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Flashcards in Bronchiectasis + Fungal Deck (41)
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1
Q

What is bronchiectasis

A

Permanent irreversible dilatation of the bronchi + airways

Due to damaged caused by chronic infection or inflammation

2
Q

What leads to more damage after initial insult

A
Impaired ciliary clearance
Accumulation of secretion / mucous
Leads to obstruction 
Microbial colonisation 
Leads to dilatation, scarring and obstruction 
Leads to vicious circle and  more damage
3
Q

What causes bronchiectasis

A

Post infection

  • Bacterial - pneumonia can cause specific area
  • Viral - serious childhood illness important - pertussis
  • Mycobacterial - TB / non-TB

Immune deficiency = more vicious and prolonged inflammation

  • Primary
  • Secondary - HIV

APBA

  • Hypersensitivity to specific fungal
  • Common in asthmatic

Systemic
- RA, IBD, sarcoid, yellow nail

Impaired mucociliary dysfunction

  • CF
  • Primary ciliary dyskinesia
  • Kartagener’s (organs on wrong side)

Bronchial obstruction

  • Tumour
  • FB

Other lung

  • COPD
  • Fibrosis
4
Q

What are the symptoms of bronchiectasis

A

Chronic cough
Purulent sputum
Recurrent chest infection
Airflow obstruction on spirometry

Other daily Sx
Cough
Wheeze
SOB
Pleuritic chest pain
Intermittent haemoptysis
- Often with exacerbation 
Lethargy
Weight loss
Fever
Coarse crackles
Clubbing
5
Q

What can you get on top of bronchiectasis

A

Recurrent infection

  • H.influenza
  • Pseudomona’s
  • Influenza
  • Klebsiella
  • S.pneumonia
  • S.aureus
  • Aeruginosia
6
Q

How do you Dx bronchiectasis

What do you do if haemoptysis

A
History and exam
Bloods
Sputum culture 
Spirometry 
CT thorax = gold standard 
CXR
Spirometry = obstructive
Bronchoscopy for haemoptysis / check no obstructing lesion
7
Q

What are other tests you can do

A
CF genotype
Primary ciliary dyskinesia 
Serum total IgE
Aspergillosis
Serum Ig
8
Q

What does CT show

A

Signet ring
Thickened wall
Traction
Tramline - parallel lines

9
Q

How do you treat bronchiectasis

When do you give long-term Ax
When is surgical eiciion recommended

A

Address underlying cause
Clear sputum
Treat infection

Conservative 
Chest physio - good for non-CF
-  Very important 
- Allows postural drainage 
of mucous 
Pulmonary rehab
Specialist nurse / dietician 
Medical 
Mucolytic
Ax if exacerbation / long term >3 exacerbations in a year 
Bronchodilator drugs e.g. neb SABA
Influenza and pneumococcal vaccine 

Surgical
Surgical excision if local / severe hemoptysis
Transplant if fit and <65

10
Q

What is specific treatment

A

Relieve obstruction
Iv Ig replacement
Steroids for APBA

11
Q

What are complications of bronchiectasis

A
More prone to infection
Infective exacerbation 
Haemoptysis 
- Due to exacerbation - mostly mild 
- Can be due to enlarged blood vessels 
Pneumonia
Pleural effusion
Pneumothorax
Cerebral abscess
12
Q

What do you want to know in Hx of PC of bronchiectasis

A
Resp symptoms 
Breathlessness 
- Always quantify how far can walk now / last year 
Recurrent infection 
Systemic Sx for cause
- weight loss 
- joint pain 
- diarrhoea
- sinusitis 
- GORD
13
Q

PMH / DH / Hx / FH

A
Birth - resp support / pre-term 
Childhood illness
Asthma 
Other infections 
Previous transplant 
Immunosuppression / chemo 
Inhaler use 
FH resp infection / bronciectaiss
14
Q

What could you ask that may prompt certain investigation

A

Fertility

15
Q

What bloods

A
Basic blood
RF 
Total IgE 
IgE to aspergillus (sign of ABPA) 
Total IgG - can replace if deficeicny
HIV / specific Ab
16
Q

What do you send sputum for

A

MC+S

AFB

17
Q

Why is spirometry useful

A

See baseline and decline

18
Q

What is important to do in infection exacerbation

A
Check last sputum culture to see organism cultured 
Look right back 
Give longer course of Ax
- 10-14 days 
Mucolytics
Diet support
19
Q

What do you do for haemoptysis

A
ABCDE 
Call for help 
Ax
Tranexamic acid
CT aorta to visualise bronchial artery 
Arterial emoblization if bleeding from there
May need intubation and ventilation 
Lobectomy 
Palliation
20
Q

Why is it dangerous

A

Clots of blood can block airway

Even small amounts can be life threatening

21
Q

What causes the haemoptysis

A

Infection damaging airway
Cough = trauma
Engorged blood vessels - common in CF / ABPA which rupture

22
Q

What is useful Q

A

How far can you walk and for how long

23
Q

What are important organisms to know

A

Pseudomona eruginosa
Non TB mycobacteria
Aspergillus fumigateurs

24
Q

Why is psuedomona important

A

Prongostic indicato if colonised

Naturally resistant to most oral Ax so always look back to see if grown

25
Q

What Ax

A

Quinolones - ciprofloxacin

Usually neb or IV

26
Q

Why is nonTB importat

A

Causes deterioration in symptoms and lung function
Requires very long Rx
Grow on AFB

27
Q

Why is aspergillum fumitas important

A

Cause of ABPA

Can cause dilated bronchial artery and massive rupture

28
Q

What is an exam question about ABPA

A

Bronchiectasis with raised IgE

29
Q

What is ABPA

A

Type 1+3 hypersensitivity to aspergillus spores

30
Q

What are the Sx

A
Wheeze
Cough
SOB
May be labelled as asthmatic but progresses
Bronchiectasis develops due to damage
Recurrent pneumonia
31
Q

What puts you at higher risk

A

Asthma

CF

32
Q

How do you Rx

A

Steroid in attack
Bronchodilator
Intracanazole

33
Q

What are complications

A

Aspergilloma (fungal ball)

34
Q

What is aspergilloma

A

Fungal ball that forms in pre-existing cavity

- TB / sarcoid / emphysema

35
Q

What are Sx

A
Cough
Haemoptysis
Lethargy
Weight loss
No response to. Ax
36
Q

How do you Rx

A

CXR - round opacity
Sputum culture
Aspergillis skin test

37
Q

How do you Rx

A

Surgical excision

Oral Icanazole

38
Q

What puts you at risk of invasive fungal

A
Immunocompromised
HIV
Leukaemia
Wegners
SLE
Broad spec Ax
39
Q

How do you Dx

A

BAL
Sputum culture
Biopsy = Dx
CXR show abscess or consolidation

40
Q

How do you Rx

A

IV anti-fugal

41
Q

Other fungal lung

A

Asthma = type 1 to fungal spore
Extrinsic allergic alveolitis
Candida
Cryptococcus