COMPLETE QUES PAPER OF ALL INDIA PRE PG EXAN 2008

Discussion in 'NEET 2013 All india Exam' started by Kavish., Jan 13, 2008.

  1. Kavish.

    Kavish. Guest

    1which peptide antibiotic is an antitumor agent?
    a)valinomycin
    b)bleomycin ans
    c)dactinomycin


    Bleomycin is a glycopeptide antibiotic produced by the bacterium
    Streptomyces verticillus. Bleomycin refers to a family of structurally
    related compounds. When used as an anti-cancer agent, the
    chemotherapeutical forms are primarily bleomycin A2 and B2. Bleomycin
    A2 is shown in the image. The drug is used in the treatment of Hodgkin
    lymphoma (as a component of the ABVD regimen), squamous cell
    carcinomas, and testicular cancer, pleurodesis as well as plantar
    warts.



    Q2most common cause of maternal mortality in India is

    Haemorrhage ans
    abortion
    septicemia
    obstructed labour

    Q.3 MOST SENSITIVE TEST FOR ACUTE KNEE INJURY ?
    LACHMAN
    ANT DRAWER
    PIVOT

    ANTERIOR CRUCIATE LIGAMENT

    Introduction

    The incidence of ACL injuries has increased dramatically over the last
    2 decades. More than 200,000 new ACL injuries occur in the United
    States annually. These injuries are important because of the extent of
    disability associated with ACL tears.

    Normal ACL Torn ACL

    Approximately 50% of patients with ACL tears also have meniscal tears.
    The lateral meniscus is torn more frequently than the medial meniscus
    in acute ACL injuries, but in chronic ACL tears the medial meniscus is
    more commonly torn.

    Attempts to identify athletes at greatest risk for ACL injury have
    identified a few predisposing factors. Individuals with a narrow
    intercondylar notch of the femur appear to have a higher risk of
    non-contact ACL injuries. Women also appear to be more susceptible to
    non-contact ACL injuries compared to male counterparts. A two-fold
    increase in ACL injuries in women collegiate soccer players and a
    four-fold increase in basketball players. The cause of this gender
    difference is not clear.



    Knee instability secondary to anterior cruciate tears is the most
    common cause of long-term disability of the knee. The ACL is the
    primary restraint to hyperextension and anterior translation of the
    tibia on the femur. It also protects against excessive varus valgus
    stress and internal and external rotation as a seconary restraint. As
    a result of this wide range of function , a variety of injury
    mechanisms , most of which are non-contact in nature, may damage this
    ligament.

    History:

    Patients with acute ACL injuries commonly report giving way of the
    knee with stopping, cutting, or jumping. A pop, immediate pain and
    swelling within several hours usually occurs with ACL injuries.

    Physical Examination:

    The examination of the knee with an acute ACL injury is often
    difficult because the pain and swelling cause muscular guarding by the
    patient. . Early examination prior to the onset of the guarding is
    advantageous and comparison to the normal knee is mandatory.







    The Lachman test is the most accurate test for diagnosis of acute ACL tears.

    The Lachman test and the varus-valgus tests often are the only tests
    that can be reliably performed in an acute knee injury. A positive
    pivot shift is diagnostic for ACL tears but it can only be elicited in
    25% of acute ACL tears. Examination with a knee ligament arthrometer
    may be helpful in diagnosis of acute knee injuries, a side to side
    difference of 3 mm. or more is diagnostic of an ACL tear.
    Diagnostic Imaging

    Every knee suspected of ACL damage should be evaluated with plain
    X-rays. Osteochondral fracture can be visualized. The Segond's
    fracture , which is seen at the lateral edge of the tibia on an AP
    view, is diagnostic of an ACL tear.

    In the chronic setting , X-ray findings associated with anterior
    cruciate insufficiency include intercondylar spurring and
    intercondylar notch narrowing .

    MRI can be useful with diagnosis of ACL injuries when the clinical
    exam is limited because of pain and swelling. This test can also
    identify associated injuries to the menisci, articular cartilage or
    bone. The accuracy of MRI in determining acute ACL injury is
    approximately 90%.

    .4organism involved in crohn's disease?a)Mycobacterium avium
    subspecies paratuberculosis

    Mycobacterium avium subspecies paratuberculosis is a pathogenic
    bacteria in the genus Mycobacteria.[1] It is often abbreviated Map, M.
    paratuberculosis, or M. avium sub. paratuberculosis. The type strain
    is ATCC 19698 (equivalent to CIP 103963 or DSM 44133).[2]

    Contents [hide]
    1 Pathophysiology
    1.1 Crohn's disease
    2 Genome
    3 See also
    4 References



    [edit] Pathophysiology
    Map causes Johne's disease in cattle and other ruminants, and it has
    long been suspected as a causative agent in Crohn's disease in humans;
    this connection is controversial.[3]

    Recent studies have shown that Map present in milk can survive
    pasteurization, which has raised human health concerns due to the
    widespread nature of Map in modern dairy herds. Map is heat resistant
    and it is capable of sequestering itself inside white blood cells,
    which may contribute to its persistence in milk. It has also been
    reported to survive chlorination in municipal water supplies.

    Even though Map is hardy, it is slow growing and fastidious, which
    means it is difficult to culture. Many negative studies for Map
    presence in living tissue, food, and water have used culture methods
    to determine whether the bacteria is present. Due to recent advances
    in our knowledge of the bacterium, some or all of these studies may
    need to be re-evaluated on the basis of culture methodology.

    Map, like most mycobacteria, is difficult to treat. It is not
    susceptible to anti-tuberculosis drugs (which can generally kill
    Mycobacterium tuberculosis), but can only be treated with a
    combination of antibiotics such as Rifabutin and a macrolide such as
    Clarithromycin. Treatment regimes can last years.


    [edit] Crohn's disease
    MAP is recognized as a multi-host mycobacterial pathogen with a proven
    specific ability to initiate and maintain systemic infection and
    chronic inflammation of the intestine of a range of histopathological
    types in many animal species including primates.

    On the assumption that Map is a causative agent in Crohn's, the
    Australian biotechnology company Giaconda is seeking to commercialise
    a combination of Rifabutin, clarithromycin and clofazimine as a
    potential drug therapy for Crohn's. As of April 2007, Giaconda
    received United States FDA IND approval for this medication, now
    called Myoconda

    Q.5pollicization refers to?
    ans.thumb reconstruction


    Pollicization is a plastic surgery technique in which a thumb is
    created from an existing finger. Typically this consists of surgically
    migrating the index finger to the position of the thumb in patients
    who are either born without a functional thumb (most common) or in
    patients who have lost their thumb traumatically and are not amenable
    to other preferred methods of thumb reconstruction such as toe-to-hand
    transfers.

    During pollicization the index finger metacarpal bone is cut and the
    finger is rotated approximately 120 to 160 degrees and replaced at the
    base of the hand at the usual position of the thumb. The arteries and
    veins are left attached. If nerves and tendons are available from the
    previous thumb these are attached to provide sensation and movement to
    the new thumb ("neopollux"). If the thumb is congenitally absent other
    tendons from the migrated index finger may be shortened and rerouted
    to provide good movement.

    The presence of an opposable thumb is considered important for
    manipulation of most objects in the physical world. Children born
    without thumbs often adapt to the condition very well with few
    limitations therefore the decision to proceed with pollicization lies
    with the child's parents with the recommendation of their surgeon.
    Persons who have grown to adulthood with functional thumbs and then
    lost a thumb find it highly beneficial to have a thumb reconstruction,
    not only from a functional but from a mental and emotional standpoint.

