NEET MDS Synopsis
DIURETICS
Pharmacology
DIURETICS
Specific Therapeutic Objective
Clinical State(s)
Drug(s) (Class)
Draw fluid from tissue to vascular space reduce tissue edema
Cerebral edema
glaucoma
Mannitol (Osmotic)
Glucose (Osmotic)
Glycerin (Osmotic)
Decrease renal swelling
expand tubular volume
Renal shutdown
Glucose (Osmotic)
Mannitol (Osmotic)
Modest and/or sustained decrease in venous hydrostatic pressure
Congestive heart failure
Hepatic cirrhosis
Udder edema
Hydrochlorothiazide (thiazide)
Chlorothiazide (thiazide)
Aggressive and/or short-term decrease in venous hydrostatic pressure
Congestive heart failure
Hepatic cirrhosis
Udder edema
Furosemide (loop)
Inhibit aldosterone action
Hepatic cirrhosis
Congestive heart failure
triamterene (K+ sparing)
spironolactone (K+ sparing - competitive)
Reduce potassium wasting 2o to other diuretic
Hepatic cirrhosis
Congestive heart failure
triamterene (K+ sparing)
spironolactone (K+ sparing - competitive)
Inhibit ADH action
Inappropriate ADH secretion
lithium (aquaretic)
demeclocycline (aquaretic
Increase calcium secretion
Malignant hypercalcemia
Paraneoplastic
Hypervitaminosis D
Furosemide (loop)
Reduce urine output
Diabetes insidpidus
Hydrochlorothiazide (thiazide)
Chlorothiazide (thiazide)
Urine alkalinization
Various
Carbonic anhydrase inhibitors
Nursing Bottle Caries
Conservative DentistryNursing Bottle Caries
Nursing bottle caries, also known as early childhood caries (ECC), is a
significant dental issue that affects infants and young children. Understanding
the etiological agents involved in this condition is crucial for prevention and
management. .
1. Pathogenic Microorganism
A. Streptococcus mutans
Role: Streptococcus mutans is the primary
microorganism responsible for the development of nursing bottle caries. It
colonizes the teeth after they erupt into the oral cavity.
Transmission: This bacterium is typically transmitted
to the infant’s mouth from the mother, often through saliva.
Virulence Factors:
Colonization: It effectively adheres to tooth
surfaces, establishing a foothold for caries development.
Acid Production: S. mutans produces large
amounts of acid as a byproduct of carbohydrate fermentation, leading to
demineralization of tooth enamel.
Extracellular Polysaccharides: It synthesizes
significant quantities of extracellular polysaccharides, which promote
plaque formation and enhance bacterial adherence to teeth.
2. Substrate (Fermentable Carbohydrates)
A. Sources of Fermentable Carbohydrates
Fermentable carbohydrates are utilized by S. mutans to form
dextrans, which facilitate bacterial adhesion to tooth surfaces and
contribute to acid production. Common sources include:
Bovine Milk or Milk Formulas: Often high in
lactose, which can be fermented by bacteria.
Human Milk: Breastfeeding on demand can expose
teeth to sugars.
Fruit Juices and Sweet Liquids: These are often
high in sugars and can contribute to caries.
Sweet Syrups: Such as those found in vitamin
preparations.
Pacifiers Dipped in Sugary Solutions: This practice
can introduce sugars directly to the oral cavity.
Chocolates and Other Sweets: These can provide a
continuous source of fermentable carbohydrates.
3. Host Factors
A. Tooth Structure
Host for Microorganisms: The tooth itself serves as the
host for S. mutans and other cariogenic bacteria.
Susceptibility Factors:
Hypomineralization or Hypoplasia: Defects in enamel
development can increase susceptibility to caries.
Thin Enamel and Developmental Grooves: These
anatomical features can create areas that are more prone to plaque
accumulation and caries.
4. Time
A. Duration of Exposure
Sleeping with a Bottle: The longer a child sleeps with
a bottle in their mouth, the higher the risk of developing caries. This is
due to:
Decreased Salivary Flow: Saliva plays a crucial
role in neutralizing acids and washing away food particles.
Prolonged Carbohydrate Accumulation: The swallowing
reflex is diminished during sleep, allowing carbohydrates to remain in
the mouth longer.
5. Other Predisposing Factors
Parental Overindulgence: Excessive use of sugary foods
and drinks can increase caries risk.
