Finasteride 적응증의 모순

남성형 탈모의 치료에 사용되는 약 중 하나:
 finasteride

다낭난소증후군에서 다모증(hirsutism)의 치료로 사용되는 약물 중 하나:
 finasteride

다모와 탈모를 한방에~
FINASTERIDE !!

When to stop antithyroid drugs before giving radioactive iodine ablation therapy

When to stop antithyroid drugs before giving radioactive iodine ablation therapy:

- Carbimazole must be stopped 3 to 5 days before ablation therapy.

- Propylthiouracil must be stopped 2 weeks before ablation therapy.


Reference:

European Journal of Endocrinology (2002) 147 1–11

"On the basis, largely, of retrospective data, it appears that carbimazole (or ethimazole), if stopped 3–5 days before treatment, does not influence the outcome of 131I radioactive iodine) therapy. Simultaneous thyrostatic medication most probably reduces the efficacy of 131I, as does restarting it within 7 days. Propylthiouracil seems to have a more prolonged radioprotective effect than carbimazole.

"It only became similar to those treated with 131I alone if more than 15 days had elapsed between the last dose of antithyroid drug(propylthiouracil) and administration of 131I (47)."

Nipple discharge

Clinical feature of pathological and physiological nipple discharge.

-Bloody or serous? ( 피가 있나 )

-spontaneous or non-spontaneous? ( 유방에 자극을 줘서 표출한것인가 )

-Single duct or multiple duct? ( 표출했을때 분비물이 여러 구멍에서 나오는가 )

Features of pathological nipple discharge:
Bloody, spontaneous, single duct discharge

Mem tip:
A: Once, again. You're reaching the end of the year without a girlfriend.
B: I'm "bloody spontaenolsly single" man.

Investigations in nipple discharge:
Subareolar U/S or Mammogram -> if normal then ductogram

if any abnormality of one or more of the above -> biopsy

if all normal chance of malignancy less than 3 %. Then follow up pt.

------------------------------------------------------------------------------

"Nipple discharge alone is not usually a sign of breast cancer. Occult malignancy is rare. A period of ‘watchful waiting’ may prevent

patients undergoing unnecessary surgery.
Patients who underwent operation for nipple discharge at a district general hospital (population 460,000) over a 3-year period were

included. All had normal clinical, radiological and cytological examination. Operation and histopathology reports were reviewed.
Eighty-six patients underwent operation for nipple discharge.
Two patients had occult malignancy – DCIS (1) and LCIS (1). No invasive cancer was found."

-<Ann R Coll Surg Engl. 2007 March; 89(2): 124–126.>

"While bloody discharge is more classically associated with a neoplasm, it may also be related to an intra-ductal papilloma."

-<BMJ Best Practice>

"Paget's disease always involvees the nipple and only involves areola as secondary event,
whereas eczema involves the areola and only secondarily affects the nipple."

-<Garden - Surgery textbook>

Elbow subluxation

(http://emedicine.medscape.com/article/104158-overview#a01)

Elbow subluxation
==================

Hx:
-Child usually between 2 to 6 years
-pulled arm

Clinical picture:
-The affected arm is held semi flexed, adducted, and pronated.

Mx:

Swelling & tenderness -> rule out fracture with X-ray
(No significant edema or effusion should be found on clinical examination.
If focal swelling or other areas of tenderness are present, radiographs should be performed)


1. supination technique.

2. hyperpronation technique

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