known as Bull Neck disease, भ्यागुते रोग
Diptheria is caused by Corynebacterium diptheriae ( Gram +ve , non motile
bacteria)
Source of infection of Diptheria is Case or carrier ( Carrier are more important source)
Most common age group for Diptheria 1-5 Years child
is
Most dangerous carrier in Diptheria is Nasal carrier
Incubation period of Diptheria is 2-6 days
Mode of transmisson of Diptheria is Droplet infection ( Main), Directly from Cutaneous
lesions and Fomites
Period of Infectivity of Diptheria is 14-28 days from onset of disease, longet for carriers.
Case Fatality Rate of Diptheria is 5-10 %
In Diptheria case/Carrier may be At least 2 cultures from Nose and Throat, 24 hours
considered non-commumicable when apart are Negative.
Toxin secreted by Corynebacterium Exotoxin
diptheriae is
Most common symptoms of Diptheria Bull neck due to cervical lymph node enlargement.
is
Main symptoms of Diptheria is Pseudomembrane/False membrane
Severe symptoms of Diptheria is Hoarseness of voice
Diptheria is diagnosed by Shick test, but now replaced by Hemagglutination Test.
Most common complication of Peripheral neuropathy (2nd Myocarditis)
Diptheria is
Most serious complication of Diptheria Bronchopneumonia
is
Drug of choice for Diptheria is Diptheria anti-toxin (For carrier: Erythromycin)
Chemoprophylaxis of Diptheria is done Erythromycin/ Penicillin

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by
Pertusis is also known as Whooping cough / 100 day cough / लहरेखोकी
Pertusis is caused by Bordetella pertusis and B. parapertusis
Incubation period of pertusis is 7-14 days
Source of infection of Pertusis is Case
In Diptheria, Subclinical or chronic Absent
carrier state are
Secondary Attack rate of Pertusis is >90 % ( Highest SAR)
Most common age group for Pertusis is < 5 Years child
Incidence and Fatality in Diptheria Female > Male
Bordetella pertusis bacteria secrets Exotoxin + Endotoxin
Stages in Pertusis are 3 Stages ( Catarrhal, Proximal, Convalescent)
Drug of choice for Pertusis is Erythromycin
Most common complication of Pertusis Bronchitis
is
Most serious or death causing Bronchopneumonia
complication of Pertusis is
Choice of chemoprophylaxis for Erythromycin / Azithromycin
Pertusis is
Poliomyelitisiscausedby Polio virus ( Serotypes 1,2 and 3)
Most common cause of epidemics of P1 serotype
poliomyelitis is
Most antigenic and Most easily P2 serotype
eradicable poliomyelitis is
Most common cause of VAPP ( Vaccine P3 serotype ( Chance is 1 per 1 million)
associated paralytic poliomyelitis) is
Most common age group for 6 months-3 Years child
Poliomyelitis is
Only one Reservoir of poliomyelitis Man
Most common clinical occurrence of Subclinical cases
poliomyelitis is
Infectious material for poliomyelitis is Faeces and oro-pharyngeal secretion
Period of communicabilty of 7-10 days before and after onset of symptoms
poliomyelitis is
Incubation period of poliomyelitis is 3-35 days ( Usually 7-14 days)
Tripod sign is present in Poliomyelitis
Recommended method for laboratory Isolation of wild poliovirus from stool
confirmation of paralytic poliomyelitis
is
Poliomyelitis affects Anterior horn of spinal cord
Differential diagnosis of poliomyelitis is Polio, Gulle Barre syndrome, Traumatic neuritis,
Transverse myelitis
Poliomyelitis is best prevented by Active Immunization with Salk and Sabin
3 Endemic countries for Poliomyelitis is Afghanistan, Pakistan, Nigeria
Incidence of poliomyelitis is high in Male (M:F=3:1)

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Hepatitis A is also known as Epidemic jaundic, Traveller's hepatitis, Infectious

hepatitis
Hepatitis A is caused by Enterovirus 72 ( Picorna virus)
Incubation period of hepatitis A is 15-45 days
Mode of transmisson of Hepatitis A is Faeco-oral ( Most common), Parenteral, Sexual
Period of infectivity of Hepatitis A is 2 weeks before to 1 week after onset of jaundice
Reservoir of Hepatitis A is Human cases
Hepatitis B is also known as Serum hepatitis, Bloomberg disease
Causative agent of Hepatitis B is Hepadna virus ( DNA Virus)
Incubation period of Hepatitis B is 45-180 days ( 6 weeks-6 months)
Mode of Transmission of Hepatitis B is Blood borne, Sexual, Parenteral, Perinatal
Reservoir for Hepatitis B is Man as case and carrier
Markers of Hepatitis B infections are HBsAg, HBcAg, HBeAg, Anti-HBc, Anti-HBe, Anti-HBs
Hepatitis B surface antigen ( HBsAg) is Australia antigen
also known as
Hepatitis B surface antigen is First First evidence of infection
antigen to appear in serum also known
as
Epidemiological marker of Hepatitis B HBsAg
infection is
Hepatitis B envelope antigen ( HBeAg) Active viral replication
indicate
HBeAg is a Marker of infectivity
In Hepatitia B, First antibody to appear Anti-HBc ( Antibody to Hepatitis B core antigen)
in serum is
Antibody to Hepatitis e antigen (Anti- End of period of infectivity
HBe) indicates
Anti-HBs ( Antibody to Hepatitis B Recovery period or End of period of communicabilty
surface antigen) indicates
Hepatitis C is also known as Silent killer Hepatitis / Post Transfusion hepatitis
Hepatitis C is caused by Hepaci virus (Flavi virus)
Incubation period of Hepatitis C is 30-120 days ( 15-160 days)
Mode of Transmission of Hepatitis C is Sexual, Perenteral, Percutaneous
Hepatit D is caused by Viriodslike
Incubation period of Hepatitis D 30-180 days
Hepatits E is caused by Calci virus
Incubation period of Hepatitis E is 15-60 days
Mode of Transmission of Hepatitis E is Faeco-oral route
Most dangerous Hepatitis for pregnant Hepatitis E
and child is
Liver Cirrhosis is common in Hepatitis B ( 2nd Hepatitis C)
Liver Cancer is common in Hepatitis C ( 2nd Hepatitis B)
Diagnostic test for Hepatitis C is RIBA ( RecombinentImmunosorbant Assay)
Vaccine and Immunogloubulin are Hepatitis A and Hepatitis B
present for

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Chances of Transmission of Hepatitis B 50 times more than Normal people

in Surgeon is
Cholera is also known as Father of public health, Blue death, Notifiable disease,
Washerman's disease, हैजा
Cholera is an acute diarrhoeal disease Vibrio cholerae ( Gram -ve bacteria)
caused by
Vibrio cholerae produces Entero-toxin
Incubation period of Cholera is 1-2 days ( Few hour- 5 days)
Reservoir for Cholera is Man only
Case Fatality Rate of cholera is 30-40 % in untreated case
Cholera is dose dependent disease, 1011
required dose of micro-organismis
Stages in cholera is 3 Stages ( Stage of Evacuation, Collapse, Recovery)
Most commom symptoms of cholera is Diarrhoea
Pathognomic features of Cholera is Rice watery diarrhoea
Death in Cholera occcur due to Renal failure
Best method for collection of stool of Rubber Cathter
Cholera is
In Cholera chronic carrier are reside in Gall bladder
Common and Epidemic causing strain Cholera 01
of V. Cholera is
Newly identified species of V. Cholerae Cholera 0139
Cholera is a Notifiable disease locally, Nationally, Internationally
Under International Health regulation, 24 Hours ( Number of cases and Death to be reported
Cholera is notifiable to WHO by daily and weekly)
National government with in
An area is decleared free of Cholera Twice the Incubation period has elapsed since last case
when
Essential for treatment of cholera is Water and Electrolyte replacement
Choice of Fluid for Rehydration therapy Ringer Lectate
for Cholera is
Most prophylatic measures for Cholera Health Education
prevention is
Drug of choice for Cholera for Adults Doxycycline
Drug of choice for Cholera for Children Azithromycin
Drug of choice for Cholera for Pregnant Azithromycin
Chemoprophylaxis of choice for Cholera Tetracycline
is
Typhoid is also known as Enteric fever, Step ladder fever, Ice Cream disease
Enteric fever includes both Typhoid and Paratyphoid fever
Most common age group for Typhoid is 5-19 Years
Reservoir for Typhoid is Man ( As case and Carrier)
In Typhoid Chronic carrier, Convalscent carrier, Incubatory carrier
are seen
In Typhoid, Convalscent excrete bacilli 6-8 weeks

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for
In Typhoid, Chronic carrier excrete >1 Years after clinical attack
bacilli for
Incubation period of Typhoid is 10-14 days
Mode of Transmission of Typhoid is Faeces, Urine of case and carrier are primary source
while Water, Food, Fingers and Flies are Secondary.
In Typhoid, Step ladder fever and Pea 1st week
soup diarrhoea is seen in
Rose spot in Typhoid is seen in 2Nd week
Intestinal Perforation in Typhoid is seen 3rd week
in
Main stay of diagnosis / Choice of Blood culture ( Done in 1st week)
diagnosis for Typhoid is
Widely used test for Typhoid is Widal test / Antibodies test ( 2nd week)
Stool culture is done in Typhoid in 3rd week
Urine test is done in Typhoid in 4th week
Drug of choice for Typhoid in case Cephalosporins ( Ceftriaxone) or Quinolones
( Ciprofloxacin)
Drug of choice for Typhoid in carrier Ampicillin/ Amoxycillin + Probenecid
Golden drug of choice for Typhoid is Chloramphenicol
BASU is related to Diagnosis of Typhoid
Neonatal Tetanus is also known as 8th day disease
Tetanus is caused by Clostridium tetani ( Gram +ve, anaerobic, drumstick
appearance bacteria)
Mode of Transmisson of Tetanus is Contamination of wound with spores
Source and Reservoir of Tatanus is Soil and dust
Incubation period of Tetanus is 6-10 days ( 1 day-several Months)
Most common age group for Tetanus is 5-40 Years
Period of communicabilty of Tetanus is None ( No person to person transmission)
Case Fatality Rate of Tetanus is 80-90 %
Most Lethal Toxin is Botulinum toxin produces by Clostridium botulism
Second most lethal toxin is Tetanus toxin
Lethal dose of Tetanus toxin for a 70 kg 0.1 mg
man is
Tetanus affects Anterior Horn of spinal cord
Types of Tetanus is 5 Types ( Traumatic, Peurperal, Otogenic, Idiopathic,
Tetanus neonatrum)
First sign of Tetanus is Trismus/ Lock jaw
Specific sign of Tetanus is Ophisthotonus ( Bow shape back)
False smile seen in Tetanus is Rhisussardonicus
Drug of choice for Tetanus is Metronidazole ( Old: Benzathine penicillin)
Tetanus is best prevente by Active Immunization with Tetanus Toxoid
Herd Immunity in Tetanus Does not protect
Neonatal Tetanus Elimination is Incidence rate < 0.1 /1000 live birth.
Tuberculosis is also known as Koch's disease, Koch's phenomenon, Social Barometer

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Most common age group for 15-45 Years

Tuberculosis is
Types of Tuberculosis is 2 ( Pulmonary-80% & Extra-pulmonary-20%)
TB of pleura is known as TB pleurisy
TB of Gland/Lymphnode is known as Scrofuld/ Kings evil
TB of Intestine is known as Bovine TB
TB of skin is known as Lupus velgaris
TB of spine is known as Pott's disease
TB of Blood is known as Miliary TB
Most common Extra pulmonary TB in Lymph/Gland TB
Nepal is
Most common Extra pulmonary TB in Abdominal TB
World is
Suspect case of TB is Productive cough > 2 weeks with or without
Hemoptysis
Method of choice as a case finding tool Sputum smear examination (Z-N staining) by direct
for Tuberculosis is microscopy
Number of Sputum smear sample 2 ( 1st Sample : on the spot & 2nd Sample: 2 hours apart
examined during Z-N staining is of 1st sample) – Single sample positive indicates TB
positive .
Best way of Estimating the prevalence Tubercullin test/ Mantoux test
of infection in a population is
In Montoux / Tubercullin test 0.1 ml of PPD ( Purified protein derivatives)) is injected
Intradermally on forearm
Reading of Mantoux test should be Result read after 72 hours ( 3 days)
done after
Mantoux test is positive if induration is >9 mm ( Indicates past or current infection with TB)
Montoux test is negative if induration is < 6 mm
Montoux test is doubtful if induration is 6-9 mm
Elimination level of TB ( WHO and STOP <1 case / million population
TB strategy) is
Every TB Sputum positive patient can 10-15 Individual in a year
infect up to
TB (AFB) was discovered by Robert koch
TB bacilli are Alcohol and Acid fast
Generation time of TB bacilli is 20 hours
TB bacteria remain alive In Sputum for 1 days and In droplet nuclei for 10 days
World TB day is 24th March
TB was decleared as " Global 1983 AD
emergency " by WHO in
Most common Opportunistic infection TB
in HIV in Nepal is
New TB regimen by WHO -2019, has 2 Category ( New TB &Retretment case)
In New TB – ALL form of TB ( Adult + 2 HRZE + 4 HR ( Total 6 months) is given
Child , PBC or PCD, Extrapulmonary)

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In New TB- Severe form ( CNS TB, TB 2 HRZE + 7-10 HR is given

pericarditis, Musculoskeletal TB,
Miliary TB)
In Retreatment case – If Rifampicin 2 HRZE + 4 HR is given
senitive and Isoniazid Sensitive
In Retreatment case- If Rifampicin 6 (H)RZE + Livofloxacin (250 mg)
Sensitive but Isoniazide Resistance
In Retreatment case- If Rifampicin 6 HRZE
Sensitive but Isoniazid Unknown
In Retreatment case-If Rifampicin 6 HRZE
Sensitive but Isoniazid Resistance +
Fluroquinolone resistance
MDR-TB should be Refer to National DR-TB Management
MDR-TB ( Multidrug Resistant TB) is Resistance to Isoniazid and Rifampicin with or with out
reistance to other drugs
XDR-TB ( Extensive Drug Resistant TB) is Resistance to Rifampicin amd Isoniazid AND to any
member of the quinolone family AND to one of the
injectable second line drugs ( Kanamycin, Caperomycin
or Amikacin)
Dose of Isoniazid is ( H) 5 mg/kg
Dose of Rifampicin (R) 10 mg/kg
Dose of Pyrizinamide (Z) 25 mg/kg
Dose of Ethambuto (E) 15 mg/kg
Dose of Streptomycin (S) 15 mg/kg
Most effective Anti-tubercular drugs is Rifampicin
Most bactericidal Anti-tubercular drug Rifampicin
is
Most Toxic Anti-tubercular drugs is Isoniazid
Anti-tubercular drugs causing rapid Isoniazid
conversion is
Anti-tubercular drugs causing orange Rifampicin
discolouration of urine is
Anti-tubercular drugs first to develop Isoniazid
resistance is
Anti-tubercular drugs contraindicated Rifampicin
in AIDS patients on protease inhibitor
Anti-tubercular drugs contraindicated Thiacetazone ( Cause Exfoliativedermatitis)
in HIV
Anti-tubercular drugs contained in all Rifampicin and Isoniazid
phase of all cateogories is of DOTS is
Injectable Anti-tubercular drugs is Streptomycin
Anti-tubercular drugs contraindicated Streptomycin
in pregnancy is
Anti-tubercular drugs contraindicated Ethambutol
in children < 6 years age

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Anti-tubercular drugs causing Optic Ethambutol

neuritis ( Red-Green color blindness)
Anti-tubercular drugs causing Streptomycin
Vestibular damage is
First line Bacteriostatic Anti-tubercular Ethambutol
drugs is
Recently omitted
Leprosy is also known as Hansen's disease/ Social disease/ Oldest disease known
to man kind
Leprosy is caused by Mycobacterium leprae
Leprosy mainly affects Peripheral nerves
Most commonly affected nerve in Ulnar nerve
Leprosy is
Leprosy is disease of High infectivity but low pathogenicity
Incubation period of Leprosy is Few weeks- 25 Years ( 3-5 Years)
Most common age group for Leprosy is 10-20 Years
Mode of transmission of leprosy is Most common is droplet infection ( Others: Direct or
indirect contact, Breast milk from lepromatous mother,
Transplacental, Insects vectors, Tattooing needles )
Types of Leprosy a/c to WHO 2 ( Paucibacillary&Multibacillary)
Paucibacillary leprosy is having Skin lesion 1-5
Multibacillary leprosy is having Skin lesion > 5
Paucibacillary leprosy are Tuberculoid
Multibacillary leprosy are Lapromatous
Pure neuritic type leprosy is (a/c to Leprosy having No skin leison
Indian classification)
Cardinal Features of Leprosy are 4 ( Hypopigmentedleison, Partial or total anesthetic
pathches, Thickened nerve, Smear Positive )
Early manifestation of Leprosy is Macular leison
Best method of diagnosis of Leprosy is Slit and Scrape method
Lepromine test is done in Leprosy
Lepromine test is based on Cell mediated Immunity ( CMI)
Leprosy exhibit both Cell Mediated and Humoral Immunity
Reading of Lepromine test should be After 48 hours and After 21 days
done
Lepromine test is positive if Redness > 10 mm
Early reaction in Lepromine test is FERNANDEZ reaction
known as
Late reaction in Lepromine test is LATE MITSUDA reaction
known as
Leprosy is NOT Ameanable to Long and Variable Incubation period ( Most important
Eradication due to reason), Disputed MOT, Presence of Subclinical cases
and our inability to detect them, Complicated spectrum
of disease manifestation, Absence of Vaccine, Discovery
of Extra human reservoir.

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Leprosy is Public health problem if Prevalence > 1/10,000 population

Elimination Level of Leprosy is Prevalence < 1/10,000 population
Treatment of Leprosy is done by Multi Drug Therapy ( MDT)
Treatment duration of Paucibacillary 6 Months (To be completed with in 9 months)
Leprosy is
Treatment duration 12 Months ( To be completed with in 18 months)
ofMultibacillaryLeprsoy is
Treatment for Paucibacillary Leprosy Dapsone 100 mg X OD( Supervised daily )
include Rifampicin 600 mg/ Months for 6 months ( Supervised
Monthly)
Treatment for Multibacillary Leprosy Dapsone 100 mg X OD ( Supervided daily)
include Rifampicin 600 mg/Months ( Supervised monthly) +
Clofazimine 50 mg X daily & 300 mg/ Month
( Supervised daily and Monthly)

Follow up after treatment of Anually for 2 years

Paucibacillary Leprosy
Follow up after treatment of Anually for 5 Years
Multibacillary Leprosy
ROM therapy in Leprosy is done if Single leison is present.
ROM Therapy includes Rifampicin 600 mg + Ofloxacin 400 mg + Minocyclin
100mg
Types of Leprae reaction 2 ( Type 1 and Type 2)
Type 1 Leprae reaction is Reversible
Type 2 Leprae reaction is also known as Erythema NodusumLeprosum ( ENL)
Drug of Choice for Leprae reaction is Prednisolone
HIV/AIDs is also known as Handsome disease, Slim's disease, White disease,
Wasting syndrome
AIDs stands for Acquired Immunodeficiency Syndrome
HIV stands for Human Immuno Deficiency Virus
AIDs is caused by HIV Virus also known as Lente virus ( Retro virus) – RNA
virus
Types of HIV virus is 2 ( HIV-I &HIV-II)
World wide HIV/AIDs is caused by HIV-I
Target cell of HIV/AIDS T Lymphocytes , T Helper cell ( CD4 cell)
Most commom Age group for HIV/AIDs 20-39 Years ( 20-49 Years)
is
Incubation period of HIV/AIDS Months-10 Years ( Month to > 6 Years)
For AIDS Nepal is Concentrated epidemics
For AIDS World is Modern/ Global Pandemics
Chances of HIV transmission in Increase 8-10 times
presence of STD is
Reservoir for AIDS is Cases and Carrier
Sources of HIV/AIDS is Blood (Main), Semen, CSF (Breast milk, Vaginal
Secretion, Tears, Saliva, Urine: They have low virus

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concentration)
Most common mode of HIV Heterosexual ( Others: Blood and Blood Products,
transmission is Needles/Syringe, Vertical Transmission)
Route having maximum potency of HIV Blood and Blood products ( Efficiency is > 90 %)
transmission is
Efficiency of Sexual route for HIV 1.1.1 %
transmission is
Efficiency of Cutaneous penitration 0.3 %
route for HIV transmisson is
Efficiency of Vertical transmission of 15-30 %
AIDS
Efficiency of Breast feeding for 10-15 %
transmisson of HIV
Efficiency of Mother to Child 25- 45 %
transmission of HIV/AIDS
Seroconversion period for HIV/AIDS is 3-12 weeks ( 8 weeks ) Also known as Window period
and is most transmiable period.
HIV was discovered by Montozier and Gallo in 1983 AD
Stage of HIV/AIDS 4 stages in adult while 3 stages in child
A/c to WHO , Major sign of HIV/AIDS 3 ( > 1 month fever, > 1 month diarrhoea, Body weight
loss more than 10 %)
A/c to WHO, Minoe sign of HIV/AIDs is Chest Infection, Fungal infection, Herpes infection
Diagnostic criteria for HIV/AIDS(WHO) 2 Major signs + 1 minor sign indicates AIDS
Screening test for HIV/AIDs is ELISA/ RAPID/ SIMPLE
Diagnostic test/ Confirmatory test for Western Blot Assay ( WBA)
HIV/AIDS is
Western Blot Assay is based on Detecting Viral Core protein p24 and envelope
glycoprotein (gp 41)
Most common Opportunistic (IOS) Pneumocystis carinii pneumonia ( Fungal)
infection in HIV/AIDS in world is
Most common Opportunistic infection Tuberculosis
(IOS) in Nepal is
Definite condition suggesting patient GeneralisedKaposisarcomaand Cryptococcal meningitis
have HIV/AIDS is
Normal CD4 count is 500-1500 cell/mm3 (700-1200 cell/mm3)
Most common cancer in HIV/AIDS is Kaposis sarcoma caused by Cytomegalo virus
Therapy used for HIV/AIDS is HAART ( Highly Active Anti-retroviral Theray)
ART should be started if CD4 count is Less than 500 cell/mm3 [ Priority < 350 cell/mm3]
IOS is seen in HIV/AIDS when CD4 Below 200 cell/mm3
count is
4 'C' used for prevention of HIV and Condom promotion, Counseling client, Contact tracing,
STIs include Complete treatment
Best way for prevention of STIs is Contact Tracing
Reduction in Mother To Child 50 %
Transmisson by Caesarean

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Choice of drug for child born with HIV Nevirapine: 2 mg/kg given with in 72 hour of birth.
infected mother is
Reduction in Mother To Child 50 %
Transmission by Nevirapine
Main drugs used in HAART is Zidovudine
Visceral Leishmaniasis is also known as Kala-azar, Dum-dum fever, Camel hump fever, Black
fever, Double/ Two peak fever, Death fever
Kala-azar is a disease of Reticuloendothelial system
Causative agent of Kala-azar/ Visceral Leishmania donovani ( Protozoa)
Leishmaniasis is
Causative agent of Cutaneous Leishmania tropica
Leishmaniasis (Oriental sore) is
Vector for Kala-azar is Sandflies ( Female phlebotamine)
Most common age group for Kala-azar 5-9 Years child
MoT of Kala-azar is Bite of female phlebotaminesanflies, Blood transfusion,
Contact( Crushing of insects while feeding)
Main reservoir of Infection of Kala-azar PKDL cases ( Post Kala-azar Dermal Leishmaniasis )
is
Incubation period of Kala-azar is 10 days to 2 years ( Av. 1-4 months)
Habitat of sandflyis Cracks and cervices of walls, tree holes caves
Stages of Leishmania donovani 2 ( Amastigote and Promastigote)
Amastigote stage is present in Human . Amastigote stage is round shape also known
as L.D body
Promastigote stage is present in Sandfly
Infective stage of Leishmania for Man Promastigote stage ( Flagellated)
Diagnostic test for Kala-azar is rk-39 dipstick test
Useful test for surveillance of Kala-azar Aldehyde test ( Screening test)
is
Test for both diagnosis and survey of ELISA
Kala-azar is
Useful test for Immunity status in Kala- Leishmanin test ( Montenegero test)
azar is
Leishmanin test/ Montenegero test is 48-72 hours
read after
Leishmanin test is positive if induration >5 mm
is
Newer drug of choice for Kala-azar is Inj. Liposomal Amphotericin B ( 3 dose is sufficient to
treat Kala-azar: 5 mg/kg ) – Patient should be admitted
in hospital for 1 weeks.
Dose of Miltefosine in Kala-azar 50-100 mg X BD for 28 days
treatment is
Best measures to control Vector borne Simple Environmental manipulation
disease is
Insecticide of Choice for Sandfly is DDT ( sprayed up to a height of 6 feet from floor, 1-2
gm /sq. meter

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Lymphatic Filariasis is Worm infestation caused by Nematod worm.

