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Physician Assistant Exam: Bronchiectasis

Bronchiectasis is a chronic condition characterized by dilation of the alveolar air sacs and covered on the Physician Assistant Exam (PANCE). The airways can become huge and dilated, and affected patients can have difficulty clearing mucous.

Bronchiectasis is usually an irreversible condition secondary to long-standing lung inflammation. Often, the inflammation has been occurring for years. Causes include cystic fibrosis, pulmonary infections, and malignancy.

Here are a few clinical points you need to know about bronchiectasis:

  • The person often has a chronic productive cough with significant sputum production.

  • Cyanosis and/or clubbing (the fingernail kind, not the bar-hopping kind) can be present.

  • The imaging test to best help in diagnosing bronchiectasis is the high-resolution CT scan. A pulmonologist may perform a bronchoscopy to make sure a lung malignancy isn’t present. In addition, the bronchoscope can be used to “suck out all the junk” — stuff that the affected person is unable to clear.

  • Antibiotics and bronchodilating agents are given for acute exacerbations.

One often-repeated PANCE question involves a person who has long-standing bronchiectasis and develops nephrotic proteinuria with no hematuria. What does this mean? The answer is secondary amyloidosis — the protein buildup is due to long-standing inflammation from the bronchiectasis.

You are evaluating a 56-year-old man who presents with clubbing. He denies any fevers or chills. He does not have a smoking history. On physical examination, you note the presence of palmar erythema and telangiectasias. His abdominal examination is positive for the presence of a fluid wave. Which one of the following is a likely cause of his clubbing?

(A) Bronchiectasis
(B) Lung cancer
(C) Endocarditis
(D) Cirrhosis
(E) Kidney disease

The answer is Choice (D), cirrhosis. Clubbing is a nonspecific clinical sign that you can see in a variety of disorders, including Choices (A) through (D) of this question. The lack of fevers and chills is a sign that endocarditis isn’t likely to be present.

The man has no history of a chronic cough with productive sputum, which would be a tipoff that bronchiectasis isn’t present. This person has the findings of cirrhosis, including palmar erythema, telangiectasias, and a fluid wave suggesting the presence of ascites. Clubbing is not typically a sign of kidney disease, Choice (E). Unlisted causes of clubbing include other lung processes as well as inflammatory bowel disease and many malabsorption syndromes.

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