NEET MDS Synopsis
Antiarrhythmic Drugs - Class IV Calcium Channel Blockers
Pharmacology
Class IV Calcium Channel Blockers
• Block the movement of calcium into conductile and contractile myocardial cells
• Treatment: treatment of supraventricular tachycardia
– Diltiazem
– Verapamil
Adverse Effects
• Adverse effects associated with vasodilation of blood vessels throughout the body.
• CNS – dizziness, weakness, fatigue, depression and headache,
• GI upset, nausea, and vomiting.
• Hypotension CHF, shock arrhythmias, and edema
Nursing Caries and Rampant Caries
Conservative DentistryNursing 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.
Degrees of Mental Disability
PedodonticsDegrees of Mental Disability
Mental disabilities are often classified based on the severity of cognitive
impairment, which can be assessed using various intelligence scales, such as the
Wechsler Intelligence Scale and the Stanford-Binet Scale. Below is a detailed
overview of the degrees of mental disability, including IQ ranges and
communication abilities.
1. Mild Mental Disability
IQ Range: 55-69 (Wechsler Scale) or 52-67 (Stanford-Binet
Scale)
Description:
Individuals in this category may have some difficulty with academic
skills but can often learn basic academic and practical skills.
They typically can communicate well enough for most communication
needs and may function independently with some support.
They may have social skills that allow them to interact with peers
and participate in community activities.
2. Moderate Mental Disability
IQ Range: 40-54 (Wechsler Scale) or 36-51
(Stanford-Binet Scale)
Description:
Individuals with moderate mental disability may have significant
challenges in academic learning and require more support in daily
living.
Communication skills may be limited; they can communicate at a basic
level with others but may struggle with more complex language.
They often need assistance with personal care and may benefit from
structured environments and support.
3. Severe or Profound Mental Disability
IQ Range: 39 and below (Severe) or 35 and below
(Profound)
Description:
Individuals in this category have profound limitations in cognitive
functioning and adaptive behavior.
Communication may be very limited; some may be mute or communicate
only in grunts or very basic sounds.
They typically require extensive support for all aspects of daily
living, including personal care and communication.
Antral Puncture and Intranasal Antrostomy
Oral and Maxillofacial SurgeryAntral Puncture and Intranasal Antrostomy
Antral puncture, also known as intranasal antrostomy, is a
surgical procedure performed to access the maxillary sinus for diagnostic or
therapeutic purposes. This procedure is commonly indicated in cases of chronic
sinusitis, sinus infections, or to facilitate drainage of the maxillary sinus.
Understanding the anatomical considerations and techniques for antral puncture
is essential for successful outcomes.
Anatomical Considerations
Maxillary Sinus Location:
The maxillary sinus is one of the paranasal sinuses located within
the maxilla (upper jaw) and is situated laterally to the nasal cavity.
The floor of the maxillary sinus is approximately 1.25 cm below
the floor of the nasal cavity, making it accessible through the nasal
passages.
Meatuses of the Nasal Cavity:
The nasal cavity contains several meatuses, which are passageways
that allow for drainage of the sinuses:
Middle Meatus: Located between the middle and
inferior nasal conchae, it is the drainage pathway for the frontal,
maxillary, and anterior ethmoid sinuses.
Inferior Meatus: Located below the inferior
nasal concha, it primarily drains the nasolacrimal duct.
Technique for Antral Puncture
Indications:
Antral puncture is indicated for:
Chronic maxillary sinusitis.
Accumulation of pus or fluid in the maxillary sinus.
Diagnostic aspiration for culture and sensitivity testing.
Puncture Site:
In Children: The puncture should be made through
the middle meatus. This approach is preferred due to
the anatomical differences in children, where the maxillary sinus is
relatively smaller and more accessible through this route.
In Adults: The puncture is typically performed
through the inferior meatus. This site allows for
better drainage and is often used for therapeutic interventions.
Procedure:
The patient is positioned comfortably, usually in a sitting or
semi-reclined position.
Local anesthesia is administered to minimize discomfort.
A needle (often a 16-gauge or larger) is inserted through the chosen
meatus into the maxillary sinus.
Aspiration is performed to confirm entry into the sinus, and any
fluid or pus can be drained.
If necessary, saline may be irrigated into the sinus to help clear
debris or infection.
Post-Procedure Care:
Patients may be monitored for any complications, such as bleeding or
infection.
Antibiotics may be prescribed if an infection is present or
suspected.
Follow-up appointments may be necessary to assess healing and sinus
function.
Non-barbiturate sedatives
Pharmacology
Non-barbiturate sedatives
1- Chloral hydrate is trichlorinated derivative of acetaldehyde that is converted to trichlorethanol in the body. It induces sleep in about 30 minutes and last up to 6 hr. it is irritant to GIT and produce unpleasant taste sensation.
2- Ramelteon melatonin receptors are thought to be involved in maintaining circadian rhythms underlying the sleep-wake cycle. Ramelteon is an agonist at MT1 and MT2 melatonin receptors , useful in patients with chronic insomnia with no rebound insomnia and
withdrawal symptoms
3- Ethanol (alcohol) it has antianxiety sedative effects but its toxic potential out ways its benefits.
Ethanol is a CNS depressant producing sedation and hypnosis with increasing dose.
Absorption of alcohol taken orally is rapid, it is highly lipid soluble, presence of food delayed its absorption, maximal blood concentration depend on total dose, sex, strength of the solution, the time over which it is taken, the presence of food and speed of metabolism.
Alcohol in the systemic circulation is oxidized in the liver principally 90% by alcohol dehydrogenase to acetaldehyde and then by acetaldehyde dehydrogenase to products that enter the citric cycle.
Alcohol metabolism by alcohol dehydrogenase follows first order kinetics in the smallest doses. Once the blood concentration exceeds about 10 mg/100 ml, the enzymatic processes are saturated and elimination rate no longer increases with increasing
concentration but become steady at 10-15 ml/ 1 hr. in occasional drinkers.
Thus alcohol is subject to dose dependant kinetics i.e. saturation or zero order kinetics.
Actions
- Ethanol acts on CNS in a manner similar to volatile anesthetic.
- It also enhances GABA so stimulating flux of chloride ions through ion channels.
- Other possible mode of action involve inhibition of Ca-channels and inhibition of excitatory NMDA receptors.
- Ethanol has non selective CNS depressant activity.
- It causes cutaneous vasodilatation, tachycardia and myocardial depression
SELENIUM
Biochemistry
SELENIUM
normal serum level is 50-100 mg/day
Selenium dependent enzymes include glutathione Peroxidase and 5-de-iodinase. Selenium concentration in testis is the highest in adult. It is very necessary for normal development and maturation of sperm.
Hydromorphone
Pharmacology
Hydromorphone
About 8-10 times more potent than morphine when given intravenously.
Slightly shorter duration of action.
More soluble than morphine, thus higher concentrations may be injected if necessary.
Better oral/parenteral absorption ratio than morphine, but not as good as codeine or oxycodone.
It is used for the treatment of moderate to severe pain
Skeletal System Formation
Anatomy
Bones begin to form during the eighth week of embryomic life in the fibrous membranes (intramembranous ossification) and hyaline cartilage (endochondral ossification)