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semester 1 ( 3rd year) > Case 6: Haemoptysis > Flashcards

Case 6: Haemoptysis Flashcards

1
Q

what is haematemesis

A

vomiting blood

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2
Q

what is melena

A

black tarry stool indicating GI bleed

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3
Q

what is epistaxis

A

nose bleed

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4
Q

4 most possible diagnoses if experiencing haemoptysis

A

lung cancer (if smoker)
PE
infection (pneumonia or TB)
vasculitis

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5
Q

2 good questions to ask for suspicion of lung cancer

A

do they smoke
have they noticed the ends of their fingers becoming swollen

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6
Q

2 good questions to ask for suspicion of PE

A

do they suddenly feel more breathless
do they have acute chest pain

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7
Q

2 good questions to ask for suspicion of infection (pneumonia or TB)

A

are they producing lots of sputum
do they have fever

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8
Q

2 good questions to ask for suspicion of vasculitis

A

any nose bleeds or haematuria
any purpuric rash

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9
Q

what is the most common type of lung cancer

A

NSCLC (80-85%)

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10
Q

what is the less common type of lung cancer

A

SCLC (15-20%)

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11
Q

main subtypes of NSCLC

A

adenocarcimoma
squamous cell
large cell

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12
Q

adenocarcinoma is more commonly seen in which subtype of people

A

non smokers and women

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13
Q

squamous cell carcinomas are normally more related with what

A

smokers

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14
Q

what type of lung cancer grows and spreads more rapidly

A

SCLC

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15
Q

most people with SCLC normally present at what stage of the disease

A

stage 4

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16
Q

which type of lung cancer is more chemotherapy responsive

A

SCLC (but this generally carries a poorer prognosis due to late detection of the disease)

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17
Q

what are the 2 indications for suspected lung cancer referral

A

chest x-ray findings that suggest lung cancer
aged over 40 with unexplained haemoptysis

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18
Q

what testing is usually done with rapid access lung cancer clinics

A

straight to CT approach
this is followed by timely radiology report and then physician review

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19
Q

what may happen to the patient when intravenous contrast is injected

A

hot flush

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20
Q

why are patients kept in the clinic 15 minutes following the contrast injection

A

in case of an allergic reaction
most patients feel a warming sensation

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21
Q

what mild reaction may happen after injection of contrast

A

nausea and vomiting in 5%

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22
Q

what moderate reaction may happen after injection of contrast

A

hives and swelling in 1%

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23
Q

is anaphylaxis common following contrast injection

A

no severe reactions are rare in 0.1%

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24
Q

what different manifestations can lung cancer have

A

paraneoplastic manifestation

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25
Q

what are paraneoplastic manifestations

A

symptoms that develop when a malignant tumor causes changes in your body that aren’t directly caused by the cancer itself

the tumour may secrete a hormone or protein that affects a particular body system

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26
Q

how can lung cancer cause lambert-eaton syndrome

A

can cause autoantibodies that block ach being released in muscle synapses

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27
Q

lambert-eaton syndrome symptoms

A

muscle weakness

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28
Q

how can lung cancer cause syndrome of inappropriate antidiuretic hormone secretion (SIADH)

A

there is release of anti-diuretic hormone causing low sodium

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29
Q

symptoms of SIADH

A

nausea
vomiting
confusion
in severe cases seizures

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30
Q

how can lung cancer cause hypertrophic osteoarthropathy

A

there is new bone forming in the periosteum in the lower forearms and lower legs

31
Q

symptoms of hypertrophic osteoarthropathy

A

pain and marker clubbing

32
Q

how can lung cancer cause cushing’s syndrome

A

ectopic secretion of ACTH by small cell tumour
hyperparathyroidism

33
Q

what does the TNM stand for

A

T= primary tumour
N= regional lymph node involvement
M= distant metastasis

34
Q

symptoms of cushing’s syndrome

A

hypertension
weight gain

35
Q

these paraneoplastic manifestations are more common with which type of lung cancer

A

SCLC

36
Q

which test confirms SIADH

A

raised urinary sodium >30

37
Q

when a lung tumour is found on CT what further investigation is done

A

confirm diagnosis of cancer with biopsy
confirm stage of the disease
assess patients fitness and wishes

38
Q

what does the ECOG performance status scale assess

A

it assess the patients functioning in terms of their ability to care for themself, daily activity, and physical ability (walking, working, etc)

39
Q

what must you not do before a PET scan

A

do strenuous exercise for 24hrs before
eat within 6hrs before

40
Q

what tracer is injected before PET scan

A

flurodeoxyglucose (FDG) - similar to naturally occurring glucose so the body uses it in similar way

