Karnataka II PUC Health Care - Vocational (KSEAB) cheat sheet

Health is defined by WHO (1948) as a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.

Levels of care: primary (first contact, e.g. PHC/sub-centre), secondary (district hospital, specialist), tertiary (medical college/regional institute, super-specialty).

India's rural public delivery pyramid: sub-centre (1 per 5,000 population; 3,000 in hilly/tribal areas) → PHC (1 per 30,000; 20,000 hilly) → CHC (1 per 80,000–1,20,000) → district hospital.

National Health Mission (NHM) = National Rural Health Mission (2005) + National Urban Health Mission (2013), with ASHA as the community-level link worker.

Health team roles: physician diagnoses/prescribes, nurse assesses and delivers care, pharmacist dispenses, lab technician performs investigations, health worker conducts outreach and referral.

Ayushman Bharat has two pillars: Health and Wellness Centres (comprehensive primary care) and PM-JAY (health insurance cover of ₹5 lakh per family per year).

Hospitals are classified by ownership (public/private), function (general/specialty), and system of medicine (allopathic, ayurveda, homeopathy).

Referral system moves a patient from a lower to a higher facility when needs exceed local capacity; counter-referral returns the patient with a care plan.

Anatomical position: standing erect, face forward, arms at sides, palms forward; terms like medial, lateral, proximal, distal, anterior, posterior are referenced to it.

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

Abdominopelvic quadrants: RUQ, LUQ, RLQ, LLQ; the appendix lies in the RLQ, the liver in the RUQ.

Skeletal system: 206 bones in the adult; axial skeleton (skull, vertebral column, rib cage) plus appendicular skeleton (limbs, girdles).

Vital signs normal adult ranges: pulse 60–100/min, respiration 12–20/min, blood pressure 120/80 mmHg (normal), oral temperature 36.5–37.5 °C.

Blood: plasma ~55%, formed elements ~45%; haemoglobin normal ~13–17 g/dL (male), ~12–15 g/dL (female).

Prefixes/roots/suffixes: cardio- (heart), nephro- (kidney), hepato- (liver), -itis (inflammation), -ectomy (surgical removal), -otomy (incision), -algia (pain), -emia (blood condition).

Homeostasis is maintained by negative feedback loops (e.g. insulin lowers raised blood glucose; baroreceptors adjust blood pressure).

Digestive order: mouth → oesophagus → stomach → small intestine (duodenum, jejunum, ileum) → large intestine → rectum/anus; most absorption occurs in the small intestine.

DRABC sequence: Danger, Response, Airway, Breathing, Circulation - assess before intervening.

Adult CPR: compressions at least 100–120/min, depth 5–6 cm, ratio 30 compressions to 2 breaths; use an AED as soon as available.

Choking: encourage coughing if effective; for severe obstruction in a conscious adult give up to 5 back blows then 5 abdominal thrusts (Heimlich), alternating.

Severe bleeding: apply direct pressure with a clean dressing, elevate the limb if possible, and do not remove a soaked dressing - add another on top.

Burns: cool with running water for about 20 minutes, remove jewellery, cover with a clean non-adherent dressing; never apply oil, toothpaste or ice.

Fracture/suspected spinal injury: immobilise in the found position, support the head and neck, and do not move the casualty unless there is immediate danger.

Poisoning: identify the substance, do not induce vomiting in corrosive or petroleum ingestion, and preserve the container for the hospital.

Snake bite: keep the patient calm and still, immobilise the bitten limb below heart level, remove tight items; do not cut, suck or apply a tourniquet.

Fainting: lay the person supine, raise the legs, loosen tight clothing, ensure fresh air; recovery is usually rapid - if not, treat as a medical emergency.

Bed bath order: face and neck → arms and axillae → chest and abdomen → back → legs → perineal area last; change water when cool or soiled.

Pressure ulcer prevention: reposition a bedridden patient at least every 2 hours, keep skin clean and dry, use pressure-relieving devices, and inspect bony prominences.

Oral care for an unconscious patient: place in lateral position, use a padded tongue blade, perform with suction ready, never instil fluid that cannot drain.

Temperature recording sites: oral, axillary, tympanic, rectal; axillary reads ~0.5 °C lower than oral, rectal ~0.5 °C higher.

Pulse is counted for a full minute, noting rate, rhythm and volume; an irregular pulse requires a full-minute apical count.

Intake–output chart: record all oral, IV and tube feeds as intake; urine, vomitus, drainage and stools as output; normal adult urine output ~1–1.5 L/day (minimum ~0.5 mL/kg/h).

Positioning: Fowler's (sitting up, aids breathing), Trendelenburg (head down, used for shock/venous return), lateral (prevents aspiration, used for unconscious patients).

Enema administration: warm solution to about 37 °C, lubricate the tip, insert gently, and position the patient left lateral with knees flexed.

Chain of infection: infectious agent → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host; break any link to prevent spread.

Hand hygiene moments (WHO): before touching a patient, before clean/aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings.

Standard precautions apply to all patients regardless of diagnosis; transmission-based precautions (contact, droplet, airborne) are added for specific infections.

