NEET MDS Synopsis
Precipitation Reaction
General Microbiology
Precipitation Reaction
This reaction takes place only when antigen is in soluble form. Such an antigen when
comes in contact with specific antibody in a suitable medium results into formation of an insoluble complex which precipitates. This precipitate usually settles down at the bottom of the tube. If it fails to sediment and remains suspended as floccules the reaction is known as flocculation. Precipitation also requires optimal concentration of NaCl, suitable temperature and appropriate pH.
Zone Phenomenon
Precipitation occurs most rapidly and abundantly when antigen and antibody are in optimal proportions or equivalent ratio. This is also known as zone of equivalence. When antibody is in great excess, lot of antibody remains uncombined. This is called zone of antibody excess or prozone. Similarly a zone of antigen excess occurs in which all antibody has combined with antigen and additional uncombined antigen is present.
Applications of Precipitation Reactions
Both qualitative determination as well as quantitative estimation of antigen and antibody can be performed with precipitation tests. Detection of antigens has been found to be more sensitive.
Agglutination
In agglutination reaction the antigen is a part of the surface of some particulate material such as erythrocyte, bacterium or an inorganic particle e.g. polystyrene latex which has been coated with antigen. Antibody added to a suspension of such particles combines with the surface antigen and links them together to form clearly visible aggregate which is called as agglutination.
Application of precipitation reactions
Precipitation reaction Example
Ring test Typing of streptococci, Typing of pneumococci
Slide test (flocculation) VDRL test
Tube test (flocculation) Kahn test
Immunodiffusion Eleks test
Immunoelectrophoresis Detection Of HBsAg, Cryptococcal antigen in CSF
Beta-Adrenergic blocking Agents- Antianginal Drugs
Pharmacology
Beta-Adrenergic blocking Agents
• Prototype - Propranolol
• Prevent or inhibit sympathetic stimulation
– Reduces heart rate
– Myocardial contractility
– Reduce BP - decreases myocardial workload and O2 demand
• In long-term management used to decrease frequency and severity of anginal attacks
• Added when nitrates do not prevent anginal episodes
• Prevents exercise induced tachycardia
• Onset of action 30 min after oral dose. 1-2 min IV
Therapeutic Actions
• Block Beta adrenergic receptors in the heart and juxtaglomerular apparatus
• Decrease the influence of the sympathetic nervous system decreasing excitability of the heart
• Decrease cardiac output.
• Indicated for long term management of anginal pectoris caused by atherosclerosis
Atenolol, metoprolol, and nadolol have the same actions, uses, and adverse effects as propranolol, but they have long half-lives and can be given once daily. They are excreted by the kidneys, and dosage must be reduced in clients with renal impairment.
Intrinsic Muscles of the Tongue
AnatomyIntrinsic Muscles of the Tongue
The Superior Longitudinal Muscle of the Tongue
The muscle forms a thin layer deep to the mucous membrane on the dorsum of the tongue, running from its tip to its root.
It arises from the submucosal fibrous layer and the lingual septum and inserts mainly into the mucous membrane.
This muscle curls the tip and sides of the tongue superiorly, making the dorsum of the tongue concave.
The Inferior Longitudinal Muscle of the Tongue
This muscle consists of a narrow band close to the inferior surface of the tongue.
It extends from the tip to the root of the tongue.
Some of its fibres attach to the hyoid bone.
This muscle curls the tip of the tongue inferiorly, making the dorsum of the tongue convex.
The Transverse Muscle of the Tongue
This muscle lies deep to the superior longitudinal muscle.
It arises from the fibrous lingual septum and runs lateral to its right and left margins.
Its fibres are inserted into the submucosal fibrous tissue.
The transverse muscle narrows and increases the height of the tongue.
The Vertical Muscle of the Tongue
This muscle runs inferolaterally from the dorsum of the tongue.
It flattens and broadens the tongue.
Acting with the transverse muscle, it increases the length of the tongue.
