Ancillary Tests for Pulmonary

Question 1

What gives sputum its color?

Answer 1

Neutrophils

Question 2

What will improve the quality of a sputum sample?

Answer 2

Obtain Specimen Before Antibiotic Tx
Rinsing mouth prior to expectoration
No food 1-2 hours prior to expectoration
Immediate innoculation

Question 3

What can cause a sputum sample to be rejected?

Answer 3

More than 10 squamous epithelial cells per low power field

Question 4

What are common bacteria seen in pneumonia?

Answer 4

Strep Pneumo
Klebsiella(with alcohol abuse)
Haemophilus Influenza

Question 5

When is Sputum Cytology Used?

Answer 5

For Non-Squamous Cell Lung Cancer

unable or unwilling to undergo other diagnositic procedures

Question 6

What are the different pleural space procedures?

Answer 6

Needle Aspirate
Thoracentesis
Pigtail catheter
Chest Tube
Tunneled Catheter
Pleurodesis

Question 7

What are the different types/ causes of Pleural Effusions?

Answer 7

Exudates 
Transudates
Empyema
Hemothorax
Chylothorax
Malignancy

Question 8

What are the Potential Contraindications of Thoracentesis?

Answer 8

Coagulopathy
Small effusions unless US or CT guidance
Hemodynamic Instability
Pt on mechanical ventilation with high airway pressures.

Question 9

Where are the cough receptors located?

Answer 9

On the pleura.

If Pt starts coughing during during Thorocentesis, you must STOP!

Question 10

What are the potential complications of Thoracentesis?

Answer 10

Hypotension
Pneumothorax
Bleeding/Hemothorax
Infection
Re-expansion pulm edema
Damage of intercostal vasculature and nerves
Inadverted damage of subdiaphragmatic organs (liver

Question 11

What is the Acute lifesaving intervention for Pneumothorax?

Answer 11

Needle Decompression IF YOU HAVE THE RIGHT EQUIPMENT.

Need Large Needle Length and guage to be sucessful.

Question 12

When is a Chest tube indicated for draining a pleural effusion?

Answer 12

If fluid has high density, high output, high protein content, or blood.
If uncomplicated Pleural effusion, transudates, exudates, or non-traumatic pneumothorax a chest catheter is fine
Trauma Related pneumothorax may require chest tube insertion if persistant leak

Question 13

What is a Pleurodesis?

Answer 13

Inflamation of pleural surface to promote adhesion formation and prevent re-accumulation of fluid or recurrence of pneumothorax

Question 14

What chemicals are used for Pleurodesis?

Answer 14

Talc, Doxycycline, Tetracycline, Mynocycline, Bleomycin

Question 15

What determines sucess of Pleurodesis?

Answer 15

Etiology of Pleural effusion and rate of production

Question 16

What are the different endoscopic procedures for the respiratory system?

Answer 16

Fiberoptic Bronchoscopy
EBUS EM navigation bronchoscopy
Interventional Bronchoscopy
-Stent Placement
-Endobronchial valves
-Tumor
-Brachytherapy

Question 17

What are contraindications for Bronchoscopy?

Answer 17

Severe hypoxemia or hyper-carbia with impending resp failure
Obstruction
Hemodynamic Instability
Unstable Angina or recent MI
Coagulopathy
Recent oral intake