UPMSP Vocational Health Care cheat sheet

Levels of organisation ascend: cell → tissue → organ → organ system → organism; anatomy studies structure, physiology studies function.

Body cavities: cranial and spinal (dorsal); thoracic (heart, lungs, mediastinum), abdominal and pelvic (ventral), separated by the diaphragm.

Vital signs adult ranges: temperature 36.1–37.2 °C oral, pulse 60–100/min, respiration 12–20/min, blood pressure 120/80 mmHg, SpO2 ≥ 95%.

Homeostasis is maintained by negative feedback loops: receptor detects change, control centre (hypothalamus) compares to set point, effector reverses the change.

Skeletal system: 206 bones in the adult; axial skeleton 80 (skull, vertebral column, ribs, sternum), appendicular 126 (limbs and girdles).

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

Primary health care principles (Alma-Ata 1978): equitable access, community participation, intersectoral coordination, appropriate technology, preventive focus.

Four main tissue types: epithelial (covering), connective (support), muscular (contraction), nervous (conduction); each is identified by cell shape and matrix.

Bed bath sequence: face and neck → arms and axillae → chest and abdomen → legs → back and buttocks → perineum last; water 43–46 °C, change water when cool or soiled.

Pressure injury risk assessed with the Braden Scale (six subscales: sensory perception, moisture, activity, mobility, nutrition, friction/shear); score ≤ 12 = high risk.

Reposition the immobile patient at least every 2 hours; inspect bony prominences (sacrum, heels, occiput, trochanters, elbows) each turn.

Oral care for the unconscious patient: lateral or semi-prone position, no fluid instilled, suction ready, dentures removed, use swabs not a toothbrush with paste.

Intake–output chart: record all oral, tube and IV intake and urine, vomit, drain and stool output; normal adult urine output 0.5–1 mL/kg/hour.

Hand hygiene per WHO 'My 5 Moments': before patient contact, before aseptic task, after body-fluid exposure risk, after patient contact, after touching surroundings.

Body temperature sites ranked by reliability: rectal/core > oral > axillary; axillary reads about 0.5 °C lower than oral.

Perineal care is given front to back to prevent urinary tract infection; use separate swabs per stroke and never return a used swab to the bowl.

Adult CPR sequence: check response and breathing ≤ 10 s, call for help, 30 chest compressions (100–120/min, depth 5–6 cm) then 2 rescue breaths; AED as soon as available.

Choking adult with effective cough: encourage coughing; ineffective cough and conscious: 5 back blows then 5 abdominal thrusts, alternating; unconscious: start CPR.

Recovery position: lateral, lower arm forward, upper leg flexed, head tilted back to keep airway open; used for unconscious breathing casualties.

Severe bleeding: apply direct pressure with a dressing, elevate if no fracture, add layers without removing soaked dressings; tourniquet only for uncontrolled limb bleeding.

Burns: cool with running water 20 minutes, remove jewellery and loose clothing, cover with cling film or clean non-fluffy dressing, never apply ice, butter or toothpaste.

Fracture immobilisation: splint above and below the joint, check distal pulse, sensation and capillary refill before and after splinting.

Snakebite: keep the patient still and the limb below heart level, remove rings, do not cut, suck or apply a tight bandage; transport to hospital for antivenom.

Heat stroke (core > 40 °C, dry skin, altered consciousness) needs rapid cooling and urgent transport; heat exhaustion has sweating and core < 40 °C.

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

Sterilisation methods: autoclave 121 °C at 15 psi for 15–20 min (moist heat), hot-air oven 160 °C for 2 h, ethylene oxide for heat-sensitive items, gamma radiation for single-use supplies.

Disinfection levels: high (glutaraldehyde, ortho-phthalaldehyde) kills all but spores; intermediate (alcohol, iodine) kills vegetative bacteria; low (detergent) reduces bioburden.

Spore test with Geobacillus stearothermophilus is the standard biological monitor for steam autoclaves; Bacillus atrophaeus for dry heat and ethylene oxide.

Colour-coded waste: yellow = infectious/incineration, red = recyclable plastics, white = sharps, blue = glassware, green = general.

Sharps safety: never recap by hand, use a one-hand scoop technique or safety device, discard immediately into a puncture-proof container filled to three-quarters.

Standard precautions apply to all patients: hand hygiene, gloves, gown, mask, eye protection, safe injection practice and safe waste handling.

Needlestick injury: wash with soap and water, do not squeeze, report immediately, and start HIV post-exposure prophylaxis within 2 hours where indicated.

Energy values: carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g, alcohol 7 kcal/g.

Balanced diet proportions: carbohydrate 50–60% of energy, protein 10–15%, fat 20–30% (saturated < 10%).

Basal metabolic rate is raised by fever (~13% per 1 °C above 37 °C), pregnancy, growth and hyperthyroidism; lowered by starvation, hypothyroidism and ageing.

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

Protein-energy malnutrition: marasmus = severe wasting with weight-for-age < 60% and no oedema; kwashiorkor = oedema, moon face, fatty liver, low albumin.

Deficiency diseases: vitamin A → night blindness and xerophthalmia; vitamin D → rickets and osteomalacia; iron → microcytic anaemia; iodine → goitre and cretinism.

Therapeutic diets: diabetic (controlled carbohydrate, high fibre), low-salt (< 2 g sodium/day), low-protein for renal failure, high-protein/high-calorie for burns and tuberculosis.

Food safety: keep hot food above 60 °C and cold food below 5 °C; the danger zone 5–60 °C allows rapid bacterial multiplication.

Antenatal schedule (WHO 2016): 8 contacts - first before 12 weeks, then at 20, 26, 30, 34, 36, 38 and 40 weeks.

