2 - hemoptysis

Question 1

definition of hemoptysis? pseudohymoptysis?

Answer 1

expectoration of blood from lower resp tract, ranges from blood tinged sputum to frank blood. pseudo = bleeding from upper resp tract or GIT

Question 2

massive hemoptysis?

Answer 2

potentially life threatening, it’s massive if it sounds like a lot of blood

Question 3

lung has a dual blood supply? majority of pulm. hemorrhage is from?

Answer 3

pulmonary (low pressure high flow, deoxy blood) bronchial (high pressure low flow, oxygenated blood) –> most hemorrhage is from bronchial circulation

Question 4

hemoptysis ddx: 5 categories

Answer 4

airways. parenchymal. vascular. miscellaneous (cocaine, drugs, catamenial). idiopathic/cryptogenic.

Question 5

hemoptysis ddx: common in west vs. world wide?

Answer 5

west: bronchitis, bronchogenic carcinoma, bronchiectasis. world wide: TB, paragonimus westermani (parasite infection)

Question 6

non smoker, <50 yo, non massive hemoptysis and clear CXR: what is it reasonable to do?

Answer 6

probably acute bronchitis, lower resp. tract infection: give short course antibiotics and follow up in a week

Question 7

ABCs?

Answer 7

ensure adequate IV access, adequate monitoring, and adequate help

Question 8

role for bronchoscopy?

Answer 8

confirms bleeding is from lungs, might localize bleeding and help with diagnosis but not helpful for management

Question 9

diffuse alveolar hemorrhage: is a ___ not a ____? duration? presenting symptoms?

Answer 9

syndrome, not a diagnosis. cough, hemoptysis, fever.

Question 10

causes of DAH?

Answer 10

pulmonary hemorrhage (from MS, increased LVEDP, etc.) capillaritis. diffuse alveolar damage.