NEET MDS Synopsis
Stimulants
Pharmacology
Stimulants:
Amphetamines: amphetamine is a substrate of serotonin and NE uptake transporters so in cytoplasm, it competes for transport into storage vesicles → ↑ [ ] in cytoplasm then excess amines bind to membrane transporter and are transported out of cell
Drugs:
a. Dextroamphetamine: psychomotor stimulant (↓ fatigue), short-term weight loss, prevents narcolepsy
b. Methylphenidate (Ritalin): prevents narcolepsy, treatment for ADD and ADHD
c. Methamphetamine: psychomotor stimulant, abused widely (cheap, easy to make)
Side effects:
a. CNS: euphoria, anxiety, agitation, delirium, paranoia, panic, suicidal/homicidal impulses, psychoses, tolerance (develops rapidly to most CNS effects), physical dependence (not clinically relevant)
b. CV: headache, chills, arrhythmias and HTN (may be fatal)
MUSCLE
Anatomy
MUSCLE
Types:
Skeletal (voluntary)
Cardiac (involuntary)
Smooth (involuntary)
Anticonvulsant Drugs
Pharmacology
Anticonvulsant Drugs
A. Anticonvulsants: drugs to control seizures or convulsions in susceptible people
B. Seizures: abnormal neuronal discharges in the nervous system produced by focal or generalized brain disturbances
Manifestations: depend on location of seizure activity (motor cortex → motor convulsions, sensory cortex → abnormal sensations, temporal cortex → emotional disturbances)
Causes: many brain disorders such as head injury (glial scars, pH changes), anoxia (changes in pH or CSF pressure), infections (tissue damage, high T), drug withdrawal (barbiturates, ethanol, etc.), epilepsy (chronic state with repeated seizures)
C. Epilepsy: most common chronic seizure disorder, characterized by recurrent seizures of a particular pattern, many types (depending on location of dysfunction)
Characteristics: chronic CNS disorders (years to decades), involve sudden and transitory seizures (abnormal motor, autonomic, sensory, emotional, or cognitive function and abnormal EEG activity)
Etiology: hyperexcitable neurons; often originate at a site of damage (epileptogenic focus), often found at scar tissue from tumors, strokes, or trauma; abnormal discharge spreads to normal brain regions = seizure
Idiopathic (70%; may have genetic abnormalities) and symptomatic epilepsy (30%; obvious CNS trauma, neoplasm, infection, developmental abnormalities or drugs)
Neuropathophysiology: anticonvulsants act at each stage but most drugs not effective for all types of epilepsy (need specific drugs for specific types)
Seizure mechanism: enhanced excitation (glutamate) or ↓ inhibition (GABA) of epileptic focus → fire more quickly → ↑ release of K and glutamate → ↑ depolarization of surrounding neurons (=neuronal synchronization) → propagation (normal neurons activated)
The amino acids buffer system
Biochemistry
The amino acids buffer system
Amino acids contain in their molecule both an acidic (− COOH) and a basic (− NH2) group. They can be visualized as existing in the form of a neutral zwitterion in which a hydrogen atom can pass between the carboxyl and amino groups.
By the addition or subtraction of a hydrogen ion to or from the zwitterion, either the cation or anion form will be produced
Thus, when OH− ions are added to the solution of amino acid, they take up H+ from it to form water, and the anion is produced. If H+ ions are added, they are taken up by the zwitterion to produce the cation form. In practice, if NaOH is added, the salt H2N - CH2 - COONa would be formed. and the addition of HCl would result in the formation of amino acid hydrochloride.
Infections caused by gonorrhea
General Pathology
Infections caused by gonorrhea
1. Acute urethritis. Mostly in males. Generally self-limiting. Dysuria and purulent discharge.
2. Endocervical infection. Purulent vaginal discharge, abnormal menses, pelvic pain. Often co-infection with other STD’s. Some women are asymptomatic.
3. Pelvic Inflammatory Disease (PID). Consequence of ascending endocervical infection. Causes salpingitis, endometriosis, bilateral abdominal pain, discharge, fever. May lead to sterility, chronic pain, and ectopic pregnancy because of loss of fallopian cilia.
