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Week 219 - Haemoptysis Flashcards

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1
Q

Week 219 - Haemoptysis: What is the difference, in terms of pH, between haemoptysis and haematemesis?

A
  • Haemoptysis - Alkali

* Haematemesis - Acid

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2
Q

Week 219 - Haemoptysis: What are the three broad vascular sources of haemoptysis? Give a brief description of each.

A
  • Bronchial arteries; small proportion of CO, higher pressure, MORE IMPORTANT in haemoptysis.
  • Capillaries.
  • Pulmonary arteries; low pressure but almost entire cardiac output.
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3
Q

Week 219 - Haemoptysis: What is the most common cause of haemoptysis?

A

Acute or chronic bronchitis.

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4
Q

Week 219 - Haemoptysis: What are the major airway causes of haemoptysis?

A
  • Acute/Chronic Bronchitis.
  • Bronchiectisis.
  • Bronchogenic carcinoma.
  • Metastatic cancer.
  • Bronchial adenomas.
  • Sarcoidosis.
  • Kaposi’s sarcoma.
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5
Q

Week 219 - Haemoptysis: What are the parenchymal causes of haemoptysis?

A
  • Infection; TB, pneumonia, lung abscesses, aspergilloma)

* Auto-immune; Vasculitis with granulomatosis, Goodpasture’s syndrome, CVDs.

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6
Q

Week 219 - Haemoptysis: What are the vascular causes of haemoptysis?

A
  • Pulmonary infarction.
  • Elevated pulmonary venous pressure (heart failure,mitral stenosis)
  • Arteriovenous malformations.
  • Pulmonary veno-occlusive disease.
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7
Q

Week 219 - Haemoptysis: You are in a GP clinic and someone presents with haemoptysis, what is your course of action?

A

Refer to chest clinic, CXR.

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8
Q

Week 219 - Haemoptysis: What are the common causes of haemoptysis that presents with small streaks/clots?

A
  • Smokers (Bronchitis)
  • Pneumonia/TB
  • Bronchiectasis
  • Lung Cancer
  • Heart failure
  • PE
  • Anticoagulation
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9
Q

Week 219 - Haemoptysis: What are the common causes of haemoptysis that present with large volume (>100ml)?

A
  • Bronchiectasis
  • Lung cancer
  • TB
  • Aspergilloma
  • Vascular abnormalities
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10
Q

Week 219 - Haemoptysis: What is the management of massive haemoptysis?

A
  • Ensure airway patency (intubate if needed).
  • 02 therapy
  • Ensure adequate IV access
  • FBC, coagulation, grp and save, U+E, CXR
  • Reverse any coagulopathy
  • Maintain systolic BP >100
  • Tranexamic acid
  • Nebulised adrenaline
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11
Q

Week 219 - Haemoptysis: Give a definition of bronchiectasis.

A
  • Abnormal and permanent/chronic dilation of one or more of the bronchi.
  • It is a radiological diagnosis.
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12
Q

Week 219 - Haemoptysis: What are the inherited causes of bronhiectasis?

A
  • cystic fibrosis

* Immotile cilia syndromes (e.g. Kartagener’s syndrome)

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13
Q

Week 219 - Haemoptysis: What are the acquired causes of bronhiectasis?

A
  • Childhood pneumonia
  • Chronic bronchial obstruction
  • Chronic aspiration
  • Allergic Bronchopulmonary Aspergillosis
  • Immunoglobin deficiency and HIV
  • Associations with RA and ulcerative colitis
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14
Q

Week 219 - Haemoptysis: What is ABPA?

A

Allergic bronchopulmonary aspergillosis

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15
Q

Week 219 - Haemoptysis: What are the physical signs of bronchiectasis?

A
  • Breathlessness
  • Polyphonic wheeze
  • Finger clubbing
  • Coarse, mid inspiratory crackles
  • Respiratory failure
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16
Q

Week 219 - Haemoptysis: What is the treatment for bronchiectasis?

A
  • PHYSIO
  • Antibiotics for exacerbations
  • Bronchodilators
  • Treatment of respiratory failure
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17
Q

Week 219 - Haemoptysis: What are some of the complications of bronchiectasis?

A
  • Infective exacerbation
  • Haemoptysis
  • Respiratory failure
  • Associated Rheumatoid disease
  • Brain abscess, Amyloidosis (Rare)
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18
Q

Week 219 - Haemoptysis: What is the mortality of pulmonary embolis?

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A
  • 30% if untreated

* 2-8% treated

19
Q

Week 219 - Haemoptysis: What is Virchows triad?

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A

Three factors that lead to a predisposition for thrombosis.
• Venous stasis
• Injury to vessel wall
• Increased blood coagulopathy

20
Q

Week 219 - Haemoptysis: It is quite common for there to be no signs of DVT, but if symptoms were present what would they be?

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A
  • Local pain and tenderness.
  • Fever
  • Swelling
  • Homan’s Sign - Pain in calf, on dorsiflexion of foot.
21
Q

Week 219 - Haemoptysis: What is Homan’s sign?

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A
  • Pain in calf, on dorsiflexion of foot.

