NEET MDS Synopsis
Functions in Different Regions of the Cortex
Physiology
Sensory:
Somatic (skin & muscle) Senses:
Postcentral gyrus (parietal lobe). This area senses touch, pressure, pain, hot, cold, & muscle position. The arrangement is upside-down (head below, feet above) and is switched from left to right (sensations from the right side of the body are received on the left side of the cortex). Some areas (face, hands) have many more sensory and motor nerves than others. A drawing of the body parts represented in the postcentral gyrus, scaled to show area, is called a homunculus .
Vision:
Occipital lobe, mostly medial, in calcarine sulcus. Sensations from the left visual field go to the right cortex and vice versa. Like other sensations they are upside down. The visual cortex is very complicated because the eye must take into account shape, color and intensity.
Taste:
Postcentral gyrus, close to lateral sulcus. The taste area is near the area for tongue somatic senses.
Smell:
The olfactory cortex is not as well known as some of the other areas. Nerves for smell go to the olfactory bulb of the frontal cortex, then to other frontal cortex centers- some nerve fibers go directly to these centers, but others come from the thalamus like most other sensory nerves
Hearing:
Temporal lobe, near junction of the central and lateral sulci. Mostly within the lateral sulcus. There is the usual crossover and different tones go to different parts of the cortex. For complex patterns of sounds like speech and music other areas of the cortex become involved.
Motor:
Primary Motor ( Muscle Control):
Precentral gyrus (frontal lobe). Arranged like a piano keyboard: stimulation in this area will cause individual muscles to contract. Like the sensory cortex, the arrangement is in the form of an upside-down homunculus. The fibers are crossed- stimulation of the right cortex will cause contraction of a muscle on the left side of the body.
Premotor (Patterns of Muscle Contraction):
Frontal lobe in front of precentral gyrus. This area helps set up learned patterns of muscle contraction (think of walking or running which involve many muscles contracting in just the right order).
Speech-Muscle Control:
Broca's area, frontal lobe, usually in left hemisphere only. This area helps control the patterns of muscle contraction necessary for speech. Disorders in speaking are called aphasias.
Perception:
Speech- Comprehension:
Wernicke's area, posterior end of temporal lobe, usually left hemisphere only. Thinking about words also involves areas in the frontal lobe.
Speech- Sound/Vision Association:
Angular gyrus, , makes connections between sounds and shapes of words
Vitamin B12: Cobalamin
Biochemistry
Vitamin B12: Cobalamin
Vitamin B12, also known as cobalamin, aids in the building of genetic material, production of normal red blood cells, and maintenance of the nervous system.
RDA The Recommended Dietary Allowance (RDA) for vitamin B12 is 2.4 mcg/day for adult males and females
Vitamin B12 Deficiency
Vitamin B12 deficiency most commonly affects strict vegetarians (those who eat no animal products), infants of vegan mothers, and the elderly. Symptoms of deficiency include anemia, fatigue, neurological disorders, and degeneration of nerves resulting in numbness and tingling.
Nomenclature for stereoisomers
Biochemistry
Nomenclature for stereoisomers: D and L designations are based on the configuration about the single asymmetric carbon in glyceraldehydes
For sugars with more than one chiral center, the D or L designation refers to the asymmetric carbon farthest from the aldehyde or keto group.
Most naturally occurring sugars are D isomers.
D & L sugars are mirror images of one another. They have the same name. For example, D-glucose and L-glucose
Other stereoisomers have unique names, e.g., glucose, mannose, galactose, etc. The number of stereoisomers is 2 n, where n is the number of asymmetric centers. The six-carbon aldoses have 4 asymmetric centers, and thus 16 stereoisomers (8 D-sugars and 8 L-sugars
An aldehyde can react with an alcohol to form a hemiacetal
Similarly a ketone can react with an alcohol to form a hemiketal
Pentoses and hexoses can cyclize, as the aldehyde or keto group reacts with a hydroxyl on one of the distal carbons
E.g., glucose forms an intra-molecular hemiacetal by reaction of the aldehyde on C1 with the hydroxyl on C5, forming a six-member pyranose ring, named after the compound pyran
The representations of the cyclic sugars below are called Haworth projections.
Fructose can form either:
a six-member pyranose ring, by reaction of the C2 keto group with the hydroxyl on C6
a 5-member furanose ring, by reaction of the C2 keto group with the hydroxyl on C5.
Cyclization of glucose produces a new asymmetric center at C1, with the two stereoisomers called anomers, α & β
Haworth projections represent the cyclic sugars as having essentially planar rings, with the OH at the anomeric C1 extending either:
below the ring (α)
above the ring (β).
Because of the tetrahedral nature of carbon bonds, the cyclic form of pyranose sugars actually assume a "chair" or "boat" configuration, depending on the sugar
Muscles Around the Eyelids
AnatomyMuscles Around the Eyelids
The function of the eyelid (L. palpebrae) is to protect the eye from injury and excessive light. It also keeps the cornea moist.
