C.O.P.D & Bronchiectasis and Suppurative Lung Diseases- 2 - Free MCQ Practice

The most prevalent form of bronchiectasis is the cylindrical type.

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Bronchiectasis Sicca: Only hemoptysis is present without sputum production. It has upper lobe involvement.

The image displays numerous cystic clusters of thin-walled cystic spaces within the lung parenchyma on both sides, with a more pronounced presence on the left, as the left lower lobe is more frequently affected in bronchiectasis.

• Fluid-filled bronchi appear as tubular or branching formations when they extend horizontally.
• The term "varicose bronchiectasis" denotes irregular bronchial dilatation.

The most effective examination to assess the damage and expansion of significant airways filled with pus in Bronchiectasis is HRCT.

• Spiral CT is the preferred method for detecting pulmonary embolism.
• Pulmonary angiography is performed for lung sequestration and is considered the gold standard for pulmonary embolism.

The CT scan allows better delineation of parenchymal processes, pleural disease, masses or nodules, and cavity.

Bronchiectasis can be a consequence of various necrotising infections that are either poorly managed or left untreated. A primary infection is especially a frequent trigger for bronchiectasis.

Chest CT is more specific for bronchiectasis and is the imaging modality of choice for confirming the diagnosis.

• In COPD, Ventilation/perfusion matching leads to under- ventilated lung which usually has low oxygen content which leads to localized vasoconstriction limiting blood flow to that lung tissue.
• Supplemental oxygen abolishes this constriction, leading to improved ventilation/perfusion matching.
• High flow oxygen is not tolerated as it leads to crusting, dryness and epistaxis.
• The treatment is guided by PaO₂ which should be maintained at 60 mm Hg or so (SaO₂ of 85-90%). During the period of exercise, sleep or other activities, the flow rate may be increased by another 1-2 L/min.
• While continuous therapy is required for patients who show hypoxaemia at rest, intermittent treatment during specific periods may be used for patients who demonstrate intermittent hypoxaemia

• The term lung abscess refers to a microbial infection of the lung which results in necrosis of the pulmonary parenchyma.
• In the given choices almost all cause lung abscess. However Harrisons mentions: Most lung abscesses in moribund intubated patients are due to anaerobic bacteria, like pepto streptococcus, Bacteroides etc.

Structures that make up the cilia including inner and/or outer dynein arms, central apparatus, radial spokes, etc. are missing or dysfunctional and thus the axoneme structure lacks the ability to move. Axonemes are the elongated structures that make up cilia and flagella. The underlying cause, dysfunction of the cilia begins during and impacts the embryologic phase of development, in immotile cilia syndrome.

Though this is a highly debatable topic, most search results and discussion with faculty and google books mentions duration of smoking to be more important that the number of cigarettes smoked.

Typical offending organisms that have been known to cause bronchiectasis include the following

1. Pertussis
2. Influenza virus
3. Herpes simplex virus
4. Certain types of adenovirus
5. Measles virus
6. Mycobacterium tuberculosis/Mycoplasa pneumoniae

These organisms lead to progressive bronchial wall damage and dilation.

• While chest radiographs lack sensitivity, the presence of "tram tracks" indicating dilated airways is seen with bronchiectasis.
• Chest CT is more specific for bronchiectasis and is the imaging modality of choice for confirming the diagnosis. CT findings include airway dilation detected as parallel "tram tracks” or as the “signet-ring sign”-a cross-sectional area of the airway with a diameter at least 1.5 times that of the adjacent vessel.
• The crazy-paving pattern is seen in pulmonary alveolar proteinois and also can be observed in exogenous lipoid pneumonia, sarcoidosis, mucinous bronclioalveolar cell carcinoma, and acute respiratory distress syndrome.

• Idiopathic bronchiectatic lesions are most commonly found in the lower lobes, probably because mucociliary clearance is facilitated by gravity in the upper lobes.
• The lesions are identified most commonly in the left lower lobe, followed by the right lower lobe and left upper lobe
• Bronchiectasis due to primary ciliary dyskinesia in the middle lobe, and bronchiectasis due to hypogammaglobulinemia in the lower/middle lobe and lingual segment
• The most common organisms are Haemophilus influenza (15%), Staphylococcus aureus (13%), Streptococcus pneumonia (5%), Pseudomonas aeruginosa (5%), and Mycoplasma pneumonia (5%).

• situs inversus
• chronic sinusitis
• bronchiectasis