* A sign of DVT.

22
Q

Week 219 - Haemoptysis: What is the scoring system for calculating risk of DVT?

Study These Flashcards
A

Wells’ Score

  • Score ≥2 - DVT likely
  • Score <2 - DVT unlikely
23
Q

Week 219 - Haemoptysis: What is the main imaging used for DVTs?

Study These Flashcards
A

Doppler Ultrasound

24
Q

Week 219 - Haemoptysis: What does a d-dimer test signify?

Study These Flashcards
A

D-dimer is a breakdown product of cross-linked fibrin, it is elevated in thromboembolism.

25
Week 219 - Haemoptysis: What is the management of DVT?
* S/C heparin until diagnosis confirmed. * USS * Continue heparin / start anti-coagulants * Stop heparin when INR 2.5 * Warfarin for 3/12 if clear cause * Warfarin for 6/12 if no clear cause.
26
Week 219 - Haemoptysis: What is the difference in pathophysiology between a large and small clot? (In terms of where it lodges)
* Large clot - Bifurcation of pulmonary arteries > haemodynamic compromise. * Small clot - Distal airways > infarction > pleuritic pain.
27
Week 219 - Haemoptysis: How does a paradoxical emboli occur?
* Atrial septal defect | * Causes systemic manifestation, e.g. stroke, renal failure acute limb infarction.
28
Week 219 - Haemoptysis: What are the three classifications of PE?
* Massive PE * Acute minor PE * Acute thomboembolic PE
29
Week 219 - Haemoptysis: What are the causes of a massive PE? What is the presentation?
• Acute; Recent surgery/immobility. - Catastrophic drop in cardiac output, hypotension, cyanosis, tachypnoea, hypoxaemia. • Sub-acute; progressive occlusion. - SOB, tachypnoea, hypoxaemia, hypotension.
30
Week 219 - Haemoptysis: How does an acute minor PE present?
• Often with infarction; SOB, pleuritic pain, haemoptysis, fever.
31
Week 219 - Haemoptysis: How does a chronic thomboembolic PE present?
• Progressive SOB, pulmonary hypertension, Right sided heart failure.
32
Week 219 - Haemoptysis: What are the cardinal signs of PE?
• Dyspnoea, Tachypnoea, pleuritic pain.
33
Week 219 - Haemoptysis: How does the Well's scoring system for PE work?
* >6 high probability of PE. * 2-6 moderate probability of PE. * <2 low probability of PE.
34
Week 219 - Haemoptysis: What is the gold standard investigation for PE?
• CT pulmonary angiogram
35
Week 219 - Haemoptysis: What is the scoring system for predicting patient 30-day outcome with PE?
PESI score
36
Week 219 - Haemoptysis: What is the immediate management for someone suffering from PE?
* Hi-flow oxygen, IV fluids, analgesia. * Clexane (whilst Ix) * Unfractionated Heparin (If PE diagnosed and if rapid action is required). * Thrombolysis - rTPA, if severe haemodynamic compromise.
37
Week 219 - Haemoptysis: What is the longer-term management for PE?
* Warfarin - until INR 2-3. | * IVC filter placement (rarely) - for recurrent VTE despite anticoagulation.
38
Week 219 - Haemoptysis: What are the prophylaxis steps that should be taken to prevent thromboembomolotic disease?
* low dose heparin to all immobile patients. * Anti-embolus stockings / early mobilisation. * Women should stop HRT/OCP prior to operations. * FHx of VTE - investigate for thrombofilia.
39
Week 219 - Haemoptysis: What are the risk factors/causes of septic emboli? What is the complication of septic emboli?
* I.V. drug users, pelvic thrombphlebitis, infected venous catheter or pacemaker wire. * Results in multiple lung abscesses.
40
Week 219 - Haemoptysis: What is the differential diagnosis of a cavitating mass?
* Carcinoma (usually squamous cell). * Lung abscess. * Rheumatoid nodule. * Embolus (septic - usually IV drug user) * Vasculitis with granulomatosis (wegeners). * Bronchogenic cyst * Hydatid cyst
41
Week 219 - Haemoptysis: What is the pathology behind Vasculitis with granulomatosis?
• Known as 'Wegener's triad' - necrotising granulomatous inflammation of the respiratory tract. - Focal necrotising glomerulonephritis. - Systemic vasculitis.
42
Week 219 - Haemoptysis: What are the symptoms of vasulitis with granulomatosis?
* Chronic ENT symptoms * Systemic symptoms * haemoptysis / lung cavities * Renal failure * High ESR
43
Week 219 - Haemoptysis: Aside from 'miscellaneous' causes, what are the classifications of pulmonary hypertension?
* Pulmonary arterial hypertension. * Pulmonary venous hypertension. * Pulmonary hypertension associated with hypoxemia. * Pulmonary hypertension due to chronic thomboembolic disease.
44
Week 219 - Haemoptysis: Which two types of pulmonary hypertension can be referred to the pulmonary arterial hypertension (PAH) service?
* PAH | * Pulmonary hypertension due to chronic thromboembolic disease.

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