14146353 Community Medicine Last Moment Revisions Copy

8/3/2019 14146353 Community Medicine Last Moment Revisions Copy

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Community Medicine - Last moment revisionsHealth

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 ratesm) 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

Sullivans index : This index (expectation of life free of disability) is computed by subtracting from the lifeexpectancy the probable duration of bed disability and inability to perform major activities.

3. Nutritional status indicators a) Anthropometric measurements of pre school childrenb) Heights (and some weights) of school children at school entry c) Prevalence of low birth weight (less than 2.5 kg)

4. 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

BCGTyphoid oral Bacterial Plague

Live Oral polioattenuated Yellow fevervaccines Measles

Rubella Viral MumpsInfluenza

Epi. typhus Rickettsial

TyphoidCholeraPertussis Bacterial C.S. meningitisPlague

RabiesInactivated Salk (polio)or killed Influenza Viral vaccines Hepatitis B

JapaneseencephalitisKFD

DiphtheriaToxoids Bacterial

Tetanus

IMMUNO- Hepatitis AGLOBULINS MeaslesHuman Rabies Human normal Ig Immuno- Tetanusglobulins Mumps

Hepatitis BVaricella Human specific Ig Diphtheria

DiphtheriaNon -human Tetanus(Antisera) Gas gangrene Bacterial

BotulismRabies Viral

Attenuated Vaccines

Killed Vaccines


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

Low (replicates)

Long Infrequently Possible Possible

?

High

Short Frequently None None

None

INCUBATION PERIOD & CAUSATIVE ORGANISM

Respiratory infections Small pox 12 days, 7-17 days Variola virus Chickenpox 14 -16 days

Extreme 7-21 days Varicella zostervirus

Measles 10 days average 7 days Measles virus (RNAparamyxovirus)

Rubella 2 - 3 weeksaverage 18 days

RNA virus of Togavirus family

Mumps 2 - 3 weeks usually 18 days

Myxovirus

parotiditis (RNAvirus) Influenza 18 - 72 hours Influenza virus 3

types A,B&C Diphtheria 2 - 6 days Corynebacterium

DiphthariaeWhooping cough 7 - 14 days B. pertussis Meningococcal meningitis 3 - 4 days N. menigitiditis SARS 2 - 7 days

commonly 3 - 5 days New strain of corona virus

Tuberculosis 3 - 6 weeks M.tuberculosis

Intestinal infections Poliomyelitis 7 - 14 days Polio virus 3

serotypes 1,2 and

3 Viral hepatitis A 15-45 days usually 25-30 hepatitis A virus Viral hepatitis B 45-180 days average 100 hepatitis B virus Viral hepatitis E 2 to 9 weeks hepatitis E virus Cholera A few hours upto 5 days

commonly 1-2 days V. Cholerae

Acute diarrhoeal diseases Typhoid fever 10-14 days short as 3 days long as 3

weeks S.tiphy

Food poisoning Staphylococcal

Botulism Cl.perfringens B.cereus

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

StaphylococcusaureusClostrybiumbotulinum

Bacillus.cereus Amoebiasis 2-4 weeks or longer E.histolytica Ascariasis 2 months Ascaris

lumbricoides Hookworm infections

Nectar americanus Ancylstoma duodenale

7 weeks 5 to 7 weeks

Nectaramericanus Ancylstomaduodenale

Arthropod borne infections


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Dengue syndrome Classical Dengue fever

Dengue haemorrhagicfever (DHF)

3 to 5 days(commonly 5-6 days) 4 to 6 days

Dengue Virus

Malaria -Falciparum -Vivax -Quartan -Ovale

12 (9-14) days 14 (8-17) days 28 (18-40) days 17 (16-18) days

Lymphatic filariasis 8-16 months Wuchereriadancrofti

Zoonoses Viral

Rabies 3-8 weeks Lyssa virus type 1 Yellow fever 3-6 days Flavivirus fibricus Japanese encephalitis FlavivirusKFD 3 to 8 weeks Flavivirus

