COMMUNITY

MEDICINE SPOTTERS
 CONTENTS

1. RICKETS
2. BITOT’S SPOTS
3. Egg
4. Fish
5. Soyabean
6. Custard apple
7. Meat
8. Rice
9. Wheat
10. Raggi
11. Vaccine
12. Mosquito
13. Sand flea
14. Slow sand filter
15. Rapid sand filter
16. Sanitary latrine
17. Clinical thermometer
18. Alcoholmeter
19. Lactometer
20. Berkefeld filter
21. Bleaching powder
22. Dettol
23. UNICEF
24. WHO
25. DDT
26. ORS
27. Condom
28. Copper-T
29. Lippes loop
30. Oral contraceptive pills
31. Vaginal sponge
32. Safety goggle
33. Ear plug
34. DOTS
RICKETS MODEL
-Vitamin D deficiency

-Symptoms:

CHILDREN -RICKETS ADULT-OSTEOMALACIA

Craniotabes Difficulty in walking
bossing of frontal and parietal bones Waddling gait
Delayed milestone,knocked knees,bow Bone pains
legs,Harrison’s sulcus,Rickety
rosary,kyphoscoliosis,pegion
chest,deformed pelvis

-SOURCES:

DIETARY SOURCES NON-DIETARY

SOURCES
ANIMAL PLANT FORTIFIED Sunlight-UV –B
 Liver  Mushroom  Milk
 Egg yolk  Raggi  Vanaspathi
 Butter  Margarine
 Cheese  Infant foods
 Mil and
milk
products
 Fish
 Fish liver
oil

BITOTS SPOTS
-Vitamin A deficiency:

Triangular,pearly white or yellowish foamy spots on bulbar conjunctive on either

side of cornea.
-Symptoms:

OCCULAR EXTRA-OCCULAR
 Nightblindness  Follicular hyperkeratosis
 Conjunctival xerosis  Anorexia
 Bitot’s spots  Growth retardation
 Corneal xerosis
 keratomalacia

-Sources

ANIMAL PLANT FORTIFIED

 Egg  Spinach  Margarine
 Liver  Amaranth  Vanaspathi
 Milk  Pumpkin seeds
 Butter  Carrot
 Cheese  Drumstick leaves
 Fish liver oil  Coriander
 Fish  Bengal gram
 meat

EGG
-Nutritive value:

Protein 13.3g/100g
Fat 13.3g/100g
Minerals 1g/100g

-Nutrients not present in egg:

 Carbohydrate
 Vitamin C
-Why egg is known as referral protein?

 Have all the 9 essential amino acids

 Have all the fats soluble and water soluble vitamins in appreciable amounts
 Minerals like calcium,iron ,phosphorus,zinc etc are present
 Net protein utilization (NPU)=100

FISH
-Nutritive value

Protein 19.5 g/100g

Fat 2.4 g/100g
Minerals 1.5 g/100g

SOYABEAN
-Nutritive value

Proteins 43.2g
Fats 19.5g
Calcium 240mg
Energy 432kcal

-What is known as ‘poor man’s meat ‘and why?

 Pulses are known as poor mans meat.

 It has double the protein in wheat and thrice that in rice and even more
protein than egg,fish or meat. And also have minerals and B group
vitamins.

CUSTARD APPLE
-Nutritive value
Calories 104
Calcium 17mg
Iron 4.31mg
Carotene 0
Vit C 37mg

MEAT
-Nutritive value

Protein 21.4g/100g
Fats 3.6g/100g
Minerals 1.1g/100g

RICE
-Nutritive value

Proteins 6.8g
Fats 0.5g
Carbohydrates 78.2g
Minerals 0.6g
Energy 345kcal

-Parboiling of rice

 Hot soaking process

Soaking the paddy in hot water at 65-70deg C for 3-4 hours

Grains will swell up

Draining of water

Steaming the soaked paddy in same container for 5-10 minutes

 Paddy dried

Milled or homepounded.

Significance:

 To preserve the nutritive value of rice

 Resistance to insectsfor storage

WHEAT
-Nutritive value

Protein 11.81g
Fat 1.5g
Carbohydrate 71.2g
Minerals 1.5g
Energy 346kcal

RAGGI
-Nutritive value

Proteins 7.3g/100g
Fats 1.3g/100g
Carbohydrates 72g
Minerals 2.7g
Calcium 344mg
Iron 3.9mg
Energy 328kcal

-What is Weaning?

