NEET MDS Synopsis
MCQs Paediatrics 1
Paediatrics
1.cleft palate is best repaired
1) Soon after birth B
2) At one month
3) At 6-8 months
4) Between 12-18 months
Ans 4
Cleft lip repair should be done between 3-6 months of age.
2. Intra-osseous access for drugs and fluid administration is recommended for paediatric group up to the age of
1) <one year
2) <4 yeats
3) <6 years
4) Up to 12 years
Ans. 3
3. Which of the following is a true statement regarding congenital diaphragmatic hernia (CDH)
1) Common on right side
2) Associated with pulmonary hypoplasia
3) Present with recurrent vomiting at birth
4) Baby benefited with bag mask ventilation
Ans. 4
CHD is common on left side by which gastric contents herniate to thoracic cavity , Bag mask ventilation in these babies leads to gastric distension which may further compress the lungs and increase mediastinal shift.
Antral Puncture and Intranasal Antrostomy
Oral and Maxillofacial SurgeryAntral Puncture and Intranasal Antrostomy
Antral puncture, also known as intranasal antrostomy, is a
surgical procedure performed to access the maxillary sinus for diagnostic or
therapeutic purposes. This procedure is commonly indicated in cases of chronic
sinusitis, sinus infections, or to facilitate drainage of the maxillary sinus.
Understanding the anatomical considerations and techniques for antral puncture
is essential for successful outcomes.
Anatomical Considerations
Maxillary Sinus Location:
The maxillary sinus is one of the paranasal sinuses located within
the maxilla (upper jaw) and is situated laterally to the nasal cavity.
The floor of the maxillary sinus is approximately 1.25 cm below
the floor of the nasal cavity, making it accessible through the nasal
passages.
Meatuses of the Nasal Cavity:
The nasal cavity contains several meatuses, which are passageways
that allow for drainage of the sinuses:
Middle Meatus: Located between the middle and
inferior nasal conchae, it is the drainage pathway for the frontal,
maxillary, and anterior ethmoid sinuses.
Inferior Meatus: Located below the inferior
nasal concha, it primarily drains the nasolacrimal duct.
Technique for Antral Puncture
Indications:
Antral puncture is indicated for:
Chronic maxillary sinusitis.
Accumulation of pus or fluid in the maxillary sinus.
Diagnostic aspiration for culture and sensitivity testing.
Puncture Site:
In Children: The puncture should be made through
the middle meatus. This approach is preferred due to
the anatomical differences in children, where the maxillary sinus is
relatively smaller and more accessible through this route.
In Adults: The puncture is typically performed
through the inferior meatus. This site allows for
better drainage and is often used for therapeutic interventions.
Procedure:
The patient is positioned comfortably, usually in a sitting or
semi-reclined position.
Local anesthesia is administered to minimize discomfort.
A needle (often a 16-gauge or larger) is inserted through the chosen
meatus into the maxillary sinus.
Aspiration is performed to confirm entry into the sinus, and any
fluid or pus can be drained.
If necessary, saline may be irrigated into the sinus to help clear
debris or infection.
Post-Procedure Care:
Patients may be monitored for any complications, such as bleeding or
infection.
Antibiotics may be prescribed if an infection is present or
suspected.
Follow-up appointments may be necessary to assess healing and sinus
function.
COMPOSITE RESINS -Components
Dental Materials
COMPOSITE RESINS
Components
Filler particles-colloidal silica, crystalline silica (quartz), or silicates of various particle sizes (containing Li, AI, Zn, Yr)
Matrix-BIS-GMA (or UDMA) with lower molecular weight diluents (e.g., TEGDMA) that correct during polymerization
Coupling agent- silane that chemically bonds the surfaces of the filter particles to the polymer matrix
Herpes simplex
General Pathology
Herpes simplex is subdivided into type 1 and 2, the former usually developing lesions around the lips and mouth and the latter producing vesicular lesions in the genital region
- contracted by physical contact; incubation 2-10 days.
- primary HSV I usually is accompanied by systemic signs of fever and Lymphadenopathy, while recurrent herpes is not associate with systemic signs.
