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Flashcards in 219 Haemoptysis 2 Deck (51):
1

What are the risks of a massive haemoptysis?
(3 listed)

Asphyxiation
Exanguination
Shock

2

What are the 3 broad categories for causes of haemoptysis?

1. Airway disease
2. Pulmonary parenchymal disease
3.Pulmonary vascular disease

3

Name 4 types of airway disease which can result in haemoptysis

1. Bronchiectasis
2. Neoplasms
3. Airway trauma
4. Bronchovascular disease
5. Dieualafoy's disease

4

Name 3 infectious processes which can cause haemoptysis by damaging the lung parenchyma
(4 listed)

1. TB
2. Pneumonia
3. Mycetoma
4. lung abscess

5

Name 2 inflammatory diseases which can cause haemoptysis by damaging the lung parenchyma
(3 listed)

Wegener's granulomatosis
Lupus pneumonitis
Goodpasture's syndrome

6

Name a genetic defect which can cause haemoptysis by damaging the lung parenchyma

Ehlers-Danlos syndrome (vascular type)

7

What is catamenial haemoptysis?

Endometriosis of the lung

8

Name the 6 substances which can cause consolidation on a CXR

1. pus
2. blood
3. pulmonary oedema
4. inflammatory exudate
5. tumour
6. inhaled H20

9

Which bloods should be ordered for a person with haemoptysis?

FBC, U&E, G&S, ABG,Clotting screen

10

What does the Well's score measure?

The likelihood of a person suffering a DVT/PE

11

What does the PESI score measure?

30 day estimate of mortality following PE

12

In what other situations can a d-dimer be raised?

Post op
Trauma
Liver failure
Renal failure

13

What are the 3 elements of Virchow's triad?

1. Injury to vessel
2. Venous stasis
3. Increased blood coagulability

14

What are the signs (if any) of a DVT?

Local pain and tenderness; fever; swelling; homan's sign

15

What is Homan's sign?

Pain on passive dorsiflexion of the foot in a DVT

16

Name 3 Ddx of DVT

Superficial thrombophlebitis
Ruptured Bakers cyst
Dependent oedema - from HF, liver failure, renal failure

17

Where in the body can a PE arise from?
(4 listed)

Leg (upper > lower)
Prostatic venous plexus
Pelvic veins
Paradoxical emboli fromR-L shunting (in ASD, VSD, PFO)

18

Which cancer is often diagnosed from a preceding PE?

Pancreatic cancer

19

What percentage of leg thrombi embolise?

20%

20

What are the consequences of small emboli?

Distal infarcts --> eg in the lung get pleuritic chest pain

21

What is chronic thromboembolitic pulmonary embolism?

Mainly a consequence of incomplete resolution of previous PE. Can cause pulmonary HTN.
Progressive SOB and subsequent RHF

22

What are the 3 cardinal signs of a PE?

dyspnoea
tachypnoea
pleuritic pain

23

What is the ECG pattern in a massive PE? - what does this signify?

S1 Q3 T3
Signifies that the right heart is under strain

24

In which patients would a CTPA be inappropriate and why?

Young - high dose of radiation
Renal failure - IV contrast used and GFR needs to be normal to clear it
Pts with underlying lung disease

25

Which scan should be performed if a CTPA is inappropriate for a patient to diagnose PE?

VQ scan

26

Why is unfractionated heparin used for the treatment of a PE in the first instance?

There's a 6hr period where pure heparin doesn't reach it's therapeutic dose.

27

What is the target INR for warfarin users?

2-3

28

Which drug can be given for a suspected PE while investigations are being carried out?

Enoxaparin (clexane)

29

When can tPA (tissue plasminogen activator) be used for the treatment of a PE?

First 12-24 hours after initiation of symptoms

30

What is the name given to the lines of a growing thrombus?

Lines of Zahn

31

In patients with no underlying cause for a PE, what underlying coagulopathies would you be suspecting?

Factor V Leiden
Prothrombin mutation
Deficiency in protein C and S and antithrombin II

32

Which type of embolus can occur following a long bone #?

Fat embolus

33

What symptoms/signs would a person with a fat PE present with?

SOB, pleuritic chest pain, tachypnoeic
?rash, ?confusion ?neuro signs

34

Which group of patients most commonly get a septic embolus causing a PE?

IVDU

35

What are the S&S of a septic PE?

Fever
Cough
Dyspnoea
Haemoptysis

36

Which parasitic worm can cause a PE and subsequent portal HTN?

Schistosomiasis

37

What are the clinical manifestations of a pt with an inherited thrombophilia?
(4 listed)

Young + FH of VTEs
Recurrent VTEs - often in unusual site (cerebral sinus)
Recurrent foetal loss
Warfarin induced skin necrosis

38

Which type of Heparin Induced Thrombocytopaenia can be life and limb threatening?

Type 2 - immune mediated 4-10 days post op

39

Name 4 different causes of an arterial embolism

1. AF/mitral stenosis i.e. atrial thrombus
2. Atrial myxoma
3. Infected/prosthetic valve
4. Mural thrombus over previous infarct
5. Atheromatous plaques

40

What percentage of atheromatous plaques end up in the following:
1. Brain
2. Legs
3. Mesenteric/splenic/renal

1. 10%
2. 75%
3. 10%

41

Name 3 things which can cause secondary polycythaemia

COPD
Altitude
Shunts

42

Name the 5 outcomes of a thrombus

1. Resolution i.e. fibrinolysis
2. Organisation - macrophages remove
3. Recanalisation - channels in the clot
4. Embolism
5. Propagation - extension along the vessel

43

What is the fibrinolytic protein which initiates dissolving of a thrombus?

Streptokinase

44

In which condition is endothelin 1 produced inducing the proliferation of pulmonary arterial SM cells?

Pulmonary arterial hypertension

45

Which cells produce endothelin 1 in pulmonary arterial hypertension?

Vascular endothelial cells in the pulmonary arteries

46

Where is there a mutation in familial associated pulmonary arterial hypertension?
(2 listed)

BMP receptor type 2
ALK-1 mutation

47

Which CT diseases are associated with PAH?
(3 listed)

Scleroderma
SLE
Antiphospholipid syndrome

48

Name 2 inherited diseases which can cause bronchiectasis

Kartageners syndrome
Cystic Fibrosis

49

What is allergic bronchopulmonary aspergillosis?

Exaggerated immune response to the fungus aspergillus which causes bronchiectasis

50

What are the signs of bronchiectasis?
(4 listed)

SOB
Polyphonic wheeze
Clubbing
Coarse mid inspiratory crackles

51

Name 3 complications of bronchiectasis

Infective exacerbations
Haemoptysis
Respiratory failure
Rheumatoid disease
(Brain abscess ; amyloidosis = rare)