Haemoptysis

Question 1

Opening

Answer 1

Open- tell me exactly what you have noticed
Onset- when did you first notice it
Timing- how many times have you noticed it
Character- what colour is it (bright red or dark)
Amount- how much is there/ streaks or Frank blood
Site- are you vomiting it or coughing it? Any recent nose bleeds? Dental hygiene- is it gum bleeding?

Question 2

Systems review

Answer 2

General- FWARJNL

Cardiorespiratory- chest pain, palpitations, SOB, wheeze, leg swelling (PE), ankle swelling (heart failure- pink frothy sputum, may be mistaken for blood), sputum (describe and qualify that), cough, PE risk factors, travel outside UK in last year

Reticuloendothelial- any lumps anywhere, any night sweats

Question 3

Pneumonia

Answer 3

Acute productive cough of rapid onset over a day
Associated with SOB
systemic Sx eg. Fever
Classically rusty brown sputum

Question 4

PE

Answer 4

Pleuritic chest pain and SOB
Risk factors (malignancy pregnancy anti thrombin 3 deficiency)
Fever tachycardia and haemoptysis
DVT Sx

Question 5

Lung malignancy

Answer 5

Weight loss
Significant smoking history
Later stage Sx eg. Progressive breathlessness, hoarse voice, dysphagia etc.
Risks- asbestos, smoking, age, exposure to other hazardous industrial dusts
Paraneoplastic syndromes (dermatomyositis, cushings, SIADH)

Question 6

Bronchiectasis

Answer 6

Chronic productive cough
Recurrent chest infections
Cause- CF, TB, childhood respiratory illness, immunosupression

Question 7

Acute bronchitis

Answer 7

Few day history of fever, malaise, cough with SOB

Mucopurulent sputum streaked with blood

Question 7

Lung abscess

Answer 7

Large amount of blood stained foul smelling sputum
Normally a pneumonia occurs before (or infective endocarditis, foreign body aspiration, trauma)
Fever, pleuritic chest pain, cough, weight loss

NB- could also be cancer, in someone who is predisposed to lung infections and then starts coughing up blood (or bronchiectasis)

Question 7

Tuberculosis

Answer 7

Long standing fever, malaise, weight loss, lymphadenopathy
Night sweats
Risk factors- immunosuppression, travel to endemic areas, alcoholism, IVDU

Question 8

Bronchiectasis

Answer 8

Precipitated by recurrent infections or a particularly bad chest infection
Produce a large amount of sputum per day (cupfuls)
Haemoptysis and SOB present
Cystic fibrosis associated

Question 9

Tips

Answer 9

Do a clotting profile in someone with haemoptysis (or any bleeding for that matter)

Question 10

Patients perspective

Answer 10

Feelings and affect on life
Ideas
Concerns
Expectations

Question 11

PMH

Answer 11

Cancer

Bleeding disorders

Question 12

DH

Answer 12

Warfarin and oral contraceptive pill

Question 13

FH

Answer 13

Bleeding disorders

Question 14

SH

Answer 14

Smoke alcohol recreational drugs
What does your job entail
Home situation (occupants and difficulties)
Has your problem affected home life

Question 15

Investigations

Answer 15

Look at sputum and send culture 
FBC UE LFT clotting CRP ESR
 Blood cultures
TB test 
CXR 
CT chest and broncos copy if warranted