A 62-year-old smoker complains of "coughing up small amounts of blood," leading you to consider hemoptysis. Which of the following should you also consider?

In the context of a 62-year-old smoker presenting with hemoptysis, it is crucial to consider the possibility of epistaxis as a contributing factor. Epistaxis refers to bleeding from the nose, which can lead to blood being coughed up due to drainage into the throat. In cases where a patient reports blood in their sputum, differentiating between true hemoptysis from pulmonary sources and blood that originates from the nasal passages is essential. Given this patient's smoking history and the potential for underlying respiratory issues, any nasal bleeding could easily be mistaken for hemoptysis.

Considering the other options, intestinal bleeding typically presents with different symptoms and tends to cause blood in the stool rather than in sputum. A hematoma of the nasal septum, while it can lead to nasal bleeding, is a specific condition that may not be commonly associated with the act of coughing up blood directly. Bruising of the tongue is generally unrelated to the patient's symptoms as it wouldn't contribute to the presence of blood in the sputum.

In summary, given the presentation of coughing up blood, it is vital to assess for epistaxis as a possible cause, making it the most relevant consideration alongside hemoptysis in this case.