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JG Year 2 > 219 Haemoptysis 2 > Flashcards

219 Haemoptysis 2 Flashcards

1
Q

What are the risks of a massive haemoptysis?

3 listed

A

Asphyxiation
Exanguination
Shock

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2
Q

What are the 3 broad categories for causes of haemoptysis?

A
  1. Airway disease
  2. Pulmonary parenchymal disease
  3. Pulmonary vascular disease
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3
Q

Name 4 types of airway disease which can result in haemoptysis

A
  1. Bronchiectasis
  2. Neoplasms
  3. Airway trauma
  4. Bronchovascular disease
  5. Dieualafoy’s disease
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4
Q

Name 3 infectious processes which can cause haemoptysis by damaging the lung parenchyma
(4 listed)

A
  1. TB
  2. Pneumonia
  3. Mycetoma
  4. lung abscess
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5
Q

Name 2 inflammatory diseases which can cause haemoptysis by damaging the lung parenchyma
(3 listed)

A

Wegener’s granulomatosis
Lupus pneumonitis
Goodpasture’s syndrome

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6
Q

Name a genetic defect which can cause haemoptysis by damaging the lung parenchyma

A

Ehlers-Danlos syndrome (vascular type)

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7
Q

What is catamenial haemoptysis?

A

Endometriosis of the lung

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8
Q

Name the 6 substances which can cause consolidation on a CXR

A
  1. pus
  2. blood
  3. pulmonary oedema
  4. inflammatory exudate
  5. tumour
  6. inhaled H20
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9
Q

Which bloods should be ordered for a person with haemoptysis?

A

FBC, U&E, G&S, ABG,Clotting screen

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10
Q

What does the Well’s score measure?

A

The likelihood of a person suffering a DVT/PE

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11
Q

What does the PESI score measure?

A

30 day estimate of mortality following PE

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12
Q

In what other situations can a d-dimer be raised?

A

Post op
Trauma
Liver failure
Renal failure

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13
Q

What are the 3 elements of Virchow’s triad?

A
  1. Injury to vessel
  2. Venous stasis
  3. Increased blood coagulability
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14
Q

What are the signs (if any) of a DVT?

A

Local pain and tenderness; fever; swelling; homan’s sign

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15
Q

What is Homan’s sign?

A

Pain on passive dorsiflexion of the foot in a DVT

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16
Q

Name 3 Ddx of DVT

A

Superficial thrombophlebitis
Ruptured Bakers cyst
Dependent oedema - from HF, liver failure, renal failure

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17
Q

Where in the body can a PE arise from?

4 listed

A

Leg (upper > lower)
Prostatic venous plexus
Pelvic veins
Paradoxical emboli fromR-L shunting (in ASD, VSD, PFO)

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18
Q

Which cancer is often diagnosed from a preceding PE?

A

Pancreatic cancer

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19
Q

What percentage of leg thrombi embolise?

A

20%

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20
Q

What are the consequences of small emboli?

A

Distal infarcts –> eg in the lung get pleuritic chest pain

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21
Q

What is chronic thromboembolitic pulmonary embolism?

A

Mainly a consequence of incomplete resolution of previous PE. Can cause pulmonary HTN.
Progressive SOB and subsequent RHF

22
Q

What are the 3 cardinal signs of a PE?

A

dyspnoea
tachypnoea
pleuritic pain

23
Q

What is the ECG pattern in a massive PE? - what does this signify?

A

S1 Q3 T3

Signifies that the right heart is under strain

24
Q

In which patients would a CTPA be inappropriate and why?

A

Young - high dose of radiation
Renal failure - IV contrast used and GFR needs to be normal to clear it
Pts with underlying lung disease

25
Which scan should be performed if a CTPA is inappropriate for a patient to diagnose PE?
VQ scan
26
Why is unfractionated heparin used for the treatment of a PE in the first instance?
There's a 6hr period where pure heparin doesn't reach it's therapeutic dose.
27
What is the target INR for warfarin users?
2-3
28
Which drug can be given for a suspected PE while investigations are being carried out?
Enoxaparin (clexane)
29
When can tPA (tissue plasminogen activator) be used for the treatment of a PE?
First 12-24 hours after initiation of symptoms
30
What is the name given to the lines of a growing thrombus?
Lines of Zahn
31
In patients with no underlying cause for a PE, what underlying coagulopathies would you be suspecting?
Factor V Leiden Prothrombin mutation Deficiency in protein C and S and antithrombin II
32
Which type of embolus can occur following a long bone #?
Fat embolus
33
What symptoms/signs would a person with a fat PE present with?
SOB, pleuritic chest pain, tachypnoeic | ?rash, ?confusion ?neuro signs
34
Which group of patients most commonly get a septic embolus causing a PE?
IVDU
35
What are the S&S of a septic PE?
Fever Cough Dyspnoea Haemoptysis
36
Which parasitic worm can cause a PE and subsequent portal HTN?
Schistosomiasis
37
What are the clinical manifestations of a pt with an inherited thrombophilia? (4 listed)
Young + FH of VTEs Recurrent VTEs - often in unusual site (cerebral sinus) Recurrent foetal loss Warfarin induced skin necrosis
38
Which type of Heparin Induced Thrombocytopaenia can be life and limb threatening?
Type 2 - immune mediated 4-10 days post op
39
Name 4 different causes of an arterial embolism
1. AF/mitral stenosis i.e. atrial thrombus 2. Atrial myxoma 3. Infected/prosthetic valve 4. Mural thrombus over previous infarct 5. Atheromatous plaques
40
What percentage of atheromatous plaques end up in the following: 1. Brain 2. Legs 3. Mesenteric/splenic/renal
1. 10% 2. 75% 3. 10%
41
Name 3 things which can cause secondary polycythaemia
COPD Altitude Shunts
42
Name the 5 outcomes of a thrombus
1. Resolution i.e. fibrinolysis 2. Organisation - macrophages remove 3. Recanalisation - channels in the clot 4. Embolism 5. Propagation - extension along the vessel
43
What is the fibrinolytic protein which initiates dissolving of a thrombus?
Streptokinase
44
In which condition is endothelin 1 produced inducing the proliferation of pulmonary arterial SM cells?
Pulmonary arterial hypertension
45
Which cells produce endothelin 1 in pulmonary arterial hypertension?
Vascular endothelial cells in the pulmonary arteries
46
Where is there a mutation in familial associated pulmonary arterial hypertension? (2 listed)
BMP receptor type 2 | ALK-1 mutation
47
Which CT diseases are associated with PAH? | 3 listed
Scleroderma SLE Antiphospholipid syndrome
48
Name 2 inherited diseases which can cause bronchiectasis
Kartageners syndrome | Cystic Fibrosis
49
What is allergic bronchopulmonary aspergillosis?
Exaggerated immune response to the fungus aspergillus which causes bronchiectasis
50
What are the signs of bronchiectasis? | (4 listed)
SOB Polyphonic wheeze Clubbing Coarse mid inspiratory crackles
51
Name 3 complications of bronchiectasis
``` Infective exacerbations Haemoptysis Respiratory failure Rheumatoid disease (Brain abscess ; amyloidosis = rare) ```

JG Year 2 (28 decks)

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