Patients may present with the chief complaint of coughing up blood, which is called hemoptysis. However, because patient often use vague terms such as “I coughed up food with blood,” “I had blood mixed in my saliva,” and “I coughed a lot of blood after I vomited,” hemoptysis must be differentiated from hematemesis, which is bleeding from extra pulmonary sources, such as an oral cavity. The differences between hemoptysis and hematemesis are listed in a table on this clinical mind map. The list of probable diagnoses must be memorized, and can be chunked based upon the duration of hemoptysis. Further chunking can be done based upon demographics, the presence or absence of shortness of breath, fever, phlegm, and chest pain, etc. Some sources use the presence or absence of a cough as a differentiating feature when reviewing differentials. However, a cough is almost always present in patients with hemoptysis because blood is an irritant and should stimulate cough receptors in the bronchial tree.
Addressing urgent/emergent situations involves reviewing vital signs and the patient’s appearance. Several diagnoses can lead to urgent/emergent situations, such as a foreign body, severe pneumonia, bronchiolitis, and advanced stage cancer/tuberculosis. The amount of bleeding from pulmonary vasculature is rarely large enough to lead to a severe blood loss and an urgent/emergent situation. Instead, the airway obstruction caused by the presence of blood in the bronchial tree or the advanced stage of a disease can lead to an urgent/emergent situation. This situation reflects in the form of appearance of distress and/or abnormal vital signs, such as tachypnea/decreased oxygen saturation.
Weighing and removing anchor bias includes asking high yield questions (duration) and then medium yield questions (differentiating questions). A physical exam and lab data/imaging are important elements to arrive at a working and then a final diagnosis.