Other Pulmonary Diseases: The Daily PANCE Blueprint

Home Other Pulmonary Diseases: The Daily PANCE Blueprint

Other Pulmonary Diseases: The Daily PANCE Blueprint

A 71-year-old female with a history of Hodgkin’s lymphoma presents to your clinic with a worsening cough and foul-smelling phlegm production for the past few months. Vitals are stable. On physical exam, there are scattered crackles in bilateral lung fields. A CT chest is obtained and reveals extensive bronchial wall thickening. There is no honeycombing or lymphadenopathy. Which of the following is the most likely diagnosis?

A. Carcinoid syndrome
B. Pulmonary tuberculosis
C. Squamous cell carcinoma
D. Bronchiectasis
E. Viral pneumonia

Answer and topic summary

The answer is D. Bronchiectasis

Bronchiectasis is a pulmonary disorder of the bronchi and bronchioles that is defined by the destruction of the bronchial walls and abnormal bronchial dilation. In order for this condition to occur, a patient has to have some sort of airway obstruction, defect in host defense, or impairment of drainage. Etiologies include CF, rheumatic and systemic disease, pulmonary infections, and allergic bronchopulmonary aspergillosis. Clinical features include cough, dyspnea, mucopurulent sputum production, hemoptysis, and rhinosinusitis. On exam, you may hear crackles. Work-up should include a sputum smear and culture for bacteria, mycobacteria, fungi, and a CT chest. PFTs will show an obstructive impairment. Treatment aims to control chronic infections, treat exacerbations, and reduce inflammation.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒ Other Pulmonary Disease ⇒ Bronchiectasis

Also covered as part of the Internal Medicine EOR topic list

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