Lymphatic Filariasis is Nocturnal Vivoporusparasite
Lymphatic Filariasis is caused by Wuchereria bancrofti, Brugiamalayi, Brugiatimori
Definitive host for Lymphatic Filariasis Man
Intermediate host for Lymphatic Mosquito
Filariasis is
Vector for Lymphatic Filariasis is Culex quinquefasciatus
Mode of Transmission of Lymphatic Bite of infected culex mosquito
Filariasis is
Incubation period of Lymphatic 8-16 Months
Filariasis is
Lymphatic Filariasis is also known as Elephantitis
Occult Filariasis is also known as Cryptic filariasis / Topical Pulmonary Eosinophilia
In Occult Filariasis No Clinical Manifestation or Mf in blood.
Most common cause of Hydrocele in Lymphatic Filariasis
Nepal is
Disability in Lymphatic Filariasis is Permanent irreverssible disability
Choice of Diagnosis for Lymphatic Thick smear examination
Filariasis is
Most sensitive test for Lymphatic Membrane filter Concentration Method
Filariasis is
In LF, Peripheral blood smear sample Mid-night ( Sample collected between 8:30 pm up to 12
should be taken during midnight)
Drug of Choice for Lymphatic Filariasis DEC ( Diethylcarbamazine) : 6 mg/kg/day for 12 days
is (Total 72 mg/kg)
DEC is effective in killing Microfilaria
Infective stage of Lymphatic Filariasis is Microfilaria stage
For Prevention of Lymphatic Filariasis , 6 Consecutive years
MDA is required for
Malaria is also known as Black water fever , औंलो
Malaria is a protozoal disease caused Plasmodium species
by
Types of plasmodium species causing 5 ( P. Vivax, P. Falciparum, P. Malariae, P. Ovale, P.
Malaria are knowlesi )
Most common Malaria in Nepal is P. Vivax Malaria
Most Dangerous Malaria/ Epidemic P. Falciparum Malaria
Malaria is
Rare Malaria is P. Ovale
Newly Identified Species of Malaria is P. Knowlesi
P. Falciparum Malaria is also known as Cerebral malaria, Malignant Tertian malaria ( MTM),
Algid malaria
P. Vivax Malaria is also known as Benign Tertian Malaria
P. Malariae is also known as Quartan Malaria
Vector for Malaria is Female Anopheles Mosquito
Vector for rural Malaria is Anopheles Culicifacies

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Vector for Urban Malaria is Anopheles stephensi

Plasmodium species is identified by Ronald Ross
Incubation Period of Malaria is P. Vivax : 8-17 days ( 14 days)
P. Falciparum: 9-14 days ( 12 days)
P. Malariae: 18-40 days ( 28 days)
P. Ovale : 16-18 days ( 17 days)
P knowlesi: 9-12 days ( 12 days)
Malaria shows seasonal trend, Mainly July-November
seen in
Definitive Host in Malaria is Anopheles mosquito
Intermediate host/ Secondary host of Man
Malaria is
Infective form of Malaria for Man is Sporozoites
Infective form of Malaria for Mosquito Gametocyte
Mode of Transmission of Malaria is Bite of female anopheles mosquito, Transfusion
malaria( Trophozoite induced), Congenital Malaria,
Malaria in drug addicts
Sexual life cycle of Plasmodium occur in Mosquito called " Sporogony"
Asexual life cycle of Plasmodium occur Man called " Schizogony"
in
Target cell of Malaria is Liver cell &RBC ( Red blood Cells)
Stage of Plasmodium in Man 3 ( Pre-erythrocytic, Erythrocytic and Exo-erythrocytic)
Cause of relapse in Malaria is Hypnozoites ( They are trophozoites hidden in Liver)
Relapse does not occur in P. Falciparum malaria because Hypnozoites are absent
Longest relapse occuring Malaria is P. Malariae
Relapse is more common in [Link] and P. Ovale malaria
Types of fever seen in Malaria is Intermittent fever
Quatidian fever is Fever that comes daily
Tertian fever is seen in P. vivax, P. Ovale, P. Falciparum ( Fever comes in
interval of 48 hours)
Quartan fever is seen in P. malariae ( Fever comes in interval of 72 hours)
Stage in Malaria is 3 Stage ( Cold stage, Hot Stage, Sweating stage)
In Malaria, Cold stage last for 15 min-1 hour
In Malaria, Hot stage last for 2-6 hours
In Malaria , Sweating stage last for 2-4 hours
Choice of diagnosis of Malaria is Thick and Thin smear examination
Screening test for Malaria is RDT ( Rapid Diagnostic test)- Antigenic test maily detect
P. Vivax and P. Falciparum
Choice of drugs for Malaria is Chloroquine (25 mg/kg in divided dose) for 3 days
Drugs used for Radical treatment of Primaquine
malaria
Safest Anti-malarial drugs in pregnancy Chloroquine
is
Drug of Choice for P. falciparum ACT ( Artemesinin Based Combination Therapy) – It
malaria is contains: Artemether 20mg and Lumefentrine120 mg

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In pregnancy if P. falciparum malaria is If 1st Trimester: Quinine

If 2nd& 3rd Trimester: ACT
Drug of choice for presumtive or Chloroquine
Clinical malaria is
Drug of choice for complicated malaria Quinine
is
For Prevention/ Chemoprophylaxis of Chloroquine ( 1 week before to 4 weeks after then
malaria drug of choice is travelling to endemic area)
Primaquine is contraindicated in Children, Pregnancy, G6PD deficiency
Primaquine kills both Gametocyte and Hypnozoites
Anopheles mosquito is not found above 2000-2500 m
Best Environment for Anopheles Temperature 20-30 ° C & Humidity 60%
mosquito is
Most sensitive measures of recent Infant parasite rate
malaria transmission is
Sophisticated measures of Malaria API ( Annual Parasite Incidence)
incidence is
Index of operational efficiency for ABER ( Annual Blood Examination Rate)
malaria is
API is calculated by Confirmed cases during one year/ Popln under
Dengue is also known as Break-bone fever
Most common arboviral disease is Dengue
Dengue is caused by Arboviruses ( Flavivirus)
Types of serotype of dengue 4 (Den 1, 2,3,4)
Vector for dengue is Aedes aegypti
Aedes mosquito is also known as VIP mosquito or Tiger Mosquito
Flight range of Aedes mosquito is 90 Yard
Larva of Aedes mosquito survive in 5 Years
water up to
Reservoir of dengue is Man and Mosquito both
Incubation period of dengue is 4-6 days
Types of dengue 3 ( Dengue Fever, Dengue Hemorrhagic fever(DHF) &
Dengue shock syndrome (DSS)
Tourniquet test is positive in Dengue Hemorrhagic Fever (DHF)
Tourniquet test is positiv if >20 petechiaeper [Link]
Yellow fever is also known as Yellow jack, Black vomit, American plague
Causative agent of Yellow fever is Flavivirus fibricus ( Toga virus family)
Incubation period of Yellow fever is 3-6 days
Reservoir of infection of Yellow fever is Man ( Sub clinical and Clinical cases & Aedes aegypti)
Period of communicabilty of Yellow First 3-4 days of illness
fever is
Case Fatality Rate of Yellow fever is 80 %
Vaccine for Yellow Fever vaccine is Live attenuated, Lypholised ( Freeze dried)
Strain of Yellow fever vaccine is 17 D
Yellow fever vaccine is stored at -30° to +5° C

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Diluent use for Reconstitution of Yellow Cold physiological saline

fever vaccine is
Route of Yellow fever vaccine is Subcutaneous
WHO recommended validity of 10 days to 10 Years
Vaccination certificate for International
travel is
Only one Live vaccine that can be Yellow fever vaccine
administered in pregnancy is
Vaccine contraindicated with Yellow Cholera vaccine ( They should not be given together,
fever vaccine is Maintain gap of 3 weeks )
For Yellow Fever control distance 400 Meter
around airpots to be kept free of aedes
breeding is
For Yellow Fever control, Breteau index <1 % in towns and seaports
( Aedes aegypti index) should be
Rabies is also known as Hydrophobia, Madness
Rabies is caused by Lyssavirus Type 1 ( Bullet shaped neurotropic RNA
virus)
Types of Rabies virus Street virus and Fixed virus
Street virus are Naturally occuring cases
Most common age group for Rabies is 1-24 Years
Case Fatality Rate of Rabies is 100 %
Rabies affects Posterior horn of Spinal cord
Incubation period of Rabies is 4 days to many years ( ~ 3-8 weeks)
In Man Rabies is Dead-end Infection
Pathognomic features of Rabies in man Hydrophobia
is
Pathognoic features of Rabies in dog is Negri bodies
Mode of Transmission of Rabies is Animals bite ( Dogs, Cats, Monkey, Buffalo, Horse)
Except : Rat bite and Human bite , Licks on abraded
skin, Person to person but rare, Corneal and organ
transplantation.
An Effective Natural Barrier against Water
Rabies is
For to declared Rabies free area No case of Rabies in Man or animals for past 2 years
Cleaning of wound of dog bite/ Rabies 5-10 Minutes with soap and running water
should be done for
In case of Rabies, Animal should be 10 days
kept in Observation for
Stages in Rabies is 3 Stages ( Prodromal, Exciting, Late stage)
Death in Rabies occur due to Respiratory paralysis
Pre-exposure prophylaxis Vaccine for Day 0,7,21/28
Rabies is given on
Post Exposure prophylaxis Vaccine for Day 0,3,7,14,28 ( It is known as Essen Regimen)
Rabies is given on ( Intramuscualr

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regimen)
Post Exposure Intradermal Regimen for Thai Red cross Regimen ( Day 0,3,7,28 )
Rabies is
Person under Antirabictreatment Alcohol during and 1 month after treatment , Undue
should avoid physical and mental strain and late nights,
Corticosteroid and other immunosuppressive agents
Immunoglobulin used for Rabies is Human Rabies Immunoglobulim
Rabid Animal die in 10-14 days
Mad dog syndrome includes Behavior change, Running Amunk, Change voice,
Excessive salivation.
For Animal Immunization vaccine used BPL inactivated NTV : Single dose 5 ml for dog (3 ml for
is cats) revaccination after 6 months, Subsequently every
year
Modified Live virus vaccine: Single dose 3 ml, booster
every 3 years
Most logical and cost effective Elimination of stray dogs and swift mass immunization
approach for control of urban Rabies is
Japane Encephalitis is a Viral Vector borne zoonotic disease
JE is caused by Group B arbovirus ( Flavivirus)
For JE, Pigs are Amplifier Host ( Pig themselves do not manifest
symptoms but circulates virus)
For JE, Man is Incidental Dead end Host
Vector of JE is Culex tritaeniorhynchus
Most common age group for JE <15 Years
Incubation period of JE is 5-15 days ( 9-12 days in Mosquito)
In JE, There is no Man to Man transmission
Case Fatality Rate ( CFR) of JE is 20-40 % ( May reach up to 58 %)
JE shows seasonal trend, Maily seen in August-September
Mode of Transmission of JE is Bite of infected Culex mosquito
Transmission Cycle of JE is Pig-Mosquito-pig OR Waterbird-Mosquito- Waterbird
Stages seen in JE 3 ( Prodromal, Encephalitic, Post Encephalitic stage)
Best/ Choice of diagnosis for JE is CSF (Cerebro Spinal Fluid) Examimation
Best prevention for JE is JE vaccination
5 Classical STDs are Syphilis, Gonorrhoea, Chanchroid, LGV, Donovanosis
Most common Sexually Transmitted Trichomoniasis
disease in world is
Most common Sexually Transmitted Gonorrhoea
disease in Nepal is
Syphilis is also known as VIP disease, भिरङगी
Syphilis is caused by Treponema pallidum
Most common age group for Syphilis/ 20-24 Years
STIs is
Stage in syphilis is 3 ( Primary, Secondary & Tertiary)
Chancre is seen in Primary and Tertiary stage of syphilis
Condylomalata is seen in Secondary stage of Syphilis

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Non-transmittive stage of Syphilis is Tertiary stage

Severe congenital syphilis may cause Still birth
Best choice of diagnosis of Syphilis is Treponema Pallidum Haemagglutination ( TPHA) Test
( 2nd: Fluroscent Treponemal antibody absorption)
Screening test for Syphilis is VDRL ( Veneral Disease Research Laboratory)
Kahn & Chopra test is done in Syphilis
Cluster testing is done in STIs ( Sexually Transmitted Infection)
Drug of choice for Syphilis is Benzathine penicillin
Gonorrhoeais also known as धातुरोग
Gonorrhoea is caused by Neisseria gonorrhoeae
Most common age group for 20-24 Years
Gonorrhoea is
Incubation period of Gonorrhoea is 1-5 days (2-10 days )
Discharge present in Gonorrhoea is Gleet
Drug of choice for Gonorrhoea is Ceftriaxone 500 mg + Azithromycin 1 gm single dose
Chanchroid is caused by Hemophilusducreyi
Incubation period of Chanchroid is 3-5 days
Donovanosis is caused by Calymmatobacteriumgranulomatis
Incubation period of Donovanosis is 3-21 days
Sexually Transmitted protozoans are E. histolytica and Giardia lamblia
Yaws is also known as Pian, Bubas, Framboesia
Yaws is caused by Treponema pertenue
Incubation period of Yaws is 3-5 days
Reservoir of Yaws is Man
Best method of controlling the spread Contact tracing
of infection is
Plague is also known as Black death, Mahamari, The great death
Plague is caused by Yersinia pestis ( Gram -ve , Non-motile cocco bacillus)
Commonest and most efficient Vector Rat flea ( Xenopsyllacheopsis)
of plague is
Reservoir of infection for Plague is Wild rodents
Sources of Infection for Plague is Infected rodents, Fleas and cases of pneumonic plague
Mode of Transmission of Plague is Bite of infected fleas,Droplet infection, Direct contact
with tissues of infected animals
Types of Plague is 3 ( Pneumonic plague, Bubonic plague, Septicemic
plague)
Most common type of plague is Bubonic plague
Incubation period of Bubonic and 2-7 days
Septicemic plague is
Incubation period of Pneumonic plague 1-3 days
is
Drug of choice for treatment of Plague Streptomycin: 30 mg/kg IM X 7-10 days
is
Drug of choice for Chemoprophylaxis of Tetracycline
Plague is

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Chickengunya is caused by Chickengunya virus

Incubation period of Chickengunya is 2-12 days ( 4-8 days)
Mode of Transmission of Chickengunya Bites of Infected Aedes mosquito
is
Choice of diagnosis for Chickengunya is ELISA
First outbreak of Chickengunya was 1952 AD
reported on
Currently outbreak of Ebola Virus SouthAfrica
disease was reported from
Incubation period of Ebola Virus 2-21 days
disease is
Mode of Transmiaaion of Ebola Virus Body fluids (including Semen, Breast milk)
disease is
Sources of Ebola Viris disease is Cases
Reservoir of Ebola Virus disease is Bats
Case Fatality Rate of Ebola Virus 40 %
disease is
Kyasanur Forest Disease ( KFD) is also Monkey disease
known as
Kyasanur Forest Disease is caused by Group B Togavirus ( Flavi virus)
Reservoir for Kyasanur Forest Disease is Rats and Squirrels
Amplifier host of Kyasanur Forest Pigs
Disease is
For Kyasanur Forest Disease, Man is Incidental dead-end host
Vector for Kyasanur Forest Disease is Hemophysalisspinigera ( Hard Tick)
Incubation Period of Kyasanur Forest 3-8 days
Disease is
Trachoma is also known as Rough eye
Trachoma is ccaused by Chlamydia trachomatis ( immune types A,B, C)
Incubation period of Trachoma is 5-12 days
Most commonly infected age group by 2-5 Years child
Trachoma is
Mode of Transmission of Trachoma Direct or indirect contact with Ocular discharges or
Fomites, Eye seeking flies, Veneral transmission
Reservoir of Infection for Trachoma is Children with active disease, Chronically infected older
childrens and adults
Predisposing fectors for Trachoma are Direct sunlight, Dust, Smoke and Irritants ( Kajal)
Herbert's Pits is seen in Trachoma ( Herbert's Pits is Limbal follicles)
Treatment of choice for Trachoma is Azithromycin: 20mg/kg oral stat
Indication of mass treatment in If > 10 % prevalence
Trachoma is
Drugs used for Mass treatment of 1% Tetracycline ointment: BD for 5 consecutive days
Trachoma is each months or OD for 10 days each months for 6
Consecutive months .
SAFE strategy by WHO is for Prevention and Treatment of Trachoma

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S= Surgery for TrichiasisamdEntropion

A=Antibiotics use ( Azithromycin)
F= Facial cleanliness
E= Environmental improvement
Incubatio period of Salmonella Food 12-24 hours
poisoning is
Salmonella Food poisonong is caused Salmonella typhorium
by
Most common food poisonong is Salmonella Food poisoning
Staphylococcal Food poisoning is Entertoxins of Staphylococvus aureus
caused by
Temperature required for Toxin 35-37 ° C
formation by Staphylococus is
Incubation period of Staphylococcal 1-6 hours
Food Poisoning is
Food Poisoning having shortest Staphylococcal food poisoning
Incubation period is
Most dangerous but rare type of food Botulism food poisoning
poisoning is
Botulism food poisoning is caused by Clostridium botulinum ( type A, B, E)
Incubation period of Botulism FP is 12-36 hours
Botulism affects Parasympathetic Dysphagia, Diplopia, Dysarthria
Nervous system so symptoms seen are
Prophylatic treatment of Botulism FP is Anti-toxin (50,000-100000 units)
Drug of choice for Botulism food Guanidine hydrochloride
poisonong is
Incubation period of Clostridium 6-24 hours
perfirenges food poisoning is
Incubation period of Bacillus cereus FP 1-6 hours for emetic forms & 12-24 hours for diarrhoeal
is form.
Brucellosis is also known as Undulant fever, Malta fever, Mediterranean fever
Brucellosis is caused by Brucella species ( Brucella Melitensis, B. Abortus, B.
suis, B. canis )
Most virulent and invasive species of Brucella melitensis
Brucella is
Reservoir for Brucella is Cattle, Sheep, Goats, Swine, Buffaloes, Horses, Dogs
Mode of Transmisson of Brucella is Direct contact, Food borne infection, Air borne
infection
Incubation period of Brucella is Usually 1-3 days
Most striking features of Brucella is Severity of illness and absence of clinical cases
Drug of choic for Brucella is Tetracycline: 500 mg X QID for 3 weeks
Crimean Congo Fever is Zoonotic disease of domestic/wilddamimalswhichay
affects human beings
Crimean Congo Fever is caused by Nairovirus ( Bunya virus)
Vector for Crimean Congo Fever is Hard ticks ( Hyalomma ticks)

