NEET MDS Synopsis
ACRYLIC RESINS
Dental Materials
ACRYLIC RESINS
Use. Acrylic (unfilled) resins are used as temporary crown material. Temporary crowns are placed to protect the crown preparation and provide patient comfort during the time the permanent crown is being constructed
Group A Streptococcus
General Pathology
Group A Streptococcus
- scarlet fever usually begins as a Streptococcal pharyngitis/tonsillitis and then develops an erythematous rash beginning on the trunk and limbs with eventual desquamation.
- rash is due to elaboration of erythrogenic toxin by the organism
- face is usually spared, but, if involved there is a characteristic circumoral pallor and the tongue becomes bright red, thus the term "strawberry tongue".
- post-streptococcal immune complex glomerulonephritis is a possible sequela of scarlet fever.
- Dick test is a skin test that evaluates immunity against scarlet fever; no response indicates immunity (anti-toxin antibodies present); erythema indicates no immunity.
- impetigo due to Streptococcus pyogenes is characterized by honey colored, crusted lesions, while those with a predominantly bullous pattern are primarily due to Staphylococcus aureus.
- cellulitis with lymphangitis ("red streaks") is characteristic of Streptococcus pyogenes.
- hyaluronidase is a spreading factor that favors the spread of infection throughout the subcutaneous tissue unlike Staphylococcus aureus which generates coagulase to keep the pus confined.
- erysipelas refers to a raised, erythematous ("brawny edema"), hot cellulitis, usually on the face that commonly produces septicemia, if left untreated.
Stages of anesthesia
Pharmacology
Stages of anesthesia
Stage I
Analgesia
Still conscious but drowsy
Stage II
Excitement stage
Loss of consciousness, however, irregular ventilation may be present which affects absorption of inhalation agents.
Reflexes may be exaggerated.
This is a very dangerous stage
Stage III
Surgical anesthesia
Loss of spontaneous movement
Regular, shallow respiration
Relaxation of muscles
Stage IV
Medullary paralysis
Death
Ketamine
Pharmacology
Ketamine
- Causes a dissociative anesthesia.
- Is similar to but less potent than phencyclidine.
- Induces amnesia, analgesia, catalepsy and anesthesia, but does not induce convulsions.
- The principal disadvantage of ketamine is its adverse psychic effects during emergence from anesthesia. These include: hallucinations, changes in mood and body image.
- During anesthesia, many of the protective reflexes are maintained, such as laryngeal, pharyngeal, eyelid and corneal reflexes.
- Muscle relaxation is poor.
- It is not indicated for intracranial operations because it increases cerebrospinal fluid pressure.
- Respiration is well maintained.
- Arterial blood pressure, cardiac output, and heart rate are all elevated.
Nervous System - Viral Infections
General Pathology
Viral meningitis
1. Can be caused by many different viruses, including cytomegalovirus, herpes virus, rabies, and HIV.
2. CSF fluid from a spinal tap differs from that seen in a bacterial infection. It shows mononuclear cells, higher levels of protein, and normal levels of glucose.
ADRENOCORTICAL TUMORS
General Pathology
ADRENOCORTICAL TUMORS
Functional adenomas are commonly associated with hyperaldosteronism and with Cushing syndrome, whereas a virilizing neoplasm is more likely to be a carcinoma. Determination of of the functional status of a tumor is based on clinical evaluation and measurement of the hormone or its metabolites. In other words, functional and nonfunctional adrenocortical neoplasms cannot be distinguished on the basis of morphologic features.
Patholgical features
Adrenocortical adenomas
- They are generally small, 1 to 2 cm in diameter.
- On cut surface, adenomas are usually yellow to yellow-brown due to presence of lipid within the neoplastic cells
- Microscopically, adenomas are composed of cells similar to those populating the normal adrenal cortex. The nuclei tend to be small, although some degree of pleomorphism may be encountered even in benign lesions ("endocrine atypia"). The cytoplasm ranges from eosinophilic to vacuolated, depending on their lipid content.
Adrenocortical carcinomas
These are rare and may occur at any age, including in childhood.
- Carcinomas are generally large, invasive lesions.
- The cut surface is typically variegated and poorly demarcated with areas of necrosis, hemorrhage, and cystic change.
- Microscopically, they are composed of well-differentiated cells resembling those of cortical adenomas or bizarre, pleomorphic cells, which may be difficult to distinguish from those of an undifferentiated carcinoma metastatic to the adrenal.
LIPIDS
Biochemistry
LIPIDS
The lipids are a heterogeneous group of compounds, including fats, oils, steroids, waxes, and related compounds, which are related more by their physical than by their chemical properties.
Lipids are non-polar (hydrophobic) compounds, soluble in organic solvents.
Most membrane lipids are amphipathic, having a non-polar end and a polar end
Lipids are important in biological systems because they form the cell membrane, a mechanical barrier that divides a cell from the external environment.
Lipids also provide energy for life and several essential vitamins are lipids.
Lipids can be divided in two major classes, nonsaponifiable lipids and saponifiable lipids.
A nonsaponifiable lipid cannot be broken up into smaller molecules by hydrolysis, which includes triglycerides, waxes, phospholipids, and sphingolipids.
A saponifiable lipid contains one or more ester groups allowing it to undergo hydrolysis in the presence of an acid, base, or enzyme.
Nonsaponifiable lipids include steroids, prostaglandins, and terpenes
Nonpolar lipids, such as triglycerides, are used for energy storage and fuel.
Polar lipids, which can form a barrier with an external water environment, are used in membranes.
Polar lipids include glycerophospholipids and sphingolipids.
Fatty acids are important components of all of these lipids.
Clinical Physiology CVS
Physiology
Clinical Physiology
Heart Failure : Heart failure is inability of the heart to pump the enough amount of blood needed to sustain the needs of organism .
It is usually called congestive heart failure ( CHF) .
To understand the pathophysiology of the heart failure , lets compare it with the physiology of the cardiac output :
Cardiac output =Heart rate X stroke volume
Stroke volume is determined by three determinants : Preload ( venous return ) , contractility , and afterload (peripheral resistance ) . Any disorder of these factors will reduce the ability of the heart to pump blood .
Preload : Any factor that decrease the venous return , either by decreasing the intravenous pressure or increasing the intraatrial pressure will lead to heart failure .
Contractility : Reducing the power of contraction such as in myocarditis , cardiomyopathy , preicardial tamponade ..etc , will lead to heart failure .
Afterload : Any factor that may increase the peripheral resistance such as hypertension , valvular diseases of the heart may cause heart failure.
Pathophysiology : When the heart needs to contract more to meet the increased demand , compensatory mechanisms start to develope to enhance the power of contractility . One of these mechanism is increasing heart rate , which will worsen the situation because this will increase the demands of the myocardial cells themselves . The other one is hypertrophy of the cardiac muscle which may compensate the failure temporarily but then the hypertrophy will be an additional load as the fibers became stiff .
The stroke volume will be reduced , the intraventricular pressure will increase and consequently the intraatrial pressure and then the venous pressure . This will lead to decrease reabsorption of water from the interstitium ( see microcirculation) and then leads to developing of edema ( Pulmonary edema if the failure is left , and systemic edema if the failure is right) .