Spitting Up Blood

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of hemoptysis

Described as ‍blood-tingedmixed with sputumbloody, with color being ‍pinkishbright reddark redbrownish

Episodes occurred ‍ times ‍per dayoverall

Volume is ‍smallmoderatelarge, approximately ‍ mL ‍per episodedailyoverall

Worsening factors: ‍none



Associated symptoms: *Try using right-click for negatives*

‍dyspnea, ‍at reston exertion

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍pleuritic pain

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍sputum production, ‍clearwhiteyellowgreen

‍fever, up to ‍°, over ‍ ‍hoursdays

‍night sweats

‍unintentional weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths

‍fatigue

‍palpitations

‍hoarseness

‍leg edema, ‍rightleftsymmetrical

‍epistaxis

‍hematemesis



Contributing factors:

‍smokingpast smoking

‍exposure to chemicals or toxins

‍risk factors for PE

‍recent respiratory infection

no history of: ‍pneumonia, ‍lung cancer, ‍tuberculosis, ‍pulmonary embolism, ‍DVT, ‍COPD

no use of: ‍anticoagulants, ‍antiplatelet





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Viral bronchitis ‍likelysuspectedpossible

DDx: bronchitis, pneumonia, tuberculosis, lung cancer, bronchiectasis, pulmonary embolism, pseudohemoptysis from epistaxis, pseudohemoptysis from gum bleeding, pseudohemoptysis from hematemesis, mitral stenosis, Goodpasture syndrome, vasculitis, anticoagulant medication side effect, coagulopathy, pulmonary arteriovenous malformation, foreign body aspiration, trauma to the chest or respiratory tract, parasitic infection, fungal infection, autoimmune disorders, cryptogenic organizing pneumonia, endometriosis involving the lung.





PLAN:

Investigations:

- Chest X-ray

- Chest CT scan

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍coagulation profile

- Sputum culture

- Tuberculosis test

- Bronchoscopy

Treatments:

- Smoking cessation counseling

Further care:

- Referral to pulmonologist

- Follow-up in ‍ weeks

- Return if hemoptysis worsens or if new symptoms develop