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foundations pulm exam > bronchiectasis > Flashcards

bronchiectasis Flashcards

1
Q

what is the most common organism in non-CF pts with bronchiectasis?

A

H. influenza

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2
Q

______ makes up 1/2 the cases of bronchiectasis

A

cystic fibrosis

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3
Q

which organism is associated with accelerated course, more frequent exacerbations and more rapid decline in lung function?

A

pseudomonas

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4
Q

what is the overall result of bronchiectasis?

A

retained secretions colonized with pathogenic organisms resulting in COPIOUS amounts of purulent sputum

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5
Q

what is the vicious cycle of bronchiectasis?

A 
inflammatory release leading to destruction
loss of ventilatory function
can't clear out mucous
become colonized
now infected
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6
Q

what are the main symptoms of bronchiectasis?

A

cough and copious amount of mucopurulent sputum lasting months to years

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7
Q

what is the most common clinical presentation of bronchiectasis?

A

crackles/rhonchi most common
may have scattered wheezing
clubbing

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8
Q

what is the gold standard for diagnosing bronchiectasis?

A

HRCT

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9
Q

if you do a sputum analysis, what may you see in bronchiectasis?

A

dittrich plugs (small white/yellow concentrations)

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10
Q

if you do a gram stain and culture, what may you see in bronchiectasis?

A

pseudomonas or E. coli

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11
Q

what does CXR show in pt with bronchiectasis?

A 
increased pulmonary markings
ring-like structures
atelectasis
dilated and thickened airways
mucus pluggings
TRAM LINES - train tracks
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12
Q

CBC for bronchiectasis may show what?

A

leukocytosis

polycythemia

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13
Q

what will you see on spirometry for pt with bronchiectasis?

A

reduced or normal FVC
low FEV1
low FEV1/FVC

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14
Q

how to manage bronchiectasis?

A 
antibiotics
chest physiotherapy
bronchodilators
smoking cessation
adequate nutrition
immunizations
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15
Q

what is the mainstay of treatment in bronchiectasis?

A

antibiotics

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16
Q

what are acceptable outpatient abx choices?

A 
amoxicillin
tetracycline
bactrim
macrolide
second-generation cephalosporin
fluroquinolone
17
Q

what are examples of bronchial hygiene?

A 
flutter device
intrapulmonic percussive ventilation devices
incentive spirometry
vest system
nebulizers
18
Q

what kind of disorder is CF?

A

autosomal recessive genetic disorder

19
Q

what is the median age of diagnosis for CF? median survival age?

A

dx: 6-8 months
survival: 36.5 y/o

20
Q

CF is a disease of ______ gland function

A

exocrine

21
Q

what is the primary cause of death in pts with CF?

A

end-stage lung disease

22
Q

what is the pathophysiology of CF?

A

defect in the CFTR gene results in abnormal chloride transport channels
results in thick viscous mucus secretions in the respiratory tract, pancreas, and GI tract causing plugging

23
Q

what is the presentation for CF?

A

chronic hacking cough (recurrent bronchiolitis in infants)
GI manifestations (meconium ileus in babies)
male reproductive tract (infertility, undescended testes)
sinus infection

24
Q

what are other respiratory manifestations for CF pts?

A 
sputum production
decreased exercise tolerance
recurrent hemoptysis
chronic rhinosinusitis symptoms
hyperresonance to percussion
apical crackles
nasal polyps
digital clubbing
25
Q

what criteria is needed to diagnose CF?

A

clinical symptoms consistent with CF in at least one organ system AND
evidence of CFTR dysfunction by either:
elevated sweat chloride 60 or greater
genotyping (presence of two disease-causing mutations in CFTR)
abnormal nasal potential difference

26
Q

what is the primary test for diagnosing CF?

A

sweat chloride test

27
Q

what vaccines to manage CF?

A

influenza and PNA

28
Q

what bronchodilators to treat CF?

A

B-agonists and anticholinergics

29
Q

what agents to promote clearance of secretions in CF?

A

enzymes
inhaled hypertonic saline
inhaled N-acetylcysteine

30
Q

what antiinflammatory therapy to treat CF?

A

macrolides
ibuprofen
corticosteroids (inhaled and/or systemic)

foundations pulm exam (10 decks)

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