incorrect / hard Flashcards
Anion gap calculations
(Na + K) - (chloride + bicarbonate)
Bartter syndrome
autosomal recessive disorder which causes renal tubular disease, characterised by hypokalaemia hypochloraemia.
metabolic alkalosis are commonly seen in this condition
Fanconi syndrome
Fanconi syndrome is a type of renal tubular acidosis (type 2) which is associated with hypokalaemia and osteomalacia.
4 types of RTA
Type 1 RTA (distal):
inability to secrete H+ in distal tubule, causes hypokalaemia
Type 2 RTA (proximal):
decreased HCO3- reabsorption in proximal tubule
causes hypokalaemia and osteomalacia
Type 3 RTA (mixed)
extremely rare
caused by carbonic anhydrase II deficiency
results in hypokalaemia
Type 4 RTA (hyperkalaemic)
reduction in aldosterone leads in turn to a reduction in proximal tubular ammonium excretion
causes hyperkalaemia
causes include hypoaldosteronism, diabetes
Diabetes tests fasting and random glucose cut offs?
If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
IF ASYMPTOMATIC MUST BE ON 2 OCCASIONS
Diabetes HBA1C cut offs for diagnosis
a HbA1c of greater than or equal to 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus
a HbAlc value of less than 48 mmol/mol (6.5%) does not exclude diabetes
AGAIN IF ASYMPTOMATIC MUST BE ON 2 OCCASIONS
impaired fasting glucose / glucose tolerance cut offs
A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)
Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
osteoporosis in a man, what blood test should be done alongside routine
testosterone
what is nelson’s syndrome
Nelson’s syndrome occurs due to rapid enlargement of a pituitary corticotroph adenoma (ACTH producing adenoma) that occurs after the removal of both adrenal glands (bilateral adrenalectomy) which is an operation used for Cushing’s syndrome.
first drug offered in Parkinson’s where motor symptoms affecting quality of life
Levodopa
what may cause referred pain to the HIP from the lumbar spine
Femoral nerve compression may cause referred pain in the hip
Femoral nerve stretch test may be positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee. This stretches the femoral nerve and will cause pain if it is trapped
Parkinson’s medication that can cause: dystonia, chorea, and athetosis
Levodopa
unilateral vs bilateral foot drop main causes:
Unilateral: common perineal nerve
Bilateral: peripheral neuropathy
features of pulmonary hypertension on auscultation. of heart
Loud S2
what imaging is done in suspected NOF despite normal X-rays
MRI hip
cancer drug causing lung fibrosis
Bleomycin
cancer drug causing hemorrhagic cystitis
Cyclophosphamide
toxic bear
draw it or google it idk
Tonic or atonic seizures treatment
males: sodium valproate
females: lamotrigine
Myoclonic seizures treatment
males: sodium valproate
females: levetiracetam
Absence seizures (Petit mal) treatment
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures
Focal seizures treatment
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
Generalised tonic-clonic seizures treatment
males: sodium valproate
females: lamotrigine or levetiracetam
girls aged under 10 years and who are unlikely to need treatment when they are old enough to have children or women who are unable to have children may be offered sodium valproate first-line
ototoxic drugs
GENTAMICIN, furosemide, aspirin, cisplatin
4 D’s of pellagra (vit B3/ niacin deficiency)
Diarrhoea
Dermatitis
Dementia
Death
what do Auer rods suggest
APML (acute promyelocytic leukaemia)
mnemonics for HIV meds MOA
Integrase inhibitors -> raltegravir, elvitegravir, dolutegravir
Protease inhibitors -> think PRO-NAtion (protease and navir): indinavir, nelfinavir, ritonavir, saquinavir
Fusion inhibitors –> enfuvirtide
MMSE score cuts off for dementia
its out of 30 and 23 and lower suggests cognitive impairment / dementia
how does periductal mastitis present
Periductal mastitis is common in smokers and may present with recurrent infections. Treatment is with co-amoxiclav.