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Incubation period of Crimean Congo 1-13 days ( Av. 5-6 days)

Fever is
Case Fatality Rate of Crimean Congo 30 %
Fever is
Drug of choice of Crimean Congo Fever Ribavirin
is
Amoebiasis is caused by Entamoeba histolytica
Source of infection for Amoebiasis is Quadrinucleate cyst/ Tetranucleate cyst
Reservoir of infection for Amoebiasis is Man
Period of Communicability for Upto years ( till cysts excreted)
Amoebiasis is
Mode of Transmission of Amoebiasis is Feco-oral, Sexual ( Oro-rectal in homosexual), Vectors
( Flies, Cockroaches)
Incubation period of Amoebiasis is 2-4 weeks
Drug of choice for Amoebiasis is For Symptomatic: Metronidazole & For Asymptomatic:
Diodohydroxyquin
Zoonosesis An infection or infectious disease transmissible under
natural conditions from vertebrate animal to Man
Anthropozoonosesis Infections transmitted from animals (Zoo) to man
( anthro). E.g Rabies, Plague, Anthrax, Hydatid disease,
Trichinosis.
Zooanthroponoses is Infection transmitted from man (Anthro) to animals
(zoo). E.g Human TB in Cattle
Amphixenosis is Infections transmitted in either direction between
animals and man. E.g Trypanosomacruzi, Schistosoma
japonicum
SARS ( Severe Acute Respiratory Corona virus
Syndrome) is caused by
Origin of SARS was from China (2002)
Route of Transmission of SARS is Air droplets
MERS-coV ( Middle East Respiratory Betacorona virus
Syndrome) is caused by
Origin of MERS-coV was from Saudi Arabia (2012 AD)
Incubation period of MERS-coV is 2-14 days
Mode of Transmission of MERS-coV is Air droplets, Camel milk, Camel meat
Sources for MERS-coV is Camels
Reservoir for MERS-coV is Bats
Case Fatality Rate of MERS-coV is 30 %
Rickettsial Disease are A group of specific communicable disease caused by
Rickettsial organism and transmitted to man by
Arthropod vectors (Except Q fever)
Example of Rickettsial disease are Typhus, Q fever, Trench fever, Rickettsial pox
Epidemic Typhus is caused by R. prowazekii
Vectors for Epidemic Typhus is Louse
Mode of Transmission of Epidemic Scratching and Inoculation with infected louse faeces,

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Typhus is Crushing infected louse on body, Inhalation of infected

louse faeces or dust.
Drug of choice for Epidemic Typhus is Tetracycline
Endemic Typhus is also known as Flea borne typhus / Murine typhus
Causative agent for Endemic typhus is R. typhi
Reservoir of infection for Endemic Rats
typhus is
Mode of Transission of Endemic typhus Rat flea ( Xenopsyllacheopsis)
is
Incubation period of Endemic typhus is 1-2 weeks
Drug of choice for Endemic typhus is Tetracycline
Most wide spread Rickettsial Disease is Scrub Typhus
Causative agent of Scrub typhus is Rickettsia tsutsugamushi
Vector of Scrub typhu is Trombiculid Mite
Incubation Period of Scrub typhus is 10-12 days
Typical Clinical Features of Scrub Eschar ( Punched out ulcer covered with a blackened
typhus is scar, indicates location of mite bite)
Only One Rickettsial disease with out Q fever
any Vector is
Only one Rickettsial disease with out Q fever
any skin leison is
Q fever is caused by Coxiella burnetii
Mode of Transission of Q fever is Inhalation of infected dust, Aerosol transmission, Direct
contact, Contaminated food like meat, milk and milk
products.
Incubation period of Q fever is 2-3 weeks
Drug of Choice of Q fever is Tetracycline
Meningococcal Meningitis is also Cerebrospinal fever
known as
Meningococcal Meningitis is caused by N. meningitidis
Mode of Transmission of [Link] Droplet infection
is
Incubation period of M. meningitis is 2-10 days
Case Fatality Rate of M. meningitis is 80 %
Deug of choice for M. meningitis is Cases: Penicillin & For Carrier is: Rifampicin
Drug of choice for Chemoprophylaxis of Rifampicin: 600 mg X BD for 2 days
M. meningitis is

 Facts on Environmental Senitation and Health.

Facts on Environmental Senitation and Health

Country having richest source of water in Brazil ( Nepal is 2ndreachest source of water in
word world)
Percentage of fresh water in world 3%

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Salt content in sea water is 3.5 %

Drinking water should be Moderately hard ( 1-3 meq/L) hardness
PH of drinking water should be 6.5-8.5 ( Neutral)
Physiological water need ( For drinking 2 Litre/capita/day
purpose)
Daily Domestic water need for Urban area 150-200 Litre/capita/day
Daily Domestic water need for Rural area 40-60 Litre/capita/day
Daily water need for Hospital 200-250 Litre/capita/day
Most desirable temperature for drinking 5-10 ° C (40-50 °F)
water is
Safe and Wholesome water is Free from pathogenic agent and harmful chemical
agent, Pleasant to taste ( Free of colour and
odour) & Usable for domestics purposes.
Types of Sources of water 3 ( Rain Water, Surface water, Ground water)
Prime Source of all water is Rain water
Purest form of water in Nature is Rain water ( 2nd purest is Impounding reservoir)
Water source containing Vitamin B12 is Rain water
Examples of Surface waters are Impounding reservoirs, Rivers and streams, Tanks,
pond and Lakes.
Grossly polluted as well as more prone to Rivers and streams
contamination, water source is
Examples of Ground waters are Shallow wells, Deep wells, Springs
Tap water from above 1st impervious layer is Shallow well
obtained from
Tap watet from below 1st impervious layer is Deep wells
obtained from
Most important biological indicator of water E. Coli / Coliform organism
pollution is
Primary and most reliable bacterial Coliform organism
indicators for water quality is
Recent contamination of water is indicated Fecal streptococci
by
Remote contamination of water is indicated Clostridium perfinges
by
Distance should be kept between Sanitary 15 meter ( 50 feet)
well and source of water contamination is
Parpet wall in Sanitary well should be 70-75 cm
Hardness of water is defined as the Soap destroying power of water
Hardness of water is expressed in terms of Miliequivalents per litre (meq/litre) of Calcium
Carbonates (CaCO3)
1 meq/litre hardness is 50 mg CaCO3 (50 ppm) per litre of water
Types of Hardness of water 2 types ( Temporary hardness & Permanent
hardness)
Temporary hardness of water is due to Calcium and Magnesium salts of Bicarbonates , so
also known as Bicarbonate hardness.

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Permanent hardness of water is due to Calcium and Magnesium salts of Sulfates,

Chlorides, Nitrates. Also known as Non- Carbonate
hardness.
Soft water is having level of hardness <1 meq/L ( < 50 mg/L)
Moderately hard water is having level of 1-3 meq/L ( 50-150 mg/L)
hardness
Hard water is having level of hardness 3-6 meq/L ( 150-300 mg/L)
Very hard water is having level of hardness >6 meq/L ( > 300 mg/L)
Softening of water is recommended when Level of hardness is > 3 meq/L ( > 150 mg/L) of
Calcium Carbonates
Method of removal of Temporary hardnes of Boiling – Best method
water are Addition of lime
Addition of sodium carbonates
Permutit process
Method of removal of Permanent hardness Addition of sodium carbonates
of water are Base Exchange method
Both Temporary and Permanent hardness of Permutit process
water is removed by
Zero hardness of water can be brought by Base Exchange method
Key Guideline Aspects of WHO Colour : < 15 True colour units ( TCU)
recommended Drinking water quality Turbidity: < 5 Nephlometric turbidity units ( NTU)
PH : 6.5-8.5
Hardness: < 100-300 mg/litre calcium ion (50-150
mg/Litre)
Fluorine <1.5 ppm ( 0.5-0.8 ppm: Optimum level)
Nitrates: < 50 mg/Litre
Nitrites: < 3 mg/ Litre
Gross alpha radiological activity: < 0.5 Bq/Litre
Gross beta radiological activity: <1.0 Bq/Litre
Total dissolves solids (TDS): < 600 mg/ Litre
Zero pathogenic organism, Viruses, Protozoa and
infective stage of Helminthes.
Nitrites in water indicates Recent chemical contamination of water
Nitrates in water indicates Old or late contamination of water
Normal Aspects of Mercury in drinking 0.001 mg/Litre
water is
Normal Aspects of Arsenic in drinking water 0.01 mg/Litre (In Nepal: 0.05 mg/L)
is
Normal Aspects of Lead in drinking water is 0.01 mg/Litre
Normal Aspects of Iron in drinking water is 0.3 mg/Litre
Normal Aspects of Cyanide in drinking water 0.07 mg/Litre
is
Most Undesirable metal in drinking water is Lead
Undesirable metals in drinking water are Iron, Manganese, Zinc, Copper, Aluminium, Lead
Undesirable salts in drinking water is Chlorides, Fluorides, Nitrites, Nitrates, Calcium ,

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Magnesium
Undesirable gases in drinking water is Ammonia, Hydrogen sulphide, Methane
Normal Aspects of Cadmium in drinking 0.003 mg/Litre
water is
Methods of Water Purification on Large -Storage of water
Scale -Filtration of water ( Slow sand and Rapid sand
filters)
-Disinfection of water( Chlorination, Ozonation, UV
ray)
Methods of Water purification on a small Household purification of Water & Disinfection of
scale includes well
Method of Household purification of waters Boiling: Best method (Roll boiling 5-10 min)
are Chemicals: Bleaching powder, Chlorine soln/Tablet
Filtration: Ceramic filters
Disinfection of well is best done by Bleaching powder & This method is also known as
"Double Pot methods"
Bleaching powder ( CaOCl2) contains 33% Available chlorine
Chlorine acts best as a disinfectant for Around 7.0
water at PH
Features of Rapid Sand Filters are Also known as Mechanical/ American Filters
Occupies very little spaces
Removes 98-99 % of bacteria
Highly skilled operation
Effevtive size of sand : 0.4-0.7 mm
Features of Slow Sand Filters are Also known as Biological/ English Filters
Occupies large area
Removes 99.9-99.99 % bacteria
Less skilled operation
Effevtive size of sand: 0.2-0.3 mm
Vital layer / Zoogleal layer is present in Slow sand filter
Vital layer is also known as "Heart of slow sand filters"
Formation of vital layer in Slow sand filter is "Ripening of the filters".
known as
Vital layer consists of Algae, planktons, diatoms and bacteria.
Disinfecting action of chlorine in water is Hypochlorous acid ( HOCL)
mainly due to ( Minor action: Hypochlorite ion (OCL) )
Most cheapest, effective and widly used Chlorination ( Choice is chlorine gas)
method of water purification is
Chlorine is best due to it's Residual germicidal effect.
Recommended contact period of free 1 hour
residual chlorine in water is
Level of free residual chlorine (FRC) >0.5 mg/ litre ( ppm)
recommended for drinking water is
Level of free residual chlorine recommended >0.7 mg/litre (ppm)
for watet bodies during post disaster is

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Level of free residual chlorine recommended >1 mg/litre (ppm)

for swimming pool sanitation is
In bleaching powder, Bleach is mixed with Stabilize the chlorine
chlorine for to
If Chlorine is mixed with heavily polluted Super chlorination
water it is known as
Prechlorination is Process of adding chlorine in turbid water for to
reduce turbidity
Horrock's Apparatus is used for Chlorine demand estimation of water
Chlorinator/ Chloronome is used for Mixing or regulating dose of chlorine
Chloroscope is used for Measuring residual level of chlorine
Ortho-toulidine (OT) test is used for Free (residual) and combined chlorine in water
measuring
Ortho-toulidine Arsenate (OTA) test is used Free (residual) and combined chlorine separately
for measuring ( Better than OT test)
In Normal dose, Action of chlorine is not Bacterial spores, Protozoal cysts and helminthic
against ova, Hepatitis A, Polio virus
Best method of purification of pipeline Chlorine gas
water is
Best method of turbid water purifucation is Potash Allum
Contact period of Iodine for water 2 drops for 1 litre water for 20-30 minutes
purification is
Availability of chlorine in bleaching powder 33% chlorine
Water borne disease occur due to Drinking contaminated water, transmitted by
faeco-oral route. E.g. Typhoid, Cholera, Dysentry,
Hepatitis A
Water washed disease are Infections of the outer body surface which occur
due to inadequate use of water or improper
hygiene. E.g. Scabies, Trachoma, Typhus, Bacillary
dysentry, Amoebic dysentry.
Water based disease Refers toinfections transmitted through an aquatic
invertebrate animal. E.g. Schistosomiasis,
Dracunculiasis ( Guinea worm)
Water related disease/ Water Breeding dsz Infections spread by insects that’s depends on
water. E.g. Malaria, Filariasis, Dengue, Yellow
fever, Onchocerciasis
Refuse is Solid waste generated from city area.
Rubbish are Domestic waste like paper, clothings, wood, metal,
glass, dust.
Garbage are Processed food waste generated from kitchen
Litter are Waste disposed in wronge place by unlawful
human action / Waste from rural area or country
side.
Demolition are Bricks, metals, pipes, masonary
Sewage is Liquid waste containing human excreta

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Composition of sewage 99.9 % water + 0.1 % solids

Sullage is Liquid waste without human excreta
Scum is Fatty lighter waste that floats on the surface of
septic tank
Sludge is Heavy solid waste that settled down in the bottom
of septic tank
Inffluent is Water which flow inside the tank
Effluent is Water which flow outside the tank
Dry weather flow is The average amount of sewage that flows in
sewerage system in 24 hours
White water is Ground water/ Potable water/ Drinking water
Grey water/ Sullage is Waste water except from toilet
Black water is Waste water from toilet

Steps of solid waste management are: 4 Storage Collection TransportationDispose

steps ( General management )
Management of solid waste by WHO 5 Steps:-
-Minimize by 3 R ( Reduce, Reuse, Recycle)
- Seggregation
- Storage and collection
- Transportation
- Final disposal
Methods of solid waste disposal are Dumping, Sanitary landfill, Incineration, Burial,
Mannure pits, Compostings
Most satisfactory methods for solid waste Sanitary landfill ( Controlled Tipping)
disposal is
Types of Sanitary landfill method are 3 Types ( Trench, Ramp & Area method)
Easiest but unsanitary method of solid Dumping
waste disposal is
Best method for hospital waste Incineration
management is
Best method of solid waste disposal where Incineration
land is unavailable
Incineration is High temperature dry oxidation process which
reduces waste volume and weight.
Best method for solid waste disposal for Burial
small camps is
Best method for solid waste disposal for Mannure pits
household or rural area is
Best method for solid waste disposal for Composting
large scale / Refuse/ Night soil/ Degradable
waste
Types of Composting 2 Types ( Anaerobic & Aerobic process)
Anaerobic process of composting is also Bangalore method
known as

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Strength of sewage is expressed in terms of BOD ( Biological Oxygen Demand), COD ( Chemical
Oxygen Demand) & Suspended solids.
Stronge sewage has BOD >300 g/litre
Weak sewage has BOD <100 g/litre
Best chemical for Chemical Oxygen Demand Potassium dichromate
( COD) Estimation is
Stronge sewage has suspended solid amount >500 mg/litre
Weak sewage has suspended solid amount <100 mg/litre
Types of latrines/ Method of human excreta 2 Types ( Service type latrine & Non-Service type
disposal are latrine)
Service type latrine is also known as Conservancy system
Service type latrine includes Pail type latrine & Bucket type latrine
Non-Service type latrine is also known as Sanitary latrines
Sanitary latrines includes •Bore hole latrine
•Dug well or pit latrine
• Water seal latrine
• Septic tank
• Aqua privy
• Latrine for camps and Temporary use.
Instrument used to make Bore hoe latrine is Auger
known as
Use period of Bore hole latrine 5-6 People for 1 year
Size of Bore hole Latrine is Diameter: 30-40 cm
Depth: 4-8 meter
Use period of Dug well/pit latrine 5-6 People for 5 years
Size of Dug well/pit latrine is Diameter: 75 cm
Depth: 3-3.5 meter
Most Sanitary latrine is Water seal latrine
Water Seal latrine is also known as Power flush latrine
Types of Water seal latrine is 3
• P.R.A.I type
• R.C A type
• Sulabhshauchalaya
Vital part of Water seal latrine is Trape
Length of Trape in Water seal latrine is 7 cm
Length of water seal in Water seal latrine is 2 cm
Water seal in sanitary latrine is an example Sanitation barrier
of
Sanitation barrier is Barrier to prevent spread of faecal-oral disease.
Sanitation barrier can be provided by Sanitary latrine & Disposal pit
Minimum capacity of Septic tank is 500 gallons
Length of Septic tank is Twice of the breadth
Depth of Septic tank is 1.5-2 meter
Liquid depth in Septic tank is 1.2 meter
Air space depth in Septic tank is 30 cms

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Ideal retention period in Septic tank is 24 hours

Latrine Suitable for camps and temporary • Shallow trench: 3 cm diameter X 150 cm depth
use are ( For < 7 days period)
• Deep trench: 70-90 cm diameter X 1.8-2.5 meter
depth ( Semi-permanent camp)
• Pit latrine: 10-12 feet depth- Best for rural area
• Bore hole latrine
Best latrine for Rural area Pit latrine
Suitable latrine for small camp Trench latrine
Most Effective sanitation barrier is Segregation of faeces and it's proper use
Primary air pollutants are Sulphur dioxide ( SO2)
Nitrogen dioxide ( NO2)
Carbonmonoxide( CO)
Hydrocarbons & CFCs
Secondary air pollutants are Ground level ozone
Peroxyacetyl nitrate
Best indicators of air pollution are Sulphur dioxide (SO2)
Best Biological indicators of air pollution are Lichens
Soiling index is used for measuring Air pollution
Most poisonous gas is Carbonmonoxide ( CO)
Main cause of Air pollution is Carbonmonoxide (CO) release from Automobiles
Most commonly and widlydistributed air Carbonmonoxide (CO)
pollution is
Main cause of Green house effect/ Global Water vapour( Others: CO, Methane, Ozone)
warming is
Main cause of Ozone layer depletion is CFCs ( Chloroflurocarbon)
Main cause of Acid rain is SO2 ( Sulphur dioxide)
Methane gas is also known as Marsh gas
Pollutant release from industrial area is Sulphur dioxide ( SO2)
Pollutant release from Automobiles is Hydrocarbon and Carbonmonoxide
Hydrocarbon causes Lungs cancer
Sulphur dioxide (SO2) causes Asthma
Gas not commonly regarded as air pollutant Carbon dioxide ( CO2)
is
Air conditioner related disease is Legionnairel disease/pneumonia
Kata thermometer is used for measuring Cooling power of Air , Low air velocity
Wet Globe thermometer is used for Environmental heat
measuring
Globe thermometer is used for measuring Mean radiant temperature
Silvered thermometer is used for measuring Air temperature
Humidity of Air is measured by Hygrometer/ Psychrometer
Kyoto Protocol is related to Global warming
It was signed by 187 countries
Entered into force on: 16th Feb 2005
Human ear is sensitive to sound frequency is 20-20,000 Hz ( Known as Audible range)

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Daily maximum tolerable sound level to 85-90 dB

human ear
Sound level at which Auditory fatigue 90 dB region ( Greatest at 4000 Hz)
appears is
Sound levelabove which tympanic 150-160 dB
membrane rupture ( permanent mechanical
damage)
Sound level at which permanent hearing loss 100 dB
occur is
Noise level of Whisper is 20-30 dB
Noise level of Normal conversation is 60-70 dB
Noise level of Mechanical damage like Jet 150-160 dB
taking off is
Noise level of Ambulance Siren is 120 dB
Acceptable Noise level at Hospital wards 20-35 dB
Acceptable Noise level at Library is 35-40 dB
Acceptable Noise level at Class room is 30-40 dB
Acceptable Noise level at Laboratory is 40-50 dB
Acceptable Noise level at Residential area is 25-40 dB ( Bed room: 25 dB & Living room : 40dB)
20th Century has been described as " Century of noise"
Audiometr is used for Measuring hearing ability
Sound Level Meter is used for Measuring intensity of sound in dB
Most Temporary hearing loss occur in the 4000-6000 Hz
frequency range of
Food Fortification is Addition of nutritious substances to food to
improve quality of food. E.g Iodine in salt, Vitamin
A in vegetable oil
Food Addictives is Addition of colour, flavour or preservatives in food
Food Adulteration is Addition of non-nutritious substances in food for
intention of profit. E.g Mustard oil with Arginine
oil, Stone in rice
Food preservation is Managing of food in such way that it prevents
from food spoilage. E.g Gundrunk
Pasteurization process is used for Milk purification
Methods of Pasteurization process are 3 ( Vat method, HTST Method, UHT Method)
In Vat/ Holder method of Pasteurization Temperature: 63-66 ° C for > 30 minutes
( Quick cooled at 5° C)
Vat/Holder method is best for Small and rural communities
In HTST ( High Temperature and Short Time ) Temperature: 72 ° C for > 15 seconds
method of Pasteurization ( Rapidly cooled at 4°C)
Most widly used method of Pasteurization is HTST ( High Temperature and Short Time) method
In UHT ( Ultra High Temperature) method of Temperature 125 ° C for few seconds
Pasteurization
In UHT method of pasteurization Heating in 2 stages; second stage under pressure
Test used for Pasteurized milk are •Phosphate test

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•Standard plate count: Test for Bacteriological

quality of milk
•Coliform count
Most widly used test for Pasteurized milk is Phosphate test
Criteria for Housing Satnadared • Roof: > 10 feet
• Floor area: 50-100 [Link] per person
• Windows area: 1/5th of floor area ( Door +
Window: 2/5th of floor area)
• Wall: 9- inch brick wall plastered
• Others….
Cattle shed should be >25 feet away from house.
Minimum recommended area for swimming 2.2 sq. meter ( 24 [Link]) per swimmers
pool is
Level of Free Residual Chlorine in swimmimg >1 (mg/Litre) or > 1 ppm
pool is
Types of Radiation 2 ( Electromagnetic & Corpuscular)
Example of Electromagnetic radiation are X-ray & Gamma rays
Example of Corpuscular radiation are Alpha particles, Beta Particles & Protons
Most common radiation hazard is X-ray ( Ionizing radiation)
Most harmful radiation is Alpha particles
Test having lowest/ Free from radiation NMRI ( Nuclear Magnetic Resonance Imaging)
hazard is
Types of Biological Transmission of 3 Types ( Propagative, Cyclo-propagative &Cyclo-
Arthropod are development)
In Propagative Transmission Disease agent only multiplies in the body of vector
E.g Plague bacilli in rat fleas &Yellow, fever virus in
Aedes mosquito.
In Cyclo-propagative Transmission Disease agent goes under cyclical change and
multiplies in the body of vectors. E.g. Malaria
Parasite in Anophelin mosquitoes
In Cyclo-development Transmission Disease agent undergoes only cyclical change in
the body of vector. E.g. Filarial parasite in culex
mosquitoes , Guinea worm in cyclops
Housefly should be regarded as a Sign of insanitation
Important species of Housefly are Musca domestica, M. vicinia, [Link], M.
sorbens
Life span of Housefly is 15-25 days
Life cycle of Housefly includes Eggs, Larvae, Pupae, Adults (4 stages)
Larvae of Housfly is known as Maggots
Houseflies are also known as Porters of infection
Disease transmitted by Housfly are Typhoid and Paratyphoid fever
( As vectors) Diarrhoea and dysentries
Cholera and gastroenteritis, Amoebiasis,
Poliomyelitis, Yaws, Anthrax, Trachoma,
Conjunctivitis, Helminthic manifestation.