Sleep Patterns: Children who sleep less may have
increased exposure to cariogenic factors.
Malnutrition: Nutritional deficiencies can affect oral
health and increase susceptibility to caries.
Crowded Living Conditions: These may limit access to
dental care and hygiene practices.
Decreased Salivary Function: Conditions such as iron
deficiency and exposure to lead can impair salivary function, increasing
caries susceptibility.
Clinical Features of Nursing Bottle Caries
Intraoral Decay Pattern: The decay pattern associated
with nursing bottle caries is characteristic and pathognomonic, often
involving the maxillary incisors and molars.
Progression of Lesions: Lesions typically progress
rapidly, leading to extensive decay if not addressed promptly.
Management of Nursing Bottle Caries
First Visit
Lesion Management: Excavation and restoration of
carious lesions.
Abscess Drainage: If present, abscesses should be
drained.
Radiographs: Obtain necessary imaging to assess the
extent of caries.
Diet Chart: Provide a diet chart for parents to record
the child's diet for one week.
Parent Counseling: Educate parents on oral hygiene and
dietary practices.
Topical Fluoride: Administer topical fluoride to
strengthen enamel.
Second Visit
Diet Analysis: Review the diet chart with the parents.
Sugar Control: Identify and isolate sugar sources in
the diet and provide instructions to control sugar exposure.
Caries Activity Tests: Conduct tests to assess the
activity of carious lesions.
Third Visit
Endodontic Treatment: If necessary, perform root canal
treatment on affected teeth.
Extractions: Remove any non-restorable teeth, followed
by space maintenance if needed.
Crowns: Place crowns on teeth that require restoration.
Recall Schedule: Schedule follow-up visits every three
months to monitor progress and maintain oral health.
Anchorage
OrthodonticsAnchorage in orthodontics refers to the resistance to unwanted tooth movement
during orthodontic treatment. It is a critical concept that helps orthodontists
achieve desired tooth movements while preventing adjacent teeth or the entire
dental arch from shifting. Proper anchorage is essential for effective treatment
planning and execution, especially in complex cases where multiple teeth need to
be moved simultaneously.
Types of Anchorage
Absolute Anchorage:
Definition: This type of anchorage prevents any
movement of the anchorage unit (the teeth or structures providing
support) during treatment.
Application: Used when significant movement of
other teeth is required, such as in cases of molar distalization or when
correcting severe malocclusions.
Methods:
Temporary Anchorage Devices (TADs): Small
screws or plates that are temporarily placed in the bone to provide
stable anchorage.
Extraoral Appliances: Devices like headgear
that anchor to the skull or neck to prevent movement of certain
teeth.
Relative Anchorage:
Definition: This type allows for some movement of
the anchorage unit while still providing enough resistance to achieve
the desired tooth movement.
Application: Commonly used in cases where some
teeth need to be moved while others serve as anchors.
Methods:
Brackets and Bands: Teeth can be used as
anchors, but they may move slightly during treatment.
Class II or Class III Elastics: These can be
used to create a force system that allows for some movement of the
anchorage unit.
Functional Anchorage:
Definition: This type utilizes the functional
relationships between teeth and the surrounding structures to achieve
desired movements.
Application: Often used in conjunction with
functional appliances that guide jaw growth and tooth positioning.
Methods:
Functional Appliances: Such as the Herbst or
Bionator, which reposition the mandible and influence the growth of
the maxilla.
Factors Influencing Anchorage
Tooth Position: The position and root morphology of the
anchorage teeth can affect their ability to resist movement.
Bone Quality: The density and health of the surrounding
bone can influence the effectiveness of anchorage.
Force Magnitude and Direction: The amount and direction
of forces applied during treatment can impact the stability of anchorage.
Patient Compliance: Adherence to wearing appliances as
prescribed is crucial for maintaining effective anchorage.
Clinical Considerations
Treatment Planning: Proper assessment of anchorage
needs is essential during the treatment planning phase. Orthodontists must
determine the type of anchorage required based on the specific movements
needed.
Monitoring Progress: Throughout treatment,
orthodontists should monitor the anchorage unit to ensure it remains stable
and that desired tooth movements are occurring as planned.
Adjustments: If unwanted movement of the anchorage unit
occurs, adjustments may be necessary, such as changing the force system or
utilizing additional anchorage methods.
