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Haemoptysis and abnormal chest X-ray

Clinical Discipline(s)/Organ System(s)
Respiratory Medicine, Respiratory System, Infectious Diseases, Microbiology, Oncology
Progress Test Topic(s)
Respiratory
Description
A 65 year old Samoan man returns to the GP clinic where you are on your attachment. He has had a prolonged cough and the GP arranged a chest X-ray which has shown a 2.5 cm diameter cavity within an area of confluent shadowing in the superior segment of the right lower lobe. He has come back for the result and reports that he coughed up some blood recently. He is a long-term smoker and has a heavy consumption of alcohol.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy (and imaging) of the respiratory tract - mediastinum, lobar anatomy including surface markings, pulmonary and bronchial blood vessels, lymphatics, nerves, thoracic wall
   - Pathophysiology/mechanisms of haemoptysis
   - Pathology of lung cancer (and mesothelioma)
   - Pathology and microbiology of tuberculosis
   - Lung defence mechanisms including cellular and immunologic mechanisms; mucociliary clearance; consequences of impairment of lung defence mechanisms
   - Mechanisms, pathology and microbiology of aspiration pneumonia and lung abcess (and empyema)
   - Pharmacology of isoniazid, ethambutol, rifampicin, streptomycin and anti-cancer drugs
   - Cancer-associated mutations and targeted chemotherapy
Clinical and Communication Skills 
   - History from a patient with an abnormal chest X-ray and haemoptysis; assess risk factors for tuberculosis and lung cancer including occupational history
   - Examination of the respiratory system, identify features indicating involvement of structures by lung cancer
   - Interpret chest X-ray, full blood count, sputum culture, sputum cytology
   - Indications for chest CT, bronchoscopy, and other investigations
   - Differential diagnosis of haemoptysis
   - Investigation (including staging) of lung cancer
   - Outline the management of lung cancer; indications and contraindications for treatment options in lung cancer
   - Prognosis of lung cancer
   - Investigation and management of aspiration pneumonia and lung abcess
   - Presentation/manifestations of pulmonary and extra-pulmonary tuberculosis
   - Investigation and management of tuberculosis
   - Prognosis of tuberculosis
   - Multidisciplinary care; role of other health professionals in investigation and management of lung cancer and tuberculosis
Personal and Professional Skills 
   - Breaking bad news
   - Be able to counsel a patient about behaviour change including smoking cessation, giving thought to their readiness to attempt this
   - Be aware of ways in which to support a patient with cancer
   - Awareness of patient and family/whānau needs when facing death
   - Ensure a culturally safe environment in life-changing scenarios
Hauora Māori 
   - Awareness of differing risk profiles for Māori compared with non-Māori in NZ
   - Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
   - Consideration of access to spiritual and cultural support for patients and whānau
Population Health 
   - Tobacco control
   - Epidemiology of lung cancer
   - Epidemiology of tuberculosis in New Zealand
   - Infection control mechanisms for respiratory pathogens
   - Community strategies for the control of tuberculosis: immunisation, contact tracing, effective treatment measures including directly observed therapy (DOT)
   - Role of public health services in management of tuberculosis including contact tracing and directly observed therapy
   - Global health; epidemiology of smoking and lung cancer
   - Global health; epidemiology of tuberculosis, HIV and tuberculosis (including drug-resistant tuberculosis)
Conditions to be considered relating to this scenario
Common
lung cancer, tuberculosis, aspiration and lung abcess, empyema
Less common but 'important not to miss'
diffuse alveolar haemorrhage
Related Scenarios
[Hypercalcaemia and back pain]