Bronchiectasis Flashcards
What is Bronchiectasis?
1 - alveoli are damaged creating larger air spaces instead of many small ones
2 - bronchi in lungs are damaged and inflamed leading to permanent dilation of bronchi
3 - inflammation and damage to the bronchi causing a cough with mucus
4 - narrowing of airways due to type I hypersensitivity
2 - bronchi in lungs are damaged and inflamed leading to permanent dilation of bronchi
- commonly caused by recurrent infections and inflammation
Is Bronchiectasis more common in older or younger patients?
- older
- > 60
Are men or women more likely to develop Bronchiectasis?
- women
What is the prevalence of Bronchiectasis?
1 - 50-100 / 100,000
2 - 100-200 / 100,000
3 - 227-309 / 100,000
4 - 350-400 / 100,000
3 - 227-309 / 100,000
- 227/100,000 in men
- 309/100,000 in women.
All of the following are symptoms that can present in Bronchiectasis. Which are the top 3 most common?
1 - haemoptysis
2 - cough
3 - coarse crackles
4 - copious sputum production
5 - wheezing
6 - dyspnoea
7 - rhinosinusitis
8 - fatigue
9 - digital clubbing
10 - recurrent pleurisy
2 - cough (98%)
4 - copious sputum production (78%)
3 - coarse crackles (75%)
Bronchiectasis symptoms can overlap with other conditions. Which of the following is NOT a differential for Bronchiectasis?
1 - Asthma
2 - PE
3 - COPD
4 - Cystic fibrosis
5 - Allergic bronchopulmonary aspergillosis (ABPA)
6 - Chronic tuberculosis (including non-tuberculous mycobacteria)
2 - PE
- would present with SOB but not other common symptoms
What type of cells line the lumen of our airways?
1 - cuboidal epithelial cells
2 - transitional columnar epithelial cells
3 - ciliated pseudostratified columnar epithelial cells
4 - ciliated cuboidal cells
3 - ciliated pseudostratified columnar epithelial cells
Which of the following is NOT a layer of the mucosa that lines the airways?
1 - loose connective tissue
2 - goblet cells
4 - smooth muscle
5 - ciliated pseudostratified columnar epithelial cells
5 - basement membrane
4 - smooth muscle
Which of the following is NOT a layer of the submucosa that lines the airways?
1 - connective tissue
2 - smooth muscle
3 - bronchial mucinous glands
4 - basement membrane
4 - basement membrane
In the lining of the lumen, do goblet cells or bronchial mucinous glands secrete the majority of mucus in the lungs?
- bronchial mucinous glands
Which 2 of the following are part of the mucociliary escalator?
1 - cilia lining epithelial cells
2 - mucus secreted by goblet and bronchial mucinous glands
3 - smooth muscle
4 - loose connective tissue
1 - cilia lining epithelial cells
2 - mucus secreted by goblet and bronchial mucinous glands
- together they trap foreign particles and move them out of the lungs
Which of the following is NOT a cause of chronic inflammation due to abnormal cilia function in the bronchi?
1 - smoking
2 - primary ciliary dyskinesia
3 - cystic fibrosis
4 - recurrent infections
3 - cystic fibrosis
- this is classed as an abnormal mucus production, BUT this can cause chronic inflammation
Which of the following is NOT a cause of chronic inflammation due to abnormal immune system in the bronchi?
1 - Congenital hypogammaglobulinaemia
2 - Combined variable immune deficiency (CVID)
3 - Lymphoma
4 - Smoking
5 - Myeloma
6 - Post-transplant
4 - Smoking
- classed as causing abnormal cilia
What is the main cause of chronic inflammation in the lungs that causes Bronchiectasis?
1 - recurrent infection
2 - damaged cilia
3 - low mucus production
4 - low peristalsis
1 - recurrent infection
- pneumonia is very common
All of the following are organisms that are common in Bronchiectasis, EXCEPT which one?
1 - Haemophilus influenzae
2 - Streptococcus pneumoniae
3 - Escherichia coli
4 - Staphylococcus aureus
5 - Pseudomonas aeruginosa
3 - Escherichia coli
- Haemophilus influenzae = gram - coccobacillary
- Streptococcus pneumoniae = gram-positive, spherical bacteria
- Staphylococcus aureus = gram-positive spherical bacteria
- Pseudomonas aeruginosa = gram-negative, rod-shaped bacterium
If the mucociliary escalator does not function in a normal lung, or one that has chronic inflammation, what can this cause the formation of?