Introduction of semi-solid food to a child around the age of 6 months with the
gradual withdrawal of child from breast as breast milk alone cannot produce
enoughnutrients beyond 6 years.
-Common foods used for weaning?

 Cow’s milk
 Fruit juice
 Soft cooked rice
 Suji
 Dhal
 vegetables

VACCINE
TETANUS TOXOID

-Classification of vaccines:

live vaccine:BCG,measles,oral polio

killed vaccine:cholera vaccine,Typhoid vaccine
Toxoid:TT,Diptheria toxoid
Combination:DPT,MMR
Cellular Fraction:Pneumococcal,meningococcal vaccine

-Cold chain:

It is a system of storage and transport of vaccine at low temperature from the

manufracturer to the actual vaccination site.

Significance:To prevent vaccine failure.

ORAL POLIO VACCINE

-Classification of vaccine:

-Difference between OPV and IPV:

IPV OPV
 Killed formalized virus  Live attenuated
 Subcutaneously  Orally
 Induces circulating antibody but  Both humoral and intestinal
local immunity immunity
  Not useful in epidemic  Useful in controlling epidemic
 Difficult to manufacture  Easy to manufacture
 costlier  cheaper

BCG VACCINE

-Classification of vaccine

-Strain used in BCG vaccine:

“Danish 1331” strain is recommended by WHO.

-Complications:

1. Prolonged sever ulceration

2. Suppurative lympadenitis
3. Osteomylitis
4. Disseminated BCG infection
5. death

-Immunization schedule [ SURE QUESTION]

AT BIRTH  BCG
Hepatitis B
 OPV 0

AT 6 WEEKS  OPV1
 DPT1
 Hep 1

AT 10 WEEKS  OPV2
 DPT 2
 Hep 2

AT 14 WEEKS  OPV3
 DPT 3
 Hep3
 9 MONTHS COMPLETED -12 MONTHS  Measles(1st dose)
 Vitamin A(1st dose)

16MONTHS-24 MONTHS  DPT booster

 OPV booster
 Measles(2nd dose)
 Vitamin A( 2nd dose)every 6
months upto 5 years
 Japanese Encephalitis

5-6 YEARS  DPT booster

10-16 YEARS  TT

MOSQUITO:

-Life cycle:

Egg  larva  Pupa  Adult

-Mosquito borne diseses:

Anopheles-clean water Malaria,filaria

Culex-waste water West nile fever,Japanese encephalitis
Aedes-Stagnant water Dengue,yellow fever,chikungunya
Mansonoides-aquatic plants Chikungunya,Malayan filariasis

Control measures:

1. Antilarval measures:
 Environmental control-eliminate breeding places
 Chemical control-using mineral oil,paris green,synthetic insecticide
 Biological control-breeding gambusia fish etc.
2. Anti adult measure:
 Residual spray
  Space spray
 Genetic control
3. Protection against mosquito bite:
 Mosquito net
 Screeening
 Repellants

SAND FLEA
-Life cycle:

Egg  Larve  pupa  Adult

-Control measure:

 Insecticidal control-DDT
 Repellents
 Rodent Control

-Flea Indices:

1. General flea index:average number of fleas of all species per rodent.

2. Specific flea index:average number of fleas of each species found per
rodent.
3. Percentage incidence of flea species:percentage of fleas of each species
found per rodent.
4. Rodent infestation rate:percentage of rodents infested with the various
flea species.

-Diseases caused by fleas:

o Plague
o Endemic typhus
o Chiggerosis

-Classification of arthropod

CLASS INSECTA CLASS ARACHNIDA CLASS

 CRUSTACE
A
I. Mosquitoes I. Ticks Cyclops
 Anophelines  Hard ticks
 culicines  Soft ticks
II. Flies II. Mites
 House fly  Itch mite
 Sand fly  Trombiculid mite
 Tsetse fly
 Black fly
III. Lice
 Head and body lice
 Crab lice
IV. Fleas
 Rat fleas
 Sand fleas
V. Reduviid bugs

SLOW SAND FILTER

-Identification

-filter bed diagram:

-Elements

 Supernatant
 Bed of graded sand
 Under drainage system
 Filter control valves

-Vital layer:

Initially filter acts merely as a mechanical strainer.Soon the surface of sand bed is
covered with slimy growth consisting of algae,planktons,diatoms etc called ital
layer.formation of this layer is called ripening of filter.
It Removes organic matter and holds back bacteria and oxidizes ammonical
nitrogen into nitrates.

