Flashcards in 219 Haemoptysis 2 Deck (51):
What are the risks of a massive haemoptysis?
What are the 3 broad categories for causes of haemoptysis?
1. Airway disease
2. Pulmonary parenchymal disease
3.Pulmonary vascular disease
Name 4 types of airway disease which can result in haemoptysis
3. Airway trauma
4. Bronchovascular disease
5. Dieualafoy's disease
Name 3 infectious processes which can cause haemoptysis by damaging the lung parenchyma
4. lung abscess
Name 2 inflammatory diseases which can cause haemoptysis by damaging the lung parenchyma
Name a genetic defect which can cause haemoptysis by damaging the lung parenchyma
Ehlers-Danlos syndrome (vascular type)
What is catamenial haemoptysis?
Endometriosis of the lung
Name the 6 substances which can cause consolidation on a CXR
3. pulmonary oedema
4. inflammatory exudate
6. inhaled H20
Which bloods should be ordered for a person with haemoptysis?
FBC, U&E, G&S, ABG,Clotting screen
What does the Well's score measure?
The likelihood of a person suffering a DVT/PE
What does the PESI score measure?
30 day estimate of mortality following PE
In what other situations can a d-dimer be raised?
What are the 3 elements of Virchow's triad?
1. Injury to vessel
2. Venous stasis
3. Increased blood coagulability
What are the signs (if any) of a DVT?
Local pain and tenderness; fever; swelling; homan's sign
What is Homan's sign?
Pain on passive dorsiflexion of the foot in a DVT
Name 3 Ddx of DVT
Ruptured Bakers cyst
Dependent oedema - from HF, liver failure, renal failure
Where in the body can a PE arise from?
Leg (upper > lower)
Prostatic venous plexus
Paradoxical emboli fromR-L shunting (in ASD, VSD, PFO)
Which cancer is often diagnosed from a preceding PE?
What percentage of leg thrombi embolise?
What are the consequences of small emboli?
Distal infarcts --> eg in the lung get pleuritic chest pain
What is chronic thromboembolitic pulmonary embolism?
Mainly a consequence of incomplete resolution of previous PE. Can cause pulmonary HTN.
Progressive SOB and subsequent RHF
What are the 3 cardinal signs of a PE?
What is the ECG pattern in a massive PE? - what does this signify?
S1 Q3 T3
Signifies that the right heart is under strain
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
Which scan should be performed if a CTPA is inappropriate for a patient to diagnose PE?
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.
What is the target INR for warfarin users?
Which drug can be given for a suspected PE while investigations are being carried out?
When can tPA (tissue plasminogen activator) be used for the treatment of a PE?
First 12-24 hours after initiation of symptoms
What is the name given to the lines of a growing thrombus?
Lines of Zahn
In patients with no underlying cause for a PE, what underlying coagulopathies would you be suspecting?
Factor V Leiden
Deficiency in protein C and S and antithrombin II
Which type of embolus can occur following a long bone #?
What symptoms/signs would a person with a fat PE present with?
SOB, pleuritic chest pain, tachypnoeic
?rash, ?confusion ?neuro signs
Which group of patients most commonly get a septic embolus causing a PE?
What are the S&S of a septic PE?
Which parasitic worm can cause a PE and subsequent portal HTN?
What are the clinical manifestations of a pt with an inherited thrombophilia?
Young + FH of VTEs
Recurrent VTEs - often in unusual site (cerebral sinus)
Recurrent foetal loss
Warfarin induced skin necrosis
Which type of Heparin Induced Thrombocytopaenia can be life and limb threatening?
Type 2 - immune mediated 4-10 days post op
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
What percentage of atheromatous plaques end up in the following:
Name 3 things which can cause secondary polycythaemia
Name the 5 outcomes of a thrombus
1. Resolution i.e. fibrinolysis
2. Organisation - macrophages remove
3. Recanalisation - channels in the clot
5. Propagation - extension along the vessel
What is the fibrinolytic protein which initiates dissolving of a thrombus?
In which condition is endothelin 1 produced inducing the proliferation of pulmonary arterial SM cells?
Pulmonary arterial hypertension
Which cells produce endothelin 1 in pulmonary arterial hypertension?
Vascular endothelial cells in the pulmonary arteries
Where is there a mutation in familial associated pulmonary arterial hypertension?
BMP receptor type 2
Which CT diseases are associated with PAH?
Name 2 inherited diseases which can cause bronchiectasis
What is allergic bronchopulmonary aspergillosis?
Exaggerated immune response to the fungus aspergillus which causes bronchiectasis
What are the signs of bronchiectasis?
Coarse mid inspiratory crackles