Wk 2 - The case of the bloody cough

Question 1

HAEMOPTYSIS DEFINITIONS

i) name two places where the blood can come from?
ii) what is the definition of massive haemoptysis?

Answer 1

i) lungs or bronchial tree
ii) varies but most commonly over 250mls/24hrs

Question 2

PATHOPHYSIOL OF HAEMOPTYSIS

i) what % of HP originates from the pulmonary arterial system?
ii) where does most HP originate? why?

iii) how does inflammation of the mucosa affect the bronchial arteries?
how does this result in HP?

iv) what can happen to the pulmonary parenchyma itself to cause HP?

Answer 2

i) 5% originates from pulmonary arterial system
ii) most originates from the bronchial arteries as they are under high pressure
iii) bronchial arteries hypertrophy and proliferate - thinner theremore more amenable to erosion and bleeding
iv) pulm parenchyma can get necrosis and infarction eg from PE

Question 3

CAUSES OF HP

i) what is the most common cause worldwide?
ii) what is it important to consider first?
iii) is primary vascular disease common or rare?

Answer 3

i) TB is the most common cause worldwide
ii) consider neoplasia
iii) primary vas disease is rare but PE is common

Question 4

COUGH

i) name the three most common causes of a cough if CXR is normal
ii) what should be thought about if there has been a cough for >6wks?
iii) name two drugs that can cause a cough

Answer 4

i) most common causes when CXR normal is postnasal drip, asthma, GORD
ii) think cancer if cough >6weeks
iii) ACEis and beta blockers

Question 5

TAKING A HISTORY

i) what is it important to differentiate HP from?
ii) what may be happening if it is associated with menstrual periods?
iii) name three symptoms that point towards cancer/TB
iv) what does systemic disease and rash point towards?
v) what may be seen on O/E that indicates lung cancer/CF

Answer 5

i) differentiate from haematemesis
ii) assoc with period > endometriosis
iii) fever, chest pain, weight loss
iv) systemic disease and rash > vasculitis
v) finger clubbing

Question 6

MASSIVE HAEMOPTYSIS

i) is this an emergency?
ii) what approach should be taken

Answer 6

i) yes
ii) ABCDE

Question 7

TB PATHOGENESIS

i) how is it spread? where does it deposit?
ii) in what time period does the body gain control/not after infection?
iii) give three risk factors for reactivation of latent TB

Answer 7

i) spread by airbourne droplets > deposits in terminal air spaces
ii) body gains control in 4-6 weeks post infection
iii) reactivation > increasing age, immunosuppression or renal disease

Question 8

TB PATHOLOGY

i) what kind of bacteria is it?
ii) does it divide quick or slow?
iii) does it stain well with gram stain?
iv) what appearance makes it likely to be TB? (2) what is another differential?

Answer 8

i) aerobic bacillus / acid fast bacillus
ii) divides slow
iii) doesnt gram stain well
iv) granuloma with central necrosis (caseation) > can also be sarcoidosis