what is nikolsky’s sign
Nikolsky’s sign describes exfoliation and formation of blisters following rubbing the skin. This sign is nearly always present in SJS and toxic epidermal necrolysis (TEN).
what is Hutchinson’s sign
presence of a vesicular rash on the tip or side of the nose in herpes zoster ophthalmicus, caused by the reactivation of the varicella zoster virus in the trigeminal nerve. Its presence suggests ocular involvement.
what is seen on fundoscopy in Hydroxychloroquine induced retinopathy
bull’s eye maculopathy: red spot on the macula surrounded by a ring of retinal epithelial pigment loss
features of fracture of zygoma
Binocular vision post-facial trauma, painful to open mouth
diagnosis of chlamydia in woman
Vulvovaginal swabs for NAAT is the specimen of choice in females, as recommended by BASHH. (Urine first void sample first line for men)
what is sialadenitis
inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct.
Syringomyelia presentation
Features:
-a ‘cape-like’ (neck, shoulders and arms)
loss of sensation to temperature but the preservation of light touch, proprioception and vibration
classic examples are of patients who accidentally burn their hands without realising
this is due to the crossing spinothalamic tracts in the anterior commissure of the spinal cord being the first tracts to be affected
-spastic weakness (predominantly of the lower limbs)
-neuropathic pain
-upgoing plantars
Autonomic features:
-Horner’s syndrome due to compression of the sympathetic chain, but this is rare
-bowel and bladder dysfunction
scoliosis will occur over a matter of years if the syrinx is not treated
What is associated with a lemon tinge to the skin
pernicious anaemia: The light yellow tinge is caused by the combination of pallor (due to the anaemia) and mild jaundice (caused by the haemolysis).
anti-emetic used in Parkinson’s
Domperidone
shyphylis tests and results interpretation
Serological tests can be divided into:
–non-treponemal tests
not specific for syphilis, therefore may result in false positives (see below)
based upon the reactivity of serum from infected patients to a cardiolipin-cholesterol-lecithin antigen
assesses the quantity of antibodies being produced
becomes negative after treatment
examples include: rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL)
–treponemal-specific tests
generally more complex and expensive but specific for syphilis
qualitative only and are reported as ‘reactive’ or ‘non-reactive’
examples include: TP-EIA (T. pallidum enzyme immunoassay), TPHA (T. pallidum HaemAgglutination test)
the TP-EIA test has become increasingly popular in recent years
If the test has an A in the name (TPHA), it’s Always positive
If the test has an R in the name (RPR), it’s a Recent infection
Seborrhoeic dermatitis -organism
Malassezia furfur
which antibiotics may prolong the QTc
Macrolides (eg clarithromycin)
asthma diagnosis FEV1 bronchodilator reversibility %
> 12% FEV1 reversibility with bronchodilators
organophosphate poisoning symptoms
D: defaecation & diaphoresis.
U: urinary incontinence.
M: miosis (pupil constriction).
B: bradycardia
E: emesis.
L: lacrimation.
S: salivation.
Organophosphates stimulate sympathetic and parasympathetic nervous systems however, in clinical practice and in typical scenarios overstimulation of the parasympathetic system predominates.