Common tests in Dental Biostatics and applications
Public Health DentistryCommon tests in dental biostatics and applications
Dental biostatistics involves the application of statistical methods to the
study of dental medicine and oral health. It is used to analyze data, make
inferences, and support decision-making in various dental fields such as
epidemiology, clinical research, public health, and education. Some common tests
and their applications in dental biostatistics include:
1. T-test: This test is used to compare the means of two
independent groups. For example, it can be used to compare the pain levels
experienced by patients who receive two different types of local anesthetics
during dental procedures.
2. ANOVA (Analysis of Variance): This test is used to compare
the means of more than two independent groups. It is often used in dental
studies to evaluate the effectiveness of multiple treatments or to compare the
success rates of different dental materials.
3. Chi-Square Test: This is a non-parametric test used to
assess the relationship between categorical variables. In dental research, it
might be used to determine if there is an association between tooth decay and
socioeconomic status, or between the type of dental restoration and the
frequency of post-operative complications.
4. McNemar's Test: This is a statistical test used to analyze
paired nominal data, such as the change in the presence or absence of a
condition over time. In dentistry, it can be applied to assess the effectiveness
of a treatment by comparing the presence of dental caries in the same patients
before and after the treatment.
5. Kruskal-Wallis Test: This is another non-parametric test for
comparing more than two independent groups. It's useful when the data is not
normally distributed. For instance, it can be used to compare the effectiveness
of three different types of toothpaste in reducing plaque and gingivitis.
6. Mann-Whitney U Test: This test is used to compare the
medians of two independent groups when the data is not normally distributed. It
is often used in dental studies to compare the effectiveness of different
interventions, such as comparing the effectiveness of two mouthwashes in
reducing plaque and gingivitis.
7. Regression Analysis: This statistical method is used to
analyze the relationship between one dependent variable (e.g., tooth loss) and
one or more independent variables (e.g., age, oral hygiene habits, smoking
status). It helps to identify risk factors and predict outcomes.
8. Logistic Regression: This is used to model the relationship
between a binary outcome (e.g., presence or absence of dental caries) and one or
more independent variables. It is commonly used in dental epidemiology to assess
the risk factors for various oral diseases.
9. Cox Proportional Hazards Model: This is a survival analysis
technique used to estimate the time until an event occurs. In dentistry, it
might be used to determine the factors that influence the time until a dental
implant fails.
10. Kaplan-Meier Survival Analysis: This method is used to
estimate the probability of survival over time. It's commonly applied in dental
studies to evaluate the success rates of dental restorations or implants.
11. Fisher's Exact Test: This is used to test the significance
of a relationship between two categorical variables, especially when the sample
size is small. It might be used in a study examining the association between a
specific genetic mutation and the occurrence of oral cancer.
12. Spearman's Rank Correlation Coefficient: This is a
non-parametric measure of the correlation between two continuous or ordinal
variables. It could be used to assess the relationship between the severity of
periodontal disease and the patient's self-reported oral hygiene habits.
13. Cohen's kappa coefficient: This measures the agreement
between two or more raters who are categorizing items into ordered categories.
It is useful in calibration studies among dental professionals to assess the
consistency of their diagnostic or clinical evaluations.
14. Sample Size Calculation: Determining the appropriate sample
size is crucial for ensuring that dental studies are adequately powered to
detect significant differences. This is done using statistical formulas that
take into account the expected effect size, significance level, and power of the
study.
15. Confidence Intervals (CIs): CIs provide a range within
which the true population parameter is likely to lie, given the sample data.
They are commonly reported in dental studies to indicate the precision of the
results, for instance, the estimated difference in treatment efficacy between
two groups.
16. Statistical Significance vs. Clinical Significance: Dental
biostatistics helps differentiate between results that are statistically
significant (unlikely to have occurred by chance) and clinically significant
(large enough to have practical implications for patient care).
17. Meta-Analysis: This technique combines the results of
multiple studies to obtain a more precise estimate of the effectiveness of a
treatment or intervention. It is frequently used in dental research to summarize
the evidence for various treatments and to guide clinical practice.
These tests and applications are essential for designing, conducting, and
interpreting dental research studies. They help ensure that the results are
valid and reliable, and can be applied to improve the quality of oral health
care.
