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Semester 1 ( 3rd Year) > Case 6: Haemoptysis > Flashcards

Case 6: Haemoptysis Flashcards

(73 cards)

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1
Q

what is haematemesis

A

vomiting blood

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2
Q

what is melena

A

black tarry stool indicating GI bleed

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3
Q

what is epistaxis

A

nose bleed

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4
Q

4 most possible diagnoses if experiencing haemoptysis

A

lung cancer (if smoker)
PE
infection (pneumonia or TB)
vasculitis

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5
Q

2 good questions to ask for suspicion of lung cancer

A

do they smoke
have they noticed the ends of their fingers becoming swollen

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6
Q

2 good questions to ask for suspicion of PE

A

do they suddenly feel more breathless
do they have acute chest pain

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7
Q

2 good questions to ask for suspicion of infection (pneumonia or TB)

A

are they producing lots of sputum
do they have fever

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8
Q

2 good questions to ask for suspicion of vasculitis

A

any nose bleeds or haematuria
any purpuric rash

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9
Q

what is the most common type of lung cancer

A

NSCLC (80-85%)

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10
Q

what is the less common type of lung cancer

A

SCLC (15-20%)

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11
Q

main subtypes of NSCLC

A

adenocarcimoma
squamous cell
large cell

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12
Q

adenocarcinoma is more commonly seen in which subtype of people

A

non smokers and women

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13
Q

squamous cell carcinomas are normally more related with what

A

smokers

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14
Q

what type of lung cancer grows and spreads more rapidly

A

SCLC

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15
Q

most people with SCLC normally present at what stage of the disease

A

stage 4

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16
Q

which type of lung cancer is more chemotherapy responsive

A

SCLC (but this generally carries a poorer prognosis due to late detection of the disease)

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17
Q

what are the 2 indications for suspected lung cancer referral

A

chest x-ray findings that suggest lung cancer
aged over 40 with unexplained haemoptysis

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18
Q

what testing is usually done with rapid access lung cancer clinics

A

straight to CT approach
this is followed by timely radiology report and then physician review