    Retrieved from "http://en.wikipedia.org/wiki/Pollicization"



    .6radiosensitive phase of cell cycle?
    a)g2 m ans
    b)g1
    c)s


    Q7 ALL OF THE FOLLOWING ARE TRUE ABOUT V CHOLERA O 139 EXCEPT?

    SIMILAR TO EL TOR
    DISCOVERED IN CHENNAI
    PRODUCES O1 LIPOPOLYSACCHARIDE ans


    .cytogenetic abnormality in synovial sarcoma?
    ans: t(X;1 translocation ans

    Synovial sarcoma constitutes 8-10% of all sarcomas and most commonly
    affects adults in the third to fifth decades of life. This malignancy
    usually involves the extremities, especially the lower extremities
    around the knees. Synovial sarcoma is frequently misdiagnosed as a
    benign condition because of its often small size, slow growth, and
    well-defined appearance.1, 2

    Pathophysiology
    Gross specimens are usually well-demarcated, pink, fleshy masses with
    a heterogeneous appearance and may display solid, hemorrhagic, or
    cystic components on sectioning. Calcification foci are occasionally
    noted; heavy calcification tends to indicate less aggressive lesions
    and offers a more favorable prognosis.

    Synovial sarcoma is named for its resemblance to developing synovial
    tissue under light microscopy. It arises from the pluripotential
    mesenchymal cells near joint surfaces, tendons, tendon sheaths,
    juxta-articular membranes, and fascial aponeuroses. The histologic
    appearance is that of large polygonal cells (epithelioid) that secrete
    hyaluronic acid and show an organization that is suggestive of
    microscopic joint spaces. These cells are surrounded by spindle cells
    that simulate subsynovial mesenchymal cells.

    The typical morphology is that of 2 strikingly distinct,
    well-differentiated cell populations. Depending on which cell type
    predominates, the overall histologic appearances can be described as
    biphasic (epithelioid and spindle cell), monophasic spindle cell, or
    monophasic epithelioid. Marked cellular pleomorphism and atypia are
    uncommon, but when they are present, their appearance overlaps with
    that of a high-grade malignant fibrous histiocytoma and fibrosarcoma.

    Specific cytogenetic abnormalities have been identified. More than 90%
    of patients have a t(X;1 translocation mutation, which is not
    associated with other sarcomas. The translocation involves the SYT
    gene on chromosome 18 (at 18q11) and the SSX1 or SSX2 gene on the X
    chromosome (at Xp11).3, 4 These genes appear to be transcription
    regulators, whose functions occur primarily through protein-protein
    interactions. Subtypes of these translocations have been shown to
    correlate with distinct histologic subtypes.


    Frequency
    United States
    Synovial sarcoma is the fourth most commonly occurring sarcoma,1
    accounting for 8-10% of all sarcomas. Approximately 800 new cases of
    synovial sarcoma are diagnosed per year.

    Mortality/Morbidity

    Overall, survival rates are 36-76% at 5 years and 20-63% at 10 years.

    Synovial sarcoma of the head and neck region has a better prognosis
    than that of sarcoma involving the extremities, with 5-year survival
    rates of 47-82%.

    Sex
    Although different studies have cited a slight male or female
    predominance, a study including 672 cases at the Armed Forces
    Institute of Pathology (AFIP) demonstrated no significant sex or
    ethnic predilection for synovial sarcoma.1

    Age
    Synovial sarcoma can occur in patients with a wide age range, but it
    is most common in patients in the third to fifth decades of life. In a
    series of 121 cases, 83.6% of tumors occurred in patients aged 10-50
    years, with a median age of 31.3 years. Another large study included
    patients with ages ranging from 5 to 87 years.5

    Anatomy
    Synovial sarcoma is the most common sarcoma that involves the upper
    extremity, hip, groin, and buttocks in patients aged 16-25 years. In
    patients aged 6-45 years, synovial sarcoma is the most common sarcoma
    in the foot and ankle.

    Most synovial sarcomas are found within 5 cm of a joint. Despite the
    misnomer, only 10% of cases are intra-articular. The tumors are
    usually well circumscribed, but in unusual cases, they may
    interdigitate between muscles and tendons or encase neurovascular
    structures. Invasion of the adjacent bone is seen in 11-20% of
    patients, a feature that is uncommon in other sarcomas.

    The region around the knee is the most common site of involvement. In
    a large study, 73% of synovial sarcomas occurred in the lower limb;
    34% in the upper limb; and 16% in the chest/abdominal wall. Tumors
    that occur in the upper extremity tend to affect the distal extremity
    rather than the elbow or shoulder. Less common sites of involvement
    include the retroperitoneum, mediastinum, and head and neck regions.
    The most common site in the head and neck is the hypopharynx. Other
    head and neck locations include the cervical or parapharyngeal
    regions, masticator space, soft palate, tongue, suboccipital and
    infratemporal fossa regions, and sinonasal space.








    HMB-45
    An antibody to a premelanosome glycoprotein found to be present in
    melanomas and other tumors derived from melanocytes

    Corporo basal index is for sex (ref: reddy page 51)


    Q.joint b/n ear ossicles?

    ans:synovial

    REF:bdc p.223
    incudomalleolar jt. is saddle
    & incudostapedial jt. is ball & socket

    both are types of synovial joint

    Anal Fissures
    Clinical Presentation and Diagnostic Evaluations
    An anal fissure is a linear ulcer of the lower half of the anal canal,
    usually located in the posterior commissure in the midline ( Fig.
    49–10 ). Often
    misnamed as "rectal fissures," in fact, these lesions truly involve
    just the anal tissues and are typically best seen by visually
    inspecting the anal verge
    with gentle separation of the gluteal cleft. Location may vary, and an
    anterior midline fissure is seen more often in women, although most
    fissures in
    women and men reside in the posterior midline. Characteristic
    associated findings include a sentinel pile or tag externally and an
    enlarged anal papilla
    internally. Fissures away from these two locations should raise the
    possibility of associated diseases, especially Crohn's disease,
    hidradenitis
    suppurativa, or STDs. Because it involves the highly sensitive
    squamous epithelium, fissure in ano is often a painful condition. With
    defecation, the ulcer is stretched,
    causing pain and mild bleeding.
    The diagnosis is secured by the typical history of pain and bleeding
    with defecation, especially if associated with prior constipation and
    confirmed by
    inspection after gently parting the posterior anus. Digital as well as
    proctoscopic examination may trigger severe pain, interfering with the
    ability to
    visualize the ulcer. An endoscopic examination should be performed,
    but it can be delayed 4 to 6 weeks, until the pain is resolved with
    medical
    management or until surgery is performed for those cases refractory to
    medical therapy.

    REGARDING DIFFUSE AXONAL INJURY ,WHICH OF THE FOLLWING IS CORRECT?
    A)Frontal and temporal white matter,caudate nuclei, thalamus are most
    commonly involved.
    B)
    C)...
    D??????

    Diffuse axonal injury (DAI) is a frequent result of traumatic
    deceleration injuries and a frequent cause of persistent vegetative
    state in patients. DAI is the most significant cause of morbidity in
    patients with traumatic brain injuries, which most commonly result
    from high-speed motor vehicle accidents.


