Flashcards in Haemoptysis Deck (30):
What other symptoms may be mistaken for haemoptysis?
Use the surgical sieve to construct a differential diagnosis for haemoptysis.
Pneumonia (e.g. Klebsiella)
Left ventricular failure
Granulomatosis with polyangiitis
Crack cocaine use
Which of the mechanisms listed in the surgical sieve is the most common cause of haemoptysis?
What is haemoptysis?
the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs
List three key features of the history of presenting complaint.
Describe what you are coughing up.
How much was coughed up?
Did the haemoptysis occur suddenly or come on gradually?
Which differentials are associated with coughing up:
Suggest vascular problem (e.g. erosion of cancer into a blood vessel)
Lung infections can cause this
Chronic production of large amounts of blood-stained sputum suggests bronchiectasis
Which disease is classically associated with the production of a large amount of sputum?
List some causes of sudden-onset haemoptysis.
Erosion of cancer into a blood vessel
List a cause of gradual-onset haemoptysis.
Bronchiectasis (and other progressive diseases)
List some important symptoms that may be associated with haemoptysis. State the underlying pathology that may cause the symptoms.
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)
Why is it important to ask about renal symptoms (haematuria/oliguria)?
Pulmonary-renal syndromes can cause haemoptysis
List the main causes of pulmonary-renal syndrome.
Vasculitides (e.g. Granulomatosis with polyangiitis)
List some key features of the past medical history.
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
List some respiratory causes of clubbing.
Interstitial lung disease
Which respiratory disease can cause wasting of the dorsal interossei?
Pancoast lung tumours can invade the T1 nerve root
Which metabolic imbalance is important to watch out for in patients with potential lung cancer?
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)
What symptom can occur as a result of obstruction of the superior vena cava by an apical lung tumour?
Swelling of the face, neck and arms
List some signs of respiratory pathology that can be seen in the neck.
List some blood tests that may be useful in investigating a patient with haemoptysis.
FBC – check for anaemia, raised WCC
U&Es – renal derangement may raise suspicion of pulmonary-renal syndrome
Why might it be useful to perform urinalysis on a patient presenting with haemoptysis?
Haematuria may increase index of suspicion of pulmonary-renal syndrome
What form of imaging is most useful in a patient presenting with haemoptysis?
CXR – look for mass lesions, diffuse alveolar infiltrate, hilar lymphadenopathy etc.
Why might it be useful to check calcium, phosphate and ALP in a patient with haemoptysis?
Bone metastases can lead to hypercalcaemia
Which criterion is used to decide the next step in the management of a patient presenting with a possible PE?
How is the Wells score interpreted?
4+ = CTPA
< 4 = D-dimer to rule out PE
Describe the typical presentation of a tuberculosis patient.
History of growing up/recent travel to a TB-endemic region
Outline the management plan for TB.
4 months: rifampicin + isoniazid
2 month: ethambutol and pyrazinamide
Describe the typical presentation of a patient with bronchiectasis.
Recurrent cough productive of large amounts of green/rusty sputum with occasional haemoptysis
Which imaging modality is most useful for diagnosing bronchiectasis?
CT chest – shows dilated bronchi
What is primary ciliary dyskinesia?
Autosomal recessive disorder that affects the protein machinery used by epithelial cells to beat their cilia