4. Anorectal inflammation. Mostly in homosexual men. Pain, itching, discharge from anus.
5. Dermatitis/arthritis. Occurs after bacteremia. Skin will have papules on an erythematous base which develop into necrotic pustules. Asymmetric joint pain. These infections are susceptible to penicillin.
6. Neonatal infections. Ophthalmia neonatorum is a conjunctival infection from going through infected vagina. After one year of age, suspect child abuse.
Physiologic anatomy of the kidney
Physiology
The Kidneys
The kidneys are the primary functional organ of the renal system.
They are essential in homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and the regulation of blood pressure (by maintaining salt and water balance).
They serve the body as a natural filter of the blood and remove wastes that are excreted through the urine.
They are also responsible for the reabsorption of water, glucose, and amino acids, and will maintain the balance of these molecules in the body.
In addition, the kidneys produce hormones including calcitriol, erythropoietin, and the enzyme renin, which are involved in renal and hemotological physiological processes.
Anatomical Location
The kidneys are a pair of bean-shaped, brown organs about the size of your fist. They are covered by the renal capsule, which is a tough capsule of fibrous connective tissue.
Right kidney being slightly lower than the left, and left kidney being located slightly more medial than the right.
The right kidneys lie just below the diaphragm and posterior to the liver, the left below the diaphragm and posterior to the spleen.
Resting on top of each kidney is an adrenal gland (adrenal meaning on top of renal), which are involved in some renal system processes despite being a primarily endocrine organ.
They are considered retroperitoneal, which means that they lie behind the peritoneum, the membrane lining of the abdominal cavity.
The renal artery branches off from the lower part of the aorta and provides the blood supply to the kidneys.
Renal veins take blood away from the kidneys into the inferior vena cava.
The ureters are structures that come out of the kidneys, bringing urine downward into the bladder.
Internal Anatomy of the Kidneys
There are three major regions of the kidney:
1. Renal cortex
2. Renal medulla
3. Renal pelvis
The renal cortex is a space between the medulla and the outer capsule.
The renal medulla contains the majority of the length of nephrons, the main functional component of the kidney that filters fluid from blood.
The renal pelvis connects the kidney with the circulatory and nervous systems from the rest of the body.
Renal Cortex
The kidneys are surrounded by a renal cortex
The cortex provides a space for arterioles and venules from the renal artery and vein, as well as the glomerular capillaries, to perfuse the nephrons of the kidney. Erythropotein, a hormone necessary for the synthesis of new red blood cells, is also produced in the renal cortex.
Renal Medulla
The medulla is the inner region of the parenchyma of the kidney. The medulla consists of multiple pyramidal tissue masses, called the renal pyramids, which are triangle structures that contain a dense network of nephrons.
At one end of each nephron, in the cortex of the kidney, is a cup-shaped structure called the Bowman's capsule. It surrounds a tuft of capillaries called the glomerulus that carries blood from the renal arteries into the nephron, where plasma is filtered through the capsule.
After entering the capsule, the filtered fluid flows along the proximal convoluted tubule to the loop of Henle and then to the distal convoluted tubule and the collecting ducts, which flow into the ureter. Each of the different components of the nephrons are selectively permeable to different molecules, and enable the complex regulation of water and ion concentrations in the body.
Renal Pelvis
The renal pelvis contains the hilium. The hilum is the concave part of the bean-shape where blood vessels and nerves enter and exit the kidney; it is also the point of exit for the ureters—the urine-bearing tubes that exit the kidney and empty into the urinary bladder. The renal pelvis connects the kidney to the rest of the body.
Supply of Blood and Nerves to the Kidneys
• The renal arteries branch off of the abdominal aorta and supply the kidneys with blood. The arterial supply of the kidneys varies from person to person, and there may be one or more renal arteries to supply each kidney.
• The renal veins are the veins that drain the kidneys and connect them to the inferior vena cava.
