66 - chopart's fracture

The foot is generally divided into the

• Hindfoot
• Calcaneus
• Talus
• Midfoot
• Cuboid
• Navicular
• Three cuneiforms
• Forefoot
• Metatarsals
• Phalanges
• The articulation between the hindfoot and the midfoot (midtarsal joint) is frequently referred to as Chopart’s joint
• Named after surgeon who performed amputations at the calcaneocuboid, talonavicular joint
• The articulation between the midfoot and the forefoot is referred to as the Lisfranc joint.
  
• Named after French surgeon Francois Chopart (1743–1795) who performed amputations of the foot at this level
• This type of amputation renders the ankle joint unstable as almost all of the points of insertion of the ankle tendons have been remove

• All dislocations of the foot are relatively uncommon with the Lisfranc fracture-dislocation being the most common
• Most are due to falls from a height or motor vehicle accidents
• Males are more likely to have foot dislocations than females
  
  
• Chopart Fracture

• Chopart fracture-dislocation involves the midtarsal joints (talonavicular and calcaneocuboid joints)
• Typically caused by falls from a height, motor vehicle accidents and severe twisting injuries such as can occur in basketball players who land on a plantar-flexed and inverted foot
• Usually result from severe trauma
• Most commonly, there is medial displacement of the distal fragments (80%)
• The foot is displaced inward and upward
• But displacement in other directions can occur
• Eversion injuries result in lateral dislocations
• There are frequently associated fractures of the calcaneus, cuboid and navicular
• A small percentage are open
• The talus remains in the ankle mortise

Chopart's fracture dislocation. Black arrow points to talus which is dislocated from navicular (yellow
arrow) at talonavicular joint. Calcaneus (blue arrow) is dislocated from the cuboid (red arrow), which is also fractured. The dislocation is at the calcaneocuboid joint. This is an uncommon dislocation.
The forefoot is usually displaced medially rather than laterally as in this case.

• Prognosis

• Prompt reduction and early range of motion generally result in favorable outcome
• High impact injuries with greater soft tissue compromise and associated fractures worsen prognosis

.

Diagram of Chopart's fracture-dislocation from Radiographics.

65 - ap pg 2008 paper with answers - andhra pradesh medical post graduation entrance paper 2008

if u wanna know the answers with explanations click here .

1. what is the action of anterior fibres of deltoid ? c

a. medial rotation
b. lateral rotation
c. flexion and medial rotation
d. extension and lateral rotation


2. which is not lined by stratified nonkeratinised squamaous epithelium ? d

a. hypopharynx and laryngopharynx
b. oesophagus
c. cornea
d. Tympanic membrane

3. which of the following is not supplied by posterior division of obturator nerve ? b

a. obturator externus
b. obturator internus
c. Adductor magnus
d.

4. which of the following is true about azygous vein course ? c

a. superior venecava
b. posteriorly to inferior venecava
c. anterior lumbar vein
d.

5. Which of the following is not present at birth ? a

a. mastoid tip
b. mastoid antrum
c. ethmoidal labrynth
d. endolymphatic sinus

6. Which is the critical temperature of nitrous oxide ? d

a. -118 degree
b. - 88
c. 26
d. 36.5

7. Which of the following is not an amino steroid derivative ?a

a. alcurioum
b. vecuronium
c. pancuronium
d. pipecuronium

8. what is the time gap given in train of four ? none ans : 2 seconds

a. 10 sec
b. 20 sec
c. 40 sec
d. 60 sec

9. which of the following presents as follicular pink scaly rash of chronic type with palmoplantar involvement ? d

a. pitryiasia rosea
b. pitryiasis alba
c. pitryrias capitis
d. pitryisas rubra pilaris

10. Which of the following presents as chronic winter rash in woman ? a

a. asteatotic eczema
b. statis eczema
c. atopic
d. nummular

11. Which of the following presents as keratin plug without opening ? d

a. comedom
b. nodule
c. cyst
d. milia

12. which of the following is not a type of lesion in leprosy? b

a. hypopigmented patch
b. vesicle
c. erytrhrodermic
d. raised plaque


13. which of the following is not the cause of charcots joint ? d

a. leprosy
b. syringomyelia
c. diabetes mellitus
d. psoriasis


14. Which of the following is called catamite ? b

a. Passive victim of sodomy anybody
b. passive victim of sodomy young boy
c.
d.

