Question 1

A patient's chest radiograph indicates a right lower lobe infiltrate with atelectasis.The resident asks the respiratory therapy practitioner for recommendations.The practitioner should recommend which of the following?

Accepted Answer

Indications for a therapeutic bronchoscopy are the removal of secretions or mucous plugs causing lobar or segmental atelectasis,the removal of abnormal endobronchial tissue or foreign bodies,and the evaluation of endotracheal tube placement or performance of difficult intubation.

Question 2

A rigid bronchoscope cannot remove large foreign body in the tracheobronchial tree in the airways lower than the _________________

Accepted Answer

The disadvantages of the rigid bronchoscope are that it must be used with the patient under general anesthesia and that it provides a limited view of the tracheobronchial tree,as it cannot pass beyond the main bronchi.

Question 3

Which of the following are indications of fiberoptic bronchoscopies?
I.The need to reevaluate persistent pulmonary infiltrates
II.The need for aid in difficult intubations
III.The need to obtain upper respiratory tract secretions
IV.Negative sputum cytology results with diagnosed cancer elsewhere in the body

Accepted Answer

Indications of fiberoptic bronchoscopies include but are not limited to I)the need to reevaluate persistent pulmonary infiltrates and II)the need for aid in difficult intubations.

Question 4

Which of the following is NOT an absolute contraindication for a flexible bronchoscopy?

Accepted Answer

The need to evaluate problems associated with endotracheal or tracheostomy tubes (tracheal damage,airway obstruction,or tube placement)in an end-stage COPD patient is NOT an absolute contraindication for a flexible bronchoscopy.

Question 5

What procedure should follow a bronchoscopic procedure involving a transbronchial biopsy?

Accepted Answer

A chest radiograph should follow one hour after transbronchial biopsy to exclude pneumothorax.

Question 6

Which of the following are hazards during a bronchoscopic procedure?
I.Vagal response
II.Hemoptysis
III.Increase in PaCO₂
IV.Decrease in PaO₂

Accepted Answer

I)Vagal response,II)hemoptysis,III)increase in PaCO₂ and IV)decrease in PaO₂ are the hazards/complications during a bronchoscopic procedure.The hazards are 1)adverse effects of medication used before and during the bronchoscopic procedure,2)hypoxemia,3)hypercarbia,4)bronchospasm,5)hypotension,6)laryngospasm,bradycardia,or other vagally mediated phenomena,7)mechanical complications such as epistaxis,pneumothorax,and hemoptysis,8)increased airway resistance,9)cardiac dysrhythmias,10)infection hazard for health-care workers or other patients,11)cross-contamination of specimens or bronchoscopes,12)nausea,vomiting,13)fever and chills,and 14)death.

Question 7

______________ is performed to obtain lower respiratory tract secretions or tissue samples for cytological,histological,or microbiological study.

Accepted Answer

Diagnostic bronchoscopy is performed to obtain lower respiratory tract secretions or tissue samples for cytological,histological,or microbiological study.Cytological testing is frequently performed on tissue samples obtained from lesions of unknown etiology as observed on the chest radiograph.

Question 8

Bronchoscopy is commonly performed for two reasons:

Accepted Answer

Bronchoscopy is commonly performed for therapeutic and diagnostic reasons.Therapeutic indications usually involve secretion removal,foreign body removal,or airway management problems.Diagnostic bronchoscopy is performed to identify or rule out pathologic conditions.

Question 9

Which type of brush/needle/mechanical device is/are used to obtain a sample that cannot become contaminated during retrieval through the suction channel?

Accepted Answer

A sheathed cytology brush is used to obtain a sample that does not become contaminated during retrieval through the suction channel.

Question 10

Which type of sample obtained by bronchoscopic analysis should be fixated in a formalin solution?

Accepted Answer

Histological testing requires that the sample be fixed in a formalin solution.Usually,test tubes or small sample collection containers that contain formalin solution are prepared in advance.The samples are then introduced into the solution,capped or sealed,and sent to the laboratory for analysis.

