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Respiratory System > Bronchiectasis > Flashcards

Bronchiectasis Flashcards

1
Q

What is bronchiectasis?

A

Chronic irreversible dilatation of one or more bronchi or bronchioles

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2
Q

Describe the bronchi in bronchiectasis

A
  • irreversible dilatation
  • poor mucous clearance > stagnant pools
  • predisposition to chronic or recurrent bacterial infection
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3
Q

How does chronic inflammation cause bronchiectasis?

A

Inflammation causes destruction of the elastic and muscular components of the bronchial wall > irreversible dilatation

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4
Q

Primary cause of bronchiectasis in the western world

A

Congenital conditions

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5
Q

Causes of bronchiectasis

A
  • whooping cough
  • TB
  • idiopathic
  • mucociliary clearance defects: cystic fibrosis, Young’s syndrome, Kartagerner syndrome
  • hypogammaglobulinaemia
  • alpha 1 antitrypsin deficiency
  • obstructions (foreign body, tumour)
  • rheumatoid arthritis
  • inhalation of toxic gases
  • yellow nail syndrome
  • HIV
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6
Q

What blood tests can be used to identify the cause in newly diagnosed bronchiectasis?

A
  • CF genotype
  • RF + anti-CCP
  • auto antibodies
  • alpha-1-antitrypsin level
  • HIV test
  • immunoglobulin levels
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7
Q

Common organisms that cause bronchiectasis

A
  • haemophilus influenzae
  • pseudomonas aeruginosa
  • moraxella catarrhalis
  • mycobacterium tuberculosis
  • fungi: aspergillus, Candida albicans
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8
Q

What is imaging is used to investigate bronchiectasis?

A

high resolution CT
CXR

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9
Q

Classic findings in CXR of bronchiectasis

A

Dilated bronchi with thickened walls
(Tram track sign)

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10
Q

Classic finding on a CT scan of a patient with bronchiectasis

A
  • signet ring sign: bronchial dilatation bigger than adjacent blood vessels
  • bronchial wall thickening
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11
Q

What is the signet ring sign?

A

Dilated bronchus (bigger) + accompanying pulmonary artery branch (smaller)

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12
Q

Symptoms of bronchiectasis

A
  • Chronic cough - most common
  • daily purulent sputum production - most common
  • fever
  • breathlessness on exertion
  • intermittent haemoptysis
  • nasal symptoms
  • chest pain
  • fatigue
  • wheeze - less common
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13
Q

Signs of bronchiectasis

A
  • hypoxaemia
  • fever
  • haemoptysis
  • fine crackles (rales)
  • high pitched inspiratory squeak
  • rhonchi
  • history of weight loss
  • peripheral oedema
  • clubbing - less common
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14
Q

What is rhonchi?

A

Continuous gurgling or bubbling sounds heard during inhalation and exhalation

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15
Q

What is rales?

A

Fine crackles
Like Velcro being pulled apart

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16
Q

What is yellow nail syndrome?

A

Triad of:
- yellow fingernails
- bronchiectasis
- lymphoedema

17
Q

Management of bronchiectasis

A
  • exclude immunodeficiency/ treat identifiable cause
  • physio/ daily airway clearance
  • inhaled corticosteroids + bronchodilators
  • low dose macrolides
  • annual flu vaccine
  • routine vaccinations against Haemophilus influenzae + streptococcus pneumoniae
  • lung transplant
18
Q

Drug management of infective exacerbations of bronchiestasis

A
  • sputum culture needed to identify causative organism
  • 10-14 days antibitoics
  • amoxicillin for haemophilus influenzae
  • ciprofloxacin for pseudomonas aeruginosa
19
Q

What is first line treatment for exacerbation of bronchiectasis due to haemophilus influenzae?

A

amoxicillin 10-14 days
doxycycline if allergy

20
Q

What is first line treatment for exacerbation of bronchiectasis due to Pseudomonas aeruginosa?

A

ciprofloxacin 10-14 days

21
Q

What are low dose macrolides?
What is the mechanism of action?
Examples

A
  • Antibiotics with anti inflammatory and antibiotic effect
  • Inhibits protein synthesis 50s
  • e.g. Clarithromycin + erythromycin
22
Q

Outline exacerbation in bronchiectasis

A

A person with bronchiectasis with deterioration in 3 or more key symptoms for at least 48 hours:
- cough
- sputum volume/consistency
- sputum purulence
- breathlessness
- fatigue
- haemoptysis

23
Q

What additional infections can occur with bronchiectasis?

A

pseudomonas aeruginosa
non-tuberculous mycobacteria

24
Q

What three conditions make up Kartagener’s syndrome?

A

Bronchiectasis
Sinusitis
Situs inversus

25
Q

What three conditions make up Young’s syndrome?

A

Bronchiectasis
Sinusitis
Infertility in men

26
Q

How can you differentiate between COPD and bronchiectasis

A
  • diminished breath sound only in COPD
  • signet ring sign + thickened dilated airways only in bronchiectasis
  • remember that patient with COPS may develop bronchiectasis

Respiratory System (25 decks)

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