15. what is transvestism ? a ( please read Narayana reddy the definition )

a. Wearing clothes of opposite sex to be identified as of opposite sex
b. wearing clothes of opposite sex for sexual gratification
c.
d.

16. Contributory negligence is a defense in ? c

a. civil negligence
b. criminal negligence
c. ethical negligence
d.

17. Which of the following is true about pneumothorax except? c

a. radiolucency of underlying lung with no bronhial markings
b. shift of lung to hilum
c. full radio opacity of underlying lung
d. Moderate ventilation of underlying lung

18. Which of the following is not true about MRI ? c

a. MRI is useful in locating small lesions
b. CT is better than MRI in bone lesions
c. MRI is better for calcified lesions
d.


19. 1 Curie equals to ? d ( 1 giga is 1 billion )

a. 3.7 M becqueral
b. 37 M
c. 3.7 G b
d. 37 Gb

20. Biological half life of radioactive substance in organ depends upon ? c

a. initial radioactivity
b. substance half life
c. effective half life
d. metabolism of organ

21. which of the following is beneficial in Electroconvulsive therapy ? c

a. Bilateral induction of symmetrical generalised seizures
b. Induction of memory disturbances
c. use of anaesthetic agents
d. pulse oxymeter use



22. when extracellular potassium is increased from 4 meq to 10 meq what will happen ? a

a. resting membrane potential becomes more negative
b. increase in conductance of sodium
c. increase in conductions of potassium
d. Na K ATpase will be stopped

23. 10 percent dextrose is ? b ( 5 % is hypo . 25 % is hyper)

a. hypotonic
b. isotonic
c. normotonic
d. hypertonic

24. What is electromyogram ? b

a. stimulation of muscle through nerve
b. stimulation of muscle without nerve
c. direct recording of electrical activity from muscle
d. recording motor nerve conduction

25. guardian of genome ? a

a. p53
b. bcl2
c.
d.

26. Gene is ? a

a. codon
b. anticodon
c. cistron
d. okazaki fragment

27. which of the following is not the presentation of obstructive sleep apnea ? c

a. day time somnlence
b. nocturia
c. impotence
d. resp insufficiency

28. Primozide belongs to ? d

a. thioxanthines
b. phenothiazines
c. buprenorhine group
d. diphenyl.... group


29. which of the following drug is contraindicated in pregnancy and lactation ? Metronidazole is contraindicated only in 1st trimester ( I agree )

a. mebendazole
b. albendazole
c. metronidazole
d.

30 which drug caused gynaecomazia ? a

a. ketoconazole
b. fluconazole
c.
d.


31. which of the following untrue about wilson disease? a

a. increased ceruloplasmin
b.
c.
d.


32. which of the following condition s4 is absent ? b

a. pulmonic stenosis
b. mitral stenois
c. systemic hypertension
d. pulm hypertension

33. In which of the following conditions pulsus paradoxus absent in cardiac tamponade ? d

a. obesity
b. pregancy
c. MS
d. AR


34. Sternocleidomastoid atrophy seen in ? a

a. spinal muscular atrophy
b. olivopontocerebellar atrophy
c. muscular dystrophy
d. duchennes


35. Krukenberg spindle present in ? a
a. corneal endolethium
b. retina
c. lens
d.

36. photopsia seen in ? a

a. choroiditis
b.



37. Laser trabeluoplasty done in ? a

a. open angle gluacoma
b. closed angle
c. angle closure

38. power of Intra ocular lens is determined by ? a ( Keratometry)

a. keratometry
b. retinoscopy
c. ophthalmoscopy
d. gonioscopy


39. Brown reflex deposition seen in mercury poisoning ? c

a. anterior cornea
b. posteror cornea
c. anterior lens
d. posterior lens

40. Precocious puberty caused by all except ?a

a. testicular feminisation
b. albrights
c. testicular tumours
d. brain tumours

41. rosette cataract seen in ? a

a. ocular trauma
b. diabetes
c. wilsons
d.


42. which of the following disease has consistent symptoms of tinittus ? a

a. menieres disease
b.