Airborne precautions: N95 respirator, negative-pressure room, door closed; used for pulmonary tuberculosis, measles and varicella.

Droplet precautions: surgical mask within 1–2 m; used for influenza, diphtheria and pertussis.

Alcohol-based hand rub: apply 3–5 mL, rub all surfaces for 20–30 seconds; use soap and water when hands are visibly soiled or after caring for a C. difficile patient.

Sterilisation by autoclave: 121 °C at 15 psi for 15–20 minutes; chemical indicators confirm exposure, biological indicators (spore tests) confirm sterility.

Disinfection levels: high (glutaraldehyde, hydrogen peroxide), intermediate (alcohol, chlorine), low (detergents); sterilisation kills spores, disinfection does not.

Biomedical Waste Management Rules (India, 2016, amended 2018) define four colour-coded categories: yellow, red, white (translucent) and blue.

Yellow bag: human anatomical waste, soiled waste, expired/discarded medicines, chemical and cytotoxic waste - incinerate or deep-bury.

Red bag: contaminated recyclable plastic and tubing - autoclave or shred then recycle.

White translucent puncture-proof container: sharps (needles, blades, glass) - destroy by needle destroyer and send for secure landfill.

Blue container: glassware, metallic implants and broken thermometers - disinfect and recycle.

Segregation at the point of generation is the single most important step; waste must not be stored beyond 48 hours.

Needle recapping is prohibited; used sharps go directly into the puncture-proof container without bending or breaking by hand.

The hospital must maintain a BMW register, submit annual reports to the prescribed authority, and train all staff handling waste.

Macronutrients: carbohydrates 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g; alcohol 7 kcal/g.

Balanced diet concept: ~60–65% energy from carbohydrates, 10–15% from protein, 20–30% from fat; include vitamins, minerals, fibre and water.

Therapeutic diets: diabetic (low refined sugar, high fibre), renal (low protein, sodium and potassium), cardiac (low saturated fat and salt), postoperative (clear → full → soft → normal progression).

Deficiency diseases: vitamin A - night blindness/xerophthalmia; vitamin D - rickets/osteomalacia; vitamin C - scurvy; iron - anaemia; iodine - goitre/cretinism.

BMI = weight (kg) / height (m)²; Indian cut-offs: underweight <18.5, normal 18.5–22.9, overweight 23–24.9, obese ≥25.

PEM forms: marasmus (severe wasting, low weight-for-age) and kwashiorkor (oedema, low protein, moon face, fatty liver).

Exclusive breastfeeding for the first 6 months, complementary feeding from 6 months, continued breastfeeding to 2 years (WHO/UNICEF).

Health promotion uses IEC/BCC strategies: information, education and communication, with behaviour change communication targeting knowledge, attitude and practice.

Epidemiological measures: incidence = new cases / population at risk per unit time; prevalence = all existing cases / total population at a point or period.

Attack rate = new cases / population at risk during an outbreak × 100; case fatality rate = deaths from a disease / diagnosed cases × 100.

Mortality indicators: infant mortality rate, maternal mortality ratio, crude death rate; morbidity describes illness burden.

Screening tests: sensitivity = true positives / all diseased; specificity = true negatives / all non-diseased; predictive value depends on prevalence.

Herd immunity threshold is higher for more transmissible diseases; it protects those who cannot be vaccinated.

Levels of prevention: primary (immunisation, health education), secondary (early detection, screening), tertiary (rehabilitation, disability limitation).

Notifiable diseases include cholera, diphtheria, tuberculosis, measles, polio and dengue; they must be reported to the health authority.

National programmes: Universal Immunisation Programme, Revised National Tuberculosis Control Programme (now NTEP), National Vector Borne Disease Control Programme, NCD screening under NPCDCS.

Antenatal care: minimum 4 visits, with at least one in each trimester; first visit ideally before 12 weeks.

Danger signs in pregnancy: bleeding, severe headache with blurred vision, oedema of face/hands, high fever, reduced fetal movement, convulsions - refer immediately.

Eclampsia is convulsions plus hypertension in pregnancy; magnesium sulphate is the drug of choice for prevention and treatment of fits.

Postpartum haemorrhage = blood loss >500 mL after vaginal delivery (>1000 mL after caesarean); uterine massage and oxytocin are first-line measures.

Puerperium lasts 6 weeks after delivery; watch for sepsis (fever, foul lochia) and secondary haemorrhage.

Newborn care: immediate drying, skin-to-skin contact, delayed cord clamping, early initiation of breastfeeding within one hour, and vitamin K administration.

Birth weight <2.5 kg is low birth weight; <1.5 kg is very low birth weight; kangaroo mother care is used for stable low-birth-weight babies.

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

ORAL REHYDRATION: ORS is given in small frequent sips; zinc is added for 14 days in childhood diarrhoea; severe dehydration needs IV fluids.

Five rights of medication: right patient, right drug, right dose, right route, right time (plus documentation and reason).

Routes: oral (slowest onset), sublingual/buccal (fast, avoids first-pass), IM, SC, IV (fastest, 100% bioavailability), topical, inhalation, rectal.

