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Flashcards in Haemoptysis Deck (23)
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you need to ensure you are not mistaking haemoptysis with what?

- haematemesis: brownish-red blood that is vomited from GI tract
- epistaxis: particularly posterior nose bleeds
- bleeding gums


what diagnoses should you be concerned about?

Infective: TB, bronchitis, pneumonia
Neoplastic: primary lung cancer/ metastatic
Vascular: pulmonary infarction, L ventricular failure, AVM
Inflammatory: Goodpastures, hereditary haemorrhagic telangiecrasia, SLE
Traumatic: iatrogenic, wounds
Endocrine: none
Degenerative: bronchiectasis
Metabolic: none
Drugs: warfarin, crack cocaine


what is the pt coughing up?

- Frank blood: vascular problem (TB, bronchiectasis), AVM
- Blood streaked sputum: infection of lungs
- Pink frothy sputum: pulmonary oedema


what symptoms apart from coughing up blood might you ask the pt about?

- cough productive of sputum
- fever (LRTI, TB)
- weight loss (lung cancer, TB)
- pleuritic chest pain (PE, pneumonia)
- extra pulmonary manifestations (bone pain, dull swollen wrists and ankles, muscle weakness, polyuria, hypotonia)
- haematuria/ oliguria (pulmonary-renal syndrome)


what other parts of the pt history would help narrow down your differential diagnosis?

- smoking history
- exposure to asbestosis/ other inhaled industrial substances
- prior lung disease
- did he grow up abroad or travel recently
- risk factors for a DVT or PE
- anticoagulant meds


what should you look for in general inspection from the end of the couch?

- hoarse voice (invasion of recurrent laryngeal)
- purpuric rash (vasculitis affecting lungs)
- cushingoid appearance (lung cancer secreting ACTH)
- cachexia


what should you look for at the hands?

- clubbing (lung cancer, abscesses, bronchiectasis)
- tar stains (smoker)
- wasting of the dorsal interossei (Pancoast tumour - invasion of T1 nerve)


what should you look for on the arms?

hypotonic, hyporeflexive, weak arms --> hypercalcaemia due to bone metastases from lung cancer


what should you look for in the face?

- swollen face
- bleeding from oral or nasal mucosa
- saddle nose
- Horners (apical lung cancer)
- jaundice
- focal neurology


what should you look for in the neck?

- cervical lymphadenopathy, non tender (TB, bronchial carcinoma)
- Virchow's node
- Tracheal deviation (lung collapse secondary to large mass


what should you look for in the chest?

- asymmetrical lung expansion
- dullness to percussion (pneumonia, lung abscess, pleural effusion)
- stridor
- crackles (pneumonia, L ventricular failure)
- pleural rub (mesothelioma, pleuritis, distal PE)


what signs would you look for on a chest radiograph?

- mass lesion/nodule (carcinoma, TB, abscess, granuloma)
- diffuse alveolar infiltrates (pulmonary oedema)
- hilar lymphadenopathy: carcinoma, infection, TB
- lobar infiltrates (pneumonia, PE, TB)
- patchy alveolar infiltrates (bleeding disorders, Goodpasture's)


what is PCD?

- primary ciliary dyskinesia (PCD)
- autosomal recessive
- affects protein machinery used by epithelial cells to rhythmically beat their cilia and spermatozoa


what are the typical consequences of PCD?

- bronchiectasis (inability to clear mucus)
- rhinitis and sinusitis (inability to clear mucus from sinuses)
- otits media (inability to clear mucus from middle ear)
- male infertility (sperm immobility)
- situs inversus (dextrocardia)


What is Kartagener's syndrome?

patients with PCD who show the clinical triad of bronchiectasis, sinusitis, situs inversus


what are the cardiovascular causes of clubbing?

- infective enodcarditis
- congenital cyanotic heart disease
- atrial myxoma
- axillary artery aneurysm
- brachial arteriovenous fistula


what are the respiratory causes of clubbing?

- pulmonary fibrosis
- suppurative lung diseases: abscess, empyema, CF, bronchiectasis
- bronchial carcinoma, mesothlioma
- TB


what are the GI causes of clubbing?

- cirrhosis
- malabsorption
- gastric lymphoma
- liver abscess
- liver/bowel cancer


what are the other causes of clubbing?

- congenital clubbing
- thyroid acropachy


how are lung neoplasms classified?

benign (harmartoma) vs malignant
malignant are then classified into 2 groups:
1. Non small cell lung cancer (80%): divided into adenocarcinoma, squamous, large cell carcinoma
2. small cell lung cancer


which cancers commonly metastasize to the lungs?

- colorectal
- breast
- renal
- female genital tract (cervix, ovary)


what are the extrapulmonary manifestations of lung cancer? How might they manifest?

- bone metastases = bone pain
- hypertrophic pulmonary osteoarthritis = dull, aching, swollen wrists/ankles
- ectopic ACTH secretion = Cushingoid features
- hypercalcaemia secondary to bone metastases = confusion, polyuria, muscle weakness
- Eaton-Lambert syndrome = rare NM disorder can be seen in pt with small cell lung cancer


give a differential for a solitary coin lesion on a chest radiograph

- parenchymal tumour (benign, primary lung cancer, secondary lung cancer)
- lymphoma
- granuloma: TB, sarcoidosis
- abscess
- harmartoma
- foreign object