haemoptysis

Question 1

A 52-year-old man who was born in India presents with episodic haemoptysis. His only history is tuberculosis as an adolescent. Chest x-ray shows a rounded opacity in the right upper zone surrounded by a rim of air.

Answer 1

Aspergilloma

Question 2

A 71-year-old woman presents with dyspnoea and haemoptysis for the past two weeks. Clinical examination reveals a loud first heart sound, a diastolic murmur and new-onset atrial fibrillation.

Answer 2

mitral stensosis

Question 3

A 62-year-old woman who is being investigated for renal impairment presents with haemoptysis. On examination she has a flat nose.

Answer 3

granulomatosis with polyangitis

The combination of pulmonary haemorrhage (haemoptysis), renal impairment (rapidly progressive glomerulonephritis) and flat or saddle nose (due to a collapse of the nasal septum) is characteristic of granulomatosis with polyangiitis.

Question 4

History of smoking
Symptoms of malignancy: weight loss, anorexia

Answer 4

lung cancer

Question 5

Dyspnoea
Bibasal crackles and S3 are the most reliable signs

Answer 5

pulmonary oedema

Question 6

Fever, night sweats, anorexia, weight loss

Answer 6

TB

Question 7

Pleuritic chest pain
Tachycardia, tachypnoea

Answer 7

PE

Question 8

usually acute history of purulent cough

Answer 8

LRTI

Question 9

Usually long history of cough and daily purulent sputum production

Answer 9

bronchiectasis

Question 10

Dyspnoea
Atrial fibrillation
Malar flush on cheeks
Mid-diastolic murmur

Answer 10

mitral stensosi

Question 11

Often past history of tuberculosis.
Haemoptysis may be severe
Chest x-ray shows rounded opacity

Answer 11

aspergilloma

Question 12

Upper respiratory tract: epistaxis, sinusitis, nasal crusting
Lower respiratory tract: dyspnoea, haemoptysis
Glomerulonephritis
Saddle-shape nose deformity

Answer 12

granuomatosis with polyangitis

Question 13

Haemoptysis
Systemically unwell: fever, nausea
Glomerulonephritis

Answer 13

goodpastures

Question 14

Tb creates a cavitating lesion what lobes

Answer 14

upper

Question 15

difference in vomit between bornchial circulation and pulmonary

Answer 15

pulmonary - low pressure high vol - larger quantity of blood

Bronchial circulation - smaller volume, off the aorta so high pressure - much more likely to be forced sudden bloody vomit

Question 16

Cx of haemoptysis

Answer 16

Airway disease
Tb
Lung cancer
Bronchiectasis widened and scarred
Neoplasma
Pulmonary vascular disorder
Pe
Parenchymal disease
Pneumonia
Lung abscess
TB
Coagulaopathies
Vasculitis

Rarer - trauma, foreign body, fistula, AVM , mistral stenosis, osler weber - telangiectasis if seen on mouth then can also be seen in lungs
Cocaine and catamenial(menstruation- haemoptysis cyclically in women)

Question 17

catamenial pneumothorax

Answer 17

Women with catamenial pneumothorax have recurrent episodes of pneumothorax that occur within 72 hours before or after the start of menstruation.

endometrial tissues outside uterus

Question 18

catamenia

Answer 18

mensutratoon - haemopytiss during this time for women

Question 19

Haematesmeis

Answer 19

if cough then vomit straight after

Question 20

Massive haemoptysis - more than half a cup of blood

Answer 20

bronchiectasis - CF - because of bronchial artery dilation - as getting bigger aneurysm affect then one cough from bursting

Question 21

Mx of massive haemoptysis

Answer 21

Protect airway - intubation
Stabilise and correct coagulation
Protect non-bleeding lung - double lumen tube
Identify source of bleeding - imaging ( CT contrast - CTA -inject into aorta ) and bronchoscopy
Treat bleeding - endobronchial, embolisation, surgery

Question 22

difference between monophonic and polyphonic wheeze

Answer 22

Fixed airflow obstruction that does not change like a cancer - monophonic phase
Polyphonic wheeze - lungs empty at different times through different airways - different tones

Question 23

Ix for haemoptysis

Answer 23

CTPA is the investigation of choice for hemoptysis to look for underlying vascular or pulmonary causes.