    Typically, the process is diffuse and bilateral, involving the lobar
    white matter at the gray-white matter interface. The corpus callosum
    frequently is involved, as is the dorsolateral rostral brainstem. The
    most commonly involved area is the frontal and temporal white matter,
    followed by the posterior body and splenium of the corpus callosum, as
    well as the caudate nuclei, thalamus, tegmentum, and internal capsule.
    Internal capsule lesions are associated more frequently with
    hemorrhage than are the other lesions and are secondary to the
    proximity of the lenticulostriate vessels.

    The following stages of involvement have been described by Adams and
    colleagues according to the anatomic location of the lesions4:

    * Stage I - This involves the parasagittal regions of the frontal
    lobes, the periventricular temporal lobes, and, less likely, the
    parietal and occipital lobes, internal and external capsules, and
    cerebellum.
    *
    * Stage II - This involves the corpus callosum in addition to the
    white-matter areas of stage I. Stage II is observed in approximately
    20% of patients. Most commonly, the posterior body and splenium are
    involved; however, the process is believed to advance anteriorly with
    increasing severity of disease. Both sides of the corpus callosum may
    be involved; however, involvement more frequently is unilateral and
    may be hemorrhagic. The involvement of the corpus callosum carries a
    poorer prognosis.
    *
    * Stage III - This involves the areas associated with stage II, with
    the addition of brainstem involvement. A predilection exists for the
    superior cerebellar peduncles, medial lemnisci, and corticospinal
    tracts.

    there was a repeat question about a neonate presenting with non
    passage of meconium, abd distension and vomiting for 48 hrs.
    investigation of choice will be
    a. trypsinogen assay
    b. gene testing for cystic fibrosis
    c. rectal manometry
    d. lower gastrointestinal tract contrast studies

    do not remember the EXACT stem and options but pls read the text below
    which is taken from SABISTON SURGERY 17th edition

    Meconium Plug
    Meconium plug syndrome is a frequent cause of neonatal intestinal
    obstruction and associated with multiple conditions including
    Hirschsprung's
    disease, maternal diabetes, hypothyroidism, and CF. Although most
    children with meconium plug syndrome are normal, further studies to
    exclude
    Hirschsprung's disease and CF are warranted. Typically, affected
    infants are often preterm and present with signs and symptoms of
    distal intestinal
    obstruction. Abdominal distention is a prominent feature. Plain
    abdominal radiographs reveal multiple dilated loops of intestine. The
    diagnostic and
    therapeutic procedure of choice is a water-soluble contrast enema.
    This often results in the passage of a plug of meconium and relief of
    the obstruction.

    Facial colliculus - LEVEL OF PONS

    Answers to these pls
    Final common pathway 3rd, 4th, 6th cranial nerves - VESTIBULAR NUCLEUS?

    Somatic afferent
    3rd/ 4th/ 6th/ 7th cranial nerves


    Q.what supplementation is required in pregnant females taking heparin?
    a)folic acid
    b)calcium ANS
    c)zn



    REF:http://cmbi.bjmu.edu.cn/uptodate/Va...egnant women with prosthetic heart valves.htm

    Heparin — Heparin is a large molecule that does not cross the
    placenta. Thus, it does not carry the same risk of teratogenicity as
    warfarin. However, heparin does cause bone loss, and there are many
    case reports and series of pregnant women with osteoporotic fractures
    during and after prolonged use of heparin [14]. One of the largest
    studies followed 184 pregnant women who were given heparin:
    osteoporotic vertebral fractures were found in four (2.2 percent)
    [15]. Although the incidence of fractures was not very high, they
    occurred in a population of young women in whom osteoporotic fractures
    are extremely rare.

    Other series have confirmed that chronic heparin therapy increases the
    rate of bone loss and reduces bone mineral density (BMD) in many
    patients [16,17,18]. One study, for example, monitored hip bone
    density in 14 pregnant women requiring heparin and in 14 matched
    pregnant controls [18]. Mean hip BMD fell by about 5 percent in the
    women treated with heparin (p<0.01), while there was no significant
    change in pregnant controls. More than a 10 percent reduction in hip
    BMD occurred in 5 of the 14 women taking heparin (36 percent) versus
    none of the pregnant controls. Similar results were reported in
    another controlled study which examined the effect of heparin on
    forearm BMD [17].

    Recovery of BMD occurs postpartum after the heparin is discontinued
    [16,17,18]. It is unclear, however, if the recovery is complete. We
    recommend calcium supplementation (1.2 g/day) during pregnancy and
    postpartum for women taking heparin to insure that the RDA is
    achieved.

    .Somatic efferent includes all except?
    3n.
    4n.
    6n.
    7n. ans.

    REF:The somatic efferent neurons (GSE, 'somatomotor, or somatic motor
    fibers), arise from motor neuron cell bodies in the ventral horns of
    the gray matter within the spinal cord. They exit the spinal cord
    through the ventral roots, carrying motor impulses to skeletal muscle.

    Of the somatic efferent neurons, there exist subtypes.

    Alpha motor neurons (α) target extrafusal muscle fibers.
    Gamma motor neurons (γ) target intrafusal muscle fibres.
    Examples of nerves that contain GSE fibers include the oculomotor
    nerve, the trochlear nerve, the abducens nerve, and the hypoglossal
    nerve. [1]


    Q.Meniscus can be repaired if injuryis at?
    a)outer1/3 ans
    b)middle1/3
    c)inner1/3

    REF:


    The meniscus is a C-shaped piece of fibrocartilage which is located at
    the peripheral aspect of the joint. There are two meniscii in each
    knee, the medial meniscus, and the lateral meniscus. The majority of
    the meniscus has no blood supply. For that reason, when damaged, the
    meniscus is usually unable to undergo the normal healing process that
    occurs in most of rest of the body. In addition, with age, the
    meniscus begins to deteriorate, often developing degenerative tears.
    Typically, when the meniscus is damaged, the torn piece begins to move
    in an abnormal fashion inside the joint. Because the space between the
    bones of the joint is very small, as the abnormally mobile piece of
    meniscal tissue moves, it may become caught between the bones of the
    joint (femur and tibia). When this happens, the knee becomes painful,
    swollen, and difficult to move.

    Usually this situation requires that the torn piece be removed.
    However, sometimes, the meniscus tear is along the peripheral (outer)
    aspect of the tissue.


    Diffuse axonal injury (DAI) is a frequent result of traumatic
    deceleration injuries and a frequent cause of persistent vegetative
    state in patients. DAI is the most significant cause of morbidity in
    patients with traumatic brain injuries, which most commonly result
    from high-speed motor vehicle accidents.

    DAI is a significant medical problem because of the high level of
    debilitation that is suffered by the patient, the stress that must be
    endured by the patient's family when the patient is in a persistent
    vegetative state, and the staggering medical cost of sustaining the
    patient in this state. DAI typically consists of several focal
    white-matter lesions measuring 1-15 mm in a characteristic
    distribution (see below).


    Pathophysiology
    The pathophysiology of DAI first was described by Holbourn in 1943,
    using 2-dimensional gelatin molds.1 His work led to the understanding
    that shear injury is not induced by linear or translational forces but
    rather by rotational forces. Sudden acceleration-deceleration impact
    can produce rotational forces that affect the brain. The injury to
    tissue is the greatest in those areas where the density difference is
    the greatest. For this reason, approximately two thirds of DAI lesions
    occur at the gray-white matter junction.