43. which of the following is not related to lateral sinus thrombosis ? c

a. greisinger sign
b. tobey ayer test
c. gradenigo syndrome


44. recently found association of bells palsy ? a

a. HSV
b. herpes zoster
c. EBC
d. varicella


45.sodium chromoglygate used in ? b

a. phlyctenular
b. vernal
c.
d.


46. most common site of choleasatoma ? a

a. prussaks space
b. hypotympanum



47. quinsy related to ? b

a. paratonsillar fossa
b. peritonsillar
c. crypta magna



48. external carotid artery is ligated at ? a

a. above the origin of sup thyroid artery
b. below the origin of sup thyroid artery
c. at the bificuration of common carotid artery
d. at the origin of ascending palatine artery

49. A boy presents with unilater purulent foetid discharge from nose? a

a. foreign body
b. polyp
c.
d.


50. which is false about natal teeth ? d or a

a. always present at birth
b. 2 incisors of mandibular teeth
c. severe root resorbtion problems associated
d. not removed

51. what is the most common organism causing epidural abscess ? a

a. staph aureus
b. strep
c. bacteriods
d. H .influenza


52. what is the deformity seen in fixed adduction of hip ? a or c

a. apparent shortening
b. apparent lenthening
c. true shortening
d. true lenghthening


53. 10 year old boy presents with pain in the hip with flexion adduction problem , cause ? a

a. perthes
b. transcervical fracture of neck
c. TB hip
d. Transient hip


54. Which is not secreted by stomach ? a

a. lipase
b. pepsinogen
c. HCl
d. acid


55. which part of brain most often contused in RTA ? b

a. frontal
b. parietal
c. occipital
d. temporal


56. which of the following is not a barrier method ? a
a. centchroman
b. today
c. barrier
d.


57. which of the following associated with endometrial cancer ? a

a. enteropathica haemorrhagica
b. dysgermniona
c. fibroid
d.


58. which is not true about CTEV ? d

a. Equinus of talus
b. varus of heel
c. shortened tendo acchiles
d. Triple arthrodesis is optimal treatment


59. Most common cause of fracture of neck of talus ? c ( due to forced dorsiflexion )

a. fall from height
b. plantar flexion
c. dorsi flexion
d. inversion


60. which is false about turners syndrome ? a

a. Mental retardation
b. digital deformities
c. web neck
d. short stature

61. false about klinefelters ? a

a. most common syndrome of sex gene involvement
b. most common cause of hypogonadic failure is males
c. mental retardation common
d. serum FSH levels are consistently high

62. Most common cause of perisent diarrhae in children ? a

a. rota virus
b. E coli


63. In which of the following conditions oxygen delivery is least to muscles ? c
a. Person inhaling 100 percent oxygent at the top of mount everest
b. Marathon runner at sea level
c. person with carbon monoxide poisoning
d. none of the above ( this option none of the above was also there )


64. Hb o2 dissociation curve to left by ? a

a. increase pH
b.
c.
d.


65. Blood flow to brain is not influenced by ? b

a. paco2
b. po2
c. cerebral circulation
d. systemic circulation


66. which of the following is least in proteing quality ? ?

a. gelatin
b. lactalbumin
c.
d. cashewnut protein


67. which of the following is K channelopathy ? a

a. episodic ataxia 1
b. familial hemiplegic migraine
c. myotonia
d. paramyotonia


68.which of the following is not true about berry aneurysms ? b

a. rupture leading to SAH
b. most common in post circulation
c.
d.


69. Un true about aneurysm in brain ? b >>> a

a. SAH
b. Intraventricular haemorrhage
c. papilledema
d. vasospasm

70. which is most commonly deficient in TPN ? a

a. zinc
b. chromium
c.
d.


71. what type of rbc seen in chronic renal failure ? c

a. microcytic
b. macrocytic
c. normocytic


72. most common cause of thyrotoxicosis in childhood? c

a. toxic nodular goiture
b. toxic adenoma
c. graves
d. thryotoxicosis factitia


73. Least plasma halflife ? ? norepinephrine c

a. dehydroepiandrostendione
b. aldosterone
c. nor epinephrine
d.