-Advantage

 Simple to construct and operate

 Cheaper
 99.99% bacteria removed

RAPID SAND FILTRE

-Identification

-Diagram

-Backwashing:

 Process of cleaning of rapid sand filter by reversing the flow of water

through the sand bed.it
 Dislodges the impurities and clean up the sand bed.stopped when clear
sand is visible and wash water is clear.
 15 minutes.

-Advantages:

 No storage needed
 Less space needed
 Rapid process
 Easy washing of filter
 More flexibility in operation

SANITARY LATRINE
-Identification

-Classification
  Service type latrine
 Non-service type latrine
 Bore hole latrine
 Dug well latrine
 Water seal type
o PRAI type
o RCA type
o Sulabh sahauchalaya

 Septic tank
 Aqua privy
 Latrines suitable for camps and temporary use
 Shallow trench latrine
 Deep trench latrine
 Pit latrine
 Bore hole latrine

CLINICAL THERMOMETER

-Identification
-Uses

To measuring the temperature

-Types

1. Dry bulb thermometer

2. Wet bulb thermometer
3. Maximum thermometer
4. Minimum thermometer
5. Six’s maximum and minimum thermometer
6. Globe thermometer(diagram)
 7. Wet globe thermometer
8. Silvered thermometer
9. Kata thermometer(diagram)

Study in brief about maximum thermometer,mininmum thermometer,globe

thermometer and kata thermometer.

-Effects of heat stress

Heat stroke Due to failure of heat regulating mechanism

Heat hyperpyrexia Impaired functioning of the heat regulating
mechanism
Heat exhaustion Imbalance or inadequate replacement of water
and salts lost in sweating
Heat cramps Due to lose of sodium and chloride in the
blood
Heat syncope Due to pooling of blood in lower limbs

ALCOHOL METER
-Identification(have mercury balls)

Type of hydrometer that indicates the alcoholic strength of liquids which are
essentially a mixture of alcohol and water.

-Uses:Measure the density of fluids.

LACTOMETER

-Identification
-Uses:
  A glass instrument that measures the purity of milk based on density.
 To find the amount of water in milk
 Works on Archimedes Principle

-Pasteurization of milk and methods

Heating the milk to such temperatures and for such periods of time as are
required to destroy any pathogens that may be present while causing minimal
changes in the composition ,flavor and nutritive value.

Holder method Milk kept at 63-66 deg c for 30 min 

High temperature and short time
method
Ultra high temperature method
quickly cooled to 5 deg c
Milk rapidly heated to 72 deg cheld
at that temp for 15 sec
rapidly cooled to 4 deg c
Done in 2 stages to 125 deg c for few
seccooled and bottled

BERKEFELD FILTER

-Identification
-Method of purification of water on small scale

 Household purification of water

a. Boiling
b. Chemical disinfection
c. Filteration
d. UV irradiation
e. Multi-stage reverse osmosis
 Disinfection of well

-Double pot method:

 (Figure)

2 cylindrical pots one inside another

Inside height and diameter are 30cm and 25cm

Outside pot a hole1cm is made on each pot inner pot-upper portion

outer pot 4cm above the bottom

1kg bleaching power+ 2kg coarse sand slightly moistened with water

Filled to inner pot

Inner pot introduced into outer pot

Mouth of outer pot closed with polyethylene foil

Lowered into well by a rope attached to well kerbatleast 1m below water

level

Significance:For emergency disinfection of well.

BLEACHING POWDER
-Identification
-Composition
Calcium hypochlorite

-Uses
 To disinfect water,fece,urine etc..
 Deodorant in bathroom and latrines
Bleaching agent in paper and textile industry
 As oxidizing agent because of nascent oxygen in it
-Chlorination:

Method of disinfection of water by adding chlorine as final step in the purification

of water following filtration.