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Housefly is causative agent of disease Myiasis

Species of Sandfly are Phlebotamusargentipes
Phlebotamuspapatasil
Phlebotamussergenti
Disease transmitted by Kala-azar ( Visceral Leishmaniasis)
Phlebotamusargentipes is
Disease transmitted by Sandfly fever, Oriental sore ( Cutaneous
Phlebotamuspapatasil is Leishmaniasis)
Disease transmitted by Phlebotamussergenti Oriental sore ( Cutaneous Leishmaniasis)
is
Habitats of Sandfly is Holes and cervices in walls, Holes in trees, dark
rooms, stables and store rooms
For Sandfly control sanitation measure are 50 feet
carried out for a distance of
Insecticide of choice for Sandfly is DDT ( 1-2 gm/m2 single application)
For Sandfly control, DDT is spray up to 4-6 feets of walls
height of
Required blood meal for female sandfly for Every 3-4 days m
Oviposition is
Rat Flea acts as vector for Bubonic plague
Murine typhus
Chiggerosis
Scientific name of Rat flea is Xenopsylla
Bacterial disease associated with rodents Plague, Tularaemia, Salmonellosis
are
Viral disease associated with rodents are Lassa fever, Hemorrhagic fever, Encephalitis
Rickettsial disease associated with rodents Scrub typhus, Murine typhus, Rickettsial pox
are
Parasitic infestation associated with rodents Leishnaniasis, Amoebiasis, Chagas disease,
are Trichinosis
Best approach for Arthropods control is Environmental control
Example of Residual spray for Mosquito DDT, BHC ( lindane), Malathion
control are
Example of Space sprays for Mosquito Pyrethrum extract
contro is
Pyretrum extract shows Nerve poison
Chemical commonly used as Repellants for Diethyltoulamide (DEET) & Ethyl hexanediol
Personal protection against mosquito bites
are
Chemical used in Insecticide treated bed Synthetic pyretheroids( Especially Deltamethrine)
nets is
Types of Insecticides are 3
• Organo-phosphorus insecticides
•Organo-chlorine insecticides
• Carbamate insecticides

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List of Organo-phosphorus insecticides are Malathion, Parathion, Fenthion, Diazinon,

Fenitrothion, Chlorthion, Dioxathion, Chlorpyrifos
List of Organo-chlorine insecticides are DDT, BHC, Lindane, Dieldrin
List of Carbamate insecticides are Carbaryl, Propoxur
Paris green is a Stomach poison
Chemical name of Paris green is Copper Acetoarsenite
Most widely used larvicide for Mosquito Paris green
control is
DDT ( Dichloro-diphenyl-trichloro ethane) Ziedler
was discovered by
Properties of DDT was discovered by Paul Muller ( Nobel prize)
Mechanism of Action of DDT is Contact poison ( Nerve poison)
Mechanism of Action of Pyrethrum is Contact nerve poison & Knock-down effect with
paralysis
Least Toxic Organophosphate compound is Malathion
Scabies is caused by Sarcoptes scabei ( Known as Itch mite)
Most common site of Scabies leison is Hand and wrist
Confirmatory diagnosis of scabies is Search for parasite in skin debris under
microscope
Drug of choice for Scabies is 5% Permethrine
Oral/systemic drug of choice for Scabies is Ivermectin ( single dose)
Occupational Hazards related to High Heat cramps, Heat hyperpyrexia, Heat exhaustion,
temperature are Heat stroke
Occupational Hazard related to cold are Chilblains, Trench foot, Frost bite
Occupational Hazard related to low pressure Caisson disease/ Decompresson sickness
is
Occupational Hazard related to Vibration is Vibration sickness, Neurogenic damage
Pneumoconiosis occurs due to Occupational exposure to dust
Most dangerous particle size for 0.5-3.0 Micron
Pneumoconiosis is
Exposure to Silica dust causes Silicosis
Exposure to Coal dust causes Anthracosis
Exposure to Asbestos dust causes Asbestosis
Exposure to Cotton fibre causes Byssinosis
Exposure to Sugarcane/ Molasses causes Bagassosis
Exposure to Beryllium causes Berylliosis
Exposure to Mouldy hay causes Farmer's lungs
Exposure to Iron dust causes Siderosis
Exposure to Tin dust causes Stannosis
Exposure to Avian/ bird droppings causes Bird fancier's lungs
Exposure to Compost causes Compost lungs
Lead poisoning is also known as Plumbism/ Saturnism/ Painter's colic
Greatest source of Lead poisoning is Gasoline/Petrol / Vehicular exhaust!/ Automobile
exhaust
Most common mode of Lead poisoning is Inhalation of lead

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Earliest and most consistent sign of Lead Facial pallor

poisoning is
Burtonian line is seen in Lead poisoning ( It is Lead sulphide line on gums of
upper jaw)
Most common Occupation cancer is Skin Cancer ( Mainly Squamous cell carcinoma)
Occupational cancer related to Asbestos is Mesothelioma
Occupational Cancer related to Arsenic is Skin cancer, Lungs cancer, Liver cancer
Caisson Disease is also known as Decompression Sickness
Caisson Disease occurs due to Low pressure living environment
Treatment of Caisson Disease is Recompression
Main Purpose of Pre-placement examination To place " The right man in right job".
is
Most common cause of DALY in patient Unipolar depressive disorder
having Mental problem is
Most common cause of Death in patient Alzheimer's disease and other dementias
having Mental Problem is
Triage is defined as Rapidly classifying the injuried 'On the basis of
Severity of their injuries and likelihood of their
survival' with prompt medical intervention.
In Triage system 4 Colour code system is used ( Red, Yellow, Green
& Black)
In Triage System, Red colour code represent Highest priority ( Immediate resuscitation or Life
saving surgery required in next 6 hours)
In Triage System, Yellow colour code High priority ( Possible resuscitation or life saving
represent surgery required in next 24 hours)
In Triage System, Green colour code Minor illness / Ambulatory patient
represent
In Triage System, Black colour code Dead and moribund patients
represent

 Facts on Family planning, methods and devices.

Family Planning is a Preventive servive ( A/c to WHO 1970AD)

Family planning A couple plans when to have children, using birth
control and other techniques ( Sexual education,
Prevention and management of STIs,
Preconceptional counselling and management,
Infertilty management )
Birth control Is a regimen of one or more actions, devices or
medication followed in order to prevent pregnancy
or childbirth
Objectives of Family planning are •To avoid unwanted birth
•To regulate birth spacing
•To determine [Link] child in family & to improve

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MCH
•To bring about wanted birth
•To control the time at which birth occurs
First Family planning day celebrated in 18th September 2014
Nepal on
Method of measuring contracepive 2
efficacy is •Pearl index
•Life Table analysis ( Better than pearl index)
Peral Index is No. of failures per 100 women years ( HWY) of
exposure
Pearl index represent Failure rate of Family planning method and devices
Pearl index is calculated by ( PI) ( Total accidental pregnancy/ Total months of
exposure) X 1200
Most common techniques used in clinical Pearl index
trials for measuring the effectiveness of a
birth control method ia
Life Table Analysis calculates (LTA) A failure rate per months of use
Eligible couple is A currently married couple with wife in
reproductive age group ( 15-45 years age)
Target couple is • Newly married couple
• Couple with new child
• Couple with 1-3 child
Best indicators of prevalence of CPR ( Couple protection rate)
contraceptive practice in community is
Cafteriachioice/ Informed choice is Individual can choose according to needs and wishes
after offering all methods
Characteristics of Ideal cotraceptive is Easy available, Inexpansive, Simple to use, Safe,
Effective
NRR=1 can be achieved if CPR is >60%
Failure rate / Pearl index of No method 80/ HWY or %
use is
Failure rate of Calender/ Rhythm method 24 %
is
Failure rate of Coitus interruptus is 18%
Failure rate of Condom is 3-15 %
Failure rate of Male condom is 2-14 %
Failure rate of Female condom is 5-21%
Failure rate of Diaphragm is 12% (6-12 %)
Failure rate of Vaginal sponge is Null parity: 9-20 %
Parity: 20-40 %
Failure rate of Spermicidal jelly/Chaki is 10-25 %
Failure rate of Copper-T/IUD is 0.5-2%
Failure rate of Copper-T 380 A is 0.5-0.8%
Failure rate of progestasert is 2%
Failure rate of Lippes loop is 3%

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Failure rate of Oral pills is 0.1-0.5%

Failure rate of Centachroman/ Saheliis 1.83-2.84%
Failure rate of DMPA/ Depo 0.03%
Failure rate of Vasectomy is 0.15%
Failure rate of Jadelle/Norplant II 0.06%
Failure rate of LAM method is 2% if fully breastfeed
Failure rate of Laproscopic sterilization 0.1%
Failure rate of Tubectomy/ Minilap 0.15-0.5%
Types of Family Planning methods 2
• Spacing method/Temporary method
• Limiting/ Termination/ Permanent method
Temporary method of FP includes • Artifical:- Barrier, IUCD, Hormonal methods
• Natural:- Abistnence, Coitus interrupts,
Rhythm/Calender, Basal body temperature, Cervical
method, LAM, Symptomatic method
Permanent method of FP includes Male: Vasectomy
Female: Laproscopy, Tubectomy/Minilap
Barrier methods includes Physical: E.g Condom, Diaphragm
Chemical: E.g Spermicidal jelly
Mixed: Vaginal Sponge
Hormonal methods includes OCP & Depot ( slow release)
Condom is also known as " Dual protection device" because it prevent
pregnancy as well as HIV and STIs
Female condom is known as Femidom
Male condom is made of Latex
Female condom is made of Polyurethane/ Nitrile polymer/ Latex
Most common cause of condom failure is Incorrect use
Diaphragm is also known as Vaginal or Cervical cap/ " Dutch cap"
Diaphragm is made of Soft latex or Silicon
Diameter of Diaphragm is 5-10 cm
Diaphragm should be placed/used 3 hour before intercourse and is to kept atleast6
hours after last coitus
Along with Diaphragm always placed 5 ml spermicidal jelly
Diahragm gives protection against PID & Human papilloma virus ( HPV)
Diaphragm leads to Toxic shock syndrome Left in site for > 24 hours
if
Trade name for Vaginal sponge is " Today"
Vaginal sponge is made up of Polyurethane
Vaginal sponge is impregnated/used with 1 gm Nonoxynol-9 , as spermicide.
Nonoxynol-9 acts as Surfactant which immobilizes or kills sperm
Vaginal Sponge should be removed after 6 hours of intercourse
Vaginal sponge can lead to Toxic shock syndrome
Spermicide contains surfactants like Nonoxynol-9, Octoxynol, Benzalkonium chloride
Foam tablest ( Spermicide) are intorduced At least 5 minute prior to intercourse
in vagina

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IUD is used in Uterus

IUD is made up of Polythene
Types of IUD 2 Types ( Medicated & Non-medicated)
Generation of IUD 3 Generation ( First, Second & Third)
First Generation IUD are Non-medicated. E.g Lippes loop, Grafenber's ring
Second Generation IUD are Medicated & Bioactive, Also known as Multiloaded
device. E.g CuT 380 A/Ag, CuT 220B, CuT 7
Third Generation IUD are Hormonal releasing [Link], LNG-IUD
Number (7, 220, 380) in CuT represents Surface are of Copper ( in sq. mm)
B in CuTB represents Size of IUD
A or Ag in CuT 380 A represent Silver or Gold with copper
Most commonly used IUD in Nepal is CuT 380 A/Ag
Radioopaque materials in Copper-T is Barium sulphate
CuT 380 A should be replaced in Every 10 years
Progestasert should be replaced in Every 1 year
Copper IUDs should be replaced in Every 3-5 years
First Hormonal uterine device is Progestasert
Progestasert contains 38 mg progesterone
Rate of hormone release from 65 mcg/day
progestasert is
Mode of Action of IUD are Copper inhibits Sperm motality, Capacitation &
survival While hormonal IUD also inhibits
implantation
Most common side effects of IUD is Increased Bleeding
Most common cause of IUD removal is Pain
Expulsion rate of IUD is 12-20 %
Mortality rate due to IUD is 1 death per 100000
Absolute contraindication of IUD are Suspected pregnancy, PID, Vaginal bleeding of
undiagnosed etiology, Cancer of cervix, uterus or
adnexa or other pelvic tumors, Previous ectopic
pregnancy
Timing of IUD insertion are • During menstruation or with in 10 days of
beginning of menstrual period
• During 1st week after delivery
• 6-8 weeks after delivery
Best time for IUD insertion is During menstruation or with in 10 days of beginning
of menstrual period
As Emergency contraceprion IUD should 5 days ( 120 hours) of unprotected sexual
be used with in intercourse
Insertion of IUD as emergency >99% effective ( More effective than emergency
contraception is contraceptive pills)
Composition of Combine OCPs is Ethinyl estradiol : 0.03 mg ( 30 mcg) + Norgestrel:
0.15 mg (150 mcg)
Composition of New low dose OCPs is Ethinyl estradiol: 0.02 mg (20 mcg) + Desogestrel:
0.15 mg (150 mcg)

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One Cycle of OCPs contains 28 Pills ( 21 hormonal as white + 7 Iron as grey pills)
Iron in Combined OCPs is Ferrous fumerate 35 mg
Brand name of Combine OCPs are Gulaf, Nilocon, Kanchan
Starting time of Combine OCPs is 5th day of menstruation
Effectiveness of Combine OCPs is 99.7% ( Almost 100%)
Mode of Action of Combined OCPs are Inhibit ovulation and tubal motality, Make cervical
secretion mucus thick, Makes endometrium thin
Most common side effects of OCPs is Dizziness
Other are ( Brest tenderness, Weight gain, Headache
& migraine, Bleeding disturbance)
Combine OCPs increased risk of Cervical cancer & Breast cancer
Combined OCPs prevents from • PID
• Ovarian cancer & Endometrial cancer
• Ectopic pregnancy
Absolute contraindication of Combined • Breast cancer
OCPs are • Genital cancer
• Liver disease
• Pregnancy
• Undiagnosed abnormal uterine bleeding
• Cardiac abnormalities
• History of Thromboembolism
• Congenital hyperlipidemia
Relative contraindication of OCPs are Age > 40 years & Smoking and age > 35 Years
Synthetic NON-STEROIDAL oral Centchroman ( Brand name : Saheli)
contraceptive is
Chemical used in Centchroman is Ormeloxifene
Centchroman is also known as " Once a week pill"
Centchroman is only one Anti-implantation agent approved for clinical use
Uses of Centchroman • As a contraceptive
• To treat Dysfunction uterine bleeding
Dose of Centchroman is 30 mg Twice a week for 3 months then
1 tab ( 30 mg) per week
Contraindication of Centchroman are Stein leventhal syndrome, Cervical hyperplasia,
Recent hyperplasia, Recent h/o jaundice, Severe
allergic dsz
Progesterone only pills ( POP) is also Mini pills or Micro pills
known as
Progesterone only pills contains Norethisterone or Levonorgesterol
Once a month pills is also known as Long acting pills
Once a month pills contains Quinestro as Estrogen
Male pills is also known as Gossy pills
Male pills is made up of Cotton-seed oil
Male pills causes Azoospermia by inhibiting spermatogenesis
Combine OCPs as emergency 72 hours of unprotected intercourse
contraception should be used with in -4 Pills immediately followed by 4 pills 12 hour later

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(Pills with 30 mcg estrogen)  Current used

-If POP: 1 Tab (0.75 mg) with in 72 hours of
intercourse and 2nd tablet 12 hours of first dose)
Depot Formulations are • Injectable: DMPA & NET-EN
• Subdermal: Norplant &Jadelle ( Norplant II)
• Vaginal rings
DMPA stands for Depot Medroxy Progesterone Acetate
DMPA is also known as " संगीनसुई" / " तिनमहिनेसुई" / Depo
Dose of DMPA/Depo is 150 mg X im every 3 months
Side effects of DMPA/ Depo is Disruption of Normal menstrual cycle
&Amenorrhoea, Weight gain
Time of DMPA/Depo injection With in 5 days of menstrual cycle
Mode of Action of Depo is • Inhibition of Ovulation
• Makes cervical mucus thick & viscid-prevent sperm
penitration
•Endometrium atrophic- prevent blastocyst
implantation
DMPA/Depo prevents from • PID
• Endometriosis
• Ectopic pregnancy
• Ovarian cancer
Time taken to return fertility after 4-8 months
DMPA /Depo discontinuation is
NET-EN stand for NorethiateroneEnanthate
Dose of NET-EN is 200 mg X im every 2 months
Norplant consists of 6 silastic ( Silicon rubber) rods, each containg 35 mg
Levonorgestrol ( Total: 210 mg Levonorgestrol)
Jadelleia also known as Norplant II
Jadelle consists of 2 Capsules/rod, each containing 75 mg
Levonorgestrol ( Tota 150 mg Levonorgestrol)
Jadelleworks for 3 Years
Size of Jadelle rod/capsule is Length: 4 cm & Diameter ( 2.5 mm)
Daily release of Levonorgestrol from 50 mcg/day
Jadelle is
Most effective contraception method Jadelle ( 99.95% effective)
among Temporary is
Gold Standared method for Emergency Copper IUDs / IUCD
contraception is
Methods for Emergency Contraception are • Copper IUDs Insert with in 5 days
• Levonorgestrol (POP) 0.75 mg X stat & after 12
( Execept IUDs all Emergency hours
contraception should be used with in 72 • Mifepriston 100 mg X single dose
hours of Unprotected sexual intercourse) a • Ethinyl estradiol 2.5 mg X BD for 5 days
• Ethinyl estradiol ( 50 Ug) + Norgestrol (0025 mg)
2 tab stat & 2 tab after 12 hours

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Most common side effects of Emergecy Nausea

contraceptive is
Only one method of birth control which is Sexual abstinence
completely effective is
Oldest method of Voluntary fertility Coitus interruptus/ Withdrawl method
control is
Cervical Mucus method is also known as " Billing's method" / " Ovulation method"
Basal Body Temperature (BBT) Methods is Increased progesterone production
due to
Temperature rise during Ovulation is 0.3-0.5° C
Safe period method is also known as Rhythm method/ Calendar method/ Programmed
sex
Fertile Period is Shortest cycle -18 days
Longest cycle -10 days
Vasectomy is An operation in which Vas deferens are separated
During Vasectomy , Removal of Minimum 1 cm
vasdeferens is
After Vasectomy, Condom should be use 30 Ejaculations /3 months
for
After Vasectomy person is not sterile up to 30 Ejaculations
Newly used method of Vasectomy is Non-Scalpel vasectomy
Non-scalpel vasectomy is also known as "Key hole vasectomy"
After Vasectomy, Stitch should be 5th day
removed on
Bandage used after Vasectomy is T-shape bandage for 15 days
After Vasectomy, avoid bathing for 24 hours of operation
Most cost effective contraceptive Vasectomy ( Sterilization)
measures is
Most common cause of failure of Mistaken identification of Vas deferens
Vasectomy is
Confirmation of Vasectomy is done by Histological confirmation oR" Wright's stain"
Ideal time of female sterilization is Proliferative phase of menstrual period
Time of Female sterilization are • During puerperium: 24-48 hours following
delivery
• Interval: Beyond 3 months following delivery or
abortion
• Concurrent with MTP ( Abortion)
Tubectomy is also known as Minilap
Tubectomy is An operation where resection of a segment of both
the fallopian tube is done to achieve permanent
sterilization
Laproscopy is Commonlyemployed methods of endoscopic
sterilization
In Laproscopy the tubes are occluded by Silastic ring or Filshie clip

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 Facts on Nutrition.

