Pupil and toxicology

Pupil and toxicology
===================

Dilated pupil:

-anticholinergic (e.g.  atropine, tricyclic antidepressant ) <BP will be lower>
-adrenergic (e.g. cocaine, amphetamine) <BP will be higher>

Constricted pupil:

-cholinergic (e.g. organophosphate poisoning) <antidote: atropine>
-opioids (e.g. morphine, heroin)  <antidote: naloxone>

Brain tumor headache

Characteristics of headache suggestive of brain tumor.
=========================================================

{summary

온 onset - at early morning or at night

듀 duration -  if duration of isolated headache  > 10 weeks - brain tumor unlikely.

로 location - may mimic migraine or tension headache

캐 "new" , "menigism" (아래참조)

프 precipitant - worse on exercise / valsalva (couhging / sneezing / bending over)

(래)

(리)

others:
"new"
-New - different (pattern) from previous headache
-New after age 50
-headache in children and elderly

-progressive

"like meningitis"
-with new neurologic signs (including seizure)
-with neck stiffness
-with fever
}


Though headache is a common symptom of brain tumor, it is infrequently seen in isolation. In the majority of cases, brain tumor

headache is associated with other neurologic symptoms such as seizures or focal weakness.

Isolated headache of more than 10 weeks duration is seldom caused by brain tumor.

The classic "brain tumor triad," comprising nocturnal or early morning occurrence, nausea/vomiting, and severe nature, has not

been borne out as a typical pattern in modern studies. In one series of 53 adults with brain tumor headache, this triad occurred in

only nine patients (17 percent).


Headache in brain tumor may mimic migraine and tension headache.
The headache related to brain tumor was described as similar to tension-type headache in 41 patients (77 percent), similar to

migraine (although with atypical features) in five patients (9 percent), and was unclassifiable in seven patients (13 percent).


Because of the variable nature of headache among patients with brain tumor, the diagnosis of headache attributed to brain tumor

should be considered in patients who complain of a headache with any of the following "red flags" [40]:

    Acute, new, usually severe headache or headache that has changed from previous patterns
    New headache onset in an adult, especially over 50 years of age
    Headache in the elderly or in children
    Headache on exertion, onset at night, or onset at early morning
    Headache that is progressive in nature
    Headache associated with fever or other systemic symptoms
    Headache with meningismus
    Headache with new neurologic signs
    Precipitation of head pain with the Valsalva maneuver (by coughing, sneezing, or bending over)


Reference:
- Brain tumor headache (UPTODATE) Christine L Lay, MD, FRCPC; Christina Sun, MD

Malaria

Malaria
===================

Symp/Sign:
-------------

(common)
Fever
(hemolysis:)
Pallor
Hepatosplenomegaly

(uncommon)
Jaundice
Anuria
Abdominal pain
Nausea vomiting
Arthralgia
Altered level of consciousness

{외우기 팁

Fever (당연)
Hemolysis.
Organs affected (Liver, spleen, kidney, brain)

혈색소가 파괴된다
- 어디에서 파괴되니? - spleen -> hepatosplenomegaly
- 혈색소 부족 -> pallor
- 혈색소는 어떻게 됬니? ->  jaundice 발생
옆에있던 kidney failure -> anuria
liver 가 megaly 라 아픔 -> abdominal pain
abdo pain 이니까 -> nausea vomiting.
}


Dx:
-------------
Blood smear / Giemsa-stain

Detection of parasite antigen or enzymes

Sickle cell anemia

Sickle cell anemia
==================

Symp/Sign:
------------
Vaso-occlusive pain: (of chest, abdo,  bone(avascular necrosis esp. femeur head) )
Dactylitis (sausage fingers), swollen dorsa of hands and feet

Fever
Pallor
Jaundice
Splenomegaly
Pneumonia-like sydnrome

Tachycardia
Tachypnoea

Dx:
--------------
DNA analysis
Electrophoresis
Peripheral smear
etc..

Rx:
--------------
Vaso-occlusive crisis:

(1st)
Analgesic
Oxygen

(adjunct)
Transfusion
Antibiotics
Hydration

Chronic

(adjunct)
Hydroxyurea (dec painful crisis)