Bronchiectasis: Causes, Symptoms, and Yellow Nail Syndrome

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Questions and Answers

Which of the following is the hallmark characteristic of bronchiectasis?

  • Intermittent spasms of the diaphragm
  • Transient constriction of the bronchioles
  • Permanent dilation of the bronchi (correct)
  • Temporary inflammation of the trachea

Bronchiectasis is characterized by a dry cough and minimal sputum production.

False (B)

What imaging technique is the preferred method for diagnosing bronchiectasis?

High-resolution CT (HRCT)

Yellow nail syndrome is characterized by yellow fingernails, bronchiectasis, and _________.

<p>lymphoedema</p> Signup and view all the answers

Which of the following is a common causative organism in bronchiectasis infections?

<p>Haemophilus influenzae (B)</p> Signup and view all the answers

Long-term antibiotic use is typically avoided in bronchiectasis management due to the risk of antibiotic resistance.

<p>False (B)</p> Signup and view all the answers

Name two typical findings on a chest X-ray that may suggest bronchiectasis.

<p>Tram-track opacities, ring shadows</p> Signup and view all the answers

For infective exacerbations in bronchiectasis caused by Pseudomonas aeruginosa, the usual antibiotic of choice is _________.

<p>ciprofloxacin</p> Signup and view all the answers

Which of the following signs is NOT commonly associated with bronchiectasis?

<p>Pneumothorax (D)</p> Signup and view all the answers

Surgical lung resection is a first-line treatment for all patients with bronchiectasis.

<p>False (B)</p> Signup and view all the answers

Besides antibiotics, what is another key component of bronchiectasis management aimed at clearing sputum?

<p>Respiratory physiotherapy</p> Signup and view all the answers

Patients with bronchiectasis and reduced oxygen saturation may require _________.

<p>long-term oxygen therapy</p> Signup and view all the answers

A patient with bronchiectasis experiences frequent exacerbations (more than 3 per year) despite optimal management. Which long-term medication is most appropriate to consider?

<p>Long-term azithromycin (D)</p> Signup and view all the answers

Cor pulmonale, a potential complication of bronchiectasis, primarily affects the left side of the heart.

<p>False (B)</p> Signup and view all the answers

What specific inhaled medication is typically used for Pseudomonas aeruginosa colonization in bronchiectasis patients?

<p>Inhaled colistin</p> Signup and view all the answers

Individuals with bronchiectasis should receive vaccinations against pneumococcal infections and _________ to reduce the risk of respiratory infections.

<p>influenza</p> Signup and view all the answers

A 55-year-old patient with bronchiectasis and chronic Pseudomonas aeruginosa infection develops increased dyspnea and purulent sputum. Despite being on inhaled colistin, their condition worsens. What is the next best step in management?

<p>Prescribe an extended course of ciprofloxacin (A)</p> Signup and view all the answers

Alpha-1-antitrypsin deficiency primarily leads to bronchiectasis due to its direct toxic effect on bronchial smooth muscle.

<p>False (B)</p> Signup and view all the answers

In the context of bronchiectasis, explain how 'tram-track opacities' arise on a chest X-ray.

<p>Tram-track opacities are parallel markings seen on a chest X-ray, which represent the thickened walls of dilated airways, typically viewed from the side. The markings resemble tram tracks.</p> Signup and view all the answers

In a patient with bronchiectasis and suspected cor pulmonale, elevated _________ and peripheral oedema are key clinical signs to look for during physical examination.

<p>JVP (jugular venous pressure)</p> Signup and view all the answers

Which of the following best describes the primary characteristic of bronchiectasis?

<p>Permanent dilation of the bronchi (B)</p> Signup and view all the answers

Bronchiectasis is primarily caused by a genetic predisposition, with environmental factors playing a minimal role.

<p>False (B)</p> Signup and view all the answers

List three potential causes of damage to the airways that can result in bronchiectasis.

<p>Pneumonia, Tuberculosis, Cystic Fibrosis</p> Signup and view all the answers

Match the following clinical signs with their potential association with bronchiectasis:

<p>Chronic productive cough = Excessive mucus production in dilated bronchi Finger clubbing = Chronic hypoxia and lung disease Scattered crackles = Fluid accumulation in the airways Weight loss = Increased energy expenditure due to chronic illness</p> Signup and view all the answers

Which of the following is a key presenting symptom of bronchiectasis?

<p>Chronic productive cough (D)</p> Signup and view all the answers

The presence of a 'sputum pot' by the bedside is an uncommon sign in patients with bronchiectasis.

<p>False (B)</p> Signup and view all the answers

Name two signs of cor pulmonale that might be observed in a patient with bronchiectasis.

<p>Raised JVP, Peripheral oedema</p> Signup and view all the answers

Scattered ________ throughout the chest that change or clear with coughing is a sign of bronchiectasis.

<p>crackles</p> Signup and view all the answers

Match the following chest x-ray findings with their description in bronchiectasis:

<p>Tram-track opacities = Parallel markings of a side-view of the dilated airway Ring shadows = Dilated airways seen end-on</p> Signup and view all the answers

Which of the following is the test of choice for establishing a diagnosis of bronchiectasis?

