NEET MDS Synopsis
Abnormal Types of Urine
Physiology
Proteinuria—Protein content in urine, often due to leaky or damaged glomeruli.
Oliguria—An abnormally small amount of urine, often due to shock or kidney damage.
Polyuria—An abnormally large amount of urine, often caused by diabetes.
Dysuria—Painful or uncomfortable urination, often from urinary tract infections.
Hematuria—Red blood cells in urine, from infection or injury.
Glycosuria—Glucose in urine, due to excess plasma glucose in diabetes, beyond the amount able to be reabsorbed in the proximal convoluted tubule.
Infantile Osteomyelitis
Oral Pathology
Infantile Osteomyelitis
Osteomyelitis Maxillaries Neonatarum, Maxillitis of infancy
Osteomyelitis in the jaws of new born infants occurs almost exclusively in maxilla.
Etiology
Trauma – through break in mucosa cause during delivery.
Infection of maxillary sinus
Paunz & Ramon et al believe that disease caused through infection from the nose.
Hematogenous spread through streptococci & pneumococci
Clinical features
Fever, anorexia & intestinal disturbances.
swelling or redness below the inner canthus of the eye in lacrimal region.
Followed by marked edema of the eyelids on the affected side.
Next, alveolus & palate in region of first deciduous molar become swollen.
Pus discharge from affected sites
D/D for Infantile Osteomyelitis
Dacrocystitis neonatarum
Orbital cellulitis
Ophthalmia neonatarum
Infantile cortical hyperostosis
TREATMENT
Intravenous antibiotics, preferably penicillin.
Culture & sensitivity testing
Incision & drainage of fluctuant areas
Sequestrectomy
Supportive therapy
Cardiac arrhythmia
General Pathology
Cardiac arrhythmia
Cardiac arrhythmia is a group of conditions in which muscle contraction of the heart is irregular for any reason.
Tachycardia :A rhythm of the heart at a rate of more than 100 beats/minute , palpitation present
Causes : stress, caffeine, alcohol, hyperthyroidism or drugs
Bradycardia : slow rhythm of the heart at a rate less than 60 beats/min
Atrial Arrhythmias
- Atrial fibrillation
Atrial Dysrhythmias
- Premature atrial contraction
- Atrial flutter
- Supraventricular tachycardia
- Sick sinus syndrome
Ventricular Arrhythmias
- Ventricular fibrillation
Ventricular Dysrhythmias
- Premature ventricular contraction
- Pulseless electrical activity
- Ventricular tachycardia
- Asystole
Heart Blocks
- First degree heart block
- Second degree heart block
o Type 1 Second degree heart block a.k.a. Mobitz I or Wenckebach
o Type 2 Second degree heart block a.k.a. Mobitz II
- Third degree heart block a.k.a. complete heart block
Atrial fibrillation
Atrial fibrillation is a cardiac arrhythmia (an abnormality of heart rate or rhythm) originating in the atria.
AF is the most common cardiac arrhythmia
Signs and symptoms
Rapid and irregular heart rates
palpitations, exercise intolerance, and occasionally produce angina and congestive symptoms of shortness of breath or edema
Paroxysmal atrial fibrillation is the episodic occurence of the arrhythmia Episodes may occur with sleep or with exercise
Diagnosis:
Electrocardiogram
- absence of P waves
- unorganized electrical activity in their place
- irregularity of R-R interval due to irregular conduction of impulses to the ventricles
Causes:
- Arterial hypertension
- Mitral valve disease (e.g. due to rheumatic heart disease or mitral valve prolapse)
- Heart surgery
- Coronary heart disease
- Excessive alcohol consumption ("binge drinking" or "holiday heart")
- Hyperthyroidism
- Hyperstimulation of the vagus nerve, usually by having large meals
Treatment
Rate control by
Beta blockers (e.g. metoprolol)
Digoxin
Calcium channel blockers (e.g. verapamil)
Rhythm control
Electrical cardioverion by application of a DC electrical shock
Chemical cardioversion is performed with drugs eg amiodarone
Radiofrequency ablation : uses radiofrequency energy to destroy abnormal electrical pathways in heart tissue It is used in recurrent AF
In confirmed AF, anticoagulant treatment is a crucial way to prevent stroke
Atrial flutter
Atrial flutter is a regular, rhythmic tachycardia originating in the atria. The rate in the atria is over 220 beats/minute, and typically about 300 beats/minute
he morphology on the surface EKG is typically a sawtooth pattern.