P450 Inhibitors: (+do they increase or decrease drug conc)
SICKFACES.COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides/SSRI’s
Ciprofloxacin
Omeprazole
Metronidazole
+
Ritonavir
increase drug concentrations as they are not being cleared by p450
P450 Inducers (+ do they increase or decrease drug concs)
CRAP GP’S
Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
-smoking (affects CYP1A2, reason why smokers require more aminophylline)
contents of cryoprecipitate
CryoprecipEIGHT contains factor VIII, fibrinogen, von Willebrand factor and factor XIII
what deficiency is haemophilia A and B
A: VIII (A sounds like 8)
B: IX
treatment of Schistosomiasis
praziquantel
cataracts causes
Causes
Normal ageing process: most common cause
Other possible causes
Smoking
Increased alcohol consumption
Trauma
Diabetes mellitus
Long-term corticosteroids
Radiation exposure
Myotonic dystrophy
Metabolic disorders: hypocalcaemia
maintenance fluid rate adults
25-30ml/kg/24hrs
torsades de pointes treatment
if no haemodynamic compromise:
IV MAG SULF
if haemodynamic compromise:
SHOCK
wells score DVT parameters
-Active cancer (treatment ongoing, within 6 months, or palliative) 1
Paralysis, paresis or recent plaster immobilisation of the lower extremities 1
Recently bedridden for 3 days or more or major surgery within 12 weeks requiring general or regional anaesthesia 1
Localised tenderness along the distribution of the deep venous system 1
Entire leg swollen 1
Calf swelling at least 3 cm larger than asymptomatic side 1
Pitting oedema confined to the symptomatic leg 1
Collateral superficial veins (non-varicose) 1
Previously documented DVT 1
An alternative diagnosis is at least as likely as DVT -2
Clinical probability simplified score
DVT likely: 2 points or more (ultrasound leg)
DVT unlikely: 1 point or less (do a d-dimer)
drug that precipitates digoxin toxicity
bendroflumethiazide
types of motor neuron disease
The four clinical groups are:
-Spinal ALS (the classic MND syndrome)
-Bulbar ALS (with early tongue and bulbar involvement)
-Progressive muscular atrophy (with only lower motor neuron features)
-Primary lateral sclerosis (with only upper motor neuron features).
how does progressive bulbar palsy present
LMN problem affecting CN VII, IX, X, XII
Lichen planus features
Cutaneous lichen planus is characterised by the 6 Ps:
Purple
Pruritic (itchy)
Polygonal (multiple sides)
Planar (flat-topped)
Papules or
Plaques
stages of syphilis
Primary syphilis features
Lesions are found at the site of inoculation and are often genital or perianal. Lesions tend to be painless and solitary in nature. They are round with an indurated base, and heal within 3-8 weeks.
Secondary Syphilis features
Occurs 4-10 weeks after primary infection. It typically presents with a maculopapular symmetrical rash on the palms, legs, soles and face. There also may be lymphadenopathy mucosal ulcers. Other less common features include malaise, fever, hepatitis, glomerulonephritis and neurological complications.
Tertiary Syphilis features
Tertiary or late disease occurs in approximately 1/3 of untreated patients, and manifests 20-40 years after primary infection.
It is rare due to the advent of penicillin, but if found it must be treated with urgently. Features can be categorised into gummatous (15% of patients); cardiovascular (10%) and neurological complications (7%). Gummatous disease is the presence of granulomatous-type lesions on the skin. Cardiovascular complications may include aortitis, arteritis and aortic valve regurgitation. Neurological complications include meningovascular syphilis, paresis, dementia, tabes dorsalis and pupil abnormalities e.g. Argyll-Robertson pupil.
If Tertiary Syphilis is confirmed, a CSF examination is indicated in order to test for CNS involvement.
what would you see in haemochromatosis (ferritin and transferrin saturation)
Deranged LFTs
Raised serum ferritin
Raised transferrin saturation
how far must a tumour be located from the anal margin for an anterior resection to be indicated
> 8cm
management of severe neurological symptoms of hyponatraemia (seizure, coma ect..)
150ml hypertonic (3%) saline over 20mins initially regardless of cause
until 5mmol/L increase in Na, then Treat cause but beware correcting hyponatraemia too fast as risk of Central pontine myeolinolysis
causes of hyper/eu/hypo volaemic hyponatraemia
Causes can be categorised by fluid status:
1.Hypovolaemic hyponatraemia
-Burns
-Sweating
-Diarrhoea
-Vomiting
-Fistulae
-Addison’s disease
2.Euvolaemic hyponatraemia
-Syndrome of inappropriate ADH release (SIADH)
-Hypothyroidism
3.Hypervolaemic hyponataemia
-Renal failure
-Heart failure
-Liver failure
-Nephrotic syndrome
what is this describing: The classical appearance is of a well-defined, “stuck on” warty plaque with a fissured keratin surface
Seborrhoeic Keratosis
what could an eruption of many Seborrhoeic Keratoses be a sign of
Gastric adenocarcinoma (Leser-Trélat sign)
drugs to stop before surgery
I LACK OP:
Insulin,
Lithium,
Anticoagulants/antiplatelets,
COCP/HRT,
K-sparing diuretics,
Oral hypoglycaemics,
Perindopril and other ACE-inhibitors.
maximum IV potassium infusion rate
10mmol/h
remission maintenance in crohns
Azathioprine or mercaptopurine should be offered 1st line.