Common abbreviations: OD once daily, BD twice daily, TDS three times, QID four times, HS at bedtime, PRN when required, STAT immediately, AC before food, PC after food.

Drug forms: tablet, capsule, syrup, suspension (shake before use), emulsion, ointment, suppository, injection.

Pharmacokinetics = absorption, distribution, metabolism (mainly liver), excretion (mainly kidney); half-life is the time for plasma concentration to halve.

Antibiotics must be completed as prescribed to prevent resistance; penicillins can cause anaphylaxis - check allergy history first.

Insulin is stored at 2–8 °C, never frozen; a vial in use is kept at room temperature; use an insulin syringe for accurate dosing.

Adverse drug reaction vs side effect vs overdose: a side effect is predictable and dose-related; an ADR is harmful and unintended; overdose is excessive dose.

Narcotic and emergency drugs are kept in a double-locked cupboard with a drug register and witnessed discard of unused portions.

Vital signs sequence: temperature → pulse → respiration → blood pressure; record on the chart with time and initials.

Aseptic technique for dressing: clean gloves for removal, sterile gloves and sterile forceps for the new dressing; clean from the centre outwards.

Intramuscular injection site: upper outer quadrant of the buttock (dorsogluteal) or deltoid; 90° angle, aspirate only if per protocol, massage the site.

Subcutaneous injection: 45–90° depending on needle length, abdomen/outer thigh/upper arm; rotate sites to prevent lipohypertrophy.

Intradermal injection uses a 26–27 G needle at 10–15° with a visible wheal; used for tuberculin (Mantoux) testing.

IV cannulation: select a distal vein, apply tourniquet above the site, cleanse with antiseptic, insert bevel up, check blood flashback, secure and label the cannula.

Specimen collection: label containers before collection, use sterile containers, collect midstream urine after cleansing, and transport promptly.

Urinary catheterisation: use sterile gloves and a sterile pack, lubricate the catheter, insert until urine flows, inflate the balloon only after confirming placement.

Blood collection tubes: purple/lavender (EDTA) for haematology, blue (sodium citrate) for coagulation, red/gold (clot activator/serum) for biochemistry, grey (fluoride-oxalate) for glucose.

Order of draw: blood culture → citrate → serum → heparin → EDTA → fluoride-oxalate to avoid additive cross-contamination.

Normal adult values: haemoglobin 13–17 g/dL male / 12–15 g/dL female; WBC 4,000–11,000/µL; platelets 1.5–4.5 lakh/µL; ESR <20 mm/h.

Urine routine: pH 4.5–8, specific gravity 1.005–1.030, protein and glucose negative, no pus cells or RBCs on microscopy.

Blood glucose: fasting 70–100 mg/dL, postprandial <140 mg/dL, random ≥200 mg/dL with symptoms suggests diabetes.

Liver function tests include bilirubin, SGOT/AST, SGPT/ALT, alkaline phosphatase and serum proteins; kidney function includes urea, creatinine and electrolytes.

Diagnostic aids: X-ray (bone/chest), ultrasound (soft tissue/obstetrics), CT (cross-sectional detail), MRI (soft tissue, no ionising radiation), ECG (cardiac electrical activity).

Sputum for AFB uses Ziehl–Neelsen staining; two samples are collected for tuberculosis diagnosis under NTEP.

Widal test detects antibodies against Salmonella typhi; a rising titre in paired samples is more meaningful than a single value.

Health is defined by WHO (1948) as a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.

Levels of care: primary (first contact, e.g. PHC/sub-centre), secondary (district hospital, specialist), tertiary (medical college/regional institute, super-specialty).

India's rural public delivery pyramid: sub-centre (1 per 5,000 population; 3,000 in hilly/tribal areas) → PHC (1 per 30,000; 20,000 hilly) → CHC (1 per 80,000–1,20,000) → district hospital.

National Health Mission (NHM) = National Rural Health Mission (2005) + National Urban Health Mission (2013), with ASHA as the community-level link worker.

Health team roles: physician diagnoses/prescribes, nurse assesses and delivers care, pharmacist dispenses, lab technician performs investigations, health worker conducts outreach and referral.

Ayushman Bharat has two pillars: Health and Wellness Centres (comprehensive primary care) and PM-JAY (health insurance cover of ₹5 lakh per family per year).

Hospitals are classified by ownership (public/private), function (general/specialty), and system of medicine (allopathic, ayurveda, homeopathy).

Referral system moves a patient from a lower to a higher facility when needs exceed local capacity; counter-referral returns the patient with a care plan.

Anatomical position: standing erect, face forward, arms at sides, palms forward; terms like medial, lateral, proximal, distal, anterior, posterior are referenced to it.

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

Abdominopelvic quadrants: RUQ, LUQ, RLQ, LLQ; the appendix lies in the RLQ, the liver in the RUQ.

Skeletal system: 206 bones in the adult; axial skeleton (skull, vertebral column, rib cage) plus appendicular skeleton (limbs, girdles).

