Bronchiectasis

Question 1

Pathophysiology

Answer 1

Chronic dilation of one or more bronchi
poor clearence of mucus
chronic infections.

Question 2

Causes

Answer 2

Post infective - TB, Whooping cough
Obstruction - Foreign body, Tumour
Mucocilliary defects - CF
ABPA
Rheumatoid Arthritis
Apiration
HIV

Question 3

Investigations

Answer 3

HRCT
CXR
CF Genotyping
IgE Levels
RF
Immunoglobulins
HIV test

Question 4

Imaging Findngs

Answer 4

HRCT: Cygnet ring sign - Airway more dilated than accompanying vessel
CXR: Tram track sign - Dilation of airways

Question 5

Common organisms

Answer 5

Strep Pneumoniae, Pseudomonas Auriginosa, Moraxella Catarrhalis
Candida, Aspegillus fumigatus
Staph Aureus (CF)

Question 6

Treatment

Answer 6

1. Treat cause (If possible)
   2.Chest Physio (Mucus clearance)
   3.Mucolytics
   4.Abx (Prophylaxsis,14d PO, IV)
   5.Pulmonary Rehab if MRC 3 or more
   6.Regular Vaccinations

Question 7

ABPA Pathophysiology

Answer 7

Type 1 & 3 mixed hypersensitivity reaction
Against Aspergillus fumigatus fungal spores
Common in stables
Common in patients with co-existing asthma and CF
Repeated immune activation causes airway damage

Question 8

ABPA Investigations

Answer 8

Total IgE
Aspergillus IgE
Eosinophillia

Question 9

ABPA Symptoms

Answer 9

Dry cough
Wheeze

Question 10

ABPA Treatment

Answer 10

Steroid Therapy