Nutrition is defined as Branch of Medical science which deals with food and it’s
relation to health
Nutrients are Organic and Inorganic complexes contained in the food
Types of Nutrients are 2 ( Basis of quantity)
• Macronutrients:- Carbohydrate, Fat & Protein
• Micronutrients:- Vitamin & Minerals
Major minerals are :- 5 Sodium, Potassium, Magnesium, Calcium, Phosphorus
Trace elements are Iron, Iodine, Fluorine, Zinc, Copper, Cobalt, Selenium,
Chromium, Manganese, Nickel, Tin, Silicon, Vanadium
Trace contaminants ( No known Lead, Mercury, Barium, Boron, Aluminium
function in body)
Macronutrients are also known as " Proximate principles" of diet
Micronutrients are also known as " Hidden hunger " of diet ( Especially Iodine)
Composition of Balance diet is • Carbohydrate:- 50-70 %
• Fat:- 15-30% of total daily energy intake
• Protein:- 10-15 %
On the basis of function, Nutrients 3 types
are • Body building :- proteins
• Energy giving:- Carbohydrates & Fats
• Protective food:- Viatmins, Minerals & Protein
Energy Yield by Carbohydrates 4 Kcal per gram ( Exact: 4.3 Kcal) Or 17 Kj
Energy Yield by Protein 4 Kcal per gram ( Exact: 4.1 Kcal) Or 17 Kj
Energy Yield by Fat 9 Kcal per gram Or 37 Kj
Energy Yield by Alcohol 7 Kcal per gram
Energy Yield by Dietary fibres 2 Kcal per gram
Energy Yield by Human Milk 65 Kcal per 100 ml ( 65-70 Kcal/100 ml)
Energy Yield by Sarbottam pitho 350-370 Kcal per 100 gm
Carbohydrate is reserve in human Glycogen
body in form of
Amount of carbohydrate reserved by 500 gram
human body is
Deficiency of Carbohydrates leads to Marasmus
Dietary Fibres reduces risk of Constipation and CHD ( Coronary Heart Disease)
Daily requirements for Dietary Fibre 40 grams
by an adult is approx
Smallest unit of Carbohydrate is Glucose
1 Molecule of glucose produces 38 ATP Energy ( by Glycolysis process)
Carbohydrate constitutes about 1% of the body weight in Human
Protein constitutes about 20% of the body weight
Protein is differ from Carbohydrate & Nitrogen & Sulphur
Fat in sense of
Smallest unit of Protein is Amino acid

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Total Amino acid required for human 24

body is
Essential Amino acid are 10( PVT TIM HALL)
" Don't syntesize in body" • Phenylalanine
• Valine
• Threonine
• Tryptophan
• Isoleucine
• Methionine
• Histidine:- Semi-essential ( Only for Adult)
• Arginine :- Semi-essential ( Only for Child)
• Leucine
• Lysine
Non-essential Amino acids are Cysteine, Asparate, Alanine, Glutamine, Glycine Serine,
Proline, Asparagine
Animalsproteins are Biologically complete protein ( Contains all Essential
Amino acid)
Plantproteins are Biologically incomplete protein
Reference protein is Egg ( Because it has highest NPU 96%)
Net Protein Utilization ( NPU) of Cow 81%
milk is
NPU of Meat is 79%
NPU of Fish is 77%
Protein content in Soyabean is 43 gm per 100 gm
Richest sources of Protein is Soyabean
Soyabean is also known as " Poor Man's meat"
Protein content of Eggs 13 gm per 100 gm
Protein content of Milk ( Cow) 3 gm per 100 ml
Best Indicators of protein quality is NPU ( Net Protein Utilization)
Limiting Amino acidin Cereals is Threonine & Lysine
Limiting Amino acid in Pulses is Methionine & Cysteine
Limiting Amino acid in Maize is Tryptophan & Lysine
Tryptophan is required for Niacin synthesis
60 mg Tryptophan is required to form 1 mg Niacin
Maize eater are prone to Pellagra
Deficiency of Proteins lead to Kwashiorkor
Fats constitute about 10-15 % of total body weight
Types of Fats 3
• Simple lipid:- Triglycerides
• Compound lipid:- Phospholipid, Glycoipid, Lipoprotein
• Derived lipid :- Cholesterol, Glycerol, Fatty acids
1 Kg of Adipose tissue provides 7700 Kcal energy
Most abudant lipid is Simple lipid ( Triglycerides)
Smallest form of Fat is Fatty acid + Glycerol
Types of Fatty acids 2

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• Saturated Fatty acid:- From animal source except Fish

oil .E.g Lauric, Palmitic acid, Stearic acid
• Unsaturated Fatty acid:- From Plant source except
Coconut and Palm oil.E.g Linoleic acid, Linolenic acid,
Arachidonic acid
Essential Fatty acids are 4
• Linoleic acid
• Linolenic acid
• Arachidonic acid
• Eichosapentanoic acid
Most Important Essential Fatty Acid Linoleic acid
( EFA) is
Deficiency of Essential Fatty Acid " Phenoderma" i.e Toad like skin
leads to
Richest source of Essential Fatty acid Safflower Oil ( 73% Content)
is (2nd reach source is : Corn oil-57%)
Essential Fatty Acid ( EFA) were "Vitamin F "
earlier known as
Types of Vitamins 2
• Fat soluble:- Vitamin A, D, E & K
• Water soluble :- Vitamin B & C
Vitamin A is also known as Anti-infective vitamin
Ready made / Preformed form of Retinol ( Found in Animal sources)
Vitamin A is
Proformed form of Vitamin A is Beta-carotene ( Found in plant sources)
Retinol is responsible for Rhodopsin Dim light vision
pigment formation, which is needed
for
Vitamin A is stored in Liver in form of Retinol palmitatefor 6-9 months ( 6 Months)
Richest Source of Vitamin A is Halibut liver oil
Deficiency of Vitamin A causes Xerophthalmia ( Dry eye)
Xerophthalmia is most common in 1-3 Years
children aged
First clinical sign of Vitamin A " Cunjunctivalxerosis"
deficiency is
First clinical symptoms of Vitamin A " Night blindness"
deficiency is
Grave medical emergency of Vitamin " Keratomalacia" ie Liquefaction of cornea
A deficiency is
Serious manifestation of Vitamin A " Corneal xerosis"
deficiency is
Definite sign of Vitamin A deficiency " Bitot's spot "
is
Xerophthalmia is public health >1%
problem if prevalence of Night

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blindness is
Xerophthalmia is public health >0.5%
problem if prevalence of Bitot's spot
is
Treatment of Xerophthalmiarequired 3 doses of vitamin A
• 1st day:- 200000 IU stat
• 2nd day:- 200000 IU
• 28th day:- 200000 IU
Vitmin D is also known as Kidney hormone / Sunshine vitamin
Vitamin D exists in 2 forms • D2:- Ergocalciferol
• D3:- Cholecalciferol
Cholecalciferol is synthesized in 5 minutes
body , exposure time required to
sunlight is
Richest source of Vitamin D is Halibut liver oil
Vitamin D is responsible for Calcium and phosphorus absorption
Deficiency of Vitamin D causes • Rickets in children
• Osteomalacia in adults
Vitamin E is also known as Tocopherol/ Beauty vitamin/ Anti-sterility vitamin/ Anti-
Oxidant vitamin/ Anti-ageing/ Anti-Cancer vitamin
Richest source of Vitamin E is Vegetable oil
Deficiency of Vitamin E causes Hemolytic disease of newborn, Sterility
Vitamin K is also known as Phylloquinone / Anti-bleeding vitamin/ Gut vitamin
K1 is found in Cow milk & Dark green vegatables
Vitamin K2 is synthesize in Large intestine ( Colon) by E. Coli
Richest source of vitamin K is Cow milk
Vitamin K is responsible for synthesis Clotting factors 2,7,9 & 10
of
Deficiency of Vitamin K causes Bleeding disorder , Hemorrhagic disease of newborn
Vitamin B1 is also known as Thiamine
Thiamine is responsible for Carbohydrates utilization
Praboiling of Rice prevents from Thiamine deficiency
Richest source of Thiamine is Gengelly seed ( 2nd reach: Whole grains)
Deficiency of Thiamine causes • Beri-beri
• Wernick'sencephalopathy
• Korasoff psychosis
Types of Beri-beri 3
• Dry Beri-beri: Nerve involvement
• Wet Beri-beri: Heart involvement ( Cardiac Beri-beri)
• Infantile Beri-beri: Neuropathy
Wernick's encephalopathy is seen in Chronic alcoholic patients
Clinical Features of Wernick's " GOA"
encephalopathy includes • Global confusion
• Ophthalmoplegia
• Ataxia

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Alcoholic are at greater risk of Thiamine deficiency

Vitamin B2 is also known as Riboflavin
Deficiency of Riboflavin causes Ariboflavinosis, Angular stomatitis, Glossitis&Cheilosis
Richest source of Riboflavin is Sheep liver
Vitamin B3 is also known as Niacin / Nicotinic acid/ Niacinamide
It is differ from Vitamin B-complex in Essentail Amino acid Tryptophan as its precursor
sense of
For Niacin formation Tryptophan is required
60 mg Tryptophan produces 1 mg Niacin
Richest source of Niacin is Liver meat
Deficiency of Niacin cause Pellagra & Casal's Necklace
Pellagra is also known as 4 D's disease / Poor man's disease
Pellagra is more prevalence in Maize eating community
Pellagra is characterized by • Diarrhoea
• Dementia
• Dermatitis
• Death
Vitamin B5 is also known as Pantothenic acid
Deficiency of Pantothenic acid causes "Burning feet syndrome"
Vitamin B6 is also known as Pyridoxine/ Pyridoxamine/ Pyridoxal
Richest source of Pyridoxine is Milk
Vitamin given with Anti-tubercular Pyridoxine
drugs is
Deficiency of Pyridoxine causes Peripheral neuritis & Anemia
Vitamin B7 is also known as Biotin
Deficiency of Biotin causes Dermatitis &Enteritis, Alopecia
Vitamin B9 is also known as Folic acid/ Folinic acid
Richest source of Folic acid is Liver meat
Folic acid is responsible for Nucleic acid synthesis & Blood cell formation
Most common deficiency in Folic acid deficiency
pregnancy & lactation is
Amount of Folic acid stored in body is 5-10 mg
Deficiency of Folic acid causes Megaloblastic anemia & Neural tube defects ( Spinal
bifida)
Earliest manifestation of Folic acid Diarrhoea
deficiency is
Vitamin B12 is also known as Cyanocobalamin/ Hydroxycobalmin/ Methylcobalmin
Vitamin containing minerals or Cyanocobalmin, it contains minerals Cobalt atom
metallic comound is
Highly heat stable vitamin is VitaminB12
Vitamin B12 is stored in Liver for 1-3 years
Vegetarin are at higher risk of Vitamin B12 deficiency
For Vitamin B12 absorption from Intrinsic factor is required
ileum
Richest source of Vitamin B12 is Liver meat

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Deficiency of Vitamin B12 causes Megaloblastic anemia

Deficiency of Intrinsic factor causes Pernicious anemia
Vitamin C is also known as Ascorbic acid / Anti-oxidant vitamin/ Anti-viral vitamin/
Anti-Cancer vitamin/ Heart beating vitamin/ Anti-cold
vitamin/ Circulatory vitamin/ Immunity Vitamin
Most heat sensitive vitamin is Vitamin C
Most water soluble vitamin Vitamin C
Richest source of Vitamin C is Amala ( Indian gooseberry)
Amount of Vitamin C stored in body 5 gm
is
Deficiency of Vitamin C cause Scurvy
Vitamin synthesize by colon bacteria Vitamin K2 &Vitamin B12
are
Amount of Calcium in human body 1200 gram ( 1.5-2% of body weight)
Amount of Potassium in human body 250 gram
The desirable sodium and potassium 1:1 ( in mmol)
ration in diet is
Amount of Magnesium in human 25 gram
body
Amount of Iron in human body 3-4 gram
Amount of Sodium in human body 100 gram
Most abudant mineral in our body is Calcium
Serum calcium are maintained by Vitamin D, Parathormone, Calcitonin
Richest source of Calcium is Milk and Milk products
Deficiency of Calcium causes Tetany & Impaired bone mineralization
Excess of Calcium causes Hypercalcemia
Calcium absorption is decreased by Spinach, Phylates, Oxalates & Fatty acid
Phosphorus is responsible for Bone & Teeth Formation
Daily requirements of Phosphorus is 400-500 mg/day
Iron is absorbed from Duodenum ( Vitamin C , Iron & Calcium)
Vitamin C helps in Iron absorption
Iron absorption is inhibited by Phosphate, Milk, Tea, Egg, Oxalates, Carbonate
1 mg Iron forms 2 ml of blood
1 gm Hb contains 3.34 mg of Iron
1 gm of Hb carry 1.34 ml of oxygen
Daily loss of Iron Male:- 1 mg/day
Female: 2 mg/day
Iron is stored in body in form of Serum ferritin
Deficiency of Iron causes Iron Deficiency Anemia ( IDA)
Iodine is responsible for Thyroid hormone formation (T3 & T4)
• T3:- Tri-Iodothyronine
•T4- Thyroxin
Amount of Iodine in human body is 50 mg
Blood level of Iodine is 8-12 mcg/dl
Goitrogens are Chemical substances leading to development of Goitre

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Cabbage & cauliflower are Goitrogens

Most widely used Iodisation of salts
prophylaticmeasures against
prevention of Goitre is
Level of Iodisation in salt • Production level:- 50 ppm
• Retailer level: 30 ppm
• Consumer/ household level: 15 ppm
Richest source of Iodine is Sea foods (Oysters & Lobsters are reachest source ))
Deficiency of Iodine causes • Goitre
• Hypothyrodism
• Physical & Mental retardation
• Increase rate of spontaneous abortion &stll birth
Minimum urinary Iodine excretion >100 mcg/Litre
should be
Environmental Iodine deficiency is Neonatal hypothyrodism
indicated by
Most abudant elements in nature is Fluorine
Fluorine is responsible for Normal mineralization of bones and formation of teeth
96% of fluorine are found in Bones and teeth
Fluorine are often known as " Two-edged sword"
Excess of fluorine causes Dental & Skeletal fluorosis
Deficiency of fluorine causes Dental caries
The recommended level of Fluorides 0.5-0.8 mg/Litre
in drinking water is
Zinc is a component of more than 300 Enzymes
Amount of Zinc in human body is 1.4-2.3 gram
Zinc is required for synthesis of Insulin hormone by pancrease
Deficiency of Zinc leads to • Growth failure & Sexual infantilism
• Loss of taste & delayed wound healing
Zinc combination with ORS reduces Duration and Severity of acute and persistent diarrhoea
Severe maternal Zinc deficiency may Spontaneous abortion & Congenital malformation like
leads to Anencephaly
Daily requirement of Zinc is • Men:- 12 mg/day
•Women:- 10 mg/day
• Infants:- 5 mg/day
Amount of copper in human body is 100-150 mg
Daily requirements of Copper is 2 mg/day
Excess of Copper causes Hypercupremia
Deficiency of Copper causes Neutropenia
Abnormal accumulation of Copper Wilson's disease
leads to
Most Important Extracellular Sodium
electrolyte is
Sodium is lost from body through Urine & Sweat
Deficiency of Sodium leads to Muscular cramps & Hyponatremia

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Excess of Sodium leads to Increase BP & Hypernatremia

Most Important Intracellular Potassium
electrolyte is
Reachest source of Potassium is Banana
Excess of Potassium leads to Low BP & Hyperkalemia
Egg contained all nutrients except 2 C ( Carbohydrates & Vitamin C)
Weight of egg is 60 gram
Egg Contains • Proteins: 6 gm
• Fat:-6 gm
• Calcium:- 30 mg
• Iron:- 1.5 mg
•Cholesterol:- 250 mg
1 Egg provides energy of 70 Kcal
Egg Contain all 9 essential amino acid Reference protein
so known as
Best among food protein is Egg protein
Boiled egg is superior than raw egg " Avidin" is destroyed ( Avidin prevents Biotin absorption)
because
Digestibility of Egg is 100% ( NPU:-96%)
Digestibility of Meat is 80%
Digestibility of Fish is 75%
Fish is poor source of Carbohydrates
Meat is poor source of Calcium
Milk is poor source of Vitamin C & Iron
Egg is poor source of Vitamin C & Carbohydrates
Richest source of Vitamin A & D is Halibut liver oil ( Fish liver oil)
Reachest source of Vitamin C is Indian Gooseberry ( Amla)
Reachest source of Thiamine Gingelly seeds
Reachest source of Riboflavin is Sheep liver oil
Richest source of Iron is Pistachio
Richest source of calcium is Milk & Milk product
Richest source of protein is Soyabean (43.2 % protein)
NPU of Soyabean is 55%
Limiting Amino acid in Soyabean is Methionine
The chief protein of milk is Casein
Human milk iareachest than others Water, Lactose &VitaminC
milk in • Water:- 88 gm /100 ml
• Lactose/sugar:- 7.4 gm/100ml
•Vitmin C:- 3 mg/100 ml
Energy Yield by Human milk is 65 Kcal/100 ml (65-70 Kcal)
Buffalo milk is reachest than other Fat, Protein, Mineral, Calcium & Energy
milk in • Fat:- 6.5 gm/100 ml
•Protein:- 4.3 gm/100 ml
•Minerals:- 0.8 gm/100 ml
• Calcium:- 210 mg/100 ml

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•Energy:- 117 Kcal/100 ml

Skimmed milk is Fat removed milk
Tone milk is Concentration changed milk
Clostrum milk is First milk from mother breast
Hind milk is Last milk frommother breast
Witch milk is Milk from breast of newborn

 Facts on Child Health & Intervention

Facts on Child Health & Intervention

Ovum 0-2 weeks
Embryo 2-9 weeks
Fetus 9 weeks-Delivery
Period of Viability POG : > 28 weeks
Perinatal period is 28 weeks POG -7 days post delivery
Neonatal Period 0-28 days after birth ( 0-4 weeks post delivery)
Early Neonate 0-7 days after birth ( 1st week of life)
Late Neonate 8-28 days after birth
Post Neonate 29-365 days after birth
Infancy Birth-365 days (1st year of life)
Toddlers 1-3 years age
Pre-school age 3-6 Years ( 2-4 years)
School age is 5-14 Years
Puberty • Girls:- 10-12 Years
•Boys:- 12-14 Years
Adolescence 10-19 Years ( A/c to WHO)
Early adolescence 10-13 Years
Mid adolescence 14-16 Years
Late adolescence 17-19 Years
Youth 15-24 Years ( UN definition)
Younge people 10-24 Years
Reproductive age 15-44 Years or 15-49 Years
Geriatric age Above 60 Years
Normal weight of baby is 2.5-4 kg
Average birth weight of baby in Nepal 2.8 Kg
is
Low birth weight is (LBW) Newborn <2.5 kg
Very Low birth weight ( VLBW) is Newborn < 1.5 kg (1500 gm)
Extremely Low birth weight ( ELBW) is Newborn < 1 kg (1000 gm)
Small for Gestation (SGA) is Delivery of baby <10th centile in weight expected for
gestation
Appropriate for Gestation is Delivery of baby between 10th and 90th centile in weight
expected for gestation
Large for Gestation is Delivery of baby > 90th centile in weight expected for

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gestation
Growth is defined as Increase in size or mass of tissue
Development is defined as Increase in skill and function
Single best parameters for assessment Weight
of physica growth is
Single most sensitive measure of Weight
growth is
Single most reliable criterion of Weight
assessment of health and nutrition
status is
Birth weight preferably be measured 1st hour of life
with in
Birth weight of Newborn is measured Salter's scale
by
Field instrument for measurement of Salter's scale
birth weight is
Only one vaccine contraindicated in Hepatitis B vaccine
LBW baby is
Wasting is Low weight for height
Wasting is also known as Emaciation / Nutritional wasting
Wasting indicates Acute malnutrition
Stunting is Low height for age
Stunting is also known as Dwarfing/ Nutritional stunting
Stunting indicates Chronic malnutrition
Underweight is Low weight for age
Under weight indicates Acute & Chronic malnutrition
Gomez classification of malnutrition is 'Weight for age '
based on
Birth weight doubles at 5 Months
Birth weight Triples at 1 Year
Birth weight quadriples at 2 Year
Weight gain pattern in children Age Weight incremen
• 0-3 Months 200 grams per week
• 4-6 Months 150 grams per week
• 7-9 Months 100 grams per week
•10-12 Months 50 grams per week
• 1-2 Years 2.5 Kg per year
•3-5 Years 2 Kg per year
Average birth height in Nepal is 50 cms
Birth height / length doubles at 4 Years age
Height increase pattern in children Age Height increments
• 1st year 25 cms per year
• 2nd year 12 cms per year
• 3rd year 9 cms per year
• 4th year 7 cms per year

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•5th year 6 cms per year

Birth height at 1 year is 75 cms
Birth height at 2 years is 90 cms
Birth height at 4 years is 100 cms ( Double of birth height))
Height of newborn & Infants is Infantometer
measured by
Height of Adult is measured by Stadiometer
Mid Arm Circumference is measured by Shakir's tape :- Grade are
• Green :- > 12.5 cm ( Normal)
• Yellow :- 11.5-12.5 cm ( Mild)
• Red:- < 11.5 cm (Severe)
Head circumference at birth is 33-35 cms ( Average:34 cms)
Chest circumference at birth is 32cms ( Less than 3 cms of head circumference)
Head & Chest circumference are equals 1 Years age
at
Chest circumference exceed head After 1 year
curcumference
Head Circumference (HC) should be Occipito-frontal diameter
measured in
Head Circumference is measured by Fibre-glass tape
Head Circumference velocity in 0-3 2 cms per months
months age
During 1st year there is increase in Head 12 cms
circumference by
Adult head size is achieved by 5-6 years age
Body Mass Index ( BMI) Weight (kg)/ Height (m2)
Normal weight is having BMI 18.5-24.9
Under weight is having BMI <18.5
Over weight is having BMI 25-30
Obese is having BMI >30
Growth chart is also known as Road- to-Health chart
Growth chart was designed by David Morley but later on modified by WHO
Growth chart is the Passport to child's Health care
Growth chart is designed for Longitudinal follow-up ( Growth monitoring of a child)
Growth chart is generally plotted Weight and Age
between
Best availabestandared of Growth is NHCS standared( WHO reference value)
Most common cause of Malnutrition is Low Birth weight (LBW)
Most common cause of LBW is Prematurity
Most common cause of Prematurity is Toxemia pregnancy ( Eclampsia & Pre-eclampsi)
Neonatal screening is Secondary prevention
Most common Neonatal disorder to be Neonatal hypothyrodism
screened is
Most common cause of Congenital Iodine deficiency
hypothyrodism is