Methotrexate may be considered in patients who are intolerant/have a contraindication to azathioprine or mercaptopurine or who do not respond to azathioprine or mercaptopurine monotherapy.
remission induction on crohns
A corticosteroid (either prednisolone or methylprednisolone or intravenous hydrocortisone), is used to induce remission in patients with a first presentation or a single inflammatory exacerbation of Crohn’s disease in a 12-month period. A
In patients with distal ileal, ileocaecal or right-sided colonic disease, in whom a conventional corticosteroid is unsuitable or contra-indicated, budesonide may be considered. Budesonide is less effective but may cause fewer side-effects than other corticosteroids, as systemic exposure is limited. Aminosalicylates (such as sulfasalazine and mesalazine) are an alternative option in these patients. They are less effective than a corticosteroid or budesonide, but may be preferred because they have fewer side-effects. Aminosalicylates and budesonide are not appropriate for severe presentations or exacerbations. A
Add-on treatment
Add on treatment is prescribed if there are two or more inflammatory exacerbations in a 12-month period, or the corticosteroid dose cannot be reduced. A
Azathioprine or mercaptopurine [unlicensed indications] can be added to a corticosteroid or budesonide to induce remission. In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, methotrexate can be added to a corticosteroid. A
Biological agents (such as infliximab or adalimumab) are recommended in patients with severe Crohn’s disease who fail to respond to the above.
Glasgow scale of Pancreatitis Severity
PANCREAS:
PaO2< 7.9kPa
Age > 55 years
Neutrophils (WBC > 15)
Calcium < 2 mmol/L
Renal function: Urea > 16 mmol/L
Enzymes LDH > 600IU/L
Albumin < 32g/L (serum)
Sugar (blood glucose) > 10 mmol/L
budd-chiari triad
sudden onset abdominal pain, ascites, and tender hepatomegaly
Monteggia vs Galeazzi fractures
MUgGeR
Montaggia ulna, galeazzi radius
MontaggiA (proximal dislocation and fracture)
GalleaZzi, (distal fracture and dislocation)
Note dislocation not same bone as fracture
white out of lung: causes if trachea deviated towards/away / central
Trachea pulled toward the white-out
Pneumonectomy
Complete lung collapse e.g. endobronchial intubation
Pulmonary hypoplasia
Trachea central
Consolidation
Pulmonary oedema (usually bilateral)
Mesothelioma
Trachea pushed away from the white-out
Pleural effusion
Diaphragmatic hernia
Large thoracic mass
DPP4 inhibitors suffix
-gliptins
GLP-1 analogue suffix
-tides
SGLT-2 blocker suffix
-flozin
sulphonylurea suffix
-zide/mide (and prefix often Gli eg Gliclazide)
MOA cyclizine (and indications)
Cyclizine is a H1-receptor antagonist that acts by blocking histamine receptors in the CTZ
useful in
sepsis 6
- Administer oxygen: Aim to keep saturations > 94% (88-92% if at risk of CO2 retention e.g. COPD)
- Take blood cultures
- Give broad spectrum antibiotics
- Give intravenous fluid challenges: NICE recommend a bolus of 500ml crystalloid over less than 15 minutes
- Measure serum lactate
- Measure accurate hourly urine output
new S6:
1. Senior review
2. O2 only IF REQUIRED
3. IV access + bloods (cultures, glucose, lactate, UE, CRP, clotting…)
4. IVABX
5. IV Fluids
6. Monitoring (NEWS2, UOP, lactate)
most common benign parotid neoplasm
Benign pleomorphic adenoma or benign mixed tumor
most common malignant salivary gland tumour
Mucoepidermoid carcinoma (30% of all parotid malignancies)
causes of raised anion gap metabolic acidosis
MUDPILES CAT
Methanol,
Uremia,
Diabetic ketoacidosis,
Propylene glycol,
Isoniazid,
Iron,
Lactic acidosis,
Ethylene glycol,
Salicylates
Carbon monoxide
Aminoglycoside
Theophylline
digoxin toxicity features
GIT: nausea, vomiting, anorexia, diarrhoea
Visual: blurred vision, yellow/green discolouration, haloes
CVS: palpitations, syncope, dyspnoea
CNS: confusion, dizziness, delirium, fatigue
