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RESP > 3. Bronchiectasis, Asthma and Vasculitis > Flashcards

3. Bronchiectasis, Asthma and Vasculitis Flashcards

1
Q

What is bronchiectasis?

A

Abnormal, irreversible dilatation of bronchi, caused by the destruction of muscle and elastic tissue

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2
Q

Is bronchiectasis considered an obstructive or restrictive lung disease?

A

Obstructive (as bronchi are damaged)

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3
Q

What are the causes of bronchiectasis?

A 
Infection
Congenital
Immunodeficiency
Bronchial obstruction
Rheumatic conditions
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4
Q

What are the infectious causes of bronchiectasis?

A

Post childhood bronchopneumonia or bronchiolitis
Pneumonia complication of measles or pertussis
Allergic bronchopulmonary aspergillosis
TB and mycobacterium avium

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5
Q

What are the congenital causes of bronchiectasis?

A

Primary ciliary dyskinesia
A1ATD
CF
Youngs, Marfan and Kantageners syndromes

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6
Q

What are the immune causes of bronchiectasis?

A

IgG and M deficiencies

Related to malignancy eg. myeloma

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7
Q

What are the bronchial obstruction causes of bronchiectasis?

A

Aspiration
Tumour
Mucous plugs in asthma
Compressive lymphadenopathy

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8
Q

How does bronchiectasis appear when looking at the lung?

A

Dilated bronchi containing thick secretions
Wall destroyed by chronic inflammation
Arteries increased in size

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9
Q

What is the pathogenesis of bronchiectasis?

A

Infection + impairment of drainage + airway obstruction

Bronchi collapse easily: obstruction and reduced clearance

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10
Q

What is the difference between bronchitis and bronchiectasis?

A

The wall is destroyed in bronchiectasis

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11
Q

What are the symptoms of bronchiectasis?

A

Productive cough
Dyspnoea and wheezing
Pleuritic chest pain
Recurrent LRTI

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12
Q

What are the physical findings in bronchiectasis?

A

Crackles
Coarse crepitations
Rhonchi
Clubbing

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13
Q

What are the complications of bronchiectasis?

A

Haemoptysis
Respiratory failure
Brain abscesses due to septic emboli
Secondary amyloidosis

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14
Q

What are the investigations into bronchiectasis?

A 
FBC and U&E
Sputum and blood culture
CXR and CT thorax
Bronchoscopy for obstruction
Pulmonary Function Tests
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15
Q

How is bronchiectasis treated?

A 
Treat infection and reduce risk factors
Vaccinate
Chest physio to clear secretions
Nebulised DNAse to clear airways
Nebulised antibiotics
Surgery if an aspirated foreign body
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16
Q

What is a pleural effusion?

A

Accumulation of fluid in the pleural space

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17
Q

Name 3 types of pleural effusion

A

Empyema: infected fluid
Transudative
Exudative

18
Q

What are the causes of transudative effusions?

A

Heart failure, fluid overload, nephrotic syndrome, peritoneal dialysis, hepatic cirrhosis

19
Q

What are the causes of exudative effusions?

A

Infection
Malignancy
Pulomary emboli

20
Q

What are the symptoms of pleural effusion?

A

Dyspnoea
Pleuritic chest pain
Cough and haemoptysis
Weight loss

21
Q

What are the signs of pleural effusion?

A

Decreased breath sounds over site
Bronchial breath sounds immediately above site
Dull on percussion
Absent or decreased tactile fremitius

22
Q

What investigations should be taken into pleural effusion?

A

CXR +/- CT thorax
Blood test
Thoracocentesis

23
Q

What investigations can be done on pleuritic fluid from thoracocentesis?

A

Gross examination: blood, cloudy, malodorous
Ratio of pleural fluid protein: serum protein
Glucose, LDH, amylase
Cytology
Culture and sensitivity

24
Q

What is the usually appearance of pleural fluid?

A

Thin and yellow

25
Q

What is asthma?

A

Episodic, reversible bronchospasm in response to a stimulus

26
Q

What mediators are involved in asthma?

A

IL3, 4, 5
IgE
Histamine
Leucotrienes

27
Q

What drugs can induce asthma?

A 
Aspirin
NSAIDs
Antibiotics
Beta-blockers
ACE-inhibitors
28
Q

What is Samter’s triad?

A

Aspirin sensitivity
Asthma
Nasal polyps

29
Q

What disease is intrinsic asthma associated with?

A

COPD

30
Q

What are the microscopic features of asthma?

A

Airway infiltration by neutrophils and eosinophils
Mast cell degranulation (histamine release)
BM thickening
Loss of epithelial integrity
Occlusion of bronchi
Mucous
Hyperplasia and hypertrophy of bronchial smooth muscle and goblet cells

31
Q

How should a PE be managed?

A

Oxygen and pain relief
Thrombolytic therapy
Long term anticoagulants
Embolectomy

32
Q

What are the consequences of diffuse alveolar haemorrhage?

A

Haemoptysis
Anaemia
Diffuse pulmonary infiltrates

33
Q

What are the causes of diffuse alveolar haemorrhage?

A

Primary immune-mediated diseases
Necrotising pneumonia
Bleeding diathesis
Passive venous congestion

34
Q

What types of vasculitis affect the lung?

A

GPA
EGPA
Collagen vascular disorders

35
Q

What effect does anti-GBM disease have on the lungs?

A

Focal necrosis of alveolar walls and intra-alveolar haemorrhage
Fibrous thickening of septum in alveoli
In acute phase, macrophages are haemosiderin laden as they try to clean up blood

36
Q

How is anti-GBM disease managed?

A

Plasmaphoresis

Immunosuppressive therapy

37
Q

How is GPA managed?

A

Cyclophosphamide and glucocorticosteroids
Rituximab
Plasma exchange

38
Q

How does GPA present?

A

Recurrent RTIs
Fever, night sweats, weight loss, fatigue
Conjunctivitis

39
Q

What effect does EGPA have on the lungs?

A

Severe asthma

Eosinophilia

40
Q

What investigations should be done into EGPA?

A

Eosinophilia in FBC and BAL
High IgE
RF low positive

41
Q

What effect do collagen vascular disorders have on the lungs?

A 
Interstitial pneumonia
Pulmonary hypertension
Pulmonary vasculitis
Diffuse Alveolar Haemorrhage
Pleuritis

RESP (17 decks)

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