CHSE Odisha Voc. PHC & MLT cheat sheet

Anatomical position: standing erect, face forward, arms at sides with palms forward; all directional terms (superior, medial, proximal) are described from this position.

Body planes: sagittal divides left and right, coronal (frontal) divides front and back, transverse divides upper and lower.

Vital sign adult reference ranges: pulse 60-100/min, respiratory rate 12-20/min, oral temperature 36.5-37.5 C, systolic BP 90-120 mmHg, SpO2 95-100% on room air.

Cardiac output = heart rate x stroke volume; normal resting output is about 5 L/min.

Blood flow through the heart: vena cavae, right atrium, tricuspid valve, right ventricle, pulmonary valve, lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic valve, aorta.

Normal adult urine output is 0.5-1 mL/kg/hour; output below 30 mL/hour in an adult suggests oliguria and warrants urgent review.

First aid sequence: danger, response, airway, breathing, circulation; control severe bleeding with direct pressure before moving the casualty.

Adult CPR: compressions at 100-120/min, depth 5-6 cm, compression-to-ventilation ratio 30:2, and use an AED as soon as it is available.

Cold chain: most vaccines are stored at 2-8 C; never freeze vaccines that contain aluminium adjuvant, and record fridge temperature twice daily.

FEFO (first expiry, first out) governs issue from the store; expired stock is quarantined in a labelled 'not for use' area and never returned to general shelves.

Narcotic and controlled drugs require a separate double-locked cupboard, entry in a dedicated register, and physical counting at every shift handover.

A stock register entry needs date, drug name, strength, batch number, expiry date, quantity received or issued, balance, and signature of the person receiving.

Bin card and stock register must be reconciled; a physical stock count is done monthly and any discrepancy is reported in writing, not corrected silently.

Look-alike/sound-alike pairs (for example, dopamine and dobutamine) are stored apart with high-alert warning labels.

Dispensing support is limited to picking, counting, labelling and record entry; clinical screening, counselling and dose decisions belong to the pharmacist.

Light-sensitive drugs such as vitamin A and some antibiotics are kept in amber or opaque containers away from direct sunlight.

Pharmacokinetics covers absorption, distribution, metabolism and excretion; bioavailability is the fraction of a dose reaching systemic circulation unchanged.

First-pass metabolism in the gut wall and liver reduces oral bioavailability; the sublingual and intravenous routes avoid it.

Agonist binds a receptor and produces a response; antagonist binds without intrinsic activity and blocks the agonist.

Half-life is the time for plasma concentration to fall by half; roughly 4-5 half-lives are needed to reach steady state on repeated dosing.

Therapeutic index = toxic dose / therapeutic dose; a narrow index (digoxin, warfarin, lithium) demands monitoring and careful dosing.

Enzyme induction (rifampicin, phenytoin) lowers the effect of co-administered drugs; enzyme inhibition (erythromycin, ketoconazole) raises it.

Adverse drug reaction types: A (predictable, dose-related, for example bleeding with warfarin), B (idiosyncratic, for example anaphylaxis with penicillin).

Antibiotic stewardship: complete the prescribed course, do not share antibiotics, and culture before starting antibiotics whenever feasible.

Enteral routes are oral, sublingual, buccal, rectal; parenteral routes are intravenous, intramuscular, subcutaneous, intradermal.

Intradermal injection uses a 26-27 G needle, 0.1 mL volume and a 10-15 degree angle; intramuscular uses 21-23 G and a 90 degree angle.

Subcutaneous injection (insulin, heparin) uses a 25-27 G needle at 45-90 degrees into the fatty layer of the abdomen, thigh or upper arm.

Most oral tablets are swallowed with water; enteric-coated and modified-release tablets must not be crushed or chewed.

Dose formula: amount to give = (desired dose / stock strength) x stock volume.

Drops: 1 mL of standard aqueous infusion equals 20 drops; a microdrip set delivers 60 drops per mL.

Intravenous flow rate (mL/hour) = (volume in mL / time in hours); drops per minute = (volume x drop factor) / time in minutes.

The 6 rights of administration: right patient, right drug, right dose, right route, right time, right documentation.

Venepuncture order of draw: blood culture, sodium citrate (blue), serum gel or plain (red/gold), heparin (green), EDTA (lavender), fluoride-oxalate (grey).

EDTA (lavender tube) is the anticoagulant for haematology and must never be used for calcium or electrolyte biochemistry because it chelates calcium.

Sodium citrate blue tubes need a 9:1 blood-to-anticoagulant ratio and must be filled to the mark for valid coagulation results.

Tourniquet time should not exceed 1 minute; prolonged stasis raises potassium, lactate and protein values.

Haemolysed samples falsely raise potassium, LDH and AST; lipaemic samples interfere with many photometric assays.

Universal precautions: gloves for all sample contact, no recapping of needles, sharps into puncture-proof containers at point of use.

Urine for routine analysis is a midstream clean-catch sample; the first morning sample is preferred and analysis within 1-2 hours.

Sputum for AFB must be a deep cough specimen, not saliva; two samples on consecutive days are collected for diagnosis follow-up.

Adult haemoglobin reference: men 13-17 g/dL, women 12-15 g/dL; anaemia is haemoglobin below the reference range for age and sex.