Maxillectomy
Oral and Maxillofacial SurgeryMaxillectomy
Maxillectomy is a surgical procedure involving the resection
of the maxilla (upper jaw) and is typically performed to remove tumors, treat
severe infections, or address other pathological conditions affecting the
maxillary region. The procedure requires careful planning and execution to
ensure adequate access, removal of the affected tissue, and preservation of
surrounding structures for optimal functional and aesthetic outcomes.
Surgical Access and Incision
Weber-Fergusson Incision:
The classic approach to access the maxilla is through the Weber-Fergusson
incision. This incision provides good visibility and access to
the maxillary region.
Temporary Tarsorrhaphy: The eyelids are temporarily
closed using tarsorrhaphy sutures to protect the eye during the
procedure.
Tattooing for Aesthetic Alignment:
To achieve better cosmetic results, it is recommended to tattoo the
vermilion border and other key points on both sides of the incision with
methylene blue. These points serve as guides for alignment during
closure.
Incision Design:
The incision typically splits the midline of the upper lip but can
be modified for better cosmetic outcomes by incising along the philtral
ridges and offsetting the incision at the vermilion border.
The incision is turned 2 mm from the medial canthus
of the eye. Intraorally, the incision continues through the gingival
margin and connects with a horizontal incision at the depth of the
labiobuccal vestibule, extending back to the maxillary tuberosity.
Continuation of the Incision:
From the maxillary tuberosity, the incision turns medially across
the posterior edge of the hard palate and then turns 90 degrees
anteriorly, several millimeters to the proximal side of the
midline, crossing the gingival margin again if possible.
Incision to Bone:
The incision is carried down to the bone, except beneath the lower
eyelid, where the orbicularis oculi muscle is
preserved. The cheek flap is then reflected back to the tuberosity.
Surgical Procedure
Extraction and Elevation:
The central incisor on the involved side is extracted, and the
gingival and palatal mucosa are elevated back to the midline.
Deepening the Incision:
The incision extending around the nose is deepened into the nasal
cavity. The palatal bone is divided near the midline using a saw blade
or bur.
Separation of Bone:
The basal bone is separated from the frontal process of the maxilla
using an osteotome. The orbicularis oculi muscle is retracted
superiorly, and the bone cut is extended across the maxilla, just below
the infraorbital rim, into the zygoma.
Maxillary Sinus:
If the posterior wall of the maxillary sinus has not been invaded by
the tumor, it is separated from the pterygoid plates using a pterygoid
chisel.
Specimen Removal:
The entire specimen is removed by severing the remaining attachments
with large curved scissors placed behind the maxilla.
Postoperative Considerations
Wound Care: Proper care of the surgical site is
essential to prevent infection and promote healing.
Rehabilitation: Patients may require rehabilitation to
address functional issues related to speech, swallowing, and facial
aesthetics.
Follow-Up: Regular follow-up appointments are necessary
to monitor healing and assess for any complications or recurrence of
disease.
Stages of Freud\'s Model
PedodonticsStages of Freud's Model
Oral Stage (1-2 years):
Focus: The mouth is the primary source of
interaction and pleasure. Infants derive satisfaction from oral
activities such as sucking, biting, and chewing.
Developmental Task: The primary task during this
stage is to develop trust and comfort through oral stimulation.
Successful experiences lead to a sense of security.
Example: Sucking on a pacifier or breastfeeding
helps infants develop trust in their caregivers.
Potential Outcomes: Fixation at this stage can lead
to issues with dependency or aggression in adulthood. Individuals may
develop oral-related habits, such as smoking or overeating.
Anal Stage (2-3 years):
Focus: The anal zone becomes the primary source of
pleasure. Children derive gratification from controlling bowel
movements.
Developmental Task: Toilet training is a
significant aspect of this stage. The way parents handle toilet training
can influence personality development.
Outcomes:
Overemphasis on Toilet Training: If parents are
too strict or demanding, the child may develop an anal-retentive
personality, characterized by compulsiveness, orderliness, and
stubbornness.
