NEET MDS Synopsis
Classification for antiasthmatic drugs.
Pharmacology
SYMPATHOMIMETICS
β2 -agonists are invariably used in the symptomatic treatment of asthma.
Epinephrine and ephedrine are structurally related to the catecholamine norepinephrine, a neurotransmitter of the adrenergic nervous system
Some of the important β 2 agonists like salmeterol, terbutaline and salbutamol are invariably used as bronchodilators both oral as well as
aerosol inhalants
SALBUTAMOL
It is highly selective β2 -adrenergic stimulant h-aving a prominent bronchodilator action.
It has poor cardiac action compared to isoprenaline.
TERBUTALINE
It is highly selective β2 agonist similar to salbutamol, useful by oral as well as inhalational route.
SALMETEROL
Salmeterol is long-acting analogue of salbutamol
BAMBUTEROL
It is a latest selective adrenergic β2 agonist with long plasma half life and given once daily in a dose of 10-20 mg orally.
METHYLXANTHINES (THEOPHYLLINE AND ITS DERIVATIVES)
THEOPHYLLINE
Theophylline has two distinct action:
smooth muscle relaxation (i.e. bronchodilatation) and suppression of the response of the airways to stimuli (i.e. non-bronchodilator prophylactic effects).
ANTICHOLINERGICS
Anticholinergics, like atropine and its derivative ipratropium bromide block cholinergic pathways that cause airway constriction.
MAST CELL STABILIZERS
SODIUM CROMOGLYCATE
It inhibits degranulation of mast cells by trigger stimuli.
It also inhibits the release of various asthma provoking mediators e.g. histamine, leukotrienes, platelet activating factor (PAF) and interleukins (IL’s) from mast cell
KETOTIFEN
It is a cromolyn analogue. It is an antihistaminic (H1 antagonist) and probably inhibits airway inflammation induced by platelet activating factor (PAF) in primate.
It is not a bronchodilator. It is used in asthma and symptomatic relief in atopic dermatitis, rhinitis, conjunctivitis and urticaria.
LEUKOTRIENE PATHWAY INHIBITORS
MONTELUKAST
It is a cysteinyl leukotriene receptor antagonist indicated for the management of persistent asthma.
Nevus
General Pathology
Nevus
A nevus refers to any congenital lesion of the skin, while a nevocellular nevus specifically refers to a benign tumor of neural crest-derived cells that include modified melanocytes of various shapes (nevus cells).
- nevocellular nevi are generally tan to deep brown, uniformly pigmented, small papules with well-defined, rounded borders.
- most nevocellular nevi are subdivided into junctional, intradermal, or compound types.
- most nevocellular nevi begin as junctional nevi with nevus cells located along the basal cell layer producing small, flat lesions, which are only slightly raised.
- junctional nevi usually develop into compound nevi as nevus cells extend into the underlying superficial dermis forming cords and columns of cells (compound: nevi at junction and in the dermis).
- eventually, the junctional component of a nevocellular nevus is lost, leaving only nevus cells within the dermis, thus the term intradermal nevus.
- junctional → compound → intradermal nevus.
- although uncommon, certain nevi may evolve into a malignant melanoma, particularly those which are congenital and those which are referred to as dysplastic nevi.
- a dysplastic nevus is commonly associated with patients who have multiple scattered nevi over the entire body (dysplastic nevus syndrome) with individual lesions that have a diameter greater than 1 cm.
Blood Groups
PhysiologyBlood Groups
Blood groups are created by molecules present on the surface of red blood cells (and often on other cells as well).
The ABO Blood Groups
The ABO blood groups are the most important in assuring safe blood transfusions.
Blood Group
Antigens on RBCs
Antibodies in Serum
Genotypes
A
A
Anti-B
AA or AO
B
B
Anti-A
BB or BO
AB
A and B
Neither
AB
O
Neither
Anti-A and anti-B
OO
When red blood cells carrying one or both antigens are exposed to the corresponding antibodies, they agglutinate; that is, clump together. People usually have antibodies against those red cell antigens that they lack.
The critical principle to be followed is that transfused blood must not contain red cells that the recipient's antibodies can clump. Although theoretically it is possible to transfuse group O blood into any recipient, the antibodies in the donated plasma can damage the recipient's red cells. Thus all transfusions should be done with exactly-matched blood.
The Rh System
Rh antigens are transmembrane proteins with loops exposed at the surface of red blood cells. They appear to be used for the transport of carbon dioxide and/or ammonia across the plasma membrane. They are named for the rhesus monkey in which they were first discovered.