    When shearing forces occur in areas of greater density differential,
    the axons suffer trauma; this results in edema and in axoplasmic
    leakage (which is most severe during the first 2 weeks following
    injury). The exact location of the shear-strain injury depends on the
    plane of rotation and is independent of the distance from the center
    of rotation. Conversely, the magnitude of injury depends on the
    following 3 factors:

    The distance from the center of rotation

    The arc of rotation

    The duration and intensity of the force
    The true extent of axonal injury typically is worse than that
    visualized using current imaging techniques. On the microscopic level,
    the axon may not be completely torn by the initial force, but the
    trauma still can produce focal alteration of the axoplasmic membrane,
    resulting in impairment of axoplasmic transport. This would lead to
    axoplasmic swelling, with the axon subsequently splitting into 2
    pieces and a retraction ball—a pathologic hallmark of shearing
    injury—forming. The axon would then undergo wallerian degeneration.
    Dendritic restructuring might occur, with some regeneration possible
    in mild to moderate injury.

    Within the basal ganglia, the effect of DAI produces parenchymal
    atrophy brought on by shrinkage of astrocytes in the lateral and
    ventral nuclei, with sparing of the anterior and dorsomedial nuclei,
    the pulvinar, the centromedian nuclei, and the lateral geniculate
    bodies. Cholinergic neurons have been found to be slightly more
    susceptible to trauma than are neurons belonging to other
    neurotransmitters. Peripheral lesions usually are smaller than central
    lesions. The lesions typically are ovoid or elliptical, with the long
    axis parallel to the direction of the involved axonal tracts. A high
    association is seen between thalamic injury and DAI.

    Both silver staining and beta-amyloid precursor protein
    immunohistochemical staining have proven useful in the pathologic
    identification of DAI lesions.

    DAI was classically believed to represent a primary injury (occurring
    at the instant that the trauma occurred). It has become apparent,
    however, that the axoplasmic membrane alteration, transport
    impairment, and retraction ball formation may represent secondary (or
    delayed) components of the disease process.


    Frequency
    United States
    DAI represents approximately one half of all intra-axial traumatic lesions.

    Mortality/Morbidity
    DAI rarely results in death. As many as 90% of patients remain in a
    persistent vegetative state.

    Race
    No racial predilection exists.

    Sex
    No sex predilection exists.

    Age
    DAI can occur at any age. Some studies suggest that DAI may occur in
    utero if a pregnant woman is subjected to sufficient force.

    Anatomy
    Typically, the process is diffuse and bilateral, involving the lobar
    white matter at the gray-white matter interface. The corpus callosum
    frequently is involved, as is the dorsolateral rostral brainstem. The
    most commonly involved area is the frontal and temporal white matter,
    followed by the posterior body and splenium of the corpus callosum, as
    well as the caudate nuclei, thalamus, tegmentum, and internal capsule.
    Internal capsule lesions are associated more frequently with
    hemorrhage than are the other lesions and are secondary to the
    proximity of the lenticulostriate vessels.

    The following stages of involvement have been described by Adams and
    colleagues according to the anatomic location of the lesions4:

    Stage I - This involves the parasagittal regions of the frontal lobes,
    the periventricular temporal lobes, and, less likely, the parietal and
    occipital lobes, internal and external capsules, and cerebellum.

    Stage II - This involves the corpus callosum in addition to the
    white-matter areas of stage I. Stage II is observed in approximately
    20% of patients. Most commonly, the posterior body and splenium are
    involved; however, the process is believed to advance anteriorly with
    increasing severity of disease. Both sides of the corpus callosum may
    be involved; however, involvement more frequently is unilateral and
    may be hemorrhagic. The involvement of the corpus callosum carries a
    poorer prognosis.

    Stage III - This involves the areas associated with stage II, with the
    addition of brainstem involvement. A predilection exists for the
    superior cerebellar peduncles, medial lemnisci, and corticospinal
    tracts.

    Clinical Details
    Classically, DAI has been considered a primary-type injury, with
    damage occurring at the time of the accident. Research has shown that
    another component of the injury comprises the secondary factors (or
    delayed component), since the axons are injured, secondary swelling
    occurs, and retraction bulbs form. Of patients with DAI, 80%
    demonstrate multiple areas of injury on computed tomography (CT)
    scans.

    The degree of microscopic injury usually is considered to be greater
    than that seen on diagnostic imaging, and the clinical findings
    reflect this point. DAI is suggested in any patient who demonstrates
    clinical symptoms disproportionate to his or her CT-scan findings. DAI
    results in instantaneous loss of consciousness, and most patients
    (>90%) remain in a persistent vegetative state, since brainstem
    function typically remains unaffected. DAI rarely causes death.

    Compared with patients who have an epidural hematoma, patients with
    DAI are less likely to have a lucid interval. There is little
    association between DAI and the presence of skull fractures; in
    addition, the existence of DAI has no bearing on whether a
    subarachnoid or subdural hemorrhage is present.

    The chance that a patient will remain in a persistent vegetative state
    is greater when lesions are observed in the supratentorial white
    matter, corpus callosum, and corona radiata. The prognosis also
    worsens as the number of lesions increases. For the almost 10% of
    patients who experience a return to any form of normal function, this
    improvement will be seen within the first year. DAI lesions can result
    in deficits in information transfer between the 2 sides of the corpus
    callosum, commonly resulting in auditory deficits.

    nigro protocol for treatment of epidermoid carcinoma anal ca Anal
    Canal Neoplasms
    Epidermoid Carcinoma
    Tumors arising in the anal canal or in the transitional zone that have
    a squamous, basaloid, cloacogenic, or mucoepidermoid epithelium share
    a similar
    behavior in clinical
    presentation, response to treatment, and prognosis and are considered
    collectively. They typically present as a mass, sometimes with
    bleeding and
    pruritus . At the time of diagnosis, nearly one fourth of these are
    superficial or in situ; half are less than 3 cm in size, and the other
    half are
    larger. About 71% have deep tumor penetration; 25% are node positive,
    and 6% present with distant metastases.


    In the past, treatment modalities have included either surgery alone
    or radiation therapy alone. Patients with tumors confined to
    epithelial or
    subepithelial tissue have been treated by local excision and patients
    with more advanced lesions by APR. The introduction of multimodality
    therapy
    combining irradiation and chemotherapy promised to preserve
    continence, avoid colostomy, and offer similar survival advantage. In
    keeping with this
    concept, local excision alone remains an option for superficial,
    early-stage lesions, which have been associated with variable
    survivorship (61% to 87%;
    100% in at least one study if the lesion was smaller than 2 cm.
    Although some small superficial lesions can be treated with local
    excision, most
    patients are best treated with combined chemotherapy and irradiation.


