Bronchoscopy

Question 1

What is the objective of the 2014 First PAPP Proceedings on Pediatric Flexible Bronchoscopy?

Answer 1

To establish standards of care in the performance and reporting of flexible bronchoscopy in the pediatric age group.

Question 2

What is the preferred external diameter of a flexible bronchoscope for infants?

Answer 2

2.8 mm with a working channel of 1.2 mm.

Question 3

List the basic equipment needed for flexible bronchoscopy.

Answer 3

• Flexible bronchoscope and/or videoscope
• Alligator biopsy forceps
• Brush
• Transbronchial aspiration needle
• Endotracheal tube adapter
• Video recorder

Question 4

Who should perform flexible bronchoscopy in pediatric patients?

Answer 4

A pediatric pulmonologist certified by the Philippine Subspecialty Board in Pediatric Pulmonology.

Question 5

What is a contraindication for performing endoscopy?

Answer 5

Unstable cardiac status or life-threatening cardiac arrhythmia.

Question 6

Fill in the blank: The external diameter of a flexible bronchoscope for adolescents is _______.

Answer 6

4.5 mm with a working channel of 2.2 mm.

Question 7

What should be obtained before performing a bronchoscopy procedure?

Answer 7

Informed consent/assent.

Question 8

What are the indications for using endoscopy as a diagnostic tool?

Answer 8

• Stridor affecting activity or gas exchange
• Clinical suspicion of foreign body aspiration
• Unexplained persistent cough
• Unexplained localized atelectasis
• Assessment of injury from toxic inhalation

Question 9

What is one potential adverse event related to anesthesia during bronchoscopy?

Answer 9

Inadequate anesthesia leading to cough or gagging.

Question 10

What is the minimum fasting period for clear liquids before bronchoscopy?

Answer 10

2 hours.

Question 11

What is the preferred route for inserting a bronchoscope?

Answer 11

Transnasal route.

Question 12

True or False: The carina is an important landmark used during bronchoscopy.

Answer 12

True.

Question 13

What should be done if the lens of the bronchoscope is obstructed by mucus or blood?

Answer 13

1-2 mL of sterile NSS can be instilled then suctioned gently.

Question 14

What type of biopsy involves acquiring histological samples using forceps under direct visualization?

Answer 14

Endobronchial biopsy (EBB).

Question 15

What is the role of the anesthesiologist during the bronchoscopy procedure?

Answer 15

To provide anesthesia as needed and ensure patient safety.

Question 16

What is the importance of the Technical Working Group in the development of the PAPP Proceedings?

Answer 16

They formulated the initial draft after reviewing relevant literature.

Question 17

What should a bronchoscopist do if bleeding occurs after a biopsy?

Answer 17

Instill 1-2 mL of epinephrine 1:10000.

Question 18

What is the recommended fasting period for breast milk before bronchoscopy?

Answer 18

4 hours.

Question 19

What condition should be assessed to determine the need for an anesthesiologist during bronchoscopy?

Answer 19

The requirement for general anesthesia or sedation.

Question 20

What is the responsibility of the bronchoscopist regarding infection control?

Answer 20

To formulate and implement appropriate infection control measures.

Question 21

List the monitoring devices required at the site-of-care for bronchoscopy.

Answer 21

• Pulse oximeter
• Sphygmomanometer
• Cardiac monitor
• Capnograph
• Thermometer

Question 22

What is the periodic review schedule for the Task Force on Flexible Bronchoscopy’s document?

Answer 22

Every 2 years.

Question 23

What should be the first step in the bronchoscopy procedure?

Answer 23

Insertion through and visualization of the upper airway.

Question 24

What does EBB stand for in bronchial procedures?

Answer 24

Endobronchial biopsy

EBB indicates the acquisition of histological samples by the use of forceps, under direct visualization.

Question 25

When is EBB not indicated?

Answer 25

When there is no obvious lesion or mass on the surface of the mucosa.

Question 26

Where are suitable samples for EBB analysis preferably obtained from?

Answer 26

Bronchial mucosa.

Question 27

What is the recommended number of EBB samples for reliable analysis?

Answer 27

No more than 3 biopsies per subject.

Question 28

What does TBB stand for?

Answer 28

Transbronchial biopsy.

Question 29

What is the primary difference between EBB and TBB?

Answer 29

EBB samples are taken from visible lesions, while TBB acquires samples from regions not directly visible.

Question 30

What is a serious complication associated with TBB?

Answer 30

Pneumothorax.

Question 31

What is BAL an acronym for?

Answer 31

Bronchoalveolar lavage.

Question 32

What is the primary purpose of BAL?

Answer 32

To recover cellular and non-cellular components from the epithelial surface of the lower respiratory tract.

Question 33

What is the preferred site for performing BAL in diffuse lung diseases?

Answer 33

Middle lobe or lingula.

Question 34

What volume of saline is typically used for BAL in children under 20 kg?

Answer 34

3 mL/kg divided into three equal fractions.

Question 35

What does BAL fluid indicate when pathogens not usually found in the lungs are recovered?

Answer 35

Possible infection in the immunocompromised patient.

