NEET MDS Synopsis
Hypothalamic - Pituitary Drugs
Pharmacology
Hypothalamic - Pituitary Drugs
Somatropin
Growth hormone (GH) mimetic
Mechanism
agonist at GH receptors
increases production of insulin growth factor-1 (IGF-1)
Clinical use
GH deficiency
increase adult height for children with conditions associated with short stature
Turner syndrome
wasting in HIV infection
short bowel syndrome
Toxicity
scoliosis
edema
gynecomastia
increased CYP450 activity
Octreotide
Somatostatin mimetic
Mechanism
agonist at somatostatin receptors
Clinical use
acromegaly
carcinoid
gastrinoma
glucagonoma
acute esophageal variceal bleed
Toxicity
GI upset
gallstones
bradycardia
Oxytocin
Mechanism
agonist at oxytocin receptor
Clinical use
stimulation of labor
uterine contractions
control of uterine hemorrhage after delivery
stimulate milk letdown
Toxicity
fetal distress
abruptio placentae
uterine rupture
Desmopressin
ADH (vasopressin) mimetic
Mechanism
agonist at vasopressin V2 receptors
Clinical use
central (pituitary) diabetes insipidus
hemophilia A (factor VIII deficiency)
increases availability of factor VIII
von Willebrand disease
increases release of von Willebrand factor from endothelial cells
Toxicity
GI upset
headache
hyponatremia
allergic reaction
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.
Radioimmunoassays (RIA)
General MicrobiologyRadioimmunoassays (RIA)
It is an extremely sensitive technique in which antibody or antigen is labelled with a radioactive material. The amount of radioactive material in the antigen-antibody complex can be measured with which concentration of antigen or antibody can be assayed. After the reaction ‘free’ and ‘bound’ fractions of antigen are separated and their radioactivity-measured.
Krebs Cycle
Biochemistry
Glycolysis enzymes are located in the cytosol of cells. Pyruvate enters the mitochondrion to be metabolized further
Mitochondrial compartments: The mitochondrial matrix contains Pyruvate Dehydrogenase and enzymes of Krebs Cycle, plus other pathways such as fatty acid oxidation.
Pyruvate Dehydrogenase catalyzes oxidative decarboxylation of pyruvate, to form acetyl-CoA
FAD (Flavin Adenine Dinucleotide) is a derivative of the B-vitamin riboflavin (dimethylisoalloxazine-ribitol). The flavin ring system undergoes oxidation/reduction as shown below. Whereas NAD+ is a coenzyme that reversibly binds to enzymes, FAD is a prosthetic group, that is permanently part of the complex.
FAD accepts and donates 2 electrons with 2 protons (2 H):
Thiamine pyrophosphate (TPP) is a derivative of thiamine (vitamin B1). Nutritional deficiency of thiamine leads to the disease beriberi. Beriberi affects especially the brain, because TPP is required for carbohydrate metabolism, and the brain depends on glucose metabolism for energy
Acetyl CoA, a product of the Pyruvate Dehydrogenase reaction, is a central compound in metabolism. The "high energy" thioester linkage makes it an excellent donor of the acetate moiety
For example, acetyl CoA functions as:
input to the Krebs Cycle, where the acetate moiety is further degraded to CO2.
donor of acetate for synthesis of fatty acids, ketone bodies, and cholesterol.
ATPs formed in TCA cycle from one molecule of Pyruvate
1. 3ATP 7. 3ATP 5. 3 ATP
8. 1 ATP 9. 2 ATP 11.3 ATP Total =15 ATP.
ATPS formed from one molecule of Acetyl CoA =12ATP
ATPs formed from one molecule of glucose after complete oxidation
One molecule of glucose -->2 molecules of pyruvate
['By glycolysis] ->8 ATP
2 molecules of pyruvate [By TCA cycle] -> 30 ATP
Total = 38 ATP
Multiple myeloma
General Pathology
Multiple myeloma.
Blood picture:
- Marked rouleaux formation.
- Normpcytic normochromic anaemia.
- There may be leucopenia or leucoery!hrohlastic reaction.
- Atypical plasma cells may be seen in some patients
- Raised ESR
- Monoclonal hypergammaglobulinaemia
- If light chains are produced in excess, they are excreted in urine as bence jones protein
Bone marrow
- Hyper cellular
- Plasma cells from at least 15 – 30% atypical forms and myeloma cells are seen.
SALIVARY GLANDS
Dental Anatomy
HISTOLOGY OF SALIVARY GLANDS
Parotid: so-called watery serous saliva rich in amylase
Submandibular gland: more mucinous
Sublingual: viscous saliva
Parotid Gland: The parotid is a serous secreting gland.
There are also fat cells in the parotid.