    Combined-modality therapy has evolved as the preferred alternative to
    radical surgery because, in theory, surgical mortality and morbidity
    are largely
    avoided, intestinal continuity is preserved, and survival compares
    favorably with that after surgery. Nigro and colleagues[77] were the
    first to promote
    radiation therapy plus chemotherapy as definitive treatment for
    epidermoid anal canal malignancies. The current "Nigro protocol"
    includes externalbeam
    radiation therapy to the pelvic tumor and pelvic and inguinal nodes,
    to a total dose of 3000 cGy starting on day 1 using 15 fractions (200
    cGy/day).[77] Systemic chemotherapy includes 5-fluorouracil (5-FU),
    1000 mg/m2 for 24 hours as continuous infusion for 4 days, commencing
    on day 1
    and again on day 28 (two cycles total). MitomycinC is delivered as an
    intravenous bolus at 15 mg/m2 starting on day 1 only. Many
    institutions have modified the pelvic radiation doses, approximating
    the
    doses typically delivered in rectal cancer. Although some reports have
    described comparable results using radiation therapy alone, current
    studies
    support the continued use of 5-FU and mitomycin C.[80] Although
    radiation plus chemotherapy has largely replaced the need for APR in
    anal canal
    cancers, there remain subsets of patients in whom abdominoperineal
    resection may be considered appropriate as either single-modality or
    combinedmodality
    therapy. Such groups would include patients who are already in need of
    a stoma for fecal incontinence, those for whom chemotherapy or
    radiation therapy is contraindicated, and those whose disease fails to
    resolve completely after radiation therapy plus chemotherapy


    SABISTONS TEXTBOOK OF SURGERY 17th edition

    Prions are infectious protinaceous particles


    Extrahepatic biliary obstruction has been seen with various parasitic
    infections such as
    Strongyloides,
    Ascaris, and liver flukes
    such as Clonorchis sinensis
    and Fasciola hepatica.

    what abt diploic veins a/e?a:valveless....b:thin wal........c:present
    in cranial bones.....d:develop at 8th week of gestation

    Diploic veins are valveless & are present in cranial bones 4 sure

    ans cud most probably be d:develop at 8th week of gestation

    The sigmoid sinuses, which pass through the jugular foramen and empty
    into the jugular veins, are the primary routes for venous drainage of
    the brain. However, human brains, unlike other mammals, also use
    accessory veins called emissary veins which pass though emissary
    foramen in the base of the skull and empty into the vertebral venous
    plexus inside the spinal canal. The vertebral venous plexus is an
    extensive system with a very large capacity and, unlike the veins in
    the rest of the body, the veins of the vertebral venous plexus have no
    valves. Similarly, the emissary veins, diploic veins, and craniofacial
    veins, as well as the dural sinuses, have no valves and are all
    interconnected to form on large valveless venous network. Since the
    basicranium contains the primary outlets for both venous drainage
    routes of the brain, it seem logical that changes in craniocervical
    relationships may affect these drainage ports. In addition, stenosis
    of the neural canal may compress the spinal veins.












    Q.1which peptide antibiotic is an antitumor agent?
    a)valinomycin
    b)bleomycin
    c)dactinomycin


    Bleomycin is a glycopeptide antibiotic produced by the bacterium Streptomyces verticillus. Bleomycin refers to a family of structurally related compounds. When used as an anti-cancer agent, the chemotherapeutical forms are primarily bleomycin A2 and B2. Bleomycin A2 is shown in the image. The drug is used in the treatment of Hodgkin lymphoma (as a component of the ABVD regimen), squamous cell carcinomas, and testicular cancer, pleurodesis as well as plantar warts.


    Q.waterline in iceberg represents demarcation b/n?
    1 sypmtomatic and asymptomatic
    2 dignosed and undiagnosed
    3 apparent & inapperent disease
    4 case & carriers

    REF:park 18ed/p.35



    .community health center is?a)first referral unit
    b)2nd r.u.
    c)3rd r.u

    REF:park/18ed/p.28

    Q.about Gomez classification all are true except?
    a)based on height
    b)normal is 50thcentile of Boston standards
    c)72% represents 2nd degree malnutrition
    d)has prognostic value for hospitalized childrens

    REF:It is based on weight retardation & not on height(park)



    Q.Anti-fungals are ALL EX

    a)Ciclopirox
    b)ketoconazole
    c)Undecyclenic acid
    d)Clofasamine

    ref:goodman gillman


    .wrong statement is
    A)india is signatore to 1978 alma ata declaration
    b)health is a central gov. responsibility

    REF:p/18ed/21 it is a state responsibility



    .Aortic Arch on Right seen in ?

    Corrected TGA
    Truncus arteriosus
    TOF

    Q.Coronary ligament of knee, is situated ?-
    a)Between two anterior attachment of meniscus
    b)Between two posterior attachment of meniscus
    c)b/n meniscus & tibia
    d)b/n meniscus & femur

    REF:BDC

    Q.Corporo basal index used for ?

    stature / sex / age / race

    Q.Dementia precox term coined by?
    Schneider
    Bleuler
    krapelin
    freud

    REF:ahuja 5thed/p.55












    Q2most common cause of maternal mortality in India is

    Haemorrhage ans
    abortion
    septicemia
    obstructed labour

    Q.3 MOST SENSITIVE TEST FOR ACUTE KNEE INJURY ?
    LACHMAN ans
    ANT DRAWER
    PIVOT

    ANTERIOR CRUCIATE LIGAMENT

    Introduction

    The incidence of ACL injuries has increased dramatically over the last 2 decades. More than 200,000 new ACL injuries occur in the United States annually. These injuries are important because of the extent of disability associated with ACL tears.

    Normal ACL Torn ACL

    Approximately 50% of patients with ACL tears also have meniscal tears. The lateral meniscus is torn more frequently than the medial meniscus in acute ACL injuries, but in chronic ACL tears the medial meniscus is more commonly torn.

    Attempts to identify athletes at greatest risk for ACL injury have identified a few predisposing factors. Individuals with a narrow intercondylar notch of the femur appear to have a higher risk of non-contact ACL injuries. Women also appear to be more susceptible to non-contact ACL injuries compared to male counterparts. A two-fold increase in ACL injuries in women collegiate soccer players and a four-fold increase in basketball players. The cause of this gender difference is not clear.



    Knee instability secondary to anterior cruciate tears is the most common cause of long-term disability of the knee. The ACL is the primary restraint to hyperextension and anterior translation of the tibia on the femur. It also protects against excessive varus valgus stress and internal and external rotation as a seconary restraint. As a result of this wide range of function , a variety of injury mechanisms , most of which are non-contact in nature, may damage this ligament.

    History:

    Patients with acute ACL injuries commonly report giving way of the knee with stopping, cutting, or jumping. A pop, immediate pain and swelling within several hours usually occurs with ACL injuries.

    Physical Examination:

    The examination of the knee with an acute ACL injury is often difficult because the pain and swelling cause muscular guarding by the patient. . Early examination prior to the onset of the guarding is advantageous and comparison to the normal knee is mandatory.







    The Lachman test is the most accurate test for diagnosis of acute ACL tears.

    The Lachman test and the varus-valgus tests often are the only tests that can be reliably performed in an acute knee injury. A positive pivot shift is diagnostic for ACL tears but it can only be elicited in 25% of acute ACL tears. Examination with a knee ligament arthrometer may be helpful in diagnosis of acute knee injuries, a side to side difference of 3 mm. or more is diagnostic of an ACL tear.
    Diagnostic Imaging

    Every knee suspected of ACL damage should be evaluated with plain X-rays. Osteochondral fracture can be visualized. The Segond’s fracture , which is seen at the lateral edge of the tibia on an AP view, is diagnostic of an ACL tear.

    In the chronic setting , X-ray findings associated with anterior cruciate insufficiency include intercondylar spurring and intercondylar notch narrowing .

