Pulm - Bronchiectasis, ABPA, Cystic Fibrosis

Question 0

Presentation of bronchiectasis?

Answer 0

#High-volume purulent sputum production
#hemoptysis
#dyspnea

Question 1

Single most common cause of bronchiectasis?

Other causes?

Answer 1

Cystic fibrosis

#Infections – tuberculosis, pneumonia, abscess
#Hypogammaglobulinemia
#Foreign bodies/tumors
#Allergic bronchopulmonary aspergillosis
#Collagen vascular disease (rheumatoid arthritis)

Question 2

Cannot diagnose bronchiectasis without?

Answer 2

Imaging (CT scan)

Question 3

Treatment of bronchiectasis?

Answer 3

#Chest physiotherapy
#Antibiotics on rotating schedule
#Surgical resection of focal lesions

Question 4

ABPA? Definition? Patient population?

Answer 4

Allergic bronchopulmonary aspergillosis

Hypersensitivity to fungal antigens

Exclusively in patients with asthma and history of atopic disorder

Question 5

Typical presentation of ABPA?

Answer 5

Cough, wheezing, hemoptysis and sometimes bronchiectasis

Asthmatic patient with recurrent episodes of brown-flecked sputum and transient infiltrates on x-ray

Question 6

Diagnostic tests for ABPA?

Answer 6

#Peripheral eosinophilia
 #skin test reactivity to Aspergillus
#Aspergillus anti-bodies
#Elevated IGE
#infiltrates in imaging

Question 7

Treatment of ABPA?

Answer 7

#Oral steroids for severe cases (inhaled steroids ineffective)
#Itraconizole for recurrent episodes

Question 8

Most common cause of death in CF?

Other Organs damaged?

Answer 8

Lung disease

#Sinuses (infections)
# Pancreas (steatorrhea, ADEK deficiencies, recurrent pancreatitis)
#liver (biliary cirrhosis)
#Intestines (obstructions, meconium ileus as child)
#GU tract (azoospermia, infertility, missing vas deferens)

Question 9

Presentation cystic fibrosis?

Answer 9

#Young adults with chronic lung disease
#Recurrent infection
#Sinus pain/nasal polyps

Question 10

Diagnostic test for CF?

Answer 10

Increased sweat chlorine test (over 60 mEq/L) > genotyping

Question 11

PFT in CF?

Answer 11

#Mixed obstructive and restrictive pattern
#Decrease in FVC and TLC
#Decreased Diffusion capacity

Question 12

Treatment for CF?

Answer 12

#Antibiotics based on sputum culture (inhaled aminoglycosides)
#Inhaled recombinant human deoxyribonuclease (breaks down DNA in mucus clogging airways)
#Inhaled bronchodilators
#Pneumococcal/influenza vaccination
#transplant

Question 13

Diabetes in cystic fibrosis?

Answer 13

Islet cells are spared. Beta-cell function is normal until very late in life