NEET MDS Synopsis
FACTORS AFFECTING ENZYME ACTIVITY
Biochemistry
FACTORS AFFECTING ENZYME ACTIVITY
Velocity or rate of enzymatic reaction is assessed by the rate of change in concentration of substrate or product at a given time duration. Various factors which affect the activity of enzymes include:
1. Substrate concentration
2. Enzyme concentration
3. Product concentration
4. Temperature 5. Hydrogen ion concentration (pH)
6. Presence of activators
7. Presence of inhibitor
Effect of substrate Concentration : Reaction velocity of an enzymatic process increases with constant enzyme concentration and increase in substrate concentration.
Effect of enzyme Concentration: As there is optimal substrate concentration, rate of an enzymatic reaction or velocity (V) is directly proportional to the enzyme concentration.
Effect of product concentration In case of a reversible reaction catalyzed by a enzyme, as per the law of mass action the rate of reaction is slowed down with equilibrium. So, rate of reaction is slowed, stopped or even reversed with increase in product concentration
Effect of temperature: Velocity of enzymatic reaction increases with temperature of the medium which they are most efficient and the same is termed as optimum temperature.
Effect of pH: Many enzymes are most efficient in the region of pH 6-7, which is the pH of the cell. Outside this range, enzyme activity drops off very rapidly. Reduction in efficiency caused by changes in the pH is due to changes in the degree of ionization of the substrate and enzyme.
Highly acidic or alkaline conditions bring about a denaturation and subsequent loss of enzymatic activity
Exceptions such as pepsin (with optimum pH 1-2), alkaline phosphatase (with optimum pH 9-10) and acid phosphatase (with optimum pH 4-5)
Presence of activators Presence of certain inorganic ions increases the activity of enzymes. The best examples are chloride ions activated salivary amylase and calcium activated lipases.
Effect of Inhibitors The catalytic enzymatic reaction may be inhibited by substances which prevent the formation of a normal enzyme-substrate complex. The level of inhibition then depends entirely upon the relative concentrations of the true substrate and the inhibitor
Balanced Anesthesia
Pharmacology
Balanced Anesthesia
A barbiturate, narcotic analgesic agent, neuromuscular blocking agent, nitrous oxide and one of the more potent inhalation anesthetic.
Graded Contractions and Muscle Metabolism
PhysiologyGraded Contractions and Muscle Metabolism
The muscle twitch is a single response to a single stimulus. Muscle twitches vary in length according to the type of muscle cells involved. .
Fast twitch muscles such as those which move the eyeball have twitches which reach maximum contraction in 3 to 5 ms (milliseconds). [superior eye] and [lateral eye] These muscles were mentioned earlier as also having small numbers of cells in their motor units for precise control.
The cells in slow twitch muscles like the postural muscles (e.g. back muscles, soleus) have twitches which reach maximum tension in 40 ms or so.
The muscles which exhibit most of our body movements have intermediate twitch lengths of 10 to 20 ms.
The latent period, the period of a few ms encompassing the chemical and physical events preceding actual contraction.
This is not the same as the absolute refractory period, the even briefer period when the sarcolemma is depolarized and cannot be stimulated. The relative refractory period occurs after this when the sarcolemma is briefly hyperpolarized and requires a greater than normal stimulus
Following the latent period is the contraction phase in which the shortening of the sarcomeres and cells occurs. Then comes the relaxation phase, a longer period because it is passive, the result of recoil due to the series elastic elements of the muscle.
We do not use the muscle twitch as part of our normal muscle responses. Instead we use graded contractions, contractions of whole muscles which can vary in terms of their strength and degree of contraction. In fact, even relaxed muscles are constantly being stimulated to produce muscle tone, the minimal graded contraction possible.
Muscles exhibit graded contractions in two ways:
1) Quantal Summation or Recruitment - this refers to increasing the number of cells contracting. This is done experimentally by increasing the voltage used to stimulate a muscle, thus reaching the thresholds of more and more cells. In the human body quantal summation is accomplished by the nervous system, stimulating increasing numbers of cells or motor units to increase the force of contraction.
2) Wave Summation ( frequency summation) and Tetanization- this results from stimulating a muscle cell before it has relaxed from a previous stimulus. This is possible because the contraction and relaxation phases are much longer than the refractory period. This causes the contractions to build on one another producing a wave pattern or, if the stimuli are high frequency, a sustained contraction called tetany or tetanus. (The term tetanus is also used for an illness caused by a bacterial toxin which causes contracture of the skeletal muscles.) This form of tetanus is perfectly normal and in fact is the way you maintain a sustained contraction.