Vital signs normal adult ranges: pulse 60–100/min, respiration 12–20/min, blood pressure 120/80 mmHg (normal), oral temperature 36.5–37.5 °C.

Blood: plasma ~55%, formed elements ~45%; haemoglobin normal ~13–17 g/dL (male), ~12–15 g/dL (female).

Prefixes/roots/suffixes: cardio- (heart), nephro- (kidney), hepato- (liver), -itis (inflammation), -ectomy (surgical removal), -otomy (incision), -algia (pain), -emia (blood condition).

Homeostasis is maintained by negative feedback loops (e.g. insulin lowers raised blood glucose; baroreceptors adjust blood pressure).

Digestive order: mouth → oesophagus → stomach → small intestine (duodenum, jejunum, ileum) → large intestine → rectum/anus; most absorption occurs in the small intestine.

DRABC sequence: Danger, Response, Airway, Breathing, Circulation - assess before intervening.

Adult CPR: compressions at least 100–120/min, depth 5–6 cm, ratio 30 compressions to 2 breaths; use an AED as soon as available.

Choking: encourage coughing if effective; for severe obstruction in a conscious adult give up to 5 back blows then 5 abdominal thrusts (Heimlich), alternating.

Severe bleeding: apply direct pressure with a clean dressing, elevate the limb if possible, and do not remove a soaked dressing - add another on top.

Burns: cool with running water for about 20 minutes, remove jewellery, cover with a clean non-adherent dressing; never apply oil, toothpaste or ice.

Fracture/suspected spinal injury: immobilise in the found position, support the head and neck, and do not move the casualty unless there is immediate danger.

Poisoning: identify the substance, do not induce vomiting in corrosive or petroleum ingestion, and preserve the container for the hospital.

Snake bite: keep the patient calm and still, immobilise the bitten limb below heart level, remove tight items; do not cut, suck or apply a tourniquet.

Fainting: lay the person supine, raise the legs, loosen tight clothing, ensure fresh air; recovery is usually rapid - if not, treat as a medical emergency.

Bed bath order: face and neck → arms and axillae → chest and abdomen → back → legs → perineal area last; change water when cool or soiled.

Pressure ulcer prevention: reposition a bedridden patient at least every 2 hours, keep skin clean and dry, use pressure-relieving devices, and inspect bony prominences.

Oral care for an unconscious patient: place in lateral position, use a padded tongue blade, perform with suction ready, never instil fluid that cannot drain.

Temperature recording sites: oral, axillary, tympanic, rectal; axillary reads ~0.5 °C lower than oral, rectal ~0.5 °C higher.

Pulse is counted for a full minute, noting rate, rhythm and volume; an irregular pulse requires a full-minute apical count.

Intake–output chart: record all oral, IV and tube feeds as intake; urine, vomitus, drainage and stools as output; normal adult urine output ~1–1.5 L/day (minimum ~0.5 mL/kg/h).

Positioning: Fowler's (sitting up, aids breathing), Trendelenburg (head down, used for shock/venous return), lateral (prevents aspiration, used for unconscious patients).

Enema administration: warm solution to about 37 °C, lubricate the tip, insert gently, and position the patient left lateral with knees flexed.

Chain of infection: infectious agent → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host; break any link to prevent spread.

Hand hygiene moments (WHO): before touching a patient, before clean/aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings.

Standard precautions apply to all patients regardless of diagnosis; transmission-based precautions (contact, droplet, airborne) are added for specific infections.

Airborne precautions: N95 respirator, negative-pressure room, door closed; used for pulmonary tuberculosis, measles and varicella.

Droplet precautions: surgical mask within 1–2 m; used for influenza, diphtheria and pertussis.

Alcohol-based hand rub: apply 3–5 mL, rub all surfaces for 20–30 seconds; use soap and water when hands are visibly soiled or after caring for a C. difficile patient.

Sterilisation by autoclave: 121 °C at 15 psi for 15–20 minutes; chemical indicators confirm exposure, biological indicators (spore tests) confirm sterility.

Disinfection levels: high (glutaraldehyde, hydrogen peroxide), intermediate (alcohol, chlorine), low (detergents); sterilisation kills spores, disinfection does not.

Biomedical Waste Management Rules (India, 2016, amended 2018) define four colour-coded categories: yellow, red, white (translucent) and blue.

Yellow bag: human anatomical waste, soiled waste, expired/discarded medicines, chemical and cytotoxic waste - incinerate or deep-bury.

Red bag: contaminated recyclable plastic and tubing - autoclave or shred then recycle.

White translucent puncture-proof container: sharps (needles, blades, glass) - destroy by needle destroyer and send for secure landfill.

Blue container: glassware, metallic implants and broken thermometers - disinfect and recycle.

Segregation at the point of generation is the single most important step; waste must not be stored beyond 48 hours.

Needle recapping is prohibited; used sharps go directly into the puncture-proof container without bending or breaking by hand.

The hospital must maintain a BMW register, submit annual reports to the prescribed authority, and train all staff handling waste.

Macronutrients: carbohydrates 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g; alcohol 7 kcal/g.

