Deck 7: Bronchoscopy

Question 1

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 in this type of situation.

Answer 1

D
Bronchoscopy can be useful for therapeutic purposes: it can facilitate removal of blood clots and placement of single-lumen or double-lumen endotracheal tubes and balloon catheters to tamponade (i.e. ,to exert direct pressure on)a bleeding site in the airway.In situations with massive hemoptysis or brisk bleeding,however,the flexible bronchoscope is usually inadequate because of its limited visualization and suction capabilities compared with the rigid bronchoscope.

Question 2

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

Answer 2

B
Equipment,such as 1% to 2% lidocaine spray,2% lidocaine jelly,syringes containing aliquots of 1% to 2% lidocaine,a Lukens trap,10-mL normal saline aliquots for lavage,and clean gauzes,may be placed on top of the cart for easy access.

Question 3

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

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

Answer 3

A
During the procedure,nearly all pediatric patients require some type of sedation.The most common approach is conscious sedation.Intravenous drugs are preferable to intramuscular medications because of their quicker onset,shorter duration,and titratable dosage for optimal effects.Although various sedative agents are available,the combination of a benzodiazepine (e.g. ,midazolam)and a narcotic (e.g. ,fentanyl or morphine)is widely accepted.In addition to sedative effects,the narcotic provides analgesic and antitussive effects,and the benzodiazepine offers anxiolytic effects and antegrade amnesia.The most common side effect of this combination is respiratory depression.On occasion,benzodiazepines can induce cardiovascular depression,and narcotics can elicit muscular rigidity and impaired liver and kidney functions.Fortunately,if these complications occur,specific reversal agents,naloxone (0.01 mg/kg per dose)and flumazenil (0.2 mg/kg per dose),can be given to restore the patient's respiratory status.These antagonists,along with atropine and epinephrine for adverse cardiac events,should be immediately available.

Question 4

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 5

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 6

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

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

Question 7

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

Question 8

Which of the following features characterize insertion tubes of bronchoscopes described as "spaghetti scopes"?
I)They lack cables necessary to direct the distal tip,causing it to flex and distend.
II)They are less than 2 mm in diameter.
III)They are used for patients who are not intubated.
IV)Their use is limited to visualization of an airway via insertion down an endotracheal tube.

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

Question 9

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 10

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

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

Question 11

Which of the following are considered common risk factors for children who undergo bronchoscopy?

A)Weight less than 10 kg
B)Upper airway pathology
C)Lower airway pathology
D)Preprocedure hypercapnia

Question 12

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.

Question 13

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 14

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 15

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 16

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

Question 17

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 18

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 19

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 20

During a bronchoscopy procedure on a pediatric patient,the therapist notices that a patient's SpO₂ (oxygen saturation as determined by pulse oximetry)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.