Bronchiectasis

Question 1

What are the 3 risk factors for developing chronic pulmonary infection?

Answer 1

1. Abnormal host response- immunodeficiency, immunosuppression (drugs, cancer)
2. Abnormal innate host defence- damaged bronchial mucosa, cilia
3. Repeated insult- aspiration, indwelling material.

Question 2

What are some common causes of immunodeficiency? (4)

Answer 2

1. Immunoglobin deficiency
2. Hypo-splenism- loss of B lymphocytes through non functioning spleen
3. HIV
4. Immune paresis- (myeloma, lymphoma)

Question 3

What are the common types of Immunoglobin deficiency? (3)

Answer 3

1. IgA deficiency
2. Hypoglobulinanaemia
3. CVID

Question 4

What are some causes of damaged bronchial mucosa? (3)

Answer 4

1. Smoking
2. Malignancy
3. Infection (pneumonia or flu)

Question 5

What are some reasons of abnormal cilia production?

Answer 5

1. Kartengers

2. Youngs

Question 6

Some causes of abnormal mucus? (2)

Answer 6

1. CF

2. Channelopathies- disturbance in ion channel and its functioning

Question 7

Some forms of CHRONIC pulmonary infection. (dont need to remember this)

Answer 7

1. Intrapulmonary abscess
2. Empyema
3. Chronic bronchial sepsis
4. Bronchiectasis
5. CF & other oddities

Question 8

What are the common symptoms of intrapulmonary abscess? (3)

Answer 8

1. Weight loss
2. Cough +/- sputum
3. Tiredness

Intrapulmonary Abscess- Severe localised lung infection associated with necrotic cavity formation.

Question 9

What kind of things can an intrapulmonary abscess be proceeded by?

Answer 9

1. Pneumonia
2. Foreign body
3. Post viral

Question 10

Some common bacterial and fungal pathogens that can cause intrapulmonary abscess?

Answer 10

Bac

1. Strep
2. Staph
3. E. coli
4. Gram -

Fungal - Aspergillus

Question 11

Apart from right sided endocarditis, a septic emboli can also cause _ and _ .

Answer 11

1. Infected DVT

2. Septicaemia

Question 12

Empyema is the formation of _ in the _

Answer 12

pus, pleural space

Question 13

What is the commonest cause of Empyema?

Answer 13

Pneumonia, rest are idiopathic, iatrogenic (due to treatment)

Question 14

Changes in what factors marks progression from simple to complicated effusion to empyema?

Answer 14

1. pH- More than 7.2 in simple but keeps decreasing till empyema
2. LDH- initially less than a 1000 but increases to a 1000 in empyema.
3. Glucose- Initially more than 2.2, decreases less to it.

Question 15

Complicated parapneumonic effusion requires a chest tube drainage. T/F?

Answer 15

True

Question 16

Aerobic Gram + and - such as what usually cause empyema?

Answer 16

Gram +

1. Strep mileri
2. Staph aureus

Gram -

1. E. coli
2. H. influenzae
3. Klebsiella
4. Pseudomonas

Question 17

What factors can determine empyema diagnosis?

Answer 17

1. Slow resolving Pneumonia
2. Persisting Locular (cavity) effusion
3. CT.

USS- Ultrasound most definite way to confirm diagnosis

Question 18

Pleural effusions often show up on CXR’s as a _ shaped sign.

Answer 18

D- lungs reduced to that shape.

Question 19

Treatment for Empyema? (2)

Answer 19

1. Chest drainage- 5 intercostal space? removes fluid
2. Antibiotics
   IV- broad spectrum: amoxicillin
   Oral- targeted to pathogen

Question 20

Bronchiectasis is the localised, irreversible _ of the bronchial tree.

Answer 20

Dilation

Question 21

Involved bronchi are dilated, _ and easily collapsible.

Answer 21

Inflammed

Question 22

Bronchiectasis does not affect clearance of secretions. T/F?

Answer 22

False- impaired secretion clearance

Question 23

What are the symptoms and signs of Bronchiectasis? (3 each)

Answer 23

Symptoms

1. Recurrent infections
2. Copious purulent sputum.
3. +/- haemoptysis

Signs

1. Finger clubbing
2. Coarse inspiratory crackles (NB- Fine crackles seen in pulmonary fibrosis)
3. Wheeze

Question 24

Common pathogens causing Bronchiectasis? (4)

Answer 24

1. H influenzae
2. Strep pneumonia
3. Staph aureus
4. Pseudomonas

Question 25

Bronchiectasis usually causes lower respiratory tract infections. T/F?

Answer 25

True

Question 26

Some common causes of Bronchiectasis?

Answer 26

1. Congenital- CF, Youngs, Kartanagers | 2. Others- bronchial obstruction, Rheumatoid, hypogammaglobulinaemia,

Question 27

More than 50% of Bronchiectasis cases are idiopathic. T/F?

Answer 27

True

Question 28

Chronic bronchial sepsis has the same hallmarks as bronchiectasis but different CT appereances. T/F?

Answer 28

True

Question 29

Chronic bronchial sepsis usually affects _ people

Answer 29

Young. | Older - associated with COPD or other airway disease

Question 30

What is the treatment for Bronchiectasis when colonised by bacteria?

Answer 30

1. Prophylactic- Nebulised gentamicin, colomycin 2. Macrolides- Clarithromycin, Azithromycin 250mg Anti-inflammatory antibiotics reduce exacerbation rates in bronchiectasis.