Balanced diet concept: ~60–65% energy from carbohydrates, 10–15% from protein, 20–30% from fat; include vitamins, minerals, fibre and water.

Therapeutic diets: diabetic (low refined sugar, high fibre), renal (low protein, sodium and potassium), cardiac (low saturated fat and salt), postoperative (clear → full → soft → normal progression).

Deficiency diseases: vitamin A - night blindness/xerophthalmia; vitamin D - rickets/osteomalacia; vitamin C - scurvy; iron - anaemia; iodine - goitre/cretinism.

BMI = weight (kg) / height (m)²; Indian cut-offs: underweight <18.5, normal 18.5–22.9, overweight 23–24.9, obese ≥25.

PEM forms: marasmus (severe wasting, low weight-for-age) and kwashiorkor (oedema, low protein, moon face, fatty liver).

Exclusive breastfeeding for the first 6 months, complementary feeding from 6 months, continued breastfeeding to 2 years (WHO/UNICEF).

Health promotion uses IEC/BCC strategies: information, education and communication, with behaviour change communication targeting knowledge, attitude and practice.

Epidemiological measures: incidence = new cases / population at risk per unit time; prevalence = all existing cases / total population at a point or period.

Attack rate = new cases / population at risk during an outbreak × 100; case fatality rate = deaths from a disease / diagnosed cases × 100.

Mortality indicators: infant mortality rate, maternal mortality ratio, crude death rate; morbidity describes illness burden.

Screening tests: sensitivity = true positives / all diseased; specificity = true negatives / all non-diseased; predictive value depends on prevalence.

Herd immunity threshold is higher for more transmissible diseases; it protects those who cannot be vaccinated.

Levels of prevention: primary (immunisation, health education), secondary (early detection, screening), tertiary (rehabilitation, disability limitation).

Notifiable diseases include cholera, diphtheria, tuberculosis, measles, polio and dengue; they must be reported to the health authority.

National programmes: Universal Immunisation Programme, Revised National Tuberculosis Control Programme (now NTEP), National Vector Borne Disease Control Programme, NCD screening under NPCDCS.

Antenatal care: minimum 4 visits, with at least one in each trimester; first visit ideally before 12 weeks.

Danger signs in pregnancy: bleeding, severe headache with blurred vision, oedema of face/hands, high fever, reduced fetal movement, convulsions - refer immediately.

Eclampsia is convulsions plus hypertension in pregnancy; magnesium sulphate is the drug of choice for prevention and treatment of fits.

Postpartum haemorrhage = blood loss >500 mL after vaginal delivery (>1000 mL after caesarean); uterine massage and oxytocin are first-line measures.

Puerperium lasts 6 weeks after delivery; watch for sepsis (fever, foul lochia) and secondary haemorrhage.

Newborn care: immediate drying, skin-to-skin contact, delayed cord clamping, early initiation of breastfeeding within one hour, and vitamin K administration.

Birth weight <2.5 kg is low birth weight; <1.5 kg is very low birth weight; kangaroo mother care is used for stable low-birth-weight babies.

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

ORAL REHYDRATION: ORS is given in small frequent sips; zinc is added for 14 days in childhood diarrhoea; severe dehydration needs IV fluids.

Five rights of medication: right patient, right drug, right dose, right route, right time (plus documentation and reason).

Routes: oral (slowest onset), sublingual/buccal (fast, avoids first-pass), IM, SC, IV (fastest, 100% bioavailability), topical, inhalation, rectal.

Common abbreviations: OD once daily, BD twice daily, TDS three times, QID four times, HS at bedtime, PRN when required, STAT immediately, AC before food, PC after food.

Drug forms: tablet, capsule, syrup, suspension (shake before use), emulsion, ointment, suppository, injection.

Pharmacokinetics = absorption, distribution, metabolism (mainly liver), excretion (mainly kidney); half-life is the time for plasma concentration to halve.

Antibiotics must be completed as prescribed to prevent resistance; penicillins can cause anaphylaxis - check allergy history first.

Insulin is stored at 2–8 °C, never frozen; a vial in use is kept at room temperature; use an insulin syringe for accurate dosing.

Adverse drug reaction vs side effect vs overdose: a side effect is predictable and dose-related; an ADR is harmful and unintended; overdose is excessive dose.

Narcotic and emergency drugs are kept in a double-locked cupboard with a drug register and witnessed discard of unused portions.

Vital signs sequence: temperature → pulse → respiration → blood pressure; record on the chart with time and initials.

Aseptic technique for dressing: clean gloves for removal, sterile gloves and sterile forceps for the new dressing; clean from the centre outwards.

Intramuscular injection site: upper outer quadrant of the buttock (dorsogluteal) or deltoid; 90° angle, aspirate only if per protocol, massage the site.

Subcutaneous injection: 45–90° depending on needle length, abdomen/outer thigh/upper arm; rotate sites to prevent lipohypertrophy.

Intradermal injection uses a 26–27 G needle at 10–15° with a visible wheal; used for tuberculin (Mantoux) testing.

IV cannulation: select a distal vein, apply tourniquet above the site, cleanse with antiseptic, insert bevel up, check blood flashback, secure and label the cannula.

