14146353 Community Medicine Last Moment Revisions Copy

Community Medicine - Last moment revisions Health Health is state of complete physical and mental well being not merely an absence of disease or infirmity. Determinants of health  Heredity  Environment  Life-style  Socioeconomic  Health and family welfare  Other factors like health related systems ( eg: food and agriculture, education, industry, social welfare, rural development ) Indicators of health Characteristics  Valid  Reliable  Sensitive  Specific Indicators may be classified as 1. Mortality indicators a) Crude death rate: The number of deaths per 1000 population per year in given community b) Expectation of life: Life expectancy at birth is “the average number of years that will be lived by those born alive into a population if the current-age specific mortality persists. c) Infant mortality rate: Ratio of deaths under 1 year of age in a given year to the total number of live births in the same year. d) Child mortality rate: Number of deaths at ages 1-4 years in a given year per 1000 children in that age group at the mid point of the year concerned. e) Under-5 proportionate mortality rate: Proportion of total deaths occurring in the under 5 age group. f) Maternal (puerperal) mortality rate: g) Disease specific mortality h) Proportional mortality rateMorbidity indicators They are i) Incidence and prevalence j) Notification rates k) Attendance rates at out patient departments, health centres, etc l) Admission readmission and discharge rates m) Duration of stay in hospital n) Spells of sickness of absence from work or school 2. Disability rates a) Event type indicators (i) Number of days of restricted activity (ii) Bed disability days (iii) Work loss days (or school loss days) with in a special period b) Person type indicators (i) Limitation of mobility (ii) Limitation of activity Sullivan’s index: This index (expectation of life free of disability) is computed by subtracting from the life expectancy the probable duration of bed disability and inability to perform major activities. 3.

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Nutritional status indicators a) Anthropometric measurements of pre school children b) Heights (and some weights) of school children at school entry c) Prevalence of low birth weight (less than 2.5 kg) Health care delivery indicators a) Doctor population ratio b) Doctor-nurse ratio c) Population-bed ratio

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d) Population per health/subcentre e) Population per traditional birth attendant 5. Utilization rates 6. Indicators of social mental health 7. Environmental indicators 8. Socio-economic indicators 9. Health policy indicators 10. Indicators of quality of life 11. Other indicators IMMUNIZING AGENTS VACCINES

Live attenuated vaccines

BCG Typhoid oral Plague Oral polio Yellow fever Measles Rubella Mumps Influenza Epi. typhus Typhoid Cholera Pertussis C.S. meningitis Plague

Inactivated or killed vaccines

Toxoids IMMUNOGLOBULINS Human Immunoglobulins

Rabies Salk (polio) Influenza Hepatitis B Japanese encephalitis KFD Diphtheria Tetanus Hepatitis A Measles Rabies Tetanus Mumps Hepatitis B Varicella Diphtheria

Non -human (Antisera)

Diphtheria Tetanus Gas gangrene Botulism Rabies

Bacterial

Viral Rickettsial

Bacterial

Viral

Bacterial

Human normal Ig

Human specific Ig

Bacterial Viral

Attenuated Vaccines

Killed Vaccines

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Vaccine dose Antibody persistence (immunity) Booster needed Revaccination Latency Oncogenicity

Low (replicates)

High

Long Infrequently Possible Possible ?

Short Frequently None None None

INCUBATION PERIOD & CAUSATIVE ORGANISM Respiratory infections Small pox Chickenpox Measles

Rubella Mumps

12 days, 7-17 days 14 -16 days Extreme 7-21 days 10 days average 7 days

2 - 3 weeks average 18 days 2 - 3 weeks usually 18 days

Influenza

18 - 72 hours

Diphtheria

2 - 6 days

Whooping cough Meningococcal meningitis SARS Tuberculosis

7 - 14 days 3 - 4 days 2 - 7 days commonly 3 - 5 days 3 - 6 weeks

Intestinal infections Poliomyelitis

7 - 14 days

Viral hepatitis A Viral hepatitis B Viral hepatitis E Cholera Acute diarrhoeal diseases Typhoid fever Food poisoning Staphylococcal Botulism Cl.perfringens B.cereus

