Station 1 - Bronchiectasis Flashcards
What clinical signs can be found in bronchiectasis?
- End of the bed
- Hands
- Chest
End of the bed:
-Cachexia, tachypnoea
Hands:
-clubbing
Chest:
-Mixed character crackles that alter with coughing, occasional squeaks/wheeze, sputum+++
What signs would indicate cor pulmonale?
SOA
Raised JVP
RV heave
Loud P2
What signs would indicate yellow nail syndrome?
yellow nails and lymphoedema
What investigations would you like to do for bronchiectasis in general?
Sputum culture and cytology
CXR: tramlines and ring shadows
HRCT: ‘signet ring’ sign (thickened, dilated bronchi larger than the adjacent vascular bundle)
What specific investigations would you like to look for hypogammaglobulinaemia?
Immunoglobulins (hypogammaglobulinemia - low IgG)
What specific investigations would you like to look for ABPA?
Aspergillus RAST or skin prick testing
What specific investigations would you like to look for RA?
Rheumatoid serology
What specific investigations would you like to look for Kartageners?
Primary ciliary dyskinesia
Saccharine ciliary motility test (nares to taste buds in the 30mins)
• Dextrocardia or complete situs inversus
• Bronchiectasis
• Recurrent sinusitis
• Subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian
tubes)
What specific investigations would you like to look for cystic fibrosis?
Genetic screening
- Autosomal recessive chromosome 7q
- gene encodes CFTR (Cl- channel)
what gastro disease should be queried about in a patient with bronchiectasis?
IBD
What are the congenital causes of bronchiectasis?
- Kartageners
- CF
What are the childhood infective causes of bronchiectasis?
- Measles
- TB
What are the immune over activity causes of bronchiectasis?
- ABPA
- IBD
What are the immune under activity causes of bronchiectasis?
- Hypogammaglobulinaemia
- CVID
What cause should be considered in alcoholic patients/GORD patients with bronchiectasis?
aspiration, localised to RLL
