Pulmonary haemorrhage and haemoptysis — structured oral (viva)

Branching structured oral on an adolescent with massive haemoptysis and a child with occult alveolar haemorrhage, testing the focal-versus-diffuse split, airway-first resuscitation, the haemosiderin-laden macrophage, and corticosteroid and embolization management.

branching clinical structured oral2 min readVerification in progress

Prompt

A 14-year-old boy with known cystic fibrosis is brought to the emergency department having coughed up more than a cupful of bright red blood over the past hour. He is frightened, tachypnoeic, and has blood at the lips; his oxygen saturation is 90 percent on room air.

Branch 1 — The emergency and first move

Examiner: "He is bleeding briskly from the lungs. What is your very first priority and why?" Candidate: My first priority is the airway and breathing, not stopping the source. In massive haemoptysis the immediate danger is asphyxiation from blood flooding the airway rather than exsanguination, so I would give high-flow oxygen, clear and protect the airway, and prepare to intubate while calling for senior and intensive-care help. Only once ventilation is secure would I move to locating and controlling the bleed. [1]

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References4Show ledger

[1]Gipsman AI, Grant LMC, Piccione JC, et al Management of severe acute pulmonary haemorrhage in children. Lancet Child Adolesc Health, 2025.PMID 40246361
[2]Roebuck DJ, Barnacle AM Haemoptysis and bronchial artery embolization in children. Paediatr Respir Rev, 2008.PMID 18513669
[3]Saha BK Idiopathic pulmonary hemosiderosis: A state of the art review. Respir Med, 2021.PMID 33246295
[4]Susarla SC, Fan LL Diffuse alveolar hemorrhage syndromes in children. Curr Opin Pediatr, 2007.PMID 17505192