Submandibular Gland
This gland is serous and mucous secreting.
There are serous demilunes
This gland is more serous than mucous
Also fat cells
Sublingual Gland
Serous and mucous secreting
Serous cells in the form of demilunes on the mucous acini.
more mucous than serous cells
Minor Salivary Glands
Minor salivary glands are not found within gingiva and anterior part of the hard palate
Serous minor glands=von Ebner below the sulci of the circumvallate and folliate papillae of the tongue; palatine, glossopalatine glands are pure mucus; some lingual glands are also pure mucus
Functions
Protection: lubricant (glycoprotein); barrier against noxious stimuli; microbial toxins and minor traumas; washing non-adherent and acellular debris; calcium-binding proteins: formation of salivary pellicle
Buffering: bacteria require specific pH conditions; plaque microorganisms produce acids from sugars; phosphate ions and bicarbonate
Digestion: neutralizes esophageal contents, dilutes gastric chyme; forms food bolus; brakes starch
Taste: permits recognition of noxious substances; protein gustin necessary for growth and maturation of taste buds
Antimicrobial: lysozyme hydrolyzes cell walls of some bacteria; lactoferrin binds free iron and deprives bacteria of this essential element; IgA agglutinates microorganisms
Maintenance of tooth integrity: calcium and phosphate ions; ionic exchange with tooth surface
Tissue repair: bleeding time of oral tissues shorter than other tissues; resulting clot less solid than normal; remineralization
Maintenance of Homeostasis
Physiology
Maintenance of Homeostasis
The kidneys maintain the homeostasis of several important internal conditions by controlling the excretion of substances out of the body.
Ions. The kidney can control the excretion of potassium, sodium, calcium, magnesium, phosphate, and chloride ions into urine. In cases where these ions reach a higher than normal concentration, the kidneys can increase their excretion out of the body to return them to a normal level. Conversely, the kidneys can conserve these ions when they are present in lower than normal levels by allowing the ions to be reabsorbed into the blood during filtration. (See more about ions.)
pH. The kidneys monitor and regulate the levels of hydrogen ions (H+) and bicarbonate ions in the blood to control blood pH. H+ ions are produced as a natural byproduct of the metabolism of dietary proteins and accumulate in the blood over time. The kidneys excrete excess H+ ions into urine for elimination from the body. The kidneys also conserve bicarbonate ions, which act as important pH buffers in the blood.
Osmolarity. The cells of the body need to grow in an isotonic environment in order to maintain their fluid and electrolyte balance. The kidneys maintain the body’s osmotic balance by controlling the amount of water that is filtered out of the blood and excreted into urine. When a person consumes a large amount of water, the kidneys reduce their reabsorption of water to allow the excess water to be excreted in urine. This results in the production of dilute, watery urine. In the case of the body being dehydrated, the kidneys reabsorb as much water as possible back into the blood to produce highly concentrated urine full of excreted ions and wastes. The changes in excretion of water are controlled by antidiuretic hormone (ADH). ADH is produced in the hypothalamus and released by the posterior pituitary gland to help the body retain water.
Blood Pressure. The kidneys monitor the body’s blood pressure to help maintain homeostasis. When blood pressure is elevated, the kidneys can help to reduce blood pressure by reducing the volume of blood in the body. The kidneys are able to reduce blood volume by reducing the reabsorption of water into the blood and producing watery, dilute urine. When blood pressure becomes too low, the kidneys can produce the enzyme renin to constrict blood vessels and produce concentrated urine, which allows more water to remain in the blood.
Aortic arches:
Anatomy
Aortic arches:
These are short vessels connecting ventral and dorsal aortae.
On each side they run within branchial i.e pharyngeal arches are based gradually the 4th and 5th week, in 6 pairs in total the first,
second and fifth pairs are developmental in perspective and they soon disappear.
1st aortic arch:
It disappears into a small portion persists, It also forms a piece of the maxillary artery.
2nd aortic arch:
It disappears into small portions of this arch contributing to the hyoid and stapedial arteries
3rd aortic arch:
It commonly carotid and initial segments of internal carotid artery.
4th aortic arch:
It has ultimate fate different on the right and left side on the left.
1. LEFT, both the proximal and distal segments are retained they are incorporated into the descending arch of the aorta.
2. RIGHT, the proximal segment of the right dorsal aorta persists and they are incorporated into the R subclavian artery
whereas the distal segment regresses.
5th aortic arch -
It is transient and soon obliterates.
6th aortic arch - pulmonary arch
1. RIGHT arch: this proximal segment is incorporated into the R pulmonary artery and the distal segment regresses.
2. LEFT arch: this proximal segment is incorporated into the L pulmonary artery and the distal segment persists as the ductus arteriosus.