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NEET MDS Synopsis

Neurophysiology
Physiology

Neurophysiology

Transmission of an action potential. This occurs in two ways:

1) across the synapse - synaptic transmission. This is a chemical process, the result of a chemical neurotransmitter.

2) along the axon - membrane transmission. This is the propagation of the action potential itself along the membrane of the axon.

Synaptic transmission - What you learned about the neuromuscular junction is mostly applicable here as well. The major differences in our current discussion are:

1) Transmission across the synapse does not necessarily result in an action potential. Instead, small local potentials are produced which must add together in summation to produce an action potential.

2) Although ACh is a common neurotransmitter, there are many others and the exact effect at the synapse depends on the neurotransmitter involved.

3) Neurotransmitters can be excitatory or inhibitory. The result might be to turn off the next neuron rather than to produce an action potential

The basic steps of synaptic transmission are the same as described at the neuromuscular junction

1) Impulse arrives at the axon terminus causing opening of Ca2+ channels and allows Ca2+  to enter the axon. The calcium ions are in the extracellular fluid, pumped there much like sodium is pumped. Calcium is just an intermediate in both neuromuscular and synaptic transmission.

2) Ca2+  causes vesicles containing neurotransmitter to release the chemical into the synapse by exocytosis across the pre-synaptic membrane.

3) The neurotransmitter binds to the post-synaptic receptors. These receptors are linked to chemically gated ion channels and these channels may open or close as a result of binding to the receptors to cause a graded potential which can be either depolarization, or hyperpolarization depending on the transmitter. Depolarization results from opening of Na+ gates and is called an EPSP. Hyperpolarization could result from opening of K+ gates and is called IPSP. 

4) Graded potentials spread and overlap and can summate to produce a threshold depolarization and an action potential when they stimulate voltage gated ion channels in the neuron's trigger region.

5) The neurotransmitter is broken down or removed from the synapse in order for the receptors to receive the next stimulus. As we learned there are enzymes for some neurotransmitters such as the Ach-E which breaks down acetylcholine. Monoamine oxidase (MAO) is an enzyme which breaks down the catecholamines (epinephrine, nor-epinephrine, dopamine) and nor-epinephrine (which is an important autonomic neurotransmitter) is removed by the axon as well in a process known as reuptake. Other transmitters may just diffuse away.

Graded Potentials - these are small, local depolarizations or hyperpolarizations which can spread and summate to produce a threshold depolarization. Small because they are less than that needed for threshold in the case of the depolarizing variety. Local means they only spread a few mm on the membrane and decline in intensity with increased distance from the point of the stimulus. The depolarizations are called EPSPs, excitatory post-synaptic potentials, because they tend to lead to an action potential which excites or turns the post-synaptic neuron on. Hyperpolarizations are called IPSPs, inhibitory post-synaptic potentials, because they tend to inhibit an action potential and thus turn the neuron off.

Summation - the EPSPs and IPSPs will add together to produce a net depolarization (or hyperpolarization).

Temporal summation- this is analogous to the frequency (wave, tetany) summation discussed for muscle. Many EPSPs occurring in a short period of time (e.g. with high frequency) can summate to produce threshold depolarization. This occurs when high intensity stimulus results in a high frequency of EPSPs.

Spatial summation - this is analogous to quantal summation in a muscle. It means that there are many stimuli occurring simultaneously. Their depolarizations spread and overlap and can build on one another to sum and produce threshold depolarization.

Inhibition - When the brain causes an IPSP in advance of a reflex pathway being stimulated, it reduces the likelihood of the reflex occurring by increasing the depolarization required. The pathway can still work, but only with more than the usual number or degree of stimulation. We inhibit reflexes when allowing ourselves to be given an injection or blood test for instance.

Facilitation - When the brain causes an EPSP in advance of a reflex pathway being stimulated, it makes the reflex more likely to occur, requiring less additional stimulation. When we anticipate a stimulus we often facilitate the reflex.

Learned Reflexes - Many athletic and other routine activities involve learned reflexes. These are reflex pathways facilitated by the brain. We learn the pathways by performing them over and over again and they become facilitated. This is how we can perfect our athletic performance, but only if we learn and practice them correctly. It is difficult to "unlearn" improper techniques once they are established reflexes. Like "riding a bike" they may stay with you for your entire life!

