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APPROACH TO HEMOPTYSIS
HISTORY AND CLINICAL EXAMINATION.
Nikhil Panjiyar
Roll:13,IIIrd year
Aug 2014th batch
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HEMOPTYSIS
Hemoptysis is the expectoration of blood or bloody sputum from the
lungs or tracheobronchial tree.
Hemoptysis can range from blood-tinged sputum to life-threatening large volumes of bright
red blood.
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CAUSES 3
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INSPECTION
Inspect the configuration of chest and look for abnormal movement during
breathing, use of accessory muscles, and retractions.
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PALPATION
Palpate the patient's chest for diaphragm level and for tenderness, respiratory
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PERCUSSION
Resonance Hyperesonance
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AUSCULTATION
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INVESTIGATIONS
Sputum smear and culture.
Standard chest radiograph (plain x-ray).
Computed tomography.
Bronchoscopy.
Complete blood count.
Coagulation studies.
Pulmonary arteriography.
Lung biopsy.
Renal function and urinanalysis.
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DIFFERENTIAL DIAGNOSIS
Bronchial adenoma: Causes recurrent hemoptysis along with chronic cough and local
wheezing.
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Laryngeal cancer: Hoarness is usually the initial sign and other finding related are
dysphagia, dyspnea, stridor, cervical lymphadenopathy, and neck pain.
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Plague: Pneumonic form of this acute bacterial infection, caused by Yersinia pestis, can
produce hemoptysis, a productive cough, chest pain, tachypnea, dyspnea, increasing
and hoarseness.
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Pulmonary arteriovenous fistula: Occurs in young adults with red ruby patches in
face,tongue,skin,mucous membrane and lips.
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The patient may also develop night sweats, malaise,fatigue, fever, anorexia, weight
loss, and pleuritic chest pain.
Silicosis: This chronic disorder causes a productive cough with mucopurulent sputum
that later becomes blood streaked.
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OTHER CAUSES
Pulmonary edema
Wegeners granulomatosis
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PEDIATRIC POINTERS
No cause can be found for pulmonary hemorrhage occurring within the first 2
weeks of life
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GERIATRIC POINTERS
Anticoagulants may be the reason for bleeding.
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FACTITIOUS HEMOPTYSIS
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