Haemoptysis Source? Source? Onset? Onset? Duration? Duration? Character? Character? Amount? Amount? Frothy Frothy Old Old Rusty Rusty Streaks Streaks Mixed with sputum? Mixed with sputum? If not consider infarction and trauma
Haemoptysis Source? Source? Onset? Onset? Duration? Duration? Character? Character? Amount? Amount? Massive Massive 500 mls in 24h Admission May need emergency treatment Major Major mls in 24h Non Major < ml OP Inv
What could be causing Mrs Reddys haemoptysis?
Causes Trauma Trauma Infective Infective Neoplastic Neoplastic Vascular Vascular Parenchymal Parenchymal Non pulmonary Non pulmonary
Causes Trauma Trauma Infective Infective Neoplastic Neoplastic Vascular Vascular Parenchymal Parenchymal Non pulmonary Non pulmonary Wounds Wounds Post intubation Post intubation Foreign Body Foreign Body
Causes Trauma Trauma Infective Infective Neoplastic Neoplastic Vascular Vascular Parenchymal Parenchymal Non pulmonary Non pulmonary CVS CVS Pulmonary oedema Mitral stenosis Aortic aneurysm Eisenmengers Syndrome Bleeding Diathesis Bleeding Diathesis Including Drug induced
Mrs Reddy is 42. She presents with haemoptysis, weight loss of 10 kg over 2 months and night sweats. She has never smoked
Her CXR shows cavitation in the right upper zone.
What are the possible diagnoses? 1. Tumour 2. TB 3. Pneumonia 4. Mycobateria other than TB (MOTT) 5. Any of them
What would you like to do next? 1. Sputum MC+S 2. Induced sputum x3 for AFB 3. CT Chest 4. Commence Antibiotics 5. Blood Cultures
Sputum samples are negative for AFB. You still have high index of suspicion. What next? 1. Bronchial Biopsy 2. Bronchiio-Alveolar Lavage (BAL) 3. CT biopsy 4. Mantoux test 5. Repeat CXR in 2 months
Peter is 31. He is a non smoker, suffers from heartburn and works in a job centre. He presents with coughing up a small cup full of fresh blood over 24 hours. He normally keeps well and his mother has had problems with DVT in the past.
His CXR is normal and you note that his RR is 24/min, HR 96/min and BP 121/63. His pO 2 on room air is 8.3 kPa
You put him on oxygen and start him on Warfarin 2. Low Molecular Weight Heparin 3. Aspirin 4. Streptokinase 5. Traneximic acid
What investigation would you arrange? 1. CTPA 2. CT chest 3. HRCT 4. PFTs + DLCO 5. V/Q scan
If Peter was 30 years older,smoked all his life and had emphysema on his CXR
Which test would you choose? 1. CTPA 2. CT chest 3. HRCT 4. PFTs + DLCO 5. V/Q scan
George is 73. He presents acutely with breathlessness and coughing up frothy pink sputum. He has been suffering from orthopnoea, PND and ankle oedema over several days.
He has fine inspiratory crackles at the bases and midzones, raised jugular venous pressure and has a heart rate of 110
This is his ECG
What does this show? 1. Normal sinus rhythm 2. Left Bundle Branch Block (LBBB) 3. Right Bundle Branch Block (RBBB) 4. ST elevation myocardial infarction 5. Ventricular tachycardia
Which of the following is likely to be present on his CXR? 1. Cardiomegaly 2. Upper lobe venous diversion 3. Pleural effusion 4. Kerley B Lines 5. Perhilar patchy opacification (Bats wing)
What has caused his deterioration? 1. Acute Bronchitis 2. Cryptogenic organising pneumonia 3. Pulmonary embolism 4. Acute pulmonary oedema 5. Aspiration pneumonia