Bacterial Brucellosis 1-3 weeks

as long as 6 months B.melitnsis, B.abortus, B.suis,

B.canis Leptospirosis 10 days range of 4-20 L.interrogans Plague -bubonic

-Septicaemic -pneumonic

2-7 days 2-7 days 1-3 days

Y.pestis

Human salmonellosis 6-72 hours Scrub typhus 10-12 days

Varies 6-21 days Rickettsia tsu tsugamushi

Murine typhus 1-2 weeks com12 days Rickettsia typhy Tick typhus 3-7 days Rickettsia conorii Q fever 2-3 weeks Coxiella brunetii Taeniasis 8-14 weeks T.saginata,

T.solium Hydatid disease Months to years E.granulosus Leishmaniasis 1-4 monthsRange 10 days-2years

Leishmaniadonovani

Surface infections Trachoma 5-12 days C.trachomatis Tetanus 6-10 days Clostridium tetani Leprosy 3-5 years or more M.leprae Yaws 3-5 weeks T.pertenue AIDS Uncertain 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 operationfor 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 30 th 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 in4. Japanese Encephalitis Control 5. Dengue Fever Control

DEMOGRAPHY AND FAMILY PLANNING Demographic cycle 5 stages

BIRTH RATE DEATH RATE POPULATION 1. FIRST STAGE

(High stationary) HIGH HIGH STATIONARY

2. SECOND STAGE(Early expanding)

UNCHANGED BEGINE TO DECLINE

3. THIRD STAGE(Late expanding)

TENDS TO FALL DECLINE

4. FOURTH STAGE(Low stationary)

LOW LOW STATIONARY

5. FIFTH STAGE(Declining)

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. Age at marriage 2. Duration of married life 3. Spacing of children 4. Education 5. Economic status 6. Caste and religion 7. Nutrition 8. 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

Age Motor

development Language

development Adaptive

development Socio-

personal

development 6-8 weeks

3 months 4-5 months

6-8 months

9-10 months

holds head erect

sits without support

crawling

listening

experimentingwith noisesincreasing rangeof sounds

begins to reach out forobjectstransfers objects hand tohandreleases objects

Looks atmother andsmiles

recognisesmother

enjoys hideand seeksuspicious of strangers

10-11 months12-14 months18-21 months 24 months

stands with support walks wide basewalks narrow baseruns

first words joining wordsbeginning to runshort sentences

buildsbeginning to explore

dry by day

DETERMINANTS OF MATERNAL MORTALITY IN INDIA Medical Causes ial 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

DIETARY SOURCES OF EFA Essential Fatty acids Dietary source

Per cent content

Linoleic acid Safflower oil 73 Corn oil 57Sunflower oil 56Soyabean oil 51Sesame oil 40Groundnut oil 39Mustard oil 15 Palm oil 9 Coconut oil 2

Arachidonic acid Meat, eggs 0.5 - 0.3 milk (fat) 0.4-0.6


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Linolenic acid Soyabean oil 7 Leafy greens Varied

Eichosapentaenoic acid Fish oil 10

DAILY INTAKE OF VITAMIN A (RECOMMENDED BY ICMR 1989) Group

Retinol(mcg)

or B-arotene

(mcg) Adults Man

Woman

Pregnancy

Lactation

600 600 600 950

2400 24002400 3800

Infants 0 to 12 months 350 1200

Children 1 to 6 years7 to 12 years

400 600

16002400

Adolescents 13 to 19 years 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 beabsorbed (daily needs)

Infants (5-12 months) 0.7 mg Children (1-12 years) 1.0 mg Adolescents (13-16 years) 1.8 mg (males)

2.4 mg (females) Adults, males 0.9 mg Adults, females :

Menstruation 2.8 mg Pregnancy (first half) 0.8 mg

(second half) 3.5 mg Lactation 2.4 mg Post-menopause 0.7 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 ageof 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 months7-12 months

118108

kcal/kg/day

Children 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

(females) 31.5 1970 8.2 13-15 years (males) 47.8 2450 10.2

(females) 46.7 2060 8.6 16-18 years (males) 57.1 2640 11.0

(females) 49.9 2060 8.6


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Adults Ref Males (light work) 60 2425 10.1

(moderate work) 2875 12.0 (heavy work) 3800 15.8

Ref Females (light work) 50 1875 7.8 (moderate work) 2225 9.3 (heavy work) 2925 12.2

Pregnancy + 300 + 1.25 Lactation (first 6 months) + 550 +2.3

(6-12 months) + 400 + 1.68

DAILY INTAKE OF ENERGY Age Body weight kcal/kg/24 hrs.

