Question 1

Which of the following medications is administered to the patient's nasal mucosa for the purpose of reducing the risk of epistaxis during a bronchoscopy procedure?

Accepted Answer

A)   Lidocaine
B)   Hypertonic saline
C)   Phenylephrine
D)   Racemic epinephrine C

Question 2

Why is rigid bronchoscopy preferred over flexible bronchoscopy for the removal of a foreign body from the tracheobronchial tree of a pediatric patient?

Accepted Answer

A)   It is the only way to deliver large foreign bodies through the subglottic area.
B)   It enables better ventilation of the patient while under general anesthesia.
C)   A lower fraction of inspired oxygen is required with rigid bronchoscopy, reducing the risk of oxygen toxicity.
D)   Less anesthesia is needed when rigid bronchoscopy is performed. B

Question 3

Which of the following features are consistent with a large flexible bronchoscope compared with a smaller one?

Accepted Answer

A)   Has a suction channel
B)   Provides recording of the procedure
C)   Is more rigid
D)   Produces less heat A

Question 4

Which of the following features characterize insertion tubes of bronchoscopes described as spaghetti scopes?
I. They contain light bundles.
II. They are less than 2.2 mm in diameter.
III. They are used for patients who are not intubated.
IV. They contain image bundles.

Accepted Answer

A)   III and IV only
B)   I and II only
C)   II and III only
D)   I, II, and IV only

Question 5

What percent lidocaine spray is used for neonatal flexible bronchoscopy?

Accepted Answer

A)   Less than 1% lidocaine
B)   1% to 2% lidocaine
C)   3% to 4% lidocaine
D)   5% to 6% lidocaine

Question 6

The therapist selects a 3.0-mm-diameter insertion tube to be used for flexible bronchoscopy on a neonate who requires surfactant therapy. What should the therapist do with this insertion tube at this time?

Accepted Answer

A)   Prepare the insertion tube for attachment to the flexible bronchoscope.
B)   Replace the 3.0-mm insertion tube with one that is 4.0 mm in diameter.
C)   Substitute the 3.0-mm-diameter insertion tube with a 2.0-mm-diameter insertion tube.
D)   Recommend that the physician perform rigid bronchoscopy.

Question 7

Which of the following features are considered advantages of the rigid bronchoscope over the flexible bronchoscope?
I. Improved anatomic definition
II. Ability to provide better ventilation
III. Large internal diameter
IV. Ability to introduce larger instruments

Accepted Answer

A)   I and II only
B)   III and IV only
C)   I, III, and IV only
D)   I, II, III, and IV

Question 8

A flexible bronchoscopy has been ordered in a child undergoing mechanical ventilation for acute respiratory distress syndrome. After several events of desaturation and therapeutic recruitment maneuvers, the physician wants to rule out mucus plugging. What should the therapist suggest to avoid alveolar derecruitment in this patient?

Accepted Answer

A)   Take the patient off and bag throughout the procedure.
B)   Increase PEEP on the ventilator until the procedure is completed.
C)   Use a PEEP-Keep TM adaptor.
D)   Increase tidal volume to sustain lung recruitment during the procedure.

Question 9

During a bronchoscopy procedure on a pediatric patient, the therapist notices that a patient's SpO2 is 90%. What should the therapist do at this time?

Accepted Answer

A)   Continue monitoring the patient as the procedure progresses.
B)   Provide supplemental oxygen to the patient until the SpO2 is 95%.
C)   If the patient's SpO2 falls to 88%, administer oxygen to achieve an SpO2 of 90%.
D)   Stop the bronchoscopy procedure until the patient's SpO2 returns to its preprocedure level.

Question 10

Which of the following complications of flexible bronchoscopy are considered most common?
I. Transient cough
II. Hypocapnia
III. Respiratory depression
IV. Bronchospasm

Accepted Answer

A)   I and II only
B)   III and IV only
C)   I, II, and IV only
D)   I, III, and IV

Question 11

Which of the following clinical signs receives the highest diagnostic yield in the neonatal population for flexible bronchoscopy?

Accepted Answer

A)   Wheezing
B)   Stridor
C)   Discoid atelectasis on chest X-ray
D)   Increased airway secretions

Question 12

Which of the following drug class combinations is often used to induce conscious sedation in a neonate undergoing flexible bronchoscopy?

Accepted Answer

A)   Benzodiazepine and anarcotic
B)   Cephalosporin and a narcotic
C)   Mucolytic and bronchodilator
D)   Atropine and epinephrine

Question 13

A pediatric patient is brought to the bronchoscopy suite for a follow-up assessment of laryngomalacia. Last time the child developed a mild laryngospasm during the procedure. How should this complication be prevented?

Accepted Answer

A)   Intravenous infusion of lidocaine
B)   Application of topical epinephrine to the vocal cords
C)   Application of topical lidocaine to the vocal cords
D)   Prophylactic insertion of an endotracheal tube

Question 14

When using normal saline for bronchoalveolar lavage, what is the maximum amount of normal saline per kg that should be used?

Accepted Answer

A)   1 mL/kg per aliquot
B)   1 mL/kg total
C)   2 mL/kg per lung
D)   2 mL/kg total

Question 15

Which of the following is considered an absolute contraindication for children who undergo bronchoscopy?

Accepted Answer

A)   Uncontrolled coagulopathy
B)   Pulmonary hypertension
C)   Asthma
D)   Upper airway obstruction

Question 16

Which of the following organisms is often responsible for cross-contamination between bronchoscopies?

Accepted Answer

A)   Staphylococcus
B)   Mycoplasma
C)   Pseudomonas
D)   Klebsiella

Question 17

A hospitalized patient with cystic fibrosis has developed massive hemoptysis. What is the utility of flexible fiberoptic bronchoscopy in this situation?

Accepted Answer

A)   It is useful for removing blood clots.
B)   Flexible bronchoscopy can be effectively used to insert balloon catheters to tamponade the bleeding portion of the lung.
C)   The flexible bronchoscope can be effectively inserted to enable the deposition of blood-clotting medications into the lungs.
D)   Flexible bronchoscopy is usually inadequate with limited visualization and suction capacity.

Question 18

Because one of the major risks of flexible bronchoscopy is aspiration of gastric contents, infants under 6 months should not take anything by mouth how many hours before the procedure?

Accepted Answer

A)   1 to 2 hours
B)   3 to 4 hours
C)   4 to 6 hours
D)   8 to 12 hours

Question 19

The pulmonologist has called the RT department requesting equipment for a bronchoscopy in the next 30 minutes. Which of the following methods will allow the therapist to have the scope disinfected and ready to use in that time frame?

Accepted Answer

A)   Peracetic acid submersion
B)   Alcohol submersion
C)   Ethylene oxide
D)   2% alkaline glutaraldehyde

Question 20

The therapist has been asked to clean the bronchoscope after a procedure. Which of the following chemicals should be used as a high-level disinfectant?

Accepted Answer

A)   Vinegar
B)   Soapy water
C)   5% chlorhexidine
D)   2% alkaline glutaraldehyde

Exam 7: Pediatric Flexible Bronchoscopy