    MRI can be useful with diagnosis of ACL injuries when the clinical exam is limited because of pain and swelling. This test can also identify associated injuries to the menisci, articular cartilage or bone. The accuracy of MRI in determining acute ACL injury is approximately 90%.
    -

    Q.4 organism involved in crohn's disease?a)Mycobacterium avium subspecies paratuberculosis

    Mycobacterium avium subspecies paratuberculosis is a pathogenic bacteria in the genus Mycobacteria.[1] It is often abbreviated Map, M. paratuberculosis, or M. avium sub. paratuberculosis. The type strain is ATCC 19698 (equivalent to CIP 103963 or DSM 44133).[2]

    Contents [hide]
    1 Pathophysiology
    1.1 Crohn's disease
    2 Genome
    3 See also
    4 References



    [edit] Pathophysiology
    Map causes Johne's disease in cattle and other ruminants, and it has long been suspected as a causative agent in Crohn's disease in humans; this connection is controversial.[3]

    Recent studies have shown that Map present in milk can survive pasteurization, which has raised human health concerns due to the widespread nature of Map in modern dairy herds. Map is heat resistant and it is capable of sequestering itself inside white blood cells, which may contribute to its persistence in milk. It has also been reported to survive chlorination in municipal water supplies.

    Even though Map is hardy, it is slow growing and fastidious, which means it is difficult to culture. Many negative studies for Map presence in living tissue, food, and water have used culture methods to determine whether the bacteria is present. Due to recent advances in our knowledge of the bacterium, some or all of these studies may need to be re-evaluated on the basis of culture methodology.

    Map, like most mycobacteria, is difficult to treat. It is not susceptible to anti-tuberculosis drugs (which can generally kill Mycobacterium tuberculosis), but can only be treated with a combination of antibiotics such as Rifabutin and a macrolide such as Clarithromycin. Treatment regimes can last years.


    Crohn's disease
    MAP is recognized as a multi-host mycobacterial pathogen with a proven specific ability to initiate and maintain systemic infection and chronic inflammation of the intestine of a range of histopathological types in many animal species including primates.

    On the assumption that Map is a causative agent in Crohn's, the Australian biotechnology company Giaconda is seeking to commercialise a combination of Rifabutin, clarithromycin and clofazimine as a potential drug therapy for Crohn's. As of April 2007, Giaconda received United States FDA IND approval for this medication, now called Myoconda

    Q.5pollicization refers to?
    ans.thumb reconstruction


    Pollicization is a plastic surgery technique in which a thumb is created from an existing finger. Typically this consists of surgically migrating the index finger to the position of the thumb in patients who are either born without a functional thumb (most common) or in patients who have lost their thumb traumatically and are not amenable to other preferred methods of thumb reconstruction such as toe-to-hand transfers.

    During pollicization the index finger metacarpal bone is cut and the finger is rotated approximately 120 to 160 degrees and replaced at the base of the hand at the usual position of the thumb. The arteries and veins are left attached. If nerves and tendons are available from the previous thumb these are attached to provide sensation and movement to the new thumb ("neopollux"). If the thumb is congenitally absent other tendons from the migrated index finger may be shortened and rerouted to provide good movement.

    The presence of an opposable thumb is considered important for manipulation of most objects in the physical world. Children born without thumbs often adapt to the condition very well with few limitations therefore the decision to proceed with pollicization lies with the child's parents with the recommendation of their surgeon. Persons who have grown to adulthood with functional thumbs and then lost a thumb find it highly beneficial to have a thumb reconstruction, not only from a functional but from a mental and emotional standpoint.

    Retrieved from "http://en.wikipedia.org/wiki/Pollicization"


    Q.6radiosensitive phase of cell cycle?
    a)g2 m
    b)g1
    c)s


    Q7 ALL OF THE FOLLOWING ARE TRUE ABOUT V CHOLERA O 139 EXCEPT?

    SIMILAR TO EL TOR
    DISCOVERED IN CHENNAI
    PRODUCES O1 LIPOPOLYSACCHARIDE

    Q.cytogenetic abnormality in synovial sarcoma?
    ans: t(X;1 translocation

    Synovial sarcoma constitutes 8-10% of all sarcomas and most commonly affects adults in the third to fifth decades of life. This malignancy usually involves the extremities, especially the lower extremities around the knees. Synovial sarcoma is frequently misdiagnosed as a benign condition because of its often small size, slow growth, and well-defined appearance.1, 2

    Pathophysiology
    Gross specimens are usually well-demarcated, pink, fleshy masses with a heterogeneous appearance and may display solid, hemorrhagic, or cystic components on sectioning. Calcification foci are occasionally noted; heavy calcification tends to indicate less aggressive lesions and offers a more favorable prognosis.

    Synovial sarcoma is named for its resemblance to developing synovial tissue under light microscopy. It arises from the pluripotential mesenchymal cells near joint surfaces, tendons, tendon sheaths, juxta-articular membranes, and fascial aponeuroses. The histologic appearance is that of large polygonal cells (epithelioid) that secrete hyaluronic acid and show an organization that is suggestive of microscopic joint spaces. These cells are surrounded by spindle cells that simulate subsynovial mesenchymal cells.

    The typical morphology is that of 2 strikingly distinct, well-differentiated cell populations. Depending on which cell type predominates, the overall histologic appearances can be described as biphasic (epithelioid and spindle cell), monophasic spindle cell, or monophasic epithelioid. Marked cellular pleomorphism and atypia are uncommon, but when they are present, their appearance overlaps with that of a high-grade malignant fibrous histiocytoma and fibrosarcoma.

    Specific cytogenetic abnormalities have been identified. More than 90% of patients have a t(X;1 translocation mutation, which is not associated with other sarcomas. The translocation involves the SYT gene on chromosome 18 (at 18q11) and the SSX1 or SSX2 gene on the X chromosome (at Xp11).3, 4 These genes appear to be transcription regulators, whose functions occur primarily through protein-protein interactions. Subtypes of these translocations have been shown to correlate with distinct histologic subtypes.


    Frequency
    United States
    Synovial sarcoma is the fourth most commonly occurring sarcoma,1 accounting for 8-10% of all sarcomas. Approximately 800 new cases of synovial sarcoma are diagnosed per year.

    Mortality/Morbidity

    Overall, survival rates are 36-76% at 5 years and 20-63% at 10 years.

    Synovial sarcoma of the head and neck region has a better prognosis than that of sarcoma involving the extremities, with 5-year survival rates of 47-82%.

    Sex
    Although different studies have cited a slight male or female predominance, a study including 672 cases at the Armed Forces Institute of Pathology (AFIP) demonstrated no significant sex or ethnic predilection for synovial sarcoma.1

    Age
    Synovial sarcoma can occur in patients with a wide age range, but it is most common in patients in the third to fifth decades of life. In a series of 121 cases, 83.6% of tumors occurred in patients aged 10-50 years, with a median age of 31.3 years. Another large study included patients with ages ranging from 5 to 87 years.5

    Anatomy
    Synovial sarcoma is the most common sarcoma that involves the upper extremity, hip, groin, and buttocks in patients aged 16-25 years. In patients aged 6-45 years, synovial sarcoma is the most common sarcoma in the foot and ankle.

    Most synovial sarcomas are found within 5 cm of a joint. Despite the misnomer, only 10% of cases are intra-articular. The tumors are usually well circumscribed, but in unusual cases, they may interdigitate between muscles and tendons or encase neurovascular structures. Invasion of the adjacent bone is seen in 11-20% of patients, a feature that is uncommon in other sarcomas.

