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Sentinel Bleed Massive Haemoptysis — SCE Palliative Medicine MCQ

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HardRespiratory SymptomsSentinel Bleed Massive HaemoptysisSCE Palliative Medicine

A 55-year-old woman with advanced cervical cancer develops acute massive haemoptysis (>500 mL) at home. She is known to have a tumour eroding into a major pulmonary vessel. Despite a catastrophic haemorrhage plan being in place, the episode resolves spontaneously. She is now haemodynamically stable. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Urgent hospital admission for imaging and consideration of bronchial artery embolisation — a sentinel bleed often precedes catastrophic haemorrhage; reassessment is needed

Explanation lettering: E = shown as C · C = shown as E

Option A is correct. A massive haemorrhage that stops spontaneously in the context of tumour erosion should be interpreted as a sentinel bleed—an ominous prognostic sign indicating imminent catastrophic rebleeding. UK palliative care guidance advises that such episodes warrant hospital admission when a potentially reversible cause (e.g., tumour erosion) is involved, and consideration of definitive interventions such as embolisation should follow. Options B, C and D are unsafe: they falsely imply the episode is benign or successfully managed when in fact the risk remains high. Option E is not appropriate: oral tranexamic acid has limited role, and definitive vascular control is required.

Reference: Scottish Palliative Care Guidelines – Emergencies: ‘Minor bleeding may herald a fatal bleed… consider interventions including … embolisation’; ‘Consider admission where there is a potentially reversible cause such as tumour erosion’ (NHS Scotland Right Decisions). https://rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/palliative-emergencies/bleeding/?searchTerm=fungating+tumour