Deck 7: Pediatric Flexible Bronchoscopy

Question 1

A flexible bronchoscopy has been ordered in a child undergoing mechanical ventilation for acute respiratory distress syndrome. After several events of desaturation and therapeutic recruitment maneuvers, the physician wants to rule out mucus plugging. What should the therapist suggest to avoid alveolar derecruitment in this patient?

A) Take the patient off and bag throughout the procedure.
B) Increase PEEP on the ventilator until the procedure is completed.
C) Use a PEEP-Keep TM adaptor.
D) Increase tidal volume to sustain lung recruitment during the procedure.

Answer 1

C
A PEEP-Keep TM is used when performing flexible bronchoscopy in a patient through an endotracheal tube or LMA.

Question 2

Which of the following medications is administered to the patient's nasal mucosa for the purpose of reducing the risk of epistaxis during a bronchoscopy procedure?

A) Lidocaine
B) Hypertonic saline
C) Phenylephrine
D) Racemic epinephrine

Answer 2

C
The most common route for nonintubated pediatric patients is the transnasal approach. The flexible bronchoscope is lubricated with lidocaine jelly, or another sterile water-based lubricant, and then inserted through a nostril into the nasopharyngeal area. A topical decongestant (e.g., phenylephrine) may be administered to the nasal mucosa first to facilitate passage of the scope past edematous tissue and to reduce the risk of bleeding.

Question 3

Which of the following complications of flexible bronchoscopy are considered most common?
I) Transient cough
II) Hypocapnia
III) Respiratory depression
IV) Bronchospasm

A) I and II only
B) III and IV only
C) I, II, and IV only
D) I, III, and IV

Answer 3

D
The most common complications include transient cough, respiratory depression, hypoxemia, hypercapnia, and bronchospasm during the procedure. Cough is almost universally seen during and after the procedure, but it is usually self-limited and resolves within 24 hours. Respiratory depression is usually associated with oversedation and sometimes requires reversal agents. Any bronchospasm is relieved promptly in most patients by bronchodilator aerosol treatments.

Question 4

The pulmonologist has called the RT department requesting equipment for a bronchoscopy in the next 30 minutes. Which of the following methods will allow the therapist to have the scope disinfected and ready to use in that time frame?

A) Peracetic acid submersion
B) Alcohol submersion
C) Ethylene oxide
D) 2% alkaline glutaraldehyde

Question 5

The therapist selects a 3.0-mm-diameter insertion tube to be used for flexible bronchoscopy on a neonate who requires surfactant therapy. What should the therapist do with this insertion tube at this time?

A) Prepare the insertion tube for attachment to the flexible bronchoscope.
B) Replace the 3.0-mm insertion tube with one that is 4.0 mm in diameter.
C) Substitute the 3.0-mm-diameter insertion tube with a 2.0-mm-diameter insertion tube.
D) Recommend that the physician perform rigid bronchoscopy.

Question 6

Which of the following organisms is often responsible for cross-contamination between bronchoscopies?

A) Staphylococcus
B) Mycoplasma
C) Pseudomonas
D) Klebsiella

Question 7

Why is rigid bronchoscopy preferred over flexible bronchoscopy for the removal of a foreign body from the tracheobronchial tree of a pediatric patient?

A) It is the only way to deliver large foreign bodies through the subglottic area.
B) It enables better ventilation of the patient while under general anesthesia.
C) A lower fraction of inspired oxygen is required with rigid bronchoscopy, reducing the risk of oxygen toxicity.
D) Less anesthesia is needed when rigid bronchoscopy is performed.

Question 8

Which of the following clinical signs receives the highest diagnostic yield in the neonatal population for flexible bronchoscopy?

A) Wheezing
B) Stridor
C) Discoid atelectasis on chest X-ray
D) Increased airway secretions

Question 9

Which of the following features are considered advantages of the rigid bronchoscope over the flexible bronchoscope?
I) Improved anatomic definition
II) Ability to provide better ventilation
III) Large internal diameter
IV) Ability to introduce larger instruments

A) I and II only
B) III and IV only
C) I, III, and IV only
D) I, II, III, and IV

Question 10

The therapist has been asked to clean the bronchoscope after a procedure. Which of the following chemicals should be used as a high-level disinfectant?

A) Vinegar
B) Soapy water
C) 5% chlorhexidine
D) 2% alkaline glutaraldehyde

Question 11

What percent lidocaine spray is used for neonatal flexible bronchoscopy?

A) Less than 1% lidocaine
B) 1% to 2% lidocaine
C) 3% to 4% lidocaine
D) 5% to 6% lidocaine

Question 12

Because one of the major risks of flexible bronchoscopy is aspiration of gastric contents, infants under 6 months should not take anything by mouth how many hours before the procedure?

A) 1 to 2 hours
B) 3 to 4 hours
C) 4 to 6 hours
D) 8 to 12 hours

Question 13

A pediatric patient is brought to the bronchoscopy suite for a follow-up assessment of laryngomalacia. Last time the child developed a mild laryngospasm during the procedure. How should this complication be prevented?

A) Intravenous infusion of lidocaine
B) Application of topical epinephrine to the vocal cords
C) Application of topical lidocaine to the vocal cords
D) Prophylactic insertion of an endotracheal tube

Question 14

Which of the following is considered an absolute contraindication for children who undergo bronchoscopy?

A) Uncontrolled coagulopathy
B) Pulmonary hypertension
C) Asthma
D) Upper airway obstruction

Question 15

A hospitalized patient with cystic fibrosis has developed massive hemoptysis. What is the utility of flexible fiberoptic bronchoscopy in this situation?

A) It is useful for removing blood clots.
B) Flexible bronchoscopy can be effectively used to insert balloon catheters to tamponade the bleeding portion of the lung.
C) The flexible bronchoscope can be effectively inserted to enable the deposition of blood-clotting medications into the lungs.
D) Flexible bronchoscopy is usually inadequate with limited visualization and suction capacity.

Question 16

Which of the following drug class combinations is often used to induce conscious sedation in a neonate undergoing flexible bronchoscopy?

A) Benzodiazepine and anarcotic
B) Cephalosporin and a narcotic
C) Mucolytic and bronchodilator
D) Atropine and epinephrine

Question 17

Which of the following features are consistent with a large flexible bronchoscope compared with a smaller one?

A) Has a suction channel
B) Provides recording of the procedure
C) Is more rigid
D) Produces less heat

Question 18

Which of the following features characterize insertion tubes of bronchoscopes described as spaghetti scopes?
I) They contain light bundles.
II) They are less than 2.2 mm in diameter.
III) They are used for patients who are not intubated.
IV) They contain image bundles.

A) III and IV only
B) I and II only
C) II and III only
D) I, II, and IV only

Question 19

When using normal saline for bronchoalveolar lavage, what is the maximum amount of normal saline per kg that should be used?

A) 1 mL/kg per aliquot
B) 1 mL/kg total
C) 2 mL/kg per lung
D) 2 mL/kg total

Question 20

During a bronchoscopy procedure on a pediatric patient, the therapist notices that a patient's SpO₂ is 90%. What should the therapist do at this time?

A) Continue monitoring the patient as the procedure progresses.
B) Provide supplemental oxygen to the patient until the SpO₂ is 95%.
C) If the patient's SpO₂ falls to 88%, administer oxygen to achieve an SpO₂ of 90%.
D) Stop the bronchoscopy procedure until the patient's SpO₂ returns to its preprocedure level.