COMPREHENSIVE EXAM (NBHX) – MEQ

MENTAL HEALTH – SCHIZOPHERNIA

1. Schizophrenia is a mental disorder characterized by continuous or relapsing episodes
of psychosis.

2. Major symptoms include hallucinations (typically hearing voices), delusions,

and disorganized thinking.

3. Other symptoms include social withdrawal, decreased emotional expression, and apathy.

4. Symptoms typically develop gradually, begin during young adulthood, and in many cases
never become resolved. 

5. There is no objective diagnostic test; diagnosis is based on observed behavior, a history that

includes the person's reported experiences, and reports of others familiar with the person.

6. To be diagnosed with schizophrenia, symptoms and functional impairment need to be

present for six months (DSM-5) or one month (ICD-11).

7. Many people with schizophrenia have other mental disorders, especially substance use
disorders, depressive disorders, anxiety disorders, and obsessive–compulsive disorder.

8. About half of those diagnosed with schizophrenia will have a significant improvement over
the long term with no further relapses, and a small proportion of these will recover
completely.

9. The other half will have a lifelong impairment. In severe cases people may be admitted to
hospitals. 

10. Social problems such as long-term unemployment, poverty, homelessness, exploitation, and

victimization are commonly correlated with schizophrenia.

11. The mainstay of treatment is antipsychotic medication, along with counseling, job training,

and social rehabilitation

12. Long-term hospitalization is used on a small number of people with severe schizophrenia

13. Many people with schizophrenia may have one or more other mental disorders, such
as panic disorder, obsessive–compulsive disorder, or substance use disorder.
BIOCHEMISTRY – EXTRA AND INTRACELLULAR FLUID, ACID BASE, ELECTROLYTE FLUID
BALANCE
1. An acid–base reaction is a chemical reaction that occurs between an acid and a base. It
can be used to determine pH.

2. Several theoretical frameworks provide alternative conceptions of the reaction mechanisms

and their application in solving related problems; these are called the acid–base theories, for
example, Brønsted–Lowry acid–base theory.

3. Their importance becomes apparent in analyzing acid–base reactions for gaseous or liquid
species, or when acid or base character may be somewhat less apparent

4. The concept of an acid-base reaction was first proposed in 1754 by Guillaume-François

Rouelle, who introduced the word "base" into chemistry to mean a substance which reacts
with an acid to give it solid form (as a salt)

5. Fluid balance is an aspect of the homeostasis of organisms in which the amount of water in

the organism needs to be controlled, via osmoregulation and behavior, such that
the concentrations of electrolytes (salts in solution) in the various body fluids are kept within
healthy ranges.

6. The core principle of fluid balance is that the amount of water lost from the body must equal
the amount of water taken in; for example, in humans, the output
(via respiration, perspiration, urination, defecation, and expectoration) must equal the input
(via eating and drinking, or by parenteral intake).

7. Euvolemia is the state of normal body fluid volume, including blood volume, interstitial

fluid volume, and intracellular fluid volume; hypovolemia and hypervolemia are imbalances. 

8. Fluid can leave the body in many ways. Fluid can enter the body as preformed
water, ingested food and drink and to a lesser extent as metabolic water which is produced
as a by-product of aerobic respiration (cellular respiration) and dehydration synthesis.

9. A constant supply is needed to replenish the fluids lost through normal physiological
activities, such as respiration, sweating and urination.

10. Water generated from the biochemical metabolism of nutrients provides a significant

proportion of the daily water requirements for some arthropods and desert animals, but
provides only a small fraction of a human's necessary intake.
MICROBIOLOGY – BACTERIA
1. Bacteria ubiquitous, mostly free-living organisms often consisting of one biological cell.

2. They constitute a large domain of prokaryotic microorganisms. Typically a

few micrometres in length, bacteria were among the first life forms to appear on Earth, and
are present in most of its habitats.

3. Bacteria inhabit soil, water, acidic hot springs, radioactive waste, and the deep

biosphere of Earth's crust. Bacteria are vital in many stages of the nutrient cycle by recycling
nutrients such as the fixation of nitrogen from the atmosphere.

4. The nutrient cycle includes the decomposition of dead bodies; bacteria are responsible for
the putrefaction stage in this process.

5. In the biological communities surrounding hydrothermal vents and cold

seeps, extremophile bacteria provide the nutrients needed to sustain life by converting
dissolved compounds, such as hydrogen sulphide and methane, to energy.

6. Bacteria also live in symbiotic and parasitic relationships with plants and animals.

7. Most bacteria have not been characterised and there are many species that cannot
be grown in the laboratory. The study of bacteria is known as bacteriology, a branch
of microbiology.