<p>High-resolution CT (HRCT) (A)</p> Signup and view all the answers

Sputum culture is not useful in the diagnostic workup of bronchiectasis.

<p>False (B)</p> Signup and view all the answers

Name two common infective organisms identified via sputum culture in bronchiectasis

<p>Haemophilus influenza, Pseudomonas aeruginosa</p> Signup and view all the answers

Parallel markings of a side-view of the dilated airway on a chest x-ray are referred to as ________ opacities.

<p>tram-track</p> Signup and view all the answers

Match the following management strategies with their primary role in bronchiectasis:

<p>Vaccines = Prevention of respiratory infections Respiratory physiotherapy = Clearance of sputum Long-term antibiotics = Reduction of frequent exacerbations Inhaled colistin = Treatment of Pseudomonas aeruginosa colonization</p> Signup and view all the answers

Which of the following vaccines is typically recommended as part of the general management of bronchiectasis?

<p>Pneumococcal vaccine (C)</p> Signup and view all the answers

Long-term antibiotics are typically prescribed for bronchiectasis only in patients experiencing infrequent exacerbations.

<p>False (B)</p> Signup and view all the answers

Name two potential pharmaceutical treatments for frequent exacerbations of bronchiectasis.

<p>Azithromycin, Ciprofloxacin</p> Signup and view all the answers

Inhaled ________ is often prescribed for patients with bronchiectasis who have Pseudomonas aeruginosa colonisation.

<p>colistin</p> Signup and view all the answers

Match the following scenarios with the appropriate duration of antibiotics:

<p>Infective exacerbation = 7-14 days</p> Signup and view all the answers

Which antibiotic is typically chosen for exacerbations caused by Pseudomonas aeruginosa?

<p>Ciprofloxacin (C)</p> Signup and view all the answers

Surgical lung resection is a first-line treatment option for all patients with bronchiectasis.

<p>False (B)</p> Signup and view all the answers

In addition to antibiotics, what other therapeutic intervention is crucial during infective exacerbations of bronchiectasis?

<p>Sputum culture</p> Signup and view all the answers

For breathlessness, ________ bronchodilators may be considered for patients with bronchiectasis.

<p>Long-acting</p> Signup and view all the answers

Match the management strategy with the stage of disease:

<p>Surgical lung resection = Specific areas of disease Lung transplant = End-stage disease</p> Signup and view all the answers

A patient with yellow fingernails, bronchiectasis, and lymphoedema most likely has which condition?

<p>Yellow nail syndrome (B)</p> Signup and view all the answers

Weight gain is a typical sign associated with bronchiectasis.

<p>False (B)</p> Signup and view all the answers

What imaging modality is used to visualize tram-track opacities and ring shadows in bronchiectasis?

<p>Chest X-ray</p> Signup and view all the answers

_____ rehabilitation can help improve exercise tolerance and quality of life in patients with bronchiectasis.

<p>Pulmonary</p> Signup and view all the answers

Match the following investigations with the corresponding infective organism:

<p>Sputum culture = Identifies colonising organisms Extended courses of antibiotics = Treats infective organisms</p> Signup and view all the answers

A patient with bronchiectasis has frequent exacerbations, despite adherence to physiotherapy and vaccinations. What is the next most appropriate step?

<p>Start long-term antibiotics, such as azithromycin (D)</p> Signup and view all the answers

Long-term oxygen therapy is not indicated for bronchiectasis.

<p>False (B)</p> Signup and view all the answers

What is the usual length of antibiotic courses for infective exacerbations of bronchiectasis?

<p>7–14 days</p> Signup and view all the answers

The presence of both scattered wheezes and scattered ________ throughout the chest are clinical signs of bronchiectasis

<p>squeaks</p> Signup and view all the answers

Match the following signs with their diagnostic purpose:

<p>Sputum culture = To identify colonising and infective organisms High-resolution CT = To establish an official diagnosis</p> Signup and view all the answers

Which of the following findings on chest auscultation is least likely to be associated with bronchiectasis?

<p>Focal wheezing limited to one lung field (C)</p> Signup and view all the answers

A normal chest x-ray completely rules out the possibility of bronchiectasis.

<p>False (B)</p> Signup and view all the answers

List three presenting symptoms of bronchiectasis.

<p>Shortness of breath, Chronic Productive Cough, Weight loss</p> Signup and view all the answers

Bronchiectasis involves permanent _______ of the bronchi.

<p>dilation</p> Signup and view all the answers

Which of the following statements regarding bronchiectasis management is LEAST accurate?

<p>Inhaled colistin is used to eradicate Pseudomonas aeruginosa colonization completely. (C)</p> Signup and view all the answers

Flashcards

Bronchiectasis

Permanent dilation of the bronchi, leading to sputum collection and recurrent infections.

Causes of Bronchiectasis

Idiopathic, pneumonia, whooping cough, tuberculosis, alpha-1-antitrypsin deficiency, connective tissue disorders, cystic fibrosis, yellow nail syndrome.

