A 45-year-old man with a 20-year smoking history presents with chronic productive cough with large volumes of purulent sputum, recurrent hemoptysis, and finger clubbing. HRCT chest shows 'signet ring sign' and tram-track opacities in the lower lobes. What is the most likely underlying etiology in this patient?

• A Post-necrotizing pneumonia ✓
• B Primary ciliary dyskinesia
• C Cystic fibrosis
• D Allergic bronchopulmonary aspergillosis

Explanation

This patient has classic bronchiectasis (chronic productive cough, hemoptysis, clubbing, signet ring sign on HRCT). In adults from India, the most common cause of bronchiectasis is post-necrotizing pneumonia from childhood infections. Cystic fibrosis presents earlier and is rare in Indian adults. Primary ciliary dyskinesia causes Kartagener syndrome. ABPA causes central bronchiectasis with mucus plugging.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.