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AUBF-Lec-Sputum&BAL Flashcards

1
Q

Sputum is from the?

A

From upper and lower respiratory tract

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2
Q

Tracheobronchial secretions are a misture of?

A

mixture of plasma, electrolytes, mucin and water
added with:
-cellular exfoliations
-nasal and salivary gland secretions
-normal oral flora

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3
Q

Sputum normal flora reference range

A

<10 SEC/LPF and >25 WBC/LPF

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4
Q

Sputum preservative:

A

Ref or 10% formalin

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5
Q

Sputum Collection (5)

A

First morning sputum
24-hour
Throat Swab
Sputum induction
Tracheal Aspiration

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6
Q

Sputum Collection: Most preferred

A

First Morning Sputum

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7
Q

Sputum Collection: For volume measurement

A

24-hour

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8
Q

Sputum Collection: For pediatric patients

A

Throat swab

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9
Q

Sputum Collection: For non-cooperative patients

A

Sputum induction

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10
Q

Sputum Collection: For debilitated patients (unconscious patients)

A

Tracheal Aspiration

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11
Q

Macroscopic Examination of sputum includes?

A

VOLUME
ODOR
COLOR
CONSISTENCY

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12
Q

Decrease sputum volume is associated with conditions such as

A

Bronchial asthma
acute bronchitis
early pneumonia
stage of healing

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13
Q

Increase sputum volume is associated with conditions such as?

A

Bronchiectasis
lung abscess
edema
gangrene
tuberculosis
pulmonary hemorrhage

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14
Q

Normal odor of sputum

A

Odorless

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15
Q

Sputum odor when is Lung gangrene, advanced necrotizing tumors present

A

Foul or putrid

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16
Q

Sputum odor when Bronchiectasis, tuberculosis is present

A

Sweetish

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17
Q

Sputum odor when Necrosis, tumors, empyema is present

A

Cheesy

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18
Q

Sputum odor when Liver abscess, enteric Gram-negative bacterial infection is present

A

Fecal

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19
Q

Causes of Colorless or translucent sputum color

A

Made up of mucus only

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20
Q

Causes of White or yellow sputum color

A

Increase PUS (TB, bronchitis, jaundice, pneumonia)

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21
Q

Causes of Gray sputum color

A

Increase PUS and epithelial cells

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22
Q

Causes of Bright green or greenish sputum color

A

Increase Bile, P. aeruginosa infection, lung abscess

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23
Q

Causes of Red or Bright Red sputum color

A

Fresh blood or hemorrhage, TB, bronchiectasis

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24
Q

Causes of Anchovy sauce or rusty brown sputum color

A

Old blood, pneumonia, gangrene

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25
Q

Causes of Prune juice sputum color

A

Pneumonia, chronic lung cancer

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26
Q

Causes of Olive green or grass green sputum color

A

Cancer

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27
Q

Causes of Black sputum color

A

Inhalation of dust or dirt, carbon, charcoal, smoking, anthracosis

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28
Q

Causes of Rusty (with PUS) sputum color

A

Lobar pneumonia

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29
Q

Causes of Rusty (without PUS) sputum color

A

Congestive heart failure

30
Q

Causes of Currant, jelly-like sputum color

A

Klebsiella pneumoniae infection

31
Q

Consistencies of sputum

A

Mucoid
Serous or frothy
Mucopurulent

32
Q

Mucoid Consistency of sputum is associated with

A

asthma, bronchitis

33
Q

Serous or frothy Consistency of sputum is associated with

A

lung edema

34
Q

Mucopurulent Consistency of sputum is associated with

A

bronchiectasis, tuberculosis with cavities

35
Q

Macroscopic Examination of sputum: Yellow or gray material, size of pinhead Foul odor when crushed

A

Dittrich’s plugs

36
Q

Macroscopic Examination of sputum: Hard concretion in bronchus
Yellow or white calcified TB structures or foreign materials

A

Lung stones (Pneumoliths or Broncholiths)

37
Q

Macroscopic Examination of sputum: Branching tree-like casts of the bronchi

A

Bronchial casts

38
Q

Macroscopic Examination of sputum: 3 layers:
1st (top) = frothy mucus
2nd (middle)= opaque, water material 3rd (bottom) = pus, bacteria, tissues

A

Layer formation

39
Q

Macroscopic Examination of sputum: Bronchial calculi (calcium carbonate & phosphate) Asbestos bodies, silica particles

A

Foreign bodies

40
Q

Layer formation of sputum 3 layers

A

1st (top) = frothy mucus
2nd (middle)= opaque, water material
3rd (bottom) = pus, bacteria, tissues

41
Q

Clinical Significance of Dittrich’s plugs

A

Bronchitis, bronchiectasis, Bronchial asthma

42
Q

Clinical Significance of Lung stones (Pneumoliths or Broncholiths)

