Haemoptysis Flashcards

1
Q

What can haemoptysis be mistaken for?

A

Haematemesis

Epistaxis

Bleeding gum

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2
Q

What are the diagnosis associated with haemoptysis that are most concerning?

A

Infective - TB, pneumonia, lung abscess

Neoplastic

Vascular -

Inflammatory - Wegener’s disease, Goodpasture’s syndrome, SLE, OWR syndrome, polyarteritis nodosa

Traumatic - Iatrogenic/wounds

Degenerative - Bronchiectasis

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3
Q

What is Goodpasture syndrome?

A

An autoimmune disease in which antibodies attack the basement membrane in the lungs kidneys, leading to bleeding through the lungs and kidney failure

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4
Q

What is Wegener’s disease?

A

Form of vasculitis that affects small- and medium-size vessels in many organs

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5
Q

Why is it important to ask about haematuria and/or oliguria in patients with haemoptysis?

A

Goodpasture’s syndrome, vasculatides and SLE may present as haemoptysis and have these additional symptoms

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6
Q

What are the parts of Well’s criteria for PE?

A

Clinical signs and symptoms of DVT? - 3 points

PE is the most likely diagnosis - 3 points

HR >100bpm - 1.5 points

Immobilization >3days or surgery in last 4 weeks - 1.5 points

Previous PE or DVT - 1.5 points

Haemoptysis - 1 point

Malignancy in last 6 months - 1 point

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7
Q

What score on the Well’s criteria justifies a CTPA?

A

> /=4 merits CTPA

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8
Q

What additional measures are required in a patient with suspected TB?

A

Ensure microbiologist knows to look for acid-fast bacilli

Notify the authorities for contact tracing

Place patient in isolation

Test for HIV

Look for signs of spreading to other organs

If diagnosis confirmed then refer to TB services

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9
Q

Mr Frick is a 28-year-old gentleman who is attending the Respiratory Clinic at his hospital. He has recently had several episodes of haemoptysis. He is well known to the respiratory physicians, who have managed him since he was a child. He has chronic rhinitis and has suff ered for most of his life from a rattly cough
which is frequently productive of green sputum. He suffered from many episodes of serous otitis media as a child. He still suffers from frequent episodes of sinusitis and has recently been referred to a fertility clinic by his GP because he and his wife have not been able to conceive a child after 18 months of trying.
A recent chest CT showed dilated bronchi with thick walls extending to the peripheries of both lungs.

A

Primary ciliary dyskinesia

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10
Q

What are the typical consequences of primary ciliary dyskinesia?

A

Bronchiectasis

Rhinitis and sinusitis

Otitis media

Male infertility (females are usually fertile)

Situs inversus

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11
Q

What is involved in the management of primary ciliary dyskinesia?

A

Regular physiotherapy

Regular or prophylactic antibiotics

Mucolytics

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12
Q

Miss Bonprat is a 31-year-old primary school teacher referred to the medical admissions unit of her local hospital because of sudden haemoptysis. She describes feeling unwell and lethargic for the past few weeks and thinking she had ‘caught something off the children’. She developed a cough that morning but was alarmed when she noticed she had coughed up some specks of blood onto her handkerchief. She smokes a pack of ‘light cigarettes’ every day and has not travelled abroad recently. Systems enquiry is unrevealing. Her past medical history is remarkable for hypothyroidism, for which she takes levothyroxine
every day. Examination of Miss Bonprat reveals only that her blood pressure is 160/110 mmHg and that her
urinalysis is positive for protein (+) and blood (+++). A mid-stream urine sample is sent off to the laboratories, who later that day confirm the presence of red cell casts on urine microscopy.

A

Pulmonary-renal syndrome

Goodpastures, SLE, Wegener’s etc

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13
Q

Cardiac causes of clubbing?

A

Infective endocarditis

Congenital cyanotic heart disease

Atrial myxoma

Axillary artery aneurysm

Brachial ateriovenous fistula

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14
Q

Respiratory causes of clubbing?

A

Pulmonary fibrosis

Suppurative lung diseases (abscess, empyema, cystic fibrosis, bronchiectasis)

Bronchial carcinoma, mesothelioma

TB

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15
Q

GI causes of clubbing?

A

IBD

Cirrhosis

Malabsorption

Gastric lymphoma

Liver abscess

Liver or bowel cancer

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16
Q

What is Light’s criteria?

A

Fluid is an exudate if any of the following are true:

  • Pleural fluid protein divided by serum protein >0.5
  • Pleural fluid LDH divided by serum LDH >0.6
  • Pleural fluid LDH more than 2/3 the upper limit of normal serum LDH
17
Q

How can primary malignant lung cancers be classified?

A

Non-small cell lung cancer (80%)

  • Subdivived in adenocarcinomas (30-40%), squamous (20-30%), large cell carcinomas (10%) and other (5%)
  • Responds poorly to chemo

Small cell lung cancer (20%)

  • Responsive to chemotherapy, although rapid relapse is common
  • Early metastasis so surgery not therapy of choice
18
Q

Which cancers most commonly metastasise to the lungs?

A

Secondary lung cancers are most commonly the result of metastasis from the following primary cancers:

  • Colorectal
  • Breast
  • Renal
  • Female genital tract
19
Q

Which ectopic endocrine secretions are associated with which lung cancers?

What symptoms do they cause?

A

Small cell lung carcinomas are derived from endocrine cells in the lung and therefore have the potential to synthesize and secrete hormones or hormone-like substances. The substances secreted by small cell lung cancers are antidiuretic hormone (ADH), resulting in hyponatraemia, and ACTH, resulting in Cushing’s syndrome.

Squamous cell carcinomas may not have the cell machinery to produce cholesterol-based steroids, but they can produce peptides including PTHrP. This causes hypercalcaemia.

20
Q

What are the differentials of a solitary coin lesion on a CXR?

A

Parenchymal tumour

Lymph node (lymphoma)

Granuloma (TB/sarcoidosis)

Abscess

Hamartoma

Foreign object

21
Q

What chest pain differentials require immediate management?

A

ACS

Aortic dissection

Pneumothorax

PE

Boerhaave’s perforation

22
Q

What are the features of aortic dissection?

A

History of sudden-onset tearing chest pain radiating to the back

Absent pulse in one arm

Hypertension

Difference in BP of >20mmHg between arms

New-onset aortic regurge

Pleural effusion (usually left sided)

23
Q

What are the features of Boerhaave’s perforation?

A

History of sudden onset severe chest pain immediately following an episode of vomitting
- SOB and pleuritic pain may develop shortly afterwards due to pleurisy and effusion

Signs of a pleural effusion after some hours

Subcutaneous emphysema

Abdominal rigidity, sweating, fever, tachycardia and hypotension

24
Q

What are the common complications of an MI?

A

DARTH VADER

Death
Arrhythmia
Rupture
Tamponade
HF
Valve disease
Aneurysm
Dressler's syndrome
Embolism
Re-infarction
25
Q

What is Dressler’s syndrome?

A

A secondary form of pericarditis that occurs following injury to the heart or the pericardium