8. Humans and most other animals carry millions of bacteria. Most are in the gut, and there are
many on the skin.

9. Most of the bacteria in and on the body are harmless or rendered so by the protective effects
of the immune system, and many are beneficial, particularly the ones in the gut.

10. However, several species of bacteria are pathogenic and cause infectious diseases,

including cholera, syphilis, anthrax, leprosy, tuberculosis, tetanus and bubonic plague.

11. The most common fatal bacterial diseases are respiratory infections. Antibiotics are used to
treat bacterial infections and are also used in farming, making antibiotic resistance a growing
problem.

12. The bacterial cell is surrounded by a cell membrane, which is made primarily
of phospholipids. This membrane encloses the contents of the cell and acts as a barrier to
hold nutrients, proteins and other essential components of the cytoplasm within the
cell. Unlike eukaryotic cells, bacteria usually lack large membrane-bound structures in their
cytoplasm such as a nucleus, mitochondria, chloroplasts and the other organelles present in
eukaryotic cells
MEDICAL INSTRUMENTS – ECG
1. Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a
recording of the heart's electrical activity.
2. It is an electrogram of the heart which is a graph of voltage versus time of the electrical
activity of the heart using electrodes placed on the skin.
3. These electrodes detect the small electrical changes that are a consequence of cardiac
muscle depolarization followed by repolarization during each cardiac cycle (heartbeat).
4. Changes in the normal ECG pattern occur in numerous cardiac abnormalities, including
cardiac rhythm disturbances (such as atrial fibrillation and ventricular tachycardia]),
inadequate coronary artery blood flow (such as myocardial ischemia] and myocardial
infarction), and electrolyte disturbances (such as hypokalemia and hyperkalemia).
5. Traditionally, "ECG" usually means a 12-lead ECG taken while lying down as discussed
below. However, other devices can record the electrical activity of the heart such as a Holter
monitor but also some models of smartwatch are capable of recording an ECG. ECG signals
can be recorded in other contexts with other devices.
6. In a conventional 12-lead ECG, ten electrodes are placed on the patient's limbs and on the
surface of the chest.
7. The overall magnitude of the heart's electrical potential is then measured from twelve
different angles ("leads") and is recorded over a period of time (usually ten seconds). In this
way, the overall magnitude and direction of the heart's electrical depolarization is captured at
each moment throughout the cardiac cycle.
8. There are three main components to an ECG: the P wave, which represents depolarization
of the atria; the QRS complex, which represents depolarization of the ventricles; and the T
wave, which represents repolarization of the ventricles.
9. The overall goal of performing an ECG is to obtain information about the electrical
functioning of the heart. Medical uses for this information are varied and often need to be
combined with knowledge of the structure of the heart and physical examination signs to be
interpreted.

10. ECGs can be recorded as short intermittent tracings or continuous ECG monitoring.

Continuous monitoring is used for critically ill patients, patients undergoing general
anesthesia

11. Recording an ECG is a safe and painless procedure. The machines are powered by mains
power but they are designed with several safety features including an earthed (ground) lead

12. Interpretation of the ECG is fundamentally about understanding the electrical conduction

system of the heart. Normal conduction starts and propagates in a predictable pattern, and
deviation from this pattern can be a normal variation or be pathological.

13. An ECG does not equate with mechanical pumping activity of the heart, for
example, pulseless electrical activity produces an ECG that should pump blood but no
pulses are felt (and constitutes a medical emergency and CPR should be performed).

PAIN MANAGEMENT – POST OPERATIVE / POST TRAUMA PAIN MX

 1. Pain management is an aspect of medicine and health care involving relief of pain (pain
relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and
challenging.

2. Most physicians and other health professionals provide some pain control in the normal

course of their practice, and for the more complex instances of pain, they also call on
additional help from a medical specialty devoted to pain, which is called pain medicine.

3. Pain management often uses a multidisciplinary approach for easing the suffering and
improving the quality of life of anyone experiencing pain, whether acute pain or chronic pain.
Relief of pain in general (analgesia) is often an acute affair, whereas managing chronic pain
requires additional dimensions.

4. The typical pain management team includes medical practitioners, pharmacists, clinical

psychologists, physiotherapists, occupational therapists, recreational therapists, physician
assistants, nurses, and dentists.

5. Pain sometimes resolves quickly once the underlying trauma or pathology has healed, and is

treated by one practitioner, with drugs such as pain relievers (analgesics) and occasionally
also anxiolytics

6. . Effective management of chronic (long-term) pain, however, frequently requires the

coordinated efforts of the pain management team. 