    The region around the knee is the most common site of involvement. In a large study, 73% of synovial sarcomas occurred in the lower limb; 34% in the upper limb; and 16% in the chest/abdominal wall. Tumors that occur in the upper extremity tend to affect the distal extremity rather than the elbow or shoulder. Less common sites of involvement include the retroperitoneum, mediastinum, and head and neck regions. The most common site in the head and neck is the hypopharynx. Other head and neck locations include the cervical or parapharyngeal regions, masticator space, soft palate, tongue, suboccipital and infratemporal fossa regions, and sinonasal space.

    .true about kawasaki disease?ans:
    Coronary aneurysms develop in up to 25% of patients with Kawasaki disease

    The acute presentation is described by fever, rash, conjunctival injection, cervical lymphadenitis, inflammation of the lips and oral cavity, and erythema and edema of the hands and feet. The subacute phase of the disease follows resolution of the acute presentation with desquamation of palms and soles. The most well known features present on angiography are aneurysms in the coronary arteries. Saccular and fusiform aneurysms usually develop during the subacute phase; however, later aneurysm formation is possible. Coronary aneurysms develop in up to 25% of patients with Kawasaki disease (8,9). Fifty percent of these aneurysms resolve within 2 years of the illness (. Although regressed, previous aneurysm sites may manifest later stenosis, thrombotic occlusion, and accelerated atherosclerosis (10).


    Q.best view for C1-C2 #?ans:Odontoid View


    - Discussion:
    - to evaluate C1 (Jefferson), Dens, superior facets of C2;
    - for evaluating dens fractures, body of C2, & rotary C1-C2 dislocations;
    - mach lines - teeth, C1 arch;
    - open mouth view, along w/ lateral view, will reveal fractures of the dens ;
    - atlantoaxial articulation & integrity of dens and body of C2 are best
    seen on the odontoid view;
    - this is most technically most difficult film to obtain as it requires
    patient to open his mouth as wide as possible;
    - lateral masses of C1 should align over the lateral masses of C2;
    - lateral displacement of masses of C1 w/ respect to C2 may indicate
    Jefferson or burst fracture of the Atlas;
    - combined lateral mass displacement > 7 mm suggests that transverse
    ligament is torn;
    - children:
    - overlapping lateral masses can be a normal variant in children and
    therefore this view may not allos assessment of whether frx is
    stable or unstable;

    - Normal Variants of Dens: (see dens frx)
    - dens may be completely absent, hypoplastic, or incompletely fused to
    body of C2 (lesion called Os Odontoideum)
    - Os Odontoideum is smaller than normal dens & is fixed to anterior
    ring of C1: 2 move as a unit;
    - subluxation and instability are common;

    - Assessment of RA Patient:
    - state of the odontoid peg and the lateral processes can be assessed
    by open mouth views, though disease of the tempomandibular joint
    can make this difficult;
    - concomitant vertical subluxation may conceal amount of anteroposterior
    movement at the atlantoaxial level because broader base of odontoid
    peg comes to lie opposite anterior arch of the Atlas;

    - Technique:
    - the patient is positioned as for the supine AP;
    - central beam directed perpendicular to the midpoint of the open mouth;
    - patient should softly say 'ah' to depress the tongue to the floor
    of mouth during exposure;



    .Ferruginous bodies seen in ?
    Silicosis / Asbestosis / Byssinosis / Bagassosis

    Ferruginous bodies are a histopathologic finding in patients with fibrotic lung diseases. They appear as small brown nodules in the septum of the alveolus. Ferruginous bodies are typically indicative of asbestos inhalation (when the presence of asbestos is verified they are called "asbestos bodies"). In this case they are fibers of asbestos coated with an iron-rich material derived from proteins such as ferritin and hemosiderin. [1] Ferruginous bodies are believed to be formed by macrophages that have phagocytized and attempted to digest the fibers.[/quote]













    Q.1which peptide antibiotic is an antitumor agent?
    a)valinomycin
    b)bleomycin
    c)dactinomycin


    Bleomycin is a glycopeptide antibiotic produced by the bacterium Streptomyces verticillus. Bleomycin refers to a family of structurally related compounds. When used as an anti-cancer agent, the chemotherapeutical forms are primarily bleomycin A2 and B2. Bleomycin A2 is shown in the image. The drug is used in the treatment of Hodgkin lymphoma (as a component of the ABVD regimen), squamous cell carcinomas, and testicular cancer, pleurodesis as well as plantar warts.


    Q.waterline in iceberg represents demarcation b/n?
    1 sypmtomatic and asymptomatic
    2 dignosed and undiagnosed
    3 apparent & inapperent disease
    4 case & carriers

    REF:park 18ed/p.35



    .community health center is?a)first referral unit
    b)2nd r.u.
    c)3rd r.u

    REF:park/18ed/p.28

    Q.about Gomez classification all are true except?
    a)based on height
    b)normal is 50thcentile of Boston standards
    c)72% represents 2nd degree malnutrition
    d)has prognostic value for hospitalized childrens

    REF:It is based on weight retardation & not on height(park)



    Q.Anti-fungals are ALL EX

    a)Ciclopirox
    b)ketoconazole
    c)Undecyclenic acid
    d)Clofasamine

    ref:goodman gillman


    .wrong statement is
    A)india is signatore to 1978 alma ata declaration
    b)health is a central gov. responsibility

    REF:p/18ed/21 it is a state responsibility



    .Aortic Arch on Right seen in ?

    Corrected TGA
    Truncus arteriosus
    TOF

    Q.Coronary ligament of knee, is situated ?-
    a)Between two anterior attachment of meniscus
    b)Between two posterior attachment of meniscus
    c)b/n meniscus & tibia
    d)b/n meniscus & femur

    REF:BDC

    Q.Corporo basal index used for ?

    rce/sex/stature
    Q.Dementia precox term coined by?
    Schneider
    Bleuler
    krapelin
    freud

    REF:ahuja 5thed/p.55












    Q2most common cause of maternal mortality in India is

    Haemorrhage
    abortion
    septicemia
    obstructed labour

    Q.3 MOST SENSITIVE TEST FOR ACUTE KNEE INJURY ?
    LACHMAN
    ANT DRAWER
    PIVOT

    ANTERIOR CRUCIATE LIGAMENT

    Introduction

    The incidence of ACL injuries has increased dramatically over the last 2 decades. More than 200,000 new ACL injuries occur in the United States annually. These injuries are important because of the extent of disability associated with ACL tears.

    Normal ACL Torn ACL

    Approximately 50% of patients with ACL tears also have meniscal tears. The lateral meniscus is torn more frequently than the medial meniscus in acute ACL injuries, but in chronic ACL tears the medial meniscus is more commonly torn.

    Attempts to identify athletes at greatest risk for ACL injury have identified a few predisposing factors. Individuals with a narrow intercondylar notch of the femur appear to have a higher risk of non-contact ACL injuries. Women also appear to be more susceptible to non-contact ACL injuries compared to male counterparts. A two-fold increase in ACL injuries in women collegiate soccer players and a four-fold increase in basketball players. The cause of this gender difference is not clear.



    Knee instability secondary to anterior cruciate tears is the most common cause of long-term disability of the knee. The ACL is the primary restraint to hyperextension and anterior translation of the tibia on the femur. It also protects against excessive varus valgus stress and internal and external rotation as a seconary restraint. As a result of this wide range of function , a variety of injury mechanisms , most of which are non-contact in nature, may damage this ligament.

    History:

    Patients with acute ACL injuries commonly report giving way of the knee with stopping, cutting, or jumping. A pop, immediate pain and swelling within several hours usually occurs with ACL injuries.