Danger signs in pregnancy: bleeding, severe headache with blurred vision, convulsions, reduced fetal movement, leaking fluid, high fever, severe abdominal pain - refer immediately.

Preeclampsia triad: hypertension ≥ 140/90 mmHg after 20 weeks plus proteinuria and oedema; eclampsia adds convulsions; magnesium sulphate is the drug of choice.

Normal labour stages: first (onset to full 10 cm dilatation), second (full dilatation to birth), third (birth to placenta, usually ≤ 30 min), fourth (first 1–2 hours observation).

Partograph plotting starts in active labour (4 cm); alert line and action line guide referral when the cervix dilates slower than 1 cm/hour.

Exclusive breastfeeding for 6 months, complementary feeding from 6 months with continued breastfeeding to 2 years; colostrum is rich in immunoglobulin A.

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

Newborn assessment: Apgar score at 1 and 5 minutes (appearance, pulse, grimace, activity, respiration, each 0–2); birth weight < 2.5 kg is low birth weight.

Sub-centre covers 5,000 population in plains and 3,000 in hilly/tribal areas; PHC covers 30,000 plains and 20,000 hilly; CHC covers 1,20,000 plains and 80,000 hilly.

ASHA is a trained female community health activist, one per 1,000 population, serving as the first link between the community and the health system.

Indicators: infant mortality rate = infant deaths under 1 year per 1,000 live births; maternal mortality ratio = maternal deaths per 1,00,000 live births.

Epidemiological triad is agent–host–environment; disease control breaks the chain at the mode of transmission or by raising host immunity.

National programmes include NTEP (tuberculosis, DOTS), NVBDCP (malaria, dengue, kala-azar), NPCDCS (non-communicable diseases) and RMNCH+A for maternal and child health.

Notifiable diseases (India): cholera, plague, yellow fever, dengue, tuberculosis, polio, measles, diphtheria, rabies - report to the local health authority.

Herd immunity threshold rises with pathogen transmissibility; for measles (R0 ~12–18) it exceeds 90%, so high two-dose coverage is required.

Screening tests are judged on sensitivity (detects true positives) and specificity (detects true negatives); a screening test must have high sensitivity.

Prefixes: brady- slow, tachy- fast, hyper- high, hypo- low, dys- difficult, poly- many, a-/an- without, post- after, pre- before.

Roots: cardi- heart, nephr- kidney, hepat- liver, gastr- stomach, pneum- lung, oste- bone, derm- skin, hyster- uterus.

Suffixes: -itis inflammation, -ectomy removal, -otomy incision, -ostomy opening, -algia pain, -megaly enlargement, -aemia blood condition, -uria urine condition.

Combining vowel 'o' joins a root to a suffix starting with a consonant (cardi + -logy = cardiology); omit before a vowel (cardi + -itis = carditis).

Abbreviations: BP blood pressure, TPR temperature/pulse/respiration, PRN as required, NPO nothing by mouth, OD once daily, BD twice daily, TDS three times daily, IM intramuscular, IV intravenous.

Medical records are legal documents; entries are dated, timed, signed and legible, and corrections are made with a single strike-through, initialled, never erased or overwritten.

Patient record confidentiality is protected; information is shared only on a need-to-know basis or with consent, except where statute requires notification.

SBAR communication: Situation, Background, Assessment, Recommendation - used for structured handover and escalation.

Pulse counting: use index and middle fingers over the radial artery for a full 60 seconds; record rate, rhythm and volume; never use the thumb.

Blood pressure measurement: cuff bladder covers 80% of arm circumference and 40% of arm length; arm at heart level; inflate 20–30 mmHg above the point where the radial pulse disappears.

Intradermal injection: 0.1 mL at 5–15° angle into the inner forearm, bleb forms; used for Mantoux and BCG (BCG at 60–70°).

Subcutaneous injection uses a 45–90° angle with a short needle into the outer upper arm or abdomen; intramuscular uses 90° into the ventrogluteal or deltoid site.

Urine testing with a reagent strip: read at the stated time, compare to the colour chart, protect from moisture; midstream sample is preferred for culture.

Hot and cold applications: hot water bottle ≤ 46 °C with a cover, checked every 15 minutes; cold compress for 15–20 minutes to limit reactive vasodilation.

Oxygen administration: humidify at 1–4 L/min by nasal cannula, keep oxygen away from flames, and never withhold oxygen from a hypoxic patient with COPD.

Sterile dressing technique: open the pack away from the body, use sterile forceps, clean from clean to dirty, and drop contaminated items without touching the sterile field.

Viva answers should state normal values with units: haemoglobin 13–17 g/dL (male), fasting glucose 70–110 mg/dL, serum creatinine 0.6–1.2 mg/dL.

Anatomy recall for viva: heart has four chambers, right ventricle pumps to lungs, left ventricle to aorta; normal resting heart rate 60–100 beats/min.

Respiratory system: right lung has three lobes, left has two; tidal volume ~500 mL, vital capacity ~4,800 mL male.

Nursing process steps in order: assessment, diagnosis, planning, implementation, evaluation - viva questions often ask for the correct sequence.

Universal precautions and biomedical waste categories are the most frequently examined safety topics; know the colour codes and examples.

Drug administration rights: right patient, drug, dose, route, time, documentation; check for allergies before giving any medicine.

Clinical placement expectations: supervised practice, logbook entries signed by the clinical instructor, and reflection on each procedure performed.

Emergency drugs to identify in viva: adrenaline (anaphylaxis), atropine (bradycardia), magnesium sulphate (eclampsia), oxytocin (postpartum haemorrhage).