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Respiratory > Ancillary tests and procedures > Flashcards

Ancillary tests and procedures Flashcards

1
Q

What gives the color to sputum?

A

PMNs

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2
Q

Rust colored sputum = ?

A

Strep pneumoniae

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3
Q

Currant jelly sputum = ?

A

Klebsiella

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4
Q

Should a patient rinse their mouth prior to giving a sputum sample?

A

Yes

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5
Q

How many hours prior to giving a sputum sample should a patient be NPO?

A

1-2 hours

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6
Q

What fraction of patients with bacterial pneumonia will not be able to produce a sputum specimen?

A

1/3

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7
Q

What is the cutoff of epithelial cells in a sputum sample before it is discarded? Why?

A

More than 10 per HPF.

Likely an oral sample.

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8
Q

What are the two urine tests that, when positive, warrant a sputum sample?

A

Urine antigen for pneumococcus

Urine antigen for legionella

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9
Q

What other lung pathologies beside pneumonia should a sputum sample be obtained?

A
  • Pleural effusion

- Severe obstructive or structural lung disease

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10
Q

What type of culture should be obtained with intubated patients?

A

Tracheal swab

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11
Q

True or false: for outpatient treatment, sputum samples are optional

A

True

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12
Q

What is the most common causative agent of pneumonia?

A

Strep pneumoniae

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13
Q

What is the usual treatment for community acquired pneumonia?

A

Ceftriaxone

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14
Q

When is a sputum cytology indicated?

A

For patients with non-small cell lung CA who are unable or unwilling to undergo other diagnostic testing

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15
Q

What is the yield for sputum cytology?

A

Low; only 20-25% sensitivity

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16
Q

Why, besides the low sensitivity, are sputum cytologies not a good test for NSCLC?

A

Does not provide staging information, nor is it likely to provide ideal specimens for immunohistological or molecular studies

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17
Q

When is a thoracentesis indicated?

A

Pleural effusions

Empyema

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18
Q

What is yellow nail syndrome?

A

Rare syndrome characterized by pleural effusions and yellow, thickend nails.

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19
Q

What are the contraindications of a thoracentesis?

A
  • Coagulopathy
  • Hemodynamic instability
  • Pt on mechanical ventilation
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20
Q

True or false: you do not do thoracocentesis unless under US or CT guidance. Why or why not?

A

True

Do not want to puncture the lung

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21
Q

Why do you not want to do a thoracentesis on a pt who is on mechanical ventilation?

A

More likely to puncture lung, and will create a tension pneumothorax

22
Q

When is it okay to perform a thoracentesis in patients who are anticoagulated?

A

Likely safe if PTT or PT is less than 1.5 ULN

23
Q

While doing a thoracocentesis, the needle should not be placed below which rib?

A

9th rib

24
Q

What is the max amount of pleural fluid that should be removed? Why?

A

1.5 L

Post expansion pulmonary edema

25
Q

What are the three major causes of transudate?

A

CHF
Cirrhosis
Nephrosis

26
Q

What are the three major causes of exudate?

A

Bacterial pneumonia
CA
Trauma

27
Q

What is the ratio of pleural fluid protein to serum fluid protein in exudate?

A

Greater than 0.5

28
Q

What is the ratio of pleural fluid protein to serum fluid protein in transudate?

A

Less than 0.5

29
Q

What are the complications of performing a thoracentesis?

A
  • Pneumothorax
  • Air embolism
  • Post-expansion pulmonary edema
30
Q

When should a CXR be ordered after a thoracentesis? (3)

A
  • Air is aspirated
  • Pt develops SOB, hypoxia, or chest pain
  • Pt is critically ill or mechanically ventilated
31
Q

Why should you stop a thoracentesis if the patient coughs during the procedure?

A

Will cause a pneumothorax

32
Q

What are the ssx of a pneumothorax?

A

Chest pain

Cough

33
Q

Why should the needle be inserted above the rib while performing a thoracentesis?

A

Do not want to damage the neurovascular bundle

34
Q

When can a needle drainage be used for a pneumothorax? What should be done following this procedure?

A

For a first time occurrence

CXR needed afterward

35
Q

Why is it that needle decompression of a pneumothorax is only indicated if done with proper equipment? What is the proper equipment?

A

Need to have large enough needle (gauge and length) to get through the chest wall

36
Q

When should a chest tube be used over a catheter for a pneumothorax?

A

If fluid has a high density or protein content

Trauma

37
Q

When is a catheter indicated for draining a pneumothorax?

A
  • Uncomplicated pleural effusions

- Atraumatic

38
Q

Why should you use a chest tube for a hemothorax and not a catheter?

A

Will clot

39
Q

What is medical thoracoscopy?

A

Percutaneous insertion of an endoscope into the pleural space to directly visualize and collect specimens from both the pleura and pleural space

40
Q

What is a pleurodesis?

A

Inflammation of pleural surfaces to promote adhesion formation and prevent reaccumulation of fluid

41
Q

What is the usual drug used to perform a pleurodesis?

A

Talc or abx

42
Q

What are the indications for a pleurodesis?

A

Malignant effusions

Refractory, symptomatic effusions

43
Q

What are malignant pleural effusions?

A

a condition in which cancer causes an abnormal amount of fluid to collect between the pleura

44
Q

What are the two major contraindications to a pleurodesis?

A
  • Trapped lung

- Underlying severe lung disease

45
Q

What is a trapped lung?

A

Lung that has undergone fibrosis secondary to some inflammatory etiology, and will not re-expand with pleurodesis

46
Q

What is a bronchoscopy?

A

Fiberoptic bronchoscope is passed through the bronchi is collect visualize and/or collect specimens

47
Q

What are the indications for a bronchoscopy?

A

Anytime where you suspect there is something in the airways that needs to be looked at or removed

48
Q

What are the contraindications to bronchoscopy?

A
  • recent MI
  • Recent oral intake
  • High grade obstruction
49
Q

Why is bronchoscopy contraindicated in patient on a ventilator?

A

More likely to puncture lungs

50
Q

What is a bronchoalveolar lavage?

A

a medical procedure in which a bronchoscope is passed through the mouth or nose into the lungs and fluid is squirted into a small part of the lung and then collected for examination. It is typically performed to diagnose lung disease.

51
Q

At least what amount of saline is needed for an adequate bronchoalveolar lavage?

A

100 mL

Respiratory (34 decks)

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