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Questions and Answers
What is the primary purpose of using a flexible fibreoptic bronchoscope?
What is the primary purpose of using a flexible fibreoptic bronchoscope?
- To inspect the trachea and the first 3-4 generations of bronchi (correct)
- To examine the diaphragm
- To perform biopsies of mediastinal lymph nodes
- To visualize the pleural cavity
Which of the following is NOT a type of specimen that can be collected during bronchoscopy?
Which of the following is NOT a type of specimen that can be collected during bronchoscopy?
- Transbronchial biopsies
- Mediastinal lymph node aspirates
- Pleural fluid samples (correct)
- Bronchial brushings
What is the term for biopsies taken by passing forceps through the bronchial wall?
What is the term for biopsies taken by passing forceps through the bronchial wall?
- Mediastinal lymph node biopsies
- Bronchial brush biopsies
- Pleural biopsies
- Transbronchial biopsies (correct)
What is the gold standard investigation for Sarcoidosis and Diffuse Malignancy?
What is the gold standard investigation for Sarcoidosis and Diffuse Malignancy?
What is the term for the extent of shadowing seen on an X-ray?
What is the term for the extent of shadowing seen on an X-ray?
What is the purpose of combining Computed Tomography (CT) and Positron Emission Tomography (PET) scans?
What is the purpose of combining Computed Tomography (CT) and Positron Emission Tomography (PET) scans?
What type of anaesthesia is usually used for bronchoscopy?
What type of anaesthesia is usually used for bronchoscopy?
What is the term for the normal position of the diaphragm as shown in the figure?
What is the term for the normal position of the diaphragm as shown in the figure?
Which diagnostic test is used to identify a reaction to fungi such as Aspergillus?
Which diagnostic test is used to identify a reaction to fungi such as Aspergillus?
What is the primary indication for performing a rigid bronchoscopy?
What is the primary indication for performing a rigid bronchoscopy?
Which of the following is a marker of fungal infection?
Which of the following is a marker of fungal infection?
What is the primary use of endobronchial ultrasound (EBUS)?
What is the primary use of endobronchial ultrasound (EBUS)?
Which test is used to diagnose invasive aspergillosis?
Which test is used to diagnose invasive aspergillosis?
What is the primary use of interferon-gamma release assays?
What is the primary use of interferon-gamma release assays?
What is the primary indication for performing a bronchoscopy?
What is the primary indication for performing a bronchoscopy?
Which of the following can be used to diagnose mediastinal lymphadenopathy caused by tuberculosis or sarcoidosis?
Which of the following can be used to diagnose mediastinal lymphadenopathy caused by tuberculosis or sarcoidosis?
What is the primary utility of thoracoscopy in the evaluation of pleural disease?
What is the primary utility of thoracoscopy in the evaluation of pleural disease?
Which of the following is NOT a potential application of endoscopic ultrasound?
Which of the following is NOT a potential application of endoscopic ultrasound?
What is the primary advantage of obtaining a larger tissue biopsy in lung cancer diagnosis?
What is the primary advantage of obtaining a larger tissue biopsy in lung cancer diagnosis?
Which of the following conditions may be distinguished from others based on differential cell counts in bronchial lavage fluid?
Which of the following conditions may be distinguished from others based on differential cell counts in bronchial lavage fluid?
What is the primary route of biopsy for lymph nodes in the lower mediastinum?
What is the primary route of biopsy for lymph nodes in the lower mediastinum?
What is the primary utility of cytological examination of exfoliated cells?
What is the primary utility of cytological examination of exfoliated cells?
Which of the following is a potential application of mediastinoscopy?
Which of the following is a potential application of mediastinoscopy?
What is the primary advantage of using histopathology over cytological examination?
What is the primary advantage of using histopathology over cytological examination?
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Study Notes
Bronchoscopy
- The trachea and the first 3-4 generations of bronchi can be inspected using a flexible fiberoptic bronchoscope.
- Bronchoscopy can be performed under local anesthesia with sedation on an outpatient basis.
- Abnormal tissue can be biopsied, and bronchial brushings, washings, or aspirates can be taken for cytological or bacteriological examination.
Biopsy and Tissue Sampling
- Small biopsy specimens of lung tissue can be taken by forceps passed through the bronchial wall (transbronchial biopsies).
- Lymph nodes in the lower mediastinum can be biopsied via the esophagus using an endoscopic ultrasound.
- Thoracoscopy facilitates biopsy under direct vision and is the gold standard for the evaluation of the pleural surfaces.
Imaging Investigations
- Computed tomography (CT) and positron emission tomography (PET) can be combined to reveal intrathoracic metastases.
- CT scans can be used to diagnose bronchocentric disorders such as sarcoidosis.
Cytology and Histopathology
- Cytological examination of exfoliated cells in pleural fluid or bronchial brushings and washings can support a diagnosis of malignancy.
- Histopathology allows immunohistochemistry and genetic testing to characterize the tumor and guide variant-specific therapy.
- Histopathology can also identify microorganisms using conventional staining or NAATs.
Serological Investigations
- IgG enzyme immunoassay or identification of serum precipitins (antibodies) can be used to identify a reaction to fungi such as Aspergillus.
- The presence of pneumococcal antigen in sputum, blood, or urine may be of diagnostic importance in pneumonia.
- Respiratory viruses can be detected in nose/throat swabs by immunofluorescence.
- Legionella infection may be diagnosed by detection of a Legionella antigen in urine.
- β-1,3-D-glucan detection (in blood) is a marker of fungal infection.
- Aspergillus galactomannan (in blood and bronchial lavage fluid) is used to diagnose invasive aspergillosis.
- Interferon-gamma release assays are useful in the detection of latent tuberculosis.
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