RESPIRATORY

Before going to see the patient, discuss with student(s) important features of the history in a patient with bronchiectasis (approx 10 minutes). This may include:

• frequency and severity of exacerbations
• previous pathogens and antibiotic use
• questions to determine the underlying cause e.g. previous tuberculosis, pneumonia

Ask the student(s) to take a history from a patient with bronchiectasis. If this is not the presenting complaint, encourage students to take a focused history of the presenting complaint to determine the most likely diagnosis. Ask them to focus on the past medical history and ask the relevant questions from above.

Ask the student(s) to perform a focused respiratory examination on the patient. History and examination can be observed if capacity of tutors allows.

Ask the student to summarise the key positive and negative findings of the case. Feedback on examination technique and presentation to students (max 1 minute).

Discussion points:

• What differential diagnoses for the patient's presenting complaint have you considered and why are these less likely? nb. this may not be related to the patient's bronchiectasis
• What is the most likely underlying cause of the patient's bronchiectasis?

Ask the student(s) to summarise the key features of the patient's bronchiectasis as summarised above, if not already clear from the presentation.

Recap basic pathophysiology with the student(s). Using a whiteboard or flip chart paper if possible, construct a mind-map covering the following points:

• definition of bronchiectasis
• common causes
• key findings on chest x-ray
• other key investigations
• common organisms

Ask the student(s) to find the relevant local antibiotic guidelines for management of bronchiectasis.

Discuss the key differences between management of lower respiratory chest infections and exacerbations of bronchiectasis.

1. https://radiopaedia.org/articles/bronchiectasis?lang=gb
2. https://litfl.com/bronchiectasis/