Bronchiectasis and Lung Abscess

Question 1

Define bronchiectasis

Answer 1

It is a chronic disease characterised by irreversible dilation of bronchi caused by bronchial wall damage resulting from infection and inflammation.

Question 2

What are the morphological changes usually accompanied by

Answer 2

Chronic suppurative lung disease with a cough productive purulent sputum

Question 3

describe the inflammatory response in bronchiectasis

Answer 3

ineffective in eradicating infection and a persistent cycle of chronic infection and inflammation ensues resulting in further tissue damage

Question 4

What leads to an accumulation of secretions

Answer 4

Impaired mucociliary clearance

Question 5

What predispose to bacterial infection

Answer 5

Accumulated secretions

Question 6

What does infection provoke

Answer 6

An inflammatory response - increased mucus production and impaired ciliary function

Question 7

What causes tissue damage

Answer 7

Excessive inflammation

Question 8

What produces dilation of bronchi and disruption of mucociliary clearance

Answer 8

Damage to the bronchial wall

Question 9

What are the most common causes of bronchial wall damage and bronchiectasis

Answer 9

Severe infections

Question 10

What two causes are declining due to childhood vaccination

Answer 10

Pertussis (whooping cough) and measles

Question 11

What is still a common cause of bronchiectasis in developing countries

Answer 11

TB

Question 12

In children what might give rise to bronchial obstruction and distal bronchiectasis

Answer 12

Inhalation of a foreign body

Question 13

What should all patients with bronchiectasis have measured

Answer 13

Immunoglobulins IgG, IgA and IgM with serum electrophoresis

Question 14

What should all patients with bronchiectasis have measured

Answer 14

Immunoglobulins IgG, IgA and IgM with serum electrophoresis

Question 15

What is an aspergilloma

Answer 15

A ball of fungal hyphae that appear on Xray as a mass in the centre of a cavity surrounded by a halo of radiolucency

Question 16

What gives rise to fleeting Xray shadows

Answer 16

Eosinophilic infiltrates in the lung

Question 17

Define primary ciliary dyskinesia

Answer 17

An autosomal recessive condition in which there is an abnormality of the ultrastructure of cilia throughout the body such that they do not beat in a coordinated fashion

Question 18

What is Kartagener’s syndrome

Answer 18

Ciliary dyskinesia with situs inversus

Question 19

How is the definitive test for primary ciliary dyskinesia performed

Answer 19

Brush biopsy of nasal mucosa

Question 20

When does cystic fibrosis usually present

Answer 20

In early childhood with recurrent respiratory infections and failure to thrive due to pancreatic insufficiency

Question 21

name some of the diseases which seem to have an increased incidence of bronchiectasis

Answer 21

Rheymatoid arthritis
Ulcerative colitis
Crohn’s disease
Coeliac disease

Question 22

What is the cardinal feature of bronchiectasis

Answer 22

Chronic cough productive of copious purulent sputum

Question 23

Infective exacerbation of bronchiectasis may be associated with what

Answer 23

Fever and pleuritic pain

Question 24

chronic severe bronchiectasis may cause what 3 things

Answer 24

Malaise
weight loss and
halitosis (foul breath)

Question 25

What is sometimes present

Answer 25

Clubbing

Question 26

What can be heard over affected areas

Answer 26

Coarse crackles

Question 27

What is the gold standard investigation for bronchiectasis

Answer 27

CT scan

Question 28

What should be performed to define what infective organisms are present as a guide for antibiotic treatment

Answer 28

Sputum microbiology

Question 29

What help to determine whether bronchodilator drugs may be helpful

Answer 29

Lung function tests

Question 30

What an effective treatment in clearing secretions

Answer 30

Chest physiotherapy

Question 31

What is sometimes useful in improving sputum clearance

Answer 31

Nebulised hypertonic saline

Question 32

What are antibiotics used for

Answer 32

To suppress chronic infection and to treat exacerbations

Question 33

When are bronchodilator drug and an inhaled steroid indicated

Answer 33

Where there is associated reversible airways obstruction

Question 34

what is a potential treatment for the few patients who have localised disease and troublesome symptoms

Answer 34

Surgical excision

Question 35

Where bronchiectasis has progressed to respiratory failure, what is an option

Answer 35

Lung transplantation

Question 36

WHat is a lung abscess

Answer 36

A localised collection of pus within a cavitated necrotic lesion in the lung parenchyma

Question 37

What does a patient with a lung abscess typically complain of

Answer 37

A cough with expectoration of large amount of foul material often accompanied by haemoptysis, fever, weight loss and malaise

Question 38

What may be required to distinguish between a lung abscess and other causes of cavitating lung lesions

Answer 38

A fine -needle aspiration of the lesion

Question 39

What is the most common cause of a lung abscess

Answer 39

Oropharyngeal aspiration

Question 40

What is the most common cause of a lung abscess

Answer 40

Oropharyngeal aspiration

Question 41

What is a key aspect of treatment with lung abscesses

Answer 41

Drainage of pus from the abscess cavity

Question 42

How is drainage achieved

Answer 42

Bronchial drainage using postural drainage physiotherapy or | percutaneous drainage by positioning a catheter drainage tube under radiological guidance

Question 43

What is necrobacillosis

Answer 43

An unusual cause of lung abscess that is associated with a very characteristic clinical picture first described by Limiere

Question 44

What are lung abscesses with necrobacillosis frequently involved with

Answer 44

Multiple abscesses forming often with a pleural empyema and evidence of infection elsewhere

Question 45

What is bronchopulmonary sequestration

Answer 45

A congenital anomaly in which an area of lung is not connected to the bronchial tree and has an anomalous blood supply usually from the aorta

Question 46

What is required to treat bronchopulmonary sequestration

Answer 46

Surgical resection

Question 47

What are the 4 treatment methods for bronchiectasis

Answer 47

Chest physio Antibiotics Inhaled bronchodilators Specific treatment of any underlying cause