pulmonary oedema - Ix
investigations inc:
- FBE
- UECs
- ABG/VBG
- ECG (MI, arrhythmia)
- Chest x-ray
- Echocardiogram
nipple discharge - ddx
- ductal ectasia
- intraductal papilloma
- breast ca (rarely)
(incr prolactin --> inc breastfeeding, pituitary adenoma, dopamine antagonists)
duct ectasia
caused by multiple ducts releasing green/yellow discharge, generally only on manipulation of the nipple.
DCIS
more commonly incidental finding (routine screening in asymptomatic women)
occasional presents with lump/blood nipple discharge
DCIS always needs be excluded (even tho intraductal papilloma more common)
intraductal papilloma
isolated bloody nipple discharge
paget's disease (of breast)
presents as a change to nipple appearance (rather than discharge), such as ulceration, crusting or inversion
bell's palsy
acute idiopathic peripheral facial nerve palsy
usually self-resolves starting at 3weeks, can take up to 2months (if no signs of recovery by 6weeks = start Ix)
acute tubulointerstitial nephritis (ATIN)
type IV hypersensitivity reaction
often triggered by medx within days of commencing it (eg NSAIDs/sulpha drugs/penicillins)
ssx - fever
- maculopapular rash
- flank pain
- arthralgia
can be asymptomatic
acute tubular necrosis (ATN)
most common cause of AKI in hospital
involves acute tubular necrosis includes renal tubular cell damage and death precipitated by an acute ischaemia/toxicity/sepsis
--> intrarenal vasoconstriction or a direct effect of drug toxicity is caused by an ischemic event, nephrotoxic mechanism, or a mixture of both
4 clinical stages
- initiation (acute decr GFR + sudden incr creatinine)
- extension (ongoing hypoxia following ischaemic event + inflammatory response)
- maintenance (cell repair + blood flow returns to normal
- recovery (maintenance continues with ongoing cellular differentiation + improving GFR)