History : HPI: 45 yo M c/o coughing up blood. Patient reports hemoptysis suddenly started 2 days ago. There has been 2 episodes in which streaks of blood were noticed when he coughed. Patient had cough for 1 month, productive, yellowish/greenish sputum, foul smelling. There is no chest pain or dyspnea. There is no fever but patient reports evening rise of temperature with sweating. Patient reports unintentional weight loss of 5 lb in 2 weeks. ROS: Patient travelled to Africa 3 months ago where he volunteered in the health camps. PMH/PSH/Allergies: None Medication: Prophylactic Antimalarial before going to Africa. F/H: father died of MI, mother has osteoarthritis. S/H: non-smoker, non alcoholic, no recreational drug, sexually active with wife, social worker. Physical Examination : Patient is NAD. HEENT: no exudate, no erythema, no LAD/thyromegaly. Lungs: Chest expansion normal B/L, BS normal B/L, no tactile fremitus. Diagnosis 1 : Pulmonary Tuberculosis Diagnosis 2 : Bronchiectasis Diagnosis 3 : History Findings Physical Exam Findings 1) Hemoptysis 2) evening rise in temperature, night sweats, unintentional weight loss 3) Recent visit to Africa where he volunteered in health camps History Findings Physical Exam Findings 1) Hemoptysis 2) cough for 1 month with foul smelling yellowish greenish sputum Diagnostic Study/Studies - Labs 1) CBC with differential 2) Xray chest 3) sputum ZN stain, culture/sensitivity
