Bronchiectasis

Question 1

Upper lung involvement

Answer 1

Cystic fibrosis

Post radiation fibrosis

Question 2

Lower lung field involvement

Answer 2

1. Chronic recurrent aspiration
2. End stage fibrotic lung disease
3. Recurent immunodeficiency - associated infections

Question 3

Example of chronic recurrent aspiration

Answer 3

Due to Esophageal motility disorders like in scleroderma

Question 4

Example of end stage lung fibrotic disease

Answer 4

Traction bronchiectasis from idiopathic pulmonary fibrosis (IPF)

Question 5

Example of recurrent immunodeficiency - associated infections

Answer 5

Hypogammaglobulinemia

Question 6

Affects the midlung

Answer 6

1. Infection NTM
   Most commonly Mycobacterium avium-intracellulare complex MAC
2. Dyskinetic /immotile cila syndrome

Question 7

Involvement of the central airways

Answer 7

1. Allergic bronchopulmonary aspergillosis (ABPA)
2. Cartilage deficiency
   A. Tracheobronchomegaly (mounier-kuhn syndrome)
   B. Williams-Campbell syndrome

Question 8

What is the percentage of bronchiectasis have idiopathic disease

Answer 8

25-50%

Question 9

More common in men or women in general

What about in MAC infection

Answer 9

1. Women

2. Nonsmoking women >50 years of age

Question 10

Most widely cited mechanism of infectious bronchiectasis

Answer 10

“vicious cycle hypothesis”

Question 11

Refers to dilated airways arising from parenchymal distortion as a result of lung fibrosis

Answer 11

Traction bronchiectasis

Question 12

Organism that has a propensity for colonizing damaged airways and evading host defense mechanisms

Answer 12

Pseudomonas aeruginosa

Question 13

Most common clinical presentation

Answer 13

Persistent producrive cough with ongoing production of thick, tenacious sputum

Question 14

Imaging modality of choice

Answer 14

Chest CT

Question 15

How long do take the antibiotics

Answer 15

Minimum of 7-10 days

Perhaps for as long as 14 days

Question 16

NTM should be considered if with symptoms, radiographic findings who have:

Answer 16

1. At least to sputum culture positive
2. At least 1 BAL culture positive
3. Biopsy and one sputum culture positive
4. Pleural fluid culture positive

Question 17

Recommended regimen for HIV negative infectes with macrolide-sensitive MAC

Answer 17

Macrolide
Ethambutol
Rifampin

Question 18

Decline of function in nonCF bronchiectasis was similar to that in COPD with FEV1 declining by

Answer 18

50-55ml per year

Question 19

Organisms for single severe infection that can result in significant airway damage and poor secretion clearance

Answer 19

1. Bordetella pertussis

2. Mycoplasma pneumonia

Question 20

Examples of traction bronchiectasis

Answer 20

1. Post radiation fibrosis

2. Idiopathic pulmonary fibrosis

Question 21

Proposed mechanism for noninfectious bronchiectasis

Answer 21

Immune-mediated reactions that damage the bronchial walls

E.g. assoc with autoimmune (Sjögrens and RA)

Question 22

Diagnosis for bronchiectasis

Answer 22

Clinical plus radiographic features

- persistent chronic cough and sputum production

Question 23

FEV1 declines by how much per year in healthy individuals

Answer 23

20-30ml