The Orbicularis Oculi Muscle
This is the sphincter muscle of the eye.
Its fibres sweep in concentric circles around the orbital margin and eyelids.
It narrows the eye and helps the flow of tears from the lacrimal sac.
This muscle has 3 parts: (1) a thick orbital part for closing the eyes to protect then from light and dust; (2) a thin palpebral part for closing the eyelids lightly to keep the cornea from drying; and (3) a lacrimal part for drawing the eyelids and lacrimal punta medially.
When all three parts of the orbicularis oculi contract, the eyes are firmly closed and the adjacent skin becomes wrinkled.
The zygomatic branch of the facial nerve (CN VII) supplies it.
The Levator Palpebrae Superioris Muscle
This muscle raises the upper eyelid to open the palpebral fissure.
It is supplied by the oculomotor nerve (CN III).
Acid Etching on Enamel
Conservative DentistryEffects of Acid Etching on Enamel
Acid etching is a critical step in various dental procedures, particularly in
the bonding of restorative materials to tooth structure. This process modifies
the enamel surface to enhance adhesion and improve the effectiveness of dental
materials. Below are the key effects of acid etching on enamel:
1. Removal of Pellicle
Pellicle Removal: Acid etching effectively removes the
acquired pellicle, a thin film of proteins and glycoproteins that forms on
the enamel surface after tooth cleaning.
Exposure of Inorganic Crystalline Component: By
removing the pellicle, the underlying inorganic crystalline structure of the
enamel is exposed, allowing for better interaction with bonding agents.
2. Creation of a Porous Layer
Porous Layer Formation: Acid etching creates a porous
layer on the enamel surface.
Depth of Pores: The depth of these pores typically
ranges from 5 to 10 micrometers (µm), depending on the concentration and
duration of the acid application.
Increased Surface Area: The formation of these pores
increases the surface area available for bonding, enhancing the mechanical
retention of restorative materials.
3. Increased Wettability
Wettability Improvement: Acid etching increases the
wettability of the enamel surface.
Significance: Improved wettability allows bonding
agents to spread more easily over the etched surface, facilitating better
adhesion and reducing the risk of voids or gaps.
4. Increased Surface Energy
Surface Energy Elevation: The etching process raises
the surface energy of the enamel.
Impact on Bonding: Higher surface energy enhances the
ability of bonding agents to adhere to the enamel, promoting a stronger bond
between the tooth structure and the restorative material.
ADRENOCORTICAL TUMORS
General Pathology
ADRENOCORTICAL TUMORS
Functional adenomas are commonly associated with hyperaldosteronism and with Cushing syndrome, whereas a virilizing neoplasm is more likely to be a carcinoma. Determination of of the functional status of a tumor is based on clinical evaluation and measurement of the hormone or its metabolites. In other words, functional and nonfunctional adrenocortical neoplasms cannot be distinguished on the basis of morphologic features.
Patholgical features
Adrenocortical adenomas
- They are generally small, 1 to 2 cm in diameter.
- On cut surface, adenomas are usually yellow to yellow-brown due to presence of lipid within the neoplastic cells
- Microscopically, adenomas are composed of cells similar to those populating the normal adrenal cortex. The nuclei tend to be small, although some degree of pleomorphism may be encountered even in benign lesions ("endocrine atypia"). The cytoplasm ranges from eosinophilic to vacuolated, depending on their lipid content.
Adrenocortical carcinomas
These are rare and may occur at any age, including in childhood.
- Carcinomas are generally large, invasive lesions.
- The cut surface is typically variegated and poorly demarcated with areas of necrosis, hemorrhage, and cystic change.
- Microscopically, they are composed of well-differentiated cells resembling those of cortical adenomas or bizarre, pleomorphic cells, which may be difficult to distinguish from those of an undifferentiated carcinoma metastatic to the adrenal.
Public health Dentistry
Public Health Dentistry
Terms
Health—state of complete physical, mental, and social well-being where basic human needs are met. not merely the absence of disease or infirmity; free from disease or pain
Public health — science and art of preventing disease. prolonging life, and promoting physical and mental health and efficiency through organized community efforts
1. Public health is concerned with the aggregate health of a group, a community, a state, a nation. or a group of nations
2. Public health is people’s health
3. Concerned with four broad areas
a. Lifestyle and behavior
b. The environment
c. Human biology
d. The organization of health programs and systems
Dental public health—science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts; that form of dental practice that serves the community as a patient rather than the individual; concerned with the dental education of the public, with applied dental research, and with the administration of group dental care programs. as well as the prevention and control of dental diseases on a community basis
Community health—same as public health full range of health services, environmental and personal, including major activities such as health education of the public and the social context of life as it affects the community; efforts that are organized to promote and restore the health and quality of life of the people
Community dental health services are directed to ward developing, reinforcing, and enhancing the oral health status of people either as individuals or collectively as groups and communities
Nephrotic Syndrome and Nephritic Syndrome
General Pathology
Nephrotic Syndrome
The patient will present with a triad of symptoms:
- Proteinuria, i.e. >3g/24hr-3.5g/24 hr
- Hypoalbuminaemia, i.e. <30g/L
- Oedema
>80% of cases are due to glomerulonephritis. In this syndrome, there is damage to podocytes
Clinical signs
- Pitting oedema, particularly in the limbs and around the eyes; may also cause genital oedema and ascites.
