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Infectious causes of hemoptysis

Staphylococcus
Pseudomonas
Aspergillus
Influenza

1

Tracheobronchial causes of hemoptysis

Bronchogenic Ca,bronchial carcinoid,kaposi sarcoma
Bronchitis(acute and chronic)
Bronchiectasis
Broncholithiasis
Airway trauma
Foreign body

2

Pulmonary parenchymal sources of bleeding

Pneumonia
Lung abscess
Tuberculosis
Mycetoma
Goodpasture
Idiopathic pulmonary hemosiderosis
Wegener granulomatosis
Lupus pneumonitis
Lung contusion

3

Difference btw hemoptysis and hematemesis

History:
Hemoptysis- no nausea and vomiting,lung disease,asphyxia
Hematemesis-presence of nausea or vomiting,gastric or liver disease,no asphyxia
Sputum:
Hemoptysis- frothy,liquid or clotted appearance,bright red or pink
Hematemesis-rarely frothy,coffee ground,brown to black
Lab:
Hemoptysis- alkaline pH,mixed with macrophages and neutrophils
Hematemesis-acidic pH,mixed with food particles

4

Diff btw bleed from lower and upper respiratory tract

URT- cough
LRT- epistaxis,expectoration without cough

5

Rx of low risk pts with normal chest radiograph

Outpatient
Antibiotics
Close monitoring

6

Amount or frequency of bleeding and cancer

No correlation

7

Hemoptysis associated with Orthopnea

1.CCF
2.left ventricular dysfunction
3.Mitral valve stenosis

8

Hemoptysis with fever and productive cough,causes

1.Upper respiratory infection
2.acute sinusitis
3.acute bronchitis
4.pneumonia
5.lung abscess

9

Hemoptysis associated with HIV

1.neoplasia
2.TB
3.kaposi

10

Hemoptysis associated with smoking

1.acute bronchitis
2.chronic bronchitis
3.lung cancer
4.pneumonia

11

Hemoptysis associated with weight loss

1.emphysema
2.lung cancer
3.TB
4.bronchiectasis
5.lung abscess
6.HIV

12

Hemoptysis associated with clubbing

1.lung cancer
2.bronchiectasis
3.lung abscess
4.severe chronic lung disease
5.secondary lung metastasis

13

Hemoptysis
Fever
Dullness to percussion
Unilateral rales

Pneumonia

14

Clinical findings in wegener granulomatosis

Gingival thickening
Mulberry gingivitis
Saddle nose
Nasal septum perforation

15

Risk factors that increase the likelihood of finding cancer in bronchoscopy

Male
Age >40yrs
Smoking >40 pack years
Duration of hemoptysis of more than a week

16

Bronchoscopy indicated if tumor is suspected

Fiberoptic bronchoscopy
For visualisation of bleeding site,biopsy,brushings,bronchial lavage

17

Bronchoscopy indicated in massive hemoptysis

Rigid bronchoscopy
Greater suctioning and airway maintanence capacity

18

Cause of death in massive hemoptysis

Asphyxiation not exanguination

19

Hemoptysis and alveolar infiltrates

Diffuse alveolar infiltrates- Chronic heart failure,pulmonary Edema,aspiration,toxic injury
Patchy alveolar infiltrates-bleeding disorders,idiopathic pulmonary hemosiderosis,goodpasture

20

Hemoptysis with lobar or segmental infiltrates

1.pneumonia
2.thromboembolism
3.obstructing carcinoma

21

Hemoptysis with no change in X ray

1.bronchitis
2. Upper respiratory tract infection
3.sinusitis
4.pulmonary embolism

22

Clinical diagnosis of diffuse alveolar hemorrhage is confirmed by

BAL

23

Histology associated with diffuse alveolar hemorrhage

Pulmonary capillaritis

24

Causes of diffuse alveolar hemorrhage in SLE

Pulmonary capillaritis
Bland pulmonary hemorrhage
Diffuse alveolar damage

25

MPA is always associated with

Focal segmental necrotising glomerulonephritis

26

Difference btw p-ANCA and c-ANCA

p-ANCA doesnt correlate with disease activity

27

Rx of severe DAH in MPA with unremitting respiratory failure

Recombinant factor 7

28

Most common underlying histology in DAH in goodpasture

Bland hemorrhage

29

Profile of goodpasture patient

Men in 20s who smoke

30

Preferred term for postnasal drip syndrome

Upper airway cough syndrome

31

In pts with ineffective cough,monitor for

Atelectasis
Pneumonia
Respiratory failure

32

Rx of UACS

Antihistaminic/decongestant therapy with first generation antihistaminics

33

Rx of acute cough associated with cold

First G A/D preparation (brompheniramine and sustained release pseudoephedrine)
Naproxen

34

Dx of cough variant asthma can be confirmed by

Resolution of cough after anti asthma therapy

35

Rx of asthmatic cough refractory to ICS or bronchodilators

Leukotriene antagonists

36

Rx of cough due to GERD

Lifestyle modifications
Acid suppression
Prokinetics

37

Does failure of therapy rule out GERD as a cause of cough?

No
Do pH monitoring as dose may be insufficient or medical therapy may have failed

38

Anti reflux diet

No >45g fat in 24hrs
Soda
Tea
Coffee
Chocholates
Citrus fruits
Alcohol
Smoking
To be avoided

39

In a pt with respiratory tract infection with or without sputum production lasting for less than 3 weeks,a diagnosis of acute bronchitis should not be made unless

Pneumonia
Common cold
Acute asthma
Acute exacerbation of COPD has been ruled out

40

Rx of adult pts with acute bronchitis with wheeze accompanying cough

Beta2 agonist inhalation

41

Chronic bronchitis

Pt with chronic cough and sputum expectoration daily for atleast 3months for 2 consecutive years

42

Rx of stable patient with chronic bronchitis

Beta agonists
Ipratropium bromide
Theophylline

43

Are newer antihistaminics useful in cold induced cough

No

44

Can theophylline used in acute exacerbation of chronic bronchitis

No

45

Rx of NAEB

ICS

46

History which is important in NAEB

Occupational history

47

IBD pt with cough

Bronchiolitis

48

Post infectious cough,duration

3-8weeks

49

Rx of post infectious cough

Ipratropium