Lax Toilet Training: If parents are too
lenient, the child may develop an anal-expulsive personality,
leading to impulsiveness and a lack of organization.
Phallic Stage (3-5 years):
Focus: The child becomes aware of their own
genitals and develops sexual feelings. This stage is marked by the
Oedipus complex in boys and the Electra complex in girls.
Oedipus Complex: Boys develop an attraction to
their mother and view their father as a rival for her affection. This
leads to feelings of jealousy and fear of punishment (castration
anxiety).
Electra Complex: Girls experience a similar
attraction to their father and may feel competition with their mother,
leading to "penis envy."
Developmental Task: Resolution of these complexes
is crucial for developing a mature sexual identity and healthy
relationships.
Latency Stage (6 years to puberty):
Focus: Sexual feelings are repressed, and children
focus on developing skills, friendships, and social interactions. This
stage corresponds with the development of mixed dentition (the
transition from primary to permanent teeth).
Developmental Task: The maturation of the ego
occurs, and children develop their character and social skills. They
engage in activities that foster learning and peer relationships.
Potential Outcomes: Successful navigation of this
stage leads to the development of self-confidence and competence in
social settings.
Genital Stage (puberty onward):
Focus: The individual develops a mature sexual
identity and seeks to establish meaningful relationships. The focus is
on the genitals and the ability to engage in sexual activity.
Developmental Task: The individual learns to
balance the needs of the self with the needs of others, leading to the
ability to form healthy, intimate relationships.
Potential Outcomes: Successful resolution of
earlier stages leads to a well-adjusted adult who can satisfy their
sexual and emotional needs while also pursuing goals related to
reproduction and personal identity.
Oedipus Complex: Young boys have a natural tendency to be attached to
the mother and they consider their father as their enemy.
Surface Defence Mechanisms
General Pathology
Surface Defence Mechanisms
1. Skin:
(i) Mechanical barrier of keratin and desquamation.
(ii) Resident commensal organisms
(iii)Acidity of sweat.
(iv) Unsaturated fatty acids of sebum
2. Oropharyngeal
(i)Resident flora
(ii) Saliva, rich in lysozyme, mucin and Immunoglobulins (lgA).
3. Gastrointestinal tract.-
(i) Gastric HCI
(ii) Commensal organisms in Intestine
(iii) Bile salts
(iv) IgA.
(v) Diarrhoeal expulsion of irritants.
4. Respiratory tract:
(i) Trapping in turbinates
(ii) Mucus trapping
(iii) Expulsion by coughing and sneezing.
(iv) Ciliary propulsion.
(V) Lysozymes and antibodies in secretion.
(vi) Phagocytosis by alveolar macrophages.
5. Urinary tract:
(i) Flushing action.
(ii) Acidity
(iii) Phagocytosis by urothelial cells.
6. Vagina.-
(i) Desquamation.
(ii) Acid barrier.
(iii) Doderlein's bacilli (Lactobacilli)
7. Conjunctiva:
Lysozymes and IgA in tears
RESPIRATORY DISORDERS - Asthma
PhysiologyAsthma = Reversible Bronchioconstruction 4%-5% of population
Extrinsic / Atopic = Allergic, inherited (familia), chromosome 11
IgE, Chemical Mediators of inflammation
a. Intrinsic = Negative for Allergy, Normal IgE, Negative Allergic Tests
Nucleotide Imbalance cAMP/cGMP: cAMP = Inhibits mediator release, cGMP = Facilitates mediator release
b. Intolerance to Asprin (Triad Asthma)
c. Nasal Polyps & Asthma
d. Treatment cause, Symptoms in Acute Asthma
1. Bronchial dilators
2. steroids edema from Inflamation
3. Bronchiohygene to prevent Secondary Infection, (Remove Excess Mucus)
4. Education
Midazolam
Pharmacology
Midazolam -Intravenous Anesthetics
Midazolam is a benzodiazepine used for preoperative sedation, induction of anesthesia, or maintenance of anesthesia in short procedures.