15-45 days usually 25-30 45-180 days average 100 2 to 9 weeks A few hours upto 5 days commonly 1-2 days

Variola virus Varicella zoster virus Measles virus ( RNA paramyxovirus) RNA virus of Togavirus family Myxovirus parotiditis (RNA virus) Influenza virus 3 types A,B&C Corynebacterium Diphthariae B. pertussis N. menigitiditis New strain of corona virus M.tuberculosis

Polio virus 3 serotypes 1,2 and 3 hepatitis A virus hepatitis B virus hepatitis E virus V. Cholerae

10-14 days short as 3 days long as 3 weeks

S.tiphy

1-6 hours 12-36 hours 6-24 hours Emetic form 1-6 hours Diarrhoeal form 12-24 Hrs

Staphylococcus aureus Clostrybium botulinum

Amoebiasis Ascariasis

2-4 weeks or longer 2 months

Hookworm infections Nectar americanus Ancylstoma duodenale

7 weeks 5 to 7 weeks

Bacillus.cereus E.histolytica Ascaris lumbricoides Nectar americanus Ancylstoma duodenale

Arthropod borne infections

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Dengue syndrome Classical Dengue fever Dengue haemorrhagic fever (DHF) Malaria -Falciparum -Vivax -Quartan -Ovale Lymphatic filariasis

Zoonoses Viral Rabies Yellow fever Japanese encephalitis KFD Bacterial Brucellosis

Leptospirosis Plague -bubonic -Septicaemic -pneumonic Human salmonellosis Scrub typhus Murine typhus Tick typhus Q fever Taeniasis Hydatid disease Leishmaniasis Surface infections Trachoma Tetanus Leprosy Yaws AIDS

3 to 5 days (commonly 5-6 days) 4 to 6 days 12 (9-14) days 14 (8-17) days 28 (18-40) days 17 (16-18) days 8-16 months

3-8 weeks 3-6 days 3 to 8 weeks

Dengue Virus

Wuchereria dancrofti

Lyssa virus type 1 Flavivirus fibricus Flavivirus Flavivirus

1-3 weeks as long as 6 months

B.melitnsis, B. abortus, B.suis, B.canis

10 days range of 4-20 2-7 days 2-7 days 1-3 days 6-72 hours 10-12 days Varies 6-21 days 1-2 weeks com12 days 3-7 days 2-3 weeks 8-14 weeks

L.interrogans

Months to years 1-4 months Range 10 days-2years 5-12 days 6-10 days 3-5 years or more 3-5 weeks Uncertain

Y.pestis

Rickettsia tsu tsu gamushi Rickettsia typhy Rickettsia conorii Coxiella brunetii T.saginata, T.solium E.granulosus Leishmania donovani C.trachomatis Clostridium tetani M.leprae T.pertenue Human immuno virus

VECTOR BORNE DISEASE CONTROL PROGRAMME 1. National Anti-Malaria Programme  National Malaria Control Programme (NMCP) was launched in India in April 1953. it was in operation for 5 years( 1953-58).  National Malaria Eradication Progamme (NMEP) launched in 1958.  New approach to malaria control was approved by WHO in 1978, ie. Implementation of malaria control in the context of the primary health care strategy.  An Enhanced Malaria Control Project with world bank support launched on 30th September 1997.  In 1999, the government of India decided to drop the term “National Malaria Eradication Progamme” and renamed it “National anti-malaria programme” 2. National Filaria Control Programme National Filaria Control Programme (NFCP) has been in operation since 1955. 3. Kala-Azar Control Programme

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Centrally sponsored programme was lunched in 4. Japanese Encephalitis Control 5. Dengue Fever Control DEMOGRAPHY AND FAMILY PLANNING Demographic cycle 5 stages 1. 2. 3. 4. 5.