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To test Neonatal hypothyrodism, blood Cord's blood

sample is taken from
Infant Mortality Rate ( IMR) is ( No. of Infant deaths in a given year/ Total no. of live
births in same year) X 1000
Most important indicators of Health Infant Mortality Rate
status of a community
Most important indicators of Level of Infant Mortality Rate
living & Effectiveness of MCH services
in general is
Best Indicators of Socio-economic Under 5 Mortality rate (U5MR)
development of a country is ( 2nd best indicator is :- IMR )
Most common cause of Infant Mortality Pneumonia
in world is
Causes of NeonatalMortality is "I m BPH"
(Infection, Birth Asphyxia, Prematurity, Hypothermia )
Marker to assess the quality of health Perinatal Mortality Rate ( PNMR)
care delivery is
Perinatal Mortality includes both Still birth & Early neonatal death
WHO recommended exclusive breast 6 months
feeding till
WHO recommended breast feeding for Minimum 2 years
Energy content of breast milk is 65 Kcal/100 ml
Protein content of breast milk is 1.1 gram/100 ml
Daily milk production from mother 450-650 ml
breast is
Mean output of breast milk is 5-6 Months
maximum at Milk output is :- 730 ml/day
Frequency of breastfeeding to child •Day:- 2 hourly apart
• Night:- 3 hourly apart
Most suitable food immediately after Colostrum
birth of the baby is
Colostrum milks comes for 3-6 days after birth
Colostrum milk is also known as "Beestings"/ " First milk" / " Immune Milk"
Age independent parameters for Mid Arm Circumference ( MAC) & Stunting
growth assessment is
Hypothermia is also known as "Silent killer of newborn "
Hypothermia in newborn is defined as Newborn core body temperature <36.5 ° C ( 97.7 ° F)
Main cause of Hypothermia is Low birth weight/ Pre maturity
Types of Hypothermia is 2
• Mild:- 36.5-35.5 ° C
• Severe:- < 35.5 ° C
Heat loss mechanisms are 4 ( Radiation, Convection, Conduction & Evaporation)
Coast effective methods to prevent Kangaroo Mother care ( KMC)
Hypothermia and promote bonding and
breast feeding is

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Umbilical sepsis in newborn is mainly Staphylococcus aureus

caused by
Main causative agent for Ophthalmia Chlamydia trachomatis ( 2nd is Neisseria gonorrhoea)
neonatrum is
Neonatal jaundice is Yellowish discolouration of skin and mucus membrane
due to increase bilirubin level in blood.
Clinical jaundice is having bilirubin level 5-7 mg/dl
Breakdown of 1 gm Hb, produces 35 mg bilirubin
Neonatal jaundice is commonly seen in Pre-term baby
Types of jaundice in neonates 2 Types
• Physiological jaundice
• Pathological jaundice
Physiological jaundice is Jaundice appearing after 24 hours or with in 15 days of
birth
Pathological jaundice is Jaundice appearing with in 24 hours or after 15 days of
birth
Treatment of neonatal jaundice is done Phototherapy ( Fluorescent lamp is best)
by
Most common birth injury is Soft tissue injury
New born danger signs are 9 Dangers sign of new born
• Unable to suck
• Lethargy/ Unconsciousness
• Fast breathing/ Severe chest indrawing/ Grunting
• Hypothermia/ Hyperthermia
• Skin pustules > 10 or large abscess pustules
• Convulsion
• Severe jaundice
• Vomiting all
• Umbilical redness extending to sourrounding
Most common cause of diarrhoea in Rota virus
child is
Common cause of chronic diarrhoea in Giardia lamblia
child is
Hostel diarrhoea is caused by Giardia lamblia
Steps of Hand washing are 6 Steps
Main aspects of hand washing is Friction
Best way to prevent Iatrogenic Hand washing
infection is
Hypoglycemia is defined as Blood glucose level <40mg /dl
Main cause of hypoglycemia in Low birth weight
Neonates is
Management of hypoglycemia is done Dextrose by Iv
by
Malnutrition is defined as A pathological state resulting from a relative or
absolute deficiency or excess of one or more essential

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nutrients
Most common age group for Protein 1-3 Years age
Energy malnutrition is
Types of Malnutrition 2 types
• Over nutrition
• Under nutrition
Over nutrition includes Over weight and Obesity
Under nutrirition includes Wasting, Under weight, Stunting & Micro nutrient
deficiency
Wasting indicates Acute malnutrition
Acute Malnutrition is of 2 Types
• SAM ( Severe Acute malnutrition)
• MAM ( Moderate Acute malnutrition)
MAM ( Moderate Acute Malnutrition) Marasmus, Kwashorkor&Marasmic-kwashiorkor
includes
Marasmus occur due to deficiency of Calorie
Features of Marasmus are • Little's old man face
• Monkey Face
• Loss of subcutaneous fat
• Baggy pants appearance
Kwashiorkor occur due to deficiency of Protein with calorie
Features of Kwashiorkor are • Moon face
• Flag sign
• Flaky pant dermatitis
• Enamel spot
• Syndrome of displaced child
• Puffyness of face
• Sugary baby & Healthy look
CB-IMNCI stands for " Community-Based Integrated Management of
Neonatal and Childhood illness"
Age group of Child managed by 2 Months-5 Years child
CBIMNCI is
Disease under CB-IMNCI are 5 Disease ( 3 MAD-ARI)
• Measles
• Malaria
• Malnutrition
• Diarrhoea
• ARI
CB-IMNCI was established in Nepal in 2014 AD (14th October)
CB-IMNCI was started in Nepal in 2015 AD from 3 pilot district
A/c to CB-IMNCI, ARI is defined as Infection of Ear, Nose & Respiratory tract
General Danger sign in CB-IMNCI are 4 signs
• Unable to feed and drink
• Vomiting all
• Convulsiom

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• Lethargic/Unconsciousness
Types of Pneumonia a/c to CB-IMNCI 3 Types
• Severe pneumonia/ Very Severe disease
• Pneumonia
• No pneumonia/ Cough cold
Features of Severe pneumonia are General danger sign OR Stridor in calm child
Management of Severe pneumonia Give appropriate dose of antibiotics (Ampicillin/
includes Gentamicin) and refer to higher center
Features of Pneumonia are • Chest indrawing OR Fast breathing
Management of pneumonia includes • Amoxicillin : BD for 5 days
Follow up visit in Pneumonia 3 days
Fast breathing a/c to CB-IMNCI is • < 2 months child:- >60 /min
• 2 -12 months child :- >50/min
• 12 months-59 months:- > 40/min
Follow up visit in No pneumonia 5 days
Management of No pneumonia Home therapy
includes
A/c to WHO, Diarrhoea is defined as Passage of stool weight > 250 gm with 70-95% water in
24 hours
Generally diarrhoea is Passage of watery stool 3 or more times in 24 hours
Types of diarrhoea a/c to CB-IMNCI 3
• Severe persistent diarrhoea :- > 14 days with
dehydration
•Persistent diarrhoea :- > 14 days no dehydration
• Dysentry:- Blood and mucus mixed stool
Dose of Vitamin A in diarrhoea is Single dose
Treatment of Dysentry is done by Ciprofloxacin for 3 days
In Diarrhoea Zinc tablet is given for 10 Days
Dose of Zinc tablet is • 2 -6 Months:- 10 mg X OD for 10 days
• 6-59 Months :- 20 mg X OD for 10 days
Types of Dehydration a/c to CB-IMNCI 3 Types
• Severe Dehydration
• Some Dehydration
• No dehydration
Criteria for Severe dehydration " Any of 2 of the following"
• Lethargy / Unconsciousness
• Sunken eyes
• Unable to drink
•Skin pinch goes back very slowly ( >2 sec)
Management of Severe dehydration is Treatment plan " C"
done by
Choice of Iv fluid in treatment plan "C" Ringer lectate
Amount of IV fluid given in Plan "C" 100 ml /kg ( Ringer lectate) – First 30 ml/kg then 70
ml/kg
Criteria for Some dehydration " Any of 2 of the following"

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• Restlessnes / Irritable
• Sunken eye
• Drink eagerly
• Skin pinch goes back slowly (<2 sec)
Management of Some dehydration is Treatment plan "B"
done by
In treatment Plan "B " ORS is given with in 4 hour (a/c to age group& weight)
In treatment Plan "B" if weight is 75 ml/kg
unknown then amount of ORS given is
Criteria of No dehydration is No sign & symptoms of dehydration
Management of No dehydration is Treatement plan " A"
done by
Treatement Plan "A " includes Home therapy which includes :- 4 rules
• Give Extra fluid
• Give Zinc tablet
• Continue feeding
• Know when to return ( In 5 days)
In treatement Plan "A" amount of ORS Up to 2 Years:- 50-100 ml after each loose stool
given is Above 2 Years:- 100-200 ml after each loose stool
Recently prepared ORS should be used 24 Hours
with in
Diarrhoea kills because of Dehydration
Types of Measles a/c to CB-IMNCI 3 Types
• Severe complicated Measles
• Measles with complication of eye and mouth
• Measles like illness
Criteria for Severe complicated Measles • Any danger sign OR
• Clouding of cornea OR
• Deep or extensive mouth ulcers
Management of Severe complicated • Give Vitamin A
Measles includes • Give first dose of appropriate antibiotics
• If Clouding of cornea or pus draining from the eyes:-
Tetracycline eye ointment is used
• Refer to higher center
Criteria for Measles with Eye and Pus draining from the eye & Mouth ulcers
mouth complication
Management of Measles with Eye and • Give Vitamin A
mouth complication includes • If pus draining from eye:- Use Tetracycline eye
ointment
• If Mouth ulcer:- Use Gention voilet
• Advice to follow up visit in 3 days
Management of Measles like Illness Give Vitamin A & Manage a/c to Case Based Measles
includes surveillance
Classification of Malnutrition a/c to CB- 3 Types
IMNCI • Severe Acute Malnutrtion (SAM)

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• Moderate Acute Manutriton (MAM)

• No Malnutrition
Criteria for Severe Acute Malnutrition Includes
(SAM) • Severe Vissible wasting of muscle OR
• Edema of both feet OR
• MAC : < 115 mm ( Red)
• Weight for Age less than -3 S.D
Criteria for Moderate Acute Includes
Malnutrition ( MAM) • MAC:- 115-125 mm ( Yellow)
• Weight for age is between <than -2 to -3 S.D
Criteria for No Malnutrition Includes
• MAC:- > 125 mm ( Green)
• Weight for age is normal
• Weight for height is normal
Earache is commn in children, usually Middle Ear infection
due to

 Facts on Reproductive Health & Intervention.

Facts on Reprpductive Health & Intervention

Gynecologyisdefinedas Branch of medical science that deals with women's disease
especially those affecting the reproductive system
Obstetrics is defined as The field of study concentrated on pregnancy, Child birth and
post partum period
Midwifery is defined as Art of assisting women at child birth
Neonatalogy is defined as Study of Neonates
Menstruation is defined as Periodic discharge of blood and Mucous from the inner lining of
non-pregnant uterus.
Normal duration of Menstrual 21-35 days ( Average :- 28 days)
cycle is
Normal blood loss during 30-80 ml ( Average blood loss is :- 50 ml)
Menstrual cycle is
Menarche is First menstruation / Onset of menstrual cycle
Age:- 12-15 Years ( Average:- 13 Years)
Menopause is Permanent cessation of menstrual cycle at age 45-55 Years
( Average:- 51 Years)
Reproductive age is The age between 15-49 years at which in any time the girl can be
preganant
Conception is Being pregnant/ conceiving child
Gravida is No. of pregnancy
Primi gravida is First pregnancy
Multi gravida is Pregnancy more than one time
Grand Multi gravida is Pregnancy for 4 or more than 4 times

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Para is No. of pregnancy which crosses > 22 weeks

Primi para is First pregnancy which crosses > 22 weeks
Multi para is More than one pregnancy which crosses > 22 weeks
Grand multi para is 4 or more pregnancy which crosses >22 weeks
Null parity is A women who has never gave birth of viable baby
Infertility is defined as Failure to conceive after regular unprotective sexual intercourse
for 1 years
Types of Infertility 2 Types
• Primary infertity :- Has never become fertile before
• Secondary Infertility :- Has fertile before but now problem
Sterility is Never able to conceive child
Normal menstruation is also Eumenorrhoea
known as
Menorrhagia is Regular cyclic bleeding but eithermore in amount (i.e > 80 ml) or
duration (> 7 days) or both
Metorrhagia is Irregular bleeding ( Also known as Intermenstrual bleeding/
Spotting bleeding)
Menometorrhagia is Metorrhagia with menorrhagia
Polymenorrhoea is Cyclic bleeding where cycle is reduce to < 21 days
Oligomenorrhoea is Cyclic bleeding where cycle is increased to > 35 days
Epimenorrhoea is Frequent cycle with profuse bleeding ( > 80 ml)
Hypomenorrhoea is Bleeding Scanty for < 2 days
Post Coital bleeding is Bleeding after sexual imtercourse
Dysmenorrhoea is Painful bleeding
Amenorrhoea is Temporary absence of menstruation
Types of Amenorhoea 2 Types
• Primary amenorrhoea
• Secondary amenorrhoea
Most common cause of Pregnancy
Secondary amenorrhoea is
Thelarche is Initial development of breast
Sequence of physical ThelarchePubarche Menarche (TPM)
development in pubert is
Pubarche is Development of hairy structure above skin of Pubis and Vulva
Implantation of fertilized ovum 6th -11th day
takes place at Implant on Upper posterior uterine segments
Form of Zygote that enters Morula (16 cell stage)- on 4th day
uterus firstly is
Form ofZygote that attached Blastocyst
to uterine wall is
Foetus is developed from Inner Cell mass
Types of Germ layers 3 Types
• Ectoderm
• Mesoderm
• Endoderm

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Parts developed from • Sense organ

Ectoderm are •Skin
• Nervous system
• Mucouse membrane
• Hair and Nails
Mesoderm give arise to • Blood
• Circulatory system
• Muscle amd Bone
• Kidney
• Dermis
Endoderm give arise to • Lungs & Liver
• Alimentary tract &Pancrease
• Bladder
Sex of foetus can be During Fertilization
determined at
Sex of foetus is determined by Gametogenesis
Amount of Normal Amniotic 1000-2000 ml (Av. 1500 ml)
fluid is
Normal Amniotic fluid index is 8-18 cm
Oligohydraminious is Amniotic fluid < 500 ml ( 5 cm)
Polyhydraminious is Amniotic fluid > 2000 ml (> 25 cm)
Volume of Amniotic fluid is 38 weeks of pregnancy ( 1000 ml )
maximum at
Implantation is also known as Nidation
Placenta is also known as Foetus lungs
Placenta starts to develop at 4th weeks & completed at 12th weeks
Shape of Placenta is Discoid shape
Placenta is developed from Chorionic villi
Diameter of Placenta is 20-24 cm
Weight of Placenta is 500-600 gm or 1/6th of body wt of foetus
Lobes in Placenta is 15-20 Lobes
Membrane of Placenta 2 Layes
• Amnion:- Foetus side
• Chorion:- Mother side
Function of Placenta are PNEER
• Protection
• Nutrition
• Excretion
• Endocrine function:- Produce B-HCG, Estrogen, Progesterone,
HPL
•Respiration
Most common abnormal Battle dore placenta
Placenta is
Umbilical cord is also known as Life line / Baby supply line
Umbilical cord is developed Yolk sac & Allantois

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from
Umbilical cord develops at 5th -12th weeks
Length of Umbilical cord is 50 cm
Diameter of Umbilical cord is 2.5 cm
Umbilical cord is made up of Wharton's jelly
special types of tissues called
Number of blod vessels in 3
Umbilical cord is • Umbilical artery:-2, Carry deoxygenated blood
• Umbilical vein:-1 , Carry Oxygentaed blood
Before Placenta development, Yolk sac
Nutrition to Foetus is provided
by
Before Placenta development, Trophoblastic cell
B-HCG is secreted by
B-HCG is also known as Pregnancy hormone
Trimester of pregnancy are 3
• 1st Trimester:- 0-12 weeks
•2nd Trimester:- 13-28 weeks
• 3rd Trimester:- 29-40 weeks
Normal Gestation period is 37-42 weeks ( Average:- 40 weeks Or 280 days)
High risk group pregnancy is Criteria for high risk pregnancy
• Age < 20 years or >35 years
• Height < 4 ft 10 inch ( 145 cm)
• Hb:- < 11 gm/dl , BP:- > 140/90 mm of Hg
• Twins pregnancy
• Rh-incompatibility
• Grand Multi para
• Previous history of Cs, Abortion, Ectopic pregnancy
• Unmarried mother
• Pregnancy at the interval of < 2 years
• Severe disease like:- Heart disease
Dangerous sign of pregnancy •Per vaginal bleeding
are • Severe headache
• Blurred vision
• Swelling of faces, hand, legs etc
• Severe lower abdominal pain
.
Weight gain during pregnancy 10-12 Kg ( Average:- 11 kg)
is
Best Pelvic exercise during Kegal exercise
pregnancy, labour and
puerperal period is
Ideal ANC visit 11 times
Minimum ANC visit ( WHO/ 4 times
Nepal) • 1st visit:- As soon as pregnancy determined or with in 3 months

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• 2nd visit:- 6 month

• 3rd visit:- 8 month
• 4th visit:- 9 month
Change in Uterus during Non- pregnant uterus Pregnant uterus
pregnancy Weight:- 30-60 gm (AV:- 50 gm 900-1000 gm
Length:- 7.5 cm 30 cm
Breadth:- 5 cm 23 cm
Width:- 2.5 cm 20 cm
Fundal Height during • 12 Weeks Just above symphais pubis, starts to palpate
pregnancy • 18 Weeks  Between Symphasis pubis & Umbilicus
• 24 Weeks Upper border of umbilicus / At level of Umbilicus
• 28 Weeks  1/3rd in between umbilicus &Xyphisternum
• 32 Weeks  2/3rd in between umbilicus &Xyphisternum
• 36 Weeks  At Xyphisternum
• 38-40 Weeks  Descend at the level of 34 WOG due to
lightening
Shape of Uterus during At 6 Weeks Hen's egg
pregnancy At 8 Weeks  Cricket ball
At 12 WeeksSize of fetus head
Changes in breast during • Montgomery's tubercle 8 weeks
pregnancy •Primary Areola12 weeks
• Secondary Areola 16 weeks
• Colostrum  16 weeks
Skin changes during pregnancy • Chlosma:- Butterfly like pigmentation on cheeks at 24 weeks
• Linea nigra:- Dark brown colour line between Symphasis pubis
and Xyphisternumat 20th weeks of pregnancy
• Striae gravidum:- Silvery colour stretch mark in lower
abdomen, seen in 3rd Trimester
During Pregnancy Vagina Bluish colour due to highly vascularization
becomes
During pregnancy Cervix Soft
becomes
Increment in blood volume 30-40 % ( Exact 33%)
during pregnancy
EDD is calculated by Naegele's formula
EDD:- LMP + (9 months + 7 days)
WOG ( Week of Gestation) is ANC visit date-LMP
calculated by
Most common disorder during Morning Sickness
pregnancy is
Minor disorder during • Morning sickness • Increased Micturation •Vericose vein
pregnancy are • Backache • Indigestion • Heart burn • Cramp • Itching
Major disorder during • Hyperemesis gravidum
pregnancy are • Hypertension
• Pre-eclampsia & Eclampsia

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• Ectopic pregnancy
• Molar pregnancy
• Abortion
Ante Natal Care during ° Rest and Sleep:- 10 hours ( 2 hours day & 8 hours at Night)
Pregnancy ° Coitus :- Avoid in 1st& 3rd Trimester ( Strickly)
° Immunization:- TD Vaccine 1st dose as known as pregnant & 2nd
dose after 1 month of first dose
° Folic acid:- Can be given from 1stTrimester
° Iron + Folic acid:- Given in 2nd& 3rd Trimester ( Start at 91th day
of pregnancy)
° Deworming:- Albendazole is given in 2nd Trimester
• Presumptive sign/ Subjective symptoms ( अनुमानित चिन्ह)
Sign's of Pregnancy are • Probable sign/ Objective sign ( समभाबितचिन्ह)
• Positive sign ( सकारात्मक चिन्ह)
Presumtive sign of pregnancy • Amenorrhoea ( Secondary)
are •Morning Sickness
• Frequency of micturation
• Skin changes
• Quickening:- 16-20 weeks (AV:- 18 weeks)
Primi Gravida:- 18 weeks
Multi Gravida:- 16 weeks
Probable sign of Pregnancy are • Urine Pregnancy Test:- +ve
• Hegar's sign
• Jacquemier's / Chadwick's sign:- Bluish or Purplish
discolouration vagina at 8th weeks pregnancy
• Osainder's sign:- Pulsation on lateral fornicesof vagina at 8 th
weeks of pregnancy
• Godell's sign:- Softening of cervix felt at 6 th weeks of pregnancy
• Uterine suffole
• Internal ballotement
• Braxton hicks contraction:- Contraction of uterus with out pain
at 20 WOG
Positive sign of Pregnancy are • FHS ( Fetal Heart Sound) :- 110-160 beats/min ( detected at 18-
20 WOG by Stethoscope)
• Foetal part
• USG Evidence of embryo:- Can be detected at 6 th WOG
• X-ray evidence:- Performed after 18 WOG.
Most Conclusive clinical sign of Fetal Heart Sound ( FHS)
pregnancy is
Abortion is defined as Expulsion or extraction from it's mother of an embryo or fetus
weighning 500 gm or less when it is not capable of independent
survival ( A/c t WHO)
( Termination mainly before 22 WOG)
Appropriate/ Best time for 7-8 Weeks of Gestation
Abortion is

