EXAM #1: ANCILLARY TESTS Flashcards

1
Q

What is the most common lower respiratory tract specimen?

A

Expectorated sputum sample

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2
Q

What gives purulent sputum its color?

A

Neutrophils

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3
Q

What are the important steps to obtaining a useful sputum sample?

A

1) Obtain prior to abx
2) Rinse prior
3) No food for 1-2 hrs
4) Send immediately to lab

*Note that 1/3 of patients with bacterial pneumonia will not be able to give a sample

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4
Q

What do epithelial cells in a sputum sample indicate?

A

That the sample is mostly from the mouth, NOT lower airway

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5
Q

What are the indications for sputum sampling?

A

1) Failed outpatient abx
2) ICU admit
3) Cavitary lesion
4) Active alcohol abuse
5) Severe obstructive/structural disease
6) Positive antigen test for pneumococcus
7) Positive antigen for Legionella
8) Pleural effusion

Thus, this is NOT routinely done in the outpatient setting

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6
Q

What is the utility of sputum cytology?

A

Patient with NSCLC that is unable/unwilling to undergo further diagnostic workup

*Negative test does NOT exclude NSCLCA

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7
Q

What are the indications for Thoracentesis?

A
  • Diagnostic to differentiate between:
    1) Exudate vs. transudate
    2) Empyema
    3) Hemothorax
    4) Chylothroax
    5) Malignancy
  • Drainage of a large pleural effusion
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8
Q

What are the potential contraindications to throacentesis?

A

1) Coagulopathy
2) Small effusion without imaging guidance
3) Hemodynamic instability
4) Patient on mechanical ventilation with high airway pressure

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9
Q

What are the potential complications of thoracentesis?

A

1) Hypotension
2) Pneumothorax
3) Bleeding/hemothroax
4) Infection
5) Re-expansion pulmonary edema
6) Damage of intercostal NV-bundle
7) Damage to liver

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10
Q

What is the clinical indication of likely ongoing complication occurring in the setting of thoracentesis?

A

Coughing

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11
Q

What is the immediate surgical procedure to correct a pneumothroax with hemodynamic instability?

A

Needle decompression

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12
Q

What is re-expansion pulmonary edema?

A
  • Remove a large volume from lung= increased negative pressure
  • Essentially pull fluid into the empty space
  • Pulmonary edema ensues
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13
Q

How do you decide whether to place a chest catheter or chest tube?

A

Catheter= non-traumatic

Chest tube= trauma OR

  • High density
  • High output
  • High protein content
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14
Q

What are the indications for a chest tube?

A

1) Empyema
2) High output effusion/ pneumothorax
3) Hemothorax
4) Bronchopleural fistula

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15
Q

What is medical thoracoscopy?

A

Percutaneous insertion of an endoscope into the pleural space

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16
Q

What is Pleurodesis?

A

Essentially, “gluing” the pleura together

17
Q

What are the indications for Pleurodesis?

A

1) Malignant effusion
2) Refractory symptomatic non-malignant effusions
3) Recurrent spontaneous pneumothorax

18
Q

What are the contraindications to Pleurodesis?

A
  • Trapped lung

- Underlying severe lung disease

19
Q

How can you procedurally examine the lung internally?

A

Numerous variants of bronchoscopy

20
Q

Generally, what are the indications for bronchoscopy?

A

1) Diagnosing something internal in the lung

2) Removal of FB, tumor…etc.

21
Q

What are the contraindications to bronchoscopy?

A

1) Severe hypoxemia
2) Severe sleep apnea
3) High tracheal obstruction
4) Mechanical vent.
5) Hemodynamic instability
6) Unstable angina or recent MI
7) Coagulopathy