74. Assocatied with conns syndrome ? a
a. low plasma renin
b.
c.
d.


75 not associated with barterrs syndrome ? c

a. hypokalemia
b. recurrent weakness
c. hypertension
d.


76. most common presentation in endemic goitre ? c

a. hypothryoidism
b. adenoma
c. diffuse goitre


77. which of the following is not malignant ? a

a. adenolymphoma
b. adenoid cystic carcinoma
c. acinic cell
d.


78. which of the following is associated with destruction of valves ? a
a. acute infective endocarditis
b. libman sach
c. rheumatic


79. which of the following is not the cause of Myocardial infarction ? don't know

a. coxsackie B
b. lead poisoining
c.
d.


80 which of the following is dimorphic fungi ? a

a. sporothtrix schenki
b. cryptococcus



81. what is the size of particle is rapid sand filter ? c ( answer is 0.4 to 0.7 mm )

a. o.1 mm
b. 0.2
c. 0.5
d. 0.8


82. what is diagnosed by xenodiagnosis ? a

a. chagas
b. malaria
c. kala azar


83. whip test is used for ? c

a. candida
b. gardenella
c. trichomonas


84. no need to treat partner in ? d

a. trichomonas
b. gardenella
c. herpex genitalis
d. candida


85. most common cause of primary adrenal insufficiency in india ? b
a. autoimmune
b. TB


86. which is false about crytpogenic TB ? a
a. age <> 40 years
b. incidental detected
c. bilateral
d. histology similar to invasive


104. which is not having underlying malignancy ? a

a. paget disease of bone
b. paget disease of nipple
c. paget disease of vulva
d. paget disease of anal region


105. which is not true about PBC ? a

a. no increase in risk of hepatocellular carcinoma


106. string sign of kantor seen in ? a

a. chrons
b. ulcerative colitis
c.
d.


107. claw sign seen in ? a

a. intusseption
b. volvulus
c.
d.


108 treament of hydatid cyst ? b

a. excision of cyst
b. percutanoeous drainage
c. conservative managment



109. Most common site of intra peritoneal abscess ? c
a. morrison
b. omental bursa
c. pelvic
d. left subhepatic


110. Complete Rx of intussception indicates ? b

a. free passage of barium in the small intestine
b. passage of faceus and flatus along with barium
c. improvement of clinical condition



111. which is false about hydrocele ? c ( surgical Das mentions as a rule testis cannot be felt sepearately as the fluid of hydrocele sorrounds the body of the testis on page 314 in short cases of DAS surgery )

a. almost always fluid is transudate
b. get above the swelling
c. testis is palpated separate from swelling
d. obscures inguinal hernia


112. Functional brace not used in ? a

a. fracture neck of femur
b. fracture shaft of femur
c. fracture shaft of tibia
d. fracture shaft of humerus


113, which of the following is incorrect about scaphoid? c

a. most common carpal bone injured
b. non union is complication
c. avascular necrosis of distal part is there
d. x rays to be taken successively after 2 weeks


114. what is true about dequervan tenovaginitis ? a

a. involvement of extensor pollicis brevis and abductor pollicis longus




115. what is incorrect about supra condylar fracture of humerus ? c

a. extension type is common
b. radial nerve is injured
c. cubitus valgus is most common complication
d.


116. Mechanism of action of mini pill ? a

a. rendering cervical mucus thick
b. inhibiting ovulation



117. Incorrect about internal os of cervix ? b

a. hegar dilators used
b. most common cause of first trimester abortion


118. latent period in primigravida is ? b


a. 2 hours
b. 6 to 8 hours
c. 10 to 12 hours
d. 14 to 16 hours


119. most reversible method of sterilisation ? c

a. mini lap
b. pomeroys
c. laparoscopic sterilisation
d. hysteroscopic sterilisation


120 Maltese cross in RBC seen in ? a

a. babesia
b. Entamoeba


121. which is incorrect about cystic hygroma ? b

a. brilliantly translucent
b. radiotherapy
c. sclerotherapy with bleomycin
d. sclerotherapy with actinomycin


122. which of the following is not the cause of macrocytic anaemia ? b

a. orotic aciduria
b. abetalipoproteinemia
c. Lesh nyhan
d. transcobalamine deficiency


123 . Not the cause of neonatal seizures ? b

a. pyridoxine deficiency
b. hypokalemia
c.
d.