- dentists often become infected by contact with patient saliva and often develop extremely painful infections on the fingers (herpetic whitlow).
- Herpes viruses remain dormant in sensory ganglia and are reactivated by stress, sunlight, menses, etc.
- Herpes gingivostomatitis is MC primary HSV 1 infectionÆpainful, vesicular eruptions that may extend for the tongue to the retropharynx.
- Herpes keratoconjunctivitis (HSV 1)
- Kaposi's varicelliform eruption refers to an HSV 1 infection superimposed on a previous dermatitis, usually in an immunodeficient person.
- laboratory: culture; ELISA test on vesicle fluid; intranuclear inclusions within multinucleated squamous cells in scrapings (Tzanck preps) of vesicular lesions.
Drugs Used in Diabetes -Sulfonylureas
Pharmacology
Sulfonylureas
1st generation
tolbutamide
chlorpropamide
2nd generation
glyburide
glimepiride
glipizide
Mechanism
glucose normally triggers insulin release from pancreatic β cells by increasing intracellular ATP
→ closes K+ channels → depolarization → ↑ Ca2+ influx → insulin release
sulfonylureas mimic action of glucose by closing K+ channels in pancreatic β cells
→ depolarization → ↑ Ca2+ influx → insulin release
its use results in
↓ glucagon release
↑ insulin sensitivity in muscle and liver
Clinical use
type II DM
stimulates release of endogenous insulin
cannot be used in type I DM due to complete lack of islet function
Toxicity
first generation
disulfiram-like effects
especially chlorpropamide
second generation
hypoglycemia
weight gain
Other lung diseases
General Pathology
Other lung diseases
1.Sarcoidosis
1. Sarcoidosis
a. More common in African-Americans.
b. Associated with the presence of noncaseating granulomas.
Sarcoidosis is an immune system disorder characterised by non-necrotising granulomas (small inflammatory nodules). Virtually any organ can be affected, however, granulomas most often appear in the lungs or the lymph nodes.
Signs and symptoms
Sarcoidosis is a systemic disease that can affect any organ. Common symptoms are vague, such as fatigue unchanged by sleep, lack of energy, aches and pains, dry eyes, blurry vision, shortness of breath, a dry hacking cough or skin lesions. The cutaneous symptoms are protean, and range from rashes and noduli (small bumps) to erythema nodosum or lupus pernio
Renal, liver, heart or brain involvement may cause further symptoms and altered functioning. Manifestations in the eye include uveitis and retinal inflammation
Sarcoidosis affecting the brain or nerves is known as neurosarcoidosis.
Hypercalcemia (high calcium levels) and its symptoms may be the result of excessive vitamin D production
Sarcoidosis most often manifests as a restrictive disease of the lungs, causing a decrease in lung volume and decreased compliance (the ability to stretch). The vital capacity (full breath in, to full breath out) is decreased, and most of this air can be blown out in the first second. This means the FEV1/FVC ratio is increased from the normal of about 80%, to 90%.
Treatment
Corticosteroids, most commonly prednisone
2. Cystic fibrosis
a. Transmission: caused by a genetic mutation (nucleotide deletion) on chromosome 7, resulting in abnormal chloride channels.
b. The most common hereditary disease in Caucasians.
c. Genetic transmission: autosomal recessive.
d. Affects all exocrine glands. Organs affected include lungs, pancreas, salivary glands, and intestines. Thick secretions or mucous plugs are
seen to obstruct the pulmonary airways and intestinal tracts.
e. Is ultimately fatal.
f. Diagnostic test: sweat test—sweat contains increased amounts of chloride.
3. Atelectasis
a. Characterized by collapse of the alveoli.
b. May be caused by a deficiency of surfactant and/or hypoventilation of alveoli.
Primary Bone Healing and Rigid Fixation
Oral and Maxillofacial SurgeryPrimary Bone Healing and Rigid Fixation
Primary bone healing is a process that occurs when bony
fragments are compressed against each other, allowing for direct healing without
the formation of a callus. This type of healing is characterized by the
migration of osteocytes across the fracture line and is facilitated by rigid
fixation techniques. Below is a detailed overview of the concept of primary bone
healing, the mechanisms involved, and examples of rigid fixation methods.
