Diagnostic Procedures in Pulmonary Medicine Flashcards
This procedure aspirates fluid from the pleural space or draining pleural effusion
Thoracentesis aka Pleurocentesis
In thoracentesis, pierce (above/below/within) the rib to avoid neurovascular bundle
above
This is the percutaneous sampling/biopsy of the parietal pleural lining
Closed Pleural Biopsy
Why is blind biopsy sensitive for TB pleurisy?
Because there is diffuse involvement of the pleura in TB pleurisy -> you can get samples from any part of the pleura -> imaging is not needed
T/F Focal abnormalities in the lung are usually benign unlike diffused
F: they tend to be Malignant
T/F CT Scan is used for image-guided closed pleural biopsy
T
other option is ultrasound
What kind of thoracoscopy uses single entry port and creation of Clagett window?
Pleuroscopy or medical thoracoscopy
Pleuroscopy is indicated for what procedures?
Parietal pleural biopsy or limited procedures (pleural catheter placement, lysis of adhesions, pleurodesis indwelling)
VATS and RATS are indicated for what kinds of procedures?
More invasive procedures (lung biopsy, lymph node sampling, lobectomy)
Creation of pericardial window is done using (Pleuroscopy/VATS or RATS)
VATS or RATS
T/F Medical thoracoscopy is performed with sedation of patient
T
T/F VATS and RATS are performed by an interventional pulmonologist
F
Thoracic surgeon
T/F Pleuroscopy is performed by a thoracic surgeon
F
Interventional pulmonologist
This procedure is done for creating Clagett window for chronic bronchopneumonia fistula with empyema
Open thoracotomy
Procedure performed when aiming to get samples of mediastinal lymph nodes
Mediastinoscopy/Mediastinotomy
T/F: Mediastinoscopy/Mediastinotomy can still be used if needle based sampling (EBUS) is negative and malignant nodal involvement is low
F
malignant nodal involvement remains sufficiently HIGH
T/F Bronchoscopy allows direct assessment of the mucosa, submucosa, and the lungs
T
Flexible bronchoscopy enables access to more (central/distal) parts of the respiratory tract, and can reach until the _________ and _____ bronchi
Distal; pimary and secondary
Rigid bronchoscopy is limited to the ____ airways, but provides secure airway for ventilation and conduit for other instruments
central
Match the ff
1. Gold standard in obtaining respiratory secretions (hemo/micro/cyto)
2. Gets samples for histology or cytology
3. An alveolar tissue is obtained to diagnose lung tissue rejection
4. Superior in getting samples from malignant peripheral nodules
5. gets mediastinal samples
a. EBUS and EBUS TBNA
b. Transbronchial needle aspiration
c. Bronchoalveolar lavage
d. Transbronchial biopsy with cryobiopsy
e. Robotic bronchoscopy
f. Brushing and endobronchial biopsy
g. Guided peripheral bronchoscopy
- C
- F
- D
- B
- A
T/F: BAL cannot sample distal airways ang lung parenchyma
F
it can sample areas not directly viewable or accessible
T/F: BAL is useful when sputum cannot be obtained or sampling of specific lobe or segment is desired
T
T/F Brushing in brushing and endobronchial biopsy samples abnormal bronchial mucosa and submucosa for histopathology
F
Brushing samples MUCOSAL BIOFILM for microbiology and sample BRONCHIAL EPITHELIAL LAYER for cytology
what was mentioned is for biopsy
T/F: Endobronchial biopsy is indicated in cases of endobronchial amyloidosis or sarcoidosis
T
as it takes a chunk of tissue
This bronchoscopic procedure reaches the most distal tract of the respiratory system
Transbronchial biopsy including Cryobiopsy
In Transbronchial biopsy including Cryobiopsy, at least ____ distinct pieces of alveolated lung tissue are needed for formal diagnosis of acute cellular rejection
5
T/F There his higher risk of bleeding in cryobiopsy
T
This bronchoscopic procedure uses a hollow bore needle for obtaining aspirated specimens
Transbronchial Needle Aspiration
T/F Transbronchial Needle Aspiration is indicated for lesions lying extraluminally and requires traversing the airway wall
T
This bronchoscopic procedure can be accompanied by Rapid On-Site Cytologic Evaluation for realtime feedback
‘EBUS
3 Notable findings on chest xray of a patient with congestive heart failure
- Kerley B Lines - lymphatics become engorged
- Cephalization - non-dependent vasculature on the upper portion becomes more prominent
- Bronchial cuffing - prominent bronchial walls
Condition where the blood vessels are prominent upwards and at the sides
Lung edema
T/F: PA and lateral X ray films are for outpatient setting, while AP films are at the bedside
T
What is an air bronchogram?