The ventricles do not beat as fast as the atria in atrial flutter
Supraventricular tachycardia
apid rhythm of the heart in which the origin of the electrical signal is either the atria or the AV node
it is important to determine whether a wide-complex tachycardia is an SVT or a ventricular tachycardia, since they are treated differently
Sick sinus syndrome : a group of abnormal heartbeats (arrhythmias) presumably caused by a malfunction of the sinus node, the heart's "natural" pacemaker.
Ventricular fibrillation
is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart. The ventricular muscle twitches randomly, rather than contracting in unison, and so the ventricles fail to pump blood into the arteries and into systemic circulation.
Ventricular fibrillation is a medical emergency: if the arrhythmia continues for more than a few seconds, blood circulation will cease, as evidenced by lack of pulse, blood pressure and respiration, and death will occur. Ventricular fibrillation is a cause of cardiac arrest and sudden cardiac death
PLASMA FRACTIONS
Pharmacology
PLASMA FRACTIONS:
a) Fresh frozen plasma.
b) Platelets.
c) Plasma concentrates.
d) Non-plasma recombinant factor concentrates.
Cells Of The Exudate
General Pathology
Cells Of The Exudate
Granulocytes (Neutrophils, eosinophils, and basophils)
Monocytes (and tissue macrophages)
Lymphocytes
Neutrophils (polymorphs).
Characteristics
(1) Cell of acute inflammation.
(2) Actively motile.
(3) Phagocytic.
(4) Respond to chemotactic agents like.
Complement products.
Bacterial products.
Tissue breakdown
Lysosomal enzymes of other polymorphs
Functions
(1) Phagocytosis and intracellular digestion of bacteria.
(2) Exocytosis of lysosomal enzymes to digest dead tissue as the first step in the process of repair.
Eosinophils
Characteristics
(I) Cell of allergjc and immunologic inflammation.
(2) Motile and phagocytic but less so than a neutrophil.
(3) Response to chemotaxis similar to neutrophil. In addition, it is also responsive to antigens and antigen-antibody complexes.
(4) Steroids cause depletion of eosinophils.
Functions
(1) Contain most of the lysosomal enzymes that polymorphs have
(2) control of Histamine release and degradation in inflammation
Basophils (and mast cells)
Characteristics
(1) Contain coarse metachromatic granules.
(2) Contain, histamine and proteolytic enzymes
Functions
Histamine: release which causes some of the changes of inflammation and allergic
reactions. .
Monocytes .
Blood monocytes form a component of. the mononuclear phagocytic system (MPS), the other being tissue macrophages The tissue macrophages may be :
(a) Fixed phagocytic. cells:
Kuffer cell of liver.
Sinusoidal lining cells of spleen and lymph nodes.
Pleural and peritoneal macrophages
Alveolar macrophages.
Microglial cells.
(b) Wandering macrophages or tissue histiocytes.
The tissue histiocytes are derived from blood monocytes.
Characteristics
.(1)Seen in inflammation of some duration, as they -outlive polymorphs.
(2) Actively phagocytic and motile.
(3) Fuse readily to from giant cells in certain situations.
Function
(1) Phagocytosis.
(2) Lysosomal enzyme secretion.
(3) Site of synthesis of some components of complement.
(4) Antigen handling and processing before presenting it to the Immune competent cell.
(5) Secretion of lysosyme and interferon.
Giant cells can be
(A) Physiological
Syncytiotrophoblast, megakatyocytes, striated muscle, osteoclast.
(B) Pathological:
Foreign body: in the presence of particulate foreign matter like talc, suture material etc. and in certain infections_e g fungal.
Langhan's type: a variant of foreign body giant cell seen in tuberculosis.
Touton type in lipid rich situations like Xanthomas, lipid granulomas etc.
(iv) Aschoff cell in rheumatic carditis.
(v) Tumour gjant cells e.g. Reid-Sternberg cell in Hodgkin's Lymphoma, giant cells in any malignancy.
Lymphocytes and Plasma cells
These are the small mononuclear cell comprising the immune system
They are less motile than_macrophages and neutrophils and are seen in chronic inflammation and immune based diseases.
