Mr P haemoptysis

Question 1

What can haemoptysis be confused with? (3)

Answer 1

haematemesis
epitaxis
bleeding gums

Question 2

CAGE questions USE?

Answer 2

to determine if someone is drinking too much
Have you ever felt you need to cut down on your drinking?
Have people annoyed you by criticising your drinking
Have you ever felt guilty about your drinking?
Have you ever neede an eye-opener to steady your nerves in the morning?

yes to 2 or more = alcohol abuse/dependence

Question 3

why can haemoptysis be dangerous itself?

Answer 3

1 - massive blood loss can increase risk of asphyxiation or shock

Question 4

Which letters from INVITED MD are you worried about with haeoptysis?

Answer 4

I infective: TB, bronchitis, pneumonia, lung abscess, mycetoma
N eoplastic: primary lung cancer, metastatic lung cancer
V ascular: pulmonary infarction, left ventricular failure, bleeding diathesis, arteriovenous malformation, vascular-bronchial fistula
I nflammatory: wegener’s disaese, goodpastures syndrome, systemic lupus erythematosus, hereditary haemorrhagic telangiectasia, polyarteritis nodosa, microscopic polyangitis
T raumatic: iatrogenic, wounds
D egenerative: bronchiectasis
D rugs: warfarin

Question 5

What do:
a) frank blood
b) blood-streaked sputum
c) pink frothy sputum
suggest?

Answer 5

a) vascular problem e.g. invasive cancer, bronchiectasis, TB, mycetoma
b) any infection: chronic production of lots of sputum = bronchietasis

Question 6

Massive haemoptysis can be

caused by?

Answer 6

erosion of a pulmonary blood vessel.

Question 7

sudden onset haemopytsis indicates what? (2)

Answer 7

PE

erosion of cancer into a blood vessel

Question 8

gradual onset of haemopytsis suggests what? (2)

Answer 8

lung cancer

brochiectasis

Question 9

what can dull, aching, swollen wrists ankles + heamoptysis indicate?

Answer 9

hypertrophic pulmonary osteoarthritis - secondary to lung cancer, but rare

Question 10

muscle weakness (proximal muscles, autonomic dysfunction) + haemoptysis suggests?

Answer 10

Eaton-lambert syndrome: seen in patients with small cell lung cancer

Question 11

haematuria and/oliguria + haemoptysis might suggest? (3)

Answer 11

1 - goodpasture’s syndrome - autoimmune attack of lungs + glomruli of kidneys
2 - vasculitides e.g. wegner’s granulomatosis
3 - systemic lupus erythematosus

Question 12

what signs would you be looking for on the chest radiograph? (5)

Answer 12

1 - mass/lesion
2 - diffuse alveolar infiltrates
3 - hilar lymphadenopathy
4 - lobar/segmental infiltrates
5 - patchy alveolar infiltrates