Specimen collection: label containers before collection, use sterile containers, collect midstream urine after cleansing, and transport promptly.

Urinary catheterisation: use sterile gloves and a sterile pack, lubricate the catheter, insert until urine flows, inflate the balloon only after confirming placement.

Blood collection tubes: purple/lavender (EDTA) for haematology, blue (sodium citrate) for coagulation, red/gold (clot activator/serum) for biochemistry, grey (fluoride-oxalate) for glucose.

Order of draw: blood culture → citrate → serum → heparin → EDTA → fluoride-oxalate to avoid additive cross-contamination.

Normal adult values: haemoglobin 13–17 g/dL male / 12–15 g/dL female; WBC 4,000–11,000/µL; platelets 1.5–4.5 lakh/µL; ESR <20 mm/h.

Urine routine: pH 4.5–8, specific gravity 1.005–1.030, protein and glucose negative, no pus cells or RBCs on microscopy.

Blood glucose: fasting 70–100 mg/dL, postprandial <140 mg/dL, random ≥200 mg/dL with symptoms suggests diabetes.

Liver function tests include bilirubin, SGOT/AST, SGPT/ALT, alkaline phosphatase and serum proteins; kidney function includes urea, creatinine and electrolytes.

Diagnostic aids: X-ray (bone/chest), ultrasound (soft tissue/obstetrics), CT (cross-sectional detail), MRI (soft tissue, no ionising radiation), ECG (cardiac electrical activity).

Sputum for AFB uses Ziehl–Neelsen staining; two samples are collected for tuberculosis diagnosis under NTEP.

Widal test detects antibodies against Salmonella typhi; a rising titre in paired samples is more meaningful than a single value.

Health is defined by WHO (1948) as a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.

Levels of care: primary (first contact, e.g. PHC/sub-centre), secondary (district hospital, specialist), tertiary (medical college/regional institute, super-specialty).

India's rural public delivery pyramid: sub-centre (1 per 5,000 population; 3,000 in hilly/tribal areas) → PHC (1 per 30,000; 20,000 hilly) → CHC (1 per 80,000–1,20,000) → district hospital.

National Health Mission (NHM) = National Rural Health Mission (2005) + National Urban Health Mission (2013), with ASHA as the community-level link worker.

Health team roles: physician diagnoses/prescribes, nurse assesses and delivers care, pharmacist dispenses, lab technician performs investigations, health worker conducts outreach and referral.

Ayushman Bharat has two pillars: Health and Wellness Centres (comprehensive primary care) and PM-JAY (health insurance cover of ₹5 lakh per family per year).

Hospitals are classified by ownership (public/private), function (general/specialty), and system of medicine (allopathic, ayurveda, homeopathy).

Referral system moves a patient from a lower to a higher facility when needs exceed local capacity; counter-referral returns the patient with a care plan.

Anatomical position: standing erect, face forward, arms at sides, palms forward; terms like medial, lateral, proximal, distal, anterior, posterior are referenced to it.

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

Abdominopelvic quadrants: RUQ, LUQ, RLQ, LLQ; the appendix lies in the RLQ, the liver in the RUQ.

Skeletal system: 206 bones in the adult; axial skeleton (skull, vertebral column, rib cage) plus appendicular skeleton (limbs, girdles).

Vital signs normal adult ranges: pulse 60–100/min, respiration 12–20/min, blood pressure 120/80 mmHg (normal), oral temperature 36.5–37.5 °C.

Blood: plasma ~55%, formed elements ~45%; haemoglobin normal ~13–17 g/dL (male), ~12–15 g/dL (female).

Prefixes/roots/suffixes: cardio- (heart), nephro- (kidney), hepato- (liver), -itis (inflammation), -ectomy (surgical removal), -otomy (incision), -algia (pain), -emia (blood condition).

Homeostasis is maintained by negative feedback loops (e.g. insulin lowers raised blood glucose; baroreceptors adjust blood pressure).

Digestive order: mouth → oesophagus → stomach → small intestine (duodenum, jejunum, ileum) → large intestine → rectum/anus; most absorption occurs in the small intestine.

DRABC sequence: Danger, Response, Airway, Breathing, Circulation - assess before intervening.

Adult CPR: compressions at least 100–120/min, depth 5–6 cm, ratio 30 compressions to 2 breaths; use an AED as soon as available.

Choking: encourage coughing if effective; for severe obstruction in a conscious adult give up to 5 back blows then 5 abdominal thrusts (Heimlich), alternating.

Severe bleeding: apply direct pressure with a clean dressing, elevate the limb if possible, and do not remove a soaked dressing - add another on top.

Burns: cool with running water for about 20 minutes, remove jewellery, cover with a clean non-adherent dressing; never apply oil, toothpaste or ice.

Fracture/suspected spinal injury: immobilise in the found position, support the head and neck, and do not move the casualty unless there is immediate danger.

Poisoning: identify the substance, do not induce vomiting in corrosive or petroleum ingestion, and preserve the container for the hospital.