Concepts Proposed to Attain Balanced Occlusion
ProsthodonticsConcepts Proposed to Attain Balanced Occlusion
Balanced occlusion is a critical aspect of complete denture design, ensuring
stability and function during mastication and speech. Various concepts have been
proposed over the years to achieve balanced occlusion, each contributing unique
insights into the arrangement of artificial teeth. Below are the key concepts:
I. Concepts for Achieving Balanced Occlusion
1. Gysi's Concept (1914)
Overview: Gysi suggested that arranging 33° anatomic
teeth could enhance the stability of dentures.
Key Features:
The use of anatomic teeth allows for better adaptation to various
movements of the articulator.
This arrangement aims to provide stability during functional
movements.
2. French's Concept (1954)
Overview: French proposed lowering the lower occlusal
plane to increase the stability of dentures while achieving balanced
occlusion.
Key Features:
Suggested inclinations for upper teeth:
Upper first premolars: 5° inclination
Upper second premolars: 10° inclination
Upper molars: 15° inclination
This arrangement aims to enhance the occlusal relationship and
stability of the denture.
3. Sear's Concept
Overview: Sears proposed balanced occlusion for
non-anatomical teeth.
Key Features:
Utilized posterior balancing ramps or an occlusal plane that curves
anteroposteriorly and laterally.
This design helps maintain occlusal balance during functional
movements.
4. Pleasure's Concept
Overview: Pleasure introduced the concept of the
"Pleasure Curve" or the posterior reverse lateral curve.
Key Features:
This curve aids in achieving balanced occlusion by allowing for
better distribution of occlusal forces.
It enhances the functional relationship between the upper and lower
dentures.
5. Frush's Concept
Overview: Frush advised arranging teeth in a
one-dimensional contact relationship.
Key Features:
This arrangement should be reshaped during the try-in phase to
obtain balanced occlusion.
Emphasizes the importance of adjusting the occlusal surfaces for
optimal contact.
6. Hanau's Quint
Overview: Rudolph L. Hanau proposed nine factors that
govern the articulation of artificial teeth, known as the laws of balanced
articulation.
Nine Factors:
Horizontal condylar inclination
Protrusive incisal guidance
Relative cusp height
Compensating curve
Plane of orientation
Buccolingual inclination of tooth axis
Sagittal condylar pathway
Sagittal incisal guidance
Tooth alignment
Condensation: Hanau later condensed these nine factors
into five key principles for practical application.
7. Trapozzano's Concept of Occlusion
Overview: Trapozzano reviewed and simplified Hanau's
quint and proposed his triad of occlusion.
Key Features:
Focuses on the essential elements of occlusion to streamline the
process of achieving balanced occlusion.
II. Monoplane or Non-Balanced Occlusion
Monoplane occlusion is characterized by an arrangement of teeth that serves a
specific purpose. It includes the following concepts:
Spherical Theory: Proposes that the occlusal surfaces
should be arranged in a spherical configuration to facilitate movement.
Organic Occlusion: Focuses on the natural relationships
and movements of the jaw.
Occlusal Balancing Ramps for Protrusive Balance:
Utilizes ramps to maintain balance during protrusive movements.
Transographics: A method of analyzing occlusal
relationships and movements.
Sears' Occlusal Pivot Theory
Overview: Sears also proposed the occlusal pivot theory
for monoplane or balanced occlusion, emphasizing the importance of a pivot
point for functional movements.
III. Lingualized Occlusion
Overview: Proposed by Gysi, lingualized occlusion
involves positioning the maxillary posterior teeth to occlude with the
mandibular posterior teeth, enhancing stability and function.
Key Features:
The maxillary teeth are positioned more centrally, while the
mandibular teeth are positioned buccally.
This arrangement allows for better functional balance and esthetics.
Multiphase and Multistage random sampling
Public Health DentistryMultiphase and multistage random sampling are advanced
sampling techniques used in research, particularly in public health and social
sciences, to efficiently gather data from large and complex populations. Both
methods are designed to reduce costs and improve the feasibility of sampling
while maintaining the representativeness of the sample. Here’s a detailed
explanation of each method:
Multiphase Sampling
Description: Multiphase sampling involves conducting a
series of sampling phases, where each phase is used to refine the sample
further. This method is particularly useful when the population is large and
heterogeneous, and researchers want to focus on specific subgroups or
characteristics.
Process:
Initial Sampling: In the first phase, a large sample is
drawn from the entire population using a probability sampling method (e.g.,
simple random sampling or stratified sampling).