FIRST STAGE (High stationary) SECOND STAGE (Early expanding) THIRD STAGE (Late expanding) FOURTH STAGE (Low stationary) FIFTH STAGE (Declining)

BIRTH RATE HIGH

DEATH RATE HIGH

UNCHANGED

BEGINE TO DECLINE

TENDS TO FALL

DECLINE

LOW

LOW

POPULATION STATIONARY

STATIONARY

LOWER

QUESTION In demographic cycle stage/stages in which population remains stationary a) first b) fourth c) both a & b d) none FERTILITY The actual bearing of children Reproductive period of women 15-45 years-a period of 30 years Factors affecting fertility 1. 2. 3. 4. 5. 6. 7. 8.

Age at marriage Duration of married life Spacing of children Education Economic status Caste and religion Nutrition Family planning

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9. Other factors like place of women in the society, value of children in the society, widow remarriage, breast feeding, customs and believes, industrialization and urbanization, better health conditions, housing, opportunities fro women and local community involvement. Fertility related statistics Number of live birth in the year X1000 1. Birth rate Estimated mid-year population 2. General fertility rate 3. General marital fertility rate 4. Age specific fertility rate 5. Age specific marital fertility rate 6. Total fertility rate 7. Total marital fertility rate 8. Net reproduction rate 9. Cild women ratio 10. Pregnancy rate 11. Abortion rate 12. Abortion ratio 13. Marriage rate MILESTONES OF DEVELOPMENT The „milestones‟ given here are approximations and to assess any individual child, all types of growth development and behaviour must be taken into account Motor development

Age

Language development

Adaptive development

6-8 weeks 3 months 4-5 months

holds head erect

6-8 months

sits without support

9-10 months

crawling

10-11 months 12-14 months 18-21 months 24 months

stands with support walks wide base walks narrow base runs

listening experimenting with noises increasing range of sounds

first words joining words beginning to run short sentences

begins to reach out for objects transfers objects hand to hand releases objects

builds beginning to explore

Sociopersonal development Looks at mother and smiles recognises mother enjoys hide and seek suspicious of strangers

dry by day

DETERMINANTS OF MATERNAL MORTALITY IN INDIA Medical Causes Social Factors Obstetric causes: Toxaemias of pregnancy

Age at child birth

Haemorrhage

Parity

Infection

Too close pregnancies

Obstructed labour

Family size Malnutrition Poverty

Unsafe abortion

Illiteracy

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Ignorance and prejudices Lack of maternity services Non -obstetric causes:

Shortage of health manpower

Anaemia

Delivery by untrained dais

Associated diseases, e.g., cardiac, renal, hepatic metabolic and infectious

Poor environmental sanitation Poor communications and transport facilities

Malignancy

Social customs, etc.

Accidents

CAUSES OF INFANT MORTALITY Neonatal mortality

Post-neonatal mortality

(0-4 weeks)

(1-12 months)

l. Low birth weight

1. Diarrhoeal diseases

2. Birth injury and difficult labour

2. Acute respiratory infections

3. Congenital anomalies

3. Other communicable diseases

4. Haemolytic diseases of newborn

4. Malnutrition

5. Conditions of placenta and cord

5. Congenital anomalies

6. Diarrhoeal diseases

6. Accidents

7. Acute respiratory infections 8. Tetanus LEADING CAUSES OF DEATH IN 1 -4 YEAR AGE GROUP Developing countries

Developed countries

Diarrhoeal diseases

Accidents

Respiratory infections

Congenital anomalies

Malnutrition

Malignant neoplasms

Infectious diseases

Influenza

(e.g., measles, whooping cough)

Pneumonia

Other febrile diseases Accidents and injuries

Essential Fatty acids Linoleic acid

Arachidonic acid

DIETARY SOURCES OF EFA Per cent Dietary source content Safflower oil

73

Corn oil Sunflower oil

57 56

Soyabean oil

51

Sesame oil

40

Groundnut oil

39

Mustard oil

15

Palm oil

9

Coconut oil

2

Meat, eggs

0.5 - 0.3

milk (fat)