7. A common challenge in pain management is communication between the health care

provider and the person experiencing pain.

8. People experiencing pain may have difficulty recognizing or describing what they feel and
how intense it is. Health care providers and patients may have difficulty communicating with
each other about how pain responds to treatments.

9. There is a risk in many types of pain management for the patient to take treatment that is
less effective than needed or which causes other difficulties and side effects. Some
treatments for pain can be harmful if overused.

10.  A goal of pain management for the patient and their health care provider is to identify the
amount of treatment needed to address the pain without going beyond that limit.
11. Another problem with pain management is that pain is the body's natural way of
communicating a problem. Pain is supposed to resolve as the body heals itself with time and
pain management.
12. Sometimes pain management covers a problem, and the patient might be less aware that
they need treatment for a deeper problem.
PATHOLOGY – PNEMONIA
 1. Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs
known as alveoli.
2. Symptoms typically include some combination of productive or dry cough, chest pain, fever,
and difficulty breathing. The severity of the condition is variable.
3. Pneumonia is usually caused by infection with viruses or bacteria, and less commonly by
other microorganisms. Identifying the responsible pathogen can be difficult.
4. Diagnosis is often based on symptoms and physical examination Chest X-rays, blood tests,
and culture of the sputum may help confirm the diagnosis. The disease may be classified by
where it was acquired, such as community- or hospital-acquired or healthcare-associated
pneumonia.
5. Risk factors for pneumonia include cystic fibrosis, chronic obstructive pulmonary
disease (COPD), sickle cell disease, asthma, diabetes, heart failure, a history of smoking, a
poor ability to cough (such as following a stroke), and a weak immune system.
6. Vaccines to prevent certain types of pneumonia (such as those caused by Streptococcus
pneumoniae bacteria, linked to influenza, or linked to COVID-19) are available. Other
methods of prevention include hand washing to prevent infection, not smoking, and social
distancing.
7. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is
treated with antibiotics. If the pneumonia is severe, the affected person is generally
hospitalized. Oxygen therapy may be used if oxygen levels are low.
8. People with infectious pneumonia often have a productive cough, fever accompanied
by shaking chills, shortness of breath, sharp or stabbing chest pain during deep breaths, and
an increased rate of breathing. In elderly people, confusion may be the most prominent sign.
9. The typical signs and symptoms in children under five are fever, cough, and fast or difficult
breathing. Fever is not very specific, as it occurs in many other common illnesses and may
be absent in those with severe disease, malnutrition or in the elderly.
10. In addition, a cough is frequently absent in children less than 2 months old. More severe
signs and symptoms in children may include blue-tinged skin, unwillingness to drink,
convulsions, ongoing vomiting, extremes of temperature, or a decreased level of
consciousness.
11. Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly
by fungi and parasites.
12. Pneumonia frequently starts as an upper respiratory tract infection that moves into the lower
respiratory tract. It is a type of pneumonitis (lung inflammation).
13. The normal flora of the upper airway give protection by competing with pathogens for
nutrients. In the lower airways, reflexes of the glottis, actions of complement
proteins and immunoglobulins are important for protection.
14. Microaspiration of contaminated secretions can infect the lower airways and cause
pneumonia. The progress of pneumonia is determined by the virulence of the organism; the
amount of organism required to start an infection; and the body's immune response against
the infection.

EPIDEMIOLOGY – INFLUEZA & JE

1. Japanese encephalitis (JE) is an infection of the brain caused by the Japanese encephalitis
virus (JEV).
2. While most infections result in little or no symptoms, occasional inflammation of the brain
occurs. In these cases, symptoms may include headache, vomiting, fever, confusion
and seizures.
 3. This occurs about 5 to 15 days after infection.

4. JEV is generally spread by mosquitoes, specifically those of the Culex type. Pigs and wild

birds serve as a reservoir for the virus. The disease occurs mostly outside of cities.
5. Diagnosis is based on blood or cerebrospinal fluid testing.
6. Prevention is generally with the Japanese encephalitis vaccine, which is both safe and
effective. Other measures include avoiding mosquito bites. Once infected, there is no
specific treatment, with care being supportive.
7. This is generally carried out in a hospital. Permanent problems occur in up to half of people
who recover from JE.
8. The disease primarily occurs in East and Southeast Asia
9. Japanese encephalitis is diagnosed by commercially available tests detecting JE virus-
specific IgM antibodies in serum and/or cerebrospinal fluid, for example by IgM
capture ELISA.

10. Influenza, commonly known as "the flu", is an infectious disease caused by influenza

viruses.
11. Symptoms range from mild to severe and often include fever, runny nose, sore throat,
muscle pain, headache, coughing, and fatigue. These symptoms begin from one to four days
after exposure to the virus (typically two days) and last for about 2–8 days.

