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302 > Bloody Cough > Flashcards

Bloody Cough Flashcards

1
Q

what is massive haemoptysis?

A

most commonly over 250mls/24 hours

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2
Q

where do 5% of haemoptysis originate from?

A

pulmonary arterial system: high compliance low pressure system and rest from bronchial arteries (3-8th thoracic levels) high pressure

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3
Q

mechanism of bleeding of bronchial arteries?

A

inflammation of mucosa, bronchial arteries hypertrophy and proliferate becoming more amenable to erosions and bleeding

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4
Q

other mechanism of bleeding?

A

necrosis and infarction of lung parenchyma (PE), invasion of blood vessels by tumour, rupture of distended pulmonary capillaries mitral stenosis and LVF, intracavitary anastomoses fungal problems, vasculitis of pulmonary vessels

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5
Q

causesof haemoptysis

A

lung cancer, kaposi sarcoma, TB, bacterial pneumonias, bronchiectasis, bronchitis cystic fibrosis PE,SLE,

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6
Q

how does cough pathophysiology work?

A

intake of noxious stimulus causes mechanosensory receptors Adelta fibres and chemosensory fibre c fibres through afferent limb of vagal nerves to botzinger ventral respiratory group in midbrain. efferent part causes muscular contraction leading to intake of air with strain against a closed glottis and forced expiration

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7
Q

common causes of cough

A

postnasal drip, asthma, GERD, infection, COPD, blood pressure drugs

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8
Q

less common but very important causes of cough?

A

aspiration, bronchiectasis, bronchiolitis, cystic fibrosis, lung cancer, sarcoidosis and interstitial lung disease

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9
Q

which drugs cause cough?

A

ACEi and beta blockers

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10
Q

what to ask for haemoptysis?

A

is it mixed in with sputum, catemenial heamoptysis (periods),features of asthma, how much sputum is produced, fever, chest pain weight loss, rashes joint pain vasculitis,
find risk factor for PE and HIV, travel history, ask about drug history

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11
Q

What is mortality rate of massive haemoptysis?

A

38%

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12
Q

how does death happen from massive haemoptysis?

A

asphyxiation ( not getting enough oxygen)

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13
Q

when reassessing when to do bronchoscopy?

A

unstable, if stable then CT

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14
Q

pathophysiology of TB

A

airborne droplets inhaled and deposited in terminal airspaces. macrophages ingest bacilli and they replicate within endosomes
transported to regional lymph node

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15
Q

how fast does TB divide?

A

16-20 hours

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16
Q

what does bacillus not have?

A

phospholipid outer membrane

16
Q

what does bacillus not have?

A

phospholipid outer membrane

17
Q

histology of TB?

A

granulomatous inflammation with central necrosis caseation. rim of lymphocytes, fibroblasts and central infected macrophages giant cells and AFBs in granulomas

18
Q

what stain for tb

A

ziehl-neelsen stain and auramine rhodamine

19
Q

OTHER FORMS of TB?

A

skeletal- 15-30%
genitourinary- pus in urine sterile pyuria
Enteritis- weight loss, diarrhoea, blood in stools
CNS- meningitis, archnoiditis, tuberculoma, spinal cord compression extension of discitis

20
Q

treatment for TB?

A

2 months RIPE
followed by isoniazid and rifampicin for 4 months
CNS involvement then 12 months

21
Q

side effects of pyrazinamide?

A

joint pain, nausea and vomiting

22
Q

isoniazid side effects?

A

peripheral neuropathy, fever, and optic neuritis

23
Q

ethambutol side effects

A

peripheral neuropathy, optic neuropathy, hout,

24
Q

What do you see in inactive or latent TB?

A

calcified granulomas

25
Q

what else will you see in TB CT?

A

tree-in-bud

26
Q

what is incidence?

A

how many people develop disease over given time/ number of people at risk of developing disease over given time

27
Q

what is person time

A

number of people in the study and the amount of time each person spends in the study

28
Q

what is an assumption with person time?

A

assumes disease probability during study period is constant, but often invalid as many chronic diseases increase with age

29
Q

equation of prevalence and incidence?

A

prevalence= incidence x disease duration

30
Q

cohort study?

A

group of individuals free from disease with an exposure of interest

31
Q

Strengths of cohort?

A

more than one disease can be measured
offers some evidence of cause-effect
good when exposure is rare
can calculate incidence and risk

32
Q

disadvantages of cohort?

A

loss to follow up
requires large sample long duration and expensive
less suitable for rare disease
less suitable for diseases with long latency
does not eliminate confounding

33
Q

what is relative risk?

A

incidence of disease among exposed/ incidence of disease among non-exposed

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