There are a number of Rh antigens. Red cells that are "Rh positive" express the one designated D. About 15% of the population have no RhD antigens and thus are "Rh negative".
The major importance of the Rh system for human health is to avoid the danger of RhD incompatibility between mother and fetus.
During birth, there is often a leakage of the baby's red blood cells into the mother's circulation. If the baby is Rh positive (having inherited the trait from its father) and the mother Rh-negative, these red cells will cause her to develop antibodies against the RhD antigen. The antibodies, usually of the IgG class, do not cause any problems for that child, but can cross the placenta and attack the red cells of a subsequent Rh+ fetus. This destroys the red cells producing anemia and jaundice. The disease, called erythroblastosis fetalis or hemolytic disease of the newborn, may be so severe as to kill the fetus or even the newborn infant. It is an example of an antibody-mediated cytotoxicity disorder.
Although certain other red cell antigens (in addition to Rh) sometimes cause problems for a fetus, an ABO incompatibility does not. Rh incompatibility so dangerous when ABO incompatibility is not
It turns out that most anti-A or anti-B antibodies are of the IgM class and these do not cross the placenta. In fact, an Rh−/type O mother carrying an Rh+/type A, B, or AB fetus is resistant to sensitization to the Rh antigen. Presumably her anti-A and anti-B antibodies destroy any fetal cells that enter her blood before they can elicit anti-Rh antibodies in her.
This phenomenon has led to an extremely effective preventive measure to avoid Rh sensitization. Shortly after each birth of an Rh+ baby, the mother is given an injection of anti-Rh antibodies. The preparation is called Rh immune globulin (RhIG) or Rhogam. These passively acquired antibodies destroy any fetal cells that got into her circulation before they can elicit an active immune response in her.
Rh immune globulin came into common use in the United States in 1968, and within a decade the incidence of Rh hemolytic disease became very low.
METAPLASIA
General Pathology
METAPLASIA
A reversible replacement of one type of adult tissue by another type of tissue. It is usually an adaptive substitution to a. cell type more suited to an environment, often at the cost of specialised function.
(1) Epithelial metaplasia:
Squamous metaplasia. This is the commoner type of metaplasia and is seen in:
Tracheobronchial lining in chronic smokers and in bronchiectasis.
In Vitamin A deficiency.
Columnar metaplasia:
Intestinalisation of gastric mucosa in chronic gastritis.
(2) Connective tissue metaplasia:
Osseous-Metaplasia in :
Scars.
Myositis ossificans
Myeloid metaplasia in liver and spleen.
INFLUENZA
General Pathology
INFLUENZA
An acute viral respiratory infection with influenza, a virus causing fever, coryza, cough, headache, malaise, and inflamed respiratory mucous membranes.
Influenza B viruses typically cause mild respiratory disease
Symptoms and Signs
mild cases:
Chills and fever up to 39 to 39.5° C
Prostration and generalized aches and pains, Headache, photophobia and retrobulbar aching
Respiratory tract symptoms may be mild at first, with scratchy sore throat, substernal burning, nonproductive cough, and sometimes coryza. Later, the lower respiratory illness becomes dominant; cough can be persistent and productive.
severe cases
sputum may be bloody. Skin is warm and flushed. Soft palate, posterior hard palate, tonsillar pillars, and posterior pharyngeal wall may be reddened, but no exudate appears. Eyes water easily, and the conjunctiva may be mildly inflamed
Encephalitis, myocarditis, and myoglobinuria are infrequent complications of influenza and, if present, usually occur during convalescence
Gabapentin
Pharmacology
Gabapentin (Neurontin): newer; for generalized tonic-clonic seizures and partial seizures (partial and complex)
Mechanism: unknown but know doesn’t mimic GABA inhibition or block Ca currents
Side effects: dizziness, ataxia, fatigue; drug well-tolerated and no significant drug interactions
Pulmonary ventilation
PhysiologyVentilation simply means inhaling and exhaling of air from the atmospheric air into lungs and then exhaling it from the lung into the atmospheric air.
Air pressure gradient has to exist between two atmospheres to enable a gas to move from one atmosphere to an other.
During inspiration: the intrathoracic pressure has to be less than that of atmospheric pressure. This could be achieved by decreasing the intrathoracic pressure as follows:
Depending on Boyle`s law , the pressure of gas is inversely proportional to the volume of its container. So increasing the intrathoracic volume will decrease the intrathoracic pressure which will allow the atmospheric air to be inhaled (inspiration) . As decreasing the intrathoracic volume will increase the intrathoracic pressure and causes exhaling of air ( expiration)
So. Inspiration could be actively achieved by the contraction of inspiratory muscles : diaphragm and intercostal muscles. While relaxation of the mentioned muscles will passively cause expiration.
