A 60 years old chronic smoker presents with complaints of hemoptysis. Her chest X-ray appears to be normal. What is the next best investigation:

Answer is A (Bronchoscopy) : The patient presents a case of hemoptysis with normal X-ray but with risk factors for cancer (Age and history of smoking). Bronchoscopy together with a bronchial or transbronchial biopy is the investigation of choice as indicated in the following algorithm from harrisons text. Algorithm in Harrisons 16th/208 does not elaborate the distinction between bronchoscopy and HC and thus reference to previous editions is recommended.