Haemoptysis Flashcards
Which score is used to assess for PE.
What do you do with the number
Well’s criteria.
Includes:
Clinical signs and symptoms of DVT-3 points
PE is the most likely diagnosis- 3 points
Heart rate >100 bpm- 1.5 points
Immobilization >3 days or surgery in the last 4 weeks- 1.5 points
Previously diagnosed DVT or PE- 1.5 points
Haemoptysis- 1 point
Malignancy diagnosed in the last 6 months- 1 point
Well’s score of 4 or greater merits a CTPA
Score of less than 4 only justifies d-dimer to exclude PE
Which part of the lungs does reactivation of TB often affect and why
Reactivation of TB typically (although not always) aff ects the upper lobes because Mycobacterium tuberculosis is a highly aerobic bacterium and the apices are the most oxygenated part of the lungs.
What should you tell micro to look for if you suspect TB
Acid fast bacilli (AFB)
What things must you do with TB patient
- Ensure micro know to look for AFB
- Notify the autorities for contact tracing
- Place patient in isolation to prevent further spread
- Test them for HIV (the TB could be secondary to HIV)
- Look for signs of spread
Where might TB spread to and what symptoms
Meningeal irritation, bone or joint pain in the weight-bearing joints, dysuria and pelvic pain, abdo pain
What drugs do you give for TB
For the first 4 months:
Rifampacin, isoniazid, pyrazinamide and ethambutol
Then for the 2 months after just rifampicin and isoniazid
What is bronchiectasis- any features?
Dilated airways
- productive of green sputum
- occasional haemoptysis
Read the case of Mr Frick!
……
What happens in bronchiectasis- why does it cause dilated airways
For some reason, the lung fails to clear irritant mucus.
There is chronic inflammation which leads to scar tissue formation. The scar tissue shrinks after a while, pulling in the wall of the bronchi.
Why might someone with bronchiectasis also have chronic sinusitis or lack of fertility
Primary Ciliary Dyskinaesia is when there is a protein lacking called dynein from cilia. It leaves you with an inability to clear mucus.
Autosomal recessive.
Affects the protein machinery used by epithelial cells to rhythmically beat their cilia and by spermatozoa to rhythmically beat their tails.
What are the consequences of primary ciliary dyskinaesia
- Bronchiectasis
- Otitis media
- Chronic sinusitis
- Male infertility (women usually fine, as movement of oocyte is dependent on peristalsis of fallopian tube rather than cilia lining these tubes)
- Situs inversus.
What is situs inversus and why does it occur in people with primary ciliary dyskinaesia?
The rhythmical beating of cilia is thought to play an important part in setting up the usual pattern of body asymmetry during embryogenesis.
Many patients with PCD have their organs on the ‘other side’ (e.g. dextrocardia).
What is kartagener’s syndrome (or kartagener’s triad)
Bronchiectasis, sinusitis and situs inversus
How do you investigate PCD
biopsy of the nasal mucosa and examination under a microscope, looking for abnormal beating of the ciliated epithelia. Microscopy of spermatozoa of PCD males often reveals immobile spermatozoa.
How would you manage PCD
- Regular physiotherapy, to help clear the lungs of mucus.
- Regular or prophylactic antibiotics, to prevent recurrent chest infections and sinusitis.
- Mucolytics can help clear mucus in the lungs and sinuses more easily in some patients.
T/F pcd patients sometimes show an improvement in symptoms as they get older
It is worth knowing that patients with PCD tend to show an improvement of symptoms by their early thirties and that many patients lead near normal adult lives.
What are red cell casts in urine
clumps of red cells that have squeezed through the glomeruli
What is nephritic syndrome vs nephrotic syndrome
nephrotic syndrome involves the loss of a lot of protein, whereas nephritic syndrome involves the loss of a lot of blood.
Outline features of nephrotic syndrome
Proteinuria
Hypoalbuminuria (protein leaving blood into urine through gaps in podocytes)
Oedema (oncotic pressure of blood reduces)
Dyslipidaemia (liver tries to increase albumin production, but increases fat production in the process too)
Outline features of nephritic syndrome
Haematuria
Proteinuria too!
HTN (usually only mild)
Low urine volume due to reduced renal function
What is likely to be the onset of a lung cancer causing haemoptysis
Actually sudden.
Sudden onset consistent with PE or erosion of a cancer into a pulmonary blood vessel.
Gradual onset points to a progressive condition such as bronchiectasis.
Causes of pulmonary renal syndrome
Goodpasture’s syndrome, an autoimmune condition where autoantibodies − attack the lungs and the glomeruli in the kidneys. This is important to identify early since the patient progresses rapidly to irreversible renal failure
Vasculitides, e.g. Wegener’s granulomatosis, microscopic polyangiitis, − polyarteritis nodosa
Systemic lupus erythematosus.
Why might wasting of the dorsal interossei worry you
Could indicate invasion of T1 nerve root by apical lung cancer (Pancoast tumour)
Why might a swollen face worry you with haemoptysis
Could indicate obstruction of superior vena cava by tumour
What is saddle nose representing
Wegeners granulomatosis
Why might you spot tracheal deviation with a lung tumour
lung collapse secondary to a large mass such as a tumour or abscess
What can cause crackles on auscultation
pneumonia, left ventricular failure, bronchiectasis
What might cause pleural rub on ausculatation
?mesothelioma, pleuritis from pneumonia, distal PE causing infarction and associated pleurisy
When are the Head/mantoux skin sensitivity tests used in TB
Th e skin sensitivity tests (Heaf, Mantoux) and newer T-cell based assays (e.g. Quantiferon, ELIspot) are only useful to determine latent TB infection and tell you nothing about disease activity.
As many people are infected but not diseased, these tests are of little diagnostic value. Th ey are used in contact tracing to see if somebody who has been exposed to open TB has become infected.