- Possible hypertension
Causes
- Primary causes – these are diagnoses of exclusion that are only made if secondary causes cannot be found
o Minimal change disease (MCD)
o Focal segmental glomerulosclerosis
o Membranous nephropathy
- Secondary causes – note that these fall into the same three categories as above:
o Minimal change disease – Hep B, SLE, diabetes M, sarcoidosis, syphilis, malignancy
o Focal segmental glomerulosclerosis –HIV, obesity, diabetes M, hypertensive nephrosclerosis
o Minimal change disease –drugs, malignancy, particularly Hodgkin’s lymphoma
- Differential diagnoses include cardiac failure, i.e. increased JVP, pulmonary oedema and mild proteinuria, and liver disease, i.e. reduced serum albumin.
- The condition causes an increased susceptibility to infection – partly due to loss of immunoglobulin in the urine. Patients tend to be prone to streptococcus infection, as well as bacterial peritonitis and cellulitis.
- Nephrotic syndrome also increases the risk of thromboembolism and hyperlipidaemia.
- The former is due to an increase in the synthesis of clotting factors and to platelet abnormalities, and the latter is a result of increased synthesis of these by the liver to counteract reduced oncotic pressure.
Investigations
- These are the same as those carried out in GN.
- Also, check for cholesterol as part of confirming the presence of hyperlipidemia.
- Renal biopsy – order this for all adults. In children, because the main cause is minimal change GN, steroids are the first-line treatment. Therefore, in children, biopsy is necessary only if pharmaceutical intervention fails to improve the situation.
- The hypercoagulant state seen in the nephrotic syndrome can be a risk factor for renal vein thrombosis. This can present as loin pain, haematuria, palpable kidney and sudden deterioration in kidney function. This should be investigated with Doppler USS, MRI or even renal angiography.
- Once diagnosed, give warfarin for 3 to 6 months.
Management
- Generally, this involves treatment of the underlying condition which is usually GN. Therefore, fluid management and salt intake restriction are priorities. The patient is usually given furosemide along with an ACE inhibitor and/or an angiotensin II receptor antagonist. Prophylactic heparin is given if the patient is immobile. Hyperlipidaemia can be treated with a statin.
Nephritic Syndrome
Acute and chronic
forms of the syndrome exist. The main difference between this and nephrotic syndrome is that in nephritic syndrome haematuria is present. There is also proteinuria, hypertension, uraemia, and possibly oliguria. The two standout features are hypertension and RBC casts. The urine will often appear ‘smoky’ in colour due to the presence of RBC casts. Very rarely, it may appear red
Causes
1. Post-streptococcal
2. Primary:
- Membranous glomerulonephritis
- Rapidly progressive glomerulonephritis
- IgA nephropathy (Berger’s disease)
3. Secondary
- HSP
- Vasculitis
Clinical Features
- Abrupt onset of :
o Glomerular haematuria (RBC casts or dysmorphic RBC)
o Non-nephrotic range proteinuria (< 2 g in 24 hrs)
o Oedema (periorbital, sacral )
o Hypertension
o Transient renal impairment (oliguria, uraemia)
- Urinary casts – these are cylindrical structures produced by the kidney and present in the urine in certain renal diseases. They form in the DCT and collecting duct, dislodging and passing in the urine where they are detected by microscopy. RBC casts are usually associated with nephritic syndrome. The presence of RBCs within a cast is always pathologic and strongly indicative of glomerular damage.
- The proteinuria present is often smaller than in nephrotic syndrome, thus a coexistent condition of nephrotic syndrome is not usually present.
- Encepelopathy may be present, particularly in children, due to electrolyte imbalances and hypertension. This type of presentation is indicative of glomerular damage, but requires renal biopsy to determine the exact problem. In this respect it is similar to nephrotic syndrome.
Overlapping of the two syndromes is possible as nephrotic syndrome may precede nephritic syndrome, although not vice-versa.
Mechanisms of the syndrome vary according to cause; both primary and secondary causes exist. Post-infectious GN is the classic illustration of nephritic syndrome, but the condition may be caused by other glomerulopathies and by systemic diseases such as connective tissue disorders
Two clinical terms to remember:
- Nephritic syndrome; which comprises edema, proteinuria, hypoalbuminemia, hematuria (smoky urine), oligurua and hypertension.
- Nephrotic syndrome; which comprises of albuminuria, hypoalbuminemia, edema, hyperlipidemia, lipiduria.