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Respiratory 01.15 > Haemoptysis & Pulmonary Embolism > Flashcards

Haemoptysis & Pulmonary Embolism Flashcards

1
Q

3 things virchow’s triad precursors to THROMBUS formation?

A
  1. Stasis (of blood)
  2. Vascular damage
  3. Probs with constituents (eg Thrombophillia)
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2
Q

32y/o female, on OCP, just got off flight from australia, complaining of 1/7 SOB, Pleuritic chest pain, Dull ache in swollen calf, feverish - diagnosis?

A

Pulmonary embolism

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3
Q

PE = v diff to diagnose but what would be some “cardinal” signs?

A 
Pleuritic chest pain
SOB
Fever
Haemoptysis
Signs of R hrt strain - s1, q3, t3 on ECG & raised pulmonary pressure (JVP raised?)
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4
Q

4 haematological disorders that could contribute to thrombus formation

A

Factor V Leiden
Prothrombin mutation
Protein C, S deficiency
Antithrombin deficiency

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5
Q

With what 4 possible conditions might a “paradoxical embolus” cross from the right heart to the left hear & systemic circulation?

A

Patent ductus arteriosus
Patent foramen ovale
Atrial septal defect
Ventricular septal defect

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6
Q

What finding on auscultation might indicate a patent foramen ovale?

A

Continuous “machine-like” murmur

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7
Q

Why is injury to the bronchial circulation so catastrophic in causing haemoptysis?

A

It is systemic - comes straight off the aorta so v high pressure and can be fatal loss of blood.

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8
Q

PE diagnosed in an IV drug user - likely source of their thrombus?

A

Infected thrombus formation from injection

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9
Q

Infective endocarditis patient has PE - source of thrombus?

A

Vegetation from valve dislodged

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10
Q

Give at least 3 diff diagnosis for a swollen painful leg other than DVT

A 
Cellulitis
Ruptured bakers cyst
Oedema
Superficial thrombophlebitis
Haematoma
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11
Q

List some major risk factors for PE / DVT

A 
Elective Surgery
Immobility
OCP
MI /Heart failure
Fracture
Nephrotic syndrome
Smoking
Genetic
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12
Q

Other than clot embolus, what types of embolus could occur (5 - think, fractures, scuba, cancer, birth, tropical disease)

A 
Fat embolism (fracture)
Gas (SCUBA / knife injury / removal of line)
Amniotic fluid - in birth
Schistosomiasis eggs in liver
Tumour embolus
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13
Q

Sources of ARTERIAL thrombus (4)

A

Left atrial (AF / Mitral Stenosis)
Infected / damaged valves - endocarditis / prostheses
Atherosclerotic plaque dislodged
Aneurysm

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14
Q

Why might ARTERIAL / left heart thrombus cause a stroke?

A

Goes from L heart - aorta - carotid & lodges in brain

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15
Q

This condition (also possible at altitude) might increase thrombus risk

A

Polycythaemia (rubra vera)

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16
Q

Why might a young / pregnant woman opt for a ventilation perfusion scan over a CT Pulmonary Angiogram to investigate suspected PE?

A

CTPA much higher level of radiation - potential damage to mother / foetus and breasts.

17
Q

What would be a quick effective way to diagnose suspected DVT without messing around with D Dimers and Well’s scores?

A

Doppler ultrasound of the leg

18
Q

Initial treatment of suspected DVT while waiting for Doppler?

A

Sub cutaneous Low Molecular wt Heparin (Enoxaparin / Clexane) - stop when INR reaches 2.5

19
Q

Longer term treatment for DVT?

A

Warfarin - 3 - 6 months

20
Q

Three main types of PE presentation?

A
  1. Massive - fatal / life threatening - similar to MI
  2. Acute, smaller - symptomatic - SOB, pleuritic pain, SOB, fever
  3. Chronic - progression of symptoms incl rh failure, pulmonary HTN, prog SOB
21
Q

As well as fever, pleuritic chest pain, SOB and haemoptysis, what other symptoms might someone have with a PE?

A

Syncope
Dizziness
Agitated / restless

22
Q

Useful investigations in suspected PE (radiological and blood and cardiac)

A
  1. ABGs
  2. D-Dimer
  3. CXR (may be normal, may exclude other illness, may see small effusion, wedge shape, linear shadow)
  4. ECG -S1 Q3 T3 = Big S wave lead 1, Big Q wave lead 3, inverted t wave lead 3 = just indicates RIGHT HEART strain not nec. PE
  5. CT Pulmonary Angiogram - gold standard
  6. Ventilation / perfusion scan
23
Q

Management of PE - Immediate treatment?

A

High Flow O2, IV fluids, Analgesia (for pleurisy)
Unfractionated heparin / Clexane / Enoxaparin
Thrombolysis - tPA if severe

24
Q

Management of PE longer term?

A

Warfarin - 3 to 6 months, get INR 2-3
IVC filters
Novel oral anticoagulants (NOACS) - Apixaban, Rivaroxaban (factor Xa inhibitors)
Direct thrombin inhibitors (DTIs) Dabigatran

25
Q

4 most common causes of streaky / small haemoptysis (think chronic)

A

Smokers / bronchitis
Pneumonia / TB
Bronchiectesis
Lung cancer

26
Q

Most common cause of massive hameoptysis

A

Bronchiectesis

Lung cancer

27
Q

things that look opaque on cxr

A 
Consolidation
Infarcted lung
Collapse (fluid / tissues have encroached lung space)
Mass (tumour)
Pleural effusion

Respiratory 01.15 (5 decks)

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