Subsequent Sampling: In the second phase, researchers
may apply additional criteria to select a smaller, more specific sample from
the initial sample. This could involve stratifying the sample based on
certain characteristics (e.g., age, health status) or conducting follow-up
surveys.
Data Collection: Data is collected from the final
sample, which is more targeted and relevant to the research question.
Applications:
Public Health Surveys: In a study assessing health
behaviors, researchers might first sample a broad population and then focus
on specific subgroups (e.g., smokers, individuals with chronic diseases) for
more detailed analysis.
Qualitative Research: Multiphase sampling can be used
to identify participants for in-depth interviews after an initial survey has
highlighted specific areas of interest.
Multistage Sampling
Description: Multistage sampling is a complex form of
sampling that involves selecting samples in multiple stages, often using a
combination of probability sampling methods. This technique is particularly
useful for large populations spread over wide geographic areas.
Process:
First Stage: The population is divided into clusters
(e.g., geographic areas, schools, or communities). A random sample of these
clusters is selected.
Second Stage: Within each selected cluster, a further
sampling method is applied to select individuals or smaller units. This
could involve simple random sampling, stratified sampling, or systematic
sampling.
Additional Stages: More stages can be added if
necessary, depending on the complexity of the population and the research
objectives.
Applications:
National Health Surveys: In a national health survey,
researchers might first randomly select states (clusters) and then randomly
select households within those states to gather health data.
Community Health Assessments: Multistage sampling can
be used to assess oral health in a large city by first selecting
neighborhoods and then sampling residents within those neighborhoods.
Key Differences
Structure:
Multiphase Sampling involves multiple phases of
sampling that refine the sample based on specific criteria, often
leading to a more focused subgroup.
Multistage Sampling involves multiple stages of
sampling, often starting with clusters and then selecting individuals
within those clusters.
Purpose:
Multiphase Sampling is typically used to narrow
down a broad sample to a more specific group for detailed study.
Multistage Sampling is used to manage large
populations and geographic diversity, making it easier to collect data
from a representative sample.
INTERARCH RELATIONSHIPS
Dental Anatomy
Interarch relationship can be viewed from a stationary (fixed) and a dynamic (movable ) perspective
1.Stationary Relationship
a) .Centric Relation is the most superior relationship of the condyle of the mandible to the articular fossa of the temporal bone as determined by the bones ligaments. and muscles of the temporomandibular joint; in an ideal dentition it is the same as centric occlusion
Centric occlusion is habitual occlusion where maximum intercuspation occurs
The characteristics of centric occlusion are
(1) Overjet: or that characteristic of maxillary teeth to overlap the mandibular teeth in a horizontal direction by 1 to 2 mm the maxilla arch is slightly larger; functions to protect the narrow edge of the incisors and provide for an intercusping relation of posterior teeth
(2) Overbite or that characteristic of maxillary anterior teeth to overlap the mandibular anterior teeth in a vertical direction by a third of the lower crown height facilitates scissor like function of incisors
(3) Intercuspation. or that characteristic of posterior teeth to intermesh in a faciolingual direction The mandibular facial and maxillary lingual cusp are centric cusps yhat contact interocclusally in the opposing arch
(4) Interdigitation, or that characteristic_of that tooth to articulate with two opposing teeth (except for the mandibular central incisors and the maxillary last molars); a mandibular tooth occludes with the same tooth in the upper arch and the one mesial to it; a maxillary tooth occludes with the same tooth in the mandibular arch and the one distal to it.
2. Dynamic interarch relationshjps are result of functional mandibular movements that start and end with centric occlusion during mastication
a. Mandibular movements are
(1) Depression (opening)
(2) Elevation (closing)
(3) Protrusion (thrust forward)
(4) Retrusion (bring back)
(5) Lateral movements right and left; one side is always the working side and one the balancing or nonworking side
b. Mandibular movements from centric occlusion are guided by the maxillary teeth
(1) Protrusion is guided by the incisors called incisal guidence
(2) Lateral movments are guided by the Canines on the working side in young, unworn dentitions (cuspid rise or cuspid protected occlusion); guided by incisors and posterior teeth in older worn. dentition (incisal/group guidance)
c. As mandibular movements commence from centric occlusion, posterior teeth should disengage in protrusion the posterior teeth on the balancing side should disengage in lateral movement
d. If tooth contact occurs where teeth should be disengaged, occlusal interference or premature contacts exist.