124. Anti Avidin is ? a

a. biotin
b. thiamine
c.
d.


125. which is incorrect about Burkitts lymphoma ? b

a. High mitotic activity
b. HIgh Apoptotic cell death
c. small nuclei proliferation
d.



126. Serious complication of bacterimic shock ? a

a. causes shock lung
b. decrease peripheral resistance
c. increase cardiac output
d. decrease cardiac output


127. Calcium channel blocker showing affinity to cerebral vessels ? a

a. nimodipine




128. chromosome associated with familial polyposis colon ? a

a. chromosome 5
b. chromosome 6
c. chromosome 11
d. chromosome 13


129. which of the following is the cause of break of glomerular basement membrane sometimes and sub epithelial deposits in electron microscopy? c ( rapidly progressive is the answer )


a. membranous
b. focal glomerular sclerosis
c. rapidly progressive
d. minimal change


130. which of the following is not the branch of maxillary branch of internal carotid artery ? d
a. inferior alveolar
b. middle meningeal
c. anterior tympanic
d. posterior tympanic


131. which of the following is untrue about calcium homeostastis in chronic renal failure ? b

a. secondary hyperparathryoidism
b. primary hyperparathyroidism
c. multiple myeloma


132. what is column of bertini in kidney ? b

a. renal tumour
b. anatomical description given ( tongue shape extension )


133. Skeletal muscle most sensitive to tubocurarine ? b

a. diaphragm
b. Extra ocular
c. muscles of jaw


134. which is not true about VVF ? amenorrhea seen in vvf b

a. amenorrhea
b. Hydronephrosis




135. which of the following leads to cyclical haematuria ? a

a. vesico uterine fistula



136. which is correct about this ? c

a. Sperm production is cyclical
b. Continous Gnrh secretion is essential
c. sertoli cells are important for mitotic and meiotic activity
d. secretion of testosterone from leydig cells depends upon FSH


137. What is the stage of ovarian cancer with b/l with capsule intact, no ascites ? b

a. IA
b. IB
c. IC
d. II


138. what is epicolic node ? b

a. node draining colon
b. adjacent to aorta


139. A boy draws triangle but not diamond shape age is ? c

a. 3 years
b. 4 years
c. 5 years
d. 6 years


140. which of the following is not included in Human developmental index ? a

a. Infant mortality rate
b. percapita income
c. life expectancy at birth
d. Education


141. Most common presentation of Meckels diverticulum ? a

a. Lower GI bleeding




142. Bulging fissure in lung is due to infection ? b ( Klebsiella)

a. Mycoplasma
b. Klebsiella


143. which deficiency is seen in alcoholic with dementia ? a

a. Thiamine


144. Which microorganism is responsible for classical presentation of hydrocephalus, chorio retinitis , intracerebral calcification ? a

a. Toxoplasmosis

b. Rubella



145. Which defect is not detected by amniocentesis ? b
a. cystic fibrosis
b. phenyl ketonuria
c. downs syndrome


146. what is the drug of choice of antiepilepsy in porphyria ? d ( as comment received )

a. phenytoin
b. phenobarbitone
c. valproate
d. Clonazepam

147. which type of porphyria is transmitted as Autosomal recessive ? c

a. AIP
b. PCT
c. congenital erythropoietic
d. variegate


148. what is aseptic autolysis called ? a

a. maceration
b. adipocere
c. mummification


149. what is the mechanism of abruption of svt by carotid massage ? b

a. decrease sympathetic discharge
b. increase parasympathetic discharge to SA node
c. increase parasympathetic discharge to conducting system from SA to AV node
d. ventricular depolarisation


150. which of the following cast has no significance ? a

a. Hyaline cast


151. what is the range of proteinuria is microalbuminuria ? a

a. 30 to 300mg / d


152. which semicircular canal is stimulated with cold water ? a

a. lateral scc
b. posterior scc
c. anterior scc
d.



153. which of the following is associated with renal stones ? b

a. tiagabine
b. zonasimide
c.
d.


