NEET MDS Synopsis
Blood-Lymphatic Pathology
General Pathology
Blood-Lymphatic Pathology
Disorders of primary hemostasis
1. General characteristics of disorders of primary hemostasis (due to problems of blood vessels or platelets):
a. Occur early in life.
b. Unlike secondary hemostasis, bleeding occurs in more superficial areas such as skin and mucous membranes rather than in secondary hemostasis.
c. Signs include petechiae.
d. Can be caused by vascular and platelet abnormalities or alterations in the plasma proteins required for adhesion of platelets to vascular subendothelium.
e. Laboratory findings include prolonged bleeding time, as seen in platelet disorders.
2. Vascular abnormalities
Scurvy
(1) Caused by a vitamin C deficiency leading to decreased synthesis of collagen. Note: vitamin C is necessary for the formation of collagen via hydroxylation of lysine and proline.
(2) Symptoms include:
- Delayed wound healing.
- Petechiae and ecchymosis.
- Gingival bleeding, swelling, and ulcerations.
3. Platelet abnormalities
a. Thrombocytopenia
(1) Characterized by a decreased number of platelets.
(2) The most common type of bleeding disorder.
(3) Can be caused by a number of diseases, such as irradiation, acute leukemia, disseminated intravascular coagulation (DIC), or idiopathic thrombocytopenic purpura (ITP).
b. Thrombocytopenic purpura
(1) Idiopathic: An autoimmune disease characterized by the presence of autoantibodies against platelets, resulting in the removal of platelets by splenic macrophages.
(2) May also be drug-induced.
Disorders of secondary hemostasis
1. General characteristics of disorders of secondary hemostasis (due to problems with clotting factors):
a. Symptoms occur later in life.
b. As compared to disorders of primary hemostasis, bleeding occurs in deeper areas and larger vessels (i.e., joint spaces).
c. Laboratory findings include abnormal:
- Partial thromboplastin time (PTT)—measures the intrinsic and common clotting pathway (i.e., tests all coagulation factors except factor 7).
- Prothrombin time (PT)—measures the extrinsic pathway.
- Does not affect the bleeding time.
Hemophilia
a. Caused by a deficiency of particular clotting factor(s).
b. All types of hemophilia affect the intrinsic pathway of the clotting cascade.
c. Signs and symptoms include:
- Prolonged PTT.
- Continuous bleeding from cuts or trauma, which can lead to excessive blood loss.
- Bleeding into joint cavities (hemarthroses) and muscle.
Two types:
(1) Hemophilia A (classic hemophilia)
- Caused by a deficiency of factor 8 (antihemophilic factor).
- Transmission: sex-linked recessive—only occurs in males; however, females can be carriers.
(2) Hemophilia B (Christmas disease)
- Caused by a deficiency of factor 9 (plasma thromboplastin).
- Transmission: sex-linked recessive—only occurs in males; however, females can be carriers.
- Lower incidence rate than hemophilia A.
(3). Vitamin K deficiency
- Causes include malnutrition and malabsorption of fats.
- A decrease in clotting factors 2, 7, 9, and 10 and prothrombin is observed.
- Prolonged PT.
Disorders of both primary and secondary hemostasis
1. von Willebrand’s disease
a. Characterized by a defective von Willebrand’s factor (vWF). Defective vWF affects both primary hemostasis by affecting platelet adhesion to
endothelium, and secondary hemostasis, by a defective factor 8.
b. Genetic transmission: autosomal dominant.
It is the most common hereditary bleeding disorder.
2. Liver disease—disease of the liver results in a decreased production of coagulation factors and therefore can lead to problems with hemostasis.
3. Disseminated intravascular coagulation a condition in which clots form throughout the vasculature. This uses up all available clotting factors and platelets, resulting in problems with bleeding.
Prenatal Counseling
Pedodontics Prenatal Counseling for Dental Health
Prenatal counseling is a crucial aspect of establishing a child's dental
preventive program. Initiating this process before the birth of the child allows
parents to prepare for their child's health and well-being effectively. This
period is particularly significant for first-time parents, as they are often
more receptive to health recommendations and eager to learn how to provide the
best care for their child.
Importance of Prenatal Counseling
Timing: The best time to begin counseling is during
pregnancy, as expectant parents are highly motivated to learn about health
practices that will benefit their child.
Parental Awareness: Expectant parents become acutely
aware of their child's dependence on them for nurturing and health care,
fostering a strong instinct to provide the best possible environment for
their child.
Key Counseling Topics
Parental Hygiene Habits:
Role Modeling: Parents should be encouraged to
adopt good oral hygiene practices, as children often emulate their
parents' behaviors.
Impact on Child's Oral Health: Discuss how parents'
oral health can directly affect their child's health, including the
transmission of bacteria that can lead to dental issues.
Pregnancy Gingivitis:
Education: Inform the mother-to-be about the
potential for pregnancy gingivitis, a common condition characterized by
swollen and bleeding gums due to hormonal changes.
Myth Dispelling: Address common myths surrounding
childbirth and dental health, emphasizing the importance of maintaining
oral hygiene during pregnancy.
