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Medicine

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Respiratory

Question
17 out of 20
 

A young man with tuberculosis presents with massive recurrent hemoptysis. For angiographic treatment which

vascular structure should be evaluated first. (AIIMS May 2009 & LQ)



A Pulmonary artery
B Bronchial artery

C Pulmonary vein
D Superior vena cava

Ans. B

Bronchial artery

Sources of Bleeding in Hemoptysis

1). Bronchial Arteries: Most common source of Bleeding in Hemoptysis (>90% cases)

2). Pulmonary Arteries: Uncommon source of bleeding in hemoptysis (<10% cases)

Causes of hemoptysis in TB

1). Rupture of dilated vessel in a cavity (Rasmussen’s aneurysm) (AIIMS May 2008) It is of pulmonary artery in origin. (Ref. Hari-18thed., Pg 1345)

2). Erosion of vessel

3). Aspergilloma formation in an old cavity

Extra Edge: Commonest source of hemoptysis in TB is from rupture of bronchial artery.

Extra Edge - Treatment of TB in special situation:

1). Pregnancy with TB = H, R, E (S and Z are contraindicated)

2). Jaundice with TB = S, E (H, R, Z are contraindicated)

3). CRF with TB = R full dose, H half dose daily, E half dose twice a week only.

(S and Z are contra indicated in end stage renal failure).

Note:In mild to moderate renal failure, H, R, Z may be given in the usual doses (Ref. Hari 18th ed., pg. 1356)

Extra Edge - Indications of Corticosteroids in TB –

1). TBM

2). Addison’s crisis

3). Seriously ill pt. before chemotherapy is effective

4). Pericardial, pleural effusions

5). Genitourinary TB

6). Choroid retinitis

Extra Edge – Indication of Higher dose of Pyridoxine in TB

1). Alcoholics

2). Malnutrition

3). Pregnant /lactating mother

4). CRF

5). Diabetes

6). HIV, AIDS

Extra Edge - Indications of Surgery in TB

1). Massive hemoptysis

2). Empyema chest tube.

3). MDR TB with localised disease

Respiratory Flashcard List

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