Pulmonary Diagnostics final UPDATED
Exam Questions and CORRECT Answers
Clinical situations where flexible bronchoscope (FB) would be indicated - Correct Answer-
hemoptysis (coughing up blood), Wheeze and stridor; suspected airway obstruction,
pulmonary infiltrates of unknown cause, unexplained lung collapse, suspected or known
bronchogenic carcinoma, mediastinal and hilar lymphadenopathy, lung transplant,
endotracheal intubation, evaluation of foreign body aspiration, chemical or burn related
injury of the airway, unexplained superior vena cava syndrome, unexplained vocal cord
paralysis or hoarseness, suspected fistulas
Absolute Contraindications for FB - Correct Answer- uncorrectable hypoxemia, lack of
patient cooperation, lack of skilled personnel, lack of appropriate equipment and facilities,
unstable angina, uncontrolled arythmias
Relative contraindications for FB - Correct Answer- unexplained or severe hypercarbia,
uncontrolled asthma attack, lack of patient cooperation, uncorrected coagulopathy, recent
myocardial infarction, unstable cervical spine and impaired neck mobility, need for large size
tissue specimen
What is the goal of sedation during FB? - Correct Answer- the goal of sedation is to improve
patient comfort during the procedure
Describe the Mallampati classification - Correct Answer- commonly used method to identify
individuals who may pose difficulty during intubation. assessed by having the patient open
their mouth and protrude tongue as much as possible
What vital signs should the RT - Correct Answer-
What vital signs should the RT monitor while a patient is sedated for a FB? What else should
be moniored? - Correct Answer- pulse oximetry. heart rate, blood pressure, chest movement.
In mechanicallt ventilated patients, the RT must ensure the airway is secured, verify adequate
ventilation and gas exchange, and quickly communicate the development of any
complications
What is a BAL and when is it indicated? - Correct Answer- BAL is a bronchioalveolar lavage.
It is used to obtain specimens from the alveolar level of the lung.
,What is the difference between a BAL and bronchial washings? - Correct Answer-
bronchiolar washings are generally obtained for the cytological examination to look for
cancer and for microbiologic analysis to diagnose mycobacterial or fungal infections. Unlike
BAL, brochial washings are obtained from the large airways.
When is a rigid bronchoscopy (RB) indicated? - Correct Answer- The major indication for
rigid bronchoscopy is in managing central airway obstruction. Although the role of rigid
bronch has declined, RB remains an invaluable took for the control of a compromised airway,
massive hemoptysis, and silcone stent placement and for removing asphyxiating foreign
bodies.
Describe the following thermal ablation techniques: Electrocautery, Argon plasma
coagulation, laser photocoagulation - Correct Answer- A: application of electrocautery
requires use of accessories such as knifes, snares, or probes
B: Argon plasma coagulation is a noncontact technique to apply electrical current to the
endobronchial lesion.
C: Lasers can produce tissue reaction by thermal, photochemical, or electromagnetic effects.
The thermal effects of the laser is mainly used to remove the endobronchial lesion
What are thermal ablation techniques used for? - Correct Answer- used to coaguate,
carbonize, or vaporize lesions which protrude into the airway lumen and obstruct the central
airways
What should a RT consider regarding oxygen delvery during thermal ablation? - Correct
Answer- During the application of "hot therapies" (thermal ablation), the FiO2 should always
be maintained below 40% to prevent endobronchial ignition
What are endobronchial stents used for? - Correct Answer- Stents are the device designed for
internal splinting of the airway lumen. Airway stents have been used to help reduce airway
obstruction from malignant or benign processes that compress the airway from the outside.
Airway stenting can offer immediate releif of acute respiratory distress, allow successful
intubation, and may prolong survival.
Describe the two different types of endobronchial stents - Correct Answer- Two types of
airway stents: Metallic and silicone.
A: Self-expanding metallic stents (SEMS) are commercially available in covered and
uncovered forms. Covered stents are designed primarily to prevent growth of granulation
,tissue into the lumen of the stent. Current SEMS are made from nitinol, a nickel-titanium
alloy that is well adapted for endobronchia applications.
B: Silicone stents have two major designs, straight and Y-shape (for disease involving the
carina)
Indications for self-expanding metalic stent (SEMS) - Correct Answer- extrinsic compression
of central airways, stabilizing airway patency after endoscopic removal of an intrinic tumor,
sealing fistula between the lung and the gastrointestinal tract, and managing of post-lung
transplant anastomotic complications
What patient population may benefit from bronchial thermoplasty (BT)? - Correct Answer-
patients with bronchial asthma
What responsibilities does the RT have pre FB procedure to ensure patient safety? - Correct
Answer- 1. Assuring that all documentation is in place and a preprocedure "time-out" is done
to assure the correct procedure is being done on the correct patient.
2. Recognize the patient's O2 reuirements and anticipates appropriate O2 supplement during
the procedure.
3. administer inhaled bronchodilators prior to or during the procedure if the patient exhibits
bronchospasm
4. In mechanically ventilated patients, the RT may help optimize the length and size of the
ETT, place a bite block to protect equipment, and adjust ventilator settings prior to and during
the procedure.
What serious complications are possible with a FB? - Correct Answer- transient hypoxemia
with SpO2 less than 90%, tension pneumothorax, bronchial hemorrhage greater than 30mL,
hypotension with mean arterial pressure less than 60mmHg, and tachycardia greater than 140.
You are preparing a patient for her flexible bronch. Her weight is 50kg. What is the total dose
of lidocaine that should not be exceeded to help avoid methemoglobinemia - Correct Answer-
350 mg
What effects could be seen during a flexible bronch procedure on an intubated patient
receiving mechanical ventilation? - Correct Answer- high peak inspiratory pressures
Anergy is defined as: - Correct Answer- impaired immune response
, Anthropometrics is defined as: - Correct Answer- body measurements: the most frequently
used are height and weight
Azotemia is defined as: - Correct Answer- excess nitrogenous waste in blood
Basal Metabolic rate is defined as: - Correct Answer- hourly resting energy consumption after
fasting
Body mass index is defined as: - Correct Answer- relationship of height to weight
indirect calorimetry is defined as: - Correct Answer- energy measurement based on oxygen
consumption and O2 production
Cachexic is defined as: - Correct Answer- so thin that ribs stick out in persistnat malnutrition
What is the most helpful technique for nutrition assessment dietitians perform in the acute
care setting? - Correct Answer- Interviewing
What does BMI stand for and what are the two variables used to calculate it? - Correct
Answer- BMI= Body Mass Index
Variable 1: Weight
Variable 2: Height
What is the normal range for BMI? - Correct Answer- 18.5 o 24.9
How do you calcuate IBW? - Correct Answer- Males: 106+6(Ht-60)
Females: 105+5(Ht-60)
Height is in inches
Why are serum proteins useful as biochemical indicators when assessing nutritional status? -
Correct Answer- Protein energy malnutrition (PEM) may be reflected in low values for
albumin, transthyretin (prealbumin), and retinol-binding protein. Blood levels of these
