Deck 22: Flexible Bronchoscopy and the Respiratory Therapist

Question 1

Which of the following are considered indications for flexible bronchoscopy?
1) Unexplained lung collapse
2) Need for large size tissue specimen
3) Evaluate endotracheal tube-related injury
4) Bronchogenic carcinoma

A)1 and 3 only
B)1, 2, and 3 only
C)1, 3, and 4 only
D)1, 2, 3, and 4

Answer 1

C

Question 2

Which of the following are divisions of imaging systems used during flexible bronchoscopy?
1) Fiberoptic
2) Video
3) Hybrid
4) Fusion

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Answer 2

B

Question 3

Which of the following are considered contraindications for flexible bronchoscopy?
1) Severe hypercapnia
2) Impaired neck mobility
3) Hemoptysis
4) Recent myocardial infarction

A)1 and 3 only
B)1, 2, and 4 only
C)3 and 4 only
D)2, 3, and 4 only

Answer 3

B

Question 4

In a patient with suspected bronchogenic carcinoma, how many biopsy specimens need to be collected during an endobronchial biopsy?

A) 1
B) 2
C) 3
D) 4

Question 5

Which of the following are considered indications for rigid bronchoscopy?
1) Large foreign body extraction
2) Management of massive hemoptysis
3) Self-expandable stent placement
4) Mediastinal and hilar lymphadenopathy

A)3 only
B)2 and 3 only
C)1, 2, and 3 only
D)1, 2, 3, and 4

Question 6

The assessment of the upper airway prior to a flexible bronchoscopy procedure to help identify patients in whom it may be difficult to secure an airway is referred to as:

A) the Glasgow Coma Scale.
B) the Mallampati classification.
C) the APACHE scale.
D) the Borg scale.

Question 7

To obtain lavage fluid, the bronchoscope is wedged at which of the following locations?

A) The level of the carina
B) The level of second or third generation bronchus
C) The level of fourth or fifth generation bronchus
D) At least at the level of the sixth generation bronchus

Question 8

Your patient is being scheduled for a flexible bronchoscopy and is inquiring about when to stop taking her warfarin. After consulting the physician, what would you tell her?

A) 1 to 2 days prior to the procedure.
B) 3 to 5 days prior to the procedure.
C) 1 week prior to the procedure.
D) She does not need to discontinue her warfarin.

Question 9

Where should a bronchoalveolar lavage be obtained?

A) The nondependent part of the lung
B) The dependent part of the lung
C) The largest lobe of the lung affected
D) The smallest lobe of the lung affected

Question 10

During thermal ablation, how are endobronchial ignitions prevented?

A) The FiO₂ should always be maintained at 21%.
B) The FiO₂ should always be maintained below 40%.
C) The procedure is only performed for 3 sec at a time.
D) The patient's airway is cooled with cryotherapy prior to the procedure.

Question 11

For patient safety, to help avoid methemoglobinemia, the total dose of lidocaine should not exceed:

A) 2 mg/kg.
B) 5 mg/kg.
C) 7 mg/kg.
D) 10 mg/kg.

Question 12

What is the most difficult parameter to monitor during FB?

A) Depth of sedation
B) Airway pressure
C) Chest movement
D) Pulse oximetry

Question 13

What two directions can the distal tip of a flexible bronchoscope be flexed?

A) Up to 90 degree in ante-flexion and up to 30 degree in retro-flexion positions
B) Up to 270 degree in ante-flexion and up to 220 degree in retro-flexion positions
C) Up to 180 degree in ante-flexion and up to 90 degree in retro-flexion positions
D) Up to 180 degree in ante-flexion and up to 130 degree in retro-flexion positions

Question 14

When is endobronchial biopsy performed?

A) To obtain a sputum sample from a visible endobronchial lesion.
B) To obtain a tissue sample from a visible endobronchial lesion.
C) It is used with transbronchial needle aspiration.
D) It is used during bronchial stent placement.

Question 15

What are the two major complications of transbronchial biopsy?

A) Uncontrollable coughing and bleeding
B) Pneumothorax and bleeding
C) Pneumothorax and coughing
D) Cardiac arrest and pneumothorax

Question 16

Which of the following must be continuously monitored during a bronchoscopy?
1) Cardiac monitoring
2) Blood pressure
3) Oximetry
4) MetHb levels

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, 3, and 4 only

Question 17

What is the major challenge of ultrathin bronchoscopy?

A) Bronchoscopy kinking during procedure
B) The equipment is expensive
C) Issues with CT guidance equipment
D) Maintaining proper anatomical orientation in the peripheral airways

Question 18

Metallic stents are placed during:

A) flexible bronchoscopy.
B) rigid bronchoscopy.
C) either flexible or rigid bronchoscopy.
D) mediastinal surgery.

Question 19

A technique of obtaining a specimen of the lung parenchyma by using flexible forceps positioned distally through the working channel of the bronchoscope is referred to as:

A) an endobronchial biopsy.
B) bronchial brushing.
C) transbronchial needle aspiration.
D) a transbronchial biopsy.

Question 20

What portion of the airway are bronchial washings generally obtained?

A) The large airways
B) Either of the upper lobes
C) Either of the lower lobes
D) The lowest portion of the airways possible

Question 21

Which of the following are roles of the RT during bronchoscopic procedures?
1) Collaborates with other members of the patient care team to determine if the procedure is indicated.
2) Ensures that all documentation is in place before the procedure.
3) Helps to recognize the patient's oxygen requirement and anticipates appropriate oxygen supplement during the procedure.
4) Assists the physician in operating the bronchoscopic accessories.

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 22

Hypoxemia during FB on a mechanically ventilated patient is typically due to:

A) inappropriately set alarms.
B) equipment failure.
C) loss of lung volume.
D) bronchospasm.

Question 23

Which of the following are indications for self-expanding metallic stent placement?
1) Extrinsic compression of central airways
2) Stabilizing airway patency after endoscopic removal of an intrinsic tumor
3) Sealing fistula between the lung and the gastrointestinal tract
4) Managing benign central airway obstruction

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, 3, and 4

Question 24

During bronchoscopy of an intubated patient receiving mechanical ventilation, what should the RT be aware of?

A) Risks are minimal since the patient already has a secured airway.
B) The resistance imposed by the bronchoscope may cause tracheal pressures to increase noticeably.
C) Albuterol should be available to address and airway resistance changes.
D) Inspiratory and expiratory effort (measured by tracheal pressure) appears minimally affected in most patients.

Question 25

Which of the following is an advantage of brachytherapy?

A) It is a treatment option for all lung cancer types.
B) It does not require the use of a bronchoscope.
C) A lower dose of radiation can be delivered to the tumor cells while minimizing radiation to the normal tissue.
D) A higher dose of radiation can be delivered to the tumor cells while minimizing radiation to the normal tissue.