0 .4 -0 .6

7

Linolenic acid Eichosapentaenoic acid

Soyabean oil

7

Leafy greens

Varied

Fish oil

10

DAILY INTAKE OF VITAMIN A (RECOMMENDED BY ICMR 1989) or BRetinol carotene (mcg) (mcg) Adults Man 600 2400 Woman 600 2400 600 2400 Pregnancy 950 3800 Group

Lactation 0 to 12 months

Infants Children

1 to 6 years 7 to 12 years

Adolescents 13 to 19 years

350

1200

400 600

1600 2400

600

2400

CUT-OFF POINTS FOR THE DIAGNOSIS OF ANAEMIA g/dl (Venous blood)

MCHC (per cent)

Adult males

13

34

Adult females, non-pregnant

12

34

Adult females, pregnant

11

34

Children, 6 months to 6 years

11

34

Children, 6 to 14 years

12

34

REQUIREMENTS OF IRON FOR DIFFERENT AGE GROUPS Age Group

Iron in mg that should be absorbed (daily needs)

Infants (5-12 months) Children (1-12 years)

0.7 mg 1.0 mg

Adolescents (13-16 years)

1.8 mg (males) 2.4 mg (females)

Adults, males

0.9 mg

Adults, females : Menstruation Pregnancy

2.8 mg (first half) (second half)

Lactation Post-menopause

0.8 3.5 2.4 0.7

mg mg mg mg

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THE SPECTRUM OF IODINE-DEFICIENCY DISORDERS IN APPROXIMATE ORDER OF INCREASING SEVERITY Disorders

Levels of severity

Goitre

- Grade I - Grade II - Grade III - Multinodular

Hypothyroidism

Varying combinations of clinical signs (depending on age of onset, duration and severity)

Subnormal intelligence Delayed motor milestones Mental deficiency

Variable severity

Hearing defects Speech defects Strabismus (squint)

- Unilateral - Bilateral

Nystagmus Spasticity (extrapyramida) Neuromuscular weakness

- Muscle weakness in legs, arms, trunk - Spastic diplegia - Spastic quadriplegia

Endemic cretinism

- Hypothyroid cretinism - Neurological cretinism

Intrauterine death (spontaneous abortion, miscarriage)

RECOMMENDED DAILY INTAKE FOR ENERGY

Group

Group

Body weight Kg.

Energy allowance per day kcals

MJ

Infancy 0-6 months 7-12 months Children

118 108

kcal/kg/day

1 -3 years

12.03

1240

5.1

4-6 years

18.87

1690

7.0

7-9 years

26.37

1950

8.1

Adolescents 10-12 years

(males)

35.4

2190

9.1

13-15 years

(females) (males)

31.5 47.8

1970 2450

8.2 10.2

(females)

46.7

2060

8.6

(males)

57.1

2640

11.0

(females)

49.9

2060

8.6

16-18 years

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Adults Ref Males

Ref Females

(light work) (moderate work)

60

2425 2875

10.1 12.0

3800 1875

15.8 7.8

2225 2925

9.3 12.2

+ 300

+ 1.25

(first 6 months)

+ 550

+2.3

(6-12 months)

+ 400

+ 1.68

(heavy work) (light work)

50

(moderate work) (heavy work) Pregnancy Lactation

DAILY INTAKE OF ENERGY Body weight

Age

Kg

kcal/kg/24 hrs. (approximate)

1 year (average]

112

1 to 3 years

12.0

100

4 to 6 years

18.8

90

7 to 9 years

26.3

80

Reference man

60

45

Reference woman

50

40

RECOMMENDED PROTEIN ALLOWANCES Protein allowance Particulars (g/kg/day)

Group Man (60 kg)

sedentary work moderate work heavy work

Woman (50 kg)

sedentary work moderate work heavy work pregnancy lactation (0 to 6 m)

to 3 months to 6 months to 9 months to 12 months

(g/day)

1

60.0

1

50.0

1 1

+ 15.0 + 25.0

Infants

0 3 6 9

2.3 (a) 1.8 (a) 1.65 (b) 1.5 (b)

