QuestionSBA
QuestionChoice
Bronchiectasis is the permanent dilation of the airways within the lung secondary to chronic inflammation or infection. It presents with a persistent productive cough (often with large volumes of sputum), shortness of breath, and sometimes haemoptysis. Coarse crackles are heard on auscultation and patients may also have finger clubbing. Patients are prone to repeated chest infections. 'Tram-track' opacities are a characteristic chest X-ray finding in bronchiectasis, and a CT scan would show dilated airways.
10006836
a
Bronchiectasis
QuestionChoice
Asthma is an appropriate differential diagnosis in this patient. However, the productive cough and lack of a wheeze described by the patient make it less likely. Asthma patients are also more likely to have a family history, other atopic disease, or diurnal variation in their symptoms - all of which are absent in this patient.
10006840
e
Asthma
QuestionChoice
Tuberculosis (TB) is the most common cause of bronchiectasis worldwide, but is unlikely in this patient. Tuberculosis is uncommon in the UK, and this patient has no history of travelling to TB-prevalent countries. Although TB may cause a persistent cough, it would typically present with systemic symptoms such as night sweats, weight loss, and a fever. A CT/CXR would also show signs of TB.
10006838
c
Tuberculosis
QuestionChoice
Lung cancer may cause a chronic cough and finger clubbing. However, it is unlikely here given the lack of systemic symptoms such as weight loss, and no lesions being found on chest X-ray or CT.
10006837
b
Lung cancer
QuestionChoice
Cystic fibrosis is a common cause of bronchiectasis. However, it is an unlikely cause in this patient. A patient with cystic fibrosis would typically have signs much earlier in life (e.g. meconium ileus) which would lead to a pre-existing diagnosis- which is absent in this patient. They may present with clubbing, but also commonly have pancreatic damage.
10006839
d
Cystic fibrosis
Concept
Chapter
2693
3719
Bronchiectasis
Topic
132
Respiratory
13914
A 58-year-old farmer presents to his GP with a two-year history of progressive shortness of breath, particularly on exertion. Over this time, he has also had a cough productive of large volumes of green sputum. He has had five chest infections requiring antibiotics within the past year. He denies any weight loss, and his observations are normal. He has smoked 20 cigarettes per day for the last 35 years and does not drink alcohol. There is no past medical history of note and he has never travelled abroad.

Examination notes bilateral clubbing of the fingers. A chest X-ray shows tram-track opacities, and a CT scan demonstrates dilated airways throughout the lungs with no lesions.

What is the most likely diagnosis?
a