Chapter 90: Hemoptysis Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient with a smoking history of 35 pack years reports having a chronic cough with recent symptoms of pink, frothy blood on a tissue. The chest radiograph shows a possible nodule in the right upper lobe. Which diagnostic test is indicated?

a. Coagulation studies b. Computed tomography (CT) c. Fiberoptic bronchoscopy d. Needle biopsy

ANS: B a. Infection b. Lung abscess c. Malignancy d. Thromboembolism

CT is suggested for initial evaluation of patients at high risk of malignancy, such as a smoker with >30 pack years, who have suspicious findings on chest radiography. Coagulation studies are performed for patients taking anticoagulants or a history of coagulopathy. Fiberoptic bronchoscopy is used with CT but is not the initial test. Needle biopsy is performed if other tests indicate a tumor.

2. A patient reports coughing up a small amount of blood after a week of cough and fever. The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient’s symptoms?

ANS: A

NURSINGTB.COM a. Observation b. Prophylactic antibiotics c. Specialist consultation d. Surgical intervention

In a healthy patient without risk factors who has a cough and fever, infection is the most likely cause. Lung abscess may occur but is less likely. Malignancy is also less likely. Thromboembolism is more likely after surgery or with trauma.

3. A patient with hemoptysis and no other symptoms has a normal chest radiograph (CXR), computed tomography (CT), and fiberoptic bronchoscopy studies. What is the next action in managing this patient?

ANS: A

Patients with negative findings on CXR, CT, and bronchoscopy, with no risk factors may be observed for 3 years. Antibiotics are not indicated, since signs of infection are not present. Specialty consultation and surgery are not indicated.