Children

1 to 3 years 4 to 6 years 7 to 9 years

1.83 1.52 1.48

22.0 30.0 41

10 to 12 years 13 to 15 years

1.46 1.40

54 70

Adolescents Males

10

Females

16 to 18 years 10 to 12 years 13 to 15 years 16 to 18 years

1.31 1.45 1.33 1.21

78 57 65 63

(a) In terms of milk protein alone (b) In terms of mixed protein of NPU 65 relative to egg SUGGESTED INTAKE OF DIETARY FAT Fat intake g/day



Essential fatty acids Energy %

(energy per cent)

Adults : Man & Woman

20*

Pregnant woman

30

12.5

9

3 4.5

Lactating mother

45

17.5

5.7

Older children

22

9

3

Young children

25

15

3

About half of this will come from invisible fat present in the foods.

Phenomenon

CONCISE LIST OF INDICATORS OF NUTRITIONAL STATUS Indicator

Maternal Nutrition Infant and preschool child nutrition

School child nutrition

Food materials

birth weight proportion being breast fed and proportion on weaning foods, by age inmonths, mortality rates in children aged 1,2,3 and 4 years, with emphasis on 2-year-olds If age known: height for age weight for age If age unknown: weight for height arm circumference clinical signs and syndromes height for age, and weight for height at 7 years or school admission clinical signs

ADULTERATION OF FOODS Common adulterants

Cereals such as wheat, rice

Mud, grits, soapstone bits.

Dals

Coaltar dyes, khesari dal

Haldi (Turmeric) powder

Lead chromate powder

Dhania powder Black pepper

Starch, cow dung or horse dung powder Dried seeds of papaya,

Chilli powder

Saw dust, brick powder

Tea dust/leaves Coffee powder

Blackgram husk, tamarind seeds powder, saw dust, used tea dust Date husk, tamarind husk, Chicory,

Asafoetida (Hing)

Sand, grit, resins, gums

Mustard seeds

Seeds of prickly poppy-Argemone

Edible oils

Mineral oils, argemone oil,

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Butter

Starch, animal fat.

Ice -cream Sweetmeats

Cellulose, starch, non-permitted colours, Non-permitted colours.

Fresh green peas in packing

Green dye

Milk

Extraction of fat, addition of starch and water

Ghee

Vanaspati

NUTRITION PROGRAMMES IN INDIA Ministry

Programme

Vitamin A prophylaxis programme Prophylaxis against nutritional anaemia Iodine deficiency disorders control programme Special nutrition programme Balwadi nutrition programme ICDS programme Midday meal programme

Ministry of Health and Family Welfare Ministry of Health and Family Welfare Ministry of Health and Family Welfare Ministry of Social Welfare Ministry of Social Welfare Ministry of Social Welfare Ministry of Education

A MID-DAY SCHOOL MEAL Foodstuffs

g/day/child

Cereals and millets

75

Pulses

30

Oils and fats

30

Non-leafy vegetables

30

CLASSIFICATION OF HARDNESS IN WATER Level of hardness (mEq./litre)

Classification (a) Soft water (b) Moderately hard (c) Hard water (d) Very hard water

Pollutant

8

Leafy vegetables

Less than 1 ( 300 mg/L)

MAJOR AIR POLLUTANTS, THEIR SOURCES AND ADVERSE EFFECTS Sources

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Respirable particles Carbon Monoxide Nitrogen dioxide Sulphur dioxide Carbon dioxide Formaldehyde Other organic vapours (Benzene, toluene, etc.) Ozone Radon and "daughters" Asbestos Mineral fibres

Noxious Agents Oxides of Nitrogen

Hydrocarbons

Tobacco smoke Stove Aerosol sprays Combustion equipment, Stove, Gas heaters Gas cookers, cigarettes Coal combustion Combustion, respiration Particle board, carpet adhesives, insulation Solvents, adhesives, resin products, aerosol sprays Electric arcing, UV light sources Building material Insulation, fireproofing Appliances