12. Diarrhea and vomiting can occur, particularly in children. Influenza may progress
to pneumonia, which can be caused by the virus or by a subsequent bacterial infection.
Other complications of infection include acute respiratory distress
syndrome, meningitis, encephalitis, and worsening of pre-existing health problems such
as asthma and cardiovascular disease.

13. There are four types of influenza virus, termed influenza viruses A, B, C, and D. Aquatic
birds are the primary source of Influenza A virus (IAV), which is also widespread in various
mammals, including humans and pigs. Influenza B virus (IBV) and Influenza C virus (ICV)
primarily infect humans, and Influenza D virus (IDV) is found in cattle and pigs
14. In humans, influenza viruses are primarily transmitted through respiratory droplets produced
from coughing and sneezing. Transmission through aerosols and intermediate objects and
surfaces contaminated by the virus also occur.

15. Frequent hand washing and covering one's mouth and nose when coughing and sneezing
reduce transmission. Annual vaccination can help to provide protection against influenza
GERIATRIC – FUNCTION OF AMOs
1. to understand and treat the often complex physical and mental health needs of
older people
2. to help their patients protect their health and cope with changes in their mental
and physical abilities, so older people can stay independent and active as long
as possible.
3. Assess the patient’s mental status and cognitive (thinking) skills

4. Understand patient’s acute and chronic health issues

 5. Discuss common health concerns, such as falls, incontinence, changing sleep
patterns and sexual issues

6. Organize medications

7. Educate the patient about personal safety and disease prevention

8. Explain and recommend adjustments to the patient’s medication regimen to

ensure adherence

9. Link the patient with local resources as needed

10. Many older people have health conditions that do not require hospitalization, but
must be treated with medication, changes in diet, use of special equipment (such
as a blood sugar monitor or walker), daily exercises or other adaptations

11. help design and explain these healthcare regimens to patients and their families.
They often function as “case managers,” linking families with community
resources to help them care for elderly members.

12. work with treatment teams that have large older patient populations, such as
outpatient surgery, cardiology, rehabilitation, ophthalmology, dermatology and
geriatric mental health (treating older patients with psychiatric conditions, such as
Alzheimer’s, anxiety and depression).

13. In rehabilitation and long-term care facilities, geriatric AMOs manage patient care
from initial assessment through development, implementation and evaluation of
the care plan. They may also take on administrative, training and leadership
roles.
PROFESIONALISM ISSUE IN HEALTHCARE – POWER AND EMPOWERMENT AMOS
1. empowerment recognizes and realizes the power with the people. Empowerment
is not something given to employees by the top management; it is rather the role
of die top management to create a culture in which employees can use their full
potential to the benefit of the organization. In this process, employees also attain
the stage of maturity.
2. The term empowerment has been used recurrently in the fields of social
intervention, and its definition entails its extension across various spheres of
knowledge, thus requiring a contextualization of its meaning.
 3. It proposes the creation of responsible communities in which those individuals
who constitute the body assume greater control over their lives and participate
democratically in daily life, bearing in mind the different collective arrangements
and their context
4. The concept of empowerment is complex, and one that in recent decades has
shown increasing academic and social relevance in diverse fields of knowledge,
having been incorporated into a wide range of areas, in particular, administration,
economics, public health, psychology, social work, and political sociology.
5. Empowerment is the degree of autonomy and self-determination in people and in
communities. This enables them to represent their interests in a responsible and
self-determined way, acting on their own authority.
6. It is the process of becoming stronger and more confident, especially in
controlling one's life and claiming one's rights. Empowerment as action refers
both to the process of self-empowerment and to professional support of people,
which enables them to overcome their sense of powerlessness and lack of
influence, and to recognize and use their resources.
7. Power is a complex and extensive concept in AMOs, which has a decisive impact
on the accomplishment of duties, satisfaction and achievement of professional
goals. 
8. The term “power in nursing” describes a nurse’s ability to wield influence,
mobilize resources, and empower patients. This includes the power to heal and
the power to influence others. Expanding the latter is the concept of expert
power, which involves using knowledge to influence others. Nursing personnel
are now a strong and functional part of healthcare organization leadership.
9. A workplace that promotes and empowers nurses is the first prerequisite for
encouraging a nurse’s power, also developed through education and growing
confidence on the part of the individual nurse. A sense of personal empowerment
can be enhanced by co-workers, including doctors, administrators, and fellow
staff.

RESEARCH – RESEARCH PROCESS, ETHICAL, & VARIABLES