154. In which of the following conditions acetazolamide is not used ? b

a. epilepsy
b. cirrhosis


155. Which of the following is not the presentation of Extrinsic allergic alveolitis ? a

a. Bronchial asthma and wheeze
b. B/l reticulo nodular shadows


156. Band shaped keratopathy seen in ? a

a. JRA


157. Which of the following is incorrect about dubin johnson syndrome ? a

a. alkaline phosphatase is elevated



158. Systolic murmur in TOF is due to ? b

a. VSD
b. pulm stenosis


159. which glycogen storage disease doesn't affect muscles ? a

a. type 1
b. type 2
c. type 3
d. type 4


160. Cholestasis is due to all except ? c

a. obesity
b. excessive haemolysis
c. high protein diet
d. pregnancy



161. which is the characteristic lesion of pregnancy ? d

a. vitiligo
b. pemphigus
c. tinea
d. chloasma


162. A person recently exposed to sex presents with painless granulomatous ulcer with everted edges ? a

a. primary chancre
b. chancroid
c. LGV
d. Donovanosis


163. which type of clostridium tetani has no flagella ? a ( not sure )

a. type 1
b. type 2
c. type 4
d. type 3




164. Specific congenital abnormality associated with DM ? a

a. caudal regression syndrome
b. VSD




165. Fibrates acts by reducing ? b ( VLDL according to K.D.Tripati )

a. chylomicrons
b. VLDL
c. LDL
d. HDL



166. shortest acting benzodiazipine ? a
a. midazolam
b. lorazepam


167. Severity of Aortic stenosis is determined by ? a

a. Late ejection systolic murmur
b.
c.
d.


168. mRNA codes for ? a

a. poly A
b. poly U
c. poly C
d. poly G



169. Which of the following has propensity to metastasize through lymph nodes ? a

a. alveolar rhabdomyosarcoma
b. osteosarcoma



170. which of the following is not poor prognosis factor in malnutrition ? a

a. dermatosis
b. hepatomegaly
c.
d.


171. Extended ESI benefit are all except ? d

a. news paper establishments
b. non power 18 employees
c. non power less than 18 employees
d. small power 10 to 18 employees



172. which of the following is not seen due to mutiple myeloma ? b

a. amyloidosis
b. pxoximal tube defect
c. light chains
d.

173. treatment of vault prolapse ? a

a. sacral colpoplexy


174. Not a contraindication for external cephalic version ? a

a. breech presentation



175. Not a leading cause of DIC in pregnancy ? c

a. eclampsia
b. abruptio placenta
c. Heart disease




176. Engaging diameter in brow presentation ? a


a. mentovertical


177 A blunt trauma to chest with Bp 80/50 pulse rate 100 /mt with jugular vein distention ? a


a. cardiac tamponade
b. pneumothorax



178. which of the follwoing doesn't change pH of stomach ? a

a. sucralfate
b. H2 blocker
c. omeprazole
d.


179. Toxicity associated with haemodialysis ? a

a. Aluminium
b. magnesium


180. what is rider walker coefficent ? a

a. Efficacy in comparision to phenol



181. which of the following doesn't cause diarrhoea ? b

a. diabetes
b. hypercalcemia
c.
d.



182. which is not true about otosclerosis ? b

a. conductive deafness
b. non progressive deafness
c. autosomal dominant
d. flouride is therapeutic



183. which of the following is not associated with fulminant hepatic failure ?

a. herpes simplex
b. paramyxovirus
c. infectious mononucleosis


184. oral hairy leukoplakia caused by ? a

a. Ebstein barr virus


185. Contact period of chlorination ? a


a. 1 hour
b. 30 minutes
c. 1 1/2 hour
d. 2 hours



186. Which of the following is not associated with vibrio cholera ? a


a. Haemolytic uraemic syndrome



187 which of the following is not absorbable suture ? d

a. catgut
b. polyamide
c. polygalactyl
d. polyester



188. Prognosis of breast carcinoma is best determined by ? b

a. oestrogen/progesterone receptors
b. Axillary lymph node status


189. Sudden painless vision loss in a patient with myopia ? a

a. Retinal detachment
b. Central retinal artery occlusion


190. Most common site of Tuberculosis of genital tract ? c

a. endometrium
b. ovary
c. fallopian tube



191. Which of the following conditions disappear spontaneously in first year of life ? d

a. port wine stain
b. capillary haemangioma
c. cavernous haemangioma
d. strawberry haemangioma