Concept of Compression
Compression of Bony Fragments: In primary bone healing,
the bony fragments are tightly compressed against each other. This
compression is crucial as it allows for the direct contact of the bone
surfaces, which is necessary for the healing process.
Osteocyte Migration: Under conditions of compression,
osteocytes (the bone cells responsible for maintaining bone tissue) can
migrate across the fracture line. This migration is essential for the
healing process, as it facilitates the integration of the bone fragments.
Characteristics of Primary Bone Healing
Absence of Callus Formation: Unlike secondary bone
healing, which involves the formation of a callus (a soft tissue bridge that
eventually hardens into bone), primary bone healing occurs without callus
formation. This is due to the rigid fixation that prevents movement between
the fragments.
Haversian Remodeling: The healing process in primary
bone healing involves Haversian remodeling, where the bone is remodeled
along the lines of stress. This process allows for the restoration of the
bone's structural integrity and strength.
Requirements for Primary Healing:
Absolute Immobilization: Rigid fixation must
provide sufficient stability to prevent any movement (interfragmentary
mobility) between the osseous fragments during the healing period.
Minimal Gap: There should be minimal distance (gap)
between the fragments to facilitate direct contact and healing.
Examples of Rigid Fixation in the Mandible
Lag Screws: The use of two lag screws across a fracture
provides strong compression and stability, allowing for primary bone
healing.
Bone Plates:
Reconstruction Bone Plates: These plates are
applied with at least three screws on each side of the fracture to
ensure adequate fixation and stability.
Compression Plates: A large compression plate can
be used across the fracture to maintain rigid fixation and prevent
movement.
Proper Application: When these fixation methods are
properly applied, they create a stable environment that is conducive to
primary bone healing. The rigidity of the fixation prevents interfragmentary
mobility, which is essential for the peculiar type of bone healing that
occurs without callus formation.
Seizure classification
Pharmacology
Seizure classification:
based on degree of CNS involvement, involves simple ( Jacksonian; sensory or motor cortex) or complex symptoms (involves temporal lobe)
1. Generalized (whole brain involved):
a. Tonic-clonic:
Grand Mal; ~30% incidence; unconsiousness, tonic contractions (sustained contraction of muscle groups) followed by clonic contractions (alternating contraction/relaxation); happens for ~ 2-3 minutes and people don’t breathe during this time
Drugs: phenytoin, carbamazepine, Phenobarbital, lamotrigine, valproic acid
Status epilepticus: continuous seizures; use diazepam (short duration) or diazepam + phenytoin
b. Absence:
Petit Mal; common in children; frequent, brief lapses of consciousness with or without clonic motor activity; see spike and wave EEg at 3 Hz (probably relates to thalamocorticoreverburating circuit)
Drugs: ethosuximide, lamotrigine, valproic acid
c. Myoclonic: uncommon; isolated clinic jerks associated with bursts of EEG spikes;
Drugs: lamotrigine, valproic acid
d. Atonic/akinetic: drop seizures; uncommon; sudden, brief loss of postural muscle tone
Drugs: valproic acid and lamotrigine
2. Partial: focal
a. Simple: Jacksonian; remain conscious; involves motor or sensory seizures (hot, cold, tingling common)
Drugs: carbamazepine, phenytoin, Phenobarbital, lamotrigine, valproic acid, gabapentin
b. Complex: temporal lobe or psychomotor; produced by abnormal electrical activity in temporal lobe (involves emotional functions)
Symptoms: abnormal psychic, cognitive, and behavioral function; seizures consist of confused/altered behavior with impaired consciousness (may be confused with psychoses like schizophrenia or dementia)
Drugs: carbamazepine, phenytoin, laotrigine, valproic acid, gabapentin
Generalizations: most seizures can’t be cured but can be controlled by regular administration of anticonvulsants (many types require treatment for years to decades); drug treatment can effectively control seizures in ~ 80% of patients