Bronchiectasis

Question 1

Clinical signs

Answer 1

Cachexia, tachypnoea
Clubbing
Mixed character crackles that alter with coughing, squeaks and wheeze
+++ sputum
Cor pulmonale
Yellow nail syndrome: yellow nails and lymphoedema

Question 2

Features of cor pulmonale

Answer 2

Ankle swelling
Right ventricle heave
Raised JVP
Loud p2

Question 3

Investigations

Answer 3

Sputum culture and cytology
CXR: tramlines and ring shadows
HRCT: signet ring sign

Question 4

Investigations for specific causes

Answer 4

Immunoglobulins - hypogammaglobulinemia
Aspergillus RAST - ABPA
Rheumatoid serology
Saccharine ciliary motility - nares to taste buds time of 30 mins (Kartageners)
Genetic screening - CF
Hx of IBD

Question 5

Causes of bronchiectasis

Answer 5

Congenital: kartageners and CF
Childhood infections: measles and TB
Immune over activity: ABPA, IBD associated
Immune under activity: hypogammaglobulinemia, CVID
Aspiration: alcoholics and GORD, localised to right lower lobe

Question 6

Treatment

Answer 6

Physiotherapy - active cycle breathing
Prompt abx treatment of exacerbations
Long term prophylaxis with low dose azithromycin 3x/week
Bronchodilators/inhaled steroids if obstruction
Surgery for localised disease

Question 7

Complications

Answer 7

Cor pulmonale
Secondary amyloidosis (dip urine for protein)
Massive haemoptysis (mycotic aneurysm)