Post-tetanic potentiation - This occurs when we perform a rote task or other repetitive action. At first we may be clumsy at it, but after continuous use (post-tetanic) we become more efficient at it (potentiation). These actions may eventually become learned reflexes

The Action Potential

The trigger region of a neuron is the region where the voltage gated channels begin. When summation results in threshold depolarization in the trigger region of a neuron, an action potential is produced. There are both sodium and potassium channels. Each sodium channel has an activation gate and an inactivation gate, while potassium channels have only one gate. 

A) At the resting state the sodium activation gates are closed, sodium inactivation gates are open, and potassium gates are closed. Resting membrane potential is at around -70 mv inside the cell. 

B) Depolarizing phase: The action potential begins with the activation gates of the sodium channels opening, allowing Na+ ions to enter the cell and causing a sudden depolarization which leads to the spike of the action potential. Excess Na+ ions enter the cell causing reversal of potential becoming briefly more positive on the inside of the cell membrane.

C) Repolarizing phase: The sodium inactivation gates close and potassium gates open. This causes Na+ ions to stop entering the cell and  K+ ions  to leave the cell, causing repolarization. Until the membrane is repolarized it cannot be stimulated, called the absolute refractory period.

D) Excess potassium leaves the cell causing a brief hyperpolarization. Sodium activation gates close and potassium gates begin closing. The sodium-potassium pump begins to re-establish the resting membrane potential. During hyperpolarization the membrane can be stimulated but only with a greater than normal depolarization, the relative refractory period.

Action potentials are self-propagated, and once started the action potential progresses along the axon membrane. It is all-or-none, that is there are not different degrees of action potentials. You either have one or you don't.

Multiphase and Multistage random sampling
Public Health Dentistry

Multiphase 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.



HYPERPLASIA
General Pathology

HYPERPLASIA
It is the increase in the size of an organ or tissue due to increase in the number of its constituent cells. This is seen in organs made up of labile and stable cells.

Causes
I. Increased demand:
- Bone marrow in hypoxia and haemolytic states.
- Thyroid gland in puberty

2. Persistant Trauma:
- Acanthosis of the epidermis in chronic inflammations and in warts.
- Hyperplasia of oral mucosa due tooth and denture trauma.
- Mucosa at the edges of a gastric ulcer.

3. Endocrine target organ:
- Pregnancy hyperplasia of breast.
- Prostatic hyperplasia.

4. Compensatory:

Hyperplasia of kidney when the other kidney has been removed.

5. Idiopathic:
Endocrine organs like thyroid, adrenals, pituitary etc. can undergo hyperplasia with no detectable stimulus. .
 

Autoimmune Diseases
General Pathology

Autoimmune Diseases
These are a group of disease where antibodies  (or CMI) are produced against self antigens, causing disease process.

Normally one's immune competent cells do not react against one's own tissues.
This is due to self tolerance acquired during embryogenesis. Any antigen encountered at
that stage is recognized as self and the clone of cells capable of forming the corresponding antibody is suppressed.

Mechanism of autoimmunity

(1) Alteration of antigen

 -Physicochemical denaturation by UV light, drugs etc. e.g. SLE.
- Native protein may turn antigenic  when a foreign hapten combines with it, e.g. Haemolytic anemia with Alpha methyl dopa.

(2) Cross reaction: Antibody produced against foreign antigen may cross react with native protein because of partial similarity e.g. Rheumatic fever.

(3) Exposure of sequestered antigens: Antigens not normally exposed to immune competent cells are not accepted as self as tolerance has not been developed to them. e.g. thyroglobulin, lens protein, sperms.

(4) Breakdown of tolerance : 
- Emergence of forbidden clones (due to neoplasia of immune system as in lymphomas and lymphocytic leukaemia)
- Loss of suppressor T cells as in old age and CMI defects

Autoimmunity may be
- Organ specific.
-  Non organ specific (multisystemic)

I. Organ specific.
(I) Hemolytic anaemia:
- Warm or cold antibodies (active at 37° C or at colder temperature)
- They may lyse the RBC by complement activation or coat them and make them vulnerable to phagocytosis

(ii) Hashimoto's thyroiditis:
 
- Antibodies to thyroglobulin and microsomal antigens.
- Cell mediated immunity.
- Leads to chronic. destructive thyroiditis.

