8. Haemoptysis Flashcards

1
Q

What are 2 things you are worried about in a patient who presents with haemoptysis?

A
  1. Life threatening lung disease

2. Massive haemoptysis: asphyxation or shock

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2
Q

Using the surgical sieve what are the causes of haemoptysis?

A

Infective: TB, bronchitis, pneumonia, lung abscess, mycetoma
Neoplastic: lung cancer
Vascular: PE, LVF, bleeding tendency, AV malformation, vascular-bronchial fistula
Inflammatory: Granulomatosis with polyangiitis, goodpasture’s syndrome, SLE, hereditary haemorrhagic telangiectasia, polyarteritis nodosa
Traumatic: Iatrogenic, wound
Endocrine: none
Degenerative: bronchiectasis
Metabolic: none
Drugs: warfarin, crack cocaine

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3
Q

What questions should you ask in someone with haemoptysis?

A

What are they coughing up? frank blood/ blood streaked/ frothy sputum
Amount?
Onset?
Progression?

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4
Q

What 6 associated symptoms should you ask about in someone with haemoptysis? What do these indicate?

A

Sputum? indicates LRTI or bronchiectasis
Fever? LRTI, night sweats may indicate TB
Weight loss? Cancer/ TB
Pleuritic chest pain? Pneumonia/ PE
SOB? (Quantify by asking how far they can walk before feeling out of breath)
Haematuria/ oliguria? (Rare: pulmonary renal syndrome)

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5
Q

What 3 signs might you look out for on general inspection in someone with haemoptysis?

A

Hoarse voice: invasion of recurrent laryngeal nerve
Cachexia
Purpuric rash/ petechiae: vasculitis affecting lungs

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6
Q

What 3 signs might you look out for on the hands in someone with haemoptysis?

A

Clubbing
Tar stains
Wasting of dorsal interossei: invasion of T1 nerve root by apical lung cancer

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7
Q

What 3 signs might you look out for in the arms in someone with haemoptysis? What are these caused by?

A

Hypotonic, hyporeflexive, weak arms

Hypercalcemia due to bone mets

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8
Q

What 6 signs might you look out for in the face of someone with haemoptysis?

A

Swollen face: SVC obstruction by tumour
Bleeding from oral/ nasal mucosa
Saddle nose: granulomatosis with polyangiitis
Horner’s syndrome: miosis, ptosis, anhydrosis
Jaundice: liver mets
Focal neuology: brain mets from lung cancer

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9
Q

What 3 signs might you look out for in the neck of someone with haemoptysis?

A

Non-tender cervical lymphaednopathy: TB, bronchial carcinoma
Virchow’s node: GI malignancy mets
Tracheal deviation

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10
Q

What 6 signs might you look out for in the chest of someone with haemoptysis?

A
Asymmetrical lung expansion
Dullness
Stridor
Crackles
Pleural rub: mesothelioma
Pleuritis: Pneumonia
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11
Q

What may haemoptysis be mistaken with?

A

Haematemesis (GIT)
Epistaxis
Bleeding gums

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12
Q

What is associated with frank blood, blood-streaked sputum and frothy sputum?

A

FB: Invasive cancer, TB, Bronchiectasis, AV fistula
BSS: Infection, bronchiectasis
FS: Pulmonary oedema

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13
Q

What information in a history can narrow down the differential for haemoptysis?

A

Smoking Hx: Lung cancer
Inhaled industrial substances e.g. Asbestos: lung cancer
Hx lung disease: chronic condition/ susceptibility
Grow up abroad/ recent travel?
Risk factors for DVT/PE?
Anticoagulants/ known bleeding tendencies

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14
Q

What are the signs of DVT?

A

Unilaterally inflamed leg, pitting oedema, tenderness over deep veins, distended non varicose superficial veins

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15
Q

What is the most common finding OE in PE?

A

Tachycardia

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16
Q

Which clinical scoring system is used to assess risk of PE? What is the newer, less subjective, alternative to this?

A

Wells criteria

Geneva score

17
Q

How can the fluid from a pleural effusion be classified?

A

Transudate: <25g/L protein. Results from increased hydrostatic pressure or decreased oncotic pressure
Exudate: >35g/L protein. Results from cells being in the pleural space