The case of the bloody cough Flashcards
haemoptysis
up coughing blood that has come from lungs or bronchial tree
definition of massive haemoptysis
over 250mls lost in 24hrs
Causes of haemoptysis
inflammation of mucosa, hypertrophied bronchial arteries
necrosis of lung parenchyma
rupture of pulmonary capillaries
vasculitis of pulmonary vessels
most common cause of haemoptysis worldwide
tuberculosis
most common causes of haemoptysis in UK (3)
lung cancer
PE
infection
How does the cough reflex work?
noxious sensation stimulates cough receptors
afferent fibres go to botzinger complex
efferent motor fibres cause cough
pre-Botzinger complex
neurons of the ventral respiratory group in the medulla that are the respiratory rhythm generator
common causes of cough (6)
postnasal drip asthma GORD infections COPD blood pressure drugs
rarer causes of cough (6)
aspiration bronchiectasis cystic fibrosis lung cancer sarcoidosis interstitial lung disease
Define bronchiectasis
abnormal dilation of the bronchi with accumulation of mucus
travel history risky for TB (4 locations??)
Sub Saharan Africa
Eastern Europe
India
Southeast Asia
TB Chest X-Ray Findings (3)
- patchy consolidation
- enlarged lymph nodes
- cavitations
how to diagnose active TB (3)
identify infected area
isolate organism
need to find out susceptibility to antibiotics
How to diagnose latent TB? (3)
Mantoux test
IGRA assay
identify immune response to TB specific antigens
How is tuberculosis spread?
airborne droplets
what organism causes TB?
Mycobacterium tuberculosis
what type of bacteria is TB?
acid-fast bacilli
what can cause TB reactivation?
late stage renal disease
HIV
immunosuppression
lifestyle risk factors for TB (4)
homelessness
overcrowded living
drug/alcohol misuse
prison inmate
treatment of TB
2 months of quadruple therapy
4 months of dual continuation therapy
TB quadruple therapy
isoniazid
rifampicin
ethambutol
pyrazinamide
TB double therapy?
TB double therapy
isoniazid and rifampicin
side effects of rifampicin
orange secretions
hepatoxicity
n+v
side effect of ethambutol
optic neuropathy
side effects of all TB drugs? (3)
nausea and skin rashes
hepatotoxicity
TB treatment when CNS involvement?
2 months quadruple therapy
10 months continuation therapy
Caseating granuloma
Central necrosis; characteristic of TB and fungal infections
Granulomatous inflammation
- Macrophages mass together around foreign bodies
- Connective tissue surrounds and isolates the mass
symptoms of tuberculosis
chronic cough, pleurisy, malaise, haemoptysis, night sweats
investigations for active TB (2)
CXR
sputum smear or culture
side effects of isoniazid (4)
Hepatitis, peripheral neuropathy, drug-induced SLE, agranulocytosis
side effects of pyrazinamide (2)
hepatotoxicity, hyperuricemia