(3) Pernicious anemia

Antibodies to gastric parietal cells and to intrinsic factor.

2. Non organ specific.

Lesions are seen in more than one system but principally affect blood vessels and connective tissue (collagen diseases).

(I) Systemic lupus erythematosus  (SLE). Antibodies to varied antigens are seen. Hence it is possible that there is abnormal reactivity of the immune system in self recognition.

Antibodies have been demonstrated against:

- Nuclear material (antinuclear I antibodies) including DNA. nucleoprotein etc. Anti nuclear antibodies are demonstrated by LE cell test.
- Cytoplasmic organelles- mitochondria, rib osomes, Iysosomes.
- Blood constituents like RBC, WBC. platelets, coagulation factors.

Mechanism. Immune complexes of body proteins and auto antibodies deposit in various organs and cause damage as in type III hypersensitivity

Organs involved
- Skin- basal dissolution and collagen degeneration with fibrinoid vasculitis.
- Heart- pancarditis.
- Kidneys- glomerulonephritis of focal, diffuse or membranous type 
- Joints- arthritis. 
- Spleen- perisplenitis and vascular thickening (onion skin).
- Lymph nodes- focal necrosis and follicular hyperplasia.
- Vasculitis in other organs like liver, central or peripheral nervous system etc,

2. Polyarteritis nodosa. Remittant .disseminated necrotising vasculitis of small and medium sized arteries

Mechanism :- Not definitely known. Proposed immune reaction to exogenous or auto antigens 

Lesion : Focal panarteritis- a segment of vessel is involved. There is fibrinoid necrosis with initially acute and later chronic inflammatory cells. This may result in haemorrhage and aneurysm.

Organs involved. No organ or tissue is exempt but commonly involved organs are :
- Kidneys.
- Heart.
- Spleen.
- GIT.

3. Rheumatoid arthritis. A disease primarily of females in young adult life. 

Antibodies

- Rheumatoid factor (An IgM antibody to self IgG)
- Antinuclear antibodies in 20% patients.

Lesions

- Arthritis which may progress on to a crippling deformity.
- Arteritis in various organs- heart, GIT, muscles.
- Pleuritis and fibrosing alveolitis.
- Amyloidosis is an important complication.

4. Sjogren's  Syndrome. This is constituted by 
- Kerato conjunctivitis sicca
- Xerostomia
- Rheumatoid arthritis. 

Antibodies

- Rheumatoid factor

- Antinuclear factors (70%).
- Other antibodies like antithyroid, complement fixing Ab etc
- Functional defects in lymphocytes. There is a higher incidence of lymphoma


5. Scleroderma (Progressive systemic sclerosis)
Inflammation and progressive sclerosis of connective tissue of skin and viscera.

Antibodies
- Antinuclear antibodies.
- Rheumatoid factor. .
- Defect is cell mediated.

lesions

- Skin- depigmentation, sclerotic atrophy followed by cakinosis-claw fingers and mask face.
- Joints-synovitis with fibrosis
- Muscles- myositis.
- GIT- diffuse fibrous replacement of muscularis resulting in hypomotility and malabsorption
- Kidneys changes as in SLE and necrotising vasculitis.
- Lungs – fibrosing alveolitis.
- Vasculitis in any organ or tissue.

6.Wegener’s granulomatosis. A complex of:

- Necrotising lesions in upper respiratory tract.
- Disseminated necrotising vasculitis.
- Focal or diffuse glomerulitis.

Mechanism. Not known. It is classed with  autoimmune diseases because of the vasculitis  resembling other immune based disorders.
 

Nursing Caries and Rampant Caries
Conservative Dentistry

Nursing Caries and Rampant Caries
Nursing caries and rampant caries are both forms of dental caries that can
lead to significant oral health issues, particularly in children.

Nursing Caries

Nursing Caries: A specific form of rampant caries that
primarily affects infants and toddlers, characterized by a distinct pattern
of decay.

Age of Occurrence

Age Group: Typically seen in infants and toddlers,
particularly those who are bottle-fed or breastfed on demand.

Dentition Involved

Affected Teeth: Primarily affects the primary
dentition, especially the maxillary incisors and molars. Notably, the
mandibular incisors are usually spared.