Yellow Nail Syndrome

Yellow fingernails, bronchiectasis, and lymphoedema.

Symptoms of Bronchiectasis

Shortness of breath, chronic productive cough, recurrent chest infections, and weight loss.

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Signs of Bronchiectasis

Sputum pot by the bedside, oxygen therapy, weight loss, finger clubbing, signs of cor pulmonale, scattered crackles/wheezes that clear with coughing.

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Sputum Culture in Bronchiectasis

To identify colonizing and infective organisms in the sputum.

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Common Infective Organisms in Bronchiectasis

Haemophilus influenzae and Pseudomonas aeruginosa.

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Chest X-Ray Findings in Bronchiectasis

Tram-track opacities and ring shadows.

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High-Resolution CT (HRCT)

Test of choice for establishing the diagnosis of bronchiectasis.

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General Management of Bronchiectasis

Vaccines, respiratory physiotherapy, pulmonary rehabilitation, long-term antibiotics, inhaled colistin, long-acting bronchodilators, long-term oxygen therapy, surgical lung resection, lung transplant.

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Management of Infective Exacerbations in Bronchiectasis

Sputum culture, extended courses of antibiotics (7–14 days), ciprofloxacin (especially for Pseudomonas).

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Antibiotic Duration for Exacerbations

Extended courses of antibiotics, usually 7–14 days, are required to treat.

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Antibiotic for Pseudomonas Exacerbations

Ciprofloxacin is the usual choice.

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Bronchiectasis Pathophysiology

Wide airways accumulate sputum, fostering organism growth, leading to chronic cough and recurrent infections.

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Yellow Nail Syndrome Characteristics

Characterized by yellow fingernails, bronchiectasis and lymphoedema; notable for stable patients in OSCE scenarios.

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Tram-Track Opacities

Parallel markings seen on chest x-ray, indicating a side view of dilated airways.

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Ring Shadows (Bronchiectasis)

Ring-like shadows observed on chest x-ray, representing dilated airways viewed end-on.

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Respiratory Physiotherapy (Bronchiectasis)

Utilized to eliminate sputum, aiding in preventing infections and improving lung function.

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Pulmonary Rehabilitation

Program designed to enhance lung function and overall quality of life, using exercise and education.

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Azithromycin in Bronchiectasis

For frequent exacerbations (3+ per year), this macrolide reduces inflammation and bacterial load.

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Inhaled Colistin

Administered via inhalation to combat Pseudomonas aeruginosa colonization in the airways.

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Bronchodilators in Bronchiectasis

May improve airflow and reduce breathlessness by relaxing the airway muscles.

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Surgical Lung Resection

Surgical removal of localized areas with severe damage; option when disease is confined.

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Lung Transplant

Considered for end-stage bronchiectasis to replace damaged lungs with healthy ones.

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Study Notes

Bronchiectasis Overview

  • Bronchiectasis involves permanent dilation of the bronchi, the large airways that transport air to the lungs.
  • This dilation leads to sputum collection, organism growth, chronic cough, continuous sputum production, and recurrent infections.
  • Bronchiectasis results from damage to the airways, with potential causes including idiopathic factors, pneumonia, whooping cough (pertussis), tuberculosis, and Alpha-1-antitrypsin deficiency.
  • Other causes include connective tissue disorders like rheumatoid arthritis, cystic fibrosis, and yellow nail syndrome.

Yellow Nail Syndrome

  • Yellow nail syndrome is characterized by yellow fingernails, bronchiectasis, and lymphoedema.

Symptoms

  • Key presenting symptoms of bronchiectasis include shortness of breath, chronic productive cough, recurrent chest infections, and weight loss.

Signs

  • Signs include a sputum pot by the bedside, oxygen therapy (if needed), weight loss (cachexia), finger clubbing, and signs of cor pulmonale such as raised JVP and peripheral oedema.
  • Other signs are scattered crackles throughout the chest that change or clear with coughing, plus scattered wheezes and squeaks.

Investigations

  • Sputum culture helps identify colonizing and infective organisms, most commonly Haemophilus influenza and Pseudomonas aeruginosa.
  • Chest x-ray findings include tram-track opacities (parallel markings of a side-view of the dilated airway) and ring shadows (dilated airways seen end-on).
  • High-resolution CT (HRCT) is the test of choice for diagnosis.

Management

  • General management includes vaccines (e.g., pneumococcal and influenza), respiratory physiotherapy, and pulmonary rehabilitation.
  • Long-term antibiotics (e.g., azithromycin) are used for frequent exacerbations (3 or more per year).
  • Inhaled colistin is specifically for Pseudomonas aeruginosa colonization.
  • Long-acting bronchodilators may be considered for breathlessness, and long-term oxygen therapy for patients with reduced oxygen saturation.
  • Surgical lung resection may be considered for specific areas of disease, and lung transplant is an option for end-stage disease.

Infective Exacerbations

  • Sputum culture should be done before starting antibiotics.
  • Extended courses of antibiotics are required, usually 7–14 days.
  • Ciprofloxacin is the usual antibiotic choice for exacerbations caused by Pseudomonas aeruginosa.

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