The case of the bloody cough

Question 1

haemoptysis

Answer 1

up coughing blood that has come from lungs or bronchial tree

Question 2

definition of massive haemoptysis

Answer 2

over 250mls lost in 24hrs

Question 3

Causes of haemoptysis

Answer 3

inflammation of mucosa, hypertrophied bronchial arteries
necrosis of lung parenchyma
rupture of pulmonary capillaries
vasculitis of pulmonary vessels

Question 4

most common cause of haemoptysis worldwide

Answer 4

tuberculosis

Question 5

most common causes of haemoptysis in UK (3)

Answer 5

lung cancer
PE
infection

Question 6

How does the cough reflex work?

Answer 6

noxious sensation stimulates cough receptors
afferent fibres go to botzinger complex
efferent motor fibres cause cough

Question 7

pre-Botzinger complex

Answer 7

neurons of the ventral respiratory group in the medulla that are the respiratory rhythm generator

Question 8

common causes of cough (6)

Answer 8

postnasal drip
asthma
GORD
infections
COPD
blood pressure drugs

Question 9

rarer causes of cough (6)

Answer 9

aspiration
bronchiectasis 
cystic fibrosis
lung cancer
sarcoidosis
interstitial lung disease

Question 10

Define bronchiectasis

Answer 10

abnormal dilation of the bronchi with accumulation of mucus

Question 11

travel history risky for TB (4 locations??)

Answer 11

Sub Saharan Africa
Eastern Europe
India
Southeast Asia

Question 12

TB Chest X-Ray Findings (3)

Answer 12

• patchy consolidation
• enlarged lymph nodes
• cavitations

Question 13

how to diagnose active TB (3)

Answer 13

identify infected area
isolate organism
need to find out susceptibility to antibiotics

Question 14

How to diagnose latent TB? (3)

Answer 14

Mantoux test
IGRA assay
identify immune response to TB specific antigens

Question 15

How is tuberculosis spread?

Answer 15

airborne droplets

Question 16

what organism causes TB?

Answer 16

Mycobacterium tuberculosis

Question 17

what type of bacteria is TB?

Answer 17

acid-fast bacilli

Question 18

what can cause TB reactivation?

Answer 18

late stage renal disease
HIV
immunosuppression

Question 19

lifestyle risk factors for TB (4)

Answer 19

homelessness
overcrowded living
drug/alcohol misuse
prison inmate

Question 20

treatment of TB

Answer 20

2 months of quadruple therapy

4 months of dual continuation therapy

Question 21

TB quadruple therapy

Answer 21

isoniazid
rifampicin
ethambutol
pyrazinamide

Question 22

TB double therapy?

Answer 22

TB double therapy

isoniazid and rifampicin

Question 23

side effects of rifampicin

Answer 23

orange secretions
hepatoxicity
n+v

Question 24

side effect of ethambutol

Answer 24

optic neuropathy

Question 25

side effects of all TB drugs? (3)

Answer 25

nausea and skin rashes

hepatotoxicity

Question 26

TB treatment when CNS involvement?

Answer 26

2 months quadruple therapy

10 months continuation therapy

Question 27

Caseating granuloma

Answer 27

Central necrosis; characteristic of TB and fungal infections

Question 28

Granulomatous inflammation

Answer 28

• Macrophages mass together around foreign bodies

- Connective tissue surrounds and isolates the mass

Question 29

symptoms of tuberculosis

Answer 29

chronic cough, pleurisy, malaise, haemoptysis, night sweats

Question 30

investigations for active TB (2)

Answer 30

CXR

sputum smear or culture

Question 31

side effects of isoniazid (4)

Answer 31

Hepatitis, peripheral neuropathy, drug-induced SLE, agranulocytosis

Question 32

side effects of pyrazinamide (2)

Answer 32

hepatotoxicity, hyperuricemia