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Mnemonic for Causes of pancytopenia

Cytopenia is a reduction in the number of each type of peripheral blood cell. A reduction in all 3 types of cellular components in peripheral blood is termed pancytopenia and this involves anaemia, neutropenia, and thrombocytopenia.

"All my blood has taken some poison"

• Aplastic anemias
• Megaloblastic anemias
• Bone marrow infiltration
• Hypersplenism
• TB
• SLE
• Paroxysmal nocturnal hemoglobinuria

Initially, mild impairment in marrow function is inapparent and pancytopenia may become apparent only during times of stress or increased demand (e.g., bleeding or infection). More
severe degrees of cytopenias affect the peripheral blood count even in the steady state.

Severe pancytopenia is defined as follows :
i)Absolute neutrophil count < 500/mm3
ii)Platelet count < 20,000/mm3
iii) Corrected reticulocyte count < 1%

The peripheral smear shows pancytopenia with circulating blasts "High power"

Wound Healing Phases

A video showing the phases of normal wound healing

Illustrated photos of Milia

Definition of Milia :

Milia form as multiple, firm, white lesions that range from 1 to 4 mm in diameter. They are very common, benign, keratin-filled cysts.

Milia usually appear on the face and most commonly affect the eyelids, nose, and malar region, sometimes on the genitalia; It is formed at base of hair follicle or sweat gland.

Milia are commonly associated with newborn babies 40% of newborns, but can appear on people of all ages.


Other names: milk spot or an oil seed.Milium is the single of milia.

Types of Milia :

1- Primary or spontaneously.
2- secondary caused by trauma, radiotherapy, skin infection, or bullous diseases.

Treatment:

In children milia often disappear within two to four weeks.Options include simple excision, electrodessication of the surface, or puncture and expression of the contents

Techniques of Ossiculoplasty - Incus Transposition

Aftere elevating tympanomeatal flap, drilling of attic area was done. Remnant incus removed. With a diamond burr and acetabulum made in the body which accomodates head of stapes.
underlaying of the temporalis fascia graft done.

Non-healing ulcer of Basal cell carcinoma

A 60-year-old retired construction worker presents with a non-healing skin lesion on the back of his hand that occasionally bleeds when he gets out of the shower. The most likely diagnosis is

• A) basal cell carcinoma
• B) squamous cell carcinoma
• C) superficial spreading malignant melanoma
• D) actinic keratosis
• E) keratoacanthoma

The answer is A. (Basal cell carcinoma)

Basal cell carcinoma is the most common form of skin cancer. The lesions are induced by ultraviolet radiation in susceptible individuals. Risk factors include age older than 40, light complexion, positive family history, and male sex. The lesion in the photo has pearly, raised borders with telangiectasia and a central ulcer that may crust. Sun-exposed areas are most commonly affected. Diagnosis is achieved with shave or excisional biopsy.

Treatment is accomplished with excision, electrodessication and curettage, liquid nitrogen application, Moh's surgery, radiation treatment, and topical 5-fluorouracil cream. Almost 50% of patients with basal cell carcinoma will have another within 5 years.

Anatomy of spinal nerves exiting through the intervertebral foramina

The spinal cord is an extension of the brainstem (the lowest part of the brain), extending from the base of the skull down to the low back. Along its length, it gives off 31 pairs of spinal nerves, which branch to form the peripheral nerves of the neck, trunk, and extremities. The origins of the spinal nerves as they emerge from the spinal cord are called nerve roots.

This image shows a dissection of the cervical region, showing a posterior view of cervical spinal nerves exiting the intervertebral foramina on the right side.

The spinal nerves exit from the vertebral column through openings between adjacent vertebrae. These openings, called intervertebral foramina, are located just in front of the facet joints. The spinal nerves are named and numbered according to the vertebral levels at which they exit. There are eight paired cervical nerves (C1-C8), twelve thoracic (T1-T12), five lumbar (L1-L5), five sacral (S1-S5), and one coccygeal (Co1).

Note :

-There are eight pairs of cervical nerves, although there are only seven cervical vertebrae. The C1 nerves exit above the C1 vertebra (between C1 and the base of the skull).
-Although the spinal nerves correspond to their respective vertebral levels, the spinal cord itself is shorter than the vertebral column, extending only as far as the L1 vertebra. Below that level, the spinal canal contains only the roots of the lumbar, sacral, and coccygeal nerves, as they descend to exit at the appropriate levels. This bundle of descending nerve roots is called the cauda equina (Latin for "horse's tail").

The on the right views a portion of the spinal cord, showing its right lateral surface. The dura is opened and arranged to show the nerve roots.

Nerve Roots:—

Each nerve is attached to the medulla spinalis by two roots, an anterior = ventral, and a posterior = dorsal, the latter being characterized by the presence of a ganglion, the spinal ganglion.