Haemoptysis Flashcards
What can haemoptysis be mistaken for?
Haematemesis
Epistaxis
Bleeding gum
What are the diagnosis associated with haemoptysis that are most concerning?
Infective - TB, pneumonia, lung abscess
Neoplastic
Vascular -
Inflammatory - Wegener’s disease, Goodpasture’s syndrome, SLE, OWR syndrome, polyarteritis nodosa
Traumatic - Iatrogenic/wounds
Degenerative - Bronchiectasis
What is Goodpasture syndrome?
An autoimmune disease in which antibodies attack the basement membrane in the lungs kidneys, leading to bleeding through the lungs and kidney failure
What is Wegener’s disease?
Form of vasculitis that affects small- and medium-size vessels in many organs
Why is it important to ask about haematuria and/or oliguria in patients with haemoptysis?
Goodpasture’s syndrome, vasculatides and SLE may present as haemoptysis and have these additional symptoms
What are the parts of Well’s criteria for PE?
Clinical signs and symptoms of DVT? - 3 points
PE is the most likely diagnosis - 3 points
HR >100bpm - 1.5 points
Immobilization >3days or surgery in last 4 weeks - 1.5 points
Previous PE or DVT - 1.5 points
Haemoptysis - 1 point
Malignancy in last 6 months - 1 point
What score on the Well’s criteria justifies a CTPA?
> /=4 merits CTPA
What additional measures are required in a patient with suspected TB?
Ensure microbiologist knows to look for acid-fast bacilli
Notify the authorities for contact tracing
Place patient in isolation
Test for HIV
Look for signs of spreading to other organs
If diagnosis confirmed then refer to TB services
Mr Frick is a 28-year-old gentleman who is attending the Respiratory Clinic at his hospital. He has recently had several episodes of haemoptysis. He is well known to the respiratory physicians, who have managed him since he was a child. He has chronic rhinitis and has suff ered for most of his life from a rattly cough
which is frequently productive of green sputum. He suffered from many episodes of serous otitis media as a child. He still suffers from frequent episodes of sinusitis and has recently been referred to a fertility clinic by his GP because he and his wife have not been able to conceive a child after 18 months of trying.
A recent chest CT showed dilated bronchi with thick walls extending to the peripheries of both lungs.
Primary ciliary dyskinesia
What are the typical consequences of primary ciliary dyskinesia?
Bronchiectasis
Rhinitis and sinusitis
Otitis media
Male infertility (females are usually fertile)
Situs inversus
What is involved in the management of primary ciliary dyskinesia?
Regular physiotherapy
Regular or prophylactic antibiotics
Mucolytics
Miss Bonprat is a 31-year-old primary school teacher referred to the medical admissions unit of her local hospital because of sudden haemoptysis. She describes feeling unwell and lethargic for the past few weeks and thinking she had ‘caught something off the children’. She developed a cough that morning but was alarmed when she noticed she had coughed up some specks of blood onto her handkerchief. She smokes a pack of ‘light cigarettes’ every day and has not travelled abroad recently. Systems enquiry is unrevealing. Her past medical history is remarkable for hypothyroidism, for which she takes levothyroxine
every day. Examination of Miss Bonprat reveals only that her blood pressure is 160/110 mmHg and that her
urinalysis is positive for protein (+) and blood (+++). A mid-stream urine sample is sent off to the laboratories, who later that day confirm the presence of red cell casts on urine microscopy.
Pulmonary-renal syndrome
Goodpastures, SLE, Wegener’s etc
Cardiac causes of clubbing?
Infective endocarditis
Congenital cyanotic heart disease
Atrial myxoma
Axillary artery aneurysm
Brachial ateriovenous fistula
Respiratory causes of clubbing?
Pulmonary fibrosis
Suppurative lung diseases (abscess, empyema, cystic fibrosis, bronchiectasis)
Bronchial carcinoma, mesothelioma
TB
GI causes of clubbing?
IBD
Cirrhosis
Malabsorption
Gastric lymphoma
Liver abscess
Liver or bowel cancer
What is Light’s criteria?
Fluid is an exudate if any of the following are true:
- Pleural fluid protein divided by serum protein >0.5
- Pleural fluid LDH divided by serum LDH >0.6
- Pleural fluid LDH more than 2/3 the upper limit of normal serum LDH
How can primary malignant lung cancers be classified?
Non-small cell lung cancer (80%)
- Subdivived in adenocarcinomas (30-40%), squamous (20-30%), large cell carcinomas (10%) and other (5%)
- Responds poorly to chemo
Small cell lung cancer (20%)
- Responsive to chemotherapy, although rapid relapse is common
- Early metastasis so surgery not therapy of choice
Which cancers most commonly metastasise to the lungs?
Secondary lung cancers are most commonly the result of metastasis from the following primary cancers:
- Colorectal
- Breast
- Renal
- Female genital tract
Which ectopic endocrine secretions are associated with which lung cancers?
What symptoms do they cause?
Small cell lung carcinomas are derived from endocrine cells in the lung and therefore have the potential to synthesize and secrete hormones or hormone-like substances. The substances secreted by small cell lung cancers are antidiuretic hormone (ADH), resulting in hyponatraemia, and ACTH, resulting in Cushing’s syndrome.
Squamous cell carcinomas may not have the cell machinery to produce cholesterol-based steroids, but they can produce peptides including PTHrP. This causes hypercalcaemia.
What are the differentials of a solitary coin lesion on a CXR?
Parenchymal tumour
Lymph node (lymphoma)
Granuloma (TB/sarcoidosis)
Abscess
Hamartoma
Foreign object
What chest pain differentials require immediate management?
ACS
Aortic dissection
Pneumothorax
PE
Boerhaave’s perforation
What are the features of aortic dissection?
History of sudden-onset tearing chest pain radiating to the back
Absent pulse in one arm
Hypertension
Difference in BP of >20mmHg between arms
New-onset aortic regurge
Pleural effusion (usually left sided)
What are the features of Boerhaave’s perforation?
History of sudden onset severe chest pain immediately following an episode of vomitting
- SOB and pleuritic pain may develop shortly afterwards due to pleurisy and effusion
Signs of a pleural effusion after some hours
Subcutaneous emphysema
Abdominal rigidity, sweating, fever, tachycardia and hypotension
What are the common complications of an MI?
DARTH VADER
Death Arrhythmia Rupture Tamponade HF
Valve disease Aneurysm Dressler's syndrome Embolism Re-infarction
What is Dressler’s syndrome?
A secondary form of pericarditis that occurs following injury to the heart or the pericardium
