BRONCHIECTASIS Flashcards
Which of the following is the most common clinical manifestation of bronchiectasis?
A) Fever and chills
B) Persistent productive cough with thick sputum production
C) Chest pain and hemoptysis
D) Shortness of breath with wheezing and stridor
Persistent productive cough with thick sputum production
What is commonly observed on pulmonary function tests in patients with bronchiectasis?
A) Normal airflow
B) Severe airflow obstruction
C) Mild to moderate airflow obstruction
D) Restrictive lung pattern
Mild to moderate airflow obstruction
What characterizes an acute exacerbation of bronchiectasis?
A) Fever and pleuritic chest pain
B) Increased volume and purulence of sputum
C) Sudden onset of dyspnea and wheezing
D) Severe hypoxemia and cyanosis
Increased volume and purulence of sputum
Which radiographic feature is consistent with bronchiectasis on a chest radiograph?
A) Diffuse bilateral infiltrates
B) Tram tracks indicating dilated airways
C) Pneumothorax and pleural effusion
D) Elevated hemidiaphragm and blunted costophrenic angle
Tram tracks indicating dilated airways
Which imaging modality is the gold standard for confirming the diagnosis of bronchiectasis?
A) Chest X-ray
B) Chest CT
C) Pulmonary function tests
D) MRI of the chest
Chest CT
Which of the following CT findings is characteristic of bronchiectasis?
A) Airway dilation with “tram tracks” or “signet-ring” sign
B) Ground-glass opacities and consolidation
C) Pleural plaques and fibrosis
D) Hilar lymphadenopathy and cavitary lesions
Airway dilation with “tram tracks” or “signet-ring” sign
Which of the following pathogens is most commonly associated with infectious bronchiectasis?
A) Streptococcus pneumoniae
B) Haemophilus influenzae and Pseudomonas aeruginosa
C) Mycoplasma pneumoniae
D) Legionella pneumophila
Answer: B) Haemophilus influenzae and Pseudomonas aeruginosa
Rationale: The most common bacterial pathogens isolated in infectious bronchiectasis are H. influenzae and P. aeruginosa. S. pneumoniae (A) is a frequent cause of community-acquired pneumonia, M. pneumoniae (C) is associated with atypical pneumonia, and Legionella (D) causes Legionnaires’ disease, not chronic bronchiectasis.
What is the recommended duration of antibiotic therapy for acute exacerbations of bronchiectasis?
A) 3–5 days
B) 7–10 days, potentially up to 14 days
C) 4–6 weeks
D) 6 months of continuous therapy
Answer: B) 7–10 days, potentially up to 14 days
Rationale: The standard duration of antibiotic treatment for an acute exacerbation of bronchiectasis is 7–10 days, and in severe cases, therapy may extend to 14 days. Shorter durations (A) are inadequate, and prolonged courses (C, D) are reserved for chronic infections such as nontuberculous mycobacterial (NTM) disease.
Which of the following is the most common nontuberculous mycobacterial (NTM) pathogen in bronchiectasis?
A) Mycobacterium tuberculosis
B) Mycobacterium avium complex (MAC)
C) Mycobacterium leprae
D) Mycobacterium kansasii
Answer: B) Mycobacterium avium complex (MAC)
Rationale: MAC is the most common NTM pathogen in bronchiectasis. M. tuberculosis (A) is not an NTM and causes tuberculosis rather than NTM-related bronchiectasis. M. leprae (C) causes leprosy, and M. kansasii (D) is another NTM species but is less frequently associated with bronchiectasis than MAC.
What is the recommended treatment for macrolide-sensitive MAC infections in HIV-negative patients?
A) Rifampin monotherapy
B) A macrolide combined with rifampin and ethambutol
C) Isoniazid, rifampin, and pyrazinamide
D) Amphotericin B
Answer: B) A macrolide combined with rifampin and ethambutol
Rationale: The recommended treatment for macrolide-sensitive MAC includes a macrolide (clarithromycin or azithromycin) plus rifampin and ethambutol. Rifampin alone (A) is ineffective, isoniazid-based regimens (C) are for tuberculosis, and amphotericin B (D) is an antifungal, not used for mycobacterial infections.
Which of the following is NOT recommended for routine use in non-CF bronchiectasis?
A) Hypertonic saline
B) Dornase alfa (DNase)
C) Chest physiotherapy
D) Pulmonary rehabilitation
Answer: B) Dornase alfa (DNase)
Rationale: Dornase alfa (DNase) is routinely used in cystic fibrosis (CF)-related bronchiectasis but is not recommended for non-CF bronchiectasis, as it lacks efficacy and may be harmful. Hypertonic saline (A), chest physiotherapy (C), and pulmonary rehabilitation (D) are beneficial in promoting secretion clearance.
Which of the following is an indication for surgical intervention in bronchiectasis?
A) Localized, severe bronchiectasis with recurrent infections
B) Diffuse bronchiectasis affecting multiple lobes
C) Mild bronchiectasis with minimal symptoms
D) Asymptomatic bronchiectasis detected on CT scan
Answer: A) Localized, severe bronchiectasis with recurrent infections
Rationale: Surgical resection is considered for localized, severe bronchiectasis that causes recurrent infections or massive hemoptysis despite medical therapy. Diffuse disease (B) is not amenable to surgery, and mild/asymptomatic cases (C, D) do not require intervention.