SOURCES OF INDOOR AIR POLLUTANTS Sources Adverse effects Automobile exhaust, gas stoves Respiratory tract irritation, bronchial and heaters, wood-burning hyperactivity, impaired lung defences, stoves, kerosene space heaters bronchialitis obliterans Automobile exhaust, cigarette smoke Automobile exhaust high altitude aircraft cabins

Lung cancer

Sulphur dioxide

Power plants, Smelters, oil refineries, kerosene space heaters

Lead

Automobile exhaust leaded gasoline

Exacerbation of asthma and COPD, respiratory tract irritation, hospitalization may be necessary, and death may occur in severe exposure Impaired neuropsychological development in children

Ozone

using

Cough, substernal discomfort, bronchoconstriction, decreased exercise performance, respiratory tract irritation

OCCUPATIONAL DISEASES There is no internationally accepted definition for the term "occupational disease" However, occupational diseases are usually defined as diseases arising out of or in the course of employment. For convenience, they may be grouped as under: I. Diseases due to physical agents: (1) Heat Heat hyperpyrexia, heat exhaustion, heat syncope, heat cramps,burns and local effects such as prickly heat. (2) Cold Trench foot, frostbite, chilblains (3) Light Occupational cataract, miner's nystagmus (4) Pressure Caisson disease, air embolism, blast (explosion) (5) Noise Occupational deafness (6) Radiation Cancer, leukaemia, aplastic anaemia, pancytopenia (7) Mechanical factors Injuries, accidents. (8) Electricity Burns II. Diseases due to chemical agents: (1)Gases: C02, CO, HCN, CS2, NH3, N2, H2S, HCI, SO2 - these cause gas poisoning. (2)Dusts (Pneumoconiosis) : (i) Inorganic Dusts : (a) Coal dust .. Ahthracosis (b) Silica .. Silicosis (c) Asbestos .. Asbestosis, cancer lung (d) Iron .. Siderosis (ii) Organic (vegetable) Dusts : (a) Cane fibre .. Bagassosis (b) Cotton dust .. Byssinosis (c) Tobacco .. Tobacossis

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(d) Hay or grain dust

..

Farmers'lung

(3) Metals and their compounds: Toxic hazards from lead, mercury, cadmium, manganese, beryllium, arsenic, chromium etc. (4) Chemicals : Acids, alkalies, pesticides (5) Solvents : Carbon bisulphide, benzene, trichloroethylene, chloroform, etc. III. Diseases due to biological agents: Brucellosis, leptospirosis, anthrax, actinomycosis, hydatidosis, psittacosis, tetanus, encephalitis, fungal infections, etc. IV. Occupational cancers: Cancer of skin, lungs, bladder V..Occupational dermatosis: Dermatitis, eczema VI..Diseases of psychological origin: Industrial neurosis, hypertension, peptic ulcer, etc.

Community Medicine - Frequently Asked Questions                                

The name chikunguniya is derived from Makonde word means „that which bends‟ First in the history – RAECH. A Hom. Drug selected which covers the totality found in the majority of cases in an epidemic in a particular area in a given time – Genus epidemicus First pathogenic bacillus seen under the microscope by Robert koch – Anthrax. The most common intrauterine infection - Cytomegalovirus Tuberculosis infection of the Skins Lupus vulgaris Widal test Previous infection impairs reading. Chronic liver disease Hepatitis C. Blood transfusion is not Indicated if blood contains HbsAg + anti-HBC Pure motor type of paralysis is seen in Poliomyelitis. Pasteurization kills 90% bacteria in milk. KFD is caused by Ticks. Tuberculin test‟ Present and past disease. Best prognosis in reversibility(post-tubectomy) is seen in. Isthmo-isthemic type anastomosis Extra calories recommended during lactation is - 550 Kcal/day In iron deficiency anaemia, first change seen in blood is Decreased serum ferritin. Arbovirus prevalent in India I) Dengue ii) West Nile iii) Chicungunya. Most common cause of hepatocellular carcinoma is Hepatitis B Vaccine in the UIP which aims at preventing blindness is Measles Emergency Contraception is usually done following an Accidental exposure to - Unprotected sexual intercourse Herpes simplex infection can be transmitted to the neonates= During delivery The satellite lesions are seen in Borderline tuberculoid leprosy Amoebic cysts are generally Boiling method. In a definitive case of poliomyelitis positivity is defined by Demonstration of polio virus in the stool culture. Incidence of diarrhoea in comCohort study. Munity can be assessed by studying the calculation of In India, disease to be Eradicated in near future is Guinea-worm MTP is legal up to 20 weeks of pregnancy. Most common metabolite accumulation in blood in epidernic dropsy is Pyruvic acid. Best diagnostic method for cytomegaloinclusion disease is – Raising antibody titre in serum. Most important arthropod control is by – Environmental control. Best prophylaxis of cholera is – improved water sanitation.

