SPUTUM, BAL, SWEAT

Question 1

Tracheobronchial secretions are a mixture of

Answer 1

Plasma, electrolytes, mucin, water

Question 2

Most important single component of sputum viscosity

Answer 2

Sialic acid

Question 3

Acceptable sputum specimen criteria

Answer 3

<10 SEC/LPF and >/= 25 WBC/LPF

Question 4

Preferred sputum specimen collection time

Answer 4

First morning

Question 5

24-hour sputum collection use

Answer 5

Volume measurement

Question 6

Pediatric sputum collection method

Answer 6

Throat swab

Question 7

Non-cooperative patient sputum collection

Answer 7

Sputum induction

Question 8

Debilitated/unconscious patient sputum collection

Answer 8

Tracheal aspiration

Question 9

Sputum specimen preservation methods

Answer 9

Refrigeration or 10% formalin

Question 10

Decreased sputum volume causes

Answer 10

Bronchial asthma, acute bronchitis, early pneumonia, stage of healing

Question 11

Increased sputum volume causes

Answer 11

Bronchiectasis, lung abscess, edema, gangrene, tuberculosis, pulmonary hemorrhage

Question 12

Colorless or translucent sputum indicates

Answer 12

Mucus only

Question 13

White or yellow sputum indicates

Answer 13

Increased pus (TB, bronchitis, jaundice, pneumonia)

Question 14

Gray sputum indicates

Answer 14

Pus and epithelial cells

Question 15

Bright green or greenish sputum indicates

Answer 15

Bile, P. aeruginosa infection, lung abscess

Question 16

Red or bright red sputum indicates

Answer 16

Fresh blood, hemorrhage, TB, bronchiectasis

Question 17

Anchovy sauce or rusty brown sputum indicates

Answer 17

Old blood, pneumonia, gangrene

Question 18

Prune juice sputum indicates

Answer 18

Pneumonia, chronic lung cancer

Question 19

Olive green or grass green sputum indicates

Answer 19

Cancer

Question 20

Black sputum indicates

Answer 20

Dust, carbon, charcoal, anthracosis, smoking

Question 21

Rusty sputum with pus indicates

Answer 21

Lobar pneumonia

Question 22

Rusty sputum without pus indicates

Answer 22

CHF

Question 23

Currant jelly-like sputum indicates

Answer 23

Klebsiella pneumonia infection

Question 24

Foul or putrid sputum indicates

Answer 24

Lung gangrene, advanced necrotizing tumors

Question 25

Sweetish sputum indicates

Answer 25

Bronchiectasis, tuberculosis

Question 26

Cheesy sputum indicates

Answer 26

Necrosis, tumors, empyema

Question 27

Fecal odor sputum indicates

Answer 27

Liver abscess, enteric gram-negative bacterial infection

Question 28

Mucoid sputum indicates

Answer 28

Asthma, bronchitis

Question 29

Serous or frothy sputum indicates

Answer 29

Lung edema

Question 30

Mucopurulent sputum indicates

Answer 30

Bronchiectasis, tuberculosis with cavities

Question 31

Yellow or gray material, pinhead-sized, with foul odor when crushed

Answer 31

Dittrich plug

Question 32

Significance of Dittrich plug

Answer 32

Bronchitis, bronchiectasis, bronchial asthma

Question 33

Hard bronchial concentrations (lung stones), yellow/white calcified TB structure

Answer 33

Pneumoliths or broncholiths

Question 34

Broncholiths are commonly seen in

Answer 34

Histoplasmosis, chronic tuberculosis

Question 35

Branching tree-like bronchial casts are seen in

Answer 35

Lobar pneumonia, bronchitis, diphtheria

Question 36

Layers of sputum formation

Answer 36

1st (top) - frothy mucus

Question 37

Foreign bodies in sputum indicate

Answer 37

Bronchial calculi, asbestos bodies, silica particles

Question 38

Pneumoconiosis macroscopic structures

Answer 38

Foreign bodies

Question 39

Elastic fibers in sputum indicate

Answer 39

Tuberculosis

Question 40

Pigmented cells in sputum clinical significance

Answer 40

CHF, heavy smokers

Question 41

Heart failure cells in sputum

Answer 41

Hemosiderin-laden macrophages

Question 42

Carbon-laden cells in sputum microscopically

Answer 42

Angular black granules

Question 43

Coiled mucus strands in bronchial asthma

Answer 43

Curschmann's spirals

Question 44

Colorless globules resembling blastomyces

Answer 44

Myelin globules

Question 45

Cluster of columnar epithelial cells in bronchial asthma

Answer 45

Creola bodies

Question 46

Parasites seen in lungs

Answer 46

A. lumbricoides, Strongyloides, hookworms, E. histolytica, E. gingivalis, T. tenax, P. westermani, E. granulosus, T. canis

Question 47

Important diagnostic test for P. jirovecii (P. carinii)

Answer 47

Bronchoalveolar lavage (BAL)

Question 48

Best stain for delineating P. jirovecii cysts

Answer 48

Grocott's methenamine silver stain

Question 49

Most predominant cell in BAL

Answer 49

Alveolar macrophages (56-80%)

Question 50

Cells in BAL for interstitial disease, pulmonary lymphoma, nonbacterial infections

Answer 50

Lymphocytes (1-15%)

Question 51

Cells increased in cigarette smokers, bronchopneumonia, toxin exposure

Answer 51

Neutrophils (<3%)

Question 52

Cells in BAL for hypersensitivity reactions

Answer 52

<1-2%

Question 53

Percentage of ciliated columnar bronchial epithelial cells in BAL

Answer 53

4-17%

Question 54

Test used to diagnose cystic fibrosis

Answer 54

Sweat test

Question 55

Autosomal recessive disorder affecting mucous-secreting glands, associated with pancreatic insufficiency, respiratory distress, and intestinal obstruction

Answer 55

Cystic fibrosis

Question 56

Electrolyte increased in sweat in cystic fibrosis

Answer 56

NaCl

Question 57

Test to induce sweat production

Answer 57

Pilocarpine iontophoresis (Gibson and Cooke)

Question 58

Method to measure sweat sodium

Answer 58

Flame photometry, ion exchange electrode

Question 59

Current and duration for pilocarpine iontophoresis

Answer 59

0.16 mA current, 5 minutes

Question 60

Sweat sodium and chloride value diagnostic for cystic fibrosis

Answer 60

>70 mEq/L

Question 61

Sweat sodium and chloride value for borderline cystic fibrosis

Answer 61

40 mEq/L