• The kidney and the nervous system communicate via the renal plexus. The sympathetic nervous system will trigger vasoconstriction and reduce renal blood flow, while parasympathetic nervous stimulation will trigger vasodilation and increased blood flow.
• Afferent arterioles branch into the glomerular capillaries, while efferent arterioles take blood away from the glomerular capillaries and into the interlobular capillaries that provide oxygen to the kidney.
• renal vein
The veins that drain the kidney and connect the kidney to the inferior vena cava.
• renal artery
These arise off the side of the abdominal aorta, immediately below the superior mesenteric artery, and supply the kidneys with blood.
Antiarrhythmic Drugs-Class I Sodium Channel Blockers
Pharmacology
Class I Sodium Channel Blockers
• Block movement of sodium into cells of the cardiac conducting system
• Results in a stabilizing effect and decreased formation and conduction of electrical impulses
• Have a local anesthetic effect
• Are declining in use due to proarrhythmic effects and increased mortality rates
• Na channel blockers - Class 1 drugs are divided into 3 subgroups
• 1A. 1B, 1C based on subtle differences in their mechanism of action.
• Blockade of these channels will prevent depolarization.
• Spread of action potential across myocardium will slow and areas of pacemaker activity is suppressed.
Class IA Sodium Channel Blockers
• Treatment of: symptomatic premature ventricular contractions, supraventricular tachycardia, and ventricular tachycardia, prevention of ventricular fibrillation
– Quinidine (Cardioquin, Quinaglute)
– Procainamide (Pronestyl, Procanbid)
– Disopyramide (Norpace)
• Quinidine – prototype
• Low therapeutic index
• High incidence of adverse effects
Class IB Sodium Channel Blockers
• Treatment of: symptomatic premature ventricular contractions and ventricular tachycardia, prevention of ventricular fibrillation
– Lidocaine (Xylocaine)
– Mexiletine (Mexitil)
– Tocainide (Tonocard)
– Phenytoin (Dilantin)
Side Effects: Lidocaine
• Drowsiness • Paresthesias • Muscle twitching • Convulsions • Changes in mental status (disorientation, confusion) • Hypersensitivity reactions (edema, uticaria, anaphylaxis)
Side Effects: Phenytoin (Dilantin)
• Gingival hyperplasia
• Nystagmus
• Ataxia, slurring of speech
• Tremors
• Drowsiness
• Confusion
• Lidocaine – prototype
• Must be given by injection
• Used as a local anesthetic
• Drug of choice for treating serious ventricular arrhythmias associated with acute myocardial infarction, cardiac surgery, cardiac catheterization and electrical conversion
Class IC Sodium Channel Blockers
• Treatment of: life-threatening ventricular tachycardia or fibrillation and supraventricular tachycardia unresponsive to other drugs
– Flecainide
– Propafenone
Adverse Effects
• CNS - dizziness, drowsiness, fatigue, twitching, mouth numbness, slurred speech vision changes, and tremors that can progress to convulsions.
• GI - changes in taste, nausea, and vomiting. CV - arrhythmias including heart blocks, hypotension, vasodilation, and potential for cardiac arrest.
• Other Rash, hypersensitivity reactions loss of hair and potential bone marrow depression.
Drug-Drug Interactions
• Increased risk for arrhythmias if combined with other drugs that are know to cause arrhythmias- digoxin and beta blockers
• Increased risk of bleeding if combined with oral anticoagulants.
Drug Food Interactions
• Quinidine needs an acidic urine for excretion. Increased levels lead to toxicity
• Avoid foods that alkalinize the urine- citrus juices, vegetables, antacid, milk products
Child Psychology
PedodonticsTheories of Child Psychology
Child psychology encompasses a variety of theories that explain how children
develop emotionally, cognitively, and behaviorally. These theories can be
broadly classified into two main groups: psychodynamic theories and theories of
learning and development of behavior. Additionally, Margaret S. Mahler's theory
of development offers a unique perspective on child development.
I. Psychodynamic Theories
Psychosexual Theory / Psychoanalytical Theory (Sigmund Freud,
1905):
Overview: Freud's theory posits that childhood
experiences significantly influence personality development and
behavior. He proposed that children pass through a series of
psychosexual stages (oral, anal, phallic, latency, and genital) where
the focus of pleasure shifts to different erogenous zones.