192. which of the following is true about prostate cancer screeing ? a

a. Digital screening along with PSA is additive






193. 193. Which of the following is associated with Normal anion gap metabolic acidosis ? a

a. cholera
b. Diabetic keto acidosis
c. starvation
d. vomitting


194. Gynaecomastia not seen in ?a

a. Myxedema
b. Thyrotoxicosis
c.
d




195. Discordant twin complication in multiple pregancy is due to ?


a. Twin Twin transfusion syndrome



196.Distressing Complication after modified radical mastectomy ? a
a. lymphedema
b. axillary vein thrombosis
c. seroma
d.


197. Hyperosmolar agents in glaucoma acts by ? a ( I think it is a repeat ) if vitreous volume reduction given as option then that will be correct.


a. Increasing aqueous outflow



198. Most common cause of death due to burns in early period is ? b

a. sepsis
b. Hypovolemic shock
c
d

199. Initial management of dacrocystitis is ? c


a. syringing
b. topical antibiotics
c. massaging
d.


200 Which of the following is not a anthropozoonosis ? c


a. Rabies
b. plague
c. dracunculosis
d.

i think i repeated one question , because there is another question which has to be included . and that is

201 - what is the most common cause of perinatal mortality ?

a- birth asphyxia
b- birth injury
c- intrauterine infections
d- congenital anamolies

i think the answer is a . but not sure so please do post in the comments with reference and let me know the correct answer .

64 - congenital dislocation of hip ( CDH )

Synonyms: CDH, Developmental dysplasia of the hip, DDH, dysplasia of the hip

Developmental dysplasia of the hip (DDH) was formerly referred to as congenital dislocation of hip. DDH is now the preferred term to reflect that DDH is an ongoing developmental process, which is variable in presentation and not always detectable at birth. Developmental dysplasia of the hip refers to a range of developmental hip disorders, from a hip that is mildly dysplastic, concentrically located, and stable, to one that is severely dysplastic and dislocated.1

There is a suggestion that the national screening programme in the UK, that has operated since 1969, has not resulted in any less operations for late disease.2 Even the use of ultrasound has failed to improve the situation.3 It may be that the use of more experienced clinicians in the screening programme, rather than very junior doctors, produces better results.4
Epidemiology

* The prevalence of developmental dysplasia of the hip varies with age and method of assessment. In unscreened populations the median prevalence of persistent and clinically diagnosed hip dysplasia is estimated to be 1·3 per 1,000 births.1
* The prevalence of neonatal clinical hip instability detected through the Ortolani and Barlow manoeuvres is higher, ranging from 1·6 to 28·5 per 1,000.1
* The left hip is dislocated more often than the right. This is thought to be due to the common position of the baby's left hip against the mother's sacrum, restricting movement.
* It is more common in cultures that use swaddling of babies, forcing the hips into extension and adduction.5

Risk factors

* There are racial differences. In the USA it is found that native Americans and Laplanders have a high incidence whilst Chinese and African Americans have a low incidence.
* Positive family history of the condition increases the risk in a manner suggestive of multifactorial inheritance.6
* About 80 to 85% are female.
* About 60% of cases are first-born, compared with about 40% of all babies.
* Breech presentation increases the risk of DDH. The extended breech position in which knees are extended is a higher risk than with knees flexed. Elective caesarean section reduces the risk compared with vaginal breech delivery7 but it remains higher than after a cephalic presentation.
* Restriction of movement as with oligohydramnios increases the risk.
* It is commoner with neuromuscular disorders, such as cerebral palsy, meningomyelocele and arthrogryposis.

Examination

* The Ortolani and Barlow tests are the most common clinical tests for newborn babies.
* In the Ortolani test, the examiner applies forward pressure to each femoral head in turn, in an attempt to move a posteriorly dislocated femoral head forwards into the acetabulum. Palpable movement suggests that the hip is dislocated or subluxed, but reducible.
* In the Barlow test, backward pressure is applied to the head of each femur in turn, and a subluxable hip is suspected on the basis of palpable partial or complete displacement.8
* A clunk feels like turning a light switch on or off. A click is much lighter and probably of no significance.
* Some units insist that the neonatal test should be performed only by an experienced person, usually an orthopaedic surgeon or a paediatrician, and not repeated by others less skilled for fear that numerous tests, perhaps with a little more force than necessary, may encourage instability of the joints.
* An early sign is limitation of hip abduction.