Question 36

What is a sensitive marker of aspiration in children found in BAL?

Answer 36

Lipid laden macrophage (LLM).

Question 37

What complication can occur during BAL, affecting 10-30% of children?

Answer 37

Transient fever.

Question 38

What are contraindications for performing BAL?

Answer 38

Bleeding disorders, severe hemoptysis, and refractory hypoxemia.

Question 39

What is the recommended post-anesthesia care for patients after bronchoscopy?

Answer 39

Close monitoring until fully awake and in control of the airway.

Question 40

What information should be included in a bronchoscopy report?

Answer 40

Prebronchoscopic impression, indication for procedure, bronchoscopic findings, postbronchoscopic impression, type of anesthesia used, and complications.

Question 41

What is the maximum dose of adenosine for pediatric resuscitation?

Answer 41

12 mg.

Question 42

What is the usual dose of epinephrine for pediatric resuscitation?

Answer 42

0.01 mg/kg IV/IO.

Question 43

What is the dose range for midazolam in pediatric sedation?

Answer 43

0.025–0.05 mg/kg IV.

Question 44

What are the adverse effects of fentanyl during bronchoscopy?

Answer 44

Bradycardia, dysphoria, delirium, nausea, vomiting, pruritus, urinary retention, hypotension.

Question 45

What type of drug is nalbuphine?

Answer 45

Synthetic narcotic agonist-antagonist analgesic.

Question 46

What is the purpose of using propofol in bronchoscopy?

Answer 46

For moderate sedation.

Question 47

True or False: BALF collection is considered a high-risk procedure.

Answer 47

False.

Question 48

What is the onset time for moderate sedation during bronchoscopy?

Answer 48

Within 30 seconds.

Question 49

What is the duration of drug effect for moderate sedation in bronchoscopy?

Answer 49

Diminished extremely quickly (5–15 min).

Question 50

What are common adverse effects of using moderate sedation for bronchoscopy?

Answer 50

Profound respiratory depression, increased salivary and airway secretions, myoclonic movements, anaphylactic reactions.

Question 51

What is the recommended induction dose for moderate sedation in bronchoscopy?

Answer 51

0.5–1 mg/kg IV over 1–5 min.

Question 52

What is the maintenance infusion dose for moderate sedation during bronchoscopy?

Answer 52

50–250 mcg/kg/min.

Question 53

What type of receptor does ketamine act on?

Answer 53

Competitive NMDA receptor antagonist and partial agonist at opioid μ-receptor.

Question 54

What is one of the advantages of ketamine in pediatric flexible endoscopy?

Answer 54

Potent bronchodilator and analgesic.

Question 55

What are some adverse effects associated with ketamine?

Answer 55

Increased salivation, emergence delirium, laryngospasm, nausea, vomiting.

Question 56

What is the IV dose range for ketamine?

Answer 56

0.25-0.5 mg/kg.

Question 57

What is the infusion dose for ketamine?

Answer 57

0.25 mg/kg/hr.

Question 58

What is the IM dose for ketamine?

Answer 58

2 mg/kg.

Question 59

What is the oral/rectal dose for ketamine?

Answer 59

6-8 mg/kg.

Question 60

What type of drug is dexmedetomidine?

Answer 60

Selective α-2 agonist.

Question 61

What are the advantages of dexmedetomidine?

Answer 61

* Mild respiratory depression at higher doses * Attenuates sympathetic response * Lower incidence of oxygen desaturation * Reduced need for oral cavity suction.

Question 62

What are the adverse effects of dexmedetomidine?

Answer 62

Bradycardia, hypotension.

Question 63

What is the IV bolus dose for dexmedetomidine?

Answer 63

1–3 mcg/kg over 10 min.

Question 64

What is the infusion dose for dexmedetomidine?

Answer 64

0.5–3.0 mcg/kg/hr.

Question 65

What is the purpose of using local anesthetics like lidocaine in bronchoscopy?

Answer 65

To decrease coughing or bucking during instrumentation.

Question 66

What are the toxicity symptoms of lidocaine overdose?

Answer 66

* Circumoral paresthesia * Anxiety * Cardiac arrhythmias * Cardiovascular collapse.

Question 67

What is the maximum dose limit for lidocaine in bronchoscopy?

Answer 67

3 – 4 mg/kg.

Question 68

What is flumazenil used for?

Answer 68

To rapidly reverse the sedative and respiratory effects of benzodiazepines.

Question 69

What is the IV dose range for flumazenil?

Answer 69

0.01–0.02 mg/kg, may be repeated every 1 min to 1 mg.

Question 70

What is the infusion dose for flumazenil?

Answer 70

5 mcg/kg/min.

Question 71

What is naloxone used for?

Answer 71

Specific opioid antagonist.

Question 72

What are some adverse effects of naloxone?

Answer 72

* Nausea * Vomiting * Tachycardia * Hypertension * Delirium * Pulmonary edema.

Question 73

What is the dose range for naloxone?

Answer 73

0.01 – 0.1 mg/kg IV/IM, max of 2 mg/dose.

Question 74

What is the recommended frequency for naloxone dosing?

Answer 74

May repeat every 2 min.