Question 11

The need to retrieve a foreign object is done under most circumstances with ______________

Accepted Answer

Retrieving a foreign body is done with a rigid bronchoscope under most circumstances.

Question 12

Which type of brush/needle/mechanical device are is/are used to sample areas of interest by "biting" off small chunks of tissue?

Accepted Answer

The forceps are used to sample areas of interest by "biting" off small chunks of tissue.Forceps may also be used to retrieve small foreign objects that may be easily grasped.However,once the object has been grasped,the entire bronchoscope must be withdrawn because few foreign objects will pass through the small suction channel.

Question 13

Which type of brush/needle/mechanical device is/are used to sample an area of interest that lies on the opposite side of the bronchial wall from where the bronchoscope is located?

Accepted Answer

The Wang needle is used to sample an area of interest that lies on the opposite side of the bronchial wall from where the bronchoscope is located.The Wang needle passes through the bronchial wall and material is then aspirated for analysis.

Question 14

Patient monitoring should be done before,during,and after bronchoscopic procedures.Which of the following is important to monitor?

Accepted Answer

It is important to monitor a)the patient's level of consciousness,b)the patient's vital signs,including heart rhythm,and c)the patient's subjective response to the procedure.

Question 15

A resident is called to the medical intensive care unit to perform an intubation of a COPD patient with acute respiratory failure.A several unsuccessful attempts the physician asks the respiratory care practitioner for recommendations.Which of the following should the practitioner recommend?

Accepted Answer

The flexible bronchoscope provides a convenient way to assess endotracheal tube placement and to check the tube for obstruction.In some cases,difficult intubation may be performed by passing a flexible bronchoscope through the endotracheal tube and advancing it during direct visualization.The ability to direct the flexible tip of the bronchoscope facilitates the placement of the endotracheal tube.

Question 16

A pulmonologist performs a fiberoptic bronchoscopy on an outpatient with recurrent bouts of pneumonia.During post-procedure instruction,the patient should be informed to contact the physician if which of the following occurs?

Accepted Answer

Outpatients should be instructed to contact the bronchoscopist regarding a)dyspnea,wheezing,hemoptysis,b)fever,chest pain or discomfort,or any new findings presenting after the procedure has been completed.Oral instructions should be reinforced by written instructions that include names and phone numbers of persons to be contacted in emergency.Periodic post-procedure follow-up monitoring of patient condition is advisable for 24-48 hours for inpatients.

Question 17

A patient vomits and aspirates after ingestion of excessive amounts of ethanol.The resident asks the respiratory therapy practitioner for recommendations.The practitioner should recommend which of the following?

Accepted Answer

Indications for a diagnostic bronchoscopy are the evaluation of lesions of unknown etiology as observed on chest x-ray,the assessment of patency or mechanical properties of the upper airway,investigation of hemoptysis,persistent cough,localized wheezing,or stridor,sampling of lower respiratory tract secretions for cytological,histological,or microbiological analysis,investigation of suspicious or positive cytological findings,and the need to determine the location and extent of injury from toxic inhalation or aspiration.

Question 18

__________________ is performed to remove excessive pulmonary secretions or foreign material suspected of causing lobar or segmental atelectasis.

Accepted Answer

Therapeutic bronchoscopy is performed to remove excessive pulmonary secretions or foreign material suspected of causing lobar or segmental atelectasis.By performing bronchoscopy,the material (secretions or foreign bodies)may be removed and the lobe or segment reinflated

Question 19

Bronchoscopy is visual examination of the tracheobronchial tree.This procedure may be performed __________________

Accepted Answer

This procedure may be performed using a)a flexible fiberoptic or a b)rigid bronchoscope.

Question 20

Which type of testing and analysis performed on bronchoscopic sample would be performed to detect cancerous cells?

Accepted Answer

Cytological testing is performed to study a cell's structure,function,or origin.Tissue samples obtained by bronchoscopy are frequently suspected of being cancerous.

Quiz 18: Bronchoscopy Assisting