NEET MDS Synopsis
Transoral Lithotomy
Oral and Maxillofacial SurgeryTransoral Lithotomy: Procedure for Submandibular Duct Stone Removal
Transoral lithotomy is a surgical technique used to remove
stones (calculi) from the submandibular duct (Wharton's duct). This procedure is
typically performed under local anesthesia and is effective for addressing
sialolithiasis (the presence of stones in the salivary glands).
Procedure
Preoperative Preparation:
Radiographic Assessment: The exact location of the
stone is determined using imaging studies, such as X-rays or ultrasound,
to guide the surgical approach.
Local Anesthesia: The procedure is performed under
local anesthesia to minimize discomfort for the patient.
Surgical Technique:
Suture Placement: A suture is placed behind the
stone to prevent it from moving backward during the procedure,
facilitating easier access.
Incision: An incision is made in the mucosa of the
floor of the mouth, parallel to the duct. Care is taken to avoid injury
to surrounding structures, including:
Lingual Nerve: Responsible for sensory
innervation to the tongue.
Submandibular Gland: The gland itself should be
preserved to maintain salivary function.
Blunt Dissection:
After making the incision, blunt dissection is performed to
carefully displace the surrounding tissue and expose the duct.
Identifying the Duct:
The submandibular duct is located, and the segment of the duct that
contains the stone is identified.
Stone Removal:
A longitudinal incision is made over the stone within the duct. The
stone is then extracted using small forceps. Care is taken to ensure
complete removal to prevent recurrence.
Postoperative Considerations:
After the stone is removed, the incision may be closed with sutures,
and the area is monitored for any signs of complications.
Complications
Bacterial Sialadenitis: If there is a secondary
infection following the procedure, it can lead to bacterial sialadenitis,
which is an inflammation of the salivary gland due to infection. Symptoms
may include pain, swelling, and purulent discharge from the duct.
Meperidine
Pharmacology
Meperidine (Demerol)
Meperidine is a phenylpiperidine and has a number of congeners. It is mostly effective in the CNS and bowel
Produces analgesia, sedation, euphoria and respiratory depression.
Less potent than morphine, 80-100 mg meperidine equals 10 mg morphine.
Shorter duration of action than morphine (2-4 hrs).
Meperidine has greater excitatory activity than does morphine and toxicity may lead to convulsions.
Meperidine appears to have some atropine-like activity.
Does not constrict the pupils to the same extent as morphine.
Does not cause as much constipation as morphine.
Spasmogenic effect on GI and biliary tract smooth muscle is less pronounced than that produced by morphine.
Not an effective antitussive agent.
In contrast to morphine, meperidine increases the force of oxytocin-induced contractions of the uterus.
Often the drug of choice during delivery due to its lack of inhibitory effect on uterine contractions and its relatively short duration of action.
It has serotonergic activity when combined with monoamine oxidase inhibitors, which can produce serotonin toxicity (clonus, hyperreflexia, hyperthermia, and agitation)
Adverse reactions to Meperidine
• Generally resemble a combination of opiate and atropine-like effects.
- respiratory depression, - tremors, - delirium and possible convulsions, - dry mouth
• The presentation of mixed symptoms (stupor and convulsions) is quite common in addicts taking large doses of meperidine.
Sub-Stages of Adolescence
PedodonticsThree Sub-Stages of Adolescence
Adolescence is a critical developmental period characterized by significant
physical, emotional, and social changes. It is typically divided into three
sub-stages: early adolescence, middle adolescence, and late adolescence. Each
sub-stage has distinct characteristics that influence the development of
identity, social relationships, and behavior.
Sub-Stages of Adolescence
1. Early Adolescence (Approximately Ages 10-13)
Characteristics:
Casting Off of Childhood Role: This stage marks the
transition from childhood to adolescence. Children begin to distance
themselves from their childhood roles and start to explore their
emerging identities.
Physical Changes: Early physical development
occurs, including the onset of puberty, which brings about changes in
body shape, size, and secondary sexual characteristics.
Cognitive Development: Adolescents begin to think
more abstractly and critically, moving beyond concrete operational
thinking.
Emotional Changes: Increased mood swings and
emotional volatility are common as adolescents navigate their new
feelings and experiences.
Social Changes: There is a growing interest in peer
relationships, and friendships may begin to take on greater importance
- Exploration of Interests: Early adolescents often
start to explore new interests and hobbies, which can lead to the
formation of new social groups.
2. Middle Adolescence (Approximately Ages 14-17)
Characteristics:
Participation in Teenage Subculture: This stage is
characterized by a deeper involvement in peer groups and the teenage
subculture, where social acceptance and belonging become paramount.
Identity Formation: Adolescents actively explore
different aspects of their identity, including personal values, beliefs,
and future aspirations.
Increased Independence: There is a push for greater
autonomy from parents, leading to more decision-making and
responsibility.
Romantic Relationships: The exploration of romantic
relationships becomes more prominent, influencing social dynamics and
emotional experiences.