Contraction of diaphragm will pull the diaphragm down the abdominal cavity ( will move inferiorly) , and then increase the intrathoracic volume ( vertically) . Contraction of external intercostal muscle will pull the ribs upward and forward which will additionally increase the intrathoracic volume ( transversely , the net result will be increasing the intrathoracic volume and decreasing the intrathoracic pressure.
Relaxation of diaphragm will move it superiorly during expiration, the relaxation of external intercostal muscles will pull the ribs downward and backward , and the elastic lungs and chest wall will recoil. The net result is decreasing the intrathoracic volume and increasing intrathoracic pressure.
All of this occurs during quiet breathing. During forceful inspiration an accessory inspiratory muscle will be involved ( scaleni , sternocleidomastoid , and others) to increase negativity in the intrathoracic pressure more and more.
During forceful expiration the accessory expiratory muscles ( internal intercostal muscles and abdominal muscles ) will be involved to decrease the intrathoracic volume more and more and then to increase intrathoracic pressure more and more.
The pressure within the alveoli is called intralveolar pressure . Between the two phases of respiration it is equal to the atmospheric pressure. It is decreased during inspiration ( about 1 cm H2O ) and increased during expiration ( about +1 cm H2O ) . This difference allow entering of 0.5 L of air into the lungs.
Intrapleural pressure is the pressure of thin fluid between the two pleural layers . It is a slight negative pressure. At the beginning of inspiration it is about -5 cm H2O and reachs -7.5 cm H2O at the end or inspiration.
At the beginning of expiration the intrapleural pressure is -7.5 cm H2O and reaches -5 cmH2O at the end of expiration.
The difference between intralveolar pressure and intrapleural pressure is called transpulmonary pressure.
Factors , affecting ventilation :
Resistance : Gradual decreasing of the diameter of respiratory airway increase the resistance to air flow.
Compliance : means the ease , which the lungs expand.It depends on both the elastic forces of the lungs and the elastic forces , caused by the the surface tension of the fluid, lining the alveoli.
Surface tension: Molecules of water have tendency to attract each other on the surface of water adjacent to air. In alveoli the surface tension caused by the fluid in the inner surface of the alveoli may cause collapse of alveoli . The surface tension is decreased by the surfactant .
Surfactant is a mixture of phospholipids , proteins and ion m produced by type II pneumocytes.
Immature newborns may suffer from respiratory distress syndrome , due to lack of surfactant which is produced during the last trimester of pregnancy.
The elastic fibers of the thoracic wall also participate in lung compliance.
Zygomatic Bone Reduction
General SurgeryZygomatic Bone Reduction
When performing a reduction of the zygomatic bone, particularly in the
context of maxillary arch fractures, several key checkpoints are used to assess
the success of the procedure. Here’s a detailed overview of the important
checkpoints for both zygomatic bone and zygomatic arch reduction.
Zygomatic Bone Reduction
Alignment at the Sphenozygomatic Suture:
While this is considered the best checkpoint for assessing the
reduction of the zygomatic bone, it may not always be the most practical
or available option in certain clinical scenarios.
Symmetry of the Zygomatic Arch:
Importance: This is the second-best checkpoint and
serves multiple purposes:
Maintains Interzygomatic Distance: Ensures that
the distance between the zygomatic bones is preserved, which is
crucial for facial symmetry.
Maintains Facial Symmetry and Aesthetic Balance:
A symmetrical zygomatic arch contributes to the overall aesthetic
appearance of the face.
Preserves the Dome Effect: The prominence of
the zygomatic arch creates a natural contour that is important for
facial aesthetics.
Continuity of the Infraorbital Rim:
A critical checkpoint indicating that the reduction is complete. The
infraorbital rim should show no step-off, indicating proper alignment
and continuity.
Continuity at the Frontozygomatic Suture:
Ensures that the junction between the frontal bone and the zygomatic
bone is intact and properly aligned.
Continuity at the Zygomatic Buttress Region:
The zygomatic buttress is an important structural component that
provides support and stability to the zygomatic bone.
Zygomatic Arch Reduction
Click Sound:
The presence of a click sound during manipulation can indicate
proper alignment and reduction of the zygomatic arch.
Symmetry of the Arches:
Assessing the symmetry of the zygomatic arches on both sides of the
face is crucial for ensuring that the reduction has been successful and
that the facial aesthetics are preserved.