Characteristic Features

Decay Pattern:
Involves maxillary incisors first, followed by molars.
Mandibular incisors are not affected due to protective factors.


Rapid Lesion Development: New lesions appear quickly,
indicating acute decay rather than chronic neglect.

Etiology

Feeding Practices:
Improper feeding practices are the primary cause, including:
Bottle feeding before sleep.
Pacifiers dipped in honey or other sweeteners.
Prolonged at-will breastfeeding.





Treatment

Early Detection: If detected early, nursing caries can
be managed with:
Topical fluoride applications.
Education for parents on proper feeding and oral hygiene.


Maintenance: Focus on maintaining teeth until the
transition to permanent dentition occurs.

Prevention

Education: Emphasis on educating prospective and new
mothers about proper feeding practices and oral hygiene to prevent nursing
caries.


Rampant Caries

Rampant Caries: A more generalized and acute form of
caries that can occur at any age, characterized by widespread decay and
early pulpal involvement.

Age of Occurrence

Age Group: Can be seen at all ages, including
adolescence and adulthood.

Dentition Involved

Affected Teeth: Affects both primary and permanent
dentition, including teeth that are typically resistant to decay.

Characteristic Features

Decay Pattern:
Involves surfaces that are usually immune to decay, including
mandibular incisors.
Rapid appearance of new lesions, indicating a more aggressive form
of caries.



Etiology

Multifactorial Causes: Rampant caries is influenced by
a combination of factors, including:
Frequent snacking and excessive intake of sticky refined
carbohydrates.
Decreased salivary flow.
Genetic predisposition.



Treatment

Pulp Therapy:
Often requires more extensive treatment, including pulp therapy for
teeth with multiple pulp exposures.
Long-term treatment may be necessary, especially when permanent
dentition is involved.



Prevention

Mass Education: Dental health education should be
provided at a community level, targeting individuals of all ages to promote
good oral hygiene and dietary practices.


Key Differences
Mandibular Anterior Teeth

Nursing Caries: Mandibular incisors are spared due to:
Protection from the tongue.
Cleaning action of saliva, aided by the proximity of the sublingual
gland ducts.


Rampant Caries: Mandibular incisors can be affected, as
this condition does not spare teeth that are typically resistant to decay.

CARTILAGE
Anatomy

CARTILAGE

There are 3 types:

Hyaline cartilage
Elastic cartilage
Fibrocartilage

Matrix is made up by: Hyaluronic acid

Proteoglycans

 

- In cartilage the protein core of the proteoglycan molecule binds through a linking protein to hyaluronic acid to form a proteoglycan aggregate which binds to the fibres

- In the matrix there are spaces, lacunae in which one to three of the cells of cartilage, chondrocytes, are found

- The matrix around the lacuna is the territorial matrix

- Type II collagen fibrils are embedded in the matrix

- The type of fiber depends on the type of cartilage

- Cartilage is surrounded by perichondrium which is a dense CT

- Apositional growth takes place in the perichondrium

- The fibroblasts of the perichondrium change to elliptic chondroblasts which later change to round chondrocytes

- Interstitial growth takes place around the lacunae

- Nutrients diffuse through the matrix to get to the chondrocytes   this limits the thickness of cartilage

Hyaline cartilage

Found: Rib cartilage,  articulating surfaces,  nose,  larynx, trachea, embryonic skeleton, Articulating cartilage has no perichondrium

 Bluish-white and translucent

Contains type II collagen that is not visible

 

Elastic cartilage

Found:  external auditory canal,  epiglottis

Similar to hyaline except that it contains many elastic fibres ,Yellow in colour,  Can be continuous with hyaline

Fibrocartilage

Found: Intervertebral disk, symphysis pubis

Always associated with dense CT,  Many collagen fibres in the matrix, No perichondrium

- Chondrocytes tend to lie in rows, Can withstand strong forces

CLEANING AND PICKLING ALLOYS
Dental Materials

CLEANING AND PICKLING ALLOYS

The surface oxidation or other contamination of dental alloys is a troublesome occurrence. The oxidation of base metals in most alloys can be kept to a minimum or avoided by using a properly adjusted method of heating the alloy and a suitable amount of flux when melting the alloy . Despite these precautions, as the hot metal enters the mold, certain alloys tend to become contaminated on the surface by combining with the hot mold gases, reacting with investment ingredients, or physically including mold particles in the metal surface. The surface of most cast, soldered, or otherwise heated metal dental appliances is cleaned by warming the structure in suitable solutions, mechanical polishing, or other treatment of the alloy to restore the normal surface condition.

