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Z Year3 Clinical Presentations > Haemoptysis > Flashcards

Haemoptysis Flashcards

1
Q

What could haemoptysis be confused with?

A
  1. Haematemesis: brownish red blood that is vomited from the Gi tract
  2. Epistaxis: particualrly posterior nosebleed
  3. Bleeding gums: combined with cough, may be confused with true haemopytsis
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2
Q

What could the infective causes of haemoptysis be?

A
  1. Pulmonary TB
  2. Bronchitis
  3. Pneumonia
  4. Lung abscess
  5. Mycetoma
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3
Q

What could the neoplastic causes of haemoptysis be?

A
  1. Primary lung cancer

2. Metastatic lung cancer

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4
Q

What could the vascular causes of haemoptysis be?

A
  1. PE
  2. Left Ventricular failure
  3. Bleeding diathesis e.g. coagulopathy + severe thrombocytopenia
  4. Atriovenous malformation
  5. Vascular-bronchial fistula
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5
Q

What could the inflammatory causes of haemoptysis be?

A
  1. Granulomatosis with polyangiitis
  2. Goodpastures syndrome
  3. SLE
  4. Hereditary Haemorrhagic telangiectasia
  5. Polyarertitis nodosa
  6. Microscopic polyangiitis
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6
Q

What could the traumatic causes of haemoptysis be?

A
  1. Iatrogenic (post lung-biopsy or intubation)

2. Woulds (rib fracture, stab injury

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7
Q

What are the degenerative causes of haemopytsis?

A
  1. Bronchiectasis
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8
Q

What could the drug causes of haemoptysis be?

A
  1. Warfarin

2. crack cocaine use

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9
Q

If he is coughing up frank blood what could this indicate?

A
  1. vascular erosion of a blood vessel (invasive cancer, bronchiectasis, TB)
  2. ruptured av malformation
  3. vascular-bronchial fistula
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10
Q

If he is coughing up blood-streak sputum what could this indicate?

A

infection of lungs but if chronic suggest bronchiectasis

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11
Q

If he is coughing up frothy sputum what could this indicate?

A

pulmonary oedema (secondary to left ventricular heart failure or severe mitral stenosis) - can be pink

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12
Q

How do you get the patient to quantify how much they cough up?

A

teaspoon, tablespoon, egg

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13
Q

What would onset of haemoptysis indicate?

A
  1. Sudden onset: PE or erosion of a cancer into a pulmonary blood vessel
  2. Gradual, progressive: bronchiectasis
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14
Q

What would a cough productive of sputum with haemoptysis indicate?

A

indicates lower respiratory tract infection (TB, penumona, bronchitis) or bronchiectasis

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15
Q

What would a fever with haemoptysis indicate?

A

associated with lower respiratory tract infection and night sweats with TB

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16
Q

What would weight loss with haemopysis indicate?

A

cancer and TB (check if planned or not)

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17
Q

What would pleurtic chest pain with haemoptysis indicate?

A

arise following PE or pneumonia that has spread to pleura

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18
Q

What would shortness of breath with haemoptysis indicate?

A

how far can walk etc, sudden onset SOB PE and more gradual onset heart failure

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19
Q

What would haemturia/oliguria with hhaemoptysis indicate?

A

If affects kidney and lungs:

  1. Goodpastrues syndrome
  2. Vasculitides e.g. granulomatosis with polyangitism microscopic polyangitis, polyarteritis nodioa
  3. SLE
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20
Q

What do you check with haemoptysis with lifestyle?

A

CHECK SMOKING HITORY AND EXPOSURE TO ASBESTOS OR OTHER INHALED INDUSTRIAL SUBSTANCES -> lung cancer

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21
Q

What would prior lung disease with haemoptysis indicate?

A

TB or bronchiectasis or vulnerability to repeated infections

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22
Q

What would recent travel indicate with haemoptysis?

A

Which country and vaccinated - TB

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23
Q

What would anticoagulant medication or known bleeding diathesis with haemopytsis indicate?

A

can increase risk/magnitude or internal haemorrhage

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24
Q

What are the risk factors for DVT/PE?

A
  1. Prolonged stasis
  2. Recent trauma or surgery (blood vessel damage)
  3. Malignancy causing hypercoagulable blood
  4. Other clotting abnormalities
  5. History of pervious venous thromboembolism
  6. Painful swollen leg?
25
Q

What would a hoarse voice on general inspection with haemoptysis indicate?