Snake bite: keep the patient calm and still, immobilise the bitten limb below heart level, remove tight items; do not cut, suck or apply a tourniquet.

Fainting: lay the person supine, raise the legs, loosen tight clothing, ensure fresh air; recovery is usually rapid - if not, treat as a medical emergency.

Bed bath order: face and neck → arms and axillae → chest and abdomen → back → legs → perineal area last; change water when cool or soiled.

Pressure ulcer prevention: reposition a bedridden patient at least every 2 hours, keep skin clean and dry, use pressure-relieving devices, and inspect bony prominences.

Oral care for an unconscious patient: place in lateral position, use a padded tongue blade, perform with suction ready, never instil fluid that cannot drain.

Temperature recording sites: oral, axillary, tympanic, rectal; axillary reads ~0.5 °C lower than oral, rectal ~0.5 °C higher.

Pulse is counted for a full minute, noting rate, rhythm and volume; an irregular pulse requires a full-minute apical count.

Intake–output chart: record all oral, IV and tube feeds as intake; urine, vomitus, drainage and stools as output; normal adult urine output ~1–1.5 L/day (minimum ~0.5 mL/kg/h).

Positioning: Fowler's (sitting up, aids breathing), Trendelenburg (head down, used for shock/venous return), lateral (prevents aspiration, used for unconscious patients).

Enema administration: warm solution to about 37 °C, lubricate the tip, insert gently, and position the patient left lateral with knees flexed.

Chain of infection: infectious agent → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host; break any link to prevent spread.

Hand hygiene moments (WHO): before touching a patient, before clean/aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings.

Standard precautions apply to all patients regardless of diagnosis; transmission-based precautions (contact, droplet, airborne) are added for specific infections.

Airborne precautions: N95 respirator, negative-pressure room, door closed; used for pulmonary tuberculosis, measles and varicella.

Droplet precautions: surgical mask within 1–2 m; used for influenza, diphtheria and pertussis.

Alcohol-based hand rub: apply 3–5 mL, rub all surfaces for 20–30 seconds; use soap and water when hands are visibly soiled or after caring for a C. difficile patient.

Sterilisation by autoclave: 121 °C at 15 psi for 15–20 minutes; chemical indicators confirm exposure, biological indicators (spore tests) confirm sterility.

Disinfection levels: high (glutaraldehyde, hydrogen peroxide), intermediate (alcohol, chlorine), low (detergents); sterilisation kills spores, disinfection does not.

Biomedical Waste Management Rules (India, 2016, amended 2018) define four colour-coded categories: yellow, red, white (translucent) and blue.

Yellow bag: human anatomical waste, soiled waste, expired/discarded medicines, chemical and cytotoxic waste - incinerate or deep-bury.

Red bag: contaminated recyclable plastic and tubing - autoclave or shred then recycle.

White translucent puncture-proof container: sharps (needles, blades, glass) - destroy by needle destroyer and send for secure landfill.

Blue container: glassware, metallic implants and broken thermometers - disinfect and recycle.

Segregation at the point of generation is the single most important step; waste must not be stored beyond 48 hours.

Needle recapping is prohibited; used sharps go directly into the puncture-proof container without bending or breaking by hand.

The hospital must maintain a BMW register, submit annual reports to the prescribed authority, and train all staff handling waste.

Macronutrients: carbohydrates 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g; alcohol 7 kcal/g.

Balanced diet concept: ~60–65% energy from carbohydrates, 10–15% from protein, 20–30% from fat; include vitamins, minerals, fibre and water.

Therapeutic diets: diabetic (low refined sugar, high fibre), renal (low protein, sodium and potassium), cardiac (low saturated fat and salt), postoperative (clear → full → soft → normal progression).

Deficiency diseases: vitamin A - night blindness/xerophthalmia; vitamin D - rickets/osteomalacia; vitamin C - scurvy; iron - anaemia; iodine - goitre/cretinism.

BMI = weight (kg) / height (m)²; Indian cut-offs: underweight <18.5, normal 18.5–22.9, overweight 23–24.9, obese ≥25.

PEM forms: marasmus (severe wasting, low weight-for-age) and kwashiorkor (oedema, low protein, moon face, fatty liver).

Exclusive breastfeeding for the first 6 months, complementary feeding from 6 months, continued breastfeeding to 2 years (WHO/UNICEF).

Health promotion uses IEC/BCC strategies: information, education and communication, with behaviour change communication targeting knowledge, attitude and practice.

Epidemiological measures: incidence = new cases / population at risk per unit time; prevalence = all existing cases / total population at a point or period.

Attack rate = new cases / population at risk during an outbreak × 100; case fatality rate = deaths from a disease / diagnosed cases × 100.

Mortality indicators: infant mortality rate, maternal mortality ratio, crude death rate; morbidity describes illness burden.

Screening tests: sensitivity = true positives / all diseased; specificity = true negatives / all non-diseased; predictive value depends on prevalence.

Herd immunity threshold is higher for more transmissible diseases; it protects those who cannot be vaccinated.

Levels of prevention: primary (immunisation, health education), secondary (early detection, screening), tertiary (rehabilitation, disability limitation).