Infant Dental Care:
Early Care: Provide a review of infant dental care
practices, including:
The importance of cleaning the infant's gums even before teeth
erupt.
Guidelines for the introduction of the first toothbrush and
toothpaste.
Recommendations for regular dental check-ups starting at the age
of one or when the first tooth appears.
Benefits of Prenatal Counseling
Improved Oral Health: By educating expectant parents
about their own oral hygiene and its impact on their child, both the parents
and the child can achieve better oral health outcomes.
Preparation for Parenthood: Counseling helps parents
feel more prepared and confident in their ability to care for their child's
dental health from an early age.
Long-term Health: Establishing good dental habits early
on can lead to a lifetime of healthy oral practices for the child.
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.
Digital Radiology
Radiology
Digital Radiology
Advances in computer and X-ray technology now permit the use of systems that employ sensors in place of X-ray ?lms (with emulsion). The image is either directly or indirectly converted into a digital representation that is displayed on a computer screen.
DIGITAL IMAGE RECEPTORS
- charged coupled device (CCD) used
- Pure silicon divided into pixels.
- Electromagnetic energy from visible light or X-rays interacts with pixels to create an electric charge that can be stored.
- Stored charges are transmitted electronically and create an analog output signal and displayed via digital converter (analog to digital converter).
ADVANTAGES OF DIGITAL TECHNIQUE
Immediate display of images.
Enhancement of image (e.g., contrast, gray scale, brightness).
Radiation dose reduction up to 60%.
Major disadvantage: High initial cost of sensors. Decreased image resolution and contrast as compared to D speed ?lms.
DIRECT IMAGING
- CCD or complementary metal oxide semiconductor (CMOS) detector used that is sensitive to electromagnetic radiation.
- Performance is comparable to ?lm radiography for detection of periodontal lesions and proximal caries in noncavitated teeth.
INDIRECT IMAGING
- Radiographic ?lm is used as the image receiver (detector).
- Image is digitized from signals created by a video device or scanner that views the radiograph.
Sensors
STORAGE PHOSPHOR IMAGING SYSTEMS
Phosphor screens are exposed to ionizing radiation which excites BaFBR:EU+2 crystals in the screen storing the image.
A computer-assisted laser then promotes the release of energy from the crystals in the form of blue light.
The blue light is scanned and the image is reconstructed digitally.
ELECTRONIC SENSOR SYSTEMS
X-rays are converted into light which is then read by an electronic sensor such as a CCD or CMOS.
Other systems convert the electromagnetic radiation directly into electrical impulses.
Digital image is created out of the electrical impulses.
OEDEMA
General Pathology
OEDEMA
Excessive accumulation of fluid in the extra vascular compartment (intersttitial tissues). This includes ascites (peritoneal sac), hydrothorax (pleural cavity) hydropericardium (pericardial space) and anasarca (generalised)
Factors which tend to accumulate interstitial fluid are:
- Intravascular hydrostatic pressure
- Interstitial osmotic pressure.
- Defective lymphatic drainage.
- Increased capillary permeability.
Factors that draw fluid into circulation are:
- Tissue hydrostatic-pressure (tissue tension).
- Plasma osmotic pressure,
Oedema fluid can be of 2 types:
A. Exudate.
It is formed due to increased capillary permeability as in inflammation.
B. Transudate
Caused by alterations of hydrostatic and osmotic pressures.
Exudate
Transudate
Specific Gravity
>1.018
1.012
Protein Content
High
Low
Nature of Protein
All Plasma Protein
Albumin mostly
Spontaneous Clotting
High(Inflammatory Cells)
Low
Local Oedema
1. Inflammatory oedema. Mechanisms are.
- Increased capillary permeability.
- Increased vascular hydrostatic pressure.
- Increased tissue osmotic pressure.
2.Hypersensitivity reactions especially types I and III
3. Venous obstruction :
- Thrombosis.
- Pressure from outside as in pregnancy, tourniquets.
4. Lymphatic obstruction:
- Elephantiasis in fillariasis
- Malignancies (Peau de orange in breast cancer).
Generalized Oedema
1. Cardiac oedema
Factors :Venous pressure increased.
2. Renal oedema
- Acute glomerulonephritis
- Nephrotic syndrome
3. Nutritional (hypoproteinaemic) oedema. it is seen in
- Starvation and Kwashiorkor
- Protein losing enteropathy
4. Hepatic oedema (predominantly ascites)
Factors:
- Fall in plasma protein synthesis
- Raised regional lymphatic and portal venous pressure
5. Oedema due to adrenal corticoids
As in Cushing's Syndrome
Pulmonary oedema
- Left heart failure and mitral stenosis.
- Rapid flv infusion specially in a patient of heart failure.
