EXAM #1: ANCILLARY TESTS

Question 1

What is the most common lower respiratory tract specimen?

Answer 1

Expectorated sputum sample

Question 2

What gives purulent sputum its color?

Answer 2

Neutrophils

Question 3

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

Answer 3

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

Question 4

What do epithelial cells in a sputum sample indicate?

Answer 4

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

Question 5

What are the indications for sputum sampling?

Answer 5

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

Question 6

What is the utility of sputum cytology?

Answer 6

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

*Negative test does NOT exclude NSCLCA

Question 7

What are the indications for Thoracentesis?

Answer 7

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

Question 8

What are the potential contraindications to throacentesis?

Answer 8

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

Question 9

What are the potential complications of thoracentesis?

Answer 9

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

Question 10

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

Answer 10

Coughing

Question 11

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

Answer 11

Needle decompression

Question 12

What is re-expansion pulmonary edema?

Answer 12

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

Question 13

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

Answer 13

Catheter= non-traumatic

Chest tube= trauma OR

• High density
• High output
• High protein content

Question 14

What are the indications for a chest tube?

Answer 14

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

Question 15

What is medical thoracoscopy?

Answer 15

Percutaneous insertion of an endoscope into the pleural space

Question 16

What is Pleurodesis?

Answer 16

Essentially, “gluing” the pleura together

Question 17

What are the indications for Pleurodesis?

Answer 17

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

Question 18

What are the contraindications to Pleurodesis?

Answer 18

• Trapped lung

- Underlying severe lung disease

Question 19

How can you procedurally examine the lung internally?

Answer 19

Numerous variants of bronchoscopy

Question 20

Generally, what are the indications for bronchoscopy?

Answer 20

1) Diagnosing something internal in the lung

2) Removal of FB, tumor…etc.

Question 21

What are the contraindications to bronchoscopy?

Answer 21

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