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NEET MDS Synopsis

Pneumoconioses
General Pathology

Pneumoconioses—are environmentally related lung diseases that result from chronic inhalation of various substances.

1. Silicosis (stone mason’s disease) 
a. Inhalant: silica dust.
b. Associated with extensive fibrosis of the lungs.
c. Patients have a higher susceptibility to tuberculosis infections.

2. Asbestosis
a. Inhalant: asbestos fibers.
b. Associated with the presence of pleural plaques.
c. Consequences include:
(1) Mesothelioma (malignant mesothelial tumor).
(2) Bronchogenic carcinoma.

3. Anthracosis
a. Inhalant: carbon dust.
b. Usually not as harmful as silicosis or asbestosis.
c. Associated with the presence of macrophages containing carbon.



Physiologic anatomy of the respiratory system
Physiology

Respiration occurs in three steps :
1- Mechanical ventilation : inhaling and exhaling of air between lungs and atmosphere.
2- Gas exchange : between pulmonary alveoli and pulmonary capillaries.
3- Transport of gases from the lung to the peripheral tissues , and from the peripheral tissues back to blood .
These steps are well regulated by neural and chemical regulation.

Respiratory tract is subdivided into upper and lower respiratory tract. The upper respiratory tract involves , nose , oropharynx and nasopharynx , while the lower respiratory tract involves larynx , trachea , bronchi ,and lungs .

Nose fulfills three important functions which are :

1. warming of inhaled air .

b. filtration of air .

c. humidification of air .

Pharynx is a muscular tube , which forms a passageway for air and food .During swallowing the epiglottis closes the larynx and the bolus of food falls in the esophagus .

Larynx is a respiratory organ that connects pharynx with trachea . It is composed of many cartilages and muscles and

vocal cords . Its role in respiration is limited to being a conductive passageway for air .

Trachea is a tube composed of C shaped cartilage rings from anterior side, and of muscle (trachealis muscle ) from its posterior side.The rings prevent trachea from collapsing during the inspiration. 

From  the trachea the bronchi are branched into right and left bronchus ( primary bronchi) , which enter the lung .Then they repeatedly branch into secondary and tertiary bronchi and then into terminal and respiratory broncholes.There are about 23 branching levels from the right and left bronchi to the respiratory bronchioles  , the first upper  17 branching are considered as a part of the conductive zones , while the lower 6 are considered to be respiratory zone. 

The cartilaginous component decreases gradually from the trachea to the bronchioles  . Bronchioles are totally composed of smooth muscles ( no cartilage) . With each branching the diameter of bronchi get smaller , the smallest diameter of respiratory passageways is that of respiratory bronchiole. 

Lungs are evolved by pleura . Pleura is composed of two layers : visceral and parietal .
Between the two layers of pleura , there is a pleural cavity , filled with a fluid that decrease the friction between the visceral and parietal pleura.
 

Respiratory muscles : There are two group of respiratory muscles:


1. Inspiratory muscles : diaphragm and external intercostal muscle ( contract during quiet breathing ) , and accessory inspiratory muscles : scaleni , sternocleidomastoid , internal pectoral muscle , and others( contract during forceful inspiration).
 

2. Expiratory muscles : internal intercostal muscles , and abdominal muscles ( contract during forceful expiration)

The Laryngopharynx
Anatomy

The Laryngopharynx


The laryngeal part of the pharynx lies posterior to the larynx.
It extends from the superior border of the epiglottis to the inferior border of the cricoid cartilage, where it narrows to become continuous with the oesophagus.



Posteriorly, the laryngopharynx is related to the bodies of C4 to C6 vertebrae.



Its posterior and lateral walls are formed by the middle and inferior constrictor muscles, with the palatopharyngeus and stylopharyngeus internally.



The laryngopharynx communicates with the larynx through the aditus or inlet of the larynx.
The piriform recess is a small, pear-shaped depression of the laryngopharyngeal cavity on each side of the inlet of the larynx.

Smooth Muscle
Anatomy

Smooth Muscle

Light microscopic Structure:

cells - long - spindle shaped,  nucleus lies in the widest widest part of the fiber,  when the fiber contract the nucleus become folded, 30 - 200 µm long,between fibres lie endomycium

Electron microscopic structure:

 Mitochondria, ribosomes, golgi, rough EPR, myofilaments are present but no sarcomeres and no Z lines,thin filaments - actin and tropomyosin (7nm), thick filaments - myosin (17nmØ)

- intermediate filaments (10 nm)

- actin and myosin overlap more than in skeletal muscle and can therefore contract more

 A rudimentary sacroplasmic reticulum is present in the form of invaginations on the surface called caveolae , So there are no T-tubules,  Cells communicate through gap junctions.

Dense bodies

Filaments are attached to dense bodies which take the place of the Z line in skeletal muscle

There are two types of dense bodies - cytoplasmic and membrane

contains a percentage actinin (like the Z line)

dense bodies transmit contractile force to adjacent fibres

 

Arrangement:

Fibres can be single or in groups, normally arranged in sheaths,  In the GIT are 2 or 3 layers

Nerve supply:

2 types:

Where it is arranged in layers a few fibres are innervated together

impulse spread through the gap junctions between fibres (slow contraction)

In the iris and the vas deferens each fiber is individually supplied (quick contraction)

FLUORIDE
Biochemistry

FLUORIDE

The safe limit of fluorine is about 1PPM in water. But excess of fluoride causes Flourosis

Flourosis is more dangerous than caries. When Fluoride content is more than 2 PPM, it will cause chronic intestinal upset, gastroenteritis, loss of weight, osteosclerosis, stratification and discoloration of teeth

Helicobacter Pylori Agents
Pharmacology

Helicobacter Pylori Agents

  Antimicrobial

• Amoxicillin,

• Clarithromycin,

• Metronidozole

• Tetracycline

 

 Antisecreteory agents accelerates symptom relief and yield healing (omeprozole)

  Bismuth subsalicylate

 

Therapy For H. Pylori

  Original

• Tetracycline

• Metronidazole (Flagyl)

• Bismuth subsalicylate

• Given for 14 days

• >90% effective in eradicating microorganisms

 

 New triple therapy

• Amoxicillin

• Clarithromycin

• Omeprazole (Prilosec)

• Given for 7 days

• >90% effective in eradicating microorganisms

 

Dual Therapy

  Amoxicillin or clarithromycin

  Omeprazole

  Given for 14 days

  60-80% effective in eradication of H. Pylori

Carbonic anhydrase inhibitors
Pharmacology

Carbonic anhydrase inhibitors

Acetazolamide, Dichlorphenamide, Methazolamide, Ethoxzolamide

Mechanism of Action

1.    Carbonic anhydrase (CA) facilitates excretion of H+ and recovery of bicarbonate by the proximal renal tubule and ciliary epithelium of the eye. Sodium is recovered in exchange for H+. 
2.    Inhibitors block CA block sodium recovery. A very mild diuresis is produced (this is really a side effect of their use in glaucoma) because relatively unimportant mechanism for Na recovery and because proximal tubule site means that other sodium recovery mechansims continue to process their normal fraction of the sodium load.
 

Miscellaneous Non-Neoplastic Diseases - Urticaria
General Pathology

Urticaria (hives) refers to the presence of edema within the dermis and itchy elevations of the skin which may relate to either a Type I (MC) or Type III hypersensitivity reaction.

Type III hypersensitivity reaction.

 - exaggerated venular permeability MC related to IgE mediated disease and release of histamine from mast cells.

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