signs of antiphospholipid syndrome on blood tests
(paradoxically) prolonged APTT + low platelets
Anti-phospholipid syndrome CLOT
C- clotting time increased APTT
L- livedo reticularis
O- obstetric complications
T- thrombocytopoenia
paget’s treatment
bisphosphonates - either oral risedronate or IV zoledronate
which cancer sauses ACTH
Small cell lung cancer
cancer causing SIADH
small cell lung cancer
HiNTS exam findings
Head-impulse test
To perform the head impulse test:
- Gently move the patient’s head side to side, making sure the neck muscles are relaxed.
- Then ask the patient to keep looking at your nose whilst you turn their head left and right.
- Turn the patient’s head 10-20° to each side rapidly and then back to the midpoint.
Interpretation
A positive test indicates there is a disruption to the vestibulo-ocular reflex, so the eyes move with the head, then saccade rapidly back to the point of fixation on the clinician’s nose (a ‘corrective saccade’). Patients will also have difficulty fixating on the clinician’s nose. If there is a corrective saccade (a positive head-impulse test) this is reassuring that the pathology is most likely a problem with the vestibulocochlear nerve on the ipsilateral side – that is, it is peripheral and not central.
Nystagmus
To assess nystagmus:
- Observe the patient’s primary gaze while they look straight ahead.
- Then ask the patient to look to the left and to the right without fixating on any object (which can minimise nystagmus).
Interpretation
The direction of the saccadic eye movement is important.
Unidirectional nystagmus is reassuring and more likely to be of peripheral origin. When nystagmus changes direction or is vertical, it is much more likely to be associated with central pathologies.
Bidirectional nystagmus, in particular, is highly specific for stroke. In this case, the saccadic movement beats in the direction that the patient is looking, then changes direction with their gaze (gave-evoked nystagmus).
Test of skew
To perform the test of skew:
- Ask the patient to look at your nose and subsequently cover one of their eyes.
- Then, quickly move your hand to cover the patient’s other eye. During this process, observe the uncovered eye for any vertical and/or diagonal corrective movement.
- Repeat this manoeuvre on the other eye.
Interpretation
Any abnormal movement observed here, often associated with vertical diplopia, is highly specific for a central cause of vertigo.
causes of hypokalaemia
DIRE:
Drugs (loop/thiazide diuretics)
Inadequate intake / loss (diarrhoea or vomiting)
RTA
Endocrine (cushings/conn’s)
causes of hyperkalaemia
DREAD:
Drugs (k+ sparing diuretics, ACEi)
Endocrine (addissons)
Artefact (haemolysis)
DKA (iatrogenic w insulin treatment)
nephrotoxic antibiotics
gentamicin, vancomycin and tetracyclines .
What problems may long-term amiodarone use cause?
Hypothyroidism and thyrotoxicosis (pulmonary fibrosis ?)
function of Subscapularis
positioned anteriorly on your chest, helps with internal rotation of shoulder
function of Supraspinatus
- positioned on top of your shoulder and runs parallel to your deltoid. Needed for the first 20° of shoulder abduction, then the rest of abduction is done by the deltoid
function of Infraspinatus
- positioned posteriorly on the superior aspect of your back, helps with external rotation of shoulder
function of Teres minor -
positioned posteriorly on the superior aspect of your back, helps with external rotation of shoulder
define HAS-BLED parameters
Hypertension i.e uncontrolled BP
Abnormal renal function (creatinine >200 umol/L or transplant or dialysis)
Abnormal liver function (cirrhosis or bilirubin >2x normal or AST/ALT/ALP >3x
normal)
Stroke
Bleeding tendency or predisporition
Labile INR
“Elderly” (aged >65)
Drugs (e.g concomitant aspirin or NSAIDs) or alcohol Generally if:
Score 0 = low risk of bleeding. Anticoagulation should be strongly considered.