Key Concepts:
Id, Ego, Superego: The id represents primal
desires, the ego mediates between the id and reality, and the
superego embodies moral standards.
Fixation: If a child experiences conflicts
during any stage, they may become fixated, leading to specific
personality traits in adulthood.
Psychosocial Theory / Model of Personality Development (Erik
Erikson, 1963):
Overview: Erikson expanded on Freud's ideas by
emphasizing social and cultural influences on development. He proposed
eight stages of psychosocial development, each characterized by a
central conflict that must be resolved for healthy personality
development.
Key Stages:
Trust vs. Mistrust (Infancy)
Autonomy vs. Shame and Doubt (Early Childhood)
Initiative vs. Guilt (Preschool Age)
Industry vs. Inferiority (School Age)
Identity vs. Role Confusion (Adolescence)
Intimacy vs. Isolation (Young Adulthood)
Generativity vs. Stagnation (Middle Adulthood)
Integrity vs. Despair (Late Adulthood)
Cognitive Theory (Jean Piaget, 1952):
Overview: Piaget's theory focuses on the cognitive
development of children, proposing that they actively construct
knowledge through interactions with their environment. He identified
four stages of cognitive development.
Stages:
Sensorimotor Stage (0-2 years): Knowledge through sensory
experiences and motor actions.
Preoperational Stage (2-7 years): Development of language and
symbolic thinking, but egocentric and intuitive reasoning.
Concrete Operational Stage (7-11 years): Logical thinking about
concrete events; understanding of conservation and reversibility.
Formal Operational Stage (12 years and up): Abstract reasoning
and hypothetical thinking.
II. Theories of Learning and Development of Behavior
Hierarchy of Needs (Abraham Maslow, 1954):
Overview: Maslow proposed a hierarchy of needs that
motivates human behavior. He suggested that individuals must satisfy
lower-level needs before addressing higher-level needs.
Levels:
Physiological Needs (food, water, shelter)
Safety Needs (security, stability)
Love and Belongingness Needs (relationships, affection)
Esteem Needs (self-esteem, recognition)
Self-Actualization (realizing personal potential)
Social Learning Theory (Albert Bandura, 1963):
Overview: Bandura emphasized the role of
observational learning, imitation, and modeling in behavior development.
He proposed that children learn behaviors by observing others and the
consequences of those behaviors.
Key Concepts:
Reciprocal Determinism: Behavior, personal
factors, and environmental influences interact to shape learning.
Bobo Doll Experiment: Demonstrated that
children imitate aggressive behavior observed in adults.
Classical Conditioning (Ivan Pavlov, 1927):
Overview: Pavlov's theory focuses on learning
through association. He demonstrated that a neutral stimulus, when
paired with an unconditioned stimulus, can elicit a conditioned
response.
Example: Pavlov's dogs learned to salivate at the
sound of a bell when it was associated with food.
Operant Conditioning (B.F. Skinner, 1938):
Overview: Skinner's theory emphasizes learning
through consequences. Behaviors followed by reinforcement are more
likely to be repeated, while those followed by punishment are less
likely to occur.
Key Concepts:
Reinforcement: Increases the likelihood of a
behavior (positive or negative).
Punishment: Decreases the likelihood of a
behavior (positive or negative).
III. Margaret S. Mahler’s Theory of Development
Overview: Mahler's theory focuses on the psychological
development of infants and young children, particularly the process of
separation-individuation. She proposed that children go through stages as
they develop a sense of self and differentiate from their primary caregiver.
Key Stages:
Normal Autistic Phase: Birth to 2 months; the
infant is primarily focused on internal stimuli.
Normal Symbiotic Phase: 2 to 5 months; the infant
begins to recognize the caregiver but does not differentiate between
self and other.
Separation-Individuation Phase: 5 to 24 months; the
child starts to separate from the caregiver and develop a sense of
individuality through exploration and interaction with the environment.