1 - malignancy
2 - tar from cigarettes
3 - mucous plugs
4 - ciliary dysplasia
3 - mucous plugs
In chronic inflammation, cytokines released by immune cells damages epithelial cells, cilia and elastin in the walls of the lumen. This causes dilation of the bronchi filled with excess mucus. Which cell then tries to repair the damage by secreting collagen?
1 - macrophages
2 - T helper cells
3 - chrondrocytes
4 - fibroblasts
4 - fibroblasts
- results in airways become less elastic and stiff in their dilated form
In Bronchiectasis if the airways are dilated and stiff due to the damaged elastin and increased collagen deposition by fibroblasts air struggles to flow through the airways. Is this then classed as an obstructive or restrictive lung disorder?
- obstructive
- air can get in, but cannot leave
The chronic inflammation of the airways can spread to the pleura of the lungs. If the inflammation continues this can cause hypoxia and pulmonary arterioles vasoconstrict to limit blood flow to the damaged lung tissue. If this is widespread it can cause what?
1 - PE
2 - pulmonary hypertension
3 - hepatomegaly
4 - raised JVP
2 - pulmonary hypertension
- vasoconstriction of enough pulmonary arterioles increases overall pulmonary vascular resistance
If pulmonary hypertension occurs due to chronic bronchiectasis, what is a dangerous condition this can cause?
1 - cor pulmonale
2 - PE
3 - hepatomegaly
4 - raised JVP
1 - cor pulmonale
- right ventricle hypertrophy caused by pulmonary system
- pulmonary hypertension leads to right ventricle hypertrophy
Which of the following is NOT a common symptom in bronchiectasis?
1 - persistent cough
2 - copious purulent sputum
3 - failure to thrive
4 - intermittent haemoptysis
3 - failure to thrive
Which of the following is NOT a clinical sign of bronchiectasis?
1 - clubbing
2 - CO2 retention flap
3 - coarse crepitations
4 - wheeze
2 - CO2 retention flap
Which of the following is NOT a common complication of bronchiectasis?
1 - pneumothorax
2 - pericarditis
3 - pleural effusion
4 - haemoptysis
5 - amyloidosis
6 - pneumonia
2 - pericarditis
All of the following should be conducted if a patient presents with suspected bronchiectasis, EXCEPT which one?
1 - chest X-ray
2 - sputum sample for culture
3 - hypersensitivity test
4 - high-resolution computed tomography
5 - bronchoscopy
6 - spirometry
3 - hypersensitivity test
- can be done but not as important as other tests
If we perform high-resolution computed tomography in a patient with suspected bronchiectasis, what are we likely to see on the image?
1 - signet rings
2 - bronchial wall thickening
3 - enlarged aortic arch
4 - deviated trachea
1 - signet rings
In a patient presenting with an acute presentation of bronchiectasis, which 2 of the following should be given as an inhaler?
1 - prednisolone and salmeterol
2 - salbutamol and salmeterol
3 - salmeterol and hydrocortisone
4 - prednisolone and salbutamol
1 - prednisolone and salmeterol
- ICS + LABA
In a patient presenting with an acute presentation of bronchiectasis, which of the following are common methods to target the excessive mucus?
1 - postural tilt
2 - exercises
3 - acapella device
4 - mucolytic drugs
5 - all of the above
5 - all of the above
In a patient presenting with an acute presentation of bronchiectasis, should they be prescribed with antibiotics?
- yes, emperical antibiotics at a prophylactic dose
- BUT change based on sputum or bronchoscopy culture
Why is it important to discuss vaccinations in patients who have bronchiectasis?
1 - increased risk of infection
2 - all patients are immunocompromised
3 - antibiotics don’t work on these patients
4 - immunoglobulins require treating
1 - increased risk of infection
What is the prevalence of Bronchiectasis?
1 - 50-100 / 100,000
2 - 100-200 / 100,000
3 - 227-309 / 100,000
4 - 350-400 / 100,000
3 - 227-309 / 100,000
- 227/100,000 in men
- 309/100,000 in women.