Surface tarnish or oxidation can be removed by the process of pickling. Castings of noble or high-noble metal may be cleaned in this manner by warming them in a 50% sulfuric acid and water solution . . After casting, the alloy (with sprue attached) is placed into the warmed pickling solution for a few seconds. The pickling solution will reduce oxides that have formed during casting. However, pickling will not eliminate a dark color caused by carbon deposition 

The effect of the solution can be seen by comparing the submerged surfaces to those that have still not contacted the solution. the ordinary inorganic acid solutions and do not release poisonous gases on boiling (as sulfuric acid does). In either case, the casting to be cleaned is placed in a suitable porcelain beaker with the pickling solution and warmed gently, but short of the boiling point. After a few moments of heating, the alloy surface normally becomes bright as the oxides are reduced. When the heating is completed, the acid may be poured from the beaker into the original storage container and the casting is thoroughly rinsed with water. Periodically, the pickling solution should be replaced with fresh solution to avoid excessive contamination.

Precautions to be taken while pickling

With the diversity of compositions of casting alloys available today, it is prudent to follow the manufacturer's instructions for pickling precisely, as all pickling solutions may not be compatible with all alloys. Furthermore, the practice of dropping a red-hot casting into the pickling solution should beavoided. This practice may alter the phase structure of the alloy or warp thin castings, and splashing acid may be dangerous to the operator. Finally, steel or stainless steel tweezers should not be used to remove castings from the pickling solutions. The pickling solution may dissolve the tweezers and plate the component metals onto the casting. Rubber-coated or Teflon tweezers are recommended for this purpose.

Efficiency in Heat Sterilization
Oral and Maxillofacial Surgery

Tests for Efficiency in Heat Sterilization – Sterilization Monitoring
Effective sterilization is crucial in healthcare settings to ensure the
safety of patients and the efficacy of medical instruments. Various monitoring
techniques are employed to evaluate the sterilization process, including
mechanical, chemical, and biological parameters. Here’s an overview of these
methods:
1. Mechanical Monitoring


Parameters Assessed:

Cycle Time: The duration of the sterilization
cycle.
Temperature: The temperature reached during the
sterilization process.
Pressure: The pressure maintained within the
sterilizer.



Methods:

Gauges and Displays: Observing the gauges or
digital displays on the sterilizer provides real-time data on the cycle
parameters.
Recording Devices: Some tabletop sterilizers are
equipped with recording devices that print out the cycle parameters for
each load.



Interpretation:

While correct readings indicate that the sterilization conditions
were likely met, incorrect readings can signal potential issues with the
sterilizer, necessitating further investigation.



2. Biological Monitoring

Spore Testing:
Biological Indicators: This involves using spore
strips or vials containing Geobacillus stearothermophilus,
a heat-resistant bacterium.
Frequency: Spore testing should be conducted weekly to
verify the proper functioning of the autoclave.
Interpretation: If the spores are killed after the
sterilization cycle, it confirms that the sterilization process was
effective.



3. Thermometric Testing

Thermocouple:
A thermocouple is used to measure temperature at two locations:
Inside a Test Pack: A thermocouple is placed
within a test pack of towels to assess the temperature reached in
the center of the load.
Chamber Drain: A second thermocouple measures
the temperature at the chamber drain.


Comparison: The readings from both locations are
compared to ensure that the temperature is adequate throughout the load.



4. Chemical Monitoring


Brown’s Test:

This test uses ampoules containing a chemical indicator that changes
color based on temperature.
Color Change: The indicator changes from red
through amber to green at a specific temperature, confirming that the
required temperature was reached.



Autoclave Tape:

Autoclave tape is printed with sensitive ink that changes color when
exposed to specific temperatures.
Bowie-Dick Test: This test is a specific
application of autoclave tape, where two strips are placed on a piece of
square paper and positioned in the center of the test pack.
Test Conditions: When subjected to a temperature
of 134°C for 3.5 minutes, uniform color development
along the strips indicates that steam has penetrated the load
effectively.



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