Risk-Taking Behavior: Middle adolescents may engage
in risk-taking behaviors as they seek to assert their independence and
test boundaries.
3. Late Adolescence (Approximately Ages 18-21)
Characteristics:
Emergence of Adult Behavior: Late adolescence is
marked by the transition into adulthood, where individuals begin to take
on adult roles and responsibilities.
Refinement of Identity: Adolescents solidify their
sense of self, integrating their experiences and values into a coherent
identity.
Future Planning: There is a focus on future goals,
including education, career choices, and long-term relationships.
Social Relationships: Relationships may become more
mature and stable, with a shift from peer-focused interactions to deeper
connections with family and romantic partners.
Cognitive Maturity: Cognitive abilities continue to
develop, leading to improved problem-solving skills and critical
thinking.
RESPIRATORY DISORDERS - Bronchitis
Physiology
Bronchitis = Irreversible Bronchioconstriction
. Causes - Infection, Air polution, cigarette smoke
a. Primary Defect = Enlargement & Over Activity of Mucous Glands, Secretions very viscous
b. Hypertrophy & hyperplasia, Narrows & Blocks bronchi, Lumen of airway, significantly narrow
c. Impaired Clearance by mucocillary elevator
d. Microorganism retension in lower airways,Prone to Infectious Bronchitis, Pneumonia
e. Permanent Inflamatory Changes IN epithelium, Narrows walls, Symptoms, Excessive sputum, coughing
f. CAN CAUSE EMPHYSEMA
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
Autism in Pedodontics
PedodonticsAutism in Pedodontics
Autism Spectrum Disorder (ASD) is a complex developmental disorder that
affects communication, behavior, and social interaction. In the context of
pediatric dentistry (pedodontics), understanding the characteristics and
challenges associated with autism is crucial for providing effective dental
care. Here’s an overview of autism in pedodontics:
Characteristics of Autism
Developmental Disability:
Autism is classified as a lifelong developmental disability that
typically manifests during the first three years of life. It is
characterized by disturbances in mental and emotional development,
leading to challenges in learning and communication.
Diagnosis:
Diagnosing autism can be difficult due to the variability in
symptoms and behaviors. Early intervention is essential, but many
children may not receive a diagnosis until later in childhood.
Symptoms:
Poor Muscle Tone: Children with autism may exhibit
low muscle tone, which can affect their physical coordination and
ability to perform tasks.
Poor Coordination: Motor skills may be
underdeveloped, leading to difficulties in activities that require fine
or gross motor skills.
Drooling: Some children may have difficulty with
oral motor control, leading to drooling.
Hyperactive Knee Jerk: This may indicate
neurological differences that can affect overall motor function.
Strabismus: This condition, characterized by
misalignment of the eyes, can affect visual perception and coordination.
Feeding Behaviors:
Children with autism may exhibit atypical feeding behaviors, such as
pouching food (holding food in the cheeks without swallowing) and a
strong preference for sweetened foods. These behaviors can lead to
dietary imbalances and increase the risk of dental caries (cavities).
Dental Considerations for Children with Autism
Communication Challenges:
Many children with autism have difficulty with verbal communication,
which can make it challenging for dental professionals to obtain a
medical history, understand the child’s needs, or explain procedures.
Using visual aids, simple language, and non-verbal communication
techniques can be helpful.
Behavioral Management:
Children with autism may exhibit anxiety or fear in unfamiliar
environments, such as a dental office. Strategies such as
desensitization, social stories, and positive reinforcement can help
reduce anxiety and improve cooperation during dental visits.
Oral Health Risks:
Due to dietary preferences for sweetened foods and potential
difficulties with oral hygiene, children with autism are at a higher
risk for dental caries. Dental professionals should emphasize the
importance of oral hygiene and may need to provide additional support
and education to caregivers.
Special Accommodations:
Dental offices may need to make accommodations for children with
autism, such as providing a quiet environment, allowing extra time for
appointments, and using calming techniques to help the child feel more
comfortable.
Varicose Veins
General Pathology
Varicose Veins
- are abnormally dilated, tortuous veins produced by prolonged increase in intraluminal pressure and loss of vessel wall support.
- The superficial veins of the leg are typically involved
-venous pressures in these sites can be markedly elevated -> venous stasis and pedal edema (simple orthostatic edema)
-Some 10% to 20% of adult males and 25% to 33% of adult females develop lower extremity varicose veins
RISK FACTORS
-> obesity
-> Female gender
-> pregnancy.
-> familial tendency (premature varicosities results from imperfect venous wall development)
Morphology
- wall thinning
- intimal fibrosis in adjacent segments
- spotty medial calcifications (phlebosclerosis)
- Focal intraluminal thrombosis
- venous valve deformities (rolling and shortening)
COMPLICATIONS
- stasis, congestion, edema, pain, and thrombosis
- chronic varicose ulcers
- embolism is very rare.
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.