Notifiable diseases include cholera, diphtheria, tuberculosis, measles, polio and dengue; they must be reported to the health authority.

National programmes: Universal Immunisation Programme, Revised National Tuberculosis Control Programme (now NTEP), National Vector Borne Disease Control Programme, NCD screening under NPCDCS.

Antenatal care: minimum 4 visits, with at least one in each trimester; first visit ideally before 12 weeks.

Danger signs in pregnancy: bleeding, severe headache with blurred vision, oedema of face/hands, high fever, reduced fetal movement, convulsions - refer immediately.

Eclampsia is convulsions plus hypertension in pregnancy; magnesium sulphate is the drug of choice for prevention and treatment of fits.

Postpartum haemorrhage = blood loss >500 mL after vaginal delivery (>1000 mL after caesarean); uterine massage and oxytocin are first-line measures.

Puerperium lasts 6 weeks after delivery; watch for sepsis (fever, foul lochia) and secondary haemorrhage.

Newborn care: immediate drying, skin-to-skin contact, delayed cord clamping, early initiation of breastfeeding within one hour, and vitamin K administration.

Birth weight <2.5 kg is low birth weight; <1.5 kg is very low birth weight; kangaroo mother care is used for stable low-birth-weight babies.

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

ORAL REHYDRATION: ORS is given in small frequent sips; zinc is added for 14 days in childhood diarrhoea; severe dehydration needs IV fluids.

Five rights of medication: right patient, right drug, right dose, right route, right time (plus documentation and reason).

Routes: oral (slowest onset), sublingual/buccal (fast, avoids first-pass), IM, SC, IV (fastest, 100% bioavailability), topical, inhalation, rectal.

Common abbreviations: OD once daily, BD twice daily, TDS three times, QID four times, HS at bedtime, PRN when required, STAT immediately, AC before food, PC after food.

Drug forms: tablet, capsule, syrup, suspension (shake before use), emulsion, ointment, suppository, injection.

Pharmacokinetics = absorption, distribution, metabolism (mainly liver), excretion (mainly kidney); half-life is the time for plasma concentration to halve.

Antibiotics must be completed as prescribed to prevent resistance; penicillins can cause anaphylaxis - check allergy history first.

Insulin is stored at 2–8 °C, never frozen; a vial in use is kept at room temperature; use an insulin syringe for accurate dosing.

Adverse drug reaction vs side effect vs overdose: a side effect is predictable and dose-related; an ADR is harmful and unintended; overdose is excessive dose.

Narcotic and emergency drugs are kept in a double-locked cupboard with a drug register and witnessed discard of unused portions.

Vital signs sequence: temperature → pulse → respiration → blood pressure; record on the chart with time and initials.

Aseptic technique for dressing: clean gloves for removal, sterile gloves and sterile forceps for the new dressing; clean from the centre outwards.

Intramuscular injection site: upper outer quadrant of the buttock (dorsogluteal) or deltoid; 90° angle, aspirate only if per protocol, massage the site.

Subcutaneous injection: 45–90° depending on needle length, abdomen/outer thigh/upper arm; rotate sites to prevent lipohypertrophy.

Intradermal injection uses a 26–27 G needle at 10–15° with a visible wheal; used for tuberculin (Mantoux) testing.

IV cannulation: select a distal vein, apply tourniquet above the site, cleanse with antiseptic, insert bevel up, check blood flashback, secure and label the cannula.

Specimen collection: label containers before collection, use sterile containers, collect midstream urine after cleansing, and transport promptly.

Urinary catheterisation: use sterile gloves and a sterile pack, lubricate the catheter, insert until urine flows, inflate the balloon only after confirming placement.

Blood collection tubes: purple/lavender (EDTA) for haematology, blue (sodium citrate) for coagulation, red/gold (clot activator/serum) for biochemistry, grey (fluoride-oxalate) for glucose.

Order of draw: blood culture → citrate → serum → heparin → EDTA → fluoride-oxalate to avoid additive cross-contamination.

Normal adult values: haemoglobin 13–17 g/dL male / 12–15 g/dL female; WBC 4,000–11,000/µL; platelets 1.5–4.5 lakh/µL; ESR <20 mm/h.

Urine routine: pH 4.5–8, specific gravity 1.005–1.030, protein and glucose negative, no pus cells or RBCs on microscopy.

Blood glucose: fasting 70–100 mg/dL, postprandial <140 mg/dL, random ≥200 mg/dL with symptoms suggests diabetes.

Liver function tests include bilirubin, SGOT/AST, SGPT/ALT, alkaline phosphatase and serum proteins; kidney function includes urea, creatinine and electrolytes.

Diagnostic aids: X-ray (bone/chest), ultrasound (soft tissue/obstetrics), CT (cross-sectional detail), MRI (soft tissue, no ionising radiation), ECG (cardiac electrical activity).

Sputum for AFB uses Ziehl–Neelsen staining; two samples are collected for tuberculosis diagnosis under NTEP.

Widal test detects antibodies against Salmonella typhi; a rising titre in paired samples is more meaningful than a single value.