Case presentation A 59-year-old man presented to his GP with complaints of - Cough and breathlessness for the past three weeks - Weight loss of 1 kg over the same period - Two episodes of hemoptysis  - Increasing fatigue - Smokes of 20/day and has been an active smoker for 40 years Examination findings: - Nicotine staining of fingers - No palpable lymphadenopathy - Other clinical examination was unremarkable. *This Case Challenge is from the Editorial Team of Docplexus and is meant for educational purposes only.