Peripheral smear terms: microcytic hypochromic suggests iron deficiency; macrocytic suggests B12 or folate deficiency.

ESR is raised by infection, inflammation and anaemia; it is a non-specific marker and falls in polycythaemia and sickle cell disease.

Fasting plasma glucose of 126 mg/dL or more on two occasions, or random glucose of 200 mg/dL or more with symptoms, indicates diabetes.

Serum creatinine and urea rise in reduced kidney function; creatinine is the more reliable marker because urea varies with diet and hydration.

Urinalysis dipstick: nitrite and leucocyte esterase positive suggests urinary tract infection; ketones suggest fasting, vomiting or ketoacidosis.

Gram stain: Gram-positive organisms retain crystal violet and appear purple; Gram-negative organisms appear pink after counterstain.

Culture media: MacConkey agar selects Gram-negative organisms; blood agar grows most pathogens and shows haemolysis patterns.

Hand hygiene moments: before patient contact, before an aseptic task, after body fluid exposure risk, after patient contact, after contact with patient surroundings.

Alcohol-based hand rub is used for visibly clean hands; soap and water is required when hands are visibly soiled or after exposure to spore-formers such as Clostridioides difficile.

Biomedical waste colour coding: yellow for human anatomical waste, soiled and infectious waste; red for contaminated recyclable plastic; white translucent for sharps; blue for glassware and metallic implants.

Sharps are discarded immediately into a puncture-proof, leak-proof container filled to no more than three-quarters, then sealed and labelled.

Needle-stick injury first aid: wash with soap and water, do not squeeze or suck the wound, apply antiseptic, report immediately and start post-exposure prophylaxis assessment within hours.

Spill management: absorb with paper or granules, cover with disinfectant (sodium hypochlorite 1% for blood), leave contact time, then clean wearing gloves.

Sterilisation by autoclave: 121 C at 15 psi for 15-20 minutes; a biological indicator (Geobacillus stearothermophilus spores) verifies efficacy.

Biomedical waste is stored no longer than 48 hours before transport to the common treatment facility; records are kept for at least 5 years.

Informed consent requires capacity, adequate information, comprehension and voluntariness; it is documented before procedures.

Confidentiality: patient information is shared only with the care team on a need-to-know basis; disclosure without consent is permitted only where required by law or to prevent serious harm.

Medical records are legal documents: entries are made in ink, timed, dated, signed with name and designation, and errors are struck through with a single line, never erased.

The four principles of biomedical ethics are autonomy, beneficence, non-maleficence and justice.

Cold chain at a PHC: vaccine vial monitor status is checked before use; a vial whose VVM square has reached the discard point is discarded even if the expiry date is valid.

National immunisation schedule in India: BCG, hepatitis B birth dose and OPV-0 at birth; pentavalent and OPV at 6, 10 and 14 weeks; measles-rubella at 9-12 months and 16-24 months.

Referral note content: patient identifiers, presenting complaint, examination findings, treatment given, reason for referral and receiving facility.

A PHC reports notifiable diseases (polio, measles, diphtheria, cholera, plague, yellow fever) to the district surveillance unit without delay, alongside routine IDSP reporting.

Normal urine: pale yellow, clear, specific gravity 1.005-1.030, pH 4.6-8.0, no protein, glucose, ketones, blood, nitrite or bilirubin by dipstick.

Proteinuria on dipstick of 1+ or more is confirmed with a heat and acetic acid test or 24-hour urine protein estimation.

Urine microscopy: more than 5 white cells per high-power field suggests infection; more than 3 red cells suggests haematuria; casts indicate renal origin.

Pregnancy test detects beta-hCG in urine; first morning urine gives the highest concentration and the earliest reliable result.

Urine culture requires a clean-catch midstream sample in a sterile container; a colony count of 100,000 CFU/mL or more indicates significant bacteriuria.

Dipstick strips are stored in a tightly closed container away from moisture and light, and are read at the manufacturer's stated time, not later.

Bence Jones protein is detected by heating urine; it precipitates at 40-60 C and redissolves near boiling, unlike albumin.

Complete blood count reference for adults: white cells 4,000-11,000 per microlitre, platelets 150,000-450,000 per microlitre, haematocrit about 40-50% in men.

Differential count: neutrophils 40-75%, lymphocytes 20-45%, monocytes 2-10%, eosinophils 1-6%, basophils under 1%.

Erythrocyte sedimentation rate by Westergren: men up to 15 mm/hour, women up to 20 mm/hour at one hour.

Blood glucose estimation: fluoride-oxalate tube prevents glycolysis and preserves glucose for up to 24 hours at 4 C.

Liver function: raised ALT and AST indicate hepatocellular injury; raised alkaline phosphatase and bilirubin suggest cholestasis.

Renal function: normal serum creatinine about 0.7-1.3 mg/dL in adults; estimated glomerular filtration rate below 60 mL/min/1.73 m2 indicates chronic kidney disease.

Lipid profile thresholds: total cholesterol below 200 mg/dL desirable, LDL below 100 mg/dL optimal, triglycerides below 150 mg/dL normal.

Quality control: run normal and abnormal controls daily, plot on a Levey-Jennings chart, and stop reporting if a control falls outside 2 standard deviations until repeat confirms.