EXAM #1: ANCILLARY TESTS Flashcards
What is the most common lower respiratory tract specimen?
Expectorated sputum sample
What gives purulent sputum its color?
Neutrophils
What are the important steps to obtaining a useful sputum sample?
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
What do epithelial cells in a sputum sample indicate?
That the sample is mostly from the mouth, NOT lower airway
What are the indications for sputum sampling?
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
What is the utility of sputum cytology?
Patient with NSCLC that is unable/unwilling to undergo further diagnostic workup
*Negative test does NOT exclude NSCLCA
What are the indications for Thoracentesis?
- Diagnostic to differentiate between:
1) Exudate vs. transudate
2) Empyema
3) Hemothorax
4) Chylothroax
5) Malignancy - Drainage of a large pleural effusion
What are the potential contraindications to throacentesis?
1) Coagulopathy
2) Small effusion without imaging guidance
3) Hemodynamic instability
4) Patient on mechanical ventilation with high airway pressure
What are the potential complications of thoracentesis?
1) Hypotension
2) Pneumothorax
3) Bleeding/hemothroax
4) Infection
5) Re-expansion pulmonary edema
6) Damage of intercostal NV-bundle
7) Damage to liver
What is the clinical indication of likely ongoing complication occurring in the setting of thoracentesis?
Coughing
What is the immediate surgical procedure to correct a pneumothroax with hemodynamic instability?
Needle decompression
What is re-expansion pulmonary edema?
- Remove a large volume from lung= increased negative pressure
- Essentially pull fluid into the empty space
- Pulmonary edema ensues
How do you decide whether to place a chest catheter or chest tube?
Catheter= non-traumatic
Chest tube= trauma OR
- High density
- High output
- High protein content
What are the indications for a chest tube?
1) Empyema
2) High output effusion/ pneumothorax
3) Hemothorax
4) Bronchopleural fistula
What is medical thoracoscopy?
Percutaneous insertion of an endoscope into the pleural space