3. Bronchiectasis, Asthma and Vasculitis

Question 1

What is bronchiectasis?

Answer 1

Abnormal, irreversible dilatation of bronchi, caused by the destruction of muscle and elastic tissue

Question 2

Is bronchiectasis considered an obstructive or restrictive lung disease?

Answer 2

Obstructive (as bronchi are damaged)

Question 3

What are the causes of bronchiectasis?

Answer 3

Infection
Congenital
Immunodeficiency
Bronchial obstruction
Rheumatic conditions

Question 4

What are the infectious causes of bronchiectasis?

Answer 4

Post childhood bronchopneumonia or bronchiolitis
Pneumonia complication of measles or pertussis
Allergic bronchopulmonary aspergillosis
TB and mycobacterium avium

Question 5

What are the congenital causes of bronchiectasis?

Answer 5

Primary ciliary dyskinesia
A1ATD
CF
Youngs, Marfan and Kantageners syndromes

Question 6

What are the immune causes of bronchiectasis?

Answer 6

IgG and M deficiencies

Related to malignancy eg. myeloma

Question 7

What are the bronchial obstruction causes of bronchiectasis?

Answer 7

Aspiration
Tumour
Mucous plugs in asthma
Compressive lymphadenopathy

Question 8

How does bronchiectasis appear when looking at the lung?

Answer 8

Dilated bronchi containing thick secretions
Wall destroyed by chronic inflammation
Arteries increased in size

Question 9

What is the pathogenesis of bronchiectasis?

Answer 9

Infection + impairment of drainage + airway obstruction

Bronchi collapse easily: obstruction and reduced clearance

Question 10

What is the difference between bronchitis and bronchiectasis?

Answer 10

The wall is destroyed in bronchiectasis

Question 11

What are the symptoms of bronchiectasis?

Answer 11

Productive cough
Dyspnoea and wheezing
Pleuritic chest pain
Recurrent LRTI

Question 12

What are the physical findings in bronchiectasis?

Answer 12

Crackles
Coarse crepitations
Rhonchi
Clubbing

Question 13

What are the complications of bronchiectasis?

Answer 13

Haemoptysis
Respiratory failure
Brain abscesses due to septic emboli
Secondary amyloidosis

Question 14

What are the investigations into bronchiectasis?

Answer 14

FBC and U&E
Sputum and blood culture
CXR and CT thorax
Bronchoscopy for obstruction
Pulmonary Function Tests

Question 15

How is bronchiectasis treated?

Answer 15

Treat infection and reduce risk factors
Vaccinate
Chest physio to clear secretions
Nebulised DNAse to clear airways
Nebulised antibiotics
Surgery if an aspirated foreign body

Question 16

What is a pleural effusion?

Answer 16

Accumulation of fluid in the pleural space

Question 17

Name 3 types of pleural effusion

Answer 17

Empyema: infected fluid
Transudative
Exudative

Question 18

What are the causes of transudative effusions?

Answer 18

Heart failure, fluid overload, nephrotic syndrome, peritoneal dialysis, hepatic cirrhosis

Question 19

What are the causes of exudative effusions?

Answer 19

Infection
Malignancy
Pulomary emboli

Question 20

What are the symptoms of pleural effusion?

Answer 20

Dyspnoea
Pleuritic chest pain
Cough and haemoptysis
Weight loss

Question 21

What are the signs of pleural effusion?

Answer 21

Decreased breath sounds over site
Bronchial breath sounds immediately above site
Dull on percussion
Absent or decreased tactile fremitius

Question 22

What investigations should be taken into pleural effusion?

Answer 22

CXR +/- CT thorax
Blood test
Thoracocentesis

Question 23

What investigations can be done on pleuritic fluid from thoracocentesis?

Answer 23

Gross examination: blood, cloudy, malodorous
Ratio of pleural fluid protein: serum protein
Glucose, LDH, amylase
Cytology
Culture and sensitivity

Question 24

What is the usually appearance of pleural fluid?

Answer 24

Thin and yellow

Question 25

What is asthma?

Answer 25

Episodic, reversible bronchospasm in response to a stimulus

Question 26

What mediators are involved in asthma?

Answer 26

IL3, 4, 5 IgE Histamine Leucotrienes

Question 27

What drugs can induce asthma?

Answer 27

``` Aspirin NSAIDs Antibiotics Beta-blockers ACE-inhibitors ```

Question 28

What is Samter's triad?

Answer 28

Aspirin sensitivity Asthma Nasal polyps

Question 29

What disease is intrinsic asthma associated with?

Answer 29

COPD

Question 30

What are the microscopic features of asthma?

Answer 30

Airway infiltration by neutrophils and eosinophils Mast cell degranulation (histamine release) BM thickening Loss of epithelial integrity Occlusion of bronchi Mucous Hyperplasia and hypertrophy of bronchial smooth muscle and goblet cells

Question 31

How should a PE be managed?

Answer 31

Oxygen and pain relief Thrombolytic therapy Long term anticoagulants Embolectomy

Question 32

What are the consequences of diffuse alveolar haemorrhage?

Answer 32

Haemoptysis Anaemia Diffuse pulmonary infiltrates

Question 33

What are the causes of diffuse alveolar haemorrhage?

Answer 33

Primary immune-mediated diseases Necrotising pneumonia Bleeding diathesis Passive venous congestion

Question 34

What types of vasculitis affect the lung?

Answer 34

GPA EGPA Collagen vascular disorders

Question 35

What effect does anti-GBM disease have on the lungs?

Answer 35

Focal necrosis of alveolar walls and intra-alveolar haemorrhage Fibrous thickening of septum in alveoli In acute phase, macrophages are haemosiderin laden as they try to clean up blood

Question 36

How is anti-GBM disease managed?

Answer 36

Plasmaphoresis | Immunosuppressive therapy

Question 37

How is GPA managed?

Answer 37

Cyclophosphamide and glucocorticosteroids Rituximab Plasma exchange

Question 38

How does GPA present?

Answer 38

Recurrent RTIs Fever, night sweats, weight loss, fatigue Conjunctivitis

Question 39

What effect does EGPA have on the lungs?

Answer 39

Severe asthma | Eosinophilia

Question 40

What investigations should be done into EGPA?

Answer 40

Eosinophilia in FBC and BAL High IgE RF low positive

Question 41

What effect do collagen vascular disorders have on the lungs?

Answer 41

``` Interstitial pneumonia Pulmonary hypertension Pulmonary vasculitis Diffuse Alveolar Haemorrhage Pleuritis ```