Score 1–2 = low–moderate risk of bleeding. Anticoagulation should be considered.
Score ≥3 = high risk of major bleeding. Alternatives to anticoagulation should be considered.
Causes of transudative plural effusion
Congestive heart failure
Liver cirrhosis
Severe hypoalbuminemia
Nephrotic syndrome
causes of exudative plural effusion
Malignancy
Infection (e.g. empyema due to bacterial pneumonia)
Trauma
Pulmonary infarction
Pulmonary embolism
Felty’s syndrome features
RA, splenomegaly, neutropenia
components of child-pugh score
Albumin
Bilirubin
Clotting (prothrombin)
Diffuse ascites
Encephalopathy
JONES criteria for Rheumatic fever
Jones Criteria
A diagnosis is considered likely if there is:
-Evidence of recent streptococcal infection (eg, history of scarlet fever, positive throat swab or rising or increased antistreptolysin O titre (ASOT) >200 U/mL or DNase B titre).
-Plus two major criteria; or
-One major and two minor criteria.
Major Jones criteria
Arthritis
Usually the earliest manifestation, typically a “flitting” or migratory polyarthritis affecting one joint then others in quick succession. Most commonly affected joints are the knees, ankles, elbows and wrists.
Pancarditis
Affects all layers of the myocardium, however endocardial inflammation may predominate causing valvulitis. This may manifest clinically as a tachycardia, new murmur or new conduction defect.
Sydenham’s chorea
Neurologic disorder consisting of abrupt, non-rhythmic, involuntary movements along with muscular weakness and emotional disturbance. They are most frequently marked on one side and cease during sleep.
Erythema marginatum
Geographical pink/red, nonpruritic rash involving mainly the trunk, thighs and arms. Characteristically, the rash has raised, sharp outer edges with a diffuse clear centre, making a ring (and contributing to its alternate name, erythema annulare).
Subcutaneous nodules
Firm, mobile painless lesions
Minor Jones criteria
Fever
Arthralgia (unless if arthritis meets major criterion)
Raised acute phase proteins (ESR and CRP)
Prolonged PR interval on ECG (except if carditis meets major criterion)
fixed rate insulin rate in DKA
0.1units/Kg/hour
cut-off for platelet transfusion
<10x10^9 for patients not bleeding,
<30x10^9 with active bleeding,
<100x10^9 if severe bleeding or bleeding at critical sites
The Kidney Disease: Improving Global Outcomes (KDIGO) criteria are widely used to stage the AKI, what are the stages:
Stage 1:
Increase in creatinine to **1.5-1.9 **times baseline, or
Increase in creatinine by ≥26.5 µmol/L, or
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours
Stage 2:
Increase in creatinine to** 2.0 to 2.9** times baseline, or
Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours
Stage 3:
Increase in creatinine to **≥ 3.0 ** times baseline, or
Increase in creatinine to ≥353.6 µmol/L or
Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or
The initiation of kidney replacement therapy, or,
In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2
Membranous glomerulonephritis histology:
basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2
Open angle glaucoma treatment
first line: prostaglandin analogue (PGA) eyedrop
second line: beta-blocker, carbonic anhydrase inhibitor, or sympathomimetic eyedrop
**if more advanced: ** surgery or laser treatment can be tried2
Features of AIN(Acute interstitial nephritis)
fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension
sterile pyuria
white cell casts
histology: marked interstitial oedema and interstitial infiltrate in the connective tissue between renal tubules
maintanence fluid for adult with underlying heart disease:
20-25mls/kg/day