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In a communicable disease with high mortality, test most useful must be – Highly specific. The largest number of leprosy patients in India are in – Bihar state. In India, the highest accident rate is reported from – Road traffic accidents. The daily protein requirement per kg body weight is highest during – Infancy. The method of refuse disposal that has been condemned by WHO as the most insanitary method is – Dumping. “AIDS DAY” is celebrated every year on – 1 st December. The slimming disease – AIDS. First AIDS case in India- 1986 at Chennai in a CSW. The most common root of transmission of HIV – Un protected sexual intcourse . Invariably fatal irrespective of best treatment – HIV NACP – 1986, NACO -1992 Severe CD4 lymphopenia is seen in HIV infection Common neoplasm in HIV infection – Kaposi‟s sarcoma. Aids was officially recognized in June1981 at the centre of disease control, USA. 3 to 12 wks of infection of HIV the individual is infectious and non reactive with the antibody detection tests – Window Period. Screening test for HIV – ELISA. Best latrine for rural community is – Water seal. Most effective in preventing TB and leprosy is – Early diagnosis and treatment. Tuberculin test positivity depends on- Induration Vaccine given earliest in a Child is BCG. „Flaky paint‟ appearance of Skin is seen in Kwashiorkor. Most common complication of IUCD is Bleeding. The vector of Japanese Encephalitis in India is Culex Vishuni In Kwashiorkor, the Immunoglobulin which is most affected is lgA. Greenish vaginal discharge With severe itching is seen in Diagnosis of Trichomonas infection. Following is rich in linolic acid Safflower oil. Most common route of spread Faeco-oral Hepatitis E is Diseases under WHO surveillance - I) Polio ii) Malaria iii) Influenza. Maximum safe doses of Radiation per year in human is 5 rads Man is intermediate host in Hydatid cyst. Most common malignancy in AIDS patient is Kaposi sarcoma In India, disease to be Eradicated in near future is Guinea-worm Best diagnostic method for cytomegaloinclusion disease is – Raising antibody titre in serum. Most important arthropod control is by – Environmental control. The richest source of niacin is – Meat Best prophylaxis of cholera is – improved water sanitation. In a communicable disease with high mortality, test most useful must be – Highly specific. The largest number of leprosy patients in India are in – Bihar state. In India, the highest accident rate is reported from – Road traffic accidents. The daily protein requirement per kg body weight is highest during – Infancy. The method of refuse disposal that has been condemned by WHO as the most insanitary method is – Dumping. Most effective in preventing TB and leprosy is – Early diagnosis and treatment. In am epidemic of poliomyelitis, best to stop spread is – OPV drops to all infants above 6 weeks age. Highest biological valve is of – Egg. IUCD with shortest life span is – Progestasert. The best epidernioligical marker for the HBV is – HbcAg. Best indicator for malaria prevamence in a community is – Infant parasite rate. Most common cause of failure of OCP is – Irregular intake. “Ring immunization” most commonly used for – Diphtheria. Most common carcinoma in India is – Oropharyngeal. Most commonly maximum production of breast milk is seen at – Three months after delivery.

