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Flashcards in Week 219 - Haemoptysis Deck (44):
1

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

• Haemoptysis - Alkali
• Haematemesis - Acid

2

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

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

3

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

Acute or chronic bronchitis.

4

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

• Acute/Chronic Bronchitis.
• Bronchiectisis.
• Bronchogenic carcinoma.
• Metastatic cancer.
• Bronchial adenomas.
• Sarcoidosis.
• Kaposi's sarcoma.

5

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

• Infection; TB, pneumonia, lung abscesses, aspergilloma)
• Auto-immune; Vasculitis with granulomatosis, Goodpasture's syndrome, CVDs.

6

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

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

7

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

Refer to chest clinic, CXR.

8

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

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

9

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

• Bronchiectasis
• Lung cancer
• TB
• Aspergilloma
• Vascular abnormalities

10

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

• 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

11

Week 219 - Haemoptysis: Give a definition of bronchiectasis.

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

12

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

• cystic fibrosis
• Immotile cilia syndromes (e.g. Kartagener's syndrome)

13

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

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

14

Week 219 - Haemoptysis: What is ABPA?

Allergic bronchopulmonary aspergillosis

15

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

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

16

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

• PHYSIO
• Antibiotics for exacerbations
• Bronchodilators
• Treatment of respiratory failure

17

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

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

18

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

• 30% if untreated
• 2-8% treated

19

Week 219 - Haemoptysis: What is Virchows triad?

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

20

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

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

21

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

• Pain in calf, on dorsiflexion of foot.
• A sign of DVT.

22

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

Wells' Score
- Score ≥2 - DVT likely
- Score <2 - DVT unlikely

23

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

Doppler Ultrasound

24

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

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.