What is a potential last-resort treatment option for advanced, refractory bronchiectasis?
A) Long-term oxygen therapy
B) Lung transplantation
C) Intravenous immunoglobulin therapy
D) Continuous antifungal therapy
Answer: B) Lung transplantation
Rationale: Lung transplantation is a last-resort option for patients with severe, progressive bronchiectasis who fail medical therapy. Long-term oxygen (A) may be needed in end-stage disease but does not treat the underlying condition. IVIG (C) is useful for immunodeficiencies but not bronchiectasis alone, and antifungals (D) are only used in ABPA, not refractory bronchiectasis.
What is the most serious complication of recurrent infections in infectious bronchiectasis?
A) Pulmonary fibrosis
B) Life-threatening hemoptysis
C) Pulmonary hypertension
D) Pneumothorax
Answer: B) Life-threatening hemoptysis
Rationale: Recurrent infections in bronchiectasis can lead to damage of mucosal blood vessels, causing hemoptysis. In severe cases, massive hemoptysis can be life-threatening and requires urgent intervention. Pulmonary fibrosis (A) is more typical of interstitial lung diseases, pulmonary hypertension (C) may occur in late-stage disease, and pneumothorax (D) is rare in bronchiectasis.
Which pathogen is associated with worse outcomes in bronchiectasis?
A) Haemophilus influenzae
B) Staphylococcus aureus
C) Pseudomonas aeruginosa
D) Streptococcus pneumoniae
Answer: C) Pseudomonas aeruginosa
Rationale: Pseudomonas aeruginosa is associated with more severe disease, frequent exacerbations, and increased lung function decline in bronchiectasis. H. influenzae (A) and S. pneumoniae (D) are common but not linked to worse prognosis, and S. aureus (B) is less frequently isolated.
What is the approximate annual decline in FEV1 in patients with non-CF bronchiectasis?
A) 10–15 mL
B) 20–30 mL
C) 50–55 mL
D) 70–80 mL
Answer: C) 50–55 mL
Rationale: Studies indicate that patients with non-CF bronchiectasis experience an FEV1 decline of 50–55 mL per year, similar to COPD patients. Healthy controls (B) experience a lower decline (20–30 mL per year).
Which of the following statements about long-term macrolide therapy in bronchiectasis is correct?
A) Macrolides should be used in all bronchiectasis patients.
B) Macrolide therapy has both antibacterial and anti-inflammatory benefits.
C) Long-term macrolide therapy is associated with reduced macrolide resistance.
D) Macrolides have no role in bronchiectasis management.
Answer: B) Macrolide therapy has both antibacterial and anti-inflammatory benefits.
Rationale: Macrolides (e.g., azithromycin, erythromycin) have both antimicrobial and anti-inflammatory properties, helping reduce exacerbations and mucus production in bronchiectasis. However, they are not used in all patients (A), and resistance (C) is a concern.
Which of the following is the most common cause of upper lobe-predominant bronchiectasis?
A) Chronic aspiration
B) Cystic fibrosis (CF)
C) Hypogammaglobulinemia
D) Idiopathic pulmonary fibrosis (IPF)
Answer: B) Cystic fibrosis (CF)
Rationale: Upper lobe-predominant bronchiectasis is most commonly associated with cystic fibrosis (CF) due to thick, dehydrated mucus leading to chronic infection and inflammation. Chronic aspiration (A) and hypogammaglobulinemia (C) typically cause lower lobe disease, while traction bronchiectasis from IPF (D) affects the lower lungs.
Which etiology is most commonly associated with central airway-predominant bronchiectasis?
A) Bronchial atresia
B) Mycobacterium avium-intracellulare complex (MAC) infection
C) Allergic bronchopulmonary aspergillosis (ABPA)
D) Esophageal motility disorders
Answer: C) Allergic bronchopulmonary aspergillosis (ABPA)
Rationale: ABPA causes immune-mediated damage to the bronchial walls, leading to central airway-predominant bronchiectasis. MAC (B) affects the mid-lung fields, bronchial atresia (A) causes focal disease, and esophageal motility disorders (D) lead to lower lobe involvement due to chronic aspiration.
Diffuse bronchiectasis affecting the mid-lung fields is commonly associated with which infection?
A) Tuberculosis
B) Mycobacterium avium-intracellulare complex (MAC)
C) Haemophilus influenzae
D) Staphylococcus aureus
Answer: B) Mycobacterium avium-intracellulare complex (MAC)
Rationale: MAC infection is known to cause mid-lung field-predominant bronchiectasis. Tuberculosis (A) and H. influenzae (C) can cause bronchiectasis but do not preferentially affect the mid-lung fields, and S. aureus (D) is more relevant in CF-related infections.
Which of the following conditions is most commonly associated with lower lobe-predominant bronchiectasis?
A) Cystic fibrosis
B) Post-radiation fibrosis
C) Chronic aspiration
D) Allergic bronchopulmonary aspergillosis (ABPA)
Answer: C) Chronic aspiration
Rationale: Chronic aspiration, seen in esophageal motility disorders (e.g., scleroderma), GERD, and neuromuscular diseases, primarily affects the lower lung fields. CF (A) and post-radiation fibrosis (B) affect the upper lobes, while ABPA (D) involves the central airways.
