Version June 2024
| Present illness |
| How much blood has been coughed up in the past 24 to 48 hours? |
| Is the blood mixed with phlegm? Is the phlegm clear, white, or purulent? |
| When was the first time the hemoptysis occurred? |
| Is hemoptysis a new or recurrent symptom? |
| Is there any bleeding from the nose, gums, stomach, or rectum? |
| Is the patient dyspneic? |
| Does the patient raise phlegm (without hemoptysis) daily or frequently? |
| Are there other symptoms to suggest infection (eg, fever, chills, night sweats, purulent sputum)? |
| Has the patient had a skin rash? |
| Has the patient lost weight? |
| Any headache or bone pain? |
| Does the hemoptysis occur during menses? |
| Are there any symptoms to suggest systemic disease (eg, rash, hematuria, joint pain, or swelling)? |
| Comorbidities or risk factors |
| Does the patient currently smoke? How many packs per day? How many years? |
| Does the patient smoke e-cigarettes or vape? For how long? What substances (eg, nicotine, flavoring, THC) and what types of device? |
| Has the patient previously smoked? How many pack per day for how many years? When did they stop smoking? |
| Does the patient use cocaine? |
| Does the patient have known or suspected pulmonary, cardiac, or renal disease? |
| Has the patient had a thoracic procedure (eg, stent placement, pulmonary artery catheter, aortic graft) or surgery? |
| Has the patient had joint symptoms or a history of collagen vascular disease or associated symptoms? |
| Does the patient have a known or suspected bleeding disorder? |
| Does the patient take aspirin, nonsteroidal anti-inflammatory drugs, anti-platelet drugs, or an anticoagulant? |
| Are there any recent risk factors for deep vein thrombosis (DVT), such as surgery, hospitalization, travel, or immobility? |
| Does the patient have a history of upper airway or upper gastrointestinal disease or symptoms? |
| Where has the patient travelled, either recently or in the past and to what countries? |
| Has the patient had tuberculosis (TB) or been exposed to TB? |
| Is the patient at high risk for TB or unusual parasitic disorders based upon travel history? |
| Has the patient been exposed to trimellitic anhydride or other organic chemicals? |
| Has the patient been exposed to asbestos? |
| Family history |
| Have family members had problems with blood clots? |
| Have family members had problems with hemoptysis, brain aneurysms, epistaxis, or gastrointestinal bleeding (suggesting possible hereditary hemorrhagic telangiectasia)? |
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