Appearance in x ray where air-filled (dark) bronchi is visible due to the opacifications of the surrounding alveoli (gray/white)
Apicolordotic view is used to examine which part of the lungs and mostly used to check what disease?
Lung apices
TB
Lung window in CT scan is for visual inspection of (low/high) density lung parenchyma
Mediastinal window is to view (low/high) density structures like lymph nodes
Lung- low
Mediastinal - high
In CT, bronchiectatic dilatation of the airways, predominantly in lower lobes indicate what disease?
COPD
In CT, cystic dilatation of the upper lobes indicate what disease?
Cystic fibrosis
The appearance of this lobule and its distribution pattern of injury provides diagnostic information
Secondary pulmonary lobule
Centrilobular emphysema tends to first appear in the (upper/basilar/apical) lung zone
Upper
Peripheral emphysema tends to first appear in the (upper/basilar/apical) lung zone
Basilar
Nonspecific interstitial pneumonitis is the interstitial thickening in what part of the lung
Apices
Idiopathic pulmonary fibrosis has interstitial thickening in what part of the lung
Base
Pathology of the lymphatics or interstistium has beading and/or thickening of the ___ septa
interlobular
This is the most common agent administered IV in PET, which is taken up by the cells in direct proportion to their metabolic activity
18F-Fluoro-2-deoxyglucose (FDG)
T/F PET is most used for discrimination of benign and malignant nodules and for lung cancer staging
T
T/F Transbronchial needle aspiration is for sampling lung lesions for parenchymal lung abnormalities concerning for cancer
F
it’s TRANSTHORACIC
T/F Transthoracic needle aspiration should be considered in context of size and location of lesions, experience of center and operator, and patient-specific factors
T
T/F: TTNA is when there’s concern for malignancy that is not high enough to warrant immediate excision; patient is not a surgical candidate and lesion is not amendable for surgical resection
T
Most common malignant diagnosis found on TTNA of the lung
Adenocarcinoma
Pulmonary function test requested for px with suspected COPD
Simple spirometry
Pulmonary function test requested for px with suspected idiopathic pulmonary fibrosis
Lung volume study and dlco
Pulmonary function test requested for px with suspected pulmonary fibrosis
Lung volume study
T/F Restrictive airway diseases have scooping in the flow volume loop
F
OBstructive
T/F Lung volume studies aid in diagnosis of restrictive respiratory diseases
T
Optimal sample amount in Sputum testing
Epithelial cells <10/LPF, PMNs >25/LPF
This is the primary diagnostic test for all presumptive TB
MTB GeneXpert
T/F Cytological analysis is recommended only when more invasive techniques cannot be pursued
T
T/F Cytological analysis has no added benefit when combined with CXR to screen for lung cancer
T
In exhaled breath condensate, this is the most highly-validated of the biomarkers identified
Exhaled NO
T/F Exhaled NO fraction is thought to correlate with eosinophils in sputum and blood and one’s response to inhaled corticosteroids
T
This is key element in diagnosing cystic fibrosis
Sweat
Sweat testing has the ability to discriminate CF at equal or greater than ___ mmol
60