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Types of Abortion 2 Types ( Spontaneous & Induced abortion)

• Spontaneous abortion:- It includes
Threatened abortion
Inevitable abortion
Incomplete abortion
Complete abortion
Missed abortion
Septic abortion
Habitual abortion
• Induced abortion:- It includes
Therapuetic/ Legal abortion
Criminal/ Illegal abortion
Spontaneous abortion is also Miscarriage
known as
Induced abortion is also known Deliberate
as
Most common cause of Chromosomal abnormality
miscarriage in early pregnancy
is
Threatened abortion is A clinical entity where the process of miscarriage had started but
has not progressed to a state from which recovery is impossible
Only abortion in which Threatened abortion
pregnancy can be continued is
Inevitable abortion is Clincal type of abortion in which changes have progressed to a
state from where continuation of pregnancy is impossible
Missed abortion is Abortion in which fetus is dead and retained inside the uterus
for a variable period
Septic abortion is Any abortion associated with clinical evidence of infection of the
uterus and it's content
For to consider Septic abortion • Rise in temperature at least 100.4 ° F (38°C) for 24 hours or
there should be more
• Offensive or purulent vaginal discharge
• Other evidence of pelvic infection such as :- abdominal pain
and tenderness
Habitual / Recurrent abortion A sequence of three or more consecutive spontaneous abortion
is before 20 weeks
Safe Abortion service was 26th September 2002 AD.
legalized in Nepal on
Safe Abortion Policy 2003 AD
Safe Abortion service was 14th March 2002 AD
passed by Parliament on
Safe Abortion service was 18th March 2002 AD
started from maternity hospital
on
A/c to Safe Abortion Service in • Legal abortion can be done up to :- 12 weeks of Gestation in

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Nepal which :-
Medical abortion :- Up to 9 weeks ( 63 days) of Gestation
Surgical abortion:- Up to 12 weeks of Gestation
• In case of Rape &Inscent :- Abortion can be done up to 28 WOG
( Old was:- up to 18 WOG)
• If Life threating to Mother or Any Anamolies :- Up to 28 WOG
( Old was:- Can be done any time a/c to Dr. Consult)
Management of Abortion • Before 12WoG:- Dilation and Evacuation followed by Curettage
• After 12 WoG:- Oxytocin drip followed by expulsion of fetus
and placenta
Ectopic Pregnancy isdefined as Implantation and development of Zygote outside the normal
uterine cavity
Ectopic Pregnancy is also Tubal Pregnancy
known as
Most common site of Ectopic Fallopian tube:- 97% ( Ampulla)
Pregnancy is Other sites :- Ovarian ( 2%) & Abdominal (2%)
Most common cause of Ectopic PID ( Pelvic Inflammatory Disease)
Pregnancy is
Triad of Ectopic Pregnancy • Amenorrhoea:- Short period
includes • Abdominal pain
• Vaginal bleeding
Quickening is absent in Ectopic Pregnancy
Ectopic Pregnancy doesn’t >3 months
exceed
Hydatidform mole is also Molar Pregnancy
known as
Hydatidform mole is A disease of the Placenta where there is partly degenerative and
party neoplastic proliferation at the chrionic villi
Urine Pregnancy Test is B-Hcg present in blood
positive in Molar Pregnancy
due to
Choice of diagnosis in Molar USG ( Sonography)
pregnancy is made by
USG in Hydatidform mole Snow strom appearance
shows
Methods of treatment in Suction and Evacuation (S/E) of the uterus
Hydatidform mole
Ante Partum Hemorrhage Bleeding from or into the genital tract after 28 th week of
(APH)is defined as pregnancy but before the birth of baby ( Up to 2 nd stage of
labour)
Causes of APH are Mainly 3 causes:-
• Placental bleeding ( 70%):- It includes= Placenta Previa (35%)
&Abruptio Placenta
• Unexplained (25%)
• Extra Placental (5%):- Includes= Cervical Polyps, Cervix cancer,

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Vericose vein, Cervical erosion

Extra Placental bleeding is also Incidental bleeding
known as
Placenta Previa is defined as Partial or Complete implantation of Placenta in lower uterine
segments
Placenta Previa is also known Incidental / Unavoidable bleeding
as
In Placenta Previa Foetal Part is Upper uterine segments
felt in
Types of Placenta Previa on 4 Types :-
basis of degree • 1st degree/ low lying
• 2nd degree/ marginal
•3rd degree/ Incomplete
• 4th degree/ Complete
The only one symptoms of Vaginal bleeding
Placenta Previa is
Types of bleeding in Placenta • Sudden onset
Previa • Painless
• Apparently causeless and recurrent
•Bleeding is always revealed
• Bright red colour blood
Choice of diagnosis of Placenta Ultrasonography (USG)
Previa
Per vaginal Examination is Placenta Previa
completely contraindicated in
Other condition in which Per • Heavy vaginal bleeding with unknown cause
Vaginal examination is • Abruptio Placenta
contraindicated are
Abruptio Placenta is defined as Form of APH where the bleeding occur due to premature
separation of normally situated placenta
Types of Abruptio Placenat 3 Types
• Revealed:- Most common type of Abruptio placenta
• Concealed :- Rare type of Abruptio placenta
• Mixed
Most Important predisposing Hypertension in pregnancy
factors for Abruptio Placenta is
Types of bleeding in Abruptio • Painful, Often attributed to Pre-eclapmpsiaor trauma
Placenta • Bleeding may be Revealed, Concealed and mixed
• Dark colour blood
Abruptio Placenta is mainly Clinically ( Supported by Lab, USG & MRI)
diagnosed by
Drugs which is used to Betamethasone
accelerate fetal lungs
maturation in case of Abruptio
Placenta is

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Types of Twins 2 Types

• Dizygotic twins (Dz):- Most common types of Twins
• Monozygotic twins (Mz)
Dizygotic Twins result from Fertilization of two ova
Dizygotic Twins is also known Fraternal/ Binovular twins
as
Monozygotic Twins result from Fertilization of single ova
Monozygotic Twins is also Identical Twins/ Uniovular
known as
Polyhydraminos/ Hydraminos A state where liquor amnii exceeds 2000 ml
is
Amniotic fluid is replaced in Every 3 hours
Hypertension is BP >140/90 mm Hg measured two times at least 6-hours interval
Protein uria is Urinary Excretion of > 0.3 gm protein/ 24 hours specimen or 0.1
g/L
Gestational Hypertension is BP > 140/90 mm Hg for the first time in pregnancy after 20
weeks, with out proteinuria
Pre-eclampsia is Gestational hypertension with proteinuria
" BP > 14/90 mm Hg for the first time in pregnancy after 20
weeks , with proteinuria "
Types of Pre-Eclampsia 2 Types
• Mild Pre-eclampsia :- BP > 140/90-160/110 mm Hg + Protein
urea (< 3 gm)
• Severe Pre-eclampsia :- BP > 160/110 mm Hg + Protein urea
(>3 gm)
Eclampsia is Pre-eclampsia complicated with grand mal seizures and/or coma
HELLP syndrome is Includes:-
H:- Hemolysis
EL:- Elevated Liver enzymes
LP:- Low Platelets count
Chronic Hypertension is Known hypertension before pregnancy or HTN diagnosed for first
time before 20 weeks of pregnancy
Pregnancy Induced • Gestational HTN
Hypertension (PIH) includes • Pre-eclampsia
• Eclampsia
Choice of Anti-hypertensive Methyl-dopa:- 250-500 mg X TDS/QID
drugs in pregnancy is (2nd choice:- Hydralazine)
Stage of Eclapmsia 4 Stages
• Pre monitory stage
• Tonic stage:- Last for 30 Seconds
• Clonic stage :- Last for 1-4 minutes
• Stage of coma
In Eclapmsia tongue bitings Clonic stage
occurs in
Drug of Choice for Eclampsia is Magnesium sulfate ( MgSo4)

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Antidote of Magnesium sulfate Calcium gluconate

is
Only definitive treatment of Termination of pregnancy ( Delivery)
Pre-eclampsia is
If the Fit is not controlled 6-8 hours
,women with Eclampsia should
be delivered with in period of
MgSo4 is used in patient with • Eclampsia
• Severe Pre-eclampsia
• HELLP syndrome
• Unstable mild Pre-eclampsia
Labor is defined as "Series of events that takes place in the genital organs in an
effort to expel the viable product of conception ( Fetus, Placenta
& membrane) out of the womb through vagina into the outer
world"
Parturation is The process of giving birth
Delivery is Expulsion or extraction of a viable fetus out of the womb
Normal labor is also known as Eutocia
Abnormal labor is also known Dystocia
as
Criteria for Normal labor 5 Criteria
• Spontaneous onset at term
• With vertex presentation
• Without undue prolongation
• Natural termination with minimal aids
• Without having any complication affecting the health of the
mother and/or the baby
False labor pain is also known False labor / Sporious labor
as
"Welcome sign" is related to Lightening in labor
True labor pain is charcaterized 8 Characteristics of true labor pain
by • Painful uterine contraction at regular interval
• Frequency increase gradually
• Intensity and duration of contraction increase progressively
• Associated with " Show"
• Progressive effacement and dilation of cervix
• Descent of the presenting part
• Formation of " Bag of forewaters"
• Not relieved by Enema or sedatives
" Show " is Expulsion of cervical mucus plug mixed with the blod
Characteristics of False labor • Dull in nature
pain are • Confined to lower abdomen and groin
• Not associated with hardening of the uterus
• Usually relieved by Enema and Sedatives
Stage of labor There are 4 Stages :-

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• 1st stage
• 2nd Stage
• 3rd Stage
• 4th Stage
1st stage of labor • Starts with onset of true labor pain and ends with full dilation
of cervix
• Full dilation of cervix is : 10 cm
• Duration of 1st stage of labor :-
Primi gravidae :- 12 hours
Multi parae :- 6 hours
• This stage is also knowna as :- " Cervical stage"
•Partograph is filled in 1st stage of labor after cervical dilation is :-
4 cm
• Has 2 phase:- Latent phase ( 0-4 cm dilation) & Active phase (4-
10 cm cervix dilation)
2nd Stage of labor • Starts with full dilation of cervix and ends with expulsion of the
fetus from birth canal
• Has 2 phases:- Propulsive &Expulsive phase
• " Bear down effort" is seen
• Duration of 2nd stage of labor:-
Primi gravidae:- 2 hours
Multi parae :- 30 minutes
• Danger stage for baby
• Episiotomy can be done :- 3-4 cm ( Medio lateral incision at 5
O' clock or 7 O' clock )
• For Episiotomy :- Kocher's shape forcep is used
3rd Stage of labor • Starts from expulsion of the fetus and ends with expulsion of
placenta and membrane
• Duration of 3rd stage of labor :- 15 minutes for both Primi
gravidae and Multi parae
• Dangerous stage of labor
• AMTSL ( Active management of third stage of labor) includes:-
Oxytocin :- 10 IU X IM givem with in 1 minutes of delivery of
baby
Controlled cord traction (CCT)
Fundal massage
4th Stage of labor It is the stage of observation for at least 1 hour after expulsion of
placenta and membrane after birth
Complication of 3rd stage of Complications are :-
labor • PPH ( Post Partum Hemorrhage)
• Retained Placenta
• Shock
• Pulmonary embolism
• Inversion of Uterus
Prolonged labor in Nepal If labor taks> 8 hours
• Multi parae:- > 8 hours

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• Primi gravidae:- > 12 hours

According to WHO, Prolonge If labor takes > 18 hours
labor is
Common cause of prolonged • Abnormal uterine contraction
labor are • Abnormal presentation and position of the fetus
• Cephalopelvic disproportion ( CPD)
Normal rate of Cervical dilation • Primi gravidae:- 1 cm/hr
during labor is • Multi gravidae:- 1.5 cm/hr
Factor affecting labor are 3 " Ps"
• Power ( uterine contraction)
• Passanger ( Fetus)
• Passage ( Pelvic)
The Principle movements 9 Movements
during labor are • Engagement
• Descent with increasing flexon of the head
• Internal rotation
• Crowning
• Delivery of head by extension
• Restitution
•External rotation
•Delivery of the shoulders
• Delivery of the trunk by lateral flexon
Early clamping should be done • Rh-incompatibility
in case of • Asphyxiated baby
• Diabetic mother
The cord is clamped with Kocher's forcep
Delayed clamping for 2-3 More 80-100 ml blood to fetus
minutes helps to transfer
Agar scoring is done at 1 min and 5 minutes after birth
Average blood loss during 500 ml
vaginal delivery is
Average blood loss during 1000 ml
Cesarean delivery
Average blood loss during 1500 ml
Cesarean with hysterectomy is
Most common presentation is Vertex/ Cephalic presentation
Most common abnormal Breech presentatin
presentation is
Most common presenting part Occipito
is
Most common position is Left Occipito anterior (LOA)
Most common Lie is Longitudinal lie
Most common attitude is Flexon
Post Partum Hemorrhage (PPH) Any amount of bleeding from or into the genital tract following
is birth of baby up to the end of puerperium, which adversely

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affects the general condition of the patient evidence by rise in

pulse rate and falling blood BP.
PPH a/c to (WHO) Excess blood loss (i.e > 500 ml) following birth of baby
PPH a/c to condition & blood • If Normal vaginal delivery :- > 500 ml
loss • If Cesarean delivery :- >> 1000 ml
( All are said to be PPH) • If Cesarean with Hysterectomy:- > 1500 ml
• If Anemic mother:- > 300 ml
Types of PPH 2 types
• Primary PPH
• Secondary PPH
Primary PPH is Hemorrgage with in 24 hour following the birth of baby
Causes of Primary PPH are 4 "Ts"
• Tone ( Atonic uterus):- 80% cases
• Traumatic :- 20%
• Tissue ( Retained tissue)
• Thrombin ( Blood Coagulopathy)
Most common cause of Post Atonic uterus
Partum Hemorrhage is
Secondary PPH is Hemorrhage beyond 24 hour and with in puerperium
Most common cause of Retained bits of Cotyledon ( Placenta) or membrane
Secondary PPH is
Specific test for PPH is Bedside clotting test
Choice of prevention of PPH in Oxytocin
health facilities is
Choice of prevention of PPH in Misoprostol
Home delivery is
LOCHIA is defined as It is the vaginal discharge for the first fortnight during
puerperium
Types of Lochia a/c to colour of 3 Types
discharge • Lochia rubra:- For 1-4 days ( Red in colour)
• Lochia serosa:- For 5-9 days ( Pink or pale brownish)
•Lochia alba:- For 10-15 days ( Pale white)
Retained placenta is The placenta is said to be retained when it is not expelled out
even 30 minutes after the birth of the baby ( a/c to WHO:- 15
minutes)
The commonest cause of Atonic uterus
retention of Non-separated
placenta is
While separating placenta, Lithotomy position
patient is placed in
Placenta accreta/ Morbid Placenta accreta an extremely rare form in which the placenta is
adherent placenta is defined as directly anchroid to the Myometrium
Inversion of Uterus is defined It is an extremely rare but a life threating complication in the
as third stage in which the uterus is turned inside out partially or
completely

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Degree of placenta inversion 3 degree

Most common cause of Spontaneous
inversion of uterus is
Puerperal pyrexia is A rise in temperature reaching 100.4 °F (38 °C) or more
( measured orally) on two separated occassion at 24 hour apart
( excluiding first 24 hour) with in first 10 days following delivery
Most common cause of Puerperal sepsis
Puerperal pyrexia is
Puerperal sepsis is An infection of the genital tract which occur as a complication of
delivery
For Involution of Uterus time 6 weeks
required is
Most common cause of Acute Staphylococcus aureus
mastitis & breast abscess is
Drug of choice of Acute Dicloxacillin:- 500 mg X 6 hourly for 7 days
mastitis is
Breast engorgement is due to Exaggerated normal venous and lymphatic engorgement of the
breast which precedes lactation
Symptoms of Breast Considerable pain and feeling of tenseness or heaviness in both
engorgement is the breast
Management of Breast • Support the breast with binder or brassier
engorgement includes • Frequent suckling
•Manual expression of remaining milk after each fed
• Analgesics
• If severe breast pump may be useful
Decidua is Prepared endometrium for growth and development of Zygote
VernixCaseosa is Curdy substance present in body of baby after delivery
Lanugo is Fine, soft hair that covers the body and limbs of human fetus
Milia is White spot on tip of nose and fore head
Mongolian spot is A benign, flat, congenital birth marks which appear blue in back (
buttock)
Good contraction during labor 3 contraction in 10 minutes and each contraction last for > 40
is seconds
Stage of puerperium 3 Stages
• Immediate:- with in 24 hours of delivery
•Early:- Up to 7 days
• Remote:- Up to 6 weeks
Steps of successful breast 10 steps
feeding a/c to ( WHO/ UNICEF )
Recommended frequency of 8-12 feeds/24 hours
breast feeding • Day feed:- 2 hourly apart
• Night feed:- 3 hourly apart
Duration of Each feeding 5-10 minutes at each breast
should be at least
Most common and best "Cradle hold position"

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position of breast feeding is

In breast milk secretion started 3rd -4th day of post partum
from
Hormone responsible for milk Prolactin
secretion is
Hormone responsible for milk Oxytocin
ejection is
Daily production of milk from 450-600 ml/day
mother breast is
Mean output of breast milk is 5-6 months
maximum at ( Milk output is:- 730 ml/day)
Most suitable food Colostrum
immediately after birth is
Colostrum milkes comes from 3-6 days after birth
Colostrum is also known as " Beestings"/ " First milk"/ " Immune milk"
WHO recommend Exclusive Till 6 months age of baby
breast feeding should be done
for
WHO recommend breast Till 2 years age of child
feeding should be done for
Energy content of breast milk is 65 Kcal/100 ml
During breast feeding milk Foremilk
which comes at first is
During breast feeding milk Hindmilk
which comes at last is
BSE stands for Breast Self Examinatiom
CBE stands for Clincal Breast Examination
Breast examination should be 20 Years
made habbit/ started by the
age of
Breast Self Examination should Monthly
be performed
Best time to screen Breast by After 1 week of menstruation/ Following menses
Self Examination technique
(BSE) is
Steps in BSE technique 6 Stpes ( 3 Insepction& 3 Palpation)
Most Effective Screening Mammography
method for detection of Breast
cancer is
Clinical Breast Examination Yearly
should be done
Most common cancer in female Breast cancer
in world is
Most common cancer in female Cervical cancer
in Nepal is

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Most comon site of Breast Upper outer quardant of breast

cancer is
Degree of Uterine prolapse 4 degree
• 1st degree
• 2nd degree
• 3rd degree
• 4thdegree
4th degree uterine prolapse is Complete prolapse/ " Procidentia"
also known as
Commonest symptoms of Something coming down from vagina
uterine prolapse is
Exercise recommended in Kegel exercise
uterine prolapse is
Treatment of choice of 3rd Vaginal hysterectomy
degree uterovaginal prolapse is
The main complication of Decubitus ulcer
uterine prolapse in context of
Nepal is
Infertility is defined as Failure to conceive with in one or more years of regular
unprotected coitus
Types of Infertility is 2 Types
• Primary infertility:- Indicates those who has never conceived
• Secondary infertility:- Indicates previous pregnancy but failire
to conceive subsequently
Sterility is defined as One who is never able to conceive
Aspermia is Failure of emission of semen ( No ejaculation)
Azoospermia is No spermatozoan in the semen
Oligospermia is Sperm count < 20 million/ml
Polyspermia/ Polyzoospermia Sperm count > 350 million/ml
is
Most common pelvic tumor is Fibroid
Endometriosis is defined as Presence of functioning endometrium (glands & stroma) in sites
other than uterine mucosa
Most common symptoms of Dysmenorrhoea
Endometriosis is
Most common sites of Ovary
Endometriosis is
" Chocolate cyst " is seen in Ovarian Endometriosis ( Endometrioma)
Leucorrhea is defined as Excessive normal vaginal discharge
Most common cause of vaginl Vaginal Trichomoniasis
infection ( Vaginitis) is caused
by
Most common STD in world is Trichomoniasis
Most common STD in Nepal is Moniliasis ( Candidiasis)
Trichomoniasis is caused by Trichomonasvaginalis ( Protozoa)

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Vaginal discharge seen in Forthy yellow discharge

Trichomoniasis is
" Strawberry" cervix is seen in Trichomoniasis
Drug of choice for Metronidazole:- 200 mg X TDs for 7 days
Trichomoniasis is
Moniliasis is also known as Candidiasis
Moniliasis is caused by Candida albicans ( fungus)
Vaginal discharge seen in Thick curdy white in flakes and pruritic
Moniliasis is
Drug of choice for Moniliasis is Fluconazole:- 150 mg X once a week for 6 weeks
Vaginal discharge seen in Grey-white, Fishy odour and nin-pruritic
Bacterial vaginosis is
Drug of choice for Bacterial Metronidazole:-200 mg X TDS for 7 days
vaginosis is
Drug of choice for Chlamydia Azithromycin : 1 gm Orally single dose
infection in vagina
Collection of pus in uterus is Pyometra
known as
Salpingitis is Infection of fallopian tube
Dyspareunia is Painful sexual intercourse
Most common sexual Dyspareunia
dysfunction is
PID stands for Pelvic Inflammatory Disease
Most common cause of PID is Chlamydia trachomatis (30%) & N. gonorrhoea (30%)
Most common symptoms of Pain
PID is
Gold standared test for Laparoscopy
diagnosis of PID is
PID doesn’t includes Cervicitis
In Rh-incompatibility case ( Rh- Rh anti-D immumoglobulin ( IgG) is given X IM
negative mother)
Rh anti-D immunoglobulin is Rh-ve mother with in 72 hour following delivery or abortion
given to
Dose of Rh anti-D 300 microgram ( ug)
immunoglobulin is
Rh- immuno globulin 28 weeks of pregnancy ( This is additional to the dose given with
prophylaxis can be given to Rh- in 72 hours after delivery)
ve nonimmune women at
Huhner test is also known as Post coital test ( PCT) / Sims test
Huhner test is used to Sperm survival and sperm motility into female reproductive
determine system
Most common abnormal Battledore placenta ( Placenta in which umbilical cord is
placenta is attached)
Types of Female pelvis 4 Types
• Gynaecoid/ Genuine female pelvis

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• Anthropoid
• Android
•Platypelloid
Most common female pelvis is Gynaecoid
Shape of male pelvis is Android
Bandl's ring/ Pathological Obstructe labor
retraction ring is associated
with
Most common congenital Spinal bifida occulta
defect/ anomoliesis
Meconium Aspiration Terms or post-term babies who are small for gestation
Syndrome ( MAS) usually
occurs in
Oxytocics are The drugs that have power to excite contraction of the uterine
muscle. E.g . Oxytocin, Prostaglandins, Ergot derivatives
Oxytocin must be stored at 2°-8°C temperature
Tocolyticare drugs that Relax uterus and prevent uterine contraction.E.g. Betamimetics
( Terbutaline), Calcium channel blocker e.t.c.
Tocolytic drugs are used to Prevent pre-term labor and delivery
Induction of labor ( IOL) means Initiation of uterine contraction ( after period of viability) by any
method ( medical, surgical or combined) for the purpose of
vaginal delivery
Partograph is A composite graphical record of key data ( maternal and fetus)
during labor entered against time on a single sheet of paper
During filling partograph • FHS, Maternal pulse & uterine contraction are monitor:- 1/2
hourly
• Temperature and urine output are monitor:- 2 hourly
• P/V exmn, BP and Cervix dilation are monitor:- 4 hourly
Causes of Maternal mortality • Hemorrhage-24% ( 19% PPH & 5% APH) Most common
are • Eclampsia-21%
• Abortion-7%
•Obstructed labor-7%

 Facts on First Aid & Basic Medical procedure.