-Breakpoint chorination:

The point at which chlorine demand is met and free chlorine the free residual
chlorine starts appearing in the water.If chlorine is added beyond break point free
chlorine remains in it.

-Chlorine demand:

The difference between the amount of chlorine added to the water and the
amount of residual chlorine remaining at the end of a specific period of contact at
a given temperature and pH of water

DETTOL
-Identification

-Types of disinfection

Precurrent As preventive measure to

prevent onset of disease
eg:chlorination of water
Concurrent Immediate destruction of
pathogens as soon as they come
out of the infected person
eg:disnfection of saliva,sputum
Terminal After death or discharge of
infected person

-Uses:
 As antiseptic liquid
 For first-aid and personal care uses
 For disinfecting floors
  For disinfecting cloths

UNICEF LOGO
-Identification
-Functions:
 Child health
 Child nutrition
 Family and child welfare
 Education
 GOBI campaign

G-growth chart

O-Oral rehydration

B-Breast feeding

I-Immunization

WORLD HEALTH ORGANIZATION (WHO)

-Identification
UN Symbol surmounded by a staff with a snake coiling around it.

-Functions:

 Prevention and control of specific diseases

 Development of comprehensive health services
 Family health
 Environmental health
 Health statistics
 Biomedical research
 Health literature and information
  Cooperation with other organizations

-Structure:

I- The world health assembly

II- The executive board
III- The secretariat

DDT
-Identification

-Full form:Dichlorodiphenyltrichloroethane

-Uses:

 In second world war to contol malaria,body lice etc.

 As agricultural and household pesticide
 To kill mosquito,fleas,body lice..
 Used as a contact poison against several arthropods

Disadvantages

Water insoluble ,so not washed by rain and high half life (2- 5 yrs in
soil and 150 yrs in water)
 Egg shell thinning and embryo death
 Toxic to aquatic organisms
 In humans affects hormone production
 Bioaccumulation:Dissolve in fat in body
 Estrogen mimic:Bind to receptors and prevent hormone to bind

ORAL RHYDRATION SOLUTION (ORS)

-Identification:(electral powder)

-Composition: as recommended by WHO

Sodium chloride 2.6g/L

Potassium chloride 1.5 g/L
Trisodium citrate 2.9 g/L
Glucose 13.5 g/L

-Preparation:

1. Using ORS packet

 1L of boiled cooled drinking water + Powder of ORS packet can be used
within 24 hrs of preparation and discarded if not used within this time.
 Fresh solution should be prepared if required.
2. Home preparation:
1 teaspoon of salt + 6 teaspoon of sugar +1L of clean drinking
waterproper stirring.

-What else can be given during dehydration:

 Rice water
 Soup
 yoghurt
 Tender coconut water
 weak tea.

-How to give ORS:

 Below 2 yrs old children:1 teaspoon every 1-2 minutes and after every
stool give 50-100 ml of solution
 Older children: frequent sips
 Adults:as much as they need.
 2-10 yrs children:100-200ml
CONDOM

(barrier method)
-Identification:(NIRODH)

-Classification of contraceptive methods:

1. TEMPORARY
A. Barrier method
 Physical-condom,cervical caps..
 Chemical –spermicidal jellies,creams..
 Combined –both physical and chemical
B. IUCD
 Non-medicated-1st Generation IUD:lippes loop
 Medicated
 2nd Generation IUD:Cu T
 3rd Generation IUD:Hormonal devices
C. Hormonal contraceptives
 OCPs
 Combined pills
 Progestogen only pill
 Post-coital pill
 Once a month pill
 Male pill

 Depot formulations
 Injectable contraceptives
 Subdermal implants
 Vaginal rings
D. Post coital methods
 Menstrual induction
 Menstrual regulation
 MTP
 E. Miscellaneous methods
 Abstinence
 Coitus interruptus
 Safe period
 Natural
 Basal body temperature
 Cervical mucus method
 Symptothermic method
 Breast feeding
 Birth control vaccines
2. PERMANENT
A. Tubectomy
B. Vasectomy

-Benefits/merits/advantages:

 Easily available
 Cost effective
 Safe
 Easy to use
 No need of medical assistance
 No side effects
 Light and disposable
 Protect from unwanted pregnancies and STDs

-Disadvantages:

 Interfere with sexual sensation

 May slip off can cause failure

COPPER-T

(Intra uterine devices-2nd generation)

-Identification:(draw figure and label)

-Classification of contraceptive methods:

(refer above)

-Advantages of copper devices:

 Low expulsive rate

 Less side effects
 Easier to fit in nulliparous women
 Better tolerated by nulliparous women
 Increased contraceptive effectiveness
 Used as post-coital method if used within 3-5 days of unprotected
intercourse

-Action:

 Produce foreign body reaction in uterus

 Copperaffects enzymes in uterus reduces sperm motility,capacitation
and survival

-Side-effects and complications of IUDs:

 Bleeding-commonest
 Pain: as low backache,cramps in lower abdomen etc
 Pelvic infection :2-8 times more at risk
 Uterine perforation
 Pregnancy
 Ectpic pregnancy
 Expulsion
 Fertility after removal:usually not impaired
 Cancer and teratogenesis
 Mortality :rare
LIPPES LOOP

(Intra uterine devices-first generation)

-Identification:(draw figure n label)

 Double S shaped device with a tail,non toxic ,non reactive..

 Available as A,B,C,D.D is the largest
 Have barium sulphte for x-ray observation and tail to make sure that it is in
place

-Classification of contraceptive methods:(refer above)

-Advantages of IUDs:

 Simplicity no complex procedure needed

 Insertion takes few minutes
 Once inserted stays in place
 Cost effective
 Reversible contraceptive effects
 Free of systemic metabolic side effects
 Highest continuation rate
 No need of continual motivation of couple

-Contraindications of IUD:

ABSOLUTE RELATIVE
 Suspected pregnancy  Anemia
 PID  H/O PID
 Vagibal bleeding of unknown  Congenital malformation of
caue uterus
 Ca cervix, uterus etc  Purulent cervical discharge
 H/O ectopic pregnancy  Unmotivated persons
 Menorrhagia

ORAL CONTRACEPTIVE PILLS (MALA –D/MALA-N)

Hormonal contraceptives
-Identification

-Classification of contraceptive methods

-Types of pills

 Combined pills
 Progestogen only pill
 Post-coital pill
 Once a month pill
 Male pill

-How to administer pills:

 Pills given orally for 21 days starting from 5th days of menstrual cycle
 Packet has 21 pills(contraceptive pills) + 7 dummy pills(have brown film)
 Should be taken at a fixed time mostly bed time
 If a pill is missed should take it soon as she remembers and rest of pills as
usual time

-Risk and benefits of pills:

ADVERSE EFFECTS BENEFICIAL EFFECTS

 Cardiovascular effects  Protects from benign breast
diseases,ovarian cysts,iron
deficiency anemia,PIDs,CA ovary
 Carcinogenesis  100% effective
 Metabolic effects-elevated
BP,Lipids etc
 Other adverse effects:
 Liver disorders,ectopic
pregnancies,lactation etc
 Breast tenderness,weight
gain,headache,bleeding
 disturbances

VAGINAL SPONGE

(Barrier method)
-Identification

 sponge soaked in vinegar or olive oil

 Have spermicide-nonoxynol -9
 Trade name:’TODAY’

-Pearl Index:

Universally accepted measure of contraceptive efficacy

Pearl index=No of pregnancies*1200/cycles of use

-Classification of contraceptive Methods:(refer above)

SAFETY GOGGLES/PROTECTIVE GLASSES

-Identification:

-Uses:

 To protect eyes when heating or mixing chemicals

 Protect eyes from broken glasses and flames
 Protect from flying objects or toxic substances
 Protection from heat hazards

EAR PLUG
-Identification:

-Uses:
  Reduce overwhelming loud background noise
 More comfortable in hot,humid work areas
 Protect ear from going into damage due to loud noises fro machines etc..

DOTS (DIRECT OBSERVED TREATMENT SHORTCOURSE)

-For tuberculosis

-Phases:

2 phases

INTENSIVE PHASE CONTINUATION PHASE

 2-3 months  4-6 months
 Under direct supervision of  A multiblister combipack with
health worker drug is given
 First dose is taken under
supervision

-Advantages of DOTS:

 Help the patient to complete the full course of medication

 Monitored closely to prevent the side effects of medication
 Encourage and support to complete the routine checkups