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Medical negligence requires the plaintiff (i.e. the patient or relative if the patient has died) should establish the following 4Ds: Existence of the doctor’s Duty to the plaintiff based on existence of the doctor-patient relationship. Applicable standard of care and its violation (Dereliction of Duty). Direct causation (failure to exercise a duty of care must lead to damage) Damage (a compensable injury).
Richter Syndrome Transformation of CLL into an aggressive large B-cell lymphoma (seen in 3-10% of cases)Inactivation of TP53 and of CDKN2A is a main mechanism in the transformation to Richter syndromeManifests with weight loss, fevers, night sweats, muscle wasting, (i.e., B symptoms) and increasing hepatosplenomegaly and lymphadenopathy.Treatment remains challenging and prognosis poor
Carney’s triad: GIST, Pulmonary chondroma, and/or functioning extra-adrenal Paraganglioma. Associated with succinate dehydrogenase mutations Carney’s syndrome/complex: An autosomal dominant syndrome associated with spotty pigmentation of the skin, endocrinopathy, and endocrine and nonendocrine tumors, including the following:Myxomas of the skin,heart breast, and other sites Primary pigmented nodular adrenocortical disease Psammomatous melanotic schwannomas Growth hormone–producing pituitary adenomas Testicular Sertoli-cell tumors Tumors of the thyroid gland and ductal adenomas of the breast, as well as acromegaly due to somatomammotroph hyperplasia and adenomas not dependent on growth hormone–releasing hormone .
Mnemonic for Corneal Stromal Dystrophies The dystrophy- material deposited and staining method can be remembered by this mnemonic - "Marilyn Monroe Always Gets Her Men in L.A.City" !! Macular dystrophy - Mucopolysaccharide - Alcian blueGranular dystrophy - Hyaline materials - Masson trichromeLattice dystrophy - Amyloid - Congo red
Highlights of Fungal Keratitis Trauma by vegetative/plant matter; indiscriminate use of topical steroids Apergillus (MC in India); Fusarium; Candida Symptoms: Acute pain, redness, watering, decreased vision, photophobia - Less severe than bacterial keratitis - "More Signs less symptoms!!"Signs: Blepharospasm, lid edema, ciliary congestion O/E : Dry looking yellowish white lesion with feathery edges; satellite lesions seen, dense immobile hypopyon present which may NOT be sterile (since fungi can penetrate intact Descemet’s membrane); Perforation and vascularisation are rare Treatment: Antifungal drops and ointments )Itraconazole, anatmycin); Cycloplegics (Homatropine/Cyclopentalate/Atropine)
Dyes commonly used in tattooing are: Black color: India Ink (MC used); China Ink, Soot Blue: Prussian blue (ferric ferrocyanide); Cobalt, Indigo, Ultramarine Green: Chromic oxide Red: Cinnabar, vermillion Brown: Ochre Methods to make tattoo readily visible are: Infrared photography Ultraviolet light Rubbing the part and examining under magnifying glass Treating with hydrogen peroxide and 0.5% caustic potash Histological examination of regional lymph nodes may show tattoo pigment deposition.
Anatomical Snuff Box Boundaries Medial: tendons of the extensor pollicis longus Lateral: tendons of the Extensor pollicis brevisand more laterally abductor pollicis longus Floor scaphoid, trapezium bonestendons of the ECRL and ECRBbase of 1st metacarpal can be palpated distally and the radial styloid process can be palpated proximally Contents Radial arterySuperficial branch of the radial nerveCephalic vein (variable)
Assessment of adequacy is the first step in the evaluation of a thyroid fine needle aspiration (FNA) sample Adequate specimen should contain ≥ 6 groups of well visualized follicular cells (≥ 10 per cluster)A minimum number of follicular cells is not required for samples with cytologic atypia or if inflammation or abundant colloid are present
