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JG Year 2 > 219 Haemoptysis 2 > Flashcards

219 Haemoptysis 2 Flashcards

1
Q

What are the risks of a massive haemoptysis?

3 listed

A

Asphyxiation
Exanguination
Shock

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2
Q

What are the 3 broad categories for causes of haemoptysis?

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

Name 4 types of airway disease which can result in haemoptysis

A
  1. Bronchiectasis
  2. Neoplasms
  3. Airway trauma
  4. Bronchovascular disease
  5. Dieualafoy’s disease
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4
Q

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

A
  1. TB
  2. Pneumonia
  3. Mycetoma
  4. lung abscess
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5
Q

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

A

Wegener’s granulomatosis
Lupus pneumonitis
Goodpasture’s syndrome

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6
Q

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

A

Ehlers-Danlos syndrome (vascular type)

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7
Q

What is catamenial haemoptysis?

A

Endometriosis of the lung

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8
Q

Name the 6 substances which can cause consolidation on a CXR

A
  1. pus
  2. blood
  3. pulmonary oedema
  4. inflammatory exudate
  5. tumour
  6. inhaled H20
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9
Q

Which bloods should be ordered for a person with haemoptysis?

A

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

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10
Q

What does the Well’s score measure?

A

The likelihood of a person suffering a DVT/PE

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11
Q

What does the PESI score measure?

A

30 day estimate of mortality following PE

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12
Q

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

A

Post op
Trauma
Liver failure
Renal failure

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13
Q

What are the 3 elements of Virchow’s triad?

A
  1. Injury to vessel
  2. Venous stasis
  3. Increased blood coagulability
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14
Q

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

A

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

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15
Q

What is Homan’s sign?

A

Pain on passive dorsiflexion of the foot in a DVT

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16
Q

Name 3 Ddx of DVT

A

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

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17
Q

Where in the body can a PE arise from?

4 listed

A

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

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18
Q

Which cancer is often diagnosed from a preceding PE?

A

Pancreatic cancer

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19
Q

What percentage of leg thrombi embolise?

A

20%

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20
Q

What are the consequences of small emboli?

A

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

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21
Q

What is chronic thromboembolitic pulmonary embolism?

A

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

22
Q

What are the 3 cardinal signs of a PE?

A

dyspnoea
tachypnoea
pleuritic pain

23
Q

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

A

S1 Q3 T3

Signifies that the right heart is under strain

24
Q

In which patients would a CTPA be inappropriate and why?

A

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
Q

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

A

VQ scan

26
Q

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

A

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

27
Q

What is the target INR for warfarin users?

A

2-3

28
Q

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

A

Enoxaparin (clexane)

29
Q

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

A

First 12-24 hours after initiation of symptoms

30
Q

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

A

Lines of Zahn

31
Q

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

A

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

32
Q

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

A

Fat embolus

33
Q

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

A

SOB, pleuritic chest pain, tachypnoeic

?rash, ?confusion ?neuro signs

34
Q

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

A

IVDU

35
Q

What are the S&S of a septic PE?

A

Fever
Cough
Dyspnoea
Haemoptysis

36
Q

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

A

Schistosomiasis

37
Q

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

A

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

38
Q

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

A

Type 2 - immune mediated 4-10 days post op

39
Q

Name 4 different causes of an arterial embolism

A
  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
Q

What percentage of atheromatous plaques end up in the following:

  1. Brain
  2. Legs
  3. Mesenteric/splenic/renal
A
  1. 10%
  2. 75%
  3. 10%
41
Q

Name 3 things which can cause secondary polycythaemia

A

COPD
Altitude
Shunts

42
Q

Name the 5 outcomes of a thrombus

A
  1. Resolution i.e. fibrinolysis
  2. Organisation - macrophages remove
  3. Recanalisation - channels in the clot
  4. Embolism
  5. Propagation - extension along the vessel
43
Q

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

A

Streptokinase

44
Q

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

A

Pulmonary arterial hypertension

45
Q

Which cells produce endothelin 1 in pulmonary arterial hypertension?

A

Vascular endothelial cells in the pulmonary arteries

46
Q

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

A

BMP receptor type 2

ALK-1 mutation

47
Q

Which CT diseases are associated with PAH?

3 listed

A

Scleroderma
SLE
Antiphospholipid syndrome

48
Q

Name 2 inherited diseases which can cause bronchiectasis

A

Kartageners syndrome

Cystic Fibrosis

49
Q

What is allergic bronchopulmonary aspergillosis?

A

Exaggerated immune response to the fungus aspergillus which causes bronchiectasis

50
Q

What are the signs of bronchiectasis?

(4 listed)

A

SOB
Polyphonic wheeze
Clubbing
Coarse mid inspiratory crackles

51
Q

Name 3 complications of bronchiectasis

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

JG Year 2 (28 decks)

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