A

invasion of reccurent laryngeal nerve by cancer

26
Q

What would purpuric rash or petechia on general inspection with haemoptysis indicate?

A

vasculitis affecting lungs

27
Q

What else do you look for in general inspection with haemoptysis?

A

Cachexia

28
Q

What would hypotonic, hypo-reflexive, weak arms with haemoptysis indicate?

A

hypercalcaemia due to bone metases from lung cancer

29
Q

What would a swollen face on a facial exam with haemoptysis indicate?

A

obstruction of superior vena cava by tumour

30
Q

Why do you check bleeding from oral or nasal mucosa in facial exam with haemoptysis?

A

source of blood (check if true haemptysis)

31
Q

What would a saddle nose with haemotysis suggest?

A

granulomatosis with polyangiitis

32
Q

What would horners syndrome with haemoptysis indicate?

A

invasion of sympathetic supply to face by apical lung cancer

33
Q

What would jaundice with haemoptysis indicate?

A

liver cancer that has spread to lung or vice versa

34
Q

What would focal neurology with haemoptysis indicate?

A

brain metastasis from lung cancer

35
Q

What would cervical lymphadenopathy, non tender with haemoptysis indicate?

A
  1. TB

2. bronchial carcinoma

36
Q

What would left supraclavicular lymphadenopathy with haemoptysis indicate?

A

GI malignancy which may have metastised to the lungs

37
Q

What would tracheal deviation with haemoptysis indicate?

A
  1. pleural effusion due to cancer

2. lung collapse secondary to a large mass such as tumour of abcess

38
Q

What does asymetrical lung expansion with haemoptysis indicate?

A

lung pathology in side of reduced expansion

39
Q

What does dullness on percussion of chest with haemoptysis indicate?

A
  1. pneumonia
  2. lung abscess
  3. malignant pleural effusion
40
Q

What does stridor with haemopytsis indicate?

A

tumour or foreign body obstructing bronchus

41
Q

What does crackles with haemoptysis indicate?

A
  1. pneumonia
  2. left ventricular failure
  3. bronchiectasis
42
Q

What does pleural rub with haemoptysis indicate?

A
  1. mesothelioma

2. pleuritis from pneumonia

43
Q

What would hepatomegaly with haemoptysis indicate?

A

liver malignancy spread from lungs and vice versa

44
Q

What would unilateral signs of DVT on legs with haemoptysis indicate?

A

may have caused PE

45
Q

What would you look for in FBC with haemoptysis?

A
  1. Anemia

2. High WBC

46
Q

What would you look for in CRP with haemoptysis?

A

raised in infection, inflammation or malignancy

47
Q

What would you look for in clotting screen with haemoptysis?

A

for bleeding disorder which could be cause/exacerbating

48
Q

What would you look for in U+Es with haemoptysis?

A

renal involvement

49
Q

What would you look for in ALP with haemoptysis?

A

bone metastasis from a primary lung cancer

50
Q

What would you look for in liver enzymes with haemoptysis?

A

for liver involvement of a cancer

51
Q

Why do you do a urine test in haemoptysis?

A

look for haemturia for pulmonary-renal syndrome

52
Q

What imaging do you do with haemoptysis?

A

Chest XR

53
Q

What would mass lesion/nodules on chest radiograph with haemoptysis indicate?

A
  1. carcinoma
  2. TB
  3. abscess
  4. vasculitides
54
Q

What would diffuse alveolar infilatrates on chest radiograph with haemoptysis indicate?

A

pulmonary oedema

55
Q

What would hilar lymphadenompathy on chest radiograph with haemoptysis indicate?

A
  1. Carinoma
  2. Infection
  3. TB
56
Q

What would lobar or segmental infiltrates on chest radiograph with haemoptysis indicate?

A

1, pneumonia

  1. infarction due to PE
  2. TB
  3. adenocarcinoma causing malignant consolidation
57
Q

What would patch alveolar infilatrates on chest radiograph with haemoptysis indicate?

A
  1. bleeding disorders
  2. goodpastures syndromes
  3. idiopathic
  4. pulmonary haemosiderosis
58
Q

What would lobar collapse on a chest radiograph with haemoptysis indicate?

A

obstructing carcinoma

59
Q

How would you confirm the diagnosis of lung cancer?

A
  1. cytology of sputum and bonchoscopic washing - by CT guided PFNB or on a bronchscopy
  2. Stage cancer with Ct scan and bone scan

Z Year3 Clinical Presentations (37 decks)

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