Steve's Haemoptysis

February 06, 2018 Print Friendly Version of this page Print Get a PDF version of this webpage PDF
By Chris Warner (4th year Medical Student)
Steve French
11/10/1945 (72 Years)
Noticed that there has occasionally been streaks of blood in his sputum for the last month. Sputum is usually white. Had a cough for the last 2 years which has become progressively more frequent. Cough gets worse with viral illnesses and on exertion. He gets more breathless on exertion now, can only walk to the kitchen (10m) before needing to stop to take a break where he could previously walk 200m. Unintentional weight loss if asked, two belt holes in the last 6 weeks. No foreign travel. Possibly hoarse voice but no other symptoms
Past Medical History
COPD, Hypertension
Drug History
Allergy to Penicillin. Takes Amlodipine, Simvastatin and 2 inhalers
Family History
Social History
Smokers 30 cigarettes per day for over 50 years. Drinks a can of cider each night. Lives alone
Introduction & consent

Name & age

Asks open question & clarifies it is not haematemesis

Establishes duration and trigger (if present)

Type: fresh, streaks in phlegm, clots

Amount and frequency

Time course (worsening, continuous, intermittent)

Alleviating or exacerbating factors (specifically exertion, dust, smoke)

Associated symptoms: chest pain, cough, fever, shortness of breath (pulmonary embolism), ankle swelling, wheeze, bone pain, nosebleeds (vasculitis)

Screens for red flags (haemoptysis, weight loss, hoarseness, night sweats)

Establishes if symptoms of anaemia are present: lethargy, palpitations, shortness of breath

Asks for any recent illness, bleeding from elsewhere or any family members/contacts with similar symptoms

Asks if patient smokes and clarifies how much and for how long

Asks for any foreign travel

Checks occupation of patient & checks for asbestos exposure

Drug history and allergies

Alcohol and illicit drug use

"Was there anything you thought it might be?"

"What about it is worrying you in particular?"

"Is there anything in particular you were hoping we would to today?"

Communication skills (empathy and avoids jargon)

Summarises back to patient

Gives reasonable differential diagnosis (lung cancer, COPD exacerbation, pneumonia, fibrosis)