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19
Q

what may happen to the patient when intravenous contrast is injected

A

hot flush

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20
Q

why are patients kept in the clinic 15 minutes following the contrast injection

A

in case of an allergic reaction
most patients feel a warming sensation

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21
Q

what mild reaction may happen after injection of contrast

A

nausea and vomiting in 5%

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22
Q

what moderate reaction may happen after injection of contrast

A

hives and swelling in 1%

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23
Q

is anaphylaxis common following contrast injection

A

no severe reactions are rare in 0.1%

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24
Q

what different manifestations can lung cancer have

A

paraneoplastic manifestation

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25
what are paraneoplastic manifestations
symptoms that develop when a malignant tumor causes changes in your body that aren't directly caused by the cancer itself the tumour may secrete a hormone or protein that affects a particular body system
26
how can lung cancer cause lambert-eaton syndrome
can cause autoantibodies that block ach being released in muscle synapses
27
lambert-eaton syndrome symptoms
muscle weakness
28
how can lung cancer cause syndrome of inappropriate antidiuretic hormone secretion (SIADH)
there is release of anti-diuretic hormone causing low sodium
29
symptoms of SIADH
nausea vomiting confusion in severe cases seizures
30
how can lung cancer cause hypertrophic osteoarthropathy
there is new bone forming in the periosteum in the lower forearms and lower legs
31
symptoms of hypertrophic osteoarthropathy
pain and marker clubbing
32
how can lung cancer cause cushing's syndrome
ectopic secretion of ACTH by small cell tumour hyperparathyroidism
33
what does the TNM stand for
T= primary tumour N= regional lymph node involvement M= distant metastasis
34
symptoms of cushing's syndrome
hypertension weight gain
35
these paraneoplastic manifestations are more common with which type of lung cancer
SCLC
36
which test confirms SIADH
raised urinary sodium >30
37
when a lung tumour is found on CT what further investigation is done
confirm diagnosis of cancer with biopsy confirm stage of the disease assess patients fitness and wishes
38
what does the ECOG performance status scale assess
it assess the patients functioning in terms of their ability to care for themself, daily activity, and physical ability (walking, working, etc)
39
what must you not do before a PET scan
do strenuous exercise for 24hrs before eat within 6hrs before
40
what tracer is injected before PET scan
flurodeoxyglucose (FDG) - similar to naturally occurring glucose so the body uses it in similar way
41
what does a PET scan show
areas which use high amounts of glucose glow on scan cancer tumours use more glucose
42
what are two possible complications of CT guided lung biopsy
pneumothorax haemoptysis
43
what may patients get whilst taking pembrolizumab (an immunotherapy agent)
immunotherapy related pneumonitis
44
symptoms of immunotherapy related pneumonitis
dry cough shortness of breath relatively normal inflammatory markers
45
when does immunotherapy related pneumonitis typically come about
around 3 months into immunotherapy treatment
46
how is immunotherapy related pneumonitis treated
steroids intravenous methylprednisolone in severe disease oral prednisolone in milder disease (immunotherapy is withheld during treatment)
47
what is pleural effusion
buildup of fluid in the pleural space
48
common examination finding of pleural effusion
reduced chest expansion reduced breath sounds dull percussion finger clubbing
49
clinical signs of right sided pleural effusion
dull percussion note reduced breath sounds reduced vocal resonance
50
clinical signs of right sided pneumothorax
hyper-resonant percussion note absent breath sounds no/reduced vocal resonance
51
clinical signs of right sided pneumonia
dull percussion note bronchial breathing increased vocal resonance
52
transudate vs exudate
exudates= fluids, cells or other cellular substances that are slowly discharged from blood vessels usually from inflamed tissues transudates= fluids that pass through a membrane or squeeze through tissue or in the extracellular space of tissues
53
description of exudates
local process caused by factors which change the formation and absorption of pleural fluid high pleural fluid protein usually above 30 and raised LDH
54
description of transudates
generalised process caused by factors that alter hydrostatic pressure, pleural permeability, and oncotic pressure low pleural fluid protein usually less than 30 and low/normal LDH
55
exudative causes of pleural effusion
vascular- PE infective- pneumonia and TB inflammatory- pancreatitis traumatic- haemothorax (blood in pleural space and often associated with rib fractures) autoimmune- rheumatoid arthritis metabolic- uraemia iatrogenic- drug related (amiodarone, methotrexate, sodium valporate, nitrofurantoin- as these are oesinophil rich) environmental- asbestos related neoplastic- primary pleural malignancy (mesothelioma) or metastatic cancer from many solid organ tumour most commonly breast and lung
56
transudative causes of pleural effusion
cardiac- congestive heart failure commonly presents with bilateral effusion (less common with unilateral disease) renal- chronic kidney disease results in generalised fluid overload and classically bilateral effusions, nephrotic syndrome is a form of glomerulonephritis which presents with low serum albumin and reduced oncotic pressure and generalised oedema hepatic- liver cirrhosis (chronic alcohol abuse or fatty liver disease), usually causes a right sided effusion often termed hepatic hydrothorax
57
investigation findings for pnueumonia/TB
positive sputum for AFB (acid-fast bacillus) fever and nigh sweats
58
investigation findings for mesothelioma
asbestos exposure chest pain and weight loss
59
investigation findings for PE
acute pleuritic pain CTPA showing saddle embolus
60
investigation findings for pancreatitis
abdominal pain raised serum lipase
61
investigation findings for metastatic breast cancer
ER positive adenocarcinoma in pleural fluid
62
investigation findings for cardiac failure
pedal oedema raised JVP
63
investigation findings for liver cirrhosis
jaundice ascites
64
what is mesothelioma
malignant tumour of the mesothelium
65
where do the majority of mesothelioma cases arise
90% arise in the pleura but it can also develop in the peritoneum, pericardium and testes
66
what is the strongest risk factor for mesothelioma
asbestos exposure
67
high risk occupations for mesothelioma
shipyard workers construction workers boiler engineers (can also be at home in family for example washing the asbestos covered clothes)
68
classic presentation of mesothelioma
shortness of breath chest pain pleural effusion
69
does mesothelioma commonly metastasise
it can metastasis but more commonly progresses locally
70
3 main subtypes of mesothelioma
sarcomatoid epitheliod mixed
71
which type of mesothelioma has a poorer prognosis
sarcomatoid
72
is there a cure for mesothelioma
no
73
treatment for mesothelioma
treatments are supportive not curative such as chemotherapy and radiotherapy surgery not gone

Semester 1 ( 3rd Year) (12 decks)

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