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CLINICAL MEDICINE > 3. Bronchiectasis > Flashcards

3. Bronchiectasis Flashcards

1
Q

Define Bronchiectasis.

A

It is the abnormal permanent dilatation of the Bronchi.

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2
Q

The presence of …….. leads to Bronchiectasis.

A
  1. Respiratory infection
  2. Defect in the host’s defence
  3. Impairment of drainage
  4. Airway obstruction
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3
Q

State 3 common aetiologies of Bronchiectasis.

A
  1. Infections (Bacterial, Mycobacterial, A.BP.A)
  2. Airway obstructions (Intraluminal tumours, L.N, COPD)
  3. Immunodeficiency (Ciliary dyskinesia, HIV, Cystic fibrosis)
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4
Q

What are the common causes of Bronchiectasis in developed countries?

A
  1. Cystic fibrosis
  2. Smoking
  3. COPD
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5
Q

What are the common causes of Bronchiectasis in developing countries?

A
  1. Bacterial infections in childhood
  2. Tuberculosis
  3. Airway obstruction
  4. Smoking
  5. COPD
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6
Q

State other causes that may lead to Bronchiectasis.

A
  1. Aspiration
  2. Primary Ciliary Dyskinesia
  3. Allergic Bronchopulmonary Aspergillosis (ABPA)
  4. Alpha-1 Antitrypsin deficiency
  5. Connective Tissue disorders
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7
Q

State the pathology usually seen in Bronchiectasis.

A

It usually affects the lower lobes, bilaterally. The bronchi and bronchioles are dilated up to 4x the normal size.

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8
Q

State the 3 morphological types of Bronchiectasis.

A
  1. Cystic type (most common)
  2. Cylindrical type (2nd commonest)
  3. Varicose type (rare)
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9
Q

What is Kartagener’s Syndrome?

A

It is a triad of Sinusitis, Bronchiectasis, and Situs Inversus.

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10
Q

What are the clinical features seen in Bronchiectasis patients?

A
  1. Cough with daily mucopurulent expectoration lasting from months to years
  2. Weight loss
  3. Weakness
  4. Occasional hemoptysis
  5. Dysapnea
  6. Bronchospasm
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11
Q

A post-tubercular patient presents to the OPD with non-productive cough. What is your probable diagnosis?

A

Dry Bronchiectasis (bronchiectasis sicca)

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12
Q

What are the common signs observed in Bronchiectasis patients?

A
  1. Coarse crackles (in lung bases)
  2. Wheezing (indicates active infection)
  3. Clubbing of Fingers
  4. Cyanosis
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13
Q

A patient on examination has coarse crackles in the Upper Lobe areas of his Lungs. What do you conclude from this finding?

A

Post-Tubercular Dry Bronchiectasis

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14
Q

What do you think coarse crackles indicate?

A

They indicate dilated bronchioles and presence of purulent material.

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15
Q

How do you confirm your diagnosis of Bronchiectasis?

A

By sending the patient for imaging.

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16
Q

What tests would you suggest for imaging of a Bronchiectasis patient?

A
  1. High Resolution CT of Thorax
  2. Chest X-Ray
  3. Bronchoscopy
17
Q

What is usually seen in a Chest X-Ray of a Bronchiectasis patient?

A
  1. Increased pulmonary markings
  2. Cystic spaces
  3. Honeycombing
18
Q

What lab tests would you carry out in a suspected case of Bronchiectasis?

A
  1. Total WBC Counts
  2. Sputum analysis
  3. Alpha-1 Antitrypsin Levels
  4. Autoimmune Screening Tests
19
Q

What are the goals of treatment for Bronchiectasis?

A
  1. Improve symptoms
  2. Reduce complications
  3. Control exacerbations
20
Q

What would you advise a patient with Bronchiectasis?

A
  1. Stop smoking and avoid passive smoking
  2. Ensure adequate nutrition is obtained
  3. Obtain Influenza and Pneumococcal vaccinations
21
Q

What is the mainstay therapy for Bronchiectasis?

A

Antibiotic Therapy

22
Q

What would you prescribe to a patient with mild-moderate bronchiectasis?

A
  1. Amoxicillin
  2. Azithromycin
  3. Fluoroquinolones
  4. Tetracyclines

*Administer orally

23
Q

What would you prescribe to a patient with severe bronchiectasis?

A
  1. Aminoglycosides
  2. 3rd Generation Cephalosporins
  3. Antipseudomonal Penicillins
  4. Fluoroquinolones

*IV administration

24
Q

Beside the mainstay therapy, what other treatment regimes would you consider for treating Bronchiectasis?

A
  1. Bronchial Hygiene through chest physiotherapy and mucous drainage
  2. Bronchodilators
  3. Mucolytic agents
  4. Surgical resection or Transplantion
25
Q

What are the complications likely to occur in a Bronchiectasis patient?

A
  1. Recurrent Pneumonia
  2. Empyema
  3. Lung Abscess
  4. Recurrent/Massive hemoptysis
  5. Progressive Respiratory Failure
  6. Cor pulmonale

CLINICAL MEDICINE (5 decks)

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