COMPOSITE RESINS -ACID ETCH TECHNIQUE
Dental Materials
ACID ETCH TECHNIQUE
Cavities requiring added retention (to hold firmly) are treated with an acid etching technique. This technique improves the seal of the composite resin to the cavity wall. The enamel adjacent to the margins of the preparation is slightly decalcified with a 40 to 50 percent phosphoric acid solution. This etched enamel enhances the mechanical retention of the composite resin. In addition, the acid etch technique is used to splint unstable teeth to adjacent teeth. The acid is left on the cut tooth structure only 15 seconds, in accordance with the directions for one common commercial brand. The area is then flushed with water for a minimum of 30 seconds to remove the decalcified material. Etched tooth structure will have a chalky appearance.
Diclofenac
Pharmacology
Diclofenac
Short half life (1‐2 hrs), high 1stpass metab., accumulates in synovial fluid after oral admn., reduce inflammation, such as in arthritis or acute injury
Mechanism of action
inhibition of prostaglandin synthesis by inhibition of cyclooxygenase (COX). There is some evidence that diclofenac inhibits the lipooxygenase pathways, thus reducing formation of the
leukotrienes (also pro-inflammatory autacoids). There is also speculation that diclofenac may inhibit phospholipase A2 as part of its mechanism of action. These additional actions may explain the high potency of diclofenac - it is the most potent NSAID on a molar basis.
Inhibition of COX also decreases prostaglandins in the epithelium of the stomach, making it more sensitive to corrosion by gastric acid. This is also the main side effect of diclofenac and other drugs that are not selective for the COX2-isoenzyme.
Rhythmicity
Physiology
1.Rhythmicity ( Chronotropism ) : means the ability of heart to beat regularly ( due to repetitive and stable depolarization and repolarization ) . Rhythmicity of heart is a myogenic in origin , because cardiac muscles are automatically excited muscles and does not depend on the nervous stimulus to initiate excitation and then contraction . The role of nerves is limited to the regulation of the heart rate and not to initiate the beat.
There are many evidences that approve the myogenic and not neurogenic origin of the rhythmicity of cardiac muscle . For example :
- transplanted heart continues to beat regularly without any nerve supply.
- Embryologically the heart starts to beat before reaching any nerves to them.
- Some drugs that paralyze the nerves ( such as cocaine ) do not stop the heart in given doses.
Spontaneous rhythmicity of the cardiac muscle due to the existence of excitatory - conductive system , which is composed of self- exciting non-contractile cardiac muscle cells . The SA node of the mentioned system excites in a rate , that is the most rapid among the other components of the system ( 110 beats /minute ) , which makes it the controller or ( the pacemaker ) of the cardiac rhythm of the entire heart.
Mechanism , responsible for self- excitation in the SA node and the excitatory conductive system is due to the following properties of the cell membrane of theses cells :
1- Non-gated sodium channels
2- Decreased permeability to potassium
3- existence of slow and fast calcium channels.
These properties enable the cations ( sodium through the none-gated sodium voltage channels , calcium through calcium slow channels) to enter the cell and depolarize the cell membrane without need for external stimulus.
The resting membrane potential of non-contractile cardiac cell is -55 - -60 millivolts ( less than that of excitable nerve cells (-70) ) .
The threshold is also less negative than that of nerve cells ( -40 millivolts ).
The decreased permeability to potassium from its side decrease the eflux of potassium during the repolarization phase of the pacemaker potential . All of these factors give the pacemaker potential its characteristic shape
Repeating of the pacemaker potential between the action potentials of contractile muscle cells is the cause of spontaneous rhythmicity of cardiac muscle cells.
Factors , affecting the rhythmicity of the cardiac muscle :
I. Factors that increase the rate ( positive chronotropic factors) :
1. sympathetic stimulation : as its neurotransmitter norepinephrine increases the membrane permeability to sodium and calcium.
2. moderate warming : moderate warming increases temperature by 10 beats for each 1 Fahrenheit degree increase in body temperature, this due to decrease in permeability to potassium ions in pacemaker membrane by moderate increase in temperature.
3. Catecholaminic drugs have positive chronotropic effect.
4. Thyroid hormones : have positive chronotropic effect , due to the fact that these drugs increase the sensitivity of adrenergic receptors to adrenaline and noreadrenaline .
5. mild hypoxia.
6. mild alkalemia : mild alkalemia decreases the negativity of the resting potential.
7. hypocalcemia.
8. mild hypokalemia
II. Factors that decrease rhythmicity ( negative chronotropic):
1.Vagal stimulation : the basal level of vagal stimulation inhibits the sinus rhythm and decrease it from 110-75 beats/ minute. This effect due to increasing the permeability of the cardiac muscle cell to potassium , which causes rapid potassium eflux , which increases the negativity inside the cardiac cells (hyperpolarization ).
2. moderate cooling
3. severe warming : due to cardiac damage , as a result of intercellular protein denaturation. Excessive cooling on the other hand decrease metabolism and stops rhythmicity.
4. Cholenergic drugs ( such as methacholine , pilocarpine..etc) have negative chronotropic effect.
5. Digitalis : these drugs causes hyperpolarization . This effect is similar to that of vagal stimulation.
6. Hypercapnia ( excessive CO2 production )
7. Acidemia.
8. hyper- and hyponatremia .
9. hyperkalemia
10. hypercalcemia
11. Typhoid or diphteria toxins.