Core Clinical Problems

Question 1

If a patient presents with haemoptysis, what are the main points in the history of PC that you want to know?

Answer 1

Source
Onset
Duration
Character
Amount

Question 2

What do you want to know about the source of the blood in haemoptysis?

Answer 2

Is it definitely from the chest?
it could be from a nose bleed
is it GI? - haematemesis, coffee ground, malaena

Question 3

What do you want to know about the character of blood that is coughed up?

Answer 3

Frothy
Old
Rusty (strep oneumonia infection)
Streaks
Mixed with sputum? (if not, consider infarction and trauma)

Question 4

What do you want to know about the amount of blood coughed up?

Answer 4

> 600ml = massive: emergency admission and treatment

<600ml = non-massive: ca usually do Ix as an out-patient

Question 5

What are some causes of haemoptysis?

Answer 5

Trauma - wounds intubation, foreign body
Infection - pneumonia, abscess, acute bronchitis, TB, bronchiectasis, fungi
Neoplasm - primary, secondary
Vascular - PE, vasculitis (eg SLE), atriovenous malformation
Parenchymal - ILD, sarcoidosis, haemosiderosis, Goodpasture’s syndrome, CF (because blood vessels in lungs aren’t formed properly)
Non-pulmonary - CVS (Po oedema - pink frothy sputum), bleeding diathesis (inc. drug induced)

Question 6

What are the main differentials for:
42 year female, non-smoker, presents with haemoptysis, weight loss of 10kg over 2 months and night sweats? CXR shows upper right lobe cavitation.
What would you do next?

Answer 6

Tumour
TB
pneumonia

Zeihl-Neelson stain for acid fast bacilli

Question 7

What is pink frothy sputum characteristic of?

Answer 7

pulmonary oedema