First Aid is defined as Immediate treatment given to the victim of trauma or sudden
illness before arrival or available of expert medical help
First Aid is based on the Medicine and Surgery
principle of
Golden rules of First Aid is ABC ( Airway, Breathing & Circulation)
Main aims of First Aid is To preserve life of victim
Others aims are:- To promote recovery, To limit worsening of
condition & To make medical care available at the earliest

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Quality of First Aider are • Observant

• Tactful
• Resourceful
• Dexterous
• Explict
• Discriminating
•Continuity
• Kindness
• knowledge
First step in First Aid is To observe the situation
Major methods of First Aid are • Open air way : By head tilt and chin lift
• Adequate breathing:- Artificial breathing at rate of 12-16/min
• Sufficient circulation:- Cardiac massage at rate of 100/min
Mouth to Mouth respiration is " Kiss of life "
also known as
CPR stands for Cardio-pulmonary resuscitation
CPR should be started if Carotid pulse is absent
Ratio of Chest compression and • If One First Aider:- 30:2
respiration for First Aider • If Two First Aider:- 15:2
CPR is necessary or not this 5 Sec
should be evaluated with in
In CPR, chest compression is 2 Finger above xyphoid process and press sternum 4-5 cm at the
given at angle of 90°
BLS stands for Basic Life Support
ALS stands for Advance Life Support
Shock is defined as Peripheral circulation failure causing tissue perfusion to be
inadequate to meet the metabolic demand of tissue
Signs of shocks are • Cold and calmmy skin, Hypotensiom& Fast and weak/thready
pulse
Types of shock 5 Types
• Hypovolemic / Oligaemic shock
• Neurogenic/ Self limiting/ Psychogenic/ Vasovagal syndrome/
Fainting shock
• Cardiogenic Shock/ Fatal shock
• Anaphylatic shock / Hypersensitive reaction
• Septic shock / Septicemia
Most common type of Shock is Hypovolemic shock
Causes of Hypovolemic shock • Hemorrhage, Severe dehydration, Severe burn, Peritonitis,
are Ascites, Intestinal obstruction, Pancreatitis
In all types of Hypotension Neurogenic shock ( Hypotension with Bradycardia is seen)
with tachycardia is seen except
Neurogenic shock last for 5-10 Minutes
Drug of Choice for Neurogenic Atropin
shock is
Causes of Neurogenic shock are • Sudden severe pain, Fever, Bad News, Spinal Anesthesia and

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Injury
Most dangerous shock is Cardiogenic shock
Appropriate position for Propped up/ Half sitting position
patient with Cardiogenic shock
Fluid is avoided in Cardiogenic shock
Drug of Choice for Cardiogenic Dopamine
shock
Causes of Anaphylatic shock • Drugs like:- Penicillin
are • Anesthetic agent:- Procaine, Lignocaine
• Anti-snake venom, Anti-tetanus serum
• Bee or wasp stings
In Anaphylatic shock, patients Respiratory obstruction ( Laryngeal spasm)
dies due to
Choice of drugs for Anaphylatic Adrenaline (1:1000) X 0.5 ml X SC/IM
shock is
Causeof Septic shock is Gram negative bacteria (E. Coli)
Main symptoms of septic shock Fever
is
Complication of Shock are • Renal failure
• Lactic acidosis
• ARDs
• DIC ( Disseminated Intravascular coagulation)
Poisons are Any substances taken into the body by means ( i.e ingestion,
Inhalation, Injection or absorption) in sufficient quantity that
interferes with normal physiological functions
Poisoning refers to Development of harmful effects following exposures to poisons
Causes of poisoning are 3 Causes
• Accidental
• Suicidal
• Homicidal
Route of Poisoning are 4 routes are
• Ingestion
• Inhalation
• Injection or Inoculation
• Direct contact of skin
Universal antidote/ General Activated charcoal
antidote is
Contact poison is also known Absorbed poison. E.g DDT, BHC
as
Poisoning in which vomiting is • Drowsy or unconsciousness patient
contraindicated are • Kerosene or petroleum product poisoning
• Corrosive poisoning
Vomiting or Gastric lavage is 4-6 hours of poison ingestion
done when patients comes
with in

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Poisoning in which Pupil dilates • Alcohol poisoning

are • Barbiturates poisoning
• Dhaturopoisoning
Poisoning in which Pupil • Opoid poisoning
constrict are • Organophosphorus poisoning
( OM) • Mushroom poisoning
• Morphine poisoning
Person become cherry red Carbon monoxide
colour in
Aluminium poisoning is also Celphos/ Insecticide poisoning
known as
Wound is defined as Loss of continuity of tissue following injury or operation
Types of wounds 2 types
• Closed wound:- 3 types ( Abrasion, Contusion, Hematoma)
• Open wound :- 4 types ( Incised , Lacerated, Punctured,
Perforated)
Incised wound is Straight and regular cut by Sharp cutting object
Lacerated wound is Irregular cut by blunt object
Punctured/ Stab wound is Deep wound that occurs due to something sharp and
[Link] as:- Nail
Perforated/ Gunshot wound is An injury in which an objects enters body or a structure and
passes all the way through. E.g Wound made by Gun shot
Abrasion is Scraping or peeling of Superficial layer ( epidermis).It is very
painful due to nerve ending is exposes
Contusion is Subcutaneous tissue, muscle and blood vessels are injuried but
not overlying tissues . More common in Brain
Hematoma is Collection of blood under skin
Process of wound healing occur 2 Mechanism
by • Primary intention:- No scar, wound heals by Fibrocyte& Fibrin
• Secondary intention:- Scar, wound helas by Granulation tissues
Savlon is Cetrimide ( Cetavlon) + Habitane ( Chlorhexidine)
Differences between two stitch 0.5 cm (1/4 inches)
during suturing
Main diet which helps in Protein
wound healing is
Major Vitamin having role in Vitamin C
wound healing is
Major mineral having role in Zinc
wound healing is Others are:- Copper and Magnesium
Indication of early change of • Tight bandage
dressing are • Sign of infection
• Tetanus, Gas gangrene
•Excessive foul smelling discharge from dressing
Burn is defined as Injury caused by dry heat
Scald is defined as Injury caused by moist heat

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In Burn, hypovolemic shock Burn is 20-40 %

occur if
In Burn, death occur if Burn is > 60 %
Types of burn 3 types
• Erythema/ Superficial burn:- Most painful burn
• Partial thickness burn:- Epidermis and some portion of dermis
is lost, Blister formation , Heals by Epithelial tissue
• Deep/ Full thickness burn:- Epidermis + Dermis both are lost,
Heals by Granulation tissue
Degree of burn 4 degree of burn
• 1st degree:- Erythema -10% burn
• 2nd degree:- Blister formation, Partial thickness, Heals in 3-4
weeks-20% burn
• 3° degree:- Full thickness burn-30% burn
• 4° degree:- Whole Epidermis + Dermis + Bone
Most common cause of burn is Thermal ( Dry heat)
Most common cause of death Hypovolemic shock
in burn is
Most dangerous complication Acute renal failure
of burn is
Burn in which Fracture may Electric burn
occur is
Alkaline burns are more Acid burns
dangerous than
First Aid of burn is Burning process should be stopped or covered by blancket
" Wallace rule of Nine" is Burn ( Givem by Alexander wallace)
related to
Calculation of Burn % A/c to Wallace rule of Nine
Wallace rule of Nine • Head and Neck:- 9% ( Up to 1 year:- 18 % & Up to 5 Year:- 13%)
• Anterior chest:- 9%
• Posterior chest:- 9%
• Anterior abdomen:- 9%
• Posterior abdomen:- 9%
• Rt. Upper limb:- 9%
• Lt. Uper limb:- 9%
• Rt. Lower limb:- 18%
• Lt. Lower limb:- 18%
• Perineum:- 1%
3 "C" rule of management is Burn ( Cool, Clear, Cover)
related to
Skin grafting is required in 3° ansd4° burn
Fluid of choice in case of burn Ringer lectate
is
Parkland formula of fluid % of burn X wt. in kg X 4 for 24 hours (1/2 fluid is given in first 8
resuscitation is hour and remaining fluid is given in 16 hour)

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TBSA formula 1 Palm= 1 % burn = 220 ml for 48 hours

Prinprick test is done in Burn ( To identify whether burn is superficial or deep burn)
In Burn, body fluid loss mainly Evaporation
by
Best anti-microbial ointment in Silver sulfadizine 1%
case of burn is
In adult Hospitalization is >15%
required if burn % is In child: > 10% .
And If Perineal burn hospitalization is required
Hemorrhage is defined as Loss of blood from vascular compartment
Types of Hemorrhage on the 3 Types
basis of Vessels involved • Arterial bleeding:- Bright red, Spurts like jet, Dangerous
• Venous bleeding:- Dark red, Steady flow
• Capillary bleeding:- Bright red, Oozes out
Types of hemorrhage on the 3 Types
basis of time of injury • Primary hemorrhage:- At the time of injury- with in 6 hours
•Reactionary hemorrhage:- 6 hours- with in 24 hours
• Secondary hemorrhage:- After 7-14 days of injury / All
hemorrhage after 24 hours
Clinically types of hemorrhage 2 Types
are • External/ Revealed
• Internal/ Concealed
Main cause of Reactionary Slippage of suture and ligature
hemorrhage is
Principle of treatment of Control bleeding
Hemorrhage is
First aid treatment of Apply pressure bandage
Hemorrhage is
Condition of Fluid replacement • If blood loss is < 10%:- No fluid is required
for Hemorrhage • If blood loss is 10% :- Fluid is required ( Fluid used is:-
Crystalloid solution like:- NS, RL)
• If blood loss is 10-15%:- Fluid is requird ( 1/2 crystalloid + 1/2
Colloid solution)
• If blood losss is > 15%:- Blood transfusion is required
Fracture is defined as Loss of continuity of bone
Causes of Fracture are • Direct voilence
• Indirect voilence
• Muscle inco-ordination
• Pathological fracture:- E.g Osteomyelitis, Osteomalacia
Types of Fracture Mainly 2 types
• Simple/ Closed fracture
• Compound/ Open fracture
On the basis of pattern, Types 7 types
of Fracture • Transverse
• Communicated

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• Oblique or spiral fracture

• Impacted fracture
• Green stick fracture :- Fastest healing fracture
• Multiple fracture
• Wedge or compression fracture
Most common fracture in Child Green stick fracture ( 2nd :- Supracondylar fracture)
is
Most common fracture in adult Colle's fracture also known as Dinner fork like fracture ( It is the
is fracture of lower end of radius)
Most common fracture in old is Femur ( Neck part) fracture
Stage of Fracture healing 5 Stages
• Hematoma formation:- 1st stage
• Granulation tissue formation
• Callus formation:- 1stsign
• Consolidation
• Satge of remodelling:- Last stage
Best diagnosis of fracture is X-ray ( Anterior posterior view & Lateral view)
done by
Complication of fracture is • Beeding and shock
• Delay union
• Mal-union
• Non-union
Ultimate aim of fracture Restoration of function
treatment is
First aid management of Immobilization of the fractured part
fracture is
Most common complication of Deep Vein Thrombosis ( DVT)
long bone fracture is
Principle of treatment of 3 Principle
fracture • Reduction
• Immobilization
• Restoration of function
Fracture healing is rapid in Child
In Adult fracture usually heals 4-16 weeks ( Upper limb:- 6-8 weeks &lower limb:- 12-16 weeks)
in
In Child fracture usually heals 45 days (1.5 months)
in
In Old fracture usually heals in 6 Months
Plaster of Peris ( POP) is used Splint and bandage
as
Chemical formula of Plaster of CaSo4.1/2 H20
peris is
Dislocation of Joint is A total disturbation of joint with no remaining contact between
articular surfaces
Most common dislocation in Shoulder joint

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Adult is
Most common dislocation in Radio-ulnar joint
Child is
Most common dislocation in Temporomandibular joint dislocation
old age is
Causes of TMJ dislocation are • Deep yawing
• Blow on the chin while mouth open
• During chewing hard substances
Treatment of TMJ dislocation is Downward backward jerk
Strain is Injury to Tendon
Sprain is Injury to Ligament
For Sprain Creeps bandage is used and removes after 4-5 days
"RICED" strategy is applied for Fracture, Strain and Sprain
• R:- Rest injuried part
• I:- Ice or cold compression
• C:- Compress the injury
• E:- Elevate the injury part
• D:- Diagnosis of soft tissue injury
Frost bite is This result from freezing of tissue and ischemic necrosis due to
vasospasm
For Frost bite, Environment (-4 to -10)° C
temperature should be

 Facts on Sterillization and Disinfection.

Sterillization Destroys all microbes including spores

Disinfection Destroys all microbes except spores
Antiseptic Substance that prevent growth of micro-organism in
living tissues.
Asepsis Prevention of contact with micro-organism
Decontamination / Sanitization Makes items as safe to handle
Sterile State of being free from all living micro-organism
Germicide Agent that destroys micro-organism especially
pathogenic organisms.
Detergents Surface cleaning agent that makes no antimicrobial
claims on the label. E.g Soap
Deodorants Substances which supresses or neutrlizes bad odours

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.E.g Lime and bleaching powder

Classification of Physical method & Chemical method
Sterilization/Disinfection includes
Physical Method of Sterilization • Heat :- Dry Heat & Moist heat
includes • Filtration:- Depth filters & Membrane filters
• Radiation:- Ionizing & Non-Ionizing radiation
• Ultrasonic vibration
Example of Dry Heat method of Flaming, Incineration, Hot Air oven
Sterilization are
Example of Moist Heat method of Pasteurization, Water bath, Boiling, Tyndalization,
sterilization are Autoclaving
Example of Ionizing radiation are X-rays, Y-rays & Cosmic rays
Example of Non-Ionizing radiation are UV rays & Infrared rays
Chemical Methods of Sterilization *Alcohols:- Ethyl alcohol &Iso propyl alcohol
includes *Aldehydes:- Formaladehydes, Glutaraldehydes, Ortho-
Phthaladehyde
*Phenolic compound:- Cresol, Lysol, Chlorhexidine,
Chloroxylenol
*Halogens:- Iodine, Chlorine, Iodophors
* Oxidising agent:- Hydrogen peroxide, Paracetic acid
* Salts:- Mercuric chloride, Copper salts
*Surface acting agent:- Soaps, Quaternary ammonium
* Dyes: Aniline dyes, Acridine dyes
* Gas sterilization: Ethylene oxide, Low
teprFormaladehyde, Beta-Propiolactone ( BPL)
Dry Heat kills the Organism by " CODE"
• Charring , Oxidative change, Denaturation of bacterial
protein, Elevated level of electorlytes.
Moist Heat kills the Organism by Denaturation and Coagulation of proteins
Holding Temperature required for Hot 160 ° C for 1 hour
Air Oven is
Holding Temperature required for 121°C for 15 min at 15 lb pressure
Autoclaving is
Temperature required for 100 °C for 20 min for 3 consecutive days
Tyndalization is
Hot Airoven is best method of • Glass ware like:- Glass syringe, Petri dishes, Flasks,
sterilization for Test tubes, Pipettes, Slide
• Surgical instrument like: Scalpels, Scissors, Forceps
Chemical likes:- Liquid paraffin, Fats, Glycerol, Gloves
dust powder
Milk is best disinfected by Pasteurization
Clinical Thermometer is best Isopropyl Alcohol
disinfected by
Autoclaving is best method for Culture media, Metallic surgical instrument, Surical
sterilization of blade, All suture material except catgut

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Formaladehyde gas is best method for Operation theater, Ward, Entry way, Laboratory
sterilization of fumigation
Perservation of Anatomical Specimen Formaladehyde
is done by
Endoscope and Cystoscope are best Orthopthadehyde (2nd choice is : Gluteraladehyde)
sterilized by
Cidex is 2% Glutaraldehyde
Catgut suture
Catheter
Plastic syringe Are best sterilized By Ionizing radiation ( Y-ray i.e gamma radiation)
Swab
Bone and tissue graft
Adhesive dressing
Sterilization by Ionizing Radiation ( X- Cold Sterilization
ray, Y-ray & Cosmic ray) is also known
as
Heart lungs machine, Respirator & Ethylene oxide
Dental equipment are best sterilized
by
Sharp instrument are best sterilized by Hot Air Oven ( 2nd: Cresol)
Vaccine, Sera, Antibiotics, Sugar Filtration
solution and Body fluid are best
sterilized by
Metallic Inoculation wire is best Red hot by Bunsen burner
sterilized by
Contact lense is best disinfected by Hydrogen peroxide ( H2O2)
Hydrogen peroxide is used to disinfect Contact lenses, Ventilators, Tonometer biprism
Incineration is best method of Infective materials like soiled dressing, Bleeding,
Sterilization of Animal Carcasses
Most powerful / Most effective Alcohol solution with Chlorhexidine
Antiseptic solution is
Ideal Method of Sputum disinfection is Autoclaving
Sputum can be disinfected by Autoclaving, Burning, Cresol 5%, Boiling, Phenol
Savlon contains Cetrimide3 %( Cetavlon)+ Chlorhexidine 0.3 %
( Habitane)
Dettol is Chloroxylenol
Fiberotic laryngoscope is best Glutaraldehyde
sterilized by
Most common used disinfection is Chlorine
Most common method of instrument Autoclaving
sterilization is
Silver sulfadizine is used on Burn surfaces
Silver nirtrate (1%) soln is used to Ophthalmia neonatrum in infants
prevent
Example of Aniline dyes Crystal voilet, Gention voilet, Brilliant green, Malachite

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green
Example of Acridine dyes Acriflavin, Euflavin, Proflavin, Aminacrine
Ethyl alcohol is used as Surgical sprit (70% ) for Antiseptic hand rub
Sterilization accuracy is assessed by Geobacillusstereothermophilus& Bacillus subtilis
[Link]
Test used to check efficiency of Bacillus stearothermophilus
Sterilization in an Autoclave
Types of Disinfectant 3 Types ( High level, Intermediate level, Low level
disinfectant)
High level disinfectant are Glutaraldehyde, Formaldehyde, H2O2, Chlorine
Intermediate level disinfectant are Isopropyl alcohol, Phenol
Low level disinfectant are Quaternary ammonium compound like Benzalkonium
chloride
Sporicidal agents are EFGH-3P-HA
• Ethylene oxide
• Formaldehyde
•Glutaraldehyde
• Hydrogen peroxid
• Paracetic acid
• O-phthalic acid
• Plasma sterilization
•Hot Air Oven
• Autoclaving
Most resistant structure to steriization Prions
is
Prions are best killed by Sodium hydroxide for 1 hour
Boiling of milk is an example of Precurrent disinfection
Types of Disinfection are 3 Types
-Precurrent disinfection
-Concurrent disinfection
-Terminal disinfection
Example of Precurrent disinfection are Disinfection of water by chlorine, Pasteurization of
milk , Hand washing
Concurrent disinfection is Application of disinfective measures as soon as possible
after the discharge of infectious material release from
the body of infected person.
E.g Disinfection of Urine, Faeces, Vomit, Contaminated
linen, Apron, Gloves e.t.c through out the course of
illness.
Terminal disinfection is Application of disinfective measures after the patient is
dead or has ceased to be a source of infection.
E.g. Terminal cleaning of rooms, funitures, beddings

References:-

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 Review of K. park by Vivekjain 7th edition.

 Dc dutta text book of Gynecology & Obstetrics 8 th edition.
 Dr. TilakBdr Pathak text book of Anatomy for CMA.
 Medscape
 Surgery Essence by Priteshsingh 4th edition.
 Review of Pharmacology by Govind Rai gorg and Sparsh gupta 9 th& updated to 12thedition.
 K. Park 23rd Edition
 Review of Microbiology by ApurbaSankarshastry&Sandhya Bhatt K 6 th edition.
 CB-IMNCI ( Community Based Integrated Management of Neonatal and Childhood Illness)
 Vital Text book by Hari Bista for loksew.
 Annual Report by DoHS of Nepal
 NDHS survey by DoHS of Nepal

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