Functions of the blood
PhysiologyFunction of Blood
transport through the body of
oxygen and carbon dioxide
food molecules (glucose, lipids, amino acids)
ions (e.g., Na+, Ca2+, HCO3−)
wastes (e.g., urea)
hormones
heat
defense of the body against infections and other foreign materials. All the WBCs participate in these defenses
Bile
PhysiologyBile contains:
bile acids. These amphiphilic steroids emulsify ingested fat. The hydrophobic portion of the steroid dissolves in the fat while the negatively-charged side chain interacts with water molecules. The mutual repulsion of these negatively-charged droplets keeps them from coalescing. Thus large globules of fat (liquid at body temperature) are emulsified into tiny droplets (about 1 µm in diameter) that can be more easily digested and absorbed.
bile pigments. These are the products of the breakdown of hemoglobin removed by the liver from old red blood cells. The brownish color of the bile pigments imparts the characteristic brown color of the feces.
Ludwig's Angina
General SurgeryLudwig's Angina
Ludwig's angina is a serious, potentially life-threatening cellulitis or
connective tissue infection of the submandibular space. It typically arises from
infections of the teeth, particularly the second or third molars, and can lead
to airway obstruction due to swelling. This condition is named after the German
physician Wilhelm Friedrich von Ludwig, who first described it in the 19th
century.
Etiology
Common Causes:
Dental infections (especially from the lower molars)
Infections from the floor of the mouth
Trauma to the submandibular area
Occasionally, infections can arise from other sources, such as the
oropharynx or skin.
Microbial Agents:
Mixed flora, including both aerobic and anaerobic bacteria.
Common organisms include Streptococcus, Staphylococcus, and
Bacteroides species.
Pathophysiology
The infection typically begins in the submandibular space and can spread
rapidly due to the loose connective tissue in this area.
The swelling can lead to displacement of the tongue and can obstruct the
airway, making it a medical emergency.
Clinical Presentation
Symptoms:
Swelling of the submandibular area, which may be bilateral
"Brawny induration" (firm, non-fluctuant swelling)
Pain and tenderness in the submandibular region
Difficulty swallowing (dysphagia) and speaking (dysarthria)
Fever and malaise
Possible elevation of the floor of the mouth and displacement of the
tongue
Signs:
Swelling may extend to the neck and may cause "bull neck"
appearance.
Trismus (limited mouth opening) may be present.
Respiratory distress due to airway compromise.
Diagnosis
Clinical Evaluation: Diagnosis is primarily clinical
based on history and physical examination.
Imaging:
CT scan of the neck may be used to assess the extent of the
infection and to rule out other conditions.
X-rays may show air in the soft tissues if there is a necrotizing
infection.
Management
Initial Management
Airway Management:
Ensure the airway is patent; this may require intubation or
tracheostomy in severe cases.
Medical Treatment
Antibiotics:
Broad-spectrum intravenous antibiotics are initiated to cover both
aerobic and anaerobic bacteria. Common regimens may include:
Ampicillin-sulbactam
Clindamycin
Metronidazole combined with a penicillin derivative
Surgical Intervention
Drainage:
Surgical drainage may be necessary if there is an abscess formation
or significant swelling.
Incisions are typically made in the submandibular area to allow for
drainage of pus and to relieve pressure.
Complications
Airway Obstruction: The most critical complication,
requiring immediate intervention.
Sepsis: Can occur if the infection spreads
systemically.
Necrotizing fasciitis: Rare but serious complication
that may require extensive surgical intervention.
Thrombosis of the internal jugular vein: Can occur due
to the spread of infection.
Prognosis
With prompt diagnosis and treatment, the prognosis is generally good.
However, delays in management can lead to significant morbidity and
mortality due to airway compromise and systemic infection.
General chromosome abnormalities
General Pathology
General chromosome abnormalities
The normal human cell contains 46 chromosomes, including 22 homologous pairs of autosomes and one pair of sex chromosomes (XX for female and XY for male). A somatic cell is diploid, containing 46 chromosomes. Gametes are haploid, containing 23 chromosomes.
Aneuploidy
(a) Any deviation in the number of chromosomes, whether fewer or more, from the normal haploid number of chromosomes.
(b) Nondisjunction—a common cause of aneuploidy. It is the failure of chromosomes to pass to separate cells during meiotic or mitotic cell division.
(c) Often seen in malignant tumors.
Deletion: loss of a sequence of DNA from a chromosome.
Translocation: the separation of a chromosome and the attachment of the area of separation to another chromosome.