Children between 1 and 2 months

* True dislocation has occurred and the Ortolani test is used.
* The thigh is flexed and abducted and the femoral head is lifted anteriorly into the acetabulum. Reduction will be felt as a clunk rather than heard as a click. This procedure is impossible after 2 months because soft tissue contractures develop.

3 to 6 months

* The physical signs are rather different and so are the requirements of examination.
* If the hip is dislocated it is in a fixed position.
* The Galeazzi sign:
o The child is examined lying supine with the hips and knees flexed.
o A positive sign is that one leg appears shorter than the other.
o This is usually due to dislocation of the hip but any discrepancy of limb length will produce a positive sign.
* Other physical signs for late dislocation include asymmetry of the gluteal thigh or labral skin folds, decreased abduction on the affected side, standing or walking with external rotation of the affected leg, and leg length inequality.

Bilateral dislocation of the hip

* Can be quite difficult to diagnose, especially after the neonatal period.
* There is often a waddling gait with hyperlordosis.
* The Galeazzi sign for hip shortening is often absent as are asymmetrical thigh and skin folds, or asymmetrically decreased abduction.
* Careful examination is needed with a high level of suspicion.

Investigations

* Dynamic ultrasound is used to assess hip stability and acetabular development in infants.
* It is the technique of choice and has even been suggested as a universal screening procedure.9
* In older children, x-rays of the pelvis are required.
* Arthrography, CT and MRI may also be needed.

Management

* Bracing is first-line treatment in children younger than six months. Surgery is an option for children in whom nonoperative treatment has failed and in children diagnosed after six months of age.10
* It is important to diagnose developmental dysplasia of the hip early to improve treatment results and to decrease the risk of complications.10
* However early detection and treatment does not entirely avoid the need for subsequent surgery, and surgery is needed by up to 5% of infants treated with abduction splinting.1
* The indications for the various procedures and the most effective management interventions remain controversial.

At birth

* It is usually sufficient to maintain the unstable hip in a position of flexion and abduction for one or two months.
* This keeps the femoral head in the correct position and allows time for the ligamentous structures to tighten as well as bones to grow normally.
* The Pavlik harness, Frejka splint and other orthoses are kept in place until the hip is clinically stable with normal ultrasound or X-ray measurements. Controversially, double or triple nappies are often used in newborns for 2 or 3 weeks until splints and harnesses will fit properly.

Between 1 and 6 months

* A true dislocation may have occurred, so the aim of treatment is to reduce the femoral head into the acetabulum.
* The Pavlik harness is used to put the hip in the normal position by flexing it at least 90° and preferably 100 to 110°, with relatively full but gentle abduction of 50 to 70°.
* Spontaneous reduction of the femoral head usually occurs within 3 or 4 weeks and the harness is continued until X-ray measurements are normal. This is usually 3 months for dislocation and 2 months for subluxation.11
* If this does not occur, closed surgical reduction is attempted with 1 to 3 weeks of preliminary skin traction to place the femoral head opposite the acetabulum, percutaneous adductor tenotomy, closed reduction and a hip spica cast.

Between 6 months and 2 years

* Surgical closed reduction may work but, if there is significant instability, an open reduction may be necessary.
* Open reduction is required for children above 2 years of age. A hip spica cast is worn for 6 weeks with a gradual return to full activities.
* Pelvic osteotomies and femoral shortening may be required.

Complications

* Surgery can result in a number of complications including re-dislocation, stiffness, blood loss and avascular necrosis of the capital femoral epiphysis (which occurs in 5 to 15% cases).
* Avascular necrosis of the capital femoral epiphysis is caused by compression of cartilage when reducing the femoral head under pressure, which may result in occlusion of intra-articular and extraosseous epiphyseal blood vessels causing infarction.
* Although it revascularises, there may be abnormal growth and development.
* Extreme abduction, especially combined with extension and internal rotation, results in a higher rate of avascular necrosis.