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Ancillary tests and procedures Flashcards

1
Q

What gives the color to sputum?

A

PMNs

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2
Q

Rust colored sputum = ?

A

Strep pneumoniae

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3
Q

Currant jelly sputum = ?

A

Klebsiella

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4
Q

Should a patient rinse their mouth prior to giving a sputum sample?

A

Yes

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5
Q

How many hours prior to giving a sputum sample should a patient be NPO?

A

1-2 hours

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6
Q

What fraction of patients with bacterial pneumonia will not be able to produce a sputum specimen?

A

1/3

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7
Q

What is the cutoff of epithelial cells in a sputum sample before it is discarded? Why?

A

More than 10 per HPF.

Likely an oral sample.

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8
Q

What are the two urine tests that, when positive, warrant a sputum sample?

A

Urine antigen for pneumococcus

Urine antigen for legionella

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9
Q

What other lung pathologies beside pneumonia should a sputum sample be obtained?

A
  • Pleural effusion

- Severe obstructive or structural lung disease

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10
Q

What type of culture should be obtained with intubated patients?

A

Tracheal swab

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11
Q

True or false: for outpatient treatment, sputum samples are optional

A

True

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12
Q

What is the most common causative agent of pneumonia?

A

Strep pneumoniae

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13
Q

What is the usual treatment for community acquired pneumonia?

A

Ceftriaxone

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14
Q

When is a sputum cytology indicated?

A

For patients with non-small cell lung CA who are unable or unwilling to undergo other diagnostic testing

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15
Q

What is the yield for sputum cytology?

A

Low; only 20-25% sensitivity

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16
Q

Why, besides the low sensitivity, are sputum cytologies not a good test for NSCLC?

A

Does not provide staging information, nor is it likely to provide ideal specimens for immunohistological or molecular studies

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17
Q

When is a thoracentesis indicated?

A

Pleural effusions

Empyema

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18
Q

What is yellow nail syndrome?

A

Rare syndrome characterized by pleural effusions and yellow, thickend nails.

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19
Q

What are the contraindications of a thoracentesis?

A
  • Coagulopathy
  • Hemodynamic instability
  • Pt on mechanical ventilation
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20
Q

True or false: you do not do thoracocentesis unless under US or CT guidance. Why or why not?

A

True

Do not want to puncture the lung

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21
Q

Why do you not want to do a thoracentesis on a pt who is on mechanical ventilation?

A

More likely to puncture lung, and will create a tension pneumothorax

22
Q

When is it okay to perform a thoracentesis in patients who are anticoagulated?

A

Likely safe if PTT or PT is less than 1.5 ULN

23
Q

While doing a thoracocentesis, the needle should not be placed below which rib?

24
Q

What is the max amount of pleural fluid that should be removed? Why?

A

1.5 L

Post expansion pulmonary edema

25
What are the three major causes of transudate?
CHF Cirrhosis Nephrosis
26
What are the three major causes of exudate?
Bacterial pneumonia CA Trauma
27
What is the ratio of pleural fluid protein to serum fluid protein in exudate?
Greater than 0.5
28
What is the ratio of pleural fluid protein to serum fluid protein in transudate?
Less than 0.5
29
What are the complications of performing a thoracentesis?
- Pneumothorax - Air embolism - Post-expansion pulmonary edema
30
When should a CXR be ordered after a thoracentesis? (3)
- Air is aspirated - Pt develops SOB, hypoxia, or chest pain - Pt is critically ill or mechanically ventilated
31
Why should you stop a thoracentesis if the patient coughs during the procedure?
Will cause a pneumothorax
32
What are the ssx of a pneumothorax?
Chest pain | Cough
33
Why should the needle be inserted above the rib while performing a thoracentesis?
Do not want to damage the neurovascular bundle
34
When can a needle drainage be used for a pneumothorax? What should be done following this procedure?
For a first time occurrence CXR needed afterward
35
Why is it that needle decompression of a pneumothorax is only indicated if done with proper equipment? What is the proper equipment?
Need to have large enough needle (gauge and length) to get through the chest wall
36
When should a chest tube be used over a catheter for a pneumothorax?
If fluid has a high density or protein content Trauma
37
When is a catheter indicated for draining a pneumothorax?
- Uncomplicated pleural effusions | - Atraumatic
38
Why should you use a chest tube for a hemothorax and not a catheter?
Will clot
39
What is medical thoracoscopy?
Percutaneous insertion of an endoscope into the pleural space to directly visualize and collect specimens from both the pleura and pleural space
40
What is a pleurodesis?
Inflammation of pleural surfaces to promote adhesion formation and prevent reaccumulation of fluid
41
What is the usual drug used to perform a pleurodesis?
Talc or abx
42
What are the indications for a pleurodesis?
Malignant effusions | Refractory, symptomatic effusions
43
What are malignant pleural effusions?
a condition in which cancer causes an abnormal amount of fluid to collect between the pleura
44
What are the two major contraindications to a pleurodesis?
- Trapped lung | - Underlying severe lung disease
45
What is a trapped lung?
Lung that has undergone fibrosis secondary to some inflammatory etiology, and will not re-expand with pleurodesis
46
What is a bronchoscopy?
Fiberoptic bronchoscope is passed through the bronchi is collect visualize and/or collect specimens
47
What are the indications for a bronchoscopy?
Anytime where you suspect there is something in the airways that needs to be looked at or removed
48
What are the contraindications to bronchoscopy?
- recent MI - Recent oral intake - High grade obstruction
49
Why is bronchoscopy contraindicated in patient on a ventilator?
More likely to puncture lungs
50
What is a bronchoalveolar lavage?
a medical procedure in which a bronchoscope is passed through the mouth or nose into the lungs and fluid is squirted into a small part of the lung and then collected for examination. It is typically performed to diagnose lung disease.
51
At least what amount of saline is needed for an adequate bronchoalveolar lavage?
100 mL

Respiratory (34 decks)

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