Treppe is not a way muscles exhibit graded contractions. It is a warmup phenomenon in which when muscle cells are initially stimulated when cold, they will exhibit gradually increasing responses until they have warmed up. The phenomenon is due to the increasing efficiency of the ion gates as they are repeatedly stimulated. Treppe can be differentiated from quantal summation because the strength of stimulus remains the same in treppe, but increases in quantal summation
Length-Tension Relationship: Another way in which the tension of a muscle can vary is due to the length-tension relationship. This relationship expresses the characteristic that within about 10% the resting length of the muscle, the tension the muscle exerts is maximum. At lengths above or below this optimum length the tension decreases.
Oxytetracycline
Pharmacology
Oxytetracycline
Treats Oxytetracycline is a medicine used for treating a wide range of infections including infections of the lungs, urinary system, skin and eyes. It may also be used to treat sexually transmitted infections, infections caused by lice, rickettsial infections, cholera and plague. It is very occasionally used to treat leptospirosis, gas gangrene, and tetanus.
Clinical Signs and Their Significance
Oral and Maxillofacial SurgeryClinical Signs and Their Significance
Understanding various clinical signs is crucial for diagnosing specific
conditions and injuries. Below are descriptions of several important signs,
including Battle sign, Chvostek’s sign, Guerin’s sign, and Tinel’s sign, along
with their clinical implications.
1. Battle Sign
Description: Battle sign refers to ecchymosis
(bruising) in the mastoid region, typically behind the ear.
Clinical Significance: This sign is indicative of a
posterior basilar skull fracture. The bruising occurs due to the
extravasation of blood from the fracture site, which can be a sign of
significant head trauma. It is important to evaluate for other associated
injuries, such as intracranial hemorrhage.
2. Chvostek’s Sign
Description: Chvostek’s sign is characterized by the
twitching of the facial muscles in response to tapping over the area of the
facial nerve (typically in front of the ear).
Clinical Significance: This sign is often observed in
patients who are hypocalcemic (have low calcium levels). The twitching
indicates increased neuromuscular excitability due to low calcium levels,
which can lead to tetany and other complications. It is commonly assessed in
conditions such as hypoparathyroidism.
3. Guerin’s Sign
Description: Guerin’s sign is the presence of
ecchymosis along the posterior soft palate bilaterally.
Clinical Significance: This sign is indicative of
pterygoid plate disjunction or fracture. It suggests significant trauma to
the maxillofacial region, often associated with fractures of the skull base
or facial skeleton. The presence of bruising in this area can help in
diagnosing the extent of facial injuries.
4. Tinel’s Sign
Description: Tinel’s sign is a provocative test where
light percussion over a nerve elicits a distal tingling sensation.
Clinical Significance: This sign is often interpreted
as a sign of small fiber recovery in regenerating nerve sprouts. It is
commonly used in the assessment of nerve injuries, such as carpal tunnel
syndrome or after nerve repair surgeries. A positive Tinel’s sign indicates
that the nerve is healing and that sensory function may be returning.
Pulmonary edema
General Pathology
Pulmonary edema
Pulmonary edema is swelling and/or fluid accumulation in the lungs. It leads to impaired gas exchange and may cause respiratory failure.
Signs and symptoms
Symptoms of pulmonary edema include difficulty breathing, coughing up blood, excessive sweating, anxiety and pale skin. If left untreated, it can lead to death, generally due to its main complication of acute respiratory distress syndrome.
Diagnosis
physical examination: end-inspiratory crackles during auscultation (listening to the breathing through a stethoscope) can be due to pulmonary edema. The diagnosis is confirmed on X-ray of the lungs, which shows increased vascular filling and fluid in the alveolar walls.
