Haemoptysis Flashcards

1
Q

What other symptoms may be mistaken for haemoptysis?

A

Haematemesis
Nose-bleed
Bleeding gums

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2
Q

Use the surgical sieve to construct a differential diagnosis for haemoptysis.

A
- Infection
TB 
Pneumonia (e.g. Klebsiella)
Lung abscess
Mycetoma
Bronchitis
- Neoplastic
Lung cancer 
- Vascular
PE
Left ventricular failure 
Bleeding diathesis 
Arteriovenous malformation
Vascular-bronchial fistula
- Inflammatory/Autoimmune
Granulomatosis with polyangiitis
Goodpasture’s syndrome
SLE
Osler-Weber-Rendu syndrome
Polyarteritis nodosa
- Trauma
Iatrogenic
- Endocrine
- Degenerative
Bronchiectasis
- Metabolic
- Drugs
Warfarin
Crack cocaine use
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3
Q

Which of the mechanisms listed in the surgical sieve is the most common cause of haemoptysis?

A

Infection

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4
Q

What is haemoptysis?

A

the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs

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5
Q

List three key features of the history of presenting complaint.

A

Describe what you are coughing up.
How much was coughed up?
Did the haemoptysis occur suddenly or come on gradually?

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6
Q

Which differentials are associated with coughing up:
Frank blood
Blood-streaked sputum
Frothy sputum

A

Frank blood
Suggest vascular problem (e.g. erosion of cancer into a blood vessel)
Blood-streaked sputum
Lung infections can cause this
Chronic production of large amounts of blood-stained sputum suggests bronchiectasis
Frothy sputum
Pulmonary oedema

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7
Q

Which disease is classically associated with the production of a large amount of sputum?

A

Bronchiectasis

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8
Q

List some causes of sudden-onset haemoptysis.

A

PE

Erosion of cancer into a blood vessel

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9
Q

List a cause of gradual-onset haemoptysis.

A

Bronchiectasis (and other progressive diseases)

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10
Q

List some important symptoms that may be associated with haemoptysis. State the underlying pathology that may cause the symptoms.

A

Cough productive of sputum – suggests lower respiratory tract infection or bronchiectasis
Fever – associated with lower respiratory tract infections
Weight loss – systemic feature of lung cancer and TB
Pleuritic chest pain – PE or pneumonia
Shortness of breath – clarify whether it is sudden-onset (e.g. PE) or gradual-onset (e.g. heart failure)
Haematuria/Oliguria

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11
Q

Why is it important to ask about renal symptoms (haematuria/oliguria)?

A

Pulmonary-renal syndromes can cause haemoptysis

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12
Q

List the main causes of pulmonary-renal syndrome.

A

Vasculitides (e.g. Granulomatosis with polyangiitis)
SLE
Goodpasture’s syndrome

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13
Q

List some key features of the past medical history.

A
Smoking 
Exposure to asbestos and other inhaled substances 
Prior lung disease (e.g. TB)
Growing up abroad and recent travel 
Risk factors for DVT/PE 
Anticoagulant use or bleeding diathesis
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14
Q

List some respiratory causes of clubbing.

A

Lung cancer
Bronchiectasis
Interstitial lung disease
Empyema

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15
Q

Which respiratory disease can cause wasting of the dorsal interossei?

A

Pancoast lung tumours can invade the T1 nerve root

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16
Q

Which metabolic imbalance is important to watch out for in patients with potential lung cancer?

A

Hypercalcaemia of malignancy
This is due to spread of the cancer to bone
NOTE: keep and eye out for signs of hypercalcaemia (e.g. hypotonia, Hyporeflexia, weak arms)

17
Q

What symptom can occur as a result of obstruction of the superior vena cava by an apical lung tumour?

A

Swelling of the face, neck and arms

18
Q

List some signs of respiratory pathology that can be seen in the neck.

A

Cervical lymphadenopathy

Tracheal deviation

19
Q

List some blood tests that may be useful in investigating a patient with haemoptysis.

A

FBC – check for anaemia, raised WCC
CRP
Clotting screen
U&Es – renal derangement may raise suspicion of pulmonary-renal syndrome

20
Q

Why might it be useful to perform urinalysis on a patient presenting with haemoptysis?

A

Haematuria may increase index of suspicion of pulmonary-renal syndrome

21
Q

What form of imaging is most useful in a patient presenting with haemoptysis?

A

CXR – look for mass lesions, diffuse alveolar infiltrate, hilar lymphadenopathy etc.

22
Q

Why might it be useful to check calcium, phosphate and ALP in a patient with haemoptysis?

A

Bone metastases can lead to hypercalcaemia

23
Q

Which criterion is used to decide the next step in the management of a patient presenting with a possible PE?

A

Wells criteria

24
Q

How is the Wells score interpreted?

A

4+ = CTPA

< 4 = D-dimer to rule out PE

25
Q

Describe the typical presentation of a tuberculosis patient.

A

History of growing up/recent travel to a TB-endemic region
Haemoptysis
Night sweats
Weight loss

26
Q

Outline the management plan for TB.

A

4 months: rifampicin + isoniazid

2 month: ethambutol and pyrazinamide

27
Q

Describe the typical presentation of a patient with bronchiectasis.

A

Recurrent cough productive of large amounts of green/rusty sputum with occasional haemoptysis

28
Q

Which imaging modality is most useful for diagnosing bronchiectasis?

A

CT chest – shows dilated bronchi

29
Q

What is primary ciliary dyskinesia?

A

Autosomal recessive disorder that affects the protein machinery used by epithelial cells to beat their cilia

30
Q

What are the consequences of primary ciliary dyskinesia?

A
NOTE: most consequences are due to the inability of the cilia to clear mucus 
Bronchiectasis 
Rhinitis and sinusitis 
Otitis media
Male infertility (sperm are immobile)
Situs inversus (Kartagener’s syndrome)