Bronchoscopy

Question 1

One of the major advantate of RIGID bronch

Answer 1

Large OPEN CHANNEL

Question 2

Size range of RIGID Bronch

Answer 2

3 to 7 mm or larger (DIAMETER)

Length: 20 to 50 cm

Question 3

Defined by the diameter of THE LARGEST INSTRUMENT that will pass
GLASS ROD telescope
Need for GA

With HOLES allowing ventilation of the CONTRAlateral lung
*side and distal tip

Answer 3

RIGID BRONCH

Question 4

Flexible bronch is defined by their
Usual size of pediatric bronch nowadays

Answer 4

OUTER diameter

2.8 mm diameter or 3.5 mm

Question 5

This instrument foces the patient to breathe AROUND the instrument
Rely on fiber glass to transmit image

Answer 5

FLEXIBLE bronch

Question 6

INDICATIONS OF BRONCH

Question 7

Helpful in assessment of tracheostomy and its dynamics and position

Answer 7

Flexible bronchoscopy

Question 8

Assessing aspiration from post larynx to cervical trachea

Answer 8

RIGID BRONCH

Question 9

Assessing Tracheostomy from post larynx to SUBglottic

Answer 9

RIGID bronch

Question 10

Indications of bronch by symptoms

Answer 10

*CSA

COUGH >1 month
Stridro >2 weeks
Atelectasis >6 weeks

Question 11

Contraindications for bronch

Answer 11

NO ABSOLUTE
But with relative contraindications:

Bleeding <50, 000
Massive hemoptysis

Severe bronchospasm, obstruction

Hypoxemia

Question 12

Procedure to distinguish transplan rejection vs infection

Answer 12

Tranbronchial biospy

Question 13

Volume of BAL adult vs pedia

Answer 13

5 aliquots of 50 mL
3 aliquots of 100 ml

Pedia
10 to 20 ml in 2 to 4 aliquot (regardless of wt)
Adjust volume based on FRC and body weight (PAPP in 5-20ml fractions)
Adjust volume 3ml/kg (PAPP if less than 20 kilos, divided into 3 equal fractions; if >20kg, 20 ml fractions

Question 14

Duration of bal

Answer 14

1-3 minutes

Question 15

Lowest possible platelet count where BAL can be done safely

Answer 15

20,000 platelets/ml

Question 16

Temp prior bal fluid processing

Answer 16

4 degrees celsius

Question 17

BAL fluid has how many cells and cell diff count

Answer 17

100k to 250k cells/ml

Alveolar macrophage 80 to 90%&raquo_space; Lymphocytes 5% to 10%&raquo_space; neutrophils <5%»eosinophil 0to1%

*ALNE

Question 18

% of neutrophils with active bacteria

Answer 18

95%

Question 19

this cell infilitrate is common in Alveolitis, Scleroderma,

Asthma, CF, ARDS

Answer 19

NEUTROPHILS

Question 20

cells in sarcoidosis and TB, HPneumonitis

Answer 20

Lymphocytes

Question 21

Cells increased in P jirovecii,
FBA,
ILD, Drug induced

Answer 21

eosinophils

Question 22

bacteria without neutrophils maybe contaminant except

Answer 22

neutropenic patients

Question 23

immunocompromised patients ma have these pathogens regardless of numbers

Answer 23

Question 24

may not be a true pathogen in immunocomprosed

Answer 24

CMV
Herpes

candida
aspergillus

atypical bacteria

Question 25

staining for PAP

Answer 25

PAS

Question 26

Gomori-Grocott (met silver)

Answer 26

fungi P Jirovecii

Question 27

iron macrophages from pulmo hemorrhage

Answer 27

Prussian blue

Question 28

how many hours will macrophage become positive for iron staining

Answer 28

50 hours

Question 29

iron will clear if no bleeding

Answer 29

12-14 hrs airways 2-4 weeks parenchyma *normal up to 3%

Question 30

to detect lipid laden macrophages to diagnose aspiration

Answer 30

lipid stains (oil red or sudan. iv)

Question 31

Bronchoscopy sizes

Answer 31

Question 32

recommends that ebb be taken from

Answer 32

subsegmental carina

Question 33

TBB

Answer 33

alveolar sample lung periphery

Question 34

BBB

Answer 34

study of bronchial epithelial cells

Question 35

aspirarion of secretion in larger airways

Answer 35

bronchial washing

Question 36

preferred site in diffuse lung disease

Answer 36

middle lobe or lingula

Question 37

easy to do bal in infants

Answer 37

right lower lobe

Question 38

gold standard in diagnosing chronic pulmo aspiration

Answer 38

bal