A

Histoplasmosis (most common) Chronic tuberculosis

43
Q

Clinical Significance of Bronchial casts

A

Lobar pneumonia, bronchitis, diphtheria

44
Q

Clinical Significance of Layer formation of sputum

A

Bronchiectasis, lung abscess gangrene

45
Q

Clinical Significance of Foreign bodies

A

Pneumoconiosis

46
Q

Microscopic Structures that may be found in sputum: Slender fibrils w/ double contour & curled ends

A

Elastic fibers

47
Q

Microscopic Structures that may be found in sputum: Colorless, hexagonal, double pyramid, often needle-like; arise from disinteg. of eosinophils

A

Charcot-Leyden crystals

48
Q

Microscopic Structures that may be found in sputum: Heart failure cells: hemosiderin-laden macroph.
Carbon-laden cells: angular black granules

A

Pigmented cells

49
Q

Microscopic Structures that may be found in sputum: Coiled mucus strands
Can also be observed macroscopically

A

Curschmann’s Spirals

50
Q

Microscopic Structures that may be found in sputum: Colorless globules occurring in a variety of sizes and bizarre forms

A

Myelin globules

51
Q

Microscopic Structures that may be found in sputum: Clusters of columnar cells

A

Epithelial Cells (Creola bodies)

52
Q

Microscopic Structures that may be found in sputum: Candida albicans. Cryptococcus neoformans, Coccidioides immitis Histoplasma capsulatum , Blastomyces dermatitidis, Aspergillus fumigatus

53
Q

Microscopic Structures that may be found in sputum: Migrating larva: “ASH” (Heart to Lung migration) Ascaris, Strongyloides, Hookworm E. histolytica, E. gingivalis, T. tenax, P. westermani (egg), E. granulosus, T. canis

54
Q

Clinical Significance of when seen in sputum: Elastic fibers

A

Tuberculosis

55
Q

Clinical Significance of when seen in sputum: Charcot-Leyden crystals

A

Bronchial asthma

56
Q

Clinical Significance of when seen in sputum: Pigmented cells

A

Congestive heart failure Heavy smokers

57
Q

Clinical Significance of when ween in sputum: Curschmann’s Spirals

A

Bronchial asthma

58
Q

Clinical Significance of when seen in sputum: Myelin globules

A

No significance
Mistaken as Blastomyces

59
Q

Clinical Significance of when seen in sputum: Epithelial Cells (Creola bodies)

A

Bronchial asthma

60
Q

Fungi seen in sputum

A

Candida albicans. Cryptococcus neoformans, Coccidioides immitis Histoplasma capsulatum , Blastomyces dermatitidis, Aspergillus fumigatus

61
Q

Parasites seen in sputum

A

Migrating larva: “ASH” (Heart to Lung migration) Ascaris, Strongyloides, Hookworm E. histolytica, E. gingivalis, T. tenax, P. westermani (egg), E. granulosus, T. canis

62
Q

Other microscopic structures seen in sputum

A

Neoplastic cells, bacteria, leukocytes

63
Q

A procedure for collecting the cellular milieu of the alveoli by the use of bronchoscope through which saline is instilled into distal bronchi and then withdrawn

A

Bronchoalveolar Lavage (BAL)

64
Q

Bronchoalveolar Lavage (BAL): A procedure for collecting the ________ of the alveoli by the use of ______ through which ______ is instilled into distal bronchi and then withdrawn

A

cellular milieu; bronchoscope; saline

65
Q

Bronchoalveolar Lavage (BAL) Important diagnostic test for _______ in immunocompromised patients

A

Pneumocystis canni (Pneumocystis jiroveci)

66
Q

Important diagnostic test for Pneumocystis canni (Pneumocystis jiroveci) in immunocompromised patients

A

Bronchoalveolar Lavage (BAL)

67
Q

Cells seen in Bronchoalveolar Lavage

A

56-80% Alveolar macrophage

1-15% Lymphocytes

<3% Neutrophils

<1-2% Eosinophils

4-17% Ciliated columnar bronchial epithelial cells

68
Q

Cells seen in Bronchoalveolar Lavage: most predominant

A

56-80% Alveolar macrophage

69
Q

Cells seen in Bronchoalveolar Lavage: interstitial dse, pulmonary lymphoma, nonbacterial infections

A

1-15% Lymphocytes

70
Q

Cells seen in Bronchoalveolar Lavage: cigarette smokers, bronchopneumonia, toxin exposure

A

<3% Neutrophils

71
Q

Cells seen in Bronchoalveolar Lavage: hypersensitivity reactions

A

<1-2% Eosinophils

72
Q

Cells seen in Bronchoalveolar Lavage: 4-17%

A

Ciliated columnar bronchial epithelial cells

Finals (20 decks)

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