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Yr3 Medicine- Respiratory > Bronchiectasis > Flashcards

Bronchiectasis Flashcards

1
Q

What is bronchiectasis?

A

Chronic inflammation, causing destruction of elastic & muscular components of bronchial wall, leading to permanent dilation of bronchi.

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2
Q

State some potential causes of bronchiectasis

A
  • Post infectious: childhood infections (e.g. measles, pertussis [whooping cough], bronchiolitis), severe bacterial pneumonia, TB
  • Immune deficiency: hypogammablobulinaemia
  • Genetic/defects in mucociliary clearance: CF, primary ciliary dyskinesia, Young’s syndome, Kartagener syndrome
  • Obstruction: tumour, foregin body
  • Toxic insult: gastric aspiration, inhalation of toxic chemicals
  • Allergic bronchopulmonary aspergillosis
  • Secondary immune deficiency: HIV, malignancy
  • RA
  • Other associations: IBD, yellow nail syndrome
  • Idiopathic
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3
Q

What is Young’s syndrome?

A

Triad of:

  • Bronchiectasis
  • Sinusitis
  • Reduced fertility
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4
Q

What is Kartagener syndrome?

A

Triad of:

  • Bronchiectasis
  • Sinusitis
  • Situs invertus
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5
Q

Discuss for allergic bronchopulmonary aspergillosis:

  • What it is
  • Who it is common in
  • Presentation
  • Investigations
  • Management
A
  • ABPA is characterised by respiratory difficulty caused by hypersensitivity reaction to aspergillus sppp. It is often een in pts with history of atopy
  • More common in pts with asthma or CF
  • Present with cough, haemoptysis, generally systemically unwell, fungal sinusitis
  • Investigations:
    • Sputum sample for aspergillus
    • Bloods: elevated IgE, eosinophilia, aspergillus serum preciptins
    • CXR
    • CT Scan
  • Management:
    • Oral corticosteroids & itraconazole (may require steroids for up to 6 months)
    • Optimise control of underlying conditions
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6
Q

What is yellow nail syndrome?

A

Triad of:

  • Yellow nails
  • Respiratory problems e.g. bronchiectasis, chronic sinusitis, pleural effusions
  • Lymphoedema
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7
Q

Explain why pts with bronchiectasis end up in a viscious cycle of inflammation

A
  • Idea that bronchiectasis pts have impaired defences. Impaired defences predispose them to more infections
  • More infections predisposes them to more inflammation and lung damage
  • Predisposes to more infections
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8
Q

State the symptoms of bronchiectasis

A
  • Chronic cough
  • Dyspnoea
  • Copious amounts of purulent sputum (especially with infection)
  • Halitosis
  • Haemopytsis
  • Wheeze
  • Reccurrent infections
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9
Q

State what you might find on clinical examination of someone with bronchiectasis

A
  • Clubbing
  • Cyanosis
  • Coarse inspiratory basal creptitations
  • Wheeze
  • High pitched inspiratory squeaks
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10
Q

Pts with bronchiectasis are susceptible to respiratory infections; state some common causative organisms- highlighting the most common

A
  • Haemophilius influenza (MOST COMMON)
  • Pseudomonas aeruginosa
  • Klebsiella
  • Moraxella catarrhalis
  • Streptococcus pneumoniae
  • Fungi- aspergillus, candida
  • Staphylococcus aureus (LESS COMMON)
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11
Q

What investigations would you do if you suspect bronchiectasis, include:

  • Bedside
  • Bloods
  • Imaging

*For each, justify why

A

Bedside

  • Sputum culture & sensitivity: check for infection
  • Spirometry: obstructive pattern
  • ?ABG: if breathless

Bloods

  • FBC: infection/inflammation
  • CRP: infection/inflammation
  • U&Es: routine
  • LFTS: routine
  • Serum immunoglobulin: check for hypogammaglobulinaemia
  • Sweat chloride test: check for CF

Imaging

  • High resolution CT: show bronchial dilation and thickened bronchial walls
  • ?CXR: may show features of bronchiectasis- bronchiectasis not usually apparent on CXR unless very advanced
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12
Q

Discuss what you would see on high resolution CT of someone with bronchiectasis

A
  • Dilation of bronchi
  • Thickening of bronchial walls
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13
Q

What is the gold standard diagnostic test for bronchiectasis?

A

High resolution CT

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14
Q

Discuss what you might see on CXR of someone with bronchiectasis

A
  • Increased bronchovascular markings
  • Tram track opacities
  • Ring shadows
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15
Q

State some potential complications of bronchiectasis

A
  • Massive haemopytsis
  • Pneumonia
  • Pleural effusion
  • Pneumothorax
  • Amyloidosis
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16
Q

Discuss the management of bronchiectasis

A
  • Treat underlying condition e.g. cystic fibrosis
  • Airway clearance techniques e.g. physiotherapy
  • Mucolytics
  • Pulmonary rehabilitation (MRC dyspnoea score >3)
  • Antibiotics (for acute exacerbation. Or if pt hs chronic infections consider long term antibiotics)
  • Flu vaccination
  • Bronchodilators if required
  • Inhaled corticosteroids
  • Oral corticosteroids (actue exacerbation)
  • Long term oxygen therapy
  • Pulmonary resection
17
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Yr3 Medicine- Respiratory (11 decks)

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