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Medical Studies 1 > 8.6 Pathophysiology, Diagnosis & Treatment of Bronchiectasis > Flashcards

8.6 Pathophysiology, Diagnosis & Treatment of Bronchiectasis Flashcards

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USMLE® Step 1 flashcards
1
Q

Describe the history findings of bronchiectasis

A
  • Productive cough
  • Chronic/recurrent episodes [>3] each leasting >4 weeks
  • Could have dyspnoea wheeze, growth failure etc.
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2
Q

Aside from its clinical syndrome, what else is needed to diagnose bronchiectasis? If this is not present, what is the new diagnosis?

A

Needs radiographic features of HRCT
With: bronchiectasis
Without: Chronic suppurative lung disease

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3
Q

What is meant by a suppurative cough

A

A cough where purulent sputum (i.e. sputum containing pus) is produced

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4
Q

What is the pathological description of bronchiectasis?

A

Permanent and abnormal dilation of the bronchi; usually in the context of chronic airway infection causing inflammation

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5
Q

HRCT diagnostic features of bronchiectasis

A
  • Diameter of bronchi wider than pulmonary arteries
  • Failure of bronchi to taper, causing:
  • Visualisation of bronchi in outer 1-2cm of the lung fields
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6
Q

Describe the ‘cycle of bronchiectasis’, starting from inflammation

A
  • Inflammation
  • Abnormal airway function
  • Infection
  • Thickened airway secretions
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7
Q

What innate immune cells are primarily involved in the inflammatory response during bronchiectasis

A

Neutrophils

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8
Q

Describe the pathophysiology of bronchiectasis

A
  • Impaired drainage, airway obstruction, or a defect in host defense
  • Immune effector cells and inflammatory cytokines activated
  • Transmural inflammation, mucosal oedema, ulceration in airways
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9
Q

Abnormal airway function can start the cycle of bronchiectasis. What are some ways that this can occur?

A
  • Cystic fibrosis
  • Ciliary dyskinesia
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10
Q

Infection can start the cycle of bronchiectasis. What are some ways that this can occur?

A

Recurrent pneumonia;

  • Post-obstruction (e.g. inhaled foreign body)
  • Post infection (tuberculosis, adenovirus)
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11
Q

Thickened airway secretions can start the cycle of bronchiectasis. What is one way this can occur?

A
  • Young syndrome (thick production of mucus)
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12
Q

Inflammation can start the cycle of bronchiectasis. What are some ways that this can occur?

A
  • Systemic inflammatory disease (e.g. sarcoidosis)
  • Recurrent small volume aspiration (e.g. gastric contents)
  • Chronic infection (e.g. TB)
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13
Q

List some common respiratory diseases that can be comorbid with bronchiectasis

A
  • COPD
  • Pulmonary fibrosis
  • Pneumoconiosis
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14
Q

Is bronchiectasis more common in men or women?

A

Women

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15
Q

After the age of 60, by what factor does the risk of bronchiectasis increase?

A

8 to 10

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16
Q

Sputum-related questions to ask during a history

A
  • Volume
  • Nature
  • Colour
  • Frequency
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17
Q

History symptoms indicative of bronchiectasis

A
  • Sputum/haemoptysis
  • Dyspnoea/exercise intolerance
  • Impaired sleep quality
  • Systemic infection (fever/sweats/fatigue)
  • Poor appetite/underweight
18
Q

Vaccines that are important for reducing risk/worsening of bronchiectasis

A
  • Flu
  • Pneumococcus
  • COVID
19
Q

Focused history questions for cystic fibrosis

A
  • Family history
  • Pancreatitis
  • Difficulty maintaining weight (not so much any more)
  • Male infertility
20
Q

Focused history questions for underlying immune deficiency/ciliary dyskinesia

A
  • Recurrent sinusitis
  • Extrapulmonary infections (discharging ears/severe dermatitis)
  • Male infertility
21
Q

Focused history questions to ask for recurrent aspiration

A
  • Cough and or choking when eating?
  • Cough when laying down/during the night?
22
Q

List some respiratory comorbidities of bronchiectasis

A
  • COPD
  • Asthma
  • Pulmonary fibrosis
  • MSK issues
23
Q

How can MSK issues cause bronchiectasis?

A
  • Inability to cough
  • Reduced ability to clear irritants/pathogens
  • Starts bronchiectasis cycle
24
Q

How can pulmonary fibrosis cause bronchiectasis?

A
  • Fibrotic tissue
  • Creates traction bronchiectasis
  • Leads to abnormal airways, and therefore starts the bronchiectasis cycle
25
Q

Exam findings that are suggestive of bronchiectasis

A
  • Over/underweight
  • Clubbing
26
Q

How can dyspnoea lead to deconditioning and obesity?

A
  • Reduced physical activity
  • Leads to deconditioning and weight gain
  • Therefore, also causes obesity
27
Q

What lung sounds are suggestive of bronchiectasis?

A

Coarse crackles

28
Q

Underlying diseases that may be found on physical exam for bronchiectasis

A
  • CF (portal hypertension)
  • Rheumatological (skin nodules etc.)
  • Infection
29
Q

Investigations for bronchiectasis

A
  • Sputum culture
  • CXR
  • HRCT
  • Lung function (spirometry/DLCO)

Plus or minus:

  • 6 minute walk
  • ABG
30
Q

List some HRCT findings of bronchiectasis

A
  • Sputum plugging
  • Dilated bronchi
31
Q

What condition can upper lobe bronchiectasis be reflective of?

A

Cystic fibrosis

32
Q

What does sweat test record? If it is elevated, what condition is thought to be more likely?

A
  • It tests for chloride ions
  • If chloride is elevated: cystic fibrosis
33
Q

What is oesophageal pH testing commonly used to diagnose? Why is it considered uncomfortable.

A
  • It is used to diagnose GORD
  • Uncomfortable, because it requires a nasogastric tube
34
Q

Goals of bronchiectasis treatment

A
  • Improve quality of life
  • Reduce morbidity and mortality
  • Address underlying causes]
  • Control exacerbations
35
Q

How does positive expiratory pressure (PEP) help with airway clearance?

A
  • Creates gas behind mucous
  • Helps to push it forward and out of the airways
36
Q

What is the role of physiotherapists in airway clearance

A

Can teach exercises and assist in the clearance of mucous from airways

37
Q

Why are nebulized and inhaled bronchiectasis treatments difficult for most patients to access

A
  • They are not on the PBS
  • Therefore, many patients are unable to afford them
38
Q

Why is it easy for patients to become dependent on prednisolone?

A

It makes people feel good, and is addictive

39
Q

Bronchial hyper-reactivity is sometimes cormorbid with bronchiectasis. How can this be tested for and treate?

A

Tested:
- Mannitol challenge (increasing amount of bronchoconstrictor)
- Spirometry

Treated:
- Inhaled corticosteroids
- Bronchodilators

40
Q

List some high-risk activities/occupations for patients with bronchiectasis

A
  • Gardening
  • Building industry
  • Healthcare industry
  • Animals
  • Tropical regions
41
Q

List the five main aspects of bronchiectasis treatment

A
  • Physiotherapy
  • Management of acute exacerbations
  • Psychological help
  • Vaccinations
  • Palliative care/surgical help
42
Q
A

Medical Studies 1 (90 decks)

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