Bronchiectasis

Question · easy

A 58-year-old woman with a 5-year history of daily productive cough and three treated pneumonias in the past year undergoes high-resolution chest CT. Which of the following CT findings is diagnostic of bronchiectasis?

A solitary cavitary lesion with an air-fluid level An airway diameter greater than that of its accompanying vessel, with lack of distal airway tapering Ground-glass opacities with traction on the surrounding parenchyma Bibasilar honeycombing with architectural distortion

Question · medium

A 66-year-old man with known non-CF bronchiectasis presents with increased sputum purulence and volume over 4 days. He has never had a sputum culture performed. While awaiting current sputum cultures, which empiric antibiotic choice is most appropriate?

Inhaled tobramycin monotherapy Oral amoxicillin alone A fluoroquinolone, to ensure Pseudomonas coverage No antibiotics until culture results return

Question · medium

A 61-year-old woman with non-CF bronchiectasis has had four antibiotic-treated exacerbations this year. You consider starting long-term azithromycin. Which step is essential BEFORE initiating chronic macrolide therapy?

Perform CT-guided lung biopsy to confirm the diagnosis Nothing — long-term macrolides require no pre-treatment evaluation Exclude nontuberculous mycobacterial infection and check the QT interval on ECG Begin empiric four-drug NTM therapy prophylactically

Question · hard

A 49-year-old man with idiopathic non-CF bronchiectasis and copious daily sputum asks about dornase alfa (recombinant DNase), which a relative with cystic fibrosis uses. What is the correct recommendation?

Dornase alfa is indicated only when combined with inhaled corticosteroids Dornase alfa is indicated only if Pseudomonas is cultured Dornase alfa is first-line mucolytic therapy for all bronchiectasis Dornase alfa should not be used in non-CF bronchiectasis — it lacks efficacy and may cause harm

Question · hard

A 70-year-old man with severe bilateral bronchiectasis coughs up approximately 400 mL of bright-red blood over 2 hours and becomes increasingly hypoxemic. After calling for help and preparing for definitive therapy, which management sequence is most appropriate?

Secure the airway (intubate if needed), position him bleeding-side down to protect the nonbleeding lung, localize the source, and proceed to bronchial artery embolization Immediate bilateral surgical lobectomy Nebulized tranexamic acid as sole therapy with ward observation High-dose intravenous glucocorticoids and observation