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Most common vector for Japanese „B‟ encephalitis in India is – Culex tritaeniorhynclus. Most commonly, longitudinal studies give – Incidence of the disease. Most common non-veg food containing no carbohydrate is – Fish and egg. Best single indicator of health status of a population is – Expectation of life at one year. Best indicator of medical manpower is – Doctor population ratio. Most sensitive index of malaria transmission in a community is – Infant parasite rate. Most labile / fragile vaccine is – OPV. Schick test positivity means that the person is most susceptible to – Diphtheria. Most common cause of blindness in India is – Cataract. Most commonly suboccipital, postauricular and posterior cervical lymphadenopathy is characteristic of German measies – Rubella. Most common cause of breech presenation is prematurity. Most satisfactory method of refuse disposal is – Controlled tipping. Hospital refuse is best disposed off by – Incineration. Most effective in a sanitation barrier is – Segregation of faeces and its proper disposal. Gamma(y) irradiation is used to sterilize - Surgical instruments. Most pure water in nature is – Rain water. The disinfecting action of chlorine is most commonly due to – Hypichlorous acid. Best index of MCH services in a community is – Infant mortality rate (IMR). Least toxic organophosphorus insecticide is – Malathion. Most commonly insecticide used for space spray is 0 Pyrethrum. Most commonly “ Rose-Bengal test” is done to detect – Conjunctival xerosis. Most commonly diagnostic power of a test is reflected by – Predictive value. Most common major air pollutant is – SO2 Most commonly active immunity with sub-clinical cases occures Diphtheria. Most commonly herd immunity does not protect the individual in a case of – Tetanus. Most common process that destroys all microbial life including spores is called as – Sterilization. Commonest side effect of BCG – suppurative lymphadenopathy. Site of extraintestinal amoebiasis – Liver. Pathagnomonic symptom of rabies – aerophobia.[ fanning test] Test for diagnosis of rabies – corneal test. In India trachoma is seen as endemic – Punjab. Most imp cause of low birth wt – Mat Malnutrition. Common cause of IMR – LBW. Maternal mortality is caused largely – anemia or Hge Epidemic dropsy – Argemone oil consumption. Toxic principle in kesary dal resp for neurolathyrism – BOAA [β-oxalyl amino alanine] Most common conventional contraception used – condom. Vit a def is diagnosed by – Rose Bengal test. Milling rice – thiamine lost. Post exposure vaccine – used for rabies. Man is at the dead end – Tetanus and Rabies. „Corpulence index‟ – Obesity. Commonly used Tb drug developing fast resistance – INH. Pellagra is prevalent high – AP Biological transmit of disease is not seen in – House fly. Control of -------mode of transmission is difficult to control – Air. Indian man Ca – oro-pharyngeal Optimum Chlorine level to destroy Guinea worm – 5 ppm. Blindness by WHO – visual acuity less than 1/60 Diseases carry social stigma – Leprosy, syphilis, AIDS, Addtction. Normal chlorination does not affect polio virus. Action of chlorine to kill the germs at maximum at – ph 7. Break point chlorination -point at which residual cl appears in the water

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Cheapest and effective method of disinfection water sources – bleeching powder. The 60 mts period kept after bleeching – contact period. WHO standards of drinking water – less than 10 coliform bact per 100ml. When nitrites are present in water – recent contamination Nitrates in water indicates old contamination. Temparary hardness –Ca, Mg, Bicarbonate. Permanent –Clorides.Nitrtes.Sulphates Most harmful radiation alpha particles. Gamma rays have high penetrating ability. Sewage –solid waste containing liquid as well as solid excreta. Garbage –waste substances of food and vrg. Refuse –solid waste of the cities. Sullage –kitchen waste water Auger is the special equipment required for bore hole latrine. Common cause for developing to heart disease in India – Rheumatic fever. Ca Cx is least in – Israelis. Silicosis predisposes to Tb. Exposure to grain dust causes – Farmers lung. To cotton dust – brown lung. Common symptom for chemical food poisoning – vomiting. Most common occupational disease is Dermatosis. Largest cause for death in India – Road tr accidents. World population on Oct 12th 1999 – 6 billion World population – 680 crores [recent] India stood 2nd after China with 102 crores. 2nd Wed of October – World disaster reduction day. Growth is defined as physical maturation. Development is functional maturation

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