41
Q

what does a PET scan show

A

areas which use high amounts of glucose glow on scan
cancer tumours use more glucose

42
Q

what are two possible complications of CT guided lung biopsy

A

pneumothorax
haemoptysis

43
Q

what may patients get whilst taking pembrolizumab (an immunotherapy agent)

A

immunotherapy related pneumonitis

44
Q

symptoms of immunotherapy related pneumonitis

A

dry cough
shortness of breath
relatively normal inflammatory markers

45
Q

when does immunotherapy related pneumonitis typically come about

A

around 3 months into immunotherapy treatment

46
Q

how is immunotherapy related pneumonitis treated

A

steroids
intravenous methylprednisolone in severe disease
oral prednisolone in milder disease
(immunotherapy is withheld during treatment)

47
Q

what is pleural effusion

A

buildup of fluid in the pleural space

48
Q

common examination finding of pleural effusion

A

reduced chest expansion
reduced breath sounds
dull percussion
finger clubbing

49
Q

clinical signs of right sided pleural effusion

A

dull percussion note
reduced breath sounds
reduced vocal resonance

50
Q

clinical signs of right sided pneumothorax

A

hyper-resonant percussion note
absent breath sounds
no/reduced vocal resonance

51
Q

clinical signs of right sided pneumonia

A

dull percussion note
bronchial breathing
increased vocal resonance

52
Q

transudate vs exudate

A

exudates= fluids, cells or other cellular substances that are slowly discharged from blood vessels usually from inflamed tissues

transudates= fluids that pass through a membrane or squeeze through tissue or in the extracellular space of tissues

53
Q

description of exudates

A

local process

caused by factors which change the formation and absorption of pleural fluid

high pleural fluid protein usually above 30 and raised LDH

54
Q

description of transudates

A

generalised process

caused by factors that alter hydrostatic pressure, pleural permeability, and oncotic pressure

low pleural fluid protein usually less than 30 and low/normal LDH

55
Q

exudative causes of pleural effusion

A

vascular- PE

infective- pneumonia and TB

inflammatory- pancreatitis

traumatic- haemothorax (blood in pleural space and often associated with rib fractures)

autoimmune- rheumatoid arthritis

metabolic- uraemia

iatrogenic- drug related (amiodarone, methotrexate, sodium valporate, nitrofurantoin- as these are oesinophil rich)

environmental- asbestos related

neoplastic- primary pleural malignancy (mesothelioma) or metastatic cancer from many solid organ tumour most commonly breast and lung

56
Q

transudative causes of pleural effusion

A

cardiac- congestive heart failure commonly presents with bilateral effusion (less common with unilateral disease)

renal- chronic kidney disease results in generalised fluid overload and classically bilateral effusions, nephrotic syndrome is a form of glomerulonephritis which presents with low serum albumin and reduced oncotic pressure and generalised oedema

hepatic- liver cirrhosis (chronic alcohol abuse or fatty liver disease), usually causes a right sided effusion often termed hepatic hydrothorax

57
Q

investigation findings for pnueumonia/TB

A

positive sputum for AFB (acid-fast bacillus)
fever and nigh sweats

58
Q

investigation findings for mesothelioma

A

asbestos exposure
chest pain and weight loss

59
Q

investigation findings for PE

A

acute pleuritic pain
CTPA showing saddle embolus

60
Q

investigation findings for pancreatitis

A

abdominal pain
raised serum lipase

61
Q

investigation findings for metastatic breast cancer

A

ER positive adenocarcinoma in pleural fluid

62
Q

investigation findings for cardiac failure

A

pedal oedema
raised JVP

63
Q

investigation findings for liver cirrhosis

A

jaundice
ascites

64
Q

what is mesothelioma

A

malignant tumour of the mesothelium

65
Q

where do the majority of mesothelioma cases arise

A

90% arise in the pleura but it can also develop in the peritoneum, pericardium and testes

66
Q

what is the strongest risk factor for mesothelioma

A

asbestos exposure

67
Q

high risk occupations for mesothelioma

A

shipyard workers
construction workers
boiler engineers
(can also be at home in family for example washing the asbestos covered clothes)

68
Q

classic presentation of mesothelioma

A

shortness of breath
chest pain
pleural effusion

69
Q

does mesothelioma commonly metastasise

A

it can metastasis but more commonly progresses locally

70
Q

3 main subtypes of mesothelioma

A

sarcomatoid
epitheliod
mixed

71
Q

which type of mesothelioma has a poorer prognosis

A

sarcomatoid

72
Q

is there a cure for mesothelioma

A

no

73
Q

treatment for mesothelioma

A

treatments are supportive not curative such as chemotherapy and radiotherapy
surgery not gone

semester 1 ( 3rd year) (12 decks)

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