    Physical Examination:

    The examination of the knee with an acute ACL injury is often difficult because the pain and swelling cause muscular guarding by the patient. . Early examination prior to the onset of the guarding is advantageous and comparison to the normal knee is mandatory.







    The Lachman test is the most accurate test for diagnosis of acute ACL tears.

    The Lachman test and the varus-valgus tests often are the only tests that can be reliably performed in an acute knee injury. A positive pivot shift is diagnostic for ACL tears but it can only be elicited in 25% of acute ACL tears. Examination with a knee ligament arthrometer may be helpful in diagnosis of acute knee injuries, a side to side difference of 3 mm. or more is diagnostic of an ACL tear.
    Diagnostic Imaging

    Every knee suspected of ACL damage should be evaluated with plain X-rays. Osteochondral fracture can be visualized. The Segond’s fracture , which is seen at the lateral edge of the tibia on an AP view, is diagnostic of an ACL tear.

    In the chronic setting , X-ray findings associated with anterior cruciate insufficiency include intercondylar spurring and intercondylar notch narrowing .

    MRI can be useful with diagnosis of ACL injuries when the clinical exam is limited because of pain and swelling. This test can also identify associated injuries to the menisci, articular cartilage or bone. The accuracy of MRI in determining acute ACL injury is approximately 90%.
    -

    Q.4 organism involved in crohn's disease?a)Mycobacterium avium subspecies paratuberculosis

    Mycobacterium avium subspecies paratuberculosis is a pathogenic bacteria in the genus Mycobacteria.[1] It is often abbreviated Map, M. paratuberculosis, or M. avium sub. paratuberculosis. The type strain is ATCC 19698 (equivalent to CIP 103963 or DSM 44133).[2]

    Contents [hide]
    1 Pathophysiology
    1.1 Crohn's disease
    2 Genome
    3 See also
    4 References



    [edit] Pathophysiology
    Map causes Johne's disease in cattle and other ruminants, and it has long been suspected as a causative agent in Crohn's disease in humans; this connection is controversial.[3]

    Recent studies have shown that Map present in milk can survive pasteurization, which has raised human health concerns due to the widespread nature of Map in modern dairy herds. Map is heat resistant and it is capable of sequestering itself inside white blood cells, which may contribute to its persistence in milk. It has also been reported to survive chlorination in municipal water supplies.

    Even though Map is hardy, it is slow growing and fastidious, which means it is difficult to culture. Many negative studies for Map presence in living tissue, food, and water have used culture methods to determine whether the bacteria is present. Due to recent advances in our knowledge of the bacterium, some or all of these studies may need to be re-evaluated on the basis of culture methodology.

    Map, like most mycobacteria, is difficult to treat. It is not susceptible to anti-tuberculosis drugs (which can generally kill Mycobacterium tuberculosis), but can only be treated with a combination of antibiotics such as Rifabutin and a macrolide such as Clarithromycin. Treatment regimes can last years.


    Crohn's disease
    MAP is recognized as a multi-host mycobacterial pathogen with a proven specific ability to initiate and maintain systemic infection and chronic inflammation of the intestine of a range of histopathological types in many animal species including primates.

    On the assumption that Map is a causative agent in Crohn's, the Australian biotechnology company Giaconda is seeking to commercialise a combination of Rifabutin, clarithromycin and clofazimine as a potential drug therapy for Crohn's. As of April 2007, Giaconda received United States FDA IND approval for this medication, now called Myoconda

    Q.5pollicization refers to?
    ans.thumb reconstruction


    Pollicization is a plastic surgery technique in which a thumb is created from an existing finger. Typically this consists of surgically migrating the index finger to the position of the thumb in patients who are either born without a functional thumb (most common) or in patients who have lost their thumb traumatically and are not amenable to other preferred methods of thumb reconstruction such as toe-to-hand transfers.

    During pollicization the index finger metacarpal bone is cut and the finger is rotated approximately 120 to 160 degrees and replaced at the base of the hand at the usual position of the thumb. The arteries and veins are left attached. If nerves and tendons are available from the previous thumb these are attached to provide sensation and movement to the new thumb ("neopollux"). If the thumb is congenitally absent other tendons from the migrated index finger may be shortened and rerouted to provide good movement.

    The presence of an opposable thumb is considered important for manipulation of most objects in the physical world. Children born without thumbs often adapt to the condition very well with few limitations therefore the decision to proceed with pollicization lies with the child's parents with the recommendation of their surgeon. Persons who have grown to adulthood with functional thumbs and then lost a thumb find it highly beneficial to have a thumb reconstruction, not only from a functional but from a mental and emotional standpoint.

    Retrieved from "http://en.wikipedia.org/wiki/Pollicization"


    Q.6radiosensitive phase of cell cycle?
    a)g2 m
    b)g1
    c)s


    Q7 ALL OF THE FOLLOWING ARE TRUE ABOUT V CHOLERA O 139 EXCEPT?

    SIMILAR TO EL TOR
    DISCOVERED IN CHENNAI
    PRODUCES O1 LIPOPOLYSACCHARIDE

    Q.cytogenetic abnormality in synovial sarcoma?
    ans: t(X;18) translocation

    Synovial sarcoma constitutes 8-10% of all sarcomas and most commonly affects adults in the third to fifth decades of life. This malignancy usually involves the extremities, especially the lower extremities around the knees. Synovial sarcoma is frequently misdiagnosed as a benign condition because of its often small size, slow growth, and well-defined appearance.1, 2

    Pathophysiology
    Gross specimens are usually well-demarcated, pink, fleshy masses with a heterogeneous appearance and may display solid, hemorrhagic, or cystic components on sectioning. Calcification foci are occasionally noted; heavy calcification tends to indicate less aggressive lesions and offers a more favorable prognosis.

    Synovial sarcoma is named for its resemblance to developing synovial tissue under light microscopy. It arises from the pluripotential mesenchymal cells near joint surfaces, tendons, tendon sheaths, juxta-articular membranes, and fascial aponeuroses. The histologic appearance is that of large polygonal cells (epithelioid) that secrete hyaluronic acid and show an organization that is suggestive of microscopic joint spaces. These cells are surrounded by spindle cells that simulate subsynovial mesenchymal cells.

    The typical morphology is that of 2 strikingly distinct, well-differentiated cell populations. Depending on which cell type predominates, the overall histologic appearances can be described as biphasic (epithelioid and spindle cell), monophasic spindle cell, or monophasic epithelioid. Marked cellular pleomorphism and atypia are uncommon, but when they are present, their appearance overlaps with that of a high-grade malignant fibrous histiocytoma and fibrosarcoma.

    Specific cytogenetic abnormalities have been identified. More than 90% of patients have a t(X;18) translocation mutation, which is not associated with other sarcomas. The translocation involves the SYT gene on chromosome 18 (at 18q11) and the SSX1 or SSX2 gene on the X chromosome (at Xp11).3, 4 These genes appear to be transcription regulators, whose functions occur primarily through protein-protein interactions. Subtypes of these translocations have been shown to correlate with distinct histologic subtypes.


    Frequency
    United States
    Synovial sarcoma is the fourth most commonly occurring sarcoma,1 accounting for 8-10% of all sarcomas. Approximately 800 new cases of synovial sarcoma are diagnosed per year.

    Mortality/Morbidity

    Overall, survival rates are 36-76% at 5 years and 20-63% at 10 years.

    Synovial sar

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