1. By Dr. Zahoor 1

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3. A 65 year old woman is brought to the emergency room after coughing up several table spoons of bright red blood. For the last 3-4 months, she had a chronic non- productive cough but no fever. Most recently she has noticed some scanty blood – streaked sputum. She complains of fatigue and weight loss of 25lb in past 3 months. She denies history of chest pain, fever, night sweats. She is a smoker 1 pack of cigarettes per day for past 30 years. She worked in library with no history of occupational exposure. 3

4. On examination Patient is thin, mildly anxious, alert and oriented Finger clubbing – present Cyanosis – not present Pulse rate - 88/min Blood Pressure – 150/90 Respiratory rate – 16/min Temperature – 99.4 o F Neck examination – no lymphadenopathy Chest – scattered ronchi bilaterally CVS – regular pulse, no murmurs Abdomen – no hepatosplenomegaly Neurological examination - normal 4

5. 1. What is likely diagnosis ? 2. What investigation you will do ? 3. What are common causes of hemoptysis ? 5

6. 1. Lung cancer 2. X-ray chest CT – chest 3. Bronchitis Lung cancer Tuberculosis Pulmonary embolism (hemoptysis with acute onset of pleuritic chest pain and dyspnea) 6

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