Kg (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

Group ParticularsProtein allowance

(g/kg/day) (g/day)

Man (60 kg)

sedentary work moderate work

heavy work 1

60.0

Woman (50 kg)

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

1

1 1

50.0

+ 15.0 + 25.0

Infants 0 to 3 months 3 to 6 months 6 to 9 months 9 to 12 months

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

Adolescents Males 10 to 12 years

13 to 15 years 1.46 1.40

54 70


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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 Essential fatty acids g/day Energy % (energy per cent)

Adults : Man & Woman 20* 9 3 Pregnant woman 30 12.5 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.

CONCISE LIST OF INDICATORS OF NUTRITIONAL STATUS Phenomenon Indicator

Maternal Nutrition Infant and preschool child nutrition

School child nutrition

birth weight proportion being breast fed and proportion on weaning foods, by ageinmonths, 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 Food materials Common adulterants

Cereals such as wheat, rice Mud, grits, soapstone bits.Dals Coaltar dyes, khesari dalHaldi (Turmeric) powder Lead chromate powderDhania powder Starch, cow dung or horse dung powder Black pepper Dried seeds of papaya,Chilli powder Saw dust, brick powder Tea dust/leaves Blackgram husk, tamarind seeds powder,

saw dust, used tea dustCoffee powder 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 Cellulose, starch, non-permitted colours, Sweetmeats Non-permitted colours.Fresh green peas in packing Green dyeMilk Extraction of fat, addition of starch and water Ghee Vanaspati

NUTRITION PROGRAMMES IN INDIA Programme Ministry

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 WelfareMinistry of Health and Family Welfare

Ministry of Social Welfare Ministry of Social WelfareMinistry of Social WelfareMinistry of Education

A MID-DAY SCHOOL MEAL

Foodstuffs g/day/child Cereals and millets 75 Pulses 30 Oils and fats 8 Leafy vegetables 30 Non-leafy vegetables 30

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

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

Less than 1 ( 300 mg/L)

MAJOR AIR POLLUTANTS, THEIR SOURCES AND ADVERSE EFFECTS Pollutant Sources


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Respirable particles

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

Tobacco smoke StoveAerosol 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 Noxious Agents Sources Adverse effects

Oxides of Nitrogen Automobile exhaust, gas stovesand heaters, wood-burningstoves, kerosene space heaters

Respiratory tract irritation, bronchialhyperactivity, impaired lung defences,bronchialitis obliterans

Hydrocarbons Automobile exhaust, cigarettesmoke

Lung cancer Ozone Automobile exhaust high altitude

aircraft cabinsCough, substernal discomfort,bronchoconstriction, decreased exerciseperformance, respiratory tract irritation

Sulphur dioxide Power plants, Smelters, oilrefineries, kerosene spaceheaters

Exacerbation of asthma and COPD,respiratory tract irritation,hospitalization may be necessary, anddeath may occur in severe exposure

Lead Automobile exhaust usingleaded gasoline

Impaired neuropsychologicaldevelopment in children

OCCUPATIONAL DISEASES There is no internationally accepted definition for the term "occupational disease" However, occupationaldiseases 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 sy nco pe, hea tcramps,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: C0 2 , CO, HCN, CS 2 , NH 3 , N 2 , H 2S, HCI, SO 2 - 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(i i) 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, chlorofor m, etc.

III. Diseases due to biological agents: Brucellosis, leptospirosis, anthrax, actinomycosis, hydatidosis, psittacosis, tetanus, encephalitis, fungalinfections, 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 com- Cohort 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 Kaposis 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 weeksage. 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 [ -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 12 th 1999 6 billion World population 680 crores [recent] India stood 2 nd after China with 102 crores. 2 nd Wed of October World disaster reduction day. Growth is defined as physical maturation. Development is functional maturation

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