Emergency medicine: massive haemoptysis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Emergency medicine: massive haemoptysis

Sample item

A 48-year-old man with sequelae of old pulmonary tuberculosis and a cavity in the right upper lobe coughs up about 600 mL of fresh blood in 24 hours and is tachypnoeic. After positioning him with the bleeding side down and securing the airway, which intervention is the most appropriate definitive measure to control bleeding?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Bronchial artery embolisation

In massive haemoptysis the bleeding vessel is nearly always a hypertrophied bronchial artery supplying the diseased lung, and death is by asphyxia rather than exsanguination. Management is airway protection, lateral decubitus positioning with the bleeding lung down, resuscitation, tranexamic acid, then bronchial artery embolisation, which controls bleeding in most cases. Surgery is reserved for failure or recurrence in suitable patients.

Option by option

  • A. Bronchial artery embolisation (correct)

    Correct. Embolisation of the culprit bronchial artery is the first-line definitive treatment.

  • B. Prolonged chest physiotherapy

    Chest physiotherapy may provoke further bleeding and does not control the source.

  • C. Emergency right upper lobectomy as first-line

    Emergency resection carries high mortality and is reserved when embolisation fails.

  • D. Continuous nebulised salbutamol

    Salbutamol has no haemostatic effect on bleeding from a cavity.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Bronchial artery embolisation. In massive haemoptysis the bleeding vessel is nearly always a hypertrophied bronchial artery supplying the diseased lung, and death is by asphyxia rather than exsanguination.

Why is "Prolonged chest physiotherapy" not the answer?

Chest physiotherapy may provoke further bleeding and does not control the source.

Why is "Emergency right upper lobectomy as first-line" not the answer?

Emergency resection carries high mortality and is reserved when embolisation fails.

Why is "Continuous nebulised salbutamol" not the answer?

Salbutamol has no haemostatic effect on bleeding from a cavity.

What concept does this question test?

It tests Emergency medicine: massive haemoptysis in General Medicine. Management is airway protection, lateral decubitus positioning with the bleeding lung down, resuscitation, tranexamic acid, then bronchial artery embolisation, which controls bleeding in most cases. Surgery is reserved for failure or recurrence in suitable patients.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Emergency medicine: massive haemoptysis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.