Low oxygen saturation and disturbed arterial blood gas readings may strengthen the diagnosis
Causes
Cardiogenic causes:
Heart failure
Tachy- or bradyarrhythmias
Severe heart attack
Hypertensive crisis
Excess body fluids, e.g. from kidney failure
Pericardial effusion with tamponade
Non-cardiogenic causes, or ARDS (acute respiratory distress syndrome):
Inhalation of toxic gases
Multiple blood transfusions
Severe infection
Pulmonary contusion, i.e. high-energy trauma
Multitrauma, i.e. severe car accident
Neurogenic, i.e. cerebrovascular accident (CVA)
Aspiration, i.e. gastric fluid or in case of drowning
Certain types of medication
Upper airway obstruction
Reexpansion, i.e. postpneumonectomy or large volume thoracentesis
Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation
Lack of proper altitude acclimatization.
Treatment
When circulatory causes have led to pulmonary edema, treatment with loop diuretics, such as furosemide or bumetanide, is the mainstay of therapy. Secondly, one can start with noninvasive ventilation. Other useful treatments include glyceryl trinitrate, CPAP and oxygen.
VITAMIN C
Biochemistry
VITAMIN C: ASCORBIC ACID, ASCORBATE
Vitamin C benefits the body by holding cells together through collagen synthesis; collagen is a connective tissue that holds muscles, bones, and other tissues together. Vitamin C also aids in wound healing, bone and tooth formation, strengthening blood vessel walls, improving immune system function, increasing absorption and utilization of iron, and acting as an antioxidant.
RDA The Recommended Dietary Allowance (RDA) for Vitamin C is 90 mg/day for adult males and 75 mg/day for adult females
Vitamin C Deficiency
Severe vitamin C deficiency result in the disease known as scurvy, causing a loss of collagen strength throughout the body. Loss of collagen results in loose teeth, bleeding and swollen gums, and improper wound healing.
Structures and best view X ray
Radiology
Fractures of the Zygomatic Arch
Structures: Zygomatic arch, zygomatic bone.
Best Views:
Submento-Vertex View: Provides a clear view of the
zygomatic arch and helps assess fractures.
Waters View: Useful for visualizing the zygomatic
bone and maxillary sinus.
Reverse Townes View: Can also be used to visualize
the zygomatic arch.
Base of Skull
Structures: Base of the skull, cranial fossae.
Best Views:
Submento-Vertex View: Effective for assessing the
base of the skull and related fractures.
Maxillary Sinus
Structures: Maxillary sinus, zygomatic bone.
Best Views:
Waters View: Excellent for visualizing the
maxillary sinus and any associated fractures.
Fractures of Zygoma
Structures: Zygomatic bone, zygomatic arch.
Best Views:
Waters View: Good for assessing zygomatic
fractures.
PA View: Provides a frontal view of the zygomatic
bone.
Reverse Townes View: Useful for visualizing the
zygomatic arch.
Nasal Septum
Structures: Nasal septum, nasal cavity.
Best Views:
PA View: Useful for assessing the nasal septum and
any associated fractures.
Condylar Neck Fractures
Structures: Mandibular condyle, neck of the condyle.
Best Views:
Lateral Oblique View (15°): Good for visualizing
condylar neck fractures.
Transpharyngeal View: Useful for assessing the
condylar region.
Medially Displaced Condylar Fractures
Structures: Mandibular condyle.
Best Views:
Lateral Oblique View (30°): Effective for
visualizing medially displaced condylar fractures.
Coronoid Process of Mandible
Structures: Coronoid process.
Best Views:
PA View of Skull: Can help visualize the coronoid
process.
Fractures of Ramus and Body of Mandible
Structures: Mandibular ramus, body of the mandible.
Best Views:
Lateral Oblique View (15°): Useful for assessing
fractures of the ramus and body of the mandible.
Horizontal Favorable and Unfavorable Fractures of Mandible
Structures: Mandible.
Best Views:
Lateral Oblique View (30°): Effective for
evaluating horizontal fractures.
Bony Ankylosis of TMJ
Structures: Temporomandibular joint.
Best Views:
CT Scan: Provides detailed imaging of bony
structures and ankylosis.
Fibrous Ankylosis of TMJ
Structures: Temporomandibular joint.
Best Views:
CT Scan: Useful for assessing fibrous ankylosis.
Internal Derangement of the Disk
Structures: TMJ disk.
Best Views:
MRI: The best modality for evaluating soft tissue
structures, including the TMJ disk.
Disk Perforation
Structures: TMJ disk.
Best Views:
MRI: Effective for diagnosing disk perforation.
Arthrography
Structures: TMJ.
Best Views:
Arthrography: Can be used to assess the TMJ and
visualize the disk and joint space.