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Year 3 > Haemoptysis (oxford clin cases) > Flashcards

Haemoptysis (oxford clin cases) Flashcards

1
Q

What is haemoptysis?

A

Coughing up blood

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2
Q

What may haemoptysis be confused with? Explain what each of the other terms mean

A

Haemetemasis= vomitting blood
Epixstasis= nose bleed (posterior especially)
Bleeding gums

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3
Q

How can you make sure a patient is actually describing haemoptysis and not haemetemasis, epistaxis or bleeding gums?

A

Ask them what they think the cause of the bleeding is- they might tell you it felt like it started with a drip in the nose
Ask about the colour of the blood- darker will suggest its partially digested blood
Ask about a history of nosebleeds, alcohol use, gastro conditions

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4
Q

How serious of a symptom is haemoptysis?

A

Very serious- it is a red flag symptom

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5
Q

Why would you be particularly concerned about haemoptysis?

A

It can be lifethreatening:
It may be the first presentation of a very serious lung condition
It may be serious if there has been large blood loss

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6
Q

What is the most common cause of haemoptysis?

A

Infection

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7
Q

What must be ruled out when someone presents with haemoptysis?

A

Lung cancer

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8
Q

What does haemoptysis when someone is coughing up frank blood suggest?

A

A vascular problem eg a rupture of a blood vessel eg in cancer, TB, bronchiectasis

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9
Q

What does haemoptysis when someone is coughing up blood streaked sputum suggest?

A

Infection of the lungs, and if there is large volumes of sputum then bronchiectasis

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10
Q

What does haemoptysis when someone is coughing up frothy sputum suggest?

A

Pulmonary oedema

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11
Q

What pathologies might sudden haemoptysis suggest?

A

Vascular problems eg blood vessel rupture from a tumor

PE

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12
Q

What pathologies might gradually worsening haemoptysis suggest?

A

Bronchiectasis

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13
Q

What other symptoms should you ask about in a history if someone presents with haemoptysis and why?

A

Is there a cough
Is there sputum- lower resp tract infection?
Has there been sudden and unplanned weight loss- suggestive of TB or cancer
Have there been night sweats- signs of TB or cancer
Is there pleuritic chest pain- suggestive of PE
Is there shortness of breath- sudden onset could be PE and gradual could be heart failure

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14
Q

What might haematuria and/or oligouria alongside haemoptysis suggest?

A

There are a few conditions that can affect both the kidneys and lungs so consider them as differentials eg Goodpastures, systemic lupus

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15
Q

What factors on history, examination and investigations would raise your suspicions of TB?

A

Foreign travel especially if there is a lack of immunisation and to a high risk area like Asia
Chronic productive cough with green/ yellow coloured sputum
Weight loss, night sweats
Raised CRP and WCC
Pyrexia
Consolidation or pulmonary oedema on chest radiograph

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16
Q

What factors on history, examination and investigations would raise your suspicions of pneumonia?

A 
Chronic productive cough with green/yellow coloured sputum
Pleuritic chest pain
Raised WCC and CRP
Tachycardia 
Tachypnoea 
Crackles on auscultation
Low oxygen saturation on room air
17
Q

What factors on history, examination and investigations would raise your suspicions of bronchiectasis?

A 
Chronic productive cough with large volumes of sputum produced 
Wheeze
Dyspnoea at rest
History of recurrent respiratory illness
Possible clubbing 
Crackles and wheeze on auscultation
18
Q

What is the most common finding on examination in someone with a PE?

A

Tachycardia with a normal ECG

19
Q

What factors on history, examination and investigations would raise your suspicions of PE?

A 
Sudden onset pleuritic chest pain
Breathlessness (worse on exertion)
Swollen limb
Being immobile for a long time 
Clotting disorder
Recent surgery
Lung cancer
Normal ECG
Lack of cough
20
Q

What is the first line investigation when you suspect lung cancer?

A

Chest x ray

21
Q

If you suspect lung cancer and chest x ray doesn’t show it what should you do?

A

Send the patient for a CT scan as it will visualise it better

22
Q

What investigation is done to help rule out a PE?

A

D dimer

23
Q

What scan is done if a high risk of PE is suspected?

A

CTPA

24
Q

What criteria is used to score someone’s risk of PE?

A

Well’s score

25
Q

What are the categories in the Well’s score?

A

PE being the most likely diagnosis
Clinical signs or symptoms of DVT
Being immobilised for 3 days or surgery in the past 4 weeks
Previous DVT or PE
High heart rate (over 100/min)
Malignancy diagnosed in the last 6 months

26
Q

What will you see during a resp examination when someone has TB?

A

Crackles
Reduced chest expansion
Hyperresonance/dull on percussion
Reduced breath sounds on auscultation

27
Q

What must doctors do if they suspect someone has TB after ABC?

A

Inform the authorities (TB is a notifiable disease)
Check the infection hasn’t spread to other parts of the body (meninges, spine, organs)
Test for HIV as it could be secondary to HIV
Place the patient in isolation to prevent spread

28
Q

What is the first line treatment for TB?

A

A group of 4 abx, 2 for 2 months and 2 for 4 months

29
Q

What are side effects of treatment of TB?

A

One abx will turn urine bright orange

It was also make the oral contraceptive pill less effective so alternate methods of contraception should be used

30
Q

What is the pathophysiology underlying bronchiectasis?

A

Chronic inflammation of the airway leads to a build up of scar tissue
This tissue shrinks and pulls the airway walls out leading to a widened airway
There is also difficulty clearing mucus due to chronic inflammation damaging the cilia which results in a productive cough

31
Q

Why is sputum sometimes coloured green?

A

Due to the presence of neutrophils and macrophages- when they die they release an enzyme which is green in colour

32
Q

What are the 2 types of fluids in pleural effusion?

A

Transudate

33
Q

What is transudate?

A

Fluid in the pleural cavity that is lower in protein as it has been squeezed out of the lung vasculature

34
Q

Where does transudate come from?

A

The lung vasculature

35
Q

What is exudate?

A

Fluid in the pleural cavity that is rich in protein and originates from cells in the cavity eg pathogens or malignant cells

36
Q

Where does exudate originate from?

A

Cells in the pleural cavity eg pathogens, cancer

37
Q

What are the types of of lung cancer?

A

Small cell lung cancer

Non- small cell lung cancer (squamous cell, adeno and large cell carcinoma)

38
Q

What is the difference between grade and stage?

A 
Stage= how far it has spread
Grade= how histologically different it is to normal cells

Year 3 (104 decks)

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